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Depression: A Slow Crawl Through Hell

Imagine with me a world full of hopelessness, where sleep is the only thing you desire. You’re alone, isolated from others, questioning why you can’t be “normal” like them. Covered by a heavy blanket, you’re smothering in despair, and time has slowed so every second is its own eternity of sorrow.

Or perhaps you’ve visited this horrible place, otherwise known as depression. Jim Shoopack, age 38, called his experience with depression a “slow crawl through hell.” Diagnosed in 2001, Jim clearly recalls his relief when he found there was actually a name for the way he felt. “When I was suffering from depression, but didn’t know what depression was, life sucked.”

What non-depressed individuals imagine depression to be can’t do it justice. Depression is a true medical illness. It’s more than just being sad,” Dr. Robert E. Morrow, MD, of Pocono Psychiatric Associates says. “It is the only pain I know of that routinely causes people to contemplate ending their lives to escape the way it makes them feel.” Clients often tell Morrow it’s worse than any physical pain they’ve ever had to deal with. Morrow explains depression is the result of the brain’s inability to allow an individual to have the normal full range of emotions.

Social Stigma & Statistics
Step 1: Recognize the Symptoms & Get Help:

Cheryl*, age 46, says she didn’t get help for a long time because she felt ashamed. She would often wonder why she was unable to control herself and felt she should be able to “suck it up.” Ten years after being diagnosed with depression, she wants people to know they shouldn’t feel something is wrong with them if they have symptoms of depression.

Dr. Morrow agrees social stigma is one of the reasons people are not thoroughly treated for depression. 1:4 women and 1:6 men suffer symptoms at least once in their lives, but Morrow says these numbers may be skewed, as women may be more likely to admit they have symptoms and seek help.

Medications & Holistic Treatments
Step 2: A Plan of Action

Safer medications, such as Paxil, have helped relieve some of the social stigma attached to depression and have helped some people better deal with the illness.

Bev, age 50, claims she turned to medication because she was “stuck” in spite of employing a range of other strategies. “Use of medication does not negate a holistic approach. It works in tandem,” she says. Both approaches together have helped her adequately address her symptoms.

Kelly, age 26, tried a long list of medications, all of which made her feel disconnected, numb, and lifeless. She’s been able to take control of depression by finding and focusing on what she calls her “source”—something she defines as what fuels her from the inside and makes her happy. The number one cure for her depression has been outdoor exercise. She breaks though self-imposed limitations by skiing, rock climbing, biking, and trail running. She also uses camping and backpacking to learn contentment away from materialism and the “If only I had…” complex. Yoga, meditation, and reflection are all key factors, and she’s also currently learning the correlation between nutrition and mental health.

For Cheryl, medication worked. “When I went on medication, it reminded me of when The Wizard of Oz turned color. I also have Thyroid Disease and never questioned the doctors when they diagnosed me and told me I’d have to take a pill for the rest of my life, so why would I question taking a pill to help manage my depression for the rest of my life? I didn’t always feel that way, but now I’m okay with it,” she says. Cheryl has also incorporated faith, therapeutic massage, Chinese herbs, and acupuncture, and she says a number of approaches together have cured her.

Sisters, Anita Bondi, PhD, LMT, and Louise Bowman, MSNutr., LAC, are co-directors of Wellspring Holistic Center in East Stroudsburg. “The body and its functioning are beautiful, complex mysteries, and each person is unique and different. There is not a ‘one plan fits all’ way to treat anyone. Depression can be the result of many different things. In Holistic Medicine we look beyond diagnosis and prognosis. We see each person as an individual–listening to their unique story and history, and treating the whole person not just the label,” Bondi says. Bowman, who specializes in acupuncture, echoes the whole body approach and adds that treatment plans are based on symptoms, palpation, pulse diagnosis, and more.

Dr. Morrow agrees medication isn’t always the answer for everyone and says holistic treatments aid in the treatment of depression. “Medication gets you up off the floor to get the therapy you need,” Morrow says. He stresses that therapy and follow-up are key.

Jim Shoopack found medication and therapy helped him get back on track. He then learned the correlation between exercise and mood. He incorporated running into his treatment plan and later formed an organization called “Run Over Depression,” through which he still promotes awareness of Mental Health Illness, speaks publicly, and works toward removing social stigma.

*Names of some individuals interviewed have been changed to protect their privacy.

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The Increased Diagnosis and Unmet Needs of Depression

The average age of first episode depression has been occurring at earlier ages since the 1930s, and it seems more common than ever, but more likely we’re simply recognizing it more and the stigma has lessened, according to Dr. Robert E. Morrow, MD, of Pocono Psychiatric Associates.

Unfortunately, many people diagnosed are still undertreated. Why? One reason could be what Dr. Morrow calls the “Golden Rule.” Translation: “Those who have the gold rule.” The number of psychiatrists is dwindling nationally because of comparatively low insurance reimbursements and funding. Lack of funding could be because procedures such as heart surgery or cancer treatments are more profitable, or because mental health issues are still not as openly discussed and accepted as outpatient surgical procedures and high blood pressure. Whatever the reason, it’s a national need we can no longer ignore.

Out of pocket costs often force patients to compensate by visiting their family doctor for medication. As a result, they also skip the therapy they so desperately need and forgo holistic treatments. Remember, no one method of recovery can stand-alone successfully.

In 2010, Pocono Medical Center conducted a Community Needs Assessment Survey. The results showed additional mental health services in Monroe County as one of the two most pressing unmet needs in our community. Kathy Kuck, CEO of PMC, confirms Monroe County shows higher percentages of mental illness when compared at both the state and national levels, and she feels strongly about addressing the need. As a result, a Community Health Connections Steering Committee has been formed under her leadership. Read more about this initiative here.

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Even if you’re not depressed, you can help.

What to do?
Recognize the signs of depression, and encourage friends or family members with symptoms to see a doctor.
Urge Politicians to address these unmet needs in our society.
Read the article, “A Community Comes Together” on page 26 of this issue to learn more about what is being done locally to address mental illness and wellness, and get involved by supporting it.

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Go to the sources
Local sources offer advice on dealing with depression

Dr. Robert E. Morrow, MD
Dr. Robert E. Morrow, MD heads Pocono Psychiatric Associates, a private adult psychiatric practice located in East Stroudsburg, PA. He also serves as Vice Chairman of the Department of psychiatry for Pocono Medical Center, and acts as a Psychiatric Consultant for East Stroudsburg University. He is the Medical Director of Catholic Social Services in Stroudsburg, and is a Clinical Assistant Professor at the Commonwealth Medical College in Scranton, PA. Several publications have been credited to his name, and he speaks frequently to various medical groups on psychiatric, drug, and alcohol topics.

Dr. Morrow explains depression is triggered by (not caused by) a major stressor in life. He says the more episodes you have, the easier it is to have another. Look at these statistics:
50% of the people who have one episode, will likely have another
75% of those who have suffered a second, will suffer a third episode
After the third episode, there is a 90-95% chance episodes will continue to reoccur

I’m the last person anyone would ever think of seeing,” Dr. Morrow says, “but depression is the second most disabling medical condition in the United States in terms of lost productivity at work.” That’s not good news for employers. Worse, only 20% of those diagnosed with depression get treated, and only 20% of those treated are thoroughly treated. This is due to both social stigma, and perhaps largely due to medical costs and low individual reimbursements for treatment.

Many people who have suffered symptoms and sought treatment also expressed a frustration with the low number of doctors available, and long waiting lists that came with those who are in practice. This correlates with both the decline of psychiatrists in the United States and an unmet community need.

According to statistics, women make more suicide attempts than men, but men have a higher percentage of completed suicides. Dr. Morrow says almost everyone has some degree of ambivalence when attempting suicide. Doctors have learned this through conversations with people who have attempted suicide and survived. “We are almost always told that there was an inner voice asking, “Oh my God, what have I done?” during that final second,” Dr. Morrow says.

And what about the suicidal side effects of antidepressant drugs? Dr. Morrow explains this is rare, and usually only happens when someone has another form of mental illness that would call for a different kind of treatment, such as bipolar disease, for example.

He also says the greatest time of risk is during the initial stages of treatment, when an individual is feeling well enough to act on their depressive or suicidal thoughts, but not well enough to overcome them just yet. Close follow-up, thorough treatment, and strong communication, are all important to ensure success.

Dr. Morrow has provided the following suggestions:
Get plenty of exposure to natural light
Nutrition—maintain a well balanced diet
Sleep! You must rest your brain to heal
Therapy—don’t skip it!
Consider medication, if appropriate
Exercise often
Seek complimentary holistic treatments
Avoid all alcohol! Although it may make you feel better temporarily, alcohol affects the central nervous system, and symptoms will worsen as a result

Perhaps one of the most important things to focus on while treating depression — HOPE.

Dr. Morrow says hope can keep people going, and he tells each of his new patients the same thing: “My job is to hold on to the hope that’s still there, until you’re well enough to hold it again.

Dr. Morrow refers to the book, Darkness Visible, by William Styron, as a good literary description of depression.

He also suggests the following websites for more information on depression and statistics related to depression:
www.psychcentral.com
www.nimh.nih.gov
www.nami.org

Many people diagnosed with depression are undertreated. If someone is undertreated, suicide attempts and a less-than full recovery are more likely. For example, lets say Adam is seeing his family doctor to obtain prescriptions for antidepressants, but he’s not getting therapy. He may be at a greater risk of attempting suicide. Family doctors are typically General Practitioners, not Psychiatrists. While none of them would ever intentionally leave a patient undertreated, they may not recognize other symptoms or issues as easily as a Psychiatrist might, such as bipolar disease perhaps. Without meeting regularly and talking at length with patients about their innermost thoughts, how can they possible be completely in the know? Because of time restraints and different skill sets, family doctors are simply unable to adequately address the needs of each patient struggling with depression much of the time. Dr. Morrow says most family doctors recognize this, and will tell him that many patients sitting in their office often actually belong in his.

And yet, Dr. Robert E. Morrow, MD heads Pocono Psychiatric Associates, says his practice is currently operating with a waiting list, which points back to an unmet community need and low number of available psychiatrists. Sound like a vicious cycle?

Now, perhaps more than ever, mental illness is ‘top of mind’ in the United States for everyone from parents to politicians on Capitol Hill, especially after a steady increase of mass public shootings over the last several years. Now is the time for civilians, doctors, hospitals, and politicians to come together and address this need that seems to scream for our attention. Make your voice heard, and talk to both your medical providers and politicians about how to be proactive rather than reactive—hasn’t mental illness been ignored long enough?

Every citizen can lobby for this important cause at www.careforpa.org.

Anita Bondi and Stephen Myles Davidson, DO
Anita Bondi is co-director of Wellspring Holistic Center, which she founded in 1994. She has been a Body/Mind Therapist since graduating from college as a Social Worker in 1986, and has added many licenses, certifications, and degrees since then, most notably her Ph.D in Holistic Studies in 2001.

Anita says, “My twenty-five years of training in the healing arts runs the gamut from traditional massage therapy to specialized studies with osteopathic physician, Stephen Myles Davidson, DO. I am trained to look at the whole person, beyond diagnosis, medications, and prognosis. I take a history that includes past traumas, accidents, injuries, lifestyle choices, diet, and exercise. I listen. I palpate. I look. I touch. A patient needs a medical team (made up of doctors, practitioners, experts) they trust, that listens to them, takes the time to treat them individually, and keeps trying until the patient responds positively.”

Find more about Anita’s work at her website: http://wellspringholisticcenter.com

Learn more about Dr. Stephen Myles Davidson at http://www.healthabounds2.com

Louise Bowman
Louise Bowman is co-director of Wellspring Holistic Center, with locations in East Stroudsburg and Stroudsburg, PA. She is a licensed Acupuncturist, holds her masters in Nutritional Counseling, and is also a certified yoga instructor. Louise has been in practice since 1998, when she graduated from Bastry University in Seattle, Washington.

Below is some more in-depth information about Acupuncture and Chinese Medicine from Louise:

Traditional Chinese Medicine (TCM) is an eastern medicine practice that has been around for thousands of years and includes a variety of therapies such as acupuncture, herbal medicine, Tui Na (massage), qigong (exercise) and diet. These therapies can be used in combination or as a standalone treatment.

TCM is a whole body approach to medicine. What does that mean? When a patient comes for treatment, the TCM practitioner wants to know what is happening in every area of their body, even if it appears to be unrelated to the patient’s immediate concern. Most concerns would be categorized as symptoms in eastern medicine instead of diagnoses as in western medicine. Why? Because TCM has a different set of diagnoses based on symptoms, pulses, and tongue. For example, when someone complains of depression, the practitioner will want to know how the depression is expressing itself in the individual. Are they tired all the time? Do they feel like crying for no reason? Do they have heart palpitations? What’s going on in the rest of their body? Have their bowel movements changed? Are they having out bursts of anger or rage? Once all information is gathered, the pulses are taken, the tongue is looked at, and a TCM diagnosis is made. This is when treatment begins.

How does it work? TCM follows meridians (or channels) that run all through the body. Within those channels, we find something called Qi, which represents your vital energy. The energy in these channels is supposed to flow in a specific direction with equal intensity. Through our life experiences, the energy can become disrupted, and the flow of energy is put off balance as a result. TCM is used to figure out where the imbalance(s) is/are and then treat the whole person based on this information. Treatments may include therapies such as acupuncture, herbal medicine, and diet. The goal is to restore balance, so the body can return to its normal function.

TCM is a great adjunct to many other treatments, because it works at a different level in the body. There is not a conflict between taking medication and having acupuncture. Herbal medicine, however, may be contraindicated with certain medications; therefore each case is looked at separately.

Visit Louise’s website for more information at http://wellspringholisticcenter.com.

Jim Shoopack
Jim Shoopack, 38, is an educator who was diagnosed with depression in 2001. After beginning therapy and medication, he began to focus on distance running to conquer his depression. As a result, in 2005 he formed “Run Over Depression,” an organization dedicated to providing hope to those struggling with this difficult illness. Through “Run Over Depression,” Jim also attempts to educate people, with a goal of removing the social stigma of depression. Jim wants people to view him as an example and to know that depression has a “face.” “People do not choose to become clinically depressed. Anyone can be affected by it,” Jim says.

The organization is called ‘Run Over Depression,’ but I think it’s important for people to realize it could just as easily be called ‘Exercise over depression.’” You can walk, jog, lift five-pound weights, or any other sort of exercise, to help combat depression. It’s also important for people to remember ‘you are what you eat’—yes, fruits and vegetables are two of the best things you can eat. Eating fast food all of the time will only make you overweight, and the garbage in much fast food will not help you to feel better about yourself,” Jim says.

He also points out that depression is a negative cycle of thought, and a negative thought pattern, that takes time to change. He says, “I’ve learned that when I feel that way, I need to mentally stop and think of something happy, positive, or funny. It helps that negative snowball affect to cease and helps me to develop a positive snowball affect.”

He also mentions the importance of relationships. “Sometimes it’s just that having one person who can relate to you…who understands you. That will keep you going, and that person gives you a reason for living. I consider it a blessing that I was given this vocation.”

There is a plethora of information, including several additional website links on Jim’s website www.runoverdepression.com. Jim is also available for speaking engagements.

Cheryl” (age 46)
Cheryl emphasizes the need to recognize the symptoms of depression and says her husband was the one who finally convinced her to see a doctor. “Family members should speak up when they notice a loved one suffering, and people struggling with depression shouldn’t feel ashamed,” she says.

Cheryl said her mother and grandmother both suffered from depression. “Back then, it wasn’t as acceptable to talk about these things, and my mother simply self-medicated with alcohol. It wasn’t until later, that I realized depression ran in my family, and therefore, it was part of my genetic make-up.”

Cheryl’s has had great success with medication. Nonetheless, she stresses her Physiologist was just as important, and says therapy helped her find more self-coping mechanisms. She also says medications sometimes need to be adjusted. “They may work for a while and then become less effective over time, and you must be cautious to ensure the medication you are taking isn’t negatively affecting you in another way.” At one point, Cheryl says she was taking a medication that was helping her depression symptoms, but it started to affect her liver, so she had to consult with her doctor and switch to something else.

Bev” (age 50)
Bev says she turned to medication because she was “stuck” in spite of employing a number of strategies such as counseling, journaling, prayer and mediation, exercise and diet, and a support system of family and friends. She explained that one approach alone did not adequately address her symptoms, and says she has found medication and holistic approaches to work in tandem.

But also stressed that “If you are a woman of perimenopausal or menopausal age, get your hormone levels checked. This information can be very helpful,” she says.

Kelly” (age 26)
Kelly began to struggle with depression as an adolescent. “I became incapable of expanding my mind in search of solutions, and everything felt like a road block with no way around it,” she says. “Sleeping was a coping mechanism, because she felt so hopeless in her waking life.”

Medication didn’t work for Kelly. Instead, she has employed many holistic methods in order to combat depression, and like Jim, she found that physical activities helped tremendously. “Yoga and meditation have also been huge vehicles in my search for true happiness,” Kelly says. “Yoga is more than physical exercise, but it’s a powerful instrument for cleaning out the ‘gunk’ that blocks our connection to the source. It’s like washing a dirty window so that natural light pours in. I could liken meditation to organizing a closet. Through observation, I learn about all of the unnecessary clutter that I can let go of, and I see what I value most in life.”

Kelly says she does occasionally feel herself sliding mildly into depression and anxiety. “Life is fluid like that. The difference now is that I can consciously see it for what it is, and I can choose to overcome it.”

Written by J. Renee Olson
J. Renee Olson (a/k/a Jennifer Olson) is a writer, author and blogger living in the Pocono Mountains of PA. To read more of her work, visit her website, www.jreneeolson.com

Photo by Regina Nicolardi
Regina Nicolardi is an award winning freelance photographer from NEPA whose publication credits include National Geographic Magazine. See more of her work at reginanicolardi.com

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