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Is There Any Help?

Question:

Dr Schwartz, I have been searching for help literally most of my life. I have been diagnosed as having moderately severe depression, atypical depression, anxiety disorder and post traumatic stress disorder. These diagnoses came from different doctors at different times in my life, but most of this in the past 5 years. I have been on many different medications and have been through ‘talk therapy’ at different times but nothing seems to ‘stick’. I have felt better on some medications but after weeks or months slipped back into the dark cloud of my depression and the same result with the talk therapy. My problems began when I was very, very young, probably four years of age, and I was never really treated for any disorders until I was in my mid thirties. Is it possible that a person can live so long in a depressed state that there is no possibility of getting well or even feeling well enough to lead a functional life? I can no longer stand feeling better for a period of time and then sinking back down into depression. It has become more painful to lose the ground I’ve gained then to just be untreated and live in a depressed state. I have been prescribed, at different times Serzone, Wellbutrin, Buspar, Prozac, Symbyax and more that I can’t even remember. The most recent treatment I had was using Ritalin to ‘wake up’ the frontal lobe of my brain and help me to focus. This treatment was the most successful so far but even this didn’t last more than eight months and then the depression took over and completely enveloped me again. At this time, I have not had any type of treatment for a little over a year. Can you please give me an opinion as to if there might be some treatment option that will work and continue working? I would greatly appreciate any insight you can provide. Thank you.

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  • Dr. Schwartz responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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Answer:

People can live in a depressed state for a very long time just as you have experienced. It sometimes happens that a person may have a depression that is resistant to the usual medication treatment. However, psychiatrists now have a number of approaches to those depressions that seem to resist the average types of treatment and you need to learn about them by consulting the psychiatrist who has been treating you or by finding a new one if you have lost faith in the previous doctor. My point to you is that you do not have to believe that you are condemned to a life of depression. It is important that you remain hopeful and, although depressed, hopeful.

In addition to medication it is important that you enter long term psychotherapy. You mention the fact that you have tried the "talking therapies" before but without any luck. I have a number of ideas about that and other types of treatment.

If you want to try a different type of treatment then I can recommend Dialectical Behavioral Therapy. DBT can help you with depression, trauma and ways to find peace in your life. There are those who also recommend EMDR, Eye Movement Desensitization Response, which has had some success with relieving symptoms of trauma. You need to find therapists (Psychologists, Social Workers, and Psychiatrists) who specialize in these types of treatment. Please remember that all psychotherapies are based on talking but these types, particularly DBT, are very focused and oriented towards reducing tension, depression and learning new behaviors.

The older types of "talk therapy" are known as psychodynamic or psychoanalytic psychotherapy. These can work but they usually take a long time and, in my experience, depend on seeing the therapist several times.  

Lastly, it is necessary for you (and for everyone who is in psychotherapy) to be active in your treatment. What do I mean by "being active in your treatment? What I mean is that it is important to exercise, eat healthy and get plenty of sleep. It is also important to learn and use such methods as Meditation (that is included in DBT) and Yoga. Forming a circle of friends is important so as to avoid socially isolating your self. If you do not have a social network there are self help groups that can help you end the isolation. 

The fact is that there are no magic medicines or magic psychotherapies that can make depression and anxiety vanish. These things can and do help a lot but it is vital that you engage in activities such as exercise, etc.  

Do not give up hope! Instead, go at this depression with more determination than ever before, but integrate these other activities into your daily existence. 

Best of Luck  

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