Long-term depression

Thank you to everyone for your replies. I appreciate it very much. My son is seeing his psychologist again this Thursday. I will ask her about the medication you all have mentioned. Thank you!! Blessings and happy holidays to everyone 😀

@thankful. Thanks for your kind words. You have demonstrated the cardinal rule for treatment of mental illness: If you have attained remission and you are doing well on a particular drug/combination of drugs (as I am currently doing), don't make the mistake of tapering or tinkering with your drugs in the hope that you will become drug-free and your illness is "cured." Of course, this rule does not apply in the case of all mental illnesses. For example, if your illness is not severe, or if it not complex ( depression and anxiety being present at the same time, bipolar with anxiety etc.), you could consider tapering in consultation with your doctor. But this luxury is permitted only once: if your illness returns after tapering it means that it is chronic. In that case, you should immediately resume taking the medications. In many cases, you might require enhanced dosages of your previous medications or addition of new medications to achieve remission. Each relapse makes the illness more difficult to treat. But this time, be prepared to take your medications for the long term. This is not easy; it is natural to try to be drug-free. But that does not work in case of chronic illnesses. At this point, the most important thing--and also the most difficult--is to accept that you may have to take the medications for the rest of your life. But if you don't do that and again attempt to taper your medications, you are likely to suffer another relapse, which will be even more difficult to treat and more severe than the previous one. Sometimes you may suffer a relapse even while taking your medications. This happens when a drug that you are taking "poops out" (becomes ineffective) after several years of use [It happened to me]. That makes the treatment of your illness even more difficult. @thankful you have done the absolutely right thing by not trying to taper 1 mg Klonopin. If that has kept you well for 20 years, why tinker with it? If you are doing fine on 1 mg Klonopin, it is safe to infer that your illness is a mild one. But since you have taken the medication for 20 years, it is probably not a good idea to tinker with it. Regards.

@gingerw, you say that your depression has not been pharmacologically treated for several years. Well, you are very lucky and your depression seems to be a mild one. Good luck to you and I hope you stay drug-free. Regards.

From what I know, regarding the treatment of young individuals suffering from depression, physicians/psychiatrists are cautious about the use of medications due to higher risks of side-effects, including suicidal thoughts, that can result. This suggests it might be all the more useful to consider an opinion that includes genetic testing for drug effectiveness for a full picture of what one's options may be presently and in the future. I have had depression and anxiety issues my whole life, not diagnosed until much later in life at the age of 50, and I cannot imagine my life now without pharmacological aid, but it is a complicated matter when considering drugs, especially potential dependence on some, for youth. With respect to the depression, it might also be useful to consider vitamin D, vitamin B supplements, and light therapy as concomitant adjuncts to antidepressants that might be used. Exercise and a healthy diet are important, too. I'm not aware of how cognitive behavioral therapy has been applied to younger individuals, but for anxiety it is very helpful to me in handling distressing thoughts. All things being said from my part, I am in general agreement that we should not stigmatize anyone for using medication in the treatment of chronic mental illness but rather seek all avenues that may yield success in the treatment of debilitating psychological pressures that may be rooted in our inherited traits as much as by environmental or other factors. Each person is deserving of the most careful and compassionate course of treatments and therapies that may prove useful and all the understanding that we can offer.

Agree completely with the advice of @guener that extra caution is required while treating young individuals and that genetic testing for drug effectiveness would be helpful. Also, that supplements such as Vitamin D etc. might help, and that Cognitive Behavioural Therapy (CBT) might be useful. Ideally, both drugs (if required) and CBT at the same time optimize treatment; they complement each other. Sometimes genes are responsible for mental illnesses, sometimes environment, and sometimes both. As things stand, it is not clear if a mental illness can be prevented if an individual inherits certain genes. Hopefully, that might be possible in the future if suitable scientific methods are developed.

@pankaj @guerner @gailb This has been a very valuable series of posts. Each person's experience is different, based on genetic makeup, age and situations. I completely agree a medication should not be stopped without titrating off with the oversight of your doctor, and your own critical awareness to how you are responding. I also agree with the possibility that you cannot stay away from pharmacology as a treatment if you need to and it has worked in the past. In my situation I chose to attempt to work with my depression and it's different levels without using medication due to other physical conditions that made citalopram a counterproductive thing to be involved with. There are many times when it's not an easy day.
Ginger

Thank you @gingerw for your reminder that each of us is different in our body chemistry and in the other issues (such as medications) with which we are dealing. This is why the Mayo Connect community is so valuable; multiple people offer their experiences and ask questions that help them learn about their situations and ultimately help others as well.

I found my years of talk therapy to be immensely helpful in my quest to find a way out of my physical and mental distress. I learned Cognitive Behavioral Therapy techniques and used Gestault Therapy to learn how to express my anger, love and other emotions. My only regret is that I didn't have the assistance of medication during those years. Because I'd had such a tramatic childhood, I didn't consider that my problems with depression and panic disorder might also be brain chemistry based, probably inherited. I was strongly influenced by my early therapist who was medication adverse. She had been so helpful in my talk therapy that I believed her assessment without question. I spent many years in misery prior to beginning my antidepressant at age 63.

Your insight is very welcomed and helpful, as you said, we are each unique when it comes to medication. What is good for one person may be detrimental to another. Having a DNA test to determine the best medications for our chemistry is a good thing to do if possible. I hope you have a peaceful day Ginger.

So true, @gailb. Brain chemistry deficits from long-standing stressors often respond well to meds.

@thankful, @pankaj

@pankaj- Thank you for your sage words! I am in total agreement with you on this.
I have noticed so many posts more recently that people are deciding on their own to either stop cold turkey taking the drug(s) they are taking or tapering on their own w/o the council of a physican (preferably a Psychiatrist) that I want to shout out STOP! This is harmful to you! I appreciate your words of wisdom and experience. May God bless you and all our dear friends that are suffering with these illnesses and bring joy into our lives especially during this Holiday Season. Jim @thankful