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I'm at a loss..........


mourningperson
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Hello,

I was formerly diagnosed as clinically depressed in 1991 - although I know that I was depressed years before that. I'm 53 years old.

Since 91, I have tried out every anti depressant except the MAOI's. I believe I did a short stint with Lithium, but nothing of any length.

Although I suffered with depression all these years, it was somewhat manageable.

My husband and I were quite clear that my depression was affected by my hormonal fluctuations/PMS.

About 2-3 years ago, I've kind of lost count at this point, my depression all of a sudden, escalated to an all time high.

Suddenly I was completely incapacitated and having suicidal ideation.

We were quite desperate and began to hear about VNS (Vagal Nerve Stimulation) therapy.

Amazingly, I was able to get my HMO (Kaiser Permanente) to let me have the surgery, to have the device implanted.

Briefly, it's like a pacemaker device, implanted in my chest with a wire that runs from it up around the vagal nerve in my neck.

Every few seconds, the implant gives off a mild electrical stimulation, that effects the nerve. Supposedly, this was "cutting edge" technology in the treatment for depression. (It's been used, successfully, to treat epilepsy for some time).

Unfortunately, after at least a year's trial, the conclusion was reached that it was not helping my depression and the device was turned off.

My depression continued to escalate, alarmingly.

As a total last resort, I agreed to undergo ECT treatments.

Between reading Kitty Dukakis's book in which she touted her experience with ECT and well meaning friends who said they knew of people who had been helped tremendously by ECT, my husband and I decided to do it.

So, last January and February, I underwent 13 treatments.

It was the scariest and most horrendous experience of my life - and believe me, I've had my share......

After the 13 treatments, I was advised to continue with "maintenance" treatments.

I decided not to.

It was true that I was no longer feeling suicidal, but that was only because I was so spaced out and memory impaired from the treatments.

I was in a daze and very subdued for quite some time afterwards.

I'm still experiencing memory problems, but I realize that could also be attributable to meds (Cymbalta, Ambien and Klonopin - on an "as needed" basis - or the depression itself.

I was "maintaining" somewhat, still pretty depressed - then, this last August, my younger (46) sister (only sibling), who I loved very much, died unexpectedly from liver failure due to her many years of alcoholism.

Although, totally in grief, I rose to the occasion and handled a lot of things that needed to be done after her death.

Unexplicably, in November, I began to feel better than I had in quite awhile, and began to do more things and started to get my life back.

Let me add here, that under my doctor's advice, I decided to try a course of anti depressant again. I had tapered off of Cymbalta earlier and as a Last Resort, agreed to try Effexor, beginning around the first of August.

My doctor told me that Effexor was usually effective for "treatment resistant" patients such as myself.

The Effexor (up to 150 mg) made me nauseous and killed my appetite completely, so after a little over a month, I decided finally to quit anti depressants once and for all. They didn't seem have enough of a positive effect to warrant staying on them.

I VERY slowly tapered off the med over the next month or two. My doctor advised me to use Prozac during the taper to buffer the effects.

Now, I've been off of all anti depressants for approx 2 -3 weeks.

I had been maintaining more or less, but about 2 weeks ago, took a major downturn and have been there ever since.

I've given up on any of the doctor's from Kaiser, I do not feel that anything they've ever suggested or prescribed has EVER helped me, in fact I believe that I've experienced more harm than good from them.

The point I'm trying to get to is, I became highly suicidal a few days ago.

The anguish and despair that I felt was so incredibly overwhelming, that I decided that i had-no-choice. I just couldn't go on any longer like this.

The thought that I'd absolutely ruin my husband's life and could possible go to "hell", always stopped me before, but this time, I knew that I had to do it anyway. I felt so utterly hopeless.

It's silly to think of, but the reason I'm alive at the moment is because, before I could do the deed, I felt that I had to put my messy bathroom and closet in order. I didn't want my husband to have to deal with or go through so many things while dealing with his grief.

Well, it took me all through the night to get the job done, then I had to wait a few hours for the right amount of time to come around again.

As I waited, I became so frightened. Frightened of what may happen to me after death, frightened of being separated from my husband - I was so utterly alone.

So this time, because of the cleaning, I didn't follow through and it scares me to know how close I came - and can still come.

My last effort, is to go to a new therapist this Tuesday. She's a catholic, so I believe she'll better understand my fears and concerns.

I'm also going to have her recommend another psychiatrist, out side of my HMO and re discuss whether I'm a person, who has to be on an anti depressant. That would be ok with me, if I could find one that works for me!

I feel like erasing this whole diatribe at this point, it's so long and involved.

And, It doesn't even cover other elements involved - long standing family issues that have negatively effected me.

One last thing, my husband reminded me tonight, that we had seen an Ob/Gyn a month ago, who convinced us that most of this horror was due to the onset of menopause.

It made a tremendous amount of sense, the many years of dealing with severe PMS and the fact that I was perimenopausal when this all began.

So, I'm going to pursue the hormonal issue and the therapy aspect and possibly medication again - and see if something pans out.

I'm just worn out and confused at this point, I feel that this is my last chance to find an answer.

I truly apologize for the indecent length of this post, but am just trying to get enough of the facts out, so hopefully, someone might have some suggestions.

I strongly feel, though every one seems to discount it, that a major part of my depression is my confusion about religion. I want so desperately to have a faith in God to get me through all of this, but no matter how hard I try, I don't understand or accept some of the basic Christian reasons for suffering in the world. This continued confusion - now a fixation, will continue to haunt me, until I can understand it better.

Again,

I apologize so much for this length and don't know if anyone will read it, but I'm on my last legs and really need some serious help.......

mourningperson

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Guest ASchwartz

Dear MourningPerson:

Please do not apologize for the length of your message. In fact, I found your message very compelling and passionate.

I am not even sure of where to start. That is primarily because I am awed and dismayed by the amount of suffering you have had to endure and with so little in the way of positive results. However, I want to impress upon you the fact that it is important to keep fighting and never give up.

First, I am of the belief that religious or spiritual conviction can be very reassuring. That does not mean you must subscribe to any one religion, or, if you do, you do not have to accept all the tenets of that religion. If you are Catholic, take from it what feels good to you and do not focus on the rest. More than anything, it is the spiritual aspect of all religions that is most important: at least in my opinion.

Second, I cannot tell from your story whether or not you have had psychotherapy. I want to suggest to you that you could benefit from Cognitive Behavioral Therapy or, a variation on that, Dialectical Behavioral Therapy. In looking for a therapist, it is important that you find a psychologist or licensed clinical social worker who is trained in and makes use of those skills. Also, there are group therapies that use those two skills.

Third, I want to encourage you, with the guidance and clearance of your Medical Doctor, to start exercising. Exercise is a good way to relieve stress and even take the edge off of a serious depression. It may not be a cure in itself, but it helps.

Please remain with our community. I know there are many others who have shared many of the types of experiences that you have and can offer a lot of support.

Remember the show "Annie," about the poor orphan girl no one wanted? She sings:

"The sun will come up tomorrow, bet your bottom dollar that tomorrow there will be sun, tomorrow, tomorrow, "it's only a day away."

Allan

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Mourning,

I don't know that I have anything to add that will do anything other than to restate what Allan has said.

Let me echo Allan's sentiment that the length of your post is not a problem. You've been through a lot and in order to communicate that, you had to write a lot. It's unfortunate that the treatments you've been offered have not helped consistantly. That happens sometimes. I think we all wish it were easier to treat depression.

ECT is generally a treatment of last resort, which it seems that you have qualified for after having taken so many medications, and the vagus nerve treatment. The memory problems you are experiencing are normal enough for such treatment to the best of my understanding. noone thinks that this is a good thing, but in the face of the intense and unrelenting pain of depression and suicidal thoughts, many people make their peace with it - but you've not had a good outcome there either.

Just FYI, there are two more "stimulation" treatments to know about; transcranial magnetic stimulation, and deep brain stimulation. TMS is non-invasive, using magnetic waves (like in an MRI scanner) to stimulate the brain. I'm not sure of its availability as a treatment, or how well it works, however. Deep brain stimulation is *highly* invasive - it works like the vagus nerve stimulation, but instead of attaching to the vagus nerve, the wire goes into your brain to a "gate" area that attaches the emotional and rational parts of your brain together. The idea is that this gate is normally supposed to be shut (more) but in chronic depression, it somehow opens up, leading people to ruminate and stay depressed. The electrical stimulation helps the gate stay closed. This intervention is still very experimental, and not very well studied but it is worth knowing about at least.

the psychotherapies that allan has described are known to be useful in treating depression and mood aggitation. If you've not experienced them, they are more than worth a shot (given that other options are not working out well). In all forms of psychotherapy, there is a distinction that can be made between the therapy techniques that are taught or used, and the person of the therapist, and the relationship that you form with the therapist. CBT and DBT are wonderful and highly useful techniques, but it is equally important that you focus on how you feel about being with the therapist; that you like the therapist and he or she likes you. Being in a loving and compassionate and safe relationship is and has always been the ultimate antidepressant.

Allan is right to push you (with your doctor's knowledge and permission) towards exercise. Simple exercise has been shown to have an antidepressant action. For best effects, however, it has to be vigorous, and regular (multiple times a week). You need to check with a physician so that you know you are medically healthy enough to participate to a vigorous degree. This interview transcript might help to provide perspective. Different kinds of exercise appeal to different people so find the kind you like the best. Many people like social forms of exercise (and socialization has its own anti-depressant effects), but some people like to look inward and focus on how they feel during exercise. Pick the kind you can look forward to the most, becuase the most important thing is to do it consistantly and vigorously. The one that I've had best luck with is Iyengar Yoga, but everyone has different preferences.

You may find that developing mindfulness skills is a good way to get some respite from unrelenting depression. There are many different sorts of practices that can help provide these skills but most of them center on different varieties of meditation. Marsha Linehan (the founder of DBT psychotherapy) is Catholic herself, and she incorporated "monk" meditation techniques into her DBT therapy (listen to this interview with Dr. Linehan for more info). A different approach is used by Dr. Steven Hayes in his ACT therapy (more info here). And then there is straight up mindfulness meditation of the sort taught by Shinzen Young (watch for our podcast interview with Shinzen Young which will be published on Mental Help Net April 1st.)

I'm focused here on "problem solving", I guess - trying to make you aware of pathways that you might not have explored before that might be useful to you. But let me close by saying that I'm touched by what you've written, and I feel for you, and hope you feel better soon.

Mark

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