What next with depression?

[Straussful]

DD aged 18 has depression. She has been on 50mg Sertraline for 10 months. 6 weeks ago it was upped to 100mg. She is not improving. She cries quietly a lot, doesn't want to meet anyone, is finding it hard to focus on study (exams in June). She has had two rounds (8 sessions each) of CBT in the past two years but feels she needs something more than that.

I don't know where to turn. Part of her worry is how will she come off this medication, will she ever be able to have kids or will she risk passing depression onto them, will depression be a part of her life forever more. I can't answer these questions so I'm thinking of sending her back to the GP (she's never met him, it's all over the phone but he's been very good). What do people do when a higher dosage doesn't seem to be working? Keep upping it? How does depression run? It seems she's been struggling for such a long time with no respite. Her school experience has been very poor and a contributor, I think, to her depression and I hope (maybe desperately) that leaving in June will have a positive effect, but what if it doesn't?

I appreciate any stories of how depression runs, is full recovery possible?

I can only speak from my own experience of depression. It can last for weeks but now that I am better at recognising it I can take steps to make it shorter. I have tried CBT too and it is helpful sometimes to back over your notes. Has she tried journaling? On bad days I try to think of something I am grateful for and write it down. Otherwise just doing what makes her happy (for me its colour by number apps) and try to talk to people. I am the higher dose of setraline now too but a GP did once tell me that its not so effective when you are depressed about something (current situation) rather than just clinical depression. The higher dose isn't really helping me either as its a bit of both really. This WILL end and we will get some normality back. I have also had some zoom therapy meetings which helped me get my focus back a while ago. Odd as it sounds sometime I look at mental health chats and quickly realise that I am quite lucky really. Hope she feels brighter soon.

That is helpful Ally. Thank you. It's been three years of a slow slide to this stage and I do hope that getting out of that vile school will help.

Thank you, it is a lonely place supporting someone with depression. I sympathise with how lonely it must feel to be in the thick of it

Fresh air and exercise sounds very basic but it really does help. Hope your dd feels better soon. The black cloud will pass - there is blue sky underneath, she just can’t see it right now but it is there.

If she hates her school then no meds will fix that.

Sertraline is not the only antidepressant so if she hasn't seen any improvement at all on 100mg, it might be worth asking her GP about alternatives.

CBT can be helpful but I've sometimes found classic counselling / talking therapy to be more helpful. CBT is very practical and task-focused. Sometimes it helps to have space to talk about your experiences and feelings to someone who will ask the right questions and say the right things to help you get "unstuck", if that makes any sense.

Also, this doesn't cut it as a solution by itself, but personally I find that daily walks outside in the fresh air make a big difference to my mood, ditto regular yoga. Mindfulness can be helpful too and there are various apps. All of these things only help if you are well enough to motivate yourself to do them in the first place though.

So true about motivation. One of the first doctors we saw recommended fresh air and exercise but mostly DD is so low that she can't make herself go out and dreads meeting anyone she knows. She's so sociable and confident no-one would guess she's like this in private.

Re her school, I wrote to tell her year head that she has depression, is on medication and is coping well but will miss occasional days when she really cannot help it. She has kept up her work standard more or less which is miraculous considering what she's been through. Anyway her year heads response was silence except for an announcement to DD's class to say that any missed days were going to be taken as a lack of interest in school work and no excuses would be accepted. While I've always said I wouldn't wish depression on my worst enemy it turns out that this year head excuse for a human is the exception I will make.

But the school management is appalling in general and they are awful and unsupportive to pretty much everyone, it's just that those Who are needy are the ones who probably feel it more. Anyway, there are less than three months left.

I will encourage fresh air and I have emailed the GP to explain the situation.

Thank you all for your support. Depression is so horrible.

I have suffered from depression and found 'fresh air and exercise' to be about as much use as CBT which is as much use as a chocolate kettle.
She needs to see a psychotherapist/psychologist/psychiatrist. Unfortunately such services are difficult to access on the NHS.

OH was on max dose of sertraline (200mg) for around 3 years before he was stable enough to start thinking of reducing. We are very aware that the depression is not cured - it is always there, in the background - but he now has coping mechanisms that make it much more manageable and life is good again. It took a very long time to get to that place, but please tell your daughter there is hope.

Maybe focus on the short term for now - the holidays, the next half term - I would imagine that once the exams have gone that will be one pressure eased, although I guess she might be worried about what comes next.

Small steps, but purpose, structure and routine have been really important for my OH's recovery. Being the one in the supporting role is very, very difficult - make sure it doesn't consume you.

@BigBlueDog me too and I meant “fresh air and exercise” to be used in conjunction with the other treatments she is receiving. I found that exercise alongside other things helped. It was certainly a better option than staying in my room or bed.

Has she accessed Kooth.com? Teens I work with find it helpful

@OnlyToWin
It just annoys me that people suggest that exercise and fresh air could be a cure for depression.
If your mental health is good and you feel in a bad mood once in a while then maybe it might help ... but depression is a different matter entirely.

@BigBlueDog I know just what you mean. It’s like being told to “cheer up” or “calm down” as if that helps. I did find that forcing myself into a bit of a routine of getting out of bed, making my bed, forcing myself to have some breakfast, going for a walk etc. did help me feel I had a little control and was not just being swept along. It’s not easy though and particularly when your energy is so low.

My GP recommended getting to know nature - names of plants, etc? A good day is when I shower, dress and put on some makeup so going out is really not going to happen. Its exactly like being told what "cheers up" other people - chocolate teapot. We have a paved over garden which suits us fine and I was dragged to the woods every weekend as a child so I am done with nature thanks

The GP should change the anti depressant to a different one. There are groups of anti depressants - this one clearly isn’t working for her.
She could benefit from counselling - CBT works for some but not others. It depends what her issues are really. Contact your local MIND - they offer reduced rate therapy or can you self refer to you local primary care therapy services and ask for 1to 1 therapy.
Someone has mentioned a young adults service above.
Good luck.

This website might be helpful
youngminds.org.uk/find-help/