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The question was submitted 17/01/2008

Subject: type of depression / meds not working?

I am a 41 yr old female who has struggled with depression off & on since childhood. I was finally diagnosed and started on medication about four years ago, but I'm still struggling. I've gone from Celexa to Effexor XR to Cipralex to Welbutrin to Zoloft. The Celexa & the Cipralex never really worked. The Effexor worked for a few months and then seemed to wear off, even with adjusted dosages. The Welbutrin made me throw up constantly, so I had to go off that. Now I feel like the Zoloft isn't really doing much for me anymore, and I'm on 150mg.

How can you tell if a medication is really not working anymore, or if you're just experiencing a bad patch? And what is the difference between a treatment resistant depression, chronic depression and dysthymia?

Thank you for your time and your input.

Answer from DepNet

Hi “Type of depression/Meds not working”

Let me sort out the definitions first.

Treatment resistant depression is depression that fails to respond to the usual “first line” treatments. There are various more detailed definitions but the general sense of it is that some depressions don’t respond as easily as the “average case”. This doesn’t mean that they will not get better. Some require more “powerful” treatment with multiple medications or ECT or TMS while others eventually improve all on their own. All patients with treatment resistant depression should be seen by a psychiatrist.

Chronic depression is just what the name says “chronic” and is (hopefully) controlled by treatment but will re-emerge sooner or later, each time the treatment is ceased. This type of depression is responsible for the mistaken belief that we can become “addicted” to antidepressants “Each time I try to stop the drugs I get depressed again…I’m addicted to them”. NO you’re not addicted you simply have a chronic depression that is controlled by medication (the same as epilepsy, blood pressure, diabetes and a host of other diseases are controlled by medication).

Dysthymia is a mild depression that lasts more than 2 years. People with dysthymia can also suffer episodes of major depression.

It sounds like you have a chronic (or recurrent) depression and with the history of medication problems you should be seeing a psychiatrist. It might be that you will need to add psychotherapy or perhaps a “mood stabilizer” to your antidepressants or change to another class of agents. With chronic depression it is often difficult to know what to expect from treatment “What’s normal, I’ve been depressed for so long” and you should discuss this with your psychiatrist who hopefully can help you develop realistic expectations.

The answer was published on DepNet 24/01/2008