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I have been in therapy for the last 13 years.  THIRTEEN YEARS!  I've tried all sorts of medications...Celexa, Lexapro, Wellbutrin, Effexor, Paxil, Prozac, Trazadone, Risperdal, Ritalin.  There are even more that I can't remember.  And yet I'm still depressed.  None of the medications have really worked consistently or effectively.  Many didn't work at all, while also having the joyous side effects of killing my libido (GREAT for relationships  ;) ) and making me gain weight (ditto).

Is it really my lot in life to always feel depressed and down and down on myself?  The irony about depression is that no matter what good things happen in my life, I don't get much enjoyment out of them.  I'm so lucky in so many ways...I have excellent health, I got into graduate school (a goal of mine for years but something that I was too scared to pursue), I live independently, have dated a lot...and none of this makes me feel the least bit of pleasure :)

What's also ironic is that if I could just get this damn depression to ease up, I could probably bring so many more positive things in my life.  Like, maybe I'd have the energy and wherewithall to join a sports team or pursue some of the activities that I've always wanted to.  Or...maybe I'd meet Mr. Right rather than scaring away all of the guys I date with my insecure feelings.  But I always feel so tired and discouraged..  This makes it very hard for me to try new things.  No matter what I do, a dark cloud always seems to descend upon me, especially when I have free time on my hands. 

Are there some people with dysthymia (like I have) who just aren't helped by medication?  Exercise helps a bit, but even that only does so much.  Sorry if this post lacks focus...I just needed to vent.

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devon00:

Have you tried any mood stabilizers? One with known AD properties, like Lamictal, might be worth a try. I don't see any listed in the meds you have taken.

People with treatment-resistant depression, like you describe, often respond well to mood stabilizers / anticonvulsants. I'm one of those people. Decades of depression, in spite of dozens of ADs. Lamictal has been a godsend.

Worth asking your pdoc about this.

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Devon00 -

Revlow has some good suggestions about drugs, I think.  At least it's worth a try and I personally have a fair amount of faith in drugs, although have spent some time like everyone else here fooling around trying to find the right ones.

I also have dysthymia and major depression, recurrent, and am coming out of episode number five at this point.  Dysthymia does suck and the more I need to do the things I know will help the less I feel like doing them, such as exercise as you mention.

It's just my opinion, but I think if I'd been in therapy thirteen years I'd give it a rest for a while.  At some point, especially with depression and dysthymia, if therapy is just going over what happened that fucked things up then I think you can kind of overdose or burn out on it.  And I get tired of therapists anyways, I've found many of them to be not that smart and not particulary helpful.

Of course I don't know all your circumstances, but it sounds as if things just don't seem to change for the better for you, so is there the possibility of making some big changes?  I mean moving to a whole new place where no one knows you and you can make a fresh start with a new job or school, etc.  Obviously it takes some planning, but not as much as you might think.  I've done it a few times myself and it's been a lifesaver.

You'd be amazed how much of your identity you hold on to that is actually created and/or maintained by other people.  It's worse in a small town or among a small group of friends/family, but I'm sure you know what I mean:  "Oh, all the Smiths have a little drinking problem," or "You know those Browns can't seem to hang on to a job," or "You can't really trust a Jones with a secret unless you want it all over town." 

I've been able to grow in ways that I never would have if I had stayed in the same places.  I've had to physically move my head to make any changes inside of it take hold, if that makes any sense.  I still stay in touch with folks from all the various places I've been, but when you show up somewhere new no one has any assumptions about you and that lack of preconceived notions makes a huge difference in your own attitude about yourself and what you're capable of doing.

I think a complete change to one's circumstances occasionally is important with depression, but especially dysthymia.  The other thing I find that's most helpful besides changing venues and exercise is as much daylight as I can expose myself to - even cloudy days help.  Staying inside too much is an immediate downer for me and too easy for me to do. 

So to answer your original question, no, I don't think you have to stay depressed forever.  I wish you luck in finding a way to get better. Keep us posted how you get on.

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Devon -

The short answer is that yes, you may well have to fight this from now on, or at least until science catches up with the brain.  My tdoc and the last two pdocs have pretty much agreed that my Double Depression (dysthymia + MDD) is treatment-resistant, and that I'll probably be a lifer on the meds.

That does NOT mean, however, that you have to keep hurting.  I'll second revlow's suggestion about thinking outside the box on meds.  Since the usual meds aren't working, time to talk to your pdoc about alternatives.  For revlow, it's been Lamictal.  For me, it's Adderall.  Adderall has made huge inroads into my dysthymia, as an adjunct to my Effexor XR.  A foray into cutting back the Effexor proved that the Adderall doesn't do the job by itself, but in combination, they have given me energy I though would never return.

Speaking of energy, I like Catnapper's idea of a change of pace, but I don't think you necessarily have to go to the extreme of completely uprooting.  You say you wish you had the energy to join a sports team or pursue some other activities; I suggest you sign up whether you feel like you have the energy or not, and I think you'll find that participating will actually give you the energy (not only that, but exercise is an absolutely proven antidepressant).  I signed up for martial arts last August, and I think it's really helped me.

You may be a long-term resident in the Abyss, Devon

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Devon -

The short answer is that yes, you may well have to fight this from now on, or at least until science catches up with the brain.  My tdoc and the last two pdocs have pretty much agreed that my Double Depression (dysthymia + MDD) is treatment-resistant, and that I'll probably be a lifer on the meds.

That does NOT mean, however, that you have to keep hurting.  I'll second revlow's suggestion about thinking outside the box on meds.  Since the usual meds aren't working, time to talk to your pdoc about alternatives.  For revlow, it's been Lamictal.  For me, it's Adderall.

I am so wanting to try lamictal with my Cymbalta. Cymbalta was the miracle drug elevating my MDD to dysthymia, but as my tdoc so eloquently stated, when I said, "I'm HAPPY with dysthymia after this past summer of hellish suicidal-ness." He replied, "that is not accceptable."

Aye, Aye, Captain!

So, on going discussions with pdoc, who wants to see how I feel when SAD slips into oblivion til October. He's wary of my suspiscions that I am in the BPII spectrum and not just plain vanilla MDD, ADD, GAD. It's only after reading Air Marshall's links, chatting with some BPII's that I realized mania is waaaaaaaaaaaaaay more than swinging from chandeliers with lampshades on your head. That, in fact, mania can manifest itself as irritability, inexplicable sadness, followed by contentment, etc...this is more my brain.

S9

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I know the pain and frustration of being in therapy for so long-( for me its almost 20 years!!) Have you always had the same tdoc? has it been the same type of treatment?

ovet the years i've had many different tdoc and pdocs. some were helpful and some i didn't realize weren't helpful until i'd left them. one tdoc was great help for 5-6 yrs but then decided he couldn't go any further with me. i was furious, sad rejected. but it ended up being the best thing. the tdoc i've had now for about 5 years has been by far the best- but i never would have gotten to her without the pain and frustration of leaving the others.

its taken years of some tdocs saying they didn't think i was depressed, my having to ask for meds and eventually having to be persistant to be hospitalized so the truth of how bad it was could be acknowledged and the real treatment could begin.

it took a long time for me to hear the concept of patient as a consumer of services and as such you have the right to shop around for what you need!

also along the way- cbt, dbt, emdr ( its like an alphabet soup!) and many many drug trials- its so trial and error and when a pdoc seems to have gotten complacent, ive moved on to a new one with new perspective and new determination to not accept the sucky status quo!!

the depression may continue to be an underlying thing for you- but there are always new options of thinngs to try- you never know- the right one for you could be right around the corner! good luck!

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Well, I was an undiagnosed dysthymic, so I didn't get meds, but with therapy, and trying for years, I gradually reached a much better place then I started, at least until a series of disasters knocked me on my ass. I'll admit it's better with good meds.

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Heya Devon,

NO!  Not forever.  There are lots of chances for you.

YES!  Others here have mentioned this.  Depression that doesn't respond to antidepressants ... might *very well* respond to mood stabilizers!!!

Please give mood stabilizers a chance.

This textbook I have makes the case that many people have been tried on multiple antidepressants (like you) and have been ill until trying stabilizers.

Seriously.

Either whatever you're on now, plus lithium.

Or, some other stabilizer like Epival/Depakote, Lamictal, or Tegretol.

Worth a shot.

And might work.

Keep fighting.  It doesn't have to be like this.

;)

--ncc--

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Mood stabilizers make ADs more potent. They also can stabilize you if you are BP spectrum as well as unipolar depressed. Depressed people have cycles too, just depressed and more depressed. Double depression, or dysthymia and MDD, is just that, the lighter depression covered by the darker, reverting when the darker lifts, and so on.

They used to think I was MDD, but I am BP1. BP manifests itself in a lot of ways!

But DX isn't as important as relief of symptoms and treatment. Ask about Lamictal.

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My pdoc told me he sometimes augments an AD with a small dose of lithium in

patients with treatment resistant depression.  I also have high praises for lamictal,

which keeps me from the severe depression along with my wellbutrin. 

Don't give up!!  There are still options available to you.

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