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?
