My heart is breaking, and I don't know why

December 27, 2007 12:15 PM

How do I deal with this overwhelming sadness that has no apparent cause?

I've been depressed for years, probably most of my life. Usually when it was at it's worst, the main symptom was complete apathy and a great desire to sleep most of the day. I've been very happily stabilized on antidepressants for the past 5 or 6 years.

My meds stopped working this summer, and I just started on nortriptyline about 4 or 5 weeks ago. When I was first starting on them, I had random, unprovoked crying spells, but this is... different.

I had started feeling like I could see the glimmerings of the old me coming back just before Christmas. But it hit me about mid-morning today that I feel utterly bereft and heartbroken, with nothing particularly to be heartbroken about. I'm happily married, I have an adorable dog, and I generally like my life. Okay, my job is making me miserable, as past questions show, but this level of sadness is far beyond what one would normally attribute to their workplace. It's the kind of sadness I've felt when grieving the death of someone I had loved.

If I had something to be sad about, then I could work my way through the grief. But in my vast arsenal of coping strategies, I don't seem to have any to help me deal with 'feeling sad with no reason'. Somehow it's just never happened before.

I have an appointment to see my doctor in two weeks, and I've signed up for face to face counselling, but that will probably not start any sooner, and possibly later. It seems frivolous to make an emergency appointment for extreme sadness, but I will if I have to. (An emergency appt at the GP, that is, not going to the emergency room) I've been off sick a lot from work lately, and I'd really like to stay functioning if at all possible.

Has anyone dealt with this before? Any strategies to help me get through this?

(Because most doctors and counsellors would ask at this point--no, I'm not thinking of hurting myself.)

posted by happyturtle to Health & Fitness (29 answers total)

Best answer: Can you call the doctor who prescribed your medication, and ask if it's okay to up your dose? I know nothing about nortriptyline, but when I was on an antidepressant for PPD and then got some really bad news, my doctor talked to me on the phone and told me the new dose to take to get me through the worst of it.
posted by The corpse in the library at 12:21 PM on December 27, 2007

Have you seen a therapist before?

Meds did not help me in the slightest and so I was switched from drug to drug for a while. Still, nothing.

Then, I found a therapist I liked. We worked through things, I changed some things about my life, and have been a much happier person for it.

Prior to that my depression sounded like your current situation (having an alright life with nothing to be depressed about). So, if you have not seen a therapist before, or have clicked with any of your prior therapists shop around.

All the best.
posted by munchingzombie at 12:23 PM on December 27, 2007

Response by poster: I've had therapy before, but it's been a long time. Until the med failure this year, I've just felt like a normal person who happens to need to take a pill every day, and I didn't have anything in particular to discuss with a therapist. My username was completely appropriate, as I genuinely felt happy most of the time.

(I don't want to change my name to sadturtle!)
posted by happyturtle at 12:28 PM on December 27, 2007 [1 favorite]

Studies show that a combination of meds and therapy provides the best results for combating depression. The therapy is a great idea. And if I were you, yes, I would schedule the appointment with your doctor for sooner. Call them up and tell them you can't wait.

As far as help in the mean time, force yourself to do some physical activity. Take the dog for a walk. That is the only thing that has help me. I feel for you, I have been there.
posted by Silvertree at 12:35 PM on December 27, 2007

Try to find a therapist that helps. You don't feel like there's anything wrong, but you do think there's something to fix. A therapist you click with will be able to find that (and will also bebe better suited for med prescribing/suggestion.)

And just like you'd switch pills if the ones you are taking don't help, do the same with your doctor. Find one that fits your needs. It's not always easy "breaking up" with a person in that situation (or for me, talking to a therapist to being with), but you owe it to yourself to not be a sadturtle.

Good luck.
posted by MCMikeNamara at 12:39 PM on December 27, 2007

I would also suggest calling your doctor to ask about dosage -- if you've been with this DR for a while, then s/he should be able to help you address the dosage without bringing you into the office.

Therapy is almost never a bad suggestion, and you might be surprised at what you turn up while talking. But it sounds like you felt pretty stable and the only real change has been your meds, so it seems likely that maybe you just haven't found the "sweet spot" for the new one yet.

Best of luck to you. I live with this, too, and it can be rough sometimes.
posted by dryad at 12:39 PM on December 27, 2007

bebe = be
being = begin

Other than that, my advice remains the same :)
posted by MCMikeNamara at 12:39 PM on December 27, 2007

Response by poster: As far as help in the mean time, force yourself to do some physical activity. Take the dog for a walk. That is the only thing that has help me. I feel for you, I have been there.

Walkies are doing a great deal for the dog, and nothing at all for me. I've actually increased the length of her walks over the past few weeks. I've not noticed any difference in myself, either positive or negative from the extra effort.

Try to find a therapist that helps. You don't feel like there's anything wrong, but you do think there's something to fix. A therapist you click with will be able to find that (and will also bebe better suited for med prescribing/suggestion.)

I don't know how much choice I will have here. I called my company's Employee Support Programme, and they said my employer covered face to face counselling and that someone would call me to schedule an assessment, but they didn't know how soon because of holidays. I've never used this program before, so I am not sure how much choice I will get over the therapist.

I will give my GP a call to ask about dosing.
posted by happyturtle at 12:59 PM on December 27, 2007

i would go ahead and make that emergency appointment. even though *this* sudden mood change doesn't appear to be dangerous, there might be another change coming that could be.

you should always tell your doctor about sudden, dramatic mood changes. call him or her now.
posted by thinkingwoman at 1:04 PM on December 27, 2007

For me, fighting the sadness seems to make it worse. Paradoxically, it helps if I relax my body and dwell in the sadness for a few minutes -- but just sad feelings, not the thoughts that want to bubble up as well. Saying to myself, "I feel like a weight is on me, my chest is tight..." can actually crowd out thoughts like, "I'm such a bad (whatever) and my life is a total (fill in the blank). At least for a little while.

If you get tempted to think, "Other people have real problems, and I have nothing to feel sad about..." remind yourself that depression itself is a very real problem. The meta-depression can be even more debilitating than what you started out with.

One thing that might do more for you than an emergency MD visit: anything physical, especially if you concentrate on what your body is doing. Everybody tells you to exercise, but shelving books, washing dishes, pushing a cart around the supermarket can offer a respite if you use it to focus your mind on just what's happening right now.

I really wish you well. The two weeks will feel like a long time, but if you're able to stay in the moment to any degree, you'll benefit. I know, it's much easier said than done.
posted by wryly at 1:10 PM on December 27, 2007 [4 favorites]

The obvious suggestions to me is that first, you may be on the wrong medication (antidepressants aggravating/complicating depression is far from an uncommon effect) and second that you are under-estimating the impact your work problems are having on you. I don't know how things run where you are but in your position (I've been medicated for depression in the past, but not for several years) I would be trying to get a referral to a psychiatrist. Personally I feel the trend of GPs prescribing drugs for mental health is questionable. I think the attention of an expert in the specific problem is worthwhile, particularly if your medications are giving you problems.
posted by nanojath at 1:15 PM on December 27, 2007

Oh, in your position I'd also quit my job, but I understand there is an "unfinished business" aspect. And that you've gotten that advice a lot. Even so.
posted by nanojath at 1:16 PM on December 27, 2007

Do get some exercise-walking for an hour at a time would be perfect. And do get out in the sun as much as you can. Get a bottle of B vitamin complex-also some fish oil tablets. Try not to overindulge in sugar and simple carbs.

One thing I used to do when that depressed was to journal. Getting out as much of what was inside as possible. Also, writing prayers to God, the more honest the better, seemed to help as well.

And call your GP NOW.
posted by konolia at 1:18 PM on December 27, 2007

(browsing past archives indicates that the GP/psychiatrist issue is complicated and that I don't understand the UK health care system... sorry)
posted by nanojath at 1:25 PM on December 27, 2007

If I had something to be sad about, then I could work my way through the grief. But in my vast arsenal of coping strategies, I don't seem to have any to help me deal with 'feeling sad with no reason'. Somehow it's just never happened before.

I have struggled with depression (at times major) for most of my life, and am a great proponent of medication and talk therapy. So all that follows is not a suggestion to forego your meds or the counseling. By all means, pursue them.

However:

In recent years, I have found -- counterintuitively, it initially seemed -- that there is some real solace to be found in the buddhist principle of accepting suffering as a basic fact of life. Sometimes there is a clear trigger for our pain; sometimes we hurt for no discernable reason. There are moments where the heart just aches, on account of it being the heart. It doesn't actually mean there's anything wrong with you.

We live in a society in which Happiness-with-a-capital-H is held up as the gold standard of existence (I think it's analogous with the level of beauty that's held up as the gold standard of physical appearance, and which is so unattainable by definition that even the supermodels get airbrushed in their photos!). With apologies to Elvis Costello, we are constantly exhorted to get happy! no matter what we have to buy, drive, eat, implant, have sex with, or give birth to in order to get there. We are inundated with endless advertising, celebrity gossip, and the beep-beep-beep of a hypertech world.

Sadness untethered to an actual "event" (the end of a relationship, for example) to supposedly give it meaning and to "allow" us to feel it has no place in such a world. It's seen as a failure or a weakness -- certainly not as something that comes part and parcel with being alive. It flies in the face of our social/cultural expectations that there is always an answer/solution to feeling unhappy. Change jobs! DTMFA! Lose 50 lbs.! Have kids! Buy a time-saving gadget! Gaze upon sunsets and reflect on your luck at being alive!

But while sometimes these might be perfectly good solutions to particular situations, other times there isn't any solution. This isn't to say that we should all bone up on our playing-chess-with-Death skills and settle in for the long, cold winter of the rest of our dreary fucking lives; it is, instead, to make the suggestion that you invite the sadness in for a little bit. Don't make any assumptions about it. Make no judgments about the feeling or -- more importantly -- about yourself. You are not a failure, you are not bad, you have done nothing wrong. Let the din of the outside world fade. Just sit there, and observe simply: "this is me, just feeling sad." Breathe slowly, softly, comfortably. It's just you. Feeling sad. Feelings come and go. This feeling has come, and will one day go, too.

In the meantime: keep walking the dog. (And when you go on walks, don't necessarily expect to "feel better." Just use it as an opportunity to observe the world around you: "Those clouds are moving fast. The sun feels nice on my face. The dog is really freaked out by that new garden gnome next door. There are three girls riding yellow bikes halfway down the block.") Find out if you can see your doctor sooner. Eat as well as you can (when I'm feeling down, I always reach for lots of fish and fresh vegs). And maybe pick up a copy of When Things Fall Apart.

I wish you all the best.
posted by scody at 1:36 PM on December 27, 2007 [38 favorites]

could it be somewhat physiological - more specifically related to the lack of light - in other words, ">Seasonal Affective Disorder?

It might not be the source of your sadness, but perhaps it is contributing to it...

wishing you all the best...
posted by bitteroldman at 1:39 PM on December 27, 2007 [1 favorite]

I also say get an actual psychiatrist, not a GP, to monitor your prescriptions. In the meantime do what you can to break your mood. Sometimes what helps me is having a deep, from the bottom of my guts, uncontrollable cry. I lay down on the bathroom floor because I feel safe there and sob for an hour. Then i get up and listen to some Fingertips-era Stevie Wonder and feel better.
posted by Sara Anne at 1:41 PM on December 27, 2007

I've struggled with the same problem and I would agree with the suggestion that you may need to switch meds. In the meantime, I know you say that walking your dog doesn't do much for you, but is it possible at all to get some more strenuous exercise than walking? When I was depressed, I know it was hard enough to get out of bed just to walk, but when I did that, it didn't work for me either. When I go to the gym and run on the treadmill or actually do something that gets me huffing and puffing, I really do feel a difference.

If it turns out that your company won't give you much choice regarding a therapist, you can always go see one on your own and pay out of pocket. Don't know if this is an option for you, but if it is you may want to have a look at this site. Even if you go for one or two sessions, it may help until you're able to see the one that your GP has referred you to.
posted by triggerfinger at 1:42 PM on December 27, 2007

I will say that when I had similar symptoms, Wellbutrin took care of it for me.
posted by ShooBoo at 2:54 PM on December 27, 2007

Nortriptylene can make things worse. Much worse. It may be doing so for you. Ask your doctor about this.
posted by foxy_hedgehog at 3:10 PM on December 27, 2007

I've struggled with depression for a long time and I've experienced what you describe. What I find cathartic is watching silly movies where the good guys win with a lot of adversity. I'm talking like Eight Below here. Or like The Natural, I just sob like a dumbass when the ball hits the lights. Then I laugh at myself and everything seems better.

Things are going okay for you, maybe a litte controlled unhappiness is what you want.
posted by fleacircus at 3:45 PM on December 27, 2007

I suggest vigorous exercise (weight lifting, running, what have you) to get those happy hormones flowing. Also, I recommend staying VERY busy from now on. Set some relatively short-term goals and dive right in.

Whatever you do - stay busy, busy, BUSY!
posted by survivorman at 4:18 PM on December 27, 2007 [1 favorite]

I had depression from a very small age and an anxiety disorder for half of my life, so I really understand where you're coming from in wanting to get rid of this persistent feeling.

For me, I finally went on meds for about two years, but I kept having to be switched to different ones or having them increase the dosage because it would stop working every few months. I'll never know how much of the medication actually helped me cure my depression.

I finally got rid of the depression when I moved out of my parents house, went through cognitive behavioral therapy to help my anxiety, got off the meds, and started eating fresh foods, mostly unprocessed foods. Light exercise also helped a bit. In the end, it turned out that my life was a lot shittier than that I realized, and that I had real reasons to be depressed.

I still get depressed sometimes, but I feel like I have control over it if I just accept that sometimes I'm going to be depressed for a little while, something like what scody said.

I consider myself in "maintenance" mode and feel like it's healthy to accept the sadness for that reason, but you don't sound like you're in that stage, and I think it may be better for you to really objectively think about how your life is. Are there many things that you're simply accepting because you think you have no other choice? Alot of my depression had to do with perceived or real lack of control. I had to change and improve the situations to find happiness.

I'm not sure if our situations have any similarly, and I can only offer advice from how my own battle went. I wish you the best of luck.
posted by fan_of_all_things_small at 4:19 PM on December 27, 2007

You should really check out this recent blog post from dooce.com about struggling with depression, it provides amazing perspective. Also I just got a light box to help with winter blues, it helps an insane amount.
posted by pwally at 4:33 PM on December 27, 2007

It sounds to me like you have the larger situation in hand and are looking for a way to sit out the next few weeks. Personally, I find old movies do the trick wonderfully: I own the entire Fred & Ginger collection on DVD for just such purposes. Some of my female friends swear by sobby chick flicks, although with those I usually end up just yelling at the protagonists ("Damnit Darcy, just tell her how you feel!")
posted by tkolar at 5:52 PM on December 27, 2007

I second scody's recommendation of Buddhist practice. This set of talks on releasing emotional reactions describes practices which I have found very helpful. They have a lot in common with wryly's suggestion of "dwelling" in the experience of the sadness.
posted by Coventry at 7:50 PM on December 27, 2007 [1 favorite]

Response by poster: It's morning here, and as usual, I feel significantly better in the mornings. But I can still feel the sadness underneath waiting to strike, so I'll take everyone's advice and call my GP. Thank you.
posted by happyturtle at 12:06 AM on December 28, 2007

Response by poster: Just a followup: I called my GP, and he agreed to up the dosage of my antidepressant. Then later when I was talking to my mom about the overwhelming sadness, she said she felt that way for years, without knowing it was depression. Years! And I'm worried about how I'm going to get through a couple of weeks.
posted by happyturtle at 2:23 PM on December 29, 2007

Happyturtle, I'm glad you talked to your GP! I hope the change in dosage will help. There's lots of us wishing you well.
posted by scody at 11:17 PM on January 2, 2008