how to get help for depression when I'm high-functioning?
June 13, 2022 1:59 AM Subscribe
I am depressed and I need help. I feel like medical providers aren't taking my depression seriously because I am high-functioning: I manage to get myself out of bed and to my job, I shower most days, I eat. It seems like the only way to get taken seriously would be to start sabotaging myself intentionally until my life seems "bad enough". How can I get this taken seriously so I can get the help I need?
The thing is that I am "high-functioning" in terms of getting to work because losing my job would have not only financial consequences but also visa consequences: I would have to leave my current country and move back to my home country where access to health care, and especially mental health care, would be even more difficult than it already is. So the only thing that is keeping me moving is a high level of fear about the alternative. Other than this fear, the only thing I feel is apathy.
I wanted to change my antidepressant and told my GP (who prescribed it) that it used to help but now it was just making me numb; she basically got stuck on the "it used to work" and couldn't take in the "it's not helping me anymore" and wouldn't prescribe a new one. I went off of the old one anyway against her advice (not cold turkey, I weaned like you're supposed to), but now I think if I go back she'll be mad and/or just try and put me back on the old one that I don't want to take anymore.
I had a therapist for a few weeks who basically decided that the solution to all my problems was to get a dog. Maybe, but according to my rental agreement that's a no-go. (And there is a waiting list for dog walkers at the local shelter - I guess I'm not the only one who's gotten that advice.) I stopped therapy with her after a few weeks because I couldn't seem to communicate to her that I needed something more than "get a dog and go out for walks". I am looking for a new therapist but waiting lists are long.
I don't know if I'm just having bad luck or if I'm doing a really bad job of communicating that I am in a very bad place. It feels like everyone thinks if I can get out of bed and go to work that I must be basically OK and things will resolve themselves, but I have been depressed for years (I had been taking the old antidepressant for three years before it stopped helping) and it is not resolving. I would rather not blow up the few parts of my life that are actually sort of working, but it seems like if I don't do that I will just continue to not be believed. How can I get across that no matter how functional my life looks, nothing is OK emotionally and I really need help?
The thing is that I am "high-functioning" in terms of getting to work because losing my job would have not only financial consequences but also visa consequences: I would have to leave my current country and move back to my home country where access to health care, and especially mental health care, would be even more difficult than it already is. So the only thing that is keeping me moving is a high level of fear about the alternative. Other than this fear, the only thing I feel is apathy.
I wanted to change my antidepressant and told my GP (who prescribed it) that it used to help but now it was just making me numb; she basically got stuck on the "it used to work" and couldn't take in the "it's not helping me anymore" and wouldn't prescribe a new one. I went off of the old one anyway against her advice (not cold turkey, I weaned like you're supposed to), but now I think if I go back she'll be mad and/or just try and put me back on the old one that I don't want to take anymore.
I had a therapist for a few weeks who basically decided that the solution to all my problems was to get a dog. Maybe, but according to my rental agreement that's a no-go. (And there is a waiting list for dog walkers at the local shelter - I guess I'm not the only one who's gotten that advice.) I stopped therapy with her after a few weeks because I couldn't seem to communicate to her that I needed something more than "get a dog and go out for walks". I am looking for a new therapist but waiting lists are long.
I don't know if I'm just having bad luck or if I'm doing a really bad job of communicating that I am in a very bad place. It feels like everyone thinks if I can get out of bed and go to work that I must be basically OK and things will resolve themselves, but I have been depressed for years (I had been taking the old antidepressant for three years before it stopped helping) and it is not resolving. I would rather not blow up the few parts of my life that are actually sort of working, but it seems like if I don't do that I will just continue to not be believed. How can I get across that no matter how functional my life looks, nothing is OK emotionally and I really need help?
There IS a question at the end about how much this affects your ability to live your life but I would argue your ability to live your life is severely impacted, you're just white knuckling through it.
This. If there are no such quizzes in your location you have to start to really labour the point that the only reason you are forcing yourself to do enough not to lose your job is a desperate fear of deportation....Really emphasise this point. You take NO pleasure in any part of your day to day activities. Left to your own devices you'd NOT get out of bed, NOT shower and NOT feed yourself with any regularity. You are no longer participating in social activities, your hobbies and you are withdrawing from your friends and family...[basically, whatever is true for you, list it]
If you feel this doesn't get through to your providers you need better providers.
posted by koahiatamadl at 4:14 AM on June 13, 2022 [2 favorites]
This. If there are no such quizzes in your location you have to start to really labour the point that the only reason you are forcing yourself to do enough not to lose your job is a desperate fear of deportation....Really emphasise this point. You take NO pleasure in any part of your day to day activities. Left to your own devices you'd NOT get out of bed, NOT shower and NOT feed yourself with any regularity. You are no longer participating in social activities, your hobbies and you are withdrawing from your friends and family...[basically, whatever is true for you, list it]
If you feel this doesn't get through to your providers you need better providers.
posted by koahiatamadl at 4:14 AM on June 13, 2022 [2 favorites]
Depending on if you live in the USA, and maybe other countries- I am not familiar with them, you could do a "partial inpatient program." Many of them are online, and/or happen in the evenings for working folks. There are many too that one can self refer to instead of having to get a GP referral. I know half a dozen people, friends and relatives who have done this sort of program, and all have been happy to have had the option, and felt so much better once they completed it.
In terms of therapy/medication- I find it so frustrating when I am told that it isn't always clear how and why medications work, but then when you bring up an issue the doctor tries and discredits you. "Pooping out" does happen with meds, though it is unclear why. Additionally, when doctors try and sell me on something (for me it is always loosing weight,) I ask them what are the peer reviewed studies that show xyz(what they are recommending.) I feel like the dog walking example is a clear situation where there are not peer reviewed studies to show that getting and walking a dog helps with depression. I am just writing all this to say, you are not getting the care you need, and you should try and look for other options. What is helpful about a partial inpatient program is that it is generally a few weeks of intensive mental health care, including looking at your medications, getting you on the right dosage, and various types of therapies. Good luck, and you should feel proud that you are seeking the help you need to function.
posted by momochan at 5:08 AM on June 13, 2022
In terms of therapy/medication- I find it so frustrating when I am told that it isn't always clear how and why medications work, but then when you bring up an issue the doctor tries and discredits you. "Pooping out" does happen with meds, though it is unclear why. Additionally, when doctors try and sell me on something (for me it is always loosing weight,) I ask them what are the peer reviewed studies that show xyz(what they are recommending.) I feel like the dog walking example is a clear situation where there are not peer reviewed studies to show that getting and walking a dog helps with depression. I am just writing all this to say, you are not getting the care you need, and you should try and look for other options. What is helpful about a partial inpatient program is that it is generally a few weeks of intensive mental health care, including looking at your medications, getting you on the right dosage, and various types of therapies. Good luck, and you should feel proud that you are seeking the help you need to function.
posted by momochan at 5:08 AM on June 13, 2022
It feels like everyone thinks if I can get out of bed and go to work that I must be basically OK and things will resolve themselves, but I have been depressed for years (I had been taking the old antidepressant for three years before it stopped helping) and it is not resolving.
IANAD/IANYD, but it sounds like you may be in the dysthymia (a.k.a. Persistent Depressive Disorder) club. As a fellow member, I can assure you that being able to get out of bed while still being depressed as hell is perfectly normal. It’s kind of a hallmark, really. When one is continually depressed over a period of years, you develop ways to put on a mask to appear “normal”. One of which is the “good worker” mask, where you get out of bed and go to work. I’ve been doing it for pretty much all my life, all the while wrestling with the demon behind the mask.
Frankly, your GP is an idiot if they don’t understand that psych meds often lose their effectiveness over time. That’s not even a disputed thing.
A good psychologist/psychiatrist should be able to recognize it pretty easily. I think your best bet would be to find a psychologist or psychiatrist who can work with you on the depression and get you on the right meds. I will note that effective psych treatment for PDD can take years, and often it is more of a “maintain a functional life” sort of thing, but with a whole lot less white-knuckling or mask-wearing.
posted by Thorzdad at 5:30 AM on June 13, 2022 [8 favorites]
IANAD/IANYD, but it sounds like you may be in the dysthymia (a.k.a. Persistent Depressive Disorder) club. As a fellow member, I can assure you that being able to get out of bed while still being depressed as hell is perfectly normal. It’s kind of a hallmark, really. When one is continually depressed over a period of years, you develop ways to put on a mask to appear “normal”. One of which is the “good worker” mask, where you get out of bed and go to work. I’ve been doing it for pretty much all my life, all the while wrestling with the demon behind the mask.
Frankly, your GP is an idiot if they don’t understand that psych meds often lose their effectiveness over time. That’s not even a disputed thing.
A good psychologist/psychiatrist should be able to recognize it pretty easily. I think your best bet would be to find a psychologist or psychiatrist who can work with you on the depression and get you on the right meds. I will note that effective psych treatment for PDD can take years, and often it is more of a “maintain a functional life” sort of thing, but with a whole lot less white-knuckling or mask-wearing.
posted by Thorzdad at 5:30 AM on June 13, 2022 [8 favorites]
Look, this is experience, not advice, but my health caregivers seem to notice when I a. Start rocking in front of them (they ask me if I'm aware of it, and I am, and say so and say it comforts me), b. Cry and keep using tissues or hankies during our conversation c. Talk in a deadpan voice because all the emotion has been sucked out of me.
I'm suggesting that you possibly mask symptoms of your depression because reasons. If you let yourself go, they have more than your words to rely on (though that should be enough), they can make notes about changes in your behaviour. Maybe even if you (uncharacteristically) get angry in front of them - "no-one is listening to me", I dunno. It's difficult to get appropriate treatment for mental illness. My first doctor said I should eat more bananas. My current doctor tells me I need more exercise (I know, I know I need it but I can't get out of bed!) And I guess for a lot of them, the things they prescribe (antidepressants, therapy, exercise) while all good and useful, are either not possible for their patients, or their patients aren't willing to try it.
You have my empathy, for what it's worth.
posted by b33j at 5:31 AM on June 13, 2022 [2 favorites]
I'm suggesting that you possibly mask symptoms of your depression because reasons. If you let yourself go, they have more than your words to rely on (though that should be enough), they can make notes about changes in your behaviour. Maybe even if you (uncharacteristically) get angry in front of them - "no-one is listening to me", I dunno. It's difficult to get appropriate treatment for mental illness. My first doctor said I should eat more bananas. My current doctor tells me I need more exercise (I know, I know I need it but I can't get out of bed!) And I guess for a lot of them, the things they prescribe (antidepressants, therapy, exercise) while all good and useful, are either not possible for their patients, or their patients aren't willing to try it.
You have my empathy, for what it's worth.
posted by b33j at 5:31 AM on June 13, 2022 [2 favorites]
I and friends have had pretty good luck with therapists who specifically advertise that they work with professional academics. Even if it's not your field, it might be worth a try as a search term to find someone who is used to dealing with people like you. (And, at times, me.) I'm afraid my specific recommendations would only be useful in one US state. Sympathy and best wishes.
posted by eotvos at 7:22 AM on June 13, 2022 [1 favorite]
posted by eotvos at 7:22 AM on June 13, 2022 [1 favorite]
As a specific example, the PHQ-9 is a self-scorable depression inventory. The Beck Depression Inventory seems to be less popular, but enumerates more specific symptoms, which is useful in self-evaluation.
Agreed that it sounds like being depressed has been your baseline for so long that your answers to questions like that may not be reliable any more. Try to reset / recalibrate to what you think "normal" is like for a friend or for you in the past.
posted by momus_window at 12:51 PM on June 13, 2022
Agreed that it sounds like being depressed has been your baseline for so long that your answers to questions like that may not be reliable any more. Try to reset / recalibrate to what you think "normal" is like for a friend or for you in the past.
posted by momus_window at 12:51 PM on June 13, 2022
I came in to say exactly what eotvos did! I'm my case, I have had huge success with two people who were both psychiatrists (so had been to medical school) and gave therapy to or supervised other therapists. They are used to working with people who are "high functioning" but suffering, and who are (apparently?!?) too good at talking about what's going on with them.
posted by heyforfour at 3:30 PM on June 13, 2022 [1 favorite]
posted by heyforfour at 3:30 PM on June 13, 2022 [1 favorite]
Preferably, change treatment providers.
If that is not an option, start taking notes. Make a diary of how you feel every day, of every time you feel hopelessness or fail to feel pleasure, etc. Keep it for at least 1-2 weeks. Lots of doctors will take this much more seriously than a general description.
If you are in the USA or someplace with a similar malpractice culture, I have seen people recommend that when a doctor refuses tests or treatment, you should ask them to make a note in your chart that you had this conversation and the doctor refused treatment. I have never tried this and I'm not sure I'd have the guts, but people say it works.
I do think that a lot of GPs though are very insecure about prescribing psychiatric drugs. They get into a rut with the one or two they are most comfortable with, and don't feel confident enough in their knowledge to branch out. If you can find either a psychiatric practitioner or a GP who is explicitly comfortable and familiar with treating mild depression, I bet you'll have better results.
posted by Salamandrous at 6:31 PM on June 13, 2022
If that is not an option, start taking notes. Make a diary of how you feel every day, of every time you feel hopelessness or fail to feel pleasure, etc. Keep it for at least 1-2 weeks. Lots of doctors will take this much more seriously than a general description.
If you are in the USA or someplace with a similar malpractice culture, I have seen people recommend that when a doctor refuses tests or treatment, you should ask them to make a note in your chart that you had this conversation and the doctor refused treatment. I have never tried this and I'm not sure I'd have the guts, but people say it works.
I do think that a lot of GPs though are very insecure about prescribing psychiatric drugs. They get into a rut with the one or two they are most comfortable with, and don't feel confident enough in their knowledge to branch out. If you can find either a psychiatric practitioner or a GP who is explicitly comfortable and familiar with treating mild depression, I bet you'll have better results.
posted by Salamandrous at 6:31 PM on June 13, 2022
This thread is closed to new comments.
What i would say is keep searching for a new psychotherapist and, if possible insurancewise, another GP.
This will depend on where you live, but I also at that point started seeing a psychiatrist - initially because where i live (Austria, EU), the state health insurance demands a diagnosis by a psychiatrist for mental health medical leave, and also i wanted a different anti-depressant and in Austria, psychotropic or mood altering meds require an initial prescription by a psychiatrist.
The psychiatrist was the most helpful of the three at that point. She saw immediately that i was a functioning shell, and that just because i kept up appearances did not mean i was in the least okay.
If where you live you are able to see a psychiatrist, i would recommend that. However, i should add that i saw her privately, not on insurance, so i was able to see her for 50 minutes appointments rather than only for a prescription.
She also helped me get a place in a clinic, the time there was a huge help/turning point.
Psychotherapy also was very useful and provided the support i needed after the clinic.
With both providers my main criteria was that they are older and have decades of practice. I found that for me i have a hard time trusting mental health care providers without much life experience. Also, they will have more experience in working within mental health care insurance restrictions.
Also, personally i favour those who work with the person-centred approach, and avoid the psycho analytic approach, and also CBT.
If a psychiatrist is not an option for you, i would say focus in finding a good psychotherapist. If they are worth their money they should be able to tell quickly where you are at. If you feel not understood, don't go back. Where i live, you can book a first session at no charge, that is only billed after you decided to become a client, and if you don't no fee is billed.
Courage and strenght,
posted by 15L06 at 3:29 AM on June 13, 2022 [3 favorites]