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Re: TREATMENT RESISTANT DEPRESSION » JahL

Posted by sweetmarie on July 29, 2001, at 9:06:05

In reply to Re: TREATMENT RESISTANT DEPRESSION » sweetmarie, posted by JahL on July 29, 2001, at 6:40:06

> We've spoken about this before. I've been classed an 'unhelpable case' by about 6 English pdocs now (& 1 American).

>
> I've heard the 10-15% figure bandied around before. However before (English) pdocs start talking about 'treatment-resistance' they ought to define what constitutes 'treatment'. All the pdocs up to, but not including my present one, have been happy to brand me 'treatment-resistant' based upon non-response to SSRIs, TCAs & MAOIs. Well by my reckoning that would render 30-50% of depressives 'resistant' (ie lack of *remission*).
>
> Fact is only APs & AEDs have helped at all so far & up until a month ago I was forced to order these over the Net.
>
> Then you've got stimulants (which I had to fly to the US to get a trial of) & (more controversially) opioids. Of course there is no way UK pdocs will even consider either of these. But it's beyond me how pdocs can class you as T.R. w/o offering the full range of viable treatments.

> Given our limited understanding of the brain it wouldn't surprise me if there existed a hard-core of 'Untreatables', but like y'self I don't like to be defeatist in my attitude. And I especially don't appreciate defeatism in pdocs, who seem particularly susceptible to it.

Hi Jah

I was wondering about you - glad to hear from you again.

I think that many (most) psychiatrists (and GPs for that matter) from this country are either limited in knowledge, limited in imagination, obstructive regarding patient input, or just plain useless. Or all of the above. This general attitude is one of the reasons behind my decision to write a feature on treatment resistant depression. Far too many sufferers are told that they are untreatable, precisely for the above reasons. What I want to do is to (hopefully) empower other depression sufferers NOT to accept this `diagnosis`. I`m lucky to have a psychiatrist who encourages my input, and also because I`m being treated by a specialist in TR depression (Professor Ferrier from the RVI, Newcastle). HE tells me that he will never run out of treatment options; i.e. there are so many meds/other types of treatment that probability dictates this.

A non-response to TCAs, MAOIs, and SSRIs ought not to render a sufferer `treatment resistant`, as it has done in your case. To me, it smacks of laziness on the part of the psychiatrist.

Medication treatments are being developed all the time, and advances are being made - not fast enough perhaps, but research is continuing. So, I find it very destructive for any psychiatrist/GP to label someone treatment resistant, because it simply can`t be known. And, whilst it can`t be known, it is surely better to remain positive than to tell someone that they cannot be helped.

I`m assuming that APs are anti-psychotics, but what are AEDs? Also, what are opoids?

You are right in what you say about our limited understanding of the brain. But again, this is being looked into more and more, and more and more is being understood. Also, there MAY be a number of `untreatables`, but we don`t know that for sure.

This country in general (i.e. your basic `man in the street`) is largely misinformed, and therefore tends to be wary/downright prejudiced when it comes to mental health issues. Also, the NHS services (treatments, psychiatrists, after care etc.) leave much to be desired. There is a LOT of room for improvement, and ... well, it makes me cross basically, but that`s a digression.

I suppose that part of what I want to do is de-mystify the whole area. I think, anyway.

O well - enough of that.

Thanks for replying. I hope that things are not too bad,

Anna.

P.S. Any further input still wanted. Please ...


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