How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr John B Your Own Question

Dr John B
Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience:  PhD in Clinical Psychology, registered clinical psychologist.
40845682
Type Your Mental Health Question Here...
Dr John B is online now
A new question is answered every 9 seconds

My husband has been suffering depression for a year. He now feels nothing will help him an

Customer Question

My husband has been suffering depression for a year. He now feels nothing will help him and that he has changed. He was taking prozac Sept-Dec then nothing, now he is on venlafaxine - started 6th Apr, dose increased to 150mg two days ago. Attends 1hr long CBT session per week. He has been really down for the last 3 weeks and sees no way out. I am desperately trying to help him. He's self employed and works alone mostly.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr John B replied 2 years ago.

Hi,

 

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?

Customer: replied 2 years ago.
Hi, thanks for your response. Pills are prescribed by GP. CBT therapy is done by psychologist, CBT practitioner. MBABCP. I don't feel my husband is responding to this kind of therapy and 1hr per week doesn't seem adequate to me. He is very tearful almost daily. He is getting to the point where he is accepting he's changed and is pushing me away. Is there anything else we can try?
Expert:  Dr John B replied 2 years ago.

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?

Customer: replied 2 years ago.
He has been referred but they said cbt is enough for him and gp should monitor the medication - shocking in my opinion! I have not been asked once to give any feedback... It took me to get my husband to be seen by somebody other than gp for months, nobody is taking it seriously. I don't think he'd harm himself, but he is really down and so tearful all the time.
Expert:  Dr John B replied 2 years ago.

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!

Customer: replied 2 years ago.
Many thanks for your help. What would you recomend we do? Resistant depression - is that treatable? He believes he changed and therefore nothing will work, no pills or anything.
Expert:  Dr John B replied 2 years ago.

Hi,

 

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.

Expert:  Dr John B replied 2 years ago.

Hi,

Was my answer helpful? If so, please press accept. If not, let me know and I can opt out and open the question up to another expert.

Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience: PhD in Clinical Psychology, registered clinical psychologist.
Dr John B and other Mental Health Specialists are ready to help you
Expert:  Dr John B replied 2 years ago.
Hi,

I just wanted to check in on how you were progressing with getting your husband reviewed by a Psychiatrist? If I can be of any further assistance or you have any other question please don't hesitate to contact me.

Regards,

John
Customer: replied 2 years ago.
Hi, I called samaritans but they said they only provide comfort type of help. He will be viewed by GP again along with me on Monday. I have found a private psychiatrist via a friend if gp offers no tangible solution.
Unfortunately my husband believes he has changed and is not happy with this life although he is unsure why coz he loves me (his words) and I am unable to help or persuade him that it is depression talking. He thinks he changed and became depressed as a result... I wonder whether he thinks like this because he's been left in this state for so long that he no longer recognise what's a real feeling ... It's absolutely devastating to see such a happy and full of life person to be this lost ...even more frustrating that I cannot help.
Thanks. Katerina
Expert:  Dr John B replied 2 years ago.

Hi Katerina,

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.

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education