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Ask Dr. Dombeck
Psychotherapy and Mental Health Questions

Now What?

I saw a psychotherapist, an MFCC, for 13 years, beginning at the age of 22 and ending this past June. I had been suffering from depression and suicidal thoughts since at least the age of 10. Nevertheless, I had managed to become a University student, where I eventually got bachelor's and master's degrees in English literature. The talk therapy helped right from the beginning, but the Prozac I began taking a few years later had a more profound effect. Over the years I had mixed success with antidepressants, trying various dosages and combinations of Desipramine, Wellbutrin, Zoloft, Paxil, and perhaps others. I'm now taking a combination of Effexor (300 mg/day) and Dexedrine (30 mg/day), and it seems to be working -- I think. For the last few years of therapy I probably wasn't clinically depressed. At least, when I was depressed, I got out of it quicker. A year ago I had been feeling good enough long enough that for the first time I imagined that therapy was something that could be completed. My therapist agreed, and we set an end date. During the final six months of therapy, though, I lost some of the sense of well-being I had had. I didn't know why I wasn't feeling as well, but I thought perhaps it had something to do with the impending separation from my therapist. Still, I didn't think it would help if I stayed in therapy. After 13 years in therapy I believed I had to experience what it was like to be out of therapy. I was surprised that I didn't miss therapy or feel like I _needed_ it. I continued to feel varying degrees of lousy, and I think I've lacked motivation and enthusiasm. I continue to see my prescribing psychiatrist every six months or so, but I don't know whether a different prescription would help. I feel like I'm at a point at which I'm not depressed enough to be depressed, but certainly I'm not content and satisfied with how I feel, how I'm experiencing life. In short, I don't know what my next step should be. I took a 12-week course in cognitive behavioral therapy for depression given by my HMO (Kaiser) and liked it a lot. I also felt a lot of resonance reading Judith Wallerstein's "The Legacy of Divorce," especially in regard to my persistent passivity. I really could use some advice, or perhaps you could pose some questions that might point me in the right direction. I could live out the rest of my life in my present state, but I really, really hope that I can do better. My life is not without pleasures but there's also so much low-grade, low-down suffering. Dear Dr. Dombeck, I read your column and like the answers you give. Can you talk about something I haven't seen in your column? That is, what to do when a person has done all the kinds of things you suggest but the depression overall doesn't get better? I take medication and have been in therapy and even have been in the hospital. I work full time and try to do healthy things. But I still get so bad that all I do is cry when I'm alone, and have to fight tears even when I'm around other people. I pray for this problem to go away, in fact I think I would do anything to be more normal. But sometimes it is so bad I don't know if I can go on. So what do you tell people when they feel like they've tried and tried and still can't get better?



  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
  • Dr. Dombeck intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
  • Questions submitted to this column are not guaranteed to receive responses.
  • No correspondence takes place.
  • No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Dombeck to people submitting questions.
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  • Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.

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