At 22 years old, after months long assessments, I have been diagnosed with severe ADHD, depression and moderate anxiety. Here is a quick timeline of my experience:

• May - August :
  • I started CBT therapy and Sertraline 50mg
  • Gradually I was upped to the a dose of 75mg.
  • In this whole period I did not experience any improvements or side effects, except a loss of appetite in the first few days.
• September:
  • I started taking Methylphenidate 18mg and went back to just 50mg of Sertraline.
  • From the first day I had felt a sentiment of calmness and control. But it slowly faded away and I still felt I could not concentrate on things or act productive.
  • I also stopped going to therapy as I saw that CBT was not effective for me.
• October - November:
  • This was a completely different month. I wasn't fully in control of my attention span but it was much better than I've ever been. What was more shocking was how internally I felt at peace and something that I'd describe now as euphoric (as I assume this was just a side effect of the medication). U
  • Until mid november I was actually going around telling people I think I might not be depressed anymore, as I had felt for the first time in a way that I haven't felt since early childhood. I was able to accomplish incredible feats related to discipline and I saw my academic results improving greatly. Unfortunately this sentiment slowly faded away and I was back to my old self by the end of November.
• December - Now I was upped to 36mg of Methylphenidate and I noticed a much better control of my attention but unfortunately I have not felt that feeling of relief again. And as it seems the effectiveness of the dose diminished from the first few days to now.
  Since December I've had numerous breakdowns, feeling completely exhausted and burnt out. I suffered from classic problems of procrastination starting to work on difficult projects only a couple of days before the deadline and it was all crashing down. I submitted multiple disgustingly low quality pieces of work because I just did not work in time enough but the few days I did work I did incredible amounts of effort and I do feel like the pills helped me stay focused. After this deadline period though I was just met with my normal depression symptoms where I had a long streak of days that I could not even get out of bed or brush my teeth.

I don't know what more to do. I always knew I was broken and needed help. And for all my life I thought that seeing a psychiatrist is a last resort in case "I can't fix myself" on my own. Now it's been almost a whole year and I am in a critical time period where I need to excel and put in the work but I find myself succumbing to my symptoms while jumping up and down with the doses of some pills that barely seem to have an effect.

I didn't have many people around me from the start, and many of them would not understand my condition at all (nobody from my family does). But now it seems that even the few that were empathetic I have unfortunately tired out. I've heard my fair share of bad remarks that have gradually demoralised me (ADHD is not real. I'm just lazy. I just like to complain. etc) and due to the fact that I also have codependency problems this has greatly hurt me and made me feel like I am completely alone and nobody cares for my troubles or has my wellbeing in their best interest. Right now I just wish I'd know what to do. I wish there was some clear step by step goal oriented way to "happiness" or at least normality. I don't even know what more to tell my psychiatrist other than how I don't feel well, which is what I've been telling him since the start.

If you've been through a similar journey, I'd love to hear your experience and any advice you wish you had received earlier.

Before we start, no, I don't mean "bring politics into" mental health. Politics obviously covers mental health issues, practices, and institutions. However, I've come to realize a certain approach to mental health has taken root in discussions around mental health. This approach is based on the criticism of mental health from an ideological point. It centers on the idea that mental health is treated only as a chemical imbalance in the brain, and that sociopolitical conditions aren't considered. One of the most prominently figures cited for this is Mark Fisher.

“The current ruling ontology denies any possibility of a social causation of mental illness. The chemico-biologization of mental illness is of course strictly commensurate with its depoliticization. Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism. First, it reinforces Capital’s drive towards atomistic individualization (you are sick because of your brain chemistry). Second, it provides an enormously lucrative market in which multinational pharmaceutical companies can peddle their pharmaceuticals (we can cure you with our SSRIs). It goes without saying that all mental illnesses are neurologically instantiated, but this says nothing about their causation. If it is true, for instance, that depression is constituted by low serotonin levels, what still needs to be explained is why particular individuals have low levels of serotonin. This requires a social and political explanation; and the task of repoliticizing mental illness is an urgent one if the left wants to challenge capitalist realism.”

― Mark Fisher, Capitalist Realism: Is There No Alternative?, 2009

This, I think, is true to a degree. Denying the mental or physical results of certain policies benefits the rich. However, this criticism, whether intended by Fisher or not, is often used to reduce psychiatry and psychotherapy to mere, atomized, asocial, apolitical practices.

First of all, this hasn't been true in my case. Sure, I have my criticisms of the procedure and the practitioners, but I've talked about a variety of sociopolitical issues in therapy. I mean, how can you not talk about these issues? There are obviously social patterns in a population, and if they're not bad practitioners, the psychiatrists pick up on them. This doesn't mean that I talked about political theory in my therapy, but among numerous topics, I talked about things like the male gender role, the attached aggression and violence, the effects of emotional repression as a result of traditional roles. I know people who extensively talked in therapy about gender roles, queerphobia, and the associated problems.

Therapy helped me on political issues too. I used to be much more repressed, unable to express my disapproval, unable to handle any conflict. But with the help of psychiatry, I started expressing my opinions, including my disapproval, more and more. This included standing up for myself, and while there are many power structures I can't overcome as an individual, this change helped me better stand up for myself against people who have power over me. It also helps me feel not as much like a piece of shit when I can't, because learning to face my emotions helps me realize I have limits.

But, according to the Fisherian argument I've seen repeated countless times, this isn't what psychiatry does. It just treats you like an asocial animal, which is not true at all. If anything, psychiatry emphasizes, again and again, that humans are social animals, therefore, have social needs, and that not meeting those needs will lead to mental problems. Seriously. Search "humans are social creatures psychiatry" on whatever search engine you use and also on Google Scholar. You'll find, page after page, pop article and scientific article, talking about the importance of this.

The second thing I want to mention is that links between inequality and mental health are an important area of research. You can search for keywords like "socioeconomic status mental health" and "inequality mental health" on Google Scholar to see many articles written about this. You can alternatively replace "socioeconomic status" with "SES" and "mental health" with "mental illness" or a mental disorder of your choosing.

To add further support to my argument, let's look at the textbook "Psychology, Global Edition, 5th Edition" of Pearson, which is a very widely known publisher. It has an entire chapter dedicated to social psychology (Chapter 12). The chapter about psychological disorders, Chapter 14, has the following listed as one of its learning objectives (emphasis mine): "Compare and contrast behavioral, social cognitive, and biological explanations for depression and other disorders of mood."

Let's also look at WHO's mental disorders page (emphasis mine).

"At any one time, a diverse set of individual, family, community, and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances – including poverty, violence, disability, and inequality – are at higher risk. Protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics. Many of the risk and protective factors are influenced through changes in brain structure and/or function."

I think one of the other negative things about this argument is that, it denies the possibility that some people face mental illness not mainly as a result of social issues, but as a result of some biological unluck. I haven't checked it out specifically, but I think mental illnesses aren't necessarily mainly a result of social conditions or trauma. I can't claim this with certainty, but neither can the opposing side. However, my approach leaves a possibility open for people who may be experiencing exactly this. Therefore, without knowing, it doesn't claim that certain experiences can't exist.

Before I finish, I want to say that I don't deny the existence of bad practice. I've heard many stories of bad psychiatrists, and even if I hadn't, it would be unrealistic to think they wouldn't have such a problem, considering the problems in education and funding. However, my point is, it's not realistic to say psychiatry overlooks the social reasons for mental illnesses. There may be problems, but in no way they are a shared, distinctive feature of the field.

And last of all, this may be harsh but I think it needs saying, Mark Fisher fell victim to suicide. He's not exactly an epitome of healthy coping mechanisms, and his criticisms about mental health should be evaluated with that in mind. I often think intellectualization tends to come in the way of mental health for, well, intellectual people.

Edit: The last paragraph was poorly explained. I further elaborated here.

Traumatic brain injury multiplies the risk of major depression eightfold. While the emotional trauma of whatever caused such deep damage may be understandable, from a blast in a war zone to a blow on the playing field, there’s a physiological component, too, that neuroscientists have long suspected but have been unable to identify.

“As clinicians, a lot of us had a gut feeling that [TBI-associated depression] is a different disease,” said Shan Siddiqi, a Harvard Medical School assistant professor of psychiatry and a clinical neuropsychiatrist at Brigham and Women’s Hospital in Boston. “Why did nobody detect it before? I think the reason is because unlike other psychiatric disorders, TBI caused a sort of structural reorganization of the brain.”

https://www.statnews.com/2023/07/06/depression-after-traumatic-brain-injury/

I have a very close friend that has been in the deepest troughs of depression for the past couple of years. They live about an hour away, so though my wife and I try to physically show up to support them whenever we can, that's much less often than we'd like. Their support network is thin, and day-to-day basically consists of only their partner, with whom they live, and who is visibly fraying at the seams.

This person (I'll just call them John for the sake of readability) is currently on medication for their depression and OCD (I'm nearly certain it's Lexapro, can't remember for sure) and has on and off therapy, though they often find themselves at odds with their therapists' perspectives. Some of this is because it feels like the profession has been flooded with folks who lack experience with patients with severe chronic mental illness, and some of this is (I suspect) John's illness distorting their thinking, leading to frustration and anger in the moment that doesn't make sense in retrospect.

John had a particularly bad day yesterday, and after I spent some time with them, we started talking about how they felt like they needed considerably more support than they were able to get in their current situation. Unfortunately, the only option he was aware of was "group homes", which seems like a pretty broad term and I don't know much about what they look like (or how successful they are at helping people like John).

I'm trying to get a sense of the spectrum of options available for people like John who are suffering from severe chronic mental illness. On the one end, there's what we're doing now; regular psychiatry and counseling, and on the other end, I guess, is involuntary in-patient behavioral health/medicine clinics. Being involuntarily committed to such programs has been a source of trauma for them in the past, so I'd like to avoid anything even close to that end of the spectrum, if possible. I know that there are, for example, 90-day rehabilitation centers for folks with substance use disorders (I have a family member that found a lot of success at one of these), but do similar programs exist for folks non-substance-related mental illness? Does anyone have personal experience with any of these programs?

Thanks in advance to anyone who takes a moment to read and share their thoughts; I know this is a really challenging topic.

I've been rewatching Ozark. The third season features a bipolar character, and his storyline has been hitting me hard.
There is an emphasis on "getting better". Staying somewhere and getting better. Giving things time.
It's been making me wonder if time really makes things better.

Time heals wounds, but it doesn't fix broken things. It helps with grief. It helps forget the things that make it worse.

Twelve years ago, things got bad enough in my life that I attempted suicide. I had no psychological safety nets at the time. No mental security. What saved me at the time was a mix of luck, a couple of smart decisions on my part, and the good will of some people I barely knew.

I have since spent a lot of time creating and nurturing safety nets to make sure this never happens again. A variety of social, technological and mental mechanisms to stop me at every step, should things ever get this bad again.

And now, I'm... alive. Things got bad this last month. Really bad. Worse than twelve years ago. Worse than they've ever been. But I'm alive. My safety nets worked. I wouldn't be writing this without them.

I'm getting the feeling that I'm going to carry this burden for the rest of my life. Time didn't fix shit. I just got better at defending myself since.

Insight once came to me after I was prepped for a surgical procedure. As my body's weight began to evaporate, a pain I had never recognized, but which must have always been sounding in the background noise of my being, vanished. The superadhesive worry--which sometimes frightened others as much as myself, that in order to socialize, I had learned to sometimes twist into a temporary shape resembling charm--came unstuck and peeled away. Then followed a great thought, a mandate for how I should spend the remainder of my life. Also, I needed to poop. But more than that, I needed to get out of this semi-public hospital bed and to a private space immediately, so I could allow this cosmic insight a moment to fully bloom. Time was against me. Anesthetized, I knew I was slipping toward, maybe even over, the falls past which I would forget everything of this experience until a groggy post-procedure awakening brought dull daylight and its senseless aches back to me. I had to somehow save the thought. I searched, but the bathroom gave up no markers, no specimen cup labels to write on. I wondered about tearing toilet paper into little letters, hiding them above the cabinet. But would I remember to return to read the message? With an increasingly calm desperation, I dug my nails into the flesh of my hand and repeated again and again the life-saving insight delivered during communion with the world that lay beyond pain. Please remember, please remember this thought.

When I regained consciousness, it was waiting for me like a friend who had lost patience, and now seemed much less attractive. What I had somehow stolen from the gods, secreted in my closed palm through a swim across the river Lethe, was this message: “Do Drugs.”

I had realized that analysis, working on the problem of myself both mentally and verbally, had won me no appreciable gains. Insight, I had. But relief, happiness, an improved outlook? Nothing I had done had really helped me feel better. Anesthesia instantly had. These aren’t the words of an addict coming on-line. I was a reluctant user of any substance. However, in the years following I forced myself to again undertake drug trials with my psychiatrists. Methodically, I worked through every class, waltzed backward through the eras of drugs, danced off-label with each oddball wallflower, ingested every twisted molecule to ever win over the FDA with a promise of psychiatric benefit and maybe some that merely had intrigued one of my more historically-curious doctors. When Eddie Haskell, MD wanted to resurrect a drug of the bad old days just to see what it’d do to a person, I was the patient with his hand out.

I overslept and didn’t sleep. I gained and lost a third of my body weight. My head felt like a styrofoam block, then like the slate of a blackboard being scraped with tableware. I was more or less charged, sweaty, sensitive to light, and shaky. Some drugs make you feel like Benjamin Braddock in his birthday diving suit. Others make you feel like an amnesiac idiot in Benjamin Braddock’s birthday diving suit. A common theme emerges. These substances could help me feel slower, distant from the world, claustrophobic, clammy, sensorily distorted. Sometimes, they dulled my anxiety, or dried my hair-trigger tear ducts, but they accomplished this through impairment, and very clumsily. I have never been drunk, but I think it’s like a drunk traffic cop: success in psych meds comes about by the stopping of certain avenues, slowing up of traffic, blocking lawful turns. And it’s sometimes noted in the overall impact that fewer crashes have occurred. To me this is not success. Impairment so far hasn't been healing for me. I want my turn at quoting the line, "I feel like myself again."

And so, my heart sinks at every day's new headline about psychedelics. If you follow health news at all, you know they are a hot topic, showing a ridiculous amount of promise. Despite fitting the diagnostic profile, my former home was far from anywhere with signups for studies. I reached out to several "clinics" offering psychedelic-assisted therapy. They struck me as resembling many legal weed shops--loads of young bros polishing their presentation and sanitizing an extortionate drug deal in hopes of financing a Tesla. With fees starting at 8x the plane ticket to administer and contextualize a drug that costs less than $20 a dose, I wouldn't credit their soft patter as containing much idealism.

And here I am--for other reasons besides. Yes, a part of me thought living here would put legal psychedelics within my reach, but I'm not seeing any opportunities. Now I'm kicking myself for never having tried to cultivate mushroom spores, never having ventured to ask acquaintances for a hand. I'm marooned here and psilocybin is about blow up in the States.

Hello everyone,

I recently got put on some SSRI for my worsening suicidal ideation and honestly I can't believe the difference it's made. It's like a version of myself that I find hard to believe existed, but can draw parallels with the version of me before I got depressed, etc.

I'm just curious how I should be viewing these changes in me: Are they really me without depression/anxiety or is it a more lurid exaggerated version of that?

Any other thoughts on SSRIs in general welcome! I'm interested in seeing Tildians' thoughts on them :)

I am just coming out of a lifetime of depression. I am 24 now, and I have no memories of an idyllic childhood, carefree adolescence or an exciting college life. Sure there were moments I enjoyed more than others, but all were consumed by that all encompassing grey void. The one that makes everything have a dreary sameness. The one that steals every good thing and every bad thing, and just makes them both nothing

I have been crawling out of my depression for the last 6 years. I made small steps through college, but due to a horrible junior year, I fell back a lot in my senior year and the year after that. I worked a horrible job as a phone support technician. However quitting that job was my first step of healing, so that was one good thing I got out of it. I have been unemployed for the last year and a half, which has been the most valuable period in my life. I could do nothing but look into my own pain, observe my own wounds. It fucking sucked. But sometimes the only way is through.

Being depressed all my life, I haven't really done anything. I am a virgin and I've never been in a romantic relationship; I still feel a bit ashamed and uncomfortable with this. I've only ever had a few friends, though me having any is a bit of surprise. I've never focused on something, worked on it day-in-day. Thinking of all the opportunities I've never had for friends, for quiet moments, for the nervous butterflies of just meeting someone you like, fills me with an overwhelming sense of anguish. It hurts so much to imagine all the possibilities that I could have had if I had escaped sooner. But dwelling on it doesn't help me at all, so I try and not think about it too much.

Now that I am not being crushed by depression, I am filled with so many conflicting emotions. I am impatient because now that I can experience some of life, I want it all now. I am terrified because I am, for all intents and purposes, a new person who has no experience in anything. I am excited because I have so many first times for so many different things. I am scared shit less because I am unemployed and I don't have a clear path to finding work. I am constantly stressed that everything will come crashing back down around me, and I will fall back into depression. I am happy because I am going to see my best friend soon, for the first time I am on this side.

I am writing this because I want to say it to people who know nothing about me. I want other people to acknowledge my pain. Its a bit selfish, I know, but I am okay with that. So if you read through all of this, thank you

And if you are going through depression or even just hard times, please feel free to message me. And no you won't be bothering me, no I dont have better things to do, no I won't judge you.

Hello my lovelies,

I struggle with a moderate amount of anxiety and obsession with self-image, which tend to amalgamate as some kind of depression or other over time. At least I think they do. I've never really been sure if what I experience is actually depression, or if I'm just a Mopey Idiot, or if I have a more acute cognitive issue that I'm not aware of.

I keep very precise semi-quantitative logs of my mood and behavior every day, and they suggest to me that some of my stress is related to being a little overloaded. I'm working on cutting back on some of that responsibility. But it's also extremely obvious to me that, for quite some time—I think since about early October 2019—I've lacked the physical energy that typically allows me to be consistently happy. There was no one, singular "proximate cause" two years ago, certainly it was none of my actual obligations (at that time I had very little work to speak of). However, I nevertheless very distinctly remember that my energy was suddenly just sapped, and has not come back to the level it was at before. The best theory I have is that it might've been a mini-existential crisis triggered immediately by some books I'd been reading, with a background of relatively more social isolation than usual. There have been specific circumstances since then in which I can be high-energy (and I mean be, not just act like I am), but they are fleeting and rare. The overall background energy of my life has been different.

In short, I do not really have a solid anchor per se, even as I have many little mini-anchors. I have been floating around for a while as a result.

At least that has been my working theory for a little while. The persistence of my condition has led me to question whether that theory is useful, or whether there is something fundamentally wrong with my brain. I am Young and Naive so I simply do not know how to tell. The pandemic has made it much more challenging to figure out the root cause of my problems, because I cannot tell if they are just because I can't do the fun activities I like doing in the social environments I like doing them in, or something presumably biochemical.

Things that each help a little:

• Getting more sleep
• Getting more exercise
• Being good about meditating, or when my therapist is useful (rarely)
• Being successful (I have a job for the summer and a likely career after I graduate. Knock on wood)
• Being hot as fuck (I'm not that attractive, but I feel pretty after I exercise, or when I dress nice, or when people compliment my body)

Things that each help a lot:

• Having extremely attentive and caring friends
• Not being around people who constantly drain me
• Consuming certain substances

Specifically, the most non-low-energy I've felt in a long time was when I ate some funky little mushrooms with my friend this year. Specifically, after I snapped back to reality (mom's spaghetti). I was just more alert and more able to function properly. My brain operated at its normal capacity; words flowed freely from my mouth in a gorgeous array of sentences; positive banter was at an all-time high; I was positive and optimistic; and so on. You know how you can sort of visualize the ideas popping around and the gears turning when you're sober but just really on top of your social life? Well that's what it was. Unfortunately my ability to be a normal person only lasted like 1 or 2 days from there, and then it was back to the same old.

This has made me ask the question: might it be prudent to look into some sort of legal medical prescription that would have a similar effect? That is, anti-depressants or like whatever. I'm also open to alternative treatments but I am mainly asking about prescription meds. I just don't know anything about the whole world of medication. I almost never take meds for anything ever, even physical injuries, and I'm afraid that if I start doing medication I'll never be able to stop. The concept of always being medicated is a little scary to me. Like even if it helps, I'm still worried. But I kind of feel like nothing I've done so far has been able to permanently work, so I kind of need to do something.

I appreciate any thoughts that you can give!!!

xoxoxo
beezselzak