When I'm low, I'm low
September 20, 2014 5:59 AM   Subscribe

How do you effectively seek treatment for anxiety and depression when the symptoms come and go?

I feel as if I function in a kind of general state of low-grade anxiety and depression a lot of the time (when things are only going so-so, and more the anxiety than depression, I think). If I am in a low-stress period, I tend to feel relatively confident and do okay at enjoying life.

However, when I get stressed (and I get stressed rather easily, over things that a lot of people would take in stride), I start plummeting into depression and worsened anxiety, and all the distorted thinking that goes with it. In the most recent episode, I was crying at the smallest things or for no reason at all, thinking horrible self-hating thoughts, having difficulties sleeping, and feeling this urge to self harm that was stronger than I have felt before. And having intrusive thoughts about suicide. And I have these kind of obsessive and circular thought patterns that I think are driven by anxiety. During this kind of period, my confidence also tends to drop precipitously. I mean, like, I really just feel utterly incompetent, view every decision I have made in the past as horrible, and feel unable to have regular interactions with people. I try to fight it, and on the outside to other people I often just seem kind of quieter than usual or moody, but I really do struggle. And the past year or two there have been an unsettling number of episodes of having sort of dramatic crying jags in front of people I don't even know that well when I reach some kind of breaking point. The severity of all of this kind of varies, though, I should mention. The latest episode just felt a bit more severe than others.

My past pattern for dealing with this all is to reach out to someone to vent and get reassurance. Usually, if someone I trust can tell me that my thoughts are distorted and that I am not a horrible person, eventually I kind of pick myself up and power through whatever the crisis is. The thing is, I feel like this is an imperfect way to deal with these episodes, because it leaves me dependent on others and doesn't stop me from having all these issues in the first place. I do do a bit of journaling and can sometimes get myself to do something productive like go out to exercise and may eventually feel better from those activities, but often it goes back to the reassurance-seeking pattern.

So I feel like I want to get some sort of treatment that would even things out. It would be awesome not to experience all of these feelings and symptoms which have led to a decent amount of drama in my life the last couple of years and left me feeling kind of emotionally drained. The thing is, I have a hard time getting and continuing treatment because often I get into the low mood or have the crisis, then it gets better and when I am feeling good I have a hard time remembering what the low point was like. I feel confident again, start making plans for the future, etc. I might start therapy, but then have nothing to talk about because I feel like things are going great. I have started taking some kind of medication once or twice, but then stopped because I was feeling okay (before the medication really had time to work) and because I feel ambivalent about whether I really need it or want it.

Does this sort of pattern sound familiar to anyone? If you have experienced this difficulty in getting treatment or this kind of issue with moods and successfully dealt with it, how did you do that?
posted by anonymous to Health & Fitness (9 answers total) 34 users marked this as a favorite
I'm with ya.

Just a few thoughts that I hope will be helpful.

I'm 36 years old and have been dealing with this kind of stuff off and on my whole life. Only once did I truly fear that I was spiraling into a serious depression, and, as I'm sure you've experienced, even then I've "bounced back."

When I look back on my life, I realize that there different things have caused me anxiety and depression. For example, in high school, I was seriously distraught at being a person who lacked attention to detail in his work. This was a common criticism that I had of myself (and that I received from others). I thought this flaw was something inherently wrong with me. Today, I realize that I simply hadn't developed the skills of being thorough in my work. It took longer than it should have for me to develop these skills, though, because I constantly fretted about them as a younger person, instead of realizing I could actually fix them.

Today, the thing that causes me anxiety is uncertainty about my ability to make good decisions. There are certain things that I fall behind on (house repairs, job skills, life goals) because I default to thinking that it's my lot in life to not be able to do wood-working repairs, to not be able to learn a new job skill, and to not be able to set and achieve major life goals. In reality, I know that I simply haven't practiced woodworking enough to be able to fix my old house (or I haven't practiced hiring contractors to do it for me); I haven't practiced learning a new job skill enough; and I haven't practiced setting goals and attempting (and failing!) to achieve them.

So what does this have to do with anxiety and depression?

In my own personal experience, I've started to recognize anxiety and depression not as something inherent to my personality, but as the result of me not having learned some type of skill -- social or otherwise -- that leads to me feeling isolated and sad.

I'll give you another example. One of the guys I work for has a huge personality, is very wealthy, and grew up in a highly structured, highly traditional family. Now, he's no saint and I don't like the way he does a lot of things, but after working for him for 10+ years and seeing his interactions with his children, I realized that his kids have learned a very specific set of skills that will help them navigate this world in a positive way. Me? I never learned those skills. So I struggled for years, felt low self esteem, and really have "lost" 20 years of my life to underachievement. Now that I can pin my anxiety to skills I never learned, I can take action.

So maybe next time you're not in a depression, spend some time (not too much!) thinking about how you ended up in your last depressive episode. Maybe you'll be able to identify one or two things that cause you anxiety, and then you can work on learning skills that help you reduce the emotional burden of those situations. I think it's important to do this work when you're feeling good. In my experience, too much self-reflection when I'm feeling down just makes the spiral worse.

Obviously I'm no doctor, so take my advice with a grain of salt. But this approach has started to work for me. Perhaps it can help others as well.
posted by joebakes at 6:29 AM on September 20, 2014 [17 favorites]

I have an anxiety disorder and what I discovered is that when I was untreated, I was more prone to anxiety attacks and general anxiety. I wasn't anxious 24/7, but I was anxious more frequently and the intensity of the anxiety was worse.

I've been on Celexa for years now, and it evens it all out. Do I still get anxious, sure, when there's something real to be anxious about. But it's not interfering with my day-to-day life, it helps me NOT to stress out, and I feel better in general. Also, I don't blow small things out of proportion.

So speak with a doctor and see if a low dose of a medication might be indicated. You can have depression as a brain chemical imbalance and not be actively depressed.
posted by Ruthless Bunny at 6:56 AM on September 20, 2014

- Take your journal, review it, and flag all the places where you describe the lowest of the low points so they will be easy to reference.
- Start treatment and continue the mood journal. Commit to maintaining the treatment for at least 6 to 12 months, regardless of how you feel on any given day - set alarms to take your medicine, make a checklist, whatever you have to do. If you find your resolve flagging, flip back in the journal to your flagged places and review how you felt at your low points. Review this post. Perhaps write down a page that describes why you never want to feel that way again to review at these times as well.

I suspect that when the trial period ends you may find your life has been so much better, in general, that you will see the value in continuing treatment even when you are feeling all right, to be able to avoid the low points.

Disclaimer: If you really think you are going to harm yourself and are thinking of suicide, you need to start treatment immediately or discuss how to change treatment (i.e. call help now), and not hold off to document it for yourself.
posted by treehorn+bunny at 7:09 AM on September 20, 2014 [3 favorites]

If reaching out to others helps you, you don't have to get rid of that coping skill, because it can be immensely healthy. You may need to tweak it in a way that makes it less "dramatic" or exhausting, which quite likely will involve reaching out to others much earlier, before it feels like crisis mode -- and, hey! Talking to a therapist is pretty much practice for that.

I really like what joebakes wrote about looking for patterns or triggers, and those patterns or triggers are the things therapy will be most helpful in addressing, both in identifying when they're happening and in employing healthy coping mechanisms during them.

You don't have to be in crisis to be in therapy, and in fact you'll probably get more work done if you're not. It does help to have a curiosity about how you and your mind work.
posted by jaguar at 7:47 AM on September 20, 2014 [1 favorite]

I haven't had a serious low period in about two years, but I do have many minor low periods. What's working for me now seems to be having a monthly appointment with my therapist. He says I can schedule it more frequently if I have a really bad period.

Mine is more anxiety than depression, and just the thought of knowing I can make it through until my next appointment (or making an additional one), seems to really help. As do many of the exercises and techniques I've picked up in therapy sessions to help me learn how to handle my anxiety, my triggers, and what can happen.
posted by PearlRose at 7:49 AM on September 20, 2014

I have had very, very similar experiences to this for most of my life. I'm still looking for the right fix but one thing that has helped me a lot is CBT (Cognitive Behavioural Therapy) and working with a behaviourist to learn how to process my very strong negative emotions a lot better than I used to.

I've also had good luck with going to the gym and hitting stuff, but it has to be a regular habit -- when I'm low the last thing I feel like doing is "exercise", but if I'm already in the habit of going every other day I always feel better afterwards.

Good luck to you -- Its not easy to live this way while it seems like everyone just sails through life.
posted by id girl at 8:01 AM on September 20, 2014

I have started taking some kind of medication once or twice, but then stopped because I was feeling okay (before the medication really had time to work) and because I feel ambivalent about whether I really need it or want it.

One of the challenging things about any chronic condition is keeping yourself out of denial. It is always so tempting to believe that it was just a fluke, that you aren't really sick and don't really need to keep taking care of yourself and managing your symptoms. Depressed people do it, diabetics do it, addicts do it, people with relapsing chronic pain do it — it's a natural human reaction to the scary and demoralizing thought that you are going to be grappling with this shit for the rest of your life.

You need to drop the denial. That doesn't mean giving up all hope and succumbing to the depression. It does mean accepting that the depression will come back, and committing yourself to being ready for it when it does. One form that commitment can take is resolving to stay on your meds even when you feel okay — not necessarily forever, but at least for a few months or a year, so you can get a clear sense of whether they're helping. Another form that commitment can take is resolving to show up for therapy even on days when you feel good.

It sounds like right now you are resisting making those commitments. That itself is something you could spend some time talking about in therapy.

It helps to realize that therapy isn't just for talking about bad feelings. You can talk about things that are going well for you, and to try to work out what you're doing to make things go so well. You can talk about how you're hoping the bad shit won't come back, and try to channel that hope into proactive self-care rather than using it to feed your denial. You can show up and say "My mood is fine right now, but I know there's some unpleasant stuff that I'm avoiding thinking about."
posted by nebulawindphone at 9:28 AM on September 20, 2014 [6 favorites]

Hi. I was (very similar at least to) you. What I learned (the hard way, after dealing with this for 30+ years) was that I lacked healthy coping skills for dealing with my mental and emotional life. I over-identified with my thoughts, and got easily stuck in negative and anxiety-filled thought patterns that would cause me to feel terrible about myself or make bad decisions out of fear. I used to hate people who seemed effortlessly happy, like it was some exclusive club that was forever denied to me. I had to let go of my self-identification of being a depressed person, and realize that there was more to me than that, and that I wouldn't turn into some vapid cherry moron if I wasn't riddled with sadness all the time. I equated (quite wrongly) depression with being "realistic" or "observant". This was not a healthy coping mechanism for me.

CBT helped. I couldn't afford a lot of therapy, so my therapist recommended that I read Three Minute Therapy which helped even more. I changed how I thought - if I had a negative thought, I would replace it with a positive one. I replaced negative descriptions of emotions with positive ones: I'm not 'terrified', I'm 'excited'. Took a few weeks, and thousands of corrections, but eventually the constant negative talk died down.

Then to deal with my anxiety, I went out and started doing things that pushed me way past my comfort zone, over and over again. Not stupid risk taking, but just things I was scared of trying that were fairly safe. The more I did that, the more I realized a lot of my negative self-talk was unfounded and that I didn't need to freak myself out over, well, anything really. I make far better decisions when I'm not crippling myself with criticism and worry. I learned how to actually have fun.

I also read The Power of Now which helped me to take a step back from my constant thinking and realize that I was more than my thoughts, and that my thoughts were not always 100% accurate descriptions of reality. I was able to drop the negative filters I was seeing myself and the world through. I was able to push through all the noise and finally just BE. I remember when I felt actually happy for the first time ever. I was shocked, and kind of sad that I had the ability to feel this way and hadn't been able to before. I finally understood what people meant about it being a choice. But it's not like the choice is "Ok, I'm going to be happy forever now" and then you are. It's more like a decision to be very aware of one's thoughts and to steer them in a good direction or let them go if they are not helpful. It takes WORK, especially at first. But it does get easier.

And yes, I still have moments where I feel like I'm slipping. But now I have skills to cope with this, and I just breathe through it, and it passes instead of sucking me down into a depressive spiral. My biggest weapon against depression now is gratitude. This made me feel all kinds of icky and fake way back when, but I have since realized that truly being able to feel grateful for the good things in your life (and some days it's just "I can breath air and walk around") is really important.

All of this enables me to take a much more proactive stance on problems that come up in my life, and helps me keep a positive outlook that not every bump in the road is leading to sure calamity. I hope you find something within this wall of text that you resonate with, and that you can find ways to make the life changes you want.
posted by ananci at 3:12 PM on September 20, 2014 [7 favorites]

Hi, I'm you. This is massively hypocritical because I gave up on CBT, but I do think that style of therapy would be helpful. The way we are seems to be largely to do with fixed thought patterns and invasive thoughts (I can't do anything, I'm horrible, I have to hurt myself) and CBT is designed to help with that.

I know "mindfulness" is a bit of a trendy recommendation these days, but reading some proper Zen philosophy has provided me with a bit of a rock in the tough times. I think it works in similar ways to CBT: cutting through the harmful stuff you're telling yourself, and allowing yourself to have emotions without them taking over your life. Memail me if you want any specific recommendations
posted by mymbleth at 9:15 AM on September 22, 2014 [1 favorite]

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