Treatment-resistant depression

[Zoostar84]

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?

[romantic_thi3f]

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.

[Zoostar84]

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.

[White_Rose]

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

[Zoostar84]

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.

[White_Rose]

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

[romantic_thi3f]

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.

[Zoostar84]

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.

[blondguy]

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

[White_Rose]

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