Physicians routinely prescribe pills and counseling sessions and the rest is left up to the person suffering 24 hours a day from the debilitating disease, as well as his caregiver or advocate, if he has one. Unfortunately, depression by its very nature cannot be cured by medications or counseling. And my ideas that follow are not in the area of cure at all. Instead, they're basic suggestions that I think can help during the lengthy, sad time when every move is so critical.
Be aware that I have never had depression. However, I have been the caregiver for my son during the time he endured and survived three long episodes over the past 22 years. I think that it's more important to have a caregiver/advocate for depression than most other illnesses or conditions. And I believe that I am best equipped to see what it might take to move therapies for MDD to the next level. I'm going to concentrate on three areas where I believe medical professionals could provide better resources and assistance.
1. Send patients home with a pamphlet that includes a variety of suggested therapies and information on how to deal with day-to-day stresses. A depressed person may not be in a frame of mind to read such a publication, but the caregiver will find it helpful. Too often, I had to make numerous calls to track down sources for various situations. The all-inclusive pamphlet could include the following recommendations, kept concise, yet complete.
• Physical and mental exercises. Assuming a person knows what to do to help themselves is unproductive and irresponsible.
• Recommended diet. Nutritionists who work with hospitals and physicians have such information (with basic recipes for nutritious meals) ready to go.
• Lists of publications about the disease, starting with Depression for Dummies. Shouldn't everyone know about something so basic? Maybe, but we're not talking about everybody. We're talking about a person with depression. The thought processes aren't the same as they might be for other people.
• Locations for mental health centers and low-cost clinics for those with no insurance.
• Information on where to apply for health benefits for those with no insurance.
• Approximate costs for medical appointments, drugs, counseling, emergency room visits, hospital stays, and other therapies.
• What to do if there's no improvement after a certain time.
Such pamphlets would not have to be printed out ahead, but rather tailored to each patient. It would take only minutes to print and to insert the pages into a two-pronged report folder. Depressed people need all the help they can get in terms of organization because their thought processes focus on things much more basic, such as living through another day.
I find it amazing that, in the 21st century, computers aren't better used to facilitate communications between patients and medical professionals. Rarely is there a follow-up, for example. Even brief emails from the physician or his staff is better than nothing. Computer literate people -- especially the young -- email, text and twitter for communication, whether social or business. It's time to use technology in the medical profession. Sharing files, preferably computerized, is another example. Recently my cat was treated at an emergency veterinarian clinic. I brought her home with far more information about her ailment and how to care for her than what my son received after he spent five days in the hospital with MDD. Plus, the information about my cat was sent to her regular veterinarian for him to use in her further treatment. Not one physician, clinic or hospital shared my son's files with another facility.
2. Give patients DVDs with information that might mirror some of what I suggested for pamphlets, expanded to take advantage of the format. DVDs are cheap to reproduce and a depressed person might watch a DVD when he couldn't read a book. Being unable to concentrate is one of the hallmarks of depression. The DVD should be in conversational English, full of interesting graphics (think Hollywood-style), whatever it might take to inspire someone to do something for themselves to promote recovery.
3. Establish mental health care coordinators in clinics and ERs to work with patients by answering questions and monitoring medications. Many depressed people go to ERs because they don't have anywhere else to turn, especially if they have no insurance. With a coordinator on staff, people might get the help they need to prevent an extended and costly hospital stay. A care coordinator also might help in creating the therapy tools I describe above.
4. Put yourself in the place of someone with depression, especially the MDD variety. How would you like to be treated when you're taken from your safe place, which is usually your home? Wouldn't it be better, for example, to be in a group counseling session where the room is painted a cheery color, the seats are comfortable and the welcome mat is out, than to have the more familiar sterile environment? Trash the "mental health clinic" sign out front. If the clinic is located at 824 Main St., call it the 824 Main St. Clinic. A clinic or office treating physical ailments doesn't hang out a shingle for a "physical health clinic." Words, appearances and attitudes mean a lot.
Treating depression is far different from, say, a broken leg. It shouldn't be handled in the same manner. By thinking differently and reconsidering the fundamentals of therapy, physicians and clinics might one day provide the care depressed people so urgently need and deserve.
