# CBT with long-term mild depression



## justhere (Jun 20, 2009)

Would you assert that CBT and being mindful takes A LOT of practice & potentially could be required for a life-time?  I have been in a low-grade depressive state with agoraphobic tendencies for approx 20 years and now I am doing the CBT work sheets and talk therapy. I dont feel better "yet" however. Sometimes it feels daunting and hopeless.


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## ladylore (Jun 20, 2009)

*Re: CBT Worksheets and Resources*

Welcome to Psychlinks.

CBT techniques take a while before it becomes automatic thinking. CBT can be used for the rest of your life.


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## David Baxter PhD (Jun 20, 2009)

*Re: CBT Worksheets and Resources*



justhere said:


> Would you assert that CBT and being mindful takes A LOT of practice & potentially could be required for a life-time?  I have been in a low-grade depressive state with agoraphobic tendencies for approx 20 years and now I am doing the CBT work sheets and talk therapy. I dont feel better "yet" however. Sometimes it feels daunting and hopeless.



Are you taking any medications?


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## justhere (Jun 20, 2009)

*Re: CBT Worksheets and Resources*

 Yes, for years and years: zoloft and lamictal but i think relatively low doses.


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## David Baxter PhD (Jun 20, 2009)

*Re: CBT Worksheets and Resources*

When was the last time these were reviewed by your doctor(s)?


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## justhere (Jun 20, 2009)

*Re: CBT Worksheets and Resources*

 I gather from your inquiry that you have faith in medication and believe that this could be a huge factor in my prolonged "flat-liner" level of depression?  I no longer see a psychiatrist because most do not accept medicare and I see my primary care physician for medication prescriptions.  Do you have any suggestions?


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## David Baxter PhD (Jun 20, 2009)

*Re: CBT Worksheets and Resources*



justhere said:


> I gather from your inquiry that you have faith in medication and believe that this could be a huge factor in my prolonged "flat-liner" level of depression?  I no longer see a psychiatrist because most do not accept medicare and I see my primary care physician for medication prescriptions.  Do you have any suggestions?



Some people can manage symptoms of dysthymia and mild OCD without medication. Some people do fairly well with a short time (1-3 years) on medication combined with some form of psychotherapy.

Some people, probably as a result of their biological makeup, appear to require medication for the long-term, perhaps for life.

But in my experience, 


some conditions more than others may require long-term medication - OCD is one of those; and
for some people, medication that appears to be helpful initially seems to lose its effectiveness after a while - switching medications at that time seems to help such people.
You indicate that you have been "in a low-grade depressive state with agoraphobic tendencies for approx 20 years". It's indeed possible that you're simply not on enough medication (i.e., the dose is too low) but it's also very possible that the medication is not helping you at all any more. And after 20 years, I would certainly be looking at a change.

I know there is some research suggesting that Zoloft is one of the more effective SSRI medications for OCD but there is also evidence that Luvox (fluvoxamine) is the most effective. There are also some suggestions that Prozac (fluoxetine) is effective with OCD. It might be worth discussing this with your family physician.

I also wonder why you are on lamictal. That is usually prescribed as a mood stabilizer, as in cyclothymia or bipolar disorder rather than unipolar depression or dysthymia...

Finally, it sound as if you are trying to apply CBT techniques recently as a self-help technique, rather than as part of psychotherapy. Again, this might not be the best approach to treating OCD. See http://forum.psychlinks.ca/obsessiv...our-steps-dr-jeffrey-schwartz-brain-lock.html. 

Whatever approach you use, you'll likely have more success if you use that approach with the help of an experienced therapist. Self-help is fine for maintenance but, as with many things, when you are first learning something having an experienced teacher or mentor is often more effective.


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## David Baxter PhD (Jun 20, 2009)

*Re: CBT Worksheets and Resources*

Added: My apologies re: OCD comments. I was reading another thread and confused it with this one.

For depression and agoraphobia, you might ask your doctor about Celexa, Cipralex (Lexapro), Effexor, or Prozac rather than Luvox.


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