What can be done for situational depression that won't go away?

March 31, 2014 11:17 AM

What can be done for situational depression/adjustment disorder that never ends?

I've been dealing with this for (not kidding) decades. It feels like the kind of heart-wrenching grief from right after a breakup or when someone dies, but it never goes away or lessens even after all these years. I cannot change the external situation that is causing it (think grief/loss). I went to therapy when it first happened and have done therapy and done therapy and done therapy many, many times since then, and it's never helped, because (I think) it cannot change the external situation. I also went to a psychiatrist and tried various antidepressant medications (sometimes several at once) and all of them did nothing--it was like taking sugar.

I've never had any trouble functioning and I've never self-harmed or been suicidal. I hold down a fairly demanding full-time job and own a home. I function just fine, I just feel like shit while I'm doing it. I already eat a healthy diet and exercise and get enough sleep. I have never used recreational drugs and I don't drink or smoke. I am not looking for suggestions on how to function better; I want to feel emotionally better.

My self-esteem is fine. The worst experience I've ever had in therapy was CBT--my sadness isn't due to any sort of cognitive distortion or internal thing, it's due to a real external thing that is out of my control.

My last therapist was a grief specialist. I worked with her for about seven months (without getting better) and she told me she didn't feel like she could help me. I'm really interested in complicated grief, and have even written Columbia about it (they're the main university doing research), but the treatment for it is really, really specific to bereavement (my loss is not a death), and when they wrote me back they didn't really have any suggestions other than "sorry, Targeted Grief Therapy really is only applicable to bereavement." I tried to enroll in a TMS study but I am too functional (and they really need people with organic depression).

I am currently in therapy (with a newer therapist than the last one). She really wants to help me but doesn't know what will work. I've always interviewed several therapists before working with one and had a good rapport with therapists I've chosen, so it's not an issue of "fit"--it just never helps. I feel like when I go to therapy I just cry for an hour--and I cry plenty when I'm at home. Getting empathy (from family, friends, or my therapist) also has not helped, neither has talking about it over and over. The passage of time is obviously not helping either.

Is there anything else I can try? I'm really looking for scientific answers or links to research, so if you say, for a totally fictitious example "gardening makes people feel better," then I would prefer a scientific explanation as to WHY (what neurotransmitter is involved, what is going on with the brain to make it so).

I am in the US and have so-so insurance.

Email is [e-mail] if you want clarification or to answer anonymously.

Thanks.

posted by anonymous to Health & Fitness (14 answers total)

If you continue to live in a state of grief, if the source of your grief is continuous, I'm not exactly sure if there are any pharmacological or theraputic resources that will actually work.

It's rather like saying, "I'm in a situation where I have to walk to work each day. My feet hurt. I have to wear these exact shoes, and I have to walk this exact route. Make me feel better." If you can't change some part of the equation, exactly what would work?

So what can you do to change the situation?

You say you can't change the external situation. It's hard to imagine what that situation might be. When you mention Complicated Grief, you're talking about people who WON'T change, not people who CAN'T change. The therapy aimed at such people is to get them to realize that they must reframe the thought process, and exit out of grief into acceptance.

I believe that you can overcome this, but you may need to work with more therapists, and/or try different anti-depressants.

There is no magic thing that makes you suddenly not sad. There has to be some effort on your part to change the external situation that keeps you exactly where you are.

It's hard because if you've been holding onto this grief and in this situation for decades, you may not even see the exit, because you've invested so much time and energy into this thought process.

There will be no quick fix, just more work. It will be gradual, not sudden.

I will ask you one question. Would the person you are grieving want you to live your life as miserable as you are? How does living in this manner honor that person?

I wish you well on your journey and I wish you peace with your grief.
posted by Ruthless Bunny at 11:52 AM on March 31, 2014 [9 favorites]

Maybe EMDR, since you didn't specifically mention that as something you've looked into? I only have second- and third-hand anecdotal information (though there's various kinds of research out there to sift through and make your own decisions), and that's all from people who were dealing with event-in-the-past PTSD (though in one case the originating event was an accident that caused permanent life changes, so there were issues of ongoing mourning so to speak), but maybe it's worth just a sit-down with a practitioner to see if it's a fit for you?
posted by Lyn Never at 11:53 AM on March 31, 2014 [3 favorites]

I'm not sure I have the right picture of what is going on for you but I imagine that something terrible happened many years ago (rape, war, disability) to you or someone extremely close to you and it changed your world and ever since you have been unable to adjust and be happy in the "new normal" world that includes this loss.

I would suggest that you start by reading Victor Frankl's Man Search for Meaning. He personally went through one of the worst possible situations (concentration camp during the Holocaust) and from that experience developed an approach to psychotherapy that can help people deal with the worst things that can happen to humans.

Two of his famous quotes deal with situation where you are now - there is an unavoidable, irreducible external problem that you are unable to change - and challenges you to find a way to live with it by changing yourself. This is not the classic "challenge your irrational thoughts" of CBT. This is a deeper challenge to find meaning and happiness in life in the face of an awful reality.

“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.”
“When we are no longer able to change a situation, we are challenged to change ourselves.”

Finally, have you been evaluated for dysthymia (long-term, functional depression)? If there is a scientific, neurotransmitter level solution, it might be there.
posted by metahawk at 11:57 AM on March 31, 2014 [7 favorites]

I function just fine, I just feel like shit while I'm doing it.
...a real external thing that is out of my control...

The snippets above make me think ACT (acceptance and commitment therapy) might be worth a look.

Wikipedia's summary of the evidence for ACT.
posted by Bentobox Humperdinck at 12:12 PM on March 31, 2014 [4 favorites]

I find it curious that you have not identified the outside circumstance that is causing you this grief. If you could talk about it and name it and pinpoint it perhaps that would be helpful for us to better answer your question. You might ask yourself why you have not explicated it entirely for us.

EMDR might help. I also think that you should minimize the impact this event has on your life by not discussing it or dwelling in your sorrow. Those things keep the pain active and alive and real.

Perhaps this is the loss of something or someone dear. I just have a feeling that is what this is. I am sorry for your loss. Truly.

I lost someone too - well, I threw him away - and I think of him every day. I cried about him this morning. It is just a part of my life and that is ok. After I cried I went to work and had lunch with a friend and returned some pants at the mall and then I came home and read your question and thought of him again. It just is.

I try to focus on the lovely times we had and to forgive myself for hurting him and doing what I did. One day at a time. It's been almost five years and my grief gets worse as time goes on, not better. But this is one of the beautiful things about life. Without sorrow there is no joy. Every day I thank him for loving me for years, and I thank the Universe for showing me that kind of love - something I doubt I'll ever have again - and I remind myself that some people never have that. And it causes me great pain but it was also a very tremendous gift to be loved that way.

And I also work on loving myself and on forgiveness and kindness. When I think of him and cry and feel grief I say "hello grief, it is nice to see you," and then I mentally wander away to the best of my ability.

I hope my long story was not too irrelevant. I just feel like this is about the loss of a loved one. I'm sorry if I am off base.

I did EMDR to recover from my abusive relationship (which I entered after leaving the man I describe above). It was helpful and I would recommend it. Learning how to accept the intrusion of thoughts about the man who once loved me and to say "hello thought" and to move on to other things mentally has been enormous. And finally I recommend you think about what it is you are gaining from holding on to grief. I know it doesn't feel positive or good but you derive some benefit from it. Maybe it keeps this thing alive like I mentioned above. Maybe it's something else. But I might journal or at least think about what, if any, benefits I get from staying in a grieving state.

This may just be your cross to bear. Be kind with yourself about that. It's ok.

I wish you the best of luck.
posted by sockermom at 12:51 PM on March 31, 2014 [2 favorites]

It might be helpful to seek out medications and talk therapies that are suited to PTSD rather than depression--this sounds like an ongoing experience of trauma rather than a kind of dysthymia.

EMDR, as mentioned above, is the main therapy for PTSD. A psychiatrist is likely to prescribe antipsychotics rather than SSRI's for PTSD. Hitting on the right medication can really help manage persistent sadness/anxiety whatever the cause, and I would definitely keep trying, perhaps with a new psychiatrist.
posted by munyeca at 12:58 PM on March 31, 2014 [4 favorites]

I have been living with such an ambiguous, unresolvable grief for many years now. It's less specific but what has helped most is reading popular Buddhism (particularly Pema Chodron's books), and yoga. Doesn't depend on finding a particular therapist or therapy, which is one reason it has been very helpful to me.
posted by mmiddle at 2:35 PM on March 31, 2014 [2 favorites]

I was coming in here to suggest something similar mmiddle. It sounds to me like you have invested a lot of time, energy, money for therapy, etc. into your grief/depression. From the way you have framed and stated your issue, you seem to me to be very attached to your grief and the way you have chosen to react to it. Just as others have said, one way to address an ongoing issue like this is to reframe it. To choose to look at it in a different way or to stop looking at it so closely. Buddhist meditation teachings can help with setting aside attachment to things or to ideas that are negative and hurtful.

Pick up a copy of Full Catastrophe Living, by John Kabot-Zinn and see if any of the teachings in there give you a new way of looking at your situation.
posted by agatha_magatha at 3:07 PM on March 31, 2014 [3 favorites]

I think calling it an adjustment disorder negates some of the meaning. Adjustment disorders are generally short term and people do eventually adjust. For whatever reason you haven't.
Situational just means you can identify a cause or event.
Without knowing the event is hard to recommend anything beyond really generally.

People do process really terrible things and move forward all the time. Those things can range greatly, because so many things can have a profound impact on identity and relationships.

For me I have an acceptance about how traumatic events have shaped me into somebody I like. It took a long time to get here. But on a day to day level I don't feel something is missing because I won't imagine it differently. I've let go the what ifs and the fantasy of the prefect world in which bad thing didn't happen.

I think your next step may be to get an evaluation by a psychiatrist who can point you or suggest treatment modalities based on your traits. I'm not talking about an hour interview, I'm talking about someone who will investigate using actual diagnostic tools mostly in the form of lengthy tests to figure out what diagnosis fits best and what type of therapies are more likely to be effective.
posted by AlexiaSky at 4:35 PM on March 31, 2014 [1 favorite]

You might be interested in the work of George Bonanno (here's one short article but there are many others and he's written a book). He's a psychologist who studies how people bounce back from grief, what happens in the brains of people who have normal resilience after a bad event, etc. I haven't read deeply enough to know whether his work has an answer for your situation, but it sounds like exactly the kind of thing he studies, and you might be able to find something useful in his work even if not an exact treatment path.
posted by LobsterMitten at 6:49 PM on March 31, 2014 [1 favorite]

I am so sorry for your loss and agree that trauma oriented therapies (such as EMDR) might help.
posted by salvia at 8:48 PM on March 31, 2014

I assume you have tried a variety of therapies? It seems pretty clear that talk therapy isn't going to do you much good. If you haven't already, experiment with whatever you can... psychodrama, bodywork, etc.

(I also assume you have done all the standard self-help type stuff. If not, I recommend a book called Undoing Depression for suggestions and explanations of habits which could make things feel better long-term.)

I understand the difficulty in "looking on the bright side" when your objective situation sucks. But keep in mind that some people are able to do it, and there are techniques outside of their innate personalities that help. In my case (and I can't claim that I am always able to do this or am particularly good at it, by the way; with luck you'll be better than me!) what works best for me is alternating between mindful engagement with the crap I have to deal with (for a long time, this was being a 24/7 caretaker for a very demanding person and I had no reasonable choice in the matter) and escapism; going through the motions and thinking about entirely different things. Your mind probably works differently so that particular technique may or may not be helpful, but when you have the energy to experiment, there is still hope of finding something that makes you feel good.
posted by metasarah at 6:10 AM on April 1, 2014 [1 favorite]

Have you had a through wellness panel (vitamin d, iron, thyroid, etc)? Health issues can make it more difficult to treat depression if you have an underlying issue that is not being addressed. (I'd still pursue the PTSD angle mentioned here.)
posted by typecloud at 6:43 AM on April 1, 2014

I'm in a very similar situation, where I deal with grief that is external and outside of my control. I also am very functional, I don't have depression, I am relatively healthy and active, and have good relationships with people. However, like you, I deal with grief that is an external situation and probably will not change.

I truly know how this feels and I am sorry to know that you have to deal with this also. I also wish I had more answers for you. There is one item that my therapist has suggested that has helped me the most which I will describe below.

When I am going about my day and I feel grief, I recognize the grief is there, however, I think of it like watching leaves float down a stream. Therefore, I feel it and let it pass and go about my day. Considering that the situation won't change I know all I can do is accept the situation and let it pass, even if the grief is there.

I know this is a very simple thought, but it helps me. Good luck to you, and feel free to message me at any time. I truly understand your pain, and wish there was more I could do to help.
posted by lullu73 at 4:50 PM on April 1, 2014