My Life In Outpatient Treatment: Week 4

This is a continuation, Week 4, of my daily journal while in outpatient treatment for depression, anxiety and avoident personality disorder. Please click for Week 1, Week 2 and Week 3.

Week 4, Day 19:
My doctor informed me today that they believe my depression is caused by ingrained personality traits which are linked with my avoidant personality disorder tendencies. Supposedly I can fix this by thinking positive things and making positive situations and decisions. I consider this ‘Reprogramming Talia’.
We also discussed change in group therapy today and the therapist had each person write down their top 5 necessities for change. Here are mine:

  1. You have to want to change (willingness)
  2. You have to have help to make change occur (therapist, doctors, etc)
  3. You have to have a solid support system
  4. You have to have the ability to be flexible
  5. You have to allow the change to happen (don’t fight it)

Everyone came up with different answers and it was interesting to see how other people view change and how much needs to happen for change to occur.
Change wouldn’t be worth it, if it was easy.

Day 20:
After yesterday and the realization about the ingrained personality traits, my thoughts have become increasingly negative about myself.
How did I become like is? Is it my fault that these personality traits evolved? Did I make myself like this (unconsciously, of course)? “I am wrong. I am messed up. I made this.”
I want to know why I’m like this. I want to know why I developed in this way.
I want to blame someone, anyone for me turning out this way. Maybe because then I would be the victim and not the perpetrator. And in a way, aren’t I still a victim? A victim of circumstances, situations and environments? Something had to have happened for me to turn out this way.

Day 21:
I feel like I can’t talk. I just get looked over. My issues aren’t important enough. I asked to see my therapist today, but I doubt he’s going to pull me out.
I feel like I’m not getting any better. I’ve been here for a month. I just don’t matter.

Day 22:
Today I talked about how I felt. The group therapist gave me the suggestion to look at situations in my life that have caused me pain and hurt. I am supposed to pick situations that still bother me; situations I still need to process. I am supposed to journal it and hopefully reprocess the situation. I should look at it as a learning experience rather than allowing it to hurt me.
I have a very ‘all or nothing’ attitude. I don’t want to invest time and energy into something if it isn’t going to work out.
My therapist also discussed my discharge from the program today. We decided that I would discharge in a week. I don’t know how I feel about this.

Please stay tuned for Week 5. Here are the links for Week 1, Week 2 and Week 3.

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Therapies for Depression

Therapy is one of the best ways to face mental disorders head on. It gives you a chance to confront your issues and learn to cope with them, if not completely solve them. This post is going to focus on a variety of the therapies offered, however it will only touch upon some of the most popular forms of treatment.

Psychotherapy, known as ‘talk therapy’, is a form of treating depression by counseling patients and helping them understand their illness. It helps them develop strategies and tools for dealing with their symptoms, stress, and behaviors. There are many different kinds of psychotherapies as it is not a ‘one-size-fits-all” approach. The kind of psychotherapy a person receives depends on his or her needs.  While psychotherapy may be the best, and only option for those with mild or moderate mental illnesses, those with severe depression may need medication as well. Several, but not all, forms of psychotherapies will be discussed.

Cognitive Behavioral Therapy, or CBT is a blend of cognitive therapy and behavioral therapy. Cognitive therapy focuses on a person’s thoughts and beliefs while behavioral therapy focuses on a person’s learning, actions, and behaviors. Both of these can influence a person’s mood and actions. CBT attempts to change a person’s thinking to be more positive, healthy and adaptable. CBT helps restructure negative thought patterns so a person can interpret their environment and personal interactions in a positive and realistic way. It also helps a person recognize things that could be contributing to the depression and teaches realistic coping skills.

Interpersonal Therapy, or IPT focuses on the interactions and behaviors a person has with important people in their life on a day-to-day basis. IPT is used to treat depression and dysthymia and focuses on helping a person improve their communication skills and increase their self-esteem. This therapy focuses on emotions and depression that is usually situational, such as loss/grief, relationship conflicts and major life events. The therapist helps the patient identify their troubling emotions and triggers and teaches them how to express their emotions in a more appropriate and healthy manner. A variation of IPT, known as Interpersonal and Social Rhythm Therapy or IPSRT is used to treat bipolar disorder

Dialectic Behavioral Therapy, or DBT is a form of CBT developed to treat people with suicidal thoughts and actions. Dialectical refers to a discussion of two opposing views until a balance of the two extremes is found. The therapist assures the patient that their behaviors are valid and understood but also teaches that it is the patient’s responsibility to change disruptive or unhealthy behaviors. DBT involves both individual therapy, to learn new skills and group therapy, to practice them. DBT is also an effective treatment for patients with borderline personality disorder.

Family focused therapy, or FFT was designed specifically for treating bipolar disorder. FFT includes family members in therapy sessions to improve relationships and identify difficulties and conflicts which could be detrimental to a patient’s treatment. This therapy specifically focuses on educating the family about the disorder, teaching family members how to effectively communicate, and solving problems together as a family. FFT focuses on the stress families feel when they are caring for their relative, and aims to prevent ‘burning out’ but also holds the patient responsible for their own well being and actions. Several studies have found FFT to be effective in helping a patient become stabilized and preventing relapses.

There is also the therapies developed by Sigmund Freud, psychodynamic and psychoanalytic therapies. These therapies will discussed in a future post, as well as an explanation for why there therapies are no longer used by today’s therapists.

National Institute of Mental Health

The Mayo Clinic

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

Forms of Depression

There are many types of depression.

Major Depression interferes with everyday life. It is characterized as having more than 5 of the symptoms discussed in a previous post, for over a 2 week period. Major depression can occur only once, but there are often several episodes.

Seasonal Affective Disorder or SAD, is the onset of depression during winter months. It is generally attributed to the lessening of sunlight and it is usually effectively treated with light therapy.

Postpartum Depression occurs after the birth a newborn. It is attributed to hormonal and physical changes, as well as the new, overwhelming responsibility of a newborn. If not treated, it could lead to trouble caring and bonding with the baby.

Bipolar Disorder, also known as manic-depressive disorder is characterized by major mood swings. The moods swings from manic to depressive are often gradual, although they can occasionally occur abruptly. There are multiple types of bipolar disorder, depending on the severity of the mood swings.

Persistent Depression Disorder, or PDD, also formerly known as dysthymia is a form of depression where the symptoms last for at least 2 years. It is usually less severe, but more chronic. It is not disabling but persistent as described in the title. People with PDD usually look at life with a “glass half empty” mentality.

Psychotic Depression is major depression with psychosis. This is characterized by hallucinations, delusions and paranoia.

Premenstrual Dysphoric Disorder or PMDD, is depression that occurs with the hormonal changes a week before a woman’s period and improve with the onset her period.

Atypical depression, which is actually more common than the name suggests, is depression where mood is temporarily improved by a  positive event. This depression is characterized by a heaviness in the arms and legs.

Adjustment Disorder is a severe reaction to a difficult event. It is triggered by a stressful, life-changing event and is a type of stress-related mental illness that may affect feelings, thoughts and behavior.

 

  1. National Institute of Mental Health
  2. Anxiety and Depression Association of America
  3. Mayo Clinic