There’s no quick fix for relief from depression.
Although antidepressants like Prozac have been around since the 1970s, they usually take weeks to make a difference. And for up to 40 percent of patients, they simply don’t work.
As a result, there are limited options when patients show up in an emergency room looking for relief from depression or with suicidal depression.
The doctors and nurses at Ben Taub General Hospital in Houston say they see this problem every day.
You can get a sense of what they’re up against by visiting the cavernous, bustling emergency center at Ben Taub, which is part of the massive Texas Medical Center. More than 100,000 patients a year get emergency care here, and about 5,000 of them are seeking relief from depression and need psychiatric evaluation.
The hospital’s 24-hour Psychiatric Emergency Center gets a steady stream of people with suicidal depression, says Charlzetta McMurray-Horton, who is in charge of mental health nursing.
Ben Taub General Hospital in Houston sees 100,000 emergency patients a year, 5,000 of whom need psychiatric evaluation.
“If the police bring them in, they’re going to come through this door,” McMurray-Horton says, pointing to one entrance. “If the ambulance brings them in, they’re going to come through this door,” she says, pointing to a different entrance.
And one of the challenges in treating these severely depressed patients is that there simply isn’t any drug that provides quick relief from depression, says Anu Matorin, medical director of the Psychiatric Emergency Center.
Matorin talks about one recent patient. The woman had suffered bouts of depression since college, Matorin says. But after she had a baby, it became severe. She stopped eating and sleeping. She began to think about suicide.
Finally, the woman made a desperate call to her mother, Matorin says.
“She was very emotional, very tearful, not making sense,” Matorin says. “She says, ‘I just can’t take it anymore. I don’t know how to feed the child.’ The mother could hear the infant crying in the background.”
The family called 911, and the woman arrived at the hospital with a police escort. Matorin says she evaluated the woman and put her on antidepressants.
Then came the hard part, Matorin says. She knew the drugs might help the woman eventually. But they weren’t going to do anything about her suicidal thoughts during the next few critical days, she needed quick relief from depression.
So Matorin did the only thing she could for her patient. She admitted her to the hospital’s locked inpatient unit.
I ask to see the facility, so McMurray-Horton takes me there.
‘Keep Them Safe, Keep Them Alive’
The unit can handle 20 patients, and its main room is warmer, softer and more colorful than you might expect. Think Holiday Inn, without any sharp objects or hard edges.
But there’s no avoiding the fact that this is a place where safety is paramount and privacy isn’t, says McMurray-Horton. Shatterproof plastic windows around the nurses’ station provide unobstructed sightlines to pretty much everywhere.
“Patients don’t want to be here,” says McMurray-Horton, explaining that about three-quarters of them are in the unit because they have been deemed a threat to themselves or someone else.
So it’s not surprising that our tour of the unit is interrupted by the loud protests of one enraged patient.
Units like this are necessary in part because drugs for depression don’t work fast enough to help someone in the early days of a crisis, Matorin says.
And McMurray-Horton says staff members here have a simple goal for patients in crisis: “Keep them safe, keep them alive until they’re in a different space.”
Counseling can help, McMurray-Horton says. So can family. And she says most people in crisis just start to feel better after a few days in a place where staff make sure that “they stay in, and the world stays out.”
That was certainly true of the depressed young mother that Matorin admitted. She got better and went home several days later.
But that woman probably could have skipped the hospital stay altogether if the drugs used to treat depression were as quick and effective as, say, painkillers, Matorin says.
If drugs were more effective, “I think it would transform psychiatric care and really eliminate some of the stigma and fear and concern about treatment,” she says.
Jon Hamilton is a correspondent for NPR’s Science Desk. Currently he focuses on neuroscience, health risks, and extreme weather.