Why People with Major Depression Don’t Get Better

When Someone does not experience remission from major depression, we need to ask ourselves why, and come up with new solutions. This discussion will focus on the treatment of these individuals by first explaining what symptoms predict poor response to treatment and what symptoms of major depression result in the most psychosocial dysfunction.

Introduction: 00:00 to 01:40
What Causes Functional Impairment in Depression: 01:41 to 04:07
Cognitive Impairment: 04:08 to 06:27
Anhedonia makes everything worse: 06:28 to 08:49
Emotional Blunting: 08:50 to 11:01
Doctor Vs Patient What’s Important to Treat in Depression: 11:02 to 15:53
loneliness and Depression: 15:54 to 17:43
Conclusion: 17:44 to 20:04

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Disclaimer: This is not medical advice, and the information is provided for educational purposes only. Please consult your doctor for any specific medical questions. All content is created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider. If you think you have a medical emergency, call your doctor, go to the emergency department, or call 911. We do not endorse any specific treatment, tests, or procedures. Reliance on this information is solely at your own risk.

[lucyilly]

I wouldn’t wish this illness on my worst enemy.

[debbieporter]

I have Treatment resistan t MDD, Severe anxiety, OCD, BPD, and am on medication. I don't have depressive episodes. It's daily, it never leaves, and it's been that way for over 20 yrs..It's ruined my life.

[camellia]

So true about some psychiatrists from privileged backgrounds not being able to empathise with patients who have had struggles.

[marylamb]

I had severe depression for years. I was referred to a Chinese doctor with a reputation for curing hard cases. She asked me about my diet. I told her that eggs gave me severe asthma attacks, and that this had never happened before. She wrote a prescription for three antibiotics. I thought she was nuts. I took them, and within three days I have never experienced depression ever again. It was due to bad gut bacteria, killed with antibiotics.

[shawnaford]

This is a great topic. Thriving is the goal, surviving is not enough, yet anhedonia is even below surviving and merely existing. I had years of anhedonia and it was not until the ssri was removed that I started to recover some of my old self.

My experience was a little different as I finally got a new team and was diagnosed as Autistic and with ME.
Explains so much and now I know my fatigue is not “just depression”. It has a physical aspect and it explains why exercise seemed to make my depression worse.

I am celebrating my first partial remission in 12 years. I look forward to part two.

[cindymorton]

Grateful that you are bringing this to light. Have experienced major depression many times over the past 40 years. Most recently had to take 8 weeks off work and just recover. Thankyou

[michelecantelo]

I would love to hear your thoughts on CPTSD / High ACE score individuals and the realistic treat-ability of depression and anxiety and realistic expectations of becoming "normal" in that regard. I appreciate your videos a ton! Great work!!

[makeaprettycake]

I’m bi-polar spectrum, I consider the depressive side more debilitating and life threatening. In my experience I can see why psychiatrists try to address it from a medical standpoint as opposed from a patients narrative. After having routinely experienced ups and downs, it seems obvious to me that things like confidence, connectedness, meaning, etc really are just at the whim of the brain. One of the traumatic experiences I’m struggling with is that witnessing this routine inflation and destruction of my personality challenges the commonplace understanding of the self. (Just like schizophrenia) If I separate myself from the narrative, it does just seem like depressive episodes are considerable amounts of emotional pain, that don’t necessarily have to do with anything. It’s the experience of being relatively stable that connects people to narratives of meaning, confidence and purpose. The MDD may not see it, but as a BP it can change like a light switch, and you get that immediate clarity. I’ve had success keeping my mood good with routine like sleep, sunlight, diet and exercise but I’ve had to accept that NOTHING can get me to go to the gym if I’m experiencing anhedonia and avolition. What I’m trying to do now is experiment with using a short term stimulant to get me back into the gym mid depressive episode to get the upward momentum rolling again. Really curious if you have any off label suggestions for those who are looking for a non daily approach to interrupting an episode. Great video.

[sebek]

Thank you for this. I think a lot of healthcare providers don't understand the patient's subjective experiences of MDD. I would be so grateful if you would continue to expound on these topics and lead us on an exploration of new possibilities beyond the old "chemical imbalance" narrative. I think anhedonia in particular is the most insidious and painful aspect of MDD. It does seem to me that anhedonia is rooted in the physiology of the brain, and that both chemical and behavioral interventions could affect that, but I would be very curious to know your thought on what interventions, clinical or otherwise, have shown some efficacy in addressing anhedonia as a symptom. Much appreciated!

[veronicaladd]

It's loneliness that can give you more depression, but the problem is who do you feel comfortable with. Some people you just meet or long time friends I can't be with for more than a few minutes!!

[margaretlane]

When someone is severely depressed it's almost impossible to do the things you need to do to do to combat loneliness

[paulineiqbal]

Thank you for your information Doc. I was diagnosed with major depression, severe GAD, treated with nine or ten (sorry i lost count!) antidepressants, to no avail. I was beginning to lose hope. Eventually diagnosed with Bipolar 1. Treated with Lithium and Quetipine and after about two weeks i began to feel better. All made sense in the end, even the initial symptoms which had serious mental and physical symptoms i had from the onset became clearer. I attend Bipolar UK support group which is very good where i learned how better to manage my illness. I am thankful and live a healthy life. Sometimes it takes a specialist diagnosis and correct treatment to make all the difference. Good health to you!

[cathy]

I totally agree, medicine can just do so
much, I think the other factors you brought up are vital to our functioning
in a depressed state

[Pleasedontbealarmed]

Really interesting. In his gripping recent memoir Donald Antrim writes: 'What is the hospital, if not all of us? What is medicine, if not touch?' It may be true that depression is (in part?) a social disease, caused by isolation, loneliness, or deprivation of touch. Or maybe it's the case that something in someone's life collapsed -- the very thing that someone had hoped would give life that much needed 'meaning'. But how to restore that part again, I wonder, if that's not something we should expect directly from medication or psychotherapy? Especially if someone is in the deep end of a major clinical depression and unable to experience, or unable to expect (or even accept) any support from social connections, even if there are close family members and friends around to offer it? Do you think there's some kind of order to be followed here: first medication and psychotherapy to help someone out of the darkest days of the depression (but which medication? and which therapy?) and then later, when some improvement is happening, something that is more rooted in daily life, in the realm of purpose, connection, touch, interest, ambition?

[svalentina]

What a delightful, informative video, even when I thought I had a good grasp on it, I learned so much about this terrifying, sad and all-too-prevalent disease. I say terrifying because so many people have it, let it go untreated, and it has a devastating impact on their lives. Thank you.

[和平-j]

I think you hit the point. I think it is impossible to use a scientific and objective analysis angle to look at a mentally ill patient. I think what the therapist can do is to understand the patient with heart, but the main power of change lies in the patient himself. So the conclusion is that psychotherapy should be the main treatment method, but I think modern psychotherapy has become based on emphasizing scientific principles, and I think this has lost the original spirit of psychotherapy. Everyone's problems are different, and there is no consistent answer. If the therapist wants to help, I think it is the therapist's strong empathy and ability to analyze things that lead the patient to see the root of their problems step by step. For example, I later found out that my problem was that I was escaping from this real society, because I felt that this social culture was difficult to adapt to, but how to enhance my confidence was something I had to explore, and the therapist could only play an auxiliary role.

[Hussain]

I want to ask you doctor on why do people think that depression only happens in individuals with low spirituality, and it never happen to individuals who have a strong tie in doing spiritual practices

[michaelshannon]

You brought up the doctor v patient dissonance which is something very important. I have a friend who studied psychology and therapy. He did everything by the book, got good grades, etc. But in chatting with him he didnt have the slightest clue what it felt like to be desperate, to be lonely, to feel like an alien, to want to die. He hadnt a clue. And all his solutions are based on putting the horse in front of the kart.
Example: Healthy ppl enjoy walking in the forest therefor ppl who are mentally ill should walk in the forest. He never thought that its actually ppl who are declared as being healthy who enjoy walks in forests. Its because they are a certain way that the forest is enjoyable. He would say the same for exercise, for eating healthy, for socializing, for movies, hobbies etc. His idea is basically to try and make the so called mentally ill normal. Do what normal ppl do and you will feel normal which is good.
This has been my experience of therapy. Just do what normal ppl do and you will feel ok. Absolute bullshit. You may be able to improve a persons emotional state with meds but many ppl who have serious mental health issues such as NPD, BPD, Autism, Anxiety Disorder, Schizo Affective Disorder etc are inherently broken due to a broken state of self that cannot be repaired as the self is unconscious. Normal ppl are normal due to a form of rearing that is conducive to social expectations, its why normal ppl dont really have a sense of self as theres nothing diverging about their experience for them to notice or reflect on.
You cannot fit a square into a circle and this is very analogous to what therapy often attempts to do.

[minepolz]

Thanks for video, i also experienced emotional blunting, apathy, and anhedonia on SSRI and switched to SNRI and feel a lot better, can you make a video about why antidepressants sometimes just stop working for no reason (Poop out) and what we can do about this to avoid this issues

[paulharrisonadventuregearm]

Homocysteine, Copper, SAMe, dhea cortisol ratios are the major drivers of depression. Get as many tests as possible to work out which part of your methylation cycle, hormones and minerals are out of average levels