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.

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 :)

Hello,

So I've been officially diagnosed with depression a few years ago. I am on medication for it and I've done therapy in the past. I am a more functional person than I was, let's say, one year ago as I've adjusted my medication.

However there is something that is SEVERELY affecting my quality of life and that is the generalized lack of interest or extreme difficulty in doing almost anything. Yes I've talked with my doctor about this. It's "normal" and we are working on it.

I don't know many people and COVID-19 took a hit on my already limited social life. So I guess I want to share my experience and hear from others who experience(ed) the same difficulties. When you are trapped in not wanting to do anything, what the hell do you do?

Recently I've started reading a physical book again. I think it is a good thing for me to have something to do that does not involve a screen. Plus it makes me sleepy if I am a bit tired which, for me personally, is great. Aside from this next experiment, the activities I do the most are playing one or two video games, study for my degree and work part-time.

Another thing I've started doing is doing the bare minimum in terms of physical exercise. I am working on doing pull-ups (I went from doing 0 to 1,5 =) ) and doing some squats. School and work rob me of a lot of energy so I tend not to exercise. But now I'm trying to at least do something.

I will try to keep up with this post but I have a tendency to procrastinate on them if I get a lot of replies. Thanks for bearing with me =).