Treatment Resistance

Posted on May 15, 2010 in DBSA Support Groups and Conferences Depression Psychotropics Stigma

Before I went to DBSA National two weeks ago, when I ran into a person for whom the meds weren’t working I had one response and that was to think “There but by the grace of God go I.” Encounters at that conference and with some of my own members have changed that reaction. I met — for one — a writer who had lived with depression for nearly twenty years. None of the medications she has tried — and she has been on them all — has worked, so she has chosen to take no meds at all. Members of her support group have told her that she is on a wicked path: if you don’t take the meds, they say, you are being noncompliant and willfully resisting treatment. Secretly, I suspect, they worry that some of her stand will rub off on them and they will stop taking their meds, returning to the dark lands of depression and mania from which the medications saved them.

I’m on her side here. The reason why I take medication is that the benefits they offer in the stabilization of my moods outweigh the side effects. But if they don’t work, all you get are the side effects. So why press her? She told me that she will keep trying new medications as they come out. Hope for a medical cure remains alive in her heart.

One of the speakers at the convention was Paula Kamen who wrote an interesting book about her experiences fighting a fifteen-year-plus-long unending headache (([amazonify]B002BWP68G::text::::All in my head – An epic quest to cure an unrelenting, totally unreasonable, and only slightly enlightening headache[/amazonify] by Paula Kamen)) writes of the different ways that people responding to those with untreatable chronic conditions fail to help. She gives several examples including the case of a Dallas, Texas neurologist who told his patient that the reason why her course of treatment wasn’t working was because she didn’t believe in God enough. Others will refuse to prescribe narcotics even when the pain is severe and all other remedies have been exhausted. Alternative healers with their kneejerk diagnosis of a “lack of balance” will often belittle patients when their poking, prodding, and remanipulation of the spinal column yields no relief. Of these, she writes

Don’t insult us and belittle us with the argument that pain is all a result of the body trying to communicate a message, like we’re too angry. If you told someone with cancer or diabetes that, you would be considered cruel and even stupid. This is a double standard for people in pain, another version of dismissing the pain as purely “psychosomatic”….don’t assume that the mind always has “control” over the body, that it is just a matter of changing thought patterns.

The control argument is often used as a hammer to goad those suffering from intractable depression. I know of one woman living with bipolar disorder for whom no antidepressant measure worked for six years. She enjoyed a period of remission, only to see it followed by the commencement of yet another episode. Psychiatrists attempted to pressure her into [[Electroconvulsive_therapy|ECT]], but she would have no truck with the notion of zapping her brain. When I visited her at the Quaker meeting house that she calls her spiritual home, I spent about half an hour talking to someone who felt that the solution was to get her off her medications. Yet doing so would lead to a catastrophic cascade of moods. She remains on the medications because despite their shortcomings, they do allot her a measure of relief. If this is not part of your equation, you have little business advising the person to choose one therapy option over another. You have no business at all warning against psychiatric or alternative health “conspiracies” if the person in question is finding acceptable comfort from therapy.

As for changing thought patterns, I have found that in my personal experience this can take the edge off of a depression, but it has never cured one for me. The woman who I met at National feels this to be true as well. She described a life where depression sits in her lap every day. She can’t dismiss it because it is potent. The Beast (as I have called it) can only be tamed by cognitive therapy to a certain degree for some of us. If the medications or other therapies work, then we live full lives. If they don’t, then we must eek out our existence doing what we can with tools that can blunt but never rid us of the sword.

To say to people with untreatable depression that they have failed in their drug regimen or their exercise program ((One symptom of depression is that sufferers just don’t feel like engaging in physical activity. Walking a mile can be more a sign that the depression is lifting than a cure.)) or herbal medicine or their thinking is insensitive and barbaric. Hope can go a little way. But what is most lost in any kind of pain is a sense of belonging to the human race. Friends don’t like to hear about our failure as we battle deterioration from disease. Yet their love is vital.