Another depression question! Give me strategies to help.

March 28, 2016 11:10 AM

I have tended toward depression for much of my life, and it’s been really bad for the past several months. What do I try next?

I’ve never been the happiest person on earth, but things are especially bad right now. I am relatively functional, still able to get to work often enough to avoid getting fired and to hang out with my teen/tween kids enough to avoid being a negligent parent, but I’m not doing much else. I spend most of my time alone either crying or on the verge of tears. I’m not enjoying anything in my life right now and have a hard time seeing that improving. I’m aware that depression makes it seem like everything always has been and will be terrible, but that doesn’t help talk myself out of it, especially when I do have objectively bad $%^& in my life that is, statistically, likely to worsen rather than improve. Help me be one of those awesome people who feel okay despite it all!

Compounding factors:
*I have had severe insomnia for 10 years. I usually get about 4 hours of sleep a night, in stretches of 90 minutes or less. Particularly bad nights leave me extra miserable. I suspect that fixing the insomnia would dramatically improve the depression, but I haven’t managed to pull that off despite trying 100 different things on my own, with doctors, with sleep specialists, and with counselors. It’s pretty clear that it’s not an anxiety related thing or obviously linked to mental health in any way (though I know insomnia and depression feed off each other).
*In the past, having a caring partner around was a big help when I was depressed, but I’m currently single. I have friends who care about me but none of them are able to significantly increase the time they spend with me.
*Related to the above, I am still grieving a 20-year marriage ending two years ago, and another important relationship ending last fall.
*I have significant physical health problems that are mystifying doctors and leave me in significant pain and with less ability to be physically active than I’d like. Odds are good that these will worsen over time.

Things I have tried:
*Meds: Celexa, mirtazapine, trazadone. The latter two didn’t seem to do anything at several different dosages (though withdrawal sure did suck!) Celexa left me euphoric for a few days, and then I lost all motivation to do anything or care about anything for the next three months I was on it. That wasn’t any better than unmedicated depression for me so I went off.
*Counseling: I’ve seen five different counselors with different treatment philosophies. Nothing moved for me while I was in therapy, and getting myself to the appointments took up energy/ time/ money I much preferred to spend on other things.
*Self-help CBT type stuff: this does help me when I’m a little depressed. When I’m a lot depressed, not so much, and not now.
*Meditation: occasionally it’s helpful while I’m actually meditating, but it doesn’t shift anything outside of that time for me. I have tried it consistently for months on end before.
*Exercise: if I’m completely sedentary, I feel worse, but exercise beyond casual walks doesn’t seem to help. Despite that, I have been hauling myself to the gym three times a week. I am limited in what exercises I can do because I have a torn rotator cuff, arthritis in my knees, a foot issue which frequently means I can’t walk any distance, asthma and heart issues, and can’t swim.
*Daylight exposure: no noticeable effect.
*Socializing: I force myself to see friends at least once a week, often more, and usually accept any invitation I’m given so I don’t let myself never leave my house (which is my preference). I do not enjoy myself or feel better before/during/afterward, but it makes me feel like I’m trying at least and it helps maintain relationships with people I care about.
*Hobbies and activities I once enjoyed: I dislike them and wonder what I ever did like about them.
*Massages, junk food: make me feel better for a few hours.

I apologize for being the whiny pain-in-the-butt depressed person who rejects every possibility that might help, but I’m afraid that’s kind of where I’m at. Please tell me what to try next? If it’s something that’s already on my list, please suggest specific ways to do it differently that might help it work better for me.

posted by metasarah to Health & Fitness (12 answers total)

Keep experimenting with medication. I was depressed for all of my life until I went on Wellbutrin and it has made a world of difference. Not saying it's for everyone, but it's worth it to keep trying. I was never motivated to keep up with therapy or exercise (because depression, duh), and stopgap measures were just that. I was put on lexapro which was a total nightmare, but then I was put on Wellbutrin and I can say without a doubt that that was the best decision I've ever made.
posted by greta simone at 11:16 AM on March 28, 2016 [3 favorites]

You say you've seen a sleep specialist, but you don't say if you've had a sleep study. If so, please excuse.

Husbunny has had a HUGE turn-around since he got his CPAP, he's evangelical about the damn thing, even hassling ME (and my snoring) to get one.

He does well on Welbutrin as well.

Lots of meds and dosages to try, and I agree, if you sort out sleep, the rest is SO MUCH EASIER!

Good luck to you.
posted by Ruthless Bunny at 11:45 AM on March 28, 2016

The Depression Cure terrible name, but it worked for me. I've found the changes to my diet and activity levels have accomplished in the last year what years and years of other things did not. I thought it sounded too woo for me but if the science is shaky it's a harmless kind of shaky.

Also the sleep. I didn't sleep from ages 15-30+ and now that I've managed to sleep most nights it's amazing. You have to get this sorted.
posted by French Fry at 11:49 AM on March 28, 2016 [1 favorite]

I would say only this: stop apologizing for being a whiny depressed person. Depression hurts, and it lies to you, and it's exhausting and horrible and hard. Powering through it enough to be a (single!) parent is even harder. Just... be gentle with you, ok?
posted by missrachael at 12:17 PM on March 28, 2016 [1 favorite]

Have you seen a psychiatrist or were the meds prescribed to you my your primary care physician? I would definitely make an appointment with a psychiatrist and give meds another go. It sounds like the ones you tried didn't work for you, but there are still a lot more options out there. Medications probably won't solve everything, but I think you should definitely keep trying them out. For example, Wellbutrin can be a great antidepressant option. It worked well for me except for making me too anxious, but I was on a fairly high dose. There are also other SSRIs you could experiment with.

I suspect that fixing the insomnia would dramatically improve the depression,

Yeah, sleep deprivation is The Worst, and I'm sure it's probably making everything else even more terrible. Again, there are definitely still other medication options out there. You do want to be cautious with sleep meds because of dependence and other issues, but for short term treatment, there are the hypnotics like ambien/lunesta/etc. (I took ambien for a bit, but due to my addiction history, it isn't something I could continue with.) Trazadone didn't do much for me either, but I took seroquel for a couple years and it completely knocked me out. I wasn't a fan of seroquel for a number of reasons, and I think antipsychotics should be used cautiously when prescribed as sleep aids, but it is still something you could explore with a psychiatrist.

Currently, I take clonidine to help with sleep, along with other behavioral approaches. It helps me relax enough to put me to sleep, and I love that it's non-addictive/non habit forming, but I don't find it lasts very long.

In the short term, have you tried just taking some benadryl (diphenhidramine) or doxylamine succinate (sold in the US under unisom among other brand names)? These are sedating antihistamines that shouldn't be used long term because you can build up tolerance pretty quickly, but if you can manage to get a few decent nights of sleep, that may make the rest of this feel a bit more manageable.

Of course, IANAD, IANYD, etc, and I know your main questions isn't about medications, but I just wanted to throw out my lay persons opinion, especially as someone who has struggled with insomnia and mental health issues over the years.
posted by litera scripta manet at 12:22 PM on March 28, 2016 [1 favorite]

Get a full panel vitamin and hormone levels test as a priority. Get tested to see if you have markers for absorption issues as well. You might find the sleep issues resolve once you have good and balanced levels again if they're off. Yes to a sleep study anyway in case it's apnea related.

I've been taking an MAOI, which is an older treatment for depression that doesn't have the side-effects like modern SSRIs, SNRIs, etc. It has totally changed my life. They now have a transdermal patch that makes it so you don't have dietary restrictions either (which aren't that bad, I'm on the oral med because my insurance sucks). Lithium might be something to consider short-term if you are feeling close to your limit for dealing with life.

I know it seems like you've tried everything but I promise you, there is other stuff out there. Find a good psychiatrist that you trust and hammer away at it until you figure it out. This is the hardest part of dealing with depression, because it can be so frustrating when you know something is wrong and you want to fix it but nothing has worked yet. Be patient. Be gentle with yourself. You might find once you're in a slightly better place that all the other stuff (meditation, CBT etc) starts working again. It did for me.

Maybe you and spouse can start a tantra practice? If nothing else, it might take your mind off things until they get better.

Best of luck.
posted by ananci at 12:24 PM on March 28, 2016 [1 favorite]

My sleep issues + fatigue + achiness and pain ended up being, surprise surprise, a sleep disorder. But it wouldn't have been caught by my first sleep specialist because it's a relatively new diagnosis -- Upper Airway Resistance Syndrome (UARS) -- and my first sleep specialist did not know about it. Many sleep studies still don't actually score Respiratory Event Related Arousals (RERAs) which are necessary to make a diagnosis. It doesn't show up at all on a home sleep study.

It's also linked to insomnia, fatigue, and depression/anxiety and shows up more often in women than sleep apnea does.

Depending on when you did your previous sleep consults and who they were with, you may not have been screened for UARS. If you're not sure if your previous work with the sleep docs included this, I would suggest reading the symptoms, seeing if it sounds familiar, and then finding a sleep doctor who diagnoses it and starting from there. (If you're in Boston, drop me a memail if you want the sleep program I went to; it was surprisingly hard to find one that does this, probably because most insurance companies won't cover treatment for UARS the way they cover treatment for apnea.)
posted by pie ninja at 12:27 PM on March 28, 2016 [3 favorites]

I've read that it helps if you enjoy whatever kind of exercise it is that you're doing.

Water aerobics classes for people who can't swim are totally a thing. Gardening totally counts as exercise... and sunshine, which is also important.
posted by aniola at 1:43 PM on March 28, 2016

You don't mention trying medications for sleep, unless mirtazapine and trazadone were prescribed off-label in an attempt to address that...?

I would press on with sleep medicine, and I don't mean "sleep medicine," the specialty that hasn't had anything new to offer for decades and mostly pounds the "sleep hygiene" drum even though it's not really compatible with how most humans have slept through most of human history, I mean, medicine for sleep.

I take some relatively heavy-duty drugs to keep myself sleeping like people are expected to sleep, and with sleep depression I am a dysthymic or worse, but with good sleep on a regular basis I'm a different person, one who is able to experience pleasure and joy and so forth.

I think Z-drugs are lifesaving medicines, but everybody seems to have different reactions to sleeping pills, so you'll likely need to do some experimenting. But I've gone through phases sleeping the way you've described, and wanted to throw myself off a building, and it wasn't depression; it was sleep deprivation. (I have theories about post-partum depression being more a normal reaction to sleep deprivation than "depression"...).
posted by kmennie at 2:56 PM on March 28, 2016 [2 favorites]

I know this sounds like the nuclear option, but ECT (electro-convulsive therapy). Yeah, shock treatment. It's VERY safe, and for most people has minimal side effects. It's completely different from whats shown in movies and TV.

I had intractible depression for decades which did not respond to any of the many different medications and their combinations that I tried. Also decades of talk therapy. But I finally underwent a round of the ECT 6 years ago and it changed the whole ballgame. You may or may not do it in the context of inpatient care. I started out that way, checked out and stopped ECT treatments, but then tried again a few months later outpatient. I didn't become some skipping, whistling, super cheerful person. But I felt essentially and fundamentally different--optimistic. I just had faith that everything would work out OK. In fact, I went through some very difficult, fairly catastrophic shit shortly following, but it really was fine. It was hard, but I felt like I could cope and I did. Very different feelings than ever before.

The most common objection I hear is fear of loss of short-term memory. But, honestly, I really didn't mind the idea of losing my short-term memories. They were crap and sad. And I had a little bit of trouble with short-term memory, but it didn't last long, and that's all fine now. Aside from that, it doesn't hurt AT ALL; they use general anesthesia for a very short period--less than 5 minutes. You're a little fuzzy when you wake up, but the staff is all super nice and sweet, and it's generally a pleasant experience overall.

Feel free to memail me for more details if you'd like.
posted by primate moon at 7:25 PM on March 28, 2016 [1 favorite]

Oh, boy, depression and insomnia often go hand-in-hand and feed on each other in a vicious circle. I feel your pain there.

It sounds like there are still medications and combinations of medications you have yet to try. I know only too well how frustrating it is to try drug after drug like a shot in the dark, but if you find the right one it will have been well worth the effort.

FWIW the next thing I'm going to try for insomnia is hypnotherapy. I heard of several people having success with that, and I'm running out of medications to try. If it works, I'll let you know.
posted by The Underpants Monster at 11:18 PM on March 28, 2016

I'm a doctor so naturally I think of meds first but - MEDS! There are so many other options out there that you haven't tried. I know it's a lot easier said than done because a lot of the meds take a significant amount of time to trial, and side effects can be rough. But this is your life and I really think it'll be worth it for you to try some other things. Many if not the majority of people have to try multiple options to find the right depression (and sleep) med for them. Keep plugging at it!
posted by treehorn+bunny at 7:13 PM on March 29, 2016