October is national depression and anxiety awareness month

I'm writing this post in large part because May is not the recognized month for depression and anxiety awareness, and it's May, and October is--well, October is a long way away.

Check out http://www.projectsemicolon.org

About a month ago, I went in for my annual physical, and was pleasantly surprised to be greeted by the nurse and asked if I had any history with depression, or if I was feeling sad.  This was one of the standard intake questions, which was recently added to the list of things they ask about for physicals. I responded that I had, gave a brief history, and then remarked that it was refreshing that they are now doing this.

Since ending taking Klonopin at the beginning of this year, I had a resurgence of my issues with insomnia, anxiety, and depression.  The triad of these conditions is common, and if you can defeat one of them, you can generally break the cycle of each of them feeding into the other.  My path, once I figured that out was to determine how to deal with my depression as I had in the past.  Klonopin and some cognitive behavorial therapy in addition to my workouts kept everything in check for a while. And then it was gone.

I experimented with taking Turmeric, which seemed to provide a boost to my mood, but I quickly found out that there is an interaction between turmeric and aspirin that can cause a substantial risk of bleeding.  I stopped the turmeric.  And then I decided that I needed to enlist my doctor.

One of the things that I am commonly asked about by people who don't know me is if I'm getting enough exercise, because "exercise is the best cure for depression."  Those of you who know me are probably picturing me laughing hysterically at this.  I generally take a step back, breathe, and then explain that I'm a triathlete, that I often get 2 workouts in a day, and I have had ups and downs with depression throughout my time as a swimmer and now in my adult life as a triathlete.

Exercise is a mood booster and has been shown to be effective in combatting mild depression as effectively as some drugs.  It has its limitations--for more severe cases of depression, exercise cannot be the only line of defense.   A well written article on the benefits of exercise for depression can be found at http://www.theatlantic.com/health/archive/2014/03/for-depression-prescribing-exercise-before-medication/284587/ 

The problem with this is that exercise is not a panacea.  The details of the article touch on this, but the article also goes on to say that depressed patients are likely to lie about the amount of exercise they get.  It sums up the problem that some depressed patients have with their relationships with their doctors, therapists, and psychiatrists.  It hints that medical professionals may first think that the depressed individual must not be getting enough exercise if that exercise is not helping.

At one end of the spectrum is the existence of "Post Ironman Depression Syndrome," which is a very real, very physical, and simultaneously very mental encapsulation of the relationship between exercise and depression.  Put simply, in the time following an ironman triathlon, the athlete's body has to rest and recover.   This resting and recovering is a change to the standard amount of exercise they have been getting up to that point, and when combined with the completion of a task that was likely their huge goal they had been working up to, the athlete is left without direction.  Without direction, and in the let-down that occurs in the phase of "What do I do next?", depression ensues.  I experienced this first-hand following both my first Ironman, and my last.  With my first Ironman, I had initially decided to go on and continue with racing at that distance in the future, having a second ironman on the schedule for 6 months later.  I wound up with appendicitis, and then two surgical hernias that would take over a year to get past.  Complicating my post-ironman-depression was a year that I spent predominantly on the couch. My second ironman motivated me--I took a few weeks off, and started working with my triathlon coach to prepare for my third ironman, which (to date) has been my last.  At this race, I achieved what I had previously set as my lifetime goal for that distance of race (sub 13 hours), by going 12:44 on that day.

The experience of achieving this goal was both satisfying and elating.  It also led to a lack of direction.  Joanna, my tri-coach, largely saved me from a complete downward spiral by not allowing me to take a month off of training after this race.  I got a week--and then returned to training after that time, and that was about right.

Triathletes, and I imagine a lot of athletes in other sports, have a tendency to bury themselves in the process.  The amount of training required is extreme, and being involved in it can mask the symptoms of depression.  Life can often go on autopilot, and recognizing the symptoms of depression can be difficult.  If your life has become about waking up, going on a workout, going to work, going on a workout, going back to work, going home and going to sleep, that can be ok.  If you experience no joy from that process, that's probably not ok, in particular if you have experienced joy in the past from it.

Help is available, but getting proper help can be difficult to achieve.  It's my opinion that the state of mental health care in this country is poor.  I'm currently on an antidepressant (Wellbutrin) that I was prescribed by my primary care physician, largely because I told him it had worked for me in the past--which it did in the late 90s.  The benefit of Wellbutrin is that I can train on it, and it doesn't make me lethargic or cause weight gain like SSRIs (Zoloft, Celexa, Prozac) can.  The problem is that my primary care physician is reticent to prescribe it at the dosage I was on previously for a long period of time, which means I need to find a psychiatrist.  And I have health insurance, so that shouldn't be a problem, right?

Wrong.  My health insurance carved out mental health care to a different program, and my experience with that is that there are a lot of really bad psychiatrists on that plan.  Effectively, good psychiatrists don't sign on to be bound by cheap health insurance, at least in the Los Angeles area, and the ones who I've encountered on this plan either phone it in on a daily basis, or are simply bad at what they do.  I have wound up effectively self-medicating when seeing one of these psychiatrists in the past.  A patient should not be in a position where he goes to a psychiatrist and that doctor asks what he thinks he should be on, and then breaks out a prescription pad and is done with him.  Patients go to doctors to get well, and doctors should use their expertise to help them to get well.

So, the plan at this point is that I'm going to mail my primary care doctor a list of the psychiatrists that are on my plan, and hopefully he will be able to recommend one of them.  To add to the list of frustrations, I have to snail mail this list to him, because the system at his office does not allow email attachments, and he wants a full list that cannot be transcribed to simple text and fit within the confines of the email size limit.  Ultimately, this limitation was put in place by his office due to HIPAA.  Thanks, HIPAA--I'm sure that something you've done has helped somebody, somewhere, but for the most part, you're a pain in the ass.

I have digressed.  If you're depressed and you're an athlete, please reach out to get some help, and do not take an explanation from anyone that you should be happy simply because you're working out. You don't have to live this way, and while difficult to do, navigating the health system in the United States is possible, and can dramatically benefit your quality of life.