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There's only so much medication can do: How much?


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My pdoc says there is only so much medication can do and to recover I have to do other things to sort of rehabilitate myself. I kind of agree with this so I've been working on exercising, eating well, getting out and seeing my friends, getting enough sleep and I've been continuing with therapy.

 

However, I'm still definitely experiencing symptoms of depression. I'm terribly tired all the time, I haven't much appetite, I'm having quite a lot of SI urges and I'm not really able to care or get interested in anything. And I don't feel sad exactly, there's just this constant, low level ache.

If nothing changes too much by my next pdoc appointment, would it be worth pushing for a med adjustment? I've been a lot worse and I think medication has really helped but I don't know if it could do any more for me (I have not tried many ADs). My pdoc is not exactly gung ho with meds so if he seems reluctant to change anything, how can I advocate for myself? I think I'm doing as much as I can and I don't want to give up on recovering fully.

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Hi Squish.

I think your pdoc is right in a way, depression does require activity and effort to recover from. It was sad when I was IP and I saw people who really wanted to change their lives for the past 15 years but said "I'll do it when I find meds that work".

 

However, it's REALLY hard to do the things that help when you are deeply depressed. I needed therapy to get better, but without meds I'm not sure I would have stayed alive long enough for therapy to help, or been able to put into place any of the strategies I had learned. 

 

I imagine that your pdoc is wanting to prevent you from ending up in that first situation. Do you have a therapist? I imagine being able to describe to your pdoc the positive lifestyle changes you have been making may reassure him. If not, you have the right to be assertive and ask for an increase or change in medications and depending on where you live, seek a second opinion. 

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I agree with Blue, and I think your pdoc should be open to a med change.  If you have tried your current med for a number of months and it isn't really doing the job, he should be willing to consider a new one, or an addition to the one you're taking.

 

I do agree that you also need to eat good food, exercise, etc.  If you have a GP, I hope you have been tested for thyroid issues, anemia, and other medical problems that could be contributing to feeling ill and unmotivated.

 

olga

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I also agree with the above post.  Continue you to do the things you are working on and when you see your dr go over what you have been doing and how long you have been working on each thing.  I try to always keep in mind of how it was before I found this spot where I can at least have some peace.  

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If nothing changes too much by my next pdoc appointment, would it be worth pushing for a med adjustment? I've been a lot worse and I think medication has really helped but I don't know if it could do any more for me (I have not tried many ADs). My pdoc is not exactly gung ho with meds so if he seems reluctant to change anything, how can I advocate for myself? I think I'm doing as much as I can and I don't want to give up on recovering fully.

 

I agree with above posters, that I think your pdoc should be open to a med adjustment, especially since you've been eating right, exercising, sleeping, socializing ... because those are things that a pdoc might look at before a med adjustment (sometimes), you've done them, so like I mentioned above, I think you should ask for a med adjustment.  I'd tell pdoc exactly what you've told us here.

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Thanks for the replies! I only have short appointments and I get overwhelmed and intimidated really easily so I find it hard to be assertive. I often start second guessing myself and worrying that I'm being unreasonable, or lazy, or asking for too much. I'm torn between accepting that this is as good as it's going to get and trying to figure out how to live with feeling like this and hoping that there's something else that might help and finding a way to try that. 

 

It's good to know that you think it's reasonable to ask for a med adjustment too; that'll help. I might print something out and bring it with me in case I start panicking and my mind goes blank or I'm finding it difficult to speak.

 

 

bluelikejazz: I do have a therapist and have learned a lot but I think there's not much more I can learn from her at this point. I suppose there are different therapists and types of therapy I could try though.

 

 

olga: I've had so many blood tests! At one point I felt like the human pincushion. All of them normal, luckily.

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Okay, so I'm glad the physical stuff has been ruled out.

 

Go to your appointment armed with a printout of some of these comments, or make a list.  Every time I go to one of my specialists, I have a written list.  The doctor and I talk, but then I tell him I have my list and I glance at it to see if there is an important point that we have missed.  I do this because I'm older and forgetful, but there is nothing wrong with a young person having a list so they can stay on topic.

 

Also, Effexor (venlafaxine) is not effective for everyone.  Have you tried any of the SSRIs?  Have you ever tried an antidepressant that is considered more "energizing," like Wellbutrin?  If you haven't, you need to discuss these possibilities with your pdoc.

 

If you have trouble being forceful, can you bring someone with you?  A friend or a favorite auntie?  Someone who is a little more aggressive and will ask questions that you are too reticent to ask?  It's unfortunate, but we all have to be our own best advocate.  It you are going there alone, go with an agenda, and give yourself a pep talk in advance.

 

"I deserve to be happy.  There is no reason why I have to spend my life depressed.  I'm going to be like Auntie Olga and march in there and tell him that I want a good quality of life and I don't accept being lethargic and tired and apathetic."

 

:)  I'm serious.  You really have to DEMAND good treatment from your doctors.  I can't believe that your pdoc isn't "gung ho" about meds.  Does he think you're going to pull out of MDD with a healthy diet and lots of sleep?  No NO NO NO!!  Some of us have had chemical changes in our brains and all the good nutrition and exercise in the world is not going to pull us out of the Black Pit.

 

You can have a good life.  If he isn't willing to try other meds to help you have that life, then you need to find another doctor.  If you are seeing a therapist, ask her to recommend one, and tell her why you are unhappy with this one.  We ALL deserve a good quality of life, and it sucks that he is telling you that YOU have to pull yourself out of this.

 

hmph

 

Auntie olga

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Olga is right. It's good to go into appointments armed with an agenda. I have to write mine down, too. To keep myself from chickening out, I hand the list of items over to my doc right when I go in. Then we talk about them one by one. The first time I did it I told him that I have problems being assertive and I was too chicken to ask for "too much." He told me the same thing that Olga told you. It's not asking too much to want treatment that helps you feel better and function. That treatment means exercise, diet, therapy, getting out, but it means meds too.

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Sounds like you are doing all the right things as far as exercise, getting out with friends, therapy, etc. So pat yourself on the back! That is a major accomplishment.

 

I understand though that depression can still linger even if you do everything right.

 

The max dose of effexor is 300mg. Maybe you need a bump up of your dose? Might be worth asking your pdoc about.

 

Take care and keep us posted!

 

ETA: I agree with the others that printing out something or writing down a list of what you are going through and want you want changed can be very helpful. I recently tried this for the first time with my pdoc. It helped because I was very nervous and anxious over the first visit. It should help relieve the stress of trying to remember everything and getting everything covered if you have short visits like I do. Good luck!

Edited by Wonderful.Cheese
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Thank you, thank you Olga! I've tried a couple of SSRIs, which didn't do much and Wellbutrin isn't licensed for depression where I live, unfortunately (anything energizing would be great, really). Maybe bumping up effexor would work? (Thanks Wonderful.Cheese, I'd forgotten I could go up a bit more.)

 

I don't really have anyone I could bring in with me (other than my mother, who doesn't like that her baby is on meds in the first place  :brooding: ). So, I will give myself a pep talk and make several lists for my next appointment. 

 

Thanks Coffeetime, it's nice to know I'm not the only person who is really not very good at this.

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Oh, too bad you can't try Wellbutrin.  Well, maybe going up on your dose of Effexor might help, and it appears you are taking less than the usual therapeutic number of mg.  It's certainly worth asking about.

 

However, he might not be willing to do that.  I guess what I want for you is a doctor who works with you to get you to a level of functioning that means you can have a satisfying life.  If that means bumping up your current medication, fine---let's try that.  But I would also like him to be willing to suggest something else.  Maybe there is another med that works well as an adjunct to Effexor.  I don't know, since I have no medical training.  I just want him to be more aggressive in his treatment of your illness.  It sounds like he wants things to glide along and doesn't get the fact that you are still depressed.

 

He also doesn't get that it's not your fault. 

 

This guy really is a qualified psychiatrist?  With an MD degree and everything?  In all my years here at CB, I don't recall a member saying that they had a pdoc who was hesitant about prescribing antidepressants.

 

Also, whether or not you feel "sad" doesn't concern me.  If you are sleeping too much or not enough, if you have SI urges, if you don't care about life and various activities, and you have no appetite---those are all symptoms of mental illness and I feel that he is not taking you seriously.  I wish I lived in your neighborhood---I would go with you to that appointment and he'd be sitting bolt upright in his chair by the time I got done talking. :lol:

 

Well, make your list of points and emphasize to him the aspects of your depression that are impinging on your quality of life.  You can do this! 

 

olga

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I agree with the previous posters, and don't have anything to add except I can totally relate.  I am in a similar situation, except my main symptom that is not showing adequate improvement is the anxiety.  I really encourage you to advocate for yourself, or get someone to come with you to do so.  If your pdoc isn't willing to work with you, then find another one.  I know, easier said than done, but your health is important, and you need your doctors to be on the same page with you. 

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My pdoc has a rule I must shower every day. My tdoc gives me a list of homework to do, which

H includes exercise, setting a timer on my naps so I can't sleep more than 3 hrs, keep the dishes washed, leaving the house every day and shopping for myself(my son works at a grocery store so it really isn't an imposition).

Once I started taking 150zoloft everything became easier to do.

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Olga: he's very qualified; he has more than 20 letters after his name, including MD. I think he's more interested in treating psychosis and schizophrenia than boring old depression though. Plus there's really not enough psychiatrists where I live and depression isn't considered that serious so I only get infrequent appointments. (I'm in the middle of a 3.5 month gap between them right now and hoping someone cancels. I didn't get a med change last time either.) I wish you did live in my neighbourhood! I think you live a few thousand miles away though.

 

Sparkle: sorry to hear you can relate! Having anxiety that isn't going anywhere must be exhausting.

 

Savannah: I set myself homework like that too, or else I'd never get out of bed! It's good to hear it has become easier.

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  • 3 weeks later...

Squish,

 

I have recently had a series of ECT treatments, which got me out of a very dark place.

 

Not everyone is interested in or qualified for ECT, but naturally I am singing its praises since I have had such a positive experience; others' mileage may have varied, as the saying goes.

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I aggre with your pdoc that meds can only do so much. The way I like to look at it was before I got on the right cocktail path i was drowning, I started them started to feel a bit better and got a life preserver to help bring me to shore. Then once I got stable and delt with crap and stoped drowining and could breathe again, I was on the shore. But I started to long for the boat in the ocean, to get on that boat and go. But it takes work and all boats must return to harbor sometime.

 

Or as my tdoc put it, a stake knive to a butter knive- i.e. the pain's not all gone but it hurts less.

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  • 4 weeks later...

I have an appointment tomorrow! Someone cancelled! I have made four different lists to bring with me.

  • Things I have been doing to help myself over the past few months
  • Things that have improved
  • Symptoms that really have not improved or got worse and
  • Things he can do that might help. 

I should probably make another copy, so I can hand one set over and keep the other to refer to myself.

 

I will be assertive and clear and calm(ish). And if (when) I start crying I will just take some deep breaths and power through and not waste time feeling bad about or apologizing for dissolving but just power through with the lists.

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Hmm, well. I had the appointment. No change in meds.I can maybe get a dose increase if I gain some weight. My pdoc says I should keep seeing slow improvement anyway because my brain is still recovering from when I got too thin over last winter.  Keep on keeping on. Come back in three months.

I am frustrated. It wasn't a total waste of time because I did get some advice about going back to uni and it's good to know I'm doing about the right things on my end. But. I'm kind of suffering a bit. Crying myself to sleep at night because it's just so hard.

 

Knowing that I won't get relief from that any time soon makes me despair and wonder why I'm bothering, really.

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I don't understand why your dosage is dependent on your weight.  I would think that feeling some relief from the depression would help you to stay on track with gaining and keep up a healthy appetite.  I'm no pdoc, of course.

 

I'm bummed that you have to wait another three months before your next appointment.  Do you feel like you'll have enough support with friends, family, and your therapist?

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I think I will have to get a second opinion. I don't feel confident that I'm getting the best treatment at the moment. There just doesn't seem to be any urgency? I get advised to do what I'm already doing and the only med change I've had since moving from my GP to a pdoc has been a 50% dose increase of the medication I was taking anyway. Which was more than four months ago. Which my GP could have and probably would have done anyway. Why am I even bothering seeing this guy?  :wall:

 

Surely the longer depression goes on the harder it is to treat? And meanwhile I'm miserable and disabled by it.

 

 

 

I'll have to go through my GP again to get another referral, I think. It's really frustrating to think that I might be stuck like this when more aggressive treatment could help me recover. 

 

I'm lucky that my family and therapist are supportive and my friends try at least. This thing isn't going anywhere fast though.

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A good way to advocate for yourself is to document the activities you have been doing and record if and how much it makes you feel better. In Dr. David Burns Book " The New Mood Therapy" he has an exercise where you schedule activities to do, and than record a number determining how easy it was for you to do and if you felt any pleasure from it. 

I think it would only be fair for your doctor to make a med adjustment after you show him you have been doing your part to help with your depression. It is very true that meds can not do everything, but you should also be feeling a relief from depressive symptoms on your current med. 

Wishing you good luck and I hope your depression lifts soon. :)

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When you talk to your GP, explain to him about all the stuff you've been doing, and that you wrote it all down to take to the pdoc.  If an antidepressant isn't working after 4 months, it's time to try another one.  How complicated is that, right?  I don't understand why your pdoc doesn't understand that concept.

 

There are a lot of people who don't get relief from Effexor.  So you try an SSRI, or something else.  It is wrong to put the blame back on the patient, saying that "you can't expect the meds to do it all,"  or "you aren't trying to help yourself."  This pdoc is minimizing your illness, and that irritates the heck out of me.

 

Hang in there and I hope you can see a doctor who LISTENS.  sheesh.

 

olga

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I'm in Ireland but my pdoc has worked for the NHS a lot in the past. And all the psychiatry guidelines are about the same in both countries anyway. I'm in the UK system too because I move back and forth a lot so I could possibly see a pdoc through the NHS.

 

I only have depression though and I'm semi functional, so I'm not particularly hopeful.

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I would look for a new pdoc. I think if your symptoms are only partially treated and you ask for a med change, there needs to be a damn good reason for your pdoc to refuse. It seems like UK docs are overly conservative and don't realise the horror of being depressed and the devestation it brings to a persons life and their very soul.

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