I'm stuck. What can I do?
February 16, 2010 3:03 PM   Subscribe

What should I do for depression that has plateaued?

I've been struggling with depression for the past four years since high school. I also have some shadows of Asperger's syndrome. In high school, I was an honors student who was taking AP and Honors courses. I'm a 21 year old community college student who effectively flunked out of a four-year college. Each semester, I manage to squeak by with Incompletes, low Cs and the rare F, mostly because of my professors taking pity on me. I find this very upsetting, and I can scarcely handle thinking about it. This cycle repeats over and over, as my mother and psychologist think I need the structure of a school to improve. I have trouble concentrating on my courses because of the brain fog. I can barely read a page of text before losing attention, and it takes way more energy than it did in high school. This goes for pleasure reading, too, as well as many other activities I consider pleasurable. A day that I waste spending video games is a good day, because that means I was able to keep it together enough to bother setting up the system and focus enough to play the game without giving up. Other days, I just find myself keeping idle by sitting in front of the computer, switching between refreshing two or three blogs until the day is over. Homework is very hard for me. When I attempt it, it's usually incomplete. Socializing was hard for me in high school, but I had friends and hung out with them regularly, but now that I'm depressed, I can scarcely manage to talk to cashiers in stores. The only real useful task I can do is cook, which I find pleasant and a bit of a release. In my household, I make dinner for my mom and younger sister (who is in high school). However, I like that as there is little abstract thinking and it's very structured. I follow the recipes or make some simple improvisations, and I'm not judged so much for the end results.

I'm on medication. I've been on a bevy of SSRIs, Welbutrin, Adderal, and tranquilizers. I'm currently on Effexor XR and Abilify. I find that medication tends to improve my mood, but to the point that I get out of bed, can make dinner for my family, and get to class for a few months, followed by a decline. The improvement in mood is not to the point that I can succeed academically, like I did in high school. When I was on an ineffective med, I was at college, and found myself not leaving bed until 10 PM at night and eating one large meal because I couldn't bring myself to leave the dorm multiple times per day. I also see a CBT therapist, who mostly thinks I need better study skills.

Since meds are helping me, but not so much, what's left for me? I'm guessing I'm not really a good candidate for electroconvulsive therapy, since I'm able to function with medication. Further, I'm afraid to try it because brain fog seems to be my biggest problem, which sounds like a big side effect of the procedure. But if therapy and medication don't work well enough, what else is there?

followup email: alivefish@live.com
posted by anonymous to Health & Fitness (8 answers total) 12 users marked this as a favorite
IANAD, IANAT, etc etc etc but....has your doctor ruled out any possible physical conditions which may be contributing, like low thyroid or a sleep disorder?

The other thing (not therapy, not medication) that can help is regular rigorous exercise (after being cleared for this by a physician, blah blah blah). Not walking or slow jogging-- rigorous aerobic exercise. (That will possibly address both the depression and the ADHD.)
posted by availablelight at 3:08 PM on February 16, 2010

IANAD, etc. Sounds you haven't tried tricyclics or MAOI's? Find yourself a top level psychopharmacologist-- not just a plain psychiatrist, ideally an academic who studies this stuff-- to make sure you have tried all the meds and combinations before giving up on meds. At least 80% of people should be able to find a workable med or combo.

Fish oil can sometimes help, as can light therapy (it doesn't just work for seasonal, but, if you do have seasonal aspect, this is a time when it would be bad so...). Those are worth throwing into mix.

Exercise is good, too-- if you can get yourself to do it. It sounds like you have serious anhedonia which may be making concentration and homework impossible: when you find the right med or combination, you should find that the small pleasure of getting stuff done comes back. Don't give up on meds just yet-- it may well be possible to find something that makes you feel much, much better and gets you back on track at school.
posted by Maias at 4:12 PM on February 16, 2010

For years I've had trouble with depression.

In late November '09 I began exercising hard, two or three times a week, 90 minutes at a time. To force myself to this, I paid for 18 sessions with a personal trainer at the YWCA. It was a big expense for me, but I knew that if I paid for the sessions I would go. The trainers who worked with me were wonderfully supportive, despite my being clumsy and weak. My 18 sessions are finished now but I continue to work out regularly, just because I like it.

Now, after two and a half months of exercising regularly and vigorously, my mood is the best it has been in years, despite several major stressors. No medication or therapy has ever been this effective. (I still take a small daily dose of an antidepressant.) I've lost a bit of weight and have toned up some, but by far the best benefits of exercising have been mental and emotional. I strongly encourage you to try this if there is any way that you can. Very best wishes.
posted by FrauMaschine at 4:50 PM on February 16, 2010 [1 favorite]

In addition to the excellent suggestions above, you might try to find a support group. Sharing experiences and information can be helpful to discover new directions to try — A psychiatrist with a good reputation for understanding and treating depression. The latest pharmacology. What has worked for others. A regional center that specializes in treating depression.

Since the anti-depressants haven't been very successful, I second a thorough medical workup to look for other conditions that might be a factor. Thyroid is the one that leaps to mind, but there are many others, less well known because they are infrequently found. (It would be good to see a specialist for this, rather than the family doc.)
posted by exphysicist345 at 5:48 PM on February 16, 2010

I had a friend who was consistently battling depression through high school and college - she was on and off meds for years and eventually came to find that doing yoga a few times a week really helped her clear out the fog that you are describing, and find a sense of clarity in her life. I personally feel it was the physical activity that helped her most, as she rarely got much exercise before the yoga.
posted by LZel at 7:38 PM on February 16, 2010

I strongly disagree with your parents and therapists - staying in your current cycle of taking classes that you don't understand, where you aren't learning and professors are passing you out of pity keeps you in a cycle of failure that makes it very hard to work through the depression. Furthermore, accumulating a lousy academic record isn't going to do you much good in life.

However, I do agree that you need a schedule, a reason to get out of bed and out of the house every day, at least five days a week. My suggestion is to look for a volunteer job where you feel that you are making difference in the world and which uses the skills that are currently working you. Being successful at something, especially something that makes the world a better place, will help rebuilt your self-confidence.

It will help that if you have a volunteer job where just work when you are there and don't have to worry about homework or time managment. Don't take a job that requires much reading, concentration/accuracy or higher order thinking. Good choices might be work at an animal shelter or as a hospital greeter. If you have a car and are a capable driver, you could do transportation or delivery for wide variety of agencies. You might find something that is a good fit at Volunteer Match

The next step might be a part-time job and then, when you are ready, try school again and see what a difference it makes when you are ready to learn.

I wish you the very of luck. You are not going to be following the "normal" path through life but you can still end up in a wonderful place that is right for you.
posted by metahawk at 9:37 PM on February 16, 2010

If I were you, I would

a) get a new therapist
b) follow FrauMaschine's advice
c) eventually wean myself off the meds

Best of luck.
posted by Paris Elk at 11:36 PM on February 16, 2010

Check your throwaway account.
posted by saveyoursanity at 10:11 PM on February 19, 2010

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