It's there a point at which depression needs to be accepted?
July 5, 2018 7:36 AM   Subscribe

You stare into the abyss. One half of you lives, works, loves, creates, volunteers, parents, and plays, but the other half is always staring into the abyss. Quietly. Without a fuss. Staring, always. Do you just learn to live like that?


I'm in therapy. I talk about the depression. It seems pointless, and, increasingly, kind of pathetic. Been months. I'm perfectly functional - thriving, even - outwardly. Maybe that's all that matters? Am I fighting a Quixotian battle here trying to recapture the way I used to feel before I knew I was miserable?
posted by MiraK to Health & Fitness (39 answers total) 44 users marked this as a favorite
 
It's an interesting and important question. I think it's a question you could actually ask your therapist if they are someone you trust. (Funny thing to say about a therapist, but you know what I mean.)

While the circumstances are by no means identical, I was felt similarly to this for a long time-- successful professionally, parenting-wise, able to be happy at times but also deeply sad and frightened. I worked so hard for such a long time to either fix or come to terms with my depression.

And then I started taking lithium and....I just stopped needing to try so hard to be happy and I didn't need to accept so much sadness. It took a long time and a lot of different therapy/medication efforts to find out that that is what works for me.

So...basically I think there comes a time when acceptance is only the only course left and that there may even be some comfort in that, but there is also the potential that there is something still out there that could help in a different way. I'm not even sure that the two are mutually exclusive. If you are willing to look the abyss in the face perhaps you can also look other possibilities for care in the face as well knowing that they may not succeed in which case you know that you can look into the abyss while still being as present as possible for the other non-abyss parts of you life.

No matter what, I wish you calm, and warmth, and all the happiness that is available to you. You are a brave and thoughtful person.
posted by jeszac at 7:48 AM on July 5, 2018 [16 favorites]


Personally I think depression changes you. It will always be different, you can't really ever forget how you feel when you're depressed. I'm on the other side and I still have anxiety, but depression made me feel like it would never get better. That's depression. It can definitely get better, you just have to find what works for you.
posted by Bistyfrass at 8:09 AM on July 5, 2018 [8 favorites]


I think the answer to this is different for me depending on where I am, what I'm doing, and what time scale I'm thinking at.

If I'm at my psychiatrist's office and we're talking about possible dosage changes? The answer is "HELL NO, THERE IS NO ACCEPTABLE AMOUNT OF DEPRESSION, WE WILL NOT REST UNTIL WE HAVE DRIVEN THESE SYMPTOMS BACK INTO THE SEA."

If I'm at work and I feel like utter fetid butt and I'm just trying to get through the day? The answer is "Yup, I'm going to accept that I feel like this right now. I'm not going to deny it. I'm not going to ignore it. I'm not going to pretend I feel different. I'm definitely not going to beat myself up for failing to feel different. I'm just going to accept it, and then I can start to figure out how to be kind to myself as I'm going through it, and what I'm capable of accomplishing in spite of it."

If I'm looking back over the past year, and ahead over the year to come, and thinking about how the arc of my life is going? The answer is a combination of the two: "Okay, no way around it, I have to accept that the first half of 2018 was miserable. And I have to accept that the second half might be just as miserable. I honestly have no idea if I can make things better. But, fuck it, I have to try. I'm going to aim for something better and see what happens."
posted by nebulawindphone at 8:13 AM on July 5, 2018 [27 favorites]


I don't know. Some folks's depression gets fixed (at least temporarily) and some well, they never find a solution for it. I think right now we're so rudimentary at trying to fix depression that it seems like everything we can do for it now is a guess and check and it's all "who knows, let's give it a shot!" We don't seem to have any way to figure out ahead of time what will work and what won't and what might make you worse instead of better. This bothers me deeply but again, what can you do but wait for science to figure out better ways to treat it. Maybe in another 10, 20, 30 years they'll come up with something better.

To some degree I think you do end up just having to "live like that" because it's going to be a recurring health problem and like many other recurring health problems, there's no good solution or sometimes ANY solution or even alleviation of symptoms. You can keep trying, or at least maybe one of the guess and checks might do something for you. Not that I can diagnose anything, but it kind of sounds like dysthymia what with the "I can still do things in life" aspect of it. But it will probably always be a chronic problem even if something helps someday.

But if this question really boils down to "I don't feel like I am getting anywhere with therapy, what's the point?" then...I dunno. If you want to quit because it's not making any difference in your life, I suppose you can do that. Or try some other methods of therapy instead. CBT seems to be getting a good reputation these days.
posted by jenfullmoon at 8:15 AM on July 5, 2018


I can say that for me personally, acceptance and forgiveness is certainly a part of how I cope with depression. I feel better when I don't beat myself up about not getting much done on a bad day, or when I don't berate myself for having negative ruminations. (You can see how that might create a bad spiral.) It's not acceptance in the sense of giving up—I'm always trying to find ways to feel better—but acceptance is one of my tools for feeling better.

Nobody is constantly in total control over how they feel. It's not wrong to feel depressed. It is unpleasant, but there's no use denying it or castigating yourself for feeling that way.
posted by Anticipation Of A New Lover's Arrival, The at 8:19 AM on July 5, 2018 [2 favorites]


(Just on a practical level, though: A lot of people have to try a handful of different depression treatments before one works. So if your question is code for "I tried an antidepressant or two and I'm still depressed, should I give up?" or "I've been in therapy for X amount of time and I'm still depressed, should I give up?" the answer is "No, you shouldn't give up, but you should try something different." Try meds if you haven't. Try therapy if you haven't. Switch therapists if you're in therapy and it's been a year and you're going nowhere. Switch meds. If you're getting meds from your PCP, switch to seeing a real psychiatrist or a psych NP.)
posted by nebulawindphone at 8:20 AM on July 5, 2018 [4 favorites]


You've been through a really dramatic and stressful year, though, right? And you wrote in previous questions that your ex was abusive, so maybe you've had quite a number of dramatic and stressful years?

I wouldn't draw any conclusions about depression settling in to stay until you've had a good few years with much lower stress and no abusive environment. It's just as possible you damped down a lot of emotions for a very long time as a coping mechanism, and now that your environment has changed it's all coming forward. It can take a long time to reach a new equilibrium.
posted by trig at 8:20 AM on July 5, 2018 [22 favorites]


Notes:

- I'm happy with my therapy. Making progress on lots of other fronts. I just feel pathetic going on every week and saying, "oh btw still depressed in case you were wondering, lol," and then trying to work through the whys and wherefores of this week's fascinating, novel iteration of the depression.

- not on meds. My therapist says I likely don't need it since I'm pretty functional.
posted by MiraK at 8:23 AM on July 5, 2018


Maybe tell your therapist you'd like to see how it feels not to talk about it for a few weeks?

(For what it's worth, on the subject of long-lasting depression, I've always liked this comic.)
posted by trig at 8:28 AM on July 5, 2018 [3 favorites]


I'm mainly exhausted and bored by the thing now.

For what it's worth, I generally have to hit this point with my own depression and anxiety before I get more motivated to fix it. It took me a while, but now I realize that I sometimes actually need to wait until I hit "Totally bored and fed up with myself" to find motivation to make the changes I need.

I will echo what others have said about trauma, though. Trauma takes time to heal. I will also note that I've read in multiple places that outward signs of depression will often lift much sooner than inward symptoms. A therapy client who's starting to make positive life changes and is able to start socializing and working and such again is on the right path, but it often takes a while for their inner monologue and feelings to catch up.
posted by lazuli at 8:29 AM on July 5, 2018 [6 favorites]


Even though your therapist says you don’t “need” meds since you are functioning, it is okay to request to try meds. For my husband, he was basically functioning most of the time but he wasn’t at his best - his 50% was passable but his 100% was so much more, and he wasn’t getting any joy out of life. It was like I was living with a different person.

For him, medication was like flipping a switch. He went back to being his old self. So it is worth considering.
posted by mai at 8:35 AM on July 5, 2018 [14 favorites]


So much of depression is what you notice and don't notice. When I'm depressed, I am always aware of what is missing and that what isn't will be gone someday, so much so that I don't enjoy the having and I ignore that new things will arrive....and I judge the hell out of myself for doing that.

You describe here being pretty functional, even thriving, but when you pull out and reflect, you see the emptiness and feel pathetic about it. People who aren't depressed would see the fullness, or at least see the balance of empty and full and feel meaning from that.

I think it is entirely possible to learn how to perceive your life in a more balanced way.
posted by amycup at 8:42 AM on July 5, 2018 [4 favorites]


I guess. Lately, my close friends knowing how badly I've struggled with suicidal thoughts makes me feel like I'm now the dude who cried wolf. It's just something I've had to accept about myself that I will struggle with these thoughts and depression for the rest of my life because it's apparently not going away.

Some periods are much better than others. I wouldn't change letting very close people know who I am. Which is an abyss starer, no matter how upbeat, helpful and kind I try to be to the world. It doesn't stop for me at least.

I would try medication if you're not getting out of it. It doesn't "change" who you are because depression is not who you are. I tried getting off Wellbutrin in January for a few months and it is a thing I guess I need to be on for awhile.
posted by OnTheLastCastle at 8:42 AM on July 5, 2018


Re: medication - "My therapist says I likely don't need it since I'm pretty functional."

I would push back on this, because if pretty functional still means you are experiencing the existential dread of depression on most or all days, pretty functional means nothing of value. If you had any other disease that left you pretty functional on a daily basis, would you not treat it? You deserve to be mostly or fully functional on a daily basis.
posted by juniperesque at 8:46 AM on July 5, 2018 [26 favorites]


Yeah, "functional" is not reality. I was functional but suicidal for two years. I take medication now. I am functional AND happy. I still go to therapy because I have stuff to process, but neither I nor my therapist or psychiatrist will ever be willing to settle for "functional". You shouldn't either.
posted by Hermione Granger at 9:07 AM on July 5, 2018 [8 favorites]


Yeah just chiming in to say, if you are not on meds then you need to be considering it. Everyone's experience with being medicated is different, but I would still try it.
posted by Medieval Maven at 9:15 AM on July 5, 2018 [1 favorite]


Your therapist is an idiot. "Not functional" is not the benchmark for meds. The benchmark for meds, by at least one completely reasonable metric, is "has exhausted talk therapy with no or minimal improvement." AND HEY GUESS WHAT?

Talk therapy is not particularly helpful for depression that is organic in nature. Drugs to fix your broken brain chemistry are helpful.
posted by DarlingBri at 9:16 AM on July 5, 2018 [4 favorites]


I don't think demonizing a therapist is helpful here. There are many considerations for antidepressants, and they tend to show most efficacy for severe depression that creates multiple impairments in important life areas. Which doesn't mean they're ineffective for milder depression, and there are certainly therapists who are reflexively anti-medication, but presumably the therapist has a fuller understanding of your current situation. Maybe you can talk more to them about what they're seeing?
posted by lazuli at 9:21 AM on July 5, 2018 [8 favorites]


Have you read The Noonday Demon: An Atlas of Depression by Andrew Soloman? The book is so interesting, insightful, and compassionately-written. It is long but beautiful: there are some free excerpts online if you want to check it out.

I live with mental illness -- PTSD and anxiety to be specific -- but have only really effectively been treating it these past two years. I was very high-functioning but, for all of the success and outward happiness in my life, there was a negativity and bleakness lurking in me that would sometimes be tucked away and other times be overbearing. I saw two therapists -- the first was a good start but my work with the second has been life-changing -- and eventually added a very low dose of Zoloft to the mix to get over a hump. She really understands trauma and got me. I am on a break from my therapist -- because she feels I'm doing so well! -- but still check in with my psychiatrist once a month; eventually I hope to try life without the medicine to see if it'll be a lifelong or short-term addition. In any case, while I can tell you that I'm happier than ever, the first year and a half of therapy was super bleak. While I was gaining insight and making changes for the better, it was painful and rather miserable for much of the time. I'm so glad that's over and would never want to go back but am glad I slogged through to get where I am now. My second therapist first felt I didn't need medication but eventually we both agreed it'd be helpful to get over the hump. Ending a difficult relationship with an abusive partner also helped; little trips, both near and far, were also good for helping me reset. All those things added up but there was no one quick fix.

I don't know if our experiences are similar but I can say that you may be in the throes of therapy where it's helpful but not happy at all. It may feel like a plateau but you are actually making so much progress? I don't know know what you need -- for me, changing therapists was helpful as was adding the medicine -- but perhaps accepting that this may be your reality for now could actually get you closer to contentment. As for me, acknowledging that life has its ups and downs and my mental illness can make those harder and linger longer helps me get through the day or two where I am really down. However, to feel so miserable day in and day out -- regardless of how "functional" and outwardly successful you are -- that is a sign to look into more options. How about giving yourself a set amount of time -- say two week or a month -- and just see if your mood and outlook improves, even a bit? If not, then you can start looking into more options.
posted by smorgasbord at 9:22 AM on July 5, 2018 [7 favorites]


Also, looking through some of your past questions, you mention that you were having a hard time telling your therapist the extent of some of your problems. Is that still the case? If so, maybe start there?

Also also, in most states, therapists can't prescribe medications. Even if your therapist is just absolutely anti-medication, you can talk to a psychiatrist about your symptoms, too. Again, though, you'll want to make sure you're letting them know the full extent, as much as you can, about the symptoms you're experiencing.
posted by lazuli at 9:25 AM on July 5, 2018 [2 favorites]


your therapist is not an idiot and they can make recommendations, but they are not qualified to make an authoritative decision on whether you might benefit from medication unless they are also a medical doctor. they may be. but if not, all they can offer is an opinion. even if your therapist is a psychiatrist, you can get a second opinion unless you aren't personally interested in exploring medical treatments.

but the question is not whether you need medication, like for survival, or worse, whether drugs will "fix" your brain. the question's just, might you benefit from it. this is a pretty important distinction.
posted by queenofbithynia at 9:26 AM on July 5, 2018 [1 favorite]


All I can relate is my personal experience, for what it's worth.

a. Therapy was not enough for me, I needed meds;
b. The meds didn't remove all sadness from me, just turned down the volume on them enough for me to feel happiness and anticipation;
c. But the world being how it is means that I am still sad/angry/depressed a deal of the time, because there are lots of external reasons I would be, and I don't expect my meds (or any meds) to erase that, so;
d. I carve out time for other kinds of healthy coping and self-care, especially interactions with friends and supportive people. Or just naps.

I think all I can tell you is that no, you will probably not stay in this emotional place forever, meds or no meds, but how quickly you move out of it may be affected by meds. There is no shame in taking them, or in abstaining from them and choosing another path. It might even be that an additional/different form of therapy can help you. A friend of mine swears by her "play therapist" which is not something I've tried, and there are other kinds as well. You have options if you feel stuck. You can try other things.
posted by emjaybee at 9:29 AM on July 5, 2018 [2 favorites]


I also looked up a bit more of your posting history and see you deal with PTSD as well. So much love and sympathy for you there! If I understand correctly, your current therapy is CBT-based? While CBT can do a lot of of good for many, it also can be not at all helpful for others. Switching to a therapist who specializes in treating trauma and does EMDR made all the difference for me. While my first therapist was good in many ways, she just did not get me -- and, frankly, I probably didn't get her totally either. Are you still seeing the same therapist you've mentioned before? You are justified in feeling he's not the best fit for you and have my "permission" to look up other options. If I may make a bold statement, those of us with trauma in our backgrounds are used to sticking in less-than-ideal situations with the hope that they will get better, if only we can work hard enough, etc. However, sometimes things are just a bad match and we should listen to our guts -- which we have been conditioned to see as faulty. If something feels off, then it is off. You don't have to do anything that we are recommending but please listen to your heart and head and gut, and trust yourself to be able to take the next step when it's time.
posted by smorgasbord at 9:35 AM on July 5, 2018 [4 favorites]


If you want to try meds, go ahead. Nobody, including your therapist, can know how much or how little they might help you. The right medication could just make you feel more like yourself, and able to enjoy some things. Functioning is really important, but so are hope, pleasure, and the ability to be present.
posted by wryly at 9:36 AM on July 5, 2018


Just a note that there are CBT-based trauma treatments, so a therapist doing CBT is not necessarily wrong for trauma, but it needs to be a trauma-focused CBT, not standard CBT. smorgasbord's point of making sure you're working with a therapist experienced and trained in treating trauma is a good point, though, even if the trauma is not what you're actively focused on right now.
posted by lazuli at 9:44 AM on July 5, 2018


Okay - maybe I'll try meds then? Aside from my therapist's opinion (which was only in response to my asking for advice, not an unsolicited suggestion nor pressure either way), I've been iffy about meds myself because due to my ADHD, I just cannot be counted on to remember to take them every day, and as I understand it, depression medications are the kind that WILL cause issues if I forget a dose. (I even forget to take my ADHD meds half the time, thank goodness that's nbd outside of me having an extra-scattered day.)

Re: my therapist. This one's new, very experienced including in trauma therapies, psychodynamically oriented but not strictly so? and I'm doing great with opening up -- different from my old CBT therapist with whom I had some trouble but who nevertheless helped me kick butt last year.

Thank you for all your perspectives. It really helps to hear all these views and experiences.

One particularly poignant comment from OnTheLastCastle stood out: "Lately, my close friends knowing how badly I've struggled with suicidal thoughts makes me feel like I'm now the dude who cried wolf." -- I'm so sorry you're going through this. I hope you have professional help in addition to your (well-meaning but maybe inadequate?) social support system. All the love!

(For all the talk these days about being open with our mental health struggles, we as a society seem to be still firmly in the "talk about it so you can raise awareness" phase, not the "talk about it so your friends can help you deal" phase. Most folks don't have any idea how to deal with the relentlessness and plain annoyingness of a persistent health condition. Even those of us who live with one (or two or three) generally have no resources or know-how to support a loved one through their issues with the patience and calm these struggles demand. It's something to think about. -- end of digression.)
posted by MiraK at 9:55 AM on July 5, 2018 [5 favorites]


Thank you, I'm doing well. What has helped me remember to take my meds is doing it FIRST THING and then also having some at work because I still forget. I had to go through a few different medications before finding one that worked.

Your digression is spot on. It's a fine line to express how you're feeling and try to avoid being relentlessly negative/annoying/repetitive when it's sometimes the (literal!) only thing in your brain.
posted by OnTheLastCastle at 10:01 AM on July 5, 2018 [1 favorite]


You can let your prescribing doctor know about your worries about missing doses. Some medications have longer half-lives than others, so they may want to factor that in to their recommendations.
posted by lazuli at 10:01 AM on July 5, 2018 [1 favorite]


I was functioning just fine before my meds. I was getting out of bed every day, feeding my kids, taking them to school and their extra curricular activities, cleaning the house, etc. Things were getting done. But then I was also constantly aware that it appeared to me that everything and everyone would be better off if I wasn't alive anymore, I was yelling at my children, I was disengaged from my marriage and my friendships, and nothing brought me joy.

I was functional but I wasn't fine. Meds made me okay again. My children noticed a difference in me. So did my husband and friends. I experienced joy again for the first time in many years.

I have a reminder set on my phone to alert me to medication time. My meds live in my everyday carry bag so there is never a time I can forget to take them.

It's worth a try for you, I think.
posted by cooker girl at 10:14 AM on July 5, 2018 [3 favorites]


Some depression meds do cause issues with skipped doses, but if you talk to your doctor about that and needing to start with something that'll be more tolerant of that--like I used to take Prozac and I also have the problem with ADD and compliance and I never had seriously bad results from missing a day or taking late pills that people have on some of the newer things? I don't take them anymore because my brain shifted hard in the anxiety direction in my 20s and they now make that worse, but I think it's worth checking into.

Just in general, related to that: You can't get your before-brain back any more than you can go back to having the body you had as a teenager, no matter how much you want it to be that way again. You're just built differently now than you were when you were younger. But you can work WITH the brain that you have now to do the best you can do with what you have now. There's a certain level of acceptance that your brain is never going to be "normal", but that isn't the same as accepting some level of serious suffering in your day-to-day. It's the same as with your ADD: It's fine to wish you didn't have to deal with it, of course, but at some level you just have to move forward with the fact that now you have ADD and you have to do things differently than other people do in order to get results that are good for you.

The fact that you're currently functional probably means you've actually been doing pretty well with that so far, but you don't have to give up on feeling better than you currently do, as long as you don't fall into the trap of thinking that "better" has to be by someone else's standards instead of your own.
posted by Sequence at 10:22 AM on July 5, 2018 [5 favorites]


The metaphor that I use is a "postbellum" period. Being in the phase after worst-part-of-the-pit depression is way better than the pit, or the war, and it feels like it's the best that one can reasonably expect to get. After all, no one is actively dying! Maybe the country is just like this now?

But it is not. It is possible to feel better than this. It is possible for the low-key half of you that is sitting there on the edge of the abyss to wake up one morning and get really interested in pottery. It is possible for you to realize on a subway platform that you actually haven't thought about death all week, and the thought of it now brings a brief ordinary frisson of discomfort and nothing worse.

I can't promise this will ever happen for you. But it has happened every single time for me. So it's possible. And I think everyone's right in saying that given your particular givens, you don't know enough to confirm that this state of emotional affairs is permanent.
posted by peppercorn at 11:29 AM on July 5, 2018 [5 favorites]


The average depressive episode, as I understand it, resolves in about six months even without treatment. Most cases resolve in under two years, although people who have had depression before have a pretty high chance of another case down the road.

There are people who are depressed longer than that, sometimes basically their whole lives, but that's not the most common case. If it's only been "months," you don't need to give up and accept depression as the new normal.

I have, uh, extremely mixed feelings about Scott Alexander of Slate Star Codex, especially when it comes to social issues, but he is a psychiatrist and I think this article on things to try to treat depression is good:

"I think the important lesson here is that with sufficient work depression either is treatable, or it will go away on its own before you get a chance to finish the treatment algorithm, which is annoying for researchers but probably pretty acceptable to the patient. And once it does, you know what drug works for you, you can sometimes stay on it to decrease chance of relapse (maintenance treatment is a totally different ball game I’m not getting into here) and you can restart first thing when you start feeling depressed again.

The most important thing I’m writing this for, and the lesson I want to hammer home, is that if your doctor just gives you an SSRI and tells you to stay on it even when it clearly isn’t working, there are other options. "

You don't have to stop at "functional." Keep trying.
posted by waffleriot at 11:57 AM on July 5, 2018 [3 favorites]


You go in every week, talk about your week and state that you're still depressed. Maybe your therapist is in a rut. Tell Therapist you really need to feel better, that this level of therapy isn't enough. Ask Therapist if they have additional help for you. Yes, I would go to the doctor and get meds.

I'd also think about whether this therapist is able to do more than hand-holding and if a different therapist is indicated. I have recurrent severe depression and anxiety, and it's not easy to find therapists who can go to the next level.

Also, depression responds well to exercise, nature and maybe Vitamins D and B12. Having a Fitbit helps me be more active. Summer, my dog, and geocaching help me get outdoors. I take Vitamin D, and I find I do better if I have red meat once every 5 - 7 days, minimum.
posted by theora55 at 12:43 PM on July 5, 2018


It was that way for me, but I can't really pinpoint one moment when it became clear to me. I don't have any clear memory of a Time Before Depression, though; my earliest memories from ages 3-5 are of already having the main symptoms.
posted by The Underpants Monster at 3:18 PM on July 5, 2018


I have depression and ADHD and I take my meds before I even get out of bed in the morning. They're on my nightstand, and when my alarm goes off literally the first thing I do is take them, gulp some water, and then snooze for a bit before actually getting up. It makes it hard to forget them.
posted by Anticipation Of A New Lover's Arrival, The at 5:23 PM on July 5, 2018


I have dealt with continual severe depression (and suicidal ideation) for well over 50 years. After awhile, depression simply becomes part of you, just as the color of your eyes are a part of you. You end up simply living with it, pain and all. Therapy helps keep me more-or-less level, but the depression still does a number on you.

All the self-hate, the lack of motivation, the lack of self-confidence, the anxiety. It’s all still there, doing their thing. But, you just sort-of learn to accept it. Or, maybe it’s simply learning to live with it? You’re still suffering depression but, eh, it’s just another day. Your life is just gray. On the plus side, you learn to wear really good masks so as to not concern people.

Sorry I can’t paint a happy picture, but, yeah, you can end up simply living with it.
posted by Thorzdad at 6:39 PM on July 5, 2018 [2 favorites]


Lots of great and insightful answers; I just want to use the occasion to link this reply I got on this site from tkolar (long since gone, at least with that username) in 2006, when I was at the worst of my depression :
ClarrisaWAM wrote...
I too always assumed that the average person out there was at least somewhat miserable.

Whether it's 'average' or not is somewhat beside the point. It's unhealthy, unhappy, and unneeded.
(sorry, just a little bitter about those 10 wasted years)
(second, longer commend by him here)
It took me another 5-6 years after that to really get better, but now that I'm on the other side of it, I think of him sometimes. He was right! I didn't believe it then, but he was right.
posted by ClarissaWAM at 12:29 PM on July 6, 2018 [1 favorite]


- not on meds. My therapist says I likely don't need it since I'm pretty functional.

Meds meds meds. You have literally nothing to lose and so, so much potential gain. If they do nothing, or you don't like them, stop.

I'm 50, diagnosed with Major Depressive Disorder at 22, and have suffered four major depressive episodes lasting more than six months in my life (so far; I fully expect there will be more). Intermittent spans of suicidal ideation, and one outpatient and one inpatient hospitalization. I am a huge proponent of ongoing therapy, but all the talk therapy in the world can't make the difference that an increase or change in meds can when you're in a true depressive episode. Talk therapy for people who suffer from chronic mental illness has limited success without the meds to raise the floor and make it possible for the patient to act on their options and suggested therapeutic activities.

The switch in meds I made about a year ago has lifted me out of the hole higher than I have been since 1995. I have lived down for so many years that I had literally forgotten I could process the world around me this way. My entire life has changed for the better since then on every front, and I attribute all of the ability I have had to take advantage of opportunities for improvement entirely to the medication. You can't play if you don't suit up.
posted by tzikeh at 8:40 PM on July 6, 2018 [1 favorite]


and as I understand it, depression medications are the kind that WILL cause issues if I forget a dose.

A minor point but one I find important to address.
I take medication for both ADHD and depression (long-release ritalin, and Pristiq (desvenlafaxine), an SNRI). I still have Issues but if I take them both early in the morning the day usually goes well. This is a substantial "but...", as I usually need the ritalin to do anything else except get locked in habitual behaviour; but I do not find the SNRI causes major issues when I forget one or two doses. One, I feel slightly more stewy. Two, I notice suicidal ideation starts creeping back in if I'm stressed. Beyond that I typically remember to retake it. That's the worst of it, and I'm happy to attribute that to it not doing its work on those days.
Anecdotally, Effexor and Cymbalta are the worst for such side effects. If this is really an issue that will come up for you (it sure does for me - I would have deep reservations about switching to those two even if the evidence that they helped more was strong) then I strongly discourage writing the idea off, but be picky about your medication and don't hesitate to try something else. I had terrible reactions to a couple before I found something that worked, and I just wish I'd tried different ones sooner instead of swearing it off for a while.
posted by solarion at 10:02 PM on July 8, 2018 [1 favorite]


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