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What are my other treatment options if antidepressants and talk therapy do not seem to be working?

Mental Health Psychiatry
Hi Doctors, I’m a 21 year old student who was recently diagnosed with anxiety and depression 1 year ago. My psychiatrist started me on SSRI after multiple episodes of self harm and suicidal ideation. However, even at maximum dosage, I still experience negative thoughts and low mood. In a...
DOCTOR’S ANSWER (1)
Thank you for sharing details about your situation and experience with psychiatric treatment. Your issues pertain mainly to anxiety and depression. May I make the following comments:
 
1. So far you have been tried on an antidepressant under the family of SSRI (serotonin specific reuptake inhibitor). There are many antidepressant medications that come under this family. It is not uncommon for a person not to respond to a particular SSRI and yet will respond to another SSRI. If you look at the chemical structure of the SSRIs, you will realise that they are very different from one another. Therefore, it may be worthwhile for your doctor to switch you to another SSRI. Commonly used SSRIs in Singapore include sertraline, escitalopram, fluoxetine, fluvoxamine and paroxetine.
 
2. The other possibility is to consider another antidepressant that is from a totally different family. The SNRI. These are medications that act on two neurotransmitters in the brain, serotonin and norepinephrine. There are some studies indicating that SNRIs may be a better option for persons who do not respond to SSRIs. Commonly used SNRIs in Singapore include Venlafaxine, desvenlafaxine and duloxetine.
 
3. For talk therapy to be effective, I would recommend that cognitive behavioural therapy (CBT) be used. Most counsellors just provide simple counselling or supportive psychotherapy. CBT is a more structured form of therapy and involves looking at the person's thoughts and behaviour and aims to modify the person's style of thinking and coping with challenges. Very often it involves homework. This means that the client will bring home forms with him and chart down his thoughts and learn to modify them on his own in between sessions. For CBT to be effective, the sessions are held pretty frequently, for example, once every two weeks. There is a lot of work that is done by both therapist and client; it is not just allowing ventilation and providing emotional support.
 
I hope you will find my comments and suggestions useful. I wish you speedy recovery so that you can carry on with your life trajectory.

Dr Ng Beng Yeong
MBBS, MMed (Psychiatry), FAMS

NG BENG YEONG PSYCH MEDICINE CLINIC
3 MOUNT ELIZABETH
MOUNT ELIZABETH MEDICAL CENTRE
#15 - 05 Singapore 228510

477 views 25 Dec 2018
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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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