Too paralyzed to seek help for depression

July 25, 2007 7:11 AM

I am in desperate need of psychological help, but the task of finding a therapist/psychiatrist, going to appointments, and obtaining a prescription for antidepressants seems completely insurmountable.

I'm not on the verge of suicide, but I suspect that if I let my depression go untreated, that's where all this is headed. Nothing feels like it's worth my time, and most of my energy is devoted to erasing a look of utter hopelessness, worthlessness, and dejection from my face. Everything I do is strictly out of a sense of obligation, but even that is falling apart: I've decided to call in sick to work tomorrow, but I'm not sick; I've stopped feeling like I need to be nice to my few friends; sometimes I feel so low I can't get off the couch to make myself dinner; etc.

I've hinted at my permeating sense of hopelessness and despair in one or way or another to a few friends, and, bless their hearts, they hear me out, but I don't think any of them really get how hugely serious this is. It feels too dramatic to say, "Every night as I fall asleep, I think to myself over and over again, 'I'm worthless, I only make mistakes, there's no space in the world I want to occupy,'" and too selfish to say, "Therefore, take care of me right now." I'm also afraid of what they'd think of me, and the people they might gossip about me with.

I know what the route is to getting better, but I can't conceive of picking one therapist out of all the therapists in my area, or getting myself to go to the sessions. Figuring out all the little logistical details, like payment, is scary. I don't know where to start, and I won't know what to do once I've started. The whole task literally seems impossible.

All that for this simple question: What can/should/do I do? I've made an email account for your answers, which I would appreciate immensely: [e-mail]

posted by anonymous to health & fitness (21 comments total)

If you posted some details concerning your geographical location, I am sure someone here could help identify one or two therapists that you could just pick from. As I understand it, the logistics w/r/t to payment and such fall into place rather quickly, and making that first appointment will feel like a rush of relief.

Email the admins and ask someone to at least post your zip.
posted by xmutex at 7:35 AM on July 25, 2007

I e-mailed you, Anonymous. Please feel free to e-mail me your general location to post here.

Your primary care doctor is a good resource for getting an antidepressant prescription and also for recommending a therapist or a psychiatrist. They may even be able to give you a referral and set up the appointment for you.

Sometimes getting on antidepressants from your primary care doctor is a good first step in feeling better enough to take on finding a psychiatrist and/or therapist.

Assuming you are in the US and have health insurance, you can also call your health insurance company and talk to a general customer service rep. You should ask

(1) What specific mental health coverage you have
(2) What you are required to do in order to take advantage of your mental health coverage (e.g. referral from your primary doctor, etc), and
(3) A list of local therapists and psychiatrists who are covered under your plan. They should even be able to narrow the list down based on gender & specialty.

Good luck & do not give up - you *can* feel better.
posted by tastybrains at 7:44 AM on July 25, 2007

xmutex is totally right. As soon as you get your location up there, folks will be able to help you find services.

The logistics of all this can be really scary, but you will see that when you walk in somewhere (a clinic, a therapists's office, etc.) and say "I need help," you really will get it and most of the time people really walk you through the steps. Very few people who are in dire need of these services march in and proclaim that they are ready, excited and have the emotional and financial resources to deal with whatever is confronting them. So, really, you are in a place that is familiar to most agencies. So don't let the logistical stuff hold you back. It will get dealt with.

Do you have a friend that you can confide in who can provide some emotional support and encouragement? When you feel this way you cannot hint-- your friends can't be expected to intuit what you mean. You have to say, "I am incredibly depressed and very scared. I really need you right now." If they hear that and they are good friends, they will step up and be ready to help you out with some of the scarier steps. Even getting a ride to your first appointment is a HUGE help in these situations.

Good luck.
posted by sneakin at 7:51 AM on July 25, 2007

"Assuming you are in the US and have health insurance..."

Even if you don't have insurance there's likely a community mental health clinic in your area that will provide services on a sliding scale.
posted by bdk3clash at 8:06 AM on July 25, 2007

Ask a trusted friend who is sensible, clear-thinking, and reliable to help you get help.

Talk through the whole process with them, breaking it down into component tasks. Figure out what they can do (calling for appointments? coming to the first visit with you?) and what only you can do. Make a date to check back in to make sure you're getting your parts done.
posted by ottereroticist at 8:46 AM on July 25, 2007

I have three words for you: walk-in clinic. When you feel like you are ready to help yourself, walk in and see if you can get a doctor there to help you find resources in the community. You can also get some antidepressants. That way you don't have to deal with appointments and picking and all of that crap until you've already got some basic help. Good luck

PS - I will tell you that I put off that trip forever, and when I got there I almost turned around and walked out of the walk-in clinic parking lot. I'm glad I went through with it.
posted by crazycanuck at 8:48 AM on July 25, 2007

Anonymous e-mailed me to let me know they are in the Austin, TX area, in case anyone has any more specific recommendations.
posted by tastybrains at 9:01 AM on July 25, 2007

I might be out of line here, but why don't you google a mental health hotline in your area? I could be wrong, but I don't believe they require you to be on the brink of jumping before they'll help. I am pretty confident that if you call and explain just what you stated here, they will have the compassion and care to be able to get you in a low-or-no-cost clinic TODAY, and that the individual you see there will have some social work experience to help you quickly and easily find the right resources immediately. You're right, it is INCREDIBLY hard to get help when you are feeling so low and so awful about yourself, and the obstacles always seem impossible, but just by being brave enough to take a step here you are moving in the right direction.

(If I'm reccommending an inappropriate use of a resource by suggesting to call, I apologize).
posted by bunnycup at 9:03 AM on July 25, 2007

I would start here, probably with the Community Mental Health link in the sidebar. They are sure to offer free or sliding scale services, or be able to refer you to a place that does.

Anonymous, if you are affiliated with a university, that is good news. You can usually get free care. If you aren't, you still might be able to. Oftentimes if you agree to fill out a survey once a year you can get X number of free visits. It is worth calling UT Counseling & Mental Health Center and asking about your options if you are not at the university.
posted by sneakin at 9:12 AM on July 25, 2007

Been there, done that. Recently.

That first step seemed so huge. like crazycanuck, i put that first one off for at least a year. The path I took consisted of going to a walk-in clinic, where I was given a prescription for an anti-depressant (paxil), and a referral. I was barely able to get out of the car, but I knew that if I didn't go in then, I probably never would. The whole anxiety thing was making it very difficult. in fact, I was on the paxil for about a month, before I felt good enough to actually make the appointment for the referral. It definitely paid off though.

It looks like you have 211 available in your area, which is a hotline set up specifically set up to point you in the right direction in cases like this.
posted by ArgentCorvid at 9:33 AM on July 25, 2007

As you already know, depression can paralyze you, making it hard for you to decide even simple things. Your situation is serious - you need to do something NOW, out of an obligation to yourself. I could imaginge that even trying to decide what to do with all this advice might seem like too much.

My advice is don't try to decide what to do next by yourself. Pick a friend and borrow their non-depressed problem solving abilities. Print out this thread. Say "This is me. Help me take the next step." Let them make the phone call, take you to the appointment.
posted by metahawk at 9:50 AM on July 25, 2007

Take a look at this thread and, hell, just call someone who looks like they have a nice face. Or Google around to read about them. They or their office should walk you through the rest.
posted by xmutex at 10:36 AM on July 25, 2007

does your employer have an "employee assistance plan" (aka "EAP"). some companies do, and it's a helpful way to at least start bootstrapping up. my SO had similar levels of paralysis for a while, wanting to get help but incredibly overwhelmed with the need for activation energy to bootstrap up. (need a prescription, but need a primary care physician, but need a health insurance card, but ... etc)

if you can outsource some of the ability to deal to a friend, that might help. even just talking about what steps you can take might help.

it can seem overwhelming, but one thing i've found that helps is breaking things down into progressively smaller steps. "find a therapist" is a huge task. maybe "look up the numbers for one or two therapists" is a more achievable task, followed by "make one phone call".

good luck with it.
posted by rmd1023 at 11:00 AM on July 25, 2007

"I've decided to call in sick to work tomorrow, but I'm not sick."

Actually, you are. Don't get caught up in guilt about taking the sick day - those are for you to use when you're sick, which you are.

Whatever you do (GP, hotline, walk-in clinic, etc.), do it as soon as possible. Take the first step, and things will happen from there. Don't worry about insurance issues, follow-up appointments, or anything else. Just take that first step, get others involved, and let them know exactly how you're feeling. Don't worry about "erasing a look of utter hopelessness, worthlessness, and dejection from [your] face" - you don't need to keep up appearances when you're seeking help for this kind of thing.

Finally, if someone tries to brush you off (doesn't take you seriously, doesn't believe you're depressed, etc.), go someplace else. Keep seeking help until you get help that is helpful for YOU.

You can do it...many have been where you are, and we've made it through. You will, too. I'm rooting for you!
posted by splendid animal at 11:03 AM on July 25, 2007

I'm going to address one small part of your question as others have already covered some of the appointment making aspects.

I get the impression that you have not been eating much, and probably not getting the best nutrition in what you do eat. Go to the store today and buy yourself some nutritious food that is easy to prepare. Specifically, if you have been eating a lot of junk food, you have probably not been getting much protein, and this will contribute to a lack of energy. If you can't manage anything else, get some powerbars and fresh fruit.
posted by yohko at 12:40 PM on July 25, 2007

If you're too depressed to figure out how to see a shrink, do something small first to get yourself less depressed. Like go for a walk, listen to your favorite upbeat song, and then start thinking about how to go about the therapy.

If your life is OK except for your depression, that means you probably have a car. Use it to join a group that engages in fun, OUTDOOR activities. Spend as much time as you can outside, even looking up at the sky. You will feel both happier AND calmer. Light therapy has been shown to be as effective as popping pills. I use an Apollo GoLite in the winter, and sometimes on rainy days.

Every night as I fall asleep, I think to myself over and over again, 'I'm worthless, I only make mistakes, there's no space in the world I want to occupy,'

Try Mike Brescia's CD, Freedom from Depression Now. (He has an Internet site.) Every night as you fall asleep, it will remind you over and over again that you are NOT worthless, you can learn from your mistakes and there is plenty of space for you in the world. It may not work miracles, but it will you feel better by putting these kinds of encouraging thoughts into your head. Plus it's cheap.
posted by serena15221 at 1:55 PM on July 25, 2007

To second what has already been said...your primary care physician can prescribe an anti-depressant for you. Being in the exact same boat just a few weeks ago, I found it much easier to make an appointment with someone I knew, in an office that was familiar to me, than to show up at a walk-in clinic, or to try to wade through the system to find a psychiatrist or therapist. I also made a list of all my symptoms, which I just handed to my doctor, so there was no fear of downplaying my feelings, or of breaking down crying. New favorite word: anhedonia!
posted by saratravels at 1:59 PM on July 25, 2007

I agree with everyone who said to enlist the help of a friend. I found it horribly intimidating and humiliatng to go to my GP for help with depression, but I had two people who helped me immeasurably. One was a work colleague who had previously been prescribed antidepressants and had been tremendously helped by them; she sat by me while I made the phone call to make my appointment. I'd been putting it off. The other was a friend who drove me to the appointment, waited for me and drove me home again afterwards.

Five years later I'm on an even keel; I wish the same for you. I've been there and I am so much better now. It can be done. Good luck; all the best to you.
posted by andraste at 8:34 PM on July 25, 2007

Every night as I fall asleep, I think to myself over and over again, 'I'm worthless, I only make mistakes, there's no space in the world I want to occupy'


Oh boy, I know what that's like. It's shit.

If you can, try saying to yourself, over and over, "I am worthwhile, and I am worth looking after."

Because you ARE.

I say this to myself a lot, and it does pull you back from the abyss.

You know by now from reading this thread that you have a number of options. My only advice would be to see these things you are afraid of (making the call, going to the appointment, taking the meds etc etc) as individual hurdles. It's not one big undifferentiated lump.

Once you start breaking these things down into smaller bits, you can them tick off as you go. This will help you understand you are making progress towards getting better, and it will also help you feel less overwhelmed by that great big undifferentiated lump of 'stuff' that is scaring you so much right now.

Good luck.
posted by gerls at 10:49 PM on July 25, 2007 [1 favorite]

Make the appointment with your doctor. Get some antidepressants and start exercising.

Fuck the world. Fuck everybody who has ever caused you pain. They're not going to keep you down.
posted by LordSludge at 10:59 AM on July 26, 2007

Also look into support groups - they can be an invaluable resource. It's heartening to know you're not alone (when you go to a group, or in this thread, of course), and that can sometimes give you a boost, energy wise, to get some sort of help.

Rooting for you and hope everything turns out ok...
posted by rmm at 10:08 PM on July 27, 2007