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.

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.