The recent suicide of a patient got me to thinking about something that I don't think gets communicated well to patients. It is particularly applicable to the rednecks and other 'rugged individualists' who form the bulk of our gun culture, outdoor culture, and other people who eschew 'pills' in favor of 'natural' treatment.
Depression is viewed by many as a 'weakness', and there are certainly some who respond to depression or any other life-hurdle by rolling-over, giving-up, and wanting someone else to fix their life for them. I think we all know that doesn't generally go well, whether you're just a naive college-kid who got too far in debt going down an academic rabbit-hole, or an alcoholic who has to face the reality that the only one who can climb back into life via the AA's 12-step program is themself.
Anyway, I think we as doctors/scientists take some things for granted and as foundational knowledge, that the public really doesn't realize, and likewise, the public often has a jaded and cynical view of the 'science' that Big Pharma has set up that so many doctors can't see beyond.
The REALITY with 'depression' (and 'anxiety', and 'obsessive compulsive disorder' and 'post-traumatic-stress-disorder' and whatever other catch-phrase best describes the patient's own personal challenge) is that it is NOT just a 'character flaw' or an inability to deal with reality. It is a very tangible, documentable, and REAL series of enzymatic issues, epigenetic phenomena, and chemical imbalances, happening in the environment of a specific genetic inheritance, as affected by specific life challenges.
As such, it is no different than say a person who is exposed to an unusual level of toxins due to their job or whatever, and that affects some people more than others, based on their genetics, their enzymatic state, and epigenetics (epigenetics is a series of tangible and dynamic changes in the way existing genes are read versus ignored, depending on environmental influences, and these changes can last a lifetime - and even be passed on to the next generation). So expose a whole crew to something, and some might get sick, some even die, and others barely notice an effect. Some will be ill for 24 hours, and others have lifelong changes, or even bear children with issues reflecting their parent's toxic exposure. None of that is 'weakness' and none of it is something that can be gotten through by just 'being tough'.
A woman who was sexually abused as a child isn't just being 'weak' if she doesn't regain a healthy and happy and functional life as she grows up - she has measurable, tangible, REAL chemical changes, alterations of neurotransmitters, and PERMANENT epigenetic changes that affect her chemistry and physiology going forward. If she was pregnant when horrible things happened, her child will have REAL chemical changes, alterations of neurotransmitters, and permanent epigenetic changes as well. Yes, she can compensate for those changes to a great extent, and yes she can indeed have a happy and normal life in the long run, but she will NOT get there simply by 'being tough', and it will very likely require a comprehensive life-approach involving not just 'drugs', but also not just 'counseling' or not just 'natural supplements' or not 'JUST' anything.....it will require ALL of the above.
How do you deal with a toxic exposure, or an environmental condition that messes up these things...? You use diet, supplements, and antidotes of various sorts. And yes, sometimes you use 'drugs'. Someone who has been exposed to a toxic dose of something and refuses the antidote because it is a 'drug' is a fool, and may be a dead fool before long. Some 'drugs' are complex synthetic chemicals that we don't even know how they work, and some are ordinary vitamins given at therapeutic doses, or any number of entities between these extremes. Some are even vitamins that have to be modified synthetically because the patient lacks an enzyme needed for the vitamin to work, either due to genetics, or due to the effect of a toxin, or the effect of some other environmental stress.
Just being in a 'pill' or from a 'drug company' doesn't mean much clinically; all it means is that in order to obtain the particular entity involved, somebody had to 'make' it, which likely means it comes in a pill, in a bottle, and from a pharmacy. That's NOT a 'bad' thing, any more than getting an antidote for a poison from a pharmacy would be a bad thing.
You use WHAT WORKS.
In this case, a man had lost his wife after her long illness, and he was "not a pill person". Having seen several patients DIE over the past couple years from CoVid because they "didn't like to take pills" so refused to take even the zinc and quercetin that could have benefitted them, I've gotten less patient with the "I don't believe pills are the answer" attitude - I do understand the cynicism and reluctance to succumb to our 'pill culture' where so many people do NO diet, NO counseling, NO prayer, NO supplements, NO exercise, and just want a 'wonder drug', but the opposite attitude is just as dangerous, just as silly, and just as deadly.
There ARE medications that help depression, and yes, some of them are the 'old kind' that blunt all feelings and make you a zombie like in One Flew Over the Cuckoos Nest, but those are seldom even considered these days. Most of the medications we now use are ones that correct enzymatic deficiencies that are genetic, or have been epigenetically induced, some compensate for receptor geometry that would be ok with a 'normal' level of stress, but cannot handle a high-stress environment, and some enable the patient to absorb or properly metabolize ordinary nutrients and vitamins in their diet that they happen to be unable to use (and even a 'perfect' diet completely fails to benefit patients if they fail to take the 'pills' that may be needed to fix such a situation).
Depression is no different than hypertension in that regard - yes, some people can lower their blood pressure 'naturally' by meditating, altering their potassium/sodium balance, or eating more omega-3 fatty acids. Others have ACE receptors that are crappy, renal arterial stretch receptors that have deteriorated with age, or other issues, and will never, EVER, get normal blood pressure without 'drugs'. They can do all the 'natural' stuff they want, and can virtue-signal to their friends about how they are 'avoiding drugs' and doing everything 'naturally' - AND they can go on to have a nice 'natural' stroke, and drool on themselves for a few years before dying of pneumonia or pressure ulcers from sitting in a wheelchair all that time. What a great thing they avoided 'drugs'...
This gentleman had a supportive family and could have lived many years of healthy and happy life, and been of benefit to his kids and grandkids, but was too stubborn to 'take pills' because he thought that a person shouldn't need pills to be happy. Well, God gave us FEET too, so I guess we shouldn't need to wear shoes, then, should we...??? Try going without shoes for a week. I think God gave us the intelligence to invent shoes, and a society where some people make their living making shoes for the rest of us. God did NOT give us the tough feet of animals, nor did He give us the innate sense many animals have to go eat the right plant for what ails them....but he did give us knowledge of pharmacology and physiology, and there are pharmacies where we can get the right things to help us when we need them, just like shoes.
The goal SHOULD be to live as long a life, and as functional a life, and as happy a life, as possible, for our own sake as well as that of our family, friends, and community. Doing that without 'pills' is no more virtuous than it would be to do it without shoes....
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) What's my treatment? Diet and exercise.
