Friday, January 18, 2008

Early Medical Intervention For Major Depression

I am sure I am not unlike many people with treatment resistant depression insofar as I am constantly wondering WHY? Why is no medication working? Why does therapy, while being supportive and managing to keep me here on this earth, not help me become well? Why do others get well with medications, or ECT, or therapy, while I continue to struggle?

I recognize there are no hard and fast truths to any of these questions. I do however, have theories about my own circumstances.

One theory is that I was not diagnosed, and "fully" treated for depression until I was 36 years old. Now that I understand what a depressive episode is I definitely had severe depressive episodes as early as 17 or 18 years old. From what I know of my history I had at least 7 or 8 major depressive episodes, lasting anywhere from 3-4 months, up to two years before my primary care physician recognized I was depressed and needed a referral to a psychiatrist. I moved around a lot, so I saw many family physicians between 18 and 36, it was my current Dr. who saw I needed help.

I say "fully" treated because between 19 and 36 I saw at least 6 different psychologists. Not one mentioned depression was an illness, or that there were medications to treat depression, or that I was having a major depressive episode.

The first I saw was during my first year of university when I was 19 years old. This psychologist told me my thoughts of suicide were because I did not have a clear "career path". They had me do career testing, which showed the profession I should choose was in the corrections system, that of a "Prison Warden" was at the top of the list. If you knew me you would see that this should have raised red flags. I am so left leaning that I do not even believe in the corrections system. I think this career came up because I was having severe "black and white , all or nothing thinking". Also, my father was a policeman, so I grew up in a world that embraced the corrections philosophy. The psychologist never once explained I was depressed, or that depression was a treatable illness.

Three years later I returned to university. That year I had another severe major depressive episode (MDE). I was suicidal most of the time, had a plan in place, visited the place I was going to commit suicide numerous times, found myself crying uncontrollably in class, was unable to do any assigned work, and was completely distraught for no apparent reason. I am not sure how I managed to take myself to the university's counselling department, but I did. I saw a psychologist who really helped me using cognitive behavioural therapy. She was very helpful, but again never spoke to me of depression as an illness, or told me about medications that might help.

For the rest of University I was well and upon leaving school, desperate for a job to pay off my student loans I took a position in a large corporation. Almost immediately I knew I had done the wrong thing. I did not belong in this kind of job. I owed $30,000 though and I felt trapped by my debt. Problem was, I was good at my job and I kept getting promotions. With each promotion and wage increase it became more and more difficult for me to extricate myself from the organization. Not because I was greedy, but because of my intense need to feel feel financially safe. Also, contrary to reason, with each promotion my self esteem seemed to sink and I feared I would be fired, or would never find another job.

In my 11 years working for that corporation I saw three different psychologists for three separate MDE's through the companies employee wellness program. I did not do well with any of these psychologists. During treatment not one of them mentioned depression as an illness, or that I may have an illness, or that medication might help, despite my repeating my depression history to each of them.

During my fourth MDE at the organization I began having anxiety attacks. I had been an intense "worrier" since as young as I can remember. As early as 9 I used to sneak into our medicine cabinet and take whatever I could find to help me sleep (neo citron, cold medicine, 292's, etc.) I could never seem to sleep because I worried about everything. This was different though, I began to feel like I could not breathe when I was having what I now recognize as anxiety attacks.

I sought out an external psychologist. I saw her for therapy once a week, for two years. It did not help at all. I gave up. Again, no mention of depression as an illness.

I was feeling so desperate. One day I was in a bookstore and was looking at books on the psychology shelves and I stumbled on the book "Listening to Prozac". I bought it and read it. It was the first I had ever heard of depression being a bona fide medical illness. I had never heard of anti depressants. I was dumb founded.

In the book the author discussed a theory about the "kindling effect" of untreated depression. His theory was that with each untreated MDE the episodes become longer, harder to treat and closer together. This has been my exact experience.

Why had no one told me about this? Maybe I was stupid for not figuring this out earlier on my own, but this was before there was really anything being written about antidepressants in the newspapers and the professionals I saw for help never mentioned a thing about medication.

After reading a few more books about antidepressants, some pro, some con, and some by people struggling with mental illnesses, at 33 I went to my family doctor and asked her to give me an anti-depressant. We tried two different ones. They did not help.

I went back to my Family Doctor and she referred me to an outpatient program at the hospital. They had me join a class that taught cognitive behavioural therapy and then had me join a 3 month psychodynamic group therapy group. Despite both groups being taught as part of a psychiatric program there was, from what I recall, NO talk of medications being an important part of fighting depression. At the end of the psychodynamic group I was still severely depressed and quite vocal in the group about having no support once the group ended. The psychiatrist leading the group knew I was still depressed. Yet, no one followed up with me after the group ended.

A few months later I became spontaneously well for approximately a year and a half. I began slipping into a severe depression the summer of my 36th year. I went to my Family Doctor again and she finally referred me to a mood disorders clinic, where I met, and began seeing, a private psychiatrist for the first time. He is and was a godsend.

Now, six plus years into this MDE I'm still searching for something that will help me, but I believe I at least FINALLY, in the psychiatrist I see, have the knowledgeable and completely supportive help I needed all along.

I often wonder, had I received help at 18 or 19, instead of 36, would I be better today? Would I be struggling so hard to find something to help me?

18 comments:

Anonymous said...

Have you tried a light box? I have major depression and am on lithium, quetiapine and Cymbalta. I have been using my light box for a few days and am starting to feel a bit better. Good luck in your quest for better mental health.

Aqua said...

Anon,
Yes I have a lightbox and use it for an hour every single morning for 2.5 years. I don't think it does anything for me, but I like sitting in front of it. The light feel good (I love the sun). They are not cheap and you need to choose the right type of box. It needs to be a 10,000 lux light from what I understand.
...aqua

Anonymous said...

Hello aqua

Sorry your lightbox didn't help. I forgot to mention something else although you probably know about it already. I use VegEPA fish oils from www.vegepa.com. My psychiatrist endorses me using these. I found out about them by a book from an eminent psychiatrist in the UK called Dr Basant Puri. I read his book called "The natural way to beat depression". Its no good buying any old EPA which is why I buy mine from the website. According to Dr Puri the EPA must not contain DHA which many supplements do but not this one. It hasn't cured my depression but both me and my pdoc think it takes the edge off. Its just a thought. I am sorry for your long term suffering.
all the best x

miss mouse said...

Hi...found you through your comment at ShrinkRap. My guess is that you may be one of those folks who is really capable of acting like you have it all together, so you didn't 'seem depressed' to a string of family docs and psychologists.....but in the last 5 years or so there has been so much in the media about depression that it does seem like at least ONE of them ought to have done a good assessment for depression!!! I have MDE, recurrent, (full remission at present thanks to Effexor XR, light box, psychotherapy and bioenergetics) and PTSD, chronic, mostly in remission (because the MDE is in full remission, the PTSD sometimes shows up a bit...for a long while i was too depressed to HAVE any anxiety!!). Anyway, it's a real struggle to sort out what is chemical and what is content when i am down, tho my therapist and i are much better than we used to be. It's tough, tho, and it does take time. I had to switch psychiatrists - just didn't have a good enough connection with the first one I saw in my most recent MDE event, and tho she had started me on the Effexor XR, I didnt get to an effective dose til I got to a psych MD that wanted to hear about my feelings and stress level, not just a checkoff of depression symptoms..
Keep fighting for yourself and if your gut tells you something needs to change, then work for a change - in provider, in drug, in dose, whatever.....you can get better, it is just elusive in a lot of cases. I don't know where you live or your resources, but is it possible to see an MD at an academic setting who is up on current research AND clinical treatment? I chose my current MD for that reason - she is on staff at a psychiatric hospital and can access loads of research, colleagues, therapists, etc.
Accepting that SOME of the symptoms may linger, or flare up at times, has been a better way for me to look at my MDE and PTSD. When I focus on being 'all better', I get into some really negative self talk. This is where the therapy helps more than the meds.Be gentle with yourself, and take good care. Will be thinking of you.

mini uk said...

Hi, I too found you through Shrinkrap, I emapathise a lot with what you say, my history sounds rather similar to yours, has taen me about 19 years(I hadn't realised it was that many years) to find someone who would actually listen to me & not just guess how i was feeling, shame such profesionals seem to be the minority.

Aqua said...

Anon,
Thanks for the info. I do take salmon oil, but I will look into what you describe here.

Miss Mouse,
Yes, I always hid my anxiety and depression under a false bravado of "I can pull up my socks". I did very well in school and at work until this last MDE, it has been so severe I'm not sure how I have managed to remain here. Despite my stiff upper lip throughout the years I did ask for help again and again. I just did not know I should have been asking for psychiatric help, and no one told me that was what I needed.

Sounds like you have had a real struggle too, but also sounds like you fought hard for yourself and are now getting the help and care you need. I'm glad. I am very happy with my pdoc. He used to work at a mood disorders clinic and is very knowledgeable about mood disorder treatments. Also provides therapy for me, and is the best therapist I have ever had. Unfortunately, the chronicity of my MDD, and having an anxiety disorder on top of that, is making it really hard to treat. Today at least, I feel hope.

Mini UK,
I hope you are in good hands now. It is disheartening to be treated the wrong way for so long. I hope all goes well from here on.

Thanks for the comments and support.
...aqua

Cheryl said...

Thanks for being open about your symptoms and illness. I too have been dealing with this for a very long time and the symptoms started (had my first suicidal episode) in college. It gets better then worse and I hate it! Right now I am "having a spell" as some of my family members put it and despite being able to completely convince most people I am OK, I am losing it. It helps to know there are others who have made it through this. Do the episodes come with greater frequency as you get older and is the fight really worth it? I know that sounds bad to say, but I can't help but wonder if being around will hurt my kids more than just not! I had to find a new Dr. and have 10 more days to make it through before I see him. Any suggestions??

I admire y'all who get up everyday and fight the fight--

Aqua said...

Hi Cheryl,
Thanks for the comment. I'm sorry you are having what sounds like a similar difficult time. I see my episodes getting closer together and lasting longer each time I have one. I too can act completely sane around people I need to. At work my boss said she never saw any changes in my work...but the last month or so at work I would just sit there looking at most of my work, not comprehending it or being able to follow through. I would spend a lot of time surfing the internet looking for ways to kill myself.

Even now most people see me as "high functioning" (I hate that term, but don't know how else to describe it). My pdoc has told me to go to the hospital if suicidal...but I know I would show up and despite explaining how desperate I was feeling, somthing in me would project a strong personality and they would send me home...I'd feel completely dismissed and then feel even more at risk of committing suicide. My pdoc has said I could have them call him and he would explain my circumstances. I don't know why, but I feel like that is crossing boundries I don't feel comfortable with.

Cheryl said...

Thanks aqua that helped a lot. I thought I was just the most manipulative person around to be able to convince people I was fine, while all the time wanting to, well, you know the feeling.
I am doing what I have to do to control the anxiety and emotions until the appointment and just pray the Dr. will be a good one. Sounds like we have a lot of common history, is it a fluke or do most people with MDD have similar experiences. Maybe I should find a support group and educate myself better about the disease, but real-life stories like the ones posted here have given me a dose of hope--at least for today!

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