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AT THE JUNCTION.
African young girls are always on the go at the earlier age of about 9 years. Loving blindly without taking into account the consequences: The argument over abortion is rarely waged with much reference to reason. Our courage and determination...
How do I know if I am being a good parent?
Parents desire to do a good job in raising kids. How do you know whether you are doing a good job? This article explores the complexities of trying to figure out how you are doing as a parent. How do I know if I am being a "good" parent?
Often...
Indentify Your Weaknesses: 21 Common Weight Loss Barriers
A self-help guide to help readers determine what is keeping them from losing weight successfully.
People have free will, as we all know, and that means that tough issues like weight loss can become very confusing. Thousands of books and videos...
Menopause, Just What Is It?
Just what is this thing called menopause? And what does it have to do with you?
Simply stated, menopause is a biological event that marks the end of a woman’s menses and hence her natural reproductive cycle. Perimenopause is defined as...
Naming a Daughter -- Naming a Son. Do You Have "Gender Issues?"
When you hear the name Rex what comes to mind? Unless you had a dog or a horse named Rex as you were growing up, you probably imagined someone like an older man in a tweed jacket sitting in a dark, book-lined study as a small fire burns happily in...
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Depression Series: Why Don’t I Respond to Medications? (Part 1)
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.
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.
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.
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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