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.
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.
mike@drrayel.com
