Navigating Trust Issues in Severe Depression Treatment: A Patient's Dilemma

Q: Navigating Trust Issues in Severe Depression Treatment: A Patient's Dilemma

Hello, Xiao Wen： I believe your attending physician has not given up on you, and his explanation regarding the medication is not misleading. <br>The medication you are currently taking does have the effects described, but drugs that act on the brain typically take a bit longer to

Major Depressive Disorder, Single Episode

I am a patient with severe depression, and every time I enter the consultation room, I experience an inexplicable fear.
Initially, I was willing to cooperate with the doctor because I wanted to recover.
However, when I noticed that the medication dosage was increasing and realized that the doctor was not truthful with me, my trust in him diminished.
During my last appointment, I expressed to the doctor that I often feel like disappearing for no reason.
My first suicide attempt was due to an overdose, and although I have had thoughts of wanting to die since then, I have not engaged in self-harming behaviors; at most, I isolate myself in my room and cry uncontrollably, usually at night.
The doctor threatened me that if I did not comply with taking the medication, he would write a referral for me to be hospitalized at a facility in Taoyuan.
I want to ask, if I am not at risk of harming myself, how can they force me to be hospitalized? Right now, I can only obediently take the medication, and I don't know what to do.
My attending physician has deceived me; he told me that the medication's effects differ from what I found at the Central Health Insurance Agency of the Ministry of Health and Welfare.
For example, he said that "Mirtazapine" is used for depression and anxiety, but the correct indication is for major depressive disorder and diabetic peripheral neuropathy.
He also told me that "Lorazepam" helps relax the brain and prevents headaches, but the correct indication is for anxiety and tension, as it is a medium-acting sedative.
I would like to ask what I should do next to recover.
My family has told me to reflect on my behavior over the past month.
I often have intrusive thoughts, and when I think about things I shouldn't, I break down and cry.
At that moment, I truly feel like no one can help me.
Now my attending physician is also telling me that I need to be sent to a rehabilitation facility.
I really don't know what to do; I feel so helpless.

Xiao Wen, 20~29 year old female. Ask Date: 2016/04/10

Dr. Liang Sunyuan reply Psychiatry

Hello, Xiao Wen: I believe your attending physician has not given up on you, and his explanation regarding the medication is not misleading.
The medication you are currently taking does have the effects described, but drugs that act on the brain typically take a bit longer to show results.
I think he may have suggested hospitalization out of concern for the possibility of drug overdose or suicidal behavior.
In treating depression, in addition to medication, psychological adjustment and a protective environment are also very important.
Besides taking your medication regularly, you could also try engaging in activities that interest you to help relax your mind, such as listening to music, exercising, reading, or traveling, which should provide some assistance.
It is indeed painful to be in a state of depression, but with proper treatment, most people gradually improve.
Wishing you all the best.

Reply Date: 2016/04/10

More Info

Navigating the complexities of severe depression, especially when trust issues arise with healthcare providers, can be an incredibly challenging experience. Your feelings of fear and mistrust towards your doctor are valid, particularly when you feel that your treatment is not aligning with your expectations or understanding. It’s crucial to address these feelings while also focusing on your recovery.

Firstly, it’s important to recognize that severe depression can significantly impact your perception of reality and your relationships with others, including healthcare providers. The fear you experience when entering the doctor's office may stem from a combination of anxiety about your condition and past experiences, particularly if you have felt let down or misled in your treatment. This is not uncommon among patients dealing with mental health issues, and it’s essential to communicate these feelings to your doctor or therapist.

Regarding your concerns about medication, it’s understandable to feel apprehensive when the dosage increases or when you perceive discrepancies in the information provided by your healthcare provider. Medications for depression, such as antidepressants and anxiolytics, can have varying effects on individuals, and it may take time to find the right balance. It’s essential to have open discussions with your doctor about your concerns regarding the medications you are prescribed. If you feel that your doctor is not being transparent or honest, it may be beneficial to seek a second opinion from another mental health professional. This can provide you with a fresh perspective and potentially restore your trust in the treatment process.

The threat of hospitalization can be alarming, especially if you feel that you are not in immediate danger of harming yourself. However, it’s crucial to understand that hospitalization is often considered a safety measure when a patient is at risk of self-harm or when their condition is not manageable in an outpatient setting. If you are feeling overwhelmed and unable to cope, it may be worth considering hospitalization as a way to stabilize your condition and receive intensive support. This does not mean you have failed; rather, it can be a step towards recovery.

In terms of coping strategies, here are some suggestions that may help you navigate this difficult time:
1. Open Communication: Try to express your feelings and concerns to your healthcare provider. If you feel uncomfortable doing this in person, consider writing a letter or email outlining your thoughts. This can help you articulate your feelings without the immediate pressure of a face-to-face conversation.

2. Support System: Lean on your family and friends for support. Share your feelings with them, and let them know how they can help you. Sometimes, just having someone listen can make a significant difference.

3. Therapeutic Options: If you feel that medication alone is not sufficient, consider exploring therapy options such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT). These therapies can provide you with tools to manage your thoughts and emotions more effectively.

4. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, deep breathing exercises, or yoga can help reduce anxiety and improve your overall mood. These techniques can be particularly beneficial when you feel overwhelmed by negative thoughts.

5. Journaling: Writing down your thoughts and feelings can be a therapeutic outlet. It can help you process your emotions and identify patterns in your thinking that may contribute to your distress.

6. Educate Yourself: Understanding your condition and the medications you are taking can empower you. Research reputable sources about depression and its treatment options, and discuss any findings with your healthcare provider.

7. Consider a Support Group: Connecting with others who are experiencing similar challenges can provide a sense of community and understanding. Support groups, whether in-person or online, can be a valuable resource.

Ultimately, your recovery is a journey that requires patience and self-compassion. It’s okay to feel lost and unsure at times, but taking proactive steps towards understanding your condition and advocating for your needs can lead to a more positive outcome. Remember, you are not alone in this, and there are people and resources available to support you through your recovery.

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