Does long-term mental illness treatment get easier?
October 20, 2011 1:56 AM   Subscribe

If you have a mental illness and found a successful treatment plan, does keeping up with it ever get easier? Staying well has proved more difficult than I imagined it to be.

I found a successful treatment plan (medication, therapy, etc) for my depression over a year ago. It provided immediate improvement to my quality of life provided I kept up with it. This was not a problem early on but long-term the mental effort expended on keeping up is wearing. I find myself slipping backwards more and more often. One or two nights without enough sleep, missing a day or two of medication, one setback and things start to seriously derail. There is so little margin for error before the depression sinks in again. It is so much easier to be Depressed Me than Well Me.

It feels like I am putting in a lot of effort for what are, in the grand scheme of things, marginal returns: not a spectacularly successful life, just a middling, almost-normal one. I mostly get things done but have yet to consistently go above and beyond in the facets of my life in a way that would make me that truly successful. Instead it seems like a lot of effort is expended just doing all of those things that keep the depression at bay, leaving little energy for building a richer and better life.

I'm hoping that there is some evidence out there that if I just keep hacking away at this it will get easier. I'll get better coping mechanisms, missing medication will hurt less, overcoming daily anxieties and negative self-talk will get easier and require less energy. Being miserable will not be so much simpler than being happy. Or maybe this really is the most I have to hope for. What is the long-term experience of people here?
posted by Hey nonny nonny mouse to Health & Fitness (16 answers total) 32 users marked this as a favorite
A member who'd like to remain anonymous asked to post this comment:
My spouse struggled with a similar issue for quite some time. And over time, they have gone from "struggling to get through the day" to "more like what used to feel normal." Part of the solution was a radical change in daily routine and setting. This was a forced change, from work. Initially, they were terrified about being able to cope. But the medication meant they could cope, and the fact of being able to cope made them feel better in the longer term.

As a spouse, I can say that the difference might seem small to you, but even in the initial stages, the difference was such a huge relief to me. So please hang in there. If the medication is helping, there's a good chance things WILL get better.

Good luck.
posted by taz at 2:25 AM on October 20, 2011

Not missing medication is really really important. Do you use a Dosette box or something similar? Have a routine that at a set time each night/morning you take it? If I miss meds the slide starts and it's always hard to stop that slide and get back to what passes for my normal.
posted by episodic at 2:47 AM on October 20, 2011 [3 favorites]

First and foremost, stay on the medication. I once described my depression, and what the Wellbutrin did for me, to someone who wanted to know what it was like as this:

"I have this natural tendency to be pulled down. That's how my brain works, how I'm wired. The medication... it doesn't pull me up in the same way, it just helps to balance things out, and gives me the space to pull myself up. It's like... water wings, I guess, for my brain, I tend to sink and the pills zero it out so I don't have to overcome the sinking just to be neutral, I can actually go upwards." Which is the part you seem to be having the biggest issue with - the natural sinking tendency of your brain.

Get into the habit, associate it with something else. I made a point of keeping it next to a glass of water in my apartment, next to where I put my phone, and set a reminder on my phone for 'take pill'. Start getting into that and it helps.

If you have problems sleeping, tell your therapist. You might need something for that.

And change something in your routine, just one thing. You need to get out of your groove and do something different. Take a walk at lunchtime, deliberately buy a CD of some group that just sounds interesting and listen to it, just something. One step. And then another. And keep stepping.

I'm pretty sure now that one of the things that helped lose me my job was my depression and the problems I had, putting me onto the Big List Of Layoff Possibilities, and I did not let it destroy me like people thought it would (and I am one of those people). I kept going. You keep going too.

You can memail me if you want someone to talk to about some of this stuff.
posted by mephron at 3:13 AM on October 20, 2011

Medication doesn't cure depression, it just controls the symptoms. If you have depression that requires it, as opposed to something that can be alleviated by talk therapy alone, missing doses is always going to be a problem unless you happen to be in remission. (And even then you may need to keep taking it to prevent a recurrence. There are a lot of different thoughts on this if you look up depression and remission.) Set a dedicated alarm, get yourself a days-of-the-week pill box and refill it religiously every time you get to the last day, tape the pills to the steering wheel of your car if you need to. This is a serious ounce of prevention v. pound of cure situation.

I've been in treatment for bipolar disorder etc. for something like two and a half years, and I've gotten a lot better and more together over the course of it, but I have also had many many temporary dips and three or four medication reconfigurations, all of which is exacerbated by a case of ADD I can't tolerate the meds for. Are you talking about this with your therapist yet? Aside from the fact that this is exactly the kind of thing to talk to a therapist about, you want to be sure you can discount the possibility that things seem hard because the depression is breaking through and you need a medication adjustment.
posted by Adventurer at 4:11 AM on October 20, 2011

You said that you started this "over a year ago" so I'm extrapolating it's been less than two years, correct? As someone who has learned to deal with her recurring depression and ADHD, I can reassure you of the following things:

- It is normal to slip up and it is *okay* to slip up. It won't feel okay in the sense that you'll feel depressed, yes, but the best thing I've practiced is *not* then giving into despair or focusing on how hard it is for how little return; it's too easy to blow the issue out of proportion and lose perspective that way, and it's a hard habit to break, but you need to think of it less like "I'm putting in all this work and the issue isn't solved" and more like "If I do this as often as I can, I will feel better more often than I wouldn't, and the slip ups will be fewer."

- A year or two is great progress, but it is going to take more time before it feels easier. On a literal neurological level, your brain has built up and physically reinforced pathways for depression over however many years before you got treatment. It feels easier to be depressed because it's the electrical path of least resistance in your brain.

When you start treating it, you have to do two things, both of which are daunting in the beginning: stop using the depressive pathways so these huge reinforced monsters actually die out from disuse, AND start building new healthier pathways that will take a long time to compare to the structural splendor of your depressed pathways. The way it helps me to envision it is there is this huge eight lane highway that your brain takes to go to almost every exit it knows, and you have to start with an unfinished dirt bike trail you're slowly cutting through the forest a mile away. You have to convince your brain to take your shitty bike trail instead. Wow, right? Why would it do that? It's so much more work.

But there's no other option. Really. You keep building up that bike trail, and you keep all the resources on making it into a highway, until the other highway falls apart from lack of upkeep. You start at 99% depressed highway, 1% willful bike trail, and it is exhausting. You hire some workers to help (medication) and suddenly you can *just* overtake the regrowth of plants on the bike trail and make it a yard longer per day. And you eventually reach a point where it's 49% depressed highway, 51% healthy highway, and shit really takes off because suddenly the healthy highway is the path of least resistance. My friend and I have both felt this is seriously the case, where the snap from exhausting to much easier is that sudden, after years of struggle.

So when it was more difficult for myself, I would remind myself to not take the depressed pathway as much as I could avoid it; slip ups for me meant one fewer opportunity to take and reinforce the healthy pathway, and yet another reinforcing of the depressed pathway. But if I DID slip up, which is inevitable considering the insane task ahead of you in the beginning, I would NOT despair or beat myself, because then I've reinforced the depressed pathway multiple times instead of fewer. It's okay to stop progress for a few days, everyone needs a rest. It's some of the hardest work in the world. If you're making progress then you know that slowly but surely you will eventually outpace the depressed highway -- and that's why you shouldn't despair: there is no good reason, and the more you do, the more you set yourself back.

The only way to do it is to do your best for longer and longer, screw up, and do it again. It is not possible to not screw up. Seriously. A person cannot start using mental pathways they don't have, so everyone keeps taking the depressed highway, especially in the beginning. You can't focus on one-and-done, because it is impossible. You couldn't build the pathways in a day no matter how great your willpower is, it is seriously not possible. You are competing against pathways that have been reinforced for far, far longer than you have been working to dismantle them. You can only focus on better. You can only focus on less frequent, less intense depression. For a long time you will have times where you backtrack slightly and it feels SO FRUSTRATING. You're fine, though. Keep going. Have a crap day, or week; get nothing done; return to your little bike path and keep building it up until you're exhausted and need to rest again.

There is no other way to do it that won't make things worse. If you don't accept some failures, you will actually set yourself back further. When I was nearing the 51/49% split, as I like to think of it, I had started to feel so disappointed that all this work wasn't fixing things for long. When I started accepting failures, when I could lie in bed depressed and think "this'll be however long it lasts and then I'll try again," stuff got much easier.

You might also consider looking up all the research on how will power is a finite resource; it should give you some perspective on your expectations. Depressed people have a tendency to drain the will power reserves dry and then feel like failures when it isn't enough. You have to realize the extent of what a bad ass you are for not doing worse, seriously, and realize how much progress you are making. It helped me quit judging myself to frame things in terms of literal biological processes that can only progress so quickly; I hope it helps you, too. Being able to see in a more concrete way exactly how difficult the task is, but also see in a concrete way that it is possible to approach, gave me faith to keep fighting it and kept me from reinforcing the despair pathways as much as I would otherwise. These days, I actually have trouble getting very sad about anything; once your healthy pathway is the one of least resistance it gets built up faster, with less work, and the depressed pathway crumbles even faster.

Stick in there, and use the slip ups as an opportunity to remind yourself how you used to have days like that so much more often.
posted by Nattie at 4:17 AM on October 20, 2011 [80 favorites]

It's not so much that it gets easier as that it gets more routine. Getting enough sleep and taking your medication properly becomes as basic to life as eating breakfast: once in a while it might not happen, but 99% of days it does. The trick to making it routine is making it easy to do your healthy habits. (For example, if mornings are more predictable than evenings, take your medication in the mornings instead of trying to remember it every night.) There's still an effort, but becomes your normal.
posted by mchorn at 7:31 AM on October 20, 2011 [1 favorite]

You need to make sure you are discussing this specifically with your therapist. For example:

a) what makes you think that most people live spectacularly successful lives rather than middling ones? They don't

b) is your definition of spectacularly successful mis-calibrated in some way? In other words, are you trying to live your father's/society's/etc's definition of spectacularly successful or your own?

Perhaps one or both of those things is why staying well is wearying?
posted by spicynuts at 7:43 AM on October 20, 2011 [1 favorite]

I'm hoping that there is some evidence out there that if I just keep hacking away at this it will get easier. I'll get better coping mechanisms, missing medication will hurt less, overcoming daily anxieties and negative self-talk will get easier and require less energy. Being miserable will not be so much simpler than being happy. Or maybe this really is the most I have to hope for. What is the long-term experience of people here?
Focus on the "overcome" and less on the "coping mechanisms". You may not have control over the brain chemicals that cause depression, but you do have control over how you react to things. Instead of letting your mind focus on the negatives of a situation, focus them on the solutions. Many problems are solvable if you take the time to sit down and figure out what to do. Be less reactive to things.

Yes, absolutely, it gets easier. But like anything else, it takes dedication and practice, and those are frustrating. The secret is twofold: one, nobody is ever done. Two is don't beat yourself up. If you stumble, you figure out why you stumbled, look at the chain of events and figure out a way not to do it next time.

2) Take your medication regularly, sleep on a regular schedule and eat plenty of protein. (Especially tryptophan, the precursor to serotonin. SSRIs won't work if there isn't enough serotonin to begin with.)
posted by gjc at 8:07 AM on October 20, 2011 [1 favorite]

I sent you some thoughts via mefi mail. Hang in there.
posted by brackish.line at 8:31 AM on October 20, 2011

I'm hoping that there is some evidence out there that if I just keep hacking away at this it will get easier. I'll get better coping mechanisms, missing medication will hurt less, overcoming daily anxieties and negative self-talk will get easier and require less energy.

One of my son's friends confided some very tough family issues to me recently, and said (she was very upset at the time), "I wish my Mom was like you--but she has Depression." You could hear the capital D in her voice.

When I told her, openly and without any shame (I'm well beyond worrying about what other people think) about my own depression, and how I take meds every day, have for years and probably always will, she was a little shocked. I explained that most days now, I'm good; my depression doesn't own me, I own it. But it took me a while to get to this place, to find the right medications, and the right therapist, and maybe her Mom just hadn't reached that point yet.

So yes, it absolutely does get easier if you keep working on it! You start to know yourself better. You learn your triggers, you know when the meds are not working as they should and maybe you need to switch something up. You find yourself starting to engage in that negative self-talk and end up laughing because you now realize "I didn't do this one thing right' does NOT mean 'I'm a total loser, I can't do anything right!"

And, you know, you'd be surprised what all those people you mentally categorize as 'normal' in your head are actually struggling with in their own lives. We all have our demons.

Which doesn't mean you can't find contentment, happiness, bliss, whatever! But for most of us, I think it is more of a journey than a destination.

There was a time when I was just so sure that everyone else was normal and I was the odd one out, because of my depression.

But now I know we are Legion.
posted by misha at 9:18 AM on October 20, 2011 [6 favorites]

Associate taking your meds with something that you have to do every day. For me it's that first trip to the bathroom. I have to do it when I wake up so it just makes sense that they go together. It used to be the shower, but then I started not showering until 1 or 2 in the afternoon and I'd forget before work. Not a good idea.

And I have to agree with getting out of the routine you're in. I actually sang when we went to karaoke last week. Terrifying for sure, but when I finished singing I felt great.
posted by theichibun at 9:19 AM on October 20, 2011 [1 favorite]

Everyone is different. For me, this is what has helped create a system/structure for being more well than depressed (but of course I am still depressed sometimes), in no particular order:

1. Finding work that is fulfilling and matches my core values.

2. Living in a city, living in a place I love -- location matters to me and the energy of the city helps buoy me.

3. Medication. I have taken medication for 16 years and no plans to stop. I imagine that I will take medication through menopause and likely for my entire life.

4. Therapy. I have gone to therapy at least twice per month for the past 16 years. I have no plans to stop. Right now I go once a week due to a grief situation. Therapy is like medication -- studies show that when you go it works and when you stop going it stops working.

5. Getting older, having more experience with depression. Being older has helped me very much. I don't know exactly why, but part of it is having more experience with depression, and sort of knowing how to manage it, interact with it, not being freaked out by depression. Sort of like surfing (I don't really surf) -- having the experience to ride out the mood-wave and to have confidence that a better/smoother time will come. (I don't know that this would be effective for someone who has treatment-resistent, unremitting depression.) Part of it is losing the excruciating self-esteem agonies of youth/young adulthood. Like, I can (sometimes) experience *just* the depression without layering on self-hatred and/or depression about being depressed.

6. Peer support and community. I am part of formal and informal communities of people w/mental health experiences.

7. Disability rights. Similar to 6. The philosophy of disability rights is very helpful, empowering.
posted by ClaudiaCenter at 10:16 AM on October 20, 2011 [4 favorites]

The medication is really necessary for me and for just about everyone I know that deals with this. It just is. If you were diabetic you would not expect that sometimes you could just skip your insulin shot and be fine. Mental illness is like that.

Therapy, on the other hand, works better over time. You're correcting habits - it's like training for a marathon or something. Yes, the full 26.2 miles is probably always going to be a real struggle, but you're going to look back at some point and realize that running 3 miles is way less of a big deal than it used to be.

I still struggle a lot, but I'm also way better than I used to be. Now I'm struggling to do things that were simply impossible to dream about a few years ago. I'd say that's cause for hope.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 12:09 PM on October 20, 2011 [1 favorite]

It feels like I am putting in a lot of effort for what are, in the grand scheme of things, marginal returns: not a spectacularly successful life, just a middling, almost-normal one.

That is a success. Remember that, and treasure it.
posted by Lovecraft In Brooklyn at 3:40 PM on October 20, 2011 [3 favorites]

Medication- do.not.miss!

Also, it took me about 3 years with an amazing therapist to re-wire my brain. Now I respond to situations how I choose to respond to them, rather than how I was "programmed" (by parents, life experiences) to respond. I can't control anything in the world except myself, and I choose to do things that make me happy. For me, this included redefining things like success, happiness, security, family in a way that works for me, not what others expect or choose for themselves. It is a lot of work and requires a lot of meta-cognition, but the work was soooo worth it for me!
posted by kamikazegopher at 8:57 PM on October 20, 2011 [1 favorite]

I know that it's sometimes hard to remember to take your meds. I had good luck with signing up for a Mefite favorite, Health Month, after realizing I'd missed 7 morning doses of medicine in one month! Set an alarm for a while if you have to. Buy one of those days-of-the-week med dispensers and fill them every Sunday - you'll instantly know if you've taken your meds today or not.

Also, I told my doctor that after missing just one dose of my antidepressant, about 8-10 hours later I'd become extremely depressed and it felt like my whole world was crashing down. She responded by increasing my dose, but also splitting it, so that I take 2/3 of the dose in the morning and 1/3 at night. This way if I do happen to miss a dose, the effects are somewhat mitigated and I don't go into crisis mode.
posted by IndigoRain at 4:25 PM on October 22, 2011 [1 favorite]

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