My heart goes out to reader Nancy, who posted the following message on my “Depression Is Conquerable” post:

“I read with interest your posts about depression. I have been a long-time sufferer–since I was a child–of major depression as well as post traumatic stress disorder. I have taken countless medications, undergone cognitive behavioral therapy treatment with multiple doctors, researched and read about the topic extensively and even was evaluated by a psych for ECT. I’ve been suicidal, hospitalized, and, in short, have tried everything I know how to do to combat this. It has never gotten better. I have never had a period where I didn’t experience depression. I know this is not the case for all depression sufferers. For many, the right medication does the trick. For others, a combo of meds and therapy works. But for others, nothing works. The remaining options are minimal. I’d love to hear from others who share my experience on how they fight the hopelessness demons. Suicide may be a permanent solution but for many of us, depression is a permanent reality.”

First of all, Nancy, you are in my prayers. I cannot imagine living with that kind of pain indefinitely. Eighteen months of it practically killed me, so I offer my sincere sympathy.

I e-mailed your note to my doctor, a wise and compassionate physician, because I didn’t know how to respond. This is what she had to say:

“I’d recommend she consider a consult at a major teaching hospital–Hopkins, Columbia, Massachusetts General, Emory, Mayo…there are several others, whichever is closest to her, and most will see people from all over the country. It can be expensive (though I know Hopkins’s consult is covered by Medicare if she is disabled or elderly) but can bring hope and new options to those who have suffered for decades. Another thing that can be helpful is a local support group, like DRADA in Baltimore. There are others nationwide.”

When I was in torment a year ago I often wondered what I would do if no medication combination worked (I was going on combo 23). I thought about Abraham Lincoln, and those like him that had to battle this demon without the help of meds and the kinds of cognitive behavioral therapy we have available today.

Joshua Shenk, author of the acclaimed book, “Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness” explains Lincoln’s “blueprint for a successful life with suffering” in an interview with Johns Hopkins, published in the Winter 2007 issue of the John Hopkins Depression and Anxiety Bulletin.

First, Shenk says, the melancholic leader acknowledged his pain. He sat his problems down for a long interview and examined every square inch of them. He asked them how long they intended to stay with him, and when they said forever, he wrote up some rules.

“Very well,” he told them, “but there are curfews and you are not allowed to do A, B, and C.” Then he strapped a harness around each wild invisible body. According to Shenk, Lincoln learned to live with his pain and adapted to the pain on its own terms.

Finally, Abe turned to a cause greater than himself. “Listen guys,” he told his problems, “not only are you going to abide by these rules, you are going to chip in and help me do a few things around here because I know what you are capable of.” He channeled his suffering to make it work for him.

Without my meds, I don’t know if I could be that strong and selfless and courageous. But the fact that someone else could, in fact, manage quite well with the pain–and even use to fuel greatness–does give me hope if the day arrives (God forbid) that no medication combination gives me relief and I’m staring the unsightly Black Hole in the face again.