Posted by polarbear206 on May 3, 2007, at 22:43:28
In reply to Re: Do antidepressants work ?, posted by Ines on May 3, 2007, at 14:52:47
> First- Jenny, you say you have dysthymia. Is that your formal diagnosis? Dysthymia is almost always more difficult to treat than major depression, partcularly if you have dysthymia + episodes of major depression. And it also takes longer to treat. Maybe it'll help to be aware of that- you may need more experimenting than other people but you'll get there. I think I've said before (as has Racer above) that it looks like you've tried a lot of things, but in a lot of cases not had an adequate trial- i.e. not for long enough at an adequate dose. I know it's difficult to stick to something that makes you feel worse to begin with, but the problem with doing that is you may end up feeling that nothing works and giving up. You really have to give the medication a chance to kick in, othersise you're setting yourself up for failure. Why not make a commitment to try whatever's precribed to you for at least 3 months? Then find a good pdoc with a good reputation, maybe send him a letter in advance of the appointment with all your symptoms, age of onset, sleep and eating patterns, all of those details, and a list of all the meds you've tried, with length of trial and details of your reactions to them. And then put yourself in his hands and do what he says for as long as he says. You could finally find relief- imagine how that would feel. Best of luck, keep us updates.
>
> Re: antidepressant efficacy. I think it's really unfair to suggest that antidpressants do nothing at all. They clearly do for a lot of people. When it comes to difficult cases, it's finding the right medication, or combination of medications, for each individual person that will be difficult. I think a lot of that (but not all) has to do with finding the right, experienced, pdoc and getting the right diagnosis. Clearly different types of depression respond better to different treatments, but a lot of GPs will still deny that and say it doesn't matter which AD you give someone, they're just as likely to repond well to it. That's just silly as far as I'm concerned.
>
> Then we come to the placebo effect, an the issue of whether people will get better overtime regardless. I think that's true for episodic depression that has clear external causes (like a bereavement, excessive stress at work etc). In those cases people will likely get out of it on their own, but they may be pushed along by an AD. But if you're talking about chronic recurrent depression, dysthymia, atypical depression... I don;t believe that's true at all. People will struggle and fight and get a bit better only to get worse again. I think it is unfair to suggest to those people (and I include myself here) that they will get better on their own. They need long term medication, and therapy to get to know their patterns better and prevent relapse. Then there are the cases where depression is recurrent/ chronical but clearly cause by some horrible external event like childhood trauma. There we will probably still need medication, but therapy will play a major role and may be the difference between sucess and failure.
>
> I have quite a strong opinion on this because I undermined myself by not getting adequate treatmtent for years, trying to get out of it on my own, and only managing to keep my head floating above the water but never really getting better. By letting it go on for so long I've made it much worse to treat because the patterns of behaviour associated with the depression become so ingrained and hard to get out of.
>
> Re the placebo effect, I do believe it is very real, but not sufficient in chronic cases. I do believe that if someone reallly wants to get better, and really wants a medication to work, they'll help themselves along. On the other hand, if someone goes on meds reluctantly, or thinking at the outset that they won't work, they'll hinder the process. Everything to do with the mind is just so complex and influenced by so many factors. That's what makes it so difficult for the doctors trying to treat it.
>Well put Inez.
Thanks,
Polarbear
poster:polarbear206
thread:755317
URL: http://www.dr-bob.org/babble/20070502/msgs/755683.html