I saw a psychotherapist, an MFCC, for 13 years, beginning at the age of 22 and ending this past June. I had been suffering from depression and suicidal thoughts since at least the age of 10. Nevertheless, I had managed to become a University student, where I eventually got bachelor's and master's degrees in English literature. The talk therapy helped right from the beginning, but the Prozac I began taking a few years later had a more profound effect. Over the years I had mixed success with antidepressants, trying various dosages and combinations of Desipramine, Wellbutrin, Zoloft, Paxil, and perhaps others. I'm now taking a combination of Effexor (300 mg/day) and Dexedrine (30 mg/day), and it seems to be working -- I think. For the last few years of therapy I probably wasn't clinically depressed. At least, when I was depressed, I got out of it quicker. A year ago I had been feeling good enough long enough that for the first time I imagined that therapy was something that could be completed. My therapist agreed, and we set an end date. During the final six months of therapy, though, I lost some of the sense of well-being I had had. I didn't know why I wasn't feeling as well, but I thought perhaps it had something to do with the impending separation from my therapist. Still, I didn't think it would help if I stayed in therapy. After 13 years in therapy I believed I had to experience what it was like to be out of therapy. I was surprised that I didn't miss therapy or feel like I _needed_ it. I continued to feel varying degrees of lousy, and I think I've lacked motivation and enthusiasm. I continue to see my prescribing psychiatrist every six months or so, but I don't know whether a different prescription would help. I feel like I'm at a point at which I'm not depressed enough to be depressed, but certainly I'm not content and satisfied with how I feel, how I'm experiencing life. In short, I don't know what my next step should be. I took a 12-week course in cognitive behavioral therapy for depression given by my HMO (Kaiser) and liked it a lot. I also felt a lot of resonance reading Judith Wallerstein's "The Legacy of Divorce," especially in regard to my persistent passivity. I really could use some advice, or perhaps you could pose some questions that might point me in the right direction. I could live out the rest of my life in my present state, but I really, really hope that I can do better. My life is not without pleasures but there's also so much low-grade, low-down suffering. Dear Dr. Dombeck, I read your column and like the answers you give. Can you talk about something I haven't seen in your column? That is, what to do when a person has done all the kinds of things you suggest but the depression overall doesn't get better? I take medication and have been in therapy and even have been in the hospital. I work full time and try to do healthy things. But I still get so bad that all I do is cry when I'm alone, and have to fight tears even when I'm around other people. I pray for this problem to go away, in fact I think I would do anything to be more normal. But sometimes it is so bad I don't know if I can go on. So what do you tell people when they feel like they've tried and tried and still can't get better?
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Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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