Shelley Uram, M.D.
January 4, 2011
The Meadow's Overview of the Core Issues and how they relate to our psychological and behavioral symptoms is the most encompassing model I have worked with. This model accurately captures our nature at birth, and how the chronic psychological "bumps and bruises" through our formative years can distort our underlying nature. Ultimately, many of us develop psychological and behavioral symptoms that are directly rooted in these early psychological traumas. These symptoms can include inflexible or inadequate coping mechanisms, addictions, mood and anxiety disorders, personality disorders, etc.
Depressive conditions very commonly develop from these earlier childhood psychological traumas.
There are currently over 21 million American adults diagnosed with a depressive disorder, or almost 10% of all American adults. These numbers do not include the many, many more who have not sought professional help. This is a staggering number of people!
When someone feels the pain of depression, they want relief; the state of depression feels very uncomfortable and negative. In our country, the vast majority of people who go to a doctor for depressive symptoms are treated with antidepressant medication.
Many people feel significant relief within a few to several weeks after starting the medication. Later on, if the depression recurs, they will likely, once again receive a prescription for antidepressant medication. Eventually, many patients are instructed to remain on this medication for years to come in order to prevent a recurrence of their depression.
One of the current popular recommendations from our national and local psychiatric associations is that psychiatrists should treat patients with medication, striving towards a goal of 100% relief of symptoms. Most patients are happy with feeling so much better; however, they have not addressed the underlying issues that initially lead to the depressive state.
Why does this matter? Why should we address the underlying issues behind the depressive state if medication takes away the symptoms?
In my opinion, we are all ultimately trying to master the challenges that show up in our lives. There is a subtle "push" in all species to keep on evolving their mastery skills and ability to cope. We develop better mastery skills with our relationships, health, life stressors, etc. We all stumble and fail at times; sometimes we are flat out stymied by life circumstances. Ultimately, we want to come to some kind of terms with the challenges that show up in our lives, and feel more at peace with them.
In my opinion, many people who suffer from depression are in a "stymied" state of dealing with life challenges. Very often, it is their coping skills that are not adequately flexible or mature enough to successfully deal with the challenge. They are left feeling overwhelmed or "shutdown". In this condition, they are simply not able to master the circumstances at hand.
In my opinion, if a patient is overwhelmed by their symptoms, antidepressant medication may be helpful to alleviate some of the symptoms. The patient can then enter into a "working zone" of being able to actively participate in psychotherapy, and eventually reach a new level of mastery in dealing with their life-stressors.
I think it is wise to utilize antidepressant medication if it is an adjunct to the patient MASTERING the underlying issues.Unfortunately, the trend in our country is to replace the psychotherapy with only symptom relief through medication.
If a person's coping skills are not maturing, they are just as vulnerable to another bout of depression as they were the first time. Research has actually shown that a person is even more vulnerable to further depression episodes with each new episode of depression.
In my opinion, we psychiatrists should tailor our medication prescribing to meet their ideal needs in psychotherapy. For example, if a patient ideally needs to experience some sadness or anxiety in order to be motivated to master the underlying issue in therapy, I think it is appropriate to let them have some of their symptoms, but to a tolerable degree.
I view some depressive or anxiety symptoms as a "barometer"that tells us how we are doing inside. Instead of automatically silencing these depressive or anxiety "signals" with medication, these symptoms can frequently be utilized to motivate us to dig deeper in psychotherapy.
The Meadow's Overview of the Core Issues, is an excellent diagnostic and treatment model upon which to base psychotherapy. It is from this model that mental health professionals can analyze where a patient is psychologically "stuck", and in what therapeutic directions to move. In patients that medication would serve the purpose of alleviating certain symptoms that would stand in the patient's way of utilizing this psychotherapy, then the two treatment modalities could become a unified and useful treatment approach.
Exceptions to the above would include patients who are not interested in mastering the underlying issues and improving their coping skills. If a patient clearly wants to just have the symptoms removed, I do not see a problem utilizing only a medication approach. Other possible exceptions include patients who suffer from other disorders, such as psychosis, Bipolar I disorders, Schizoaffective disorders, etc. When patients have reached an extremely distressed state and have thoughts of harming themselves or others, then the medication route is often helpful in bringing some relief, after which the psychotherapy can play an increasingly important role.
©2011 Shelley Uram