Slacker: Dear Dr. Expert, I'm a depressive, slacker, and underachiever. Due to my failings, all my dream career bubbles have burst. Prozac has really turned me around, but reversing 41 years of bad thinking is painfully slow. How do I get motivated in this fallback career that I'm mired in (e.g., your recommendation of a motivational book(s) I could check out at the public library)?
Sighed (and signed),
Unfocused by the Bay

Frankly, I'm not a big fan of motivational books. Many are poorly written and filled with a combination of cliché and common sense. Even the few which may have something useful to say generally fail to motivate the unmotivated. Most people find that they are only motivated to buy the books, but not motivated to read them through, implement, and stick with the program. So what's a guy (or gal) like yourself to do? First of all, lack of motivation is a common symptom of depression. Let's consider the drug strategies. You say you've been "really turned around" by Prozac, but perhaps the effect of your antidepressant is only partial and incomplete. There are now a number of psychopharmacological strategies specifically for "gussying up" the antidepressant effects of a single drug such as Prozac. These may be as simple as merely increasing the dose, adding a second antidepressant, or adding a particular "activating" drug such as thyroid hormone or a stimulant such as Ritalin.

There is also a psychotherapy strategy. You fail to mention whether or not you are currently receiving psychotherapy in addition to taking Prozac. I cannot emphasize enough that the best treatment for most people with depression is a combination of psychopharmacotherapy and psychotherapy. This is the position of the American Psychiatric Association. We now know that experience can also influence brain chemistry just as much as drugs do. Psychotherapy is a proven method of modifying both behavior and experience. Cognitive therapy, one of the most popular new, brief therapies, is a hybrid of dynamic and behavioral treatment. The treatment is often limited to a dozen or fewer sessions and the work is highly structured. Rather than using free association, the therapist and patient establish a focused treatment plan with goals to be achieved. The therapist and patient plan a series of conscious actions, such as completing three new activities in a 24-hour period, and frequently include homework after the sessions, like completing life strategy charts, or practicing new coping skills.

Cognitive therapy has been particularly helpful in treating depression. Brain imaging studies (PET scans) have shown that cognitive therapy has the same effect upon specific areas of brain functioning in depressed individuals as does antidepressant medication such as Prozac. While dynamic psychotherapy can be extremely helpful to people who have the capacity to investigate themselves, make use of insight, and the patience required to accomplish this goal, other more directive therapies, such as cognitive therapy, have demonstrated a particular usefulness in treating many of the symptoms of depression more quickly.

Why just use drugs to treat your depression, when a hybrid of approaches will substantially increase your prospects for success in overcoming the inertia of depression? You can find more information on combining drug treatment of depression with psychotherapy at http://www.psycom.net/depression.central.combined.html.