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Question:

I had depression for about 40 years. I am 66 years old and started having symptoms around age 25.I have been on all types of antidepressant. They all work for awhile but then return. I'm about to give up.

I will not try electric shock treatment. Tried depakote and tried lithium, this did not agree with me. What can I do? Please help me.

Answered by: Jonathan W. Stewart

The best thing to do is to obtain a consult with a good psychopharmacologist. If you live in the New York Metropolitan area, you can call the Columbia Psychiatry Department referral line listed on this website for a referral.

If you are not within easy commute of New York City, call the Department of Psychiatry at the medical school nearest to you and ask for a referral to a psychopharmacologist.

Your story could result from a number of problems. One is that you and your psychiatrist were fooled. That is, what you thought was a good medication effect was really other factors - life events, it was time for your depression to remit, etc - if so, not surprising the medicine that did not work in the first place did not continue to work.

A second is that you do not have depression, but a medical illness; for example, hypothyroidism and Parkinson's disease can present with depression — these seem unlikely in the questioner's case since one would hope such problems would have been noticed in 40 years.

A third reason might be that the dose of medication was not sufficient.

A fourth could be that although many medications have been tried, there are some that either have not been tried or that were not given sufficient opportunity to help.

Fifth, it has been suggested, though untested, that people can become deficient in the precursors of the neurotransmitter chemicals that allow the brain to function properly; perhaps adding the building blocks for the neurotransmitters could restore sufficient supplies returning the individual to normal brain functioning and depression relief, but this is entirely speculative.

Finally, as the question suggests, there are a wide variety of augmentation strategies that often turn the tide, including lithium and thyroid, among many others.

The most important thing is not to allow discouragement to keep one from continuing to try new approaches. Our studies suggest that even among patients as refractory to usual treatments as the questioner appears to be, as many as 75% can achieve significant improvement within a year.