A blog follower asked yesterday if one in deep depression could make use of activities I’ve suggested in posted blogs. The simple answer is no. The full answer is “it depends on the level of depression.” I’ve been waiting until this blog had more followers before the critical “let’s start at the beginning.” Let’s listen to a conversation between Mitch and his psychiatrist Zeke in Too Late in the Afternoon: One Man’s Triumph Over Depression, the book I have published, to capture a numbering system developed by my psychiatrist and me to communicate levels of depression.
“I spent one hour with Zeke in his office, giving him my health history and the litany of events leading up to my depression.“Zeke told me I had some heavy things I’d gone through,and he wanted to start me on a common antidepressant—a Serotonin-Norepinephrine Reuptake Inhibitor, SNRI for short, to take the edge off my pain and move me back into a functioning mode. ”
“He said, ‘I want to be honest with you. Different people react differently to different medications. The SNRI I’m prescribing will make you feel better, won’t make any difference, or will make you feel worse. The medication may take up to four weeks to reach its full effect, but you’ll know in two or three days if it’s making you worse. If it does,I want you to call me right away, and we’ll jump to Plan B.
“‘I also want you to keep track of the depth of your depression on a scale of 1-5 so we can both determine where you are at any given period of time. A 5 is normal. A 4 is feeling uncomfortable but still able to function; an upper 4 is mild depression and a lower 4 is moderate depression. A 3 is severe depression in which you have significant problems with thinking, eating, sleeping, and socializing; it is where hopelessness sets in and you just want to cry. A 2 is major depression that is not sustainable without some sort of relief. Thoughts of death arrive at this stage as a means of escaping the extreme anguish of the psyche. A 1 is a depression so dreadful and deep that, without intervention, a person considers suicide, and either embraces it or lives a life more horrific than anything the worst physical suffering can bring.’”
Here is the point. If a person is at a 1 or a 2, the first thing she needs to do is stabilize. That will probably mean medication of some sort. If a person is at a lower 3, he probably will not be able to get much benefit from the suggestions I have made until he sees either a psychiatrist or a psychotherapist to stabilize. If he is an upper 3, he may be able to benefit some but still needs to stabilize by one of the two sources above. A person at a 4 will be able to benefit greatly from the suggestions. It’s stability first. I’ll cover more of this in the next posting.