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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Simcha on June 12, 2004, at 23:45:22
Fellow Psychobabblers,
I've been posting for some time. I think I'm relatively experienced in dealing with my condition. My diagnosis currently is Major Depressive Disorder with Recurrant Features. Basically this means that I have a 99.9% chance of suffering another Major Depressive Episode in my lifetime.
Currently my treatment is twofold. Psychotherapy and medication. I take the following:
Celexa 40mg. daily in the morning.
WellbutrinXL 300mg. daily in the evening.
Neurontin 600mg. daily in the evening.I can take more Neurontin if I feel I'm experiencing anxiety or if I experience difficulty with bruxism. Also I can take Ambien 10mg at night if I have some insomnia.
Now, I've been relatively stable for over three years now. I did have a brief episode at the end of last year. The pdoc increased and changed the formulation of my Wellbutrin from 200SR to 300XL.
I'm in grad school and I work full time with Severely Emotionally Disturbed children as a Mental Health Counselor.
What gives me pause is the following. Whenever I've shared my diagnosis with a professor they are always amazed that I'm so functional. They ask me what I'm doing to treat such a "serious" condition. They wonder if I should seek deeper psychotherapy in order to one day live med-free.
I try to explain to them that I was in psychotherapy for roughly seven years and in twelve step groups of various kinds for over four years at the time I finally gave in and sought medical help. I thought that I could have this treated without medication. That proved to be untrue.
I sought the help of my general practicioner at first. He put me on EffexorXR. Once I got up to 150mg. and I was on it for about six weeks I experienced the first morning I ever experienced without depression. I knew because I woke up finally wanting to be awake and alive. It was like a veil had lifted. I don't ever remember waking up feeling like I wanted to be awake and alive, even as a child.
Now, I've received treatment from two different psychiatrists. Effexor had some unpleasant side effects even though it was effective in treating my depression. I shared with both psychiatrists my history and my family's history. There is a history of severe mental illness on my father's side and there is a strong history of depression and anxeity on my mother's side. Both psychiatrists have told me that they believe that my depression is genetic and that I've been depressed for most of my life. We've been able to isolate at least six discrete major depressive episodes in my 34 years of life.
I find myself lucky. The medication I take is remarkably effective. I've always been a very highly functional person. During periods of severe depression my quality of life suffers greatly. The major depressive episode before I sought medical treatment rendered me unable to function even though I avoided having to go to the hospital.
I have never really contemplated how serious my condition is. I've always poo pooed other people's reactions to my diagnosis. Somehow I've always been able to cope. I am a true survivor.
Now, I find myself questioning this. I've had at least two professors, who I really respect, tell me that my condition is very serious. I've had one at least tell me that perhaps psychoanalysis might help me to be able to get off of the medication.
Somehow this scares me. I remember what life was like without medication. It was not fun at best. It was terrible and almost unliveable at worst. I don't like the prospect of having to take medication for the rest of my life. It's a hassle. I need to keep track of all of the prescriptions. I need to keep appointments to get refills. I need to remember to take the medication continuously or it doesn't work. I also need to keep all of my psychotherapy appointments in order to keep my mind clear.
This is a lot of work. It would be nice to find something, like psychoanalysis, that would cure me. Both psychiatrists have told me that the medication is not a cure. They have maintained that I need therapy and that I need to do all that I do to remain mentally fit. Now, if there is a psychotherapy that can promise to cure me, I'm game.
Well, also I really don't believe that there is any talk therapy that can cure me. That the medication was the only thing that put me over the edge into remission tells me that there is at least a cause that is organic for my depression. If I stop medication, won't I be missing part of the treatment?
Geez, I'm not so sure. Can anyone out there relate to anything that I'm saying? Does anyone out there know that they need to stay on medication to be well for perhaps the rest of their lives? Has anyone wrestled with this like I'm wrestling with it?
I'd appreciate anyone's wisdom.
Thanks,
Simcha
Posted by harryp on June 13, 2004, at 0:12:57
In reply to Am I in Denial? Complete Treatment for Depression?, posted by Simcha on June 12, 2004, at 23:45:22
Maybe I can help. I have been getting analytic therapy (from a trained psychoanalyst/MD) for years, and the best thing I can say about it is that it is truly great education.
I respond strongly to other people's emotions, and learning more about my own emotional reactions has make me much more effective as a friend and in understanding other people's (and my) motivations. Frequently, when people are mean or offensive, I can figure out why, and realize that it has nothing to do with me at all.
However it hasn't done squat for my chronic, often totally debilitating depression, which has made a train wreck out of my educational, personal, and professional goals for over a decade!
Last year I went into "end-stage" so-to-speak, and scared my doc into offering a MAOI (huh? Aren't those the awful old drugs that kill you on the first dose?). To his and my surprise, the blasted thing wiped out my depression almost completely with NO side effects worth mentioning! I'm back in grad school and life is definitely NOT wonderful, but I can get up in the morning, so at least there's hope.
In short, therapy and meds can wind up being equally essential. I don't think I could have survived without either. The therapy made me stronger, but you can't beat depression with strength. I don't know if I'll need to be on meds for life or not; the brain never stops changing in response to the environment, and when my life gets better I may be less suceptible to depression.
So you should do what works. Your profs are right--your condition is very serious, but it sounds like you are dealing with it admirably. Psychoanalysis can sometimes truly "cure" things (like mild personality disorders and neuroticism) but expecting it to make severe depression vanish permanently is probably not reasonable.
In summary, I think anyone who does therapy could benefit from analytic therapy for its own sake, but you definitely shouldn't expect it to make your medication unnecessary.
Posted by Racer on June 13, 2004, at 9:13:47
In reply to Am I in Denial? Complete Treatment for Depression?, posted by Simcha on June 12, 2004, at 23:45:22
You're not in denial. And the fact that you are so highly functional should tell you something pretty important about the treatment course you're on, right? After all, if you can work with severely disturbed kids, you are very, very highly functional.
The first time I went on anti-depressants, I was in therapy. I'd been in therapy for a couple of years, and we hit The Hard Stuff in a big way. My depression got much worse, and I couldn't get past the block to work on the hard things we were facing. After spinning my wheels for a while, feeling really wretched, my primary care doctor sat me down and told me that I was depressed (really?) and sent me to a psychiatrist for an anti-depressant. That drug gave me what I needed to work past the block in therapy.
Unfortunately, my therapist was anti-drug. She kept saying that any gains I made in therapy while on drugs were false, because the drug was a crutch. She was rabidly anti-med. And she's not the only therapist I've met who has that idea. My own personal theory is that each mental health practitioner has his/her own blind spots about treatment that come from focussing on their own methods. (Although most psychiatrists seem to have a healthy respect for psychotherapy, so it's really more the therapists tending towards an anti-med view.)
Anyway, I think you're right about not looking at being med free as the answer. Maybe someday you will no longer need the meds -- who can say? If what you're doing works for you, and you can function at the level you described -- you have no idea how I envy you right now -- you're doing it right for you for now. Maybe pschoanalysis would help, maybe it wouldn't. If you're satisfied that the therapy you're in is working for you, why change it? If you're interested in trying psychoanalysis, try it. But not because someone has 'prescribed' it to you as a cure for anti-depressant medication, if you see what I mean.
Yes, depression is a serious condition. There's no question about that. But it's like diabetes, you can control it. No, no cure on the horizon, but there are ways to control it -- and you're already doing the full treatment and it's working for you.
Best luck.
Posted by Simcha on June 13, 2004, at 12:02:34
In reply to Re: Am I in Denial? Complete Treatment for Depress » Simcha, posted by Racer on June 13, 2004, at 9:13:47
Thanks to both of you who have replied. It really does help to hear from others who have similar histories. It's a nice reality check.
I just get frustrated at times when I speak with people, who are professionals, who act as if medication is a crutch, or a temporary necessary "evil", or as if somehow I'm misguided in believing the medication really gets at the root cause of my condition. Somehow I just know that without the medication I would be taking a great risk of having a major depressive episode that would be extremely crippling. The episodes that preceded medication were getting progressively worse. Medication is what pushed me over the edge into remission and it gave me a peek as to what it is like to live without depression for the first time in my living memory.
I also get frustrated at having to keep up with the pills, the scripts, the appointments, the insurance, the pharmacy, my doctors, and all the logistics that go with being on six medications almost daily. I also have asthma so I need these meds almost daily too. Oh, and from time to time it is necessary for me to take two more meds if my condition warrants it. It's enough to cause me considerable anxiety at times. I also always wonder what all this medicine does to my organs like, my liver, my kidneys, and other organs that may be affected.
I decide, one day at a time, that it is better to live without depression and to be able to breathe freely than to live medication free. I'm medically dependent on my medications. In our culture it is frowned upon to be dependent on anything. I have had a particularly difficult time accepting that my life necessitates dependence on medication for living well (or living at all for that matter).
Simcha
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