I'd appreciate advice on being treated for chronic mild depression.

January 8, 2005 1:18 AM

It's taken me years to realize it, but depression has made an impact on my life I just can't ignore any more. I have come out of it often enough to know it's really worth licking. But it seems I spend 3/4 of my year or more grumpy, lazy, and increasingly empty-feeling. The lazyness is the killer, actually. I have lots of things I do to feel better, but I'd like to check out clinical treatment options, too, as I feel I've reached the limit of simple diet and lifestyle remedies. I have no idea where to begin. If anyone here has been treated for chronic mild depression I'd appreciate advice on what I can do. Thanks Meta!
posted by anonymous to health & fitness (53 comments total)

I suffer from bipolar disorder and spend quite a lot of my time in a depressed state. I have found that cognitive behavoural therapy is one of the best tools for combatting depression, but like you I can be lazy. A qualified CBT therapist can help only so far: it takes regular practice to beat the symptoms. Anti-depressants can help of course, but I found that they just made me feel comfortable with my low level of activity. The drugs didn't actually lift me out of the state I find myself in: under-employed, listless and often full of fear for the future. I'll be interested to read what others have to say on the subject.
posted by cbrody at 4:40 AM on January 8, 2005

Its difficult to give a diagnosis and therefore a suggestion of the most effective treatment over the 'net (oh, and not being a health professional) but....

If you're talking about chronic mild depression then I'd go with the idea of CBT as a good place to start.
I don't think that ADs are the right solution. I have always considered them (in an ideal world) as short term solution to get you out of a hole and allow you to deal with the causes of your depression. Unless, that is, you have more severe mental health problems that require constant management - but that doesn't sound like you.
I think that the proper answer is to see a councilor/psychologist for basically some initial consultations. They would have the job of assessing your problems and needs and would be best placed to decide what sort of longer term help may be most suitable (CBT, psychotherapy etc, etc). This of course can be expensive and time consuming and availability will depend on where you live, how much money you have and the like.
I'd love to be able to suggest some really useful books but most of the ones I've ever read are a couple of hundred pages of stating the bleeding obvious wrapped up as some novel way of dealing with the world.
Just go and talk to you doctor first. If S/he isn't particularly sympathetic with mental health issues then find one that is. Alternatively you could google for either a local health clinic or maybe a support group in your area that either maybe helpful in itself or be able to point you in the right direction of some local services that are.

Good luck.
posted by qwerty155 at 6:14 AM on January 8, 2005

One simple thing to try is get out in sunlight as much as you can. It isn't just for seasonal affective disorder sufferers!

Other than that, see a doc. A good place to start is with your regular doc-ask him or her for a referral. I don't suggest you let your GP give you a prescription tho. Wait to see a specialist if you go the med route, at least to begin with. Reason being you want to make sure you have plain vanilla depression, not a hidden subtle form of bipolar disorder, which can be triggered with ADs. This is especially important if you have relatives with the disorder.

And oh yes, I have bipolar disorder (type two) so I found out the above by experience.
posted by konolia at 6:27 AM on January 8, 2005

Is there no longer a place in society for willpower?

Has strength of will been clinically replaced by diagnosable categories, ready to be blurred by a litany of drugs?

It's heartbreaking to see a girl vernal and alive be straightjacketed by lithium. And so many other friends etherized, measuring time by a pill box.
posted by orange clock at 7:28 AM on January 8, 2005

Shutting up when all you have is opinion and someone has asked for help also takes willpower. twit.
posted by dong_resin at 7:41 AM on January 8, 2005

Thank you, orange clock. We'll call you when the shuttle lands.

anon, I'd consult with your personal physician. I've been treated for mild depression and have done very well with a small dosage of Lexapro. Unfortunately, you may have to experiment with several different drugs to find the right one for you -- if, in fact, prescription anti-depressants are the answer. They are not for everyone. But your physician can take blood work and ask you the right questions to determine whether your depression is chemically-based or more psychologically-based.

My doctor recommends a combination of both drug and talk therapies -- i.e., seeing a psychiatrist/psychologist. In this case, your physician may be aware of a CBT therapist in your area whom he or she trusts is a good one. Good luck.
posted by mrkinla at 7:42 AM on January 8, 2005

Is there no longer a place in society for willpower?

Bullshit. Willpower and Jesus Christ have been substituting for medical treatment for far too long. Do you go around telling people to "snap out of it?" Or that they should "look on the bright side?"

This is a disease, not a personality. Depressed people are not depressed about something. They are depressed, period. Sometimes they have money, love interests, good jobs, and all the tangible things you could want out of life. They're depressed anyway, because it's a disease.

To the original poster, please see a doctor and determine whether medication is right for you.
posted by Saucy Intruder at 7:43 AM on January 8, 2005

Is there no longer a place in society for willpower?

Bite me. You don't know what you're talking about.
posted by lodurr at 8:10 AM on January 8, 2005

There's no shame in being medicated for depression- it's an illness, just like mono or cancer. And the funny thing about orange clock's attitude (which I've heard a million times before) is the assumption that people can take a pill that will solve all their problems, and that people are doing so instead of "having willpower". Pills don't solve all your problems- they make you better so you can deal with your problems. I liken it to taking a cold medicine when you're sick- it doesn't cure you, but it makes you feel well enough that you can rest and your body can better deal with your illness.
posted by ThePinkSuperhero at 8:23 AM on January 8, 2005 [1 favorite]

I suppose being on Mefi the odds are that you're male, Anon but in case you aren't - going off all hormonal birth control really helped me.
posted by JoanArkham at 8:35 AM on January 8, 2005

Orange Clock: Wow...just...Wow. It amazes me that there are still people out there that spout that kind of nonsense. You can't equate chronic depression with that bad feeling you got when your significant other dumped you. This is a chemical imbalance in the brain. Frankly, until you have dealt with clinical depression (or many other chronic problems), you don't really understand what willpower means. And if you have had to deal with something like that and that is as much empathy as you can muster, then there is something essentially human that you appear to be missing.

Having finsihed venting now: Anon, there is a lot of good advice in this thread. If your depression is mild then CBT can help a lot. Even if your depression is severe, retraining your thought processes can help you make rational decisions when you are feeling a decidedly irrational mood. The brain does respond chemically to the way you use it, and you can change some of the ways it works. In my experience, this is a very difficult thing to do, but also very worthwhile. That is where the aforementioned willpower actually does come into play. Keeping that discipline of thought can be difficult at times.

If it turns out that you have to go on meds, then be patient and expect some hard times. Every person’s chemistry is different, so it is pretty much impossible to predict which med will work best for you. With me, Zoloft worked a treat until it stopped working at all. Paxil put me to sleep, and the Prozac-Wellbutrin cocktail stopped me from remembering my dreams. Now I've been on just Prozac for a year or so and it seems to be working well. Unfortunately, for some people they don't work at all.
On preview: Take what Pink said above to heart. Anti Depressants DO NOT make you feel good. They help you to not feel bad for no reason

The only advice I would give you is to act now while you are with it enough to be worried about it. The really sneaky thing I've found with my depression is that I don't realize how bad it is when I am in it, and I forget after I have been out for a while.
posted by ad hoc at 8:39 AM on January 8, 2005 [1 favorite]

Anti Depressants DO NOT make you feel good. They help you to not feel bad for no reason.

That is *perfect*.
posted by ThePinkSuperhero at 8:41 AM on January 8, 2005 [1 favorite]

Anonymous ... check out these previous discussions : Seasonal Affective Metafilter Disorder and Predicting who'll benefit from anti-depressants. There are personal accounts and interesting discussions relative to depression.

BTW - I'm with ThePinkSuperhero: There's no shame in being medicated for depression. I was resistant to the idea of SSRI medication for years - and finally relented. It changed my life.

By all means, visit a doctor for a diagnosis. Any combination of talk therapy, cognitive behavioral therapy, and/or medicattion may be of help to you.

Is there no longer a place in society for willpower?

orange clock: I'm with Saucy Intruder and lodurr..."You don't know what you're talking about".
posted by ericb at 8:41 AM on January 8, 2005

*medication*
posted by ericb at 8:44 AM on January 8, 2005

(On preview, I see several people have said what I typed before my DSL went down this morning. I'm going to leave it in my message anyway.)

Definitely see a doc. Depending on how the conversation goes, she may suggest therapy and/or meds. Several of my friends find therapy very helpful (their depression seems to be more situational). Many of us find meds to be a life-saver (literally). (Some of their depressions are situational, but some - like mine - appear to be almost completely biological.)

If you go with meds, you may have to try several before finding one that works for you. 8 years ago, the first med I tried made everything worse and I spent a month crying in the basement. The second med enabled me to get up and start functioning again, but I couldn't feel any emotions at all. Other friends have also tried several meds before finding the one that works properly with their biochemistry. Most of us have ended up on Celexa or Lexapro in the end.

I just went back on meds 3 months ago, after years of struggling with constant but varying levels of depression (and realizing that I was starting to go downhill fast). And WOW. Seriously, I feel better than I have in years. I smile. I sing again. I can focus better at work. I sleep through the night. I have the energy to go out and do things, rather than holing up in my house like a hermit. I have hope. For me, Lexapro is a gift that has given me back my life. This is the person I am - not the girl from September who couldn't function enough to wash dishes, clean the litterbox, or even bathe for over a month.

A few other things my friends & I find helpful in keeping our moods healthy, even if we're on meds: a light box, omega-3 oils, B vitamins

There is nothing wrong with getting help for depression, just like there is nothing wrong with getting help for diabetes or high blood pressure or cancer.
posted by belladonna at 8:51 AM on January 8, 2005

anonymous, see a doctor. Ask your GP/PCP for a referral to a psychiatrist, or find one online. Good luck.

orange clock, bite my ass, you troll.
posted by Faint of Butt at 8:54 AM on January 8, 2005

Willpower and Jesus Christ have been substituting for medical treatment.

My view is drugs have become Jesus Christ, and willpower was never involved.

My girlfriend of some time was put on lithium, and she was robbed of life, of personality. In every sense it took her away from her, as a chorus of the lazy, like you, cheered from a comfortable sofa.

My point is not trollish, but to simply proceed with caution. Good luck.
posted by orange clock at 9:09 AM on January 8, 2005

Your girlfriend had a bad experience, which is a horrible shame, orange clock, but that's not any reason at all that anonymous should shun treatment for his/her problem.
posted by ThePinkSuperhero at 9:25 AM on January 8, 2005 [1 favorite]

orange clock: Different meds work for different people. I have bipolar disorder and OCD, and tried many different meds before I found what works for me and does not make me a zombie. Do not take one person's experience with one med and apply that to all people and all meds.

Mental illnesses like bipolar and depression need meds to assist the person in their recovery. Yes, they have been overprescribed in some cases, but that does not mean that you should turn every person away from meds. People are not "lazy" when they are seriously depressed. They are ill and need help.

For the record, the med that I ended up staying with is lithium. It works for me and does not make me a zombie. It stops my mood swings and bad behaviors, and allows me to go to work each day and function.
posted by veronitron at 9:26 AM on January 8, 2005

Having suffered from the same condition as you anonymous I can only echo what others have said; go to see your doctor, or if your doctor is unsympathetic then find another doctor. Explain as best you can how this depression makes you feel and they will likely refer you to a cognitive behavioural therapist. It was the best move I've ever made. There is no shame in being depressed and often finding the will to talk to someone about it is the biggest step you can make to a cure.

I wish you all the luck in the world.
posted by squealy at 10:00 AM on January 8, 2005

I'd like to suggest to all us depression-sufferers that when a know-nothing pops in to spew the old "pull yourself up by your bootstraps" bullshit, that we stop flaming when someone has clearly and richly described why that person is wrong.

There is nothing to be gained from a pile-on. Orange Clock just proved that by maintaining his belief. He just will not get it. So don't stress out about it: he's not important.
posted by five fresh fish at 10:04 AM on January 8, 2005

I think this thread has gotten to be too much about the meds. Personally, I've been there done that and I hate to think where I would have been without them, but from Anon's post, it appears that his/her depression is not severe, so I think it is a very ignorant/lazy doctor who would immediately be dishing out the pills.
Orange Clock: I'm sorry that someone you've known has had some bad experiences, but as far as I understand, lithium is really down the list of last resorts now (and there are plenty of meds with far less side effects) and as a result I'm guessing that your girlfriend was very ill - you don't actually believe that will power along would have helped her do you?
posted by qwerty155 at 10:07 AM on January 8, 2005

anon, please do an AskMe search for depression threads; there have been several, and they have been most excellent.

I'm going to contribute a note that I upped my Celexa dosage from 30mg daily to 50mg daily about a month ago. OMG! What a shocking difference! I'm actually happy and sociable and productive and all that jazz. I don't think I've ever been so normal! Oh - and much to my surprise, I'm less tired than previously (the main side effect).

One of the biggest difficulties I face is accepting who I really am. For going on thirty years, my "me" was a self-doubting, unhappy, anti-social, unproductive fellow. I thought that was who I was.

I'm finding out, and having great difficulty accepting, that that "me" was actually not really me. Old habits die hard. This is probably where CBT would help clear the last hurdles.
posted by five fresh fish at 10:09 AM on January 8, 2005

Orange Clock, I hope for her sake she's an ex-girlfriend now. A non supportive loved one is worse than useless. And if she was ill enough to be put on lithium her problems are way past anything "will power" can cope with. And sorry, but sometimes bipolars have to make a tradeoff between being the life of the party and being stable.

Actually having supportive understanding people in one's life really makes a diff when you are coping with a chemical imbalance, whether depression or bipolar. Should be part of every treatment plan.
posted by konolia at 10:58 AM on January 8, 2005

Is it possible to be depressed but not feel sad?
posted by mecran01 at 11:11 AM on January 8, 2005

Good advice posted here. For what it's worth, my own experience has been that the meds are helpful, but they are only a tool. Working with a counselor/pshrink helped me the most.

Also, and this may sound strange (it did to me) the psychiatrist who prescribed the meds for me (Effexor) was very big on nutrition and, specifically, blood sugar issues. In the course of my treatment, we discovered that I am quite hypoglycemic. I had to make a bunch of changes to my diet and found that it helped a lot.

There are many ways to approach treatment. Find one that makes sense for you. And good luck. Clinical depression is a bitch.
posted by TeamBilly at 11:12 AM on January 8, 2005

One other AskMefi thread on chronic depression.
posted by whatnotever at 11:20 AM on January 8, 2005

The pointless yammering on this thread is only one reason why this kind of question should be taken to a professional.

Nothing to worry about here - some talking, and maybe some in-the-main benign medications can make a huge difference in your quality of life.
posted by ikkyu2 at 11:40 AM on January 8, 2005

I suffer from chronic depression occasionally and having gone through the litany of drugs discussed previously in this and other threads I decided that chemical help wasn't what I needed. (You should have seen the look on the doctor's face as I flushed 3 months worth of Prozac down the toilet with him watching.)

Seasonal depression, bi-polar disorder, chronic depression, they all affect different people in differing ways. What works for you may or may not work for me. Your best bet is to see a doctor and get started on some form of treatment.

Personally I drink a lot of basil and catnip tea (infusion)now as the b-complex vitamins boost me better than any pill ever has. YMMV, but for me it's worked for 4 years now.
posted by kamylyon at 11:41 AM on January 8, 2005

Also, to say "there's no shame in being medicated for depression" is sort of specious, for two reasons:

1) Right or wrong, people do feel ashamed of it. They shouldn't, but they do.

2) Excessive, sometimes disabling feelings of shame and guilt are part of the neuro-chemical syndrome. Trying to hand-wave this away with a platitude doesn't work.

These are things that ought to be discussed with the mental health practitioner up front; I also recommend a discussion about privacy, disclosure and DSM coding, so you know where you stand.
posted by ikkyu2 at 11:45 AM on January 8, 2005

Is it possible to be depressed but not feel sad?

Yes. Especially in men, depression does not always manifest as sadness. It can be irritability, lack of motivation, sometimes even anger, change in your sleep (either too much or too little), change in your eating habits, etc. When I am depressed, usually I am irritable, and have a general sense of rebellion about everything in life. There are also times when I am sad and depressed, it's not the same every time.
posted by veronitron at 11:49 AM on January 8, 2005

Is it possible to be depressed but not feel sad?

Yup, With me it was mostly wanting to sleep or eat constantly, and a total inability to feel any sense of accomplishment regardless of the objective merits of anything I had done. Made it hard to feel motivated to do anything as the feedback mechanism was broken. I very very rarely felt Sad per se

On Preview: What veronitron said :)
posted by ad hoc at 11:59 AM on January 8, 2005 [2 favorites]

What's been said here is excellent. I started on Effexor XR six months ago and it's helped immensely.

If you are hesitant about going to the doctor and/or starting on drugs to treat depression because you feel that that would be a defeat or a sign that depression has beaten you, try to think of it differently. If you have cancer, you don't try to fight it "on your own," you tell that mother to step off by fighting it with chemo/radiation/etc. If you have depression, you fight it with drugs/therapy/etc. "Resorting" to drugs is not giving up, it is using the tools at your disposal to fight back.

Also, if the drugs are working properly, they will make you feel nothing but normal. They will not make you happy. They will turn off the extra anxiety, bad thoughts, depressed thoughts, lack of motivation, etc. I didn't realise how many things were wrong until I went on meds and those things disappeared. I still deal with them from time to time, but now I can recognise them as unnatural and unnecessary, having experienced life without them.
posted by heatherann at 12:14 PM on January 8, 2005

Regarding the thread cited earlier, the SSRI "poop out" thing was my last hold out against meds. I've been seeing a CBT therapist for about 9 months, and it'd helped me realized the severity of the problem and decide to be more aggressive about treating it. This is probably about week 4 on an SSRI and the difference is impressive. My mood is much better, my irritability has gone way down, my sleep troubles are on the way out (slept all night last night!) and my disabling headaches are gone.

However: make sure your GP does a thorough work up to make sure something else isn't going on. Sleep Apnea is probably an underlying cause in my case, but thyroid problems and a host of other things can be related.

To educate yourself on various psychiatric meds (which is really for your own curiosity -- get a good psychiatrist and go with their advice), check out www.crazymeds.org.

Personally, I don't look up the psych drugs until after I've been on them for a bit. Sometimes it's just a bit too much information...
posted by daver at 12:30 PM on January 8, 2005

Q: Is it possible to be depressed but not feel sad?

A: Yes. Especially in men, depression does not always manifest as sadness.

One of the things I discussed (well, ranted) with my doctor when seeking treatment for depression is that so much of the literature is terribly ineffective for men with a bit of machismo about them. When I'm depressed I don't feel "anxiety," I get pissed off and hostile. That basically translates as anxiety as far as practicioners are concerned, but it took me a long-assed time to put that together.

Depending on your comfort level, it worth noting that there have been a couple of AskMe threads asking for recommendations for therapists. This does involve revealing your location, which you may not be comfortable with. Try and find a good doctor to help and advise you. Like all professions, there are good doctors and bad doctors and some doctors are better with some patients.

And good luck, getting treatment for depression is no different than getting treatment for diabetes or a broken leg. Explore the options and take the most effective and least invasive solution available.
posted by stet at 1:11 PM on January 8, 2005

anon: Lots of good advice here. It's commonly held that both drugs and seeing a shrink are the best combo to treat depression. I'm glad you're at the point of asking for help. It took me a long time to get there and I'm doing much better. Right now I'm not doing any sort of therapy; I simply cannot afford it. However, the drugs I've been taking have stopped me from sizing up bridge abutments.

orange clock: a chorus of the lazy isn't trollish? Bullshit. Your situation was with one drug and one person. You cannot use the same paintbrush for every situation. Again: Anti Depressants DO NOT make you feel good. They help you to not feel bad for no reason. They are not the "happy pills" so many seem to think they are. Anti-depressants, hopefully, put you in a place where you have the ability to deal with your depression and, again hopefully, come off of the drugs.
posted by deborah at 1:12 PM on January 8, 2005

I've been on meds for depression before and they helped me quite a bit. However, for me there was always a trade-off: changes in my personality or side effects that were uncomfortable for me.

These days, when I find myself mildly depressed, I become really diligent about exercising and eating right. It is very difficult to find the motivation to do so, but after a few weeks, I feel enormous benefit from it. I just determine what my standard workout will be, then do it every day no matter how I feel.

There are a number of ways to tackle depression (see above!). Just keep trying until you find the method that works best for you. In the meantime, hang in there. You're going to feel better soon.
posted by kamikazegopher at 2:47 PM on January 8, 2005

Also, and this may sound strange (it did to me) the psychiatrist who prescribed the meds for me (Effexor) was very big on nutrition and, specifically, blood sugar issues. In the course of my treatment, we discovered that I am quite hypoglycemic. I had to make a bunch of changes to my diet and found that it helped a lot.

I want add my voice to amplify this realm of options.

The original poster, in essence, said, "My brain chemistry sucks. Ideas?" The runaway response (that I see at least) was, "Take pills and seek therapy."

The pills change brain chemistry. So does the therapist by offering internal (mental) habits that CAN SOMETIMES promote "happy" brain chemistry.

There are other powerful ways of changing brain chemistry and have been minimized by a pill-heavy thread, er, culture. (I injest pills. I'm not trolling or holy-than-thou.)

...eliminating blood sugar spikes (ala hypoglycemia), daily sweat-inducing exercise, a morning walk, deep power breathing once a day, food that's alive, avoiding fastfood, spending time outdoors, developing and maintaining relationships, a body that's clean on the inside...

Even when *I* read what I just wrote, I think, "Fuckin jesus, that sounds ridiculous." But it isn't. It's just so foreign.

I think it needs to be restated: Depression is about brain chemistry. Pills are ONE way to alter brain chemistry, but there are safer, more reliable, less expensive, more balanced and maybe more effective avenues to try... "instead of" or "in addition to" pills --- and that's your call, original poster.
posted by Moistener at 2:49 PM on January 8, 2005

I would agree to the seek therapy and possibly try medication.

The medication is so that you can think more clearly - the therapy to learn how to avoid getting in the 'rut' again. It may be that you have dysthymia which a long term (2 years or more) type of depression and in that case therapy will most definitely help. I'm basing this on 'But it seems I spend 3/4 of my year or more grumpy, lazy, and increasingly empty-feeling'.
posted by squeak at 2:58 PM on January 8, 2005

Yeah, diet and nutrition and exercise can have a big effect. Trouble is, it's hard to make changes to these things when one is depressed... a short course of antidepressants might be just what the doctor ordered here.

I'm on record in several depression-related threads as having taken Paxil. My depression was situational, basically, but taking the medication helped me realize that my problems were not insoluble. I was able to find a solution and make some changes in my life. One of those changes was moving the hell away from Detroit. I still can't believe I lived there so long, and was so afraid to leave.

After I got through the rough spot, a couple years later I hit another rough spot related to my job and the uncertainty thereof. When I felt the dread coming on, I got some Paxil fast and started taking it again. I knew the rough spot would eventually end one way or another -- but there was certainly no reason to suffer in the meanwhile.
posted by kindall at 5:11 PM on January 8, 2005

Sometimes the behavioral/CBT online articles are difficult to read (erm, in my experience, anyway) and difficult to recommend. When you feel good, the articles make sense and are easy to follow. When you do not feel good -- thus, when you need the articles the most -- the same articles seem suddenly and totally worthless, impractical/impossible to follow, irritating, condescending, etc. Argh! But they do have some value . . . Most offer similar advice a la these three:

one (in a totally 1990s site design)
another that gets into specifics
yet another that's a bit general
posted by oldtimey at 5:22 PM on January 8, 2005

BTW folks it is bipolar not bi-polar. That is a particular pet peeve of mine and some of my fellow sufferers.
posted by konolia at 7:49 PM on January 8, 2005

anon--I had much of the same experience and finally got to the point you're at now, this past summer. I was in therapy for 4 or 5 years, and it helped--but not enough. I have always been terrified of taking medication, but I finally realized that it might actually help me feel better. The previous posters who mention that it might not be fun at first are right--it can be really hard adjusting to any of them--but eventually the side effects go away, at least for the most part (from my experience, and others who I know very closely), and they really make a difference.

If you haven't tried therapy (CBT or otherwise) it might be a good start. It did really help me--but eventually it was not enough. My therapist recommended medication for many years before I was brave enough to try them. And what ad hoc said above is so perfect--antidepressants don't make you feel happy all of the time... they really do just take the edge off and make you not feel bad for no reason.

Also--the mention about birth control is a great one. If you are female and are on oral contraceptives, I also found that going off of them helped a great deal.

And if you're afraid of side effects of medication--they can happen, but many of them go away over time, and there are plenty of medications to choose from.

I'd also recommend seeing a psychiatrist if you do decide to go on medication--they're just more knowledgeable.

I wish you luck!
posted by fabesfaves at 8:29 PM on January 8, 2005

And so many other friends etherized, measuring time by a pill box.

I am glad to measure my time by my pill box. The alternative, for me, is hellish pain followed by death by my own hand.

When I finally got on the right combo of meds (it took two years and a bit of desperate pleading), I was given my life back.

Granted, I find my psychiatrist to have the personality of a piece of cardboard, and to be wholly uninterested in talking to me (do psychiatrists even *do* talk therapy anymore? the only ones I've seen write a scrip and that's it), but as long as she gives me the magic tickets for the pills that keep me alive, I don't really mind.

Some people are warped by pills, but for some of us, it's the thread we hang by. Be glad if you are fortunate enough to not count yourself among our number.
posted by beth at 9:44 PM on January 8, 2005

And so many other friends etherized, measuring time by a pill box.

I am glad to measure my time by my pill box. The alternative, for me, is hellish pain followed by death by my own hand.

Exactly. I wasn't joking about sizing up bridge abutments. I've been thisclose to suicide three times. The third time I finally asked for help. I never want to feel that way again.
posted by deborah at 10:23 PM on January 8, 2005

Hallelujah, sister. Or brother. never sure on the internet...

For me, the pills relieved me of endless suicidal ideation, crippling agrophobia, and complete self-hatred. For the first time in decades, I felt relief. It was such an improvement I thought I was saved.

With a recent dosage adjustment, I've discovered that a dull emotional flatline and lack of enthusiasm for life isn't the best it gets. It's starting to dawn on me that feeling great is more than not feeling like death.

Nowadays, I'm working on actual joy. It sometimes happens for me. It's an amazing thing.

I think this is going to be a good year. I can now finally start to make the behavioural changes that are so important to becoming alive and well.
posted by five fresh fish at 11:15 PM on January 8, 2005

The lazyness is the killer, actually. I have lots of things I do to feel better, but I'd like to check out clinical treatment options, too, as I feel I've reached the limit of simple diet and lifestyle remedies. I have no idea where to begin.

I don't know if what I have to say will resonate with you or not, but your description sounds familiar to much of what I have experienced. I grew in therapy, basically, and so becoming functional for me manifested itself as giving up therapy and taking some responsibility for my own well being. I could see myself becoming attached to the idea that there would always be something that 'needed fixing,' and decided to accept things as they were and go from there.

That being said, taking responsibility for my own well being actually involves a lot of work–and a lot of help, mostly in two key areas (really one, but two is easier to describe):

1) Self observation, or becoming *very* intimate with myself, my motivations, my mental and physical habits, everything. Meditation helped a great deal in this regard (not creative visualization or any other type of goal-oriented meditation, but 'just sitting.')

2) Finding role models. A big part of my depression (don't know if this will resonate, but if it does, I hope its helpful) was about not seeing opportunities, or not knowing how to make reasonable choices, not knowing how to deal with not knowing, and, basically, not having good role models (sorry folks). One of the reasons therapy wasn't especially helpful, in my case, it that there was a lot of taliking 'about' life, and not a lot of practical experience 'living' life, and in this regard, making friends and becoming closer to people in my community who are functional and have more experince than I do in areas that I want to succeed in has been of particular significance. Unfortunately (I am assuming you live in a cultural environment that is similar to mine, but forgive me if I miss the mark) it can be easier to look up a therapist in the phone book than it is to find people in the community to get close to. But it is possible.

I could go on and on, but this may not even be a direction you're interested in. If it is, holler.

Take care.
posted by al_fresco at 11:46 PM on January 8, 2005

I grew in therapy, basically,

…grew up in therapy… sorry.

…and to add a bit, I was (am) close to people who chose 'clinical' solutions to their obstacles (medical and otherwise), and decided it wasn't the path for me.
posted by al_fresco at 12:29 AM on January 9, 2005

IANAP.

The best advice anyone could possibly give you here I will give you: be careful and thorough when finding a doctor who will prescribe meds. Don't rely upon your GP or internist to diagnose and prescribe an antidepressent. See a psychiatrist; and see a psychiatrist that's willing to put some time and effort into making an accurate diagnosis.

I deeply disagree with orange clock's attitude. However, I do feel that there's a big problem with antidepressents (and antianxieties like Xanax) being over-prescribed by general practitioners or careless psychiatrists.

I also strongly believe that bipolar disorders require a different treatment regimine than do chronic depressions and that many people's bad experiences with antidepressents have occured because they were bipolar but mistakenly diagnosed as chronic depressive. Antidepressents can aggravate the manic portion of the bipolar cycle, causing either hypomania or full-blown mania. Consensus is that the mania stage is the more dangerous and, thus, aggravating it is worse than useless. So, your doctor should require you (or you should on your own initiative) keep a diary for a sufficient length of time to differentiate between a bipolar or monopolar disorder.

Almost all studies have found that a combination of talk therapy and drug therapy is quite a bit more effective than either one alone. Find a psychiatrist that's still willing to do substantial talk therapy (unlikely), or, more realistically and possibly ideally, a counseling psychologist who can work with a psychiatrist to provide the talk therapy you need alongside the medication. Even discounting the possibility that there's a component of your depression that is psychological (as opposed to being purely physical), if you've suffered from chronic depression then you've developed coping habits that will, once medicated, likely be counter-productive. Also, you'll likely be confused as to what you're feeling and your self-image. You've lived with an abnormal depression for a long time. You've adjusted to it. Now, you'll need to adjust to being healthy.

If you take meds, and you probably will, keep in mind that everybody's brain is subtly different and each of these meds—even the ones that supposedly work the same way—are different. Don't give up if one doesn't work for you. Another very likely will. And finding the correct dosage may also take some time.

Don't let people who have orange clock's attitude dissuade you. Even if we were to assume that their opinion that it's an "unnatural band-aid" were correct, they'd still quite often be wrong in their ultimate judgment. Why? For the same reason we use band-aids. Often, treating the symptoms in some fashion is the first step in being able to focus on treating the cause. And, again, that's assuming the "it's only a band-aid" opinion is correct; and it probably isn't.

Also, orange clock's anecdote also brings up an important issue. Especially in the case of people who are bipolar—which orange clock's partner probably is if they've been prescribed lithium—both the person herself and the people close to them might find the manic stage of their illness to be attractive. And it is...right up until it isn't. Mania is like the little girl with a curl on her forehead: it's really good when it's good; but it's really, really bad when it's bad. Anyway, I can't help but wonder if orange clock didn't fall in love with his/her partner's illness and resents its treatment. This is very similar to what happens in the cases of people who are drug and alcohol addicts and go into treatment: their partners are often the biggest stumbling blocks to them getting better. The attraction to the vibrant and carefree manic person is easy to see. But people can be attracted to a dysfunctional depressed person, as well. A caretaker personality might prefer (consciously or unconsciously) that you be depressed so they can "take care of you". Such a person might get in the way of you actually finding your way to being a healthy person again.

Finally, and ironically in light of the previous paragraph, a really, really big problem those of who suffer from chronic major depression have is that doing the things we need to do to get better—find a doctor, go to appointments, refill meds, whatever—are quite hard for us because, well, we're depressed. Here it can be quite important to get some people around you to be a support structure so that you do and follow-through on the things you need to do to get and stay healthy. And it may well be, per the previous paragraph, that your partner is not the ideal person to help you do this.

Good luck.
posted by Ethereal Bligh at 1:34 AM on January 9, 2005

I had bouts of Depression following my divorce. While I am suggesting something quite different, it is not a substitute for seeing a doctor.

Try fasting for a day or two.

The logic of this is that your body's metabolism becomes focused on the state of fasting, and has little time to respond to your brain's requests for a little psychosomatic sympathy. It kind of works like the body's own natural answer to Lithium. It worked for me. After about six months of in and out depression, I could recognize when I was descending into a spiral, and I would fast, usually for two days. Just a bit of herb tea and diluted juice.

The source for this advice was the writings of an 18th century hasidic rabbi (Nachman of Breslov) but among his sensible advice there is also a lot of stuff like "do not eat chickens with black feet." But fasting is not as radical and approach as medication if done with moderation. And there really is nothing particularly spiritual/religious to the practice of fasting for health reasons.
posted by zaelic at 8:19 AM on January 9, 2005

My current psychiatrist does talk therapy. Also, the first psychiatrist I ever had did talk therapy (and this was only three years ago). So they do exist, but it does take some searching. I find it much more useful than having to see two people (a psychiatrist and a therapist), and I can discuss how the medications are affecting me at greater length. Many therapists don't really understand medication (I'm sure some do, but the ones I've seen didn't) and so it can be hard to discuss the effects of the meds with them. But don't let me discourage you, it does work to have both.
posted by veronitron at 8:40 AM on January 9, 2005

Yeah, a psychiatrist that's serious about talk therapy is best. Hard to find, though, these days.
posted by Ethereal Bligh at 11:29 AM on January 9, 2005

Huh. I had no trouble finding someone who was willing to take my money week after week as I described my problems. I also got nothing out of the experience, ultimately. After a good 12 sessions of me talking, talking, talking, I started to ask when she would start contributing more to the process or giving me some kind of feedback or advice or analysis or something. I received the following mindfuck in reply:

"This is a relationship. The way this proceeds is we establish trust and get to know one another and form a relationship within the bounds of this room. Then, once that relationship is established, we begin to explore the issues you have in all your relationships within this relationship. Do you always storm into a relationship making demands?"

I said: no, but I typicially don't pay at the door either. Six more weeks down the line I gave up. I don't judge all talk-therapists by this experience, but it certainly was educational.
posted by scarabic at 10:45 PM on January 9, 2005