I had to field a call the other day from a local Children and Youth worker. Nice lady . . . but not terribly informed about mental health issues . . . specifically Major Depression. She was calling about a patient of mine who is trying to get custody of her grandchild after the child’s mom essentially abandoned him. The kid was in a temporary group home awaiting clearance to go to live with his grandmother (my patient). I can understand her lack of knowledge. C+Y workers do good work but are not necessarily trained in mental health issues. My gripe is that when my patient had her clearance interview with the C+Y psychologist (who I assume is trained in mental health issues), she was given a hard time about being on antidepressants for such a long time. She was a bit rude about it with my patient as well. When the C+Y worker called, she, too, questioned why someone would need to be on antidepressants for years at a time.
I don’t mind being questioned . . . but these people sound like they never met someone with chronic, recurrent depression before. Like people only get depressed once in a lifetime!!!
Oh, if only my work . . . and my patient’s lives . . . were so easy.
Everyone who has an episode of Major Depression who gets better (regardless of why they got better) has an elevated risk of having another episode of Major Depression. When a patient goes through several cycles of getting depressed and then better . . . getting depressed and then better . . . getting depressed and then better . . . we start to think that maintenance treatment is necessary to maintain health.
So what is maintenance treatment.
Typically, when patients get better on an antidepressant they find that a moderate dose of that antidepressant can help them stay in that good place. It is not unusual for the dose of medicine that KEEPS you better to be lower than the dose needed to GET you better. So, for example, if you get “un-depressed” with 150 mg of Zoloft, a maintenance dose of 100 or 50 mg might be all you need to keep the Depression Demon away. Each case is different, of course, with it’s own collage of complexities. Generally speaking, we stick with what works for patients who need maintenance treatment.
This is true for patients who need more intensive interventions to get better. It has been known for years that certain patients only respond to ECT (shock treatments). Those patients will sometimes only STAY better if they get maintenance ECT treatments . . . once a month, for example. Those of us using TMS (Transcranial Magnetic Stimulation) to treat Major Depression are still working out the process of providing maintenance treatments. There are clear indications that it can work very effectively for some patients. The biggest advantage of using TMS to keep the Depression Demons away is the lack of side effects.
Bottom line is . . . we gotta do whatever works. The advantages of maintenance treatment far outweigh to disadvantages to those who’s lives are impacted by symptoms of recurrent Major Depression. Be it medicine or TMS . . . you gotta do what you gotta do.
–Dan Hartman, MD
