Hello and welcome to Healthcare Magic. Thanks for your query.

You seem to be having a lot of negative ideas and thoughts. Such kind of negative thoughts and a lack of interest / amotivation or hopelessness about life are often indicators of depression. If your current life situation is comfortable and stress-free, but you still keep having these thoughts, it may indicate that you may be dipping into a depression. Remember, that depression can occur without any apparent stressors of difficult situations. Certain neuro-chemical imbalances in the brain can cause a person to have these depressive ideas, hopelessness, passive death wishes, etc.

It is good that you have been able to realize that things don't seem okay with you. Now, it is important to seek help early because, there is a chance that these symptoms can worsen up to a point when you don't even feel motivated to get help. Don't worry, there are effective treatment options - in the form of medication and psychological therapies which can help you overcome these unnecessary thoughts and feelings. If you are scared of taking medication, then there are good counselling therapies like CBT (Cognitive Behaviour Therapy), which can specifically tackle such kind of negative thinking. So, please don't hesitate to seek the help of a psychiatrist or psychologist. You will first need to have a detailed psychological assessment and then, further management can be discussed and planned.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Hello again,

It appears that you may be suffering from a chronic or resistant type of depression. 200mg of Zoloft (Sertraline) is a high dose of anti-depressant. Though many people respond well to anti-depressant medication, there will be a proportion of people who respond only partially or have a poor response to treatment. If depressive symptoms are persistent despite receiving an adequate dosage and duration of different types of antidepressants, then it is likely that the person is suffering from a "treatment-resistant depression".

In such difficult cases, the management approach first involves investigating for any causes for treatment resistance, for example, certain medical causes, like thyroid problems, certain vitamin deficiencies or other medical problems can be contributory. If so, they have to be detected and treated appropriately. Ongoing stress can also be an important factor which can perpetuate the symptoms.

Further treatment options include trying different combination of anti-depressants, augmenting the antidepressant with other psychiatric medication like an anti-psychotic or a mood-stabilizer, thyroxine supplementation, etc. Certain specific antidepressants like Venlafaxine, Bupropion, etc. can have a stimulating effect and may be better effective in treating reduced energy and amotivation. In some, cases, where anti-depressants are not effective, stimulant medication can also be tried. Combining intensive one-to-one psychological therapies with medication often gives good results. Sometimes, if medication and psychotherapy fail, there are still other options like Transcranial Magnetic Stimulation (rTMS) which can be considered.

I appreciate your efforts in trying to practice CBT techniques and other self-help methods. I understand that it can be very frustrating to put in a lot of sincere efforts but still keep battling with your problems. Please don't get dejected or give up hope at all. There are still many options available to tackle your 'resistant' depressive symptoms. Continue to remain positive till your doctor is able to find a more effective form of treatment that gives positive results. Hopefully, with your determination and continued efforts, and a trial of other treatment strategies by your doctor, you should be able to come out these problems soon.

All the best.

-Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Hello again,

Yes, I think that it would be a better option to have a psychiatrist do the evaluation, as the approach would be more targetted. For example, certain specific vitamin deficiencies like depression and so, for such things, a psychiatrist would be in a better position to know what to look for.

From the additional information you have provided, it is likely that you may be having a hormonal problem which could be contributing to the treatment resistance. In such a case, a psychiatrist would still be able to treat you, unless it is a complicated problem and he / she feels that you need a complete endocrine work-up.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

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