UKC

I know a few others on here have had issues with depression and other mh probs, and there's been some good advice.

My ongoing issue is mixed low mood, irritability and general grumpyness. Been to GP several times over the past 12 years and been on SSRIs for a long while. I've been to CBT sessions, mindfulness meditation and talked to friends/wife but I still have issues every few months. I also have an IBD which is generally well controlled. Usual blood tests are normal and Thyroid tests too.

My variable moods have already cost me two jobs and I'm starting to worry I may not be able to work.

What should I do?

In reply to The Potato:

Have you considered starting a business that isn't particularly people oriented? I recommend it

In reply to The Potato:

Are your periods of low mood and so forth linked with feelings of fatigue, from general tiredness up to smothering inability to do pretty much anything and when you do it pretty much knocks you out?

If so have a chat with your GP about ME. Any other symptoms such as loss of strength or dexterity in your hands, unexpected numbness somewhere on your body, one of your legs not working sometimes or other stuff?

T.

In reply to Pursued by a bear:

No doesn't seem like ME

In reply to The Potato:

Really sorry but it might cheer you up, do you have a chip on your shoulder?

In reply to Dave the Rave:

I didnt dislike btw

I don't think I'm the right person to diagnose that, certainly isn't something I've ever heard said of me

In reply to The Potato:

It was just a potato joke to cheer you up Hope it did

In reply to Pursued by a bear:

Did you mean MS rather than ME by any chance?

In reply to JLS:

No. But that was the purpose of the second group of questions.

I am tediously familiar with most of the answers to them.

T.

In reply to The Potato:

Could you look for/is there a pattern to what triggers you into being grumpy with other people? I've been through the grumpiness phase of depression, and I can't remember what changed so that I'm only 'normally grumpy', like if somebody is being unreasonable in refusing to wear a seatbelt or something like that, rather than it being an unwarranted outburst over something very small, or something that the other person doesn't even know they're at fault for (and probably can't do). As far as I can remember, the outbursts were a reflection of what was going on internally, and I became more agreeable as I became more at peace.

On the plus side, I don't have the grumpy outbursts, which is something I guess, but I couldn't tell you how to not have them anymore.

Reading into Buddhism may have helped a little bit (and absorbing related things on my facebook feed by osmosis), but I think doing the internal work of dealing with certain issues may have been more at the root of things, it's hard to remember whether the change of mood my Mum noticed coincided with me seeing a therapist who help me to change my life. If you're trailing around parts of your past behind you and feeling their impact that may be a place to look. 

Edit: How we see ourselves can play a part, I think, how we talk to ourselves mentally about the world, our place in it, and whether we compare ourselves to others - and how.

In reply to The Potato:

At the risk of sounding like a GP. Anything else you could tell us ? How much do you drink? Smoke weed ? Take any over the counter meds ? What’s your diet like ?

In reply to The Potato:

This might seem a bit out there at first glance, but I really recommend reading this book:

https://en.wikipedia.org/wiki/How_to_Change_Your_Mind

It's a great read and has loads of fascinating history and whatnot, but it also outlines some extremely promising new evidence of a different way of approaching depression. A way that makes a lot of sense, in my opinion - and Pollan is pretty convincing, he's a good bloke. We know that SSRIs, meditation* and CBT are the best ways we know of so far for dealing with bad mood/depression, and you've been down those roads and know what they're about. It's certainly worth being aware of another approach.

Good luck, and feel free to email me if you like.

Jon

*how's this going? My view/experience is that this is pretty hard-won path to feeling less miserable, but there's a lot (as in, an infinite amount) to learn if you've got the motivation and openness to weird hippy ideas. If you're not really sold on it, maybe try out different approaches, different people's ideas of what "mindfulness meditation" is all about are quite different.

Dave - the chip joke went right past me sorry

Timmd - thanks for sharing I hope it's something like that for me, I've tried to get a better inner balance but not sure I've achieved that, I'll try again.

Jon - I'll certainly have a read ta, I'm pretty open to different ways of thinking, but I draw the line at things like crystal healing 

Dunc56 - yes those are relevant too, non smoker, low alcohol intake, exercise three or four times a week, I eat pretty much everything and have plenty of veg and fish. Only prescription drugs for IBD and ssri.

In reply to The Potato: sleeping ok? 

Do you work in an office environment?  Seeing enough daylight?

In reply to wbo2:

Good point, we generally need a minimum of 15 minutes daylight a day to keep ticking over mentally. 

I was working mostly indoors but made sure I got out at lunch time for a short walk and or cycled in where possible, otherwise it would be a cycle or run in the evening.

Sleep is usually 8-9h with maybe one disturbance from wife or child, but when I'm properly down I get 12-16h in 24, but that's not often thankfully.

In reply to The Potato:

Have you tried an SNRI? SSRIs never did much for me but Venlafaxine was like a revelation.

In reply to Blunderbuss:

I found the same.  

ill book an appt and talk to my gp about it thanks

In reply to Jon Stewart:

I did have Psilocybe cubensis twice before they were made illegal and would like to be able to try psychadelics again having read / listened to podcasts on the subject of depression.

In reply to The Potato:

Dave Macleod did this video on how the keto diet improved his mood. It could be something worth experimenting with. 
 

youtube.com/watch?v=UPi41bSrFdI&

In reply to Blunderbuss:

I take that, I didn't know that it's an SNRI, it's the only one which has really done the trick for me too. 

In reply to The Potato:

I think realistically the method of the single big dose, mediated with therapists and "integration" sessions described by Pollan is only going to work in very specific circumstances. But I think that using these drugs in a very carefully controlled setting, as an internal experience (eyes closed, carefully chosen music on) rather than a recreational/social setting can have a very positive effect on seeing the world and your self in a new and more positive way. As a rough guide, if you have a 'proper journey' in this way, I'd expect lasting effects to stay with you for about a month; but traces of what you've discovered may stay with you permanently. I don't think that social/recreational use would be of much use in depression - it's the experience of seeing what is going on in your own mind that is therapeutic, not the giggling and visual distortions you get when you're just getting high with your mates. Obviously there are risks (psychological, not physical), but generally speaking difficult experiences also tend to have a positive outcome long term (even if they are absolutely terrifying in the moment - although this has never happened to me).

I'm not sure psychedelics work if you're on SSRIs btw, because they work on the serotonin system - that's worth looking into if you're considering it.

In reply to The Potato:

It's definitely harder to be agreeable with others when we're less at peace.

In reply to The Potato:

As some have said, venlefaxine seems to be pretty good. Certainly worked better than citalopram (rubbish).

I couldn't maintain the dose of venlefaxine I needed since it gave me incidents of atrial fibrillation.

Latest, is that a consultant psychiatrist has diagnosed me with ADHD. Not sure I agree with this although I believe I have some historical neurological issues that seem to have a significant overlap with ADHD.

Anyway, the drug I'm now on is Elvanse which seems to be doing whatever is required for concentration, focus and generally making me a nicer person.

Adult ADHD might be an area worth looking into.

In reply to purplemonkeyelephant:

Hi, what sort of thing are you thinking of?

Thks.

p.s. How to change your mind is a v interesting read.

In reply to ClimberEd:

Gardening, dog walking, using your skills to create things you can sell from home etc. Generally low pressure jobs that aren't heavily people oriented. 

It would most likely be a pay cut, but better than not working at all. 

In reply to The Potato:

Personally, it normally feels like I've managed precisely zero day-to-day improvement in the areas you mention being problematic, but thinking back longer-term, I realise I'm vastly happier and less troubled now than I was five or ten years ago. Things which I think* have helped me are:

• lots of running - nothing hard or strenuous, just quite a lot of it, like 5k, four or more times a week
• daily meditation - I manage this for 10 mins a day, about 50-60 days in a row, then kind of forget about it for some stupid reason for about the same amount of time, then notice that I'm feeling a bit more jangled
• vitamin D and magnesium (specifically: magnesium citrate, though not sure if it needs to be exactly that as I've not tried anything else) supplements
• only eating between 12-noon and 8pm maybe five days a week

There's not been any one of these things which feel has been 'the fix' for me but with each of them I notice a slip back to being less happy if I stop doing them for more than a week or two.

* Possibly the only important factor here is that I think these things help me.

In reply to The Potato:

Very interesting thread this. I've alway had a low mood, lack of interest in things, aimless and pessimistic attitude to life and general grumpiness for as long as I can remember. About the only thing that lifts it is running, although if things don't go to plan, (like now as I've been laid up with flu for a couple of weeks), it can become a source of angst.

I think it's basically how I'm wired, so I tend to take a stoic attitude to it, knowing that the really bad patches will pass. Probably not the healthiest approach to take, so I'd encourage you to take the advice further up thread re: GPs. However this attitude has (so far) allowed me to keep a lid on things at work, and I've worked with some right idiots over the years, (I'm 53 now).

Maybe just try to hang on in there at work whilst pursuing the GP route and looking at changing to SNRIs?

In reply to Michael Hood:

That's really interesting to me.  You are the first person I know of where ADHD diagnosed as an adult isn't because you already worked it out and pushed for the diagnosis.  

In reply to marsbar:

My wife and daughter had worked out that I ticked some of the boxes, but a previous psychiatrist I saw decided I didn't have adult ADHD. However seeing him led to various scans and neuro-psychological tests. I score very highly on some forms of intelligence but my executive functions are weak, so focus is easy to distract (I'm brilliant at procrastination 😁) and I struggle with multi-tasking, time management, prioritisation, etc. But the flipside is I can be totally focused (and ignore all around me) for ages on a single task that really grabs me.

I certainly don't have the H bit, but there is ADHD in the family, niece (diagnosed) and brother almost certainly was (not diagnosed). One of the questionnaires the latest psychiatrist got me to fill out was whether I had certain things happen or exhibited certain behaviours as a child/youth. Discussed this with brother in attempt to remember and we couldn't recall me exhibiting typical ADHD stuff but he scored quite highly on virtually every question.

Anyway, as I've previously said, I'm not convinced the ADHD diagnosis is correct (I didn't push for it, was just trying another avenue that might lead to some effective help to enable me to function more fully/normally), but however I'm wired up has enough of a crossover that it makes ADHD treatment effective. My daughter is sure I'm somewhere on some spectrum or other. What we eventually realised was that the work related stress and anxiety that I experienced (which led to me leaving my "audit" career), was basically a secondary symptom of my neurology interacting badly with a working environment that was unsuitable for it, rather than the stress/anxiety being a primary cause. In my previous career as a software developer I'd had no stress/anxiety problems of that sort, so presumably that work and the work environment it is done in fitted in with my brain (I just didn't have any reason to know this back then).

Oh and I found counselling and CBT about as useful as a treatment in the long term as citalopram; i.e. no use at all (only thing it did give me was some insight into what was going on in my head). I suspect this may be the case for anyone similar to me (with or without ADHD).

Edit: I'd bet (haven't looked it up), that going into too much detail and not knowing when to stop is an ADHD behaviour 😁

In reply to Ridge:

Similarly, I've always been miserable to one degree or another and had a pessimistic outlook to life. I have never ever doubted for even half a second that life is entirely pointless and that the best I can hope for is to ameliorate the most unpleasant aspects of being alive, try to not to make things worse for anyone else, and devote some energy to experiencing fleeting moments of pleasure or satisfaction along the way. 

However, I've always been very resistant to medicalising this "condition", and while I've been to the GP a stack of times, I've never taken the drugs. I was once told that "some people just don't have enough serotonin and SSRIs put that right"- which is complete bollocks from a neurological point of view and as a simplistic way to think about who you are, is really not for me. My outlook on life has got a lot more to it than a scientifically illiterate "chemical imbalance". This isn't to poo-poo the whole of medical psychiatry, because drugs can be the best treatment in loads of cases; but I don't believe that all of the misery experienced by people in our society and treated with drugs is due to "chemical imbalances". I think a lot of it is "the human condition" combined with a bit of "western malaise": I don't think we've been entirely successful in constructing a society that is optimally conducive to human flourishing. In fact, I reckon we've made a right pig's breakfast of the whole enterprise, given the potential.

This is definitely sensible advice, but I do think it's worth thinking hard about the medicalisation of misery and whether it's always the best approach. I still have bad patches, and there's no doubt plenty more to come, but the more time I spend doing things that really are good, the less misery I experience. For me, that's climbing and being in the mountains, learning about things I'm interested in like music and philosophy, spending time with people I really love doing things we really love together, cooking and eating good food, experiencing great art...all these things that I'm lucky enough to have access to. And to be fair, if I can do all this stuff all the time, then the claim that life is terrible doesn't seem quite so compelling and I look more like a spoilt brat complaining about how hopeless it all is.

Doing more and more of these good things is a virtuous circle. Every really good experience you have makes you want to seek it out again - this is how the reward circuitry of the brain works. And stimulating it with a view of a cloud inversion from a snowy fell-top, latching the top of a scary boulder problem, or getting totally immersed in a musical or dramatic masterpiece doesn't have the downsides of using cocaine, gambling or other destructive behaviours. I think there's a lot of mileage in this approach of doing good stuff as a treatment for feeling miserable.

The catch is that if I get depressed, I haven't got the energy or motivation to do any of the good stuff, and I'll just drink and take drugs and sleep any time I don't have to be at work - which of course is a vicious circle, a downward spiral of self-destruction, but which thankfully in my case generally just burns itself out before I've lost my job and/or all my friends. If it was heading that way, I guess I'd go to the GP and get some drugs to try to stop it, but thankfully in my case things just swing back after a while and my enthusiasm for the things I like resurfaces.

So what am I trying to say here? Just that I think medical diagnoses and the drugs that go with them can obviously be useful in some or many cases, but that we can be very quick to look at problems through a medical lens, when there might be other ways to see them. Ways that don't have side effects like becoming fat and impotent, and which can be hard to quit once you're dependent on them. Are there ways of fitting more good stuff into your everyday life to change your brain state, rather than getting a prescription to fix something that is wrong with you?

In reply to The Potato:

As a fellow sufferer I know how debilitating depression can be, and how it can easily morph into social anxiety, crushing tiredness, lack of motivation, poor eating habits etc. SSRIs aren't working for me either - and I've tried a few. You and I might possibly have treatment-resistant depression (TRD), for which conventional medication and therapy seem not to be fully effective.

Approaches to the treatment of depression are going into new and interesting directions. Some less conventional forms of treatment are still mostly at, or a little beyond, the research stage - but nonetheless look very promising. Unfortunately a little while yet before these treatments become available on the NHS:

Supervised microdosing of Ketamine or Psilocybin (magic mushrooms):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717203/

https://www.theguardian.com/science/2019/mar/23/ketamine-can-it-really-be-a...

(Warneford Hospital in Oxford already offers Ketamine treatment (non-NHS) for patients with TRD. You need a referral from your GP or psychiatrist, and it is quite costly. I tried unsuccessfully to get a referral, so it isn't easy):

https://www.oxfordhealth.nhs.uk/wp-content/uploads/2018/11/Ketamine-Service...

Prof Edward Bullmore (consultant psychiatrist) has opened up another avenue of research, suggesting that there may be a link between mental depression and physical inflammation (eg rheumatoid arthritis), and that mental disorders have their roots in the immune system. His book, "The Inflamed Mind - a Radical New Approach to Depression" is worth a read:

https://www.waterstones.com/book/the-inflamed-mind/edward-bullmore/97817807...

In reply to AllanMac:

From what I've seen online of the ketamine clinics in the US, it's not a microdose. It's getting absolutely spangled on IV ket, in a fairly horrible environment. The evidence looks pretty promising, but there's no way I'd pay thousands of dollars and have needles stuck in my veins, for something I can get for a quid. There's no therapy or anything that goes with it - it's just taking the drug for its psychological effects. Obviously I wouldn't condone getting some dodgy street ket and then guessing how big a line is going to make for an effective treatment for one's severe depression, but on the other hand the value for money represented by supervised IV'ing the same drug seems somewhat questionable. After all, an awful lot of people do the odd line of ketamine and come to absolutely no harm - at low, infrequent doses it doesn't appear to be a risky drug (different story with heavy use). Now this is pure speculation on my part, but I think what might be going on with ketamine might be similar, but less dramatic than with psychedelics: the drug disrupts the repetitive thinking styles associated with depression, showing the patient that their depressive thinking isn't the only possible reality that their brain is capable of producing. This is not altogether different to meditation either, but it takes a lot less time and effort.

As for microdosing psilocybin, there's basically no evidence yet. As far as I know, there's been one RCT of microdosing LSD, but not for depression, for "creativity" or somesuch, and it turn up much. But you could at least be very confident it's not going to do you any harm, just rather unlikely to do you any good.

The evidence for high dose, mediated psilocybin treatment is cracking though - this isn't up to date, but it gives a flavour of the Imperial College work:

youtube.com/watch?v=8kfGaVAXeMY&

In reply to Michael Hood:

Hyper focus is an ADHD thing too.  

In reply to Jon Stewart:

Thanks for the link - interesting talk. She mentions working with Prof David Nutt, who I heard giving a talk at Hay on pretty much the same subject.

Imperial's valuable research would seem to be hampered by the same level of ignorance from above that had David Nutt removed from his work as gov't adviser back in 2009, by Alan Johnson (what is it about that surname?). I think also that Big Pharma may have been exerting a negative influence on the science behind the uses of substances like psilocybin for depression; they would rather sell profitable 'life sentences' of SSRIs to people, rather than one-off treatments.  

In reply to AllanMac:

Whatever it is that Alan Johnson thought he was protecting us from, it can’t be any worse than the image of a singing pharaoh removing its head to reveal....Alan Johnson: https://www.independent.co.uk/arts-entertainment/tv/news/masked-singer-itv-...

In reply to Michael Hood:

It sounds like you may have the inattentive form of ADHD, which doesn't involve hyperactivity. There's a short summary here:

https://www.healthline.com/health/adhd/difference-between-add-and-adhd#inat...

You may already know this but there's a strong hereditary element in ADHD, so the family manifestations fit.  

(I should say I'm not a clinical expert in this, but I do have inattentive ADHD, diagnosed rather late in life. Drop me an email if you want...)

In reply to AllanMac:

Yes, I think Nutt is the boss of the research group and 2nd in command (or something) is the lovely Robin Carhart-Harris who's done a lot of the communication about it: TED talks, loads of podcasts, etc.

Here's Michael Pollan and Robin-Carhart Harris at the Royal Institution:

youtube.com/watch?v=LcAj1oxMT9U&

I'm quite positive that the research is no longer being hampered - the results are just too compelling, the risks just aren't materialising, and people are talking about it all over the place (articles in the papers, podcasts, all over youtube, etc). The Imperial work hasn't been shut down, it has been expanded in 2019 to create the Centre for Psychedelic Research:

https://www.imperial.ac.uk/news/190994/imperial-launches-worlds-first-centr...

It certainly represents a threat to big pharma: especially since you can get psilocybin for free from pretty much anywhere that grass grows for a couple of months every year! If it really does work as well as it seems to from the research so far, we have been culturally pretty idiotic. As a society, we've allowed immeasurable suffering to go on and on for hundreds of years while doing everything we can to stop people using an effective treatment that's just growing out of the ground in front of us. It really makes you question how we came up with our ides of what is 'mad' and what is 'sane'. The mind boggles.

Mini update - GP doesn't feel that my symptoms warrant an SNRI, I got my testosterone tested which came back normal, Im looking into different form of counselling, but I must say I'm feeling a bit at a loss. Ill try and keep busy and meet with people socially as often as possible. At the moment I'm quite happy just to sleep as much as possible which in itself is rather saddening as I'm not physically tired at all.

In reply to The Potato: If you feel like you're drifting a little bit, going back to your doc and 'hamming up' your tale of woe probably wouldn't be an unethical thing to do. It's about regaining your bounce in the end.

In reply to The Potato:

So you suffer from depression, are sleeping all the time, SSRIs don't seem to work and your doc wont give you an SNRI?! 

I'd see another doc... 

In reply to The Potato:

You said you were exercising 3x per week - definitely keep this up, or increase it if possible, since the evidence shows exercise to be equally effective as SSRIs in treating depression. Actually more effective if you look long term. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/

Personally, I find that doing some resistance training (weights, push-ups etc) at home particularly good since it doesn't involve leaving the house (there's no way I'm going to a f*cking gym), combines well with a podcast, and you see rapid progress. Even if it does jack shit for your mental state, you'll have listened to some good material and got stronger muscles, so your life will have been objectively improved.

You also mentioned mindfulness meditation. My understanding is that to have any real effect, you need to do about 10mins dedicated practice as part of a daily routine. If you're not doing this (and I appreciate it is very difficult to do when you have zero motivation), I'd recommend using this app https://www.headspace.com/ as it is very down-to-earth and bullshit free, with a decent amount of free content.

I have no idea what your sense of humour is like, but there's always a chance you'll piss yourself laughing at this (or be totally horrified, apologies if so), which is probably about as therapeutic as a thousand hours of counselling:

https://play.acast.com/s/dear-joan-and-jericha-julia-davis-and-vicki-pepper

In reply to Blunderbuss:

That's what I was alluding to re hamming up how things are, but you put it much more understandably than I did. If his doc is otherwise good, overstating things would be my next approach before thinking again, being easily knocked back can be a part of depression - he shouldn't leave it as things are for too long.

In reply to The Potato:

Perhaps doing some volunteering could be helpful, towards staying engaged more widely than seeing friends, and maybe keeping an eye on how you are with your moods when interacting with different kinds of people too? One meets all kinds of random sorts in my experience - positive and negative.  It'd possibly give you something to use towards asking for SNRI's too, because you'd have (but hopefully not need) more of a range of things to talk about for your reasons why.