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Depression revisited - 5/28/2007 1:52:15 AM   
SweetDommes


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For those who remember my last thread on this topic - I'm now on an anti-depressant.  I was having suicidal thoughts again, and decided that I was done with that nonsense.  I'm on lexapro, and with the exception that it threw my sleep cycle into horrible disarray for the first month (I'm still working on getting it fixed), and the three days where it felt like my skin was trying to crawl off my body (that was last week's fun), I'm feeling much better now.  Hopefully this is the end of depression for me.

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Earth is the insane asylum for the universe.

Friends are God's apology for relatives
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RE: Depression revisited - 5/28/2007 4:46:34 AM   
LeatherBentOne


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Some people who suffer from depression find it necessary to try different anti-depressants or combinations thereof before they get adequate relief.  Im fortunate as Ive been on the same medication since 1991 and it's still working.  Also, be aware that it takes 4-6 weeks before the medication levels reach their peak in your bloodstream, so don't be too quick to toss a particular  medication aside because of side effects.  They decrease as time passes.

Im also one of those people who, when being diagnosed, was told that I'd probably be on anti-depressants for the rest of my life.  Being on medication for any reason is a challenge for some, especially those people like myself.  Just in case you need to stay on anti-depressants for an extended period of time, please remember that it's not your fault youre depressed and it doesnt mean you are weak.  It means that you have the courage to reach out for a helping hand and accept that hand when its extended to you.

At times, people can seem cruel because they arent educated, and they pass remarks like my sister did, "What do you have to be depressed about?"  Others may use your depression to degrade you because they are insecure.  My advise is to read upon depression so that you can educate the ones that lack knowledge of the disease, and dismiss the ones who are just plain ignorant.

Best Wishes
LBO

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RE: Depression revisited - 5/28/2007 5:51:22 AM   
adoracat


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i've been on antidepressants before.  there's a large family history of mental illness...depression, depression self-treated with alcohol, schizohphrenia, bipolar disorder.

i tried to commit suicide with an overdose of antidepressants (16 years ago the 25th) and so for *me*, i wont take them again.  my personal choice.

my mama has been on them for some 20 years now.  her brain doesnt make some of the chemicals it needs, and my grandmother used to give her holy hell about it.  i had enough one day and told granny "fine, you give up your heart meds, and your glasses"  "but i need those to be healthy and to see!"

"so does mama.  when you can give up your things that you need, THEN you talk to her."  granny fumed and called me a hyena again, mama cried and hugged me and i stood there cape blowing in the wi...

nah, just the first two of those happened.  but being on the right path for treatement, and feeling better again, those things can sure make you feel like a bit of a superhero.  :)

kitten, who still has bad days, but deals.

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RE: Depression revisited - 5/28/2007 8:52:27 AM   
SweetDommes


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I know about it taking time to get into my system and the side effects and stuff - I'm a nurse lol

I just wish that I could get my sleep cycle back to normal *sigh*

_____________________________

Miss Karen and Miss Holly

Earth is the insane asylum for the universe.

Friends are God's apology for relatives

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RE: Depression revisited - 5/28/2007 9:00:13 AM   
DommeChains


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A psychiatrist friend of mine frequently recommends the use of melatonin to help re establish sleep cycles when the patient is on anti depressants.  You might want to ask your doctor what he/she thinks of you trying it.

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RE: Depression revisited - 5/28/2007 10:10:11 AM   
VeryMercurial


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I am glad you are feeling much better.
I take Zoloft, it has helped me a lot.
Good luck and feel better.

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RE: Depression revisited - 5/29/2007 8:54:43 AM   
Aswad


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quote:

ORIGINAL: LeatherBentOne

Some people who suffer from depression find it necessary to try different anti-depressants or combinations thereof before they get adequate relief.


Depending on the figures, anywhere from about 30% (conservative clinical figures) to 85% (optimistic research figures) of people will get relief from the first antidepressant they try. The huge difference in the figures is due to the inclusion/exclusion criterion for research; a head pdoc at the local ward said he'd never seen a patient in clinical practice that fit the criterion for the research. Clinical figures vary with the skill of the treating physician, sample variation, and so forth.

Fairly solid clinical figures put the number of people who are treatment refractory (three unsuccessful attempts at treatment) in the range from 10-30%. About 75-85% of these will achieve remission if treated with tranylcypromine (Parnate) at doses of 2.4mg/kg/dy; this is expensive, however, and the doctors are reluctant to try it (interactions; dietary restrictions).

Combinations are more frequently used than they should be in regular patients (the most fashionable being Wellbutrin + SSRIs, which has not been scientifically researched/tested), and are less frequently used than they should be in refractory patients.

quote:

Im fortunate as Ive been on the same medication since 1991 and it's still working.


Good to hear. That's the way it's supposed to work. I know some people who have been on Parnate or Nardil since they came on the market; some drugs are more robust than others, but if remission is achieved, continuing to take the meds is fairly effective in preventing a relapse.

quote:

Also, be aware that it takes 4-6 weeks before the medication levels reach their peak in your bloodstream, so don't be too quick to toss a particular  medication aside because of side effects.  They decrease as time passes.


The side-effects decrease, at least most of them, and you get used to what's left, so you don't generally notice it all that much.

It does not take 4-6 weeks to reach either steady-state or peak, though, with the exception of a few drugs (TCAs, mood stabilizers). Peak is reached in hours, at most; steady-state is reached in days. What can take longer, however, is for the body to adapt.

How long it takes before the med starts working, if it will, depends on the type of med and the type of depression. Amineptine (Survector) prompted several case reports of complete remission in 1-3 days. I've seen moclobemide (Manerix; Aurorix), first-hand, cause a clinically significant improvement in hours; same thing goes for tranylcypromine and l-deprenyl/selegiline. Both should be given 1 week to start working, however, as the rate of response depends on the nature of the depression. SSRIs generally take 2-4 weeks before they start working.

quote:

Im also one of those people who, when being diagnosed, was told that I'd probably be on anti-depressants for the rest of my life.  Being on medication for any reason is a challenge for some, especially those people like myself.


Life-time maintenance therapy can be beneficial, particularly with recurring depression. There are some concerns about safety and efficacy, however; e.g. the SSRIs apparently increase the likelyhood of osteoporosis quite significantly. MAOIs are the only ones that have had time (and ability) to show long-term safety, as they have been on the market for like four decades or something, and some have used them that long.

I can relate to the difficulty accepting long-term medication, particularly if it is of a sort that interferes with personality, energy or cognitive performance; it took me a long time to get to the point where I was willing to try the first one.

After I read up on it, however, I realized that there are several meds out there that I don't have a problem with, should I end up needing long-term maintenance, and few I have a big problem with for short-term use.

quote:

At times, people can seem cruel because they arent educated, and they pass remarks like my sister did, "What do you have to be depressed about?"  Others may use your depression to degrade you because they are insecure.


My personal favourite, at a time when I was too messed up to get out of bed, was, "You never told me you were a complete retard when you rented the place" ... that was a nurse. I just ground my teeth, swallowed the bile, and reminded myself that my salary probably had one more digit than hers, and that 'retard' ... well, I'm 98th-99th percentile, so suffice to say that doesn't cover it in any way.

Family can be particularly irksome, because one becomes conflicted about whether to tell them to sod off or "I love you, too". And there's the whole thing about revisiting the issue of "is there really something wrong with me?" and "why can't I 'just pull myself together'?", which bites more when the statements that reintroduce that doubt come from people one is supposed to be able to trust. Never mind the whole bit about feeling like you're pulling people you love down into the gutter with yourself, not wanting to be a burden, etc.

I try to bear in mind Hanlon's Razor when confronted with ignorance:

Never attribute to malice what can be adequately explained by incompetence.


Of course, I've seen a fair bit of malice, too, but there will always be POS bastards out there.

quote:

My advise is to read upon depression so that you can educate the ones that lack knowledge of the disease, and dismiss the ones who are just plain ignorant.


That's sound advice.

If the meds don't work, it might also be good to read up on treatment; the docs are often too overworked to keep up with the newest research, or even the markers that indicate what kind of meds are more likely to be useful.

_____________________________

"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do.
" -- Rorschack, Watchmen.


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RE: Depression revisited - 5/29/2007 9:04:55 AM   
Aswad


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quote:

ORIGINAL: adoracat

i tried to commit suicide with an overdose of antidepressants (16 years ago the 25th) and so for *me*, i wont take them again.  my personal choice.


There are many better ways to do it than with antidepressants.

I've got a lethal dose of phenobarbital lying around, but I don't have a problem with it: if I wanted to, I could do it a million different ways. A friend of mine said after spending two days involuntarily committed because some doc mistook her dislike of him as suicidality, that she identified about half a dozen surefire ways to kill herself in the ward without anyone being able to stop her.

Of course, phenobarbital is one of the better choices, possibly combined with an opiate pain-killer (they also take away any fear). Irreversible; neat, tidy corpse; and the pathologist can safely say one went peacefully. All in all, that many less things going through the loved ones' heads afterwards.

quote:

kitten, who still has bad days, but deals.


It usually turns out well, eventually. You might want to try hard exercise, green tea, proper nutrition (incl. supplements) and a regular sleep pattern with 9 hours per night. Pretty hard to overdose on that.

Oh, and serious pain helps. Even whipping yourself on a daily basis will make a difference. I'm not joking. Russian pdocs have started using it because they can't legally prescribe opioids to patients.

Of course, there are also antidepressants that won't be fatal (or permanently injuring) in overdose, although almost all will be unpleasant or give a rush.

_____________________________

"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do.
" -- Rorschack, Watchmen.


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RE: Depression revisited - 5/29/2007 9:10:10 AM   
Aswad


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quote:

ORIGINAL: SweetDommes

I just wish that I could get my sleep cycle back to normal *sigh*


Rozarem.

It's kind of like melatonin, in that it works at the same receptors, except it doesn't affect the stomach, and is way more potent.

If you're having a temporary problem, it can also work to talk to a sleep doc about what they call "sleep hygiene", and possibly use a benzo or barbiturate to "force" a proper sleep pattern for a little while. Melatonin should combine okay with that.

_____________________________

"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do.
" -- Rorschack, Watchmen.


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RE: Depression revisited - 5/29/2007 3:26:20 PM   
Vendaval


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Glad to hear you are feeling better overall.  Are your sleep patterns
completely backward or broken up into separate period of time? 

_____________________________

"Beware, the woods at night, beware the lunar light.
So in this gray haze we'll be meating again, and on that
great day, I will tease you all the same."
"WOLF MOON", OCTOBER RUST, TYPE O NEGATIVE


http://KinkMeet.co.uk

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RE: Depression revisited - 5/30/2007 3:42:23 AM   
Aswad


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quote:

ORIGINAL: DommeChains

A psychiatrist friend of mine frequently recommends the use of melatonin to help re establish sleep cycles when the patient is on anti depressants.


That would depend on the antidepressant, wouldn't it? I mean, adding melatonin to e.g. the MAOIs would seem outright dangerous, since the bioavailability would be increased, along with the body ceasing to break it down. And κ-antagonists or µ-agonists will (iirc) tend to elevate melatonin by themselves.

_____________________________

"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do.
" -- Rorschack, Watchmen.


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RE: Depression revisited - 5/30/2007 4:22:42 AM   
Donnalee


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My UM takes 3mg of Melatonin an hour before bed for about a week when his sleep schedule gets disturbed or out of whack.....it doesn't seem to mess with his SSRI at all, and gets him back on a nice rhythm.  I've never seen any negative side effects of it.

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RE: Depression revisited - 5/30/2007 5:05:01 AM   
DommeChains


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Let me clarify then.  This particular doctor rarely uses MAOIs due to their frequent interactions with many other meds.  The majority of the anti depressants ordered are SSRIs or atypical ones such as Wellbutrin.  Nor does this doctor recommend this to everyone.  I have worked with this doctor for several years and have seen good results with the combination of melatonin with most of the more commonly prescribed anti depressants when someone has had a disruption of their sleep patterns either due to the underlying depression or as a side effect of the medication.

Of course the doctor takes many issues into consideration before making a recommendation and each patient is considered holistically before anything is prescribed or recommended.  As with any treatment option there are risks, exceptions and sometimes less than desirable results.  I was merely offering a suggestion to the OP and did suggest the OP discuss it with her physician.

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RE: Depression revisited - 5/30/2007 7:33:04 AM   
SweetDommes


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quote:

ORIGINAL: Vendaval

Glad to hear you are feeling better overall.  Are your sleep patterns
completely backward or broken up into separate period of time? 


Right now, my body wants to be awake for 3-5 hours, then sleep for 4-6, then be up again for 3-5.  It's crazy.  I have trouble sleeping for more than 6 hours at a time.

I am getting better though - the first week to week and a half, I could only sleep 2-3 hours at a time.

_____________________________

Miss Karen and Miss Holly

Earth is the insane asylum for the universe.

Friends are God's apology for relatives

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RE: Depression revisited - 5/30/2007 7:59:53 AM   
Aswad


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quote:

ORIGINAL: Donnalee

My UM takes 3mg of Melatonin an hour before bed for about a week when his sleep schedule gets disturbed or out of whack.....it doesn't seem to mess with his SSRI at all, and gets him back on a nice rhythm.  I've never seen any negative side effects of it.


Taken by itself, or along with only an SSRI, there are rarely any significant side-effects in short term use. Long-term use is more unclear, as animal studies have given mixed results. Epilepsy might prove to be a "use with caution" in the long run.

All in all, a wonderful med. Helps a lot of people with little problem.

_____________________________

"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do.
" -- Rorschack, Watchmen.


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RE: Depression revisited - 5/30/2007 8:31:18 AM   
Aswad


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quote:

ORIGINAL: DommeChains

Let me clarify then.


I got it, I just wanted to point out (in case others didn't know; it's OTC most places, after all) that it isn't the case for all antidepressants.

quote:

This particular doctor rarely uses MAOIs due to their frequent interactions with many other meds.


Fair enough.

They are rarely "necessary", as such, although I think they make a nice alternative to ECT in serious cases, and work quickly and effectively in most cases of atypical depression.

You might want to point him in the direction of Manerix and Emsam, both of which bear having a closer look at.

Unlike the older ones, their CYP enzyme "footprint" is very limited, and they are more selective. Manerix is reversible, and Emsam doesn't have a significant impact on GI-tract MAO-enzymes, so both can go pretty far before dietary restrictions become a problem (the exception being Marmite and Bovril, as always, which I'd call OTC adrenergics, not foodstuffs); 600mg and 6mg respectively (more, according to trials, but FDA is conservative with overseas products). Both are rapid-acting (about twice as fast as SSRIs, except for atypical depressives where they tend to start exerting a weak effect after about 90 minutes), neither carries a significant risk in case of overdose.

The usual interactions with sympathomimetics (amphetamines, ephedrine, epinephrine, cocaine, etc.) and opioids remains, but can (as always) be managed by adjusting the dose; it's not brain surgery, any doctor can do it.

quote:

The majority of the anti depressants ordered are SSRIs or atypical ones such as Wellbutrin.


SSRIs are not a problem in combination with melatonin, AFAIK. I do seem to recall that Wellbutrin might be questionable, though, due to the effect on seizure threshold. There is some potential to trigger subclinical epilepsy with such a combination, IIRC, but it's rare.

quote:

Nor does this doctor recommend this to everyone.


I wasn't criticising the doctor. Sorry if it came across that way.

quote:

I have worked with this doctor for several years and have seen good results with the combination of melatonin with most of the more commonly prescribed anti depressants when someone has had a disruption of their sleep patterns either due to the underlying depression or as a side effect of the medication.


Melatonin is indeed a "wonder drug" for many people with sleep pattern disturbances, especially since it's so hard to get people to enforce proper sleep hygiene.

For me, though, the only things that have resolved my sleep issues are (a) continous use of buprenorphine, which I was prescribed for treatment refractory depression at the time, (b) intermittent use of flunitrazepam, which is still legal here, or (c) continous or intermittent use of phenobarbital.

I use 50mg of phenobarbital now. That's too low a dose to act as a hypnotic, and I don't develop a tolerance to the effects. It's the first time since my teenage years that I've had any significant amount of stage IV sleep, and I can successfully wake up (rested, even) without my dear nephandi having to dare bring out the bucket of ice water.

quote:

I was merely offering a suggestion to the OP and did suggest the OP discuss it with her physician.


Indeed, and good advice. Didn't mean to suggest otherwise. Some people do take OTC drugs without talking to their physician first, though, so I figured it a reasonable precaution to mention that it depends on the type of antidepressant. Again, not criticising.

_____________________________

"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do.
" -- Rorschack, Watchmen.


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RE: Depression revisited - 5/30/2007 9:08:57 AM   
slaverosebeauty


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I guess I am one of the lucky ones, I have NEVER had to take anything for my depression, I use other methods of fighting it. I took a class that had a LOT of different suggestion on how to combat depressoin WITHOUT meds, that was over 10 years ago. I hit the bottom a few times, but, never took meds, I balanced things on my own.

With who I was around, music, food, activities, etc. I do believe a lot of it is, mind over matter. I decided to NOT let my depression own me, once I did that, and set my mind to it, its harder for the depression to rule me, its difficult at times, but, its worth it.

Good luck with the new meds, you might want to also try St. Johns Wort; at my worst times, it helps.

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RE: Depression revisited - 5/30/2007 9:15:06 AM   
KatyLied


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Sleep disturbance is a hallmark of depression.
If it continues ask your doctor for recommendations.
The best thing in the meantime is to commit to a ritual for bedtime, the same activies prior to bedtime, same bed time every night, no napping during the day, etc, some people find different things calming and use relaxation techniques.



_____________________________

“If you want to live a happy life, tie it to a goal, not to people or things.”
- Albert Einstein

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RE: Depression revisited - 5/30/2007 10:07:03 AM   
SweetDommes


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rose - I did St. John's Wort ... it made me sick to my stomach unless I ate quite a bit of food with it, and didn't work well enough.  I also tried various non-medicine things (spending more time out in the sun, exercising, etc. etc. etc.).  I was still suicidal from time to time and I was tired of it.

Katy - unfortunately, because I almost never get home from work at the same time two days in a row, it's very very difficult to get any kind of routine going in terms of bedtime.  I am working on it though - and I plan to talk to my doctor in another couple of weeks.  I'm just glad that the feeling of my skin trying to crawl off my body has stopped.

_____________________________

Miss Karen and Miss Holly

Earth is the insane asylum for the universe.

Friends are God's apology for relatives

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RE: Depression revisited - 5/30/2007 1:53:33 PM   
Aswad


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quote:

ORIGINAL: slaverosebeauty

I guess I am one of the lucky ones, I have NEVER had to take anything for my depression, I use other methods of fighting it. [...] Good luck with the new meds, you might want to also try St. Johns Wort; at my worst times, it helps.


St. John's Wort is a herbal antidepressant of comparable potency and side-effects to the SSRI class of medications. Through the two active ingredients, it acts on a number of different neurotransmitters in various unpredictable ways, making it what is called a "dirty drug". There are plenty of synthetics that do the same thing, and IIRC, the principal active ingredient of St. John's Wort can be synthesized.

I don't get what's up with artificially distinguishing between man-made and chance-made. Sure, plants do their darndest best to think up ways to dissuade or kill whoever eats them, and this can sometimes have paradoxically positive effects on people. It doesn't mean the mechanisms are different, just that one is discovered, and the other is engineered. By now, most of what we eat, drink and supplement ourselves with is virtually engineered, by the use of selective breeding and (sometimes) genetic engineering.

quote:

I took a class that had a LOT of different suggestion on how to combat depressoin WITHOUT meds, that was over 10 years ago. I hit the bottom a few times, but, never took meds, I balanced things on my own.


That's not the bottom, then.

It may feel like the bottom but, speaking from experience, there is a long way to go at that point. A few years before things got real bad for me, I thought I'd hit bottom too. Life did not see fit to leave me in blissful ignorance, though. Crawling back at that point takes everything, even with meds that are strong enough to kill you if you're not careful. Got off with a few trips to the ER, some temporary heart issues and a few months of circulatory collapse, though, so nothing bad. Feels good when you finally improve enough to spend your days crying and banging your head on the wall occasionally.

Studying the topic in depth has convinced me of one thing: the bottom is an illusion, there's always further to go.

The interesting dividing line, to me, is the one where one has "fallen, and can't get up". That's when the meds become necessary to recovery, rather than a potential aid.

quote:

With who I was around, music, food, activities, etc.


If one can still abide the company of others, enjoy music, eat without being forced to, or undertake any sort of activity, the bottom is nowhere in sight.

What is frequently described as "hitting bottom", is really the point when a light depression begins. For comparison, in laymans terms, moderate depression is when suicide might actually be the rational choice for that individual (emphasis on might), although generally detrimental to the people around; severe depression is what might in less politically correct times may be referred to as being "stark raving mad".

At least, that is a rough summary of the scale my pdoc used.

quote:

I do believe a lot of it is, mind over matter.


Not so much mind over matter, as mind over mind.

Therein lies the difficulty.

It's like trying to lift yourself off the ground.

You can find something external to lift yourself with, whether a crane, a rope, a friend, a higher place to grab and pull, or whatever. By analogy, to the extent that your mind is still healthy enough to change the environment so that the stressors/dissonances/whatever can be managed, then you can "lift" yourself; similarly, meds can usually do it, therapy can sometimes do it, and so forth. A quadraplegic will have difficulty lifting themselves more than a few inches off the ground, while someone else can lift them back in their chair.

quote:

I decided to NOT let my depression own me, once I did that, and set my mind to it, its harder for the depression to rule me, its difficult at times, but, its worth it.


I'm very glad that worked for you.

For me, at the time, though, there would be a few problems with that approach, such as "I/me", "decided", "let", "set", "mind" and "worth it", all of which were void concepts at the time.

In helping with the treatment of other people with depression, I've found some markers to sort them according to what will be most useful to them, but that's complicated.

Suffice to say that, if one thinks "BDSM" is too broad an umbrella, depression is a useless term.

P.S.: In no way was this post meant to invalidate your experiences. I hope things will keep improving for you. I'm glad your efforts have worked.

_____________________________

"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do.
" -- Rorschack, Watchmen.


(in reply to slaverosebeauty)
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