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Poison Ivy

Poison Ivy A couple of weeks ago, I was informed by a patient that an attorney I highly respected shot himself in the head in a public place. He was a bit older than me. The news instantly brought a wave of sorrow that penetrated me to my bones. I always knew him as a man of integrity, saturated with a sense of duty to serve his fellow man in their times of desperate need. The world will miss him. I miss him.Over the years, I have evaluated many patients with exotic illnesses, Polycythemia Vera, Hairy Cell Leukemia, Polyarteritis Nodosa, Wegener's Granulomatosis and Pheochromocytoma to name a few. These are the types of illnesses that are featured on Mystery Diagnosis channels on Discovery Channel. But when it comes to a disease that causes profound misery, I can think of no other illness that is rooted in the land of wretchedness other than major depression. It is relatively common. Some estimates predict that from five to twenty percent of us will suffer from it at some point in our lives. Some epidemiologists suggest that by the year 2020, major depression will be the second leading cause of medical disability world-wide.Every day I evaluate people who say they have depression in some form or another. Most of these patients are referring to something mildly upsetting happens to them and they are saddened for a while. They recover. Major depression is chronic and unrelenting. It lasts. Patients see the world in shades of black and white, no vivid colors. Everything is gray, oscillating between dark and light gray, no sunshine, only darkness and despair. The disease is crippling, leads to suicide; its victims lose their jobs, family, and all social contact of one sort or another. They are imprisoned in their beds, they refuse to see anyone especially their psychiatrist because they feel they do not deserve to get better.There is a profound loss of pleasure. Major depression is in some sense more tragic than cancer or spinal cord injury. There is no denying that life is sorrowful, but most people know how to cope with the disappointments, failures and unrequited loves in our lives. We compete with others in almost all aspects of our lives, and most of the time we lose to another person better at what we thought we were good or great at. I suspect we all live a life of rejection more than acceptance. But somehow we find a way to feel the vast pleasures of the life, the sunrises and sunsets, the subtle winds that blow on our faces on a cool, crisp spring day, the warm soothing touch of a loved one's hand and the amazing creatively fulfilling power of music, magical movies and the laughter of small children. Truly depressed people survive in a world of anhedonia: the inability to feel pleasure. Friendship, achievement, family, food, humor, sex, nature - none can bring pleasure.People suffering from major depression have very few, if any positive feelings and an overwhelming number of negative ones. Many times they feel overwhelming guilt and/or grief which leads to them to live in a forest of incapacitating despair. Not just guilt or despair from an event that went bad in their lives, they feel guilt and despair about their depression, what it has done to their family, friends, loved ones, fellow workers. They are further moved closer to the darkest place in Hell by not being able to just snap out of it. They become delusional, facts are distorted, under and over interpreted, always leading them to the conclusion that all things are terrible, worsening and in fact, hopeless. Those afflicted with major depression stop eating, stop sleeping, and when they sleep, the architecture of their sleep itself is profoundly disturbed. And unexpectedly, their glucocorticoids are elevated. They feel that they are fighting an enormous mental battle just to stay alive against all odds.It should not surprise anyone that worldwide, major depression accounts for 800,000 suicides per year. Women are more likely to attempt suicide when they are depressed than men. Men are much more likely to be successful. The highest risk group are white males over the age of sixty-five years-old with an access to guns. For most men that live in the South, access to guns is as natural as drinking water. That brings us back to my attorney friend. He had a daughter who had a substance abuse problem. She had recently been discharged from her second hospitalization for rehabilitation. I suspect that her father, the attorney, may have felt somehow responsible for her illness, perhaps she had depression because he was suffering from it and he thought he made everyone in his life miserable. Perhaps he envisioned the only way to keep his daughter free from her depression and self medication of her depression with illicit drugs was to end his life. Perhaps he thought that afterwards his daughter could live guilt free, and her depression would lift because her depressed father was gone, and he would no longer be the source of her illness. As I recall, he was the noblest of men. I heard that once the daughter was told about her father's suicide, she took a drug overdose and ended up almost dying herself. Two people, a father and a daughter, with major depression, perhaps believing that each one had their depression because the other one did, each blaming themselves for the other's failures. If that does not make you stop dead in your tracks and think a minute, nothing will. The irony of it all. Two people infected with major depression's delusional thinking to the point of each trying to commit suicide; one successful, one not. The man had a gun. And how does the daughter live with herself now? I hope that her delusions won't grow and take over her life like a huge Poison Ivy vine. Sadly enough, the statistics are on the side of the Poison Ivy.Doc.

Posted by Amanda Sanders at 8:57 AM
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