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Meds Don't Seem To Work So Now What?

Question:

I have been constantly depressed on a daily basis for the past 6 months. I have suffered from depression off and on since a child but it has never lasted this long before. I have tried a number of anti-depressants, none of which really “worked” and many gave me some weird side effects. The last psychiatrist that I saw had me on Wellbutrin-300 mg/day. When my depression didn’t subside after a month, he suggested that I may be among that percentage of the population that doesn’t respond to anti-depressants. I am a recovering addict/alcoholic (7 years) and go to meetings on a regular basis. I think constantly about dying or killing myself and see no other way out of this blackness right now. I know that is selfish (I have children) but I don’t really seem to care. The only time I’m at peace is when I’m asleep. I started seeing a therapist on a weekly basis about 2 months ago. She has taken me through one session of EMDR. But when one feels this bad, one really wants some relief immediately. Please help.

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

The first line of intervention in the treatment of severe unipolar (non-bipolar/manic) depressions is usually the prescription of anti-depressant medications. While these agents work well for many people, they often have severe side effects including reduced sexual desire and impotence, and they sometimes don’t work for people. An alternative to medication treatment is psychotherapy. There are two recommended forms of psychotherapy for depression that have been scientifically shown to work as well as or better than medication management. These are Cognitive Behavioral therapy for depression, and Interpersonal Therapy for depression. These types of psychotherapies are somewhat specialized – not all therapists are competent to offer them. If you decide to go this route, you must interview your therapist beforehand as to his or her knowledge and exertice in these therapies. Note that your medical doctor will often not be aware of how well the right form of psychotherapy can work for depressive patients and may not know to recommend psychotherapy for you. You may have to explore this one on your own with a psychologist.

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p> When both medication and psychotherapy treatments for depression fail, the treatment of last resort is often electro-convulsive therapy (also known as electro-shock therapy). This therapy is administered by a psychiatrist (medical doctor with special training in the treatment of severe mental illness). It involves giving you a sedative and then passing an electrical current through your brain and nervous system. This is repeated multiple times over weeks. ECT sounds very scarey to many, but it is actually not as dangerous as you might think and has been shown to produce real results where no other treatments are working. Normal side effects include some short-term memory loss, but to my knowledge no lasting damage.

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p> My advice is to talk to your doctor about whether CBT or IP psychotherapy for depression, and/or ECT might be workable treatments for you to try.

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