Why does everything just feel wrong?

March 18, 2024 3:33 PM

I wake up with a sense of... if not anxiety then dread. During the day I'm okayish, and can get on with work and be reasonably productive. But everything just feels wrong somehow.

Have been treated for depression for many years. While attempting to fix some weird RLS-like symptoms (as well as other side effects from SSRIs), was switched from duloxetine to vortioxetine. Am on 15mg and I feel... okay? Like, I can function, and go to work, and have a relationship.

But everything just feels wrong in some way. I wake up with a sense of dread. I feel disconnected from my goals, such as they are, where once they felt truly motivating. I'm moving back to [big UK city] from [small UK city] and I feel sorta nothing about it, which seems surprising given it's where all my friends are + a lot of history. I'm in a nice relationship but it feels like I'm going through the motions - in many ways that's how my whole life feels.

Phrases that have appeared in my journal recently: "spinning my wheels", "something pretty huge is missing from my life", "I don't feel joy, or love, or a sense of belonging or purpose".

Is this just... garden variety depression and a sign I should get back on SSRIs? My 'peak', if I had one, was being on 200mg sertraline a few years; that really did feel like the cobwebs had been blown away. But the last couple of years have been ruinous for my mental health, and while things feel "okay" at the moment, they don't feel good. Maybe I need a big psychedelic experience, or a retreat, or some other big shakeup. (Quitting my job isn't an option at the moment.)

I've tried ketamine in the past. I'm in weekly therapy, have been for about 18 months.

posted by osmond_nash to Health & Fitness (20 answers total)

Is there any chance you have bad air quality? Mild carbon monoxide poisoning manifests as feelings of dread. Does it still happen if you sleep in a different building?
Might also be worth doing a sleep study or getting a device that tracks your oxygen saturation over night. Sleep apnea also has unpleasant mental side effects.
posted by nouvelle-personne at 3:41 PM on March 18 [8 favorites]

A lot of people have a feeling we're on the wrong timeline these days. It isn't just you.
posted by zadcat at 4:20 PM on March 18 [4 favorites]

Best answer: Anecdata: As a fellow who suffers from similar malaise and angst, the things that usually help me are: disconnecting from news/social media (COMPLETELY disconnecting works best for me), getting better sleep, reducing/eliminating pot & alcohol, exercising more, connecting more with neighbors and family and friends, spending time outside, etc. Basically, anything where I'm interacting with the real world and real people helps me to escape the feeling that things are wrong.

But I think the thing that helps me most when I get in a funk like this is completely disconnecting from the news and/or social media. Neither is a good representation of the Real World. Sometimes, though, it's hard to see that unless you completely remove yourself from the never-ending flood of bullshit. (Example: I just got back from a three-day camping trip to a remote area with no cell service. Just me and my girlfriend and our dog. My mindset is 100x better than it was before we left.)
posted by jdroth at 4:25 PM on March 18 [9 favorites]

Best answer: This is a discussion to have with your prescribing doctor.
posted by heatherlogan at 4:49 PM on March 18 [15 favorites]

Best answer: You said you're in therapy -- have you talked to your therapist about it? They're probably in the best position to be able to factor in everything you're going through, and whether medication could be an appropriate intervention (even if they can't prescribe it).
posted by lapis at 4:53 PM on March 18

Best answer: The therapist isn’t helping, they might not be the right person to help find a solution. Definitely go back to the prescribing doctor. You know the thing that works, just need to find a way to deliver it given the side effects.
posted by shock muppet at 5:06 PM on March 18 [1 favorite]

A "sense of impending doom" can actually be a symptom of a medical (as opposed to mental) health issue... might not be a bad time for a medical checkup, if you haven't had one lately.
posted by stormyteal at 5:18 PM on March 18 [15 favorites]

Best answer: Did the medication change correspond with the sense of dread, dissociation, and/or anhedonia? Because it really does sound like a symptom if the timeline indicates they are. I mean, it could also be a reaction to the last couple of years and/or life, but the way you describe it sounds like a problem, so I'd talk to your prescriber.
posted by gideonfrog at 5:52 PM on March 18

Yes, I recently saw sense of impending doom as a symptom of something or side effect of something. I can't remember what though. Seconding that you should have a physical check-up also. Also, googke infrasound and see if there are any possible sources in your environment.
posted by If only I had a penguin... at 6:04 PM on March 18

In the past, I have awakened with a rush of dread or anxiety. I was told that it's a cortisol or adrenaline rush. I've not gotten over it, but naming it was helpful. It might be worth asking your medical professional about it.
posted by jennstra at 7:04 PM on March 18 [4 favorites]

For me, a sense of looming dread sometimes means I'm developing an allergic reaction to something (agreeing with the "it could be physical/medical" comments above).
posted by adventitious at 8:31 PM on March 18 [1 favorite]

Best answer: Yes, considering your lengthy experience actually paying attention to your mental health, I agree with the people above suggesting it might have an environmental or otherwise external cause. Check your living spaces, especially your bedroom, for mold, clothes moths, carbon monoxide, lead, and any other critters that may be violating the human space bubble. Make sure your bed hasn’t sunk into a crater when you weren’t looking. Double check any and all of your different medication dosages and interactions, and discuss your symptom with a GP or other flavor of medical person who can order stuff like blood tests and other diagnostics.

It might feel a bit paranoid, but it seems like a lot of us who struggle with anhedonia and long term depression can build up a tolerance, of sorts, to huge blaring issues. Like someone with a high pain tolerance shrugging off a broken rib as bruised and then blammo, internal bleeding. That’s a bit extreme but I suspect you know what I mean. Sometimes we are so used to feeling like shit that something another person would take seriously seems fine.

It could also definitely be the world as it currently is. Don’t discount that in your investigations. I am ever more certain that humans are not meant to have a fire hose of current events blasted at us on the daily.
posted by Mizu at 8:47 PM on March 18 [2 favorites]

Phrases that have appeared in my journal recently: "spinning my wheels", "something pretty huge is missing from my life", "I don't feel joy, or love, or a sense of belonging or purpose".

Is this just... garden variety depression and a sign I should get back on SSRIs?

That does sound like depression all right. I think I might give the SSRIs a go again and see if they help.
posted by Tell Me No Lies at 11:32 PM on March 18 [1 favorite]

Another factor to consider is the weather, is it spring there yet? Does the sun hide behind clouds all day?
posted by mareli at 3:31 AM on March 19

Please see your doctor for a physical if you can. A sense of impending doom can mean standard middle aged malaise, but it's also a symptom of heart disease.
posted by champers at 3:33 AM on March 19 [3 favorites]

1. Cortisol levels are highest in the early morning. This can cause waking up with a feeling of doom, and/or a racing heart, anxiety, etc. It doesn’t always go away as the day progresses.
2. Vitamin B has been shown to have a positive effect on cortisol levels. There are many articles about this; here’s one.
3. Anecdata: when I don’t take Vitamin B complex regularly, I get anxiety and feelings of doom.
posted by MexicanYenta at 5:11 AM on March 19 [1 favorite]

People are all responding to the idea that you're feeling an "impending sense of doom" but that's not what you're describing.

disconnected from my goals, such as they are, . . . I'm moving back to [big UK city] from [small UK city] and I feel sorta nothing about it,. . . I'm in a nice relationship but it feels like I'm going through the motions Phrases that have appeared in my journal recently: "spinning my wheels", "something pretty huge is missing from my life", "I don't feel joy, or love, or a sense of belonging or purpose".

That sort of emotional blunting was actually my experience on a couple of antidepressants though at this point I don't remember whether they only occurred with SSRIs or not. Definitely bring it to your prescribing doctor, as it might be a known side effect of what you're on.
posted by We put our faith in Blast Hardcheese at 7:02 AM on March 19 [1 favorite]

Vortioxetine goes up to a 20mg dose in case that helps.
posted by ellieBOA at 7:37 AM on March 19 [1 favorite]

Because this could be a side effect of medication, you can't have a complete conversation about this if it doesn't involve your pdoc and care team.

But, one low-hanging fruit: you mention being treated for RLS-like symptoms, which means at some point you might have tried magnesium supplements at bedtime and then stopped when you moved on to something else. If that's the case, or if you have not tried this, give it a shot and see if your morning dread eases any.

There's so much stuff this could be that's easily recognizable in hindsight, certainly if you have not had a pretty comprehensive health exam with bloodwork (I recognize this is apparently not "standard" on the NHS, but figure out who on your care team can push for this) you really, really should. Health conditions don't always make a big entrance, and you have supplied a number of little clues that something in your body appears to have been changing in the past couple years and you may be over-crediting them to "mental health" when they might be "health".

People and even doctors are prone to forgetting that stress is so fucking bad for your body and that stress isn't just having a difficult job, it's grief and it's having low resilience due to mental/physical health issues and it's the economy and pandemics and political upheaval and worries. And it'll trash your thyroid, disrupt your gut so you can't absorb vitamins or produce serotonin, give you gallstones, affect your heart and lungs (and that's BEFORE accounting for any known or asymptomatic rounds of covid you've had), make your immune system go haywire and turn on you, and on and on. It's worth insisting on a physical health accounting, because no amount of therapy will touch kidney disease or a failing thyroid or alarming inflammation markers.
posted by Lyn Never at 9:40 AM on March 19 [3 favorites]

Response by poster: Thank you all for your lovely answers <3
posted by osmond_nash at 9:25 AM on March 22 [1 favorite]