Depression is tricky stuff and you have to be smarter than it is. I wish I knew how to explain how you do that, but the reality is that it can be done. Anyone who tells you otherwise is lying.

in keeping with what I just said in another comment on this blog there are as many roads to recovery as there are human beings...

but I do think they start with STOPPING the pathologizing and defeatest attitude that there is something fundamentally wrong with us.

from there the roads go in all different directions, but, hell yeah, people recover and learn to live with certain levels of difficulties in successful ways all the time...

but if you don't believe you can, well then you won't...I will say that much.

some recovery stories I've collected:

Recovery Stories

http://bipolarblast.wordpress.com/recovery-from-extreme-states-psychosis-etc/">More Recovery Stories

Er. A good therapist should discuss triggers and how to avoid them. How many therapists did you see? I mean, it took me 4 tries before I found a good one.

One thing that I found greatly helpful to treat my mental illness was to find someone who was in a similar circumstance, but live far enough away that I didn't really care what I said, and being able to discuss mental health with them.

A therapist who discusses triggers and how to avoid them makes a good circus trainer, yep. A therapist who discusses triggers and how to make them non-triggering makes a good healer. Most therapists are really good circus trainers...

Philip wrote:
"...You can't get it from a therapist either (they can help some people, but were useless for me). You can only get it from yourself..."

I think I have to take issue with you, there, Philip... Certainly, one must be prepared to take responsibility, and make the decisions, but one can make those decisions based upon the suggestions that are made to one by others (a counsellor, for example).

I think it was Fidders who used to have a quotation from Aristotle in his header "We become just by performing just actions, temperate by performing temperate actions, brave by performing brave actions." And if one doesn't know what amounts to a just, temperate or brave action, , and one wishes to do those things, then one must ask someone whom one perceives to have these qualities, and they may give one some pointers. "But I already do the actions that you've suggested," one might say. "Yes, you do, which must only mean that you are just, temerate and brave already, mustn't it?" would most likely be the reply.

Now, of course, a patient is perfectly free to reject such a suggestion. But, let's face it, who would?

Matt

re:Matt..but one can make those decisions based upon the suggestions that are made to one by others (a counsellor, for example).

If you force someone into treatment, it usually doesn't work because the person did not make that decision (to change their ways) themselves.

Wanted advice might help, but it comes with the problem the advice might be bad. The correct answer comes from within the person as its truth is self evident in ones mind of checks and balances.

Dear Philip:

I wrote this response to a new blogger that was struggling with a similar issue (depression and isolation) as you brought up in this post topic here. It's not long and doesn't have all the answers; but is simple and to the point without a lot of blather.

Dear New Blogger:

Sounds like you have been on quite a long roller coaster ride. I'm not going to give you a lot of advice in this comment; since you appear to be an intelligent person capable of making rational and right decisions for yourself. I personally have been down your path more times than I care to recall emotionally. Sometimes we have these expectations of ourselves that we are not able to come to terms with; once you throw in a few huge zingers like a major loss, traumatic event, or three added to the mix; you are on the elevator to depression hell and a very blurred existence.

I took almost all the so called wonder drugs, and went through all kinds of therapy. Then one day I decided enough was enough with the so called professional and pseudo scientific bullshit. I embraced the pain, the loss, the anger, and burrowed down in seclusion and tears until I could gather the strength to force myself to walk out that front door and start to live again.

I didn't step out blindly though! I really took the time I needed desperately to self examine my whole life experience, every ounce of the emotional rainbow I could allow myself to feel, allowing myself to connect with others that I choose were worthy of that trust (which were few and far between). Only then was I ready to start thinking about where my life was going to go.

I began by following what I was truly passionate about and felt inspired by; then I started walking toward it with all the effort I could muster from my feeble and worn soul. Soon I started to allow today to just be; I lowered my expectations and in return I opened up a whole new realm of never ending possibilities and dreams yet imagined. Only then was I really able to forgive and not ever forget; but turn the past weakness and defeats into a strength and falter to grow from!

From that place all was in a much better focus finally! Sadness had its proper place, but then so did joy and wonderment in its own unique balance. Life was finally the gift it had always promised to be. I can only guess that you are in the beginning steps of a sometimes very painful adventure and journey in this life. But as the path grows full of light and life; or dark with clouds of sorrow you will also overcome because it's all within you. If you choose anything, then choose to have faith in this gift.

Yours Truly,
It does matter

Mark p.s wrote:
"...Wanted advice might help, but it comes with the problem the advice might be bad..."

Well, you may well be right, although even before this question arises, is the issue of whether even realizes that something is wrong. Their behaviour might impact negatively on others, and yet it somehow becomes the responsibility of those others for reacting the way that they did, for example. We can all justify our actions in some way that allows us to avoid blame, of that there is little doubt.

Anyway, coercion is not a viable methodology, I agree, for the simple reason that this, in and of itself, might be a trigger for the person concerned - I know how I react if people choose to order me, as opposed to seeking my co-operation. Oddly enough, most don't seem to see the need to follow the latter course.

Matt

I'm glad to know that many people have found their way out.
However I would like to remember those who don't.
Some people stays for years taking antidepressants, changing from one to another with no success.
I don't think that antidepressants, at least those who are on the market at this era of biochemistry knowledge, are of any help and there are people who reported being depressed after taking an SSRI prescribed off-label.
These are the people who have to find a way out.
Asking Philip if he has found a "cure" is somewhat strange.

Philip and others have tried the cold turkey approach, and that's actually worked. And that's great.

Please don't pathologize those of us for whom Nicoderm or methadone (in the analogy) is our chosen method instead.

Philip Dawdy responds: actually, i've never quit any med cold turkey, except for atypicals which i was on a low dose of.

My point (which Philip, in fairness, probably misunderstood) wasn't about going off medication cold turkey vs. weaning off of it. It was on using medication vs. not using medication. And that's a far more controversial subject, to say the least.

Ana wrote:
"...Asking Philip if he has found a "cure" is somewhat strange."

There is no cure, because there's nothing wrong, in the first place. But convince somebody that their behaviour is "bad" or "aberrant," in some sense, and see how it fucks them up. Conversely, satisfy them that their behaviour is perfectly acceptable to one, or show them an alternative that is acceptable to one, and the mist rises. Cause and effect, and nobody I've ever spoken to has managed to convince me that I'm wrong in that assessment, and I can't be the only one who's noticed.

Matt

I had similarly concluded that I was not, in fact, bipolar, after having been off meds for a few months and basically fine (hard to evaluate, since I was having other health issues). I sought a second opinion sometime later, and (after several sessions) point blanked asked if he thought I was bipolar. He said that I didn't meet the criteria in the slightest, that my primary diagnosis was childhood-onset chronic insomnia and (probably linked) fibromyalgia. No shit I'm grouchy: anyone who could count a week's hours of sleep on their fingers and ached all day every day would be moody too.

I started wondering if maybe it's depression, when I reached a point the other night when I really thought I ought to kill myself. Disclaimer: I have never attempted any self-harm or suicide, and I honestly think that every time I arrive at that conclusion it's a fairly rational process. Insomnia is a death sentence, I will always either be psychotic from sleep deprivation or hung over on the few sleep aids that work on me. I'm about to finish college, and I'm doubtful that I'll survive the real world. There aren't many jobs that allow "sleep days", which I need from time to time to catch up. I've barely survived several semesters during bad spells. When I was 12 I was so delusional and paranoid from lack of sleep that I was convinced there were snipers in the trees outside my house. If I had to be near the windows, I was holding my breath watching for red targeting lasers to appear. The paranoia has never been as bad as in junior high, largely because I now know it's irrational. I still suspect I'm being watched sometimes, but I know I'm imagining it, so I don't worry about it or get preoccupied. Does it even count as paranoia if I can keep it at a distance? I don't know.

Oh, so, my point, I don't meet the criteria for depression either, not even the loosey-goosey definition being justified these days. The low moods are so rare, so brief, and so clearly tied to circumstances. I'm just an insomniac. I consider it a blessing to have found a psychiatrist who recognizes insomnia as a primary condition rather than just a symptom (hence the prior diagnosis of bipolar several years ago). I'm wary of meds after having gained 50+ lbs on Abilify and being on such a cocktail of sleep meds. I'm even warier after the new doc's first script: Xyrem. It worked like magic, got me deep sleep and stopped the aching. It took me three months to realize it had side effects that scare the living daylights out of me (namely shutting off my cognitive processing). So it works, but I don't dare take it. We're about to test a couple other meds on me (if anyone has any thoughts on baclofen or tizanidine, I'd appreciate the info). So this is my life for the foreseeable future: juggling on and off of meds that either don't work, have outrageous side effects, or that I build up a tolerance to in a handful of nights. Sometimes I wonder if it's worth bothering with this nightmare just to end up as the night shift at a shopping mall. If mental institutions were sensible places, I'd go check myself in for life. I'm pretty sure I can't hack it in the real world, and insomnia is not exactly considered a disability.

Wow, so I really rambled, sorry Philip. Take liberty to cut out anything you find unnecessary or that doesn't contribute to the content. I need a smoke, which requires stepping out into the New England snow. In fact, you can probably delete the whole damn whiny post. Was just needing to vent a bit. Nobody gets it. I feel like people here get it.

Jordan wrote:
"...No shit I'm grouchy: anyone who could count a week's hours of sleep on their fingers and ached all day every day would be moody too..."

I'm curious... If I were to say to you "it's not acceptable to me that you're an insomniac, and that you need drugs in order to get a good night's sleep - what are you going to do about it?", what would your reaction be?

This methodology is called "Confrontational Therapy," I understand, and you should feel free to take the suggestions I've made with a grain of salt, or dismiss them altogether. The point is to present you with a choice - and it is your choice, as Philip suggested at the very outset - and that choice should be made from the entire universe of possibilities in the full knowledge that you can go back and make another choice, in due course, if the first doesn't work.

Please also be aware that I have never been certified by any professional organization for the purpose of administering psychotherapeutic techniques, not that I'd want to hold myself out as being a professional in this area, given the mess they've made of it!

Matt

Can we begin by clarifying your "confrontation"? Are you saying "I think it's unacceptable that you're an insomniac. I insist that you take drugs to sleep." Or "I think it's unacceptable that you use drugs to maintain your sleep cycle."

I don't see any option besides taking something from time to time. I won't take anything too regularly, the hangovers are too invasive. But after years of being batshit crazy from lack of sleep, I can't see going without meds as an option if I intend to remain in the contributing population of society.

What is the purpose of this "confrontation" question process? If it's to get me to either decide to not take meds or to be content with taking meds, it's remarkably useless. I have to take something sometimes. But I've run through nearly all the potential sleep inducing agents on the market at this point, and they either do nothing or I build up a tolerance so fast that it becomes useless. The doc says we can try barbiturates next. I'm hoping it doesn't come to that.

Jordan wrote:
"Can we begin by clarifying your "confrontation"? Are you saying "I think it's unacceptable that you're an insomniac..."

I wasn't saying anything particularly, I think. I was just paraphrasing your own argument back to you, as I'd read it in your previous comment.

That is, you seemed to be saying that you were an insomniac, that you'd found you'd had to use drugs to get some decent sleep, but that the drugs did as much harm as good, and that you were generally dissatisfied with that state of affairs. Interestingly, when I put that argument back to you, from my perspective, you rejected the possibility that you could do anything about it: drugs are inevitable. Have I summarized accurately?

The confrontation, as far as I can see, is not between you and me, but between competing thought processes in your own mind, because I'm in full agreement with whatever you tell me - not least because there's no point in arguing with you!

Matt

It's not a competing thought process. I'd love to not take sleeping pills. I go without them for as long as possible as often as possible. And I lose my mind and crash and burn every time. I have to take something every week or so to keep myself from the downward spiral into ridiculous levels of sleep deprivation. The side effects of most of the meds I can reconcile with needing to take them to survive. It's the overall process of trial and error, juggling multiple meds to fend off tolerance, and having some meds with side effects that sideline me in the meantime that I'm sick to death of. If the one or two meds that get me some sleep with minimal side effects could last me forever on a regular basis, that'd be fine by me. Unfortunately that list currently consists of klonapins, and I build up a tolerance within two or three uses spread over several weeks. So I keep working up and working down in between testing countless other meds. It's exhausting, it's debilitating, and it's weighing pretty heavily on my morale.

I'm not arguing or trying to argue, I didn't mean to imply that the confrontation question posed was an actual confrontation. I've found myself in a familiar place of despair and frustration, but with any luck it will improve as I get back into managing things with my old standby.

Jordan wrote:
"...I've found myself in a familiar place of despair and frustration, but with any luck it will improve as I get back into managing things with my old standby."

I think the first thing to say is that I know where you are (not in the physical sense, like where you live, but in the sense of how you're feeling, right now), pretty much. I've been there, and it's not nice, particularly when people are ignoring what one is going through. The second point is that neither confrontation nor conflict need involve violence. Funny things, words, we attach our own meanings to them in odd ways, sometimes.

I've perhaps mis-read you, but you seemed to be saying that the only solution you could perceive for your insomnia was drugs, and even that was only a short-term solution, before you built up resistance. If that is the choice you've made (and it is your choice), then any possibility involving you dealing with this yourself is going to be very difficult to accomplish, in practise.

Can you accept the possibility that you can accomplish the objective (plenty of non-drug induced sleep), even if you don't know how, yet? I'm not saying that you *can* do it, but if you can't even accept the possibility, then you're making it really hard on yourself. Remember, people get a good night's rest all the time, so it can be done - it's important to remember that.

Matt

I accept the possibility, but find it dishearteningly remote. I've tried countless strategies over the years, from sleep hygiene and light therapy to hypnosis. I've seen therapists over the years, found some helpful and others less so. But despite whatever progress I've made in talking shit out, I still don't sleep, and the conception of insomniacs as hysterical worrywarts is as outdated as the belief that migraines are psychosomatic. I think the extent and longevity of the insomnia (which has been present for as long as I can recall, back to when I was in the single digits) lends credence to the cause being physiological. Since few doctors even consider primary insomnia to really exist, there hasn't been much research into the matter.

And thank you for reminding me that "people get a good night's rest all the time". Go tell a paraplegic that people learn to salsa all the time. Doesn't help them much, does it? I really don't mean to be snarky, but sleep is something that most people take for granted. Even people who have bouts of insomnia from time to time get the relief of natural sleep at some point. It's inconceivable to most people to not be able to sleep more nights than not. If I had a dime for every well-intentioned but thoroughly ignorant suggested remedy (have I tried a hot bath? warm milk? tea? a boring book? works for so-and-so every time), I'd be rich. This is not a recent difficulty for me, it's just one I've reached my wit's end with.

Cure is a tricky word in this arena unfortunately as is the word recovery.

Some folks subscribe to the idea that drug induced symptom remission is in a fact a cure or recovery but I don't agree.

You can argue the semantics of such words until you are blue in the face but people will still appropriate them as they see fit.

I spent a significant portion of my life suffering three supposedly incurable mental, genetic, chemical disorders or whatever you want to call them.

In time I found a path of self healing. I have not suffered from suicidal ideation, depressions, manias, turbulent inner voices, ptsd triggers, anxiety or any other disabling mental health symptoms for over ten years.

I did that entirely on my own without therapy or psychiatric drugs of any kind.

My experience is the complete cessation of the illness itself without drug dependency. That is the measure of my recovery and I think settling for less than that amounts to a job half done and can't honestly be called recovery.

What I did amounted to a cure and is a more effective cure than anything I have ever read about for these kinds of problems.

"As for cures, no, I haven't found any, except my own force of will on bearing down and pushing through life and by paying close attention to things and thoughts that trigger depressive cycles and avoiding them and by kind of just accepting life and my place in it and not fighting it. You cannot get that in a pill of any kind. You can't get it from a therapist either (they can help some people, but were useless for me). You can only get it from yourself.

Depression is tricky stuff and you have to be smarter than it is. I wish I knew how to explain how you do that, but the reality is that it can be done. Anyone who tells you otherwise is lying."

amen Philip, that is how it is done

congrats again on beating your bipolar against all expectation and prognosis

Jordan wrote:
"...This is not a recent difficulty for me, it's just one I've reached my wit's end with."

As I wrote, before: I've been there, and I know what it's like. Incidentally, I don't know what the difference between a so-called able-bodied person and a paraplegic is, aside from the obvious paralysis, that is. Similarly, I don't know what the difference between you and I is, although I am aware that I can get to sleep without difficulty, and you can't, yet. Also, I wouldn't draw a distinction between physiological and psychological causes, if I were you, just because there has to be a physical manifestation of your brain's unwillingness to shut down for the night.

Anyway, remote or not, at least you're able to concede the possibility that you can sleep without the aid of drugs, even if you've already closed off a bunch of avenues that I might have raised (sleep hygiene, changing your nighttime routine, and so on). I suppose it's not that surprising that the possibility is remote, given your experience with failed "cures". Sometimes, though, it's worth looping back, and taking a second look, just in case there's something one missed on the first pass. I'd buy a new toothbrush, if it were me.

Matt