A friend of mine has depression. They are seeing a psychologist or therapist or something, and they are on meds. But they are getting no better. They still have thoughts of death/suicide, and they are still stunningly depressed.
So, they are not getting much better. We (meaning this person’s friends) question if she is seeing the therapist often enough, and if she even is taking her meds.
What should I do?
(wasn’t quite sure where to put this, GQ seemed most appropriate)
It probably belongs in MPSIMS.
First question is how long your friend has been on medications. It usually takes two weeks to ten days for medications to kick in. And some medications work better with some people so there is some trial-and-error in it. Don’t get discourages or let your friend become discouraged, she will get there. Encourage her to take the medications – they can work wonders, but they don’t do nuthin’ if she doesn’t swallow them.
How long has she been on meds? It can take a few weeks for them to take effect. Not every med will work for everyone with depression - some need a higher dosage than the usual prescription, some need a different one entirely. Certain side effects can be considered by some people to be worse than the depression, and they may just discontinue the meds rather than speaking up about it and getting them changed.
If your friend is open to discussion about it (which I would guess, considering that you know this person is thinking about death and so on), you might want to gently broach the topic. Ask generally how things are going, like if he or she likes the therapist at all, if the psychologist (it has to be some kind of medical doctor who’d prescribe the meds, at least in the US) wants to change medications, if the meds have had any side effects. You might get more information that way than if you come out and bluntly ask, unless you know your friend will be truthful. Many depressed people try to hide the extent of their depression, and being blunt - unless you have reason to believe otherwise - might not get you accurate answers.
Some take longer to begin having a noticeable effect. 4 to 6 weeks, depending on dosage. Also for most of them, not taking it every day at approximately the same time can result in little to no results.
As pointed out, medication is only part or treatment. Working through with a good professional, understanding and support of friends and family, and realization on their part make up the largest part. Important note that C K Dexter pointed out, there are many varieties of anti-depressants out there and have a wide result for each individual. Sometimes trial and error happens before the best one, or combination, is selected.
Long road. long long road ahead.
Sadly, not everyone responds to meds or to therapy or to a combination of both.
For some people, depression is an ongoing, even life long problem. 10-20% have not recovered after 5 yrs.
ECT (electroconvulsive therapy) is a last ditch procedure for uni polar and bipolar mood disorders, however it is often successful with depressed and suicidal patients when all else has failed.
Hopefully your friend is being monitered by a competent psychologist and medical practitioner, who will know what is the appropriate course to follow. If she isn’t or you suspect she is not following her treatment, it may be necessary for you to get specific advice from your local mental health support team.
If your friend is on meds they are probably seeing a psychiatrist, not a therapist. It is possible, however, they are seeing a therapist (which anyone can call themselves) and they are taking something ineffective like herbs, vitamins or eye of newt. First make sure they are seeing someone proper.
Some people will disagree with me on this one, but in most cases meds should be used to support legitimate therapy under a psychologist or other trained mental health professional. Taking meds for some forms of depression is like taking morphine if your foot is nailed to the floor. It treats the symptoms but the problem doesn’t go away and eventually you become dependant on avoiding the problem.
If your friend is experiencing some external stimulus that might be reason for being depressed, dealing with the problem exclusively through medication is not the answer. Many psychiatrists are quick to write out prescriptions and call it therapy. It’s a good way to earn loads of money but does not always serve the patient’s best interests.
You are spot on. The meds are only intended to level the person out. Not to cure or resolve an issue or problem.
Is your friend male or female?
And how old?
This makes a difference…
Unlike in the past, psychiatrists are often able to treat clinical depression with appropriate medications and a minimal amount of therapy. Sometimes, even 20-30 minute sessions once a month can be enough after the medications kick in.
I think that is because a lot of depression is a chemical imbalance in the brain, similar to Parkinson’s Disease. The symptoms can often be treated successfully with medication to correct the imbalance.
I don’t know of any “happy” pills that are used to treat depression, however. If you are taking prozac, for example, and it works for you, you don’t feel “high” – you just feel “normal” again. If a non-depressed person takes prozac, she or he won’t feel any happier.
Some psychologists work in conjunction with psychiatrists so that medicine can still be prescribed even if your therapy is with the psychologist only.
Please remind your friend often that depression is not her or his fault. It is not a character flaw. It is not a matter of attitude or of will-power. And it is about much, much more than sadness.
If your friend is actually talking about suicide, the therapist needs to know and so does the next of kin. Depression is often a fatal disease. Your friend may need to be in a “safe place” until she can be helped. You are NOT doing your friend a favor to keep this a secret. Consider that your friend is not in a position to know what is best. Her or his brain is temporarily damaged and can’t think straight.
I am not a doctor, but a long-term survivor.
Bless you for caring and trying to help!
I think that one of the reasons that you are getting so many different answers is that there are different kinds of depression. What is right for one is not right for someone else.
You know, I thought this was the case as well. I started on Prozac, waited for it to kick in, and boy, did it ever. My primary care physician prescribed it, so I asked her if I needed to see someone. She asked me if I wanted to talk with anyone, and we agreed that for me, the depression was the problem.
So, on an ancedotal level, it is possible to just take the drugs and not go to counseling.
And to echo everyone else, it takes a while for the meds to kick in, and some people have to switch from med to med before they find a good solution.
And Zoe is spot on about her advice - if your friend is talking about suicide, someone needs to be notified. If need be, a quick in-patient session may be necessary to start the ball rolling, so to speak.
It varies by state, but in the US “therapist” is often a restricted term, meaning it’s illegal to use it without the education and/or license required by that state.
“Depression” is a huge category. A lot of people are “depressed” but also have more pervasive problems, such as a pattern of poor relationships, or PTSD, or other issues.
If you’re wondering if therapy is helping, you may want to ask your friend what s/he thinks. S/he’s got a lot more data than you; s/he might find it helpful to know that friends are concerned about whether s/he’s getting what s/he needs.
G’day
I am not a doctor, but I am a long-term survivor of depression.
The most important thing to do is to get an accurate differential diagnosis. It is important to eliminate other conditions such as hypothyroidism before treating for depression.
If your friend has one of the so-called “reactive” depressions then antidepressants should only be used in a short-term palliative role. The hard yards will be made by some form of counselling. My opinion is that what theoretical school your therapist belongs to doesn’t matter so much as his or her empathy and practical good sense. But in outcome studies Cognitive-Behavioural Therapy does far better than other therapies for depression.
But if like me your friend has an endogenous depression such as BMD II, then he or she will need some form of drug therapy for the foreseeable future. Which drug or drugs will work best is a very individual matter (I thrive on amitryptaline), but a patient with a bipolar disorder ought to at least try lithium. Lithium is pretty unpleasant, but it has the best figures.
My experience is that people with endogenous depressions very often also have reactive depression as an overlay. I found it immensely helpful to treat my reactive depression with Cognitive-Behavioural Therapy, even though my depression was categorised as of biochemical origin.
As for initial resistance to therapy: drugs can take weeks to kick in. If your friend is still in the first six weeks of drug therapy it is probably too soon to take more drastic measures. But if he or she feels like committing suicide then he or she is in danger and ought not to be alone. Hospital is probably the safest place.
If your friend’s depression does not respond to drugs or counselling, and if it persists so severely as to spoil the quality of his or her life, his or her doctors will probably suggest electroconvulsive therapy. I know it sounds barbaric, but it really does seem to work. I haven’t ever had it myself, but I have three close friends who have had a course or two of shocks and one (a doctor) who has seen it used quite often. It is administered under a general anaesthetic. The side effects include a headache that takes perhaps as much as a couple of days to get better, loss of recent memories, and some loss of longer-term memories. But patients do say that it makes them feel a lot better.
Hope this is of some help.
Agback