Asked by Shelly, Memphis, Tennessee
I have been treated for depression since I was 8, and I am now 30. I have tried numerous medications along with a ton of therapy. I am also a recovering alcoholic who is working the AA program. My problem lies in the fact that I am extremely sensitive to medications and of the 30+, I still have yet to find something that actually works. Lexapro seemed to work for a while, but I changed due to the sexual side effects being a problem. When I tried to restart taking it, I was overcome with anxiety. I was also taking 50mg of Serzone if that makes any difference. I am currently taking Prozac-5mg, Serzone -50mg, and Klonopin as needed (reluctantly, I might add). I am hesitant to try electroconvulsive treatment, but I am at a point where I am desperate. The depression interferes with every aspect of my life and makes it difficult to fully live. I feel as if I am merely surviving in this world. I don't know what else I can do. Do you have ANY suggestions? I have a great therapist, doctor and sponsor. My patience is wearing very thin. I just want to be content in my own skin. Please help!
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
I know it doesn't help you to hear that I see people in your situation all the time, but it is true. One of the most devastating things about major depression is that it is so often not fully responsive or is completely resistant to our current treatments. And I can't tell you how many people I've seen over the years who find themselves unable to tolerate most (or all) antidepressants. Sadly, data support my own clinical experience. Thirty to 40 percent of patients don't get a full response to any given antidepressant, and 10 to 20 percent of patients will not respond to anything at all.
Not knowing anything about your case other than your question, I can only give general thoughts about how you might proceed. The first thing I would wonder about in your case is whether you might have bipolar disorder (i.e. manic depression) instead of regular old depression. The fact that you have been depressed since you were 8 years old and the fact of your alcohol addiction both point slightly in this direction. Bipolar disorder is distinguished from depression by the presence of episodes of either elevated mood or intense irritability that alternate with depressions. During these elevated periods, people often need less sleep, take inappropriate risks, talk rapidly, become hypersexual. Sometimes people will have depressive and manic symptoms all mushed together, such that they are miserable and agitated and grandiose and terrified either all at once or in rapid succession.
Many patients with bipolar disorder do not respond well to the types of antidepressants you have tried but do much better on drugs known as mood stabilizers. Examples of these types of medications include lithium, Depakote, Tegretol and many of the newer "second-generation" antipsychotics such as Zyprexa, Risperdal, Seroquel, Abilify and Geodon. You would have to get a full examination to determine whether you are better thought of as having bipolar disorder, but even if you've only had depressions, increasing evidence suggests that the second generation antipsychotics also work as antidepressants (Seroquel is close to getting FDA approval as an antidepressant). Because they have different side effects from the medications you list, they might be worth a try.
ECT is short for electroconvulsive therapy. Nothing in all of psychiatry has a worse image than ECT -- if you're old enough remember the last scene in "One Flew Over the Cuckoo's Nest," you'll know what I'm talking about. On the other hand, nothing works better for depression, at least in the short term, than ECT. I have been involved in hundreds of ECT cases, and I have seen miracles. As it is delivered in current practice, it is quite tolerable, with memory loss being the primary problem. Almost always, people's memory returns to normal after the treatment, but there have been occasional reports of long-term memory loss.
My final word of advice is not to give up. I know how hard it is to hang in there when nothing seems to take away the pain, but I have also seen many patients who failed all sorts of interventions before they found the medication or combination of medications that they could tolerate and that really made a difference in their lives.
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