episodes. He arrived at this combination by working closely with Carol
and her family, getting almost daily information about her mood, activity,
and sleeping patterns.
Agitated depressions are difficult to medicate. Some medications can
increase agitation, and the initial slowing by more sedating medications may
make the depressed person feel worse,even if they’re getting better. Either
side effect may cause them to stop taking the medication before it does
them any good. There’s also a remote possibility of precipitating a hypo-
manic episode if the underlying disorder is bipolar.
If you’re the friend or family member of an agitated depressed person,
you should make sure that the doctor has an accurate picture of what’s
going on. Often, agitated depressed people like Carol tend to minimize
their problems. It will also be important for the doctor to follow the person
closely to see how he or she responds to the medication.
Carol’s situation is not like Kinesha’s. For her, finding the appropriate
medication is the beginning of the road, not the end.
How Medication Can Make Depression Worse
Physical side effects are often less of a problem than philosophical ones.
Sometimes theideathat medication that can cure depression actually
makes it worse.
“I don’t think there’s anything that will help me,” Rachel sobs into
the phone during one of her late night calls. “I’ve tried medication
and therapy, but nothing works.”For Rachel, the road winds constantly and never seems to get any-
where. Over several years, she’s tried any number of treatments that were
supposed to cure her depression but didn’t. In Chapter 2 we followed her
through several different antidepressant medications. Zoloft made her feel
better, but it caused her to put on weight. And Wellbutrin didn’t do much
to relieve her symptoms. Therapy with Dr. Judy focused mostly on her
dysfunctional relationship with her mother rather than her depression.
Rachel’s experiences have reinforced the feeling ofhelplessness that is the
essence of depression. In her heart, she believes that nothing works for her
because she’s just too crazy. The cheerful magazine ads about depression
166 ❧Explosions into Sadness