NHS psychotherapy with no drugs - can it succeed?

[TopazRocks]

I have long-term moderate to severe depression. Since my teens (now in my 50s) More moderate just now, but disabling in most areas of my life. Have tried several ADs and many have caused me problems. Saw psychiatrist last week and I am being referred for psychotherapy. I am scared but I think this is a good thing in the longer term. She also suggested another drug to try. Since the appointment, i am having 2nd thoughts - due to fear of side effects. I've had a lot of problems before.

My question is: how will it work if i have psychotherapy when on no ADs? Is it less successful? I am very concerned that if I talk about my past I will disintegrate completely - and I'll still have to get the bus home! (over an hour). It's not just fear of being a snottery heap on the day, but at the other extreme not being able to talk myself out of the suicidal impulses.

In the past, when on ADs, they have helped keep me on an even keel, but there's also a risk if I am on meds I will be able to minimise the problems and so not benefit as much from the therapy offered.

Thoughts?!

[404NotFound]

If you've been offered long-term NHS psychodynamic/psychoanalytic psychotherapy, then grab it with both hands and hold on tight. These services do still exist in some places, but they are rare as rocking horse poo.

Yes, it can work, it has for me. I was on fluoxetine at some point, but the drugs didn't really do that much, whereas the therapy has been like re-wiring my brain in small increments for four years. I didn't have depression as a primary diagnosis, I had C-PTSD and dissociative disorder, but with a hefty dollop of depression on top. Honestly, it has bedbugs life-changing.

Obviously there are no guarantees, but you have nothing to lose by trying. I expect the service will do an assessment first to check they can meet your needs. Mine have been very aware of the possibility of therapy making things worse, and have been very good at liaising with psychiatrist, gp and the crisis team as needed, and i have felt very supported in a joined-up kind of way. No, it hasn't been easy, but so worth it, I am hugely grateful to have been offered that opportunity. These services are so rare now, if that is what you're being offered, then absolutely go and talk to them and see what they can offer.

[erinaceus]

I am inclined to agree with 404 and to add, are you able to ensure that you are under a psychiatrist and have crisis support whilst you are having psychotherapy? From my personal experience there is a balancing act between the stabilising effect of ADs and the ability to access emotions in psychotherapy. I empathise with the getting home safely comment and also the getting through the week between sessions safely as well. A good psychiatrist and crisis support can help keep you safe through all of this.

The question is not so much whether it can succeed as whether it is helpful for you. I cannot comment on that at all because I am not you and because I am in the middle of it all myself and ambivalent about continuing. I find insisting on regular reviews with my treatment team to be essential to keep an eye on any sense of progress.

I find this board helpful in feeling less alone and am looking for RL support options as well.

Good luck

[404NotFound]

bedbugs? =been.

[TopazRocks]

Thanks, both - and smiling at bedbugs! There is a waiting list of course - I think psych said 3 months or so. But I will be doing it, trying it anyway - reassured by your comments. The meds just make me feel ill, physically - and I've tried several of all types available. And I DO need to be able access the deep-down misery so I'll try not to use ADs meantime. Nice GP is on hols and I might have a chat when he gets back. And I've spoken to DH about my concerns - he has offered to meet me after my appointments - though I'm less sure this is practical. We'll see.

I'm not sure how much I'll see psych. I feel guilt at using precious resources. I feel that about GPs too. I suppose I wish i could sort my self out. I KNOW this is a feature of my condition though!! Psych did say something about 2 initial sessions/assessment where I can ask how it will all work. Despite the ambivalence, part of me is quite excited at the prospect of getting me sorted at last. But it's such a lot of shit really. ....

[erinaceus]

TopazRocks I understand the guilt at using precious resource. I really do. The resource being allocated to you is not your decision to make. You are precious. Hence, the resource is used for you.

If access to a psychiatrist is difficult, your GP can pick up this role, particularly if they are willing to work with the rest of your treatment team and you are not on medication.

I call my DH after my psychotherapy appointment most weeks, to check that he is still there