Posted by Elizabeth on March 4, 1999, at 19:42:04
In reply to Skeptic about antidepressants and therapy..., posted by David on March 4, 1999, at 12:13:31
> I have been mildly depressed for a long long time,
> without actually knowing it. But it seems to me
> that it has been forever.Hi David. I can relate to this: when I'm depressed, it's very hard for me to remember a time when I wasn't depressed, almost as though my memory is blocked.
> But last year I had two bouts of severe depression in
> late spring and then again in winter. I could not make
> myself go and seek professional advice, hesitating all
> the time, "lingering on the edge," looking for excuses
> all the time (look there, it's not so bad, pull yourself
> together, there're lots and lots of other people that
> suffer much more... and stuff like that).A lot of people go through that - I think men especially do. You seem like a very thoughtful person, and it's a difficult question where the line is between transient bad feelings that you can pull yourself out of, and depression. When you're caught up in it, it's even harder to tell which one it is.
> Finally I managed somehow to walk into a psychologist's
> room, it was about the time, when my suffering lasted
> for about 2 months and I could no longer pretend that
> everything's fine with me (you know, all your friends
> asking "how are you?" and you saying with a warm
> smile "fine, thank you" but deep inside longing to
> scream to the world "miserable!!!").
>
> The psycholigist sent me to a psychiatrist to have some
> medication prescribed since I was to leave my home
> country to study in the Netherlands temporarily.
> I received a diagnosis of major depressive disorder,
> anxiety, depersonalization, derealization, and a few
> other things that I could not understand.That's a lot of diagnoses. I think that derealization and depersonalization are usually related to anxiety.
> The psychiatrist gave me Zoloft 50mg, twice a day and
> Lexaurin 1.5mg (Bromazepamum), a total dose of 3mg a
> day. At the same time he said that my depression
> has its roots in the structure of my personality, my
> character. And he added that a psychotherapy for me
> would be difficult and complicated.This is a very dubious thing for him to say. A character disorder should only be diagnosed after you've gotten to know a person, but it sounds like he just makes the assumption that all depression is due to character pathology. I wouldn't take it too personally.
I think it was not very helpful for him to tell you that therapy would be difficult. That must have been discouraging to hear.
> I had been skeptical about medicines for depression as
> well as any kind of conventional psychotherapy before,
> although never actually tried them (I had always
> really doubted that they could be of any help to me...
> maybe I had some kind of prejudice...? I don't know.)
> and now the psychiatrist, although being honest,
> even enhanced these worries in me!Medication *works*. It's estimated that if the antidepressants are chosen intelligently and treatment carried out properly, 80% of depressed people will respond to one of the first 3 antidepressants tried (and nearly 100% will respond eventually if they keep trying things). The trouble is, there's little way of knowing which antidepressant will work, and many doctors select antidepressants haphazardly.
Psychotherapy also can help, although something that a lot of people say is that they weren't able to get anything out of it until their depression was under control with meds. This is certainly true for me.
It is possible that your skepticism - or perhaps I should say pessimism - would actually prevent therapy (or even medication) from working. I wouldn't rule out that possibility.
> I have been on Zoloft and Lexaurin for 2 months now,
> I can see a slight improvement (I have enough energy
> to pretend again that everything's all right...) but
> very often I slip into despair as to whether there
> really is any kind of help for me? Any positive vision
> of the future, I mean bright future? I don't know...Okay, aside from my thought about "reverse placebo effect," it sounds like these probably are not the right meds for you. However, I think that you should try raising the dose of the Zoloft to 150 or 200mg because quite a few people need that much. (I don't know about doses of bromazepam, as it's not used in the U.S., where I live.)
Be aware that this despair doesn't reflect reality! It's a symptom of depression - even though almost everybody responds to a medication sooner or later, many (if not most) depressives believe that they are in the tiny minority that don't! Just because you can't see the future doesn't mean it's not there.
> I have a very intense feeling that these antidepressant
> drugs just suppress the underlying causes of the
> state of my mental health without really "removing"
> them. Maybe the most severe symptoms disappear so I
> can get through a day somehow...Nobody has been able to identify any specific "underlying causes" of depression, and anyone who tells you they have is lying. We just don't know enough about the brain right now to be able to say what causes - or even what *might* cause - depression. Right now there is no cure for depression, only treatment - but I don't find it so intolerable to receive that treatment, just like my dad is receiving treatment for his high blood pressure. I take two medications and go to therapy; he takes four or five medications, exercises daily, and is on a very low-fat diet.
> But I am sure I do not want to switch to any other
> kind of pills and then to some other pills and on
> and on... and although in psychotherapy it might
> be nice to have an opportunity to talk to somebody
> (especially when my social life is and has for a long
> time been virtually non-existent), I don't believe
> I can make any progress.I have been playing musical meds for a long time, and while it's no picnic, it's worth it to be able to find one that works. I think it's only a question of how much you want to get better - it sounds like you really want to, and you don't have anything to lose by trying.
I think therapy is worthwhile also, although you may find it's not too helpful without the right meds. I don't think this psychiatrist is such a good therapist based on what you've said. So my advice is to try to find another one.
Good luck with everything.
poster:Elizabeth
thread:3400
URL: http://www.dr-bob.org/babble/19990301/msgs/3409.html