Severe treatment-resistant depression

How's their relationship with their parents?

maybe dumping you would help.

I've heard electroshock therapy is used when all else fails and apparently it can have great results. Unfortunately, it's prohibited in my country so I'd have to travel abroad to have it done.

His relationship with his parents is distant. They live in Florida so he only sees them once every few years. Why?

I think if he makes up with them, it will help. Sometimes these things are rooted in feeling a parent doesn't love us, therefore we can't live ourselves.

Or maybe it's chemical and he needs more sun and exercise. Get out and clear his head. Major therapy.

If his brain hasn't responded to any other treatment so far, it's definitely chemical. Just "hugging it out" won't help and it's kind of inconsiderate to suggest otherwise, no offence.

No actually it's not. I had severe depression which when away after repairing the relationship with my dad who I thought hated me. We talked it out and it helped better than any antidepressant did.

It was just one suggestion. Plus I think the chemicals in the brain can switch between being a cause and reflective of a cause. Good luck to your friend.

Honestly...

Some things that work for me: 1. Make a list of ten things to do. Do them, don’t overthink any of it. Keep repeating, hopefully choosing activities that will bring you joy in addition to the dopamine from just being active. 2. Exercise. Cardio is best, but anything that gets you out of your depressive zone is good. 3. No alcohol. 4. Log your dysfunctional thoughts and answer them. On paper. Google or read David Burns for more guidance on this and other great techniques that are more effective than drugs.

The worst thing to do is to think your way into a deeper hole. It’s first about clearing your mind of negative thoughts, then replacing them.

My severe depression and anxiety just morphed into anhedonia and misanthropy. Thankfully, humanity is great at making war and brutalizing each other. Hopefully, these boring little regional skirmishes yield more entertaining dividends. Otherwise, it’s just boredom.

It is true that my partner has a piss poor attitude and will not do anything that R9 suggests.

Why do people keep talking about 'chemicals' in the brain as if it's a fact when it comes to depression? It isn't. It's just a theory that hasn't been proven!

ECT worked for a family member

What about a hard reset with another class of psychedelics?

Ketamine didn’t work, but mushrooms, LSD, or DMT might.

It seems scary, but what is the alternative: to live in misery with possible suicidal ideation hovering like a grey cloud that never clears?

A friend of a friend (really) ended up so depressed and lethargic she was homeless. Family was fed up and abandoned her. Friend had to get her into a halfway home, where she now subsists on drugs and social security.

There was a study that found that depressed people see reality more accurately than people who aren't. The truth is that depressing.

I've had severe depression, but never enough to keep me completely house bound.

I've always managed to go to my AA meetings, socialize and go to work. I have noticed that it gets worse during very high stress jobs. That's improved as I age, as I don't react to high stress as I did in my 30s.

Remaining completely drug and alcohol free is a huge help, as is working out daily, & eating well/healthfully.

I've heard mixed results regarding ECT. One girl I knew said the treatment made it worse, and another had very positive results, with occasional lapses back into the severe depression every 5 years or so.

Both reacted poorly to high stress environments such as the stress associated with law school, and the other from working in a news room.

[quote] I have noticed that it gets worse during very high stress jobs.

Yeah, my theory is that it's mostly exacerbated by negative circumstances and environments. I don't buy the 'chemicals in the brain' theory (which, again, is completely unproven).

Just show him this, silly.

r9 "It’s first about clearing your mind of negative thoughts, then replacing them. "

Wow, what a novel idea. I'm sure he's never thought of that. I'm guessing you also have posters like "Teamwork makes the dream work" and "Live, Laugh, Love."

You may see it as a cliche, r20, but it’s not something that is easy to just do. Negative thoughts masquerade as reality and start popping up automatically.

The Burns techniques really work for me, but slogans like yours never have. And OP admits his partner is probably not going to do anything, whether it is sunny bullshit or something that will work.

There will always be people who just want to accept depression. In the end, they may be right. We’re all going to die and be forgotten, no matter how happy we were. I’d prefer to enjoy the trip, but feel free to do what you need.

R21 You're correct that this isn't something that's easy to do. Now reflect on that. Imagine trying to replace your accurate but negative views with some kind of happy clappy positive view that you simply can't believe is true...

Suggest he try this shit:

Check the end of the article ^^

Try God

I can tell by reading some of these posts that most of you have no idea how debilitating severe depression is. Not only do you not want to do anything, you CAN'T do anything. There is no reason to do anything, because the state of the world and/or life is so foul, there's no reason to live, much less do anything. Even getting out of bed is a struggle. What's the point? Death, that gentle friend to the depressed, is right around the corner no matter what.

I take anti-depressants which take the edge off my depression, but it's still hard. Physical exercise helps a little. But severe treatment-resistant depression is also resistant to any kind of activity, be it volunteering, getting more sunshine, etc. Those suggestions are futile, because when there's no reason to get out of bed (because life itself is futile), no incentive is sufficient.

What R16 said is true; and my anti-depressants work by scattering my brain function ever-so-slightly, making it somewhat difficult for me to concentrate on any one thing for very long. When I had to go off them for a year (drug shortage), my brain went back to the way it was in grad school: honed, insightful, and sharp as a tack. But I was so depressed (see comment at R16, again), I was hanging on to life by a thread. I forced myself to walk two miles every day, hoping that would help. Only slightly, but I'm still alive. And I hung on long enough to see the return of my medication and get back on it.

I wish good luck to you and your partner, OP.

Everyone who says "chemicals in the brain is bullshit" can fuck right off. You have no idea what you are talking about and you have clearly never experienced major depressive disorder, bipolar, or other serious mood disorders. Seriously, shut the fuck up.

OP, I have had several bouts of major depression in my life (I'm 51). Each time required a long period of med re-adjustment but once I got the right one, it was immediate relief. I am an athlete, a meditator, I have lots of social support and no significant stressors (I work for myself and I love my work). I do everything "right." However, depression is real and when I am in the throes of it, I can think of nothing but suicide. I quite literally experience constant thoughts, feelings, sensations, and experiences that I NEVER feel when I am properly medicated.

Depression is literal hell and it makes it so much worse that people are so fucking ignorant about it. When I am depressed, I just want someone to listen to the terror I am in and the horrible thoughts that I can't stop thinking and tell me that I am loved and that I will be taken care of. Tender touch, kindness, cooking for the person, cleaning for them. But no one fucking does that because everyone thinks you should be able to "snap out of it." People make meals for their friends with cancer or even broken legs. Everyone avoids the person with depression.

Sunlight

R26, sending you love from a fellow sufferer. I see you and I hear you and I believe you.

Uggh, so sorry for you and your BF. Hope he gets relief.

OP, I’ve read several articles that microdosing with LSD has been a depression game changer. Maybe look into that? I think it’s legal when done under doctor supervision.

It truly is a chemical imbalance/disorder.

I got up and went to work because I HAD, as no one else pays the bills.

Whenever unemployed, I went to AA meetings and socialized afterwards, because it genuinely helped keep a better perspective on things.

Regarding work, because that seems to be OPs actual focus, I had a boss with what I assume was severe depression. He was constantly in and out of work unexpectedly and for extended periods. He must have had a lawyer or advisor because he was apparently untouchable. He was also an asshole. When he was at work he was a dick and nothing could get done. When he wasn’t at work nothing could get done because he was completely MIA and required to sign off.

He should have been let go and allowed to go on disability or reassigned to a role where he was an individual contributor on things that weren’t time-sensitive. But maybe those weren’t options because of how the laws protecting the disabled are structured? I have no idea. But the firm wasn’t just wasting his salary. It was wasting a good portion of the salaries of everyone else he affected. They should have paid him off.

Having a challenging job is not going to be realistic for some people struggling with severe depression. Having a relatively easy job to go to and concrete manageable tasks to perform might improve someone’s mental health. Like the “sober jobs” recovering substance abusers get.

So I don’t think you can fault him if he doesn’t want to go to a demanding or stressful job and contribute financially. He might legitimately be unable to. But an expectation that he get dressed and go to a location on a set schedule for x hours a week might be reasonable. It might be 30 hours a week and it might pay $17/hour (or nothing).

IOW, maybe he should be working but it sounds like right now he is not capable of a significant financial contribution. So I would try to eliminate that consideration from your assessment of the situation. It’s sucks, but he’s ill.

R20, don’t forget this gem: “work smarter, not harder!”

[quote]My partner has very serious depression that has not responded to any normal antidepressant, ketamine or transcranical magnetic imaging.

When you say "normal antidepressant" are you just talking SSRIs (Prozac, Lexapro, Zoloft) , SNRIs (Cymbalta, Effexor) and Wellbutrin, or have you gotten into the more out there stuff. Because there are more options than just those. For some of my patients who have trouble responding to the regular ones, they do show response to one of the serotonin modulators (Viibryd and Trintellix, which also have a different side effect profile). Then you've got the TCAs like Anafranil and Elavil (those can be deadly in overdose, so if he's got a history of suicide attempt it may not be advisable), the TCA-like ones (Remeron), and then (if you can find someone who can prescribe it and he'll be able to follow the diet) Phenelzine. Sometimes supplementing with methylfolate (as a prescription, it's called Deplin, but you can buy it over the counter as well) helps if there's only a partial response to the SSRi. And then there's doing a low-dose neuroleptic like Abilify or one of the newer ones like Vraylar or Caplyta.

With some of my patients, if they're completely resistant to antidepressants, I give a trial of a mood stabilizer (I tend to use Lamictal because aside from the risk of Stevens-Johnson Syndrome, it's fairly innocuous if prescribed and taken correctly) to see if maybe we're actually looking at a bipolar disorder.

Failing that, the next stop is ECT.

R35 VotN - thank you.

Brighter people than me have benefited from ECT. While I don’t know them well enough to pry, I’ve seen two people willing to work and enjoy other people.

While I’d like to just treat my depression, I’m most likely bipolar. I have many adventures before hitting an ECT request.

Honestly the most helpful drug I’ve had in the last 30 years is Adderall added into the mix. My Dr. mentioned it 10 years ago. I didn’t even know it was an option. But I am a tired slug and it hurts to move without it. I’ve managed the impossible for all those years—the same amount still works and I haven’t increased it.

PRISTIQ!!!

[quote]Honestly the most helpful drug I’ve had in the last 30 years is Adderall added into the mix. My Dr. mentioned it 10 years ago. I didn’t even know it was an option. But I am a tired slug and it hurts to move without it. I’ve managed the impossible for all those years—the same amount still works and I haven’t increased it.

Geriatric psychiatry often uses stimulants for antidepressant purposes (but you still look 24, R38), but it's less common in younger folks.

You also sometimes see the non-stimulant ADHD meds, like Strattera or the newer (and yet also older) Qelbree used as well.

Thank you for speaking intelligibly to this significant issue, VOTN.

Yes, it can make you really unable to get out of bed, let alone leave the house and go to work.

I have had major depression for most of my life. I was able to go to university in my twenties, where I graduated with my Education degree. High stress and me don't mix well. I moved from school to school, before resigning. My issues have caused me to have lots of interpersonal conflicts.

I haven't taught in over five years, and the only job I have been able to maintain is working in the adult industry. When I go through bouts of depression, I can take time off work and not get fired. However, the job led me to a pretty serious cocaine and alcohol addiction. I'm hoping to transition into one of my passions, which is photography.

I am now in debt but no longer addicted. I have a new psychiatrist. My old one suggested Electric Shock Therapy but I absolutely refuse to do that. Right now I'm managing but have been house bound for the past four days. Luckily I met someone who has been a great support. Please be patient and understanding with your partner, it is a very real illness.

R35 Anafranil killed my father!

It's really awful to be depressed. My best friend from college has been severely depressed his whole life, and it's created enormous problems for him. he has a partner, but he almost never leaves his house (except to go to work as a college professor).

I suffer from mild depression, and took an SSRI for it for 20+ years. Suddenly last year after a family death the SSRI stopped working and I became more depressed and anxious than i had been in years. I had to taper off the old SSRI and start a new one: the weeks in between were hell. but my severely depressed friend had great advice about what to do to improve things for myself nonetheless--I was so grateful to him. he had been through so much himself that he knew some good ameliorative temporary fixes.

What are they, R44? Inquiring minds want to know. Seriously.

"Have any of you ever suffered from severe depression?... Are any of you still in it? If not, what helped you recover?"

Getting off anti-depressants and regular, vigorous exercise. (The answer no one wants to hear.)

[quote] What are they, [R44]? Inquiring minds want to know. Seriously.

It's mostly what everyone else is saying here. He said the most important things to do are to get out of the house, to get sunshine, to exercise, and to gets tasks done; he also said that he knew from experience that to a depressed person those are exactly the things they DON'T feel like doing, but they will make you feel better anyway. He also said to avoid following the news if that gets you down.

He also gave me tips about how to respond to a wave of panic. He said to practice mindful bheavior while you experience them so you're very aware of your senses (particularly touch and hearing) during the moment.

[quote] It is true that my partner has a piss poor attitude and will not do anything that [R9] suggests.

IMO, you should cut him loose. This sounds like a co-dependent relationship.

R46, it's not that it's the answer no one wants to hear. It's that your solution simply doesn't work for many people.

Some people here have written that they can't even get out of bed, go to work regularly or who have suicidal ideation. This type of depressive just isn't going to respond to rigorous exercise, because they cannot even manage to get out of bed and engage in it.

There is t a one stop solution that works for everyone.

Yes, exercising helps TREMENDOUSLY in my experience, but some people first need a medication that gives them the motivation to get out of bed on a daily basis.

[quote]I've heard electroshock therapy is used when all else fails and apparently it can have great results.

I know someone who did that, she said it didn't work. She said she forgot a few months of her most recent past but that's it. I can confirm, she's still on the hunt to solve her depression.

It was miraculous for my relative, who had failed multiple medications and made several suicide attempts. It’s called electro convulsive therapy now.

But as other posters have stated, what works for one person doesn’t work for another.

[quote]It is true that my partner has a piss poor attitude and will not do anything that [R9] suggests. - OP

And there is the ROOT of the problem. You can try drugs legal and not legal, electo, experimental things all you want but NONE will work unless that person takes steps to do something about it like R9 suggested instead of expecting a magic bean, oh I mean pill that will solve all their problem.

This woman I work for now and then has the same complaint and same piss poor attitude about common sense solutions. No, No, it's got to be some exotic mood altering drug just around the corner that she is seeking...which she never finds. "it's a chemical imbalance" she repeats ad nauseam. She's been through 24 of them so far, says she's resistant, tried electo and even Ketamine. But regular exercise, sunlight, fresh air, socializing, helping other? Nope, nope, not doing that. Usually it goes like this: I tried it once it didn't work. Except that ONCE is not how a routine of sunlight, exercise and fresh air finding a passion work.

Bottom line a lot of these "clinically depressed" people are looking for a simple solution to a complex problem. Always seeking a pill for the solution instead of the work it takes that R9 described.

I'm going to repeat what others have said. If he is not responding to the highest dose of Effexor or Lithium then he needs to have about 8 - 12 sessions of ECT. It's not as barbaric as it is made out in Cuckoo's Nest or Requiem for a Dream. He will be sedated, have a convulsion then brought into the recovery room and will be allowed home after a few hours. His short term memory might be a bit affected but that resolves after a day or so. Be careful if he is any amalgam tooth fillings as they can come loose. But generally if he has tried all the things you have said and nothing has worked then ECT is really the only game in town.

From someone who has been there I wish him and you all the best in getting to recovery.

EMDR therapy worked for me and healed so much of my trauma that now my depression only comes around every so often.

But, there are people like my father who have tried every anti depressant known to man and who is still depressed because that is all he knows. He wouldn't change even IF he could because his depression defines him. If he were to be "cured" he would then have to take responsibility for his own poor choices and he couldn't play the depression card anymore.

Some people do this and it's sad but there isn't much that can be done when someone makes the choice to remain depressed because it serves them. Sounds like your partner is one of these people and that he often gets what he wants because everyone just enables him.

I'd leave him because being around someone like this is exhausting and in the end, all you do is take care of the other person at the expense of your own mental health. I no longer speak to my father because all I ever heard was that he wanted to kill himself. He tried 4 times and at this point I wish he would just do it successfully because obviously he's still suffering and can't be helped. But I can't have him in my life anymore because growing up with that shit changes you and not for the better.

R49: "[R46], it's not that it's the answer no one wants to hear. It's that your solution simply doesn't work for many people."

The question was, "...what helped YOU recover?" I answered it.

I bet if your partner was single, he wouldn't be able to say he can't work. Being single means getting up and doing the hard shit because you simply can't afford not to.

But look at Carrie Fisher. I don’t know if ECT did her much good. And she had that lip pursing thing towards the end that was a side effect of something.

Electro Convulsive Therapy can be a great help for some people. It’s much less intensive and more focused than years ago. Psychedelic therapy has been amazing for a friend. I wish you all the best. This is a hard road.

My "mental health issues" turned out to be six neurological conditions, including narcolepsy.

Undiagnosed, untreated narcolepsy is well-known in neurological circles for causing severe depression. The problem is that depressives aren't usually seeing a neurologist.

It generally takes so long to diagnose narcolepsy in most cases, that depression is inevitable.

That makes me wonder how many "depressives" actually have narcolepsy.

There are also other conditions which when left untreated lead to depression.

And depression in and of itself is still pretty fucking nasty. Particularly when adding in the stigma surrounding it.

I hope it gets better for you both, OP. A friend regards ECT as a miracle.

R59 I have long suspected that a lot of 'depression' is actually due to other physical conditions.

This thread is fun. If there’s one thing non-depressed people love to do on the internet, it’s talk down to depressed people who already feel like shit lol

R61 Who's doing that?

I suggest having his thyroid looked at. I was fatigued, depressed, zero appetite,m—my muscles and joints hurt when I walked. I was hypothyroid and very deficient in vitamin D. Once I was put on a med and my vitamin D levels were up, I felt like a new person.

It’s probably not what’s going on with him, but it’s worth a check.

R23 I tried that and had a hellacious 5 hour trip, I was grateful to back to normal. It was like It's a Wonderful Life in a way.