Q:  Depression?  Symptoms

I am 45 years old, and to make a long story short, I have been diagnosed with about every kind of depression imaginable. I have been in counceling 5 times in the last 20 years, and probably more MDs. Every Dr has a different diagnosis, and when I question them, they really have no way to tell for sure. It is based on symptoms, but all the symptons seem to be the same for every diagnosis. I am getting too old and tired to keep fighting this. I need to know for sure what is wrong with me, if anything. Are there any medical tests that can find an exact cause or condition. And what kind of a specialist would I need to see? All I get is opinions and theories, and nothing has really helped for any length of time.

Dear Sam -- 
Sorry to hear you've faced this common situation.  If you see another specialist, you're likely to get his/her view -- not necessarily the "correct" view.  You may have reached the point where the label doesn't matter so much anymore, and it's time to be very systematic about seeing that you get fair trials of multiple treatment options.  That means:  you have probably had many antidepressants, but make sure they have been at adequate doses for adequate periods of time (generally at least 4 weeks and preferably 6, if side effects don't make that ridiculous).  You have probably tried exercise, which clearly has antidepressant properties -- but probably it needs to be regular aerobic activity, like 30 minutes minimum per day of something that makes you breath hard, and doing that for a month; so repeat a trial of that if you (be honest with yourself now) haven't done it that way.  Same logic then for mood stabilizers, at least a trial of lithium, perhaps adding that to an antidepressant if overall you're not very convinced about ! "bipolar" as one possible diagnosis; or adding it to another mood stabilizer (and making sure there's no antidepressant around) if the "bipolar" view seems possible.  

The point is, after a while "diagnosis" matters less than getting fair trials of your main options for treatment. 

Dr. Phelps

Published May, 2001