Dear Dr. Guterson - my doctor keeps increasing my Prozac and I’m still depressed, maybe even worse. Any ideas? A: I’ll start with the assumption that you truly have a clinical, biological based depression - and therefore medication is usually part of the treatment equation. Recent research has shown that higher dosages are not necessarily better. Some doctors keep going up and up but for most patients, if 40 mg maximum of Prozac doesn’t help, then it’s very unlikely that a higher dosage of Prozac will help. And this is true of other antidepressants, particularly those that work on serotonin. In fact, higher dosages can even backfire - possibly causing problems like low libido, apathy, and affecting sleep. So if Prozac isn’t working, then you probably need a different medication; or you need an additional antidepressant to augment the Prozac; or you have a biological issue (like thyroid illness); or life issues (e.g. addictions, relationships; lack of knowing yourself or your purpose); or you don’t need medication at all. But - remember - when all is said and done, swallowing a pill is not always a panacea. For most patients, treatment with pills only gets a person out of the pit of depression and onto a level playing field. Then once you are out of that pit, one finds oneself more capable to benefit from therapy and more able to fill every day with a healthy diet, exercise, sleep, and soul connection.
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"Ramblings on the Psych Ward"
Ginny was 24 years old and had three kids, ages 4, 2, and 1. Her husband was an alcoholic and she kicked him out a month ago. Ginny was going ‘nuts’ (to use a very official psychiatric term). So she handed her kids to her Mom, headed to the emergency room, made up a story that she would kill herself by walking into traffic, and within no time she was admitted to the psych ward.
When I met Ginny the next morning, she readily told me that she lied about being suicidal: “I just needed a vacation. My kids were driving me crazy and I needed a break. I couldn’t afford a hotel so here I am. It’s vacation time for me. Vacation!”
I must admit I don’t much like that word, ‘vacation’. To my strange ear, it implies ‘vacating’, as if there are gaps and holes in our time. And time is our most valuable commodity.
Don’t get me wrong - certainly times of rest, or of just being, or ‘chilling’ (as my kids like to say) are a necessary part of life; we need those times to restore our energy. And in that way this chilling is directly connected to when we are active, to our mission and purpose.
So to me the verbiage ‘vacation’ could just be tossed aside. I prefer ‘holiday’.
Of course, I shared none of this with Ginny who was in her own world. She was too busy enjoying herself on the psych ward, happy to be away from it all. It was clear that she had no interest in my meanderings about gaps and time.
Sure enough, the next morning I daringly asked Ginny how her ‘holiday’ was going and she smiled and laughed and said: “great, doc, vacation’s over now! Can I go home?!”
Dear Dr. Guterson : I’m afraid to admit this but I have an addiction to pornography and am filled with guilt. Can you help me?
A: You are brave to ask this question, brave to address your issue. I imagine you’ve talked to a therapist, maybe even more than one therapist.
Allow me to share a piece of writing that I read just this past week. It is a unique approach to your issue:
“There was a young man suffering from compulsions toward a deviant lifestyle. In utter despair, he penned a heart-wrenching letter to the Lubavitcher Rebbe. The Rebbe responded with a three-page correspondence. One point startled me. The Rebbe told this boy that he does not know why he must endure this profound challenge — it’s surely one of the mysteries of Divine providence. But then he added this: “Sometimes, a person possesses an incredible inner light that can change the world. There is no way for this person to discover that secret power within himself and call it his own, without being compelled to overcome a major life challenge.” Some might have looked at this young man and felt disdain; others might have felt empathy. But it was the Rebbe, the teacher of oneness, who saw his crisis as an opportunity. There was no tragedy here, there was a catalyst for this person to touch infinity. He was not a victim of an unfortunate condition; he was a Divine ambassador sent to places most people are not sent to, because his potential was of a different magnitude.” (from the pen of Rabbi YY Jacobson) I cannot think of a more positive or healthy way to address your question. Our most difficult challenges in life are always extraordinary opportunities to discover and realize our true potentials.