Anxiety,Anxiety Disorder - Depression Series
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Depression Series
Maria has been feeling depressed for at least two and a half
years. About three years ago, her husband of 20 years left her
for another woman. Devastated, she became despondent and tearful
almost daily.
Eventually, her depression got worse associated with inability
to function. Her appetite, energy, concentration, and sleep
became impaired. She also felt hopeless and suicidal. Her
psychiatrist put her on a starting dose of antidepressant. She
responded initially but after a few days, she felt just like
before taking the medication.
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For the past two years, Maria has tried four types of
antidepressants. She has taken the usual adult doses of these
drugs. Although she somewhat improves, she has virtually
remained the same ' depressed and disabled.
Maria seems to be taking the medications regularly. But why is
she not responding to her antidepressants?
Maria is just one of the many depressed individuals who don't
feel 'normal' despite treatment. Depression is a treatable
disease but how come some people don't do well on medications?
There are many reasons why depressed patients like Maria don't
improve on antidepressants.
First, is the diagnosis correct?
Depression can be caused by many clinical entities. Sometimes,
knowing the right diagnosis is a challenge. Medical disorders,
medications such as beta-blockers and benzodiazepines (e.g.
clonazepam), and various psychiatric disorders can cause
depression and they all require different treatment. If your
doctor fails to identify and treat the true cause of your
depression, you will remain depressed despite the use of
antidepressant.
Second, are there co-morbid disorders?
Depression can exist along with other psychiatric disorders such
as anxiety disorder, alcohol or drug problems, personality
disorder, dementia, and psychosis. Depression will persist if
these co-morbid disorders are not treated. For instance,
depressive disorder with psychosis cannot be adequately treated
just with antidepressant alone. You need an antipsychotic drug
added to an antidepressant to treat the illness.
Third, is there an ongoing neurological or medical disorder that
precipitates, aggravates, or complicates depression?
Hypothyroidism, hyperthyroidism, vitamin B-12 deficiency,
pancreatic cancer, brain tumor, Parkinson's disease, and stroke
can all cause depression. If any of these disorders are present,
antidepressants are less likely to help. The goal in these
situations is to treat the underlying medical condition. A 65
year-old lady came to see me complaining of severe depression.
On evaluation, she disclosed that she had been on three types of
antidepressants for the past four years with minimal response. I
checked her recent laboratory results which showed an abnormal
thyroid! No wonder, she was not responding to the medication.
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- Feel great all day every day
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- Prevent panic attacks
- Naturally Balance Your Brain Chemistry
- Relieve Irritability and Anxiety
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Fourth, are there ongoing psychosocial issues?
Financial problems, family conflict, work-related stress can all
precipitate and complicate depression. Despite adequate
medication treatment, some individuals will remain depressed
especially if such problems are not addressed by the therapist
or psychiatrist. Is there any way you can reduce the stressors?
Please do so the earliest you can.
The treatment of depression is frequently straightforward.
Occasionally however, various factors complicate it. For
antidepressant to be effective, a psychiatrist should ensure
that the diagnosis is correct, that co-morbid psychiatric
disorders and medical problems are treated, and that
psychosocial issues are adequately addressed.
Maria's doctor should explore further the real problem and
provide the most appropriate intervention.
About the author:
Copyright ' 2003. All rights reserved. Dr. Michael G. Rayel '
author (First Aid to Mental Illness'Finalist, Reader's
Preference Choice Award 2002), speaker, workshop leader, and
psychiatrist. Dr. Rayel helps individuals recognize the early
signs of mental illness and provide early intervention. To
receive free newsletter, visit www.drrayel.com. His books are
available at major online bookstores.
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