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Ask Eleanor
Ask Eleanor, Psychotherapist
Category: Mental Health
Satisfied Customers: 1517
Experience:  Marriage & Family Therapist/Prof. Counselor for 20 years
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RA-mab

Customer Question

What do you do for depression that does not lift? I am on antidepressant medication and seeing a therapist but it has been months and I am still struggling to get through each day. I have had a bad few years, losing my job and 3 family deaths (my brother, spouse and mother). I care for my adult son with autism and have to get my head together. Any suggestions?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Doctor Rao replied 2 years ago.

Doctor Rao : Hi,sorry to hear things aren't going well.What medications you are on now
Customer :

Cymbalta 60 mgm per day, plus meds for high blood pressure and tryp 2 diabetes

Doctor Rao : Ok
Doctor Rao : I would like to start with saying the precipitating an perpetuating factors as this is important for you to have some insight in to the illness.Depression, although commonly diagnosed but very challenging to manage.so, the more we know about it helps
Doctor Rao : Precipitating factors are the factors that might have contributed to bring the illness to surface..In you case appears to be few bad years..losing the job,family bereavement
Doctor Rao : Perpetuating factors are the factors that might be mandating the illness..for example we all know how stressful the caree role can be..in your case you said caring for your Autistic son.You at edging the great job but we can not ignore the stress associated with it
Doctor Rao : Now I come to the management. If you are on Cymbalta 60 milligrams the next possible steps are to consider adjunctive medication. This means adding another medication to improve the effectiveness. The possible options are 1. Adding an SSRI to Cymbalta (if SSRI haven't tried so far)
Customer :

Are you jumping between my and another customer? I am getting each message you send 3 or more times, identically. Then I get a message that you are disconnected.

Doctor Rao : 2. Adding small dose of medications like Quetiaine or Aripiprazole to Cymbalata following a Consutation with your doctor. 3. Adding a mood stabilizer medications like Lamotrigine to Cymbalat. 4. To consider an antidepressant of different mechanism of action..in your case the possibilities could be Wellbutrin (Bupropion) as it effects both in Serotonin and Norepinephrine.
Doctor Rao : No. Not sure why thisis happening
Doctor Rao : I am seeing you as stepped out of chat,entered the chat messages constantly..may be that is the reason
Doctor Rao : Have you got my messages now.. Numbered 2, 3 and 4
Customer :

I got 2

Doctor Rao : You keep going offline..so not sure which side is the problem
Doctor Rao : In the same message I numbered 2,3and 4
Customer :

I can talk with my doctor about the possible med changes.

Customer :

But will a med change really change this?

Doctor Rao : Ok.I hope you find this helpful.
Doctor Rao : The right combination needs to be identified..once it is done Depression can be easily controllable
Doctor Rao : Do you want to ask any further information..If so please ask. Otherwise if you happy with the answers given,please Accept the answer.
Expert:  Ask Eleanor replied 2 years ago.
Hello, I would like to offer a different answer for your consideration. First let me say that I am very sorry for all of the losses you have suffered in recent years. Those are each huge losses in themselves, but all together they are overwhelming. It is good that you are in therapy and like your therapist. I hope you recognize that you are grieving. At the end of my answer, I will paste in a paper I have written for my JA customers on the Stages of Grief. ....continuing....
Expert:  Ask Eleanor replied 2 years ago.

It is also important for you to have the support of others who have experienced deaths of loved ones and also for those caring for a family member with Autism. There are many online support groups for those living with and caring for someone with Autism. Here is a link to the Autism Society of America http://www.autism-society.org/ There are many more, just Google "Autism Support Groups." Now for Grief Support Groups. Here is a link to the Daily Strength Online Bereavement Support Group : http://www.dailystrength.org/c/Bereavement/support-group There are many others but I believe it is one of the best. You may also ask your therapist about live support groups where you live. The online groups are wonderful because you can go there anytime you feel the need to talk and seek support from others who understand. All support groups whether online or live are free. I believe with these added resources, you will begin to heal from your depression, which is really the stage of grief where you are stuck, and understandably so. It has been my pleasure to answer your question. Chat back if you need anything further. I wish you healing, take care of yourself, Eleanor

 

Expert:  Ask Eleanor replied 2 years ago.

PS: Here is the paper about the Stages of Grief:

 

 

THE STAGES OF GRIEF

Grief is an emotional process we all experience after a significant loss in our lives. Grief may be triggered by the death of a loved one, divorce, job loss, all of our children leaving home (empty nest), miscarriage, or even death of a pet. No matter what the loss, most of us will experience the following sequential stages of grief, although these can certainly vary in some people.

STAGE 1: SHOCK

The emotional shock of losing someone or something dear to us is really no different than the state of shock after physical trauma, in both we shut down. Shock protects our bodies/psyches, from what we are not yet ready to feel, a protective "timeout." Shock is of short duration, measured in hours, days.

STAGE 2: DENIAL

We tell ourselves this can't be true, can't be happening, can't be real, there must be some mistake. Denial, like shock, is usually of short duration.

STAGE 3: BARGAINING

We tell ourselves, God, that if we just do this or that, we won't have to suffer this horrible loss, feel this pain. Bargaining is usually not a lengthy grief stage unless we get stuck there by telling ourselves we can do something to avoid the pain of the next stages of grief.

STAGE 4: ANGER

We may get angry at the Drs. who could not save our loved one, angry at God, angry at ourselves for not doing something that might have prevented this loss, even angry at the one who died for leaving us. We may even displace our anger onto some innocent friend or family member. In anger, we often utter the words, WHY ME? These feelings of anger give us energy and can be a defense against entering the next stage, Depression.

STAGE 5: DEPRESSION

We may not be able to sleep, have changes in appetite, not want to engage in activities with others, have no energy, have overwhelming feelings of sadness, cry a lot, and sometime even feel hopeless. Depression is usually the longest and most difficult stage of grief. Ironically, what brings us out of our depression is finally allowing ourselves to experience our very deepest sadness.

STAGE 6: ACCEPTANCE

We come to the place where we accept the loss, make some meaning of it for our lives and are able to move on. If we have lost a loved one, we often transition from a physical relationship to a spiritual one with that person and are able to remember and be thankful for the good times. If there has been a tragic loss, either from some horrible disease or an accident, people often find a way to reach out to others who are experiencing the same type of loss and give help and comfort. In this way we are able to make meaning of the loss for our lives.

Grief that last over a year is considered complicated grief and requires the help of a mental health professional. Therapy and/or a grief support group can help us move through the normal grieving process. It is important to reach out, for if we try to get through our grief alone, we may self-medicate. Unresolved grief is the root of many addictions.

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Marriage & Family Therapist/Prof. Counselor for 20 years