Ask a Psychiatrist and Get Answers to Mental Health Questions ASAP
I am very sorry to hear of the situation, it can certainly be a very distressing and frightening when a loved one develops serious Depression. I treat patients with Major Depression regularly and I believe I will be able to assist you with this matter. From what you have written I can see that your husband is generally receiving the appropriate treatment approach as a combination of CBT and antidepressant therapy is recommended by the National Institute for Clinical Excellence. You can confirm that this is the correct treatment recommendations here.
I imagine you have a number of questions so I will await for your response but in the meantime could you please confirm for me the professional qualifications of the people involved in his treatment. Is his medication being supervised by a Psychiatrist or a GP? Is the person delivering the CBT a registered Clinical Psychologist? If not, what is their qualification. Also, are you able to provide any more information on the kind of tasks or strategies he is being introduced to as part of the CBT?
Ok, thanks for the extra information. My first recommendation would be that he be reviewed immediately by a Psychiatrist. GPs have minimal training in the use of Psychiatric medication and the GP should (after several months of unsuccessful treatment) have referred him on by now anyway. If Depression intensifies to a level where it becomes more sever CBT can quickly become ineffective and in these circumstances the standard treatment strategy is to use medication to lift the mood to a point to where the person can engage with CBT fully. I would trust your instincts on the matter of whether the therapy is working at this time, if he is not getting better after several months something is clearly not working. A review of his medication by an experienced Psychiatrist should be the priority at this point.
Usually Depression should be effectively treated within a couple of months and if your husband is not getting better at this point it would be classed as treatment resistant Depression. I seriously question why the professionals involved in his care have not escalated his treatment at this point in time.
I'm going to read between the lines here and ask whether you are becoming concerned about his safety at this point in time? Feelings of hopelessness are common to Major Depression and these in some cases can intensify to a point where risk of suicide attempt must be considered. Hopefully he is not experiencing this but are you aware of whether this matter has been broached by his treating team?
I have to say that I completely disagree with the treatment approach he has been advised upon. It is completely unacceptable for any person to spend months having to tolerate Depression. Depression can be a very dangerous illness because it has a nasty habit of getting worse when left untreated and for this reason any situation where an individual has not improved over several months should be treated seriously - it's called treatment resistant Depression!
I suggest you contact Samaritans http://www.samaritans.org/ 08457 90 90 90 for a second opinion on the situation. Samaritans provide crisis support but also provide a range of services for individuals and family members experiencing mental health problems. Samaritans will treat the situation seriously (as it should be) and hopefully assist you in contacting alternative treatment services.
So, in a nutshell: You are right to be concerned about the situation and right in being dissatisfied with his treatment so far. Contact Samaritans to begin the process of finding someone who will manage the situation appropriately.
I hope this has been of some help. If you have additional questions or would like me to clarify any part of my answer please don't hesitate to let me know. Best of luck!
Treatment resistant Depression just means that it is a situation of Depressive illness that is not responding to treatment. It certainly is treatable but it just means that the person is not responding to the initial treatment approach. As your husband has unsuccessfully trialled some medication and CBT it would be reasonable to consider his illness as treatment resistant. The priority at this point in time is to establish an effective medication regime and this should be done by a Psychiatrist (not a GP). As you have suggested that his existing GP & therapist are not initiating this I recommend you contact Samaritans (contact details in previous post) and ask for assistance in locating a Psychiatrist in your area. Once a effective medication regime is established and his mood lifts a little he should continue with the CBT.
One of the common symptóms of serious Depression is a profound sense of hopelessness - patient often believe that they have been permanently effected and will never change/get better. This is a symptom of the illness and usually when their mood is lifted this sense of hopeless fades. I often say to my Depressed patients that I understand they feel hopeless but it is the Depression talking. He may believe feel that nothing will work and that may be his Depression talking.
So, contact Samaritans and get him reviewed by a Psychiatrist ASAP.
Please let me know if you have further questions.
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That is a very disappointing response to receive from Samaritans, my understanding is that part of their mandate is to connect people with local services when contacted. NHS Choices has a search function that will provide listings of services in your area and you can find it here http://www.nhs.uk/ServiceDirectories/Pages/ServiceSearchAdditional.aspx?ServiceType=Mentalhealth .
With regards to the GP, they should arrange a review by a Psychiatrist if you request one...it's your right to request a second opinion and the GP should have no issues with arranging this for you.
With regards to your husband believing that he has been permanently changed; try to keep in mind that he is speaking from a state of illness in which his cognition, perspective & interpretations have been altered. He will be able to discuss this matter with you but he will still be responding from a state of illness. He will likely interpret things in a different manner when his mood is lifted but until then you really do need to try and accept that 'it may be the Depression talking'. I often have conversations with my Depressed patients that are similar to the one you are trying to have with your husband and I rarely am able to convince them that their cognition may have shifted whilst they are still depressed. I make it clear to them that it is my opinion that there may be cognitive changes and that we should wait to see how they view things after the Depression has lifted.
Depressed individuals can develop difficulties processing feelings but again his perception of what has happened in the past and what will happen in the future can be significantly impacted upon by the illness. It's difficult but try not to put too much stock in what he is saying while he is unwell (at least with regards to his own mood state).
My sympathies go out to you, it mus be horrible to see someone you love affected in this way. Try to keep reminding yourself of this point:
He is unwell, it affects what he says and does. Things will change when he is treated properly.
I have lost count of the number of times I have heard Depressed patients acknowledge how their thinking had been affected - after the Depression had lifted, not before.
If I can be of any further assistance to you in any way please let me know.