Depression

[Isgrimnur]

The therapist told me that my emotional baseline was already bent toward depression. I chalk it up to lousy neurochemistry.

[Carpet_pissr]

Hmmm, never really considered that. A biological predisposition to depression? Damn.

Assume it’s genetic as well.

[Isgrimnur]

There's plenty of signs that my mother is prone to depression and has been untreated all her life.

[Isgrimnur]

as-needed anxiety med whose name I can't currently recall.

Hydroxyzine

[dbt1949]

I take that. Only problem is it makes you sleepy too. There's always a trade off with medicine.

[Sudy]

I finally had my appointment with the new psychiatrist last week and I'm somewhat deflated. He's upholding the previous psychiatrist's diagnosis of bipolar II I've been questioning. He admitted it's possible it's not the right fit, but from what we discussed he thinks it is. I feel kind of like he and the former psychiatrist (whom I only saw four or five times) fit the details of my life into their narrative rather than vice versa. I'm not down on psychiatry; I just feel very tested by this situation. What if I've been taking the wrong medications for my condition, and continue to do so? What if there's something out there that could do a much better job of controlling my issues? What if these drugs inhibit me in other ways? I'm "only" 37 but I still have yet to find my place in life and I'm running out of time. How much of my potential could be being suppressed by an inaccurate diagnosis?

Despite this, I'm trying to have an open mind. I've only seen the new shrink once. (I don't really have any alternatives though; I can't afford to find my own psychiatrist. This is all through my family doctor's office.) I don't have any problem with the label of bipolar II. It just doesn't feel like me, or what I "think" me is. Those hypomanic phases just don't exist. I mean never mind hypomania; I barely remember being happy in life. There have been happy events, certainly. But I remember few extended periods when depression wasn't crouched at my door. My family doctor mentioned to me recently, "In the future, we won't have depression. We'll just have serotonin-deficiency, etc. and will be able to test the brain specifically and address these issues directly." I wish I lived in that time.

And I'm not a psychiatrist myself. I know that. But this diagnosis seems based upon a great at-home vacation I had several years ago during which I was full of energy and completed a few tasks and projects that I'd usually put off for months. I do remember what it felt like. It was great. But I didn't exhibit the symptoms of hypomania, in my mind. (Excuse the ambiguity of that sentence.) I was just... happy. We'd recently moved, spring was in the air, and I was happy to be free from work for a while. Then I mentioned I was getting up early to play online poker and he immediately saw it as a symptom. Buddy, my bankroll was like $50 and I stretched it out for years. I played $1 and $3 sit-'n'-gos. I come back to online poker every couple years since it exploded in the early 2000s. This wasn't Owning Mahowny.

[Isgrimnur]

A) Document your concerns in as factual manner you can, then discuss them with the doc.
B) Crowdsource data. I would recommend a support group. Barring that, there's always reddit, which, of course comes with its own issues.

[Sudy]

Thank you, I actually just got the opportunity to review the psychiatrist's report to my doctor for my file, as it was given to me for a possible a workplace disability claim. (As in I read it just before writing this post.) It was... interesting. There were a number of mistakes and generalizations that don't make me feel great, but ultimately they're unlikely to have any impact on anything. I suspect the psychiatrist works from a sort of form to same time.

However, one thing shocked me... he referenced that in my file I'd been previously diagnosed as having borderline personality disorder. By whom?? When?? I'm very familiar with this disorder because my wife has it. I'm guessing it was from this other psychiatrist I saw just once several years ago, but hey; it would be nice to know. What's worse, that I was diagnosed with something (likely inaccurate) and wasn't told, or that my family doctor then presumably overlooked it? So much about the treatment process feels like "throw it against the wall and see what sticks", I guess because outside of obvious symptoms, it is.


I definitely want to get involved with more support groups. I'm probably joining a depression CBT group run online by the psychiatrist in June, but that will only last so long. I've been actively hunting for Discord groups, but it's pretty rough. A lot of groups are dominated by kids. Some of the adult ones I've tried are run by tyrants or laypeople who mistakenly believe they're facilitating a clinical environment. There's a lot of attention seeking and suicidal gestures. They may be completely legitimate, but these people aren't getting the support they need and it scares me. I actually joined one of the Reddit-linked ones, but it was as much of a social club and I believe it had a porn channel. (Though I might be misremembering.) Regardless, many 18+ discords seem to. This is a big problem for me as someone who's struggled with porn addiction. Combining a healing venue with a destructive one is... not helpful.

Which just means I need to keep looking, and obviously not just on Discord. But it's a long and lonely search.

[Blackhawk]

All I can say is that the process of figuring out who you are only rarely involves big 'aha!' moments. Most of the time it is tiny pieces, added one at a time along with erroneous pieces. The false ones tend to fall away, the real ones tend to stick, and with time you get a clearer and clearer picture.

I could go back 30 years to the first time I got help and list the things that I was diagnosed with that were way off the mark. I could even list a couple that, as far as any doctor I've talked with since can tell, don't actually exist as a diagnosis. I've had a couple, though, that were right on target, and some that I just didn't see, then came to recognize as true later on.

It's a journey.

[Carpet_pissr]

I finally had my appointment with the new psychiatrist last week and I'm somewhat deflated. He's upholding the previous psychiatrist's diagnosis of bipolar II I've been questioning. He admitted it's possible it's not the right fit, but from what we discussed he thinks it is. I feel kind of like he and the former psychiatrist (whom I only saw four or five times) fit the details of my life into their narrative rather than vice versa. I'm not down on psychiatry; I just feel very tested by this situation. What if I've been taking the wrong medications for my condition, and continue to do so? What if there's something out there that could do a much better job of controlling my issues? What if these drugs inhibit me in other ways? I'm "only" 37 but I still have yet to find my place in life and I'm running out of time. How much of my potential could be being suppressed by an inaccurate diagnosis?

At the risk of sounding like an armchair psychiatrist, some of the most important, "growth" moments in our lives are when we are tested (and you may not mean it in that way). But you used the words "deflated", and "tested". An amazing Jesuit priest in Argentina that I once studied under told me something when I was all of 21 years old: that when we feel ourselves getting most riled up, most bothered, and most angry about something, that is precisely when we need to look carefully at the cause, and it's usually because it reflects some truth about us that we fear, or don't want face.

You seem to be pushing back against two different psychiatrists' evaluations of your situation. Obviously they could both be wrong, but at least strongly consider the possibility that you are pushing back precisely because you don't want to admit they are right. Easy to say/write, hard to do. I will repeat, I'm not suggesting this is the case (and if I were you, I probably WOULD get a third opinion), but at least go down that internal rabbit hole for a bit and explore, and try to ID what is causing the pushback, and if it's simply "I feel that they got it wrong" or something else.

Also, how open are you to reading books that might help with finding your "place in life"? I generally abhor self-help books, but I have read quite a few. Most are fluffy, happy, feel-good garbage, or wacky way out shit (like one of the bestsellers where the author LITERALLY claims to have parking spots open up for her because she is concentrating on making that happen in her head). Out of all the ones I have read, there are two authors who are absurdly "unqualified" (no previous writing experience, no medical training or even counselor training of any kind) to write books about mental health, that literally changed my life, and the way I think about it. If you are interested I can give you more info, just pm me. You could almost argue that they are more philosophy books than they are self-help, but they sure as hell helped me.

Dr. Phil out.

[Sudy]

An amazing Jesuit priest in Argentina that I once studied under told me something when I was all of 21 years old: that when we feel ourselves getting most riled up, most bothered, and most angry about something, that is precisely when we need to look carefully at the cause, and it's usually because it reflects some truth about us that we fear, or don't want face.

I wish I'd studied under a Jesuit priest. Anyway, I'm trying to keep an open mind. I believe the psychiatrist(s) want to help me. I just think they may be misrepresenting something in my past. In ways, there's a fine line between a bipolar II depression diagnosis and a unipolar depression one. But some of the medications prescribed for them are very different. I question whether I experience the problematically "up" moods. I've been on a mood stabilizer for several years now and I'm far from thriving. I don't remember what it feels like not to be on one, and I don't want to waste time on the wrong treatments.

There are many diagnostic criteria that seem extremely broad. It seems like you could stretch anything to fit, not unlike with a horoscope. But again, I'm not a psychiatrist. I try to trust them to help me; I just question.

You seem to be pushing back against two different psychiatrists' evaluations of your situation.

I probably expressed myself poorly, but what happened was I found out there was an undisclosed diagnosis made at some point, probably by a psychiatrist I only saw for one session several years ago as screening for a short-term therapy program. I'm frustrated that neither the psychiatrist nor my family doctor ever informed me of this. While there can certainly be crossover, borderline personality disorder is a significantly different illness with some hallmarks that I would never assign to myself. Like it's just not factual. When reading more about the disorder last night I did see some secondary traits that I could apply to myself, and I would be willing to be screened by a professional (again?) and have my mind changed, but being confronted with this was like walking into the doctor's office with the flu and being told you have radiation sickness because 70% of the symptoms list matches. Mainly I'm pissed that no one told me or treated me, if it were valid.

Also, how open are you to reading books that might help with finding your "place in life"? I generally abhor self-help books, but I have read quite a few. Most are fluffy, happy, feel-good garbage, or wacky way out shit (like one of the bestsellers where the author LITERALLY claims to have parking spots open up for her because she is concentrating on making that happen in her head). Out of all the ones I have read, there are two authors who are absurdly "unqualified" (no previous writing experience, no medical training or even counselor training of any kind) to write books about mental health, that literally changed my life, and the way I think about it. If you are interested I can give you more info, just pm me. You could almost argue that they are more philosophy books than they are self-help, but they sure as hell helped me.

I kind of have the same problems you do. I just don't trust anybody, or frequently find that the tone of these books pisses me off. I appreciate the recommendations and I'll send you a PM, as long as you promise to never ask whether I actually picked them up/read them. Chance are I won't because I'm a skeptical, grumpy, lazy bastard. But you never know....


Thank you for your reply, and everyone else. If I nitpick in my replies it's because I'm working this stuff out in my own head. I don't have a lot of other places to go with this stuff. My few friends and family are supportive, but they're either too close or often just don't understand.

[Default]

I have a gp, who isn't interested in prescriptions.
I have a prescribing physician who doesn't know anything about ADHD and the co-morbidities that go with it. Literally, does not understand that ADHD, anxiety, depression, and childhood trauma interact with each other, and are not kittens in separate boxes.
I have a therapist who is pretty good at seeing which fire needs to be put out first, but cannot write prescriptions.

I have a headache.

[Carpet_pissr]

I have a gp, who isn't interested in prescriptions.
I have a prescribing physician who doesn't know anything about ADHD and the co-morbidities that go with it. Literally, does not understand that ADHD, anxiety, depression, and childhood trauma interact with each other, and are not kittens in separate boxes.
I have a therapist who is pretty good at seeing which fire needs to be put out first, but cannot write prescriptions.

I have a headache.

Been there. Amazingly frustrating, the whole…disconnect between psychiatrist, therapist/psychologist and GP

[Smoove_B]

I have a headache.

Have you considered looking into meeting with a psychiatric nurse practitioner?

[Default]

I have a headache.

Have you considered looking into meeting with a psychiatric nurse practitioner?

Ya know where there is one that takes old guy patients? Everyone does kids around here.

[LawBeefaroni]

I have a headache.

Have you considered looking into meeting with a psychiatric nurse practitioner?

Ya know where there is one that takes old guy patients? Everyone does kids around here.

You may be able to telemed with a prescriber. See: telepsychiatry but ask your docs/therapist to see if they have any recommendations. If your therapist can facilitate/participate it would be ideal.

[Blackhawk]

Ya know where there is one that takes old guy patients? Everyone does kids around here.

Try being an autistic adult. The psychiatric world's knowledge of autism seems to have a hard cut off at 16 years of age. I've seen probably 12 different psychologists/iatrists in the ~17 years since I was diagnosed with autism. Those familiar with autism in kids: 12. Those familiar with autism in adults: 0.

[Default]

Ya know where there is one that takes old guy patients? Everyone does kids around here.

Try being an autistic adult. The psychiatric world's knowledge of autism seems to have a hard cut off at 16 years of age. I've seen probably 12 different psychologists/iatrists in the ~17 years since I was diagnosed with autism. Those familiar with autism in kids: 12. Those familiar with autism in adults: 0.

Same thing here. It's hard to find anybody that wants to deal with my dumpster fire.

[Default]

I have a headache.

Have you considered looking into meeting with a psychiatric nurse practitioner?

Ya know where there is one that takes old guy patients? Everyone does kids around here.

You may be able to telemed with a prescriber. See: telepsychiatry but ask your docs/therapist to see if they have any recommendations. If your therapist can facilitate/participate it would be ideal.

You described what my present arrangement is basically.
It would be better if we could pare it down to two people...

[Sudy]

So sorry you guys are or have struggled. Sometimes it seems like we're still actually in a lesser form of the dark ages of mental healthcare. Resources may be out there, at least in urban centers. But in terms of accessibility, it's either huge wait times or wealth that are barriers to entry. The worst part is that depending on your condition, you may have a harder time seeking treatment. There are often enough flaming hoops to jump through that even a healthy/neurotypical person would be challenged.

[Default]

Life is a fistfight already. I've come to expect it.

[Carpet_pissr]

I think telehealth, especially mental health telehealth, would be VASTLY more of a revolution in healthcare if there weren't geographic restrictions on practicing licenses. That would allow people in underserved locales to get access to (theoretically) a much higher quality of care than they could at the hyper-local level.

Imagine a coal miner in WV being able to get telehealth care from a psychiatrist in Boston with a degree from Harvard Medical (just an example, you get the idea).

[Carpet_pissr]

Life is a fistfight already. I've come to expect it.

As Mark Manson suggests: improving our lives hinges not on our ability to turn lemons into lemonade but on learning to stomach lemons better

[Isgrimnur]

[Default]

That's a lot of bottles of pee.

So far, Wellbutrin is a definite upgrade. No fog, less gloom, more energy. On the downside, slight headache, my neck seems a bit tense, probably should have had decaf at lunch. I'll try a lighter dose of Adderall tomorrow, and see how that shakes out.

[dbt1949]

This has been a really tough year for me with all that's been happening. Things are starting to calm down a bit but I find myself disoriented and no goals for the rest of my life. Why do I continue to live? I'm to olde and poor to start over again. Winning one of those million dollar lotteries might change that.
<alas>

[Unagi]

Do you have any reasonable bucket list things that you can aim for? Or any modest self-improvement / interests you’ve put off, I’m not talking about weight loss, but maybe more like cooking the perfect omelette or eating homemade bread. Or pickled eggs.

Just sorta spitballing with you on ideas.

[Blackhawk]

Model train time!

[Kraken]

Those sound like normal feelings for someone in your circumstances. You've been through a lot already, and much is still unresolved. I don't have any advice except to say I don't think anything's wrong with you.

[Daehawk]

This has been a really tough year for me with all that's been happening. Things are starting to calm down a bit but I find myself disoriented and no goals for the rest of my life. Why do I continue to live? I'm to olde and poor to start over again. Winning one of those million dollar lotteries might change that.
<alas>

"

[dbt1949]

Model train time!

I think I still have most of what I need to build another train layout.

[Blackhawk]

I figured. That's why I tossed it out there. You've mentioned a number of similar interests over the years. Miniatures, trains, maybe even models (my memory is imperfect.)

Like Kraken said, what you're feeling is normal. The building blocks of your life have changed. It happens with a change of career, retirement, leaving the military, all sorts of things. I dealt with it after my divorce in 2007,and I am looking at something similar as someone who has spent the last two decades as a full time parent, and now my kids are both grown, and the last will be out of school in six or seven weeks.

When everything we structure our lives around changes, it's disorienting. We tend to feel lost. We sometimes feel empty when we look to what is gone for meaning and find it absent. Depression is common. The experience is similar to mourning.

The good news is that it passes. With a little time we get new structure and new meaning. What can help is to focus on the opportunities it brings with it instead of what is gone. Think about the things you always wanted to do, or that you gave up because it didn't work with your old life. Chase one of those that gives you some excitement, and soon you'll find yourself thinking about the old stuff less.

When I get home, I will toss out a couple of thoughts (I hate phone typing.)

[Blackhawk]

Dredging up the past:

I have close to 200 bottles of paint. Quart of paint thinner, quart of mineral spirits and a quart of lacquer thinner. 3 dozen paint brushes. 6 Exacto knives with maybe 150 blades. 2 vises, a homemade special work station, 8 kinds of glue, special lighting with a light magnifier and a headband magnifier, specialized tools like small screwdrivers, wheel pullers (for working on trains) ,2 dozen other specialized hobbies tools, forceps, rubber bands and tape,3 Dremels etc. and many other things deemed necessary by me at different times.
Been collecting this crap all my life.(well, over 50 years anyways) I've built and worked on most everything including tools for repairing and building electronic circuit boards.

If it wasn't video games it would be something else to do by myself. Reading, boardgames, miniatures, trains, WMDs.

I have a gazillion dollars invested in model trains and lead figures. It was hard to realize I had just thrown that money away when I lost interest. Actually I didn't loose interest so much as the ability to build and paint things and the lack of room for all these stuff when it was finished.
So now I can continue these hobbies with video games. And they don't take up any physical space.

I went thru that stage once. That's why I have an army of thousands of miniature of which I've got around 2-3000 painted. I used to fantasize about groups of them guarding my rooms.

Keep in mind that I don't really know why you left these things behind. You may still have zero interest, and if so, ignore the ideas.

You mentioned lots of game related stuff and small-scale stuff (miniatures, trains, etc.) You also said that you preferred doing things alone. Have you considered looking at single player skirmish/wargames?

A couple of specific ones come to mind:
Rangers of the Shadow Deep
Pulp Alley

~Both are very cheap to get into (one is only a single book, the other is a book and a couple of decks of cards) beyond the miniatures.
~Both are extremely versatile in that they can be played in sorts of different styles (Rangers is fantasy, but doesn't define the setting much. It could be anything from stone age to Victorian fantasy (although you'd have to tweak it for later period firearms.) Pulp Alley can be anything pulpy, from Conan to Buck Rogers to Stargate SG-1 (and 30s/40s adventure films, and Shadow/Phantom/Green Hornet style superheroes, and wild west, and...) I have a vague notion to do some A-Team games with it. Being so versatile means that you can improvise to your heart's content, and can use what you already have.
~Both are designed for solo play.
~Both are small-scale - they can be played on a card table, and only require a handful of miniatures.
~Both have fairly simple rules.
~While both use terrain, but don't require it. They can be played using improvised terrain or even a whiteboard. Or you can invest in premade terrain that is collapsible for storage. But given your history of small scale crafting, you might enjoy the process of building terrain, from the basic stuff to more elaborate pieces. About 90% of everything that guy makes can is made from a chunk of old insulation foam, a jar of cheap paint, a jar of Mod Podge, and some flock. Not much is needed. The only thing with any real cost is a hot wire cutter (a little over $100), and that's optional. If you really dig into it, some people even wire LED lights into their terrain, something I believe you have the knowledge to pursue.
~Miniatures these days are cheaper than ever, if you go with Reaper Bones.

Actually playing these is only a third of the hobby. Watching movies, reading books, and doing research for ideas and inspiration (I have whole folders of screenshots from games and images I snagged from the internet with terrain ideas), planning, building, and collecting. And the purpose - pfft. The purpose is the process itself. It's the experience.

I know that you have had issues with your eyesight and details. I took that into account. The terrain is mostly washes and drybrushing. You can do it with half inch brushes. And miniatures no longer require the kind of intense detail work they used to in order to look good. Contrast paints and Speedpaint mean that you can just paint areas and the details take care of themselves.

Anyway, if this doesn't appeal, ignore it. It just seemed like something cheap and relatively low-storage that pulled from your past interests.

[Carpet_pissr]

I need to either cut down my dose of Wellbutrin, or switch to something else entirely. I noticed a very strong clenching of my jaw and tightness around my lower facial area since I've started taking it again recently (stopped about a year ago). After some research, I found that "bruxism" (teeth/jaw clenching) is quite an undertreated (but common) side affect of many antidepressants.

I have started titrating it myself down to one pill every other day to see if that helps.

Considering just switching to this:
"Researchers have found Buspar to be highly effective for depression and for preventing bruxism as a side effect. Consider switching your Paxil or Zoloft to Buspar to avoid jaw clenching and bruxism."

Also, I am just now realizing that two of the potentially serious side effects of Wellbutrin (and of course super rare) are:
1. Seizures/fainting
2. heart irregularity/palpitations

When I was on Welbutrin a few years, ago, I remember (kinda!) washing my car outside, and the next thing I knew, I was looking up at the sky, laying on the concrete, with bruises and cuts all over. Had no idea at the time what caused that, and since a battery of heart tests showed no issues, I just kind of let it go.

Since I have re-started taking it, I have "noticed" my heartbeat...which is a VERY weird feeling. The other night it was so bad I used the EKG function on my Apple watch, and sure enough, it came back "UNDETERMINED" status. Which basically means: get thee to a doctor! (normally, it will show SINUS or something) When I showed that readout to my doctor a week later, he kind of freaked out and said "that is definitely NOT normal" and did an EKG there in the office (which of course showed nothing since I was not having that feeling at the time).

[hitbyambulance]

something really interesting.... when i was on Prozac (and later, Effexor), i stopped playing video games. i just did not have any desire to do so at all - the idea was completely uninteresting to me. i switched to Pristiq a few weeks ago and what do you know - i want to play games again (and have been doing so).... i don't understand. could maybe my endorphin production/functionality been significantly altered under 'first line' SSRIs and SSNIs?

[dbt1949]

I guess we're all different. When I took Prozac it didn't slow my game playing a bit.
Ruined my sex life tho.

[em2nought]

I'm still surrounded by my mother's belongings from 2020 because I can only bring myself to get rid of a little at a time. I think that includes the condo because I'm not getting much accomplished in regard to getting it ready to sell, even with the concern of a tanking economy.

[Carpet_pissr]

something really interesting.... when i was on Prozac (and later, Effexor), i stopped playing video games. i just did not have any desire to do so at all - the idea was completely uninteresting to me. i switched to Pristiq a few weeks ago and what do you know - i want to play games again (and have been doing so).... i don't understand. could maybe my endorphin production/functionality been significantly altered under 'first line' SSRIs and SSNIs?

Whoa, that is interesting. I wonder if it was maybe bc Prozac was not working for you, thus you were still depressed, thus ‘things you normally enjoy are not enjoyable’ effect of depression was causing it?

[Kraken]

something really interesting.... when i was on Prozac (and later, Effexor), i stopped playing video games. i just did not have any desire to do so at all - the idea was completely uninteresting to me. i switched to Pristiq a few weeks ago and what do you know - i want to play games again (and have been doing so).... i don't understand. could maybe my endorphin production/functionality been significantly altered under 'first line' SSRIs and SSNIs?

Whoa, that is interesting. I wonder if it was maybe bc Prozac was not working for you, thus you were still depressed, thus ‘things you normally enjoy are not enjoyable’ effect of depression was causing it?

When I started on antidepressants, I quit keeping a journal. Writing was apparently my form of self-therapy and I just didn't feel the urge to write privately anymore.

[Carpet_pissr]

something really interesting.... when i was on Prozac (and later, Effexor), i stopped playing video games. i just did not have any desire to do so at all - the idea was completely uninteresting to me. i switched to Pristiq a few weeks ago and what do you know - i want to play games again (and have been doing so).... i don't understand. could maybe my endorphin production/functionality been significantly altered under 'first line' SSRIs and SSNIs?

Whoa, that is interesting. I wonder if it was maybe bc Prozac was not working for you, thus you were still depressed, thus ‘things you normally enjoy are not enjoyable’ effect of depression was causing it?

When I started on antidepressants, I quit keeping a journal. Writing was apparently my form of self-therapy and I just didn't feel the urge to write privately anymore.

Same for me, but not as directly perhaps (the journaling I did was almost always around a specific event which I believe was the biggest contributor to the depression).

I see "journaling" being touted quite a bit as a serious and effective form of battling depression, or at least dealing with it in a healthy way, but I still think it's under...touted. I can only speak anecdotally, but when I FINALLY tried it...wow. So cathartic, and almost instant "relief". Very hard to explain (and probably harder to convince someone who is deeply depressed). I personally wish I had "found" that option a lot sooner than I did, but hey, it's always a journey.