Why is the answer always antidepressants????

[Feelingcrazy123]

So I got referred to the mental health for an assessment - after a brief chat it came down to “cycles of depression”.

after 9 month wait I start CBT - doing daily diary, thoughts logs, feelings logs, gratitude logs etc etc etc.

I’ve had CBT and counselling a number of times over the past 10 years or so for sexual abuse, bereavement, depression and anxiety. I’ve even paid for private counselling.

im currently 28 weeks pregnant and having very intrusive thoughts and visions of my 3YO son getting very hurt. They are very graphic and very upsetting. Anxiety is through the roof but working through that and my mood is very much a massive rollercoaster. I’ve been referred to perinatal mental health team - they’ve refused me as “I don’t meet their criteria”.

my mood is all over the place - this has been like this for years so not due to pregnancy. I’m so up and down and very happy and very sad.

I just don’t know what is wrong with me and no one seems to want to explore it apart from talking therapies and medication.

I get that antidepressants will help but they won’t solve what ever is that matter with me. They won’t fix the problem only the symptoms. I don’t want to mask my issues I want to sort them out

AIBU to per-sue this and keep trying to get someone somewhere to help me figure this out.

YABU - go back on antidepressants and give up trying to figure it all out

But you've had counselling.

You've had CBT.

If you spoke to someone who listened, what do you think they could do differently that you havent already had?

People are listening.

Counselling is listening.

Apart from someone understanding what you are saying, once they have understood what do you think you should be offered that would help?

sorry I mean like a dr or mental health expert. Not a counsellor

And what could or should they offer once they've listened?

This is how anxiety works - it can transfer and spread. Your deep seated belief that something is wrong with you could well be anxiety and the more you believe it in, the stronger it gets. Intrusive thoughts are not unusual - they are just harder to ignore or dismiss if you are anxious. Could you request a mental health midwife for some ongoing support?

Because it's the cheapest and easiest option for the NHS. Mental health resources are chronically underfunded in the UK, you're 'lucky' to have been offered CBT. It's a disgrace, more support should be available.
I imagine you don't meet the threshold because you're not in complete crisis and a danger to yourself, your baby or others. But it shouldn't have to get that far before help is made available. Can you afford to pay for long term support to help you explore the issues you experience?

I am lucky to have CBT and counselling and I’m very grateful for that don’t get me wrong. It’s been through various different organisations.

I know I’m not a priority and I understand why - sue to underfunding and understaffing and so much need for mental health support at the moment.

when I spoke with the dr this morning when I explain my fear is that taking the medications will mask what’s happening to me and I won’t be seen again. I’m scared that every cycle gets longer, darker and harder. Mental health midwife team won’t even speak with me they’ve looked at my referral and said I don’t even need an assessment.

MH support sucks OP.

I did not realize that it was the mental health midwife who said no to you - they are usually different from the perinatal team but maybe it is different in different places. Sorry that happened to you.

Have you tried booking a double appointment with the GP? Do you always see the same one? I was so struck by what you said -

I’m scared that every cycle gets longer, darker and harder.

I think GPs are overwhelmed and often quite uninformed about MH but they can be a great support if you can find one who takes you seriously when you explain this. If not -

Re the perinatal team - could you speak to the manager and ask them to explain the rationale for turning your down? If it is part of an NHS trust, there will be a team to handle concerns and complaints and they can be really helpful too in situations like this if you do not feel you are getting an explanation that makes sense to you.

MH services are ridiculously over stretched and focus on highest risk at the moment, which is awful because it leaves so many people suffering. Some of the self help organizations can be a really good support. Your intrusions are really common in pregnancy and with small children, but that does not make them easier to cope with. The self help organizations like OCD UK could be good with this.

Again, I am so sorry you are feeling this way. I work in NHS MH and it makes me so furious when I see this despicable government claiming they love the NHS and are wanting to make it work.

I just don’t know what is wrong with me and no one seems to want to explore it apart from talking therapies and medication.

Is there something else you'd expect to be offered? Because talking therapies to address and change the way you're thinking, and medication to address any chemical imbalance in your brain, are pretty much the only treatments for mental health issues. You say you want people to 'explore' your mental health issues, but that's what talking therapies are for, so what other exploration would you be looking for that you wouldn't get from therapy/counselling/CBT? If you were referred to a psychiatrist, that would also involve talking and medication.

I second EMDR therapy. I think NHS mental health care is in such a bad way the only thing to do is save for a private EMDR or very good psychiatrist/psychologist (mine was £65 per session - I’ve had to stop due to lack of funds but will go again at some point). I found CBT pretty unhelpful tbh, just skims the surface, and a lot of the CBT NHS practitioners aren’t that experienced.
Other than that it is just medication. I hope you can find something that works

Yes I agree with this I think it sounds like you have ups and downs and are being listened to and treated? It maybe the hormones are making it worse and I get this and what muckyplucky has said makes sense
I have terrible Pnd anxiety and very similar situation and history of MH issues and hormones are a huge factor including monthly cycles and I have ocd intrusive thoughts etc it’s been worse in pregnancy and absolutely horrendous after I’m still struggling now but doing Cbt I have other prescriptions but scared as I had a terrible reaction to sertraline which has put me off other meds at this point of time

OP sometimes medication is the answer, in conjunction with therapy. From experience (and you'll find lots of evidence of this) it takes an awfully long time to get the right treatment if your condition is not straightforward.

If you're functioning ie holding down a job etc you'll never be on the priority list - but that doesn't mean you're not suffering does it. I didn't get the help/correct diagnosis until I had a crisis and could no long manage my life/work.

Can I recommend that you keep a mood diary if you've not done that already? That can help show up patterns and assist the doctors with pointing you in the right direction.

Not saying you do, I can't diagnose you. But if you have a mood disorder anti depressants are not the correct treatment and can make things worse.

You say you want to speak to a mental health professional…that’s exactly what CBT practitioners ARE. I feel like you’re quite muddled/unaware of how MH treatments and services work.

Youve had NHS professionals providing CBT treatments (the psychological part of MH care). You’ve also been offered the medication part of MH care. These are what are applicable and appropriate and recommended for someone with your presentation / difficulties. Sometimes they’re more effective and sometimes less effective. Most people need a combination of both, and to try different kinds of CBT or to explore DBT (which is particularly effective for your sort of emotional instability). Also to play around with different types of SSRI. None of it is a magic bullet, but your healthcare providers are providing you with exactly what the evidence-based options are.

What else are you getting at? Do you feel you’ve got bipolar disorder, schizophrenia, schizoaffective disorder? Because they’re the SMI (serious mental illness) conditions where other types of treatments / meds would be indicated….and as a very experienced MH practitioner I can say pretty confidently that you almost certainly don’t sound like you meet these criteria.

I have to go to work. I have no option. I work in private health care with no sick pay. We can’t afford to live with just one wage.

i just feel like I’m at a loose end, loosing my mind.

I’ll continue with the CBT and all the diary’s she wants me to do and take my medication.

it’s been so long since I felt like my normal self. It’s been so long since I felt content with myself. It’s been so long since I knew who I am. Im lost and I don’t know my way back

I think they are doing all they can to help you - counselling and antidepressants are what’s on offer. Don’t dismiss antidepressants, they can be utterly life-changing. And there’s no evidence to say they are harmful in the long term

OP - you’ve not answered any of my questions nor responded to any of the advice & suggestions I’ve given.

As stated, I’m a senior Mental Health Professional with many years experience in assessing and treating your exact presentation. You’ve said repeatedly that you want to be able to speak to a MH profession but then when I’ve entered into a discourse with you, you’ve blanked me. I suspect because I haven’t agreed with you that your treatment’s been awful and no one listens to you and why won’t people
take you seriously.

If you genuinely want help / advice I hope you’ll take the time to properly read my professional opinion and the wise advice from some other posters. And engage less sceptically with the work your CBT therapist is doing with you. They don’t just make it up to annoy you, it’s shown to work for many people. Otherwise, you’ll remain stuck in this state of malaise, dismay, and resentment.

apologies @MuckyPlucky for not replying to you personally.

thank you for your replies and advice.

I am going to be taking the medication (despite the side effects/risks it may potentially have on my baby when born. I feel very selfish taking the decision to take it but I’ve weighed up my risks and benefits and I understand I need the tablets).

yes your right I have lots of help in terms of CBT and counselling through the NHS and private providers. I’ve had due to rape, attempted sexual assault, the sudden and horrific death of my brother in my previous pregnancy, my confidence, anxiety and depression.

I didn’t say they make it up - I understand they are amazing people with fantastic advice and I’m trying my hardest to engage the best I can. I’m doing the mood diary, gratitude diary, thoughts diary, positive behaviour and the grounding techniques. I’ve also got other techniques we’ve discussed in my sessions that I use which can and do help me.

my concern is that every 4-6 weeks I go into a very deep dark place. I don’t understand why this cycle is happening to me, why every 4-6 weeks I want to run away from my life and not exist anymore (not suicide however I do have intrusive thoughts about myself). Why am I so happy and floating one minute and the next minute I want to scream and cry and lash out. (Again this has been going on a few years not just while pregnant)

The visions of my son getting hurt, dying and I can’t help are tourmenting me - meal times, bath time, walking down the stairs, him running and climbing like a normal child = I see him getting hurt. I know they are not real or rational thoughts.

I don’t know if this is depression or there is something more to it. If it is depression does that mean I will need therapy forever and medication forever?? Where is the end in this??

Sorry to hear you’ve had those traumatic experiences. It’s sadly very common to have lasting mood instability as a result of ptsd / c-ptsd. What you’re describing sounds like you’re managing to bumble along but then every 4-6 weeks everything gets too much and you crash. It’s possible that you’re fluctuating monthly hormones maybe making the difference between being able to cope and not being able to cope - IYKWIM? Sometimes, when there’s a lot beneath the surface (as there Will be with your various traumas) it only takes a small change to cause your mood to plummet. With the cyclical pattern you describe it’s likely to be linked to your homone levels which naturally make us all fluctuate in mood but when coupled with unresolved trauma can create huge disturbances. Could even be PMDD (worth a google).

With a 4-6 weekly pattern it’s not bipolar disorder. And you don’t describe any of the usual symptoms. So what you’re left with us emotional instability as a result of previous unresolved trauma (prob diagnosed over-simplistically by your GP as anxiety/depression). The hormonal cycle is making this untenable every 4-6 weeks. You need to get trauma therapy (EMDR - it’s expensive but you only need a handful of sessions) and maybe explore hormonal contraception after your pregnancy such as the IUS.

Please don’t talk about SSRI’s harming your baby etc. That’s a fallacy, and may possibly put some readers of this off taking their very essential medication. I’ve stated in my previous posts that Sertraline is entirely safe in pregnancy & breastfeeding. I say this as both a mental health practitioner and a mum myself who took sertraline throughout both my pregnancies. My kids are insanely healthy & happy. So please don’t spread misinformation which may cause other women to come off medication that is essential for their wellbeing.

I hope you find my advice useful (research PMDD / PTSD / c-PTSD / Sertraline in pregnancy / EMDR) and wish you all the best.

Hi OP,

It sounds like at the moment you’re being referred to front line services which is relatively short term interventions like CBT/counselling via IAPT/talking therapies and GP for antidepressants. This is all normal and in line with guidelines. However, you don’t seem to feel like this is enough, which maybe it isn’t for you.

You could ask for a referral to the mental health team in your borough for a full assessment with a psychiatrist. There are other therapies that are more exploratory like psychodynamic / integrative / person centred psychotherapies that are longer term and focus on getting deeper into personality issues. I don’t know where you are but where I work we have pathways for therapies for more complex emotional presentations. It is difficult to get this kind of help sometimes because there are thresholds but you can ask.

I wouldn’t listen too much to people telling you that you’re getting all there is and should be happy with this or trying to diagnose you from a few posts on a message board. You feel that something is wrong and hopefully you can find a professional who will listen to this. Good luck.

Intrusive thoughts can be triggered by pregnancy and worsened by it too.
Very normal to have the intrusive thoughts centred around your child being hurt (biggest fears) even if the person hurting them is you in the frightening thoughts.

I would highly recommend a book called ‘Overcoming Unwanted Intrusive Thoughts’by Sally M Winston and Martin Self.

Had to practice but the book more or less settled the intrusive thoughts situation for me, massive change in existence without them (or rather taking no notice of them).

Other things that helped massively maintain me are meditation and yoga. Cliches for a reason!

In answer to your question, ADs given as the easiest fix I’m afraid.

Best of luck

my concern is that every 4-6 weeks I go into a very deep dark place. I don’t understand why this cycle is happening to me, why every 4-6 weeks I want to run away from my life and not exist anymore (not suicide however I do have intrusive thoughts about myself). Why am I so happy and floating one minute and the next minute I want to scream and cry and lash out. (Again this has been going on a few years not just while pregnant)
...
I don’t know if this is depression or there is something more to it. If it is depression does that mean I will need therapy forever and medication forever?? Where is the end in this??

I think I know what it is you want, OP. I think you want to talk to a MH professional who really listens, and takes into account the pattern of your mood changes and all the other things. And then says "hmm - yes this is a typical presentation of X disorder" and then offers the specific treatment for X disorder, which has been developed for people with symptoms exactly as you describe.

You feel they are missing something by saying it's depression, as what you experience is not typical of depression. It's incredibly frustrating dealing with them, as they don't seem to acknowledge this.

The problem is, there isn't actually a specific disorder/issue that presents as you describe. Although some of what you describe sounds like it could be in the ballpark of OCD. But the recurrent depressions - no. So services try to fit you into the nearest option.

I'm slightly hesitant to write the next bit, as I am concerned you may take it as an answer, when really it's just something to consider, whether to rule it out or investigate more. But I would suggest you find out about how autism and ADHD (or ADD - no hyperactivity) present in women. Especially late diagnosed women who you'd not necessarily think were neurodiverse if you met them.

To be apparently managing fine and then break down, repeatedly, can be caused by the sheer exhaustion of functioning in a neurotypical world, if you are neurodiverse. When you break down (or burn out) you retreat a bit, take it easy, the demands on you drop, and so you recover and get back to normal, only for it to happen again.

If this is relevant to you, I have to warn you that it can be hard to get diagnosed on the NHS as an adult, and that if you do get a diagnosis there are basically no services or anything. It just helps to be able to put a label on it to explain to others and to help you understand yourself.

But what you could do, if it seems a possibility, is find out about what helps and try to do these things, to see if they help you. So for example, learning your personal warning signs that you're getting worn out and need to take it easy a bit to prevent a mini burnout. To be honest, this might help anyone actually!

I will also add that it can be very difficult to unpick what is trauma and what is autism, and in some ways they go hand in hand. Also OCD can often develop in autistic people.

OP I get it. CBT is rubbish and can make early childhood trauma symptoms worse.

I don't have an answer for you apart from routine, exercise and friends. It's the only things that keeps me from falling into the dark deep pit of despair. There's only so many times you can talk about your childhood and do the talking therapies and see the counsellors. I've started accepting that this is the way I am, I am this way because of my childhood and to keep myself happy I force myself to exercise, see friends and be in a routine. I'm not great at it and I do slip up but for me this is what works.

The fact that you describe mood crashes every 4 to 6 weeks makes me wonder about rapid cycling BPD. It occurs in about 5 to 10 % of patients with BPD, and is more common in women, probably due to hormone fluctuation. If that is indeed your problem, mood stabilising drugs are more effective than using antidepressants alone.
But you really need to rely on your own psychiatrist rather than the musings of random doctors online!

Thank you all so much for your replies

theres a lot to think about, consider and research here so thank you.

@MuckyPlucky Apologies again I would never want ti put anyone off medication they need and really hope I haven’t. Thanks again for your help.

@ButterflyWingsCeased that’s exactly it I want them to listen to my symptoms.

thanks again everyone I really do appreciate it

But medication and talking therapies are the two treatments for depression? What else would you like to have offered?

The idea of anti-depressants "not curing depression and only masking the symptoms" really isn't right. They are acting much like insulin to a diabetic. They are replacing things your body is lacking, to make you healthy. They are curing depression, but you have to keep taking them.

I do wonder whether a different talking therapy might be better for you - perhaps a trauma therapy like EMDR or trauma focused CBT might help with the underlying causes of the depression.