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Worsening Depression Despite Four Years of Therapy: What Now?

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Q. Hi, my names dave been suffering from major depression for at least 10 years, receiving treatment cognitive therapy for the last 4 yrs (no help) but as of late last two years or so, my moods have been rapid cycling from extreme low to happy to sad to excited and irritable to suicidal thinking, along with this I’ve have been having a sudden increase in panic attacks 2 minimum weekly. now things even more strange the world around me is becoming less and less there, less need to interact with the emptiness my mind sees, at times im feeling almost out of my body at times almost looking back over myself, and when this isn’t happening my mind is racing with thoughts which have no sense to them, flashing racing memories im not sure i even had almost like my imagination is creating my memories for me.

These feelings and all the above occur sometimes together 3 or 4 at a time, other days its just one sensation or feeling but out of a week i will experience all of the above.

My psychiatrist said it will go away as i get older, im 25. He said the anxiety and feelings of being not in myself are side effects of my anti depressant, venlafaxine xr 225mg daily4yrs and my insomnia is caused by it too but says prescribing sleep aids will worsen my moods. He offers no help as to how i can control these things. please help me i cannot cope and my doctors gives no fed back, is there anything more to this or is this just worsening depression please please help me. many many thanks and kind regards.

Worsening Depression Despite Four Years of Therapy: What Now?

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I am sorry that you experiencing emotional distress. I am not certain that I agree with your doctor who you wrote told you that your symptoms will decrease as you age. That is a theory that I am not familiar with, “growing out” of your depression and anxiety symptoms.

If psychiatric symptoms are left untreated they typically grow worse overtime. Most individuals would say that their symptoms do not disappear as they age. It usually takes some form of psychiatric treatment for symptoms to decrease.

It seems evident that you may need a different therapist and a new doctor. You should not expect a miracle cure from any therapist but you should feel substantial or at least noticeable improvement after your four years of treatment.

As for your doctor, it seems like he may be trying to manage your symptoms with medication only. Medication management is generally how a psychiatrist treats most psychiatric illnesses and some people prefer this method. According to your letter however this method does not seem to be working for you. Because of your dissatisfaction with this form of treatment it may be time to find a new treatment team.

My recommendation is that you should consider a new therapist and doctor. I recognize that finding good help may be difficult but because your symptoms are increasing it is what you should do. Your situation does not seem to be improving with their help. It is important that you find mental health professionals who can help you improve your life. It might be what you have to do to feel better. Good luck.

Worsening Depression Despite Four Years of Therapy: What Now?

Kristina Randle, Ph.D., LCSW

Kristina Randle, Ph.D., LCSW is a licensed psychotherapist and Assistant Professor of Social Work and Forensics with extensive experience in the field of mental health. She works in private practice with adults, adolescents and families. Kristina has worked in a large array of settings including community mental health, college counseling and university research centers.

APA Reference
Randle, K. (2018). Worsening Depression Despite Four Years of Therapy: What Now?. Psych Central. Retrieved on March 25, 2019, from
Scientifically Reviewed
Last updated: 8 May 2018
Last reviewed: By a member of our scientific advisory board on 8 May 2018
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