Medication for depression
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
I don't have any experience with antidepressants, so I can't help you there exactly, but I will say that if your therapist is rarely useful, you should try to find another who is more helpful. It can be frustrating to have to explain your whole deal to a new therapist when you switch but it will be worth it to find someone who's right for you (or who is at least a better fit) since you will actually be able to rely on that person to help you, advocate for you, and diagnose you with more accuracy than we ever could (since we don't know you beyond your posts and aren't mental health professionals).
I also think it's a mistake to ask "Am I actually depressed or is it just the pandemic and the associated restrictions on social activity?" It's valid for the stress, anxiety, and uncertainty of the pandemic to cause or intensify depressive symptoms in people, and it's valid to seek help for that. We often look for excuses so as to not draw this conclusion (e.g. the pandemic affects everyone so everyone is feeling this way) when in reality it makes perfect sense to acknowledge that different people's mental health will respond differently to the challenges of the pandemic, since people are affected by it in different ways. Not to mention that even with vaccines the uncertainty of the pandemic is going to continue for who knows how long. I don't know where you're located, but variants will continue to emerge in other countries for as long as the vaccine patents remain in place and a not insignificant number of people in the United States may not get vaccinated. Even if it's "just the pandemic" causing you symptoms it isn't necessarily going away soon and you should look into treatment if it affects your quality of life. Honestly, I think I could take this advice as well. I hope that makes some sense, since this is the first time I'm sharing these thoughts about the pandemic and mental health with others.
That being said, it seems great that you've identified things that mitigate your depressive symptoms in the meantime. It's super frustrating to be told to just keep doing those things (i.e., if you're feeling bad just go for a walk!) but as much as you can, carve out that space to take care of yourself and the people around you.
I used to worry about being medicated too, but then I realize that no one thinks less of someone with poor vision for wearing glasses, and no one criticizes a diabetic for taking insulin. Mental health medications are no different. If it helps you to feel better and lead a more comfortable life then that's what's most important.
I tried an SSRI and had a terrible experience (brief psychotic episode). Turns out I reacted badly because I have Bipolar.
If you want to try a non SSRI option I've found Buproprion (brand name Wellbutrin) has worked well for me. I would talk to your Doctor, they should be able to walk you through your options and find something that is right for you.
Just a heads up, you may have to try several different medications to find the right one or the right combination. It has taken me years to get everything sorted and stabilized.
You mentioned a therapist. They're the qualified professional to help you figure out what to do next. What does your therapist say?
In the meantime, avoid using any drugs without professional supervision, legal or otherwise.
Maybe it's a good idea to go to a general practitioner first in order to check if there's some hormonal imbalance or something like that.
I told my therapist that I was thinking about medication and she said I should talk to a psychiatrist. I guess I will do that soon. It's just weird because I feel like mental diagnoses are so dependent on the story I tell and I have no idea how accurately I'm representing my condition whenever I talk to these people.
I actually did see a GP in the winter to check if any hormones were screwy. Absolutely fucking perfect lab results. The doc almost sounded disappointed at how unproblematic they were. Utterly bewildering to me. I know something in my brain is not quite right, and this makes me think I'm just conjuring up the problem.
A psychiatrist is not like other doctors. They'll make an initial asessment and you'll have multiple sessions afterwards to evaluate how you're progressing, reasess the diagnostic and adjust the medication accordingly. One of the reasons for that is precisely to address your concerns. Psychiatry diagnostics are complicated and require a long and continuous collaboration between patient and doctor.
The frequency gets lower with time, but ideally you should see your psychiatrist for the duration of the treatment.
I have to agree with this, I see a psychiatrist through my local MS clinic due to having MS of course. Depression with something like MS can be quite nuanced, depression itself can be quite nuanced to deal with. Psychiatrists tend to be quite adept at doing thorough evaluations and are usually extremely knowledgeable with medications and mixing of medications (in my case especially off-label use of medications since off-label is the name of the game in MS symptom management much of the time). The neruos here almost always defer to the psychiatrists when it comes to medications outside of MS meds, since their breadth and depth of knowledge regarding medications is generally much better.
I went to neurologist for cognitive problems, brain fog, depression, got a basic depression questionnaire, then referred to psychiatrist that rotates through the MS clinic (somewhat specialized). Psychiatrist did rapid testing with a qualitative mini cognitive exam then referred straight to neuropsych testing to find out where my deficits were and given medications to help (off-label, modfinil for lead-suit fatigue that comes from faulty nerve transmission and wakefulness/clarity, often given to MSers for extreme fatigue for example). All of this was very useful.
Even the neurologists I see tend to agree that when it comes to meds and assessment for this, these are the specialists you generally want to talk to. They are used to dealing with complexity, being very shrewd and trying to find what is most effective for you. I will say that for me it didn't take many visits at all, I think partially it can depends on how well you communicate and self-manage, and how clear cut things can be, as well as input from your other doctor(s). Perhaps having a solid diagnosis at this point already (depression eval from neuro and MS diag) is what sped things along for me. I've diagnosed myself 3/3 times, the last ER doc put "diagnosed herself" straight in my chart lol, which might cut me some slack with them perhaps.
The other thing I'd consider is asking for a checkup with routine labs etc if you haven't already (I'm sure you probably have). GPs are mostly gatekeepers, they are the generalists that can simply point the way to a specialist sometimes when there's something going on... specialists are necessary for anything that isn't cursory, so self advocation for testing and referral is often needed. Sometimes the prodrome phase of some health considerations (like autoimmune conditions) can cause significant fatigue for example.
In all honesty it sounds like you are already doing much of what you can do on your own, which is excellent. I wouldn't hesitate to ask for a referral to a specialist. I find GPs to not be all that knowledgeable about antidepressants, they will often prescribe based on what the majority of their patients say works for their brand of depression, and not based on any defined knowledge of specific effectiveness for certain things (when my GP won't prescribe something, I get referral to psychiatrist who is always far more knowledgeable and comfortable, especially with off-label or for unique concerns).
Best of luck!
Just as a heads up, being on an SSRI does affect the efficacy of shrooms a lot. My partner and I took a trip together a while ago, and I very nearly dissolved into the background radiation of the cosmos when she had just feelings and visuals that I'd expect out of like, a half to a third of the dose that we actually took. We had a good time for most of it, but the come-down went really poorly for her.
I am normally a very responsible user so I feel pretty bad. I knew it had interactions, I just lapsed on her being on an SSRI.
I self-medicate with shrooms entirely, and have been experimenting more with dosage and frequency the last few months especially. I have a history of trauma-based mental illness that I was in a lot of therapy for which I feel now is mostly managed and the mushrooms help. I know it is probably not smart to use unregulated internet mushrooms from strangers as medicine (I can order online, in Canada it is decriminalized in a handful of places so there are some illegal-but-reputable online retailers), but I have had a few problems with institutional mental health practice in my area that make me hesitant.
My partner is on a variety of psychiatric medication. I obviously don't know what her internal experience is like, but she has gone from taking prolonged naps in the middle of the day and being relatively inactive to being a much more active, involved, and creative person as her medication gets sorted out. She said that getting diagnosed properly - something that just happened in the last couple years - was the best thing that ever happened to her.
A lot of people are having success with microdosing mushrooms, say <.1g of strong cubensis every other day, or three days on and 4 off weekly(stamets method). Alas not legal except in Washington state us, maybe other places.
Editied for clarity.
How does that even work? Do you not build up a tolerance?
Apparently not if you don’t take it every day. And we’re talking like an order of magnitude less than a very light dose; sub perceptual.
Thise are interesting results, which really only indicate more true study is required. Wonder what was considered a ‘micro’ dose?
I'm on 15mg/day of Lexapro (escitalopram), works okay. I'm actually in the midst of a depressive episode right now but I think that's due to other issues... it helps more than it hurts.
Actually can I ask about your mood journal? Could you give me some tips? I've been thinking that I need to start on one to get a better picture of what's going on with me.
I'm really extra with the journals. My therapists have all said it's unusual for patients to be this data-driven. I agree, but I can't imagine not doing it and expecting to be able to keep track of all the different factors that affect my mood. I can keep exactly 4 things in my brain at a time, and 3/4 of those are what I am eating for the day, so I need to write everything else down. I think the journals help a good amount overall. It's become part of my routine to update it before I go to sleep. If nothing else, it provides a record of my life that I can look back on later, for whatever reason.
Activity/mood tracker spreadsheet
So I actually have several different trackers for slightly different things. My main one is an idea I got from a friend a while ago (not sure where he got it), to look at each part of my life as a lightbulb that can vary in brightness: it can be off, dim, medium, or bright (I recommend color-coding, as it provides a visual key that you can use to detect trends a little more easily). All the lightbulbs are connected to a fixed power source with a reasonably high but still finite amount of energy. I keep track of it all with a spreadsheet on my computer that I update right before bed. Each row is a new day, and each column is a factor that I think is likely to affect my mood. I have columns for sleep, my academics in school, work/job-related stuff, exercise, my platonic social life, my romantic life, any creative work I'm doing, any media I'm consuming, and a couple other columns for specific extracurricular groups (in previous iterations I had one column for each group, but in my newest spreadsheet, I merged all the school clubs into one column because the way in which that drains energy from me is the same between them). I occasionally write little notes about things that happened during as comments on the appropriate column, just to provide some quick context ("job interview," "started vacation," "got vaccine," etc).
All of these use the off/dim/medium/bright scale except for sleep, which I record in hours. And lastly, I have a numeric value for the overall day rating (0-10). The scale for that is really subjective, but I usually hover around 7 or 7.5, my baseline for an unremarkable but not sad day (I went with this rather than a baseline of 5/10 because that would feel depressing). Anything higher would have to be actively good in some way; I semi-often get as high as 8.5, rarely 9, almost never above that, though this isn't a hard rule or anything, just how I've felt. I haven't felt like any day has been a 10 yet, but I'm not ruling it out (can think of some days I would retrospectively give that rating). Anything below a 5 is pretty concerning to me, and very concerning if it's for more than a couple days in a row. I haven't gone under 4 since I started tracking it this way; I think anything much less than that is like "danger mode" of mega-depression, like I am actively damaging some part of my life and am probably going through the rounds of actual suicidal ideation/conceivably planning, which I've been fortunate enough to have avoided recently. idk what a 0 would be, maybe getting mauled by a wild animal and becoming paralyzed, and also my house burning down and my cat dying. Or being dead myself, but I'm not sure how I would update the spreadsheet in that case.
The point of this is to find a correlation between behaviors/activities I do (as well as perceptions I have about myself that day) that affect how I ultimately feel about "the day." There are no limits on how many columns can be labeled "Bright," I just use the "finite amount of energy" thing to reassure myself that it's ok for them to not all be constantly bright at the same time. And judging from the results, that is definitely true. Because I'm a manic, I tend to be happier on days when I am doing more things, but that's not universal by any means.
There are ways I could improve this spreadsheet. In addition to the columns described above, I have a column that I've labeled "spirit/vitality." In my first iteration of this spreadsheet, it was "happiness," but I found that that was impossibly vague and led to useless data, so I changed it to this and added a separate tally for the day rating. Unfortunately this column is still much too vague to be useful, and the results are too similar to the day rating (which would normally be a sign of a correlation, but in this case it is not helpful). I've decided that next time I update the spreadsheet, I will change it out for more specific columns, probably two of them: 1) energy/awareness/alertness (more outward-focused), and 2) self-confidence/self-appreciation/self-love (more inward-focused). All TBD for sure. I decided I need to break it up in this way (or something similar, I am not 100% convinced these are the perfect categories) because it was possible for me to be relatively low-energy and still happy (depending on certain other parameters), and I think my current setup implies that I need to be very high-energy all the time, which is not true. For example, I can be absolutely fucking EXPLODING with energy and ultra-confident; and I can also be in a very slow, cool mood where I am similarly ultra-confident. Conversely I can be explosively energetic and in a terrible mood (i.e. angry or upset or neurotic or something), or very unenergetic and in a terrible mood (just depressed). I think that by organizing these columns in this way, each variable is suitably divorced from the final output of the day rating that I won't be subconsciously reverse-influenced to describe them in a particular way other than how I'm actually feeling.
I might merge more columns in the future, or add others (e.g. maybe even more specific mood columns, or multiple rating columns), or update the terminology I use (or even go with an entirely different metaphor, if I think of a better one, though I think this is good for now). It's an ever-changing document.
Here is a picture of what it looks like: https://i.gyazo.com/d8bcf44726320d17423b30434a37de4d.png
Pretty chaotic-looking at a glance, but there's a method to the madness, per the above. I don't provide specific definitions for what NEEDS to happen for a given column to be labeled dim vs. bright. I intentionally keep it vague and just go with my gut feeling. This means that it can occasionally be a little inconsistent, but it's also really flexible and I don't feel too constricted. For example, the "Dim" entries in the "<3" column could be "attractive person was obviously checking me out" just as easily as they could be "went on a date"; and "Medium" could be something as little as "got a snapchat from someone I'm crushing on" if that happened to get me really excited. The key is less the action itself and more how I felt about it in the context of my day; if it really stands out then I usually give it a higher rating. This allows me to properly emphasize "objectively" small things that nevertheless have a big impact on how I feel. The reason I don't go with numeric values for everything is because that ruins the metaphor and makes it harder to fill out. The day rating is already challenging to settle on, I wouldn't be able to be that specific for every little column. Gut feelings are just overall feelings and not so precise, which is why I think they work with the lightbulb thing.
Not convinced that my day rating scale is quite accurate to how I feel, but I think the important part is that it still lets me see waves of relative happiness/depression.
Gratefulness journal
In addition to the lightbulbs, I have a separate spreadsheet where, once a day, I pick 1 or 2 things that happened that day that made me feel good and write them down very briefly. This is my "gratefulness" journal and helps me remember that my life actually isn't complete dogshit garbage all the time. Even on my absolute worst days, I can find something. Examples are:
This journal is important for me personally because I get sad very easily, and having one place where I can go through all these ways in which my life is good helps me from sliding into the abyss. Like, not always, but usually enough that I can still function, or at least am not suicidal.
I use a spreadsheet rather than a text document so that I don't write very much on any given day (no more than the width of the screen for a single row; it's set to overflow, not wrap), because I intentionally try to pack a lot of good into one space. This way, if I need to be a little cheered up, I am bombarded with a very large array of positive thoughts.
Kindness journal
In a similar vein, I keep a spreadsheet for ways in which I am "generous" to others. I can't actually decide on a good title. Maybe "niceness" would be better, idk. It's supposed to be a more outward-focused document. I use the same format as the previous one. Examples:
It's harder to fill this one out if I've been antisocial all day, but I can usually come up with something to write anyway. If necessary I will say something stupid like "exhaled carbon dioxide from my lungs so my plant wouldn't die." The point is less the actual thing I'm saying and more the mindset that it puts me in. It reminds me that I am very connected to the world I live in and that I can have an actual impact on it.
Miscellaneous journals
I also keep a long-form journal on my computer where I will occasionally write out my thoughts. Usually this ends up being a "venting journal." Most of the time I do not write positive things in there, I write in it because I'm stressed or anxious or depressed or whatever. Occasionally, if I am just very excited about something, I will write about it too.
I've been thinking of making another spreadsheet for venting/complaining, but I'm not sure it would actually be useful in a short format, so I think I'll stick with the word doc.
I have several other documents where I sorta just write down things in my life, like a journal about particularly vivid memories I have (I only write retrospectively, never day-of, so it's like a natural filter). Or another one where I just write down my reasons for being alive (it's like a bullet-point list), which is maybe somewhat redundant now because I have my gratefulness journal, but whatever.
I also keep a dream journal that I write in the moment I wake up (if I realize I was dreaming). That one's just funny. Kinda cute sometimes too.
Hope that helps, happy to elaborate further if needed.
This is incredible, thanks so much!! I'm not sure if I'm this data driven, per se, but I definitely work better with concrete writing prompts and goals, and inputting data is a good way to do that.
Harrrd same, lol. I'm always thinking about what I'll eat next.
Have you considered the possibility that the need to keep such an extensive, detailed and comprehensive log of your mental state is a symptom in itself? Keeping a diary is good, but it is possible that this level of analytic investment is not necessarily healthy.
I've thought abt that yeah. It's not a compulsive feeling though. Not sure how to explain. Usually it's kinda a chore, I'm just in the habit. I actually forget a lot of the time so I have to estimate a couple days back.
I don't think of it as particularly different from therapy, it is a map I can use to help navigate my thoughts in the same way that a therapist helps me unravel whatever confused mess of emotions I'm experiencing. If I don't fill it in it's not like I immediately feel worse, I just don't have data that I can use, so it's harder for me to approach a mental problem. The alternative is probing my brain and relying on my interior data set; but I know my brain and it is not trustworthy when emotions are high. I also just can't remember a lot of things.
Where the mood tracker is kind of neutral/undefined (merely a tool), I would call the gratefulness journal a very positive 'analytic investment'... I think it has an immediate measurable impact on my mood. Really it reminds me that I just can't remember things if I don't write them down or remind myself of them often, except for very deeply internalized emotions. Sometimes this makes me think I have dementia. At the moment I just think I'm a bit of a clutz. An airhead. You know. Or I just have too many things going on in my life.
You should talk to a GP or similar professional. Medication can be effective, but mental health is personal so ymmv. Therapy is basically pseudoscience, if you're not getting much out of it it's not your fault, just drop it. I'm not aware of any legal substitute to mushies, but I'm very interested in seeing how effective they are at treating depression etc (they do a lot for me too; something to do with increased openness).
I found prescription antidepressants and antipsychotics really counterproductive because they fucked with my creativity and sex drive and slowed down my brain. I hated it, it was like thinking through fog. I've found managing stress really effective. That includes work/rest balance, diet, exercise, watching drug/alcohol intake etc. I'm not cured, but things are under control.
That depends entirely on what type of therapy you're referring to. I agree that old-school Freudian and Jungian psychoanalysis is pretty close to pseudoscience (but can still be beneficial to some), but those are rather outdated methods that aren't nearly as prevalent as they used to be. However, most modern Behavioral and Cognitive therapies are anything but pseudoscience, and are instead heavily driven and supported by empirical evidence.
Even so, I agree that YMMV even with those evidence-based therapies since, as you said, mental health is incredibly personal, and so what works for most won't necessarily work for absolutely everyone. The skill/dedication of individual therapists also varies as well, and can result in varying degrees of success even when they're utilizing effective treatment methods... Which is precisely why, if the therapist you currently have has not managed to help you, I would definitely recommend trying to find another therapist who is potentially qualified in different treatment methods, before totally abandoning all faith in therapy as a concept or hope that it can help you.
I agree, cognitive behavioral therapy for example is exceptionally useful and has some solid data backing it up as to effectiveness, which depending on the condition can be more effective than medication. Though OP seems to be doing some of these on their own, which is terrific. Different therapies can be useful for many different reasons, sometimes only if to uncover things we don't ourselves yet realize we are struggling with.
Hey, I thought you might be interested in something I've been learning about tangentially to my studies. I'm reading a lot of the more recent research on depression and it seems like there's a fairly strong likelyness that there's a link to your sensitivity to stress and depression. I used to have major depression disorder myself, and I'm sitting here reading and thinking "Oh yeah, this sounds just about right". So I thought I might suggest as an alternative (or as a supplicant) to just take a moment to think about all the stress in your life, how you're dealing with it, and even perhaps take a short vacation to clear out any burnout.
I think I am beginning to reach the conclusion that a great deal of my problems originate from having Too Much Responsibility. I have already dropped 1 particularly draining commitment (a job where I had to be on call basically 24/7) for my last year of college. But I still have another job and literally two majors and a fuck ton of other shit which might be challenging to drop at this point. Looking for other people to help with any sort of club stuff I do. I like helping people and making sure fun events can happen but it's pretty thankless.
Vacation is a little hard. Wish that could be an actual thing I could do for an extended period of time. I would love to drive across America. I have this week off and then I start my internship & continue my current job, and that combo goes right up until the next semester so I don't really have any time. I convinced my boss to give me a week off in July so I could meet up with some people at this little retreat in the woods. So maybe that will be a good experience for me. I think right now even this little breather is giving me a lot to think about though.
I occasionally remark to older people that I'm a little burnt out all the time and they always say that I am putting too much pressure on myself and I should drop some responsibility etc. Which is true. But it's also pretty easy for people with established careers to say that kind of thing. I think the last 2 semesters have told me that I have absolutely zero intention to be an overachiever after I graduate: I think this internship could be a good career path for me, and if it is, I am happy to stay right there for a LONG time. But until I have that sort of stability it is a little hard to justify the stuff they say, "omg just relax it'll all work out." Yes yes and I will not know that for sure until it does. :p
Sometimes the drive to achieve and to help can end up with us oversubscribing ourselves. I have been particularly bad at this, rarely saying "no" to things I didn't even particularly relish doing. I had to give myself a crash course in saying things like "I'd love to but I can't" (with no explanation offered), and stop setting myself up for such high self-expectations. I still struggle with this. In the end I have to ask myself, if this were someone else, would I expect them to be doing A, B, C and if the answer is no, I need to unsubscribe. Always saying "I'll have to think about it" gave me time to really prioritize and do that analysis for myself so I stopped over-subscribing.