If I give up on therapy, how can I manage my depression on my own?

December 13, 2006 7:21 AM

How can I best work on my depression & anxiety on my own if I choose to stop seeing my therapist? Is this a really bad idea?

I have been on antidepressants (first Celexa, now Effexor) for my depression and anxiety since 2004. Since May, I have been working with a therapist as well. I also did an 8 week group on cognitive-behavioral techniques for controlling depression through my local hospital. Note that I have always had anxiety & depression problems, it runs in my family, and I had a somewhat traumatic childhood (my mom was battling breast cancer for seven years until she died when I was 9, and the rest of my family couldn't cope).

In October, I got married, and due to insurance changes, I was no longer covered to see my old therapist and had to find myself a new one. In all honesty, even though I felt like I had good rapport with my old therapist, I don't know if it ever was that helpful for me. Now I have started seeing a new therapist. She is either insane or extremely incompetent. When we were talking about emotional eating (one of my many coping mechanisms) she took 15 minutes to read off a list of alternatives to eating, which included, I shit you not, "collecting stamps...taking care of a plant...flying a kite..." Then she read me a story written by a 12 year old about an apple tree that wouldn't grow apples.

Needless to say, I don't think this is going to work out.

I may try finding a new therapist, but in all honesty, this crap is wearing me out. I am starting to think that I want to stop talk therapy, switch from Effexor (which gives me headaches and doesn't make me feel as balanced as Celexa did) back to Celexa, and just check in with my psych dr periodically for medication management. Honestly, if it wasn't for my anxiety, which used to be crippling, I would probably want to go off antidepressants entirely.

I have been doing things on my own that seem to be having a very positive effect, and that I plan to continue, which are:

• Daily exercise.
• Eating better, less processed foods.
• Working on my sleep habits to get better sleep in the right amounts (still working on this).
• Journalling about things in my life that make me uncomfortable, and trying to explore them & how they might affect my current life.
• Working on my self esteem (trying to dress better, take time to put makeup on, do my nails, etc).
• Make sure instead of zoning out in front of the tv or computer all the time I do things that I enjoy, even if I don't feel like it.

I still am sometimes lethargic feeling and occasionally just have a hard time getting myself to do anything but the bare basics in life -- but I fail to see how hearing stories about fucking apple trees is going to help me change that.

Additionally, I find that the effort it takes to find a new therapist that my insurance approves of and setting up a new appointment, and waiting for the new appointment, and all of the crap is more mentally taxing than just ... not going to see anybody. It makes me more depressed and anxious to deal with all of this red tape and phone tag bullshit.

So...do you think it is unreasonable for me to try & continue to work on my depression & anxiety on my own? I probably am anyway in the meantime, until I get up enough motivation to think about finding a new therapist...again.

So for now, and maybe for the long haul, I would really appreciate ideas for additional things can I do, books can I read, etc, to work on this and become more vibrant, balanced & productive? I miss feeling mostly good & hopeful, and I want to get there again.

posted by tastybrains to health & fitness (20 comments total)

I don't use a therapist either.

I think your list is excellent-exercise in particular helps me trememdously.

The one thing I would add is make sure you have plenty of positive relationships in your life-as my doc calls it, "a good social support system.". Just having a good friend to talk to if you need a sounding board helps a lot.

Also try as much as you can to get out in sunshine-seriously. That helps.

(ps, you probably know this already, but effexor is a witch to withdraw from. Taper veeeery sloooowly.)
posted by konolia at 7:31 AM on December 13, 2006

Be extremely careful withdrawing from Effexor and do it only under a physician's supervision.

Anyway: You do all the typical things that therapists tell you to do, and you respond well to medication. You need occasional but regular care from a psychiatrist who is trained to recognize changing behavioral patterns and can refer you out to talk or cognitive therapy as needed - but only as needed.
posted by Saucy Intruder at 7:41 AM on December 13, 2006

Additionally, I find that the effort it takes to find a new therapist that my insurance approves of and setting up a new appointment, and waiting for the new appointment, and all of the crap is more mentally taxing than just ... not going to see anybody. It makes me more depressed and anxious to deal with all of this red tape and phone tag bullshit.

I think this is really an understated concern in treatment of psychiatric conditions today. The increased acceptance of seeking treatment for those conditions over the last few decades is a great development and I'm certainly not one of those "it's all in your head, get over it" people. That said, I have seen a lot of friends undergo a great deal of mental stress not only because of their underlying condition, but because they couldn't find a therapist they got along with, or because they had to switch therapists due to insurance concerns, or because their insurance made them spend so much on therapy they couldn't ever afford to actually go out and do anything fun and fulfilling.

Having to devote so much time, energy, and money to just getting treated is a travesty. It's very sad that our medical system would force people to jump through those hoops. And yet, here we are. It's the world we live in, and more importantly at the moment, it's the world you live in. And I think the bottom line is that this is a decision you have to make for yourself after some serious introspection and consideration of your options. I am not a psychiatrist and I certainly wouldn't presume to know whether you should continue treatment or not, but here are some questions you should ask yourself as you make the decision:

Do you think the therapy you've had so far has had a lasting, incremental benefit, or is the habit of therapy itself the thing that helps? Are you self-aware enough, and do you have a good enough social support system, that you will be able to identify any new problems that develop and return to therapy if necessary? Do you have a good enough relationship with at least one therapist that he/she will respect this decision and accept you should you need to return? Are your insurance and other financial situations stable enough that a return to treatment will remain a realistic option? In the end, only you can make the call. Good luck.
posted by rkent at 7:44 AM on December 13, 2006 [1 favorite]

Re: Effexor, I am still planning on taking it, and will work with either a psychiatrist or my reg. doctor to taper off of it and switch back to Celexa. I just hope my new psychiatrist (who I haven't met with) doesn't make therapy a condition of treatment.

It scares the shit out of me, I am really annoyed that I was ever put on it. I skipped *one* dose and got to experience some of the withdrawl symptoms. However, I have refills to last me a year, so I'm all set.
posted by tastybrains at 7:45 AM on December 13, 2006

Mindfulness meditation has helped me tremendously. You can read a book about it here. You don't need to have interest in the "whole Buddhism thing" for it to be helpful.
posted by unknowncommand at 7:59 AM on December 13, 2006

The one thing I might be concerned about, if it were me, would be losing the feeling of being accountable to someone. The stuff you're doing is great --- if you keep doing it. For me, going to a therapist is the major way that I motivate myself to do those sorts of things. If you do drop your therapist, then along with what konolia mentions about having a support network in place, maybe also set up one or two people that you specifically check in with once a week or something? People who would be willing to harass you a bit if you start falling off track? (And maybe let them know that if you do go way off track, they're empowered to more or less force you to go to the doctor or another therapist, so they don't feel like they're just cheerleaders.)
posted by occhiblu at 8:09 AM on December 13, 2006

occhiblu's point is, as usual, a good one.

I think ending therapy is something that can be a very good idea for folks. Therapy works well, and it should work fairly quickly to supply you with the kinds of coping strategies that you're able to implement on your own. It should be part of the ethics of therapy that clinicians and patients work toward resolution and termination.

That said, there is a lot of evidence from many studies that therapy works well for treating depression and anxiety. As well or better than medications, without the kinds of side-effects you've already experienced with Effexor. The nature of therapy studies is that they compare treated with untreated groups, and I think it's reasonable to assume that those who are untreated by therapy are seeking relief in other ways-through friends, exercise, etc. If you're still suffering, or if you're still suffering after a while of going it on your own, I'd encourage you to find yourself another therapist. I know that it can be a pain, and I wish it weren't, but one way to look at it is that if you cannot go through the process required to find a new therapist, you aren't doing as well as you think you are.
posted by OmieWise at 8:23 AM on December 13, 2006

I just use my primary care doctor for my medication -- is that a possibility for you? I have found my "regular" doctor to be far less annoying to deal with than the various psychiatrists I used to interact with. For tricky medication cocktails it probably wouldn't work, but primary care docs are often fine for antidepressants (and far less "I'm the expert" baggage). (FWIW, I've been on the same medication and generally the same dosage for 12 years, so your situation may well be different.)

Also -- can you think of this as a therapy holiday? Take a break from therapy and the bullshit of appointments with idiot story readers. Later, when your frustration has dissipated, you can try again.
posted by ClaudiaCenter at 8:43 AM on December 13, 2006

I would advise against the 'no therapist, do it by yourself' route - been there, done that, and it ain't pretty. The best treatment for chronic depression really appears to be medication along with some sort of talk therapy, along with the coping techniques you're doing (congrats on those btw - you're obviously taking charge). As much as the therapy aspect can be a drag, study after study notes that it really seems to be part of the solution (OmieWise mentioned this). It's not so much that having no therapist is a 'bad' idea so much as 'usually the wrong answer'.

While it's good you're taking control of your diagnosis, I still say have a therapist as a back up, even if it's someone you only see once a month (or less, if you're doing really well). Yes, your latest therapist sounds incompetant (I'd tell her to shove an apple tree up her wazoo, but that's me), but no, that doesn't mean you should throw out the idea of having a doctor around just as a resource. While people can have short courses of therapy (for something like the cognitive therapy), for a diagnosis of depression and anxiety it's something where you need a support system (including a doctor) around to help manage your moods. Family, friends and your strategies aren't always enough. I don't know if we as 'sufferers' (pardon the term - can't think of anything else) can really manage it by ourselves - it's hard, hard work, and it's hard to be objective about the one thing closest to ourselves (our mood/affect, our thoughts, our core essence). Moods are tricky, and they can slip even while we think we're doing fine by ourselves - which is why having an impartial observer like a therapist helps. They can pick up on things going wrong when we can't see them or we're not willing to, and unlike family members, they don't guilt trip us about what we can't see.

Another suggestion is something like a support group (if there are any running in your area) if you're really against the idea of having a therapist. The idea is that it can also be another resource to go to if your mood dips, and can be a great place to go when you're feeling well, as you can help others out - and that is a great mood ellevator and anxiety killer as well.

Thanks rkent for your description and sensitivity about the issue of trying to find a therapist - it is hellish. I wouldn't wish the task of finding someone, navigating the hoops or the disease upon my worst enemy. I hope to eventually come out of the maze of finding someone.

anyway, good luck, tastybrains. Feel free to hit me up for an email if you need to chat (assuming you're one of those nice zombie killers) ;)
posted by rmm at 8:51 AM on December 13, 2006

Many psychiatrists do not require therapy as a condition of treatment. If you think you'll be fine without it, then stop going. I find talk therapy useless as well (unless I am doing extremely poorly).

To help with lethargy, spend more time outdoors during daylight hours. A brisk half-hour walk outside at lunchtime really helps.

Pets can be real mood brighteners as well. Dogs are good because they require a lot of interaction (exercise, discipline, affection). It's hard to stay lethargic in the presence of a puppy.

You could also try taking up an artistic hobby (painting, playing music, dancing). Sometimes it's easier to express emotions non-verbally, and a creative/artistic endeavour provides a healthy outlet for these emotions. Good luck
posted by crazycanuck at 9:11 AM on December 13, 2006

I second the meditation. Another way to come at it besides the excellent book already referenced is Eckhart Tolle's "Power of Now." Way simple. His knowledge arose out of his experience of wanting to die. You can skip the little bit of god stuff and a few seemingly extreme pronouncements in there and still get a lot out of his deep understanding of how the mind works.

IANAT (therapist) but I've had lousy ones and also had drugs pushed at me by family physicians that presume to diagnose a psychiatric problem, unasked for. [Where the hell do they get off?] As one therapist told me, the real work is done by you, not them. Some of us are better without their "help." Just keep tabs on yourself.
posted by Listener at 10:08 AM on December 13, 2006

This workbook is excellent and used by many therapists and doctors. Its written for a lay-person with lots of exercises, none of which involve suggestions for stamp collecting or reading children's poems.
posted by damn dirty ape at 10:08 AM on December 13, 2006

If you're like me at all, and fall into bad habits with lack of structure, perhaps integrate some daily practice of coping mechanisms into your daily routine. Make that one of the "bare basics." I happen to print a things-to-do list every day from outlook, and it has "daily" items including 30 minutes pleasure reading, vitamins and flossing on it. This helps me a lot.

This is a book my therapist of old introduced me to, containing strategies for reducing and processing panic better. If you took to CBT for depression at all (and I can't profess to know what that is like, having anxiety sasns depression for the most part) you may enjoy having some tools/exercises like the ones in this book at your disposal for anxiety management. I find them a revelation, but they take practice in order to remember you have them, in those troubled moments.

Also, take a big, burly, B-vitamin complex. I am very impressed with the way this alleviates stress for me. It totally obliterates any anxiety/depression that used to plague me as a result of drinking alcohol.

on preview: yeah right on, ape.
posted by Ambrosia Voyeur at 10:23 AM on December 13, 2006

Hi, tastybrains. I, too, have pretty bad anxiety and slight depression that both run in my family. The anxiety isn't crippling; it's just constant and, like most biochemical disorders, isn't logical. I've repeatedly tried therapy and a few of my therapists have been good, but most haven't been very helpful. So I quickly get fed up with them. I consider myself a very (to a fault, even) self-aware person, and so I rarely got things to think about after a session. So my pattern is to go to a therapy until I don't find it useful, stop for a while, and then consider going again just because I'm not feeling well and I want a solution. The last time this happened, my husband said to me, "I think you just want a friend." And I think he's right. I don't think a therapist can provide me with what I'm looking for. I'm a woman in my mid-20's and I think I just want a better sense of who I am. I don't think a therapist can give me that.

I've also been on anti-depressants for a few years, but recently I stopped taking them. I didn't like the side effects, and I don't like the thought of what they do (or could do) to your body in the long-term. I've been taking fish oil capsules, which really elevated my mood at first. The effects have kind-of worn off at this point, but I'll keep trying. Also, I recently read a book called "Depression-Free, Naturally" and found it really inspiring. The author believes all depression and anxiety are rooted in chemical inbalances, but instead of fixing the imbalance with anti-depressants, she thinks they can be fixed with vitamin and mineral supplements. She recommends a formula for anxiety that I haven't tried yet, but look forward to trying soon. Best of luck to you in dealing with this, and please feel free to email me if you want to talk about it.
posted by lagreen at 10:44 AM on December 13, 2006

I don't believe it is unreasonable to try to get by without a therapist. But be aware of your own state of mind, and if you need outside help have mechanisms in place to get it easily. Know where substance abuse meetings or other recovery groups meet, even if the specific subject does not apply to you. Have someone to call.

Taking classes is a great way to put your time and energy towards something positive. Just sign up and go. When I sign up for a class I always feel compelled to attend even if I would really rather just mope around the house. You might even meet people with similar interests.
If there is a Community Center in your area, they usually have lots of stuff to do, and are usually very non-threatening.

Dance to music. Shake your groove thang.
posted by bobobox at 1:12 PM on December 13, 2006

You can't just give up after not liking one therapist, you often have to try several to find one that works for you. Your married status was supposed to give you more insurance options so why are you bailing so quickly? Your particular baggage is stuff that needs talking out, not a vitamin b or a nightclass (though these are good things!) and... and I'm siccing T on you, prepare for a nagging.
posted by zarah at 4:57 PM on December 13, 2006

Feeling Good and The Feeling Good Handbook do great things for me when I do them. That said, i still take Zoloft and see a psychologist.
posted by callmejay at 9:01 PM on December 13, 2006

So...do you think it is unreasonable for me to try & continue to work on my depression & anxiety on my own?

In a word? Yes. While I commend you on the things you're doing to deal with your depression, I share the concern of a previous commenter. Can you sustain your self-care regimen on your own?

I will say that I think your current therapist sounds like a flake. If my therapist started reading me a story about an apple tree, I think I'd start doubting the efficacy of therapy as well.

I know that finding a new therapist is difficult - I just went through the process a few months ago, and for me, that was much harder than actually going to therapy. (So was starting therapy in the first place. I talked about it for months before actually going.) But I think therapists are like friends, lovers, and depression medications - they are not one-size-fits-all.

I'd recommend setting up appointments with a few therapists. Think of these appointments as an opportunity for you to ascertain whether or not you think one of these therapists can help you meet your goals. If someone starts talking about apple trees, book it, and move on to the next.
posted by rikhei at 7:22 AM on December 14, 2006

zarah wasn't kidding about siccing someone on me, I came home after work to get an earful...ok an eyeful...on IM. That said, I really appreciate all of the responses and advice here, both those for & against & neutral to the idea of my continuing therapy. I really appreciate the book & website & action recommendations, and I plan on trying to incorporate many of these into my life as I continue to work on myself.

Nutty McAppleTree had scheduled a follow-up appointment with me before I escaped her clutches yesterday, so I've decided to write down a list of things I need from her and things I do not feel would be helpful, and I will go to this appointment to give her one more chance to see if there is any possibility of this working out. I suppose everyone has off-days. If she acts even half as nutty this next time, though, I will start shopping around yet again. However, because it takes so long to find a new therapist and get a first appointment anyway, I think I will have to be somewhat disciplined in taking care of myself anyway, so the advice in this thread will NOT go to waste.

I've ordered a couple of recommended books and am going to take some time during the holidays to read and reflect and continue to work on myself. So, thanks again!

I really wish I could mark every answer here best answer, because I am really touched at how thoughtful, helpful, and totally on topic every response here has been. However, I had to stop myself from doing that.
posted by tastybrains at 11:56 AM on December 14, 2006

A good therapist will want to work with you to help you get what you need, so that sounds like a good step.

Good luck with whatever you end up doing!
posted by occhiblu at 12:01 PM on December 14, 2006