So depressed I can barely function. What are my options?

September 2, 2024 10:07 PM

In therapy and medicated but it's not working. I feel like I'm running out of road. Give me some hope that there are still options for me.

Mid-thirties male in the UK. Have been depressed on and off for years, with the occasional bout of anxiety thrown in. The last two years have been especially bad, with bouts of sobbing and hopelessness and all that. Also an intractable and undiagnosable dysthesia which has eluded even a top neurologist. It feels like I'm just circling the drain on all this stuff, with some months being fine and some being unbearable. Absolutely sick of being miserable.

Currently on vortioxetine + lamotrigine (a new addition). Vegan, taking B-vitamin, multivitamin and iron supps. Have ordered some EPA/DHA to take as well. I've been seeing a therapist ~weekly for about a year and a half.

I have social support but I feel lonely. Have moved into a nice house share which hopefully will buoy my spirits a bit. I get support from friends but feel anxious about leaning on them too much; my dad lives not too far away so I see him but it feels like he doesn't really get it.

As an example of the sort of thing I'm looking for here: I run a startup and it was suggested to me that I might look at either stepping back fully, or taking an extended break and then returning on reduced hours. I'm going to discuss that with my co-founders, although it's pretty successful and I would be sad to leave. But I can't function, so I at least need a break while I get things under control I guess.

I'm also seeing the psych later this week, and would appreciate a steer on what sort of thing I should be asking for. I think the vortioxetine just isn't cutting it and might go back to SSRI/SNRI (switched away because of side-effects but I'll tolerate them if it keeps me sane). He also mentioned lithium at our last session as an alternative to lamotrigine, which sounds a bit scary but I would certainly consider it.

Please help. Thanking you in advance.

posted by anonymous to Health & Fitness (15 answers total)

Sending you compassion, please keep your chin up and keep at it <3

A few things that have helped me during depression - sunshine, forcing myself to take daily walks in the woods, getting a pet, Vitamin D supplements, joining a lowkey choir, and forcing myself dance and sing along to upbeat music every day in my apartment, even when I hated it.

Also, can you take a break from veganism for a few months? Add in some ethical eggs (or meat if you can stomach it)? Anecdotally I've had a few friends find their mental health improved when they added in more animal fat.

For light reading I enjoyed Allie Brosh on Depression Part 1 and Depression Part 2 (Happy spoiler she came out if it eventually, and I hope you will too).
posted by nouvelle-personne at 10:36 PM on September 2 [11 favorites]

I'm not sure whether you are in the part of the UK where the NHS is trialing at home transcranial Direct Current Stimulation, but it might be worth asking your doctor. It's also available for private purchase. There's some good evidence for this therapy, and it might be worth trying.
posted by MeadowlarkMaude at 12:02 AM on September 3

Give me some hope that there are still options for me
there are still options for you!

sending compassion & hope, along with an additional idea; mindfulness-based therapy is something you haven't mentioned:

The basic premise underlying mindfulness practices is that experiencing the present moment nonjudgmentally and openly can effectively counter the effects of stressors [nih]

there are various meditations available. i hope this is helpful. it sounds like you are taking some very good steps to take care of yourself, keep it up. good luck!
posted by HearHere at 12:59 AM on September 3 [2 favorites]

Would you consider a psilocybin therapy retreat? It is legal in the Netherlands. I know nothing about this (other than info that Michael Pollan has written about) but the evidence is so powerful it sounds like it might be worth a shot. Here's one organization I found online (no connection or referral, just random googling to give you an idea.)
posted by caoimhe at 2:28 AM on September 3 [7 favorites]

I'm finally coming out of my latest episode of treatment-resistant major depression.

My usual medication combo simply hasn't worked this time, so after 6+ months of no improvement, I started microdosing psilocybin mushrooms daily.

I don't know what the laws are like where you are, but in the US the spores are legal to buy and sell "for research purpose" and the mature mushrooms have been decriminalized in several places including where I live (Seattle).

So we grow them, dry them, grind them into a fine powder, use an itty bitty tiny measuring spoon (1/64th tsp) to load the powder into empty gelatin pill capsules, and take them with our morning meds.

A properly-sized microdose doesn't cause hallucinations or any other psychedelic effects. Just an elevated mood on the day you take them, and a cumulative effect of your brain starting to come back online and think its way out of the depression rut.

If depression is being stuck in gridlock on the freeway, then microdosing shrooms is like making new exit offramps start magically appearing so you can start moving again and get to where you're going via a different route.

This is very useful for people who have been depressed for a long time because the longer you're depressed the more those neurons have wired together to keep your brain going down the same unhealthy pathways over and over and over again. Psilocybin encourages your brain to make a bunch of random new pathways. Most of them won't go anywhere particularly useful (e.g., the walls are breathing), but when you've been severely depressed for a long time, just getting off the highway and out of the gridlock is a great start.

There's plenty of research you can read about psilocybin and depression if you Google, and I can vouch from personal experience that it's definitely not just the placebo effect. My ADHD meant that before I started putting them in my pill organizer with my other meds, I often forget to take them and then I'd forget that I forgot (I'd go about my day on the assumption that I was on shrooms even though I actually wasn't) until my husband found the capsule still sitting on my breakfast plate in the evening. He'd point it out and then suddenly my shitty unproductive day made a whole lot more sense! So I accidentally ran something pretty close to a double-blind randomized control trial on myself, and the differences on the days I actually took it were noticeable enough that I'm pretty confident in rejecting the null hypothesis. :)

Feel free to MeMail me to discuss further.
posted by Jacqueline at 2:34 AM on September 3 [7 favorites]

is supervised ketamine treatment available in the uk? i have heard positive things about it from people i trust and have been considering it myself for my ongoing major depression.
posted by dis_integration at 5:40 AM on September 3 [1 favorite]

Mindfulness, mentioned above, helped me. I went into it as a doubtful cynic and came out of it a reasonable convert (without turning into a fanatic). Also, it helped that I learned about mindfulness in group sessions, where I could hear others' stories. Their similar thoughts and situations normalized my own and helped me shift my mindset to "this is a common disease" and away from "this is my unique problem." If you can find Jon Kabat-Zinn reading his own books about mindfulness, that would be a great start. I enjoyed his words, his message, and his voice. More than once he described a feeling and a thought that was almost word-for-word some depression-derived feeling or thought I had had. So I knew he understood circumstances like mine. Good luck! Remember that you are not your depression. It's something that is happening to you not something that is your fault.
posted by Mo Nickels at 7:13 AM on September 3 [2 favorites]

I had good results with rTMS. I also take lithium in addition to lamotrigine. I feel better than I have in a decade (but not too good!) Hang in there. I also quit therapy, at a certain point it stopped helping.
posted by shock muppet at 7:43 AM on September 3

You didn't give a full list of all the meds you've tried, but I'm willing to bet there are lots and lots that you haven't. Unfortunately, sometimes a lot of trial and error is involved here - I think I can count about a dozen different failed prescriptions in my past. For me the winning combination is sertraline and mirtazipine, and they are nothing short of life-saving. My only advice is keep trying, and keep trying. (Lithium, though... I don't know about that, unless you're also having some mania. There are many, many other things I'd try first. Perhaps a new doctor might also be in order if you can manage it.)
posted by storminator7 at 7:50 AM on September 3 [1 favorite]

IANAD.

This is really hard. So so so hard. Even coming here for advice, though, is a great step!

As someone who has been there, here is what has helped me:

-Finding a psychiatrist dedicated to helping me figure this out. We did a genetic test that showed which antidepressants and anxiety meds would actually absorb properly and which wouldn't. This helped us come up with a prescription plan based on my literal brain chemistry.
-A combo of ketamine + TMS. The research around that protocol is great. TMS had a notable effect on my anxiety, like a weight was lifted off my shoulders. I can't recommend it enough.
-Deciding to DO IT. That was a really hard one. I was so sick of feeling like this off and on, and I had a moment of, shit I need to dig into this, figure out what was causing some of this (past trauma, which feels like something everyone has), and confront it head on. Luckily my therapist and pyschiatrist were super supportive of this. I read The Body Keep the Score and No Bad Parts, both of which were super helpful.
-An IOP program. I had to do FMLA from my job to do it, but it started me on a journey to make real changes (and got me away from a super toxic work environment/career path).

That being said...I am still struggling. I am going to do another round of TMS starting soon. The big difference is I now have hope that something will work, and even if I have to do TMS every year, it's worth it.

Plus, having some little bits of sunshine poking through the storm clouds gives me what I need to do the things that fight depression. Leaving my bed. Saying yes to social invitations. Getting exercise. Eating better. I could not do those things regularly with my intense depression, but now I can.

So I'd recommend talking to your doctor about:
-genetic testing to see what drugs do and don't work for you
-asking about TMS, and specifically about a ketamine+TMS protocol
-thinking about (and jounaling about) what you want to further explore in your past and current situation. Then sharing that with your therapist and making a commitement to dive into things very deeply. Perhaps with some EMDR.
posted by violetish at 9:41 AM on September 3 [1 favorite]

You run a startup - is it stressful? How does the timeline of that work line up against the onset of worse depression? Did you have more stable mental health when you had other jobs? (Obviously, you don’t have to answer here, but I wouldn’t discount lifestyle factors contributing to your depression.)

Hope you feel better soon! Sometimes I find it helpful to remind myself that I’ve had good times in the past and that they’ll probably come around again, I just have to get through the current trough.
posted by momus_window at 11:28 AM on September 3

Among the other good suggestions here, take the leave from work and rest.

No, I mean rrrrreeeessssstttttt. Start with at least 48 hours of actual cognitive rest - no screens, no words, no music. Literally avoid using your close vision. And for that first 48, only enough physical activity to promote digestion and avoid blood clots - and ideally this is outdoors or if indoors in front of windows with a view, again prioritizing distance vision.

Really, ideally, if you have the money and ability to travel this is where you find a retreat - if possible a silent one - especially if you can find one that allows for physical rest at first and then lets you step up physical activity but still really boring. Chop wood, carry water, sweep, wash dishes. Alternately, find yourself a nice all-inclusive resort and DIY your silent retreat to the best of your ability where you don't have to worry about getting fed.

As you increase cognitive load, still try really hard to stay away from screens and dedicate at least two weeks to prioritizing rest for your nervous system. Use e-ink if you prefer electronic reading, or read paper books, and if you use audiobooks keep your sessions pretty short, maybe 90 minutes max, with equal intervals of not actively listening. Do art with physical media. Keep it light, though: this is not where you take on every self-improvement project you can. Read biographies of remarkable people, read about nature and the cosmos, get a book on art therapy exercises.

Toward the middle/late-middle of this two-ish-week period of rest, read Burnout and consider picking up the accompanying workbook.

Treating your burnout and resetting your nervous system isn't going to fix your depression, but I truly believe you cannot get traction on your depression when you are in burnout, any more than you can successfully treat or manage depression with a failing thyroid or in the midst of intense caregiving responsibilities or in a war zone.

Let yourself have what we used to actually-kinda-helpfully call a "nervous breakdown" and spend at least a long weekend more or less in bed full time staring out a window in between naps. Let go and disassociate a while. Be frail. Eat gentle food and wear soft clothes and go ahead and wallow some. Cry listlessly, laugh inappropriately, rock, get fetal - don't get into trouble or take to the streets, but at least let your body do its neurochemical housekeeping functions without all your "holding it together" walls up.

If you happen to have private-luxury-hospital money and/or insurance, go on and do it there like the celebs do for "exhaustion". Let 'em pump you full of fluids and B-vitamins and gourmet meals. Get some spa treatments while you're at it, but say no to the cosmetic surgery.

Don't even expect to feel dramatically better after 2-4 weeks of rest, but it might help to set a few semi-measurable benchmarks to watch, like quality of sleep, stamina for physical tasks, and resilience in the face of small-medium disruptions or inconveniences. You should see those go up over this time.
posted by Lyn Never at 11:52 AM on September 3 [5 favorites]

Some thoughts + questions:
I have been where you are, MANY times. You are not alone at all. I'm curious as someone touched on above: do your drs think bipolar is a possibility? I was on lamictal and I think it takes a bit of
time to get up to an effective dose iirc. If you do have bouts of mania what I've found very helpful (I am not a doctor whatsoever) in my own experience is zyprexa but it makes you incredibly tired and kind of numb, so better for mania than depression (for me).

I had never heard of dysthesia but looked it up--is it similar to fibromyalgia? It's frustrating that it's flummoxing your dr but new treatments and meds come about all the time. But I empathize bc I am a chronic (very often) migraneur. There is major comorbidity w pain and depression/anxiety.

The times that have been particularly bad for me have been when I'm
not working, but ya reducing your hours if you can afford to sounds reasonable. Finally, I've found Feeling Good by David burns to be so helpful. A more modern take is ACT (acceptance and commitment therapy) like the book The Happiness Trap. I think it's a great tool to help separate us from our thoughts but I often get tripped up when he explains you need to act in a way to further your values--I struggle to know what my core values are especially when depressed. But ymmv.

Last thing--do you get joy from any media? I'm an obsessive reader and it's such an escape (though I can't really attend to the plot when I'm in a deep hole). Tv, movies, maybe to watch a flatmates?

Really glad you wrote!
posted by bookworm4125 at 8:31 PM on September 3 [1 favorite]

I’m not sure if it’s available near you but TMS (transcranial magnetic stimulation) was incredibly helpful for me.

It was daily treatment (Monday-Friday) for about 6 weeks. The appointments took about 10-15 minutes. It’s a loud machine near your head and felt like someone was tapping on my head with their finger. So, a bit odd but painless. The effects took a few weeks to kick in but it was so so helpful. 10/10 recommend!
posted by ticketmaster10 at 9:39 PM on September 3 [3 favorites]

> Absolutely sick of being miserable.

This is relatable, and may be an avenue for exploration around acceptance and tolerance of your chronic illness. One of the worst parts of depression is feeling depressed about being depressed. That can foster a lot of helplessness. I have had success in trying to manage how I feel about my depression, rather than managing the depression itself, if that makes sense. My therapist and I use a framework called IFS, it's kind of like CBT but with emotional patterns instead of intellectual patterns. Talk therapy has been essential in building self awareness of my own state and the process and triggers that cause me to move from one state to another. Building this awareness makes me feel a lot more in control, such that even when I feel the depression I am also able to step outside of it and hold space for it and sometimes even be less overwhelmed by it. It's not a cure, but it makes everything more tolerable.

Medicine (ssri) has also been helpful for me as a way to control symptoms (existential dread). But reframing the problem as one of managing symptoms rather than finding a cure has been the most helpful for me. My depression is a chronic illness like diabetes. It's not my fault, but it is my responsibility. Medicine and lifestyle choices make a huge difference, but I need to work at this consistently and likely for the rest of my life. I have had to redefine what success looks like in order to do that: i don't expect to ever be "cured" but I am still able to be happy and find life worth living.
posted by grog at 8:14 AM on September 4 [2 favorites]