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Dr. Andrew Rynne

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Suffering from depression. Not cured by medicine. How to get rid of this?

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Dr. Simmi Kumari

Psychiatrist

Practicing since :2005

Answered : 88 Questions

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Posted on Sat, 16 Mar 2013 in Depression
Question: Hi. I've had deppression all my life but didn't get diagnosed till i was 14 years old and that was by an school psychologist but i didn't start taking medication till i was 18 because my parents were reluctant of following the advice of that psychologist that was that i would benefit from psychotherapeutic invernetion. i'm 29 years old now and have been through 4 psychiatrists and seeing them didn't work neither did the medications that they tried on me. my deppression is causing me so many other medical problems (nail psoriasis, goitre, thyroiditis, elevated creatinine, dehydration) what should i do? how should i get rid of my deppression. is there a chance that it'll totally go away?
doctor
Answered by Dr. Simmi Kumari 12 days later
Hello XXXXXXX
You have mentioned that you have felt low throughout your life and diagnosed with depression at age 14. You initially been treated with psychotherapeutic methods and after age of 18 you have shown to 4 psychiatrist who have tried you on some medications also.

Listening to your history it appears That you had dysthymia and later on developed depression , so can say that you probably suffered from a clinical entity called Double Depression.
Now for this illness there are few facts which you should know.

Firstly the prognosis for it is not very good and it's more of a chronic illness
Secondly For this treatment is possible but strict adherence to the regime is required. If you frequently discontinue the medicine than you may not be able to get full remission and thus you get dissatisfied with the treatments
Thirdly sometimes combination treatments are required for such illness , means both pharmacotherapy and psychotherapy .
So keeping these fact in mind you can evaluate yourself and where ever is the flaw in your treatment can modify it and get the results.
I would suggest that there are various modalities of treatment in the field of psychiatry that can be used to treat depression , so just don't get disheartened and keep trying with your psychiatrist for your treatment. Adherence to the treatment advices is a must for you .
As far as your mention about your co morbid condition it appear that your depression may be secondary to the medical illness and not the other way round as you are thinking.
It's been well know to have mood disorder in thyroid abnormalities and with psoriasis as well. I would like to suggest you , that take treatment for them and with that your chances of getting better increases manifolds .
It's been well documented that improving thyroid function make treatment resistant depression to respond.
I hope I have answered your query and wish you best of luck
Take care

Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Simmi Kumari 5 hours later
hi thanks for your response. i'm not on medication for my thyroid. it was turning normal in blood tests in my family doctor's office and by the time i saw an endocrinologist it was too late for further tests so he didn't request them and my thyroid balanced out shortly after that day. but i developed other medical problems after that. and now some doctor's say that they believe that my thyroid will get hypoactive in the future considering it's history. i won't take psychiatric medications anymore. i'm scarred of trying other ones after what i went through with the last combination that i took. it was a combination of effexor xr 150mg, remeron 30mg (as far as i remember, and concerta 54 mg. it caused serious side effects and after years of not taking them i'm still suffering from their withdrawals (neck discomfort and etc). what should i do? do you think that my deppression will go away someday?
doctor
Answered by Dr. Simmi Kumari 39 minutes later
Hello , it's good that your thyroid level are in normal range but you need to follow up regularly for that as hypothyroidism is also very bad for patients of depression. Patient sometime respond well to treatment for depression with mild augmenting dose of thyroid hormone.

As far as you treatment is concerned you have been on many antidepressants but you left them due to side effects. My advice is you should have consulted your psychiatrist before making this decision as most of the side effects of these drugs can be managed and if not, then you could have received another medicine and would have responded.

It appears that you become non complaint to treatment easily and may have developed resistance to treatment due to poor treatment adherence.

Instead of deciding to quit, better consult your psychiatrist soon and you should start your treatment. Ask your doctor to start slow and and you be patient in the mean while so that doctor can slowly titrate your doses and remain free of side effect with gradual improvement of your symptoms. Patience with treatment will provide you with benefits you are looking for and I m hoping you will be happy soon.

Take care
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Simmi Kumari 23 hours later
thanks but there's no way i'm gonna try antideppressants again. i got the serotonin syndrome while taking the effexor xr 150mg, remeron 30mg, and concerta 54 mg. it's been 7 years that i'm off this comibnation and am still suffering from it's withdrawal. even if my psychiatrist recommends another medication i wouldn't listen to her. i've been through 4 psychiatrists and now i just see one for psychotherapy. there's no way that i'll try another psychotherapeutic medication atleast not till these withdrawals go away and i see how i feel after it. my psychiatrist knows that i'm off these drugs. i called them and told them that i wanted to stop. and because of what i'm going through i'll not try another psychotherapeutic medication.
doctor
Answered by Dr. Simmi Kumari 11 hours later
Hello,

Thanks for reveling your thoughts about psychotherapeutic agents

I would like to tell you that you may have had a serotonin syndrome , you may have been through lot of distress; but by any mean I don't think you could have it, 7 yr after discontinuation of treatment. Also there are so many anti depressants that do not cause serotonin syndrome at all.

As you have mentioned you are taking psychotherapy sessions and not able to completely relieved by them alone than you are left with options of either antidepressants or other modalities of somatic therapy like rTMS or ECT.
Now it's your choice that you should give another trial to antidepressants or not.

One thing more, you may have developed phobia of medicine as your anxiety symptoms also appear to be prominent and your complete avoidance of antidepressants in this duration.along with your complaint of persistent of serotonin syndrome which may be in actual your anxiety symptoms.

I hope you discuss in detail with your psychiatrist all your worries and let them know your feeling about anti depressants so that they can tell you in details about all the options available and also modify treatment by psychotherapy in view of your probable phobia.

I wish you luck and advice to be as true to your doctor as possible for your own good. I shall be please to support you online through this forum at all times.

Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Simmi Kumari 13 hours later
i no longer have the serotonin syndrome but its been seven years that i've stopped the medications and am still going through their withdrawals, such as neck discomfort.
doctor
Answered by Dr. Simmi Kumari 39 minutes later
Hello. My say in response to your statement is, that you are having some symptoms which need treatment.

No one can have withdrawal after 7 yrs. It is just some symptoms of your whole illness, which need to be corrected.

As they are not getting relieved, you are attributing it to the medicine. These symptoms may have started after using your medicine in past, I m not denying to that. But it cannot continue after stopping medicine for this long..so better state them part of your syndrome and start with treatment for the same.

Take care

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Simmi Kumari 9 hours later
no the neck discomfort and stuff (withdrawals of the antideppressants that i was on) is gettting better but it's taking long to go away that's why i'm sure that they were caused by the medicine that i was on. that's why i'm not going to try another antideppressants. 7 years ago when i stopped those drugs and these withdrawals kicked in they were bothering me so badly to the point that most of the time i was unable to keep my head up but now i can and don't feel these withdrawal side effects most of the time. it's like a roller coaster, the discomfort comes and goes.
doctor
Answered by Dr. Simmi Kumari 12 hours later
Hello, I know and agree that you had withdrawal symptoms which are more or less resolved. But question here is , that you are undergoing psychotherapy session and not completely relieved, you don't want to retry antidepressants and you have not discussed other somatic methods which I explained previously with your psychiatrist, so how do you expect to get better.
You have to choose among the available treatment modalities if you want to improve and have faith, because hope increases your chance of improving markedly. Also you take treatment for your comorbid illness,it's improve your prognosis.
Take care
Above answer was peer-reviewed by : Dr. Prasad
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