Depression usually starts out simple. For my patient, Cindy, for example, it began with down days during her first semester in college, when she wouldn’t get out of bed. She did not leave her apartment, wore sweat pants all the time, stopped doing her hair and makeup, gave up her spin class, and neglected her bathing and hygiene.
As time went on, she became more and more isolated from her friends. Her eating habits deteriorated — Skittles and Chinese food became her staple, and in order to sleep, she took Benadryl with a giant glass of wine.
Symptoms and Treatment of Depression
It was the same thing, day in, day out, and as bad as it sounds, her condition was treatable. It’s important for those battling depression to remember this, which is why I am sharing Cindy’s story.
Cindy’s mother saw that her daughter needed help during Thanksgiving break. She picked up the phone and made an appointment for Cindy with me. Cindy’s mother also suffered from depression and was on Zoloft at that time; so, she recognized her daughter’s illness right away.
When I saw Cindy, she was overly thin – 110 pounds — and I found out that she had been drinking almost a bottle of wine everyday for the last month, attempting to self-medicate her pain away.
I told her she had to quit drinking, or her depression would be untreatable, and since her level of addiction was minimal, she was able to do that.
She also needed to stop taking Benadryl, which she was using to help her sleep. I explained to her the ramifications of taking that drug: it makes you sluggish the next day from a drug hangover, slows down thinking and may cause memory problems. Benadryl can also be associated with gain weight. Cindy stopped taking Benadryl, too.
Next, she had to get outside and start exercising. Her mother said she’d take Cindy for a forty-five-minute walk everyday in the sun.
Then, I prescribed Zoloft, an antidepressant. Zoloft worked for her mother, so I knew it would be a good choice for Cindy. Initially, the Zoloft caused Cindy some stomach discomfort and dry mouth, but both of those side effects decreased over time.
Cindy, her mother and I decided she should stay in treatment, rather than go back to college that semester and I instructed Cindy to see a therapist weekly and follow up with me after one month.
At her follow-up, both her mother and I saw that Cindy’s mood and appearance were better. She was tan, smiling, wearing makeup, and her hair was clean and well kept.
Things were better, and after her second month of treatment, her depression went into remission and everything looked great.
Reoccurrence of Depression and Changes in Treatment
Cindy went on to complete college, hold down a good job, and, after seven years, she became engaged. That’s when new problems with depression developed. Her fiancé and mother noticed that Cindy was having trouble making the wedding plans, and they contacted me again.
When I saw Cindy, she could not understand what was happening to her. She wasn’t using alcohol or drugs, was exercising regularly and getting out for fresh air. I explained that either the nature of her depressive illness had changed or the Zoloft had stopped working.
I prescribed Wellbutrin, and told Cindy to taper off Zoloft over four weeks, at which point her mood improved and she functioned better, although she had more headaches and trouble sleeping. The Wellbutrin didn’t work as well as the Zoloft.
Life went on and Cindy married, but one year into the Wellbutrin, Cindy reported that she felt she was only functioning at 70 percent. I made sure she was not using alcohol or drugs and that she was exercising and suggested she return to therapy. I also added Deplin, a methlyfolate that increases neurotransmitters and potentates the antidepressant effect of Wellbutrin.
The combination helped, and Cindy improved until she decided to get pregnant. At that point, it was decided that she continue to take Wellbutrin and Deplin during her pregnancy. Cindy was educated on the possible risks to the baby, but the risks of depression seemed worse, so we went ahead.
The baby was born and looked great, but as the months went by, Cindy’s depression totally incorporated her and she became worse than ever. She was now on Wellbutrin, Deplin, exercising, and avoiding alcohol. She was seeing a therapist once a week. The situation looked bad and her family was very concerned about leaving her alone with the baby.
At this point I started a third medication, Abilify, an antipsychotic that potentates the action of Wellbutrin and Deplin. It worked in a week and she came out of her depression quite well.
We stayed on this combination for three years. She had another baby and things went smoothly. I continue to follow Cindy. It would be nice if I could say things are perfect, but they’re not. The Wellbutrin causes headaches and sleep problems. The Abilify makes her restless.
Cindy manages. She asks me, “Will I have to take these meds the rest of my life?” I say, “No. You are going to take them as long as they are working.”
This is Cindy’s story and it’s not over. After three depressive episodes, the probability of a fourth episode approaches 100 percent. Depression is a complicated illness, which can reoccur and is always changing. The treatments work for a while, and then stop working. The illness is also affected by life circumstance. Lifetime treatment is recommended.
Cindy knows this and remains committed to living a healthy lifestyle as well as following her treatment plan – she’s worked hard to keep her illness in check whenever possible. As a result, she’s been able to experience many of the riches life has to offer — She’s finished college, held down a good job, has loving relationships with her mother and her husband, and parents two small children – quite an achievement for someone who suffers from a chronic disease.