Eureka Springs Hospital Psychiatrist Dr. Stephen Dollins has a prescription for depression that doesn’t have to cost a dime: exercise.
“Physical activity always pays off,” said Dollins, who has been directing the hospital’s Inspirations program, which is intensive outpatient psychiatric treatment for Medicare patients, for eight years. “It always works. It works tremendously well. A lot of people improve with exercise.”
About 45 people recently attended a talk on depression given by Dollins as part of the hospital’s Lunch and Learn program. Dollins oversees the Inspirations program at 146 Passion Play Rd., Suite C. Dollins comes on Wednesday morning to work with the team that includes one nurse and two therapists providing individual and group counseling.
“I meet with folks when they first start the program, and then again every three to four weeks,” Dollins said. “About 99 percent of what we do is provide therapy. I also do some medication management consultations.”
Dollins said despite having been there for so long, a lot of people don’t know about the program.
“It is a hidden gem,” said Dollins, who is a full-time psychiatrist for the Vantage Point Behavioral Health Hospital in Fayetteville.
Dollins said having depression could be more than just a disturbance of mood. It can result in a loss of energy, weight loss, insomnia or sometimes oversleeping just to avoid feeling so bad. It can even lead to thoughts of suicide.
While sometimes depression is triggered by life events such as losing a job or the death of a loved one, Dollins said positive things could also cause depression, such as a promotion at work or a wedding.
At times, depression can have medical causes, such as a stroke, that affects the brain. He said about 50 percent of bypass surgery patients might experience depression, and thyroid problems can closely mimic depression. Betablockers commonly used to control high blood pressure can result in depression, as can steroid treatments.
Patients with depression are often prescribed anti-depressants, which Dollins said are cheap, safe and mostly non-habit forming, meaning they can be stopped without withdrawal problems. But antidepressants take a long time to kick in, two to four weeks.
“And then they are hit or miss,” Dollins said. “They work for about seventy percent of the people. People may have to try more than one anti-depressant to find one that works.”
People don’t have to stay on anti-depressants forever. He said after a patient has been in remission for six months, patients can discuss getting off the medicine with their doctor.
Talk therapy is also often effective. Dollins said talking could be either individual or group therapy, depending on individual preferences. And like the anti-depressants, sometime the first therapist seen isn’t a good fit. If that happen, try another therapist.
Studies have shown that anti-depressants are better than placebos, but not by much. Dollins said it might be a matter of mind over matter. Taking a placebo or an anti-depressant gives people a reason to be hopeful. It can also help to focus on positive actions to take, like dividing up tasks and setting reasonable goals. Expect gradual improvement, and don’t withdraw.
Some people with depression become socially isolated. It is important to have good social contacts, and Dollins said people should make themselves get out and do things, because “it really pays off.” Dollins also spoke about myths, such as depression being a form of character weakness. “That is simply not true,” he said.
“It’s all in your head,” is another myth. Dollins said it is more complicated than that. In addition to medical conditions and prescription medications that can cause depression, there can also be family history involved. However, he said “family history connection is not a major factor. Just because others in your family have depression doesn’t mean you are doomed to have it, too.”
Another myth is that anti-depressants give people a false, happy mood.
“They don’t make you happy,” he said. “It doesn’t block normal moods. If something sad happens, you will feel sad.”
Some people report anti-depressants leave them feeling very flat. They aren’t happy or sad. They just don’t care about things. He said if that is someone’s response to an anti-depressant, they need to talk to their doctor about switching medications.
Dollins said that for a long time, most new anti-depressants were “me too” medicines very similar to older anti-depressants. But there are some new medication being developed that he feels have exciting potential. He mentioned that one effective over-the-counter treatment for depression is SAM-E.
“It’s pretty good, but not as good an anti-depressant,” he said.
Dollins recommends that anyone with depression seek help. And although there is a severe shortage of psychiatrists in Northwest Arkansas, he said most primary care doctors and nurse practitioners are very familiar with treatments for depression.