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I've read and been told to "not go gently into that goodnight." I have fought this-hard, but it hasn't mattered. There is nothing gentle about any of this. It's unrelenting pain with no compassion and no identity--it's invisible. There is no fairness or reason-it just stops and engulfs me-why?! What more can I do? What more can be done? What is this plague?
Depression, espcially treatment resistant depression is an insidiously pernicious illness. It can be subtle at first but then it demonstrates that it's like a parasite-a parasite that steals everything and wants to kill the host.
Depression is a treatable disorder. Most of the time, standardized modalities are very effective in the amelioration or even the alleviation of the disorder. Sometimes however, not as readily--this form is called Treatment Resistant or Refractory Depression [TRD]. There are very minor differences in the definition of TRD, but it is generally defined as: an inadequate response to one, [or at least two or more], antidepressant trials of adequate doses and duration. Unfortunately, this is a relatively common occurrence (See Diagnosis and Definition of Treatment Resistant Depression, M. Fava; March 8, 2017).
In clinical practice this is seen up to 50 to 60% of the time. Subsequently, it is recommended that a diagnostic reassessment of these patients be performed in an effort to achieve better outcomes. There are many potential contributing and confusing factors that may be involved and not initially obvious. Examples of medical conditions include Parkinson's disease, thyroid disease, stroke, COPD, cardiac issues, unrevealed substance abuse, and significant personality disorders can be culprits. Other potential contributors include comorbid psychiatric disorders like anxiety, psychosis, early dementia, bipolar depression diagnosed as unipolar, trauma or abuse not determined initially, chronic pain, other medication interactions and/or patient noncompliance. Ascertaining all of these potential variables is both essential and challenging for the clinician as well as the patient. Collaborative historians are very valuable to assist in shedding light on the problem, i.e. family, coworkers, teachers, etc. All of these individuals or groups would, of course, require the patient's permission because of privacy laws. Reliable psychosomatic rating scales can be useful to detect, and in some cases, begin to quantify the severity of the issue. There are varying degrees of resistance. Some readily responsive to minor adjustments in treatment and others are much more tenacious.
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