A PRESCRIPTION FOR MELANCHOLIA
Stanley M. Bierman, M.D., F.A.C.P.

My computer offers the following adjectives to describe the word melancholy: dismal, doleful, gloomy, lamentable, mournful, plaintive, rueful, sorrowful, woeful, black, bleak, blue...anyway, you get the picture!

Lifting a patient's spirits following a melancholy, troubling or grievous incident involving family or business is not an easy task. By medical training, if not native instinct, doctors usually attempt to reassure individuals that things will get better and mutter standard clichés in an effort to lift their patient's flagging spirits.

Reassurance of this type should not be viewed as a Pollyanna concoction aimed at deception. Nor do physicians necessarily employ this tactic as a verbal tranquilizer for creating a mood of synthetic calm. We really do care, for physicians have come to recognize that depression and melancholy negatively influence the course of disease! However when simple reassurances fail, we are often confronted with a difficult conundrum: how to effectively deal with our patients' emotional problems. With no viable alternatives to correct or address the psychological problems that confront patients, all too often they are sent to a psychiatrist, or prescribed an antidepressant drug.

Frankly, my training as a doctor is limited insofar as my understanding of the neurochemical actions of the latest antidepressant drugs such as Zoloft, Welbuten, Prozac, Paxil, and Celexa. These potent pharmacologic agents seem to act as mood elevators by creating counterfeit brain neurochemicals presumably missing from the brains of depressed individuals. For many patients, especially those with significant, if not profound, emotional depression the changes wrought by these drugs are surely miraculous (notwithstanding their potential side effects).

However, rather than resorting to the traditional neuropharmaceutical choices to deal with melancholy or depression, I often propose to patients a viable non-drug related alternative. Summoning my more compassionate facial expression, I will state the following: "I am about to suggest to you some of the most offbeat, unconventional, unorthodox recommendations you have ever heard in your entire life!!!"

This bit of medical bravura surely gets patients' attention. I then proceed to describe a number of simple techniques whereby I personally deal with the stressful and depressive episodes that occasionally intrude into and disrupt the orderly functioning of my life:

(1) I will bicycle downhill to the local Beverly Hills Haagen Dazs ice cream parlor and have two scoops of my favorite Jamoca Almond Fudge. This may be harmful to my coronaries, but yummy for the tummy, and sublime carbohydrate narcotic for my black disposition. Bicycling back to my home above Sunset Blvd., I naively rationalize that I can burn off the calories!
(2) I lie back in a cozy easy chair and play the entire score of Phantom of the Opera. The lilting arias and lyrical melodies of the musical drama send me into a rhapsodic swoon to lift my flagging spirits.
(3) I pick up a glossy paperback edition of Gary Larson's The Far Side and laugh uproariously at his wild and hilarious cartoon antics (a Norman Cousins boost to my brain endorphin levels)
(4) I drive to the Beverly Hills Museum of Television and Radio on Beverly Drive and view a 1985 television performance by Robin Williams at the Metropolitan. I absolutely guarantee that you will smile, chuckle, giggle and finally uncontrollably roar with laughter at his wonderful comic antics.
(5) As an alternate, I will view at the BHMTR the American Film Institute Salute to Fred Astaire or Gene Kelly. Let me tell you... watching these hoofers perform their enchanting dancing magic is nothing short of enthralling. The endorphin levels in my brain probably treble.
(6) I will reflect on the love and devotion that I feel for my recently-deceased dear 93 year old mother, or telephone and schmooze with my three wonderful children, or reflect on forty-eight years of friendship and marriage to my lovely wife, Marlene.
(7) I will drive to the cliffs overlooking Santa Monica beach at 7PM and quietly share the final moments of twilight with Sadie-Lady, my lovely, but spoiled, 65 pound chocolate Labrador dog as the sun sets on the horizon.
(8) I will look at a family scrapbook and marvel at the courage of my grandparents who came penniless to this country from Russia. I also reflect on the sacrifices made by my parents who put me through medical school. I get all mushy inside thinking of my good fortune.
(9) A visit to the Palm Restaurant in West Hollywood involves the scandalous and shameful act of consuming a three pound lobster which I dip in melted butter, supplemented with mounds of onion rings and downed with a glass of house Chablis.
(10) Finally, I will stop focusing on the malevolent events that have put me in a funky mood to reflect on the fact that I live in this wonderful country of ours, can quietly observe my own religious practices, and enjoy the abundant fruits of my labor.
BIERMAN CENTURY CITY DERMATOLOGY
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