Mental health Personal Health Navigator

When a mental health issue requires a second opinion

The Question: I am a man who suffers from severe depression. I seem to be medication resistant, as I have tried many. They work for a while and then they stop working. I have been having a bad month. Started near the beginning of December. I live over 2 hours away from Sunnybrook. Currently I am taking Citalopram and Ritalin for ADHD. I am at my wits end. I am dead inside and just waiting for the outside to catch up. I don’t take care of myself at all. The psychiatrist I was with just kept trying different medications, so I quit seeing him and now my doctor handles prescriptions. I have trouble communicating what is going on inside me as I don’t want to upset anyone and have them freak out. That is why I am using e-mail. Any help, advice would be greatly appreciated. I am even willing to be locked up, to force myself to work on me.

The Answer: Your question demonstrates the pain and suffering that occurs when an individual has a mental health issue not adequately addressed. The moment I read your e-mail, I contacted Sunnybrook’s Psychiatrist-in-Chief, Ari Zaretsky, who specializes in mood disorders and cognitive therapy. He suggests that you return to your family doctor. Explain the symptoms impairing your function have not responded to your psychiatrist’s interventions.

“He needs a fresh look so I would suggest he get an evaluation from another psychiatrist to evaluate his diagnosis and treatment regimen,” Dr. Zaretsky said in an interview. “Even if the diagnosis is, in fact, correct and in keeping with the first psychiatrist’s assessment, most patients need a combination of medication and psychotherapy or psychosocial interventions.”

It’s not uncommon for patients to have more than one diagnosis. You describe yourself as having severe depression and Attention Deficit Hyperactivity Disorder, [ADHD] the latter of which is characterized by inattentiveness, over-activity, impulsivity, or a combination of those three symptoms.

Every adult who has this disorder has had it as a child, though many children may not have been diagnosed. Only about one-third of diagnosed children will grow out of the problem by adulthood, typically after the central nervous system has matured and brain has become fully wired, around age 20, according to Dr. Zaretsky.

That, in part, is why Dr. Zaretsky screens every new patient referred to him for ADHD, which affects five per cent of the population, typically more males than females.

“ADHD is common and often missed. People tend to focus on the mood disorder,” he said. “…You should target the ADHD with psycho-stimulants and cognitive behavior therapy that teaches the patient to become more organized and to be able to manage themselves more effectively.”

Chronic inattention, distractibility, forgetting appointments, severe procrastination and impulsivity are common symptoms of ADHD. In some cases, those with ADHD have difficulty holding down jobs due to their intolerance of boredom the need to do tasks that require attention to detail.

Typically, in cases where patients have the two diagnoses of depression and ADHD, the depression is treated first in order to provide the motivation and energy required to tackle the chronic ADHD problems.

Dr. Zaretsky said a day treatment program would be critically important to your treatment. In such a group, there are structured activities that can help you learn life skills. He also recommends you exercise, if you aren’t already doing that.

“Even though it is very difficult to be motivated to exercise when you are depressed,” says Dr. Zaretsky, “aerobic exercise is very beneficial to the brain and leads to the growth of new neurons.” If you are self-medicating with drugs or alcohol, to soothe your distress, refrain from both, as it will compound your issues in a “very significant way,” he said.

To sum up, please visit your family doctor, request another referral to a psychiatrist for a fresh look at your diagnoses, and request that you be enrolled in a day treatment program in your area. Thank you for your bravery in writing this letter and describing your symptoms so articulately.

About the author

Lisa Priest

Lisa Priest

Lisa Priest is the Director and Patient Engagement Lead of the North East Toronto Health Link.

Have a question about this post? Get in touch.

3 Comments

  • I just came across this and I can relate to much of what the man who wrote the question is describing, although I do not have ADD/ADHD I have suffered from Severe debilitating depression for a number of years and was recently diagnosed with PTSD. I have done more CBT than one would think possible with no appreciable improvement, been on anti-depressants and been seeing a psychiatrist for over 6 years, I have been to two inpatient programs which thankfully I was insured for at the time, and one outpatient for mood/anxiety and PTSD. I have done mindfulness and I feel like whatever small amount of light I may have had left that was fighting to try to get better has slowly gone out and I am dying on the inside and outside. And no I do not use alcohol or drugs to self medicate just to be clear.
    As much as I appreciate the comments made-they are somewhat over-simplified, I can say this as someone who has tried many things to get better. I have stopped seeing my psychiatrist also in the past few months and my family doctor is currently maintaining my medication against her better judgement as I have been actively seeking out a new psychiatrist for 2 years, yes that is correct 2 years–and in the city of Toronto that is easier said than done. So giving someone the advice to get a referral to a psychiatrist is almost useless, because I am only one of many who has tried to get help that is not available or does not exist.

  • I can completely relate to this man’s situation. I was first diagnosed with clinical depression in my early 20’s and I’m now in my 50’s. Two years ago, i was in a dark place, with suicidal thoughts and was diagnosed with both depression and ADHD. My family doctor prescribed Cymbalta. The doctor treating me for ADHD prescribed Concerta and I started coaching/counselling sessions. I’m self-employed and do not have extended health insurance. I was struggling to work on a consistent basis so my income plummeted and I had to discontinue the counselling sessions that were $150/session. I asked both my family physician and the doctor that diagnosed me with ADHD to send a referral to CAMH hoping to get some counselling that would be covered by OHIP. I called CAMH to follow up and the referrals from both doctors fell into a black hole. I was passed around to a few different departments and was unable to find anyone who could help.

    I discontinued taking the Cymbalta because after 12 months, I was just in a fog, and still cycling through periods of a couple good weeks, followed by a couple weeks where I didn’t get out of bed other than to fix the occasional meal and go to the bathroom.

    I’m now struggling financially and had to give up my apartment and move in with family. I’ve gone back to my family physician asking for help. She suggested I go on welfare, and told me to bring her whatever forms she needs to sign. She ordered some blood work and suggested that I just forget the past and move on with my life.

    I’ve contacted a few different psychiatrists, but the wait time to see them is anywhere from 6 to 9 months. I’m going back to see my family doctor this week, but I’m not confident that she’ll have much to offer in the way of help.

    I need help. I don’t want to continue like this. I’m not living — I’m just existing, waiting to die.

  • We hear you, CAS. Thank you so much for reaching out and sharing the details of this difficult situation. We encourage you to keep trying.

    You are entitled to receive a psychiatric assessment in the hospital nearest to you and your family doctor should advocate for you on this. Many group therapy treatments can still be obtained at CAMH and we encourage you to try this again. Dr. Umesh Jain is a psychiatrist in the community with expertise in adult ADHD.

    If you live in the Sunnybrook Department of Psychiatry catchment area, you can ask your family doctor for a referral to our mental health services – referral forms can be downloaded here: https://sunnybrook.ca/content/?page=psychiatry-mental-health-referral

    And we also suggest ConnexOntario’s free mental health helpline. Their team can help you find support in your area. Visit http://www.mentalhealthhelpline.ca/ or call 1-866-531-2600.

    We’re wishing you well. Remember, you’re not alone.