
- With Mayo Clinic psychiatrist
David Mrazek, M.D.
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David Mrazek, M.D.
David Mrazek, M.D.
Dr. David A. Mrazek is chair of the Department of Psychiatry and Psychology at Mayo Clinic, Rochester, Minn., and a professor of psychiatry at College of Medicine, Mayo Clinic. Dr. Mrazek has developed a federally funded psychiatric pharmacogenomics research program and implemented clinical psychiatric pharmacogenomics services at Mayo Clinic.
He has received numerous awards including the Award for Creativity in Psychiatric Education from the American College of Psychiatrists and the Agnes Purcell McGavin Award for Distinguished Career Achievement in Child and Adolescent Psychiatry from the American Psychiatric Association. He currently serves as chairman of the board of the American Board of Psychiatry and Neurology.
Dr. Mrazek has focused his current efforts on using pharmacogenomics testing to improve clinical care. One of his specific goals is to decrease the risks of taking psychiatric medications.
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Depression blog
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April 30, 2008
Know the keys to successful treatment
By David Mrazek, M.D.
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Thank you so much for sharing all of your stories. I know this takes courage, especially when you are not feeling well. You all need to know that help is available. If you're actively thinking about suicide, get help now!
I was struck by the number of you that have lost someone to suicide. I was also moved by the number of you that have had significant losses in life for any reason. I am sincerely sorry for the losses that you have experienced and know your emotional pain will get better with time.
Depression severity can vary between individuals and episodes. For instance, some people will have anxiety that accompanies their depression, while others do not. We call medications "anti-depressants," but almost all of these effectively treat anxiety as well. While it is true that there is no quick fix or cure, there are keys to successfully treating depression to decrease suffering.
Obtaining the correct diagnosis is so important and sometimes this will change over time. Considering the patient as a whole is crucial to determine how to develop an effective treatment plan. Medications alone are rarely enough. You may need to try more than one medication or a combination. Medications are not always needed for depression, depending on the severity.
Therapy alone can be extremely effective, yet therapy is not for everyone. You need to be comfortable with your provider; therapy is meant to be a safe place where you can talk and not feel judged. Therapists can help by listening and facilitating change, if the patient has insight and is ready for change. Therapists don't make people better or fix them. Therapy is a partnership and takes working together. Keep an open mind during therapy as well. Being your own expert on your illness is important too. Obtain as much information as you can, have your questions answered, know your options, and then you can choose which form of therapy (medications, talk, etc.) you'd like to begin.
On this site, we will continue to read your comments and address topics as best we can. More later on ECT, but know that it is available all over the country. Thank you again for your interest in depression.
40 comments posted
May 5, 2008 10:39 p.m.
I too tried numerous medications that would work for a while, then stop, over and over again. It's very difficult for a depressed person to persist. I have a close friend who also suffers from mental illness. He was very helpful in recognizing symptoms that my family couldn't, among them that I was showing signs of mood swings. I did some reading. The book "Why am I still Depressed?" by Jim Phelps was a big help to me. His theory is that depression is in some cases actually bipolar disorder, in which case anti-depressants may exacerbate the symptoms. I found information online from reputable sources that concurred. My psychiatrist didn't buy it, but by then I had learned to advocate for myself and I persisted. He continues to be amazed that he could have overlooked my mood swings--especially since bipolar disorder is his specialty. I've been taking Lamictal for more than a year, with good results--and it hasn't stopped working!! I recommend the book and I hope that it might help you.
- joyce
May 5, 2008 10:32 p.m.
di: what's the point of trying if it will never work out? i have nothing to offer other people. i have tried volunteering. nothing makes me happy at all.
- suffering in silence
May 5, 2008 1:14 p.m.
I have been depressed for forty or more years. Over the years I have been on various medications. The combination of Effexor and Doxepin helped me for several years. I have major depression. Some of it is chemical and some of it is what I term "situational," I worry about my grown child and how I am mentally abused. I informed my psychiatrist that the two medications that I am currently taking no longer are effective. She informed me that 25 million people take effexor and it is an excellent medication. It no longer works for me. She increased the effexor and doxepin. All I did was sleep. The next time I saw her, I stated that sleeping all the time isn't a life or a quality of life. I now just take effexor and am still depressed. I need to try another medication. Years ago, prozac worked for my friend, but the six weeks that I was on it I threw up daily. Medications respond in different ways with diffent individuals. Any assistance would be appreciated. Take care and may God bless all of us.
- no name please
May 5, 2008 11:07 a.m.
I've been on many meds for over 20 years. Prozac was a bit too much, developed TMJ! Tried Paxil,(TMJ got better)and worked well initially, but then it seemed to "wear off." Doctor said that happens sometimes and suggested Lexapro. I feel better and helps with the anxiety, although my jaw clenching is back! It's always trial and error...
- No name given
May 4, 2008 8:18 a.m.
suffering in silence. How does someone get to such a low point.I wonder who has done this to you.You say you cant do anything right or make the right decisions is this a mother or husband or other people that make you feel this way If the people around you aren't the ones to make you feel like a loser and it's your perception of yourself then take this advice. Your life is yours, yours to make mistakes with, yours to take on this journey. Whether you like it or not this is who you are and this is your story, and it's up to you to start learning how tolove yourself and to start doing what you have to.start being someone you can love, it's not about what you look like, its never about that. It's how you feel about yourself on the inside, how kind you are how interested you are in what you do, its about what you can learn to love doing, not for anyone else but yourself. You said you are a bad person, then become a good one,stop doing the things you feel are making you bad. Little by little do things that make you feel better. There are so many people you could start helping, hospitals to visit, people who need help learning to read. These things and many others all turn the focus from how bad you feel to how good you feel. Weight can be lost, looks can be improved by make up, but accepting yourself comes from within. Be kind to yourself. Search online Henry drummond the greatest thing on the earth. Read each chapter learn to love, its a wonderful message, let me know,okay
- di
May 4, 2008 7:08 a.m.
BJ, This site and others offer questionares and if you tick many of the boxes, tnen you should seek help, your doctor or family need to be told how you feel, don't be ashamed of depression once you voice it, it will get easier. Call it sadness or anything else that makes it easier to talk about.Read all you can and inform yourself about this problem that many thousand of people have. Decide how severe yours is and get help if you feel it is stopping you from living your life. What country do you live in? Good luck and take care.
- DS
May 3, 2008 4:46 p.m.
Where do you find help? How do I know if I need a doctor or a therapist or a counselor? How do I find someone that will be a good fit? I live in a small town and don't really want to ask around. Any ideas?
- BJ
May 3, 2008 3:50 p.m.
I think that meds without cognitive therapy often doesn't work, and vice versa. My experience was not being diagnosed for at least 20 years, wasting time on various forms of therapy. The depression diagnosis (and assigned cognitive therapy) was like a light going off in my head. It made so much sense! Then the first med I was on (prozac) and just the act of taking it seeming to relieve the heaviness of heart I had always felt (surely a placebo effect!). I'm not on prozac any more (changed to effexor) nor in cognitive therapy, and it seems that I've regressed a bit. What I plan to do is get a cognitive tuneup through my employee assistance program, to see if that helps. If not, I may change anti-depressants. Anyone go through their meds becoming less effective over time? If so, what did you do about it, and did it work?
- Billlaurelmd
May 3, 2008 11:50 a.m.
My depression comes from the fact that I hate myself. I hate myself so much. I think I am so ugly and now I am also fat. I hate looking at myself in the mirror sometimes. I hate my life because I feel like I can't do the things I want to do because I am such a loser. I am always doing something wrong and no matter what I do I make the wrong decisions. I can't even make decisions because I know that I will always pick the wrong one. I feel sorry for people who have to be around me because I am a bad person. There's no amount of medicine or therapy that can make me not hate myself or my life.
- Suffering in Silence
May 3, 2008 8:02 a.m.
dear Jane, I saw an australian doctor who had a hand held electronic device that was held on the head, it gives a jolt and was effective in some cases in decreasing deperession. Sorry I didnt get the name of the doctor but a research might come up with something. Fish oil is meant to help with brain function and has helped ease the length of an episodes in some people. I think it needs to be taken for several months before it helps. It is good for your health so it cant hurt.
- No name given
May 2, 2008 7:57 p.m.
I'm fortunate to be in remission (thanks to meds) from my depression and anxiety. Meds combined with therapy have pulled me out of the depths of a deep depression. I was lucky enough to find a great therapist on my first try. In the past I've done meds alone but I find that adding therapy has helped me to understand my tendencies toward depression and anxiety. It has also helped me maintain balance during a difficult time in my life.
- Robyn
May 1, 2008 9:09 a.m.
Luckily I found a good therapist my first try. She's been working with me since the summer of 06 but I wonder at what point should therapy end? One of the questions she posed to me this week was to quietly sit and think about stressors and what my triggers are and honestly I can't think of any. Since my first episode I tend to worry (on a low scale) of things which bother me but overall I feel pretty good. On my meds and doing my best to keep things in the moment and in perspective. So I guess my question for the board is: At what point has therapy accomplished it's goal? Thanks for reading and thank you so much for sharing - it helps to know your not alone and that things can improve with time and treatment.
- Marie
May 1, 2008 6:02 a.m.
I am a 43 year old woman and have dealt with depression since I was 19. Have been hospitalized several times tried every medication availabe. I either can't handle side effects or it makes me feel worse. I also have been diagnoised with seizure disorders to top it all off, and last but not least I have a Thyroid problem. I am so tired of trying diffrent meds. and nothing seems to work. I felt the best on wellbutrin which I now can't take because of seizures. I am seeing my doc. friday and I am now on lexapro for the second time which I have gained 24lbs. in two months. I am going to go off this med. because all the extra weight I have gained only makes more deppressed. I am a active person when I feel well and watch my diet always. FRUSTRATED!!!
- tessa whitmire
May 1, 2008 5:02 a.m.
i am desperate.i have been battling depression for 36 years and it's a wonder i don't kill myself.it's a living death.this is not a life at all.i've tried over 30 different medications,incl.antiseizure drugs and antipsychotics,and also ect.therapists galore,hospital stays,religion.what if anything,is left for me??? i am at a point where there is no point.please i beg you help me--is there anything like brain surgery or brain stimulation--any new drugs ??? look,i don't want to die,but i don't want to live like this,either.
- jane bergren
April 30, 2008 8:45 p.m.
The comment about finding a therapist that you feel comfortable and safe with really hits home with me. The first therapist I tried was (to put it kindly) not a good fit. I was actually told I was not a candidate for therapy, not willing to change, cynical. Face it - it's a leap of faith to get up the courage to try talk therapy and to feel totally beat up when you come out of your first session is not a great start. Thank goodness for my psychiatrist who convinced me to try again with someone else. It's been hard work, but I'm doing so much better between the right mix of medications and having someone I feel safe and comfortable with to talk things through. Sandy has helped me through a lot, and I always have something new to mull over and work on when I come out of the session. There is good help out there, and just because you may not have a helpful, kind and insightful therapist the first time out please at least consider taking another leap of faith and try again. It also was very helpful to me that I reported this very bad experience and felt like I was taken seriously and the matter was dealt with. Remember - you are worth it!!
- Julie, Eau Claire, WI

40 comments posted