Dysthymia (chronic, mild depression)

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Does anyone here suffer from dysthymia? I've had it since childhood (I think it started around age 10) and have had bouts of severe, suicidal depression too. My depression is atypical rather than melancholic, meaning that I am able to experience intermittent happiness.

The problem is that I'd feel like I were wasting the doctor's time if I sought medical attention for this. When I suffered severe depression, two doctors made me feel like an utter timewaster. One, who had only just met me, was like "you can't stay on antidepressants forever you know", before reluctantly giving me my repeat prescription (I'd attempted suicide less than a year earlier, so was still unstable and actually needed help). Another told me there was nothing else he could give me when I went to him to complain that my SSRI wasn't working*, dismissing me at a time of desperate need.

I no longer have severe depression but I do have dysthymia and anhedonia. I'd like to be treated for this, but I am reluctant to seek help. If doctors were that dismissive of me whilst I was suicidal, what hope do I have of getting assistance now?

In my experience, female doctors are more sympathetic than male ones - but they tend to be big fans of counselling (which is usually fine as counselling can help some). I don't want counselling - I just want a non-SSRI antidepressant, preferably an NDRI or MAOI. The reason I don't want counselling is because I've tried it before and it barely helps. There's nothing to discuss anyway: my unhappiness isn't caused by external factors. I think I just have high cortisol or low dopamine/GABA levels. There are many studies to prove that people with depression & insomnia have either high cortisol levels or deficient dopaminergic/GABAergic systems (I wish doctors would be more ready to look at biological causes rather than external factors).

Does anyone have any tips for seeking medical assistance without being made to feel like a timewaster?

*which is hardly suprising when the 'serotonin theory' of depression was debunked decades ago: http://www.bmj.com/content/350/bmj.h1771

Keep trying until you find a doctor who takes you seriously.

What are your specific symptoms? The doctor will want to know how your symptoms are effecting your life. Like, lack of interest in things previously engaging, random crying, thoughts of suicide, whatever ... but be specific.

CN: suicide

I have thoughts of suicide (I've done extensive research into various methods, just in case I will want to in future*) but I have no plans to do it as I have a family that would miss me. This is why I fear not being taken seriously: if I'm not a suicide risk, and my symptoms are only unpleasant but not life-threatening, why bother treating me? At least, that's what I'm worried the doctor(s) will think.

You're right: I should keep trying until I find a doctor willing to listen. Here in the UK the doctors are big fans of SSRIs too - even though evidence shows they make depression worse - and even the "specialist" psychiatrists won't prescribe the MAOIs that are proven to work, basically due to ignorance on their part. I'm thus pessimistic about my chances

*Mods: feel free to edit if inappropriate for this forum.

I the 'serotonin theory' was correct, SSRI's would cure all depression. The truth is there are types of depression that don't respond at all to SSRI's.

The serotonin theory is far too simplified. What we know about how the brain works is mostly from CAT/MRI and inhibiting certain genes , we are a bit dependent on them but we will have to wait.

What actually is depression ?sure the hippocampus can shrink by 25% and there could be an imbalance on serotonin, but that's only the effects described.

Yes feeling sad will cause for there to be changes in the brain , since changes in the brain causes 'sadness' or any other state.
But why does it stay in that low mood state?
We don't how the brain works so the cure for depression will take time

I don't know what it's like in the UK but I have seen close to 200 doctors, including a dozen psychiatrists and countless general practioners and I have never met a doctor who wouldnt be more than happy to stick their patients on drugs for life, especially SSRIs.

In Canada and the US it is incredibly easy to get any number of antidepressants. No doctor I have ever heard of has a depressed patient and just stops at one antidepressant if it doesn't work. You can easily ask for any number of antidepressants, SSRIs, SNRIs, TCAs, Wellbutrin, Remeron without a struggle whatsoever. Only MAOIs require you to do a lot of convincing and finding the right doctor to cough one up, they also require you to have tried usually several other antidepressants first. You must have really found some atypical doctors because they don't sound like any I have ever heard of or met personally.

Do you want Wellbutrin(NDRI)? Simply go see a new doctor, say you are struggling with depression, say you have tried SSRIs before but you cant tolerate the sexual side effects (doesnt matter if its true or not) and would like to try wellbutrin instead because you heard that it has no sexual side effects. Done. It is as easy as that. Thats the conversation you have. I don't know if its used in the UK or not.

Other options if you are looking for dopaminergic action is high dose Zoloft or high dose Effexor. High dose of Zoloft(150mg?) works as a selective serotonin and weak dopamine reuptake inhibitor. Effexor at 300mg acts as an SNDRI. They might be able to help with anhedonia at that dose but it will take a while to work your way up to it.

Now if I were you I wouldn't rely solely on antidepressants by themselves, I would really suggest you take up strength training as well as completely over hauling your diet, eat clean. Strength training, (weight lifting) can boost your testosterone levels naturally and definitely improve your mood and help with your anhedonia. Get plenty of sunshine too along with vitamin d supplements.

I have personally got doctors to prescribe me every type of drug under the sun. You just gotta know what to say. If you want an MAOI, specifically a non reversible MAOi, I suggest you at least have 5 or so antidepressants that you have tried already before hand. You also need to do your research, find and print out studies (pubmed is a good place to look) that show Parnate for example, and its efficacy in treating dysthymia and be prepared to convince your doctor that you are aware of the risks. Older doctors will tend to be more open to prescribing Parnate than newer doctors because they might be old enough to have been around when these drugs were still commonly used.

There are many crappy doctors. I've seen a number of them myself. But I've now found good ones, and a great therapist. Just keep looking, keep an inventory of your symptoms (an honest inventory) and prior meds, and your conclusion and other's conclusions here are certainly reasonable. I've been on multiple meds myself, and now I'm on a regimen that is really working for me. I think therapy is really important too, don't discount it if you've seen lousy therapists, as it can help you identify what you're feeling. You should be able to see a new doc, explain what you've been feeling, as well as your medical history, and they should be more than willing to help you, and to continue to try and help you. They're not all good at that (a few are horrible), but the good ones will be a huge help.

Hang in there.

I agree that dr's / psychiatrists are often too conservative with meds. Conservative may be the wrong word - it's hard to be taken seriously, at least. The old MAOI's are not often prescribed mainly due to misconceptions but perhaps also because psychiatric patients may not be considered the most reliable e.g. regarding avoiding tyramine.

I can't imagine GP's ever prescribe them so it would need to be from a psychiatrist (I had Parnate prescribed a couple of years ago and I wasn't blatantly suicidal or anything). It helps if they are familiar with you and you have demonstrated a degree of stability / reliability and acquire and express a (dispassionate) knowledge of the relevant meds.

MAOI's need to be coaxed out of the psychiatrist and it takes time - if you come on too strong it will decrease your chances. You also will need to have first gone through several different meds e.g. an ssri, snri then a tricyclic before even mentioning maoi's. SSRI + ami/nor-triptyline is worth trying and easier to get.

I don't think there are any NDRI's available for depression in the UK - burpoprion is off label and apparently is not really an NDRI.

Unfortunately, some manipulation and exaggeration may be required to get the best treatment and don't feel bad about it when you have an inadequate or incompetent dr.

i have been to one or two doctors one seduced me and other was trying to convert me into their religion. They ususally exploit your weakness.

Anyways the only way to get rid of suicidal ideation is meditation, prayer, exercise, real areobic or cardio exercise and self healing.

Thoughts are usually put into our heads by the surrounding entities so you need to get rid of those thoughts they are actually travelling negativities. Just pluck them and throw them into degradable bin.

Do some spiritual cleansing like reiki etc. Or listen to chants, or listen to meditation on youtube about clearing your mind

I have been through severe abuse, neglect, abandonment and it took lot of healing and cleansing to deal with it

It's been over a year since this thread, but there's so much good advice on here. I've not been active on the forum until now, so I'm only reading this now.

I agree with the bit about the MAOIs: doctors really don't like giving them out, even though the evidence shows the controversy over the tyramine/hypertensive crisis was exaggerated. And I agree with the having to coax the doctor to prescribe them. The problem patients have is: if we mention drugs that we haven't been prescribed before by name, the doctor will assume addiction/abuse.

It'll depend entirely on the doctor. Some are good, some are bad.

I've had one doctor describe my Dysthymia as 'long term sadness'. To which I thought "The hell it is". It may be described as a mild-depression, but it's more than that. It can be rather harsh at times. I mean, it could be like Eeyore, if occasionally Eeyore refused to get out of bed or seriously considered suicide every now and then.

Anyway, some doctors are great, some are not. Some recognize that it's a long term condition for which there is no cure, only treatment and yes, that treatment can and does require a lifetime of medication. That's nothing wrong with that, if that is how it is to be treated for the individual.

My advice on the getting doctors to prescribe medication is to learn what you can about the various medications. I believe if you are able to show that you are knowledgeable about a medication, they're more at easy about prescribing it.

In my opinion, medication is only half of the treatment, the other is therapy. While I think it's possible for one to to work without the other, I believe that's the exception and not the rule. I believe that, in most cases, both are required.

I take Paxil and have for some time. It's the most effective, though there would still be room for improvement. Yet, when you find something that kinda works, you stick with it. I've tried some medication that made things worse.

It's not entirely a big deal, taking medication, as I take several others. I sometimes wonder how the hell I'm still alive, sometimes, between heart problems and my innate ability to hurt myself.

Anyway, that's unnecessary blather. Try and find a doctor you feel comfortable with, that's the first and most important step. If you don't feel comfortable with the doctor, it's not going to work. Know about the various medications so you can talk to the doctor about them. Build a relationship of trust and that'll make a huge difference.

I also have dysthymia, have had it since I was a kid. Every now and then it turns into major depression but not since 2013, thankfully. That was when the doctors in hospital and my psychiatrist got together and decided to prescribe me a MAOI. It's moclobemide (Aurorix in Australia) and it has been the best antidepressant for me so far.

Moclobemide is a reversible MAOI which means it doesn't cause irreversible changes to the digestive system. My psychiatrist recommended that I stay away from very matured cheese and Vegemite though (and I love Vegemite!). The consequences of eating those are skyrocketing blood pressure and the danger of a stroke. No thanks!

In the past I have tried all kinds of antidepressants except tricyclic ones. That was because they are easy to overdose on and I have a history of overdosing. So doctors won't prescribe them to me. That's fine, I am pretty happy with what I'm on. It's a record amount of time that an antidepressant has worked for me, usually they taper off and stop being effective.

So yeah, try suggesting moclobemide to your doctor. Wikipedia is a good place to look if you want further information on it.