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  1. #1
    seńor member colmena's Avatar
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    Default Counselling vs. Drugs (Depression)

    Hello,

    I would very much like to know your opinions regarding treatment of depression.


    ---
    If you would like to cater for me:

    I have been given a form to fill, and have been told to consider whether I would rather be prescribed drugs (non-specific, as yet), or begin counselling.

    I believe I may have Dysthymia, and cannot see how counselling would be beneficial, but I realise there may have been some things that I could have overlooked.
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  2. #2
    Emerging Tallulah's Avatar
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    That's a tough one, Colmena--I think that proper treatment of dysthymia (which I have) involves a combination of the right drug and at least some therapy.

    Basically, the drug lifts the feelings of hopelessness so that you're able to do the work in therapy. I think if you're basically functional, maybe I'd go with the therapy and see if you can get by without the drugs. The other option would be to get on meds and then get a good book to help you.

    Effexor has been good for me, drug-wise. Dysthymia is harder to medicate, and you might have to try several before you find the right one.

    If you have any specific questions, I'd be happy to answer them the best I can.

  3. #3
    Senior Member Oso Mocoso's Avatar
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    Quote Originally Posted by colmena View Post
    I believe I may have Dysthymia, and cannot see how counselling would be beneficial, but I realise there may have been some things that I could have overlooked.
    Yeah, I suffer from seasonal depression. I am pretty much the same way. Fortunately, I have a doctor who agrees with me. My depression crops up pretty predictably around December, and gets pretty nasty until around March when it gradually starts to subside. Here in mid-May, I'm fine. If I move south, it goes asymptomatic. There's not much counseling could do to help me. There isn't really "an issue" to discuss.

    I'm not taking meds. I do plan to move before next winter, though.

  4. #4
    Senior Member matmos's Avatar
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    I am a firm believer that depression is *normal* - even the most extreme kinds. It is a natural reaction to the environment - physical or otherwise - in the same way that pain instructs you to avoid something.

    As Tallulah said the absence of light in Winter causes a problem. The ailment is a reaction to the environment. Whereas, in evolutionary terms we are still equatorial monkeys.

    I would suggest cogitive behavioural therapy as a way of *recognising* where the problem lies. It may lie in your past or present environment.

    Drugs have a habit of not dealing with the problem, only the symptoms. I don't know enough to comment further, but you sound like you have highly developed Ti and this is not doing you any favours in this case.

    Additionally the problem is that it *normalizes* and appears like the in-laws at Christmas - expected, but unwanted.

    I would try therapy before medication; if it does not work try the meds.

    Some of the work by R D Laing makes interesting reading.

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  5. #5
    Strongly Ambivalent Ivy's Avatar
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    Are you being forced to choose between them? As far as I know, the combination of medication and therapy is the most effective treatment.
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  6. #6
    @.~*virinaĉo*~.@ Totenkindly's Avatar
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    Quote Originally Posted by Ivy View Post
    Are you being forced to choose between them? As far as I know, the combination of medication and therapy is the most effective treatment.
    Yes, and the actual problem as diagnosed helps determine the level of each to use.

    Pharmacological solutions seem to be driving the diagnosis to some degree in our culture nowadays. So it's something to be aware of.

    - Healthy people do suffer distress. Not every bad feeling needs a diagnosis or "needs fixed." But pervasive bad feelings resulting in destructive behavior, inability to function in life, or a stopping of personal growth should be dealt with.

    - Often mental conditions can result from bad/weak coping skills or improper assumptions about the nature of one's life and reality. Providing better coping skills for a particular person's situation or a new outlook can help strengthen them enough that they'll continue on the path to mental health.

    - There are still some things that can have a partially (or more) biological root. it's the responsibility of the psych to figure out what is what. Sometimes dosages are given before a firm diagnosis, as part of the troubleshooting and in order to prevent self-harm or a continual slump. That seems realistic to me.

    drugs (i think) are usually best used to take the edge off the condition so that the person can move forward in therapy. So far I haven't personally met a therapist who behaves otherwise either, although there are horror stories (some left over from the late 80's and 90's where stories were predominate) and there seems to be CW that therapists are somehow bad or "drug pushers."

    Anyway, I am digressing... Let us know what you find out, Col, and how you're doing, okay?
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  7. #7
    Strongly Ambivalent Ivy's Avatar
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    I agree, Jennifer-- the drugs are helpful to relieve some of the symptoms but long-term improvement is going to depend on dealing with the underlying issues (unless the issues are entirely biochemical in nature). Self-help can work to a degree, but a therapist can accelerate the progress and help you escape from negative thinking cycles.
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    Senior Member Hirsch63's Avatar
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    Col, I've been through a bit of this...every therapist I've seen here in the US seems to strongly recommend the combination of drugs+therapy. And looking back over the last ten years I'd have to say it probably works best. I thought that the therapy was silly. I could not see how it could help me at all...then the drugs allow you to be more "open-minded" and less cynical and the therapy can take effect.

    Be aware that finding the right drug for you may take several goes. Effexor, though it works for Tallulah was horrific for me...good ol'prozac does the trick so far...lexapro was just lame. This is common as far as I understand it. Once begun it is a long term process that requires a commitment (but hopefully not an actual commitment). this is the toughest part and you have to be your own best advocate and be in as much communication with your therapist as needed to adjust your dosages to achieve a maximal benefit. You must be invested in the process as much, if not much more than you health care providers.

    The bottom line is: this can work. It is not as easy as just taking a pill but they can help.
    Last edited by Hirsch63; 05-27-2008 at 09:41 AM.
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  9. #9
    @.~*virinaĉo*~.@ Totenkindly's Avatar
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    Yes, it's important to remember that drugs don't have consistent effects between people, even the same dose of a drug.

    Personally, I did very well with Wellbutrin, but I've heard from others who did poorly. And I hated Effexor (can't say why, it just didn't "feel right") and the withdrawal symptoms took me a month to kick. Uggh.

    Usually what I see is shrinks making the best guess they have, trying you out on something for two months to see the effect, then switch or modify things if it's not quite right. Some people go through a number of drugs before they find an effective one, which isn't fun... but it's just the way it is.
    "Hey Capa -- We're only stardust." ~ "Sunshine"

    “Pleasure to me is wonder—the unexplored, the unexpected, the thing that is hidden and the changeless thing that lurks behind superficial mutability. To trace the remote in the immediate; the eternal in the ephemeral; the past in the present; the infinite in the finite; these are to me the springs of delight and beauty.” ~ H.P. Lovecraft

  10. #10
    homo-loving sonovagun anii's Avatar
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    From what I understand of the field (masters in counseling, LMHC), a combination of both medication management and talk therapy is more effective than either one alone.

    Even if you just have dysthymia, cognitive-behavioral therapy can address distorted thoughts, schemas and resulting behaviors that may be causing you emotional distress.
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