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Doctor Blake
Doctor Blake, Psychologist
Category: Mental Health
Satisfied Customers: 146
Experience:  Ph.D., Ed.S., NCSP Clinical Psychologist; 15+ years of experience; dual licensure
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I have been prescribed several antidepressants since

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I have been prescribed several antidepressants since September but have had severe side effects from them all. I am not taking any medication at the moment but have an appointment with a psychiatrist on Monday. I am very concerned about the outcome as I feel the only solution to my chronic depression is treatment but I have developed such a phobia about medication. Prescription of these medications is so trial and error I know but I feel there will never be one which treats me without causing adverse effects and belief in a treatment is so crucial. Are there any alternatives? Can deep (seeemingly crippling) depression lift spontaneously?

Good morning.

I'm sorry that you're going through a rough patch right now. It seems that you've tried a number of medication 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.

First of all, depression is considered the "common cold" of the mental health field. As such, nearly everyone develops some cluster of symptoms at some point in their lifetime that *might* qualify them for depression... and most of these never require any treatment/intervention whatsoever. These folks "recover spontaneously" - but some would also argue, "well, were they really suffering from major depression - or was it just typical stress of living?

In any event, chronic major depression is a horse of a different color altogether. Spontaneous recovery from such a disorder is theoretically possible, I suppose, but I would imagine unlikely.

Research has consistently demonstrated that medication plus treatment is more effective than medication alone or treatment alone for depression. 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 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.

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.

Customer: replied 7 years ago.
Thank you for such a detailed response. I'm not sure CBT would address my thinking issues which seem to be dominated by recollections and memories from the past - as if all the information my sub conscious mind has absorbed is surfacing - feelings I was aware of at the time but didn't like/want/have time to address then. These memories seem to come into my mind and float around randomly but constantly and I dream so much at night that by the morning i am exhausted. Is this a symptom of depression ora result of too much rumination? Would medication supress this and how could CBT help?

Thanks for your speedy reply!

Actually, your response suggests (to me at least) that CBT would be PERFECT to address your concerns. You suggest, for example, that your thinking is "dominated by recollections and memories from the past" and that you suffer from too much "rumination." Those are exactly the kinds of issues that CBT would help you to address... to help recognize that thoughts/feelings are part of who you are - but they do not define who you are... that everyone has thoughts/feelings to process - but that we do not have to become prisoner to them... that everyone occasionally gets stuck ruminating - but that we can learn new patterns of thinking and behaving besides what we've always done. It's really very hopeful!

Also, I think you had great insight when you asked about rumination because research suggests that women are more likely to be diagnosed with depression because of their cognitive style - which tends to be ruminative. You know what a guy does when he experiences uncomfortable thoughts/feeling? He distracts himself with something more pleasant. Research shows that women tend to spend more time examining and talking about these thoughts and feelings - and that all that thinking and all that talking make those thoughts and feelings come back... and ultimately contribute to depression.

Again, I'm not a medical doctor, but some medications (particularly the SSRIs) can be helpful in thwarting obsessive or ruminative thinking. Some clients I've heard also describe vividly intense dreams while using SSRIs... so you may have several questions to bring up with your physician about your medication.

I think you're an ideal candidate to at least *try* CBT... heck, it couldn't hurt, and it just might help.

There are a "bajillion" books out there on CBT and depression/anxiety (many for practitioners rather than for clients)... but a very client-friendly book to maybe consider is:

David Burns, "Feeling Good." This book isn't *exactly* CBT - but employs some CBT-type techniques... and many clients find it very helpful. He also provides a great deal of advice about overcoming depression without medication. For a psychiatrist/MD - that's encouraging!

I hope this helps. Thanks... best of luck to you!

***FEEDBACK IS WELCOME. Please let me know if you have concerns about your answers. I would like to work with you to guarantee a "positive" feedback... and am open to communicate about and "negative" concerns you might have. Bonuses are always welcomed! Thanks.

Customer: replied 7 years ago.
Thank you so much again for your encouraging and detailed response. Is CBT on line as effective as a face to face session?

No problem.

I am not aware of any research indicating what form of CBT (online or face-to-face) is considered more effective. There might be some out there - but I've not read it.

Generally speaking, I would imagine face-to-face would be more effective only because (a) you're dealing with a real human being *in the room* who can read additional language beyond what's communicated on-line; (b) you'll have the opportunity to practice new thoughts/new behaviors *in person* with a specialist, rather than via the internet; (c) many licensed mental health professionals would find on-line therapy somewhat dubious a proposition and may question the professional ethics of doing so.

I hope this helps!

***FEEDBACK IS WELCOME. Please let me know if you have concerns about your answers. I would like to work with you to guarantee a "positive" feedback... and am open to communicate about and "negative" concerns you might have. Bonuses are always welcomed! Thanks.

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