The question was submitted
Tuesday, 2 June 2009
Subject: Deep sense of Loneliness
Hi,
This is the first time i have decided to seek outside help other than my GP. I am 48 years old and life has been tough. I have been on medication for the past 3 years after finding out the only true (I thought)love of my life had an affair. 3 months after this bomb shell I lost someone very close through suicide. These events were the catalyst for a very dark period that I can not seem to get clear of. I have 5 children ranging in age from 28 to 11 and am having a lot of trouble with my soon to be 16 year old son. This in turn is putting strain on my already strained marraige and life. I want so much to be happy but to tell you the truth I'm not really sure I know what that means. I'm taking Zoloft 100mg and my GP recommends I switch to Citalprom 40mg. He tells me from experience that some times just changing the medication can help? He has also said that I can simply continue on with the new medication no break in between? Thanks for listening Kali
Answer from DepNet
Thank you for writing to us with your question. As I do not know enough about you, I cannot give you specific medication advice. But I would like to make a few observations and a few suggestions, which I hope will be useful.
Firstly, you clearly have had a number of extremely distressing losses that have likely contributed to your depression. So as well as medication for the depression, it will almost certainly also be important to have appropriate counselling or therapy, to help you sort through these events. Talking therapy in addition to anti-depressant medication can be a very effective way of tackling even quite persistent depression. And have you had any marriage counselling? That might also be useful and necessary, as it sounds as if the relationship issues are not fully resolved.
Secondly, if you are uncertain about the recommendation made about the medication by your GP, it could be very helpful to have an assessment and a second opinion from a psychiatrist. Sometimes just swapping medications within the same medication class can be helpful, but this is generally when side effects are a problem. If the medication appears to be working less well than before, or has never worked quite well enough, you may find that changing to a new medication class is more helpful. But this is NOT an area where you can get specific advice over the Internet. Making medication recommendations for a patient is a very individual process. The best advice is from a doctor with expertise and experience in the area, someone who is able to assess you and your needs in person, face to face, to discuss with you the best way of moving forwards. Your GP likely knows you extremely well, but even so, you may find it useful to see a specialist who can advise you and your doctor on the best next step.
So, in summary, I suggest the following:
1. Make sure you get the talking therapy / psychotherapy / counselling that you need to explore and address the recent distressing events, as well as taking anti-depressant medication.
2. Consider marriage / relationship counselling as well, as this sounds like an unresolved, ongoing stress in your life.
3. Consider discussing with your GP having a referral to a psychiatrist to get advice about the best way forwards. The psychiatrist can advise on both medications (whether or not to change, and if so, what to), and on psychotherapy (what type is most likely to be most helpful).
4. Don’t be embarrassed asking your GP to arrange a second opinion – if you are still feeling depressed, then both you and your GP will be pleased to have expert support. If you are concerned about discussing it with your GP, you could printout and take in your question and this response, which may assist in starting the conversation.
Good luck.
The answer was published on DepNet
Tuesday, 9 June 2009