Expert: Ivan Goldberg, M.D. - 5/18/2011

Question
Hi and thanks for taking the time to answer my question. My depression started in 2001 after the 9/11 terror attacks. I was not treated with medication until I had postpartum depression. I was put on 10mg of prozac and started to feel better within a few weeks. I have had recurrent episodes over the last few years. I am now up to 80mg a prozac and about 2 months ago, my depression came back. My doc added 75mg of effexor to the prozac and it's been almost a month. I don't know if it's gotten worse, or just feels worse because it's so exhausting to be depressed. I seem to not be responding to meds anymore and I feel hopeless since I am on the highest dose. What do you think I should do? I am so lost right now! Thank you.

Answer
Hi Wendy . . .

I know of no psychiatrist who would consider your depression "treatment resistant." It seems as if you have been on just two medications and usually the term treatment resistant is reserved for people who have had adequate trials of at least 6 medications.

The first step in treating a depression is for the psychiatrist to accurately diagnose it. Has you doctor told you if your depression is unipolar or bipolar or melancholic or atypical, or retarded or agitated Has a detailed family history been taken so that the genetic aspects could be taking into account? IN addition to depression are you suffering from anxiety, substance abuse, an eating disorder or some other psychiatric syndrome? These are all considerations that must not be overlooked.

If you think you require a more expert kind of care that what you have been receiving, you might consider seeing one of the experts listed at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .

Ivan
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