What else can I try to feel less sad?
July 4, 2014 3:35 AM   Subscribe

I have battled horrible depressions for as long as I can remember (I think this is probably a combo of inherited predisposition/anxious attachment style and life experiences). I have been through a lot (diagnosed with ptsd though that's not so bad now) and attracted a lot of undesirable people into my life (as well as some good ones). I am so tired of trying to feel ok and really draw blanks on thinking about what could bring joy. Can't imagine what my perfect day would be :(. I feel genuinely out of ideas about what to try next.

Here's what I'm ok at -

I have commited to therapy for 4 yrs. She is great.. really 'gets me' but it is long and painful (good sometimes) and expensive!

I do try and work on myself.. read books/do personal development am in a peer support network and sometimes Al Anon

I cook and eat well and enjoy both.

I find gardening and veg growing therapeutic and do this when I can (though generally when complaintive neighbour not out!)

I have relocated from a crazy, angry city to a smaller friendly one and a tranquil home/nice community.. this has been a good move

other than..

There's no work!! :( I have been trying to set up a business but am having a lot of knocks and finding it really tough without much support or sturdy self esteem. (I still get waves of passion about it.. but I suspect not as often as I need them).

Right now I have to prioritise getting a regular income - but my background is in mental health and a) there is very little here/fierce competition for jobs b) I had left it to set up my business because I felt burnt out.

I have been to a careers advisor (who was really shit/unhelpful/disniterested). I have tried hard to develop i.t skills to widen options but though the teacher was nice.. not a good teacher.. shouty/critical etc.. so I left as was learning ZILCH (he was an old guy due to retire.. not gonna change!). My trade is what would bring the doe in if I can even get a job.

Have a mainly dysfunctional family of origin (far away).. which causes ongoing heartache and I don't trust my judgement in romance after very bad experiences.. so stay away (it doesn't seek me out). I know that's fear talking, and there is a level of sorrow about this (fertile yrs are slipping through my fingers) but feel the need to prioritise safety just now. The prospect of romance frankly scares the shit out of me... whilst a part of me craves..

Friends.. I have a few lovely friends.. but mostly contact is sparse.. they are all married/have kids/careers/live away. My closest (long term) friend here is special but quite reactive. Very very anti men hassling women (in nightclubs etc). I understand this but just had an email about her assaulting a guy coming on too strong to her friend. I feel she wants to me to be ok with this kind of dramatic and stressful behaviour.. it just makes it feel easier to be alone!

I do stuff sometimes... I've probably tried every kind of course under the sun.. including dipping into things I enjoyed as a kid. I get a degree of pleasure out of some of it/a bit of contact.. but I'm not great at sticking with stuff (not sure if just me or the depression) and the local college is pretty crap.

I am generally friendly to people and make an effort but there is also ambivalence about getting closer these days... I kind of can't be arced to meet a million transitory people.

My life does not feel rich and I tend to go from apathetic to very down.. occasionally a contented mood/good day pops in but I've never figured out a pattern/the variables.

I no longer seek it all. I just long to feel ok most of the time (that would be a luxury in itself).
I have been trying to avoid ani depressants as wanted to do the work to try and heal but know I may need to try them next.

Please go gently with the replies.. it has been really hard to write this!
Sorry for long post and thanks in advance.
posted by tanktop to Health & Fitness (30 answers total) 16 users marked this as a favorite
Have you tried doing volunteer work -- especially for a cause/organization that you feel passionate about? Becoming a volunteer made a big difference in my life. It caused a cascading series of (positive) events that led to a new career, marriage, etc.
posted by alex1965 at 4:29 AM on July 4, 2014 [5 favorites]

Congratulations on all the work and things you are doing--you don't mention medication ( or perhaps I missed it). Also, I really don't think one can bring "joy" into their life--it just occasionally seeps in when peace and/or contentment has moved in. It is not something one can look for--when it will be found it will be there. What you can do is make sure that appropriate medication is giving you an even break in finding some peace, contentment and focus. Someone once asked me when I was happiest--I told them it was when I suddenly realized that I had not been anxious/depressed for a while. After years of fooling around with various therapies, medication etc the right combination of meds settled in and it has been a fundamentally life enhancing experience. Putting on prescription glasses for the first time. I had many advantages--good marriage, excellent career, wonderful children and active/athletic life but a tweak in the medication enabled me to enjoy it on a different level--Don't shoot for joy--contentment is worthy goal. Just saw your comment about anti-depressants. My post still stands.
posted by rmhsinc at 4:32 AM on July 4, 2014 [1 favorite]

If your depression is caused by broken brain chemistry, then you need to get over your reluctance to try meds. If you had diabetes that could not be controlled by diet, or cholesterol that wasn't lowered by exercise, I doubt you would be reluctant to take medication. I think you've tried all the "diet and exercise" equivalents for depression and you need to seriously consider the meds.
posted by DarlingBri at 5:18 AM on July 4, 2014 [18 favorites]

Darling Bri is absolutely right. And it has been said 100+ times on AskMeFi--medication will not "make you feel good" but rather help you experience less sadness/anxiety. There is no high--just significantly moderated/lessened lows. You don't feel good when an aspirin (NASAID) works--you just stop feeling bad.
posted by rmhsinc at 5:32 AM on July 4, 2014 [5 favorites]

I want to add that medication made a huge difference for me as well. And there are different kinds of antidepressants, so if one medication doesn't work or has undesirable side effects, there are others that might work better. Prozac and Celexa - SSRI's - did not work for me, but Wellbutrin works like a charm. Wellbutrin (bupropion is the generic name) does not cause weight gain or drowsiness like SSRI's do for some people.
posted by Rosie M. Banks at 6:03 AM on July 4, 2014 [1 favorite]

I had depression for over ten years and to my surprise it was CURED by going low-carb and taking fish oil supplements every day. There is now evidence that depression is caused by chronic low-grade inflammation of the body, so reducing your inflammation will heal you over the course of a few months. I tell as many people about this as I can, because it changed my life. Buy a book on inflammation to see what foods to eat (no wheat or omega-6 oils are the biggies). At the very least try taking fish oil every day - what have you got to lose? It's not your fault, it's your body performing under stress, so treat it well. Good luck, good luck, good luck.
posted by heatherfl at 6:13 AM on July 4, 2014 [3 favorites]

One thing my therapist recently told me is that depression is the opposite of the hope. It might sound a little simplistic, but after many years of therapy and medication off and on, just knowing that is helping me a lot. I'm still taking medication because I think it's something I need, and I do think it would be worth looking into to help you get over the hump.

You mention you have tried taking courses, but have you tried planning something fun for the future that isn't necessarily based on learning or skill-building? It may sound silly, but I actually bought a calendar and went online and started marking down free events to go to and movies I want to see. I don't have to go to these things- just the act of looking for them can be helpful. Now when I look at my calendar and think about the next few weeks and months, I feel some hope at the prospect of pleasant experiences. And when I do these activities I treat them like self-care. Sometimes it's hard to go (especially because I'm going by myself 99% of the time), but I always feel better after the fact and more energized.

I hope this can be helpful. Hang in there! {{{hugs}}}
posted by Mouse Army at 6:28 AM on July 4, 2014 [3 favorites]

If you stare at something for long enough it will become everything to you, to the point where you can't see anything else. Depression is like that, it tucks you in to the grey and that is all that you can see. I had to train myself to look at something else. It is impossible to think about yourself when you are thinking about someone else. Volunteering can help but can sometimes require a commitment that someone with depression just cannot make. What I do is, I look around me and I try to make other people feel better, even if it is just smiling and visiting with the cashier at Wal-Mart. If I make at least one person feel a little better every day, it makes me feel better. By turning my focus outward, I can shrink my depression into something less noticeable.
1) Go somewhere every day.
2) Never stay home alone for more than a few hours.
3) Say yes to anything that isn't morally or legally wrong.
4) Try to help others every day.
posted by myselfasme at 6:51 AM on July 4, 2014 [8 favorites]

To add on to what Heatherfi posted, I am now eating low-carb primal to correct a couple of physical health problems (primarily insulin resistance) and it has made a HUGE difference. The Wellbutrin helped, but going low-carb primal in addition to the Welly has given me a new lease on life. I also take fish oil (Garden of Life brand).

I know it sounds like woo, but it works for me. I know part of it is keeping my blood sugar level, but I'm willing to bet that low-carb is just plain healthier for body and mind. Eat to Live is a good guide. Mark's Daily Apple is another.
posted by Rosie M. Banks at 7:01 AM on July 4, 2014 [1 favorite]

There is now evidence that depression is caused by chronic low-grade inflammation of the body, so reducing your inflammation will heal you over the course of a few months.

I hate to be the person on the internet saying citation needed, but if there is evidence it would be helpful if you could share links to it.
posted by DarlingBri at 7:06 AM on July 4, 2014 [10 favorites]

nthing "It's time to look at meds."

Depression is a complex thing, but is often a result of something in your brain chemistry being off. There's nothing shameful or weak about taking medication for a problem that medication will fix. I've been on Wellbutrin for a year now, and it is astonishing how much my feelings and thoughts have changed. It's taken time, for sure, but it really does help.

Other than that, 1) print this out and show it to your therapist, and 2) congratulations on all the work you've been doing. I know how hard it is to even get out of bed (off the sofa, for me) sometimes.
posted by feckless fecal fear mongering at 7:48 AM on July 4, 2014 [1 favorite]

The OP wrote, "I have been trying to avoid anti depressants..."

I think that you are wise to stay away from them. In the late 1990s, I tried many different antidepressants, varying them over the course of about five years. None of them worked very well, and all of them had side-effects (some worse than others). When I was on Paxil, I gained quite a bit of weight -- weight that I was never able to lose afterwards. Later, after I stopped taking antidepressants, I found articles like the following one that made me question whether the drugs do any good at all: "Why Antidepressants Are No Better Than Placebos", by Sharon Begley (Newsweek, 01/28/2010).
posted by akk2014 at 8:18 AM on July 4, 2014 [1 favorite]

Pretend. Seriously. Several reasons:

1. the cause/effect re: how we feel and how we act is muddled.

2. the cause/effect re: how we act and how our lives (day by day) play out is muddled

3. One of the most depressing things one can do is to try to "find joy". How sad is that? Instead, act joy and let the evidence fill in from there.

4. Depression is incredibly self-propogating. If it seems artificial and contrived and shallow to simply act happy, consider that depressed people are very much in the habit of "acting" depressed, even if there's nothing they can point to causing it. So: if you're going to choose an arbitrary stance, why not choose "happy"?

Your perfect day won't rise through the murk like some towering triumph. Your perfect day is far more pedestrian. It consists of a day in which your mind doesn't constantly scan for negative fodder to endlessly fixate upon - nasty things your ex once said to you, the great apartment you're not living in, the zit on your nose, the disappointment your career has been, the cruelty of humanity or the vapidity of your friends, etc etc ad infinitum. If you simply pretend to be happy, rather than apply your usual herculean efforts to turn a perfectly good day (they're all perfectly good days) to shit by focusing and obsessing on mental negativity (reflecting nothing that's actually happening right here and right now) then your perfectly good day (they're all perfectly good days) will remain untarnished by your internal negative flights of fancy.

The phrase "come back to your senses" is deep. If you'll periodically interrupt your negative internal ruminations to examine what you're ruminating about, you'l find it's never anything here and now. You're somewhere else in time and or space. In your imagination. Try coming back to your senses. You can't get lost like that if you're pretending to be happy. It's just not convincing. So try pretending, and apply the same obsessiveness to making it convincing (even when no one's watching) that you apply to all that ruminating. Do what happy people do: go places, do things, engage with peoiple (even people you don't particularly like! Act like you like them, as happy people do!) and the world. Say "yes" more. Be outward, not inward. Be in the world, not in your musty mental dungeon.

Real problems aren't depressing. If the window near you were to shatter, you wouldn't stitch it into your life quilt of woe, you'd scream, duck, investigate, and repair. Not depressing. You only get depressed about stuff that's not happening right here and right now.....and that's because such problems have no solutions, hence inviting your mind to spin endlessly and fruitlessly around them.

Pretend to be happy, and you'll escape the habit of spinning/obsessing/ruminating. Happy people don't do that. Happy acting people don't do that.
posted by Quisp Lover at 9:09 AM on July 4, 2014 [7 favorites]

PS - greatest book title ever: "What's Wrong with Right Now ...Unless You Think About It?"

Shoot, you don't even need to read the book!
posted by Quisp Lover at 9:17 AM on July 4, 2014

You list friends, romantic relationships, and career as areas where you're feeling stuck. I think that anyone trying to make major progress in all three areas is going to feel overwhelmed. If it were me, I would prioritize one (for me, it would be career, because it's probably a bit more under my control than the other two) and ignore the other two for a bit, or else I would really really really focus on very small steps in each category and try not to pressure myself to be making major progress in all three areas at once.

I would certainly look into medication. The other bit that seems to be missing from a "rich life" is a spiritual dimension -- not religious, necessarily, but just activities that foster a sense of feeling like a part of the larger whole of the world/universe. Al-anon and gardening could fit into that, but spending more time in nature, volunteering, meditation, creative projects, tai chi, or church activities could all fit in that category, too. Those sorts of activities tend to generate more of the meaning-making ideas in one's life (the "what would bring me joy?" answers).
posted by jaguar at 9:18 AM on July 4, 2014 [1 favorite]

This page on Spirituality and Mental Health has other suggestions.
posted by jaguar at 9:20 AM on July 4, 2014

Mindfulness Meditation helps me a lot.
posted by humboldt32 at 10:36 AM on July 4, 2014 [1 favorite]

Depression is horribly all-consuming, so I very much sympathize with what you're going through.

I'm a firm believer in maintaining focused momentum, i.e. not just doing things for the sake of passing time or getting distracted or avoiding the pitfalls of introspection, but engaging in activities that gradually build up to something that is meaningful to me.

One example is spending two hours/day on writing, painting, or any creative pursuit. Doing it centers me because the process itself is personally rewarding, and I know that there is an end goal waiting to materialize, be it a full-length play or a painting I can give as a gift.

My humble suggestions for you: make your business/obtaining a regular source of income your top daily priority because there's a matter of urgency there and I think that achieving a level of progress you are satisfied with in this aspect of your life will improve your overall feelings of well-being. Keep networking and seeking opportunities either for employment or professional development. Complement this with activities that you mentioned you find therapeutic like cooking and gardening. Incorporate something in your daily routine that gives you peace -- whether it's re-reading a poem you love, a 30-minute walk around your neighborhood, or even a prayer.

You are doing all the right things despite the challenges. The best is yet to come. Good luck to you.
posted by tackypink at 12:24 PM on July 4, 2014

Anyone have any natural supplements that they recommend for depression? Obviously a whole foods multi vitamin and fish/krill oil is a basic start, but what about st john's wart or lithiaum ortate? I don't want to take any ssri's and thus I'm interested in over the counter meds or supplements that may give my mood a healthy boost.
posted by HonestAsian at 1:53 PM on July 4, 2014

what about st john's wart

As an FYI when weighing these options -- if you take St. John's Wart, it has to be entirely out of your system before you can try any SSRIs. Frankly, though it may work for some people, I've never actually seen it work for anyone I know. SSRIs, on the other hand, have been a godsend.

OP, it doesn't sound to me like your thinking or perspective is disordered at all, and you might have gone as far as you can in terms of therapy and getting healthy coping mechanisms in place. It sounds like you're doing a fantastic job with all of that (taking good care of your body, finding a good living situation, finding fulfilling hobbies, surrounding yourself with good people and trying to avoid the bad ones, starting a business for yourself, etc). I know that you say you want to do the work to heal on your own, but it sounds to me that you've actually *done* the work, and have done the healing (in terms of lifestyle and perspective changes) that you would have to do to get yourself healthy? At this point, it honestly sounds to me like the only thing left is a relatively simple biochemical issue, and you'd probably see a huge change for the better in terms of your motivation and focus on an antidepressant. It's not "cheating" to try medication, it's just a piece within the overall puzzle of living healthily (and in your case, maybe the final piece). YMMV, of course, but I would definitely try that if I were you.

There's no work!! :( I have been trying to set up a business but am having a lot of knocks and finding it really tough without much support or sturdy self esteem. (I still get waves of passion about it.. but I suspect not as often as I need them).

Financial troubles are *incredibly* stressful, and I don't think you should beat yourself up or blame yourself for not being able to create work out of thin air or because you're not endlessly passionate about something that's been throwing frightening and difficult obstacles at you for what sounds like quite a while. That's very tough to deal with, and it sounds like you're actually being very successful at keeping an even keel despite the hard knocks you're getting. The good news is that money really can buy happiness when it comes to financial stress. Is there a way to put your business on the backburner for a bit and just straight up make what money you can for a while? That's what I did while going broke pursuing my dreams and it was 100% one of the best decisions of my life.

If you're trained in mental health, maybe you would be able to get a job with an area insurance company, as a therapist, as a councilor, or as a social worker? I'm sure there are other options that I don't know about. The job wouldn't have to be perfect or for the long term or even especially well paid, but just having a defined role, defined hours, and a regular paycheck might help you get your feet back under you (mentally and financially). Meanwhile, you could then take your time growing your business to a point where it would be large and stable enough not to cause you so much stress or feel so much like a black hole for your energy.

You might also need more structure in your life than you have right now. That also wears on a person, and having a regular job might also help with that.

In terms of coping skills, I do think that you're already doing a great job, but one thing that you might want to think about is being more willing to accept the limits of your control and the limits of what you can do. If the business isn't growing at the clip that you'd like, maybe it's NOT your fault, and you just have to find a way to lengthen the business plan's timeline? If you haven't found a partner to share your life with yet, maybe it's NOT your fault, and you can just let things ride without feeling guilty? Just because things aren't ideal or not going according to how you'd planned, that doesn't mean you're necessarily doing anything *wrong.* That could just be how the cookie is crumbling this time around, you know? I think maybe you'd feel better if you got yourself more comfortable with ceding control, and just accepting the things that you can't control as they are, and trying to adapt to them, instead of trying so hard to change them. I get why you *want* them to be different (who wouldn't want her business to be fantastically successful and to be with the love of her life?) but there are just some things that are out of your hands and the only way to stay sane and be reasonably happy is to get yourself to be OK with that.
posted by rue72 at 2:26 PM on July 4, 2014 [5 favorites]

Nthing medication. SSRIs take a while to work but Wellbutrin works pretty much the same day you take it, so you can figure out relatively quickly whether you like what it does for you.
posted by Jacqueline at 9:15 PM on July 4, 2014 [1 favorite]

I have been trying to avoid ani depressants as wanted to do the work to try and heal but know I may need to try them next.

From the list you've given us, I think it's fair to say that you have done plenty of work on this, and in such a persistent and fruitful way too. A friend of mine found that anti-depressants didn't magically make her life a joyful song, they just made doing the work a lot easier. It's easier to get the exercise that you know you need, to make the effort to do the cooking and gardening you enjoy, to think clearly enough to figure out the job situation. The food and exercise and relationships are what's really healing her, but the meds make it easier for her to get that essential stuff done without wearing herself out.

If it helps, I found the book I Could Do Anything, If Only I Knew What It Was to be really helpful with sorting out my options for paid work.
posted by harriet vane at 11:34 PM on July 4, 2014 [2 favorites]

There is one post suggesting that anti-depressants may have only a placebo effect (Newsweek/Time article) and multiple posts suggesting you try anti-depressants. In this case I hope you listen to the crowd. Multiple meta analyses consistently give SSRIs and edge over placebo, particularly when they are tracked for longer periods of time. It can take patience , on the part of you and your physician, but the right combination is out there someplace. No magic, just less pain and anxiety.
posted by rmhsinc at 2:24 AM on July 5, 2014

Sorry you're dealing with this - depression is the worst.

I've seen a lot of responses assuming you've tried exercise, but you never wrote about that in your original post. If you haven't tried a regular exercise routine, please do! Anti-depressants caused me to gain massive amounts of weight, made me lethargic to the point of disability, and did absolutely nothing for my depression (and I was on over a dozen different types of ADs) so I cannot personally endorse them - the costs were way too high. Exercise, on the other hand, has effectively cured my mental health issues. Ever since I started exercising daily about 5 years ago (usually around an hour a day of walking, incorporated into my commute or running errands) I've experienced zero significant mental health issues. Highly, highly recommended.
posted by horizons at 4:36 AM on July 5, 2014 [1 favorite]

To DarlingBri, who wants sauce: just Google depression inflammation and take your pick. Here's an article from NIH and an abstract from a psychiatry journal, to start.
posted by heatherfl at 6:51 AM on July 5, 2014

heatherfi--those studies are suggestive there might be a correlation between depression and certain inflammatory responses but that is a long way from suggesting that mediating the inflammatory response will cure the depression. And as pointed out--antidepressants suppress the inflammatory responses. My take, eat a balance diet with moderate portions, exercise regularly, get adequate sleep, take responsibility for managing internal and external stressrs and see if trials of anti-depressants/anxiety medications help.
posted by rmhsinc at 8:43 AM on July 5, 2014 [1 favorite]

I actually have a serious inflammatory condition. I have modified my diet to help keep the health issue under control. An unexpected side effect is that I am much more emotionally stable. I have seen some articles linking, for example, certain oils to depression. I have become super picky about what oils I eat in part because my medical condition significantly impacts how my body processes oils. I have had the experience that when I eat the wrong oils, not only do my medical symptoms come back but I can very suddenly be suicidal when I was fine five minutes ago.

So, since I don't see much indication you have pursued that angle, all you say is you try to eat well, I will suggest that one way to effectively avoid drugs (if you wish to do that) is to look very hard at how diet impacts brain chemistry. But I am not actually as anti-drug as people think I am. I also see absolutely nothing wrong with taking the drugs and then, when you are more stable and functional, starting a food diary and doing the enormous research it will take to get anywhere with a homegrown solution where the science behind it is somewhat limited. I took a fuck-ton of drugs for a long time and, as I found non-drug solutions that worked for me, gradually reduced my dependence on drugs. It took a lot of years. Had I not taken the drugs, I would have most likely died before I could have solved anything (as my medical condition is pretty deadly).
posted by Michele in California at 10:41 AM on July 5, 2014 [2 favorites]

Your post reminds me very much of how I felt until just a few months ago. I posted about how magnesium supplements lifted what turned out to have been a pretty much life-long depression and proneness to anxiety. Later I found that my sister shares this characteristic with me and she is receiving similar benefit from the magnesium supplements. Unlike me she has a very-well-documented medical history and her blood magnesium levels have been on the high side of normal for years, yet she and I share this almost on-off reaction to very similar supplements.

Thinking of a magnesium supplement as a drug is exceedingly odd, yet it is an ion I'm not getting enough of in my diet and it is available in pill form; therefore I call it a drug and it feels strange that I enjoy life much more because I take it. The alternative is experiencing a lot of unhappiness that is just not fun. Therefore I accept taking a drug because nothing outside me is changing, it's just my reaction to it that does - and reacting such that life is engaging and worth living is ever so much better than the alternative.
posted by jet_silver at 12:16 AM on July 6, 2014 [3 favorites]

This book is not explicitly aimed at treating depression, but I really enjoyed many of the tips I found in Gretchen Rubin's book, The Happiness Project: Or, Why I Spent a Year Trying to Sing in the Morning, Clean My Closets, Fight Right, Read Aristotle, and Generally Have More Fun. The kindle version is only 8 bucks. See also her excellent blog. Her target audience seems to be people who aren't clinically depressed but want to be happier. Still, the same tips & techniques can be adapted to depressed people.

With regard to antidepressants, I agree that they're problematic. It's not the easiest book to read, but I would recommend Robert Whitaker's Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Whitaker argues that psychiatric drugs may actually worsen mental illness, at least in the long run. For a shorter take on it, see this article: "Now Antidepressant-Induced Chronic Depression Has a Name: Tardive Dysphoria. New research on why antidepressants may worsen long-term outcomes".
posted by alex1965 at 8:54 AM on July 6, 2014 [1 favorite]

So depression is an inflammatory disease, but where does the inflammation come from?
You can read it as correlation if you want, but "risk factor" and "neuroprogression" sound like causes to me.

Even if fish oil only treats the symptoms.... by god, it treats the symptoms!
posted by heatherfl at 12:47 PM on July 6, 2014 [1 favorite]

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