Re: ATM: How does one approach professional mental health care?


I just want to reinforce Heebie on the point of being willing to ditch a therapist if you think they aren't going to work with you. I'm speaking from experience -- I stayed far too long with a therapist who I didn't really trust and who wasn't working for me. Switching a new one, who was, made an immediate difference.

Also: mental illness is tough. Your brain is lying to you, and since many of us more or less live in our brain, it's hard to stop believing what our own self is telling us. That's how therapy can help.

Medication can help as well. The idea that you feel is what you are is, IMO, wrong. To a large extent, especially when you've got depression or anxiety, you feel what the chemicals in your brain are telling you to feel. Medication can adjust those chemicals, and allow you to deal with your personal issues without the weight of the depression (or anxiety, in my case).

Posted by: delagar | Link to this comment | 06-25-17 8:13 AM
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I agree with everyone that medication and therapy together are probably the best. Depression isn't about a lack of willpower, it really is a chemical imbalance (as delegar noted), and you can't really rebalance them by yourself. If you had an infection, you'd get antibiotics. I also resisted meds for way to long because I was worried about not feeling like myself. After I started taking them, I realized that they actually made me feel more like myself, because I was not longer surrounded by this fog. I still had emotions and got upset/sad/angry, but those feelings were no longer my baseline emotions.

My depression also manifests a lot in anger and irritability, and one thing I've found very helpful is mindfulness training. Related to that is letting yourself have feelings and accepting them, and then trying to release them out not onto anyone or anything. I try to do this with anger. If you try to stifle it as an "illegitimate" feeling, it often just makes it worse. This way your sort of let yourself just be/feel for a little bit and then imagine letting it go. It doesn't always help, but sometimes it does.

Posted by: Buttercup | Link to this comment | 06-25-17 8:42 AM
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My shrink put me on more meds when I was doing poorly, but as my anxiety has improved, I've tapered off that med, but he's a psychoanalyst. Not opposed to meds but definitely of the "fewer meds are better".

I'm not sure what your psychologist said, but my psychiatrist has certainly said that I need to feel my feelings and talk through them. I don't think he would want me to be severely depressed, but he would argue that permanently numbing feelings of grief and loss would be counterproductive. It would prevent dealing with them and becoming more free to make one's own choices. In other words, don't think you can avoid the tears. Maybe that's what this psychologist was trying to say, however inartfully.

I'm sure it's important to find the right fit, but depending on the orientation of the provider (CBT versus psychodynamic or interpersonal) having rough patches in the relationship and talking about them is part of the work.

Posted by: Bostoniangirl | Link to this comment | 06-25-17 9:08 AM
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Perhaps this is my experience biasing me, but to me (potentially) the most concerning aspect of this scenario is the expatriate situation. When I was in China they were just amazingly shitty and ignorant about depression. Like, offensively, dangerously so. Fortunately, I knew what meds I needed and I was in a position to bypass the doctors. They weren't malicious, it was just a cultural thing.

If whereever you are isn't western, get your meds and then reevaluate. One can't think properly in the midst of depression.

Posted by: foolishmortal | Link to this comment | 06-25-17 9:34 AM
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"This is a land of single-payer," quoth the Consul. So probably western-ish.

Posted by: chris y | Link to this comment | 06-25-17 9:50 AM
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More soon, and I'm including email for private consultation at boring length if desired, but: there are very effective antidepressants, like Wellbutrin, that will make the anger thing so much worse, so be SURE you make it clear that you want some kind of tranquility potion.

Posted by: lurid keyaki | Link to this comment | 06-25-17 9:52 AM
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I've never been able to find a therapist that I found helpful, and I don't know if that's because I've had bad luck or because I'm just bad at therapy. Over the course of the past fifteen years, I've probably done initial visits with about a half dozen people, and immediately rejected almost all of them for a variety of reasons (too obviously hippy-dippy; mentioned God; said "mm-hmm" after every sentence I spoke; annoyed me instantaneously for reasons not immediately clear to me), and then had at least a few months of sessions with three of these. One I broke off with when she started asking me whether I felt my parents had pushed me into my profession. The answer is no (I like my job a lot, even though it's very stressful sometimes, and my parents had nothing to do with it), but she kept returning to that line of questioning, which I felt was presumptuous and possibly a little racist. With the other two, I just felt like I wasn't getting anywhere.

Heebie's advice in the OP seems sound, but I don't really know where I've gone wrong. I'm basically fine (and not overwhelmed by anxiety or depression, as I was at points in the past), but I'd like to successfully go to therapy (or, more accurately, I'd like to have gone to therapy, and have already resolved some of my issues). But the process of finding someone seems really exhausting and dispiriting.

Posted by: jms | Link to this comment | 06-25-17 10:55 AM
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I endorse 2.2

Posted by: parsimon | Link to this comment | 06-25-17 10:56 AM
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6 cont'd: Like, specifically if you want a friendly ear/anecdata about the complex of procrastinating, refusing to commit to attainable goals, being perennially devastated by your own failure to live up to your obvious potential (which would entail forgoing all the other awesome lives you might like more), and generally being hopelessly unable to distinguish your strengths from your weaknesses or see yourself in any meaningfully objective light... I know a tiny bit about that stuff, second- or thirdhand, naturally.

Therapy becomes more sufferable when you're doing it for the sake of someone else. You'll never be satisfied by it, but maybe they will, those losers in the real world who expect and deliver consistency and results.

Posted by: lurid keyaki | Link to this comment | 06-25-17 11:19 AM
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9.2 is a great point.

Posted by: Blank Stare | Link to this comment | 06-25-17 11:57 AM
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9.1 is devastatingly familiar.

Posted by: Barry Freed | Link to this comment | 06-25-17 12:14 PM
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I had a great therapist! And I became a much happier person! I mean, as an essentially pessimistic, depressive person I'm still not a bundle of fun, but I'd say I'm probably 50% less of a downer.

Some observations:

1. I was really lucky that I got a good therapist off the bat, but:

2. I was willing to do dumb stuff, up to a point. Therapy works if you let it; if you go around thinking "I'm smarter than my therapist" and "this is too much woo", you won't get anywhere. So what, you're smarter than your therapist? You think getting over depression is about being smart? Your therapist is like your bike repair person - it doesn't matter whether they get the finer points of, like, Derrida, or if they whistle annoyingly through their teeth while they work; they have far more experience of bikes than you do, and they have far more experience fixing them than you do.

I mean, in a strictly "who would be more successful in a comp lit PhD program" sense, I was smarter than my therapist. In a "who knows how to look at a life so that it doesn't look like a pointless cesspool of guilt" sense, my therapist was way smarter.

Some therapists are going to be a bad fit, or genuinely not that good at therapizing, and it may matter in that situation that you are "smarter". But in general, given a reasonably compatible, reasonably intelligent therapist, try to go with their insights at least a little bit rather than thinking "here is how I can use my superior rationalizing skills to bamboozle this person" or whatever tempting approach strikes you.

3. Have a method in mind. My therapist did a lot more listening and talking than he normally did - I could tell he was kind of a behavioral-hacks guy. But he was good enough and smart enough to work with me the way I needed, which was to finally tell someone who could absolve me of things about all the stuff. (Which was what I personally needed - someone I could invest with enough authority to take them seriously when they said that I wasn't a terrible person.)

4. You will get some great insights into all that transference and internalization stuff. It's all true, more or less. When I feel terrible about something, I ask myself, "what would [my therapist] say about this, and even though he was promoted - so good was he - to a position in which he therapizes and mentors other therapists rather than civilians and I now no longer see him - I am able to put things into perspective, forgive myself, etc, as if I were actually talking to him. It's kind of neat. I visualize it, actually, as carrying a tiny primitive stone carving inside me, like a Venus of Willendorf if she were a wiry trans guy and were somehow embedded somewhere around the solar plexus without this being fatal.

I am also now a less angry person, and moderately less afraid of illness and death.

Posted by: Frowner | Link to this comment | 06-25-17 1:47 PM
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This is a tangential point but pt 2 in 12 reminded me. As a smart person, you are also very good at coming up with convincing arguments about everything, even terrible, horrible decisions. You can find some moderately intelligent-sounding reason to convince yourself or justify to your self about making bad decisions, so that's something to be aware of. (I know I did with marrying my ex, not treating my depression, etc.)

Posted by: Buttercup | Link to this comment | 06-25-17 2:06 PM
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Right. Also, if you're so smart, why can't you build a functioning AI that works better than your brain and makes all the right decisions? I mean, aren't you SMART? (
Indeed, no, intelligence is orthogonal to the problem, except where it exacerbates it.)

Posted by: lurid keyaki | Link to this comment | 06-25-17 2:35 PM
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Great work done admin., keep it up.

Posted by: Bus Rush | Link to this comment | 06-25-17 3:40 PM
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I want to echo many of the others here and say that both therapy and meds are helpful. I am currently managing on just meds because I am stone broke and can't afford it, but I wish I was in therapy and will go back to it as soon as I have decent insurance/a job.

Meds should not make you into someone else, but they *can* have side effects that impair you cognitively or impact you in negative ways. (Prozac, for example, makes me feel slightly stoned all the time. Which, while pleasant, didn't let me effectively function in society.) So be patient but persistent with any med--they take a while to kick in, you may need to taper up or down, they may interact with each other. At one point I was on 5 different meds because I'd talked various psychiatrists into trying to tweak my lived experience up or down in various ways. My current guy has me down to two. (We tried one for a while, and it was working OK, but I was feeling too emotionally volatile/fragile--like any one big piece of negative news would send me into a spiral. The converse is that in the two months or so that I was down to the one med I felt some moments of ecstatic happiness that I don't know that I've been able to feel for a decade or more--my hope is that when I go back to therapy I'll be able to make my systems a little more robust and I can drop back to the single med.)

I'm going to differ with other folks on whether or not you should lay out all the things going on (suicidal ideation, worries about potentially manipulating your therapist because you're smart, etc.). You absolutely have a right to do so, but I don't think it's the best strategy. I think laying it all out on the table gives your professionals the best chance to offer their personal best. You'll find out a lot quicker if someone's not going to work out--therapy and med-wise. It's their job to deal with the data dump, your job to share it, together you work on fixing it. Plus, especially with therapy, my experience is that the initial data dump is just the jumping off point--the real work starts once you've gotten the first layer out there. Then the digging and probing and evaluating and god help you making changes starts.

Another thing to pay attention and push both your therapist and med person about is the potential for multiple diagnoses. We figured out in my early 20s that I have major depression, but not til I was 40 or so did we key into the anxiety disorder--which changed the course of medication and made things a *lot* better. I have a sneaking suspicion that I may have the trifecta with some level of ADD as well--I had just scheduled a giant battery of assessments for that when I lost my main source of income and had to put off the tests until I could afford it. If you have trouble getting things done at work, it might be something to ask about as well.

Last--and this is important: WATCH IT with the alcohol. Even if you're not an alcoholic (and I don't think I am), binge/heavy drinking can severely fuck with your meds' functioning. I had a real rough patch a few years back where I was drinking to excess every night and didn't realize that while it was effective self-medication in the moment, it was essentially turning off all my other medication, drastically ramping up my systems the 18 hours of the day when I wasn't drunk. After 10 months stone sober and concluding that I wasn't an alcoholic, I still drink--even occasionally to excess--but no more 4 fingers of bourbon when I walk in the door every night. And if I do get drunk, I take a few days off from any alcohol to make sure my meds can still work.

I'll extend a similar offer to others upthread--if you need someone to talk about shit who has been down a similar road, feel free to drop me a line at the linked email. Good luck.

Posted by: Chopper | Link to this comment | 06-25-17 5:14 PM
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Second 15. Go neb!

Posted by: Mossy Character | Link to this comment | 06-25-17 5:24 PM
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Thanks everyone. I think I'll post serially for ease of referencing.

Posted by: Martius | Link to this comment | 06-25-17 5:37 PM
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In general, I think it's true that you are what you feel, but it's also true that you feel what chemicals tell you to feel. And so what you feel and who are you are mutable and improvable, and not sacrosanct in some way. I've been a materialist about mental states since forever and it's kind of ridiculous that I've never put my many where my mouth is.

Posted by: Martius | Link to this comment | 06-25-17 5:39 PM
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4: (potentially) the most concerning aspect of this scenario is the expatriate situation
The general attitude and responses I got were exactly what I would expect from Anglosphere therapists, based on the knowledge I mention in OP.2. I'll bear what you say in mind, though.

Posted by: Martius | Link to this comment | 06-25-17 5:39 PM
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6: antidepressants, like Wellbutrin, that will make the anger thing so much worse
Good to know. I did make clear the anger was important, and this was much of what we talked about, directly and indirectly. I'll be doubly certain that information gets to the psychiatrist/s as well. Thanks for the email. I might get in touch, but probably not immediately.

Posted by: Martius | Link to this comment | 06-25-17 5:40 PM
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9.1: Crushingly familiar, indeed. I'm not quite sure what you mean in 9.2, but maybe it relates to something significant. When I'm doing something just for my own sake (college, for instance) I tend to flake, and the perfectionism you talk about chokes me. But when other people are relying on me I usually do far better. Every job I've had I've been told repeatedly how quick and reliable I am, for instance.

Posted by: Martius | Link to this comment | 06-25-17 5:41 PM
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13: very good at coming up with convincing arguments about everything
True, and thanks for the reminder. I like to think that I'm fairly good at calling my own bullshit, and have gotten better at doing so. But you can't really measure that from the inside.

Posted by: Martius | Link to this comment | 06-25-17 5:41 PM
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16: multiple diagnoses
I was wondering about this too. In previous procrastination discussions Adderall, frex has come up.
binge/heavy drinking can severely fuck with your meds' functioning
Useful information! Thanks also for the email.

Posted by: Martius | Link to this comment | 06-25-17 5:42 PM
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12: a reasonably compatible, reasonably intelligent therapist, try to go with their insights at least a little bit rather than thinking "here is how I can use my superior rationalizing skills to bamboozle this person"
Yeah. I'm not setting out to bamboozle anyone, but I'm going in keeping this strategy layer in mind, because I might need it to get what I need. I don't know if I'll actually need that, and at this point the whole discussion is hypothetical, because I've had just the one introductory session. Chopper is right, they need the information, but I want a better feel for these people before I lay everything out; and I don't even have a psychiatrist yet, anyway. Sufficiently respecting the therapist to listen to what they say is going to be a thing; I am intellectually arrogant. The notion of absolution is interesting. I don't think that could work for me, but early days. I'll bear that in mind.

Posted by: Martius | Link to this comment | 06-25-17 6:12 PM
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7: At the least, I didn't have any adverse reaction to these people. Time will tell. Best of luck to you, and to Chopper.

Posted by: Martius | Link to this comment | 06-25-17 6:17 PM
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12: Further, as I said in the OP, I did actually gain insight just from this session. Like for instance, yes, my whole family is substantially fucked up, and maybe that needs to be approached as more than just background noise.

Posted by: Martius | Link to this comment | 06-25-17 6:20 PM
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Also, a smaller thing: I found this session kind of draining. I was tired for other reasons too, and I'm very introverted, but this felt somewhat different.

Posted by: Martius | Link to this comment | 06-25-17 6:23 PM
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27: One thing I was going to say was that if your family members are fucked-up in a way that involves a diagnosis, that's worth sharing. I have a daughter who doesn't have a diagnosis of bipolar disorder but has relatives who do and antidepressants that work for people with bipolar diagnoses do better for her than ones that don't even though no one is implying that's her problem, is that makes sense. (Also a vote for Wellbutrin plus something for the anger being potential life-changers.)

I'm doing just therapy and no psych meds but I'm at or close to the point where the latter should change and I need something for anxiety probably and maybe depression. But my amazing therapist thinks I should get my wholly physical health under control first (facing a definite surgery for uterine ablation this summer plus provablies for tonsil removal and whatever they stitch up to heal an ankle that won't un-sprain and gets worse in physical therapy, all good excuses to feel glum) and that buys me a little time.

I click with this therapist as with no other, by which I mean he totally gets me and calls me on my shit without being unkind or expecting me to actually do whatever he recommends, and vaguely remember having seen him in the blurry year when I was 18-19. There's some alternate universe where I actually took his good advice then and ended up successful and never needing the blog, presumably, but here I am now. And both physical therapy and therapy therapy can be draining way beyond what it seems reasonable for them to be. I too am happy to talk about this stuff.

Posted by: Thorn | Link to this comment | 06-25-17 6:51 PM
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fucked-up in a way that involves a diagnosis, that's worth sharing
Good point. I don't know if there were, and asking will involve conversations I really don't want to have. I'll pursue that if looks like it'll be useful. And good luck with everything.

Posted by: Martius | Link to this comment | 06-25-17 7:52 PM
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FWIW 9.2 was in reference to your employer asking you to seek help -- generally speaking I've only ever gone to therapy at the request (or demand) of other people, and I see it primarily as a way to relieve the burdens I put on people in my life. I know that sounds grim and counterproductive, but that's how it is. I can't evangelize for it much, but it's like a life sentence for me at this point. I will say that all medical approaches have limited value in helping people accommodate themselves to situations that make them truly unhappy. I'm not even 100% sure that they reliably help people get out of the bad situations. It is certainly worth a shot, though. Depression is poisonous and I'm half-convinced it's a progressive condition, so use all available weapons without mercy.

Posted by: lurid keyaki | Link to this comment | 06-25-17 8:14 PM
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So, anyone else need cheering up?

Posted by: lurid keyaki | Link to this comment | 06-25-17 8:15 PM
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31: That makes sense. My employer suggested I seek help, didn't tell or force me. I do want to keep the job, but this is mostly for me.

Posted by: Martius | Link to this comment | 06-25-17 8:23 PM
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Some antidepressants or other psych meds, including wellbutrin, can make anger worse...but wellbutrin can also help with anger, specifically if it is related to ADHD, which is somewhat likely for someone with procrastination issues too. It can be hard to guess which meds will work well ahead, although good psychiatrists can be helpful with that. Sometime it is just trial and error though.

Also, like any other health issue, doing the basic self-care things is important. Get enough sleep regularly, be social, do some relaxation/meditation, eat reasonably, and get some physical activity. It doesn't fix serious issues, but makes them less serious and easier to fix.

Posted by: Yoyo | Link to this comment | 06-25-17 11:36 PM
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I second the advice about meds, trying a bunch, etc. Also therapy. The thing that has taken me from "mostly OK" to "mostly good" is exercise. I can't overstate the impact it has had. It's at least as effective as the meds, and the synergy between them is great. I'm working with a trainer and about to add yoga, which ought to be agonizing at first but I'm confident it will turn into something good once I get the hang of it. If anger is an issue maybe try cardio boxing or a martial art. Do something structured so you know there's someone waiting for you to motivate you to go when you don't feel like it. It's easy to put together a personal workout routine for yourself and ignore it. Harder when there's a person waiting for you to show up.

Good luck! And with that, off to the gym to take my own advice!

Posted by: togolosh | Link to this comment | 06-26-17 3:34 AM
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If anger is an issue maybe try cardio boxing or a martial art.

There's little better than hitting pads or a bag for getting it all out.

Posted by: nattarGcM ttaM | Link to this comment | 06-26-17 5:06 AM
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36: I just did a ton of twist slams with the medicine ball, imagining it was landing on Trump's face. Very relaxed now.

Posted by: togolosh | Link to this comment | 06-26-17 5:09 AM
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35-6: They also talked about exercise, and martial arts. I exercise spottily. I does make feel better when I do it, but not by much. And impressionistically I flt it might actually make the anger worse, by pumping up adrenaline or whatever. I've never done martial arts though.

Posted by: Martius | Link to this comment | 06-26-17 6:15 AM
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We signed Pokey up for some summer karate classes on the vague hope that it would help him with his anger issues. It's not the only tactic we're trying, though.

Posted by: heebie-geebie | Link to this comment | 06-26-17 6:33 AM
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And impressionistically I flt it might actually make the anger worse, by pumping up adrenaline or whatever.

Not my experience (though I don't have anger or depression issues)... exercise also releases endorphins, which give you a nice relaxed high after they finish, and I've never found that even adrenaline-type sports leave an aftereffect of anger. And not all exercise need involve the release of adrenaline. Yes, combat or competitive sports probably do; but if you're worried about that, swim, or run, or something.

Posted by: ajay | Link to this comment | 06-26-17 6:36 AM
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As someone with the depression, anxiety, ADHD trifecta, I think everyone's offering great advice. I also recommend as a research tool.

In terms of disclosing suicidal ideation and self harm, it's worth knowing where providers/the law draw the line in terms of involuntary hospitalization. It's also just worth knowing more precisely what you are feeling--I've often felt like I didn't want to live, but for me that hasn't meant that I wanted or was willing to kill myself.

Several months ago, fwiw, I had some genomic testing done (paid out of pocket) that shed some light on which classes of drugs are more and less likely to work for me. It didn't necessarily tell us a whole lot more than we already knew, but in my situation it was worth giving a try.

Posted by: J, Robot | Link to this comment | 06-26-17 7:55 AM
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I want to nth everyone's recommendations about exercise. IIRC, it's as effective as medication in terms of making your brain chemistry happy, as long as you do it regularly and at a certain intensity. When I ran competitively, I feel like it kept my mood up really well, and gave me a higher baseline energy. Yoga is also a great thing for calming and centering. I had to go off my antidepressants in China (for bullshit access reasons, not because I was ready to go off them), and I'm pretty sure daily yoga is what kept me from completely slipping into full on depression. It can be hard, especially if depressed, to exercise on your own, so if you can I would recommend getting a gym buddy or joining a class/team that force you to exercise at a certain time/place.

I have irritability issues and I'm on Wellbutrin, I'm still irritable but better than I was when I was depressed. It's possible that another antidepressant would be better for that but Prozac was terrible and I am pretty low energy so I like the fact it's a stimulant.

Posted by: Buttercup | Link to this comment | 06-26-17 9:56 AM
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Now that we're past 40, I want to angst a bit. It's even kind of on topic.

My wife (Betty?), who has been diagnosed with major depression and on meds for years, is having a major episode of depression and/or anxiety in the last month or so. I think it's likely that it's work-triggered, as her job has some truly misery-making things going on, and while she's looking for other work, that's hard and also anxiety-producing in its own right (Even her therapist thinks she should quit the job - to the point of having done some job-searching in her field and sending her a couple of openings, including to one she had just applied to, but among other things she's afraid that if she just quits, having any gaps on her resume will make her unemployable. Overstating the case, but depression makes her good at catastrophizing the situation.)

I'm trying to be supportive, making sure things get done around the house and so on, but it really feels inadequate to the amount of trouble that's going on. There's a check-in with her meds doctor imminently, and while they may tweak things, I don't think I should hope for a big change, as she's already been through most of the major drugs and a few minor ones to boot.

Exercise sounds like a great idea but it's going to be very, very hard to make it happen with the life and work schedule, even before the demotivating effects of the depression itself.

I have no point, I just need to talk about this.

(What's this genetic testing for drug effectiveness? Can one just go do it?)

Posted by: Gerald Ford | Link to this comment | 06-26-17 10:08 AM
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43: For some medications, there are publications detailing which individual genetic variations affect efficacy of a particular drug. That is, for example, some individuals have an A instead of a G in a particular position on chromosome 12, which is known to affect response to fluoxetine.

The test that assays the differences is a cheap and standard technology, however the medical interpretation of the results is often ambiguous and I'm pretty sure that the vendors of the assay cannot for legal reasons provide even biolerplate medical guidance for the results. Not sure how best to get a medical interpretation of the test.

Posted by: lw | Link to this comment | 06-26-17 10:21 AM
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I am in a very similar situation to your wife's, and all I can say is that I've recently begun to focus on activities that I love and care about far more than paid work, which has allowed me to let go of a lot of worries about my job on the deepest levels. If I were given a choice today of either losing my job immediately or being prevented from working on these other projects for five years, I wouldn't hesitate for one minute to walk off the job. (Not even to project vested stock option value vs cost of living increases...) Does anything besides work have a similar gravitational pull for her?

I was just coming here to ask an off-topic presidential question. You first!

Posted by: lurid keyaki | Link to this comment | 06-26-17 10:22 AM
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43: I don't know what sort of testing is being referred to in 41.3, but several commercial sequencing companies (like 23&Me) now offer tests for genetic variation in some drug metabolism enzymes and drug transporters.

Posted by: AcademicLurker | Link to this comment | 06-26-17 10:25 AM
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45: I'm not sure if there's anything in that category. There's a definite lack of free time to pursue non-work, non-parenting interests, exacerbated by exhaustion (which might be causing the depression, be cause by it, or both) causing her to fall over by 9pm every night. Her expressed desire is to work at something - without that kind of structure in her life, things kind of fall apart.

Posted by: Gerald Ford | Link to this comment | 06-26-17 10:35 AM
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Don't underestimate lack of sleep as a trigger for depression, IME. Any way to manage the house/second-shift type stuff which would allow her more time for non-work interests? (Sorry for the assumption that she's likely pulling the second shift, but that's often the case statistically.)

Posted by: Cala | Link to this comment | 06-26-17 10:47 AM
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Sure, understood. It's tough and I've been there (am there, to some extent), and it's mostly an endurance test. Encouragement and acknowledgement that yes, life is sometimes this shitty, even in the midst of abundance: that's about all there is.

If you can't chemically induce equanimity, I wonder if there's some kind of visualization exercise that would be helpful for her: a future that isn't too painful, worst-case and best-case scenarios and everything in between. It's hard for me to imagine the future at all, in any way, and it would probably be good for me to adopt some method of discerning that, four hours from now, I'm going to deeply regret posting this much compromising personal information in a mental health thread. But best of luck to you both.

Posted by: lurid keyaki | Link to this comment | 06-26-17 10:52 AM
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I'm trying to keep the second shift down - I already do all the menu planning and cooking, we've outsourced major cleaning, so it's "just" the school-pickup-to-kid-bedtime window, which I'm covering a couple of weeknights a week (I do all the morning routine/school dropoff stuff). I have contemplated looking for regular childcare for the school pickup window to give us more evening schedule flexibility, but haven't managed to make it happen yet.

The sleep stuff is tricky - in addition to everything else, there's an ongoing saga of mild-to-moderate sleep apnea, which is proving stubbornly resistant to several treatements (CPAP, oral appliance, sleep-position pillows). The very fact of having that be hard to treat is itself kind of discouraging, and the poor-quality sleep that results is certainly not doing anything good.

Posted by: Gerald Ford | Link to this comment | 06-26-17 10:59 AM
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For those interested in genetic testing for drug efficacy, etc., check out Has to be ordered by a physician (or a pharmacist in some states?), around $200 out of pocket which your insurance may or may not reimburse. As of my last experience with them it was the broadest pharmacogenomic test on the market. Simple, easy to read report for most HCPs, interactive portal for those who care to dive deeper (portal is HCP only).

Posted by: President Used to Work There | Link to this comment | 06-26-17 12:11 PM
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How old is the kid? Are there any home day cares around you? Both my friend and I had great experiences at unlicensed home day cares as older kids (7-11ish range), and they were very affordable and within walking distance of our houses, so we could walk ourselves home or have a parent walk by. A kid that age can also tell you if there's something off or unsafe at the day care, and even just going for a few hours a day can give your wife some down time.

Posted by: Buttercup | Link to this comment | 06-26-17 12:19 PM
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My psychiatrist had me do the Genomind test, which ended up costing me $350 or so. I had thought it was covered by insurance--probably wouldn't have done it otherwise.

President Ford, it sounds like you're doing what you should be doing. Partners can do quite a bit by just looking after their own mental health, and keeping on top of everyday needs.

Posted by: J, Robot | Link to this comment | 06-26-17 12:34 PM
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Oh Lord, I missed my cue. Belatedly:

I mean, in a strictly "who would be more successful in a comp lit PhD program" sense, I was smarter than my therapist.

Aha, so your therapist would have been more successful in the comp lit PhD program!

Posted by: lurid keyaki | Link to this comment | 06-26-17 1:37 PM
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It's a trick question. No one in a comp lit PhD programme considers themselves a success.

Posted by: ajay | Link to this comment | 06-26-17 2:49 PM
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Guy next to me on the plane has a copy of "How to Win Friends and Influence People." He's using his dinner to try to hold the middle seat empty. This is the exit row.

On topic because something.

Posted by: Moby Hick | Link to this comment | 06-26-17 3:59 PM
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Mr. Influence actually covered the seat with water.

Posted by: Moby Hick | Link to this comment | 06-26-17 5:35 PM
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By accident, I think.

Posted by: Moby Hick | Link to this comment | 06-26-17 5:41 PM
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On topic because something.

Posted by: cartoon hd apk | Link to this comment | 07-12-17 11:38 AM
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Play Our Android Game.
Bus Rush
Mobile Strike

Posted by: Bus Rush Game | Link to this comment | 07-19-17 1:11 AM
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So I went to a psychiatrist; prescribed escitalopram oxalate, aka Epram, Lexapro, Cipralex and other things. Anyone have any experience?

Posted by: Martius | Link to this comment | 07-25-17 10:40 AM
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I honestly can't tell if you're spam or not. If you're not spam, you probably want to repeat the question in a way that engages with the fact that yeah, a short comment in a month-old thread with a bunch of brand names looks like spam.

Posted by: LizardBreath | Link to this comment | 07-25-17 10:44 AM
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I'm not spam! It's not my fault drug companies use a million brand names and then abuse patents so that other people make generics with more names!

Posted by: Martius | Link to this comment | 07-25-17 10:48 AM
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That part is un-spam-like, at least.

Posted by: heebie-geebie | Link to this comment | 07-25-17 10:53 AM
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I would LB were in Arabia, and Trump's tribe before her, her good sword in her hand; and she'd make an end of his posterity. Also, I didn't link to anything.

Posted by: Martius | Link to this comment | 07-25-17 11:01 AM
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Posted by: Moby Hick | Link to this comment | 07-25-17 11:05 AM
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It was only a matter of time before they came up with a spambot that could pass the Turing test.

Posted by: politicalfootball | Link to this comment | 07-25-17 11:05 AM
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Anyway, I don't have the relevant drug experience, but maybe there's enough comments in the sidebar to get the attention of a commenter who does.

Posted by: heebie-geebie | Link to this comment | 07-25-17 11:05 AM
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Some people call me escitalopram oxalate, yeah.
Some call me the gangster of Lexapro.
Some people call me Cipralex,
'Cause I speak of the Epram of love

Posted by: Moby Hick | Link to this comment | 07-25-17 11:09 AM
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I just call you Mobes.

Posted by: heebie-geebie | Link to this comment | 07-25-17 11:11 AM
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Lee took it for a bit and didn't stop being the worst person ever, so it's not magic. But it's a standard treatment for a reason, I'm sure. Do you have a way to gauge what's changing as it gets into your system?

Posted by: Thorn | Link to this comment | 07-25-17 11:18 AM
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I have found Lexapro effective. I had bad GI side effects with citalopram.

Posted by: md 20/400 | Link to this comment | 07-25-17 11:20 AM
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61: My wife took it for about two years and really appreciated it. She lost it when she quit her job, which was the huge source of stress that demanded it. (She lost her therapist at the same time, but has mostly just checked in with the therapist for renewals, so she didn't really miss that end of it.)

It was good enough for her that she still talks about it wistfully and occasionally wishes she'd get it prescribed again.

Posted by: Mooseking | Link to this comment | 07-25-17 11:22 AM
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Is Lexapro working with or against Optimus Prime?

Posted by: Moby Hick | Link to this comment | 07-25-17 11:22 AM
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When I invent a Turing-certified spambot, the pseud will be Wry Coder.

Posted by: politicalfootball | Link to this comment | 07-25-17 12:11 PM
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Thanks reprobates.
71: Kinda-sorta. I'll be taking notes on the Distribution and Nature of anger for the psychologist, so I can work in everything else there.

Posted by: Martius | Link to this comment | 07-25-17 12:12 PM
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Oh, good. Sorry about suspecting you of being spam.

Posted by: LizardBreath | Link to this comment | 07-25-17 12:21 PM
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I am pink and squishy.

Posted by: Martius | Link to this comment | 07-25-17 1:59 PM
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It's going around.

Posted by: LizardBreath | Link to this comment | 07-25-17 2:13 PM
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Hope you're doing good, I want to mention one another thing,
we are supporting the cause to remove Thalassemia .
We provide free blood to needy. I hope you support our cause too..!!

Posted by: Sundas Foundation | Link to this comment | 08-16-17 1:13 AM
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