Girl needs therapy
November 2, 2012 9:51 AM   Subscribe

Therapy hasn't helped in the past. But I need to do something, FFS. What else should I try?

I've struggled my whole life with various issues--shyness, anxiety, inattentive ADD, depression, blah blah blah. It occurred to me the other day that I'm depressed, worried and/or down on myself nearly all the damn time, and it just isn't going to get better on its own. I function, but I'm pretty miserable. And sometimes I do dip into being nonfunctional for a day or two. So I called and made yet another appointment for therapy.

But at the same time I'm wondering if there's any point in doing therapy any more. I've seen over a dozen therapists in my life, starting in college. Therapy methods I've tried include CBT, ACT, psychoanalysis, transactional analysis. Honestly, other than the first therapist I saw at age 18, none of them helped, other than providing a kindly presence for me to complain at. (I saw several of these therapists for 6 months to a year, so it's not as though I was merely therapist-hopping.)

I've also been on a colorful array of drugs, including Paxil, Zoloft, Wellbutrin, Klonopin, Vyvanse (second worst drug ever), Strattera (worst drug ever), and others that I can't recall at the moment. Paxil and Zoloft did considerably chill me out, at the same time that they zombified me. They were also hell to get off of. So I don't know that I want to head back down the psychopharmaceutical trail again so fast.

Or is all of this just the depression talking? Maybe it is better to be zombified and not freaked out all the time.

Is there anything else I could do? I try to eat well, lots of vegetables. I'm vegetarian, but have also been omnivorous with no change in my symptoms, so don't think it's that. I supplement with vitamin D and omega 3s. I drink one cup of coffee a day because I am lost without it. I exercise every day (jogging and weight-lifting). I try to meditate daily but it's hard to find the time. 36 yo female, no other known health problems.

Thanks, all.
posted by indognito to Health & Fitness (12 answers total) 10 users marked this as a favorite
Be very straightforward with your therapist about what specifically you want out of therapy. I've found that has helped me immensely with my current round of therapy. My therapist was at first the type of "Tell me what's going on...then silence for 50 minutes" type, and I said that wouldn't work for me, so he changed completely in his methodology, and now it's more like a strategy session to deal with my issues with a trusted co-conspirator than a ranting session and a quiet shoulder to cry on.

If you go in with an agenda each and every time, you might be able to see more progress.

Good luck! I know it's tough going.
posted by xingcat at 9:56 AM on November 2, 2012 [3 favorites]

Go "get a life". Afraid of heights? Hike up mountain trails until you are in tears. Social anxiety? Hang out with extroverts of the sort you find simply mortifying. Worried sick about your health? Volunteer at a hospice where people are dying. Worried sick about money? Volunteer at a homeless shelter.

You can choose to push your own boundaries and get some perspective on your problems. Not reafy to jump in with both feet? Start by watching the movie "Beyond Rangoon".

Best of luck.
posted by Michele in California at 9:58 AM on November 2, 2012 [1 favorite]

I've found therapy to have diminishing returns, but everyone's mileage may vary, and periodically I go to a few sessions with a new therapist to see if it seems helpful again.

What continues to be tremendously helpful to me is setting aside time to do "therapy" on my own a couple times per week, using books like these for structure:

The latter book, especially, has utterly changed my life.

Sometimes you need another person to get you out of a rut, give you structure, or keep you company while you face something painful. But, sometimes talking to another person gets in the way. Hope this helps.
posted by zeek321 at 9:59 AM on November 2, 2012 [5 favorites]

I would consider trying different medications. It took me years to find the right combination of medications to alleviate my depression. Try to see a really good psychiatrist; don't go to your general practitioner.

For me, therapy didn't really work until I got on to the right combination of meds - I needed the meds to get to a place where I could really engage in therapy.
posted by insectosaurus at 10:00 AM on November 2, 2012 [1 favorite]

Have you tried light therapy? I don't know what the cloud cover is like wherever you are, but most people ho live in cities have a lumen deficiency. Don't just buy the light therapy lights, but also try doing your jogging outdoors first thing in the morning (though I suppose that's what most people do), looking up at the sky every day for several minutes without thick glasses, moving to a brighter house/apartment, not working in a cubicle.

Also, try switching your exercise routine to swimming or something, going jogging in prettier neighborhoods, going dancing, getting out to the country.

You may even be tiring yourself out from overexercising. Perhaps you would have more time to meditate with less exercise.

Also, look for a purpose. Maybe fostering kittens...
posted by serena15221 at 11:10 AM on November 2, 2012

You are kind of a bit on your own here. What I mean is that therapy can help with depression, but its never going to make your life meaningful.

Take a step back, what are you trying to get out of your life? The disconnected tone of your post really jumps out at me. You mention a bunch of diagnoses, but what is it you want to do?

I mean, if you were 'all better' what would life look like?

Many of us, myself included, are kind of blown away by the existential meaninglessness of it all. For centuries, people used the idea of god as a kind of axis to define themselves, so their lives could have some meaning, but in our secular society each of us has to be the center of our own universe, and this can feel a bit lonely. Without the glue of family and community, we wander through life, clinging to one loose knit tribe after another, and meanwhile nothing is stable, permanent, or satisfying.

The truth is, you can learn how to be less shy, more focused, and even happier. I recommend REBT, which goes a step beyond CBT to address our attitudes about life. A guide to rational living is the best place to start. No therapist can tell you how you how to lead a meaningful life though.

You have to decide what is important to you. Do you want to have great love? Do you want to be successful financially? Do you want a family, or to devote your life to a noble cause? Do you want to create meaningful art? To impress others? To act on stage or sing in smoky bars?

The story of your life, what is it about? These are a few questions you can ask yourself, come up with more. We may never be able to answer them, but just thinking about things critically can be very satisfying.

We are not fixed unchangeable entities, but ever evolving processes. How do you feel like unfolding?
posted by jalitt at 11:23 AM on November 2, 2012 [5 favorites]

Would second what michelleincalifornia and insectosaurus are saying. As a mild-moderate Asperger's I am somewhat familiar with your issues. I think the way forward may lie in reflecting on your strengths (including social and familial such as e.g. kindness, generosity, nurturing, etc.) and play to them, as well as on your weaknesses (such as reticence, parsimoniousness, judgmentalism, etc.) and work on those. Friends, lovers and chocolate can help a lot, too. If you are deficient in these, that needs to be fixed pronto.

Medication can probably help once you find the right stuff (or combo), but it will only be one of many supporting factors. Ketamine is currently making a comeback as there is increasing evidence that even a single moderate dose can help reduce depression for up to 2 weeks at a time. However, it is related to LSD and has picked up a bad rep over the years - so if you want to give it a try, find a doctor who is willing to support you having it from time to time. And while it works really well for some, it can also give you a terribly bad trip and is potentially addictive. Electroconvulsive therapy, likewise, has a small but well-recognised role to play where talking therapies and pharmacological approaches have failed. I say this as an anaesthetist (anaesthesiologist) who uses ketamine on patients for its analgesic properties, and has been giving anaesthesia for ECT for years. If I got really depressed, I'd be content to try either.

But fundamentally this is a hole you need to pull yourself out of, with any help you can get. If you don't have a loving spouse/partner/friend with benefits, go try find one - it will be a great motivation. A little whining from time to time is fine, but mostly you need to find a way to kick yourself up the arse to get going - anatomically difficult as that may be.

Good luck.
posted by kairab at 11:23 AM on November 2, 2012

I think you're a lot like me. There's no medication for me. I've tried a few but I'll spare you the details. My current stack is:

For anxiety, I take a lot of Theanine. It takes the edge off without drowsiness, its cheap, and has no side-effects. I'll take tryptophan and valerian root when I just want to feel really out of it. Be warned, this combo leads to bad drowsiness and even drowsiness the next day. Theanine alone is nice.

For adhd related issues, I make sure to cut sugar and caffeine and lower carb intake (huge hyperactivity triggers for me), plan ahead, do not overstretch myself with commitments, and just take things slower than I know I can. Meditation is bunk. I'd rather practice focus by sitting and reading.

I also toss back some fish oil, niacin, and vitamin C, but they probably don't do anything for mood. I also accept that life is complerely meaingless other than the meaning I give it. I don't expect meaning or fuifillment from the norms of society or religion or whatever morals are popular at the time. I make my own rules which usually lead into my own creative projects and other things. I take responsibility for feeling down, bored, a failure, etc. I know that I can change this and a lot of these negative feelings come from unhealthy expectations from society. In other words, let your freak flag fly. It'll feel good. Write a shitty novel or draw a comic strip or goto spoken word night or whatever.

Periods where I'm eating well (especially limiting carbs) and exercising are usually my best. I've fallen off the wagon and am definitely feeling it. Ironically, some of the best advice modern medicine can give us is to simulate farm labor on a daily basis.

PM if you'd like more details. Good luck.
posted by damn dirty ape at 11:32 AM on November 2, 2012 [1 favorite]

Is there something that you want to do with your life? Imagine a situation in which you have *somehow* managed to solve all of the anxiety, shyness, depression and all the other conditions that have vexed you. For the moment don't get caught up in the details of whether that's possible or how it happened - let's just say that some new medicine combination or some experience did wonders and you no longer have any of those problems.

In this imaginative exercise, now that you no longer have those problems, what are you going to do with the rest of your life? You're in your 30s, you probably have a good 40+ years ahead of you. If you weren't struggling with all that stuff, what would you do?

You might have an answer right away ("I've always wanted to be a singer/teacher/artist"), you may have a kind of glimmer of an idea ("maybe something creative/mathematical/involving people..."), or you may be totally blank and have no idea what to do with yourself if you weren't struggling.

If you fall into the first category, start working on doing that thing even if you are only able to tiny steps, like taking a class, or buying a sewing kit and a book, or meeting with someone who does the thing you want to do and asking them about it. It will probably be hard at times, but hey, this is what you want to do with your life - it's worth the effort!

If you're in the middle category, start trying different things that are kind of in the realm of what you're interested in. If you're sure you like working with people, volunteer at a food bank or take a toastmasters course, etc. Just to see what about working with people (for example) you like so you can narrow it down.

If you're in the last group and you have no idea what you would do if you weren't struggling with your emotional problems, I'd suggest that you find a way to explore your past to try to remember anything that you've loved doing. Or try to figure out who has ever inspired you. See if you can use those as a way to define the direction you'd like to head in.

Sometimes we get so caught up in struggling with our problems, we forget where we want to go and we end up deferring life until our problems are solved. We think, once this depression is gone, *then* I'll figure out what to do. My experience is that that's a risky approach. We can spend our whole lives struggling and not doing what we want.

If this way of thinking is of interest to you and you want more guidance, look for an ACT (Acceptance and Commitment Therapy) therapist or read some ACT self-help books.
posted by jasper411 at 12:19 PM on November 2, 2012

Response by poster: Thank you, all. I am going to think over these suggestions and try to find ways to incorporate them.

Finding meaning and purpose in life is something I struggle with and always have. In addition, I have a tendency to mull on all the dismal and tragic things in the world and have forced myself to go on a media fast as a result.

Thanks again.
posted by indognito at 2:17 PM on November 2, 2012

Best answer: FWIW, I made my peace with existential crisis with this flippant but serious conclusion:

The Christian bible indicates god was lonely and decided to create humankind to alleviate his loneliness. Thus, I exist as entertainment for a cosmic intelligence beyond my comprehension. I am probably more entertaining when I am screwing up. Therefore, I cannot get this piece of it wrong.

(I am not a Christian. I am someone who gets hung up about Doing The Right Thing. This works for me.)
posted by Michele in California at 2:35 PM on November 2, 2012 [9 favorites]

Absolutely LOVE your [counter-]existential take, michelleincalifornia. It's more than a little similar to my own take, I guess - I call myself an optimistic pessimist (i.e. half expecting to be surprised by a good outcome when my default expectation is negative so I'll never be disappointed). Plus, the boredom of stewing in your own juice should, at least from time to time, create enough gumption to just say 'What The Heck' and give XYZ (whatever) a go. The outcome might be surprising(ly positive) ...
posted by kairab at 4:04 AM on November 3, 2012

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