Patient: Hello, I’ve had fatigue, muscle stiffness, and sleeping problems for 3 years after an extremely stressful college semester. I actually had much more symptoms, but last year I took a supplement called liposomal vitamin C which miraculously cured them. My PCP and psychiatrist didn’t comment on that but it’s understandable since they’re not nutritionists. Anyway, my psychiatrist claims I have depression (rather symptoms of depression). I’ve been seeing him since the beginning of this year, and I’ve taken Citalopram, Effexor, and Bupropion but haven’t felt one bit of improvement. Moreover, he kept increasing the Effexor over the months until I reached 375 mg because he thought it was working when he asked about my daily schedule, but honestly I was just following his advice (like not taking naps during the day and exercising longer). I’m so disappointed and unimpressed because he said that he could get rid of my symptoms but apparently that’s not happening. Now he wants to prescribe Zoloft next month but I want no more! I don’t think it’s worth the horrible side effects. I’ve been thinking about doing talk therapy while getting acupuncture. From your subjective standpoint, do you think I should continue seeing the psychiatrist or try the talk therapy along with other alternatives?
Doctor: There are a few points here.Point 1: When managing any long term medical conditions, it is important you see someone you trust. Without trust, a therapeutic relationship is difficult to create. When dealing with issues related to mental health, it may take time to developing a trusting relationship and if you feel that despite an adequate amount of time, a therapeutic relationship is not formed, it is probably a good idea to see another care provider.Point 2: You specifically ask about other treatment options. With depression, we are learning more and more every year and it is increasingly becoming apparent that different people respond to different treatments. I think it is perfectly reasonable for you to attempt a trial of talk therapy and acupuncture so long as it is under the guidance of a trained professional. Ideally, the trained professional should be trained and educated in all treatment modalities including medications so that if therapy fails, other options are readily available. If the professional is not trained in multiple modalities, then co-management of your care should be considered and all parties should be informed on ongoing treatment progress.i hope this calirifies things.