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Expert Q&A

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What can I do if nothing is helping my depression?

Asked by Dan, Chicago, Illinois

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What else can I do? I have tried antidepressants, therapy, cognitive behavioral therapy, rational behavior therapy, dialectical behavior therapy, acceptance and commitment therapy, a treatment center in Arizona. My kids are now 11 and 10. I feel like I have missed their entire lives. My wife is fed up. I joined Alcoholics Anonymous in 2004. That is not working, although I'm not drinking ... no serenity, no peace, no happiness. House has been on the market for a year. Job is miserable. One doctor says, " No meds." Another says, "Go back to a treatment center." Another says to "do my dishes." I feel so lost. ... 40 years old and I'm at the end of my rope. Please help.

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Dan,

The writer in me greatly admires how succinctly and eloquently you've laid out a life of difficulties and the failure of various therapeutic modalities to help you much up to this point. I don't have any magic answer to your request for help, which is exactly why I wanted to address your question today.

There are no conditions in the world more painful than psychiatric illnesses. Although they can vary greatly in symptom presentation, they share that one trait: They mainline misery. So it is not at all surprising that many people express genuine desperation when they write. What has surprised me, however, is how often people ask me to provide concrete aid, to somehow be the therapeutic presence for which they've searched in vain.

When I read a question, or in this case, a comment, like yours, I wish I had the capacity to actually help you. But all I can offer in a blog like this is information, a little advice, occasional cautionary statements and hopefully a fair amount of encouragement. I can't really tell anyone what to do or solve anyone's problems. For one thing, I don't know anything about folks who send questions, other than the few sentences you provide me.

Your situation is typical of all tough psychiatric cases in that if the problem were easily solvable, you'd have solved it. I think that is an important first point to realize. While there is always hope for improvement, there may be no single magic bullet that will solve all your issues in one fell swoop.

I know of three things that most often help people struggling with depression and addiction. These are medications, a strong therapeutic relationship and changing one's lifestyle. Let's go through each of these.

If you'd found a medication that really resolved your depression, you wouldn't be writing me. On the other hand, many people get some benefit from antidepressants, even if they don't get a full resolution of their symptoms. If you have had this experience you have two choices. You could return to a medicine that helped at least a little bit in the past, or you could try a medication or some combination of medications you haven't tried yet in hopes of finding something more effective. I'm not sure which is a better strategy in your case, but I'd recommend choosing one of these options, given the despair you voice.

You mention a number of psychotherapeutic modalities that you've tried. But what I don't hear is whether you've ever made a connection with a therapist that really effected change in your life. The older I get, the more I believe that this type of therapeutic relationship is really primary in most psychiatric treatment settings. And data support this. A study from the National Institute of Mental Health found that the most powerful predictor of a good outcome in the treatment of depression, more powerful than medication or the type of therapy employed, was the strength of a patient's positive relationship with his or her clinician.

If I could give you just one piece of advice, I would strongly encourage you to go in search of a clinician/therapist with whom you feel connected enough to do the deep work that will likely be required to help you understand and change why you feel so empty in your life. Countless times I have seen people make transformations when they enter into a therapeutic relationship that works for them. The changes aren't easy, they aren't perfect and they don't occur overnight, but they are real, and they really help. In your case, it is clear that you have gone to many doctors, all of whom have given different and perhaps conflicting advice. What is needed is for you to find one clinician/therapist that you can make a longer term commitment to seeing.

Finally, we know from many studies that there are a number of lifestyle factors that help reduce depression, and I often write about them. I usually mention diet, exercise and sleep. In your case, there is something in your comment that makes me think you might also benefit from taking on the hard task of trying to change your thoughts in a more positive direction.

This is not easy and it doesn't come naturally, but it can be very effective if one is willing to do the hard work. I have seen this in many patients, who made a commitment to challenge their negative feelings and impressions of the world. At first it requires brute force, but over time the ability to look at things more positively and to begin to feel gratitude for what one has, rather than longing for what one lacks, becomes more natural.

In your case, you might start with your two children. Rather than letting your feeling that you've missed their entire lives add to your misery, why not make a commitment today to begin to do little practical things to get more involved with their lives? Even if you don't feel connected, do things that will connect you, and over time this in itself might offer a potential path forward toward a more emotionally satisfying life.

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