I Have Treatment Resistant Depression, Now What?
Advice for a reader who falls into the category of people who don't respond well to therapy or meds.
Reader Hopeless writes,
In your articles you always advise people with depression to get help, either counseling or meds or both. But what about people who have tried both and nothing works? I have been in and out of therapy since I was 16 and now I am 43. I have tried a list of medications including all the SSRI’s (they made me irritable/jumpy to the point that I was screaming at my kids like a lunatic, and of course sexual side effects and weight gain), a tricyclic (I was too tired to function), TMS (didn’t work), and even some stimulants (made me feel crazy). I have also tried mood stabilizers which gave me akathisia (terrible side effect) and brain fog/weight gain.
I have tried exercise which works a bit and meditation which doesn’t work, and I am a SAHM so I can stick to a good routine for my mental health and get enough sleep, eat well, etc. I have a sunlamp for SAD and I am on an IUD to limit my periods since my depression was worse before my period.
Still, I am depressed, and have all of the symptoms you discuss in your atypical depression post. I sometimes have days that are ok, but I have not felt truly happy in years. My sex drive doesn’t exist and the days go by in a gray fog. I know it’s bad to raise kids as a depressed mother but what is my choice? Secretly I want to ask you: is this a life? Should I even be alive if I can’t really feel much at all? I am not going to hurt myself because of my two children but what should someone like me do?
Dear H,
I hear you, and you are not alone. You are 100% correct that medications do not work for everyone. Neither does therapy, although I hope that at least some of the therapists you’ve seen have helped you. In fact, sadly, 10-30% of people with depression are treatment resistant like you, and some studies show rates much higher.
It sounds like you have tried almost everything that our Western medicalized and therapy-focused society advises for depression. Now perhaps it is time to come to terms with a new type of life. You have children and you are willing to stick out a joyless life to be their mother. That makes you a good mother. But you cannot only be a mother.
In a sense, if you know that every day will be gray and stifling, but you are still strong enough to exercise, parent, and write to me, then you may be very well suited to try and find a new and transformative purpose in your life. You have some energy, albeit not much, and you sound intelligent and insightful. Is there some cause or purpose that you can devote yourself to? Many people find solace in spirituality, whether it is the religion they grew up with or another type of community (or solo) spiritual experience. Others can find respite in their careers, particularly careers where they help others or give back to society. Still other people can volunteer and know that they are making a difference in their community.
Finding meaning in your life is essential. There are many people whose neurotransmitters work differently than yours that are happy. Happy is a temperament, mostly, from what I see (and from what personality research suggests). But many of those happy people feel that they are still missing a deeper purpose in their lives. You may not be happy, but you can find a deeper purpose, one you are proud of and proud to tell your kids about. Then, you will most assuredly have a meaningful life, even if every day still feels like a slog.
Additionally, even if social interaction feels daunting or fills you with apathy, power through it. Just one close friend or one good conversation can often change your outlook for the day. Social connection is a form of meaning-making and can also switch your focus from your own internal world to a broader perspective.
A last note: medical research moves quickly, and there may be other classes of meds that are discovered that work for you. Similarly, you may, if you try again, find a therapist that is more helpful than the others have been, or at least one who can help you in the journey to focus your life on meaning-making versus trying not to be depressed.
I hope this perspective helps at least somewhat, and till we meet again, I remain, The Blogapist Who Says, Not Everyone’s Depression Remits.
For therapy, go here for Dr. Whiten and go here for other clinicians in her group practice Best Life Behavioral Health. For coaching with Dr. Whiten, go here. Order Dr. Whiten’s books, Couples You Meet in Counseling: 7 Common Relationship Dynamics That Sabotage Closeness, 52 Emails to Transform Your Marriage and How to Talk to Your Kids about Your Divorce: Healthy, Effective Communication Techniques for Your Changing Family, and listen to The Dr. Psych Mom Show on Spotify, Apple Podcasts, or anywhere else you listen to podcasts. Join The Dr. Psych Mom secret Facebook group for more discussion about these kinds of issues!
This blog is not intended as medical advice or diagnosis and should in no way replace consultation with a medical professional. If you try this advice and it does not work for you, you cannot sue me. This is only my opinion, based on my background, training, and experience as a therapist and person. Also, all examples involving people or clients are hypothetical amalgams, not actual people.