Advice about depression/counseling

In My Humble Opinion
1

I know that there are many on this board who have struggled with depression, life changing events, etc. and was hoping to get a little advice.

After years of having decent, but boring and unmotivating jobs I switched to a new role in my company in March hoping to find worth and motivation. I hate it. I am stressed out, avoid doing anything, take no initiative, and dream of quitting. Yet I have no idea what else I want to do besides nothing at all. I have no ambition at all.

A few months ago my girlfriend of almost 10 years tells me she is unhappy, started flirting with a guy at work, felt sexual feelings she never had with me in 10 years (our sex life had never been good, really - she was never interested), and blamed it all on me for not being romantic enough. She finally ended it a couple of weeks ago and said she will moving out of our home (still have to figure that out - we bought it together and its filled with 10 years of shared possessions).

I know I’ve hit a patch of events that would cause anyone trouble, but its also been making me think of my life, and I see that I’ve never been happy. I’ve always lived in fear of making any decisions, and inside a fantasy world in my own head of how life could be great, but I do nothing. I’m antisocial, and feel very anxious in social situations. I’ve been like that forever. I’ve gotten along, but never been satisfied with anything. Now I feel completely lost - my girlfriend left me, my career is killing me, I don’t really have any friends, I see no hope for the future, I see no way out, and I’ve just been laying on the couch and drinking too much. For the first time in my life, I called in sick and just lay on the couch sleeping and staring at the tv because I couldn’t get myself to get up and go. I’m really scared.

I know I need help, and am sitting here at work looking up the Employee Assistance Program rules and procedures. My question though - do I go to a LCSW, a psycologist, a psychiatrist, a regular doctor first? Do I need someone to get me a prescription, or do I start with just talking to a therapist? I feel overwhelmed with even this decision, as I guess I’m scared to choose the wrong one and not really get any help. And I barely got up the energy to start looking for help in first place…

2

I’m going through a rough patch myself, and I would suggest starting at your local Mental Health Center. Do not go see an MD. The ones I went to all gave me [del]drugs[/del], excuse me, medications (“it’s not a drug, it’s medication” is their by-line), despite my history of pill addiction.

I think anti-depressants areone of the biggest scams in history. They don’t work for the majority of people, and their side efects (including "increased thoughts of suicide) are horrendous.

3

First of all, be easy on yourself. I know from experience that it’s easy to condemn yourself for amotivation but that just feeds a cycle of self-hating and despair. It’s a very good thing that you still care enough to want to do something, even though it feels hard to do it.

Do you have a regular doctor that you tend to see? Just to make sure you’ve covered the bases and not overlooked health issues that may be contributing, seeing a regular doc could be a good move. If your insurance requires referrals. you may have to do that first anyway.

It’s likely that you’ll end up seeing both a psychiatrist (for possible meds) and a therapist. Both of these methods will take a while to work, and be warned, you may feel worse for a while before you start feeling better. Please don’t be discouraged by this. Also, not every med works for everyone, so you might get lucky with the first one, or it might take a few tries. It’s true that they can be very hit-or-miss in their effects and sometimes aren’t better than placebo, but I had astoundingly great results from Wellbutrin, including seeing my sex drive rocket back to its previous high level.

You might find no need for meds, or might find them useful for getting to a place where you’re functioning better and can then get more out of therapy and other assistance.

4

Regarding the risk of suicide side-effect: it’s been a while, but to the best of my understanding and the last I read up on the topic, this is a problem mostly when the antidepressant gets someone out of an extremely deep depression to the point where they still feel awful but finally have enough energy to commit suicide. Obviously there’s a definite need for frequent follow-up with a therapist to make sure the person is feeling comparatively “all right” and can deal with any new feelings and thoughts stirred up through therapy or meds.

5

I would just like to respectfully offer a counter-opinion here. Medications have worked well for me and allowed me to function better. YMMV.

I do agree with contacting a local MH Center. They’ll start by talking to you and helping you to develop a treatment plan from there, which may or may not include a medication consult, depending on what you choose.

6

first, thanks for you words and advice - its much appreciated.
I don’t really have much of a regular doctor. There is a practice that I go to for a sinus infection, have gotten a physical, etc. but not much a history there.

So when you say, I could likely end up seeing both a psychiatrist and therapist, how does that work? Which do I make an appt with now? My EAP provides 8 free counseling sessions from a list of participants, though I think that may only be with therapists, not psychiatrists. That was my concern in some way - do I go down the road of 8 weeks or so of seeing a therapist first? Do I go to a psychiatrist on my own first (I can pay for it myself), or should I trust the therapist to point me in the right direction if needed?

7

Choose a psychologist from your EAP list. (IMO, I like them better than LCSWs and have more success with them.) Ask her/him if she feels medication would be appropriate. If yes, ask her to refer you to a psychiatrist. Again, IMO, therapists tend to know who the good psychiatrists are. Meds can be short term boost and help you in therapy, they don’t always have to be something you take for the rest of your life.

Psychiatrists are MDs that can prescribe. Therapists cannot. Psychiatrists do not, as a general rule, do any therapy. But, they are specialists and that’s why I always recommend them over GPs for meds.

When you go in for your sessions, tell your therapist that you would like to know if long-term therapy is recommended and have them refer you out at the end of your EAP sessions.

If long-term therapy is recommended (meaning longer than 8 weeks, doesn’t necessarily mean years on the couch), let us know or search for the threads on how to choose a good therapist for you.

Good luck. What you’re dealing with is absolutely treatable. It is very possible to feel better and have a better life.

8

I think the typical sequence of events would be that you first try talk therapy and then if indicated you’d also see a psychiatrist. But that depends on how badly you’re feeling and if you think you have a couple of months you can devote to talk therapy before you add something else to the mix. If you’re feeling really on edge it might be better to see a psychiatrist first. That being said it will probably take longer to get an appointment with a psychiatrist. if you think you need medication first, a “clinical nurse specialist” (RNCS) can also prescribe and it might be easier to get an appointment. (This might vary by state.)

Re: talk therapy, personally, I have found psychiatric social workers (LCSW) to be generally more easy to talk with and they don’t have some sort of therapeutic agenda they want to fit you into. The LCSW is trained to know when you’d best see a psychologist (typically with more severe mental illnesses).

Good luck.

9

A good therapist will definitely make a recommendation for a psychiatrist, if it seems like it’s necessary or at least highly likely to be very helpful.

10

Just one more random voice in the cosmos saying, “We’re rooting for you.” Good luck.

Sometimes, just talking things out with a trained and neutral sounding board (therapist) is all you need, and sometimes, just fixing a chemical imbalance in a major organ (anti-depressants) is all you need, and sometimes, both, neither … Helps to have someone professionally and individually walk you through your options.

But mostly? I wish you the very best.

11

Great advice. Best of luck to you.

12

A feeling of powerlessness is a cause and a symptom of depression. Taking the steps to find help is a way to fight depression. You are at the start of a journey to a better life, that journey may be long or it may be short, you never know. Many millions have taken that journey before and it is well worth it. Take charge of your life back and do not listen to the depression.

13

I would suggest seeing your PCP and getting a mental health referral from them. I have gotten two great therapists that way. Both were MDs. I haven’t had great experiences with LCSWs. They don’t really practice any school of psychotherapy and just stir thoughts up to then let you flail. I am a bit biased so grain of salt.

I have had excellent results with anit-depressant medication, Celexa, but I’m not the norm. It was the first anti-depressant I took, it worked, five years later I’m still functional. My mother hasn’t found the right combo of medication after decades of looking.

I know it is incredibly hard to take that first step to get help. The tiniest step you could take is call your PCP and get therapists’s contact info. That hole inside that had been eating your happiness needs to get filled up! Good luck.

14

Listen to Brynda. She has helped me more than she could know.

15

Just my own experience here… I had some of the same issues you’ve outlined above, although perhaps not to the same degree.

I’ve seen a cognitive therapist off and on for a few years now (at first based on what EAP would pay-- eight sessions, then another eight sessions the following year, and now I’ve continued with the same therapist for almost a year, paying what I can afford…)

I resisted meds at first but agreed to try an anti-anxiety medication for 6 months to see if it would benefit the social anxiety. I’ve found the combo of behavioral therapy and anti-anxiety meds to be really beneficial. I’m off the meds now and I still feel much better about my life in general.

So, nothing too drastic was involved for me, but you definitely have to put in the work to “change” the way you think and react in certain situations.

16

niblet_head’s advice seems very sound to me.

17

Just my luck, huh:

So I took the predominant advice and looked through my EAP list for a psychologist. I also briefly mentioned my thoughts to a friend here at work who knows my current situation, and had suggested in the past to see someone, telling me it was good for her. She gave me the name of the person she used, and recommended them. The person was on the list and that made me feel better than blindly choosing.

Made the calls. His office is closed until 9/13. Great.

18

If you feel you can’t wait, then seeing someone is better than no one, so maybe pick another name off the list? IIRC, EAP programs have administrators? Can you call them and ask if you could start with one therapist and then transfer to the other for the last six sessions? (I don’t know if this is possible, just throwing it out there.)

19

I thought of trying that also. I think I may wait though, as I already feel like I’ve got a entire life history to lay out to someone, and I don’t think I want to waste time starting over with someone else after just a session or 2, if that makes sense.

I think I can wait. I’m not suicidal or anything, just lost, scared, and sad and coming to the realization that I always have been. 32 years in, whats another week and half?

20

Waiting is totally reasonable. I’m really glad that you are taking care of yourself. It’s so sad when people continue to suffer when they don’t have to. You are not alone. There’s alot of us our here who feel the same way you do.

In the meantime, consider getting good sleep, good healthy food, some exercise. You may find this will really help.