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Ask the Mental Health Expert Archives 2001-2004

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Depression Stigma

Q. I was at one point diagnosed with dysthymic disorder. My husband and I were arguing about this. I am on 20 mil of Prozac and I think it has been a godsend. My symptoms have decreased and I don't feel in a panic all of the time. My husband, on the other hand, seems to believe that if I truly didn't want to be on the medication, that I could control myself by basically willing it away.

I think that if the medication is working, then why change it? I was just wondering what I can say to convince him that this is beyond meditation and will power. I know that it is difficult for him to relate to because he isn't saddled with this. I just want to help him understand, and maybe realize what I go through when I am not on my medications. Can you help me?

A. There is still a great deal of misunderstanding and stigma attached to the diagnosis of depression. Many people share your husband's view that the seriously depressed individual should just "pick himself up by his bootstraps"--even when the depressed person feels like he or she doesn't even have "boots"!

Of course, there are research papers that you could show your husband. For example, Haykal and Akiskal (J Clin Psychiatry 1999 Aug;60(8):508-18) carried out a study of 42 consecutive patients with Dysthmic Disorder (DD) over a ten year period. Females treated with fluoxetine had the highest response rate (85% [N = 17]).

Interestingly, many patients with dysthymia who had required extensive psychotherapeutic help prior to state-of-the-art pharmacotherapy no longer required such therapy, once they received fluoxetine or similar SSRI medication.

Another study by Shelton et al (J Clin Psychiatry 1997 Feb;58(2):59-65) concluded that DD "?can exact a significant toll on the general health and quality of life in the affected individual" and that DD is significantly undertreated. But--do I believe that your husband will be impressed by these studies? My guess is, probably not. You might have better luck by pointing him toward more user-friendly descriptions of serious, chronic depression and how it is treated.

I strongly recommend the book by Dr. John Medina, entitled "Depression: How it Happens, How It's Healed", available from New Harbinger Publications. This book describes the causes of depression, its symptoms, and its treatment in a very friendly and readable manner. You might also point your husband to the website of the National Depressive and Manic Depressive Association (NDMDA) website (www.ndmda.org), where you will find an abundance of information.

All this is not to say that you should or must continue taking Prozac indefinitely. There are other ways, such as cognitive-behavioral therapy, by which you may be able to keep dysthymia and/or panic symptoms at bay. However, the risk of relapse must be considered very carefully, for patients who discontinue their medication. In many instances, patients with chronic, severe dysthymia do better when they continue their medications indefinitely, unless there are serious side effects.

Finally, if this argument with your husband becomes more distressing or intense for you, it might be useful to have your husband join you for a session with your prescribing physician, so that the doctor can do a little education on this issue. I hope your husband comes around and eventually understands that serious depression is not a matter of will power.

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October 2003

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