What is the next step for depression?

[Freezehead]

Just after some advice for my DH. He has been suffering with depression for the last 2-3 years, he has tried citalopram, prozac and sertraline but they haven't helped. He has also seen 2 counsellors. Nothing seems to work, he feels empty, numb and emotionless. He had a very very difficult childhood and says he shut down his emotions when he was about 10, he has never been very emotional but nothing like this, he is just like a robot now. He isn't upset or really down, just neutral and can't feel any joy or have any fun. Does anyone know what the next step would be? His GP didn't have any answers.

Persist with the therapy. Different approaches might suit him, eg avoid the more surface-level CBT type of counsellor, seek perhaps more psychodynamic psychotherapist or similar. And it'll take lots of sessions to get anywhere, but its worth it. Philippa Perry's book Couch Fiction is great (and short!) for understanding the therapeutic process.

All of the medications listed are from the same group of antidepressants (SSRIs) if they haven't been effective he might benefit from trying an antidepressant from one of the other classes. If your gp is hesitant about prescribing alternatives ask for a medication review from a psychiatrist.

Therapy might be helpful if the counselling hasn't been, possibly with someone that is experienced with trauma of he has had a very difficult childhood.

Thank you very much for the replies, I think we will go back to the GP and see if there is another antidepressant he can try as both of us would like something to work relatively quickly... Long term he probably should try a different therapist.

Totally agree with @FoggyDay58 - no one type of therapy is right for everyone, so try some different ones. As above Psychodynamic etc.. but you could also consider something like Cognitive Hypnotherapy that works at the deeper level too. There are so many therapies out there that are not widely known about and can be incredibly effective. Good luck xxK

OP there is stuff he can do but it's a matter of him doing it. He sounds almost catatonic.

Natural therapies such as St John's Wort, Same E, 5 HTP
Change in diet. Is he eating well and healthily?
Good sleep hygiene
Fresh air every day
Exercise and something like yoga or Tai Chi
Mindful meditation
CBT which he can do online - check out Beating the Blues which he can do in his own time alongside the work book
Journaling, getting all those thoughts out on paper
Taking up something meditative like drawing or painting, crafting

Venlafaxine is the only thing that worked for me, 150mg a day.

He is keeping fit and eating well etc, in fact he's in the gym most days. He says that he's ok with that as it's just straightforward, it's any emotional stuff that's the problem - he's distanced himself from me and from his friends.

He has always been very critical of himself and others and that has got much worse. He has never really been able to let go and have a good time, even as a child if he went on a bouncy castle it was to challenge himself to how high he could jump etc rather than just messing around, having fun. In fact he says he can't remember the last time he had fun. I just don't know what to do, he's not sad or upset, he's just kind of numb and not like a real person anymore. We are in the process of getting him referred to a psychiatrist so hopefully that will help. Thank you everyone for your suggestions, I'll show them all to him.

I agree he needs to try an antidepressant from a different class. All those are the same type. Maybe try Mirtazepine or Venlafaxine. Bastards for weight gain but heavier hitters than Sertraline and the like.

Or a Tricyclic antidepressant like Amitriptyline? Bit of a sledgehammer approach and takes longer as you have to start at a very low dose or it hits you like a bus but very effective for treatment resistant depression.

Steer clear of cognitive therapies like CBT and try integrative or psychodynamic therapists. Took me 3 therapists to find the one.