I'm sorry that your son is going through a rough patch right now. It seems that he's tried a number of things to help your situation. I certainly wouldn't diagnose over the internet (neither appropriate nor ethical), but I do have some advice regarding the proper treatments for depression.
Research has consistently demonstrated that treatment plus medication is more effective than medication alone or treatment alone for depression and/or anxiety. Further research has shown that Cognitive Behavioral Therapy (CBT) is the most effective form of psychological treatment/intervention - particularly in dealing with mood disorders (like depression).
A licensed psychologist/psychotherapist with specific training in CBT modalities would be able to address your concerns. I would encourage you to find a licensed mental health professional with whom to work, employing CBT. Be sure when you speak to a possible licensed mental health professional that s/he employs CBT techniques - not just "influences from CBT" or "an eclectic approach."
With regard to medical treatment, many/most physicians appear to begin with a Selective Serotonin Reuptake Inhibitor (SSRI) to treat anxiety. Because I am not an MD, it is beyond my purview to address medication concerns, however.
Again, the mantra of years of research says: medication or treatment alone is not as effective as both working in tandem. Some research has also indicated that insight-oriented talk therapy is counter-productive with some forms of mood and/or anxiety disturbance... it actually exacerbates the condition(s) So, seek out a CBT therapist who will provide targeted, efficient, and effective therapy - not someone who signs you as a "lifer." If you're going to a therapist for years, something about the therapy isn't working.
Your psychiatrist *may* know of a CBT licensed mental health professional. Please make certain, however, that they employ CBT practices.
If $$ is a super-big issue, you might want to consider contacting your local Community Mental Health Center. These tend to offer free or greatly reduced cost mental health services, including therapy and/or med management, depending upon your ability to pay.
Finally, you make note of your son's substance use. While it is possible that there may be an underlying substance abuse problem here, in all likelihood, your son is doing what many people his age do - uses (perhaps overuses) substances recreationally and/or to self-medicate. The vast majority of people in their 20s overuse substances and then "settle down" and revert to normal social use. If, however, your concerns are significant - I would encourage your son to consider speaking with the CBT therapist about this issue.
Thanks. I hope you're well and that this was helpful.
* FEEDBACK ENCOURAGED. Please contact me prior to leaving negative feedback so that we can resolve the matter. I am eager to work with all JA clients to provide them with useful/helpful answers. Thanks again.
Thank you for replying.
I absolutely agree - and understand that your son has done a great deal to address these issues. I question whether or not your son has seen the CORRECT kind of psychologist/therapist.
That is, as noted in my response, decades of research has finally concluded that traditional "talk therapy" is not as effective as CBT... and far less effective than CBT used in conjunction with appropriate medication. If your son has seen someone who does not employ CBT practice, he may have had poor results. Were his medication trials also completed in conjunction with the treatment - or separately.
In the event that you feel that your son's depression is significant enough that he may harm himself or someone else, then I certainly would urge you to have him taken to an ER for observation and possible admission.
In essence, I understand that he has gone through some therapy in the past. Do you know what practice they employed? Was it administered in tandem with medications? Not all therapies (and therapists) are alike and this is why I emphasized CBT in my response.
However - please feel free to provide me with more information if you feel it would be helpful. For example, you didn't discuss much more about his substance use (marijuana, alcohol). Would you care to? Do you know what has specifically triggered his latest bout of depression?
Thanks... I hope I can be of more help to you. Let me know.
This helps me to understand a little bit better.
If your son is coming home every night and drinking alone, then there may well be a substance use problem. Yes, it may be caused by underlying mood problems (whether bipolar or unipolar depression) - but he's currently choosing (it appears) to be dealing with it alcoholically. This is particularly true if he is actually saying he wants to stop but cannot.
I hate to keep playing "toss the questions" with you, but do you mind telling me what city you live in? (I'm not asking for your specific address or anything related to your confidentiality... but I'd like to recommend something more local to you.)
Finally, with regard to the medication and not getting better. Certainly there can be times when medication doesn't work. Most often, we assume that the problem was with initial misdiagnosis... and look at refining the diagnosis. Has he been back to see a psychiatrist (MD - who prescribes medication) since he was 15?
It *is* possible that the medications were inappropriate and unhelpful. Because I'm not a physician, I can't really speak to the medication issues.
I think it might be worthwhile for your son to attend an AA meeting. You can e-mail the Louisville intergroup chapter of AA at firstname.lastname@example.org and your can check out their website at: http://www.louisvilleaa.org/index.htm. Looking through their listings for tonight, I see over 25 different meetings listed for 8:00p! (That's impressive!)Also, later on in July, there is a special group for "young people" that he might be interested in exploring. http://www.louisvilleaa.org/Announcements/final%20flyer.pdf
You may find this an inappropriate referral - but - I know a number of young people about your son's age who come into the program assuming they're not alcoholic. They "get hooked" into seeing people having fun and living life sober - and their life gets better! Remarkably better!
This is definitely *not* a typical suggestion you might get from a licensed mental health professional... but I just wonder if this might be part of the solution to your son's problem. Maybe he's struggling with learning how to live sober... if he's spent a majority of his preadulthood on drugs/alcohol, he missed out on some major learning. AA does more than teach you how *not* to drink, it teaches you how to live.
If you're not interested in checking out a meeting, consider possibly reading the "big book" of AA. Here's a copy to read: http://www.aa.org/bbonline/
I do wish you *and* your son all the best... and hope this proves helpful.