I'm depressed & I don't know what to do about it
November 25, 2016 7:13 AM   Subscribe

I’m depressed and overwhelmed by self-doubt, and it’s worse than it’s ever been. I haven’t been depressed since my early twenties. Now, mid-thirties, it’s so all-consuming and long-lasting that it’s interfering with basic life responsibilities. I’ve barely had any interactions with formal mental health systems (though I’ve seen therapists several times in my life), and I don’t know what my next steps should/could be. I'm mostly looking for someone to explain potential treatment trajectories. (But of course I've written a wall of text inside to explain/justify myself nonetheless, and any other relevant advice is very, very welcome.)

I’m depressed and consumed by crippling self-doubt, and it’s worse than it’s ever been. I haven’t been depressed since my early twenties. Now, mid-thirties, it’s so all-consuming and long-lasting that it’s interfering with basic life responsibilities. At the same time, I don’t know how seriously to take it; after all, it’s “just my emotions”—and in the past, powering through for a few weeks or months was enough. But now “just my emotions” are making it hard to interact with coworkers or reply to straightforward emails, much less do the important non-job things that give my life real meaning, or ought to. I’ve barely had any interactions with formal mental health systems (though I’ve seen therapists several times in my life, but not for more than a few months at a time and without any meaningful results [or the expectation of them] in the end), and I don’t know what to do next, or what to expect. Not only am I not good at being proactive with this kind of mental self-care, I have basically no idea what form it will/should take a few weeks and months out, and no real willpower to make it happen.

I have health insurance through Kaiser (an ACA-subsidized bronze plan, if that makes a difference), and I live in the East Bay. I'd love to hear Kaiser-specific anecdotes and advice.

Some relevant things:

For the past year I’ve felt really emotionally flat, and since September (or earlier) I've been so depressed and sad and emotionally volatile that some days I struggle not to cry in public. The really bad stretches coincide with PMS, and in general this depression has that irrational “I’m a failure and am not worth being alive” quality that reminds me of my disproportionate frustration/anger during “normal” PMS in the past, which makes me think there’s a hormonal element. I have an IUD, which I just got a couple months ago and am very happy with so far; this terrible maybe-hormonal depression predates it (although getting the IUD certainly hasn’t made it better). I also have Hashimoto’s hypothyroidism, but it’s stable and well-managed; my most recent bloodwork was in September. I used acupuncture once before to help stabilize what seemed like irrational/fighty hormones in the past, but this time have only been able to drag myself to one appointment in mid-October, and haven’t followed up.

Some external factors: I’m a woman in my thirties, and I think a significant component to this is coming to terms with the fact that I’m neither as smart or as successful as I’d like to be. I just had a book come out on a good press—to absolutely no fanfare. If I were a different person, I’d have self-promoted aggressively in the six months leading up to publication, and it in my small field it would’ve made a meaningful difference. But I’m filled with self-doubt, and deeply emotionally ambivalent about my public self, all of which mean that I hate and suck at this, so have relied on the overworked PR person at my university-based press to do it all for me (and whatever she’s done, it’s yielded nothing).

I’m a little foggyheaded most of the time, and would probably be diagnosed with ADD if I pursued getting a diagnosis (and maybe I should?). I struggle to write routine “administrative” emails because I’m not sure what to say, and am generally very avoidant with the professional practices that are adjacent to my intellectual work (like, I need to send copies of my new book to old mentors and the smart folks who blurbed it, but it’s taken me a couple weeks to gather up all their addresses—much less assemble the packets of books and sweet notes, which often take me forever to write even if they’re fundamentally banal). Of course this makes me feel awful and self-loathing because it’s the most basic thing. I mean, I wrote an actual book, but this is hard? (It is.) If I were in a different economic situation, I’d pay someone to do it for me, but realistically that's not an option. I'm not disorganized, but I do everything at the last minute under duress of deadline (or after it), having procrastinated for weeks or months, probably out of fear of failure. I have no career to speak of, and a few years ago when I was recently out of a well regarded grad program [in a humanities field that doesn't necessarily lead to academia], with a handful of impressive-in-my-field accolades lined up on my CV, many of my friends probably assumed I'd stumble into academia sideways through a couple visiting positions in at schools in Kansas or North Dakota, before eventually figuring out something more long-term. But I haven't done any of this. Which is mostly fine, but I can't help but feel almost certain that if I had the confidence of a mansplain-y dude, I'd have a much different life. My actual job, for what it’s worth, is unrelated to any of this—it’s low-stress and basically dead-end, though it pays well enough to keep me in expensive third-wave coffee I decidedly don’t need. I’ve been dogged by low self-esteem most of my life, but I’ve also done enough interesting, off-the-beaten-path things to help circumvent it (and circumvent my shortcomings in the so-called straight world) for long stretches. From afar, I probably seem like the kind of person who's always just back from traveling with, like, nomadic herders in southern Siberia, or hitchhiking in Peru. Up close, I can barely cook myself dinner (before my partner--who cooks for 90% of the meals--moved in, I found myself eating pizza three or four nights a week) and I feel guilty about how many belated emails I owe to those not-actually-reindeer herders, who probably think I'm an asshole after such a long silence.

What else? I’m starting work on a new project that’s far more interview- & fieldwork-driven than my past ones, though I have no formal background in (or comfort with) these skills. I’m not confident enough right now to fake it ’til I make it, though in the past I might’ve been. So this is all hanging over my head in depressing ways, especially because I have an intensive 3wk research period coming up that can't be rescheduled/postponed [and which is much too short for what I need to accomplish, but I can't make more time exist in the world]. My parents are getting old and in bad health, and I’m fretting about how to help support them financially as they ages, and especially over the next year when some big housing-related questions will need to get resolved. My family is fucked up but loving and wonderful, and my partner would probably describe me as well-adjusted. My relationship is kind and supportive, with someone I suspect I'll spend a very long, largely happy life with (although it's starting to feel a little stale and because it’s the easiest thing to question, I’ve been questioning it a lot lately). The election, while intellectually horrifying, is somehow not a major source of stress in all this (I guess because I’m already enough of a cynic to be unsurprised), but patriarchy is a drag and I hate being female in this world most of the time for thousands of obvious reasons.

I’m fairly sedentary and can feel in my body that I’m not active enough. I should be meditating, and doing yoga, or just about anything, but I’ve never been able to get it together to have a regular exercise routine. (I bike commute to work regularly, riding ~5-10 miles ~4x/wk, so I’m not exactly sedentary, but I’m not getting good exercise.) I've gained about thirty pounds in the last 5-6yrs, and I hate my newly-curvy femme-y body and wish I could go back to being a semi-androgynous punk.

I suspect that any treatment plan starts with therapy, and I don’t even know what therapy could help me accomplish—I’m a grownup, I know how to mail a goddamn book at the post office even if I can’t actually bring myself to do it, and I’m not recovering from trauma or breakup, so I don’t have a specific goal to work toward besides not hating myself half the time. My sense, I guess, is that a couple months of therapy would be helpful, but to make any meaningful change I’d have to commit to something much longer? Is this even possible with Kaiser? (Whose mental health services I've heard are always insufficient, no matter how much or little you need.) I know I’m probably actually good and smart and special or whatever, no matter how self-loathing and miserable I feel right now. I’m looking for examples of next step scenarios for people who’ve dealt with this before via some strategy more productive than hoping for the best and doing nothing.

One added wrinkle is that I'm going out of town for a long stretch of Dec-Jan (and will be traveling more or less every day, which makes a regular, grounding routine hard to manage). Ugh. Help?
posted by anonymous to Health & Fitness (28 answers total) 17 users marked this as a favorite
This is a whole heck of a lot of words for a question that can be answered by "try antidepressants."

Look, I didn't want to either. I thought I needed to power through, I thought it was 'just my emotions' and I just needed to 'man up and deal with it.' That's one of the things depression makes you think- there's no point, it won't work anyway, why bother, etc.

Just try it. Even if you think it's a bunch of ridiculous bullshit that will never ever work, because, hell, what you're doing now isn't working out so hot. So why not?
posted by showbiz_liz at 7:20 AM on November 25, 2016 [13 favorites]

Oh, and I guess I should add: antidepressants changed my life. I was on them for over a year, stopped because I thought I didn't need them anymore, got depressed again, went back on them after a year and a half of being off them, and am now doing awesomely. I will probably never go off them again and I don't care. I can read again, make art again, my sex drive is back, I'm not crying at work anymore, I'm doing things with the friends I hadn't called in months. After over a year of flatness and sadness I'm basically... happy. Not all the time, not every day, but I am capable of it now in a way I just wasn't before.

For me, SSRIs were decent and lamotrigine ia awesome; Wellbutrin worked for family members but not for me, etc. It can take a couple tries to find a good one.
posted by showbiz_liz at 7:26 AM on November 25, 2016 [13 favorites]

Yes, talk to your PCP and try the solutions they suggest. You can even take them a print out of this question if talking about it is hard. When I did that I got a script for anti-depressants and therapy. It took a couple of tries to find a therapist I liked, and she worked with my insurance to try to get me as much therapy as I could get from their stingyness, then worked with me to keep costs reasonable when my insurance wouldn't cover more (yes, many plans have sucky therapy options).

For me therapy helped in both the short and long term (although in the immediate term it often seemed Hard). After a few years my therapist thought I was in a healthy place to stop, and she was right. Going from dysthymia/anxiety to me helped me to be able to do all sorts of things that have made me even happier - you can have that, too, and deserve it!
posted by ldthomps at 7:39 AM on November 25, 2016

You mentioned being sedentary. In addition to the other recommendations for therapy and antidepressants you'll undoubtedly receive, try to exercise. Even if it's just taking a walk around the block, physical activity will boost your mood.
posted by kevinbelt at 8:04 AM on November 25, 2016

My story is very similar to others above, and yours too in a lot of ways. For me, antidepressants (trintellix, for me) and Ritalin changed my life. I now resemble an adult with emotional range that includes happiness, and can mostly keep up with housework, a full time job, feeding myself healthy food, and writing my dissertation. I can actually do [just about] all the things - consistently - it blows my mind. I also see a therapist once a week and that helps too, even though mostly all she does is listen, I think it's good for my brain to have a scheduled time to just process the previous week out loud. Best wishes as you figure out your next steps. You are worth it.
posted by shortskirtlongjacket at 8:04 AM on November 25, 2016 [1 favorite]

Your brain is good at coming up with reasons NOT to do it...Don't listen to it.
Get meds.
Get exercise of any kind.
Get therapy - with goal of not hating yourself.
Stop thinking about how long it will or won't take to get better.
If possible, don't travel. Just say you are not well enough to travel. If not possible then do what you can til travel is over.
Above all, don't listen to all the reasons why not.
posted by SyraCarol at 8:10 AM on November 25, 2016

I don’t have a specific goal to work toward besides not hating myself half the time.

That's a very good specific goal. It seems clear that a lot of the behaviour you are attacking yourself for - not being able to post the books, for example - stems from this mindset of devaluing all your successes and investing small acts with a huge burden of self-hatred. So focusing on changing how you think about yourself seems like a very sensible goal, and a necessary first step to dealing with all the behaviours you are worrying about.

I would absolutely begin with a doctor, go for anti-depressants if the doctor recommends it, and get a referral for therapy in any case. I believe cognitive behaviour therapy or mindfulness-based cognitive therapy both have a good record when it comes to depression. You may want to begin to familiarise yourself with these approaches - using, for example, this book, this lecture series or this website - while you are waiting to see a doctor. I know some people for whom these self-help strategies have provided some immediate relief, while others haven't been able to get much out of them. They may be worth trying, for you, in the short term. But professional help is best. You can't reason yourself out of depression, any more than you can fix a broken leg by walking on it.
posted by Aravis76 at 8:11 AM on November 25, 2016 [3 favorites]

I get more prone to depression coming up to this time of year because I get vitamin D deficient. In amongst the other excellent suggestions here, can I suggest getting your levels tested - identifying this for me has been a life-changer.
posted by greenish at 8:14 AM on November 25, 2016

- Find some other method of birth control if you know the IUD is making PMS worse (which you do, just trust that). Lots of people are ok with hormonal birth control; lots of others have horrible side effects no matter what they try. Barrier methods aren't ideal from a usability standpoint, but are better than feeling like you're losing it once a month.

(The research says BCPs don't significantly affect appetite or weight. A ginormous number of anecdotes suggests otherwise. Whether they directly affect CICO doesn't matter, in my opinion; if they're increasing appetite such that moderating intake is uncomfortable, it's still a problem. I don't know if this is the cause of the gain for you, but would think about it. The mood distortion alone would [and has] put me off them.)

- Did the bloodwork include checks for vitamin D, iron (serum ferritin), and B12? Deficiencies in those can totally cause depression-like symptoms and brain fog.

- So can lack of sleep, how's your sleep? (Sleep deprivation can also prompt people to turn to carbs for an energy/mood boost, like that is very common. And carbs alone aren't that filling, so people tend to go overboard. Look at a moderate carb, higher protein, high fiber diet like South Beach [phase 2] to moderate appetite. And work on sleep if it's an issue.)

- I think it's very common for people to get into a slump after completing a major project. You weren't supported in marketing this book. That's a discrete job, promoting books, and it calls for skills that are different from writing books. Get some support (commiseration and tips) from other authors.

- Everyone procrastinates.

- I think I would also feel bummed out if I were in a hormonally-informed post-project slump, while in a dead-end job, if I were ambitious. Don't let the job mean anything as far as your worth as a person. That's down to your conduct with friends and community. If you have a supportive partner and friends, I'm betting you're an alright person. This job is also allowing you to write, which is great.

You have a project coming up, that will be another opportunity to express or achieve what you want to express or achieve. You have it together enough to have written a book - I'm sure you have the resources to meet the challenge ahead, once you get out of this slump.

- Discuss this with your doctor, for sure.

- I think it would help to take a holiday at a beach somewhere.
posted by cotton dress sock at 8:20 AM on November 25, 2016 [4 favorites]

For depression that isn't chronic, therapy without meds works just as well as therapy with meds. In most cases, therapy without meds works just as well as meds without therapy, except that the effects of therapy last much longer than the effects with meds. Meaning, if you stop therapy, you should continue to not be depressed, whereas if you stop meds, it could go either way.

I would personally start with a psychologist or psychiatrist, rather than a PCP. PCPs do not always have expertise in the psychological literature, and since they see you only briefly, they typically can't to do a full assessment that would permit a really solid diagnosis of a psychological condition. This matters for depression- there's evidence that medication works somewhat better than therapy for dysthymia, for example, while that's not the case for standard unipolar depression. Similarly, if you've ever had a manic episode (which for some reason are massively overdiagnosed in primary care), most antidepressants are counterindicated. If you start with a psychologist, they won't be doing the prescribing, but they can share your report with a psychiatrist (with your permission).

There are a lot of effective therapies for depression. Therapies where you talk in an unstructured way (called "nondirective supportive therapy") are the least effective but are better than nothing. The most effective are interpersonal therapy, cognitive-behavioral therapy, behavioral activation, psychodynamic therapy, and problem-solving therapy. Because these are all effective, I would *not* start with psychodynamic therapy- it tends to be much longer-term (years, often), while the others are done about 3-4 months. I'm a big believer in not spending more time and money than you need to in getting effective treatment. So I would call up psychologists around you, who are the ones who are most likely to be doing these manualized, evidence-based treatments--start with department clinics within psychology PhD programs or academic medical centers, or look on this website--and specifically ask them what type of psychotherapy they use to treat depression. If they don't name one of the treatments that I mentioned, ask them what their theoretical orientation is- they'll say behavioral, cognitive, or cognitive-behavioral if they do those treatments.

Once you pick a specific one, feel free to memail me, and I'll give you an idea of what to expect. In general, you'll be getting daily homework, and the sessions will be structured by the therapist. The therapist should be able to tell you approximately when treatment will be done in terms of a range of number of sessions. I mostly do CBT and behavioral activation (sometimes problem-solving therapy), and we usually say 10-16 sessions depending on severity.
posted by quiet coyote at 8:21 AM on November 25, 2016 [7 favorites]

I'm also one of those folks with a weird CV, a list of adventures, and accolades in my field who gets freaked out and disappears from peoples lives (usually due to shame at my inability to do adulting well), and there's a lot I can relate to in your post.

Here's what I suggest, after a 18 months of intense cognitive therapy and several years of anti-depressants.

Nthing the suggestion to talk to your doctor about anti-depressants. They can really help you feel better, while you do therapy.

I suspect that any treatment plan starts with therapy, and I don’t even know what therapy could help me accomplish—I’m a grownup, I know how to mail a goddamn book at the post office even if I can’t actually bring myself to do it, and I’m not recovering from trauma or breakup, so I don’t have a specific goal to work toward besides not hating myself half the time.

What therapy can help you do is challenge those negative thought patterns and develop new ones. In modern behavioral therapies (e.g. CBT, DBT), thoughts like I hate myself and I'm worthless are viewed as changeable, learned behaviors. It's possible that in the past such thoughts served you as a coping mechanism for stress or challenges, but those coping skills are no longer effective. In my own life, such thoughts once served as a distraction for emotions that were even more unpleasant to sit with (e.g., grief, shame).

Therapy can help you replace those skills with new ones that aren't focused on devaluing who you are and what you've been able to accomplish. Don't get me wrong--it is a long process that's not always fun or easy, but it can help you reclaim your life. One super important thing I've learned in treatment has been that I am not my thoughts--thoughts happen, and sometimes they are just automatic responses that aren't meaningful per se.

Good luck in managing these difficulties. I am cheering for you!
posted by Excommunicated Cardinal at 8:23 AM on November 25, 2016 [3 favorites]

My question history will make it clear that I don't have a great answer for you, because I'm kind of in the same boat, but I've found the book Undoing Depression to be more helpful than most things. I've also sometimes been able to nudge myself back to life by firmly focusing on one thing, such as going to the gym three times a week, planning meals, etc.; small things but if everything aligns right, it can get me back in track to be able to take on more.

Feel free to message me if you'd like to talk about it; sometimes the blind leading the blind can be comforting even if not necessarily a straight path to the finish. :)
posted by metasarah at 8:25 AM on November 25, 2016 [1 favorite]

I suspect that any treatment plan starts with therapy, and I don’t even know what therapy could help me accomplish—I’m a grownup, I know how to mail a goddamn book at the post office even if I can’t actually bring myself to do it, and I’m not recovering from trauma or breakup, so I don’t have a specific goal to work toward besides not hating myself half the time.

Each of the treatments I recommended has a different theory, supported by research evidence, about what causes or maintains depression, so it won't be on you to figure out what the problem is that you need to work on. For example, in behavioral activation, part of the theory is that it becomes harder to do things when you feel depressed, but then you do fewer things that you feel good about (either because they're pleasurable or valued), and you start doing things that you feel bad about (e.g., lying on the couch all day). That doesn't help your mood, you feel worse, it becomes even harder to do things, and it all spirals. So the treatment is, essentially, helping you set the ittiest bittiest achievable daily goals for doing things that are valued and/or will be pleasurable.
posted by quiet coyote at 8:31 AM on November 25, 2016 [3 favorites]

1) I don’t even know what therapy could help me accomplish—I’m a grownup, I know how to mail a goddamn book at the post office even if I can’t actually bring myself to do it

Therapy can maybe help you not talk to/about yourself like that. When depressed people don't do mundane stuff like bathe or eat or do errands it's never 'cause they don't know how to do it, it's cause brains are weird and complicated and create roadblocks. I'm sure you know this and also I'm sure it's still hard to sit with that.

2) Antidepressants seem like they're worth a try; something else to try since you mention PMS-related mood issues is taking 50mg of vitamin B6 every day (in the morning, because it can be kinda energizing and might keep you up at night if you take it in the afternoon.) There's some research backing this up and also a lot of anecdotal evidence. I need to take it all month for it to have an effect. I take a 50mg B complex supplement from Trader Joe's.

3) I hear that Kaiser makes it hard to get individual therapy rather than group therapy. If you can't afford to self-pay for a private therapist, look into sliding-scale places. Offhand in the East Bay I know of the Women's Therapy Center, The Wright Institute, The Psychotherapy Institute, and The Berkeley Therapy Institute. I know that sometimes sliding-scale can still be somewhat expensive; a friend who works at the Women's Therapy Center mentioned that the scale doesn't tend to go much below maybe $60 a session. A broke friend of mine has mentioned that either the Psychotherapy Institute or the Berkeley Therapy Institute--they weren't sure of the name--has a low sliding scale that was more in their budget.

Anecdotally--I've been in therapy for just over a year now, after having done therapy for briefer periods or with therapists who were not a great fit at other points in my life, and I am just starting to see more value in it now. It took a while to establish a real rapport with my therapist and sometimes I had to force myself to keep going (easier since my insurance does happen to cover it with a low copay) but now I appreciate it.

4) I believe Kaiser offers some cool group mental health classes/groups--some DBT classes, Mindfulness-based Stress Reduction, Assertiveness, CBT classes about managing depression, etc. While that's not a substitute for individual therapy, they might be helpful. I've heard good things about the assertiveness classes and MBSR classes.
posted by needs more cowbell at 8:33 AM on November 25, 2016 [3 favorites]

You sound not unlike me right now- approximate age, self-doubt, impostor's syndrome, and the IUD.

You may want to talk with your doctor about other options than the IUD. I took depo provera and Nuvaring for years before switching to the Mirena IUD in Spring 2015. Despite having been depressed (and treating my depression with both therapy and meds for nearly ten years), after Mirena I noticed a sharp increase in my own hypersensitivity- breaking out into tears at the slightest thing, easily roused by strong emotions. I had the Mirena removed about six months ago and haven't had the sudden sporadic crying issues since then. Note that, other than the crying spells, I *loved* Mirena and thought it was just great. Which was why it was difficult for me to pin down that it was the source of my aggravated emotional state.

I want to echo others who have emphasized 1) Getting regular, adequate sleep; and 2) Regular exercise. The type of exercise that is just intense enough to leave you feeling slack and euphoric after it's all done. If I don't push my workouts to the point that I just start to really wear myself out, I don't get nearly the same benefits if I just have a low or low-moderate intensity workout.
posted by nightrecordings at 8:35 AM on November 25, 2016 [2 favorites]


I am really sorry to hear that you're feeling this way. It's absolutely horrible to go through.

To SyraCarol's point- are you familiar with self-stigmatization? It seems as though this might be a small, but crucial, slice of this puzzle. Consider looking at this concept in relation to metal health issues, and chew on it for awhile, maybe.

I wish the best to you. <3
posted by erattacorrige at 8:36 AM on November 25, 2016

It's not a be-all end-all but you can try working through this simple game when you're feeling really stuck. Just follow the instructions.
posted by aniola at 9:14 AM on November 25, 2016 [2 favorites]

I'm sorry that I don't have the stamina to read all of that now. I am going for ketamine IV this week as nothing has worked for me (meds, meditation, supplements)

I'd start with healthy lifestyle stuff - eating well and exercising regularly. Exercise has helped me more than anything. Go to the doctor and have him/her run bloodwork. I'd definitely check your vitamin D levels at the very least. Try to cut out smoking, alcohol or other things that aren't good for you. Sleep is VERY important.

I'd do all of that before going to a doctor and having them prescribe meds after talking to you for 30 seconds.

It also might be good to go to 23&me for genetic testing to see if you have genetic blocks that could be a cause.

Feel free to message me

Good Luck
posted by kbbbo at 10:46 AM on November 25, 2016 [2 favorites]

I suggest finding a gentle warm-up exercise you do as part of your morning ritual that leads into some form of more aggressive exercise routine for 30 minutes. Every morning, do your warm up, then exercise for 30 minutes. Be gentle, but firm. Use the warm up to then lead into exercise (tabata routines, yoga, pilates, there are tons of gurus on line).
Use Youtube and follow along.
If you create a base of physical wellness and robustness, every thing you do will be easier. You may find your depression is easier to manage or may disappear all together. Or it may be that you will use your exercise routine as a basic level self-maintenance that then supports everything else you do, like meditation, therapy, meds or whatever.
posted by diode at 11:34 AM on November 25, 2016

I don’t even know what therapy could help me accomplish—I’m a grownup, I know how to mail a goddamn book at the post office even if I can’t actually bring myself to do it, and I’m not recovering from trauma or breakup, so I don’t have a specific goal to work toward besides not hating myself half the time.

this is a thing you could say to a therapist to see if they have a reasonable answer to it. You can find somebody who will tell you how to fix what they characterize as your cognitive 'errors' and give you little workbook exercises and so forth; you can find somebody who will let you talk at length as above without getting upset by your mood and shutting you down for having low self-esteem or telling you to stop hitting yourself hating yourself; you can find somebody with another approach entirely. but anybody good will be able to tell you what they think they can do for you and in what very rough time frame. Avoid a therapist who promises too much, too confidently; avoid one who treats your question as a defense to be deflected and not answered.

there is also some potential benefit in just having someone keep track of your moods at the same time and day every week, so that there's some semi-objective record of what the medications are doing and changing about your outer aspect, if you choose to take any medication.
posted by queenofbithynia at 11:35 AM on November 25, 2016

Hi, I've lived in the East Bay/used Kaiser most of my life. I would just call the psychiatry department to start. If right now you're thinking meds might possibly be helpful, and you'd be willing to take them, specify you'd like to see a medical doctor. I think it's likely the doctor would prescribe an antidepressant, and would refer you to one of the group mental health classes (which I've personally hated, but seem well-liked). You don't have to take meds or go to classes after this of course, but your way forward might seem clearer. Kaiser has had justifiably bad rep with their psych dept, but imo it has risen highly in the past decade or so.

If you live between Oakland and Richmond, go to Richmond (I think they have a lower case load?). I wish you the best.
posted by Zenobi at 2:13 PM on November 25, 2016 [1 favorite]

In agreement with everyone else - you are being much too hard on yourself. Being mean to yourself feels like motivation, but ultimately doesn't work very well when you start believing all those mean things you say about yourself.

I'm in a tangentially similar situation - mid 30s lady, finishing up grad school but not headed for academia, had what was probably depression in the past but it never got bad enough for me to do something about it, no major hardships in my past that give me a "reason" to be depressed. I got myself to therapy by reminding myself that it was evidence-supported and that it's just a thing I was trying and I could stop doing if it didn't work after a few months, and it was so, so helpful, especially with emotion-related tasks like writing cheerful notes and networking and making small talk. "Unconditional positive regard" is an attitude that therapists take toward their clients, and it felt awesome and was a wonderful object lesson in how to treat myself and other people. I also got some catch-up lessons in how to deal with having feelings (not something I really got from family) and it's improved my relationships with friends and family a lot, even though they weren't bad before. I also took an anti-depressant, and it was also very helpful, but it sounds like you need less convincing to consider meds.

TL;DR: I thought I would hate therapy and it was actually pretty life-changing.
posted by momus_window at 2:26 PM on November 25, 2016 [1 favorite]

I suggest putting a date on your calendar, sometime *after* your busy three week research time for worrying about coping with the declining health of your parents. Give the issue some time then, but try to redirect your thoughts up until then. I have one parent who died abruptly and one parent-in-law who died lingeringly. Sometimes the problem just solves itself. (Yeah, heartless, I know. But it's not a problem that adult children can solve in advance. Being apprehensive, which is how I am most of the time, doesn't have a payoff here, I don't think. I can't plan for my dad's old old age, because I still don't know what he wants. I don't control all the variables.) (And if it sounds like I'm saying "Have you tried not worrying?" plz feel free to make a rude noise like a Bronx cheer and just ignore my paragraph.)
posted by puddledork at 5:33 PM on November 25, 2016

I'm so sorry you're going through this. I have to echo everyone else who said to give meds a try. Don't hesitate to tell your doctor they aren't helping, because lord knows there are alternatives. As for supplements, my therapist (also an RN) and my doctor have helped me get a good regimen together which includes a B-complex and fish oil.

This is the most foo-foo thing I have ever posted on AskMe, but if you're not familiar with the song please check out the Dar Williams tune "What Do You Hear in These Sounds?" It's her take on therapy and has a number of quotables including: "oh how I loved everybody else when I finally got to talk so much about myself." The lines that follow are the best though.

I didn't think I needed therapy, but I'll tell you what: meds kept me alive, therapy helped me become happy.
posted by good lorneing at 9:27 PM on November 25, 2016 [1 favorite]

Add me to those whose life was changed by antidepressants. Here's one thing that jumped out to me. You said it's "just my emotions," and you're wrong. It's a chemical imbalance in your brain. One that is remedied quickly and easily with one little pill a day. Try it for a few weeks and see how you feel. Good luck!
posted by jhope71 at 10:08 PM on November 25, 2016

I'm so sorry you're going through this. It's so hard to get help when you don't feel like you're worth it, and it's so exhausting and daunting to make the phone calls you need to make in order to get help! Do you have a trusted friend or family member who can help you navigate?

Therapy and Lexapro saved my life -- neither one alone would have had the benefit that both together have for me (though I would choose therapy if I could only have one). Please give therapy a try; for me, it's a huge help to have someone I can say ANYTHING to who is totally on my side and who won't be hurt or upset by any of the terrible things that churn around in my head. Lexapro keeps me from falling into a pit of anxiety, depression, and despair when tiny things go wrong in life.

Please, get some help. You don't have to feel like this. You can feel better and you will be ok! Feel free to message me. I'm in the East Bay too; maybe I can help you somehow.
posted by kayray at 7:56 PM on November 26, 2016

My personal checklist for a minimum level of sanity:

1. Therapy (learn how to do CBT/ACT exercises and techniques)
2. Community (live with your family / join a knitting club - whatever works for you)
3. Medication (a game changer for me! I felt like it turned the volume down on maybe 50% of the mean scary mental 'noise'.)
4. Nutrition and water (get a thyroid/blood test and see if you need supplements)
5. Sleeping 7 hours every day
6. Tidy room (messy room = messy mind!!)
7. EXERCISE (120 minutes of walking a week as a bare minimum)
8. Organization (there are many ways to do this. I personally split my goals into monthly/weekly/daily to-do lists and track it in a MSWord table/spreadsheet)
9. Faith
10. Some kind of self-feedback exercise (sometimes I will write questions down and then record myself explaining them, out loud, like a crazy cat lady, and then listen to it and reflect. Other times I will write everything down in one big verbal vomit, and then I will read it and write my comments down. It's a bit meta and not at all psychiatric-approved, but it helps me process things! This was a big part of my recovery because my depression was caused by a backlog of unprocessed thoughts and feelings.)
11. Extrospection (read the news, volunteer, read a book - just focus on something important and external.)
12. Permission to experience the symptoms of depression. (Not everyone will understand, but it doesn't matter, depression is a real medical condition! Your symptoms are valid!! Give yourself the permission to spend time with your emotions, sometimes they just need a little space.)
13. Do things you enjoy - treat yo self after you achieve something!

It took me about 2.5 years to adjust my lifestyle to include all of the above.

Good luck!! Feel free to message me anytime! I used to have hardcore (i.e. suicidal and crying 8 hours a day) depression, I think I'm pretty high functioning now so I could probably empathize/hopefully help if you wanted to talk about it. Take care :)
posted by Crookshanks_Meow at 7:52 AM on November 27, 2016 [5 favorites]

I will be reading people's answers to this question closely, because I share a lot of these experiences. I think this question will be very familiar to people who have gone through grad school (especially in humanities and other areas that have stiff competition for very few jobs); anyone who hasn't had similar experiences knows people who have.
What I am saying is: do not discount the extent to which academia can Mess You Up.
I've heard from so many people that as the time and distance between themselves and the academy grew, the improvement in their mental health was stunning.
Consider that you might have to recover from what is, for many, a completely sick system. Depression and self-criticism are normal reactions to such a situation.
posted by Edna Million at 3:08 PM on November 28, 2016

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