Failed Therapy

[in_media_res]

Before I begin, it is possible you may have hypochondriasis, which is a very real illness.

Really? What would make you suggest that?

[diaz]

You probably don't have it, but I mentioned it just in case. A friend of mine was interested in TMS for herself, and I kind of worried that she had hypochondriasis because she always had some major illness no matter what. I didn't want her to spend the money on TMS is she was just going to conjure up another perceived illness as soon as one was cured.

Anyway, although I still think she is a bit of a hypochondriac, she underwent TMS and is feeling much better. So...I guess I shouldn't have even brought it up.

[imperfectrhyme]

I think that some people are incompatible with therapy, but you don't sound like one of them. Especially if you're reporting feeling of being abandoned. You need someone professional to talk to, if only to have an outlet for emotional release. I would definitely seek a new therapist, one that's better suited to your needs.

[in_media_res]

I think that some people are incompatible with therapy, but you don't sound like one of them.

I have a former therapist who'd disagree with you. And probably a psychiatrist, although his view seems to be that if I just took my meds I'd think it was awesome that my therapist terminated the relationship in the middle of the session.

Sarcasm aside, thank you for the note and the support. Unfortunately, this all continues and I'm still struggling with the termination.

I have found another therapist, and we continue to work to get me past the pain and anger. It's slow going. I've agreed to meet with a psychiatrist (also a new person), although I do so with trepidation since I expect the recommendation will be more meds, probably an atypical anti-psychotic.

Given my history, I'm extremely reluctant to try another round of meds -- Over 15 years, I've been through about half-a-dozen different meds (mostly SSRI's) that left me with devastating side effects (massive weight gain, blood pressure boosts, and I'm increasingly suspecting a case of tinnitus that started about the time I went on a Wellbutrin and Lexapro combination). For all of that, the meds did nothing for my mood. With the tendency of anti-psychotics to produce weight gain, in my mind they're a non-starter. I've struggled to lose 90 pounds, in an effort to salvage some of my self-esteem. I'm not going to gain any of it back on the hope that it will somehow magically improve my ability to see myself in a positive light and improve my relationships with others.

Sorry. This is probably a pretty negative post. Today's been a particularly difficult day for me. I appreciate everyone's concern and support. I'm fortunate in that I have found another therapist, and some very supportive friends and family.

[imperfectrhyme]

I'm glad to hear you are doing better. It's amazing how much variation there can be in the opinions of professionals. In the end, you have to do what feels right for you, since not feeling right is the reason you're there to begin with.

Remember to express your concerns about side-effects with the doctor and be assertive about it if you have to. Side-effects can be just as detrimental as the depression itself. Maybe you could ask about mood stabilizer that's used for treatment-resistant depression like Lamictal. Mood stabilizers might not be as statistically as effectiveness for depression but tend to have lower side-effects than atypical antipsychotics when dosed correctly.

Find hope wherever you can. Everyone needs it.

[diaz]

I'm gonna suggest TMS again, imr. Maybe meds aren't the way for you to go. I know TMS has helped me and at least 2 other friends. And we were all pretty bad off before doing it. And again - no side effects, not invasive at all.

I can tell that you are quite intelligent, in_media_res. Unfortunately, being intelligent and having treatment resistant depression makes it difficult to find psychiatrists and therapists who sync well with you. My advice is to do some thorough searching online, and schedule appointments with 2 or 3 or more. It's essential that you have therapists whom you trust and have confidence in. I've done best with therapists who were at least as intelligent as I am, if not more so. They'll be better at calling you on your bullshit - specifically, the bullshit you tell yourself.

I would also recommend researching different kinds of therapy, and then trying to find therapists who specialize in the styles of therapy that appeal to you.

[diaz]

I'm gonna sound like "Capt. Obvious" here, but hang with me.

I don't know if you do this, but I used to approach every new form of treatment skeptically, and I would go into it looking very hard for any evidence that it was working. And even if I found such evidence, I would brush it off or convince myself that it was just wishful thinking. Of course, this approach is doomed to failure, because most of the positive changes we undergo in therapy are very subtle and gradual. A fundamental change in our thinking might start with one little thought that pops into our head occasionally, or "hitting the pause button" every once in a while when we're playing the negative recording in our mind. Like trees, these initial changes are very easy to snuff out when they first take root.
For me, being skeptical and trying to anticipate potential failure and discouragement was a way to protect myself from unexpected pain and suffering. It was also probably a way to avoid ever being in a position in which I would feel foolish or naive. While my skeptical approach was effective at preventing these things, it also prevented me from being happy or feeling joy or having self-confidence.

Now I look at things with a much more open-minded, optimistic way - which is not to say I wear rose-colored glasses all the time. I just try to accept and embrace positive changes instead of questioning and doubting them. If something works, great! If it doesn't, at least I tried and I learned something new in the process. Each time you try something new, it's like climbing another step up the wall of the sinkhole that is depression. If you keep taking steps, one at a time, eventually you'll get out. As long as you are trying, you are learning and growing and making progress, whether you feel like it or not.

[in_media_res]

Find hope wherever you can. Everyone needs it.

Thanks very much for the message, and sorry for the delay in responding. I re-read my post, and it seems quite bitter -- which is reflective of where I've been lately. Thanks for the positive thoughts.

As it turns out, I was prescribed Lamictal. There were a couple of other options -- an MAOI and a newish anti-depressant called viibryd. The first seemed problematic because of dietary concerns, and the second is a combination of sorts between an SSRI and an atypical anti-psychotic -- if I have it right. In any event, it is starting to sound as though it manages to combine the worst attributes of both classes of medication. Not my cup of tea.

I've been on the Lamictal almost a week. Dosing starts quite low, and I'm scheduled to take the first increase tomorrow. So far, it's been ok. No serious side effects, and my ability to function has improved. All the existential dread of medications remains -- that's a personal issue -- but I'm assuming if the medication continues to work and I avoid the possible side effects I'll probably get over those.

Thanks.

[in_media_res]

If something works, great! If it doesn't, at least I tried and I learned something new in the process.

Diaz - thanks for the notes.

I have to confess I have a difficult time with the phrase "treatment resistant depression." I find it generally means "we tried a bunch of relatively ineffective meds and they didn't work" and presumes the problem is more in the patient than in the quality of the treatment. But then, as you've seen, I'm not terribly enthusiastic about most of these medications in the first place. So that reaction is probably not surprising.

TMS isn't an option for me -- at least for now. It's a bit new for my taste, and it's not clear the overall efficacy and durability of the treatment is all that much better than SSRI's. Your mileage, obviously, may vary and more power to you. As a practical matter, the cost is beyond my reach. But if you have the option to invest in the industry, it sounds quite promising. The goal is to develop a series of treatment centers -- like the Lasik model -- and run patients through at high rates (and high financial returns).

I'm comfortable with the therapist I've found. He tends to focus on classic psychodynamic therapy, and has been trained in EMDR (which we've used to some success). He's patient, has made himself available to a surprising degree, and is willing to put up with my near constant need for reassurance in the face of my fears of abandonment. Of course, as far as it goes, I was mostly happy with the previous therapist -- she tended towards CBT. At least, until she lost interest and patience. I'd honestly like to find someone who could work with me using DBT -- that seems most relevant given my particular mental challenges. But so far, no luck in finding a practitioner. I may be able to work some of this online and/or with my current therapist. He's not trained, but could probably help monitor progress I'm making on my own.

For better or worse, my rose-colored glasses got left along the way quite some time ago. Part of that is efficacy -- specifically as it relates to my own condition, but also to the approach overall. I've seen too many studies and talked with too many people for whom treatments either haven't worked or quit working. If I felt that it was a case of "no harm, no foul" I probably wouldn't worry so much. But I don't think that's the case. But that's probably a topic for another thread.

This seems like such a negative post. I'm sorry. I really am cautiously optimistic that either the meds or the therapy or both are going to provide some relief, as otherwise I'd probably have just given up awhile ago. But for better or worse, that seems to be the state of the art. We can hope for improvements, although when I see things like viibryd come to market I fear all we're going to be getting for the near future is just re-packaged approaches that haven't worked that well in the first place. But hope springs eternal, even in the face of difficulty.

Thanks again. Continued good luck to you in your treatment.

[vendra64]

In media res
Did you ever resolve it with your former therapist?
I am new to it all. Ive never been to a therapist,
But your story scares me.