Sigh, well, I’ve been trying to fix it for about ten years (so as long as I’ve been failing. Coincidence?? Probably not). I’m on 2 anti-depressants right this minute (the fourth or fifth cocktail of which I’ve tried). I’ve gone through years of therapy. And the result? Still depressed, often suicidally.
So what else am I supposed to do? I refuse to go to therapy again. I’m sick of telling my whole life story over and over, and looking back on my past therapists, I think they were unhelpful at best and harmful at worst (for encouraging me to pursue my ludicrous pipe dreams, for instance). Moreover, talk therapy (including cognitive behavioral therapy, which some say is the most effective form) is, according to several meta-studies I’ve looked at, of dubious benefit.
I could try ECT, but apparently it has pretty bad side-effects. I’ve looked into submitting myself as a lab rat for deep brain stimulation (for science!), but haven’t been able to find a study that wouldn’t require quitting my job and staying somewhere across the country for two months. So here I am.
But if we can sidestep the ad hominem argument for a moment, it sounds like you’re saying that my aversion to failing at something else is irrational. Would you mind pointing out the error in my reasoning? (This sort of exchange is basically cognitive behavioral therapy, btw.)
it sounds like you’re saying that my aversion to failing at something else is irrational.
That’s really irrelevant at this point. If you are clinically depressed, this is sufficient to explain both your failures and your lack of belief in your ability to succeed.
I am not a doctor and don’t want to give medical advice, but it seems to me that getting your depression under control must be the very first step you need to take—before you start thinking about new careers.
If my depression does explain my failures, then I really am pretty much destined to fail in the future since this appears to be treatment-resistant depression and as I described, I’ve run out of treatment options. Thanks anyway.
I agree with Lumifer that your priority should be treating your depression. Also, consider that your depression likely is making you pessimistic about your prognosis.
For about 5 or 6 years I had a treatment resistant fungal infection. I had to try 6 different antifungals until I found one that had some effect, and I tweaked the dosage and duration for most of those to try to make them work better. The last medication I tried didn’t work completely the first time, so I increased the dosage and duration. That totally wiped out the fungus. If you asked me if I ever thought I’d get rid of the fungal infection 6 months before I finished treatment, I’d have said no.
Knowing which antifungal medications didn’t work actually was the key to figuring out what did work. My doctor selected an antifungal medication which used a mechanism different from that of any other treatment I tried. I suggest that you look at which mechanisms the drugs that you have tried use and see what other options exist. There are many more depression treating drugs than antifungal drugs, and many more mechanisms.
You mentioned a few other non-pharmaceutical options you’ve considered. If you haven’t already considered it, I might suggest exercise. There seems to be reasonable evidence that exercise helps in depression. Anecdotally, I’ve read of several people who have claimed that running in particular cured their depression when nothing else provided much help. (I’ve suggested this to others before, and they generally think “That’ll make me feel worse!” People generally seem to discount the idea that as they get into better shape, exercise will become easier, enjoyable even.)
consider that your depression likely is making you pessimistic about your prognosis.
Yes, I’ve heard this before, but I don’t see why any reasonable, non-depressed person would be pessimistic about it. As I’ve said, it’s not like this is the first time I’ve ever been depressed in my life and I’m irrationally predicting that I can’t be cured. And I’ve heard stories like yours before: people who were depressed until they found the right combination of medications. But in my situation, my psychiatrists have gone back and forth between different combinations and then right back around to the ones I already tried. Changing them up YET AGAIN just feels like shuffling the deck chairs around on the Titanic (but of course I’d say that). If there are tons more different medications to try as you assert, none of my psychiatrists seem to know about it.
To be fully clear, anti-depressants have had an effect on me. I definitely don’t feel unbearably miserable and anxious as I do without them. They just haven’t gotten me to 100%.
I GUESS I could ask my psychiatrist to try yet another combination I haven’t tried before. But it just sounds like a nuisance, frankly.
As for exercise, yes, I’ve heard that countless times. I used to be much more active, and don’t recall it ever having a palpable effect on my mood. Nowadays, it’s just not gonna happen. I’ve tried to get myself to exercise, with some occasional success, but with my work schedule, when it finally comes time to do it, I flatly refuse. You could say, “you just gotta find something you enjoy!!” But I’m depressed! I enjoy nothing! (/sarcasm) I guess I could make sure to make time for hiking (probably what I enjoy the most) or get a membership at an expensive gym near work (which would be the most convenient arrangement for me) but the fact that exercise never particularly had an effect on me makes me not particularly motivated to do so.
If there are tons more different medications to try as you assert, none of my psychiatrists seem to know about it.
Wikipedia lists many. I count 21 categories alone. I would suggest reading at least a bit about how these drugs work to get some indication of what could work better. Then, you can go to your psychiatrist and discuss what you’ve learned. Something outside of their standard line of treatment may be unfamiliar to them, but it may suit you better.
For my last antifungal treatment, I specifically asked for something different from what I had used before and I provided a list of antifungal meds I tried, all of which were fairly standard. My doctor spent a few minutes doing some searches on their computer and came back with what ultimately worked.
Huh, interesting. Up-managing one’s doctor seems frowned upon in our society—since it usually comes in the form of asking one’s doctor for medications mentioned in commercials—but obviously your approach seems much more valid. Kind of irritating, though, that doctors don’t appear to really be doing their job. :P
The exchange here has made me realize that I’ve actually been skipping my meds too often. Heh.… :\ So if I simply tighten that up, I will effectively increase my dosage. But if that doesn’t prove to be enough, I’ll go the route you’ve suggested. Thanks! :)
SSRIs, for example, aren’t supposed to do anything more than make you feel not completely miserable and/or freaked-out all the time. They are generally known to not actually make you happy and to not increase one’s capability for enjoyment. If you are on one, and if that’s a problem, you might actually want to look at something more stimulant-like, i.e. Bupropion. (There isn’t really another antidepressant that does this, and it seems unlikely you’ll manage to convince your psychiatrist to prescribe e.g. amphetamines for depression, even though they can work.)
And then there is, of course, all sorts of older and “dirtier” stuff, with MAOI’s probably being something of a last resort.
Yeah, that accurately describes their effect on me.
I used to be on Buproprion, but it had unpleasant physical effects on me (i.e. heart racing/pounding, which makes sense, given that it’s stimulant-like) without any noticeable mood effects. I was quite disappointed, since a friend of mine said he practically had a manic episode on it. However, I took it conjunction with an SNRI, so maybe that wouldn’t have happened if I’d just taken it on its own.… Idk.
I’m actually surprised my psychiatrist hasn’t recommended an MAOI to me in that case, since she freaks the hell out when I say I’m suicidal, and I’ve done so twice. I’ll put MAOIs at the bottom of my aforementioned new to-do list. :)
As far as depression goes curetogether has a list of things that it’s users found helpful.
I don’t think gyms are ideal. Going to the gym feels like work. On the other hand playing a team sport or dancing doesn’t. At best a weekly course that happens at a specific time where you attend regularly.
You should check out my response to one of the other comments—I think it’s even more “yes, but”! I kind of see what you mean, but it sounds to me like just a way of saying “believe x or else” instead of giving an actual argument.
However, the ultimate conclusion is, I guess, just getting back on the horse and doing whatever I can to treat the dysthymia. I’m just like… ugh. :P But that’s not very rational.
It sounds like you’re saying that my aversion to failing at something else is irrational. Would you mind pointing out the error in my reasoning? (This sort of exchange is basically cognitive behavioral therapy, btw.)
Many of the things that you have said are characteristic of the sort of disordered thinking that goes hand-in-hand with depression. The book Feeling Good: The New Mood Therapy covers some of them. You may want to try reading it (if you have not already) so that you will be able to recognize thoughts typical among the depressed. (I find some measure of comfort from realizing that certain thoughts are depressive delusions and will pass with changes in mood.)
As a concrete example, you said:
I’m just not smart or hard-working enough to do anything more interesting than pushing paper (my current job).
These are basically the harshest reasons one could give for failing at something. They are innate and permanent. An equally valid frame would be to think that some outside circumstance was responsible (bad economy, say) or that you had not yet mastered the right skill set.
I am thoroughly familiar with Feeling Good and feel that I can argue circles around it. My original statement (that I’ll fail at everything) is an example of “overgeneralization” and “fortune telling.” But this sounds to me like just a way of stating the problem of induction: nothing can ever be certain or generalized because we don’t know what we don’t know etc. etc. However, science itself basically rests on induction. If I drop a steel ball (from the surface of this planet), will it float, even if I think positively really hard? No. It won’t. Our reason makes conclusions based on past evidence. If past evidence suggests that attempts lead to failure, why ISN’T it reasonable to assume that future attempts will lead to failure? Yes, the variables will be different, I guess, but it’s still a gamble. If you think I should give it a go anyway, then you may as well advise me to buy lottery tickets, imo. And I just can’t dredge up the sufficient motivation to pursue something with chances like that.
An equally valid frame would be to think that some outside circumstance was responsible (bad economy, say) or that you had not yet mastered the right skill set.
Kind of funny that you suggest blaming external forces instead of taking personal responsibility, but okay. I would say the latter is the case for me: I did not master the sufficient skill set, even after ten years or whatever. The people who are successful in my field do so MUCH earlier. So, okay, I didn’t master the right skill set. I don’t see how that’s supposed to make me feel any better. It doesn’t change my shitty situation. And it only makes me question, well why didn’t I? I wanted to; I attempted to. Clearly, I did something wrong. I either don’t have sufficient talent at my field or talent at learning to have mastered those skills.
But those are innate and permanent traits, which you (and many others) apparently consider invalid, which I don’t really get, but I’ll accept it for the moment. So due to non-innate and temporary faults, I failed to achieve my objectives. Again, how is this supposed to make me feel better? Because I’m supposed to believe those faults have mysteriously vanished, or I can work to improve them? Even if that’s so, the rewards that are reasonable to expect from attempting to improve them seem so minimal at this point that, again, it doesn’t seem worth bothering about. I’m willing to concede that this is depressive thinking, but it seems to me more like a difference of opinion than disordered reasoning: some people think hard work with little reward or low chance of a big reward is fun; I do not. It’s no different that my hating a movie you like and vice versa.
I asked that of someone else when they made the same statement about ECT. The most common side effect is memory loss. You prompted me to look into the details, and I guess I wouldn’t mind losing a couple months of memory (usually the only permanent effect). However, the jury appears to be out on ECT as well, so it may not even be worth it.
I actually looked at that exact website you linked to about ketamine. I’m all for it! However, all those studies are also across the country from me. Although you could say that quitting my job and staying across the country for 2 months is worth the chance of treating my depression, I’m not certain that the possible benefits outweigh the risk of being unemployed, and potentially for a long time, given the current labor market. After all, I could end up just in the control group and have no treatment at all, or the treatment could be ineffective.
Also, just for the sake of clarity, I was wrong: I’m actually not clinically depressed; I have dysthymia, which is a chronic low-grade depression (i.e. I can still function, go to work, seem normal, etc.). Maybe this is why none of my psychiatrists have recommended ECT, even when I was suicidal? Idk.
Sigh, well, I’ve been trying to fix it for about ten years (so as long as I’ve been failing. Coincidence?? Probably not). I’m on 2 anti-depressants right this minute (the fourth or fifth cocktail of which I’ve tried). I’ve gone through years of therapy. And the result? Still depressed, often suicidally.
So what else am I supposed to do? I refuse to go to therapy again. I’m sick of telling my whole life story over and over, and looking back on my past therapists, I think they were unhelpful at best and harmful at worst (for encouraging me to pursue my ludicrous pipe dreams, for instance). Moreover, talk therapy (including cognitive behavioral therapy, which some say is the most effective form) is, according to several meta-studies I’ve looked at, of dubious benefit.
I could try ECT, but apparently it has pretty bad side-effects. I’ve looked into submitting myself as a lab rat for deep brain stimulation (for science!), but haven’t been able to find a study that wouldn’t require quitting my job and staying somewhere across the country for two months. So here I am.
But if we can sidestep the ad hominem argument for a moment, it sounds like you’re saying that my aversion to failing at something else is irrational. Would you mind pointing out the error in my reasoning? (This sort of exchange is basically cognitive behavioral therapy, btw.)
That’s really irrelevant at this point. If you are clinically depressed, this is sufficient to explain both your failures and your lack of belief in your ability to succeed.
I am not a doctor and don’t want to give medical advice, but it seems to me that getting your depression under control must be the very first step you need to take—before you start thinking about new careers.
If my depression does explain my failures, then I really am pretty much destined to fail in the future since this appears to be treatment-resistant depression and as I described, I’ve run out of treatment options. Thanks anyway.
I agree with Lumifer that your priority should be treating your depression. Also, consider that your depression likely is making you pessimistic about your prognosis.
For about 5 or 6 years I had a treatment resistant fungal infection. I had to try 6 different antifungals until I found one that had some effect, and I tweaked the dosage and duration for most of those to try to make them work better. The last medication I tried didn’t work completely the first time, so I increased the dosage and duration. That totally wiped out the fungus. If you asked me if I ever thought I’d get rid of the fungal infection 6 months before I finished treatment, I’d have said no.
Knowing which antifungal medications didn’t work actually was the key to figuring out what did work. My doctor selected an antifungal medication which used a mechanism different from that of any other treatment I tried. I suggest that you look at which mechanisms the drugs that you have tried use and see what other options exist. There are many more depression treating drugs than antifungal drugs, and many more mechanisms.
You mentioned a few other non-pharmaceutical options you’ve considered. If you haven’t already considered it, I might suggest exercise. There seems to be reasonable evidence that exercise helps in depression. Anecdotally, I’ve read of several people who have claimed that running in particular cured their depression when nothing else provided much help. (I’ve suggested this to others before, and they generally think “That’ll make me feel worse!” People generally seem to discount the idea that as they get into better shape, exercise will become easier, enjoyable even.)
Yes, I’ve heard this before, but I don’t see why any reasonable, non-depressed person would be pessimistic about it. As I’ve said, it’s not like this is the first time I’ve ever been depressed in my life and I’m irrationally predicting that I can’t be cured. And I’ve heard stories like yours before: people who were depressed until they found the right combination of medications. But in my situation, my psychiatrists have gone back and forth between different combinations and then right back around to the ones I already tried. Changing them up YET AGAIN just feels like shuffling the deck chairs around on the Titanic (but of course I’d say that). If there are tons more different medications to try as you assert, none of my psychiatrists seem to know about it.
To be fully clear, anti-depressants have had an effect on me. I definitely don’t feel unbearably miserable and anxious as I do without them. They just haven’t gotten me to 100%.
I GUESS I could ask my psychiatrist to try yet another combination I haven’t tried before. But it just sounds like a nuisance, frankly.
As for exercise, yes, I’ve heard that countless times. I used to be much more active, and don’t recall it ever having a palpable effect on my mood. Nowadays, it’s just not gonna happen. I’ve tried to get myself to exercise, with some occasional success, but with my work schedule, when it finally comes time to do it, I flatly refuse. You could say, “you just gotta find something you enjoy!!” But I’m depressed! I enjoy nothing! (/sarcasm) I guess I could make sure to make time for hiking (probably what I enjoy the most) or get a membership at an expensive gym near work (which would be the most convenient arrangement for me) but the fact that exercise never particularly had an effect on me makes me not particularly motivated to do so.
Wikipedia lists many. I count 21 categories alone. I would suggest reading at least a bit about how these drugs work to get some indication of what could work better. Then, you can go to your psychiatrist and discuss what you’ve learned. Something outside of their standard line of treatment may be unfamiliar to them, but it may suit you better.
For my last antifungal treatment, I specifically asked for something different from what I had used before and I provided a list of antifungal meds I tried, all of which were fairly standard. My doctor spent a few minutes doing some searches on their computer and came back with what ultimately worked.
Huh, interesting. Up-managing one’s doctor seems frowned upon in our society—since it usually comes in the form of asking one’s doctor for medications mentioned in commercials—but obviously your approach seems much more valid. Kind of irritating, though, that doctors don’t appear to really be doing their job. :P
The exchange here has made me realize that I’ve actually been skipping my meds too often. Heh.… :\ So if I simply tighten that up, I will effectively increase my dosage. But if that doesn’t prove to be enough, I’ll go the route you’ve suggested. Thanks! :)
SSRIs, for example, aren’t supposed to do anything more than make you feel not completely miserable and/or freaked-out all the time. They are generally known to not actually make you happy and to not increase one’s capability for enjoyment. If you are on one, and if that’s a problem, you might actually want to look at something more stimulant-like, i.e. Bupropion. (There isn’t really another antidepressant that does this, and it seems unlikely you’ll manage to convince your psychiatrist to prescribe e.g. amphetamines for depression, even though they can work.)
And then there is, of course, all sorts of older and “dirtier” stuff, with MAOI’s probably being something of a last resort.
Yeah, that accurately describes their effect on me.
I used to be on Buproprion, but it had unpleasant physical effects on me (i.e. heart racing/pounding, which makes sense, given that it’s stimulant-like) without any noticeable mood effects. I was quite disappointed, since a friend of mine said he practically had a manic episode on it. However, I took it conjunction with an SNRI, so maybe that wouldn’t have happened if I’d just taken it on its own.… Idk.
I’m actually surprised my psychiatrist hasn’t recommended an MAOI to me in that case, since she freaks the hell out when I say I’m suicidal, and I’ve done so twice. I’ll put MAOIs at the bottom of my aforementioned new to-do list. :)
As far as depression goes curetogether has a list of things that it’s users found helpful.
I don’t think gyms are ideal. Going to the gym feels like work. On the other hand playing a team sport or dancing doesn’t. At best a weekly course that happens at a specific time where you attend regularly.
It seems you’re playing a “Yes, but” game. I am sure you can win it, do you really want to?
Yes. :)
But...
;-)
You should check out my response to one of the other comments—I think it’s even more “yes, but”! I kind of see what you mean, but it sounds to me like just a way of saying “believe x or else” instead of giving an actual argument.
However, the ultimate conclusion is, I guess, just getting back on the horse and doing whatever I can to treat the dysthymia. I’m just like… ugh. :P But that’s not very rational.
Thanks for the feedback.
Many of the things that you have said are characteristic of the sort of disordered thinking that goes hand-in-hand with depression. The book Feeling Good: The New Mood Therapy covers some of them. You may want to try reading it (if you have not already) so that you will be able to recognize thoughts typical among the depressed. (I find some measure of comfort from realizing that certain thoughts are depressive delusions and will pass with changes in mood.)
As a concrete example, you said:
These are basically the harshest reasons one could give for failing at something. They are innate and permanent. An equally valid frame would be to think that some outside circumstance was responsible (bad economy, say) or that you had not yet mastered the right skill set.
I am thoroughly familiar with Feeling Good and feel that I can argue circles around it. My original statement (that I’ll fail at everything) is an example of “overgeneralization” and “fortune telling.” But this sounds to me like just a way of stating the problem of induction: nothing can ever be certain or generalized because we don’t know what we don’t know etc. etc. However, science itself basically rests on induction. If I drop a steel ball (from the surface of this planet), will it float, even if I think positively really hard? No. It won’t. Our reason makes conclusions based on past evidence. If past evidence suggests that attempts lead to failure, why ISN’T it reasonable to assume that future attempts will lead to failure? Yes, the variables will be different, I guess, but it’s still a gamble. If you think I should give it a go anyway, then you may as well advise me to buy lottery tickets, imo. And I just can’t dredge up the sufficient motivation to pursue something with chances like that.
Kind of funny that you suggest blaming external forces instead of taking personal responsibility, but okay. I would say the latter is the case for me: I did not master the sufficient skill set, even after ten years or whatever. The people who are successful in my field do so MUCH earlier. So, okay, I didn’t master the right skill set. I don’t see how that’s supposed to make me feel any better. It doesn’t change my shitty situation. And it only makes me question, well why didn’t I? I wanted to; I attempted to. Clearly, I did something wrong. I either don’t have sufficient talent at my field or talent at learning to have mastered those skills.
But those are innate and permanent traits, which you (and many others) apparently consider invalid, which I don’t really get, but I’ll accept it for the moment. So due to non-innate and temporary faults, I failed to achieve my objectives. Again, how is this supposed to make me feel better? Because I’m supposed to believe those faults have mysteriously vanished, or I can work to improve them? Even if that’s so, the rewards that are reasonable to expect from attempting to improve them seem so minimal at this point that, again, it doesn’t seem worth bothering about. I’m willing to concede that this is depressive thinking, but it seems to me more like a difference of opinion than disordered reasoning: some people think hard work with little reward or low chance of a big reward is fun; I do not. It’s no different that my hating a movie you like and vice versa.
What side effects make ECT worse for you than depression and the risk of death? Have you looked into ketamine trials?
I asked that of someone else when they made the same statement about ECT. The most common side effect is memory loss. You prompted me to look into the details, and I guess I wouldn’t mind losing a couple months of memory (usually the only permanent effect). However, the jury appears to be out on ECT as well, so it may not even be worth it.
I actually looked at that exact website you linked to about ketamine. I’m all for it! However, all those studies are also across the country from me. Although you could say that quitting my job and staying across the country for 2 months is worth the chance of treating my depression, I’m not certain that the possible benefits outweigh the risk of being unemployed, and potentially for a long time, given the current labor market. After all, I could end up just in the control group and have no treatment at all, or the treatment could be ineffective.
Also, just for the sake of clarity, I was wrong: I’m actually not clinically depressed; I have dysthymia, which is a chronic low-grade depression (i.e. I can still function, go to work, seem normal, etc.). Maybe this is why none of my psychiatrists have recommended ECT, even when I was suicidal? Idk.