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Re: depression, etc. sid

Posted by Elizabeth on February 1, 2002, at 18:41:55

In reply to Re: depression, etc. elizabeth, posted by sid on January 30, 2002, at 23:56:59

> Well, we agree then. I was under the impression that you were against therapy after reading a few comments you wrote.

I'm not terribly impressed with it (CBT in particular), but I don't think that it's bad or useless.

> 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.

I think that CBT makes implicit assumptions about why people get depressed, or have panic attacks, or whatever. (It's unfashionable for therapists to admit this, of course; they claim to be interested only in fixing the problem, not in knowing the cause.) And I don't think that these assumptions apply to everybody.

> I guess I was so traumatized by my major depression that I am doing all I can not to have it again.

Believe me, I'm doing everything I can, too -- but that doesn't mean I continue to do things that are ineffective! (If what you're doing isn't working, find something else -- you learned that in CBT, right? :-) )

> 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.

That's reasonable, although I'm wondering what you read that seemed to rule out certain approaches. I remember people posting things that they found harmful or unhelpful about CBT, but I don't recall anyone saying that it's not even worth trying.

> Although I went through a number of therapist because it did not work with some of them (one especially).

Heh. :-) I think that finding a therapist who's a good match is essential to any kind of talk therapy. It's important to be able to work with a medical doctor, too, but you really have to "click" with a therapist, IMO.

> 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.

That's very true, and it's one reason I'm not impressed with the attempts that have been made to test psychotherapies in clinical trials. (There are a lot of design issues as well.)

> Well, I'm not up to date in my depression vocabulary.

You can still say how you feel, though, right? :-) I was curious about the quality of the residual depression/anxiety.

My residual symptoms have to do with a sort of general emotional "dulling" (no, it's not medication-induced). I have trouble enjoying things, and I seldom feel very motivated or energetic. I also can't concentrate very well. Buprenorphine helps a lot with these problems.

BTW, 75 mg of Effexor is at the low end of the therapeutic range. The threapeutic range is quite wide -- I'm taking 225 mg/day, with a target of 300 or more.

> My doc also diagnosed my me some anxiety problem, hence her choice of Effexor.

Generalized anxiety disorder, maybe? Paxil is labelled for that too, and I think pretty much any of the new ADs could get approved for it if the drug companies wanted to get them approved. Generalized anxiety overlaps a *lot* with depression, and most depressed people (including dysthymics) have some anxiety.

> 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.

Well, what's done is done; you seem to be doing pretty well, so I wouldn't worry about it. I'm glad things seem to be working so well for you -- a lot of us aren't so lucky!





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