My Brain Won't Ever Shut Up & It Is Ruining My Life

March 17, 2019 10:31 AM

I am a middle aged man with lifelong depression, OCD and anxiety. I have been through multiple therapists and tried numerous medications over the years. What do I do now? Am I doomed to feel this way for the rest of my life?

I am a middle aged man that has suffered from mental illness for my whole life. It has been particularly bad the last 10-15 years. Prior to that, I had OCD/Anxiety/Depression, but I was relatively happy in contrast to now. I at least felt hope for the future. Fast forward to having seen every type of therapist, psychiatrist and alternative doctor under the sun, and all I have to show for it is a lighter wallet. Ketamine helped my depression but was too expensive to keep doing. I would spend thousands and have to take days off of work for 3-4 days of relief.

I have constant thoughts. My brain never stops. It is rarely good. I see something or hear something and that triggers negative associations and bad thoughts. My brain is never quiet or at peace. I also have a list making habit on top of it. The only time that I feel "calm" is with marijuana. The paradox is that I don't enjoy that type of calm. I want to be alert and mentally acute. My mind is so all over the place and I find myself forgetting things. I also can't smoke during the day, so I can only enjoy that relief at night. I also worry about the long term effects of that, as well as failing drug tests.

I have an awful time concentrating.

I have been given multiple diagnoses over the years - OCD, GAD, Depression, Dysthymia and Bipolar 2. The biggest ones are the depression and OCD (which causes anxiety)

I saw numerous psychiatrists and therapists in the past. I've tried numerous classes of medicine. I am currently seeing a therapist that I found through the OCD foundation and an expensive psychiatrist in NYC for meds. I was on an SSRI and got off due to side effects and no relief. I did a Genomind test and started an SNRI and tried Lamictal. No relief. Benzos make me sleepy and even more depressed. They work for a panic attack , but not as a long term solution. The doctor now wants me to try Latuda. The problem is that every time, the doctor says "I think that you would benefit from this" and I don't. I don't know what to do. I am spending thousand a year. I don't know if I should switch doctors again. I am nervous about taking an atypical antipsychotic. I JUST DON'T KNOW WHAT TO DO!!!!

I want to start meditating. I am having a hard time deciding on the right app or right guided meditation. I know that this will help, but I don't think that it'll give me sufficient relief of my symptoms, particularly my depression

Exercise, diet and socialization have all been addressed, but this illness persists.

I am starting to think that this is just the way that I am going to be. I have been this way for so long.

Does anyone have any insight or experience with this?

posted by kbbbo to Health & Fitness (25 answers total)

That sounds super hard. And also, wow you have really done a lot to work on it, I admire your persistence.

Are you looking more for suggestions (i.e. “vagus nerve stimulators and sudarshan kriya yoga have both had some success in people with treatment resistant depression”) or more, like, philosophical help?
posted by hungrytiger at 10:59 AM on March 17, 2019 [1 favorite]

This may not be a popular opinion, but if you are interested in trying meditation I'd recommend you skip the apps and do it properly*. Given the issues you've described, you would really benefit from learning to meditate, but learning from an actual teacher who can help you do it properly.

Read up on Transcendental Meditation and see if you'd be willing to give it a go. (I know, I know... the name is terrible... The Beatles thing... But seriously. It sounds like you are in a lot of pain and I think it might help.)

*I realize apps on their own work well for lots of people. But the OP needs more than that, by the sounds of things.
posted by EllaEm at 11:05 AM on March 17, 2019 [6 favorites]

I have brain activity like you describe. I know the brain is the organ that uses the most glucose, you can check this out and it is true. Coincidentally it runs everything, and it can convert almost your entire food intake, fat stores and everything to sugar to keep doing what it wants to do. Your brain is gaming you with scenario, negative scenario creates one metabolic route for the brain feed, different thought patterns tap different metabolic processes to keep the brain doing what it wants to do.

The illness is maybe organic in origin, there can be infection, viruses, mycoplasmas, they rarely culture CNS fluid for people with lifelong depression or even bipolarity. But you can create feeds for your brain that are highly pleasurable, and you can get your brain to go along with them, negotiate. I use walking and positive attitude building, low food intake before exercise, a song I use in a three quarter rhythem to make my breathing work, two out, one in. I don't talk in my in my head while I walk but if I do I catch it and return to the rhythm of the pleasant song, or to a meditation.

I remind my self before I go, how much I love it, love it while I am doing it, how much I like being in shape, and that it is one way to have love, by being good together, mind and body. For at least one hour a day I am happy in my skin suit, happy in the world, see stuff get clean input for my perceptions grounded in motion and observation, and not silence but controlled self generated audio.

I am noticing my thinking more, my run amok brain, and engaging it with extrapolation, as to why this, what then, etc, so I can renew my blank slate. I also eat carefully so I am not out of fuel, no need for desperation on my brain's part, even while losing weight. I just realized my autonomous nervous system got way too much voice, and I needed to recenter. This I have accomplished, but it has taken some effort and time. You have to be nice to your self and brain as you retool, keep your promises to self, maintain that inner smile, allow it. Find some things your brain really likes doing with you, so it doesn't have to continually raise the dead to feed or know joy. Make deals, talk with yourself rather than autonomously plan and stick with it. Keep good company with yourself, you are worth that respect.
posted by Oyéah at 11:10 AM on March 17, 2019 [4 favorites]

You said you tried weed, and didn't like it - but what about CBD oil?
posted by speakeasy at 11:13 AM on March 17, 2019 [1 favorite]

Response by poster: Sorry to jump in here, but I have tried numerous types of CBD and numerous dosages. I think pot helps due to the psychoactive nature. Numbs me out
posted by kbbbo at 11:19 AM on March 17, 2019

You've worked really hard on this and I can see how frustrated you are.

I think that it's probably time to stop with the bandaid approach and consider the OCD Institute at McLean Hospital. Seems like you need a higher level of care.

You and I have chatted before. I know people who were a lot like you and their lives were changed completely after OCDI. Let me know if you want details.

You can do this, but I think you need intensive support.
posted by yes I said yes I will Yes at 11:22 AM on March 17, 2019 [7 favorites]

I was in your same position for a long time. Boringly, there was no big dramatic change that got me out of it. I kept trying different meds, with the same psychiatrist, and eventually, after ten or so years, hit on a combination that worked.

It's maddening, but this really is how psychiatric* care for treatment-resistant mental illnesses works: no matter how good your doctor is, the process is just "keep trying shit." The doctor's role is less about playing Dr. House and logicking out the correct med, and more about holding your hand as you keep trial-and-erroring through the different possibilities — helping you evaluate the results, understand and handle the side effects, and think about the pros and cons of staying on what you're on vs trying something new. It's the fucking worst, but the fact that your treatment is going like this doesn't necessarily mean your doctor is bad or doing anything wrong.

(Of course, if you don't like him, switch doctors! But if you feel like he listens, takes you seriously, is well-informed about things like risks and side effects, and takes your treatment goals into account, then... yeah, that's a good psychiatrist, and the problem is just that treatment-resistance is a fucking slog.)

My current meds include one atypical, and I've tried a few others over the past few years. They definitely have some serious-business side effects for some people, but they're worth trying to see if you're one of the people who can tolerate them. If your doctor expects you to just be like "Oh, yeah, my hands are shaking uncontrollably and I can't sit still but I guess I'm going to put up with it for the rest of my life," that's when you fire your doctor. My psychiatrist was great about saying flat-out, like, "If you have X or Y intolerable side effect, we will take you off this medication right away, nobody should have to put up with that shit." We tried and rejected a few based on that, and eventually found one that didn't give me any of the super fucked-up side effects that atypicals are known for. But again, shitty annoying trial and error. And where I'm like "Oh, Abilify gave me terrible side effects, Seroquel is great," I have friends who had the exact opposite experience — so there's no magic shortcut, no secret that your doctor doesn't know (or knows and isn't telling you), it's just trying shit. IT'S THE FUCKING WORST.

I wish I had cheerier stuff to say. The good news I've got is "It is possible to have failed on that many meds and eventually find one that works for you." You are not beyond hope.

*All the stuff I'm saying just applies to psychiatry. For therapy, you can and should expect a coherent treatment plan that isn't just "let's keep trying more things." I don't have OCD and don't know much about therapy for it, but it sounds like you're getting good therapy-related advice from others here.
posted by nebulawindphone at 11:26 AM on March 17, 2019 [9 favorites]

Ketamine JUST went on schedule for treatment resistant major depression. That means that if you have insurance it will now possibly cover it.
posted by spitbull at 11:27 AM on March 17, 2019 [4 favorites]

I don't have much other useful advice for you, but I do want to adamantly second EllaEm if you try meditation. Even for healthy people, meditation is difficult, periodically frustrating, and can produce some startling experiences. Having an in-person teacher of some sort I think is really important. (Citation: over 10 years of Zen meditation study.)
posted by soren_lorensen at 11:48 AM on March 17, 2019 [1 favorite]

Coming in to third the idea that an app for meditation is weak sauce, but meditation with a face to face teacher or in a community could be beneficial.

You could get a good intro by doing a mindfulness based stress reduction course.

Also, my wonderful meditation teacher Gil Fronsdal teaches in the bay area, but he offers all of his talks online, including his "introduction to meditation" series, which you could follow along with online. It's not as good as doing it in person, but it would still be helpful.

I'm happy to share more about meditation in general if you want to email me.
posted by swheatie at 12:11 PM on March 17, 2019 [2 favorites]

I'm grateful for what I consider to be A LOT of random energy - brain never stops; overthinking never stops, body kinda doesn't really stop unless I'm smoking (can not do due to employer) or drinking (well duh, alcohol is the most crude and worst self-medication out there).

I try to transfer my energies. Small steps. Do the dishes. Clean the desk. Do my numbers/pay bills/run a budget (for now; next week, next year, five years, ten years, whatever. Keep busy mind doing Anything productive.), or even take a nap if I can.

Small steps, and yeah. I'll go so far as to make a list of things to do. Sometimes it works; other times it does not. I have given up on wasting my time, my money, my energy, and my confidence on others (i.e. one counselor, PhD no less in Psy; did not know meaning of term "Misandry"; and this was during a couples session. IRL experience has time and time again shredded any faith in titles or degrees.)

Having kinda given up on the world (not in a negative way); I realized that it was up to me. I don't do as well as I could; but yeah. Not hoping for the kindness of seemingly random others to assist or help me has done me very well.

I'm going to be this way for the rest of my life. Gonna make the best of it. I'm a middle aged guy. At best; all the random energy is the best Zap I could ever hope for; and I am grateful for it. Good luck sincerely.
posted by buzzman at 1:36 PM on March 17, 2019 [1 favorite]

I am really not a doctor, but I knew somebody like you who traditional medications didn’t work for her. She went to the Mayo Clinic and learned that her body doesn’t really process SSRIs it somewhere medications. But, lithium worked wonders for her depression.
posted by ElisaOS at 1:46 PM on March 17, 2019 [2 favorites]

Totally agree with nebulawindphone that trying med combos is such a slog, but it’s also how I found the med/dose that works for me. It was years of trial and error but so life changing when we got there. (For me it’s low dose Prozac that shouldn’t actually be therapeutic for OCD at that dose - but it works for me!)

I was also nervous about trying an atypical but the side effects when I did try it (sedation, for me) were not nearly as scary as the fears I had about atypicals as a whole. It didn’t work, I got off it, it was fine.

This suggestion may be a little off the wall, but have you done any yoga? I find that when I’m really focusing on my body it slows down and calms my “monkey mind” that is otherwise spinning. I particularly like Yoga with Adriene on YouTube. The videos/classes don’t need to be OCD/anxiety/depression specific to help. I also found some temporary (few hours at a time) relief when powerlifting (heavy weights, low reps - it really let my brain chill out for a few hours afterwards).

But the right meds and a meditation practice made the most difference for me.

Hang in there. This is hard and you are awesome for slogging through it every day. Hope you find some relief soon.
posted by bananacabana at 1:47 PM on March 17, 2019

While I agree in person instruction is so much better for learning anything really. I also understand sometimes finding the right instructor can be an overwhelming task in itself and may just end up feeling like another barrier when your energy is already low. In the meantime, using a meditation app might give you a hint at what meditation can do and bolster your enthusiasm to eventually seek out a teacher in person. I've been using Waking Up, which was developed by a neuroscientist and philosopher. He has individual mediations for day 1 through day 50 along with other stand-alone lessons, which slowly teach you how to let that inside chatter fall away.
posted by pdxhiker at 2:26 PM on March 17, 2019 [1 favorite]

Forgive me if you already explored this possibility: I was well into my 40s before being diagnosed with ADHD. I had suffered from anxiety and depression ( and my brain not shutting up) for decades but never got any traction with medication & therapy. When I started treating the ADHD and understanding it better so many of my other symptoms quieted right down. ADHD is an overlooked neurological condition that has devastating consequences if it goes untreated in adults. Look up Dr Russell Barkley on youtube and see if anything resonates with you.

I am rooting for you!
posted by i_mean_come_on_now at 3:44 PM on March 17, 2019 [3 favorites]

As far as meditation apps go, I’ve had a good experience with Headspace.
posted by Autumnheart at 4:59 PM on March 17, 2019 [1 favorite]

Is it possible you might be somewhere on the autism spectrum? The aspie part of me means my brain can chatter away to itself. It used to really disturb me, but recognising it and leaning into it has really helped me.
posted by Middlemarch at 5:19 PM on March 17, 2019

Personally, I think Mark Freeman ("Everybody Has A Brain") is a great person to follow in terms of applying mindfulness to OCD and anxiety -- he is someone who has personally recovered from severe OCD and has made it one of his aims to help other people recover. He has a good popular-press workbook (The Mind Workout) that you may find helpful.

That said, given where you're at right now, I might treat that as more of an adjunct to getting OCD-focused therapy of the type that yes I said yes describes above. Mark himself went through intensive therapy as a first step, and credits it with being life-changing and with helping him make major improvements to his mental fitness. A lot of therapists are not necessarily specifically trained in treating people with OCD, and I think you really want an expert; generic talk therapy can be actively harmful if what you really need is a rigorous course of exposure and response-prevention therapy (which absolutely even applies to cases where your compulsions are purely "mental" behaviors like ruminating or trying to reassure or distract yourself).
posted by en forme de poire at 5:20 PM on March 17, 2019 [2 favorites]

Seconding the suggestion to check out CPTSD. The view on complex trauma has changed and expanded greatly in recent years, and most professionals who are not explicitly trauma specialists are not familiar with these changes. CPTSD is often frequently misdiagnosed because it can present in ways that overlap with a BUNCH of stuff — borderline personality, bipolar disorders, ADHD, OCD/anxiety/depression, autism spectrum disorders, sensory disorders, various chronic illnesses, the list goes on and on — so whenever I see someone who’s had a bunch of diagnoses over the years but no treatment ever worked, it’s the first thing I think of. Seriously this is a really common story with CPTSD. Even — perhaps especially — if you don’t think you have any or enough trauma in your past (especially childhood), please try to see a trauma specialist and see if CPTSD is a better fit. (Or if CPTSD + Other stuff is the best fit.) The effective treatments are really different for trauma stuff.

There’s a subreddit with a wiki.
posted by schadenfrau at 6:08 PM on March 17, 2019 [1 favorite]

Try the Latuda. I know many people who have had near miraculous results from antipsychotics, specifically Cyroquel and Zyprexa, on being The Only Thing That Finally Fucking Worked on their out of control and unmanageable anxiety, obsessive thoughts and ocd.
But you're definitely not going to want to combine it with marijuana at night. They do the trick well enough alone.
posted by OnefortheLast at 6:27 PM on March 17, 2019

Have you tried neurofeedback?
posted by kokaku at 6:28 PM on March 17, 2019

This sounds a lot like what some Buddhists call Monkey Mind. Meditation could help train your brain to stop.

What others here have said about meditation is also spot on: formal meditation is better than phone apps. I am skeptical that guided meditation is really what you need to learn mindfulness. It's not about relaxation or general wellness, it's learning how to focus your mind, on your own.
posted by cotterpin at 12:35 AM on March 18, 2019 [1 favorite]

I decided to try to wear my brain out. I tried exercise for over a decade, no dice. I need a lot of exercise, but it is not enough stimulation. I need to get energy out AND have good social/problem solving stimulation for my god damn inexhaustible brain.

Now I have 3 activities on week nights: class 1, class 2, and therapy. The two classes are theater adjacent (involve people, working in groups, problem solving).

Do you LIKE your therapist? It does not matter how many you have seen or how expensive/credentialed they are if you do not click and if you do not feel heard. I finally found the right one and I went from thinking therapy is bogus to feeling like it is the best money I've ever spent.

So yeah. For me, the RIGHT therapist plus More Than Just Exercise has done it for me.

Is there anything your brain is asking for that you can give it safely, from a stimulation perspective? To distract it, give it an outlet? It sounds to me like you have done a lot of work (!!), but I don't think you should give up yet. I hope you get some relief!
posted by skrozidile at 9:29 AM on March 18, 2019 [1 favorite]

One more thing: try to get CPTSD ruled out, if nothing else, because many of these well-meaning suggestions could be contraindicated for CPTSD and may make things worse. Some people with PTSD react really badly to SSRIs, others react really badly to meditation. Stuff for trauma is different. It’s important to know what you’re dealing with.
posted by schadenfrau at 10:22 AM on March 18, 2019

I, too, am a middle-aged guy with OCD and anxiety and a brain that just. won't. shut. up.
I have found that marijuana actually makes me feel worse, as I consciously know my brain isn't working like normal, which causes more anxiety.

I tried a few SSRIs and had limited success, but the side effects of numb emotions and excessive sweating made them not worth the trouble. I also drank - heavily - for a long time (especially after a specific trauma) because it shut up that part of my brain and helped me fall asleep at night.

I have come to accept that this is who I am. It makes me me. And although there's a lot of negatives to dislike about my mental disorders, they also come with some positives: I am very efficient, usually a few steps ahead of the average person in planning; I very, very rarely lose things or drop things from being careless; my mind works quickly, thus I am seen as having a "quick wit" and being funny; etc. I try to think of those positives to balance out the inner turmoil that I can't even adequately explain to anyone.

I came up with this theory that helps me: I've never played a role playing game (like Dungeons and Dragons), but I know how they work and I theorize that at birth we are given a certain number of positive stat points and a certain number of negative ones just like when a character is created in D&D. So I might have "Quick Wit +2" but I also have "Obsessive Thoughts +4." My "stats" aren't the same as most other people, but that's okay, because we all tend to average out. While I might have been stuck with the stupid racing brain, I also have plenty of good attributes. And I don't have a debilitating physical impairment. And I was born into a white family in the late 20th century, which has (let's be honest) been a boon for my life.

tl;dr - I am like you, and I find it helps to not focus, solely, on my negative attributes, but to intentionally see the bigger picture. It keeps me from wallowing in self-pity about my stupid mental issues. We are all amazingly, uniquely different, and we all have "invisible" struggles that others can't comprehend. And that's okay.
posted by tacodave at 4:34 PM on March 18, 2019