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I have been suffering from periods of severe depression for over two decades. During this time I have seen many doctors and therapists and endured various treatments as well as hospitalizations. Although I am not an expert on the evolution of treatment for the mentally ill, I can give you my personal account of how my treatment has varied over the years the last quarter century or so. To do so, I will use four time periods: 1979, 1984, 1988 and 2001.

1979

When I was first hospitalized at the age of 21 for depression and suicidal thoughts, I was held for about two weeks. During that time I saw a therapist about three times and was basically told that as long as I did not cause any trouble, they wouldn't keep me there too long. I remember thinking at that time that they were more interested in controlling my behavior than in helping me.

On the rare occasion when I saw a therapist, he had many theories on why I was depressed. I told him my father was an alcoholic-that became the reason. I told him I was the youngest child in the family-that became the reason, too. Even when I told him my life was going well: a senior in college, a steady girlfriend, and a steady job-that was the reason. According to the therapist, I felt guilty that my life was going so well. Not once was the possibility of a biological, chemical or even genetic cause ever mentioned, even after I told him my father's mother committed suicide in an institution.

After 10 days of "Good Behavior" I was given a day pass off the hospital grounds. They refused to get my coat from lock-up, so I ended up walking the streets in 10-degree weather wearing a tee shirt. Officers in patrol cars stopped me twice and asked me (their words, not mine) if I was crazy to be dressed like that in such cold weather. Each time I told the officers the truth about the coat, and each time they just drove away. I don't think they believed me.

Four days later I was "released." I was given enough medication for five days, no refill and no referral to any doctor, therapist or clinic. Luckily for me, the depression eased up on its own a few weeks later and I was eventually able to return to school and work.

1984

This depression was highlighted with manic episodes. I concocted schemes to make money, but of course none of them panned out. I was going to save the world, but I couldn't even save myself.

This time, however, I was put on Lithium almost immediately, and the mania pretty much disappeared. But the deep depression remained. Once again, most of my therapy focused on my childhood and my lack of a good father figure as being the cause.

One therapist in particular told me about an exciting new discovery he said everyone was talking about-a lot of major depressions could be attributed to what's called "hypoglycemia" or low blood sugar. It seemed to him that all I need do was regulate my sugar levels and I would be "cured." So, I was referred to a clinic called the Fryer Research Center. They sent me for a "Glucose Tolerance Test," which consisted of me drinking the most sugary drink I've ever had in my whole life and then having my sugar levels tested for five hours. Obviously, I had a tremendous amount of energy immediately after consuming the drink, only to have it fade over the five hours. At the end of the five hours, the technician showed me a chart. The technician and the doctor at Fryer both said this proved I had hypoglycemia. Of course I found out much later that just about anybody would have the same reaction to the drink, but when you're severely depressed and desperate, you'll believe anything that's told to you.

The bottom line was that after regulating my sugar levels for six weeks plus getting numerous vitamin injections at Fryer and spending thousands of dollars, I was no better off. Eventually, the depression once again faded on its own.

1998

I suffered my worst depression ever. But this time, my treatment was very different. Most importantly, my new therapist and psychiatrist recognized the physical nature of my illness. There was no "youngest child" or "guilty for good life" theories. They both immediately recognized the genetic history, too. For the first time in almost 20 years, I felt the mental health professionals were on my side.

After numerous medications and therapy failed to make much improvement, my psychiatrist, who in fact was the head of the clinic, suggested Electro-Convulsive Therapy (ECT). After researching 17 articles on the subject, I decided to go ahead and receive the treatments, which I feel saved my life. 2001

Although not completely depression-free, I lead a very fulfilling and happy life. As for my current treatment, I see a therapist once every two-three weeks, but can see her more or even call her-not trying to find some deep-rooted psychological cause for my depression, because there isn't any. I see my psychiatrist every four-six weeks, but I can also see him more often if needed.

In conclusion, at least in this case study of one, I must say that although our methods of treating mental illness still need improvement, we've come a long way in the last 20 years or so.