I am so proud of the two doctors who speak openly about their ongoing struggle with major mental illness. I am equally pleased you gave their message so much space in the January 18 issue.
I still take 150 mg bupropion tabs, b.i.d., to help me avoid resumption of cigarette smoking and to treat my major depression.
I used to commute to work each day with a good friend, also a psychiatrist. One day I asked his opinion about my puzzlement over why I wanted to take my shotgun, go behind the furnace, and blow my heart out rather than put the barrel in my mouth and blow my brains out. He said, “Jesus Christ, Dick. You’re sick!”
I was puzzled but respected his opinion. He patiently took me through the diagnostic manual, and I admitted that I would wake at 2 a.m. and stare at the ceiling. I did not enjoy eating anymore, had stopped a number of activities I used to enjoy, and had been that way for months. Of the three granddaddy antidepressants of that time, I started on imipramine and switched to desipramine in a few months for its less-sedating effect. Sure, psychotherapy was part of the treatment, and it was directed toward the proper use of the meds, changes that needed to be made in life, and other matters. I know from experience the benefit of antidepressants and how unpleasant the earlier ones were to take: dry mouth like you have never had before, constipation requiring regular enemas, and episodic sweating so profuse it runs down your face and soaks through your shirt. Noncompliance is very tempting. Nearly all the meds we prescribe are unpleasant, except the tranquilizers, which may be too much fun for some.
After four years and some necessary changes in my life, I did not require antidepressants again for 20 years until my bypass surgery. I can assure you that major surgery like that and the pain that lasts for months are major stressors to precipitate my Achilles’ heel, major depression.
Since these experiences, I have stressed compliance with medication with patients and enlisted the aid of spouses, parents, or friends to that end, using my relationship with my patients to let me enlist their help (relationship therapy). Of course, reality therapy is necessary when certain life changes need to be made no matter how difficult. (I was made to join Al-Anon by my psychiatrist friend, who threatened to never speak to me again if I didn’t.)
I am retired now at age 70. Thanks to cardiac surgery and especially cardiac rehab and now living on a farmette and caring for two retired (crippled) horses and their stalls, two barn cats, house cat, and two dogs, I can do physically what I could not do at age 60. Thanks to bupropion, I can avoid smoking cigarettes, and people can enjoy me. Without bupropion, I get so morose people cannot stand me.
God love those two doctors who speak out about their mental illness and use it to help us all.
