Advice Column

Answers to difficult questions on depression and the family.

By Michael Yapko, published on September 01, 2003

I am a 41-year-old father of four and husband of one very special lady. I have a business which, fortunately, is able to run fairly well while I am so sick with depression. I have a 20-year history of depression/anxiety. I have been in inpatient treatment a couple of times and in some psychotherapy at crisis times and am now trying to avoid having to go into a hospital again. I desperately need help as I cannot stomach taking my life on one hand, and continuing with life as it is on the other. I have been on various medications over the past year.

I don't know what your depression is about, but medications obviously haven't addressed it; neither has hospitalization. That doesn't mean these approaches won't be helpful in the future, but you'll have to be smart about the way you approach things, and strive to do it differently than before. (Doing what didn't work before in the same way makes no sense.)

A crisis is usually the worst time to address your problems sensibly and effectively. Crisis-level pressure encourages a focus on immediate relief. Too often decisions made during a crisis turn out to be bad for life beyond it. It's also much more difficult to go beyond mere symptom management to try to address and reduce depressive risk factors. A good depression expert will want to see you--and you should get help--before things become a crisis. Therapy is about learning your unique vulnerabilities and how to strengthen and manage them. No amount of medication can help you do that.

I urge you to read my book, Breaking the Patterns of Depression(Random House/Doubleday). It provides realistic perspective and opportunities to develop the life management skills known to reduce depression and relapses. I'd also encourage you to find a depression expert who practices cognitive-behavioral therapy who can help you through the crisis and strive to prevent future ones. Depression is manageable with the right tools. Take the time to learn about depression and how people recover; work with someone knowledgeable and skilled who won't divert you into irrelevant territory, and you'll likely do well.

Q: Our mother was diagnosed manic-depressive over 35 years ago. My brother and I have grown to adulthood symptom-free. After seeing the years of suffering our mother has endured, we wonder if there is anything we can do to help our children avoid this debilitating disease. The September 2002 issue of Blues Buster discusses an omega-3 fatty acid theory and it made us wonder if giving our children (ages 6, 9 and 12) a daily supplement might be beneficial.

To answer this question, I turned to two experts on mood and nutritional supplements: Ross Pelton, Ph.D., pharmacist, clinical nutritionist and health educator, and Taffy Clarke-Pelton, M..A., marriage, family therapist. Together they wrote Mind Food and Smart Pills(Doubleday). Here is their reply:

Although omega-3 fatty acids have not yet been specifically studied for prevention of bipolar disorder, some recent studies suggest that fatty acids play a role in this condition, which further suggests they might also be useful in prevention. In a landmark double-blind placebo-controlled study published in the Archives of General Psychiatry, omega-3 fatty acids provided bipolar patients such significant benefits that the study was shortened from nine to four months.

This preliminary research utilized high-dose omega-3 fatty acids (EPA and DHA) obtained from fish oils, and reported that most patients experienced highly effective mood stabilizing and antidepressant effects. The omega-3 patients were doing better on virtually every outcome measure compared to the placebo controls, and the differences in the rates of relapse were especially remarkable. Principal researcher Andrew Stoll, M.D., is now conducting a much larger three-year study, and other scientists are initiating trials to confirm the results.

The success of the trial suggests that fatty acids, which are an important part of the architecture of cellular membranes, may play critical roles in regulating thought, emotion and mood. The fatty acids may stabilize mood by "calming" nerve cells that are continually over-stimulated. Last March, a study, published in European Neuropsychopharmacologyreported that people with bipolar disorder have a significant deficiency of fatty acids, including omega-3s, in their cellular membranes.

At this point it is too early to know exactly which fatty acids may be deficient in a person with bipolar disorder or a genetic predisposition to it.

Deficiency of omega-3 fatty acids in the diet is widespread in our culture, and most people could benefit from fatty acid supplementation. Supplements containing fish oils are generally safe and well tolerated. A common dosage for adults is 2-5 grams provided as a combination of EPA and DHA.

Fish oils can contain toxins and become rancid easily, so be sure to choose a brand of certifiable purity and integrity. Some manufacturers have also developed palatable products specifically for children. When taking fish oils as supplements, it is also important to take natural vitamin E daily for antioxidant protection. People on blood-thinning medications should check with their doctor before taking omega-3 supplements.