I have severe generalized anxiety and treatment resistant major depressive disorder. I am prescribed medication by my family doctor, whom I see once every two months. During my last prescription renewal, I asked him if there are any other treatments or medications that I haven’t yet tried, and his answer was very confusing. He said, “Psychiatry hasn’t changed. The only treatment I know of that works [for depression] is to have a full life, be active socially, work full time, get plenty of exercise, and get up at 6:30am every day.” I asked him, “How do you do that with anxiety and problems, and chronic trouble sleeping?” He responded, “All at the same time, I guess.”
But the “cure” for depression seems to be impossible to do. In the past, I have tried many, many times to live a “normal” lifestyle – to regularly exercise, socialize, work part time, have hobbies, think positively, etc. I always ended up feeling much worse. More depressed, anxious, stressed, and far worst of all, an intolerable amount of guilt and shame from failing.
I asked him if there is anything more I can do to control my anxiety. He told me that the only thing that works is to do something that shakes me out of it, like travel abroad and work with impoverished people. Because I will see people who live in squalid conditions and don’t even have food and clean water and I will understand that I don’t need to be anxious.
I want to live my life as fully as possible, which means treating, managing, and/or accepting my mood and anxiety disorders. But I don’t understand what my doctor’s point is. In order to be cured of depression I need to live according to his prescribed lifestyle even if I can’t attain and maintain it? In order to be free from my anxiety disorder I need to witness abject poverty so my brain will know that my current worries are unfounded? I feel frustrated, guilty, and hurt because the message seems to be that my mental health issues are a result of a character flaw. If I could just live like undepressed people do and count my blessings I wouldn’t have these disorders.
Can you help me understand what he is saying?
I can’t speak for your family doctor. Only he knows the intended message of the words he chose to speak to you. You have described him as a family doctor. I can assure you that a family doctor is not a psychiatrist. A family doctor may prescribe an antidepressant as a first step in the treatment process. If the antidepressant works, problem cured. However, if the antidepressant does not work the next step should be his referring you to a mental health professional. A psychiatrist is a specialist and a family doctor is a generalist. There are times when a medical condition requires the use of a specialist. A surgeon is a specialist. An internist is a specialist. A cardiac physician is a specialist. A psychiatrist is a specialist.
It does appear from the words that you have written to me that your family doctor may have reached the end of his mental health knowledge base. I have known and know many psychiatrists and I have never known them to recommend to a patient that they leave the country and live among the very poor. I am at least adequately knowledgeable of every major treatment modality used by psychiatrists and I know of none that recommend moving to another country and living among the severely impoverished.
After seeing you, your family doctor may well have treated an underactive gallbladder, a case of acne and leg pain. It would be unfair to ask the family doctor to be an expert on internal medicine, dermatology and the functioning of neurons. It is also unfair to ask him to be an expert on mental health. It would not be unfair to ask a psychiatrist to be an expert on mental health because he or she is, an expert on mental health.
Finally, we come to the debate as to the cause of depression. There is no universal agreement. Is it physical? Is it psychological? Is it sometimes physical and other times psychological? Is it sometimes, a little of both?
If it’s physical then we can do surgery or prescribed medications and stop wasting our time on talk therapy. If it’s not physical then we can do talk therapy and stop wasting our time on drugs. Or maybe, we use drugs for short-term relief while the much longer process of talk therapy actually produces the cure.
No one yet, has answered the above questions though many offer opinions and some behave as if they know the answers to the above questions, conveniently ignoring the fact that scientific research has yet to provide those answers.
Most psychiatrists will either provide their own talk therapy or refer to an outside mental health professional. Of course no one in the world is more qualified to prescribe medication, evaluate medication and adjust medication, than is a psychiatrist. However, they know no more about acne than does a family doctor.
Please let me conclude by saying something that I have said in this forum many times. If your professional, be he a physician, a PhD or a plumber, is not solving your problem then by all means and without hesitation, try another. Good luck my friend.
Dr. Kristina Randle