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Mental health

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Original poster

resistant depression

19 replies

wakeupnow · 26/12/2011 19:47

any one know anything about this? My dad has had 2 severe episodes of depression in the past 10 years and now this is his 3rd. This time it's lasted 20 months. In the past ect has worked, by the way no meds seem to work for him, he's had every combination going. In the past 6 weeks he's had 10 ect's and we, as a family, could see signs of improvement BUT he now has a dodgy heart so can't have any more ect, christ that wasn our life line, any help, insight please

OP posts:

TamIAm · 27/12/2011 13:12

Is your dad having any therapy besides medication and ECT?

Most of the good, peer reviewed studies around show that the most benefit is experienced by people with depression who have a combination of talk-therapy and medications, not just one or the other. Is your dad seeing a psychologist, or a psychiatrist who does psychotherapy (ie talk therapy, not just prescribing medications)?

RudolphthePinkNosedReindeer · 28/12/2011 01:33

How old is your dad and is he working? Are the depressions triggered by anything? Exercise, if you can summon the motivation, can help a lot in many cases.

tribute · 28/12/2011 01:46

Doesn't sound as if depression is the root cause of your fathers problems. If clinical depression he would have responded to at least some of the medication he has tried. ECT is quite horrible , some say barbaric these days. It can certainly do more harm than good and even make the depression worse over time.

Have you ever sought a second opinion on your fathers care?

SantaIsAnAnagramOfSatan · 28/12/2011 01:49

can i ask if he has private health insurance? my friends mother was put through hell with ect and all sorts for years till her health insurance ran out then she was finally diagnosed with bipolar and given lithium and it was like a miracle for her.

not saying your dad is bipolar obviously but i don't know - just reminded me of her story. and it is rare to give ect for depression these days.

how does his depression manifest?

TamIAm · 28/12/2011 06:42

It's not actually all that rare for ECT to be given for resistant forms of depression, especially with concurrent suicidality, when the depression doesn't respond to more conventional forms of treatment. It's also in no way barbaric. It's done under sedation, and brain wave activity is carefully monitored via EEG to ensure that the most minimal current can be given in order to 'knock' the brain waves off their course and re-set them to something different. In addition to the sedation, muscle relaxants are given so that the person receiving ECT doesn't feel any of the muscular pain the following days that used to be associated with ECT due to muscular contractions resultant from the electric current.

It is definitely a last resort and should be used with caution - and if the person's depression isn't responding to any other forms of treatment, then I agree, that in and of itself demands further investigations into the cause of the depression. But ECT is a valid treatment under certain circumstances.

liveinazoo · 28/12/2011 07:06

i am sorry that your dad,and the rest of the family are struggling with such a horrible illlness.my mil had ect many years ago and i too have heard that these days it has a valid place.i notised another poster suggested lithium which is generally a near last resort drug as blood tests are required frequwently to measure toxicity levels in the body.has your dad tried this?i really hope that you can find someone who can help your dad have some stability.best wishes

SantaIsAnAnagramOfSatan · 28/12/2011 07:27

i didn't suggest lithium btw. i was just talking about someone else who was eventually (when private health insurance ran out - i'm in the uk) properly diagnosed as bipolar and for her lithium worked. i wasn't saying the op's dad was bipolar or lithium would be for them. i was asking if they were being treated privately. the private hospital treating her imo exploited the fact she had health insurance and gained as much money from treating her as possible. just opinion obviously but one shared by her and her daughter.

instead of giving her a proper diagnosis they went for lots of admissions and ect.

ect can have a place - as can this new device they have - anyone know what it's called? it is implanted in the patient and gives off certain currents or shocks.

i would want to be sure though that the patient had been diagnosed correctly by at least 2 different pscyhiatrists as there may be another reason why usual depression treatments aren't working.

the trials on AD's when broken down though do make it very clear that they do not work for a very significant portion of the population.

OP - is the depression the only problem and what does it look like? is there nothing else between the times of depression that causes concern?

Original poster

wakeupnow · 28/12/2011 13:42

Thank you all for your replies! Dad's had 3 different consultants over the past 20mths. I agree that psychotherapy is a great treatment but I think my dad is too low to respond to it at the moment. He's 67 & we think that his 1st episode was triggered by a combination of my brother splitting up from his fiance (they had 2 dd's together), I had a nasty dog bite and ended up in hosp, he wrote his car off by skidding on black ice and crashed into a house, he fell out of a tree and broke his pelvis. All this happened within about 4 months.
He doesn't have private cover. I'm wondering if genetics play a part as his mother suffered from the same problems late on in life.

OP posts:

NanaNina · 28/12/2011 20:34

So sorry for your dad WUN - and agree that psycotherapy can only really be tried when the depression has lifted to some extent. I too am 67 and had my first major episode in 1995 (following the death of my closest friend) no trouble for 15 years and another major episode last year, both times needing 3 months stay on psych ward. I made a full recovery the first time but this time I am still not fully recovered, (ups and downs) far more ups than downs.

I wonder if you are aware that following a major depressive episode, there is a 50% chance of having another and after a 2nd major episode, an 80% chance of a 3rd major episode - not sure what happens after that. Depression is usually caused by loss and so it seems your dad's first episode was to do with the breakup (did he lose contact with the grandchildren by any chance.) The 2nd depression sounds much like mine, a series of horrible things happening in a short time.

Tribute what are you talking about? You say you don't think depression is the root cause of his problems. He has been diagnosed by consultant psychiatrists with depression and is on his 2nd major episode. You say that he would have responded to ADs if depressed - this is not the case. There are people who are drug resistant. You go on to say that ECT is barbaric and that is absolutely not the case. I think you have to be more careful what you post, as many people on the MH threads are very vunerable. You are clearly not a medic, and sound so definite about what you are saying, which I'm sorry to say is nonsense.

Thankfully TamIam has given a responsible explanation of the place ECT has in psychiatry today.

OP - has your dad made a full recovery this time. It is such a shame that he cannot have any more ECT as I know from my experience as a patient on a pysch ward, how beneficial it was to some patients.

Does he live alone? Does he have a CPN allocated to him. You are clearly very concerned about him, so I am assuming he he has good support. Sorry I can't offer any more advice. It is one horrific illness.

RudolphthePinkNosedReindeer · 29/12/2011 00:28

Was this last episode something to do with retiring, perhaps?

ThatsNotYours · 29/12/2011 00:54

wakeupnow - "Dad's had 3 different consultants over the past 20mth." It is possible that your dad might actually be seeing 'trainee' psychiatrists or general docs/registrars, as they work on 3-6 month training rotations, overseen by a consultant, hence the staff turnover...? It might be worth clarifying who is your dad's named consultant as opposed to who he actually sees? I think your dad does have a right to see the actual consultant in overall charge of his case - just a thought. Also, my understanding is that ECT is still given because it's so effective. I do agree with other posters that CBT can be ineffective if your dad is too depressed- because one can't be motivated to actually buy into it in the first place. Sorry - not a lot else to add here other than sending big hugs! X

NanaNina - curious about, "Depression is usually caused by loss". Wondered what you meant by 'loss' / a loss trigger (other than physical loss of a near one etc.)

SantaIsAnAnagramOfSatan · 29/12/2011 11:14

all sorts of loss and bereavement/grieving can come from so many triggers - divorce, loss of job, retirement, abortion, loss of status, loss of health etc etc.

TamIAm · 29/12/2011 12:55

Depression can be caused by so many more things than 'loss'. It be caused by being overwhelmed by stress, it can be caused by concurrent mental illnesses (anxiety, bipolar, psychosis), it can be caused by nothing at all that the person (or others) can pinpoint - although that is relatively rare, or 1 million other reasons besides, yes, including 'loss' - but not limited to it.

SantaIsAnAnagramOfSatan · 29/12/2011 13:19

also being utterly crap at expressing anger therefore turning it all inwards.

or having had traumatic experiences and depression almost being a saving grace because it dumbs down the intensity.

by hormones.

by childhood abuse.

by bullying.

etc etc.

NunTheWiser · 29/12/2011 13:24

I have had depression on and off for years. It was becoming drug resistant and then I was finally diagnosed with a mood disorder and treated accordingly. I am 1000x better now. Has this been considered in your dad's case?

SantaIsAnAnagramOfSatan · 29/12/2011 13:38

what did you go on to take nun? if you don't mind me asking. i'm currently having to consider changing treatment options and aware that i am scared of 'other' drugs.

nice to hear stories of people having success with treatment changes.

fridakahlo · 29/12/2011 13:42

I did wander what tribute was going on about, certainly did not tally with my understanding of current medical practice. Whilst CBT might not be appropriate at the moment, has talking therapy been thought of? Self-expression can really help when people are bottling things up. And to go a bit woo, has acupuncture ever been looked at?

catsareevil · 29/12/2011 13:44

I suspect that if the OPs dad has until recently been having ECT then he will most likely be under the direct care of a consultant.

OP - would your dad be happy for you to meet with his consultant, you could ask them what the plan was, and whether they thought that a second opinion from someone with a special interest in affective disorders/treatment resistant depression might be warranted?

TamIAm · 29/12/2011 14:09

CBT is not the only kind of therapy out there either. If he's not able to respond to CBT, which does require a minimum level of motivation for change on behalf of the client/patient, something like art therapy might be helpful, for example. Or Narrative Therapy. Or Psychotherapy (which is not the same as CBT). There are LOTS of different fields and specialisations of therapy, lots of different schools and philosophies - and most importantly of all is finding a therapist with whom your dad 'clicks'.

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