Depression and treatment

[XCashier]

Jester's post in Off Topic struck a chord with me. Once I'd written my response out, though, I figured I'd gone way off topic and it probably should be its own post in Sickbay.

Now, I know this kind of advice does not bear on people who are clinically depressed or bipolar. I am not a doctor, psychologist, or psychiatrist. I have no mental health training, and I don't delude myself into believing that merely having a more positive outlook automatically erases life's ills and makes things better.

Depression and other mental illnesses are being taken more seriously by the medical profession and the general public. There is treatment for them; it may take a while, but it is there, and I encourage anyone who's suffering to seek treatment, whether it be counseling, dietary changes or medication. There's no need to suffer.

I've suffered from depression most of my life. Usually, I could muddle through, but I've had episodes where it's just been awful. Had a really low point a couple of months ago. I was in for a regular checkup and my doctor asked me a few questions about depression and suggested medication.

Now, I was leery about medication, but I gave it a try. The first medicine I took (I can't remember the name, it was a SSRI starting with a C) kept me up all night with a racing heartbeat. That scared the hell out of me, so I called the doctor and asked if I could discontinue that medicine. He put me on a different medicine (buproprion). I was still nervous about it, but I took it, and so far, so good. It's been a few weeks and I'm feeling much better. On a scale of 0-10, I went from somewhere in the negatives to about a 7, an 8 on really good days. I will never be Little Mary Sunshine, I'm just not wired that way, but I'll settle for "reasonably well-balanced".

So yeah, don't let the stigma associated with mental illness deter you from seeking treatment. I know that there's no cure-all, that it can take medication after medication (I was very lucky that it only took me two tries) or treatment after treatment. But you can be helped, and I don't want to see anyone else taking the final way out.

My thoughts and prayers go with everyone who is suffering.

[telecom_goddess]

I'm on buproprion and it's been working fairly well for me too, and no major side effects that I can see.

[Shalom]

Citalopram, probably. I took that for about 4 days, was so zonked by the fourth day that I couldn't drive. Switched to bupropion, and it seemed to work for me.

I got off it early this year, after almost 11 years taking it in various forms and dosages. Thus far I seem to be doing OK without. I still keep one bottle in the house, just in case.

(This place helps too. That is not a joke, being able to rant here is definitely good for my mental health...)

[XCashier]

I think that's it, Shalom, the name looks familiar. I don't have the stuff anymore; I turned the bottle in to the police station (that's what the pharmacist told me to do).

I was nervous about trying an antidepressant at first because the brain is an incredibly complex organ. We still don't know everything about it, and one wrong move and you're toast. I didn't want something messing about in there. But I already had something messing about in there, namely, the depression.

I'm glad to hear others are doing well on buproprion. I hope you continue to do well without it, Shalom.

[Gizmo]

Citalopram is a nasty piece of work for most people. I was hellishly bad on it and even had conversations with my boss on the phone and 2 seconds later couldn't remember anything bar he called. Nothing about what was said.

Sertraline seems to be the favorite around here for depression. Does give a bit of a kick to the stomach at first and can cause issues at night with sweating or dreams if taken too late in the day. Once it settles it normally isn't too bad though.

[raudf]

I'm on Sertraline for both depression and anxiety. I've had actual peaceful moments, rather than my mind winding itself up all the time. I'm going into counseling once my preferred place has an opening. I guess being surrounded by a family history of depression, I don't see the stigma. I see it as... "I've been as strong as long as I can. I have nothing left at the moment."

Getting help takes a LOT of strength.

[Seshat]

Depression - any mental illness - can have many causes. There can be damage to or malformation of the brain itself; there can be chemical problems or problems with the cells of the brain or nerves; and there can be problems with the mind or with patterns of thought.

If you have a problem with the shape or structure of your brain, or with your brain chemistry or cells, then you probably need either drugs or physical intervention. Just the same as if you have a problem with the shape or structure of any other organ, or with the chemistry of your body. I often liken it to being a diabetic: if you're a lucky one, you can make lifestyle changes. Otherwise you're insulin-dependant and that's just the way it is.

And like diabetics, some people need insulin or metformin (or in the case of depression, an anti-depressant or anti-anxiety drug) to support them while they learn the lifestyle changes and while their condition improves.


If your depression is caused by problems with the mind or with patterns of thought; 'talking therapies' are probably going to be your main solution. These are like the lifestyle changes for a diabetic, or like physiotherapy for someone who's been injured and needs to relearn how to move, or someone who just needs to learn better ways of moving.

Even if you have depression for a brain-caused reason, 'physiotherapy for the mind' - talking therapies - can help you learn how to make mental workarounds for the bits of your brain or neurochemistry that don't work right.

Most depression can be treated, and/or cured. Most people suffer depression at some point in their life: it's been described as 'the common cold of the mind'. Seek help, learn how to make the mental equivalent of lemon-and-honey-tea and chicken soup, and move on with your life.



Postscript:
There's another major cause for depression: circumstance. For such patients, a full treatment program ideally includes a social worker who can help them get out of whatever circumstances are causing the depression.
Note: grief is not depression. Normal, healthy grief - whether it be grief over a death, or grief over another sort of loss - is part of being human.

[DaisyQueen]

Just had to weight in here on this topic:
I was diagnosed with depression about 12 years ago and have been on a range of antidepressants. I found Zoloft worked the best but it gave me such awful nightmares that I was actually scared to go to sleep. I would stay awake as long as possible to avoid the nightmares. Now I am on Lexapro and while it doesn't work as well as Zoloft I'm not scared to sleep.

I agree that more and more people, and society in general, are taking depression and mental illness as a whole, more seriously. I still feel looked down on sometimes when someone hears I have depression but it's not as bad as it used to be. My ex-husband tried to use it against me in our custody case but he lost. Bastard.

I heard something on the radio yesterday that actually made me yell "YES!!!!!! YES!!!!! SOMEONE FINALLY SAID IT!!!" and I hope people really heard it. The dj's were saying that depression has very little, and sometimes nothing, to do with sadness or happiness. It has to do with the chemical imbalance. That is exactly right for me. I'm completely satisfied with my life--job I enjoy, wonderful family, hobbies I love. I can't complain. But I still struggle with depression and getting out of bed. Because of this imbalance. It has nothing to do with my happiness--I'm a happy person--I just have a hard time in my brain.

[NecessaryCatharsis]

I too would like to weigh in. I'm happy that people are starting to take more mental illness seriously, as something that really exists, and seeking professional help to deal with it. I'm happy that depression is starting to be recognized as a real, treatable malfunction within the brain, rather than as being the result of someone who is not 'trying hard enough' to just get on with things, that doctors are listening to patients more with these conditions, and that patients are seeking help.

I still feel like the mental illness stigma has not been solved, or even thoroughly explored. I have suffered from mental illness since my teens. My official diagnosis': Paranoid schizophrenic, severe social anxiety, depression, coupled with compulsive thoughts and general anxiety. When people learn this about me they are often afraid, they don't want to be somewhere alone with me, they don't want to let me into their houses or near their families.

Mental illness, and particularly things that have been around awhile (like schizophrenia), can cause the mentally ill person to behave in a way that is dangerous to others, and has been recognized as such for decades or even centuries. These illnesses used to not be treated, the person suffering was simply contained or eliminated for the good of society. It wasn't until recently that these illnesses have had successful treatments, but societies perceptions of the mentally ill person haven't necessarily kept pace with the level of treatment options. Once the diagnosis is attached to the person, other people judge based on the fear the illness provokes, rather than judging the way they would anyone else, through the actions they witness from the person in question. Many people particularly worry when they learn I suffer from auditory hallucinations, because of a high profile serial killer who blamed auditory hallucinations. The first reaction from most people is 'Are they telling you to kill me?' or 'Who do they tell you to kill?'. I have never had an urge of any sort to kill someone, my actions have never indicated that I would like to kill someone, yet that is where people go right away.

I spent a good ten years, untreated, barely functioning, knowing something was very wrong with me, but afraid to ask for help. I was locked up twice, for months at a time, by well meaning relatives, in mental hospitals. I was frequently homeless, couldn't hold a job for very long, didn't graduate from high school despite excellent test scores, couldn't maintain a relationship with anyone, and did a very poor job taking care of myself. In all of that time I never did anything that would put anyone else in danger. Other people terrified me, I was the 'victim' of many things that were my own fault, my behaviours and thoughts caused circumstances where other people could more easily take advantage of me, but no one else was ever in danger from me.

I have been successfully treated for about 12 years now. I have been working in one field, for three separate companies, in that time. I have advanced at work, made and kept a few friends, had a baby who's now 6, took care of him by myself after my husband died, while working, and taking some part time courses to advance at work. Because I have been successfully treated. Successful treatment in my case doesn't mean that I have no symptoms, or that I am now 'normal', but through medication, counselling, thought retraining I am able to stay within acceptable tolerance of normal behaviours.

And still people are afraid of me.

We have a long way to go.

[greek_jester]

We have a long way to go.

and massive at the way you've managed to get your feet under you. One of my mum's friends is schizophrenic, and every so often he'd disappear for a few weeks. Brain chemistry isn't static, so after a while the voices in his head would start coming back and he'd book himself straight into the mental health clinic until they could find a new combo that would work for him.

XCashier, I've been on Citalopram too and had to come off it; for those it works for it's great, but for those of us who don't get on with it it's a bit of a nightmare. The only good thing about it was that it depressed my appetite so I dropped 2 dress sizes! Of course the insomnia was a bit wearing. I'm now on mirtazapine, which means I at least sleep through the night. The downside is the increase in appetite; my stomach can be straining at the seams and I'll still be hungry.

I can also recommend therapy, regardless of the cause of the depression. Mine is situation based; basically 20 years of crap culminating in my mum nearly dying from her various illnesses 3 times in 4 months, my own health issues leaving me with a memory permanently Swiss-cheesed, plus problems at work sent me into a downward spiral. The antidepressants put the brakes on enough to be able to look for help, and the help came in the form of Cognitive Behavioural Therapy (CBT).

The sessions can be either group or one-on-one. The point is to first guide you to the point where you can see the root of your issues.

Once you know the reason why you're having problems, you work to map out how those issues are affecting your thought processes and how those thought processes affect your behaviour.

The final (and most difficult) stage is to start challenging those thought processes, at first in retrospect, but later as they get started. This can be very difficult, particularly if they've been very entrenched. You also have to work to find something that can be inserted in their place, as leaving a vacuum doesn't work very well.

As an example, being physically far outside of the norm (very, very short, bespectacled, a bit pudgy) bullies used to try it on with me when I was at infant/junior school. At least, they'd try it on once, before they ran away crying. Relying on the teachers was pointless; they were completely useless when it came to bullying.

One of my learned behaviours was that when threatened the only way to escape unharmed physically and emotionally was to hit first, hit hard, and never back down. I'm sure you can see where this would be a problem in polite company in day to day life, yes?

After just over a year of therapy I can now say that even when every single one of my hot buttons is not just pushed, but mashed down until it shatters, I can keep my distance and my hands to myself. I may still have a screaming row, but even then it's not hysterical red faced screaming with me kicking and punching the wall for punctuation, more of a yell a bit across the room then blank them situation.

Admitting there's a problem is the first step. Asking for help is the second. They are incredibly important steps, and taking them involves an immense amount of courage.

I don't know where this came from or I'd properly credit it (remember, Swiss-cheesed brain); all I know is that it came from Via9gag.com and had a few cute pictures of owls. I have it stuck on my wall as I think it's well worth remembering.

------------

I don't like the phrase "a cry for help". I just don't like how it sounds. When somebody says to me, "I'm thinking about suicide, I have a plan; I just need a reason not to do it," the last thing I see is helplessness.

I think: your depression has been beating you up for years. It's called you ugly, and stupid, and pathetic, and a failure, for so long that you've forgotten that it's wrong. You don't see any good in yourself, and you don't have any hope.

But still here you are; you've come over to me, banged on my door, and said, "Hey! Staying alive is really hard right now! Just give me something to fight with! I don't care if it's a stick! Give me a stick and I can stay alive!"

How is that helpless? I think that's incredible. You're like a Marine: trapped for years behind enemy lines, your gun has been taken, you're out of ammo, you're malnourished, and you've probably caught some kind of jungle virus that's making you hallucinate giant spiders.

And you're still going, "Give me a stick. I'm not dying out here."

"A cry for help" makes it sound like I'm supposed to take pity on you. But you don't need my pity. This isn't pathetic. This is the will to survive. This is how humans lived long enough to become the dominant species.

With no hope, running on nothing, you're ready to cut through a hundred miles of hostile jungle with nothing but a stick, if that's what it takes to get to safety.

All I'm doing is handing out sticks.

You're the one staying alive.

[Seshat]

Re what NC said: I also have auditory hallucinations. They don't say anything: they're like music. Hallucinations aren't necessarily anything nasty or dangerous or whatnot; they're just something you perceive that others can't.


Regarding CBT: The Australian National University developed an online CBT course intended for people who are unable to reach a therapist: most often because of sheer distance (we have areas as isolated as any in Siberia or in the Canadian tundra).

It's free, it's available to anyone English-speaking (they may have some translations), and while its results aren't as good (on a statistical average) as with a therapist, they're much, much better than with no therapy at all.

URL is http://moodgym.anu.edu.au/

Further information is best gotten from the source - that URL.

[Eisa]

I don't know where this came from or I'd properly credit it (remember, Swiss-cheesed brain); all I know is that it came from Via9gag.com and had a few cute pictures of owls. I have it stuck on my wall as I think it's well worth remembering.

Boggle the Owl! I love Boggle.

I've been trying Mood Gym for the past several months, it actually has helped some. Pointing out my warped thinking patterns, etc. My wife is going to a sleep psych and learning mindfulness techniques and when I go with her, I end up learning them too, which is useful.

I just really think I also need medication and that's not happening anytime soon because money. -sighs- I was on Zoloft at one point but it made me intensely suicidal. The only good part was that it also made me super exhausted all the time, so I was too tired to do anything about it.

Also re: stigma, I have a lot of mental health disorders and a couple of them are super stigmatized and it sucks ass. People are so judgmental, especially when they don't understand something (and refuse to try).

[greek_jester]

Boggle the Owl! I love Boggle.

Yes! That was it. Thank you!

[bainsidhe]

I'm on Sertraline for both depression and anxiety.

I was put on Sertraline when I started having anxiety attacks. Suddenly I had trouble sleeping and was constantly tapping my fingers and toes and grinding my teeth (things I don't normally do). Apparently that's opposite of what most people experience.

[Seshat]

Eisa, I'm glad moodgym is helping! I do mention it a lot here, because CBT helped both Bast and myself - though we both did it with live therapists.

Bast's experience was that until her neurochemistry was balanced, doing CBT (or any talking therapy) was impossible. We ended up coming up with a horrible analogy: it's like an amputee trying to learn to walk again before being fitted with the prosthetic leg.
However, once she was balanced - or balanced enough - talking therapies started to help her. We both use mindfulness, CBT and helpful thinking. I also use some techniques drafted from Buddhism*, she uses ... damnit. A couple of other techniques developed in the medical community. I've forgotten their names.
(* 'right thinking' is part of the eightfold path.)

For both of us, it's the 'whatever works' method. If it helps keep us functional and helps us be good people, it works.