Depression

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bookworm966 -> Depression (6/25/2008 9:40:24 PM)
I felt the depression lift for a little while. But it came back, creeping in like stormclouds. Those around me think I need 'a little vacation'. I wonder if a short inpatient stay would be cheaper than taking a real vacation? DAMN this thing thats wrong with my brain that makes me this way. I hate it. Sometimes I hate me. The meds arent working like they were. I'm not dealing with stressors well. I hide in my room, and my therapist says I'm isolating too much. I dont go out of the house unless I have to or someone makes me. I dont want to. I know inside me, the part that still thinks well, that a hospitalization is coming. I dont want to do that either. I miss work, lose money, obsess over the bills that still come anyway, and come home to the same problems that I left. I'm averaging a major episode a year. I feel weak and helpless. I'm not suicidal. Yet. Been there, done that, dont really want to go there again.

GreedyTop -> RE: Depression (6/25/2008 9:54:57 PM)
hugs I know exactly what you mean... is there a way you can go do a long weekend at a nice little B&B somewhere, maybe? a bandaid solution, at best, but sometimes, for me, that little bit of a getaway helps me get perspective, even though it doesnt knock the depression out. HAve you talked to your therapist about the meds? Might be time to switch to a different type, or dosage? if you need an ear, feel free to cmail me....

bookworm966 -> RE: Depression (6/25/2008 10:03:59 PM)
I saw my therapist today. He said if I were another patient, he would step in and make the decision for me, but since I am a nurse, know myself better than some, and recognize what's going on, he would 'trust me to make the right decision'. I have been hospitalized under an involuntary petition twice and I REALLY dont want to do that again. It leaves me no choice of facility. Dominus has offered to come take me to the hospital, so has my mom. I promised both of them that I will totally re-evaluate the situation on Sunday. I HAVE to work this weekend, I am covering for someone else, and am in a lead position. Am I safe to work? Yes. If I can manage to drag myself to work, I can forget me for a little while and do my job of taking care of other people. Taking a real vacation is not an option. Part of the problem has come from unexpected financial difficulties and I really cant afford it. I wish there was somewhere for people like me, who need to get away, that cant afford to take a trip but dont want to be hospitalized. A retreat, a safe house, something.

GreedyTop -> RE: Depression (6/25/2008 10:10:28 PM)
anyway that you can get 3 or 4 days scheduled off? trade with someone? are you active in a church? While I appreciate what your therapist is saying, I think he's kinda copping out here.. it sounds like you really COULD use his guidance here (not hospitalization, necessarily).. and a second look should be taken at your meds. It's good that working lets you get out of yourself for a while..

silk2008 -> RE: Depression (6/25/2008 10:14:06 PM)
Bookworm, I'm really sorry to hear how you're feeling. Only you and your doctor can figure out if a hospital stay is the way to go. But does heading to the hospital stay sound like an escape, or a way back to health? Are you feeling rough because you're covering new ground, and clawing your way back? Whatever you do, see if you can tell one friend the whole truth about how you're feeling. Try to cover new ground in some way. Stay close to your therapist. I think we have to find our truths to heal ourselves. Speak it, write it, paint it --find a way to express it. Just thinking about it doesn't seem to be enough. Express it. Best wishes to you. Be better to yourself than you think you should be. Compassionate kindness. Silk

shyhuzzy -> RE: Depression (6/25/2008 10:18:03 PM)
As a nurse myself, I think I would have to fuss at the Doctor for not being a "doctor" for me in this situation. sounds like a indepth discussion of medication with him is quite an option to look at, especially when we don't have the time to take off from work for some R & R just to recharge ourselves. Good luck and stay strong.

silk2008 -> RE: Depression (6/25/2008 10:20:17 PM)
Bookworm, I didn't see your 2nd post before writing my earlier message. I think your doc put you in an inappropriate position. When we health-care people are sick, we are patients. Period. All kinds of research shows that we act & behave & make decisions the same way as everybody else -- no matter what we know. It doesn't help us and in fact can hurt us because people around us assume we "know" what to do. It's ok to be unwell, to need help. You are right that we need those safe, nicer places -- but most of us don't have access to anything like them. Maybe because your stay is voluntary it will have a different feel to you than last time-- a healthier approach than waiting until the last minute? Thinking of you. Silk

Phoenix2raven -> RE: Depression (6/25/2008 10:21:17 PM)
I'm not saying this applies to everyone who suffers with depression but it helped me tremendously. The best thing is you are aware of your depression! I'm sure you are willing to do what it takes to get the help you need. If you are not willing or able to get help that is when you should consider an inpatient stay. You've already taken a step toward getting help by posting. Just remember you are not alone and if you have the guts to post here then you certainly can make the call to book a appointment with someone who can help more directly. Take it easy on yourself and you will be surprised how little effort it takes to get better.

Aswad -> RE: Depression (6/26/2008 4:10:05 AM)
When someone is depressed and can't afford the depression (i.e. when it will cause bills and the like to build up so that any improvement realized by an inpatient stay will cause the same problems to resurface when they get back out), I would say it's the right time to start talking to the doctor about the less frequently used meds. Tranylcypromine (up to 2.4mg/kg/day¹) is costly, but on par with ECT in terms of efficiency and speed of recovery; accompanied by dietary restrictions. Selegiline (10-120mg oral daily; 6-12mg patch daily) is less costly, and doesn't carry the dietary restrictions if taken as a patch (Emsam), but is somewhat less effective. Clomipramine is cheap, but carries significant side effects. Imipramine is also cheap, has much the same side effects, but is more effective for reversing learned helplessness. Tianeptine is quite available, but more of a long shot at what would be considered therapeutic doses. Amphetamine (2.5mg to 25mg per day) isn't generally started in outpatient care, and carries a light to moderate risk of addiction. Buprenorphine (100µg to 16mg per day) is usually only available at university hospitals from docs who don't fear the licencing authorities, but instantly alleviates mental anguish, social withdrawal and anxiety, while strongly reversing learned helplessness over time; it carries a light risk of addiction. Each of the above will be in the "arsenal," so to speak, and most have been in clinical use for decades, but the average pdoc will not bring them out for outpatient care unless the patient specifically requests that they should be considered. The last two should only be inquired about if the pdoc knows you well enough to realize that you're asking in the interest of therapeutic use, rather than to get high, or they'll get uncooperative fast. Health, al-Aswad. ¹ The minimum effective dosage of tranylcypromine will be the point where orthostatic hypotension occurs. Higher dosages are reserved for refractory patients. Dosing is from once daily to five times per day, depending on dose and side effects. Usually, a dose of more than 20mg/day will be divided into two or three doses, as one part of the drug is plasma concentration dependent while another gives stable effect for days after quitting.

celticlord2112 -> RE: Depression (6/26/2008 8:07:37 AM)
Depression medications can lose much or even all effectiveness if the body's metabolism is reduced (which can happen for a variety of reasons). I have no way to know your overall health, so everything here is suggestion borne of my own experience with depression. If the medication isn't working sometimes, make sure you're getting/taking plenty of the B-complex vitamins as well as Vitamin C. Also make sure you're getting plenty of the Omega-3 Essential Fatty Acids as well; these directly effect neurological health. You may also wish to experiment with eliminating certain food additives from your diet--the artificial sweetener aspartame, for example, can exacerbate depressive symptoms in some people. I have found that little routines to get me up and about and moving do wonders to keep major depressive episodes at bay. Even something as simple as taking out the trash (gets me out in the sunshine) helps. Keeping my favorite music playing in the background helps as well. Little things that encourage the "happy thoughts" do make a difference--just as imbalances of seratonin and norepinephrine can influence our thought patterns, so, too, do our though patterns influence the balances of these chemicals in the brain. One thing I do know: That you recognize the problem and are looking for solutions is a tremendous plus in your favor. Whatever else you do, don't stop doing that!

faerytattoodgirl -> RE: Depression (6/26/2008 8:49:23 AM)
yes and alot of medication can make you vomit. i tried paxil and then later tried celexa...i vomited 3 times (no exaggeration here) a day on those things. i said forget it...cause they will kill me. vomiting and heart condition = a no no.

sirsholly -> RE: Depression (6/26/2008 8:51:56 AM)
quote: ORIGINAL: bookworm966 I saw my therapist today. He said if I were another patient, he would step in and make the decision for me, but since I am a nurse, know myself better than some, and recognize what's going on, he would 'trust me to make the right decision'. Nothing pisses me off more than a copout from a medical professional in a position of trust. If you went to an orthopod because you suspected you broke your foot would you in any way accept him telling YOU to decide if it is fractured because you are in the medical profession? Please....do not EVER again accept this from anyone....you are worth so much more. i do not want to sound harsh...but please re-eval your desire to run to a safe house/retreat. Where ever your body goes your mind will follow. The illusion that everything will be ok if only i could escape for a little while is a dangerous illusion to have and will do nothing but act as a smoke screen...preventing you from dealing with the core issues of your depression. My advice...get your butt back to you doctor TODAY and tolorate none of the unprofessional crap he tossed at you. You need help...he is the one you chose to help you. He needs to do his job. i wish i could hug you...

Aswad -> RE: Depression (6/26/2008 10:14:30 AM)
quote: ORIGINAL: celticlord2112 Depression medications can lose much or even all effectiveness if the body's metabolism is reduced (which can happen for a variety of reasons). Definitely. At least for most of them. The first two on the list are insensitive to that, per se. The rest, apart from the second to last, will depend on not being malnourished (at least not grossly so). In the absence of absorption problems, a varied diet is enough to supply the basics in adequate quantities to prevent a loss of effectiveness. Either way, blood works will turn up a sufficient disturbance in that regard. However, good nutrition is useful in itself, which is a seperate mechanism of action. As you know, most of the commonly prescribed antidepressants rely heavily on placebo, and the effectiveness of that is dependent on not having too many thing break the illusion. When nutrition is inadequate, it causes more bumps in the road, so you lose the placebo effect more quickly. Also, some nutrients can have a beneficial effect. Some are short-term effective, while others are long-term effective. Some of them are long-term effective, but accelerate the natural aging of the neuronal population (e.g. vitamin B6 plus tryptophan and/or tyrosine and/or dopa). The advice you gave was sound, but like I'd reccomend running drugs by the doc, I'd reccomend running dietary advice by a dietician, since it's a complex field. Health, al-Aswad.

bookworm966 -> RE: Depression (6/26/2008 9:14:40 PM)
Thank you to everyone who took the time to read and post. I dont know yet what I will do. I blew off work tonight, which is unusual for me, in favor of staying at home and sleeping. I have been on the same 'cocktail' of meds for quite some time now... Zyprexa, Lexapro, Trileptal, and Klonopin. They have worked better for me than any other combination has. I'm leery of making changes in dosages because my last hospitalization came from a med-induced manic episode. And my insurance is great; I only pay about 90 bucks a month for all my meds, copays at the psychiatrist is $25, and inpatient care is covered. Anyway, things havent improved, but I made it to today. And will make it to tomorrow.

NormalOutside -> RE: Depression (6/26/2008 9:25:13 PM)
quote: ORIGINAL: bookworm966 I felt the depression lift for a little while. But it came back, creeping in like stormclouds. Those around me think I need 'a little vacation'. I wonder if a short inpatient stay would be cheaper than taking a real vacation? DAMN this thing thats wrong with my brain that makes me this way. I hate it. Sometimes I hate me. The meds arent working like they were. I'm not dealing with stressors well. I hide in my room, and my therapist says I'm isolating too much. I dont go out of the house unless I have to or someone makes me. I dont want to. I know inside me, the part that still thinks well, that a hospitalization is coming. I dont want to do that either. I miss work, lose money, obsess over the bills that still come anyway, and come home to the same problems that I left. I'm averaging a major episode a year. I feel weak and helpless. I'm not suicidal. Yet. Been there, done that, dont really want to go there again. Hi, bookworm. Sounds like you're having a rough time, sorry to hear that. You're right, hospitalization leads to lost income, inconvenience, and for some people, embarrassment (unfortunately and unnecessarily). It sounds like you're coping fairly poorly with life, though. You want to be happy.... you're not suicidal.... but you're also not enjoying your life. Everybody deserves to enjoy life! Could you perhaps see your GP again? If your GP doesn't have much psych background, you could ask for a referral to a psychiatrist, who can diagnose you much more accurately and probably do a med change, which might be just what you need. If it isn't, they can follow up with other treatments or a different medication, to find the right one for you. Of course, making an effort to get out a little helps. You KNOW it helps, you just can't do it, right? Get outside and walk the block. Anything to get your blood moving and a small change of scenery. Even if you think you'll hate it, push yourself and do it. Do other things that you like, too. Make/buy yourself something tasty. Have a bubble bath. Call a trusted friend/sibling/etc. It's good that you reached out for some help. Everybody needs it now and then, so don't feel bad to do it. We're all in this big trip called life together, right? Take heart, you have people here willing to listen, and I bet you have people that care about you, as well. Don't hesitate to go to emerg if you feel impulsive, fearful, suicidal, or hopeless. Someone there will help you and have you seen asap. At the very least they can observe you and hook you up with people or services to ensure your safety. Best wishes!

GreedyTop -> RE: Depression (6/26/2008 10:37:18 PM)
hugs Bookworm....

Aswad -> RE: Depression (6/26/2008 10:38:08 PM)
Cross-titrate from Zyprexa and Lexapro to Wellbutrin? Note that while Zyprexa has some small effect on depression, Lexapro has been shown conclusively to be unable to acheive therapeutic autoreceptor binding levels even with direct injection into the brain. It does alter DNA expression over the course of several years, but the effect on NMDA and AMPA receptors over the same time can cancel the benefits (about which we have no idea) of that. Either way, it takes years to get any non-placebo effect from Lexapro without concomittant use of a 5HT2A-blocker, and the effect appears to be a permanent one. The plasma levels of Trileptal should be monitored throughout, of course, but it doesn't have to go. Wellbutrin is less likely to induce mania than Lexapro and Zyprexa, in any case. If that doesn't work, imipramine and clomipramine do what Lexapro and Zyprexa try to. Unfortunately, you can't cross-titrate to tranylcypromine, and it takes 2 weeks to clear out the Lexapro and Zyprexa enough to be able to start it safely. Otherwise, that would be a good option, so it bears keeping in mind if things get worse. Initial response takes a few hours, but a robust therapeutic response usually takes at least a week after the onset of mild orthostatic hypotension. That's about the same as for ECT, without the memory loss. If you can deal with cutting Lexapro and Zyprexa for two weeks before resuming treatment, it's a good bet. Some of the others can be combined with what you're on, but under expert supervision. If you're floating well enough without, though, the best option may be to just chalk it up to a bad patch and wait for it to pass. Health, al-Aswad.

DesFIP -> RE: Depression (6/27/2008 6:47:39 PM)
For some people the meds just don't do it. The other option is ECT which is unlikely to cause the problems it did 30some years ago. Don't give up. But if there's no suicidal ideation, then you don't need hospitalization as of yet. Find a psychopharmocologist if possible, and exercise every day. 15 - 20 minutes without sunscreen in the sun increases Vitamin D levels which are very important, and in most of us too low.

dcnovice -> RE: Depression (6/27/2008 6:56:14 PM)
quote: I wish there was somewhere for people like me, who need to get away, that cant afford to take a trip but dont want to be hospitalized. A retreat, a safe house, something. This may sound strange, but you might want to see if there are any monasteries or convents near you that have guesthouses. It can be a place to escape to without costing a fortune. There's a book called Sanctuaries: The Complete United States--A Guide to Lodgings in Monasteries, Abbeys, and Retreats that might be useful. The authors are Jack and Marcia Kelly. A local B&B might also be an option for even a weekend getaway.

Racquelle -> RE: Depression (6/27/2008 7:05:58 PM)
The singlemost important piece of advise I ever had from a healthcare professional about combating depression was: Do something contrary to feeling depressed, even if you don't want to. It has been more important to me than medication, and years of therapy to remember that one simple thing - which came from one of the best sexual-health psychologists on the west coast. It can be anything - and for me it is sometimes blasting disco on the stereo, driving too fast, going to a pet store and playing with puppies, renting a great movie and watching it all cuddled in bed, going dancing, and a favorite - beating the living snot out of anyone of a number of grateful painsluts. I would suggest that some of the activities submissives often enjoy such as being humiliated ought to be put on the back burner until he or she feels better - that would be when play crosses into actual harm. I also avoid doling out insults and humiliation when I am feeling depressed because it make me feel shitty.

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