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Re: depression, etc. elizabeth

Posted by sid on January 30, 2002, at 23:56:59

In reply to Re: assumptions elizabeth, posted by Dr. Bob on January 30, 2002, at 18:59:24

> > It is possible for people who are in talk therapy to recognize why it may not be working for them (often, as has been mentioned, because they're just too depressed) and decide to pursue other forms of talk therapy (e.g., psychodynamic psychotherapy instead of CBT) or that talk therapy in general isn't likely to help them (or that they need to wait until they're less depressed, for example). In contrast, we can't see what's going on in our brains at the molecular level, so we don't have a way of evaluating what medication is most likely to yield success, or whether medication is likely to help at all. I hope this illustrates why people feel justified in making a decision to pursue psychotherapy or not but can't be certain that medications will or will not work for them without trying them (it's a mixed blessing that there are so many of them to try these days). I also think there are things that we don't understand about how talk therapy works (although in this regard CBT is probably the most simplistic type of talk therapy), so it's not necessarily a good idea to rule it out altogether.

Well, we agree then. I was under the impression that you were against therapy after reading a few comments you wrote. We still know little about therapy (its effect on depression and why or how it might have an effect) and about meds and other alternatives as well. Depression itself is not well well yet. I guess I was so traumatized by my major depression that I am doing all I can not to have it again. I used therapy (CBT + other unidentified types - if it made me progress, I did not worry about what exactly it was) and acupuncture at that time. Both helped me and now meds seem to work too (for dysthymia), so in my experience, having tried different approaches to heal was a good thing. So when I read comments that seem to rule out some approaches altogether (not saying you did), I feel the need to say that many things did help me and that perhaps one should consider different things in order to maximize the probability of healing.

I realize I was lucky that it all had some positive effect. Although I went through a number of therapist because it did not work with some of them (one especially). Finding the right person and the right approach for oneself can be long and costly however. Same thing with the acupuncture. I moved away and have not found another acupuncturist that could treat me the same way. The first one I had made a difference in my major depression, and she could help with what I now know is anxiety. Whenever I was too stressed out to function well, her treatments would help tremendously. But I am still looking for another acupuncturist in my new city. That's one advantage of the drugs: Effexor XR anywhere is the same. Other approaches vary greatly because of the human contact and the ability of the service provider, and so they are difficult to assess and compare with drugs or with each other.

> > > So I decided to try meds for the residual depression. As it turns out, it seems I have an anxiety disorder, and my doc is not convinced that I still have depression.
> >
> > What sort of residual symptoms do you have? Residual depression is by its nature hard to treat, since it's the part of the disorder that doesn't improve with the treatment being utilized. I think that it often requires some creativity to treat residual symptoms.

Well, I'm not up to date in my depression vocabulary. I've had dysthymia for 21 years, and that's what I think I still have. I have no symptoms of major depression anymore, but there remained a deep sadness in me that I could not explain. During my major depression I read about the different types of depression and realized I had had dysthymia for a long time. In my case, therapy and acupuncture did not cure the dysthymia. Now meds seem to be helping, even though I am not yet at a supposedly effective dose (75mg Effexor XR a day). I don't feel sad anymore and a specific irrational negative attitude (thought and feeling, strong reaction) I've had for a long time have decreased in the past 2 months. So it seems the meds are helping already. The info I've read on effective doses of Effexor XR were for major depression, so for dysthymia perhaps it takes less? I am not sure. My doc also diagnosed my me some anxiety problem, hence her choice of Effexor. I am not sure what the exact diagnostic would be, but indeed, I freak out more often than most people, sometimes about nothing. I did not know about the anxiety before. I am taking yoga too now to help with it, and as a long run investment for the future stressful times of my life.

I've had dysthymia for so long that I am not sure if I can ever heal from it, but I hope so and I am doing all I can to be mentally healthy some day, hopefully without meds, but with them if need be. Plus I want to do all in my power to avoid recurrent major episodes because I am not sure I could live through it again. I am not sure I would want to either. My desire to live is conditional on my metal health at this point. I can't imagine living the never ending lightless pit that depression felt like.

> > > I did a test the other day and ranked very very low for depression and high for anxiety.
> >
> > Which test was it? IME, the results of self-report rating scale tests can be misleading. Self-report is important, but it's only one tool in making a diagnosis. Sometimes people's answers on these tests can be misleading. For example, I've noticed that some people with dysthymia seem to exaggerate the severity of their depression. (This is understandable, since dysthymia is chronic.) A problem I sometimes have in trying to answer questions on diagnostic questionnaires is that I tend to take the questions on these tests more literally than they probably were intended to be taken.

It was an informal test on, nothing formal. It pointed out which parts of my brain could be problematic and what it means in term of illness or disorder. I ranked "may be possible" for limbic system hyperactivity (associated with depression) and "probable" for basal ganglia hyperactivity (associated with anxiety disorders). All other categories were rated "not probable." I realize it is not a comprehensive test, but it is in line with how I feel these days.

I wish I had taken meds before as I think my major depression would have cleared faster and I would possibly have lessened the likelihood of recurrence. But I made the choice not to take meds at the time because I was too scared of them. I looked for more info since then, and I decided to try them for the dysthymia.




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