Why People with Major Depression Don’t Get Better
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- čas přidán 19. 06. 2024
- When Someone does not experience remission from major depression, we need to ask ourselves why, and come up with new solutions. This discussion will focus on the treatment of these individuals by first explaining what symptoms predict poor response to treatment and what symptoms of major depression result in the most psychosocial dysfunction.
Introduction: 00:00 to 01:40
What Causes Functional Impairment in Depression: 01:41 to 04:07
Cognitive Impairment: 04:08 to 06:27
Anhedonia makes everything worse: 06:28 to 08:49
Emotional Blunting: 08:50 to 11:01
Doctor Vs Patient What’s Important to Treat in Depression: 11:02 to 15:53
loneliness and Depression: 15:54 to 17:43
Conclusion: 17:44 to 20:04
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Disclaimer: This is not medical advice, and the information is provided for educational purposes only. Please consult your doctor for any specific medical questions. All content is created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider. If you think you have a medical emergency, call your doctor, go to the emergency department, or call 911. We do not endorse any specific treatment, tests, or procedures. Reliance on this information is solely at your own risk.
I wouldn’t wish this illness on my worst enemy.
Could not agree more
It's brutal
So true about some psychiatrists from privileged backgrounds not being able to empathise with patients who have had struggles.
Yup, I see this all the time they try to practice in a way that is very rigid and it doesn't work. There are other areas of medicine where that works perfectly well but this is not one of them Hope this helped
I have Treatment resistan t MDD, Severe anxiety, OCD, BPD, and am on medication. I don't have depressive episodes. It's daily, it never leaves, and it's been that way for over 20 yrs..It's ruined my life.
Hey Debbie. Since when this started happening to you?
So sorry only someone who suffers understand feel free to message me 🤗
Have you tried psychedelics along with mindfulness-based CBT?
Just keep swimming
MAIOs saved my life. , Parnate
Speaking as a 68 year old who has felt depressed from her earliest memories I think the reason why, no matter what happens, my depression never really goes away is because I see this world for what it truely is and its not a pretty picture - how can anyone be happy in this nasty blood soaked cesspit - you may not see it but I do. I live in a world wherein 70billion land animals are brought into existence annually, they are factory farmed and then slaughtered to be fed to a blood thirsty flesh loving human race - oh and lets now forget all the sea creatures another 100billion - its all killing killing killing - no amount of SSRI's is going to make me happy all the while I know this to be the truth. I'll be glad when its time up I hate this place it stinks.
This is a great topic. Thriving is the goal, surviving is not enough, yet anhedonia is even below surviving and merely existing. I had years of anhedonia and it was not until the ssri was removed that I started to recover some of my old self.
My experience was a little different as I finally got a new team and was diagnosed as Autistic and with ME.
Explains so much and now I know my fatigue is not “just depression”. It has a physical aspect and it explains why exercise seemed to make my depression worse.
I am celebrating my first partial remission in 12 years. I look forward to part two.
It must be really nice to be rich and live in a big city, most of us couldn't afford treatment even if it was available to us.
@@hektik7 I’m also rich but have a lot of personal problems and family problems
@@hektik7 If this is to me, I am not rich, I am on disability I do not live in a city and the program is covered by my Provincial Health Plan.
@@PraveenSriram Unfortunately money is not a cure, it can help and hoping you are feeling better soon.
Public health or universal healthcare is generally a good thing.
It's loneliness that can give you more depression, but the problem is who do you feel comfortable with. Some people you just meet or long time friends I can't be with for more than a few minutes!!
Very true
I would like to be your friend just to talk friends who care I’m a caregiver and I feel so bad for my daughter 🤗🥲👋
True.
Grateful that you are bringing this to light. Have experienced major depression many times over the past 40 years. Most recently had to take 8 weeks off work and just recover. Thankyou
Thank you for watching and I appreciate you sharing your experience with the community
Homocysteine, Copper , SAMe , dhea cortisol ratios are the major drivers of depression. Get as many tests as possible to work out which part of your methylation cycle, hormones and minerals are out of average levels
I think you hit the point. I think it is impossible to use a scientific and objective analysis angle to look at a mentally ill patient. I think what the therapist can do is to understand the patient with heart, but the main power of change lies in the patient himself. So the conclusion is that psychotherapy should be the main treatment method, but I think modern psychotherapy has become based on emphasizing scientific principles, and I think this has lost the original spirit of psychotherapy. Everyone's problems are different, and there is no consistent answer. If the therapist wants to help, I think it is the therapist's strong empathy and ability to analyze things that lead the patient to see the root of their problems step by step. For example, I later found out that my problem was that I was escaping from this real society, because I felt that this social culture was difficult to adapt to, but how to enhance my confidence was something I had to explore, and the therapist could only play an auxiliary role.
I’m bi-polar spectrum, I consider the depressive side more debilitating and life threatening. In my experience I can see why psychiatrists try to address it from a medical standpoint as opposed from a patients narrative. After having routinely experienced ups and downs, it seems obvious to me that things like confidence, connectedness, meaning, etc really are just at the whim of the brain. One of the traumatic experiences I’m struggling with is that witnessing this routine inflation and destruction of my personality challenges the commonplace understanding of the self. (Just like schizophrenia) If I separate myself from the narrative, it does just seem like depressive episodes are considerable amounts of emotional pain, that don’t necessarily have to do with anything. It’s the experience of being relatively stable that connects people to narratives of meaning, confidence and purpose. The MDD may not see it, but as a BP it can change like a light switch, and you get that immediate clarity. I’ve had success keeping my mood good with routine like sleep, sunlight, diet and exercise but I’ve had to accept that NOTHING can get me to go to the gym if I’m experiencing anhedonia and avolition. What I’m trying to do now is experiment with using a short term stimulant to get me back into the gym mid depressive episode to get the upward momentum rolling again. Really curious if you have any off label suggestions for those who are looking for a non daily approach to interrupting an episode. Great video.
Thank you, I appreciate you sharing your stroy this is powerful stuff and watching the video
I also have bipolar 1 and I can relate to this a lot. Thanks for sharing.
MAOIs saved my life. Parnate.
I totally agree, medicine can just do so
much, I think the other factors you brought up are vital to our functioning
in a depressed state
An excellent breakdown
Thanks Doc! I appreciate the time and attention you've given to this subject! This is my first video like this, but I'll be sure to watch more of them. Excellent analysis, and I appreciate your ability to relay the information in an understandable way for the general public. I'm almost 69 yrs old, and have had the battle with major depresssion since about age 14.
What a delightful, informative video, even when I thought I had a good grasp on it, I learned so much about this terrifying, sad and all-too-prevalent disease. I say terrifying because so many people have it, let it go untreated, and it has a devastating impact on their lives. Thank you.
Thank you for this enlightening presentation. You gave me a lot to think about as I am preparing to take my certification exam. This presentation was really impactful and well done. Seeing treatment goals from a patient’s point of view is invaluable. I look forward to part 2
Really interesting. In his gripping recent memoir Donald Antrim writes: 'What is the hospital, if not all of us? What is medicine, if not touch?' It may be true that depression is (in part?) a social disease, caused by isolation, loneliness, or deprivation of touch. Or maybe it's the case that something in someone's life collapsed -- the very thing that someone had hoped would give life that much needed 'meaning'. But how to restore that part again, I wonder, if that's not something we should expect directly from medication or psychotherapy? Especially if someone is in the deep end of a major clinical depression and unable to experience, or unable to expect (or even accept) any support from social connections, even if there are close family members and friends around to offer it? Do you think there's some kind of order to be followed here: first medication and psychotherapy to help someone out of the darkest days of the depression (but which medication? and which therapy?) and then later, when some improvement is happening, something that is more rooted in daily life, in the realm of purpose, connection, touch, interest, ambition?
I would say all these things in various combinations have value. It's far too complex in comment to discuss all the various ways of evaluating and making decisions on medication and psychotherapy. Things like connection, family support, diet, exercise, behavioral activation all have a place in treatment including medication the key is knowing who would benefit from what intervention
You brought up the doctor v patient dissonance which is something very important. I have a friend who studied psychology and therapy. He did everything by the book, got good grades, etc. But in chatting with him he didnt have the slightest clue what it felt like to be desperate, to be lonely, to feel like an alien, to want to die. He hadnt a clue. And all his solutions are based on putting the horse in front of the kart.
Example: Healthy ppl enjoy walking in the forest therefor ppl who are mentally ill should walk in the forest. He never thought that its actually ppl who are declared as being healthy who enjoy walks in forests. Its because they are a certain way that the forest is enjoyable. He would say the same for exercise, for eating healthy, for socializing, for movies, hobbies etc. His idea is basically to try and make the so called mentally ill normal. Do what normal ppl do and you will feel normal which is good.
This has been my experience of therapy. Just do what normal ppl do and you will feel ok. Absolute bullshit. You may be able to improve a persons emotional state with meds but many ppl who have serious mental health issues such as NPD, BPD, Autism, Anxiety Disorder, Schizo Affective Disorder etc are inherently broken due to a broken state of self that cannot be repaired as the self is unconscious. Normal ppl are normal due to a form of rearing that is conducive to social expectations, its why normal ppl dont really have a sense of self as theres nothing diverging about their experience for them to notice or reflect on.
You cannot fit a square into a circle and this is very analogous to what therapy often attempts to do.
Exercise and contact with nature are known to have a positive effect on many for control of symptoms. Are you saying you do not believe you should have received those suggestions? Especially given they are known to make a positive difference for many??What kinda of suggestions are you looking for?
@@wendyleeconnelly2939 many of the studies conducted omit so much information - what type of mental health issues(very important), how severe, how lasting was the effect, how much did partaking in the study influenced the participants, placebo, were ppl already receiving treatment, what data might have been omitted for reasons not declared, the list goes on. When you unpack the nature of the study you see how the info truly lines up.
Do what helps but a lot of reporting on these issues is not expressed in it's full capacity.
Thank you for this. I think a lot of healthcare providers don't understand the patient's subjective experiences of MDD. I would be so grateful if you would continue to expound on these topics and lead us on an exploration of new possibilities beyond the old "chemical imbalance" narrative. I think anhedonia in particular is the most insidious and painful aspect of MDD. It does seem to me that anhedonia is rooted in the physiology of the brain, and that both chemical and behavioral interventions could affect that, but I would be very curious to know your thought on what interventions, clinical or otherwise, have shown some efficacy in addressing anhedonia as a symptom. Much appreciated!
We will talk more about this in a future video
Chemicals are what drive depression..which is either driven by inflammation or lower hormones, key minerals. Inflammation is the biggest driver of anhedonia
Yes, this is a hot topic. As I even wrote to this young and talented Dr. ,I Maois changed my life after more than 20 failed combos..Only Parnate solved the issue pointing to a Dopaminergic based approach . Once again , Dr. Gillman and hid team of 50 researchers were right on ✅
No amount of medication will fix you if you have a lack of purpose and fulfillment in your life. I still havent found mine and I doubt I ever will so i just keep white knuckling it 1 day at a time 😢
I'm living with the same outlook on this journey of so called life. Just existing day to day with no purpose with no motivation to find any purpose in this world. Living in the past day to day with no future 😢
I would love to hear your thoughts on CPTSD / High ACE score individuals and the realistic treat-ability of depression and anxiety and realistic expectations of becoming "normal" in that regard. I appreciate your videos a ton! Great work!!
Thank you for watching and we can talk more about CPTSD and ACEs in future videos
Eating well is very very important, it’s life changing!
I’m on abilify and Prozac for autistic related irritability and anger. It is fortunately working well and I’m finally getting better after 26 years on medications since the 9th grade in 1997.
Thanks, you earned a subscription
Antidepressant saved my life! I was experiencing debilitating anxiety, panic attacks & depression. Once these things were addressed I started feeling like a “normal” person. Life required less effort - I enjoyed doing things again!
Nancy please know that the suffering you felt to be put on your drugs pales in comparison to the nightmare hell you will feel once tolerance is reached. It's impossible to know when it will happen. Caveat emptor.
Did u gained any weight?
I love watching your content. As a a provider, I want to suggest if you can attach the link to your evidence based research abd cliical trial articles that support your topic.
Nice video watching it rn
The same is SO true with therapists, whether they be psycholigist, PsyD, counselors, and even social workers. So many of them haven't had- or don't seem to- have a very challenging life. What medications- on anoher point- DO is make it easier or the patient- more open to starting things that might help them pursue passions, exercise, and become willing to connect more socially.Whe you're very depressed, it's the hopelessness that makes you unable.unwilling or that it's even possible to even TRY. I started my art again, took lpong walks w/ my dog (get a pet!), sstarted weight training and started WANtING to try new things and, with my anxiety under control, traveling more. Unfortunately, the meds seemed to start working. So- looking to start again. I REALLY notice a difference.
Glad the video was helpful, thanks for watching and if you haven't subscribed please consider it and spread the word about what we are doing here
Excellent
it almost seems like depression absent of anhedonia is simply patients seeking a pick-me-up after a bad breakup or loss of a loved one
I had severe depression for years. I was referred to a Chinese doctor with a reputation for curing hard cases. She asked me about my diet. I told her that eggs gave me severe asthma attacks, and that this had never happened before. She wrote a prescription for three antibiotics. I thought she was nuts. I took them, and within three days I have never experienced depression ever again. It was due to bad gut bacteria, killed with antibiotics.
I want to ask you doctor on why do people think that depression only happens in individuals with low spirituality, and it never happen to individuals who have a strong tie in doing spiritual practices
You'll probably have to ask the people who think that why they think that. The doctor may not know why others think as they do.
Thanks fam
After being on all classes of psychiatric medication for over 50 years,with many diagnoses including schizoaffective disorder,Paranoid Schizophrenia,major depression ,psychoses,l slowly came off everything,and my mental illnesses simply vanished.l now know that it was mainly the effects of all the medication ,which ruined my life.Also,the medication caused disability and many other physical health conditions,such as diabetes.
I wish to God that l had never taken this poison.
I’m so happy that you were able to stop the medications. I, too, wish I had never started them.
Hi, May I request if you please could talk about comorbidity between adhd and Depression and cptsd and Depression? Or difference in diagnosis of adhd and Depression? I know those are different ailments but there are similar simptoms like, Problems with Memory and concentración and such
I've been depressed since I was around 7yrs old . Finally taken to psychiatrist and got meds for my serious anxiety and depression. Over the years I've had the emotional bluntly. I was always told I was shy since I was a child. They put this dome over all my symptoms and sent me to many psychologist sentand psychiatrists . Then I was sent to boarding school where my anxiety almost paralyzed me. All the new people!! I was not a social person . I had one friend at home. I took a whole bottle of my Xanax, cut my wrist , ect. But the Seroquil stopped my heart. It was the original formula which they had to take off the market. I was in a coma for two months then a month of rehabilitation. I guess God wants me down here for a reason or this is my punishment.
I think it's always possible to get better. I also believe we put far too much emphasis on medication with the hope that it will solve all the problems. There are times where medication is a very important part of mental health treatment. We need to understand where our anxiety comes from and how we can think about it differently. It's a journey but one worth taking. Hope this helps
Thanks for video, i also experienced emotional blunting, apathy, and anhedonia on SSRI and switched to SNRI and feel a lot better, can you make a video about why antidepressants sometimes just stop working for no reason (Poop out) and what we can do about this to avoid this issues
Yes this is a great topic. short answer is they are symptom management and not disease modifying, a person can still another depressive episode. More to come
Antidepressants poop out in many cases because they actually over time deplete key minerals and vitamins, especially niacin
When someone is severely depressed it's almost impossible to do the things you need to do to do to combat loneliness
Especially true when it’s accompanied by co-morbidities, as it usually is.
I think this is a really important tópic. It makes a lot of sense to me .I will try to read something about it but well ,you better write the book because I think that most of psiquiatrísts are kind of “numb” about this ( sorry )
And you are so right about this topic,the brain and nervous system are not like the heart or other organs
I believe that the brain has an halo around it that also needs to be treated … I know ,it is fantasy.
I ❤your energy and your high intelect . 👍
You are seeing psiquiatry ahead of your time . Go ahead please 🙏 and thank you
Hey Doc, I’d love to hear if you have any thoughts and/or experience with Low dose Naltrexone within your field of work? The small clinical reports seem promising for sure.
LOVE LOVE LOVE YOU
I've had so many ssri medications and in every single case the nausea and dry heaves every single day despite massive amounts of ondansatron, benedryl, taking with food, taking an hr after the nausea medication and I still throw up constantly to the point of having all thse cavities now. The benzos really help anxiety but depression is unaffected. I just don't think any medication or change will alter my depression and can't wait to not exist. I'm only delaying it until after my mama passes away.
Prayers for you. Hang on. Never give up. God has a purpose for you.
Same I wasn't even asked to be born at all. People should pay me that I exist!
Any thoughts on "tardive dysphoria" as the result of Antidepressants (especially over a long period of time)?
Good to see the younger generation of psychiatrist
And residents that genuinely
Want to help people
Rather the those on power trips
Or simply going into psychiatric
Residency simply becouse
Its the only one that they can get into but luckaly universitys are
Getting relly selective about
Who thay chose
Hi, Dr. Rossi. In your newest video, you pointed out that, with augmentation, ~67% of patients eventually achieve full remission. Does full remission also mean that the patient has recovered from anhedonia and cognitive issues, or does the definition of remission allow for some symptoms of depression to remain? Thanks again!
Be definition response is 50% reduction in symptoms and remission would be complete absence of symptoms or based on a HAM-D score or other measure depending on the study. Hope this helps
Any recommendations for someone with major depression, trying to improve anhedonia but don't tolerate Wellbutrin?
RN NCM. Yes. This. 100 percent. In chronic disease as well.
Appreciate the comment thanks for watching
Another chief cause of anhedonia from or whilst using particularly SSRIs is increased cortisol....which then leads to hypothyroidism or low testosterone.
Which then produces anhedonia
I just want to get back to work, do a good job and to find motivation and purpose again. So many thousands spent on therapies and doctors. Things have gotten somewhat better w/ therapy but recently my life has started to unravel. I want help. I lost my job. And my insurance.
I've tried a few SSRIs and they always help my anxiety very well but none of them do anything for my depression. Just started an Abilify add-on so hopefully this is the answer. So tired of the brain fog and lack of pleasure or good feelings of any kind - I've been this way for 20 years.
Any update?
@@blktegs the Abilify helped a lot for about a month or two then stopped working. I've doubled my dose and still can't seem to get any benefit from it. While it was working it was like a light switched on in my brain; it was wonderful. I had energy, focus, actually felt happy. I don't know what to do now that it's stopped working, it's such a massive let down.
I have read that seems to happen alot I'm wondering if I should even try it... what dose did you take at first?
According to my understanding, it seems that mental patients with obvious acute attack as the main performance are better in life function. The same seems to be true in patients with schizophrenia. There is a kind of mental illness patients who seem to have no obvious episodes, but continue to be depressed and lack vitality for a long time. Such people seem to be more prone to symptoms of social withdrawal and confusion of thinking. In fact, I belong to this kind of person myself. I have been troubled by cognitive dysfunction for a long time, but when I chat with people, they think that I have no major problems. In the past, my psychiatrist has always convinced me that there is no problem with comprehension at all, but I It is true that there are many obstacles in the life function, because of the lack of understanding and the confusion of thinking. I can't understand movies easily.
I don’t accept people without significant anhedonia (loss/lack of enjoyment in life/things that were previously enjoyable) as having clinical depression 🤷🏽♀️
You can suffer from more depressive symptoms than typical but I am unlikely to consider it pathological from my perspective if substantial anhedonia is usually present
No mention of institutions granting degree or residency.
Why?
Or did i miss something?
Would you be interested in reviewing, or just giving a general impression of, non-proven potential medications for depression and maybe other illnesses as well, that people are sourcing off the Internet and trying on their own. For example NSI-189. I recall this one because it's the most "popular"/famous one, and also because of all medications I have tried, it was the only one that had an unique effect the other medications did not have, namely my self-esteem would get better on it. Many people also report becoming very emotional on it (me included).
Obviously n=1, and I see you mainly focusing on strictly already proven medications, but maybe you could chime in on the purported mechanism of action of NSI-189, expansion of the hippocampus, which gets smaller due to depression.
I did a series some time ago called new medication Monday that covered some of the medications in the pipeline. I would also like to cover natural products like SAMe which I've done a lot of research and writing on. I like the idea of covering some of these medications that failed in clinical trials
Recommend this video to you. The film emphasizes the importance of the psychological dimension. You can go and meet a Taiwanese psychiatrist. Dr. Hsu
Name of programme：
Taking a Heart Look at Health - Depression(major depressive disorder)1
I want to get better so bad. The meds don't help. I don't even know how normal feels anymore.
emotional pain,brain fog and hypersomnia doesn't go away despite I'm on a lot of antidepressants from 5 years, wht and what is this??
What to do about anhedonia/blunting symptoms? What if they are the only symptoms?
At this time there is no medication or treatment that directly targets those symptoms. With Anhedonia sometimes the best approach is to just start doing the activity that was previously enjoyable and often you find the more you engage with it the more enjoyable it becomes again, fake till you make it type of approach. As the other symptoms begin to improve the anhedonia may as well. Hope this helps
@@ShrinksInSneakers How does one deal with the anxiety/OCD over the lack of enjoyment itself and the worry about how long it will take? Anhedonia often makes me very obsessive and compulsive about finding ways to get out of it and I just spend my day looking for solutions because if I am not doing that I am not able to 'sit with' the anhedonia feelings. How about treatments like ECT or MAOI which is more dopaminergic even in the absence of other depression symptoms can they be used? It seems like even the outlook for CBT/BA is grim which leads to anxiety about anhedonia too: pubmed.ncbi.nlm.nih.gov/36371903/
I actually wonder whether anhedonia is what causes people to become depressed/anxious/OCD etc to begin with in some cases.
good content. look into the camera tho
Biochemistry/methylation.... change your life circumstances, make sure you have no metabolic issues like insulin resistance. Antidepressants help like a band-aid they don't get to the core problem. Niacin is of the most common deficiencies that drive depression. Inflammation is a huge part of depression...it needs to be controlled by the bodies own defences ..Such as testosterone, glutathione, Niacin, NAD+ amongst others. If you have depression..you must not use anything with caffeine... caffeine magnifies anxiety and depression
Change both biochemistry and your circumstances
If U have been on anti depressants a long time it damages the dopamine receptors.
Antidepressants also tend to use up Niacin......faster than if you were not on antidepressants...this will make your antidepressants not work properly. There are scientific papers on this
What is your opinion about Magic Mushrooms for Depression
It will be a part of psychiatric treatment in the near future. So far the studies have been small and we need large RCTs to prove the effectiveness of these medications. Early data suggests psilocybin works but we need more data is the bottom line. I also doubt these will be disease modifying medications. This means that people will likely still be susceptible to future depressive episodes. The hope would be people would stay well longer and not require daily medications.
They work long term if the experiences are spaced out and integrated properly.
You'll never get better from pills. Fasting had a huge effect for me however. So has neutralized vinegar, you can find studies on its effects on depression.
Never seen them feel free to post them here, but if vinegar and fasting can cure everything I feel like we wouldn’t have a depression epidemic
Psycotherapy and "medication" is not a treatment. It is just useful to waste time and money. Ketamine, tms, neurofeedback etc CAN be a treatment for some people.
Lack of serotonin and melatonin.
Nutrition, nutrition !
It's certainly part of the story and healthy diet and exercise are important parts of any treatment plan.
@@ShrinksInSneakers we should speak more about gut healt, and connection with "mental illness", it is mind blowing ;)
All the best
Therapy has marginal effect at best and even in best case scenario you still need to keep going to therapy to sustain the effect. Dont let these grifters take your money, spend them on hobbies instead, woodworking or something. Where i live therapy is free and i was still not getting my moneys worth!
do you experience depression? dont we all experience depression?
Sure have, and some depressions are mild chronic and may not require any intervention at all. Others may have transient psychosocial issues that lead to low mood again may not need treatment or CBT/psychotherapy may be enough. Usually by the time people are seeing a professional they have tried everything including lifestyle intervention. The reason people see professionals is to determine what is a pathological disease process and requires intervention and what is not. This video is discussing those more challenging situations. Hope this helps clear things up
Medicine treats symptoms and has side effects. Diet is what most mental health issues can be fixed with.
Yeah have you tryed colostrum? Any physical body symptoms
When a person is abused & their reaction is framed as illness, how can they recover? You're blaming a person for the actions of others !!! Psychiatry has got it badly wrong, 99.999% of the time.
“Amen.”
Because they don’t change the way they eat.
well thats a discouraging title
I m not depressed just vomiting from humans!!!!
I have bad cognitive issues. I wondered why I wasn't beating this.
Hope this helped, thanks for visiting the channel