I am crazy. Help.
December 8, 2008 7:53 AM   Subscribe

Help me design a multi-pronged approach to dealing with longstanding depression/grief/craziness.

Anonymous so I can be more explicit about my psychiatric history.

I've had depression since I was about 12. I am now 30, female, good marriage. I have had periods of remission, but things have generally gotten worse. I don't want to end up dead.

I have a family history of suicide. There are a few different possibilities for my diagnosis: dysthymia, double depression, major depression, anxiety, borderline personality disorder, or any combination of these. My most common symptoms are periods of extreme procrastination and paralysis, suicidal thoughts, crying, utter hopelessness. I am at college and having a complete bitch of a time getting anything done. I also work a "real job" and I often feel that I am not all there, mentally. I am spacey, have poor memory and concentration, and am often paralyzed with anxiety. My performance seems to be okay (people often have trouble understanding how I can have such serious problems when my performance seems to be acceptable) but I know that I am working far, far, far below my potential. And I feel like utter shit most of the time. I use the internet compulsively and excessively when feeling anxious. I have very low energy (I know how to eat well, and exercise makes me more sleepy, but I do it.)

I have tried the following medications: Effexor, Wellbutrin, Risperdal, Celexa. Also zopiclone for insomnia. I was on the first four in various combinations for six years, and I felt like they did nothing for my mood, merely gave me side-effects (sleepiness, no sex drive.) I gradually weened off (a hellish process) and I have little faith that drugs can help me. But I am, of course, willing to try anything. I've read books (Feeling Good, Learned Optimism, a lot of others about depression, procrastination, etc.)

I have a history of grief. I've had many family members and friends die, starting from a very young age. Thankfully, no first-degree relatives (mom dad or sib), but most have been close second-degree relatives. The suicides have especially wrecked me. The latest one was pretty recent. I also have experienced some emotionally abusive relationships, and have trauma from sexual harassment. I have very little money and may soon be laid off.

I have a couple close friends, but I do not go to them much for support with this. I am embarrassed by my troubles. I don't talk much about it with my family, though they are also aware of my history. I had several not-very-serious suicide attempts in my teens/early 20s, but none recently. I really don't want to end up like my other family members who have suicided, but I feel in my gut that is where I'm headed.

I see a therapist pretty regularly. We do CBT and work on practical stuff. I have a Dr. appointment this morning, and had one a few weeks ago as well for the depression, because I need sick notes for missed obligations at school. The doctor says I need to be back on meds. I have been given a list of other therapeutic resources to access that include Dr.s who specialize in anxiety, and gestalt therapists.

This is a very complex problem that has not been adequately addressed...ever. I was in therapy for a long time, starting when I was 16. I did interpersonal and CBT. The last psychiatrist who assessed me said I may benefit from psychodynamic approaches, but I am not sure which ones.

Really, I feel like I need to take the reins here. Despite all the professionals I have seen, I feel like none of them have good answers to give me, even the nice and helpful ones. I am sick of struggling to function day-to-day and never knowing when an episode of major depression will hit and totally fuck everything in my life up. I am angry, hopeless, and full of grief. I don't understand how people keep living when life is so consistently horrific. I look at my friends who are able to have a career + friends + hobbies + family, and I am totally dumbfounded. Is that how normal people live? Can I do that too?

I need to do something. I have to design some kind of therapy regimen. Please help me with this.

Things I think I need: grief counselling, esp for suicide survivors, perhaps some kind of schema therapy, or gestalt, or maybe DBT. I've done a bit of research on these methods, but am really confused. I've also researched medications a bit (in the past) and am at a loss for what to do now. Which therapies and medications are best for what? I feel like I cannot get a straight answer from my docs.

If you can give me some ideas for a more intense, multi-pronged regimen I can try, and give me specific names/resources I can contact in Toronto, I would really really appreciate it.
posted by anonymous to Health & Fitness (14 answers total) 14 users marked this as a favorite
I'm sorry about the situation you find yourself in.

I do not know anyone in Toronto specifically but you mention you see a therapist pretty regularly. I wonder if you actually feel like the therapist is right for you? You also mention some of the work you have tried CBT etc but one thing I do know about therapys is that there is nothing wrong with trying sessions with a lot until one day you just click with one and think this is right for me. Have you considered other types of therapy - Freudian or Lacanian psychoanalysis perhaps? In respect of the multi-pronged - apologies if this seems patronising but have you considered perhaps doing a small amount of voluntary work with children or animals? It may help to take you out of yourself and give you brief respite from the anxiety you feel on a daily basis? Or perhaps a creative channel for you to channel and focus your emotions such as art? I know I find art to be terribly therapeutic. Cost is very low and there are no instructions or rules. Other than that, I know you said that money is an issue but expanding your horizons through travel can also help change your perspective and again allow you to feel a change from your present situation that you say feels stagnated.

I hope you find a way through through this world that brings you peace.
posted by numberstation at 8:08 AM on December 8, 2008

There are classes of drugs you haven't tried. IANAD. See your doctor about more options.
posted by DarkForest at 8:08 AM on December 8, 2008

I think taking the reins for your psychiatric situation is a *great* idea. Along those lines, you may also want to join an internet or in-person peer support group that has the philosophy of empowerment (the individual person taking the reins of treatment and recovery). You could try starting here, but you may also need to hunt around for the right group.

From the outside perspective, it seems as though you must be doing something right to manage your psychiatric condition. You're alive, working, in school, in a marriage, have some friends. I know you want it to be better, I just wanted to give a shout out to what you have managed so far, which shows great resourcefulness.
posted by ClaudiaCenter at 8:32 AM on December 8, 2008

I note you state you feel like drugs are not the answer and I would agree with you, however darkforest is correct there are other SSRIs though I know coming off can be horrendous. It is good to see you have enough awareness and cognition within yourself to i) see the current state is not sustainable and ii) be open to coming up with a better strategy. You should take comfort in that fact. I would look into different types of therapy and when you find a therapist you are comfortable with and a type of therapy that seems to help - stick with it. 3 days a week for 5 years is not uncommon depending on the nature of the problem. That is nothing to be fearful or scared of by the way. The right therapy can be incredibly helpful.
posted by numberstation at 8:37 AM on December 8, 2008

Your problems are serious enough that I don't feel qualified to give you advice. There's a great book on meditation called "Where ever you go, there you are" that's helped me a bit. I wish you the best, and have faith you can take the reins!
posted by xammerboy at 8:53 AM on December 8, 2008

Drugs are great if you find one that works, but if they don't work....well, depending on your spiritual beliefs there are other options.

Memail me if you want some info.
posted by St. Alia of the Bunnies at 9:11 AM on December 8, 2008

MeMail me if you would like some specific names/programs in Toronto for grief counseling and excellent psychiatric care.

In the meantime, in case you didn't know about it, the Gerstein Centre is a wonderful, non-judgmental place for those nights when you don't know what to do, need someone to talk to or somewhere to go, and the thought of a hospital makes you wary.
posted by meerkatty at 9:24 AM on December 8, 2008

I'm sorry about your problems, too. I only have a very minor suggestion about your diet and exercise. You say your exercise 'makes you sleepy' - that isn't right. You don't say how much exercise you do, and I am no nutritionist, but it sounds like you are not eating enough to compensate for the amount you do. You may be eating healthy foods, but there are many different ways to eat well, depending on what you do. You may find you have more energy if you adjust the proportions of each food group you eat (more whole grain carbs) or even if you just plain eat more. Obviously the lack of energy may have more to do with your mental health than your diet, and this is only a minor suggestion, but it may be worth investigating. It couldn't hurt to have more energy to face the day. Most importantly, never put yourself under pressure to do more exercise than you feel capable of doing, becuase it is just counterproductive. Good luck with your problems, I hope you find what you need.
posted by marmaduke_yaverland at 9:32 AM on December 8, 2008

Hello Anonymous:

this may sound weird, and even straight out crazy, but I am going to mention it anyways. It's up to you if you want to accept it or not.
In a nutshell, what you are describing can be termed "generational curse".
You describe that your family has a history of suicides, a history of sadness, grief, etc....
This is what I mean by "generational". Some illness or conditions that seem to propagate from generation to generation.

The good news is that there are ways to stop the "curse". You can break those chains and stop the sadness, the grief, the suicidal tendencies, the depression. You should NOT have to worry or think that the family "history" will repeat iin you. And as Alia of the Bunnies mentions, these options are related to spiritual beliefs. MeMail me if you want some additional info on this.
posted by theKik at 10:28 AM on December 8, 2008

When you mentioned spaceyness, trouble concentrating, poor memory, feeling "not all there," etc, I was reminded of a coworker who had the same symptoms and discovered he was diabetic. In no way do I mean to imply that that is the only factor or even a major factor, but perhaps it's possible that some portion of your problems is being made worse by diet or another physical issue. Might be worth looking into.
posted by bcwinters at 10:54 AM on December 8, 2008

A friend of mine is narcoleptic and has very similar symptoms when she's not on her meds, especially the extreme sleepiness after exercising. I know the same drugs are occasionally used to help people with depression who don't respond to normal treatment. I think she sees a neurologist and an endrocinologist so maybe you could try that and make sure your problem isn't more physical than you might think.
posted by fshgrl at 11:28 AM on December 8, 2008

I am embarrassed by my troubles.

I would focus on this. Whatever you have - depression, anxiety disorder, etc - is likely caused by a chemical imbalance, and while treatable, is not within your control. You can't just "suck it up," as you've no doubt realized. There is no reason to feel embarrased about this anymore than you'd be ashamed of being diabetic. Your friends and family can provide a crucial support network. Treatment depends on having people you can lean on. Lots and lots of people have trouble with depression and anxiety. Lots are worse off than you - you are at least functional enough to hold down a job. I know every day feels like slogging through mud, but you are NOT alone.

I could have written almost this exact same post, down to the suicide and mental illness of family members, except that I've tried different medications than you. FWIW, I'm currently on Lamictal and Klonopin, and have just started Zoloft. These at least provide a baseline of functionality - I can get out of bed in the morning, I am reasonably social. Meditation and spirituality help a lot, and meditation can be completely secular if you're not religiously inclined. I recommend the Anxiety and Phobia Workbook, which has concrete steps you can take, as well as writeups on various medications.
posted by desjardins at 12:15 PM on December 8, 2008 [1 favorite]

I feel I have nothing constructive to add except I admire your strength and courage. Good for you in creating a positive love-filled life. If you were my friend I would want to you to share your troubles with me. Please do.
posted by saucysault at 12:58 PM on December 8, 2008 [1 favorite]

Recommending a very helpful book here. Like the amazon.com reviewers, I can say there are a ton of practical tips I hadn't seen elsewhere.

Multi-pronged approach: I went on a library-book blitz recently and started photocopying and writing down information from various scattered pages. (and buying a few of the books: another I'd recommend.) I acquired lots of paper: information, encouragement, etc. that I actually deemed to be helpful. I made myself a "helpbook" [note: I often wind up making books for myself] and then realized I had lots of other information that was practical, writing exercises or whatever, and it didn't make sense to cram all that in the binder too. So now I have a "helpbook" and a "workbook." I tote the workbook around and do some of the exercises/writing/visualizations whenever I have a little bit of free time. (The helpbook is reserved for reading in periods of crisis. Actually, I ALSO made a little help-bag that contains the binder and some favorite pens, tea I like, a polished rock that cheers me up, blah blah blah. If you make a helpkit for yourself, don't bother including the schmaltzy things you think you're *supposed to* say or do or read when you're feeling awful. Put the 100% guaranteed to make you happy stuff in there. We all own something that never fails to make us feel better.)

Anyway, when you compile your own information, you're guaranteeing that it will all be relevant to YOU and your situation -- not reading through a big book of blahblah with occasional useful advice. Nothing worse than reading something you know is *supposed* to help you feel better, but man, it just DOESN'T.

I got off-topic. My multi-pronged approach includes a small focus for each of these: medicine, diet, exercise, sunshine or equivalents, connecting with friends, distractions, visualizations, creative projects. What else do you think does/would have an effect for you?

Most important thing: the right medicine(s) for you will help you be able to find and create your own resources. Ask your doctor to help you discover that medicine. There's no way I could keep lists and journals and have the energy to keep myself healthy(ish) if it weren't for the medicine that keeps my brain working.

Oh!--and I'm not even a member there, but I found the depression forums not too long ago. There's a lot of good medical info and the people seem really nice. MeFi Mail me if you want more online resources.
posted by oldtimey at 11:33 PM on December 8, 2008 [1 favorite]

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