i am so desperate and so…out of hope. i really hope you can shed some light on my “illness” and give me advice and maybe even contacts for what to do. i have “refractive major depression” and nothing is working. i sought treatment 2 1/2 years ago and after a long time everyone agreed on my above diagnosis. since then, i have honestly and literally been on over 28 different medications, even stuff for schizophrenia (which i am not) and MAOI’s. nothing has had an ounce of improvement with me. some made me ill, and that’s about it. I’ve had dozens of second and third and fourth opinions from both therapists (of all kinds) and psychiatrists. my regular doctor did an entire exam, including MRI, and i have a perfect bill of physical health. my depression and hopelessness is so bad that I’m about to lose my job. i miss miss, on average 7 out of 10 work days.–it isn’t because i don’t want to work–it’s because my depression can get so bad that…i can’t explain it–it’s just that bad. on top of that, i then feel guilty for missing work. my therapist wont see me anymore “until [i] get better, because there’s nothing [he} can do for me at this point.” I’d see another therapist, but they all say the same thing. i have no support except from my therapist–if you call the above support. my family is very abusive and everyone agrees contacting them or being apart of their volatile lives would only damage me than i already am (I’ve not been physically or sexually abused, just mentally). I’m 29 years old now, and do not blame anyone, not even my parents for what i have become. i accept responsibility for every choice I’ve ever made, as well as action or inaction. but, now, i just feel so stuck. therapy doesn’t’ work. medication doesn’t work. etc (which i haven’t had and really don’t want to have and my doctors don’t want me to have) has left some people with permanent amnesia. i am broken, and I’m not fixable. what do i do? i have no where to go, no one to turn to, and no ideas. my mind is so cloudy–if i were elderly, people would assume i had Alzheimer’s disease. my life is all black and darkness, surrounded by unending storms that torture me day and night. i can actually feel these “storms” inside my head–really. it’s not a headache I’m feeling. i know what a headache feels like. this is different. it sometimes feels like a tornado violently spinning around in my mind, destroying everything in its path. other times, if feels like my mind is literally turning to mush, sloshing around inside and everything. most of the time, the “storm” in my head is so strong that i want to bang my head against the wall to get it to stop, or to get a hammer and pry my head open to let the tempest out–to let this painful pressure out of my head. also, besides this “storm” in my head, the “storm” surrounds me, on the outside. it taunts me. it paralyzes me. it makes want to crawl into my closet and never come out. it makes me wish i could die. and no matter what i do to try to stop any of this (and i really have actively tried so many ways and so many times), nothing works.–remember, my own therapist has given up on me. i also had to find another new psychiatrist for the same reason. i am broken. i cannot be fixed. i am hopeless. i feel hopeless. i feel trapped between the choice of death and the choice of living in a dark painful experience. (I’ve been depressed since i was a child). i am tired and i either want to do something that works and helps me (one last try) or i want to quit. i can’t do this anymore. I’m too tired to hang onto nothing anymore. oh, I’ve also been hospitalized twice. my therapist is in agreement with me when i say that it was of no benefit, and only made things worse. Harvard does a brain surgery i wouldn’t mind having. I’d rather have that than ECT. problem is that just to apply, they charge $900.00–and then they can still turn you down and keep your money. i can’t afford that–not when I’m about to be fired. I’ve researched state programs, and there aren’t any that i qualify for. in Utah, you only qualify for programs if you are married or single with children. because i am single and have chosen not to be a slut and get pregnant, i literally don’t qualify for any programs whatsoever. One state worker told me “come back when you get yourself pregnant, honey.”–she didn’t say it jokingly nor nicely. I am literally falling apart. i don’t know how much longer i can hold on without some sort of relief. please, can you help me some how? even my doctors admit they don’t know what to do for me. please…please think of something they have not. i am begging. please. please help me.

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To your credit, you have sought proper therapy and have seemingly run through the gambit of conventional treatments. It’s unfortunate that you haven’t found any significant relief, but it does happen sometimes (Readers should note that most depressions are helped by medications and/or psychotherapy). As to your comment about being tried on medications for schizophrenia, this is fairly common these days. While in school I was taught to think that medications are rigidly sorted into categories (e.g., anti-depressants, anti-anxiety, anti-psychotics, etc.), but the reality of psychiatric practice is that medicines from one category are frequently used (often in combination with other more ‘category specific’ medications) to treat disorders of another category. Its important to recognize that mental illnesses don’t care about how human beings define them, and that many brain systems are involved in even the simplest problem. It’s not surprising really that so-called anti-psychotic medications might on occasion prove helpful in the treatment of really significant depression.

After having run through most all medicine combinations without having any impact, it is fairly common practice to suggest to depression patients that they undergo Electro-Convulsive Therapy (or ECT), a procedure that involves running a controlled electric current through the brain. These days the current is administered while the patient is sedated so there is no jerking around of the patient’s body. For reasons that I suspect are still not all that well understood, repeated ECT sessions act as a sort of ‘mood reset’ button, helping seriously stuck depressed people to show improved mood and functioning. The downside of ECT is that there is some short-term memory loss that occurs. I’m not familiar with reports of long-term decreases in a patient’s ability to form memories, however. ECT is considered a treatment of last resort, but it is not something that Psychiatrists hold back on using when other treatments fail. This is because the risk of suicide secondary to staying deeply depressed generally outweighs the risks associated with ECT. People tend to have have a negative association for ECT, but I’m not sure that your negative association is warranted, given the severity of the situation you describe. But you’ll need to talk with your doctor about whether or not it is appropriate for you, and what the risks really are, both pro and con.

You mention that you’ve been in therapy, but you don’t mention what sort of therapy. There are a variety of schools of therapy for depression, and it is possible you’ve never been treated with the one that is perhaps best studied and known to help depressed people, namely Cognitive Behavioral Therapy for depression. CBT for depression is not conventional supportive psychotherapy, and it doesn’t involve questions about your early family life either. Rather, CBT is a training program that teaches a depressed person to systematically examine their thinking patterns and to rationally judge whether or not each thought is based on reality or not. In your letter, you have written a number of good thought samples (e.g., “ i am broken. i cannot be fixed. i am hopeless.”) which, if you could only rationally judge them and see how they are perhaps distortions of the reality of the situation, might make you feel better somewhat. Consider seeking out a therapist who does CBT for depression and stick with a course of it for three months or so, doing the homework that will be assigned diligently, and see if it doesn’t help some. You’ve got nothing to lose. Good luck.

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