Medication treating major depression but not dysthymia?

[Banned]

Does it make sense that my medication (10mg Cipralex) has done a pretty decent job of preventing major depressive crashes over the last ten months but hasn't really worked on my dysthymia?

I'm not majorly depressed anymore or suicidal but I'm pretty blah...I don't have much energy or enthusiasm for much and seem to carry a constant undertone of sadness.

Throw in some anxiety and ocd stuff and I don't feel as good as I should or would like to. I want to go back to my psychiatrist and get my meds adjusted but I don't know when I'll be able to do that, and once again, I'm terrified of side effects. I thought the Cipralex would be a one-size fits all but probably not. I definitely need some anti-anxiety meds because I wake up with excruciating stomach pain every day.

I definitely don't want to start the never-ending cycle of "try this" no wait "try that" oh wait "maybe this will work".

I just dont' know where to settle or where to keep pushing for improvements. I'm not in therapy at all so everything rides on my meds.

 

[Daniel E.]

I'm not in therapy at all so everything rides on my meds.

Of course, there are a number of things that can help the brain, including exercise. Even learning something new can help with feeling good.

 

[Banned]

But if you're doing all those things consistently, should they not have a carryover effect? In other words, shouldn't the improvement last longer than the moment you're doing them? I exercise, I'm stupid busy and all my jobs are very physical (I run through an airport for seven or eight hours a day, work in two grooming shops grooming dogs, and teach agility classes), I don't isolate, I'm constantly looking for new activities and hobbies, I try to put things in my life that enhance it. During the day when I'm at work I'm ok, but when I get home and start to relax or reflect on my day, an overwhelming sadness takes over me. As long as I'm busy, I'm usually ok.

I also find I have mini bursts throughout the day of being in a really, really good mood, but an hour later I might be really depressed and sad and then in another hour I'm ok again. This seems to imply to me that maybe my meds aren't the right ones? Or I need more, or something.

Like I said, I don't know at what point I say "this is as good as it's going to get" and stop being greedy wanting more or better, or when to keep pushing and say "I can't settle for this - I'm still not ok". I think that's the confusing thing for me right now.

 

[David Baxter PhD]

Medication can't do all the work. My guess is that you should be in therapy again. Or still.

 

[Banned]

I'm not out by choice. It's the way it has to be right now.

---------- Post added at 09:07 PM ---------- Previous post was at 07:32 PM ----------

I guess I am out by choice, now that I think about it. I never have anything to talk about because things are so sporadic. I've kind of outgrown my last therapist and wouldn't know where to start again, so I'm trying to just deal with this on my own. The depression isn't crippling for the most part, just nagging...it just never goes away, and I'm doing the stuff I need to do. I'm doing everything I've ever been told to do and then some, which is why I think I might need a med change, or alternatively, my expectations are too high. I don't know what it is. At this point, I have yet to hear anything that I'm not already doing with concerted effort, which I attribute the significant progress I *have* made in the last year to, almost entirely on my own. I've been to a therapist only four or five times in the last year, and just to make sure I'm on track. She assured me I am doing everything right so again - do I need a med change or are my expectations too high? When I do go see her, we're done talking in the first ten minutes.

 

[Daniel E.]

Weren't you having problems locating a therapist experienced in CBT? Which I still find surprising since CBT is so popular.

 

[Banned]

The problem isn't so much the CBT but the borderline diagnosis. I was in touch with someone last week who deals a lot with anxiety and ocd and she said that she was ok with a borderline diagnosis because quite frankly most diagnoses are wrong and other therapists don't understand the need that people with ocd have to live within a rigid set of rules (her words). I decided to leave that and asked to book an initial appointment to meet with her only to find out she charges almost $300/hr (45 minutes). I'm not paying that. I don't care how good they claim to be. I've had too many experiences that have left me very skeptical and thus wanting to rely more on meds than anything else, especially when I know how to do cbt, I know how to manage my anxiety (kind of), I know how to incorporate competing behaviours when I start counting or picking and need to change gears. I know how to do all that and I do it.

I'm not sold on therapy right now because I've been doing it forever and pretty much come to a stall. I don't need to be taught skills at this point - I have them. I need to process things, and talk. And I need someone who can help me figure stuff out, but they're all too busy doing emdr and tapping. I don't feel listened to anymore and I feel immediately judged. Yep, I'm diagnosed with borderline, depression, ocd, and anxiety. But me on my worst day I am still better than a lot of people on their best day but nobody sees past the damn labels. I'm not suicidal and I'm not stupid but I often feel both when I leave my therapist's office.

 

[Daniel E.]

Sounds like you want client-centered therapy.

 

[Banned]

I'll have to look that up to see what it means. But if it means it's all about me, then yep. Me me me

Problem is, I can't do all the thinking. I know I don't feel right. I know I don't fit in with the world. I know I have this constant undertone of sadness and while I'm not actively thinking about suicide at all anymore, I can take or leave life. I'm kind of apathetic. I need to know why I feel this way, what's happened or not happened to get me here. I'm a "why" person. I want the big picture. The understanding. But if my therapist just nods and says it's understandable that I feel this way, and doesn't help me figure it out, but tells me I'm doing great in spite of feeling this way, well, that's not helpful. And I don't understand why it's so hard for someone to help me figure this out. Maybe I need to spend some time with Freud when I die (ok I'm not really a Freud fan).

I've made progress in that I'm not actively self-destructing at all, and I'd be ok if I lived to be 96 and I'm making plans for my future now and protecting my future...I wasn't doing any of that a year ago. And it's all well and good that I've done all these amazing things this past year, but I'm still really, really sad.

---------- Post added at 09:50 PM ---------- Previous post was at 09:46 PM ----------

It's actually worse feeling this way because I *want* to live and be happy, but I don't know what I'm doing wrong.

A year ago I didn't even want to live, so I didn't really care that I was miserable. That was actually easier to cope with because suicide was still an option and I didn't even want to get better. Suicide is no longer an option for me which leaves me now feeling even more stuck because I desperately want something better because I plan on being around for a long time but again, I don't know how to get it.

---------- Post added at 09:54 PM ---------- Previous post was at 09:50 PM ----------

AND...(one more thing...)

September of last year I went off my meds because I knew it would spin me into a deep enough depression where I actually could end things, and I was almost very successful...I was using it as a way to get me to where I could die "with an excuse".

Now I'm terrified to even mess with my meds because even though I feel like I could do better, I'm terrified to lose the ground I've gained.

 

[Daniel E.]

It's actually worse feeling this way because I *want* to live and be happy, but I don't know what I'm doing wrong.

Certainly, with generic, run-of-the-mill depression, there is some cognitive behavioral inflexibility that is associated with feeling "stuck."

So, for example, one approach that is similar to DBT:

ACT commonly employs six core principles to help clients develop psychological flexibility:

Cognitive defusion: Learning methods to reduce the tendency to reify thoughts, images, emotions, and memories, i.e., singing compulsive thoughts.
Acceptance: Allowing them to come and go without struggling with them.
Contact with the present moment: Awareness of the here and now, experienced with openness, interest, and receptiveness.
Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is unchanging.
Values: Discovering what is most important to one's true self.
Committed action: Setting goals according to values and carrying them out responsibly.

Acceptance and commitment therapy - Wikipedia, the free encyclopedia

 

[Banned]

I am so dumb. I forgot that now that I work for a real company I have access to free counselling through our EFAP Program. Free makes me happy. Then if it sucks I can't complain. I'm going to call them tomorrow, and I left a message for my psychiatrist to look at my meds today so hopefully I'll hear back from her soon too.

I cried myself to sleep last night. I was just so bummed about all this. Pretty cranky today too but maybe I was just hormonal.