Posted by bmwfan07 on December 12, 2010, at 16:24:24
In reply to Re: Best starting med for atypical depression?, posted by mellow on December 10, 2010, at 5:24:40
> Welcome to babble and the world of psych meds. You seem very intelligent and well researched.
Thanks!
> Why bother if you don't trust the people you are paying to help you?
You raise an excellent point, one which my parents have reminded me of too. That said, I've had relatively poor experiences with doctors and their often dogmatic approach to what are clearly not matters of dogma, but of improvement of health. Western medicine promotes the idea that the patient knows nothing and the doctor knows all. Unfortunately, the majority of patients don't contradict, rather they affirm, this notion, and the cycle continues. When a doctor gets a patient like me who's a potential challenge to their authority and "omniscience," they tend to shut down and become sanctimonious, sensing a threat to their power, knowledge, and ego. I don't deal well with this, because the primary concern in any health care setting should be the proper diagnosis and treatment of health, not the patronization and submission of the patient.
I'm hoping this new p-doc whom I've set an appointment with is more open-minded and willing to hear me out. He's an osteopath and I've heard they're often a little less conventional, which is always good.
>
> You commented that you've yet to hear of anyone who had success with an SSRI/SNRI for more than 12 months. Honestly, most people don't have success with any variety of these meds for 12 months at a time. No matter if they are antidepressants, antipsychotics, benzos, hypnotics, stimulants, etc. You may make it 3-6 months without seeing your p doc...then you might see your doc 3 times in a month during crisis. Your cocktail will probably change quite often for a few years until you find what works. Your definition of "what works" may drastically change during your journey through this.Unfortunately, that seems to be the case in most people with chronic, atypical depression and bipolar disorder. I think one of the reasons is the widespread misdiagnosis of bipolar spectrum conditions as unipolar major depressive disorder, as well as the lack of differentiation in treatment and understanding between the melancholic and atypical depressive subtypes. The latter seems to correlate with bipolar disorder and responds to similar treatments (dopaminergic drugs more so than serotonergic), but most p-docs simply treat all manifestations of major depression identically. This knowledge gap might very well explain the common SSRI poop-out and treatment resistance so common in depression.
>
> If you aren't sure if you have had a hypomanic episode I wouldn't jump to the conclusion that you are bipolar. I don't mean to sound like a debbie downer but I always warn people that simply starting an antidepressant can quickly turn into a 4-5 drug cocktail and being diagnosed with a "chronic course" disease. You may just have low mood and some emotional problems. It's great that you have a life coach!!! I would utilize talk therapy, moderate exercise, fruits, vegetables, Vitamins (particularly D3 and the B's) and plenty of time with friends/love ones before I would become over dependent on medications.
>
> The ultimate healing experience will come from within. Life is a great teacher, sometimes our worst depressions and anxieties can shapes us into incredibly strong people when it's all said and done. Learning to cope is what it's all about. I hope you hang around babble. There are some cool cats around here. You will be fine. We are all stronger than we think!
>
> peace
>The problem is my depression seems very insidious and fundamentally neurochemical, and does not seem to be responsive to any form of therapy or social interaction (in fact, at times, the latter is far more emotionally painful than isolation). It seems to be fairly severe and, as I mentioned, chronic. It's quite frustrating, because when I'm depressed and I try to get out of the house and distract myself with friends, quite often I feel punished with heightened social anxiety, rejection sensitivity, and a feeling of general misery.
I think when I get the right med(s) to combat the neurochemical element of my depression, I'll be able to tackle some of the more psychological aspects of it--discovering and mitigating triggers, being more socially connected, working on CBT and questioning my beliefs, etc. I think this form of depression really does require a holistic approach, as you suggest; but I have a feeling medication is going to be one of the bigger pieces to the puzzle.
poster:bmwfan07
thread:972935
URL: http://www.dr-bob.org/babble/20101203/msgs/973306.html