Help me determine if I'm on the right path to healing my "depression", if that is in fact what I'm dealing with.
September 29, 2011 11:22 PM   Subscribe

I can't pinpoint the source of my ongoing angst/depression/anxiety - is it emotional or physiological?

I've been experiencing "something" that might be depression, but I'm not sure. I can't seem to make significant changes to what's going on despite what I feel are reasonable efforts (yoga, therapy, running, positive self-talk, reading about letting go of my past/emotional triggers). I'm wondering if my strategies aren't working because I'm missing something in terms of figuring what the sources of my anxiety are. I regularly have days when I feel anxious and/or cry for no reason (sometimes as regular as every 2-3 days). Other days I feel calm and happy. Very occasionally when I am triggered I spontaneously burst into mild self-harm (hitting myself in the head with my hand). I am not suicidal, but when I experience these outbursts I do feel out of control, which freaks me out a little – I don’t even really know how to begin to research this part of it. Sometimes my sadness comes without external triggers but is instead a culmination of a little fatigue and a busy mind that can turn a tiny, insignificant thought into a major traumatic event. I should be clear here that I am functioning pretty fully, but these feelings are weighty and persistent and I miss being my more consistently joyful and solid self.

My suspicion has been that these feelings have come as a result of a long period of intense stress brought on by choices/life transitions (new relationship, two moves in the past year, grad school) that have awoken my childhood wounds in a big, tsunami-like kind of way (adding to my stress…sigh….). I welcome the emotional/spiritual work, though I'm pretty sure I've ended up taking on too much at once. In doing so, I haven't been taking the best care of myself - though I am slowly getting my health back - and I wonder what physiological changes may have resulted. I have had some blood work done and my cortisol is low, but other than that there didn’t seem to be anything else that jumped out at my doctor. My life is hectic and won’t lighten up for a couple more months (but I’m an adult and life is full of stressors so ideally I’d like to get to a place where I’m healthy and able to cope with my stress/life transitions a little more gracefully). I’m hoping that will allow me the freedom to do some more emotional work/exercise, but in the meantime I’d like to explore the possibility that I might be missing something in my understanding of what’s going on in my life

What I’m looking for here are any suggestions/comments/advice/resources that anyone might have based on your experiences with stress and emotional/physical health.
posted by anonymous to Health & Fitness (14 answers total) 8 users marked this as a favorite
Meds might help. I was pretty depressed for a while recently and suffered panic attacks. I went back on anti-depressants and things cleared it. It also gave me the energy to make other positive changes, like exercise.
posted by Lovecraft In Brooklyn at 11:33 PM on September 29, 2011

Acupuncture. Full stop.
posted by jbenben at 12:03 AM on September 30, 2011

Emotional and physiological are so intertwined when it comes to your subjective feelings -- and ESPECIALLY when it comes to anxiety and depression -- that there probably isn't just one thing you can pinpoint that's the source of what you're describing.

In my experience, it's often very hard when you're in the thick of it to identify what the triggers and what the things that help are. If I don't get enough sleep, for instance, the thought "gee I'm tired, I'm probably not thinking straight at all, no wonder I feel like crap" rarely crosses through my mind -- I'm busy freaking out about something totally unrelated. But those physical stressors definitely contribute in an overall way to your "psychic immune system" or however you want to think about it. Doing all the physical things you're doing to take care of yourself are important to fighting this the best you can, so keep doing them. Keep giving your body the energy it needs to work on regaining balance behind the scenes while you do it consciously as well.

What you really should do is see a therapist. And if the one you're seeing now isn't helping, or isn't helping you explore these questions, then you should look for another one. That's totally normal. You might benefit from identifying concrete things in your life you can control, like a more practical approach, or you might just benefit from talking about the things that are worrying you, like just speaking about these issues freely in safe environment. Like the physical, the emotional balm often also comes in unexpected places.

I find it unhelpful to isolate myself in periods of depression, but I also become very socially self-critical around certain people or groups. Spend time talking and being around people you know care about you, and whom you trust. Close friends. Family. Talk about these issues if you feel comfortable doing so, and don't if you don't. Don't try to power your way through this all by yourself.

I'm not sure, but it sounds like maybe an added worry is that you're not handling this gracefully. I don't know about anything else in the rest of your life, but the way you are talking about this now and the way you are thinking about this is the very definition of a graceful, mature, responsible way to deal with this. I know for a fact from direct firsthand experience how incredibly painful and horrific and crippling depression and anxiety can be. It fucking sucks, believe me I know it fucking sucks so hard. It's not your fault, you're not doing anything wrong, you're actually a very right thing by asking these kinds of questions.

Good luck.
posted by DLWM at 12:05 AM on September 30, 2011 [4 favorites]

You might look at keeping a journal to track these moods... record any thoughts or feelings you might have when it comes up, what kind of physical stimuli there might be. Is it the same set of situations that lead to it each time or is it just a sense of being suddenly overwhelmed by everything going on in your life right now.

Also, pay attention to how you're eating, how much sleep you get (and how well you sleep during that time). Set aside some free time every day to doing something that helps you relax. If thats cuddling on the couch with your partner, or a long hot bath, read a good book, or a run on the treadmil, something that helps you take your mind away from whatever troubles you have and lets it relax with you for a bit.

If you're as busy and stressed as it sounds, you may be running yourself ragged on top of everything else, and a bit of downtime could do wonders.

Also, pay attention to food cravings and satisfy them within reason.

When I'm really stressed and getting depressed about things I start to have chest pains (on both sides, and it feels like its in my lungs, like there's pressure squeezing the air out of me. I can't take a deep breath, and if I try my back starts to hurt, or I get light headed)... I've come to recognize this as a sign that an anxiety attack is pending if I don't get myself to somewhere quiet for a few minutes. Once I can breathe normally I close my eyes and take several deep breaths, reminding myself that whatever I'm upset or stressed over is just a thing, it can be dealt with, the moment will pass and everything can be okay again.

And talk to your partner about how you feel, they may have noticed signs that you're not aware of... or be able to help you find ways to reduce stress levels.
posted by myShanon at 12:39 AM on September 30, 2011 [1 favorite]

See a psychiatrist. Bloodwork won't tell you if, say, your dopamine levels are low.

As for whether it's emotional or physiological, well, in a way there's not a big difference, though I get what you mean by the question. When you say the things you've tried and they're not working, it does sound pretty physiological; it reminds me of when I get anhedonia and absolutely no amount of good-intentioned forcing myself to do stuff anyway works. Anhedonia is a dopamine-related issue, and I do not get anhedonia on Adderall. I can point to reasons and solutions when I have anhedonia but they make no difference while medication completely fixes the problem. However, there are other issues for which I have some success treating as "emotional" in the sense that I do not treat them with medication.

But how to know, right? Well, you say you will cry for no reason, but what are you thinking about when you cry? If you're thinking of specific things that upset you, then you can try unpacking that for solutions that don't require medication. If you're just baffled instead -- and I have been there, both with crying and anxiety not related to anything -- then medication might be more necessary. Many issues are a mix of the two; for example, my ADHD is about half dopamine-related (medication helps immensely) but also mired in issues of being a maximizer and perfectionist that has difficulty settling on one activity and letting go of everything I'm not doing. The thing is, though, sometimes you still need, or would greatly benefit from, medication even when it's not a 100% physiological problem. As an analogy, If both your legs are broken you'll have a much easier time learning to walk again if you can heal one leg. It would not do me much good to practice getting around my "emotional" ADHD problems if I can't focus anyway and have no desire to do anything because of low dopamine levels -- and not only that, when my tactics to address the emotional issues inevitably fail, I would simply think the tactics don't work when in fact they would work if my dopamine were not low. So you may find that yoga works great once you have medication. It just depends.

So find a psychiatrist, describe your symptoms, and go from there. Good luck!
posted by Nattie at 12:43 AM on September 30, 2011 [3 favorites]

I should also note that journaling your moods relative to diet, sleep, etc is instructive to internalize how deeply entangled emotions and physiology are. There is always a day or two before my period where I'm just really sad, and I even think I have good reason to be... until I chart it on a calendar and nothing is different those days except my cycle, and it's practically only those days, without fail. Being hungry or tired or ill will screw you, too. So let's say you get medication, and things become better... except sometimes. And you're like, hey, is this just not working? Why is it so inconsistent? Am I just going to be miserble sometimes? Well, it could be one of those other factors the other times, and they're within your control so long as you notice them.
posted by Nattie at 12:49 AM on September 30, 2011

Also because its one of my standard rants, if you do see a psychiatrist, make sure that they also have you see a real doctor about like... blood sugar levels and such? A friend was having violent mood swings to the point that his wife threatened divorce if he didn't get help. The psychiatrist he chose specialized in ADHD and diagnosed him with that after a very brief assessment, gave him a bucket of pills, adn never even considered other factors which might contribute to his behavior.

By the time they found out it was diabetes, and his blood sugar levels making his moods go crazy, he already had gangrene in his foot and went through a series of amputations and hospitalizations over the next few years. As soon as he learned how to regulate his sugars with diet and insulin, he stopped having the mood swings, and poured all the meds down the toilet.

Personally, I still think he should have looked into legal action against the psychiatrist (and this comes from someone who actually wants to go into that field).
posted by myShanon at 2:35 AM on September 30, 2011

I would like to echo myShanon that it's important to get blood tests done. We had a similar experience in my family where a real medical problem was misdiagnosed as anxiety/depression, (the final diagnosis was actually liver problems rather than diabetes but the mood swings were the same).

That being said, another family member has been on prozac for 10 years now. He is a generally positive person, had no major regrets or trauma in life so psychotherapy didn't lead anywhere. In the end it just seemed to be some kind of chemical imbalance which made his body not produce the happy hormones as much as other people - and now the medication restores the correct balance.
posted by jenp at 4:07 AM on September 30, 2011

You sound a lot (almost exactly) like me when I was untreated: some good days but some terrible, truly-awful-for-no-reason days, some days when just the added bundle of little stresses brought everything crashing down - and doing all the right things didn't really help. The exercise helps, but not completely, and there were days I'd just sit in therapy and stare, unable to verbalize anything. I couldn't do the self-talk, because whatever was making me sad was just too deep for words or thoughts to unravel. I could recognize all the Feeling Good exercises as right, but they somehow didn't apply to my amorphous sadness. It was like trying to talk my way out of a migraine.

Long story short, prescription antidepressants helped when nothing else could, and they helped immensely. I am not sure how functional or alive I'd be if I'd never tried them.

Antidepressants are not a silver bullet. They do not always work. They are not without their bizarre side effects. They don't remove your past, your habits, or your dislikes. But they can get you back to normal, sometimes when nothing else can. And they can help you understand how to manage your depression without them. That sounds counterintuitive, but without that sludgy black cloud dragging you down and obscuring things, you can get a better idea of the tangles in your thoughts and the causes of certain moods, and then you can figure out when and how the self-talk, the exercise, the meditations, etc. all works for you.

Go to a psychiatrist; see if your therapist, if you're still seeing one, has recommendations. Decent therapists will usually tell you point-blank if they think you're a good candidate for meds. Bring a copy of your bloodwork results, and ask if there's anything your doc missed. You want a thorough psych who will rule out any other possible physiological cause before tinkering with your brain chemistry - treatment for other conditions can be more predictable and/or cheaper.

Good luck; you can do this!
posted by Metroid Baby at 5:12 AM on September 30, 2011 [2 favorites]

Talk therapy alone might help you feel less like a bottle cork on the waves.

If you say what country you're in and provide a throwaway email, there's a chance somebody could contribute more specific suggestions. Good luck!
posted by bonobothegreat at 7:14 AM on September 30, 2011

Not that this replaces or overrules the other suggestions in this thread, but I'd also like to recommend a book: Transitions, by William Bridges. This book has been useful to me many times over.

You mention that you're in the middle of a whole passel of very very major life changes that have "that have awoken my childhood wounds in a big, tsunami-like kind of way". This book has been really helpful to me in circumstances exactly like this, in part because it has helped me to contextualize my stress and freaked-out feelings and general overwhelm in a way that lets me relax about it, and just see it as part of the process of change. In my case, some of the worst stress and pain came from the way I would pressure myself -- I'd blame myself for not being more functional sooner, or assume that everybody else handles these things better than me. Knowing that the messiness and confusion of the transition process is normal & expected helped me to go a little easier on myself, and made the process less painful.

I'm paraphrasing really poorly here, I'm sure, but here are a couple of concepts from the book that did me a lot of good:

1. People aren't machines; it's neither possible nor desirable to remain "functional" in the same predictable, controlled way your whole life. Don't think of yourself as a machine with a broken part that needs to be fixed; instead, realize that you are in a process of organic growth and change, and that the you that comes out the other end will be "functional" in new and different ways (and will necessarily have discarded some of the old ways of functioning in the process).

2. Major transitions have three stages: Ending, Neutral Zone, and New Beginning. In that middle stage, Neutral Zone, stuff can get very confusing and anxiety-inducing, because you're operating without the structures that have kept you safe. It's normal for this time to also bring up old issues that you thought you'd put away. If you put off going through that Neutral Zone (ie, if you try to get to your New Beginning too soon), the confusion and anxiety can linger. As unpleasant as it may be, it's necessary to live through that lost-at-sea feeling that comes with any major change.

Bridges says it much better, obviously; I highly recommend the book.
posted by ourobouros at 7:51 AM on September 30, 2011 [2 favorites]

It seems many people go through periods of angst and existential pondering. I know I have. What I tried was therapy, journaling, philosophical reading, psych drugs (i dont recommend but for some it may help), psychedlics (very introspective), meditation and trying to better myself through physical activity.

The things that really worked for me was putting my situation in comparison to others. Things can always be worse, and realizing that dwelling on issues is counter productive. What worked well for me was a psychiatrist I didn't care for, but was amazing at digging deep into issues that were troubling to me. By having to confront these issues in a safe environment prompted by questioning by a professional. I was able to dig deep into my inner thoughts, fears, irrationalities, as well as other issues. By bringing them directly to the surface I was confronted with them head on. I had to address them. I had to talk through them. It was very difficult, and emotional. Yet it was like a weight off my shoulders.

When I still feel this way from time to time, I take what I learned in therapy. I write things down. By doing this, I further enable myself to confront as I did in therapy the issues, concerns and angst at hand. It can be difficult, but its very productive. Afterwards of writing down such issues and free writes, I burn them. Its feels like a cleansing process and in addition I don't want anyone to stumble upon such personal thoughts.

Best of luck to you, and remember you are not alone.
posted by handbanana at 9:12 AM on September 30, 2011

Nutritional support - consider a brief trial of the Paleo diet while exploring these other options.
posted by egk at 3:31 PM on October 3, 2011

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