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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5095
Experience:  Dr. Mark is a PhD in psychology in private practice
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Hi, I am 57 years old and have been unemployed for the past

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Hi, I am 57 years old and have been unemployed for the past 2 years. I am currently taking 60mg of Prozac daily, .5mg Clonopin twice daily and 3mg of Lunesta for sleep. But my depression is at it's worst. I first started Prozac @ 20mg 13 years ago. The dose had to be increased eventually to 60mg, but wasn't working. My doctor tried Wellbutrin, but it I had high energy and couldn't sleep. Moved to Effexor and had good results for a couple of years til they quit working also. Have tried Cymbalta with only modest relief, and also tried Zoloft. Ultimately, they all seem to lose their effectiveness over time. So last year I had my doctor switch me back to Prozac. My symptoms have returned stronger than ever. It seems the SSRI's just can't help any more. I've been afraid to move to other classes such as MAOI's . I feel a little lost that my doctor can't do more. I've begun to feel a lot of pressure from my wife, and I don't know what to say or do. The more stressed I feel the more I just shut down. Any suggestions.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 2 years ago.

Hi, Dave! I believe I can be of help with this issue.



First, let me say I can imagine how distressing and worrisome this situation with your medications is for you. I also want you to know that at the end of the posting I'll paste in for you a technique you can use to help you when you are feeling low and in that dark hole of depression and anxiety. When you are feeling that anxiety and dark place, this is something you can use to help yourself with some relief and you can use it over and over.



You are now unsure about medications in general. It's been a frustrating road with them and you haven't gotten the relief you've been seeking. You're asking for help and that help is not going to be any other type of medication that somehow you or your doctor haven't heard of. If so, then you need to focus on four things which are not as quick and easy as meds but may be effective over the long run with less risk of side effects. The four things: herbal remedies, diet, exercise, psychotherapy.

Herbal remedies: St. John's Wort is the only herbal remedy that has any clinical evidence supporting its effectiveness for depression. Other "products" claim to, but in the literature, this is the only remedy accepted as having significant evidence. VERY IMPORTANT: do not take St. John's Wort with any antidepressants. Please check with your doctor about any other drug interactions. But this is important. Any other remedies are going to be a matter of whether you want to try it. Remember: no "natural" remedy is going to have the quick and powerful effect you will see from the medications--but not the side effects or withdrawal effects either.

So, I'm not sure it's wise for you to stop taking meds in total. It might be better to stay with the meds and add the rest of this program. But if you're frustrated with the medications, then you need to talk to your doctor about tapering off the meds in a safe and controlled manner. He/she needs to be on board because you may find afterwards that they were doing something useful after all and you want to resume taking them. And again, herbal remedies are not going to be like meds. St. Johns Wort is the only one with clinical evidence and it is not safe to take it with antidepressants.

So, consider trying this behavioral program along with the meds at first or with stopping the meds if you feel you need to do that:

Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. Also, you need to take Omega 3 fatty acids. Either in fish oil or capsules. You need because you have depression a clinical dose, about 3,000 mg a day. Discuss this with your doctor. The research is conclusive on this. So that's diet. Oh, and lean meats only. No fast food restaurants, no fatty foods.


Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit.

Psychotherapy: this requires to have you reorient your thinking about yourself and depression and meds and remedies. Medications and remedies only treat the symptoms of depression and that it is important to treat your depression as a HUMAN symptom.

So you would need to reorient your view of what's happening to you so that your emotions, which ARE after all, what is being talked about here with depression are treated with human respect and value and given a chance to help you grow and gain as a human being. This would mean changing your focus from the medications being your main "work" on your depression to your exploring your emotional reactions of being in such a depressed dark place as being your MAIN work and the meds and remedies as being the boost you need to help you not be so panicked and anxious and in a dark hole so that you CAN work on what's going on inside. Do you see this reorientation? We have emotions because they are part of how we grow and learn and become more fulfilled. But if we keep medicating them and trying to get them just to go away without ever exploring what's going on, we NEVER get that chance to get anything from them.

You need to find a psychologist or psychotherapist to help you with the underlying CAUSES of these symptoms, who can help with the depression itself. You need to feel comfortable with the psychologist and I don't want you to accept just any psychologist. You have the right to interview them until you find one who you feel comfortable with and that you feel will understand your experience!

If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list CBT therapy in their orientations and depression as one of the areas they work with.


http://therapists.psychologytoday.com/rms/

If you want someone who isn't as structured as a pure CBT therapist, consider seeing if the therapist also lists humanistic and/or psychodynamic therapy in their orientation. The idea here isn't that these types of therapy are magic. It's that you may want to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions.

I wish you the very best!

Now for the technique: here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you when the anxiety of depression is present is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety and depression, which strengthens the emotion and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?

Please remember to click the green accept button because: even though you have made a deposit, I do not get paid for my time unless you press ACCEPT. Feel free to continue the discussion as my goal is to get you the best answer possible. You can continue the discussion even after pressing ACCEPT. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Please remember to click the green accept button because: even though you have made a deposit, I do not get paid for my time unless you press ACCEPT. Feel free to continue the discussion as my goal is to get you the best answer possible. You can continue the discussion even after pressing ACCEPT. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5095
Experience: Dr. Mark is a PhD in psychology in private practice
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