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Dealing with Depression and PTSD

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metis-siren

Confident
Hey guys,

So I saw the relatively new psychiatrist this week and the consensus is that my depression is much worse than I had assumed. After talking about it for a while and explaining what types of symptoms and feelings specific to feeling depressed, I've been deemed severely depressed. Great, and I've been in this state for over a year. So the anti-depressants have been doubled.

I had thought that a lot of the issues that were around school related to being triggered and a general lack of motivation. Seems otherwise.

I thought that the depression was PTSD related, but it predates most of the PTSD symptoms. So major depression outside of PTSD?

Here's where I'm stuck. I've been kicking myself in the ass to get through school, to get out of bed, to get out of home. I've been beating myself up as just not working hard enough. I honestly don't know how to put this into perspective it just feels like I should be relieved to know this was bigger than just willpower, but I'm not. I'm frustrated.

All of the PTSD stuff I'm working on, and I thought that this was under control, I thought I had the depression under control. I feel so utterly disappointed to not have recognized this in myself.

So there you have it. I'm trying to work through the PTSD stuff, and somehow the depression is creeping in without me seeing its shadows and enveloping parts of my life I didn't even acknowledge were affected.

I don't really know how to deal with PTSD and MDD. I just feel so run down, and the anxiety attacks and flashbacks are killing me. It's been a rough stretch.

Usually I'm more eloquent, I'm just not well.

Most sincerely,

A. Lauren
 
defining the problem may be much of the solution

So I saw the relatively new psychiatrist this week and the consensus is that my depression is much worse than I had assumed.
Consensus? As in you and the psychiatrist, or, was there more than one professional involved?
So the anti-depressants have been doubled.
All of them? At once? (I'm wondering which ones, and the new dosage levels. I used to be treated for depression.)
it just feels like I should be relieved to know this was bigger than just willpower, but I'm not.
I realize psychiatrists tend to be drug oriented, but wonder if a psychologist might differ and suggest trying Cognitive Behaviour Therapy (CBT), probably at first while you are still taking anti-depressants, which could be seen as a form of trained willpower.
I thought I had the depression under control. I feel so utterly disappointed to not have recognized this in myself.
Sounds like it blindsided you. The internet has tons of "screening" tests for depression (quite similar to this site's screening tests for PTSD). I suggest you mark your calendar to regularly take such a test say, every month or two.
the anxiety attacks and flashbacks are killing me.
Well, anxiety attacks are an old friend of mine and I'm one of those now fortunate enough to be able to manage them in a non-drug way. The non-CBT approaches include diet, enforced relaxation and distractions from worrisome thoughts.

Sometimes half the job of solving a problem, is simply finding out what it is. Sounds like you've taken a giant step in that direction, a job well done. Time to take a breather, imo.

Don
 
Consensus? As in you and the psychiatrist, or, was there more than one professional involved?All of them? At once?
Don

Well it has been known for about a decade now (and I'm 22 so that's saying something) that I've suffered from MDD. However, I had thought I had it under control. I was taking a special compounded formulation of bupropion because I'm completely intolerant to serotonin and go into serotonin shock.

Because the last psychiatrist I saw prescribed this, and was extremely hesitant to increase it due to my extreme sensitivity to medications, it was never raised before he left last August. It was sitting at 50mg which is half the minimum dosage. Yeah... tis a wonder that this hasn't been going well?

Anyway, I see the psychiatrist for medications and more clinical related stuff - i.e diagnostics. I have started to see a clinical therapist as well, and she does the therapy portion. I feel like I will be getting a lot out of it. She does a modified version of Dialectical Behavioural Therapy (DBT) (which is interesting to read about, at the least).

It did blindsight me. I thought it was just me. I thought I wasn't pushing myself hard enough. So I'm laying off for now. I'm going to focus on appreciating what I am doing instead of beating myself up for everything I'm unable to do now. And I am unable to do it. I get that. I didn't want to admit it - I don't want to admit that there are things I just can't handle right now but I'm staring it in the face and I'm pulling the layers off and stripping it down to what's really going on and it's not pretty but it's honest.

Taking those online tests every couple months is a good idea, especially seeing as I believe the psychiatrist wants to increase it again once I get settled on this dosage. It would let me be able to check in. Thanks for that - I'm programming it into my PDA.

Maybe in another thread you would open up about the things that have helped you with anxiety. I know I'm interested. Oh, and I don't think I welcomed you yet - Welcome to the forum.

Sincerely,

A. Lauren
 
the things that have helped you with anxiety. I know I'm interested. Oh, and I don't think I welcomed you yet - Welcome to the forum.
Thanks. This is a pretty good summary, posted earlier today:

[DLMURL]http://www.ptsdforum.org/post57432.html#post57432[/DLMURL]

Don
 
My history with depression stretches back over 30 years at this point, although I didn't really understand that until two years ago. My current understanding of my own experience is that depression masked everything else, for decades. And I was good at masking even the depression for long stretches, except when it completely took over and I would be unable to work, or do much of anything. My past is a bit of a wasteland of false starts as a result.

Anyhow, a couple of years ago, when everything fell apart and PTSD became a huge part of the picture, it soon became apparent that until the thickest fog of depression was lifted (in my case with the help of medication), no real progress in any kind of therapy was going to be possible. That was what allowed me to decide in favour of trying medication again.

I also read a lot of stuff about depression at that time. It was frightening but also very motivating to understand that depression in and of itself is a life threatetning illness, not some weakness of mind or character.

As for the cognitive approach, again, my own experience is that there is a point at which that is not workable. Depression to the point that one can barely formulate a thought and can hardly speak, let alone comprehend what even the most well-meaning therapist is talking about, requires different tactics.

That said, once the total fogging of everything has lifted, I am left with instances of depression 'within wellness' which are indeed amenable to cognitive approaches. They can be seen to have begun with an event or thought pattern, and while they still have a rythmn of their own, they often do lift in a few days. There is always the fear that I am sinking back into the morass of clinical depression, but, thankfully, for about 18 months now, that has not happened.

Most recent example of what I mean was the recent holiday period. I was plagued with constant thoughts of ways to kill myself and felt very tempted to do so. Fortunately the thought of how that would affect my neice and nephew stood in my way. But, I also had the awareness in the back of my mind, that mid-november to mid-january is always a dark dark time for me, so the hope that this too would pass was not totally missing. Anyhow, without any need to change my medication or anything, once we got to about Jan 2nd, the triggers of this episode began to recede. The hated holidays were over, I had made it into a new year (year end life review is always a major cause of 'cognitive' depression for me) the anniversary of a beloved life partner's death had passed. The world came back to life, and me with it...

One final note...one of the yardsticks used to measure depression is interest level in 'activities you used to enjoy' This one crosses over into PTSD territory for me. Or some other realm. Never having developed a sense of 'self' my interest in activities has always been externally motivated. When I stop doing what I think I should and doing what ohers are doing, I am left with a void. But that does not mean I am depressed.

Hope something here might be helpful...

DLR
 
I had a similar conversation with my therapist today. She says that depression seems to have always been with me, only in differing severities. I know when I am depressed, it comes and goes and has since I was younger. I tried Paxil once, but quit soon after because of the side effects. I am a little confused. I wonder if I should speak with a psychiatrist or go with my original assumptions that anti-depressants are not for me.
 
I too have struggled with depression for most of my life. I have always had it, for as long as I can remember. After being DX'ed with PTSD and having gone through all of the symptoms with flashbacks, anxiety, blah, blah, blah. The depression is the worst one to deal with. For me anyway.

I was better when I was on Cymbalta. That I can say with truthfulness. But to have to live life popping a pill everyday to stay happy!!!!!!! I'm just not into that. So I will try and figure out this depression on my own. If any of you have come up with a cure....PLEASE let me know...
 
This just feels like a waiting game. I acknowledge that the depression is beyond a level where it's something I can work through on my own, that it has in effect taken reign over my life. That is so very difficult for me to admit and it scares the crap out of me.

In all honesty I would rather have to take a pill everyday for the rest of my life than have to be at that severe of a depression. And I've been here for a very long time. The best it has ever been has been at a moderate level of depression, that's as good as it has ever been.

I don't know if this makes sense but I think I'm past negative thinking. I just don't. I don't have the energy to think negatively most of the time, I can barely get myself into a shower or on a good day, get to a class.

I, too have gone through the mentality of a fresh start - especially for school, only to fall flat on my face again. So I reevaluate what's going on, how therapy has been, where my PTSD is at, external unexpected situations (such as close family members deaths) and try to find out why it's not working. As such point I would start to beat myself for not being motivated enough.

Okay, at this point I'm writing paragraphs and deleting them. I think I'm out of anything poignant to say. Suffice to say I feel like hell.

Thanks for the words, it helps to know I'm not alone in dealing with this.

A. Lauren
 
Cognitive Behavioural Therapy (CBT)

.... I don't know if this makes sense but I think I'm past negative thinking. I just don't. I don't have the energy to think negatively most of the time, I can barely get myself into a shower or on a good day, get to a class. ....
(emphasis added) It's sounding to me like you're stumbling into Cognitive Behavioural Therapy. What turned my own depression and anxiety around (> ten years duration, started with six months on prozac, couple of years' break, then need OTC St. John's Wort for about a decade but the side effects were catching up with me) was literally chancing across the classic book on CBT in a 3 for $1 used book bin:

Feeling Good: The New Mood Therapy (by David D. Burns)

This is the classic text still in print after decades, and often recommended by family doctors for patients to 'have a go' at seeing if that approach would help them (perhaps your local library carries a copy you could borrow). How about, asking your therapist about it (though, it can readily be largely a 'self-help' method).

It's a wordy text, enormously repetitious in its approach with tons of case studies, examples and exercises for the reader [I've a hunch the author figured most readers would be so far gone, they'd not pick up the basics without tremendous repetition from every angle].

Honestly, I didn't push past the first one and half chapters before I deduced what ought to be workable approach for me: As we think, we feel. Conciously quell the negative thoughts, and our negative feelings will fade away. Do this for a while, and your mind will start doing this automatically, on 'auto-pilot'. (officially CBT says 'replace' negative thoughts with positive ones, can't say as I ever tried that as it seemed like more work, and, I'd need to pay attention to the negative thoughts which seemed intuitively the wrong focus to my way of seeing it)

I was a little bit skeptical, but figured, hey, got nothing to lose. And sure enough, I could see some effect within hours. After a day, I knew I was onto a winning approach (for me anyway, at that point in my life).

Sure, at first I slipped from time to time, and yes it does take a concious applied effort. But, round about week two or three, the process was becoming pretty much fully automatic, I was no longer being aware of it happening (the negative thoughts, most of them, most of the time, just weren't popping into my mind). And when they did show up, they were so infrequent and isolated, that it was so very easy to recognize them for what they were: damaging and out of place and more than worthy of being rejected.

Anyway, this simplified version of CBT worked very well for me a bit more than two years ago, when I was able to leave my anti-anxiety & anti-depressant meds behind (for good, knock on wood). I had a relapse for a couple of weeks (didn't need meds, just toughed it out) when I was grieving over a family member who I'd been caring for a very long time that passed in a totally miserable fashion in hospital, but I recovered well enough. [There's a residual from that process that this site's screening test shows as my being deep into the PSTD region, hence my hanging about looking for answers, and for that matter, the right questions to ask].

Don
 
My primary concern isn't negative thinking - it's that I don't care, or at least feel anything most of the time. I'm glad CBT worked for you, but I'm not in the position at this point where I can replace no thoughts with a positive thought because that requires a thought in the first place. That requires more energy than I have.

Maybe I've been pushing this under the rug for so long that I don't appreciate CBT today. I guess I think I need to feel this out for a while and get my meds stabilized. I know I have a lot of work ahead of me.

Thanks for listening.

A. Lauren

I will pull myself out of this landslide...
 
Just want to say that I do have to take pills everyday as my depression is so bad that I can't function without them. It is worth it to me though cause the difference is like night and day. It took a while to find the right combination of drugs but, I am so grateful that I finally found them. Good luck to you. I hope you get some relief soon.
Take care, Morgan
 
Hi! I had written a posting about how I have suffered from depression my entire life, but wasn't diagnosed with anything until 10 years ago (I'm 50+). But, I wound up deleting everything because it is still hard to talk about it.

All I can recommend is that you continue your sessions with your therapist, and continue talking to your psychiatrist about medications. There are several different ones out there, and I have been through a lot of them. I have a young son and I need to continue trying-if not for me, then for him.

Don't look so far ahead-it is too daunting. Just get through each day as simply as you can.

I have to believe that the depression will eventually ease off with my small efforts.

Good Luck
 
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