
- With Mayo Clinic psychiatrist
David Mrazek, M.D.
read biographyclose windowBiography of
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.
Latest entries
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Depression blog
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June 24, 2009
When depression treatment isn't working
By David Mrazek, M.D.
When people say their depression treatment isn't working, lots of things come to mind.
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- Are you taking your medication exactly as prescribed?
- Are you attending to your basics needs, such as sleeping at least eight hours and eating regular, healthy meals?
- Are you using alcohol or other drugs?
- If in recovery for drugs or alcohol, are you following your sobriety plan?
- Are you taking pain medications (prescribed or over the counter)?
- Are you going to therapy on a regular basis as prescribed (if applicable)?
- Are you balancing work and leisure activities?
- Are you surrounding yourself with positive, supportive people?
- Are you dedicating some "you only" time, such as meditating, listening to music, or shopping?
- Are you trying something new to boost your mood and self-esteem (music, short concert, walk, church, coffee shop, etc.)?
- Are you keeping your mind active? You may try crosswords, sodoku, video games, or reading.
Getting better means taking care of yourself and doing things that help you feel better. You likely won't feel like it, so start slow and work up. You can do it and it will pay off by improving your depression. Share with others if you have any tips on things that help get you through the rough spots.
39 comments posted
January 21, 2012 9:01 a.m.
I'm puzzled by your suggestions. Depressed people have trouble sleeping and eating so they can't necessarily get 8 hours of sleep a night or eat regular meals. And people depressed or otherwise aren't always able to surround themselves with "supportive positive" people because they just might not have such people available in their immediate community. It would be wonderful if that was the case, but most certainly isn't always the case. I wonder why you - the Mayo Clinic - would simplify why treatment may not be working this way.
- Jennifer
October 6, 2011 12:41 p.m.
Is their a anti depressant that does not have a potential side effect of memory loss?
- No name given
August 16, 2011 7:10 a.m.
A Residential Treatment Center is a live-in facility that specializes in the treatment of chemical dependency (drug use), alcoholism, or psychological problems. Mental health issues may coexist with substance abuse, which is referred to as “Dual Diagnosis.” Psychological problems appropriate for a residential treatment center include bipolar disorder, depression, anxiety disorders, personality issues, psychological trauma such as PTSD, and self-injury behavior (cutting).
- Steven G
August 16, 2011 4:39 a.m.
Self injury, including cutting and burning, is a common manifestation of anxiety and depression. At Depression Treatment Los Angeles, patients receive psychiatric testing and evaluation, and can receive a variety of therapies. At a self injury treatment center, patients can be prescribed medications, and be prescribed speech therapy to cope with their disease.
- Tarry
November 12, 2010 4:56 p.m.
I started taking Keppra for Complex Partial Seizures in summer of 2000. I had a cholecystectomy then also. By the next spring I started noticing depression Sx. I started on RX. Found out side-effect of Keppra was Depresson. Switched to Trileptal which I am still taking. I am also still on a depression Rx. I started on Celexa. Later added Fluoxetine(which was stopped after awhile). Mood got better but even several yrs .later had not gotten energy back. Finally asked Neurologist for antidepressant that might give energy. Went on Lexapro. I was suicidal in 2.5 wks. Put me in a tail-spin. It took several yrs till I was singing around the house again. Problem is I still don't sleep well(snoring doesn't help).Melatonin 9mg. Bed 11 or later. Up5:30 Down 8. Up11. Stare at TV. Knowing I have many things to do but can't make my self do. Even things I know I will enjoy. I could not function when I had the Sz. but it is so hard to function now. Neurologist said alot of times when the Sz. are controlled the change in brain chemistry causes depression. Wonder if getting shocked will help. I know exercise, diet, nutrition, good support help. I just need someone to take me by the hand and jerk me out of the house everyday. I did get out to exercise for awhile a yr. ago. Had to pull the car to side of parking lot & take nap before I could even go in. I am so tired of this.It is causing problems at home. I try to change but it only last a few days. Scared to try new Rx fear of another tail
- Elizabeth
September 24, 2010 6:54 p.m.
Doctors are not all equal in skill or knowledge. I have so far had much more success from the research I've done on my own than from anything my psychiatrist has said. ...But I refuse to give up. I am on a waiting list for a different psych who comes with a good reputation, and hopefully he will have more valuable input. Sometimes you can be doing everything you're supposed to and still feel like you're going backwards with treatment. But that doesn't mean there isn't a solution out there for you, just that you haven't found it yet. I truly believe that. I think medical knowledge about depression is still in its infancy. They'll get there eventually. In the mean time, I strongly suggest exploring as many options as possible (under medical supervision) until you find a direction that seems to be helping. I tried a lot of conventional antidepressants that did nothing good for me, then decided to give them a break for a while and try SAMe instead, and it's done wonderful things so far. Try not to give up hope - there may be something just around the corner.
- EmotionalUmbrella
July 26, 2010 9:11 a.m.
And more importantly if your current treatment isnt working and your a male find a new Dr. You might want to read this - Maybe it will help ? http://4viola.blogspot.com/ My 15 year experience with misdiagnosed hypogonadism.
- Old Hippy
April 14, 2010 2:21 a.m.
I have had recurrent depression and anxiety since the death of my 17 year old son in 1989.Have tried several antidepressants and go to therapy, but i am 64 yo and more isolated than earlier in my life.I have been on celexa for ten years, but now it seems to have quit working, and i am back on the bottom again.Have never tried suicide but think of it as I seem to be unable to pull myself out again. I am weary from being depressed for so long.I don't know what else to do.
- Jude
April 14, 2010 2:09 a.m.
I have had recurrent depression and anxiety since the death of my 17 year old son in 1989.Have tried several antidepressants and go to therapy, but i am 64 yo and more isolated than earlier in my life.I have been on celexa for ten years, but now it seems to have quit working, and i am back on the bottom again.Have never tried suicide but think of it as I seem to be unable to pull myself out again. I am wear from being depressed for so long.I don't know what else to do.
- Jude
April 14, 2010 1:22 a.m.
Reading these comments only made me feel more depressed & hopeless. Reinforcing all my negative feelings. Without a doubt, there is no cure... Medications either don't help @ all, are a temporary bandaid fix, or cause more problems due to side effects. It's all so futile. Life is a constant struggle, filled with pain & grief... one problem after another. What's the use. It's not even worth the effort. Yet, I struggle thru each day, filled with guilt because I should value life, but I can't control this hoplessness.
- LadySuperficial
April 13, 2010 5:22 p.m.
I have clinical depression and also medication resistant depression. I have tried more than 20 meds and most work for a short time and then I relapse. I take all my meds as directed, get enough sleep, eat relatively healthy, exercise is an issue as I have osteoarthritis and can't do much walking. I am suicidal most of the time. I've had many situational things happen (as most people do) that would make anybody depressed but even when things are going well I spiral downward into a black tunnel that I can't find my way out of. Right now I am not doing well at all and am trying to come to terms with the fact that at some level I will probably always deal with depression. At 57 years old that sounds like a long time and so I think about how to end my life. Of course my therapist, doctor, and family don't want that to happen but to me it feels and sounds like the most logical and rational thing in the world.
- Kim
March 24, 2010 1:35 a.m.
Have taken antidepressants on and off for years and continually last year only to experiece the "pooped out" effect and have been struggling since .Went to a new phsyc and he says that antidepressants can actually worsen the symptons- such is the new thinking, especially with bipolar 11.- that mood stabilisers is the way to treat this. So far after a couple of months on them am still not right - no enthuasism - my spark is gone.
- Hilary
March 10, 2010 12:33 a.m.
there is no cure Im giving up no one has ever been able to help
- gail
January 16, 2010 9:23 p.m.
I have be dealing with depression for 15 years. I have tried many different medications. Some worked for a while and then seemed to stop working. Some never worked at all. Although I feel better when I go to therapy it doesn't seem to change anything (I go regularly and to a couple of different people over the years). Ok, I am a bit disappointed in the article above. Maybe I am in the wrong place but you lost me at 'Are you balancing work and leisure activities?' Everything that follows are the things I can not do (no matter how much I want to do them) when I am depressed. Do you think that reading this will help someone who is truly depressed? It kinda says 'so you don't think your depression treatment is working? Well if you aren't doing the following things then its not that the treatment isn't working, you are just doing it wrong.' Thanks
- April
December 25, 2009 11:22 a.m.
neurostar TMS therapy is a new FDA approved treatment for depression that is an alternative for those who have failed an antidepressant either do to side effects or it just didn't work...non invasive,non systemic.
- donna
December 13, 2009 9:38 a.m.
I am 46 years old and have suffered from severe depression my entire life. As a child I was extremely ADHD and put on Ritalin very young which turned me from a happy, excited child into a zomby which worked well for the Catholic school authorities but did me great harm,imo. When I was taken off the drug I was still the same except that I had decided I was defective and worthless. I was always in trouble for mischief and a problem for the public school system so I was barred from attending Jr High and sent away to a school for behavioral problem kids at the urging of my shrink, I was 12 and the 3rd youngest person there. By this time I was using any drugs I could get my hands on, I was sexually abused, emotionally abused and physically abused and I hated myself because I let it all happen. I attempted suicide at 13 or 14 and again at 17. I can remember thinking I would grow up and forget about all of it and be ok. That never happened. Heroin turned out to be my best freind and I actually felt normal. I excelled in my very technical carreer for awhile until that no longer worked and after 13 detoxes/rehabs I got clean and was diagnosed with clinical depression and anxiety. I have never found a medication that worked for me for very long. The clouds always came back along with hatred I feel for myself. My inability to connect with people has caused me great pain. Some days I find it difficult not hurting myself physically like I did when I was young.
- Mark
October 15, 2009 7:15 p.m.
Hi Kelly, Thanks for your post. My son has been treated by several psychiatrists and therapists, and, no one has ever suggested OCD. My son has not suffered any eating disorders, nor has he indulged in alcohol or drugs. All that said, I will look into the medication you've suggested. As of now, the psychiatrist at the hospital feels the drugs should be reduced, that they might be doing more harm than good. So, we're trying that. Of course, it's only a hypothesis, and, no one really knows at this point. Thanks, again. Arthur
- Arthur
October 15, 2009 1:02 p.m.
My wife has been suffering from depression, dealing with anxiety and we're even dealing with her infidelity during all of this. We have 2 kids. Will daily life ever get better? It seems like it goes great for 2 weeks, then she has another episode that is triggered by work stress or bills or whatever and we have to start all over again. Is it possible that this depression was caused by early childhood rape that I read about in some paperwork for her counselor that she left out in plain view? She never told me about that, but it would explain the cutting she did at a younger age and more recently when our marriage was falling apart, the infidelity, my being laid off, us losing our house. Yeah, its a lot to deal with, but I am dealing with it and with what she did to me and our marriage. Will it ever get better?
- Allen
October 15, 2009 11:25 a.m.
I am a 55 year old divorced (2x) white male whom has suffered major depressive episodes off and on for more years than I care to recall. I was not diagnosed until about 6 years ago after having suffered three life altering events within a one year period which led me to become suicidal. I would note that three previous suicide attempts in my life led to no diagnosis or treatment! At any rate, I have been taking meds and regularly attending therapy since my diagnosis and have found only brief periods of relief. Periods which have become much less frequent and much shorter in duration despite numerous med changes. I have begun to think that this diagnosis and ensuing treatment are little more than efforts on my part to avoid having to accept the consequences of my behavior over these 55 years, and that it is unrealistic for me to expect to feel otherwise. As I have told both my therapist and psychiatrist, I honestly do not know what is preventing me from committing suicide. Any suggestions? Anyone?
- Jim
October 11, 2009 7:30 a.m.
For Arthur: I am 38 years old, but reading about your son takes me back to being 14. Not only did I struggle with depression, I had anorexia, bulemia, and drank very large amounts of alchohol to cope. These behaviors carried into my adult life until 2 years ago when I was in intense therapy and diagnosed with attention deficit disorder (ADD), and told that my behaviors of the past exhibit signs of ADD while I had never been diagnosed. I was told that most people with ADD exhibit depression and addiction as well as extreme highs and lows. No one I had talked to had ever gone the route this therapist took me. I had tried all of the SSRI drugs (prozac, wellbutrin, etc) and none had helped me. I was put on Vyvanse, a new ADD medication, and began to feel better almost instantly. Vyvanse has not affected my appetite, a concern for most parents (and a recovering anorexic!). I feel so much better than I have in the past. I am still in therapy, because for me the medicine without the therapy was like putting a band aid on a gushing wound that needed stitches. I don't know if this is the right recommendation for your son but felt compelled to share my thoughts. God bless your family and best of luck to you.
- Kelly
October 10, 2009 3:31 a.m.
My 17 year old son has been suffering severe depression since he was 13, which has been treated and stabilized for up to a year at a time. He has been doing well for the last year, but, has now suffered a relapse and is hospitalized. They are modifying his meds, but, so far he is getting worse. It's never been very clear to me whether any of his meds have really worked. He has been taking Lexapro, Wellbutrin and Abilify together over the last year. He is a kind, thoughtful, compliant, intelligent boy, who seems to regress about once a year, but, this is, by far, the worst relapse he has experienced. I am beginning to wonder whether we need a new, different approach, if such a thing exists. It's heartbreaking to see how he is suffering. Does anyone have any other ideas ? Does anyone know the best hospital for treating adolescent depression? We are in the New York City/New Jersey area, but, will travel for the best possible experts. Thanks.
- Arthur
September 23, 2009 2:33 p.m.
I, have been depressed and anxious all of my life . The thing is-as a child I took comfort in running away from the crazy family situation in which I was raised by retreating my room to be alone the only place where I felt safe.I carried this habit into my marriage .Whenever I felt overwhelmed I would retreat to a place alone . I did not know how to talk things out because there was no support for this in my childhood . I learned to escape the pain of rejection by sulking .My husband said"pull yourself out of it"!Again no acceptance or care about my need to have a "safe place to fall"I have never been able to be comfortable with or trust anyone . I was rejected by the adults in my family -again and again .74 years of living in this world has produced a person who is self sufficient ,giving-but I can not take because of past rejections.and loss of trust in others .I tried therapy many times but found that I felt a sense of rejection even there . My Dr . feel I need treatment for these conditions .I agree . But I do not have the desire to work that hard at recovery after so many losses and rejections in the past .I, am mentally and emotionally drained .I can't concentrate on reading any thing important . I do crossword and video games .Anything that does not require me to think about the loneliness I feel all of the time .
- Anna
August 16, 2009 7:07 p.m.
Dear Janice, The first thing I would do for your Aunt, is take her from her small town into a city with a University Teaching Hospital or at least a hospital with a very good reputation. I'd have her evaluated by the best psychiatrist and neurologist that can be afforded. They will give you an accurate diagnosis and a treatment plan. Therapy, along with medication, seems to work best. As for Family members...even though I am the depressive, I know how hard it is to deal with me when I am significantly depressed. Sometimes, being in the hospital has helped me more than being at home. They "get" it there and I can be safe till it passes or another drug can be started. Otherwise, there really is not much YOU can do. Don't blame yourself or feel bad...it's an insidious disease, my poor family just does as I ask which is mostly to be left alone and perhaps do some marketing because I cannot go out when I get bad. I know this is not much but I hope it helps you a bit. As a Major Depressive, I still am acutely aware of how my illness affects those around me. I wish it did not. I can only thank the heavens that it is not contagious...lol Best Wishes, Jean
- Jean
August 13, 2009 7:36 a.m.
Thanks for the information! anxiety can be cured by just following these simple steps or by Deep breathing as these exercises are excellent for anxiety and many people report positive results from meditation. Some other natural anxiety remedies to look into are St.John's Wort, SAMe, L-Theanine, and Tryptophan.
- anxiety remedy
August 11, 2009 8:14 p.m.
A family member of mine suffers from depression, but she lives in a small town where resources are limited. The problem has been going on for years and I feel as if it is tearing my family apart. She's tried exercise, drugs, therapy but nothing has worked. What are tips for family members? I know that my patience is draining, and I feel overcome with a sense of helplessness.
- Janice

39 comments posted