Psychiatrist

I have tried a little of over 12+ types of antidepressants, augmentations (like adding an anti psychotic), and now I am on Lamictal + Pristiq; turns out I had treatment-resistant depression. I’ve had the last four months “good,” compared to previous times, where my depression was out of control (this lasted for ~ 4 years or so, and because of personal & family problems, the last 2 were the hardest times, which included suicidal thoughts and a couple of overdoses – I still have those once in a blue moon). I also went to therapy, which helped me much, as I got a lot of support from my counselor -my family is still reluctant, but I know I need to treat my depression even if they don’t accept it. In the past, my treatment with medicine was just simply not working; to the point that my psychiatrist suggested Vagus Nerve Stimulation, but I wasn’t all for it, so I’m on this new combination.

My PCP tells me I look different, that I smile more, seem happier, and that sort of thing. The last time I saw my psychiatrist, I did tell him I felt an improvement, which he also saw on the last two appointments and made comments of it as well. He also warned me that some days were not going to be like that, and that it was okay. I’ve been keeping track of my moods about every week, and some days I feel really good, others okay, and some, not good at all – make me feel like I should take the whole day off. To the point where, once again, I feel that knot on my throat because I want to cry, and sometimes, just sometimes, I do. I’ve called my psychiatrist’s office twice this month to tell him I’m not doing so good lately, as this happens about twice per week or so. I’ve not gotten a call back about it, but what really bugs me is that how do I know that depression is not going to take over me once again? How can I tell that my meds are not working well? Or how often is it “okay” to feel that way?

Having had major depression for four years, well, I really had forgotten what it was to feel happy, and I still remember that when I first started to feel good, I was in this great-awesome-wonderful-happy-excited mood and attitude just 3.5 months ago that I hadn’t felt in such a long long time. My counselor and I decided, about two months ago, that it was okay to stop going to therapy, she had suggested prior to the last time, but I just wanted to make sure I was ready. She still told me that any time I needed help with my depression to call her again.

I know about a month ago, I felt really overwhelmed with all the extra-work I was picking up, like giving extra classes during the week and on the weekends, working on a paper I want to publish, and working on some presentations for summer (all four things different in topics and audiences). I thought it was a good idea, as it would keep me occupied and because my mental state is so clear, that now I can retain and process material that before I wasn’t able to (unlike the last four years that caused me to drop out of a PhD opportunity and go back to my hometown and teach at a high school, not that is wrong to do that, but it was such a great opportunity that it still feels bad to have stopped).

Amazingly, and not sure if I’m right to do this, I want to take a part-time job teaching at a college, but now, I’m a little puzzled as if this is the right thing to do. I know I want to feel good, but I don’t want for time to pass by and not do something to get back on the road towards that PhD, and it would be nice to include such activities, and since the last month I’ve been feeling troubled twice a week, I just don’t know if this is normal or I am losing it again. I’ll appreciate your input. Thanks.I would love to be able to fix things entirely and feel for certain that this man is in fact in love with me.

It seems as if you have made an improvement. Your therapist seemed to agree otherwise she may not have been okay with you terminating your treatment. Your PCP has also agreed. He noted specific positive differences in your mood and behavior.

Your concern, as I understand it, is that you’re not certain if your improvement is sustainable. You worry that your depression may return. The primary reason for your concern is that at least twice a week you experience depression symptoms to the point where you want to cry and you call the psychiatrist’s office for his or her advice.

This is a difficult question to answer. My concern is that you have stopped seeing your therapist. I would not have recommended this. Some people believe that because they are doing better they no longer need treatment. Improvement is a sign that the counseling is likely working but not necessarily a reason to end treatment. My sense of the situation is that perhaps you have discontinued therapy too soon. Here’s why I say this.

You are taking on many new responsibilities (e.g. working on a paper that you hope to publish). These new tasks are very important for your growth and development but they can be anxiety-producing. This would be true for anyone but especially for someone with a history of anxiety and depression.

You also want to return to teaching, which is good, but it may be too much for you at this time. Again, it is difficult to know if that is true because you lack an objective source to help you determine if it’s too much for you at this time.

The point is that you don’t want to overwhelm yourself. Taking on too much could potentially cause a relapse and you don’t want that. It is important to work at a pace that is reasonable and does not overwhelm you.

My recommendation is to return to therapy. Your therapist was supportive in the past. You improved when you were working with her. She can help you manage and assess your new responsibilities. She can advise you as to whether you are taking on too much, too fast. It would be helpful to have someone like this in your corner while you’re adjusting to your new responsibilities.

It is often best in a situation like yours to gradually decrease your therapy sessions. When all is going well with your weekly sessions, for a period of time, then moving to one session every two weeks would be the next logical step, then once a month and so on.

With regard to mood, it’s best to aiim for a normal fluctuation without extremes. One should not be manically happy or desperately sad.

Life is difficult. There will be suffering and there will be happiness. Some days will be better than others. In the words of Viktor Frankl “what never can be ruled out is the unavoidability of suffering.” We should expect it, learn to deal with it and perhaps even find meaning in it.

Moods can be affected by hormones. Hormones are something that we cannot control. Moods are also affected by a lack of sleep as well as other factors. Tired people may have trouble managing their moods. It is important to recognize this.

When you sense an oncoming bad mood, try to ask yourself the following questions:

• Why am I feeling this way?
• Is this a reasonable way to feel?
• Do I have any reason to feel this way?
• Is it logical to feel this way?

Some of these answers may help you to better understand why you feel a particular way. When a negative mood arises, try to eradicate it using logic. Don’t allow yourself to be in a bad mood if there is no reason for it to occur. Logic will not work every time but it may prove helpful some of the time. If there is a legitimate reason for a negative mood, try to work through it to diminish it. What’s good is that you have begun to record your moods. This may help you to better understand them when they arise. You may see a pattern.

I hope this answer helps in some small way. I wish you luck in all of your future endeavors. Thanks for writing. I wish you well.