Still Depressed? | DrHoganPesaniello

STILL DEPRESSED?

Major Depression is treatable

Most people will feel better with psychotherapy, neurofeedback, or the first or second antidepressant they try, or with a combination of these. However, many people with depression never seek treatment or they receive inadequate treatment.

Common Concerns:

“What will others think?”

Some people fear social stigma and let the ideas of other people keep them from doing the very thing that will help their mood and will make them more socially effective and comfortable. Engaging with a psychiatrist for psychotherapy, alternative treatments, or medication treatment for depression requires courage and strength. Responsible individuals who are doing their best to address their depression deserve encouragement. In fact, most people have either had emotional symptoms themselves or know family members or dear friends who have. So, seeking treatment is not as unusual as it may seem, and lots of people understand, but may not talk about it.

“What if the therapy, medication, or biofeedback affects me negatively?”

Some people fear they will experience negative side effects from treatment. With psychotherapy, the better the therapy, the more likely an appropriate degree of challenging feelings may arise in the supportive container of therapy. A good therapeutic relationship provides both support and challenge so that difficult feelings and reactions lead to the growth or changes needed.

My experience has been that with medications, if side effects occur (often there are no side effects.), they usually are tolerable, and decrease within a few weeks. If not, another antidepressant will probably be more tolerable. If a tolerable medication cannot be found, it may be important to consider gene testing. With neurofeedback, all effects help to clarify what protocol to use. If negative effects occur, when the protocol is adjusted, those effects generally dwindle quickly. Part.

“It takes too long.”

What is challenging to most people, is that all therapy takes time to work. Neurofeedback relies on repetition for the brain to make new connections that support better mood regulation. Biofeedback and neurofeedback, relaxation training, and cognitive therapy have the potential to provide immediate relief on occasion, but it will be short lived unless treatment is sustained for long enough. However, whether or not the improvements are sustained depends on repeated practice to lock in more sustained benefit.

All antidepressants will take at least three or four weeks to begin working. When medications are effective, usually symptoms like low energy and poor sleep start to improve first, then the mood begins to improve. Because of this delay in positive effect, it is very important for people with depression to be reminded to “Hang in there!”

Sometimes one or two sessions of psychotherapy provide some immediate relief or life-changing insights. It is more likely after some initial relief, there will be some delay in achieving a full and sustained response to psychotherapy. A trusting, safe relationship with the therapist must be established. Remember, it takes a long time for people to develop habits of thinking and feeling that contribute to depression. Doesn’t it make sense that learning about and changing these habits may take some time?

While some talk therapies that focus on specific issues may be short-term, it will take longer to deal with more complex issues.

“I’m not getting better fast enough!”

In management of depression with medications and/or psychotherapy, frequent initial contact (usually weekly) with the psychiatrist is often needed to ensure that treatment is adjusted until a good response occurs. (Depressed persons can tend to stop or taper treatment before giving it enough time to work or to work fully and may need encouragement to “stay the course.”) Once a person is feeling better, it is particularly important that he or she continue the effective treatment for a period of time. A With medication that would be a minimum of 6 to 8 months, and with neurofeedback, it requires a number of trainings to “lock in” gains then the trainings need to be carefully tapered. In some cases, it is best for treatment -- whether meds or other therapy -- to be continued longer or indefinitely, maybe at reduced frequency. Generally, psychotherapy or neurofeedback have a better record for preventing relapse once discontinued. Meds have not been shown to reliably prevent relapse once discontinued. There is some evidence that intermittent medication therapy may work for some people, but this must be done with care.

In psychotherapy as well, it is often after the major mood symptoms have resolved that the real work of therapy begins. This is because intense, focused work in therapy requires emotional energy and resilience that is difficult to come by when one is deeply depressed and vulnerable.

“Why isn’t my medication making me better?”

For some people, psychological issues may have a greater contribution to the depression than realized and talk therapy may be an even more important part of the treatment.

The above is especially true if the following exists:

a long-standing pattern of relationships/work problems

lack of response to previous medical treatments for depression

trauma history, PTSD

chronic depressive symptoms lasting for years

split treatment (using one provider for therapy and another for the meds) has not worked. Sometimes split treatment is counterproductive, and the treatment should be with one provider.

In these cases, don’t be surprised if medication alone is not working. From one third to two thirds of patients have no response or an incomplete response to medications. Working with a differently skilled therapist or shifting both meds and therapy to the same provider may be the missing ingredient. Biofeedback or neurofeedback may prove more relevant and useful in addition to psychotherapy and should be considered.