Changes

Today was surprisingly, a good day. While life is not perfect, I feel like hopefully, everything is in an upward swing, rather than a downward spiral. It’s nice to have something to look forward to.

I had a job interview yesterday. After filling out tons of applications and not hearing back from anyone, I was really excited to get the call for the interview. I didn’t want to get my hopes up, though, just in case I didn’t get the job. But today, I received a call and was offered the job.

This new job is going to involve a lot of change for me. I will now be working nights and despite being a night owl, it still makes me nervous. I’m having to change my complete routine. On the other hand, it will be so nice to leave a job that wasn’t healthy for me, mentally or emotionally. Hopefully, the shaking that I have been living with constantly, will go away and my hair will stop falling out.

I feel like this could be a step in the right direction. It’s a big change, but I’m hoping that working nights, will allow me to go back to school so I can finish my degree. I’m hoping that this step will allow me to follow my dream.

I am also taking a step by seeing my doctor. I am having a full physical done as well as blood work. It’s been a couple of years and I figured I should rule out some medical issues because I have decided to see a psychiatrist. I feel that after 3 years of attempting to resolve my depression with only my therapist, with little results, it’s time I tried anew. I am hesitant about this step because of my previous misfortunes with psychiatrist, but this time I am hoping to find one that I like.

I will be recounting to you, my current experiences with medication and treatment as they occur. I’m hopeful that this time around, we will find something that works.

Loneliness

Loneliness. This is another one of the overwhelming feelings of depression. You feel that nobody possesses the ability to know or understand the way you feel. You feel as though nobody wants to be around you and that you are alone.

Depression lies. It magnifies every negative thought you have about yourself. It tells you that you don’t have any friends, that people don’t want to be around you and I often feel like my depression is telling me that truth.

I often think that my depression wouldn’t be so bad, if I wasn’t alone all of the time. My depression wouldn’t be able to lie to me if I had people to hang out with, but the truth is that I really don’t have anyone that I can count on. I feel like I can count on people to blow me off, ignore me or forget about me, but I don’t feel like I can count on most people for anything positive. I have one friend I can count on and I’m afraid of losing him. I afraid that I’m relying too much on him and eventually he’ll just be done.

What a lot of people don’t understand is the choice they have when it comes to being alone. Most people can choose between hanging out with friends or being by themselves. Unfortunately, I don’t have that choice. I don’t get to choose between hanging out with friends or being alone, I’m just alone.

It’s frustrating not having people you can count on. And you wonder if it’s you. You wonder if there’s something wrong with you, but you can’t figure out what. You wish you could figure out what it is, so you could fix it. So people would want to be around you. I know people don’t like the negativity that I can sometimes be shrouded in, but it’s not something I can just fix.

A lot of times when I think of the people in my life, I think of this quote, “No one is really busy. It all depends on what number you are on their priority list.” It just seems to me that I’m not even factored into their priority list. I’ve reached out to numerous ‘friends’ only to be ignored. I’ve tried making plans with ‘friends’ only to be blown off.

Honestly, I’m sick of their excuses. I have a disease, but I don’t use it as an excuse to not do things in my life. I still get out of bed, go to work and attempt to hang out with people. I would do anything for my friends, but I only have one that would do anything for me.

Not having someone, that’s the worst curse imaginable. Too bad I’m one of those people living that curse.

What do you think is the worst feeling to have with depression?

My Story: The Initial Treatment

When I was first diagnosed, I did everything I could to get better. I saw my primary care physician, and had him recommend a psychiatrist. I talked to my parent’s pastor and had her recommend a therapist. I took my medications, kept track of my moods, but nothing helped.

The first diagnosis of depression I received was from a nurse practitioner at my college’s health center. She also prescribed my first anti-depressant, Citalopram, an SSRI. (I will be explaining the different types of medication in a later post). While on Citalopram, my depression continued, so when I got home from school, I visited my primary care physician and obtained a recommendation for a psychiatrist.

The first psychiatrist I saw diagnosed me with dysthymia. She switched my medication to a combination of sertraline, an SSRI and Wellbutrin, an NDRI. Neither medication did anything to fix my mood. Instead, I started shaking in my hands and my legs. Whether this was a side effect of my medication or a worsening of my depression, is still unknown. I was also seeing a therapist, weekly. The talk therapy was helping more than the medication, but not enough. I ended up having to drop out of school because of a loss of motivation and disinterest.

I stopped seeing my psychiatrist, mostly because I didn’t like her. I felt like she wasn’t helping me, that she wasn’t listening to me. I felt like another number to her, an experiment. But I did continue to see my therapist. I also stopped taking my medication. Not something the doctors recommend but I didn’t feel any different when I was on it. The medication didn’t feel like it was making any difference. About a year later, my therapist again suggested that I needed to be on medication. She recommended a psychiatrist and I went, hoping that this time the doctor would listen. He put me on Cymbalta, an SNRI, starting low but quickly increasing the dosage with each visit.

I did feel better, initially, but after a while, it was like I relapsed into a more depressed state. I stopped remembering to take my medication and then I stopped caring about attending my appointments. Again, I felt like the doctor didn’t really care about me. I was just another patient with a problem. How could he understand what I was going through and which medication to treat me with, if I only saw him fifteen minutes, once a month.

I stopped caring about anything and my parents, fed up with my behavior, kicked me out. While at the time, this almost devastated me, it ended up being one of the best things to ever happen to me.

Medication

In this post I’m going to discuss the various types of antidepressants that a doctor may prescribe. I am not a doctor and I will not claim anything other than a basic understanding of medicine. If you have questions about any of these medications please ask your doctor.

The initial group of antidepressants a doctor may prescribe are reuptake inhibitors. The first medication a doctor will generally choose will be a Selective Serotonin Reuptake Inhibitors, or SSRIs. This type of medication blocks the reuptake of serotonin to the nerve, which increases the level of serotonin in the brain. SSRIs are the most commonly prescribed, generally non-sedating and best tolerated by patients.

The second most popular medication is Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs. This medication blocks the reuptake of serotonin and norepinephrine to the nerve, which increases the level of these chemicals in the brain. SNRIs are often prescribed for severe depression and are safer if a person overdoses. SSRIs and SNRIs have fewer side effects than older antidepressants, although some people tend to experience sexual problems which may be fixed by switching medication or adjusting the dosage.

Norepinephrine and Dopamine Reuptake Inhibitors, or NDRIs, block the reuptake of dopamine and norepinephrine and increases these chemicals in the brain. This is one of the few antidepressants not associated with sexual side effects. There are various other types of reuptake inhibitors including but not limited to Serotonin Antagonist and Reuptake Inhibitors (SARIs) and Noradrenalin Reuptake Inhibitors (NARIs), which affect various brain chemicals.

Another group is cyclic antidepressants. These are generally known as the first generation of antidepressants. Tricyclics (TCAs) and Tetracyclics act in the same way as reuptake inhibitors by blocking serotonin and/or noradrenaline which increases these chemicals in the brain, elevating mood. Cyclic antidepressants are designated by tri or tetra dependant on the number of rings in their chemical structure. Cyclics are powerful but less used today because of the serious nature of their potential side effects.

The last type of antidepressant I’m going to discuss is Monoamine Oxidase Inhibitors, or MAOIs. MAOIs block the natural enzyme that breaks down serotonin, epinephrine and dopamine which increases the level of these chemicals in the brain. Using MAOIs requires a strict diet because of dangerous, even deadly, interactions with foods and other medications. MAOIs cannot be combined with SSRIs. They can also be especially effective in cases of ‘atypical’ depression.

Finding the right medication takes time and patience. You may need to try several medications before you find one that works. It can take several weeks for the medication to go into effect. Medication should only be stopped under a doctor’s supervision. Make sure to report side effects to a doctor immediately. Your doctor may recommend combining two antidepressants or adding mood stabilizers or anti-psychotics.

On some occasions, antidepressants can worsen depression or lead to unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant immediately contact your doctor or get emergency help. Remember, that antidepressants improve mood and reduce suicide risk in the long run.

Occasionally, hospitalization is needed because depression is so severe. Inpatient hospitalization is necessary is you are in danger of harming yourself or others. Psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Many hospitals have partial hospitalization or day treatment programs to help people while they get their symptoms under control.

Please remember I am not a doctor and I will not claim anything other than a basic understanding of medicine. If you have questions about any of these medications please ask your doctor.

National Institute of Mental Health

Mayo Clinic

Beyond Blue, Depression & Anxiety