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Depression Series: Why Don't I Respond to Medications? (Part 1)
Maria has been feeling depressed for at least two and a half years. About three years ago, her husband of 20 years left her for another woman. Devastated, she became despondent and tearful almost daily. Eventually, her depression got worse associated with inability to function. Her appetite, energy, concentration, and sleep became impaired. She also felt hopeless and suicidal. Her psychiatrist put her on a starting dose of antidepressant. She responded initially but after a few days, she felt just like before taking the medication. For the past two years, Maria has tried four types of antidepressants. She has taken the usual adult doses of these drugs. Although she somewhat improves, she has virtually remained the same - depressed and disabled. Maria seems to be taking the medications regularly. But why is she not responding to her antidepressants? Maria is just one of the many depressed individuals who don't feel "normal" despite treatment. Depression is a treatable disease but how come some people don't do well on medications? There are many reasons why depressed patients like Maria don't improve on antidepressants. First, is the diagnosis correct? Depression can be caused by many clinical entities. Sometimes, knowing the right diagnosis is a challenge. Medical disorders, medications such as beta-blockers and benzodiazepines (e.g. clonazepam), and various psychiatric disorders can cause depression and they all require different treatment. If your doctor fails to identify and treat the true cause of your depression, you will remain depressed despite the use of antidepressant. Second, are there co-morbid disorders? Depression can exist along with other psychiatric disorders such as anxiety disorder, alcohol or drug problems, personality disorder, dementia, and psychosis. Depression will persist if these co-morbid disorders are not treated. For instance, depressive disorder with psychosis cannot be adequately treated just with antidepressant alone. You need an antipsychotic drug added to an antidepressant to treat the illness. Third, is there an ongoing neurological or medical disorder that precipitates, aggravates, or complicates depression? Hypothyroidism, hyperthyroidism, vitamin B-12 deficiency, pancreatic cancer, brain tumor, Parkinson's disease, and stroke can all cause depression. If any of these disorders are present, antidepressants are less likely to help. The goal in these situations is to treat the underlying medical condition. A 65 year-old lady came to see me complaining of severe depression. On evaluation, she disclosed that she had been on three types of antidepressants for the past four years with minimal response. I checked her recent laboratory results which showed an abnormal thyroid! No wonder, she was not responding to the medication. Fourth, are there ongoing psychosocial issues? Financial problems, family conflict, work-related stress can all precipitate and complicate depression. Despite adequate medication treatment, some individuals will remain depressed especially if such problems are not addressed by the therapist or psychiatrist. Is there any way you can reduce the stressors? Please do so the earliest you can. The treatment of depression is frequently straightforward. Occasionally however, various factors complicate it. For antidepressant to be effective, a psychiatrist should ensure that the diagnosis is correct, that co-morbid psychiatric disorders and medical problems are treated, and that psychosocial issues are adequately addressed. Maria's doctor should explore further the real problem and provide the most appropriate intervention. About The Author Copyright © 2003. All rights reserved. Dr. Michael G. Rayel author (First Aid to Mental Illness?Finalist, Reader's Preference Choice Award 2002), speaker, workshop leader, and psychiatrist. Dr. Rayel helps individuals recognize the early signs of mental illness and provide early intervention. To receive free newsletter, visit www.drrayel.com. His books are available at major online bookstores.
At the UW: Understanding our lean times by studying the real hard times - Seattle Post Intelligencer
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Alternative Medicine Depression: 14 Universal Laws for Recovery The Law of Blue Beating Stress, Anxiety and Depression Why are these illnesses on the rise? And why do some people become so ill through these illnesses, they can find it hard to function? Major Symposium About Vagus Nerve Stimulation & Depression at the American Psychiatric Association A major symposium about vagus nerve stimulation as a treatment for chronic or recurrent depression will be presented at the American Psychiatric Association's Annual Meeting in May. This is the largest gathering of psychiatrists in the world and over 25,000 psychiatrists will be in attendance. Antidepressants 101- What You Absolutely Need to Know Introduction What's The Latest on Suicide Risk and Antidepressants For Children? FDA confirms some antidepressants increase suicide risk in some children. In February of 2004, two advisory committees of the U.S. Food and Drug Administration recommended that the FDA warn practitioners about the possible risk of suicide potential associated with antidepressant treatment in children. The information was obtained from clinical trials of medications with children, expert witnesses on suicide research, testimony from families of suicide victims, as well as from those whose children had benefited from antidepressant medication. Depression: Based on a True Story "Ring, ring." The crisis operator answers the phone to a woman pleading to let her daughter know that she loves her. The woman spent her day writing letters to friends and loved ones, expressing her thoughts and emotions. From the loaded gun on the table to the rope hanging from the attic, it was a well-thought out plan (Lewis, Pamela, 2003). How to Get Rid of Your Worries: 5 Golden Rules and a Warning Suresh was a worried person when he came to me . "Sir what if I don't get placement I feel that I will fail in the coming exam. I don't know how my family will face this!" It seemed to me he was imagining all problems and getting very much worried!! This is the case of many of us; we keep worrying about events that have only remote possibility to happen. Once a friend of mine put on footwear and later knew that a dog may have bitten it the day before. The moment he knew it he began to worry; what if my leg had an unseen wound and the dog was a mad dog? Added to this was the doubt what will happen if he takes a vaccination and there is a reaction to it? Finally he had to consult many doctors to convince that he was worrying for nothing!! In this short article I try to give five methods to avoid unnecessary worries. New Treatment for Depression to be FDA Approved by Late June With the next few weeks, the FDA is expected to issue its final approval of vagus nerve stimulation as a treatment for chronic or recurrent depression. The approval of vagus nerve stimulation will be the first ever FDA approved long-term treatment option for the four million desperate Americans( and their families) who have not had an adequate response to traditional anti-depressants. Depression is Underdiagnosed in College Students Everyone feels down or blue once in awhile. Especially during difficult times, it's normal to feel sad or discouraged. But when those feelings persist for two weeks or longer, it could be depression. It's a common illness that affects an estimated 19 million Americans-that's nearly one in ten! It's also one of the most under-diagnosed illnesses on college campuses. The symptoms can come on so slowly that one day, a person realizes that he can't remember the last time he felt good. Here are some warning signs for depression: Depression Many of us feel depressed at one time or another, but for some, depression may be chronic and even debilitating. The Formula for Preventing Depression While it is arguable that depression is not always preventable, there are many cases, when using the following ideas, will keep you in good spirits - most of the time. Unfortunately, we cannot be happy all of the time, but there is something we can do about it. Mood Disorders And Depression We all suffer with bad moods from time to time. But if you are someone who is in a bad mood or depressed much of the time, take heart. There are natural remedies to help with balancing your mood disorders. How To Help A Stressed Or Depressed Loved One Having lived with a depressed partner for 3 years and suffered anxiety and depression for 5 years, I've experienced both sides. In this article, I'll show you exactly what you can do - and, what you shouldn't do - to help your loved one. Depression is a Choice There is one very simple reason for all emotional depression. Do You Think You Have Depression? Do you have days where nothing can make you happy? You are not alone. I ignored my depressive thoughts about life for years. Unfortunately I did not do anything to fix my situation until they became so dehabilitating that I had no choice. Know the Signs of Depression and Improve Your Life Typical signs of depression actually show a change in the way a person has come to think about himself. What's Causing My Depression and Fatigue? Chronic Fatigue and Chronic Depression are absolutely systemic in our society today. Recent studies done by the AMA and CMA purport one in four people in North America are suffering from some form of chronic fatigue or depression and it's expected eight out of ten of us will experience similar afflictions in our lifetime. But numbers like these don't speak to the cause and only tell half the story. Surviving the Storms of Life August in Florida has a daily ritual that Floridians take with a grain of salt. It's the daily storms that pass by and that are filled with more electricity than in a 4th of July fire works display. It's no wonder they call Florida the "Lightening Capital of the World". Because rain clouds can be literally feet away from you and dump a huge storm on the people across the street and meanwhile your side of the street remains dry. It just depends on where you are located at the moment to the degree you get rained upon. Efficacy and Safety of Vagus Nerve Stimulation for Depression Published in Journal On September 1st, the efficacy and safety of vagus nerve stimulation for depresssion was published in the prestigious peer reviewed journal of Biological Psychiatry. Learn To Take Control of Depression While depression is a growing epidemic in western society, it remains to be one of the most treatable as well. While the medical profession looks first to medication, I believe only the most severe cases require any long-term medical treatment.
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