As someone who has dysthymia / chronic depression / persistent depressive disorder yadda yadda yadda I’ve explored a few avenues in dealing with this condition. Currently on Sertraline, have been on Citalopram before, fluctuating between 50mg and 100mg. Can’t say I notice a great deal of difference to be honest. Also had CBT, hypnotherapy and ‘person-centred counselling’. I’m aware this will make me sound like a know-it-all (clearly I don’t, which is why I’m posting this) but once I became aware (like, pretty much immediately) of the therapist repeating back to me in slightly different words what I’d just said to them, it felt a bit futile to continue.
Anyway, I’m feeling that only a pretty profound experience is likely to shake me out of my all-pervasive ennui. Two approaches I’ve looked at recently intrigue me. First one psychedelic (therefore unfortunately highly illegal except in very exclusive research settings). Second one legal but pretty expensive (£3k for an average length of treatment plus travel costs, time off work etc).
Any thoughts on this most welcome.
DougieJ says
DougieJ says
https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation
Lando Cakes says
Psychedelics sound more fun.
Personally, I’m a sucker for this place, when I need a re-boot: http://www.samyeling.org
DougieJ says
Interesting. When I saw the backdrop of the first photo I assumed it was the retreat on the Holy Isle, off Arran, but I see it’s on the River Esk.
Lando Cakes says
Same people, I think. Never been to Holy Isle but I’ve heard great things.
DougieJ says
Interesting, cheers.
dai says
I also have been diagnosed with dysthymia. At that time I had come down with a pretty major depression because of marriage breakup. Am a bit scared of psychedelics but intrigued. Thing that has helped me the most is (almost) stopping drinking and taking up running. Have terrible insomnia at the moment however which is driving me almost crazy.
DougieJ says
The cutting down drinking and taking up exercise are both undoubtedly good approaches. I just can’t seem to motivate myself to do either. Guess I see psychedelics or electro therapy as a kind of magic bullet when I should probably focus more on small steps.
dai says
It seems to have worked for me. I am now pretty much addicted to running and addictive behaviour is a symptom of dysthymia I believe. I also had acupuncture to help with cutting down drinking. I was skeptical at the time but I do believe it may have actually helped. Also, through a somewhat bizarre set of circumstances I found several completely different counsellors who got me back from the brink about 5 years ago. I do have periods of “introspection” but generally these days I do much better as long as I get enough quality sleep. This can be a challenge though.
DougieJ says
👍
retropath2 says
I think the buzz around psychedelics is mainly around the suggestions that SSRI’s etc don’t work. The range of expressed “expert” opinion about them runs the whole gamut from pointless to lifesavers. As a onetime consumer (fluoxetine in my case) my view is towards the latter. I would advise against random self-sourcing of illegals as for every “promising result” there are also those where the effects aren’t so great. Musicbiz is full of the legends thereof. The trials are likely around those who have failed on current available prescribed drugs. Not every SSRI suits everyone: it is often a question of switching to find one that does, if the first one or two don’t. The problem may be more that prescribers tend often to stick to only the one they are familiar with rather than to trying alternatives. Whilst this may be safer/wiser for the prescriber, the patient may be denied the wider palette. Secondary care/psychiatrists and community mental health care teams are so currently strapped for staff and cash as to make referral into their supposed greater expertise increasingly difficult. It is a bit rock and hard place, but unless offered a safe option, stick to prescription based Rx, which includes the talking therapies.
Of course I would say this with my work background, not least as I also never saw much appeal in buying ambiguous product from dodgy blokes in carparks. I like to know what I am ingesting.
DougieJ says
Yes there’s no way I’d go down the amateur route (dodgy blokes in car parks). It would only be in a clinical setting such as this if it ever becomes more widely available:
https://www.newscientist.com/article/mg23531390-900-psychedelics-pioneer-keeps-his-inner-hippy-in-check/
Vulpes Vulpes says
Are you sure that was a therapist you were talking to? Sounds like an IT consultant to me.
DougieJ says
🙂
RubyBlue says
I have read a bit about low doses of LSD being beneficial but as has been said above, I like to know exactly what I’m taking. (Half a tab many years ago did make the curtains very hypnotic, however.)
Agree with the Doc above re: SSRIs- it can take a bit of experimentation to find the one that works for you.
Regarding therapy, it sounds like you had a bad therapist. They should help you to find the origins of your thoughts, examine patterns of thinking, and where necessary, challenge those. It’s tricky because some therapists are really crap. I’m sure you’ve thought of this but perhaps look at finding one from a perspective that suits you; it may be that person-centred isn’t for you.
Best wishes- it does take a lot of time and effort to address this stuff , which is frustrating as often you just don’t have the energy for it. It sometimes feels like a full-time job- therapy, remembering meds, meditation, mindfulness, good sleep hygiene and fucking journalling. Oh and exercise, salads blah blah.
Sometimes though one of those things (or perhaps the combo) can just click. Unfortunately it’s the day-to-day small efforts that seem to make a difference, over time.
DougieJ says
Thanks. Yes, I need to keep in mind the compounding effect of small steps.
pawsforthought says
Ruby and Retro are both right, I think, that you have to find what is right for you (be it meds or therapy). As a therapist myself I would suggest that a compassionate mind focus is the current flavour of the month for dysthymia and low mood. I quite like Paul Gilbert’s stuff, but I guess its not for everyone.
Whatever you choose I hope it helps and do report back, I’m sure there are a lot of people who would be interested.
DougieJ says
👍
Vincent says
Psychedelics are a strong brain reboot as they make the neurons pump out lots of serotonergic neurotransmitters while shutting down other bits of brain. serotonin management is the mechanism underlying the ssri anti-depressants that slow serotonin re-uptake, so there is more in the synapse, ultimately raising mood. I reckon the quiescent cerebral bits being off line then coming back also leads to a compensatory greater output of activity as the power comes back on. with psychedelics, you are getting a hefty dose, rather than something which takes at least 2 weeks to get objectively clinically active. I don’t think I was ever as optimistic or cheerful as when going through my own phase of ‘research’ in this area.
DougieJ says
👍
Twang says
Personally I wouldn’t contemplate taking psychedelics under any circumstances – my brain is bad enough as it is – but that’s just me.
Barry Blue says
My name is Barry Blue, I’m a psychotherapist, and I’ve taken ayahuasca. I’m going to go down that route again later this year, three years since the last, and, importantly, I’m not doing it via the organisation I used before. Man, it was an uncontained experience (far from the compassion based therapy pawsforthought refers to above). The most terrified I’ve ever been in my life, which is saying something. If we take out the genuinely unsafe elements – these included a bloke with a ‘Carpe Diem’ tattoo on his chest stomping around the room shouting that he was ‘the ayahuasca vampire’ – then it actually was hugely illuminating. I left the main hall when the vampire was on the march, and went to the dormitory area. There, I looked at my phone, in order to work out how long this increasing state of self-loss would last. And rather than the time, it said ‘Some bloke. Somewhere’.
To cut a very long story short – and at one stage I truly believed I was in a time loop a la the final episode of Sapphire & Steel, so we’re talking loooong here – I eventually gave in to what was going on – you could say I let go of the pisspoor egoic structures that had been clinging on – and the result was astonishing.
DougieJ says
Junglejim says
Far out, Barry! I salute you!
Sapphire & Steel eh? Whew!
Junglejim says
I’d have to describe myself as broadly pro-psychedelics. This automatically comes with a whole heap of caveats & there’s no way I’d advocate their use for other people.
I haven’t done any for decades & realistically I’m unlikely to again – so many things would have to simultaneously line up that I can’t see it happening.
That said, the altered states afforded by psilocybin gave me some of the most profound experiences of my life – up there in the same strata as falling in love, the birth of children & bereavements. Not trivial recreation, in other words.
I’ve been interested to read that psilocybin (in very moderates doses) has been given under clinical conditions to PTSD sufferers & some people with terminal diagnoses, with what appear to be postive results for the individuals concerned. Perhaps this is analogous with the ‘reboot’ notion – the feedback generally seems positive in that subjects have reported a sense of ‘oneness’ with the world & a sense of calm having gained a sense of perspective with ‘everything’ that is comforting & positive.
Exactly how this can/could be quantified & put to use to assist others beyond a select group of volunteers, I don’t know. I do however think that the fact that natural occuring psychedelics have a long established link with ‘religous’ & profound experiences in numerous cultures is significant & all that stuff about ‘doors of perception’ is not just hippy hocus pocus.
The notion posited by William S Burroughs concerning humans & substances, ‘that anything done chemically, can be achieved by other means’ always intrigued me & I think he was onto to something – my contention being that the Zen notion of ‘oneness’ is essentially the same as users of psychedelics report – but obviously one achieved with a totally ‘straight edge’ & a lot of discipline but is no less mind blowing than a peyote ‘vision’ for example.
Not sure what prompted this stream of consciousness, except to wish that all those hoping for inner peace find it & the sooner the better.
kingtim says
I’m an NHS psychiatrist so would suggest a couple of things. Firstly the evidence base for psychedelics isn’t currently good for some of the reasons suggested above. There are ongoing trials for example this one at Imperial.
https://www.imperial.ac.uk/department-of-medicine/research/brain-sciences/psychiatry/psychedelics/
Secondly, think beyond SSRI’s, particularly if motivation is a problem which usually requires some noradrenergic stimulation so an SNRI like Venlafaxine or Duloxetine could be prescribed by most GP’s.
Finally, if you’ve had more than 3 episodes of significant depression, NICE guidelines suggest a mood stabiliser to treat current episode and prevent recurrence but this would require a referral to secondary care to see a psychiatrist.
retropath2 says
Good points. How open, however, are your MDT/CMHT to accepting said referrals these days tho’ and how willing your trust to allow you to manage as you see appropriate rather than by protocol of 6 short sessions, or similar? How the trusts have emasculated the art and science of psychiatry is criminal, as has the neglect addressed thereto by government/DoH and the stigma of medical schools apropos training and specialisation.
kingtim says
Thanks retro, a really good question. I triage all the referrals in to my team so it’s my call. I have a caseload of about 100 people who I see for management of complex medication regimes. This is way more than most of my colleagues but I’m a passionate advocate for people getting the right pharmacological and psychological input. I also have a medical school post and we’re working on future recruitment!
DougieJ says
Thanks kingtim and everyone. Trouble is I find it hard to distinguish between ‘episodes’ of depression which is why I feel I have dysthymia. All I know is that I can never remember a time when I felt truly content. There have been periods when I’ve felt better or worse of course but always with a cloud on the horizon. Currently I am going through a separation which has unsurprisingly intensified my depression. My sertraline has been increased to 100mg but as I say I haven’t noticed much difference. I have also had one counselling session since my relationship breakdown moved to the next level (in Jan) but felt, perhaps unfairly, that I wasn’t going to get much out of someone basically repeating back to me what I’d said. I also even attended an AA meeting. Drink has always been my self-medication of choice and I’m fully aware it’s not good for me given my mental health. However, and I know this will be seen as denial, I felt the stories I heard in AA were far more extreme and didn’t feel able to commit to the programme. That’s my condition in a nutshell – functioning. Persistent grey / Ill at ease feeling for as long as I can remember without ever feeling suicidal. Drinking excessively without beating people up, trashing my house, losing my job etc. Just ‘meh’.
kingtim says
Hi Dougie, have you heard of “double depression”? This happens when depressive episodes are superimposed on a background of dysthymia. Sounds closer to what is happening to you at the moment?
https://psychcentral.com/news/2007/07/24/recognize-double-depression/1053.html
If that fits, it might be worth having a look at an alternative antidepressant to Sertraline.
DougieJ says
Yes, will do. Like I said in the OP, I originally had Citalopram then switched to Sertraline. Found them very similar to be honest. Have been on them for over a decade now which I’m not overly concerned about (one GP said that it may well be that I’d be on antidepressants indefinitely). So I guess they work in the sense that I’m functioning but obviously I’d like to see a more profound effect. Not sure whether this is a side effect of the meds but I think they may have a kind of emotionally numbing effect which may not be what I really need. I know the theory about the benefits of exercise etc and do get a benefit from this but I never sustain it for any length of time. An overwhelming inertia seems to always win out. I may discuss with my GP the SNRI’s that you mentioned earlier.
DougieJ says
A quick googling suggests that the emotional numbing effect is quite common. That seems to fit with my experience – love my kids to bits but didn’t cry with joy when they were born. Similarly, the lowest points of my life like what I’m going through at the moment are shit but just a slightly intensified version of my usual bleakness. My (for the time being) wife experienced depression a couple of years ago but I’d say hers was acute whereas mine is chronic and insidious.
https://www.verywellmind.com/can-antidepressants-make-you-feel-emotionally-numb-1067348
dai says
You are almost describing me (also above) although I did cry when my daughter was born. I certainly had the double depression thing going on when I went through the separation, was prescribed anto depressants but never really took them as they fucked up my stomach. My brother has been on them for years and I’m not sure they are really beneficial for him. Might suggest he consider something else …
Mike_H says
An old friend was suffering from depression and anxiety attacks after two failed marriages and was prescribed various medications and finally Prozac, none of which helped.
Another friend introduced her to some moderate spliffing, which seemed to sort her out. She was able to start working again and to enjoy it, after being unable to socialise much for several years.
Of course that’s a risky strategy, as some people’s depression is exacerbated by cannabis use. Sometimes severely so.
Twang says
Probably a diversion but Diane is microdosing psilocybin in “The good fight” at the moment…
Vincent says
Psychedelics are fascinating, life-changing, and the rest of it. I enjoyed rattling around my head and it definitely got me thinking in a good way about mental life. Understanding the complexity of everything, and seeing the universe in a blade of grass or a sustained chord can a good way to be, in my opinion. But it can bite you on the arse. I did psychedelics quite a bit 35 years ago. Then I had a very unpleasant experience and decided that it was time to stop. i never went there again, nor desired to go back. It was most enjoyable until it wasn’t.
Mike_H says
In my hippy days I had quite a lot of good experiences with LSD and then a couple of really bad ones. Brought home to me some anxieties and aspects of myself that I’d been hiding from.
One very nice one with synthetic Mescaline. A lovely warm glowing feeling for a much longer duration than any Acid trip I’d previously had, during the course of which I got roped in as a linesman at a soccer match. Now that was an interesting experience.
Quite a lot of experiences with Psilocybin mushrooms (Liberty Caps) which probably didn’t do my liver a lot of good*. My kidneys certainly didn’t appreciate them. By then I was not really getting anything worthwhile out of indulging in such stuff so I stopped.
*Quite a few unpleasant toxins, as well as the desired ingredient, in Liberty Caps apparently.
RubyBlue says
‘It was most enjoyable until it wasn’t’…. Drug (and alcohol) use in a nutshell.
DougieJ says
Or as a great philosopher once put it:
“Beer – the cause of, and solution to, all of life’s problems”.