How Can Someone Get Out Of Deep Depression?

My mother has been on an antidepressant called Triavil for over 15 years. She also takes Ativan on a daily basis. Her energy level is very low, and she also goes through days of deep depression, not talking, and feeling sleepy. She refuses to have any counseling. Is there any other medication or remedy that might be helpful? She is 72 years old, has high blood pressure and asthma.

The following answer was largely written by Dr. Arnold Lieber, who has graciously agreed to be my consultant for this psychiatric question.

Your mother sounds as though she has some degree of depression, but as always certain medical illnesses have to be ruled out. Your referring to hoping to get her back to her old self suggests that depression (or a depressive character) has not been her life long personality and that her condition is treatable. Since she must have a doctor prescribing the drugs that she is taking, speak to him to make sure that he has considered and ruled out the medical conditions that might mimic this, such as hypothyroidism, or Addison’s disease.

Even if she doesn’t want counseling perhaps she would consent to a psychiatric evaluation and consideration of a more effective trial of medication. The Triavil that she is taking consists of fixed-dose amounts of perphenazine (an antipsychotic drug with the potential for tardive dyskinesia — involuntary abnormal movements — with chronic use) and amitriptyline (Elavil, an older antidepressant with sedation-producing capacity.)

Triavil used to be popular as a treatment for depression — mostly among non-psychiatrists, but it was usually taken in too low doses to get any benefit (or side-effects) from the antidepressant it contains. It was always a poor choice of treatment and is now considered obsolete. Lorazepam (Ativan) which your mother is also taking can cause sedation and dependency.

In summary, your mother is taking a sedating antidepressant, a sedating tranquilizer, and a sedating antipsychotic. Any one alone might not make her so sleepy, but the combination very well might.

Why not persuade her to get a good consultation. If she is reluctant to get into the discussion of personal problems implied by counseling, she could still benefit from a psychiatric evaluation focused on her depression and the best ways to treat it.

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