According to the National Health and Nutrition Examination Survey 2009-2012, approximately 1 in 12 (or 8%) of Americans age 12 and over suffer from moderate to severe depression. I personally feel this is an underestimation, as on any given day, at least ¼ of my patient panel has mental health comorbidities. Depression is one of those disorders that I say is “easy from the cheap seats”. Those who have never had an episode of major depression often look at people on antidepressants as weak-willed, over-emotional, and medication-dependent. In reality though, nothing could be further from the truth.
I have had a strong interest in mental health for many years. Before I went back to medical school, I worked as physician assistant in chronic pain management and assisted in Post-Traumatic Stress Disorder research, listening to the stories of hundreds of people struggling with mental health disorders. And let me tell you, not once have I met a patient that wanted to be dependent on side-effect ridden, mind-altering synthetic medications. More often than not though, taking a medication to safely get through the day is much better than the alternatives, so most become semi-content with their suboptimal treatment.
Mental health disorders are silent killers that afflict all walks of life, from the successful 45-year-old stock broker husband, to the 25-year-old new mom, to the 15-year-old honor roll student, to the 75-year-old grandmother who just lost her husband. Deceivingly, all four of these examples can walk through their day with a smile on their face and accomplish (as they say in the military) more before noon than most people accomplish in an entire day. To you and I on the street, they look like happy, healthy people who have it all…or so we assume.
These are the same people who present to their doctor’s office, often as a last resort, asking for medication, in hopes it may help them take back some emotional control and conquer the black cloud that has followed them around like a puppy on a leash. When treating depression, it is imperative to methodically consider all treatment options prior to prescribing medication (And no, they are not all the same. If a doctor says “Eeny, meeny, miny, moe” when choosing an antidepressant to prescribe, run!). However, there are a number of people who are treatment-resistant, having tried and failed multiple medications with no relief.
There are also those for whom the side effects were so terrible that it negated what depression relief they were able to get from the drug, and so, the medication now collects dust in the back of the cabinet. And then there are those who wish not to start pharmacotherapy, or who want to wean off medications for various reasons. These situations are where many physicians become stumped. However, having a passion for root-cause medicine, instead of simply throwing everything but the kitchen sink at a disorder and then walking away when nothing sticks, I stop and ask, “What is the underlying cause, and how can I treat that?” There is an underlying cause for every ailment, I promise you.
This is where genetics come into play. Maybe you (or someone close to you) suffers from depression, as does your mom, your sister, your uncle, two cousins…and so on. The scientific community is finally catching up with what you and I have known all along- it really does run in the family!
I have been blessed to have become good friends with one of the world’s leading expert physicians in treating MTHFR gene mutations, Dr. Dan Purser. With his mentorship, I plan to incorporate more genetic diagnostics and therapeutics in treating depression and other mental health disorders, capturing those who are antidepressant resistant and/or who wish not to take pharmacotherapy.