It must be quite exasperating for you to realise that your mood has not improved despite treatment with counselling and SSRIs (serotonin sepcific reuptake inhibitors, antidepressants). May I offer a number of suggestions:
Firstly, to get your condition re-evaluated and rediagnosed. Sometimes there are many other issues that complicate a depressive disorder, like:
- chronic pain,
- anxiety and
- poor sleep.
Oftentimes for a depressive disorder, we also need to figure out why a person became depressed. For instance, it could be some relationship issues that perpetuate the depression and hence when planning interventions, we need to figure out how to resolve the relationship difficulty.
Secondly, to find out what is covered during counselling. Supportive counselling may not be the best form of psychological intervention in depressive disorders. What the evidence shows is that therapy using cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be more effective.
CBT involves looking at:
- a person"s negative thoughts,
- getting the individual to learn to monitor the negative thoughts and
- to modify them.
IPT looks at the challenges in the interpersonal arena like:
- grief,
- life transition issues,
- disputes and
- social isolation/ lack of social skills.
Thirdly, to consider the dose and duration of SSRIs used. If the dosage is too low, the antidepressant may not be effective. Most SSRIs will take about 4 to 6 weeks to work. If SSRIs do not work, then I will consider using antidepressant from another family or class, like SNRI (which works on norepinephrine receptors as well), mirtazapine, agomelatine and bupropion. There are many antidepressants available in the country so your doctor will be able to find the right antidepressant for you.
Next, is to consider augmentation with aripiprazole, which can be used as a mood stabiliser.
Lastly, you can consider in-patient evaluation and treatment. Sometimes, the home situation or problems at work can be the factor that maintains depression, so a short respite from home and work may help.
