Want to deal with depression properly once and for all!

[swabes]

Around August of last year I was put on 10mg of citalopram by my doctor to deal with my depression. Going to the doctors was very stressful for me as I am the sort of person who normally clams up about these sorts of things. Now I fear because of this I didnt get everything across to my doctor properly.
By October I took myself off the ADs as I felt they were no longer working and my mother didnt want me asking for a bigger dosage.
Since the age of 13 I have suffered with eating disorders and self harming which have gone untreated for a very long time. I made my doctor aware of this and they told me because my weight isnt currently an issue that they wouldnt refer me to anyone. To me my weight moderates my moods and although my weight does not reflect upon that of an anorexic inside my head is still very much riddled with the thoughts of someone with an eating disorder!
My partner and I have been together for nearly 2 years now and we now both think it's time I got this properly sorted. He is very supportive but my constant yoyo depression is putting a strain on everything. For nearly two years now my depression has been almost constant. I am still battling with my eating and have recently began to self harm again and have suicidal thoughts. I am very anxious and paranoid, I don't trust my own thoughts anymore. All these things are leading me to believe that my depression is a lot more serious and permanant than I first thought.

I'm going to the doctors soon with my partner and would like to know how best to put this across to them (in face to face situations with people the words rarely come out). I would like to go back on antidepressants but not citalopram and something that DOESNT make me gain weight as this would be extremely counter productive. Does anyone know the specific depression I have, can anyone relate to me? And if so could anyone suggest any treatment, CBT or other therapy which would be useful to request from my doctor.

It's very unlikely my doctor will cater to me as much as I am hoping for, they rarely are! But it seems my life has been one traumatic event after the other and I need to deal with this once and for all.

Please please reply, I need advice!

I have done countless quizes online telling me I may be extremely depressed or have a mild form of Bipolar.

[4Maddie44]

Hello, I have accepted your friendship invitation, and am very pleased you asked me.  As we both live in the UK, I may have a better understanding of the NHS and how it works.

Firstly, I am glad that you have such a supportive boyfriend.  It is good that he is going with you to the doctors, as he will remember all that is said.  I usually take my daughter with me to appointments, for the same reason.  As GPs have such limited time for consultations, you need to ask everything that is worrying you.  You can write down questions you want to ask.

I don't think there is such a thing as a specific depression.  Are you thinking of Bi-Polar, which is similar, but not really depression?

Here in the UK, it is the GP who will refer you to a psychiatrist or psychologist, if he thinks you need it.  As we do not pay, there may be long waiting lists.  You can pay and go privately if you think that is what you need.  I don't think things in the UK are the same as in USA.  My doctor has a questionnaire with specific questions to ascertain if you have depression.  Mine asks when I am really bad, and then in time, when I have been on anti-depressants, will ask the same questions again.

You can ask your GP is you can be referred.  In most towns there is a Community Mental Health Team.  He may refer you to them.  You can, or your partner can, ask if you can see a psychiatrist, as you feel the need to see one.  I have found, in my own experience, after having seen numerous psychiatrists, that they only talk medication.  A psychologist goes further into the causes of perhaps why you have depression.  In my case, it is just there, nothing has triggered it.  I have learned to live with it.  I have been on numerous anti-depressants, but I am steady at the moment.  

Some AD do make you gain weight, so be sure to ask for one that does not have this side effect.  With your boyfriends help, I am sure your appointment will be less stressful.  Let me know how you get on.  A doctor will only refer you if he thinks you need it.  Perhaps you need to ask to be referred.  I know I was referred early on in my depression, and spent time in a psychiatric hospital, but on subsequent breakdowns, although I felt I was in need of hospitalisation, the doctor did not agree, and adjusted my medication, adding others to get me through a really bad patch.

Well I have gone on a bit, but I do hope you get the results you need.  I will be thinking of you.

Take care, and keep in touch.  Now we are friends, you can write to me by messages, and these will be private, just between you and me.  I know nursegirl is a really kind and helpful person.  Are you friends with her too?

God Bless.

[swabes]

Thank you so much you don't know how much this means to me to hear back from you!

Yes I intend to be a lot more open this time with my doctor, last year it was a very daunting experience. My mum works in the mental health sector, she deals with very serious cases so if I go to her for advice she is normally very desensitised to what I am feeling because she deals with a lot worse off. But that doesn't make what I'm feeling any less real! Last time I was very distressed with her and she told me that I was not genuinely distressed, that it is all an act to manipulate everyone. At first I was angry and thought that the stress of her job has caused her to lose all sympathy! But now it is stuck in my head that all my actions are actually a subconcious act of manipulation, I'm very confused to be honest. However I feel it is best I do this without involving my mum now.
When I go to my doctors I'm bringing my partner with me as I feel he can best describe my mood over the past while as he is the only person to truly see me at my lowest of lows.
I will be open and honest with my doctor but do you think there was a reason I didnt get refered to anywhere last time I went? And what's the likelyhood of getting refered this time? My mum suggests cbt but I'm not sure what I need! Are the waiting lists to get seeing someone very long?


I know I have a lot of questions but I feel that my doctors last time helped me only to the extent of filling me with tablets and as a results I find refuge in google searches which are more likely to scare me half to death than give me sound advice.

Thank you again so much, I really hope it works this time!

[nursegirl6572]

(MY LONG WINDED REPLY....CONTINUED....)


I want to comment on something else you said....
"All these things are leading me to believe that my depression is a lot more serious and permanant than I first thought. "

For one, ALL depression is serious.  As you're finding out, it usually isn't something that will just go away on it's own, and like anything else, it will typically just get worse if you neglect to address it.  That's the unfortunate thing about your Mom not pursuing more professional help for you.  That's not a dig at her, either, as it's not always easy to know what to do to help someone, and some people are masters at hiding how they really feel, which may have been part of the case with you.  As far as depression being "permanent"...not necessarily.  For most of us with long term ongoing problems like these...these are issues we have to deal with in some respect for the rest of our lives.  And, while there may not be a "cure", with professional help, we can certainly get the disorders to a manageable level to allow us to live a pretty normal life.  Therapy teaches us coping skills and how to identify if we're not doing so great, so we can take steps to tackle it again.  Meds are a great tool, they help to control the symptoms so we can get down to work in therapy and regain some normalcy in our lives.

Hopefully you've learned that these aren't things that are wise to sweep under the rug, hoping they will improve or go away.  Without help, most times they won't...if anything, they worsen.  Its not important to dwell on any of that now, though, what you need to focus on, is the fact that you HAVE taken that super important first step of getting help.  This site is a great resource as well.  You will find info, support, compassion and tools here.  You are among people who really understand and you are FAR from alone.  All you have to do is browse around a bit to see that.  There are great forums for anxiety, and other disorders as well.  Look around.  There are "trackers" which you can use to help track your moods, anxiety, and other things.  Please feel free to ask questions, and definitely come back to update us on how the appointment went, and your journey along the way.  I've watched people go from housebound to basically regaining a normal life, and it is so rewarding.  You'll get there too, just wrap your brain around it...start trying to have some positive self talk instead of the negative you are probably very accustomed to.  Say to yourself "I AM going to get better"...."I AM going to feel joy again"..things like that.  While you're waiting for your appt, you can also start journalling...write your feelings and thoughts down, good or bad.  Set a small goal for yourself and then journal how it felt to reach it.  It could be something as small as taking a walk in the park (or something you would enjoy doing).  Small goals are just as important as the big ones.  You have to fight the small battles to win the big war, and with the right help, you can.

Very best to you..looking forward to seeing more of your posts.

[nursegirl6572]

Hello and welcome!  I'm sorry you are struggling so much, but you can get some comfort in the fact that you are reaching out for help.  You are taking a step in the right direction, and it's great that your partner is going to be supportive throughout that process.  You've stumbled upon a great site..I think you'll find it very helpful.

I hope that the doctor you have the appt with is a psychiatrist.  They are really the best people to deal with these issues, especially because you have multiple concerns that need addressed, the eating disorder tendencies, depression, anxiety, etc.  I urge you to seek the help of a psych, that is your best choice.  You can ask your PCP for a referral.  Some insurance companies do not require a referral, in which case, you can seek one out on your own.

You're right about the fact that the doctors don't spend a whole lot of time exploring these issues in depth, that is a job for the therapist, which, by the way, will be highly recommended for you.  The doctor will assess you based on the information you give him, so you need to be 100% honest and straightfoward with him.  You don't need to tell him every deep dark secret you have, but you do need to tell him the basic facts...your mood trends, any lack of motivation, sadness, anxiety, etc, that you are experiiencing.  It's also imperative for you to tell him about the self-harming and how your thought processes work.  For example, you need to tell him if you have racing thoughts, intrusive (scary) thoughts, etc.  Don't get too caught up worrying about giving the doc EVERY piece of information...he will lead the questions and ask for information that is important in the assessment process.  It's helpful for you to write down anything you feel is very important ahead of time to take with you to your appointment, including any questions you may have regarding medications.

It is best that you go in with as open a mind as possible.  Don't go into this with things (and meds) you have a preconceived notion about.  Don't tell the doctor what you think you should take...let HIM make the recommendations and be open to trying them.  Certainly share with him your concerns about taking a medication that may be commonly associated with weight gain, but DO keep in mind that it is impossible to know how you will react to a medication.  Some people gain weight on a med, some lose weight, it really depends on the person.  Plus, you have to keep in mind that you are seeking help to address the eating concerns, so as you progress through therapy, those concerns will not be as important to you, so don't rule any med out based on weight concerns.

To give you an idea of what to expect...usually the 1st appointment will be the longest, as the doctor will be information gathering and coming up with accurate diagnoses for you.  Then you will discuss with him treatment options, which most likely will include meds and therapy.  When both treatment approaches are used together, success rates increase dramatically.  Again, try to stay open minded.  You do not need to go in with a list of meds you would like to try based on your "google" based research, let your doctor do the doctoring.  

After the first appointment, you will likely be set up with a therapist, who you will see more frequently in the beginning.  You will usually only see the doctor occasionally for "med checks", to see how you're doing on any meds he may prescribe.  At first, you will probably see the doc every 2 weeks, and a therapist weekly (possibly 2-3 times a week, depending on the need).

I'm sure you already know that the first line meds used in treating a majority of these disorders are the SSRI antidepressanta, like Zoloft, Lexapro, Celexa, Prozac, Paxil.  These meds take some time before significant improvements are noticed.  It can take up to 4-6 weeks, or longer, to really be able to see some changes.  You may even require dosage increases along the way to get you to the most therapeutic level, and the same timeframe is necessary (4-6 weeks) after each increase before a fair assessment can be made about a med's effectiveness.  For these reasons, PATIENCE is something that will help you so much. Of course it's not easy to be patient, because we want to feel better NOW...but it's a process that takes time.  It does't happen overnight.  Your therapist will help you find ways to cope and teach you things YOU can do to help yourself.  The harder you work and the more you dedicate yourself to pushing yourself, the better.  You've got quite a few issues that need explored and ironed out...so be patient with yourself....improvements will come with time, and some work.

You ask what "kind"of depression we may think you have?  Of course, we cannot make any kind of determination, especially over the internet, and because we are not doctors.  That's why you have sought the help of a professional.  In the end, the "label" is not nearly as important as the treatment and goals anyway, so don't get too overly focused on the "what do I have?" thought.

(Wow, I was really long winded here..the rest is continued in my next post......)