Venlafaxine is a very effective antidepressant. However at 75mg it is literally no different from an SSRI. 150-225mg is where you should hope to see a significant change as its Noradrenaline reuptake inhibition increases. A ususal maximum dosage is 225 but for inpatients or the severely depressed dosages as high as 375 are warrented. Although rather than rasing the dosage other options are ususally better.
Well she definatly warrents a diagnosis of severe depressive disorder. Long term mental health problems often point towards personality disorders and you mentioned past major life stressors which further increase the chances. While she is unlikely to qualify for the diagnosis of a paticular PD (personality disorder) the diagnosis itself is likely warrented. Another possibility is a diagnosis of dysthymia and major depression otherwise known as double depression. A diagnosis of either personality disorder or dysthymia would indicate she needs high quality psychotherapy and a cause of behavioual therapy would also likely be useful. Mindfulness practice is every effective in reducing symptoms of chronic depression. Even a diagnosis of PTSD could be made depending on symptoms. The treatments for all are slightly different. A referal to a psychiatrist (if it hasn't already been made) needs to be made.
Gently encouraging her to exercise and eat more healthy are important but try not to become overly pushy, do the stuff with her. A ten minute walk in 1 week can turn into a twenty minute walk the next. A coffee in a park can turn into seeing a friend the next week etc..
Psychotherapy is vital, often changing the therapist is useful. In more severe depression CBT is the best practice with basic prinicpals of behavioual activation being followed. Encouging her to put into practice what she has learned will be very useful. As an example she might be taught breathing exercises by her therapist for panic attacks, learning these yourself and practicing them with her can help. So it may be helpful to come along to a few sessions with her. Either way pushing to get her back in evidence based therapy is very important.
Treating the depression depends on the diagnosis, subtype, side effects of drugs etc...
Can you tell me which sounds most like her?
Mood is much the same the whole day, subjectively feels worse in the morning, wakes up early, severe psychomotor disturbances include claims and/or evidence or poor memory, concentration, seemingly slowed or sped up thinking uncharatriscly agitated or inactive (as evidenced by difficulty sitting still (hand ringing, frequently getting up, chewing) or lack of deliberate movement (single or slow to change facial expression, no 'normal figiting', decreased startal response) - these would effect faical expessions, speech and movement. Weight and apetite loss are common but it is possible increases in apeptite and weight can be seen. Apart from waking up unususally early problems getting to sleep/waking up frequently or extreem exessive sleeping (13+ hours a day). There is ususally a more well defined 'episode' they tend to resolve even for a few weeks with almost no to no symptoms followed by a quick onset back to in severe symptoms. Significant guilt is common.
Mood subjectively feels worse in the afternoon or evening, weight gain, exessive eating in paticular of carbohydrates (not just becase thats what is easiest to get access to), exessive sleeping up to 12 hours a day or with many naps throughout the day, chronic problems that tend not to remit completely which include a pattern of long standing sensitivity to rejection (always expecting to be rejected, takes it very badly when feels rejected) and 'leaden parlysis' a feeling of heaviness in the limbs and head almost as if it takes great physical effort to move arms and legs.
Symptoms that don't quite fit either of the top two. Don't try and make it fit, if it doesn't it doesn't. Whether the symptoms fit one of the first two or not it would be good if you could describe as many symptoms she suffers as possible.
A few other questions. Is she still washing (brushing her teeth showering), is she self harming (such as cutting or burning herself), is she abusing or addicted to drugs, has she ever attempted suicide or self harm before, has she been diagnosied with any current or past medical problems (including psychiatric), has she had a blood test and a physical exam, is there a history of physical, emotional or sexual abuse/violence/bullying, does she have many friends and what antidepressants/psychotherapies/supplements has she tried?
If she becomes actively suicidal with risk factors (I'll talk about those in a minute), is frankly psychotic (claims to be hearing voices, seeing things that aren't there, doesn't move or becomes very agitated) or unable to care for herself at all i.e lies in bed ALL day an acute hospital admission in nearly all cases needs to be made and at the very least an evaluation by emergency medical services (taking her to A&E, having a GP come and visit/take her there that day, for an emergacy visit with a psychiatrist, psychologist or other mental health professional).
The rest of this is just talking about how to know if someone is more or less likely to try and kill themselves and what to do about it. The majority of the information is easily accessable online. You may want to take a look or you may find you already know it. There are different stages of suicide leading to the worst - death. Learning the warning signs for serious suicide attempts is the best way to stop someone taking/trying to take their life. The first stage is thoughts of suicide (your girlfriend mentioned them to you), the second is planning suicide, the third is obtaining the means to commit suicide (pills, gun, rope), the fourth is trying and the 5th is death. It might seem quite irrelevent to you but knowing what to do at each stage is damn important. The most important thing to remeber is don't be afraid to ask. You won't be 'putting the idea in her head'. Certain behaviours should be on your to watch out for list (some obvious, others prehaps not so), they include: writing out suicide letters, giving away prized possessions, setting affares in order (setting a will for example), increasing anger and irritability, after a period of being very ill (slow, lethagic, sleeping LOADS and in general so slow they wouldn't really have the energy to kill themselves) an increase in enegery and seeming 'wellness' but this of course could also be a sign of getting better, sudden abnormal changes in behaviour such as exessive risk taking, acting as if they don't care and abusing drugs more than normal. These two websites are pretty helpful in the area as well
http://www.helpguide..._prevention.htm and
http://www.suicide.o...e-articles.html .
The first stage - thoughts of suicide
the person should be put in contact with health services (she is)
given psychotherapy
approiate medication
tested for 'physical' diseases like cushings and hypothyroidism
The second stage - planning
all of the above and:
the person should be evaluated within 24 hours - that means you need to book her in to be seen by someone ASAP. Always mention that she has made a plan.
sometimes depending on the likelyhood of success, access to means and other symptoms hospitalization is nessary but not normally
The third stage - having or trying to obtain items to carry out plan i.e. gun, pills etc
all of the above and:
the person should be seen as soon as humanily possible - when speaking to medical sercvices you should always mention she has made attempts to obtain the items she needs
the person should not be left alone under any cercamstances
again depending on the risk of the method they have choosen, other symptoms, support network present hospitazation may become increasingly more neassary.
conviscate items such as pills
The fourth stage - trying
all of the above
immediate medical attention to ensure no lasting damage and an ergent psychiatric evaluation.
depending on the seriousness of the attempt (for example taking 10 pills or taking 300 pills) a hopsitazation is required in about 60-80% of serious attempts.
