A common practice in the treatment of a first major depression is to keep patients who have responded to drugs on them for about a year. Then, because such patients can go a long time before a second depressive episode, they are weaned from the drugs, typically over a period of a week or two. A second depression is usually treated similarly. It is only when someone becomes clinically depressed for a third time that it seems reasonable to keep patients on drugs indefinitely. When I suggest to a patient that it is time to come off these drugs, I make a few recommendations that I think lessen the chance of the depression relapsing immediately. I want to list them here, but there are certain considerations that make me hesitate:
There is another reason to hesitate to give advice over the internet, according to a child psychiatrist friend of mine. “You can get sued for medical malpractice.” That is not a thought that occurs to me very often. During the many years I have been in practice, no one has ever suggested they might sue me—except for my father, come to think of it. Towards the end of his life he threated to sue me for medical malpractice, and I had to explain to him that he could not, since I had nothing to do with his medical care. In fact, I lived in a different city.
Also, my friend points out, anybody can sue anybody else for any reason at all. If I were to recommend eating healthy salads (and I do), some guy could sue me if he choked on the salad. In fact, if he were hit by a truck after eating a salad, he could sue me for causing him to be distracted. No doubt I would win such a suit, but I would have to pay litigation costs. It is easier never to say anything on the internet, or anywhere else, for that matter. I have to take this admonishment seriously. I have readers, I know, who would like me to suffer a calamity. They root for me to die a painful death and go straight to hell. I know this because they have written to tell me so.
But I write this blog with the purpose of being helpful to people and, it seems to me, I should say what I believe. I am told I can mitigate the danger of litigation by offering up a caveat—what in the business is called a disclaimer.
So, here it comes. Get ready… THE REMARKS I MAKE IN THIS BLOG SHOULD NOT BE TAKEN AS PARTICULAR ADVICE FOR PARTICULAR INDIVIDUALS WHOM I HAVE NOT SEEN. Or THE DEPRESSED INDIVIDUAL, OR THE FORMERLY DEPRESSED INDIVIDUAL, SHOULD CONSULT HIS OR HER PHYSICIAN BEFORE IMPLEMENTING THESE SUGGESTIONS. Or INDIVIDUALS SUFFERING OBSCURE ENDOCRINE PROBLEMS OR SKELETAL ISSUES SUCH AS A RECENT FRACTURE OR ARE TROUBLED BY SUDDEN BLEEDING EPISODES OR KIDNEY STONES SHOULD CONSULT A SPECIALIST WHOM THEY CAN THEN SUE SHOULD ANYTHING GO WRONG. There. That makes me feel better.
Suggestions for Individuals Stopping Anti-depressant Medications. (Also, these recommendations may prove useful in preventing people from getting depressed in the first place.)
There is epidemiological evidence for this effect. There is a geographical gradient in which countries further and further away from the equator have a higher and higher incidence of major depression. I have seen men and women who respond to vacationing in Florida (after a few weeks) and then relapse again about a week after returning to New York. There are “light boxes” sold for the purpose of providing light when there is little light outside.
There you have it. Four reasonable strategies to prevent a relapse of a major depression. They do not actually prevent most serious depressions, but they may have an effect on borderline cases. They not only promote health in general, they promote a proactive attitude toward physical and mental health which serves to counteract the sense of helplessness many depressed people feel. (c) Fredric Neuman Author of "Caring, Home Treatment for the Emotionally Disturbed." Follow Dr. Neuman's blog at fredricneumanmd.com/blog/ or ask advice at fredricneumanmd.com/blog/ask-dr-neuman-advice-column