topic Treatment-resistant depression in Treatments, health professionals and therapies

Treatment-resistant depression

Zoostar84 — Sun, 26 Jun 2016 07:20:47 GMT

I had an appointment with my psychiatrist and previously we had talked about a plan to wean myself of one of my medications and start a new medication. I was willing to try and thought it was a great opportunity to do it now as I am currently on annual leave. My psychiatrist made a minor adjustment to the medication used to help someone with treatment-resistant depression like myself. My next appointment is in 2 months. I left feeling a bit disappointed and a bit frustrated knowing that I will be buying a certain medication that is only partially effective and I know my psychiatrist eventually wants me to stop taking it. I thought to myself, it's similar to buying a faulty product.

Well, for the next 2 months I will be keeping up my busy gym routine.

I will also reward myself by having a massage.

I don't enjoy my work but I am looking forward to going back to work as I want to get back to my busy lifestyle.

Anyone have any suggestions for treatment-resistant depression?

Treatment-resistant depression

romantic_thi3f — Fri, 01 Jul 2016 01:47:59 GMT

Hi Zoostar84,

I'm sorry that your medication wasn't helpful; was that your first medication? From my understanding treatment resistant depression occurs when two medications have been trialled and deemed ineffective. Given that you have only had one I believe that the second one has a high chance (30-50%) of being effective.

Having said that though - treatment for depression doesn't always involve medication. There are lots of different non-medical therapies to try that might be useful for you. Exercise is one, which I can see you've been doing - massage is also very therapeutic. Other therapies may include yoga, diet, alcohol and drug avoidance, acupuncture or aromatherapy, St. Johns Wort, omega 3, and of course relaxation therapies - which include things such as meditation, mindfulness (even colouring books).

The other therapy which can be helpful is counselling. I know you mentioned that you've been seeing a psychiatrist, but there are many different mental health professionals that can offer many different treatments. Ultimately, like anything - it's just about finding what works for you.

Treatment-resistant depression

Zoostar84 — Sun, 03 Jul 2016 00:34:03 GMT

thankyou for your response.

I have tried several anti-depressants over the years..maybe six to eight different ones. I am cuurently on a combination of different medications.

I have had a blood test done which shows that I have a significant reduction in a particular enzyme that is used my the medication.

I have made lifestyle changes that you suggested. I go to yoga classes, eat healthy, don't take drugs or alcohol, I get acupuncture at my chiropractor, take fish oil daily (among other supplements), meditate and i do colouring in.

I am seeing a psychologist as well and she is very helpful.

It's so frustrating that I am doing all the right things to help myself and I don't feel I am getting any better.

Treatment-resistant depression

White_Rose — Sun, 03 Jul 2016 00:56:48 GMT

Hello Zoostar

It's good to meet you. You are certainly making a huge effort to become well. Have you asked either or both your psychiatrist and psychologist if you are recovering? Have you actually been diagnosed as treatment resistant? One of the problems with depression is that we rarely have an objective picture of ourselves. Can you remember how you felt when you became depressed? Can you look back at yourself and see where you are now?

I also tried many ADs, probably for about six years. They were all SSRI, SNRI or a combination of both. I know they should not be combined but my psychiatrist prescribed them. Basically none of them worked, there was always something wrong. Eventually my GP prescribed one of the Tricyclic meds and it was like getting out of gaol. Such amazing difference and I am cross the psych did not try them. I know they are all the old drugs but they still work and lots of folk are better with them. So for me it really was a question of the right drug which helped me to get my life back.

I guess what I saying is that you have not found an effective therapy. I gather your psychiatrist only prescribes meds with no therapy and the psychologist does the therapy part. Are you happy with the way it is working, have you or rather your psych tried different types of therapy? If not then perhaps you can try something different.

Can you 'top up' the missing enzyme? I have tried colouring in but it's not for me. I get absorbed in scrapbooking and sewing. I meditate and it helps me enormously.

I hope what I have written is helpful in some way.

Mary

Treatment-resistant depression

Zoostar84 — Sun, 03 Jul 2016 03:36:17 GMT

thankyou for your reply Mary

I haven't asked either my psychologist or my psychiatrist if I am recovering. I had only recently changed my psychiatrist as I felt unsupported by my previous psychiatrist. My psychologist was very proud of my decision to stop seeing him and see a new psychiatrist. My new psychiatrist diagnosed me as treatment-resistant depression as I have tried several medications at high doses. I have asked people close to me how my mood, general interest in doing things has been over the past 2 months. I received positive feedback that my mood had improved significantly..they could tell it in the tone of my voice. But, I still don't get the same feeling that I used to when doing things I shoulbe be enjoying

I'm currently happy with what my psychiatrist and psychologist have to offer.

I'm not sure what you mean by 'top up' the missing enzyme. Do you mean by adding a medication? Well, that's what my psychiatrist has done in hope that it would kick start my anti-depressant.

Treatment-resistant depression

White_Rose — Sun, 03 Jul 2016 05:33:53 GMT

Hello Zoostar

Yes that's what I meant by topping up. Very brave of you to change psychiatrist. I needed so much help from my GP to do that. He was not a nice man I think. He used to go to sleep while I was talking to him, was never on time and saw no reason for me to complain despite telling him it made me late for work and then I needed an explanation. We had a huge argument and he ended up swearing at me. And I mean full on four letter words. I was so pathetic I went back to him after that. But I suppose I thought that was all I was worth as my husband treated me that way.

I know better now. I'm not entirely certain what treatment resistant means. I thought it meant nothing could help you but perhaps it means medication can't help you. Do you know the answer? I also tried many ADs as I said but no one said I was treatment resistant.

Other people see more about you than you do of yourself I find. I think it's good other people feel your mood has improved. Why don't you ask your psychologist? I asked the psychiatrist if I was better and he said no at first, then he got impatient and said I was an intelligent person and should know I was not better. It was only at this point that I realised we were both using 'better' with different meanings. I meant 'improving' and he meant 'cured'. Well he should have thought about it more, especially as I kept asking.

Mary

Treatment-resistant depression

romantic_thi3f — Tue, 05 Jul 2016 03:12:10 GMT

Hi Zoostar84,

Thanks for the reply - sorry I didn't see/respond earlier.

So you've definately been through the runaround of medications then; has either psychiatrist talked about what might be causing the 'low enzyme'?

I'm glad that you are being really proactive about your treatment and managing depression; hopefully the change in psychiatrist will provide some new insight as well.

You mentioned that you don't feel like you're getting better and you don't enjoy things like you used to. What would 'getting better' look like for you? Often people's experiences with happiness and joy change a little bit between episodes of depression. We often feel like we 'should' enjoy things, but sometimes what joy looks like before and after can change slightly. I know I personally don't find as much enjoyment out of certain things now as I used to - but other things make me happier than they used to before too.

Have you mentioned this to your psychologist? You may find that they have noticed certain things about your depression that maybe you haven't. Or that they have some different suggestions on how to move forward. Different things work for different people; for some, maybe it's analysing their thoughts and mindsets, and for others - maybe processing what's happened in the past, or finding and creating opportunities to be social/engaged - such as meeting new people or trying new things.

Treatment-resistant depression

Zoostar84 — Wed, 06 Jul 2016 12:33:34 GMT

Hi Mary

To answer your question treatment-resistant depression is defined as major depressive disorder (MDD) that does not respond adequately to appropriate courses of at least two antidepressants. I don't believe this is always the case. It may be that the person is yet to find the medication that is most suitable for them. In my opinion treatment-resistant depression is where the body has developed a way to counteract the mechanisms of the medication.

My psychologist wanted me to get a MRI scan of my head after telling her the symptoms I had been experiencing. She also wanted to me to see my psychiatrist at an earlier date. Given this, she will not tell me I'm improving.

Treatment-resistant depression

blondguy — Wed, 06 Jul 2016 22:32:46 GMT

Hi Zoostar

There is great advice above so I will keep my post brief.

I agree with you about treatment resistant depression. I think we have too many 'tags' for everything nowadays.

You are pro-active and smart when it comes to recovery and only my humble opinion but I would persevere with finding a med that works. I have been on AD's since 1995 and they have helped with my mood as well as taking away the bulk of the anxiety too:-)

I tried all the natural remedies for about 14 years and just for me they had no effect.

As you mentioned we all have different symptoms of course.

Your topic is a good one Zoo. Look forward to see how you are going

Kind thoughts

Paul

Treatment-resistant depression

White_Rose — Thu, 07 Jul 2016 08:19:29 GMT

Hello Zoostar

On your description I must have been treatment resistant as I had MDD and tried a dozen ADs. They were all SSRI or SNRI which was the problem I believe. Hindsight, which is always 20/20, tells me the psych should have tried the Tricyclic group of meds, which is what I am now taking thanks to my GP. Psychiatrists believe they know all about psychiatric drugs but failed horribly with me. Now I feel really good and have been taking them for six months.

Romantic has made a very good point about happiness and enjoyment. I have always read but my taste in genre has changed quite markedly. That may be something to do with age and different experiences, but even so it's a big change. I now enjoy craft type hobbies which is again different. I used to say I disliked walking on sand, and I still do, but it has always been an expectation that people are happy being on the beach. Never enjoyed it however much I tried.

Getting well again is very subjective. What does feeling well feel like? Can you really remember what it was like before depression? Just being depressed tends to fog up our memories and we can have some vague idealized picture of what we used to be. But even that picture may be incorrect as you may have felt mildly depressed for a while. So instead of trying to be someone in the past, concentrate on being the best you can in the now. I was told this proverb I think you could call it, a long time ago so I hope I have it right.

Yesterday is the past, tomorrow is the future, today is a gift, that's why we call it the present. I rather like that. Continue to grow and get well.

Mary

Treatment-resistant depression

Ben1 — Thu, 07 Jul 2016 11:32:24 GMT

Hi Zoostar84!

In response to your note about the enzyme, if you have taken any Monoamine Oxidase Inhibitors (MAOI's) for treatment-resistant depression, your levels of enzymes will be reduced as this is the natural function of the medication.

Treatment-resistant depression is difficult as it often reduces the hope of people experiencing it as they struggle to find an effective combination of medications and/or a lifestyle that works for them. Many studies show that exercise can be as effective in boosting mood as some antidepressants. Finding a supportive friend network, exercising regularly and persevering with your doctor (even those these can be difficult to achieve) will eventually resolve itself into some relief.

One final note: although lots of medications may seem quite similar, medications of the same class can have huge differences in how they work in one person compared to another. Keep persevering! In my experience it took me a long time to find good medication.

Hope this helps!

Treatment-resistant depression

Zoostar84 — Fri, 08 Jul 2016 06:58:00 GMT

Thankyou for your response again Mary

I haven't always enjoyed reading books but it is something I like to do in my spare time. I am a member of 2 libraries and wouldn't have thought it would be an interest of mine a couple of years ago. I also enjoy trivia and look forward to doing the quiz in the paper at work during lunchbreak. I understand my interests may change as I get older. I'm just finding it difficult getting really excited about something. Having passion and something that gives me a spark.

Treatment-resistant depression

White_Rose — Sun, 10 Jul 2016 04:46:42 GMT

There's nothing like a good book and a coffee on a cold day. Yes our tastes change, sometime quite dramatically. What sort of activities did you enjoy in the past? I think I said books and reading have been a constant in my life, it's the genre that changes. But I knew there was something quite wrong when I found I could not read. Not literally, just could not concentrate for more than a page or two. Many people have reported this as a side effect of depression and anxiety.

Having passion and something that gives me a spark. That's a bit of a chicken and egg problem. When we are well we can get excited about various aspects of life and they do fill our lives with joy. In depression we need these distractions to help us get well again but find it difficult to muster up any enjoyment and our previous joys cannot find any favour.

Having left a volunteer role I believe I was good at I felt very lost. Housework has never been a favourite occupation of mine and as I said reading lost it's attraction. TV was in the same league as reading, couldn't muster up the interest or motivation to go anywhere and even talking was too much effort. I cannot remember what I did at this time, which rather tells its own story. I think I tried to get interested in my old activities and did manage some embroidery.

Recovering from depression and finding joy in life is rather like building two walls adjacent to each other. Each one needs the support of the other and each one can only grow a couple of bricks at a time before needing the other wall to catch up. As we make our way back into the light we find those tools which will help us to grow up more and see further. Possibilities become more evident and as we look harder so our motivation gets stronger.

I firmly believe our experience of depression or any mental illness changes us in ways we would not have thought possible. These changes are not bad or good in themselves, just a pattern for our new lives. And that life can be as productive as you wish. To return to the walls, we can grow them as fast as we wish once we have learned how to do so, and those walls can be any shape we want.

I would love to know your thoughts on this.

Mary

Treatment-resistant depression

Zoostar84 — Fri, 15 Jul 2016 13:44:31 GMT

Thankyou for your response Mary.

In the past I enjoyed playing poker, watching movies on DVD, going to music concerts, listening to music.

I now rarely watch a movie on DVD. I occasionally got to the cinemas. I generally only listen to music when im at the gym.

To go along with your wall analogy. I believe I have set a good foundation and have bought the right tools to help the walls grow. Despite my patience the two walls do not want to grow and even somedays a brick or two fall off.

Treatment-resistant depression

Zoostar84 — Sat, 16 Jul 2016 12:11:03 GMT

I also enjoyed betting on the horse races every saturday and going to the races. I now only bet on the major races in spring carnival and only attend 1-2 meetings a year.

Treatment-resistant depression

Zoostar84 — Wed, 17 Aug 2016 07:30:11 GMT

My yoga instructor has given the class a job this week. The task of giving self care. I had meaning to get a haircut for awhile now and made it a priority today. Even simple things such as getting a haircut can improve self esteem and attract positive comments from colleagues.