My therapist thinks I need antidepressants. Do I?

[JustForTheTasteOfItDC]

TLDR:

I've been having therapy with current therapist for about 6 months, and at our last session she asked if I had considered taking antidepressants, because she was worried about how sad I had been in our previous sessions.

I hadn't thought (or realised?) I was depressed, but life has been hard for the last year, and I don't enjoy anything any more.

Do I give them a try? I've taken them a very long time ago (in my teens and 20s) and to be perfectly honest have no idea/recollection of whether they worked or not!

LONGER VERSION:

Long term relationship ended at the end of last year. I was ok at first and then struggled to cope, got signed off work for months but had some counselling through work which really helped. Have been single since and I'm happy with that, although sometimes it does feel quite lonely.

Work is currently good, but there is a lot of uncertainty in the coming months as it's possible that the place I work might be taken over next year, which may mean I am out of a job. This is obviously rather stressful!

Since covid, my life has shrunk massively, and I barely do anything. I became slightly obsessed with covid during the pandemic and afterwards, and I have read so much about the long term consequences in terms of immune system and impact on the whole body that I felt completely stuck between part of me wanting to go back to some sort of normality, and being completely fearful of that. Things that I used to enjoy doing, like going out for coffee and journaling, I really struggle with now, and in fact I find it difficult to bring myself to do it at all. Partly that's fear of covid still, partly it's a worsening of OCD that I've had for 13 years. I am still obsessed with illness, contamination, germs, particularly sickness bugs etc. I hate going out to eat because I'm convinced that whatever I eat will give me food poisoning. If I do go out (with family etc) I go to places that I've been to before, order things that I've eaten before. I can't remember the last time I ate something in a restaurant that I actually wanted to eat. I order whatever is least likely to poison me.

Home isn't much better for eating. I eat the same things pretty much every day. Making a sandwich requires hand washing about 10 times during the process. I find it really difficult to eat anything that isn't in my current repertoire of foods, because I am scared it will make me ill.

I used to enjoy sports but find it difficult to find motivation to go, and don't really enjoy it when I'm doing it.

I just feel completely stuck. I am sure that my mood/mental health is not helped by my poor eating, but I just can't bring myself to widen my current safe foods. I'm having therapy which really started because of struggling to cope after the relationship broke down, but I think my therapist also feels stuck with me which is why I think she mentioned about the antidepressants. It's also not at all focusing on the eating/OCD, so I don't know how to change that without help, or what kind of help to get for that.

I'm sorry this is long and rambling.

Maybe antidepressants would be a good idea since I can't work out what else might help at the moment?

I suppose I know that I haven't always felt this way. If this was my baseline normal, maybe I could accept it. But the lack of anything bringing joy into my life, that's not always been the case and that's quite hard. Maybe you are right, maybe I can't be "fixed". But even if I got up my baseline of "fucked up but functional and capable of feeling happy", I'd take it.

Ask GP for referral to psychiatrist to discuss medication and treatment for OCD.

I think it's important to explore ASD. It sounds like you might be burned out rather than depressed? I'm not a psychologist but I have experienced burnout which led to depression and having experienced both I find depression is I can't get out of bed to face the day, I wish I didn't wake up (ever again type way) and burnout is I'm overwhelmed/exhausted and just don't have the energy to get up.
Of course fatigue can be a sign of depression but so often women who are autistic are labelled depressed instead of burnt out. There's also a link between rumination/OCD behaviours and intrusive thoughts which might help to understand your OCD.
Do you have any siblings? I had a family member so my questionnaire rather than a parent and it was fine once I explained why.
Even if you didn't go for a formal diagnosis, you could begin to research and have your therapist help you develop tools and coping mechanisms that help autistic people and if they help you it doesn't really matter if you have a label or not xx

OCD is a, debilitating condition and I wouldn’t wish it upon anybody. There is a great podcast on BBC Sounds called “is psychiatry working” and there is an episode on OCD. I think it’s called dom’s story which is excellent

To answer your question, it’s usually 20 mg of fluoxetine to begin with, this can work incredibly well for lots of people but sometimes others need a different type of antidepressant or to increase the dose to see any response.

I think it’s important to bear the possible neuro divergence in mind. I know it doesn’t change anything in terms of the OCD itself, but what I have seen lots and lots of times is that there is some comfort in knowing that there’s almost a reason for it. Most neuro-divergent people experience higher-level of baseline anxiety (often due to sensory processing and having to live in an Neurotypical world, masking etc), than neuro typical people, and what I’ve seen in my clinic is that, this is often played out through OCD and ritualistic behaviours and intrusive thoughts, feelings of over responsibility and often a real fear around contamination or germs or famously, being sick. OCD is an anxiety disorder ultimately.
it sounds as though you’ve suffered with this for a long time, perhaps think about speaking to the GP further and perhaps just trying the anti-depressants, at some point the side effects of living with life, feeling so anxious and not being able to do things outweigh the risk of any side-effects of the meds.

Sounds like the 13 years ago therapist was “flooding” you so almost doing the worst thing you could imagine to try and create evidence as to why the fear is unfounded. This is a bit outdated now, we tend to use gradual graded exposure alongside tolerating distress techniques etc.
if you want to, you could also have a read of Professor David Veale’s book, overcoming unwanted intrusive thoughts which is very good.

Thanks, this has given me a lot to think about. I do have a sibling but they are 7 years younger and very close to my mum so I'm not sure I could enlist their help with this. I'll certainly look up some ASD specific tools/techniques though, thanks

@Thischarmlessgirl

Most neuro-divergent people experience higher-level of baseline anxiety (often due to sensory processing and having to live in an Neurotypical world, masking etc), than neuro typical people, and what I’ve seen in my clinic is that, this is often played out through OCD and ritualistic behaviours and intrusive thoughts, feelings of over responsibility and often a real fear around contamination or germs or famously, being sick. OCD is an anxiety disorder ultimately

That really resonated, and yes it's being sick (or even feeling sick) that is the anxiety for me. I have always been overly concerned (can't think of the right term!), with vomiting. I have always hated the feeling of nausea and vomiting and as a child would walk laps around my room for hours as it was often a way of deferring actually being sick. I have vivid memories of myself, and other people, being sick, from both my childhood and adulthood. I'm suspecting this is not exactly normal! 13 years ago, one of my DC had a sickness bug, and then completely unrelated to that, 2 days later my other DC was admitted to hospital with meningitis. The problem is that in my head, I think I have conflated those two things together so that vomiting = serious illness. So now I have the underlying, childhood issue of anxiety about vomiting, with the more recent vomiting = serious illness beliefs heaped in on top.

Why is it that ND people might have more of an issue with vomiting? Is it a sensory thing? Or just that it's the higher anxiety and it expresses itself as OCD?

Yes usually a sensory thing with emetophobia (phobia of vomiting) plus being out of control and fear of it happening unexpectedly or in front of others/in public
very good book called “overcoming emetophobia” by David Veale.

Due to your past conditions I would give them a try, it seems to be your brain chemistry so if you managed to combat the ocd there would be something else to replace it. Think of it like a physical condition that needs medication

Do you know I had never thought about it as a sensory thing. Seems a bit silly now not to have worked that out. I know I really hate the feeling of nausea/vomiting but assumed that nobody likes it, so couldn't work out why the way I felt about it should be any stronger/different that anyone else. Not sure that makes any sense!

thanks for the book recommendations - will check those out.

Yes I agree that focusing on the OCD might work for a while but then it will just find a new way to play out.

Re burnout, I don't know if it is that. I don't feel like I do enough to be burnt out, IYSWIM. It's just the sheer monotony of it all. Work, supermarket, chores, look after kids, cook, wash up, sleep. Rinse and repeat, day in, day out.

It doesn't feel as though I just want to go to sleep and never wake up again. But that when I do wake up, it's just the relentless need to be responsible.

That does sound more like burnout to be honest. Depression is more nothing interests you leading you to not want to be here. Of course there are varying degrees and it can be milder but the monotony can be exactly what causes the burnout. Having to be mentally present, dealing with work, kids etc add sensory issues and being autistic on top it's a lot to deal with. I would recommend looking on tiktok and searching autistic burnout. There are some great creators who talk about it and tips for helping with it. There's something particularly difficult about being undiagnosed ND in that you cope and you cope and you cope until the damn breaks and you just can't cope any longer. Because all our coping mechanisms aren't made with being ND in mind, rather they aim (unconsciously) to hide our struggles and make up for them when it just isn't possible to do that forever.

Thanks @Nn9011 just had a Quick Look at autistic burnout and found something that had a checklist of behaviours. I ticked over half of them. Interestingly one section was about stimming behaviours, which I know a little bit about but then googled what would constitute a stimming behaviour, and read that stab picking and hair pulling are examples of stimming. I had no idea about that. They are two things that I do repeatedly. One section of my hair is almost completely grey where I have pulled out so much hair and new hairs grow back grey now, and I have a permanent scab at the back of my head that I have picked daily for about the last 15 years. Had no idea they would be considered as stimming behaviours.

Hair pulling and skin picking (body focused repetitive behaviours) have huge links to ND and stimming.

I had no idea!

It's so hard, I think especially as for sooo long it was seen through the male lense but woman are very different in how we manifest Autism.
Understanding your brain is half the battle to be able to set up healthy coping mechanisms. If possible you might want to take some time off work and just rest (like actual rest not lying there thinking about all the things you should be doing). It's amazing how much that helps in the meantime. You can say it's depression on your fit note if you don't feel comfortable talking to your employer.
If you can't take time off, try talking to your employer. You are entitled to accomodations even if you don't have a diagnosis xx