Depression, SSRIs and Self-Advocacy

Depression

A recent study has concluded that SSRIs, when treating for major depressive disorder, are not that much better than placebo. Depression as a symptom and as a formal diagnosis, is too simple a label to attribute to a person who feels and experiences life without joy or pleasure and who may have real physiological changes that render his/her life unpleasant, if not unbearable. By attributing a diagnosis to a person such as “depression,” the patient and the diagnosis become frozen in time and separated from all possible antecedents, mediators and triggers. All further enquiry into the timeline of causation comes to an end and the patient (and the doctor) now objectify and identify with the diagnosis, as if some foreign entity, called “depression” just mysteriously fell out of the sky.  Add to this scenario the fact that ones entire medical school training is not aimed to enquire as to upstream causation. In the truest N2D2 tradition of medicine (name of disease, name of drug), we are trained to thread together a constellation of symptoms, arrive at a diagnosis and prescribe a treatment1; all under the 15 minute timeline and the approximately $40.00 fee that the Canadian health care system provides for a consultation. It does not take much to deduce that this is a hopelessly inadequate scenario and not one to foist onto ones worst enemy.

Depression, as a diagnosis, has a litany of possible antecedents (ancestral and genetic predispositions and inheritances), triggers (events that trigger the manifestation of the constellation of symptoms that coalesce to form a diagnosis) and mediators (lifestyle events and behaviours – diet, sleep, food, stress, exercise – that continue to contribute to the diagnosis). From ancestral trauma (that we now know to be epigenetically inherited), to early conception and birth trauma, to adverse childhood experiences and complex trauma, to head injuries, to genetic weaknesses in detoxification and methylation (creating scenarios of over and undermethylation) nutritional and hormonal inadequacies, to toxic insults such as mercury, lead, copper toxicity, mold, Lyme disease and co-infections, to sleep apnoea, to relationship struggles, workplace difficulties, transition from first half of life ego demands to second half of life soul demands; the list is long and complex.

Self-Advocacy

Unless doctors/healers of the future are trained in a new paradigm (Functional Medicine is putting up a valiant effort to educate future health care providers in this methodology), have sufficient life experience and have spent a large portion of their learning years investigating and researching the multiple layers and levels of complexity (7 Stages to Health and Transformation) that may contribute to the origins and continuations of  symptom or disease processes, you, as a health care consumer, will always be at the mercy of their experience (or inexperience) along this continuum. That is why it is imperative that all patients, as much as they can muster the lifeforce to do so, become advocates of their own health and treatment protocols. Patient self-advocacy, combined with a serious intent to do what it takes to get well, is always at the root of successful health outcomes. Or, if faced with a depressive illness or episode, we can hand over all power to the physician/healer we have consulted, take an antidepressant and hope for the best. Your choice.

Resources

  1. https://www.ncbi.nlm.nih.gov/pubmed/28178949

Qualities of a Successful Patient. Do you want to be a successful patient?

“One of the great challenges in a doctor-patient relationship is how best to structure their interactions so that the patients get their needs met and their symptoms and diseases diagnosed and treated in a systematic and productive way while at the same time interfacing with the healthcare provider and their staff so that logistical errors (bookings, lab testing, supplement and drug lists) are kept to a minimum. Patients need to act as their own health advocates and educate themselves and their chosen health care team as to what it is they need to do to optimize their health and well-being. Individuals with good ego strength and a solid footing in the world seem to have little trouble negotiating this complex territory. However, those patients with early developmental trauma, PTSD, chronic inflammation and infections, traumatic brain injury, and a host of other possible health issues will often find it difficult to navigate the complexity of an in-depth functional medicine workup and treatment plan.”

“Here are a few guidelines we have found to be of benefit to those who may find themselves struggling to get started on a healing path.”

Dr. Bruce Hoffman

A Successful Patient

  1. Identify the hierarchy of your main values: family relationships; social connections and friends; financial growth and responsibilities; mental development and education; career growth; spiritual growth; and health, wellness, and beauty.
    1. Realize you will have to raise “health, wellness, and beauty” to at least one of your top two values in order to achieve successful outcomes.
    2. Realize you will have to “rob Peter to pay Paul”—i.e., take time away from a high-value activity (such as long work hours) to devote to health practices.
    3. Realize you will have to invest financially in a wellness program. It is not the government’s responsibility to fund these complex lifestyle, nutritional, supplemental, hormonal, and mind-body programs.
  2. Realize that health benefits will be limited if you are unwilling to make significant changes to time management, lifestyle, diet, work, and relationships.
    1. Do not hesitate to make significant changes in order to bring well-being back into your life.
    2. Seek out resources and solutions to making change.
  3. Realize the significance of set daily routines.
    1. Spend time every day approaching your health with commitment and purpose.
    2. Maintain self-care routines, exercise, and appropriate sleep hygiene routines, and follow treatment schedules and regimens.
    3. Dedicate at least an hour each day to pursuing health goals.
  4. Follow the scheduled recommendations of your health care professional based on what will clinically benefit you the most.
    1. Makes prescheduled appointments based on the recommendations of care given by your health care professionals.
    2. Make up missed appointments before the end of the week.
  5. Identify yourself with solutions rather than your diagnosis and its limitations.
    1. Defining yourself by your diagnosis may shut down any further enquiry and divorce you from a cause and effect solution focused relationship with your symptoms.
    2. Educate yourself about treatment solutions for your given symptoms and health issues.
  6. Understand the significant health benefit of defining your life purpose and linking it to healing.
    1. Clearly define your life purpose and expected health goal outcomes.
    2. Ask yourself, “how will I be even more effective and productive at what I love to do if I discipline myself to do what it takes to get well. “
  7. Link cause and effect, and understand how choices you have made over a lifetime (physical, mental, nutritional, emotional, and spiritual) play a definitive role in disease/illness and health/healing.
    1. Realize that the traditional allopathic model has its limits, as does every other model.
    2. Explore and engage in a wide spectrum of health paradigms (ancient, modern, Eastern, Western, traditional, alternative).
  8. Know that one single health care professional does not have all the answers.
    1. Form constructive partnerships with health care professionals who are experts in their respective fields.
    2. Find an integrative, functional medicine specialist with the most experience in a wide-ranging spectrum of diagnostic and treatment modalities to assist you in “quarterbacking” all of your expert opinions and options.
    3. Be an active, educated, and involved participant in the healing process by becoming your own patient advocate, or delegate the responsibility (temporarily) to the most qualified person you can find.
  9. Do not confuse symptom resolution with the completion of care.
    1. Maintain the schedule recommended by your health professional.
    2. Commit to and complete a full course of therapy.
    3. Discuss treatment plan changes and/or breaks to treatment with your health care professional before implementing changes, thereby ensuring everyone understands, informs, and agrees to the treatment plan.
  10. Draw on family and friends to build a strong, supportive network.
    1. Share your experiences in health care with family and friends.
    2. Educate family and friends about ways to provide support and understand your conditions and health care needs.
  11. Understand that your maximum health potential is benefitted by a mental attitude that embraces both support and challenge in your quest for well-being.
    1. Learn to embrace your shadow self and imperfections within yourself as much as your positive attributes.
    2. Engage in physiological/medical treatment, as well as inner/psychological and spiritual/soul work.
  12. Keep current with financial responsibilities.
    1. Realize that the traditional “health care” services pay only for drug and/or surgical treatments for established diseases. The governmental services do not pay for functional medicine and will not assist you in your search for upstream causation and regulation of multiple biochemical imbalances. Like the purchase of a house or a car, your health and well-being and their continued advocacy are your own financial responsibility, not the government’s.
    2. Pay for services in advance or at the end of each scheduled appointment.
    3. Take responsibility for your own financial circumstances and commitments.
    4. Do not abandon the recommended health care program because of exhausted government health coverage or personal health insurance.
  13. Realize you are a multilayered, multileveled being and that the triggers for illness may have arisen at many moments along the timeline of your life.
    1. Spend time recollecting your whole life history to determine significant antecedents, potential triggers and mediators for illness.
    2. Spend time considering what lifestyle practices and behaviours are perpetuating symptoms.

The greatest compliment from our patients is the referral of family and friends.

We hope that you know how much we value your trust and confidence in our provision of care.

I have reviewed these guidelines and accept the responsibility of becoming a successful patient.