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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by europerep on July 5, 2010, at 10:52:44
hey there...
I have a question, or a couple of questions, concerning my further treatment against resistant depression.. it's not directly about a medication, dosage, etc.. but I'll explain that when I get there..
I have just seen the head of the outpatient department of one the university clinics located in my city, and I am deeply disappointed. It was the first time I went to this specific clinic, and surely also the last.. he invited me into a room where he had an A/C running at max power (at 18°C outside), plus all windows open while the international airport is not that far away, so it was loud as hell and I was hardly able to get my point across.. that's not what disappointed me, but I wonder whether he, as an expert psychiatrist, shouldn't maybe have an eye on the environment in which his consultations take place.. anyway, just wanted to get rid of that.
I sent him an email with the basic elements of my "story" and my relatively short list of failed medications, which is this one:
- Amitriptyline (always XR, up to 375mg/d)
- Amitriptyline (300mg/d) + Nortriptyline (75mg/d)
- Venlafaxine (always XR, 375mg/d)+ Amitriptyline (150mg/d)
- Venlafaxine (600mg/d)
- Venlafaxine (600mg/d) + Amitriptyline (25mg/d) + Aripiprazole (5mg/d)
- Venlafaxine (600mg/d) + Mirtazapine (60mg/d)he told me that there are some good combinations among them, and that therefore he concluded I do not need a new med but psychotherapy. he repeated that about ten times, to which I always replied that there is absolutely no doubt I have to do psychotherapy, but that first I need a medication that gives me back the essential parts of what used to be "me", before a therapy can succeed. I do not want to go too much into detail here because I could go on for hours like that, but the depression took away all my "social competence": the ability to talk to people (people used to, almost unanimously say "it's great talking to him", which has been related to me through others later on) because I was interested in others, I was curious etc., while now I just do not care about anything any more; I was able to make people laugh, not by being a clown, but by just being me, and I was so proud of that; I used to be able to approach people and be self-confident, because I could just "be myself" while now I always have to think about how to act in any given situation, etc..
these kind of things were my depression's symptoms from the beginning, they were gone when the amitriptyline worked for about half a year, they were gone shortly when the venlafaxine kicked in, but that's been a year now, and nothing has happened since.. I do need a working med, noone can tell me anything else.
so the point here is that I'd actually need a psychiatrist willing to pursue pharmacologic treatment for TRD, but it appears people here do not "believe" in TRD.. this professor obviously doesn't get how much I suffer, and that this life here is definitely not worth living. instead of congratulating me to have made the effort to make appointments in different clinics etc., which is not that easy when one has almost given up hope, I am being told that my depression doesn't seem bad enough to warrant other pharmacological intervention.. at best, he told me, he would add seroquel (quetiapine) to the 600mg of venlafaxine I am taking right now, or even give aripiprazole another trial although I had severe side effecs with it and stopped taking it after 2 days (à 5mg).I do really not have the time to wait for a new treatment option until I find a psychiatrist actually doing what he's supposed to do, prescribe medications.. what happened to the stereotypical psychiatrist who would just hand out meds? anyway, I will of course continue my search for a doc, but that can take months, seeing the waiting time university clinics have.. and the docs having their own practice do not seem to be willing to go beyond SSRIs, and actually refer me to these clinics.. I do have one advantage though: I study (not medicine though) at the university which runs the clinic I used to go to, and they have sort of an "antennae" on the main campus, where people know me and where I can go to get prescriptions without having to go all the way to the actual clinic.. I can just go there, tell them which meds I'm on and they'll make me the prescription.. I was wondering whether, until I see another doc, I am just going to try something out myself.. of course one's not supposed to do that, but if those who are supposed to help me are not willing to, then I have no other option for right now..
the prof said that, in order to add an antidepressant to the venlafaxine (such as bupropion or agomelatine) I'd have to go down to 300mg venlafaxine.. what do you think about that? because I was considering giving agomelatine a try, since it seemed to me to be a relatively "benign" drug with, so far, no known severe side effects.. I know it can be combined with fluoxetine, according to the drug firm servier, but I do not know about the dosage.. would it be possible that it wouldn't do its full work while added to 600mg VFX, or is the going down just a safety measure?
or maybe bupropion? of course I do not want to try any dangerous combinations, but I guess I'll have to take a little risk, and with a doc or not, I'll take the meds at home, at university, etc., so in any case it is me who has to be vigilant to eventual symptoms and so on..
so, in a nutshell: what do you think about 600mg venlafaxine + agomelatine in terms of safety? I think they come in 25mg tablets, I would probably break them in half first to get started, and then I'd see.. am I taking a risk here? I have an appointment at a private clinic in august, I hope there they'll recognize the fact that I need medication. if agomelatine doesn't work, I'd already be a step further.
thanks for any input!
Posted by Phillipa on July 5, 2010, at 12:42:54
In reply to where to go from here?, posted by europerep on July 5, 2010, at 10:52:44
Sorry just had to add relate throughly used to be the same type of person and now just a shell and time is running out for me. Hang in there. You're young. Love Phillipa
Posted by bleauberry on July 5, 2010, at 15:49:38
In reply to where to go from here?, posted by europerep on July 5, 2010, at 10:52:44
Well, if the meds are failed attempts as you said, then there is no sense at all in including any of them in going forward.
I agree with you that meds are needed for stabilizing before psychotherapy can have any meaningful effect. I've been through intensive psychotherapy on meds that were working fairly ok, and also while off meds. Psychotherapy does not work if the underlying biological part of it is not addressed first. My experience.
Whatever you do, it should not involve any of the meds you have already been on. Go for something like prozac+zyprexa, or prozac+ritalin, or any ssri+modafinil....get completely away from the ones you have already tried, and instead go for things that have high potential. A plain ssri does not fit that. Neither does another TCA.
This doc doesn't sound like the type that would go along with Parnate or Nardil. Too bad, if I'm correct in that assumption.
The last thing you want to do is add yet another med to the lousy ones you are already on. The new med, no matter how good it actually is for you, will be drowned out by the negative noise of the others.
Posted by sigismund on July 5, 2010, at 20:23:17
In reply to where to go from here?, posted by europerep on July 5, 2010, at 10:52:44
I don't know anything about the safety of 600mg venlafaxine plus agomelatine.
While it makes sense not to continue with meds that are not effective, you may find venlafaxine difficult to withdraw from.
The only side effects of agomelatine I'm aware of are elevated liver enzymes and gastric irritation.
>the prof said that, in order to add an antidepressant to the venlafaxine (such as bupropion or agomelatine) I'd have to go down to 300mg venlafaxine.. what do you think about that? because I was considering giving agomelatine a try, since it seemed to me to be a relatively "benign" drug with, so far, no known severe side effects.. I know it can be combined with fluoxetine, according to the drug firm servier, but I do not know about the dosage.. would it be possible that it wouldn't do its full work while added to 600mg VFX, or is the going down just a safety measure?
I like the idea of reducing venlafaxine because it is not helping you (if that's right), but reducing that while introducing agomelatine may make it hard to evaluate what is doing what.
Posted by emilyp on July 5, 2010, at 23:14:53
In reply to where to go from here?, posted by europerep on July 5, 2010, at 10:52:44
I am the last one to be overly cautious. But I would suggest you rethink your decision to start a new medication without a doctor's prescription. It is one thing to increase the dosage of something you already take or perhaps take a sleeping medication if you are having trouble sleeping. But to take a new medication without a doctor seems fairly risky. Every medication has potential side effects - obviously some more than others. But I am fairly sensitive to medication and have had a few really odd problems that no one could have predicted. For example, I tried Lamictal and wound up with a rash - but a completely different rash than what is normally associated with Lamictal. And it did not start until about 3 weeks after I started taking it.
I don't know that much about the combination that you are suggesting. At the same time, I also only know what you tell me. But I think there are combinations that can be much more affective when adding something else - even if the original combination is not particularly effective.
I would strongly suggest you find another psychiatrist, perhaps at another University or hospital before self medicating.
Posted by europerep on July 6, 2010, at 12:06:39
In reply to Re: where to go from here?, posted by emilyp on July 5, 2010, at 23:14:53
hi,
just to add the info I should have included in the first post, in case anybody else wants to answer:
venlafaxine is helping me a great deal. the other doc I used to see wanted me to go down with the dose, thinking that would solve the problem, and in order to be compliant I did it. at 375mg I was feeling soo awful that I decided to up it again myself.
if I could start out "clean" right now, I would try something else, but I think that I am not able to get rid of venlafaxine outside of a hospital environment (at least without anything else that would make up for it). therefore, now that I am already on venlafaxine, I want to check out all the possibilities I have, so that if I decide to go off it, I won't have no thoughts like "hmm I could have tried this and that with VFX, it might have done the job.."adding something, like agomelatine, would take four weeks, six maybe, while tapering off venlafaxine would be a VERY huge step I guess..
also, it's not about switching to self medicating for good, just about trying one other combo until I find a good doc.. just to not lose the time, because time is sooo precious!
Posted by morgan miller on July 6, 2010, at 12:46:16
In reply to where to go from here?, posted by europerep on July 5, 2010, at 10:52:44
I would also suggest considering Zoloft as an option among the SSRIs. Zoloft, Prozac, and Lexapro are your best options as far as SSRIs go.
What about a low dose of lithium? may help as an adjunct therapy.
Posted by morgan miller on July 6, 2010, at 12:51:08
In reply to where to go from here?, posted by europerep on July 5, 2010, at 10:52:44
I would start psychotherapy if venlafaxine is helping some. You don't have to be completely stabilized in order to start to benefit from psychotherapy. I would also suggest finding a place where you can do psychodynamic individual psychotherapy and psychodynamic group therapy.
Also, what is your diet like? Do you take fish oil? Do you exercise moderately or intensely?
Posted by europerep on July 6, 2010, at 13:26:38
In reply to Re: where to go from here?, posted by morgan miller on July 6, 2010, at 12:46:16
oops, damn it, yet another correction: I did take 500mg lithium add-on to the venlafaxine, with a blood test being made to see whether it's a sufficient dose..
I do exercise twice a week, the point is, I used to do it three times a week, intensively, and it was highly effective against the depression. now it isn't helping anymore at all.. I am basically doing it to stay fit and all that, it doesn't have any value as an antidepressant anymore..
I have changed my diet, as far as possible, havin all kinds of nuts, seeds, for precursors of dopamine and stuff like that.. so far I tried to get omega's naturally through kiwifruit and sometimes fish, but I guess I'll start an add-on soon, that won't bring the solution though..I have already done 50hrs of psychotherapy, and except for understanding the history of depression better, it was pointless.. I mean, right here I feel terrible, I am basically convinced that I am gonna make it another two, maybe three years, but certainly no longer.. that's why I need to have a working drug, if there is one for me..
Posted by europerep on July 6, 2010, at 14:52:44
In reply to Re: where to go from here?, posted by europerep on July 6, 2010, at 13:26:38
ok, let's say one were to go with escitalopram as a basis, what would be a decent add-on? I have had nortriptyline up to 75mg and didn't notice any effect whatsoever, so I am not sure about that.. the stimulant option scares me a little, and I can't imagine that that will do a good job over years.. damn it, I need to know what part(s) of my brain aren't working? maybe I'll even ask for a one-time ketamine infusion haha, I mean there actually isn't an easier and quicker way to say whether an NMDA antagonist might help me..
actually I have to say, I haven't been in remission in eight years, and I guess I never will be.. in order to take an MAOI I would must surely have to go to a hospital, and I don't want to be ripped out of my environment right now, I can't have that... hmmmmm :'-(
Posted by morgan miller on July 6, 2010, at 17:45:04
In reply to Re: where to go from here?, posted by europerep on July 6, 2010, at 14:52:44
Evidently Nortriptyline can be ineffective by itself but very effective when added to something like Zoloft.
ADD/ADHD medications like Ritalin, Concerta, and Focalin(preferable the XR version) are not invasive and have the potential neurotoxic effects that Adderall may have. There are actually a few studies that show that Ritalin, Concerta, and Focalin(all of which are very similar drugs-Concerta being the XR version of Ritalin and Focalin being one of the active metabolites of Ritalin-Ritalin is methylphenidate and Focalin is dexmethylphenidate) may actually be neuroprotective. How do you know that Effexor is not doing damage in the long run? You need to figure out if the benefits of some things outweigh the possible long term risks. I do not think there is any reason yet to believe that the ADD/ADHD drug I mentioned would really hurt anyone in the long run.
Posted by jade k on July 6, 2010, at 17:45:07
In reply to Re: where to go from here?, posted by bleauberry on July 5, 2010, at 15:49:38
"this professor obviously doesn't get how much I suffer, and that this life here is definitely not worth living"
Your PDoc is definately not gettin it I'd say!
"I am being told that my depression doesn't seem bad enough to warrant other pharmacological intervention"
How bad does it need to be?
Whats worse than "life is not worth living"?Sounds like a big part of the problem is that you are not being heard. I would make that a priority. Loud and clear, focus on the important stuff. Put it in writing if you have to. Poster board! Whatever!
~Jade
Posted by jade k on July 6, 2010, at 17:50:21
In reply to Re: where to go from here? » bleauberry, posted by jade k on July 6, 2010, at 17:45:07
Posted by europerep on July 7, 2010, at 15:18:32
In reply to Re: where to go from here?, posted by morgan miller on July 6, 2010, at 17:45:04
hi mm..
thanks for your answer..
my worry was not so much that methylphenidate or similar meds are neurotoxic, I was just worrying whether they weren't basically supposed to make you feel good through its dopamine action, even if DA is not the actual origin of the depression.. I could imagine that increasing DA significantly might sort of "overshadow" the depression, without solving the actual biological issue.. and then I fear that one day it will stop working, but it will have significantly altered functioning of the DA circuits, thereby making the depression even worse.. I haven't found that much evidence for improvement of TRD with MTP, but I guess it is worth a try, that is right... thanks for that, I didn't think of it so far..
Posted by europerep on July 7, 2010, at 15:28:29
In reply to Re: where to go from here? » bleauberry, posted by jade k on July 6, 2010, at 17:45:07
hi jade..
yeah, that doc is definitely not getting it, it was the first time and obviously also the last time I went to see him.. I guess I'll go back to university clinic #1, but with a different doc there, because the one I had was getting more and more pissed by the fact I didn't respond to the list of meds I indicated, saying "I think there isn't much we could do anymore, other than seroquel XR" .... right... why are such docs allowed to work in university clinics if they don't know anything about TRD?I sent the doc I just saw an email with my story before, he printed it out and it was five pages long, it was just a resume of the meds I took and stuff.. I guess as long as I admit to having ANY sort of personal issues, docs will always attribute my situation to those.. I even told the last doc I had, at clinic #1, how this life is so painful and that I cannot live it for another eight years in depression, but she wouldn't hear... you know?
Posted by europerep on July 7, 2010, at 15:33:57
In reply to Re: where to go from here? » europerep, posted by Phillipa on July 5, 2010, at 12:42:54
I just wanted to say a late thanks..
in a different way, I feel like time is running out for me too though, maybe even because I'm young.. I have been depressed since 16, and before that I wasn't exactly happy either, and so much of life has already passed by me.. there are so many experiences that are so essential for being happy as a grown-up that I haven't made, and I don't know if I ever will.. and this is supposed to be the "best part of my life"...
Posted by jade k on July 7, 2010, at 16:31:29
In reply to Re: where to go from here? » jade k, posted by europerep on July 7, 2010, at 15:28:29
Hi Europerep,
You're breakin my heart, and I DO know. You must be so frustrated. I read your post to Phillipa as well. Please know that although you have had some terrible experiences with your PDocs, there are a lot of caring docs out there that would not give up on you.
I don't know your entire history, but I'm SURE there are many more things to try. Btw-did you mention whether you've tried any MAOI's? Those are often used in cases like yours.
It sounds like your top priority right now should be to find a GOOD pdoc. I've had good and I've had lousy, and it can make all the difference in the world. Even if you don't get well right away, having an experienced, caring doc on your side makes the journey so much easier. Put the time in to find someone you trust. This isn't a life sentence.
~Jade
Posted by morgan miller on July 7, 2010, at 17:06:41
In reply to Re: where to go from here? » morgan miller, posted by europerep on July 7, 2010, at 15:18:32
> hi mm..
>
> thanks for your answer..
>
> my worry was not so much that methylphenidate or similar meds are neurotoxic, I was just worrying whether they weren't basically supposed to make you feel good through its dopamine action, even if DA is not the actual origin of the depression.. I could imagine that increasing DA significantly might sort of "overshadow" the depression, without solving the actual biological issue.. and then I fear that one day it will stop working, but it will have significantly altered functioning of the DA circuits, thereby making the depression even worse.. I haven't found that much evidence for improvement of TRD with MTP, but I guess it is worth a try, that is right... thanks for that, I didn't think of it so far..Who knows what exactly is the root cause/causes of each of our illnesses. I tend to believe in the bio-psycho-social model. So I think if it makes you feel better and it does not hurt you in the long run, why not take it. A life feeling bad is a life wasted.
Posted by bleauberry on July 7, 2010, at 18:04:58
In reply to Re: where to go from here? » bleauberry, posted by jade k on July 6, 2010, at 17:45:07
Anyone ever seen that show on TV called Medical Mysteries?
Regardless of which case they are highlighting, there is a common underlying theme in all of them. That is, multiple doctors did not listen. Multiple doctors jumped to conclusions. Multiple doctors did not dig deep enough to find clues.
Luckily in the end all of the cases had happy endings. That's because at the end of each patient's 10 or 20 or 30 year hell, some new doctor (usually the 10th or 20th by now) decided to take a closer look and found something all the others missed out of negligence...not listening, not looking, assumptions based on thin air.
Posted by jade k on July 7, 2010, at 18:15:51
In reply to Re: where to go from here?, posted by bleauberry on July 7, 2010, at 18:04:58
> Anyone ever seen that show on TV called Medical Mysteries?
>
> Regardless of which case they are highlighting, there is a common underlying theme in all of them. That is, multiple doctors did not listen. Multiple doctors jumped to conclusions. Multiple doctors did not dig deep enough to find clues.
>
> Luckily in the end all of the cases had happy endings. That's because at the end of each patient's 10 or 20 or 30 year hell, some new doctor (usually the 10th or 20th by now) decided to take a closer look and found something all the others missed out of negligence...not listening, not looking, assumptions based on thin air.Exactly. Thank you.
~Jade
Posted by morgan miller on July 7, 2010, at 18:37:37
In reply to Re: where to go from here?, posted by bleauberry on July 7, 2010, at 18:04:58
I personally think the common thread in the cause of all cases of depression is a combination of a biological predisposition with a lack of proper nurture that disrupted healthy development and gave the genetic predisposition an environment in which it could thrive. I understand there are underlying infections/illnesses that can cause chronic depression, I just do not believe that these are the most common causes. Also, someone that has a genetic predisposition and suffered from a toxic neglectful childhood, is probably more likely to suffer from depression brought on by an illness/chronic infection. This is also the case with postpartum depression(studies have actually given strong evidence for this).
Posted by jade k on July 7, 2010, at 19:11:11
In reply to Re: where to go from here?, posted by morgan miller on July 7, 2010, at 18:37:37
> I personally think the common thread in the cause of all cases of depression is a combination of a biological predisposition with a lack of proper nurture that disrupted healthy development and gave the genetic predisposition an environment in which it could thrive. I understand there are underlying infections/illnesses that can cause chronic depression, I just do not believe that these are the most common causes. Also, someone that has a genetic predisposition and suffered from a toxic neglectful childhood, is probably more likely to suffer from depression brought on by an illness/chronic infection. This is also the case with postpartum depression(studies have actually given strong evidence for this).
Hello,
I hear what you're saying, but I don't agree that all cases of depression have a common thread of childhood neglect and/or abuse. Certainly many do.
I also didn't get that bleauberry's post was referring to missed underlying infections. europerep's post points out that he has not been heard or listened to by the pdoc's he's been seeing. I thought bleauberry was simply pointing out that a comprehensive evaluation by a good pdoc now, could save him years of searching for answers in the future.
I could be wrong.
~Jade
Posted by violette on July 7, 2010, at 22:49:40
In reply to where to go from here?, posted by europerep on July 5, 2010, at 10:52:44
Hi Europerep,
I get the impression the PDoc thinks you might have dysthmia rather than TRD/MDD. I also think he would be doing you a great disservice if he went against his professional opinion and prescribed you a medication when after the assessment he concluded psychotherapy to be the best treatment to get you to your goal of feeling good again. Do you feel some indication he does not want you to get better, or does it benefit him somehow to not prescribe you another medication trial? Maybe he was just a miserable jerk? Or did he truly believe he could help you by not telling you what you might have wanted to hear?
Some PDocs feel TRD, often in the form of ahedonia, can be related to how your brain adapted to childhood experiences and can be fixed through psychotherapy. If you have had crappy psychotherapy, or maybe were not fully committed at the time, that doesn't necessarily mean that a therapist who is a better match will not be able to help you as opposed to medications. I've had my share of poor therapy experiences, for sure. I've found that finding a good match in a therapist is very difficult, and I'm not the only one who has been turned off by bad therapy-either the wrong type, a crappy therapist, or maybe just having a poorly matched therapist.
Regardless of good or bad therapy, I never had to be stablized to engage in it first. And not taking a med for the therapy I'm in now gives us lots of material to work through and I have found it to be insightful and healing. If I was taking Effexor, which I've taken before, I'd be too emotionally numb to feel the emotions that are necessary to work through in the type of therapy I'm in. If I was afraid to address the feelings full force, then I might have stayed on the Effexor.
"I need a medication that gives me back the essential parts of what used to be "me", before a therapy can succeed...the depression took away all my "social competence": the ability to talk to people (people used to, almost unanimously say "it's great talking to him", which has been related to me through others later on) because I was interested in others, I was curious etc., while now I just do not care about anything any more; I was able to make people laugh, not by being a clown, but by just being me, and I was so proud of that; I used to be able to approach people and be self-confident, because I could just "be myself" while now I always have to think about how to act in any given situation, etc.." -
Europerep, I can relate to this awful feeling of loss. I once had similar confidence, productive, was free-spirited, easy-going, traveling and going out all the time, and had alot of fun. That was me for a large part of my life. But that changed, and over the past 2 years--it slowly eroded and got worse-to the point where I lost a lot of friends because I felt I could no longer be my 'self' and didn't want to hang around anyone in that state because it was more than disappointing. Once spontaneous, I felt like I had to think about what I was going to say, felt self-conscious at times, and just wasn't comfortable being my new, depressed, self.
So I also never got back to my former 'self'. One of the toughest things I recently had to come to terms with was the loss of this former self. It feels like a great loss-I understand what you are going through. You mourn that loss, and keep searching to regain it. It's only natural.
Although it was difficult to grasp and accept, I came to realize that my old fun and confident 'self' really wasn't 'me' after all. That self had adapted to be happy to ignore and mask all the underlying pain I never adequately dealt with. Eventually, that pain trys to emerge in your conscious and wears you down. It sucks up your mental energy. It causes depression, lack of confidence, social anxiety...which leads to lack of interest...which spirals and eventually becomes ahedonia and dysthmia.
Upon this realization, I stopped searching to regain my 'old self' back and finally realized, that was never me. Both the good and bad experiences are part of who we are-and if you split off the bad stuff, the stuff that makes you uncomfortable, you really are not a 'true self'.
The stuff that contributed to my feel badly about myself was there all along. The bad stuff eventually overcame the good stuff because I had not dealt with it adequately...it just wouldn't let me ignore it anymore. Now, after beginning to integrate that bad stuff, processing all the stuff I had been repressing, the dysthmia has eroded. No, I'm not great, and I still have major anxiety problems from time to time, but I no longer feel in a depressed state. And I find anxiety to be alot better than anxiety and self-loathing.
And I am for the first time in a couple years, beginning to realize that some of my old self is actually still with me-confidence, being playful, having fun, feeling comfortable with me. I am very hopeful to be well again and fully content in the future. I realize since it took me a while to get in that state of feeling badly, it won't happen as fast as a medications. I've been at it for a year and I'm slowly getting there. The difference now is that I am starting to see how my wellness is becoming permanent. I did not see this before. It's something you have to experience first to truly identify with.
I'm just hoping you will give that PDocs opinion another thought. Because if you have been depressed since you were age 16--you might not know who you true self actually is. And-I don't want you to be chasing after a self that perhaps was never true to begin with--and end up in the same place as you are now when you become middle aged-my age.
I wished that years ago, a PDoc had told me 10 times what I needed was psychotherapy. And yeah, they knew all about my past childhood experiences. Would I have listened? Maybe not, but I don't know because I was never advised to do what this PDoc has told you what he feels is in your best interest. Maybe I would have have a similar reaction as you-being preoccupied with getting back to my old self without realizing that what I really needed to do was find a new self, a self that accepts the old after all, instead of masking it, but also integrates it into a content, happy-with-myself, new self.
Best wishes to you.
Posted by morgan miller on July 8, 2010, at 9:11:47
In reply to Re: where to go from here? » europerep, posted by violette on July 7, 2010, at 22:49:40
Good points about therapy. Medication sometimes CAN actually interfere with the process.
Sometimes people start taking medication and feel so good that they stop or put off going to some much needed therapy. Remember, medication will only take you so far. Therapy will take you to that next level where you can have more fulfilling successful relationships. Happiness in life is contingent on the success and quality of our relationships.
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