Dr. Michelle:
My daughter is a 35-year-old, college graduate. She is very smart and intelligent. During her undergrad, she suffered from depression and it continues today. She has been treated by many psychiatrists doctors. First, she was diagnosed only with depression then she was diagnosed with major depression, panic, and anxiety issues. She has been on antidepressants, went through TMS (Transcranial magnetic stimulation), and Esketamine treatment (nasal spray) for two weeks. Nothing seems to have helped. She has lost her motivation to get up, she complains about not being able to think, focus or remember. She is totally home-bound, hasn’t worked in nearly ten years, and stopped driving. She has no social life besides me and my husband. She does have a Genetic Disorder since she was 2-years-old, for that she receives ERT ( Enzyme replacement therapy). Due to her comments about neurological problems, an MRI was conducted, and it came back normal. A full cognitive test was completed recently and showed some slowness in her thinking and expression, but her memory seemed good. Please advise me where to go from here? Is any treatment can help her? I am desperate to find some treatment for her.
Devila
Dear Devila:
Your daughter seems to be dealing with some very difficult issues and I am sorry that you are not finding the treatment you need to help her experience relief. I applaud you for continuing to search for answers and not giving up.
The fact that you are not finding effective, long-lasting solutions is certainly not for lack of trying, rather, it is due to the unique challenges and complexities of your daughter’s condition. The mental health field does not have an exact recipe to treat the intersectionality of so many issues at play, such as cognitive processing, anxiety, major depression, genetic disorder, and perhaps other medical issues that might be present.
Individualized Approach
What your daughter is experiencing does require an individualized approach, different types of support, and a lot of trial and error, which is exactly what you have been doing. More specifically, individualized treatment means ongoing testing, working with different professionals across the medical and mental/behavioral health field, trying different medications, tracking symptoms and triggers, and being willing to try creative and nontraditional interventions like TMS and Esketamine treatment.
Let me mention a few things for you to confirm in relation to the interventions that you have already tried to ensure no stone has been left unturned.
- Regarding the MRI - MRI’s can have different purposes and as a result, different images and scans are taken. Be sure that the MRI your daughter received assesses for brain damage or brain injury. Much of what you described indicates the possibility that brain damage exists. If there is a brain injury, the treatments you have tried will most likely render ineffective. In addition, consider the type of doctor that conducted the MRI. Hopefully, you were able to access the expertise of a neurologist that specializes in brain injury and psychiatry in addition to the expertise of a general practitioner.
- Regarding psychiatric evaluations – if not already completed, pursue getting a neuropsychological evaluation (often referred to as a “neuro-psych”). This type of assessment will evaluate brain functioning but also includes more in-depth personality, psychological and psychiatric assessments. In other words, it is a more thorough evaluation of complex symptoms that intersect across different areas of the brain and body. Be aware that most insurance companies will not pay for a neuropsychological evaluation, and this type of evaluation will most likely require personal resources.
- Regarding your psychiatric support – Make sure that you find a good fit with a doctor that listens and takes your concerns seriously, and one that supports trying different interventions and treatments. Remember to share as much information as possible. It is never too late to provide more information regarding historical and current behavior issues to your psychiatrist.
- Medications - If your daughter has tried many different medications, perhaps it is time to wean off medications, take a break, and start over. Discuss this possibility with your psychiatrist, and never attempt this intervention without their oversight. Share information regarding times in the past where medications were more effective than not. With these types of symptoms, be sure to have your daughter continue psychiatric treatment, no matter what or who prescribes her medications.
- Therapy - Help your daughter engage in individual therapy and support her to attend therapy on a consistent basis. Make sure you are realistic about the purpose of therapy. Therapy is not to heal her from her symptoms, but rather, to help your daughter learn to manage her symptoms more effectively or teach her how to live with her symptoms.
- Research - There are many university-based hospitals or specialty medical centers that conduct research and work with more unique cases. Search online for such facilities and seek out information about the types of help they offer. Follow this link to get you started.
Shifting Your Focus
With the complexity of issues and symptoms that you are describing and the number of years this has been occurring without much change, I recommend that you and your husband might need to think of your daughter’s condition as permanent - a medical condition that might not get better.
By taking this approach, you can shift your energy away from hoping you find a cure and that her symptoms will change to having hope that you will find a way to live with her condition effectively enough for you and your husband to rediscover other joys in your life.
Learning to live with or around your daughter’s condition will require a shift in your thinking from symptom relief to symptom management. It is about finding specific and intentional ways to take a break from parenting your daughter and making sure you are finding a balance between caretaking and engaging in your own hobbies and interests.
Ask yourself questions about the future and identify solutions that fit your resources and long-term goals.
- Assuming nothing will change with your daughter’s condition, what types of support will you need from others to live with this long-term?
- What types of resources will you need to care for your daughter?
- Who can look after her when you and your husband need to go out of town or need a break?
- What do you need to change in your home’s physical space that you have not already done to accommodate her being a permanent resident?
- What expectations, rules, or boundaries are realistic for you to have for your daughter so that she is contributing to the upkeep of the house, managing some of her own activities and/or self-care?
Shifting your focus might lead to sadness and feelings of loss. You might need to grieve the loss and come to terms with how your daughter’s condition affects you and your family.
I would recommend that you engage in your own therapy so that you have the professional support to help you live with the permanency of your daughter’s situation. Therapy is a good place to discuss the reality of your situation and identify appropriate boundaries and realistic expectations of your daughter. Finally, therapy can help you work through the grief that your daughter’s situation does affect what you may have dreamed for her and what you thought you could do to make it better.
Dear Dr. Michelle blog posts are informational in nature. The posts are not meant to take the place of consulting your physician, mental health professional, or other qualified health providers regarding your well-being or the well-being of others.
