"Dr. Diane McIntosh has achieved the impossible with this book: she enables everybody to understand depression in a highly readable way. As someone who has suffered from depression, I empathize deeply with Dr. McIntosh’s narrative. She combines real-life stories with academic rigour to bring clarity and insight to this debilitating disease. Whether you’re a sufferer or a caregiver, This Is Depression will be an indispensable guide to understanding and ultimate healing.”
―Mike Lipkin, motivator and coach, Environics/Lipkin
“This book provides balanced and complete information in an easy-to-understand way. Dr. McIntosh cares so passionately about people living with mental illness and offers clear information and optimism. Mental illness does not discriminate; anyone living with mental illness or who cares for someone living with mental illness should read this book.”
―Allison Rosenthal, general manager, Otsuka Canada Pharmaceutical Inc.
“Dr. Diane McIntosh is an outstanding communicator. This Is Depression translates the way clinicians and researchers think about many aspects of the most disabling disorder in today’s society. Her discussion of the genetic and brain disruptions in people with ‘major depression’ conveys complex science in plain language and provides the rationale for subsequent discussions of cognitive and other ‘talk’ therapies as well as the different families of medications and ‘device’ therapies. I recommend This Is Depression to anyone who needs to know more about the current understanding and treatments for depression, particularly persons with lived experience and their families. Anyone reading This Is Depression before going to see a mental health specialist will be an informed consumer.”
―Sidney H. Kennedy, MD, FRCPC, FCAHS, professor of psychiatry, University of Toronto; principal investigator, Canadian Biomarker Integration Network in Depression; director, Centre for Depression and Suicide Studies, St. Michael’s Hospital
“Thoroughly up to date, this book is comprehensive yet engaging and easy to read. It describes the illness from both personal and clinical perspectives and successfully weaves case vignettes and valuable summaries of complex research literatures. Although there are many books on depression, this unique volume fills a void and I recommend it to depressed people and their loved ones, those who work with or employ depressed people, and mental health professionals looking to sharpen their psychoeducational skills.”
―Dr. Michael Thase, professor of psychiatry, Perelman School of Medicine, University of Pennsylvania
“This Is Depression is unique in that although it’s intended for people with depression (or their loved ones), it is comprehensive and head and shoulders above the rest of those slim volumes that don’t delve into the details. If anyone wants to become an expert on their own illness, this is the book. Readers will be better informed than most clinicians!”
Leslie L. Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences, New York Medical College, Valhalla, New York; and private psychiatry practitioner
Dr. Diane McIntosh graduated from Dalhousie University, where she completed an undergraduate degree in pharmacy before completing medical school and residency training in psychiatry. She is a clinical assistant professor at the University of British Columbia and has a community psychiatry practice, with a particular interest in the neurobiology of mood and anxiety disorders and ADHD. She is extensively involved in continuing medical education programs to colleagues nationally and internationally, including her own educational program, PsychedUp CME. She is the co-founder of SwitchRx (switchrx.ca), the online psychiatric medication switching tool. Most recently, she co-founded wedomatter.org, which advocates for more compassionate care for psychiatric patients and their families.
Excerpt. © Reprinted by permission. All rights reserved.
Introduction: Depression affects everyone
Mental illnesses suck.
They are serious, sometimes deadly, isolating, frightening medical disorders that affect the brain and the body.
Every person, at some time in their life, will have a mental illness or love someone who has a mental illness.
Mental illnesses impact our ability to learn and work and play and love. They also cause and worsen physical illnesses, like obesity, heart disease, and diabetes.
Stigma regarding mental illness is still a powerful force, provoking shame, promoting isolation, and causing many people to [CC1] avoid seeking help.
Ignorance drives stigma. By reading this book, you are challenging that stigma head on.
As a psychiatrist, I believe it is a privilege to be invited into a patient’s life. Patients share beliefs and experiences that are so deeply personal, private, and sometimes unsettling that they can hardly bear to think or feel them. Because of the incredible trust my patients place in me, I approach my psychiatric practice seriously and respectfully. For our mutual benefit, I also try to remain light-hearted and maintain my sense of humour―including even when confronting stigma-laden labels and themes.
Historically, labels like “crazy,” “nuts,” and “psycho” have been used cruelly to describe someone struggling with a mental illness. However, many of my patients have reclaimed those terms to describe themselves, saying things like, “What do I know? I’m nuts.” The truth is, you can be “crazy,” “nuts,” even “mentally ill,” and still be smart, funny, and articulate. When you’re better, you’ll still be a nut. You’ll still be you, only well. By discussing depression thoughtfully, with compassion, scientific evidence, ―and, yes, a bit of humour, ―I hope to destigmatize mental illness, and embolden patients and their families and friends to stand up to ignorance.
In this book, I share my twenty years of psychiatric experience working with patients who have been diagnosed with depression. I also reflect on and interpret what I believe to be the highest quality research evidence regarding depression. My practice is focused on pharmacology, also known as drug therapy, because that has become my area of professional expertise. However, I am also aware of the powerful benefits of psychotherapy, also known as talk therapy, as well as other non-medication approaches, such as faith and exercise.
In these pages, I review the diagnosis of depression and the many possible treatment options. However, psychiatry is much more than simply making a diagnosis and giving prescribing a pill. For these reasons, I explain the causes of depression, including how life experiences, genetics, hormones, and many other factors can provoke its development. Depression is often associated with other mental and physical illnesses, called “co-morbid” conditions. Anxiety is a particularly common symptom associated with depression, and it’s important to recognize its powerful influence on depression severity, an individual’s functioning, and suicide risk.
I use “patient cases” throughout the book to illustrate a range of possible depression experiences. I carefully avoided basing these cases on any details I have heard from a real patient, so the names and experiences are entirely fictional. Some of my cases may seem more severe than your personal experience with depression, but that doesn’t mean that your symptoms aren’t worthy of a careful assessment and possibly, treatment. I also include some deeply personal stories from my patients who have endured serious depression and found their path to recovery. They agreed to share their experiences and wrote by writing their own stories because they wish to acknowledge suffering but also to inspire readers and instill hope.
While my professional practice is centred on the safe and appropriate prescribing of psychiatric medications, there are other treatments that have sound scientific evidence supporting their use. I discuss all treatment options that should be considered when confronting depression. Likewise, because psychiatrists are just one of several professions that have expertise in treating mental illnesses, I describe the work of other mental health professionals and what should be expected from any therapeutic relationship.
Many terms you encounter while reading this book will may be new, or perhaps they will be used in a context that is new to you. I have included these words or concepts in the glossary at the back of the book.
Finally, while treating symptoms is important, recovery from depression must include a return to full functioning in all aspects of life. In this book, I address all areas of functioning that are impacted by depression, including family, work, and social relationships.
This book is intended to be a general guide, not an academic review, and so it addresses the questions I am asked every day in my office, by patients and their loved ones. I hope that by reading the questions throughout the book, you will recognize that you are not alone. Everyone has many questions, and I endeavour to offer answers and guidance, based on my clinical experience and scientific research. One of the most common questions I hear, after meeting a patient for the first time, is, “Will I get better?” My answer is always the same, and I say it confidently because I know it is true: “If we work as a team, yes.”
Most importantly, through this book I want to encourage readers who are depressed, or who love someone who is depressed, not to lose hope. Having met hundreds of people who saw only darkness and could not imagine a future without depression, I’ve learned that it can take time to find the right way; and sometimes you will lose your footing or feel like you’re running in circles. But there is always a path forward.