Lots of little questions about depression

April 8, 2008 2:28 PM

Help me decide how to treat my depression

I’m a late 20s grad student in my final year of my PhD. In addition to being single and poor, I am also suffering from constant anxiety about finding a post-doc before the end of the year (when my funding runs out). So since about December 07, I’ve been generally tired, less excited about stuff (including work) and worry if I will end up as an over educated barista in 2009. These are clearly symptoms of anxiety and depression.

I need help deciding whether or not I talk to a doctor and go on anti-depressants. Two thoughts here:

a) Part of me thinks that these are all not just in my head. I mean, I really am poor (can’t change that till I finish my doctorate), post-docs in my field are scarce (everyone recognizes it) and being single (which I don’t blame on anything) is not exactly helping. In fact, if I didn’t worry under these circumstances then there really would be something wrong with me (or so I rationalize). Should I just hang in there and ride it out?

b) A second thought I’ve had is just to go to my GP, describe above mentioned symptoms and get a prescription. If it works then great. And if not, I did explore a logical option and I can rule that out. Two worries here:

i. I generally don’t take any prescription meds. In the past 10 years the only prescription I’ve had is for seasonal allergies. Does this go on my permanent record something (that I took anti-depressants?) For example, could this somehow play a role in preventing me from becoming a faculty, making tenure, or reaching some otherwise prestigious position?

iii. If depression is so common these days and it’s really not such a big deal to take meds, how did people deal in the past? Were there just loads of unhappy people that just had to deal? or were people happy in general because they didn't have the kinds of pressures we have now?

Other random info: I eat healthy, exercise infrequently [of late], and have pretty decent health coverage.

Sorry for the barrage of questions but I have no one else to ask. Thanks!

posted by anonymous to health (25 comments total)

If you are depressed then you are not really going to be able to reason this through clearly and make the best decisions for yourself. Talk to your doctor or a therapist, answer their questions and let them help you. Best of luck!
posted by bonheur at 2:39 PM on April 8

Wait a second. Meds vs. not meds is not your only option here. There's talk therapy, meditation, exercise, dietary changes, and a whole host of other things that can reduce anxiety and depression.

I think you're correct in that anyone in your same circumstances would be stressed. Perhaps look into some form of stress management before you go all the way to anti-depressants - especially considering the side effects. Note that I am NOT anti-medication - I take Klonopin as needed for anxiety - but I also do other things to mitigate the impact of stress in my life.

Medication won't go on your permanent record or prevent you from pursuing any kind of academic career. Perhaps you'd have a valid concern if you wanted to be a pilot, but that's the only profession I can think of where they might care at all these days.

How did people deal in the past? I look at my grandparents, who grew up in the Depression, fought in WWII, raised six kids, and owned their own business. There must surely have been many stressful times. They had their faith, for one thing, and they also kept busy, all the time, instead of sitting around worrying about stuff.
posted by desjardins at 2:39 PM on April 8 [1 favorite]

I should mention that I've tried Zoloft and Cymbalta, and while YMMV, the side effects were worse than the panic attacks for which they were prescribed, thus my recommendation to try other things before resorting to medication. Whatever you're prescribed, you'll have to take it for at least a month to see if it works, and meanwhile you'll have to live with the side effects in addition to the anxiety and depression you already feel.
posted by desjardins at 2:42 PM on April 8

First off: Meds aren't the only way to deal with this. There's a reason we have medical professionals to figure out what treatments; you may not need meds. Or maybe you do! Go talk to a doctor, or therapist; your goal is to feel better, which may be accomplished by any number of means.

I generally don’t take any prescription meds. In the past 10 years the only prescription I’ve had is for seasonal allergies. Does this go on my permanent record something (that I took anti-depressants?) For example, could this somehow play a role in preventing me from becoming a faculty, making tenure, or reaching some otherwise prestigious position?

Assuming you're in the US: This is exactly why things like HIPAA exist. To simplify - but not much - there's basically no way your employer could find out, even if they wanted to. I know a lot of people in 'prestigious' positions who've taken antidepressents - more than one of whom, in fact, was just accepted to a very well-considered doctoral program and has been on them for years. It's obviously part of your medical records, so that doctors - who are confidential - can say things like "ah, yes, you're on $ANTIDEPRESSANT, better to go for this treatment instead of that one to avoid weird interactions" - but that stuff's very strongly locked away from anyone who isn't treating you.

A certain amount of disclosure may be necessary for, say, life insurance, but 99.99% of the time, employers are absolutely barred from even trying to access medical records.

(And if anyone asks in a job interview, you can sue the living daylights out of them for it.)

Were there just loads of unhappy people that just had to deal?

Basically, yes.
posted by Tomorrowful at 2:43 PM on April 8 [3 favorites]

Well, as far as why depression is more of a big deal these days, we absorb more data now than our grandparents could ever dream of dealing with. Also, we live in a society full of airbrushed models and worship the ideal of perfect parenting, consumerism, and global consciousness; who doesn't feel stressed by the responsibility of trying to be perfect to be accepted?

Having dealt with depression on and off my whole life (both triggered by outside stresses, such as money, and self-esteem issues), I can tell you that what worked best for me was Cognitive Behavioral Therapy along with self-hypnosis.

Also, when I committed to working out on a regular basis, I felt my anxiety (long after I'd stopped therapy and medication) was better under my control. If you physically manifest stress, i.e., have back or stomach pain or stress headaches, one hour of cardio per day may very well be all you need.

Your medical records can be pulled for 7 years as far as I know in the US; however, I can't imagine that those sorts of things could affect your future career.

As far as meds go, Paxil made me gain weight and had bad sexual side effects too. Wellbutrin is one of the only ones I know of that doesn't cause your weight to fluctuate or affect your sex drive; if you feel medication is needed, you might try that first.
posted by Unicorn on the cob at 3:24 PM on April 8 [1 favorite]

I'm guessing you've already done this, but try a depression self-assessment (one example from the Mayo Clinic) to see how severe your experience is. This will help with whatever you choose to do.

If you have a good relationship with your doc, then definitely sound him/her out on the various options that you have. Everything I've read says that the combination of medication & therapy is most effective, but YMMV, and your doc may be able to help you work through the options. (The doctor that I finally went to with my severe depression pretty much saved my life.)

I highly recommend the book Feeling Good -- cognitive behavioral therapy can help in particular with stress management (IME) and that book has great practical advice. (Do the exercises. Seriously.)

As for people in the past...my mother suffered from depression when I was a child, after Dad died, right before the Prozac revolution. She got pneumonia 2 winters in a row, which was how I learned to cook. She was sometimes distant, sometimes angry, and generally (as far I can tell/remember) in a lot of emotional pain.

Two of my great-grandfathers pretty much drank themselves to death; my grandfather was famously emotionally unavailable.

I think people had stresses, pretty severe ones, and they coped, sometimes well, sometimes badly -- or not. They wouldn't have called it depression, but it would've been the same biochemically. (At least, that's my take.)
posted by epersonae at 3:26 PM on April 8

get a referral to a therapist. it sounds like your issues are more due to external factors than biochemistry, and you don't sound debilitated. a therapist can help you deal with your feelings.

although if medication is recommended, no, it won't affect your professional development unless you want to, say, become a spy.
posted by thinkingwoman at 3:32 PM on April 8

unless you want to, say, become a spy

Even security clearances are much more open to people with basic MH conditions these days than before. Military, pilots, Peace Corps, continue to screen out based on anti-depressants. Also individual disability income insurance, but not so much life insurance.

Re people "in history" -- they had depression. It was called other things, like melancholia. There were treatments, not as many as there exist now. I believe that people with MH conditions suffered a lot more than they do today, at least based on my family tree stories.
posted by ClaudiaCenter at 3:49 PM on April 8

Hey anony mouse :)

My piece is advice is a book

Feeling Good by David D. Burns, M.D.

Apparently there's a number of Metafilterian who found it excellent, Check out this thread

Now let me tell you this: miracle pills and miracle books, they don't really exist. Unless of course, you want to believe in miracles. Your choice. I don't.

Personally, I'd rather stick with the idea that we are able to help ourselves and that we may need help by somebody ; it looks to me you choosed to ask for help
and that's usually, almost always a lot better than being in a lake of despair and pity. Indeed I asked a close friend for help because I simply felt so down low I tought I was hitting the bottom, because of a series of negative events that brought myself to doubt of myself deeply. Then I found confirmation of his recommendation on Meta ; that mean too many recommendations by people I like or trust, and I bought it.

A $8 paperback that did very good for me, a proof that good things don't have to be expensive at all.

Roughly and briefly speaking, the book is based on a set of verifiable assumption: when people think ill of themselves, then they feel ill, because they think ill of themselves. There's a series of circumstances, such as breaking of relationship, being fired or losing a job, and maybe also your anxiety of finding a job that can
be conductive to depressive toughts.

Only one last piece of advice before you consider the book : if you are feeling or recently felt suicidal, with a desire to "put an end to your misery" , you should immediately seek help from a professional, like now. Unfortunately, I can't point you to any suicide hotline or similar helping hands, because I don't know where you are.

If that's not the case, go ahead and invest that 10 buck in the book ;)
posted by elpapacito at 3:49 PM on April 8 [1 favorite]

Oh let me quote this from Metafilter user Ironmouth

I cannot emphasize how much these books have helped me and a lot of people I know. My aunt, whose a psychologist first clued me into them.

In short, Burns' system (he adapted it from his mentors Aaron T. Beck and Albert Ellis) is what every other psychology book is not--it gets you to focus on specific goals and lays out the path to reach them. Too many self-help books spout general principles and tell you how great it would be if you felt that way. Burns tells you how to start feeling that way. Its no easy way out either, you have to do the exercises for it to work.

Not only that, but he cites the hard studies showing his methods work as well as drugs in the short term and better in the long term (less relapses). With the Feeling Good Handbook, you get a full section on almost every drug out there too. He covers every base.

Again, these books have changed my life and showed me a new way of living my life. I cannot recommend them enough.

posted by elpapacito at 3:52 PM on April 8

I am also suffering from constant anxiety about finding a post-doc before the end of the year (when my funding runs out). So since about December 07, I’ve been generally tired, less excited about stuff (including work) and worry if I will end up as an over educated barista in 2009. These are clearly symptoms of anxiety and depression.

Really? I don't agree. It sounds like an acute attack of realism, with a dash of "short timer's syndrome" and a healthy respect for the vagaries of the future. Quite frankly, if you were to stop worrying about whether or not you are depressed, you would very likely feel better.

Life can suck, and it can be scary, and sometimes the future doesn't appear all shiny bright - what type of idiot would be cheerful in this situation? I suggest that you concentrate on those things you DO enjoy, and let the future take care of itself - you're already doing all you can do...have a little faith.
posted by The Light Fantastic at 3:52 PM on April 8

You might scoff at this, but have you considered learning to meditate? I've been dealing with depression and anxiety for several years. I'm finally treating the depression with Wellbutrin and a lot of exercise, but I still get very anxious and occasionally panicky about the future, especially with regards to career and money issues. I've found that meditation really helps calm me down when I start letting these negative thoughts take over.

This website has instructions for a few basic meditation techniques, and The Meditation Podcast might be helpful as well, even though it's kinda cheesy.
posted by arianell at 4:30 PM on April 8

I can personally vouch for your choice b). It worked out pretty well for me, I think I was on the pills for around 9 months. I went to a therapist during that time as well, but I never felt like I 'got' it.

It helped break the shit-spiral of anxiety causing depression causing anxiety, etc that I was in before that period.
posted by ArgentCorvid at 4:36 PM on April 8

Studies show that a combination of therapy and drugs is the best course of action for those combating depression. Just as it might take a few adjustments to get your prescription right, you might not find the "right" therapist out of the gate. I would suggest you do a little research on therapy philosophies to see what makes sense to you (as in you think you can buy into it) before contacting someone. But either way, it feels pretty good if you can find someone to talk about your day to day stressors without worrying about judgment. But no matter what, please get some kind of help if you are feeling depressed.
posted by Silvertree at 4:55 PM on April 8

yes, the research suggests that the best approach is meds plus therapy-- cognitive behavioral and interpersonal therapy are both supported by research. it's good to try to find someone who uses an empirically supported approach like CBT or interpersonal-- but the real key is whether you connect with the person and find them helpful.

if you have both rapport and empirically supported treatment, you are winning because therapist empathy is the number one correlate of treatment success and empirically supported therapies work better than other approaches so if you can find both together...

and actually, nearly-miracle pills do exist-- but they only work for some people some of the time. If you are one of them, they can be quite amazing. the problem is, you won't know unless you try. and you can try drugs that are hellish in the process of finding the one that works for you.

i've found antidepressants are extremely helpful for stuff that cognitive therapy and social support don't seem to be able to touch-- that inner voice that says "you suck" and that feeling that nothing is fun and everything is to be dreaded and that nothing will make anything any better, ever. I can talk myself out of the "you suck and everyone hates you" stuff-- but I can't talk myself into feeling pleasure or being motivated when depression makes me incapable of doing so. that's when only drugs help, for me. ymmv.
posted by Maias at 5:23 PM on April 8

I'd totally recommend taking with your doctor. I've just been through the whole graduation/get a post-doc thing, and watched a lot of friends do same. The last few months are truly the most stressful time of grad school. You should therefore expect the external pressure to get worse -- at least for this short term.

Luckily, you're thinking about this now. Go see your doctor, get on meds if they suggest it. Even just going will make you feel somewhat better; if you're given a prescription it should start working in a month or so, and you'll find life getting a little bit easier.

Either way: you will make it through. This period is tough. Looking for a post-doc is tough. Realizing that you're at the end of this period of your life when everything was set out for you is tough. Writing your thesis is tough. (Defense? Not so much, actually, but that won't stop you from stressing.) But you'll make it, and then you'll feel great afterwards.
posted by wyzewoman at 5:47 PM on April 8 [1 favorite]

Grrrrr. Talking with your doctor.
posted by wyzewoman at 5:48 PM on April 8

Make your bed everyday.
posted by snowjoe at 6:18 PM on April 8

What thinkingwoman said. Sounds like a very normal and reasonable response to a very stressful situation. And there are people out there who can help you get through this.

From what I hear, at most universities, it is extremely easy to see a therapist. Most university health plans have awesome coverage of this stuff. If you MefiMail me your university, I'll look up the details for you.
posted by salvia at 6:26 PM on April 8

To rephrase my answer so I'm actually a question you asked, no, these things are not just in your head, but that doesn't mean that therapy wouldn't help. Lots of people see a grief counselor when someone dies, for example, and that other person's death is clearly not imagined. Having someone to vent everything to (things you might not feel comfortable telling anyone else in your life) can sometimes really help. It can be a huge relief to realize you're not going through something alone and that there are people actually trained to help you think through what you are dealing with.

The other reason you should go is -- why not? You will likely never again have the extensive level of health coverage you have now. :) Might as well take advantage of it. If you're cash-poor, all the more reason to take advantage of the perks you get!
posted by salvia at 6:38 PM on April 8

Depression is a part of living. Could we possibly appreciate a beautiful day without the rainy day that came before it? Yes, that might seem like an oh too simple analogy when you are in the thick of it, but if you know what you have always known... that life IS challenging, and you have made it this far? Congratulations! And I mean that in the best of ways.

I further want to commend you for being in the middle of your rainy period, and having the wisdom to stop and evaluate your options. Frankly, I see the very questions you asked as an invitation to share some simple truths, and believe me, none are shared with you in any sarcastic way.

- It rains.
- No one melts for not having an umbrella.
posted by LiveLurker at 6:50 PM on April 8 [2 favorites]

LiveLurker: If by 'melting' you mean 'dies', then yes, some people do 'melt' in the 'rain' without an 'umbrella'.
posted by jacalata at 9:53 PM on April 8 [1 favorite]

Exercise is a free antidepressant that is as effective as pills for many people, doesn't have the nasty side effects of pills, and is good for you in a variety of other ways as well. I would try upping the exercise first.
posted by Jacqueline at 4:13 AM on April 9

The best way to treat depression is to give your mind tiny tiny goals and to achieve each of them. Every victory makes your mind think - I'm a winner! My genepool is that of a winner! I should not self-select myself out!

Tiny, tiny goals, not big never achievable ones!
posted by markovich at 9:20 AM on April 9

the feeling good book but also undoing perpetual stress
take omege 3
eat protein
go for walks
talk to people
posted by Furious Fitness at 4:00 AM on April 12