Coping with Depression

AHunter3, I am not sure what ails you but I have read many of your posts regarding your stance against meds prescribed for conditions such as depression, schizophrenia, etc. I am curious then, how do you cope with your condition?

My meds have stabilized my depression and allowed me to sleep again. However, every few days - maybe once a week - I have a down day. Not a normal ho-hum day but a day where depression rears its head and decides to wreak havoc. It’s a totally different feeling than a normal down day (those who have experienced it know what I’m talking about). So I’m at a point where my meds are no longer picking my mood up, they are holding it steady…and I want more. I want to be able to whistle while I work and to sing for no reason other than I feel like it. I want to feel comfortable in groups again. I want to be able to take a good-natured jest, and maybe respond with one, rather than taking it too seriously and saying something cutting in kind.

Am I asking too much? I know that the vast majority of serious depression cases do not result in a full recovery. That being said, I don’t think I’m out of line in striving for more. My shrink and counselor have been helpful to this point but now it’s like they don’t know what to do with me. “What do I want to get out of these sessions?” I don’t know, I’m still trying to feel like myself again! I intend to switch psychiatrists in the near future but at this point in my recovery, I question if it’s even worth it, outside of getting prescriptions refilled.
Standard Disclaimer: I understand that the SDMB is not a substitute for seeing a qualified medical practitioner yadda yadda yadda yadda

Well, first off, eliminate all the non-psychiatric, non-abstract physiological things that could be causing you to feel like that, because many things can, and when a person has a psychiatric diagnosis, it can cause those other things to be overlooked as possibilities.

Had your thyroid levels checked? Hypothyroidism can sure give you the symptoms that land you a dx of clinical depression. For a thorough rule-out, don’t just get your TSH tested, get Free T3 and Free T4 and TSH all tested. (A person’s brain can be dumping only the ordinary amount of TSH into the bloodstream because T4 is in adequate supply, and yet the body may be failing to convert T4, thyroxine, into T3, triiodothyroxine, and without that conversion you’re still gonna feel like shit w/o thyroid meds.

Ever worked with a dietician? Do you eat a balanced diet? Seldom consume lots of carbs or sugar-laden foods in the absence of protein? Been tested for how your body metabolizes sugars, not just fasting glucose but glucose tolerance test? Diabetics aren’t the only people who have to monitor their diet and/or eating habits to avoid unfortunate side-effects from sugar metabolism. It’s more associated with mood swings than pervasive gloom, but I’d still give it ample attention.

How’s your chemical sensitivity? Yeah, it’s been through some annoyingly trendy moments in recent times, but just because some ailment gets trendy doesn’t mean it doesn’t have a genuine presence as a true malady. In a similar vein, have yourself tested for pernicious anemia, Epstein-Barr, any other infectious or parasitic or chronic condition that could be playing a role here.

I am not a doctor, and no individual doctor is a specialist in everything. Do some research. Find possibilities and rule them out; get referrals from your primary care doc as necessary.
Meanwhile, give the non-physiological aspects of your life a good assessment, too. While most people who suffer from depression will say “It’s not like a case of the ‘blues’, we’re talking major incapacitation here”, it’s still true for some people some of the time that the circumstances of their lives, situations they are in, choices they made that they feel stuck with, the political state of the world, existential angst, or a broken heart from a love affair gone awry are quite capable of rendering them inert, miserable, suicidal, unable to focus, and/or other depressive things like that.
Meanwhile, bracketing ALL that off (let’s assume you’re considering all that but considering what’s below as well) — how long have you been on your current psych med? You say it has stabilized you for the most part; your complaints are twofold:

a) You still get a few rotten-apple days, or sequences of days, depression-days, in with the ho-hum “OK” days; and

b) Not much elation, joy, exuberance, and joie de vivre happening in there.
Some people who take psych meds stabilize and are then able to wean off of them; others find that if they try to wean off the meds, the full-blown symptoms come back (ugh!). Very very few people do well to just stop taking them, but if your doctor will work with you and you have the support system in place, you might try taking a “drug holiday”.

It is also true that many people develop a sort of tolerance (emotional at least as much as physical) to a specific med, which is why many shrinks will switch a patient’s meds many times over a period of years. You may find that, since psych meds have helped you, a different psych med will pick up the slack where the current one is starting to fail you. You know who to talk to about this one, yes?

Finally: how many other psych patients do you talk with as part of your regular life? Do you compare notes? Do you call each other when you need to talk to someone who knows what it feels like, etc? Mutual user-run self-help is a really good idea. Sometimes you may be the person who can help someone else, and other times you’ll find another depressive is the only person who can help you get through what you have to get through.

I didn’t answer one of your direct questions:

I’m not a depressive, never had that dx. My charts have said “paranoid schizophrenic” and “manic-depressive”, so I have 2 out of 3 in my “stamp collection”, so to speak, but not that one.

The most useful generalization I can give you is that how I feel and how I think: this is me. I am fortunate in that only a fragment of it makes me miserable, and doesn’t stick me in “miserable” and leave me there. I get screamingly lonely sometimes and when I do it’s like when some machine whine finally gets on your nerves and you become aware that it’s been whining like that for a long long time — that is, when I get hit with feeling isolated and feel like a totally unknowable alien, I also get hit with the sense that I always feel like that but tune it out much of the time. But whether it’s denial or not, sooner or later I stop feeling that (or stop being aware of feeling that) and get immersed in something I’m doing and non-miserable.

I have coping strategies for dealing with people’s reactions to the contents of my thoughts, my behaviors, and how I express the former in the latter. I’m not sure but I think I probably relate to other people more as abstractions and as a general pool of “Them” than most people do. Probably bites me in the butt at loneliness-awareness moments, but it helps. People are less frustrating that way.

I don’t think “normal” is all it’s cracked up to be. No pun intended. I don’t mean “the attempt be or behave or be seen as normal”, I mean the actual mental and emotional condition.

Thanks for the response AHunter3.

I am in great physical health. The exception being that I could stand to lose about 30 pounds. I’m at a point in recovery where I can now go out and participate in physical activities (my wife and kids really appreciate that) so I expect to be getting in a lot better shape over the next year. I have always eaten a balanced diet but my weight gain was from a sedentary lifestyle, which was one of the tips that something was wrong with me.

My last physical as well as the blood work completed when I was committed revealed nothing. No such ailments run in any of my relations. To my knowledge, the only chronic condition I have is dermatitis herpetiformis, which is essentially a gluten intolerance that can be dealt with by changing one’s diet. I have been on a gluten free diet for 12 years now, so I don’t think that that is an issue.

I have been on my meds for a year now. I’m maxed out on effexor and am taking some supplemental drugs because the effexor was not enough but I was already at the max dose. I am on some stuff for sleeping too. We tried getting me off of that and I went back to virtually complete insomnia. Maybe I just need more time to heal shrug
a) my ‘rotten apple days’ are accompanied with SI’s all over again. I’m strong enough that I do not consider acting on them but it’s a call of the Sirens.
I have not joined any group. I was far removed from the rest of the group I attended while committed (not the most positive experience) in that they had real problems (abused, assaulted, lost everything, etc), while my slide in to depression seemed more like a slippery slope rather than a single event. That being said, my wife insists that I should find another group and try again as my frame of mind while committed was not going to yield any positive experiences.

Thanks again.

What is the “max dose” of Effexor that you’re taking? I stopped taking Effexor a couple weeks ago, because I was at 450mg and it wasn’t doing much of anything. I only weigh about 100lbs and that seemed like a huge dose to me.

Now I’m taking imipramine, which seems like it might be helping (too soon to really tell yet, though).

Greenback, I have had some very good results from following the advice in Potatoes not prozac

I recommend this as a supplement to your Doctor’s advice, not as an alternative.

I have had much fewer down days; the days that are down are not as down and I seem to be losing weight as well.

I took imipramine for a while (I weighed about 86 lbs at the time) and it pretty much slammed me up against the wall. I was told that it is frequently prescribed to the “physically frail”. Did you hear anything like that when your doctor put you on it? (I also took desipramine…now I forget which one was harder on me or which one came first. It’s been 17 years.)

I do have side effects from imipramine: dry mouth and dizziness from standing up quickly, and a yellow tint to my tongue sometimes. I’m willing to put up with the side effects, they’re pretty mild overall.

I couldn’t deal with the dry mouth. But worse was the sensation that I was heavily drugged. I was in the hospital when I took it and I don’t think I could have functioned in the world with a job and people and responsibilities while I was taking it.

I am taking 350 mg. All three psychiatrists I have seen have stated that I am maxed out on effexor. I wonder if the mg is affected by the other drugs I’m on. I know that my calming agent increases the effectiveness of effexor while allowing me to sleep.

Potatoes not prozac…might be worth a shot. It’ can’t hurt anyway.

I have only been on this for a year so I would hope that the problem isn’t my body already adjusting to the meds and forcing me to change meds. I have been referred to a psychologist in order to see if I would be better served in a group or one on one sessions. Like I stated in an earlier post, groups make me feel out of place because others there have real reasons to be depressed.

Another question AHunter3: When an episode is coming on, can you avoid it by doing ?? Do you isolate yourself and mentally calm yourself? Do you push yourself to focus on a task at hand, disregarding the torrent? Or do you just call in sick and wait for it to pass?

Anyone else? I only ask AHunter3 specifically because I believe, based on past posts, that he is coping with his condition with drugs/meds. So the techniques he uses have a better chance to work for me because they would be supplemental to the meds I’m already on.

From the OP:

I should clarify something here. Or maybe I should at any rate… It’s eating at me a bit to have been described as having a “stance against meds prescribed for conditions such as depression” on this board, where the standards of ignorance-fighting is high enough to handle more subtlety and exactitude.

(But if you want to skip over this as an exercise in self-important mental masturbation and soapbox-standing, I understand)
It’s not that that’s not my position in a gross oversimplified way, but part of ignorance fighting is getting beyond the sound bite, yes?
a) “Elevator Statement / Off-the-cuff Sound Bite” — AHunter3 says psychiatrists are mostly quacks and psych meds are snake oil and you shouldn’t take 'em and no one should be forced to take 'em

b) “Conversational Expression of a Point of View” —AHunter3 says that psychiatry has a long history of pretending to know with certainty a lot more than it does about disturbing human behavior, emotions, and cognitive content and what causes it, and is still largely operating from conjecture; and that psychiatric medication, although it does has efficacious results for many people, doesn’t work that way for everybody and can actively harm people (including those who were having pleasant experiences with it except for the side effects, but also including those who experienced no benefit from them). Furthermore, as with aspirin, the mechanism by which they do work is also only understood conjecturally, and in many cases the theory of what constitutes the ailment is arrived at by working backwards from what certain pharmaceuticals do to the nervous system. So psych meds may be of great benefit to some people but they can be dangerous; you should be aware that claims are made on their behalf with flimsy support; and, as with any citizen, a person with a psych diagnosis should be allowed to refuse unwanted treatment and should not be involuntarily incarcerated except for having committed an arrestible crime, unless legal standards of mental incompetence can be shown to apply.

c) “The Historical Lecture” —AHunter3 begins with an overview of the institutional practice of pyschiatry and shows how psychiatry has always had a “split personality” of its own, being on the one hand the mechanism by which disturbing people were removed from the public sphere for the benefit of those they disturbed, and treated with an end-goal of making them socially palatable to the rest of society if such a thing were possible, otherwise keeping them locked up out of sight; and, on the other hand, an inquiry into the personal pain and disability of these maladies as they are experienced by those suffering from them, to see what might enable them to live fuller lives, to be rescued from some of the anguish that they experience, and to rescue them from lives of isolation and mental incapacity.

The first of those two roles has tended to lead to ‘treatments’ that pacify, that reduce a person’s ability to behave at all as a means of reducing the likelihood of them behaving badly, and that accept as tolerable tradeoffs treatments that destroy much of a person’s creativity, passion, capacity for imaginative or original thought, or formulation of decisive intentionality and pursuit of self-definition and purpose, as long as they blunt externally discernable symptoms that others find disturbing. Because the mantle of “medicine” is useful, in the social-politics sense, for legitimating the ‘police powers’ role of the profession, the history of psychiatry is rife with claims of medical legitimacy and precision science for ‘treatments’ that are of this nature.

And that kind of politics means playing really loose and sloppy with the medical science — the serious research, the well-intentioned endeavors to really help people, get all entangled with the social-control lies and the ‘treatments’ that were often worse than the ailments except from the perspective of the folks who wanted the crazies off the streets. That gave psychiatry a bad name among the branches of medicine, one result of which was that every time someone actually, in no-kidding legitimate real life figured out what was causing it, a given “mental illness” was removed from the jurisdiction of psychiatrists and given over to branches of medicine considered more legitimate. Examples: one dementia was found to be caused by late-stage infection by the syphilis spirochete; another set of patterns of odd behavior and thought disturbance was understood as a neurological problem called a “seizure”; yet another mental and emotional malady, once understood as an insufficiency of the thyroid gland, was offloaded to endocrinology. They may not be doing that any more (Alzheimer’s is at least in part still treated by psychiatrists even though we now know in a pretty specific sense what’s going on there), but it went on long enough that the effect was to leave behind, in the basket of ailments called “mental illnesses”, the patterns of human thought feeling and behavor that had not yielded up answers in response to conventional medical approaches.

Is there, therefore, at least a solidly good chance that the remaining constellations of symptoms & experiences & behavior are not exclusively those of a physiological condition of the body, brain, or its neurochemistry? Yeah, in my opinion — most likely, they are states of mind that the human mind (any human mind) ends up in under the right situation, and then on top of that some people are more prone to end up in those states than others, perhaps because of physiological predispositions but perhaps not exclusive due to that either. So a psychiatric profession, steeped in the medical-model tradition and for the most part insistent that the ailments it exists to treat are by definition illnesses in the medical sense (brain, neuron, neurotransmitter, etc), is probably treating conditions that don’t exist in the sense that they think they do, and approaching those conditions with strategies based on those misapprehensions. “Snake oil” is perhaps a rude and uncharitable way of putting it, but since they impose their treatments on us without our consent via those still-extant police powers, while insisting to the general public that they are doctors guided by the precise insights of modern medical science and know what they are doing, I think it’s appropriate. And, as you can see, is applicable to both sides of the two roles I said that the profession plays. The stubborn insistence on a linear physical-cause-yielding-mental-illness model very much permeates the sincere research and tends to inform the best-intentioned of program planning and development strategies.

Does any of that mean psych meds don’t alleviate suffering for some people and make it possible for them to tolerate life and get on with the business of living? Certainly not. Meds for the symptom-pattern called “depression” seem to be most favorably received and enthusiastically consumed by the folks for whom they are prescribed, with meds for the condtion known as “bipolar disorder” apparently lagging somewhat behind in popularity among those who take them, and meds for those of us bearing the label “schizophrenic” bringing up the rear. Is it fair to call something that works, for at least a decent percentage of the people who take it, “snake oil”? I’d say they are fine for those who take them voluntarily and under conditions of truly informed consent (i.e., they haven’t been sold a bill of goods about how the Good Doctors know exactly, in a highly detailed etiological sense, what is causing their problem and that the pill they’re handing out will restore their “chemical balance” just like insulin replaces natural pancreatic insulin for diabetics). But dammit, peddling that stuff making the unsupported claims that they make, and forcing it on people who don’t want it entitles me to sometimes call it “snake oil”, too, OK?

Meanwhile, the real problems probably won’t yield to inquiry until and unless funding for more complex research becomes more readily available. The second and more lofty role that psychiatry has attempted to play requires expensive investment. In particular, research designs that don’t assume a simple physiological mechanism to underlie the mental illnesses would tend to be pricey.


I don’t always know an episode is “coming on”. I think I’m fine and am my normal everyday self (and hush up, you folks whispering “what’s the baseline”) and then become aware of how people are reacting around me. OK, what I become aware of is the extent to which the people I’m dealing with in my everyday life are becoming unified in their malevolent participation in some horrible social initiative which is of great danger to me, and then, having been there enough times, something finally clicks over for me and I go “oh” and realize how close I am to thinking they are discussing me and what to pull on me next.

I don’t isolate myself when I’m like that, that just makes it worse, it’s over-isolation that gets me like that in the first place (even though a lot of day-to-day isolation is really really necessary for me)… what helps the most is to quit taking myself so seriously and sort of stand back, look at myself, point and giggle a bit, and then try to be people with people. It’s important to me to have at least a few people who can relate to lunatic “black humor”, they don’t have to be other ex-patients / lunatics but they have to at least not be walking on eggshells and oh so politically correct or hand-wringingly concerned about My Condition, you know?

Now, the other mood, the aching lonelies, those don’t get me into trouble (I wallow in it but I haven’t much of a history of trying to off myself) but I do have to cope with them and the best thing is some highly detailed meticulously intricate project I can geek out on, let my inner OCD wrap me up in fine-grained precision. Nothing like a good database project :slight_smile:

I’m not on psych meds. I tried a few voluntarily eons and eons ago and rather strongly did not like them although I was just weeks away from my first locked-ward experience and was emotionally raw and cognitively careening all over the place and had really grandiose stuff going on in my head at the time. Then subsequent to that I’ve had them forced upon me against my will a few times, although only for mercifully brief durations.

If I remember the gist of past threads with AHunter, his stand on forced mental health care is, simplified, “just because you don’t like me doesn’t mean there’s something “wrong” with me.” If you’re not a danger to people, the fact that you’re different shouldn’t warrant a sentence of life in a lock-up.

Is that close?

Actually, I really like the way you said that. Can I use that?

Anytime, dahling. It’s you, with just a dash of “me.”

Sometimes tragedies can trigger depression, true. But sometimes individual body chemistry can cause depression even in the most privileged life. Both are real reasons. It’s not a matter of will power or character or weakness. Even though there are things you can do to help yourself, don’t blame yourself.
Cut yourself some slack.

I wish you every success in finding what works for you. I have found many solutions over the past forty years. They’ve gotten much better over the last fifteen years and still continue to improve all the time. When I used to be distracted by SI, I chose to find a SP. That was one of my solutions that I could depend upon. Very important.

AHunter3 and I come at this subject from different experiences, but I have much respect for his knowledge and insights. I am very grateful that he is who he is.

SI = suicidal impulse? But what’s SP?

I think it’s also important to reiterate that AHunter3’s issue isn’t depression. His input to these discussions is more along the lines of the mental health industry as a whole rather than specifically related to the myriad treatments for depression.

Regardless of what works and what doesn’t within the realm of antidepressants and “talk therapy,” there are real pitfalls within the system that the uninformed need to learn about. For the most part, I agree with him that the system frequently oversteps its rights with regard to forced care and confinement. People are lied to and taken advantage of in order to make a *perceived problem * go away. Understanding the system is imperative, whether you’re mentally ill or not. You never know if you’re going to be the next one thrown into the system with no recourse, no rights, and no way out of a huge life-altering situation.

For those of you who have decided to give antidepressants a try, how did you evaluate potential risk versus potential benefit?

Paxil has been recommended to me, but the research is pretty scary and overwhelming. There are some sites that say, “Oh, Paxil is one of the meds with the fewest side effects”, and others that say, “Paxil will pack the weight on you and will be impossible to get off of.”

I say that I’m not willing to gain weight, but I’m also not willing to feel (and act) the way I do right now.

lorene, only you can decide which side effects you can and cannot tolerate. Talk to your doctor about any potential medication and make sure to convey your concerns.

I went on Celexa (later switched to Lexapro) for anxiety years ago. My doctor was originally going to perscribe Paxil because, in his experience, it had the highest success rate with anxiety. However, I was very concerned about weight gain. So we decided to try Celexa first. It has a lower risk of that particular side effect. It had some others (which I either didn’t get or weren’t too big a problem) and worked well for me. It hasn’t worked out so well for others I know who have had to go to other medications.

There are many different medications out there. Unfortunately, there’s no quick and easy way to tell which one will work best for you. You can only try your best bet after an honest and indepth conversation with your doctor about what your concerns are.


I have to echo Zoe and tell you not to worry about feeling like you don’t deserve to be in group therapy. If you’re having problems, you deserve to be there. However, if they don’t work for you, there’s no shame in that either. Some people do better one on one.

As to your “rotten apple days,” have you tried keeping a journal to see if there’s anything that may be triggering them? I did that for a while with my anxiety, and found there was a definite pattern to what caused some days to be much worse than others. However, I couldn’t see it until I went back over my journal on a good day., Then the darned pattern just jumped out at me! I guess I had to be a bit removed from the situation to see it.