Feeling lost with mental health treatment
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.
I don't have much to say other than I wish you the best. I haven't had these sorts of issues to this extent, but have helped family through these sorts of things. So a few suggestions:
Don't give up. Stay engaged with your doctors, follow the regimen, keep them informed of what works and what doesn't, and keep trying different things. It's hard to hear, but I've seen family take years of trying things before they found a long-term regime that worked for them.
Medication will almost certainly need to be paired with behavioral tools and strategies to help you organize, stay on track, and keep on your regime. Keep trying different strategies to help build a routine. Don't let little lapses demoralize you and snowball into bigger lapses.
Forgive yourself for your mistakes, learn from them, and keep trying different mixes of strategies.
Sorry I can't say much more; I'm just not an expert here. But I have seen people get through it. So hang in there. It may not feel like it, but the people in your life do care. They are probably just unfamiliar with how to help and how to self-care for themselves as helpers or caregivers.
Wishing you the best.
Your story sounds similar to mine. I'm 30, ADHD, major depression and generalized anxiety. CBT, in my experience, has been a joke. To try to essentially get myself to believe what I currently think is a lie, just won't work. My brain is too logical for that, and I've logically wedged myself into my mental rut.
I would suggest looking up HealthyGamerGG on youtube. He has really good insight into things and helps to explain why we may feel one way or another.
Two lessons I wish I'd learned earlier were these:
Choice = happiness.
Wherever your freedom of choice has been limited is likely where your suffering is coming from. For example, if you hate going to work, what do you wish you could do at work that you can't? And then, can you really not do that thing, or is that just an assumption (possibly based on a cognitive distortion?) and in actuality, may that thing possibly be negotiated? Maybe it can be supplemented at home or elsewhere?
And
There are 7 types of rest : physical, spiritual, creative, emotional, mental, social, and sensory. In these categories, do whatever you were not doing for the past few days/weeks in order to "rest". For example,
Physical
stretch/exercise a bit/go for a walk or sit still/sleep,
Spiritual
meditate to focus on yourself (great time to observe why you're unhappy, as in, "where are my choices limited?") or do community work for a group or organization you care about,
Creative
beautify your surroundings/create something meaningful to you or take a break from imposed creative problem solving (like from work),
Emotional
journal/talk it out with someone or take medication/stop people pleasing,
Mental
write a to-do list/brain dump or research something interesting to you,
Social
talk to someone/nurture important relationships or log off/have some "me" time,
Sensory
turn off the light/exist for a bit in silence or listen to music/burn a candle/ have a tasty snack
You'll have to do some inward observation to see which categories you need rest in.
EMDR therapy seems hokey as fuck but I found better success with that than straight CBT. I like having talk therapy to gather my thoughts but really need the EMDR stuff to process and deal with trauma.
For depression exercise is critically important. Nothing comes close to being as effective for me. Consider taking group classes if you’re having motivation troubles. Start with twice a week and work up from there, go for walks on off days. I do martial arts so there’s a community element there as well.
First of all, I'm really sorry you're in such a place. I've been in similar circumstances and to me, it felt like being stuck while being stretched out at the same time.
Needing help does not indicate that you're 'broken', 'unworthy', or whatever you have internalised. I don't blame you for feeling this way, I still feel like it from time to time again. Unfortunately, whenever you hear remarks like:
From a very young age, it's easy to believe it to be that way fundamentally. "But what if it really is fake? What if I'm not doing enough?" Becomes so internalised that it's difficult to imagine seeing yourself as an equal human being. With it's own flaws, needs, wants, hopes and dreams.
To grow up in a setting completely devoid of empathy to your struggles does not mean that you're broken. In fact, I'd argue the opposite. You've been forced to survive in an environment that's, at least for you, so dysfunctional it may as well have been broken.
Unfortunately many children grow up in situations like that and thus internalise that 'brokenness' upon themselves.
See a therapist, ideally one who is experienced in ADHD and trauma. No one should be forced to live with a self-image that involves themselves being 'broken'. You mention CBT, and if that works it's fine, still, it's the advice I wished I had received back then so here ya go.
I've been in a similar boat quite a few times. I can't speak for you, obviously, but looking back (much) of my codependency in the past stemmed from the fact that I lacked unconditional love as a child. This on it's own, made me look for the combination of unconditional love and an unconditional relationship. Sadly, it's only very young children with their parents that can even have those in a healthy setting. Codependency is the closest thing you can get, but it comes at a very great cost.
The relationship with the one person you ought to both care and love the most: Yourself.
I have to ask, given the similarities, is it by any chance the case that it's the first time you were not depressed? I've had that the first time when I was 25 and it was wild for me. Like life had more colour, and gravity was tuned down. I remember googling back then whether it wasn't hypomania because I struggled to believe that feeling that good was even healthy. When, as it turned out, it's the 'normal' for most people.
Critical work, for whom? If you ask me, it feels more like you could use time, energy and space for yourself rather than practical matters. Although I'm all to familiar myself with situations where said time, energy and space are not there for people who need it. Still, if there's anything I hope you'll take with you... it's kindness towards yourself.
Being patient and kind towards yourself when you've been told over and over how you're lazy, complain too much etc. is incredibly hard. Still, if you can accept that you are doing your best, even just a little bit, that would be progress. And it's progress that you deserve.
Best of luck, and all the best wishes, kindness and patience to you, from yourself.
First, thank you for your time and your kind words.
I have a hard time putting it in words but basically I would say I've been depressed from somewhere around age 12. Of course with better periods and worse periods. And since then the only time I ever felt close to what I can only describe as "not depressed" were generally times where this was induced by an external factor, most notably relationship partners, and they were rare occasions. To note, I did omit from the original post the fact that in July I did have two separate distinct days when I felt this way completely internally without any external factor, but at the moment it was not so satisfying and it just led me to think "hmm maybe the medication is finally starting to work" but shortly the feeling just faded.
What I felt in October was much more powerful, closer to what you're describing. At that moment I considered it me being cured of depression and I went around telling people. After it went away I also thought it might be hypomania and now mostly think it was just an euphorical side effect of the medicine.
I do want to say that the way you described it as "felt like being stuck while being stretched out at the same time" is incredibly familiar and I really like your wording.
Obviously, your doctor is the best person to talk to about your doses and your treatment. They know what your meds do and you should discuss the efficacy of the various meds. I know that they can run a genetic screening to see if certain meds will have better effects for you. If you haven't done that you should look into it.
But, to be blunt, this is the wrong mindset. A psychiatrist isn't fixing you, they're working with you to help you find a new and, for lack of a better word, more 'normal' headspace for your life. Unfortunately, it takes a long time. This is perfectly normal that it might take a long time to get everything dialed in perfectly. You might've dialed in the dose for a more relaxed you and now that life stresses are creeping up it's not as effective but remember that every change in medication or dosage has a large impact on... Well, everything. If you're able to cope, get out of bed and eat a meal, you're functioning. But after that, you've gotta cope with life. The meds aren't about making you not stressed, they're about helping you recognize that your stress is real and you're able to deal with it.
I'm only familiar with one of your meds but you said you stopped therapy because it wasn't for you - Was that you thinking clearly or just not seeing instant results? Because right now I think you're engaging in a low form of CBT here. Just with a variety of people as opposed to one-on-one. You've been taking a controlled substance without building the skills to cope with the actual stresses of life you're more encountering.
Edit: I don't mean this meanly or anything. I'm just seeing a huge hole in your plan for "getting better" and I want to be blunt with you.
While I agree that discussion in these comments can be at least a little therapeutic, it doesn't have much to do with CBT specifically -- CBT describes a certain approach to therapy that focuses on the relationship between thoughts, behavior, and feelings. The discussion here hasn't really been very similar to the way CBT talks about these things.
CBT can be very helpful for certain people and conditions -- it can be extremely helpful for anxiety and certain types of depression. But it's not for everyone. For me, its "homework" element really made it hard for me to engage with it, since (because of the ADHD) I never remembered to do the documentation over the course of the week that my therapist asked for until I was about to leave for therapy. I've also heard other neurodivergent people (particularly autistic people) describe disliking CBT's way of framing your thoughts as "wrong", but I didn't personally experience that so I assume it varies by therapist.
The only drug I've ever taken for depression was psilocybin. Depending on where you live it might be available to you. It's not necessarily a magical cure (although many people report a profound mental uplift that lasts for a few weeks). But it can show you the parts of your brain that are too calcified under normal conditions to be addressed. Most people recommend combining it with therapy for this reason. You will be able to explore your brain efficiently and share what you see with a professional who can then help.
Thank you for your experience. Psychedelics is something I have strongly considered but unfortunately in my country there doesn't seem to be any therapy options involving them and no research to be funded. Self treating is something I am not completely comfortable with because of a very bad cannabis edible experience I had which made me question if I am at increased risk for schizophrenia (it is a long story).
On this topic I particularly like this interview with David Nutt https://www.youtube.com/watch?v=UWhk2LMDwCc
I like that you're being very careful. This is an important part of taking care of yourself. Even water can be unsafe in certain circumstances, and I feel like the "hype" train can ignore the fact that not everyone has bodies suited for every substance, and one should try something important and serious under direction and care from folks who can quickly respond to a "highly unlikely" event where things go wrong
Thanks for the video!
I loved the bit where Nutt said during psilocybin trials they would ask people that were tripping to perform an executive function test. Something like counting back from 100 in 7s. But people kept saying “Fuck off, I’m talking to God”, so he stopped.
Seconding this. I have struggled from severe treatment resistant depression since I was about 14. I tried the spectrum of antidepressants and even stimulants to combat the fatigue. Nothing worked.
My most recent episode lasted from 2018-2022. I had to quit my job and try to focus on my health. I tried transcranial magnetic stimulation and later combined it with ketamine therapy. Both of these got me to a place where I was stable, but not thriving. It had a huge impact on my schedule: I was going in for TMS weekly and basically losing a whole day once a month for my ketamine therapy. The ketamine made me incredibly nauseous, even with the medication they gave me to combat it I would often throw up in the car or as soon as I arrived home. I was dependent on my partner to be able to take time from work to drive me to and from ketamine sessions. I was no longer suicidally depressed, but I was stuck in this empty life revolving around my health care without any real sense of progression.
I followed psilocybin research for years, and finally decided I needed to try it. I lived near a place where mushrooms were decriminalized, so we went and got some. With mushrooms, I honestly got more out of an afternoon sitting on my porch drinking tea than I did out of over 15 years of therapy and all of the other drugs and treatments combined. It allowed me to rewire my brain and realize that all of the things weighing me down didn't matter. It allowed me to actually love myself and stop being as hypercritical and self destructive.
I don't know that it's right for everyone and I don't know that it will cure all ills, but I strongly believe it's a tool that should be available to everyone. It completely changed my life and gave me a chance to live as the person I really am rather than the shell that depression made of me.
Thirding. I too followed the psilocybin research for some years, took my first deep trip in 2014, and it changed me for the sooooo much better. Effects last 1-2 years for me, so every year or two I reserve a day, find a trusted friend to sit with me, and reset. (Sitting is important. I do so as well for friends I love). But of course YMMV, be careful, be safe, be respectful, and do not even try if you have a family history of schizophrenia.
Howsoever you proceed, I wish you comfort and peace.
I always inquire about steps to rule out any medical contributions. For example, sleep apnea can cause anxiety, depressive symptoms, and inattention, memory and general cognitive concerns that many times overlap with ADHD and the symptoms you mentioned. Medications or other medical concerns can often be overlooked and emotional and cognitive concerns first assumed to be mental health.
Priority of cause to rule out: medical, substance-induced (this can even be caffeine), then mental health.
I understand the inquiry but physical health investigations were part of my assesment before and as part of my ADHD diagnosis. As far as general medicine tests I am completely physically healthy and functional within the norms.
As far as substance-induced a funny thing is that the fact that I don't respond at all to caffeine was one of the things that made me pursue getting myself checked-out for ADHD. Whenever I would complain about my inattention or tardiness to people they'd recommend me to drink coffe and it would never do anything for me.
I’m glad that was already ruled out. I weighed whether or not to bring it up because I didn’t want to come across as if I was assuming you didn’t already explore alternatives. However, I’d rather err on the side of information and exploration just in case.
I have a very similar set of diagnoses -- ADHD, depression, and some anxiety (in my case, social).
If your ADHD medication is less effective now than when you started, I recommend taking a short tolerance break to start (EDIT TO ADD: for clarification, I'm only referring to the ADHD stimulant medication, not the SSRI) I got sick for a week and when I started taking my medication again afterwards it was noticeably more effective. It's also possible that you genuinely need a different dose -- you need to work with your doctor or psychiatrist on this side of things. It's also maybe possible that another medication will end up being better for you than methylphenidate -- I started with it but now am doing better on Vyvanse. It's very individually dependent, unfortunately, so trial-and-error is really the only way to go here.
I have also found personally that as I get into the routine of taking my medication, it feels less helpful than it did when I first started just because I begin to take it for granted. The effects (for me at least) are subtle enough that it doesn't feel "that different" anymore, and unfortunately stimulant medication doesn't solve all your problems with ADHD, especially with comorbid depression. Things will still suck and be really hard sometimes. That shouldn't stop you from trying to make things suck as little as possible through whatever means necessary, but don't expect every day to necessarily be life-changingly better with meds the way it felt when you first started them.
I do recommend if you can afford it searching for a therapist who specializes in ADHD and takes a more trauma-focused approach rather than a generic CBT therapist -- not because it will necessarily improve your symptoms, but because the negative mindset others project on you for your ADHD symptoms can be just as harmful as the symptoms themselves. Medication can address the symptoms of ADHD but it can't treat the trauma of growing up with ADHD in a world that constantly demeans you for struggling because of it. I similarly have struggled to find a therapy approach that works for me -- CBT in particular was not a good fit.
I really do wish you the absolute best. This situation sucks ass to be in. You deserve treatment that helps you live your best life, and I hope you find a better equilibrium sooner rather than later.
Sertraline (AKA Zoloft) is an SSRI, so it's really not a good idea to stop taking it cold turkey, even for a short period, since doing that can cause serious withdrawal side effects. So IMO @sigurorhringr should just talk to their psychiatrist or prescribing physician, tell them the drugs aren't working as effectively anymore, and let them determine what to do next.
Other than that, I agree with the rest of your advice, especially about finding an ADHD specialist.
I definitely didn't intend to advise going off the SSRI at any point in my comment -- my discussion of a "tolerance break" was for the methylphenidate, where it's very common practice. Didn't realize that wasn't clear, sorry!
Ah, that makes sense. Thanks for clarifying, and sorry for misinterpreting your advice.
No worries, I didn't even realize I hadn't specified in my original comment, and that is an important thing to specify! Thanks for letting me know so I could add a clarifying edit.
First, I am very sorry about your experience. Please hold on!
You have an important grieving process to go through: grieving about what could have been had you been diagnosed earlier, what could have been had you lived in a less ableist society that embraces neurodivergent folks instead of calling them lazy and strange. It is OK to feel angry and sad about this, but what feels like an insurmountable obstacle now will become an asset once you learn how to wield it.
My first advice to people looking for mental health support is to meet several practitioners before choosing one, as there are a lot of different styles and personalities: what works for one patient will not work for another. Personally, it took 5 different practitioners before meeting one that detected my masked autism, while the previous ones just treated burnout and depression as isolated incidents instead of consequences of undiagnosed autism.
Talking about undiagnosed autism, I recommend you evaluate that possibility: although many psychiatrists still consider ADHD and Autism as exclusive diagnosis, there's a lot of people living with both conditions and raising awareness about this. Look for the AuDHD content on Mastodon and Youtube, and take a moment to go through the tests at https://embrace-autism.com/autism-tests/. I'm not trying to diagnose you, but suggesting an option that would explain why "typical ADHD treatment" would not work for you.
As an autistic person, I have strong reservations about CBT, because it can do more harm than good to neurodivergent folks if done incorrectly. Several autistic folks have reported CBT increasing masking behaviour instead of addressing underlying mental schemas. Schema therapy tries to address some of these shortcomings and could be an alternative worth trying, if you find a practitioner trained in it.