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February 13, 2011 9:45 PM   Subscribe

I've been having short, intense feelings of overwhelming despair, particularly at night. I need advice on dealing with this.

Background: I'm undergoing treatment (therapy and Effexor) for depression; I'm going to see a psychiatrist in about a week to get checked out for a different set of drugs. It is possible/likely that I have been misdiagnosed with depression when I'm really bipolar (likely bipolar II), which would explain some of why the drugs don't really work on me (they work for a little while and then sort of fail).

These episodes are despair-y more than panic-y, though I have some problems with anxiety they aren't panic attacks. They can last anywhere from a half hour to all night. At their best I just feel sort of bad and cry a little; at their worst I end up awake all night with suicidal ideations* and fantasies about self harm. They're usually accompanied by an overwhelming feeling of loneliness. I have had them triggered by things before, but the ones that come at night don't seem to have any particular cause.

I've been using beadwork as a sort of emergency thing to occupy myself a la this advice, which helps me get through the night but does still keep me awake.

The whole thing is complicated by the fact that I'm frequently sort of afraid to go to sleep because I frequently have nightmares. I used to have much worse ones, and though the ones I have now aren't about raw and fear like the ones I had on Lexapro, they're very vivid and can leave me feeling quite awful.

I'm hesitant to go to friends for help because I still carry a lot of guilt about overburdening a friend with my problems and making him carry me through a lot of them; I don't know how to ask for help.

*Since I've been treated for depression with about a million different things over the past few years and I'm really afraid of stuff like my drugs suddenly not working or switching drugs making me go crazy and kill myself, I make sure I don't have access to any methods of suicide. Mostly just because I'm sort of paranoid.
posted by NoraReed to Health & Fitness (16 answers total) 8 users marked this as a favorite
 
There's a depression hotline you can call: 630-482-9696. It can at least help you through the feelings of loneliness until you can get the right medication.

Also, are there other friends you can talk to other than the particular friend you are concerned about having burdened? As the cheesy song goes, "That's what friends are for...mitigating painful depressive episodes." Just say, hey, I'm getting help for it, but I'm having problems with really severe depression, and I was wondering if I could call you at night sometimes?

(If I were in your situation, I might actually be willing to strain a friendship in order to survive. Friendships are the some of most important things in one's life, but not actually as important as staying alive.)

Is calling in sick the day after a sleepless night an option? Catching up on your sleep may help.

I'm sorry to hear you're going through this rather brutal time. I'm glad you wrote to Ask MetaFilter to ask for help, and I hope you will do the same with friends, families, or the hotline.
posted by ignignokt at 10:16 PM on February 13, 2011


It's good that you are seeing a doctor soon. In the meantime (and speaking as someone who has used Lexapro and Effexor - been there, had the nightmares, been stuck awake all night stressing about everything), if you need to sleep I have had luck with really intense exercise. Like, thrash yourself on an exercise bike or go run up some hills. You want the eyes-closing-on-themselves full-body tiredness. Logically, you and I both know that staying up all night worrying about things is useless and it always, always looks better in the morning, but knowing that doesn't help at 3am. So make sure you're asleep by then. (I was prescribed Ambien and then benzodiazepines at the same time as the Lexapro. They didn't work for me, but has your doctor recommended them to you? It's super hard to sleep when you're worried you're going to have some whacked-out nightmares.)

If you do wake up, it's nice to have a box set of DVDs or something to keep you occupied if you know you won't get back to sleep. I got very fond of late night Seinfeld repeats.

Do you live alone? I hear what you're saying about not wanting to burden your friends, but do you have a close family member who can stay over and sit up with you if you can't sleep, or call late at night? Is there one of those 24-hour mental health hotlines where you are? Because that's exactly what they're there for, especially if you're experiencing suicide ideation.

No doubt more experienced MeFites than myself will be along soon with better advice - these are just suggestions that have worked for me.
posted by jaynewould at 10:17 PM on February 13, 2011


2 more things: From a quick skim of your profile I can't tell if you're a student. If you are, make sure your school knows, because they can cut you an awful lot of slack during rough episodes in addition to providing things like counselling. If you work, is there someone in HR that you could talk to? (I have no idea if that might affect your employment, US employment law is a mystery to me) Because the lack of sleep can really mess with your job. I lost 2 jobs that way, and I kick myself for not saying that it wasn't my fault that I was always late/tired/cranky etc.

Also, when I was having really awful nightmares my mum suggested keeping a notebook by the bed and writing them down. I didn't, but I really wish I had, because I would have the makings of a kick-ass anime horror film. Just a thought (silver linings, and all that).
posted by jaynewould at 10:27 PM on February 13, 2011


I'm unemployed and am a very part time student (taking just one class).
posted by NoraReed at 10:35 PM on February 13, 2011


This is not unusual. I've had similar experiences while on Effexor; I'm all too familiar with this kind of 'night darkness' and how bad it can get. The times that gave me the most pronounced feelings of despair were when I'd stayed up later than usual or had missed a pill, leading me to think it was related to SNRI withdrawal. Effexor has a very short half-life, which means you go into withdrawal sooner. Effexor is also infamous for the severity of its withdrawal symptoms. You should keep this in mind because it gives a thread of thought to hold onto, however tenuously, during the despair: "This is something my body is going through - the despair is produced by my brain chemistry, it is not my true situation. It's a wave that I'm riding; a trough will be along soon. This too shall pass."

Distraction, for me, is key. I find that the more I flit between things the better I'm able to cope with the despair. Plan the next days' meals; when my mind starts returning focus to the despair, start cleaning my hard drive folders; then to some stretches; TV; etc. Repeat until exhausted. When the obvious things to do become ineffective, do something unexpected - think of a task waay down on your to-do list (or something you've never done, or haven't done for years) and just start doing it. The unexpectedness and newness of it throws my brain a little off-kilter and this can help in distracting from the negative thought cycles. Perhaps it might work for you as well.
posted by Hardcore Poser at 10:51 PM on February 13, 2011 [1 favorite]


Here's my so very weak sauce: I can't address the larger issue at all, but when I'm beset by fear, anxiety, etc., it's almost always at night before falling asleep, and the best thing I've found so far to keep those thoughts more or less at bay is puzzles — especially number puzzles like Sudoko because they demand enough concentration that my mind doesn't wander much, they don't keep me up like books can, they don't have word associations like crossword puzzles do (that can send my thoughts off to bad places), they are light to hold (don't have to sit up or bother about setting stuff down or putting away before I just fall off to sleep), and are basically absorbing and boring at the same time. (For me, things like knitting/crocheting don't restrain the free association part of my brain as much as necessary to ward off the badthink, but I don't know about beading!)

I know this is ridiculously insignificant in terms of true help, but added it in case there's the smallest chance it could ease things even a tiny bit. Good luck, Nora, my thoughts and wishes are with you!
posted by taz at 10:55 PM on February 13, 2011


That really sucks, and I'm sorry.

I just want to reiterate what ignignokt said about straining a friendship. Even if you do put some strain on a friend, it's worth it. And the depression is probably telling you lies about how little your friends would be willing to do for you and how much you are burdening them.

As an anecdote, I have a friend who was severely depressed for about 18 months until recently finding medication that worked, and she was... well, kind of a pain in the ass during that time. She would call up all hours of the day and night, tell me she was self-harming, or suicidal, need driving to doctors and hospitals, and sit next to me crying but not talking for hours on end while I felt totally helpless to help and helpless to leave. The first couple of times that sort of thing happens, you are really happy to show up and do what you can. The 5th to 10th time, it's getting a bit old, and the 100th time it happens and you miss out on your weekend plans again because you don't feel you can leave her like that, it's a total PITA.

BUT it was totally worth while because she didn't kill herself, she is still with us, and we will have good times again in the future. I would rather a zillion times over that she called on me for support again rather than take any risks, or even rather than that she feel despair about having a lack of people who care. Really and truly. And I bet there are people out there who feel the same way about you.

PS: I have another friend who bakes cakes and pies when she can't sleep at night, or to recover from nightmares. She says it is soothing, and makes her feel useful, especially when she brings them into work to share the next day.
posted by lollusc at 11:13 PM on February 13, 2011 [1 favorite]


I don't know much about this specific situation, but I do work with people who are diagnosed with severe mental illness...

Distraction, distraction, distraction... if you don't give yourself something to do (which it seems like you've tried with the beadwork), then you have nothing but your thoughts to occupy yourself with. It's a negative feedback loop that, once it starts (it can start either through thoughts or physiological arousal), can be difficult to get out of unless you force yourself down another (temporary) path until you are able to seek counsel on the issues.

Deep breathing exercises can be so very useful when you're having trouble. The trick is, you have to actually do them in order to get the benefits. Not just a few attempts of a few breaths. Like, sit there and do them and meditate. It helps control the physiological aspect of anxiety, which in turn will begin to calm your brain down. If you can't control your thoughts, you have to focus on what you can control, and that is your body. Even though you describe it as despair, that is anxiety. This will help you.

I know you don't want to overburden your friends, but sometimes that's what friends are for. You need to have support; most people cannot do it on their own. The folks that think they can end up where I work. But, it sounds like you're doing alright on the doctor end of things. Now talk with your friends and use their support. It can actually bring people closer. And stop viewing them as better than you. Everyone has their own set of complex issues, no matter how perfect they seem. Obviously, talk with someone you can trust to keep the conversations confidential.

As for how to ask: just ask. That's the first step. And by asking, I mean have a conversation with a close friend. If they are your friend, they won't mind helping.
posted by XhaustedProphet at 11:48 PM on February 13, 2011 [1 favorite]


I take Vyvanse and Lexapro, and the most disturbing side effect to the Lexapro I've experienced is occasional flashes of intense anxiety. They are fleeting and come up very suddenly, even when I am feeling calm and happy. The way I deal with them is to just remind myself that it is a side-effect of the med and that it's simply a reaction to the chemicals.

On reflection, this is likely not a solution for you, but sometimes little acts can help. The mind can be terrible baggage sometimes, especially because it affects one's well-being so heavily.
posted by sundrop at 4:38 AM on February 14, 2011


"I'm unemployed and am a very part time student"

Can you sleep during the daytime and would that help? When I lived alone I used to get really irrationally afraid of sleeping at night, when Bad Things Happen (even though nothing bad's ever really happened) and end up too scared to go to sleep, with anxiety and panic and nightmares and the while nine yards. Sleeping during the daytime, with the sun out and lights and stuff, solved that problem basically completely. The worst I would get was the occasional nightmare during daytime sleep, and I slept more lightly during the daytime so tended to wake up from them before they got really bad.

Of course you run the risk of turning around your sleep cycle, but you could at least nap during the day, or commit to turning it back around after you get the help you need, if daytime sleep would help.
posted by Eyebrows McGee at 5:05 AM on February 14, 2011 [1 favorite]


I have this and suffered from it just last night. Just wanted to let you know you're not alone.
posted by saveyoursanity at 6:07 AM on February 14, 2011


I had those crushing nights of despair when I was unemployed, which makes me think maybe keeping more active during the day would help with the scary nights.

It helps immensely to find an activity that will distract you but make you sleepy. Beadwork might not be right for you since it ends up keeping you up. Video games and internet anything tend to keep me up for hours even if I'm dog tired, so I don't recommend trying those. Reading works for me, usually with a fun easy book I've read a million times before and don't mind putting down, like one of the Harry Potter books. Reading in the tub is even better; warm baths never fail to make me snoozy.

And nthing reaching out to friends. Sometimes you strain a friendship, but sometimes you find out your friends care about you a lot more than you think.
posted by Metroid Baby at 7:39 AM on February 14, 2011


I second the deep breathing suggestion. Also, guided meditation can help clear your mind. It can really help me reset when worrying gets out of control.

Here's one example of downloadable guided meditation talks I think are pretty useful.

It doesn't necessarily leave you sleepy, but it also has a definite end, so it doesn't encourage you to stay up all night either.
posted by mercredi at 2:36 PM on February 14, 2011 [1 favorite]


Thanks everyone-- I feel like I have a lot more tools to work with here, both for preventing this and for dealing with it when it happens.

I know it's cliche, but it means a lot to see posts from other people with similar problems. Knowing I'm not alone really helps.
posted by NoraReed at 2:51 AM on February 16, 2011


An update: I'm on new medications and have a couple of friends to go to now when stuff gets bad. It's gonna take a while, but I'm on the upswing. Thanks to everyone who contributed-- this was a lifeline.
posted by NoraReed at 6:55 AM on March 2, 2011 [2 favorites]


I'm really glad to hear it.
posted by saveyoursanity at 7:49 AM on March 2, 2011


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