The Mountain of Mental Health: How Will We Get to the Other Side?
According to the Centers for Disease Control and Prevention, in 2015 suicide was the
tenth leading cause of death, overall, in the United States, claiming the lives of more than
44,000 people. “Projections from the World Health Organization, show that depression will be
the second leading cause of disability in the developed world by 2020,” (Williams 1). Major
depressive disorder or clinical depression is a common, but serious mood disorder. It causes
severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping,
eating, or working. Although methods, such as medication and social therapy, are typically used
to treat depression, unconventional approaches like art and exercise therapy are making their
way into the spotlight. The question is, how well do these emerging forms of treatment work?
Could clinical norms be ridding patients of innovative treatments that work more efficiently?
Changing the typical practices of depression and stress therapy away from medication is feared.
Moving away from typical treatment practices to address depression and stress is fearful. By
adding other treatment options, it creates concerns about making the right decision regarding
individual needs and complicates personal choices. While keeping all components in
perspective, we need to decide if current practices are outdated.
Depression, regrettably, has become more common than anyone would’ve hoped. On
average, one in about six people experience a sense of depression at a point in their lives and
even more unfortunately these feelings are found in children as well. The uneasy fact that
mental illness exists is not the issue of today, it is its aggressive steady incline as the years go
by; but how do we treat it for good?
In earlier times, dehumanizing containment was the management strategy for those
treating patients with mental disorders. Thankfully, those practices have evolved along with
science, but there are still some lingering similarities between the present and the past. There
is importance in opening eyes to the comparisons between the way society approaches mental
health then and the way we do today. It is essential that the integration of relevant research
and the recognition of our societal characteristics to make mental health improvements.
Paths to new medical breakthroughs are said to have often been paved by previous
accidental discoveries. In the late 1800s, tuberculosis was at an all-time high, one in seven of all
people died from the disease and at the time no one knew what was causing it. In the 1950s
scientists finally attempted to develop drugs to treat it. In search for a cure, scientists
developed the first antidepressant, by accident. They continue to believe that searching for
new medications is the most promising direction to take in solving widespread mental illness.
Neuroscientist, Rebecca Brachman, uses this example to support her own theories about curing
depressive disorder, by studying the fairly well known drug, Ketamine, or “Special K.” This “club
drug”, group of psychoactive drugs that tend to be abused by teens and young adults at bars,
nightclubs, concerts, and parties, could possibly become the first preventative drug for major
depressive disorder and an incredible breakthrough in medicine. It would be the first resilienceenhancing drug if proven to work effectively on patients and would also open many doors to
the future of anti-depressant medication. Ketamine has shown, in animal testing, to work
similarly to immune vaccines, where the vaccine gets injected and then when you're actually
exposed to bacteria, your immune system develops a resistance to the bacteria and fights it off.
In respect to Ketamine, it would be administered only a few times and the effects would show
long term permanent results, eventually, decreasing previous signs of the diagnosed disorder
until it is completely gone. With the medication that is used today, one would receive a drug
that should suppress the symptoms, but it won't treat the depression itself, “and you'll only feel
better during the time in which you're taking it, which is why you have to keep taking it … for
the life of the disease, which is often the length of your own life,” (Brachman).
While the intentions of this effort are strictly positive, there are some underlying
negative repercussions. Neuroscientists need to look past the studies and labs to see the effects
from a realistic prospective. In a perfect world, Ketamine would help many, if not all, current
and future patients who suffer from mental health disorders, but what if the idea of using a
schedule III controlled substance, with moderate abuse potential, as a means to potentially
treat one’s depression got into the wrong hands? The hands of drug dealers and non- research
study prescribers with no intentions of giving clients proper consumption guidelines. Medical
staff members at the Mayo Clinic in Rochester, Minnesota analyzed a clinical case in which a
patient, hospitalized on numerous accounts, before his death, was involved with using
ketamine to attempt to treat his major depressive symptoms:
At the time of his initial presentation to a tertiary medical center in 2012, “Mr.
A” was a 52-year-old divorced man with a 30-year history of recurrent major depressive
disorder, persistent depressive disorder, and a remote history of outpatient treatment
for alcohol use disorder as a young adult. His first episode of major depression occurred
at age 22 in association with a suicide attempt (he jumped off a four-story building) and
subsequent hospitalization. Mr. A’s medical history was significant for corrected
hypothyroidism. The prospective course of illness encompassed four subsequent
psychiatric admissions at our medical center, annually from 2012 to 2014, illustrating
clear treatment-resistant depression and a reemerging pattern of substance misuse
(alcohol, benzodiazepines, and ketamine) …
Mr. A’s 2013 admission, 15 months later, was for major depression with suicidal
ideation with intent to overdose on prescribed medications… During hospitalization, Mr.
A reported that earlier in the year, he participated in an out-of-state research study in
which he received a single intravenous ketamine infusion, which he reported provided
antidepressant benefit for 4–5 days. Because of his perceived mood improvement, he
left the study and sought out a ketamine prescriber…
Mr. A’s next admission for major depression, 3 months later in early 2014,
differed from previous admissions based on a reemergence of increasing alcohol use (he
reported consuming four drinks daily) … He admitted to using ketamine beyond the
prescribed recommendations … Mr. A met the criteria for ketamine dependence based
on his use of increased amounts of and increased tolerance to ketamine, driving while
using despite concern from family, and loss of employment due to ketamine use …
Mr. A’s fourth admission for depression, a month after the previous admission,
was associated with a suicide attempt … Mr. A reported that he had discontinued
ketamine because he was unable to obtain the drug … We were notified of his death
from a single-car crash 3 months later. Autopsy findings included a blood alcohol
concentration of 0.133% (well over the 0.08% legal limit), tetrahydrocannabinol, and
bupropion (prescribed), (Schak).
This case exemplifies the potential harm of regulating ketamine, and especially other
substances with high potential for abuse, prescriptions among those with past alcohol or drug
abuse and/or emotional instability. The FDA ought to make an effort to conduct more research
on medications involved with mental health to ensure the safety for the mental health
population (Schak).
Many specialists resort to medication and psychotherapy when treating depression and
post-traumatic stress disorder because it’s fast and generally universal. However, in his article,
Evidence Synthesis for Determining the Responsiveness of Depression Questionnaires and
Optimal Treatment Duration for Antidepressant Medications, John W. Williams discusses how
the use of anti-depressants can result in, “high rates of early relapse.” “Emerging evidence
shows there are potential long-term adverse effects including gastrointestinal bleeding and
osteoporosis,” (Williams, 6) when taking clinical depression medication. How could someone
already burdened with one issue, be comfortable with taking medication that might give them
additional problems? In almost every source representing all perspectives, the author’s make it
known that medication is a temporary and often repeated fix.
“A cogent argument is an inductively strong argument with true premises. In a cogent
argument, the truth of the conclusion is likely but not guaranteed” (Bonevac). Because the use
of and the results of anti-depressant medication is so inconsistent with its claims, we can then
assume that not every result is the same for each patient and find the argument’s conclusion
unreliable. I found an evaluation of the FDA’s regulatory decisions, conducted by the New
England Journal of Medicine, that had evidence that the FDA may not be approving or
publishing real, holistic results of the study of the drugs that they regulate. The data from the
FDA reviews showed “bias toward the publication of positive results. Not only were positive
results more likely to be published, but studies that were not positive, in our opinion, were
often published in a way that conveyed a positive outcome,” (Turner, et al.) meaning the FDA
purposefully made appear that the regulated drugs proved to be superior over the placebos,
when in fact, the drugs acted just a fraction more beneficial for treatment. This supports the
idea that symptoms are psychological and that the patient’s belief that the drug was working
enhanced their positive symptoms, not the actual drug. This thought led me to wonder what
would work as an actual trustworthy treatment; therapy that wouldn’t negatively affect
physical health or cause the patient to undergo a deeper depression than they had before
receiving treatment.
Art in a therapeutic setting has been shown to produce long-lasting improvements in
PTSD patients. Post-traumatic stress tends to leave its victims unable to find the words to
explain their traumatic events and the emotions they feel after. Melissa Walker, a creative arts
therapist, has been using mask-making in her clinics to connect the painful situations in a
patient’s mind through a creative outlet, in a way to pull the trauma out of the confined mental
space. Many victims of traumatic events claim that after making a mask they feel as if a shadow
has lifted and were able to talk freely about their experiences leading them slowly out of their
prolonged disorders; more than the results of the medication they were prescribed and the
psychiatrist sessions they attended, for some, for as long as 23 years (Anonymous victim in
Walker).
It’s commonly known that physical activity can often times decrease some symptoms of
depression. From my personal experience, a workout usually leaves me feeling better and
increases my self-esteem. I can only imagine how influential that would be for someone with
intense depressive symptoms. Researchers at Duke University agreed and decided to look
further into the concept of exercise treatment. They gave one group antidepressant
prescriptions, while the other group was given an aerobic exercise program. “Within four
months, the mood of those in the drug group improved so much that they were, on average, no
longer depressed. But the same powerful effect was found in the exercise group— that is, the
group of people who weren’t taking any drugs.” Exercise, it seemed, works about as well as
medication. So before your doctor writes you a prescription for an antidepressant, ask about
prescribing a daily workout instead,” (Greger, 207).
Unfortunately, due to recent events on campus many students know what it’s like to
have lost a peer, or outside of school a friend, or a family member as a result of depression. It
would be wrong to continue to let the upward trend increase. We can see a pattern forming
right now, why not make a stand to stop it? Patients are expected to take the drugs for the total
duration of their symptoms, in often cases for their lifetime. Who’s to say that anti-depressants
aren’t the leading cause of clinical depression? That thought alone would cause an influx of
severe negative feelings in even patients with the most minor diagnosis of depression. Failing to
make a movement to adapt the way we approach depression, will eventually violate the shared
values of our community here at Virginia Commonwealth University and the United States. Let's
not simply accept the easy way of treating mental disorders like depression by accepting a
bottle of pills, but instead insist on alternatives that can heal the mind and the body. We can
and must make these demands from the medical community. We owe it to ourselves and those
we care about.
Work Cited
Bonevac, Daniel. “Making Moral Arguments.” Focused Inquiry True Stories: Narrative &
Understanding. 2016-2017 ed., Hayden- McNeil, 2016, pp. 85-92.
Brachman, Rebecca. “Rebecca Brachman: Could a Drug Prevent Depression and PTSD?”
TED, September 2016,
ted.com/talks/rebecca_brachman_could_a_drug_prevent_depression_and_ptsd.
Greger, Michael, and Gene Stone. How Not to Die: Discover the Food Scientifically Proven to
Prevent and Reverse Disease. Flatiron Books, 2015, (p. 198-212).
Hall-Flavin, M.D. Daniel. "Clinical Depression: What Does That Mean?" Mayo Clinic. 05 Mar.
2014. http://www.mayoclinic.org/diseases-conditions/depression/expert
answers/clinical-depression/faq-20057770
Schak, Kathryn, et al. "Potential Risks of Poorly Monitored Ketamine Use in Depression
Treatment." American Journal of Psychiatry, vol. 173, no. 3, 1 March, 2016, pp. 215-218.
PsychiatryOnline. doi:10.1176/appi.ajp.2015.15081082z.
“Suicide is a Leading Cause of Death in the United States” National Institute of Mental Health
https://www.nimh.nih.gov/health/statistics/suicide/index.shtml
Walker, Melissa. “Melissa Walker: Art Can Heal PTSD’s Invisible Wounds.” TED, November 2015,
ted.com/talks/melissa_walker_art_can_heal_ptsd_s_invisible_wounds.
Williams, John, et al. “Determining the Responsiveness of Depression Questionnaires and
Optimal Treatment Duration for Antidepressant Medications” Department of Veterans
Affairs Health Services Research & Development Service, Oct. 2009,
https://www.hsrd.research.va.gov/publications/esp/Depression-2009.pdf