Mental crisis - help?
May 18, 2019 1:38 AM   Subscribe

I'm paralyzed by anxiety and it's hurting myself and my family. I want to run away from everything.

I'm late 50s. i have a child in college and I'm the primary support for my family. I may lose my job because I can't bring myself to be productive. I don't know what to do. Faced with an obligation I get very sleepy, even when I know the task is not difficult.

I've been taking 90 min lunches sleeping in my car even with stacks of work in my office. Im not suicidal but I'm sleepwalking into a major crisis and the worse it gets the less able I am to deal with it.

I saw this somewhere and it's 100% me: I'm not tired, I just don't want to be awake.

I'm taking Adderall for adhd and depression, I'm taking Celexa for depression. My last therapist concluded I am a narcissist because the prospect of hurting my family isn't enough to motivate me to be productive. My manager is upset with my lack of progress on some projects. My wife knows I am depressed and unmotivated. She loves me but doesn't know what to do. She knows my job is in danger.

Thanks in advance for your help.
posted by anonymous to Health & Fitness (24 answers total) 13 users marked this as a favorite
I'm so sorry to hear that you're having a hard time. I totally understand the feeling of being paralyzed from anxiety, because it's my reality too. I have to disagree with your last sound the furthest thing from a narcissist to me and that conclusion that he/she came up with is just wrong. They don't understand anxiety and how debilitating it can be. I have taken to doing something to motivate myself to take action that may seem crazy to some, but it's working for me and so I'll suggest it (knowing that my suggestion isn't for everyone):

I don't know if you've heard of or read the His Dark Materials book series by Philip Pullman. In a nutshell, part of the series takes place in a parallel universe where your "soul" lives outside of your body, in animal form. You can talk to your soul and have a relationship with him/her (they are essentially yourself). In the book this is known as your "daemon".

To help me deal with feeling stuck earlier this year as part of my own healing journey, I started pulling my "daemon" out of me by talking to him (in the books the daemon is usually the opposite gender as you, but yours can be whatever gender you like, or no gender). I gave him a name, and even picked a small bear eraser to represent him. It's going to sound really crazy but sometimes I make him talk back and bounce ideas off of him. I told him how I'm feeling about things, and he helps me deep dive into myself and honestly explore/unpack why I'm feeling the way I feel. I do a lot of this unpacking when I'm at home (I live alone so it's easy to talk to myself), but also when I'm out and about (I've gotten good at making my soul conversations sound like I'm talking on the phone with someone). Finally, I talk to my daemon via journaling.

Recently, my "daemon" has been making me take action too, by telling me exactly what he wants me to do, small step by small step. We break the largest tasks into tiny steps. Longer term projects get broken down over several days. I find that on the days I talk to him less, I'm also less in touch with myself. Which makes sense, because my daemon is me, and I am him.

Am I crazy? Maybe. But so far this has been working wonders for me. Obviously you don't have to have a talking daemon. But maybe breaking tasks down at your work into small, quick wins could help? Is there a way to explain how you're feeling and what you're going through to your manager so he/she can help you come up with a plan? Maybe your wife can help you with breaking things down into small tasks? And I'd suggest finding a different therapist, one who is more supportive.

There will also be ups and downs. Don't let that discourage you. It's all part of the journey. I wish you the best of luck!
posted by starpoint at 1:55 AM on May 18 [37 favorites]

Call your PCP and explain your symptoms. Celexa is known to cause fatigue, and some people take it at night. You could need a dosage adjustment, or to switch to another med that won't make you sleepy, or the Adderall might need to be adjusted as well. What you are describing sounds like physical symptoms, those should be brought up with your prescribing physician before resorting to therapy (or beating yourself up).

Fatigue can be caused by other things, such as low Vitamin D (common in Spring), low B12 (our bodies can become inefficient at absorbing it as we age), thyroid issues, or any number of things, in addition to med side effects. Ask for your D and B12 to be tested. Lack of both of those had my husband in the ER, twice, with weird brain fog and depression-like symptoms.

In short: call your doctor, ASAP, and explain your symptoms. A therapist is not qualified to help you with physical symptoms, so don't worry about what a past therapist said to you. Get a physical work up and/or med adjustments, but do consult your doctor.

As I said, some people take Celexa at night (or late afternoon) and the Adderall in the morning, ymmv, and you should follow the advice given by your doctor (tho' you may want to ask the pharmacist about this also).
posted by Marie Mon Dieu at 1:59 AM on May 18 [26 favorites]

Just a basic question: have you started taking these medications recently and if so have the tiredness or anxiety problems manifested since you've started taking them?

Or has there been any disruption of your medication schedule? It took me a while to realize that with most SSRIs like Celexa, unless I took them on an absolutely rigid schedule, and in particular if I missed a dose, it made me feel incredibly tired all of the time.

I'd also wonder whether you're taking Adderall or Adderall XR, the extended-release version. If it's not the XR, maybe you could ask your prescriber whether that might be a factor in why you're sleepy by lunchtime, and whether trying out a switch to the XR version might be appropriate?

There are probably lots of other, better ways to combat anxiety and tiredness in general but don't overlook the possibility of medication side effects making bad problems worse. I've taken lots of different prescription psychoactive medications for a long time and in my case I think I'm just really especially bad at figuring out their exact effects on me, and hence it took me a very long time to get a handle on those effects.
posted by XMLicious at 2:11 AM on May 18 [7 favorites]

Seconding that you need to call your doc to talk about drug dosages. I've had some meds that made me ridiculously drowsy, I'd pass out in the middle of the day. I'd also ask the doctor about some basic blood tests to make sure you're not anemic or something.

I'm seriously questioning the diagnosis of narcissism. I'm no therapist, but this really sounds more like classic, severe depression to me.

It may be that you just really hate this particular job. It doesn't have to be a terrible place, it may be that you've reached a point where you're so unfulfilled you can't bear to go through the motions anymore. Could it be time to leave your current employer, or even to switch careers? Or maybe there's a problem in your marriage, or something else. You're not just having an attack of the lazies, here. This lethargy is coming from somewhere, it's something chemical happening in your body or some issue in your life you're not addressing. You have to figure out the true source of your unhappiness. You talk about your "last" therapist. Are you seeing one now? If not, please do!

As for what to do about your job right now, so you don't get fired... Well, I struggle with motivation myself and I try to overcome it sometimes by doing that thing where you kind of externalize the you of the future, you make that you a person you don't want to disappoint. Maybe it would help to think of this like a time travel story, where you know the future will be bad if you don't do X, Y and Z, but there's still time to prevent it. Try breaking things down into smaller tasks, try gameifying tasks to make them fun. Give yourself rewards for getting things done. I also try to do this thing where as soon as I think about doing a task, I jump on it. Don't give yourself a moment to dither and stall, because that moment can turn into days, weeks, months...

But above all, work on figuring out why you're so unhappy. If your current life isn't working, don't try to just tough it out. Toughing it out isn't working.
posted by Ursula Hitler at 3:19 AM on May 18 [14 favorites]

Take a day off and make an emergency appointment with your GP or PCP. Consider medical leave if that's in. any. way. possible. Find a new therapist who doesn't suck out loud.
posted by DarlingBri at 4:10 AM on May 18 [13 favorites]

I definitely agree you should to start with your PCP. I would go and say all you’ve said here, and see if you need a meds adjustment, and possibly some prescribed time off. I would ask for a note and have a frank conversation with my manager.

You sound completely overwhelmed and depressed to me, and like you are suffering without compassionate, understanding support.

I have been in this situation myself before and it’s very lonely and terrible. You deserve compassion and support! The best way to get it is to get some clarity of what you need and then find credible places for that support.

If I was your manager and I was frustrated by your output, and I knew you were experiencing a mental health crisis (and what sounds like burnout), I would want to know that you had a plan to address it and you were taking steps to improve. I would want to help you get through it and I would be happy to do that if we could talk openly about it.

On the Narcissim “diagnosis” (sounds more like a character assassination than a diagnosis to me, unless they said you had NPD?), that is... unhelpful. It sounds to me like you feel very overwhelmed and are putting in what feels like a ton of effort for little return. None of us know you and can say if the effort vs reward you are getting is reasonable, but none of us actually get to say, because it doesn’t feel right to you.

Is there some underlying twisted thinking that is making your day to day hard? Probably. A good therapist could help you sort that out and help you make sense of what is burning you out. But that’s future stuff. For now you need some help dealing with the crisis, and if anybody starts giving you the runaround on that, you would be better off finding someone else to help.

You say your wife knows you are depressed but isn’t sure how to help. Can you talk to her about the burnout you are experiencing or do you think conversation with her about it will make it worse?

If I were you I would go in this order:

1) doctor for meds eval and note
2) convo with your manager about the crisis you are in and your plan to improve
3) find a therapist to examine your burnout
4) try to find a way to ask for emotional support from your wife

Good luck! I’m so sorry you are dealing with this.
posted by pazazygeek at 4:34 AM on May 18 [7 favorites]

I am so so sorry you are going through this. I have had a very similar experience recently and came out the other side of it after a few months. It was so bad I also thought I'd lose my job. The worst part of it was the absolutely unmovable procrastination, very similar to what you describe (stuff that's objectively easy or enjoyable, but I couldn't bring myself to even open the files to start and felt crippling guilt about it). But, I'm thriving now. I say this to reassure you you are not alone, and it can get better.

In addition to everything people have said above about visiting your doctor, here are a few things that helped me.

- I talked to my boss, who luckily was understanding even though she had zero experience of depression herself. Ask a Manager has good tips on how to approach this conversation.

- I used a CBT workbook. It helped me figure out what the core fear behind the procrastination was, and then coax myself into taking tiny, tiny steps to chip away at the tasks I was afraid of. I used this one from the NHS.
posted by EllaEm at 5:12 AM on May 18 [12 favorites]

This sounds like my life when my ADHD medication isn't working. Ignore the therapist who called you a "narcissist" (ugh). Ask for a med change or adjustment from your psych, and throw in some bloodwork at an endocrinologist's office for good measure (ideally someone who's up-to-date on subclincal hypothyroidism, and the fact that some people whose levels are "within range" still might need meds).
posted by shaademaan at 5:18 AM on May 18 [2 favorites]

Talk to your doctor and your boss about FMLA paperwork, consider voluntary inpatient treatment or an intensive outpatient treatment program. If neither of those is available to you, consider discussing with your therapist and doctor how to make some time off healing including maybe some new medication trials and maybe a new therapist (it’s possible you might want to discuss further what she meant by what she said and how you heard it in case your depression is distorting.) This is what you would do if you had a medical illness. Your mental health deserves as much attention and as little shame.
posted by Waiting for Pierce Inverarity at 5:22 AM on May 18 [3 favorites]

Celexa made me not care about anything and absolutely destroyed my motivation. So my first step would be to see a doctor to discontinue it and get on an antidepressant that's not an SSRI.

My next step would be to get medical leave (FMLA if you don't have sick time saved) from work, so you don't lose your job completely before you get your mental health on track.
posted by metasarah at 5:43 AM on May 18 [6 favorites]

I don't understand why other posters are telling you to call your PCP. Do you not have a psychiatrist? A psychiatrist is a specialist in the prescribing of psychiatric medication. You should have one of those if you don't already, and calling him/her immediately is a very good idea.

You said your "last" therapist told you you were a narcissist. I can't imagine telling a patient that, even if this person thought it was true. How can throwing a stigmatizing label on a patient help him/her? However I do think you need to have somebody to talk to about your lack of motivation, depression and anxiety. Most sophisticated psychiatrists understand that supportive psychotherapy is an important part of treatment for depression and anxiety (IMO, obviously).

metasarah is clever for suggesting medical leave, if such is available.

I'm not your therapist, not giving professional advice, just my two cents.
posted by DMelanogaster at 6:29 AM on May 18 [6 favorites]

I agree with addressing your meds. Zoloft forked with my sleep - no matter what time of day I took it - and also took me from being really anxious to apathetic - I started showing up at work late, taking lots of sick days, etc. Getting off of it (carefully, with the guidance of my doc) helped.

The other thing that helped immensely was leaving the job that made me so constantly anxious. From that and other experiences I learned about how I specifically handle stress and which kinds of stressors I really just shouldn't be bothering with. I actually went to a *more* stressful job but I had a very supportive boss; that was much easier for me to handle that the stress of a boss who was a bully.
posted by bunderful at 7:46 AM on May 18 [1 favorite]

Could you find one thing, outside the house, that's not too time-consuming, that you might enjoy?
posted by amtho at 7:47 AM on May 18

Here's what I did when I had a similar period last year...

1. I took time off work, to get some breathing space.
2. I found a GP that I could actually talk to, and who wasn't already looking over my shoulder for the next patient as soon as I came in the room. That meant I had to try out a few different GPs, and sack the ones who were no use. Now, I have a GP who gets it.
3. I got a prescription that addressed my anxiety (mine was for sertraline, yours might be different given that you're already on other medications).
4. I found a therapist. That also meant working through a couple of candidates.
5. On going back to work, I structured my work-day much more rigidly & predictably, so I knew what I needed to achieve on any given day, and how I was going to get it done.
6. I learned how to say "no, that won't be possible" at work. Previously, I'd been a pleaser. I learned that I couldn't solve other people's problems, and trying to do that made me ill.
7. I learned how to ask out loud for what I need at home.

That other therapist did you more harm than good, from what you say. You can fire them when they suck, like I did with my former GPs. They're supposed to be helping you, not harming you.

Good luck. It can work.
posted by rd45 at 7:58 AM on May 18 [2 favorites]

I have been there. Break the tasks down to be as small as possible. Go somewhere to work where you must work (e.g. cafe?). In my experience, once you start it is possible to work through what seems like a mountain of stuff more easily than you think. The hardest part is getting started.

Longer term you probably need a vacation at the least. Try changing jobs. Switch something up.
posted by xammerboy at 9:09 AM on May 18 [1 favorite]

Just adding another voice suggesting you talk to your psychiatrist (or get one if your PCP is prescribing your meds). I know people for whom Celexa was a miracle med, but it made me a total sleepwalking zombie when I took it (I cannot nap, ever, but on Celexa I was falling asleep every afternoon while working; it was awful).
posted by lazuli at 9:55 AM on May 18 [2 favorites]

Burnout and depression are very real things that can negatively impact your health. I’m really sorry you are going through this.

Depending on a few factors you may qualify for FMLA leave, up to 12 weeks. I am not a lawyer but depending on where you live you may be eligible for at least some paid leave for health reasons.

NAMI for your state or city would be a good place to find out more details for your particular situation.
posted by forkisbetter at 10:13 AM on May 18 [2 favorites]

You are ill with anxiety and likely more. You may need to take some time off work. Your illness is causing your inability to effectively complete work. See a doctor as soon as you can, use sick time to take care of yourself, possible even disability time. I'm so sorry you're having such a rough time.
posted by theora55 at 12:00 PM on May 18 [1 favorite]

Concur with everybody who says there's something physically/medically wrong--most likely the meds, but who knows--and that you need primary care, stat. Also concur with everybody who disagrees with the "narcissism" diagnosis, most especially with the person who noted that the diagnostician responsible for it "sucks out loud." Best wishes to you and hopes for a full recovery. What's happening isn't your fault and it's not being caused by some flaw in your personality.
posted by Don Pepino at 1:28 PM on May 18

As a follow up on the excellent comments mentioning FMLA as a possible way to help get through this, it is a legal question, but also something that may only require a consultation with an attorney and your doctor, who likely already has the form that they can quickly fill out so you can give it to your job and then take some time off. Please also note that states often offer protections in addition to FMLA, often for smaller-sized employers, so please do not get discouraged by simply reading up on the issue online. There are also legal protections from retaliation for exercising these rights, and your own lawyer can explain more about that.

There are a variety of legal protections, including but not limited to FMLA, that may be available to help protect your health and your job, so I encourage you to Get a lawyer (MeFi Wiki), at least for a consultation. One place to start could be the National Employment Lawyers Association (NELA), which offers an online lawyer finder for plaintiffs, and/or your state's bar association, which may have a lawyer referral service.
posted by Little Dawn at 3:14 PM on May 18

IANYD but from my experience, and what can be easily found online, It is true about Celexa causing fatigue problems. I was on it for a short time and was taken off of it for very similar reasons.
posted by eusebis_w_adorno at 10:28 PM on May 18

Individual people's individual experiences with individual meds are not relevant to you. Meds are a decision made between you and your healthcare practitioner and nobody else. Focus on getting yourself to a person you trust to help you. Just focus on that one step, and ask your wife to help you or do it for you if necessary. For many of us, the relief in knowing that there is somebody taking care of you when you are in desperate need cannot be overstated, and I hope that's your experience. The meds can always be re-adjusted.
posted by DarlingBri at 5:22 AM on May 19 [2 favorites]

With the world the way it is, it's entirely possible you cannot afford to take formal leave and may not be in a position to even take a couple days PTO to make an extra-long weekend to get some real rest. If you really can't take time off, make the doctor's appointment ASAP, and you and your wife hunker down and strategize how to get through this health crisis as best you can for now. This may mean you do nothing but work, sleep, eat, and bathe for a while.

Honestly if you can't get in to your regular doc in the next day or two, consider going to urgent care to have a doctor review all your medication and your symptoms. If you're able to sleep in your car for 90 minutes in the middle of the day on a regular basis there is something measurably wrong (I know someone who did this every day for years until it happened to come up at a routine visit for his ADHD meds and his doctor was like "you're not leaving today until you have an appointment for bloodwork tomorrow, if not sooner" - he did end up with medical diagnoses for chronic illnesses that are manageable but he for sure should not have been on amphetamines and he's lucky it got caught before something real bad happened).

You may have to just decide to take it on faith that this is serious and it is a health problem for a little bit, since your fatigue/depression/anxiety are going to make you apathetic and pessimistic, but ask yourself this: if your wife or kid described to you that they can't focus at work, sleep in their car every day, and power down every time their fight-flight-freeze response is even gently triggered, would you not be seriously worried about them and urge them to get to a doctor?

You probably should have a conversation with your management extremely soon, but I'd say see the doctor first and formulate your plan from there.
posted by Lyn Never at 9:08 PM on May 19 [3 favorites]

nth-ing probable issue with the meds. Also nth-ing finding a psychiatrist or a pcp.
posted by queen anne's remorse at 8:08 PM on May 22

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