To try and beat depression without meds?

[MessyNDepressy]

I have clinical depression and anxiety. I’ve been diagnosed for a few years now but realistically I was unwell for quite a long time before that. I’ve probably had some level of depression since my teenage years but it reached its peak about 4/5 years ago. Not just low mood - ongoing suicidal thoughts etc. There has been mention from Drs that I may have ADHD but the waiting list for diagnosis in my area is 3+ years so it’s irrelevant. I ended up on citalopram for about 18 months. It did help to a degree but a few months ago I had to come off them. They gave me insomnia which never went away and the lack of sleep was starting to make me more depressed/anxious. Dr suggested I try Mirtazapine but despite collecting the prescription, I’ve never taken them. The side effects like excessive weight gain, sedative effect etc scare me too much. I know there are other options but they all have side effects and I think I’m pretty sensitive to medication. I had restless legs, dry mouth etc the whole time I took Citalopram, it never went away. I also really struggled to go to work and look after my son when I first started taking them. I don’t have the free time to keep trying different ones, suffering the symptoms etc to see if I may or may not find one that works.

I’m in a position now where I had a good period of maybe 3-4 weeks where I felt better than I’ve felt in memory but have now come crashing back down. The dark thoughts are back, the crippling anxiety from the second I open my eyes, not looking after myself, feeling overwhelmed by basic life and generally just feeling like I’m drowning. At this point, I just want to give up, I’m so tired of trying and having to fight every single day to just be alive.

I’m trying to claw my way out without using medication by making a plan of regular exercise, drinking water and eating better, vitamins, creating a basic routine and good habits, online CBT (possibly therapy sessions if I can afford them), breathing exercises - all the stuff that should, in theory, work. Has anyone else managed to actually beat depression without medication? I’m scared that I don’t have the level of discipline it will take but I won’t survive the rest of my life like this.

I should add that mental health issues run in my family, mostly undiagnosed or medicated with alcohol. Multiple people have committed suicide and others have attempted. I don’t drink or self medicate any other way other than hiding in bed and doom scrolling.

Do you live alone?

I think this is a huge ask of yourself. It might be that during a good period you could sort of maintain it with that sort of effort, but given that you've in all likelihood got an inherited chemical imbalance it's always going to rear its head again. Can you take the meds for six months and then review? Doesn't have to be a lifetime commitment if it isn't of overall benefit.

How old is your son?

This is no way to live, and won’t at all be a healthy happy environment for your children with you not wanting to live.

If not for your own sake, get on the meds for them

Has anyone else managed to actually beat depression without medication?

Yes, but only by making wholesale lifestyle and environmental changes, sacrificing a lot of things, and making choices that won't be possible for absolutely everyone.

Also, I do not consider it "beaten" as it's a life-long, ongoing fight against it, more that as I have not experienced completely bottomed-out mood, dissociation, suicidal ideation etc in years I consider the changes I've made to have been effective in alleviating it. I'm under no illusions about the fact it could easily come back, so my lifestyle is entirely about refusing to entertain anything I know impacts negatively on my mood.

I don't mean this to be as blunt and callous as it sounds, but from your OP it seems like you've tried Citalopram, that hasn't worked for you, so now you are opposed to the notion of AD's full stop. The reality is that for most people with ongoing long-term depression who do manage it through meds, they often end up going through the gamut of all the normal SSRI's, the anti-psychotics, and then the atypical AD's before they either find one or a combination thereof that actually works for them and doesn't give them debilitating side-effects.

You mention CBT, but if you went for a few cursory CBT sessions and felt no immediate benefit (indeed, it's common to come out of CBT feeling worse than when you went in) would you immediately dismiss any and all other forms of therapy?

I live with my son who is 13 nearly 14 (and my dog). He is perfectly well taken care of and loved. Every need and want is met - clean house, clean clothes, well fed, money, taxi service with his mates, does plenty of sports that I attend and support him in, spend quality time together. We have a great relationship and he’s a happy, healthy kid. This is an internal battle, not an external one - you’d meet me and think I had my shit together. Like most women, I’m great at masking and just getting on with it but that doesn’t change the hell going on in my head. That I want to fix hence my post.

The dark thoughts are back, the crippling anxiety from the second I open my eyes, not looking after myself, feeling overwhelmed by basic life and generally just feeling like I’m drowning. At this point, I just want to give up, I’m so tired of trying and having to fight every single day to just be alive

OP please accept that your son will be aware of this.

You need medication. You need to give it a good go and not give up in first few weeks if side effects are unpleasant. Your body (and mind) will adjust.

Thanks for your reply. I do know that it’s going to be a lifelong battle for me too. It just makes me sad, I wish I could just be normal and have a normal functioning brain.

It’s not so much that I’m totally against anti depressants, I’m not. I just don’t know how I’m supposed to pause life to try and find one that works. It seems like such an uphill climb to find one to the point that I’m now thinking maybe with the right plan I can fight my way out of this without them. The fear of knowing that it usually gets worse before it gets better is putting me off. The doctors are adamant I try the Mirtazapine before anything else but from what I’ve read, a lot of people end up like a zombie in the beginning. Unable to drive, sleeping 14 hours a day which just isn’t an option for me. At the moment, I’m a mental mess but I still manage to get shit done, I don’t know how I’m supposed to do that if the drug affects me that way.

I’m definitely open to therapy but the wait lists in my area are long so it would need to be something I could afford to pay for privately.

The doctors are adamant I try the Mirtazapine before anything else but from what I’ve read, a lot of people end up like a zombie in the beginning

Yes, but there are also people who don't experience this.

You need to think about which is worse. Living with your illness unchecked, or potentially, only potentially mind, experiencing some uncomfortable side-effects for a few weeks.

I’m a mental mess but I still manage to get shit done, I don’t know how I’m supposed to do that if the drug affects me that way.

You likely wont get shit done, at least, not to the extent you do currently, but is the sky really going to cave in if you struggle for a wee while? What do you think is eventually going to happen, or could likely happen, if you continue struggling along in a perpetually depressed state anyway? Generally speaking, absent of any other changes that is only ever going to go one way.

Do you have any opinion on what is actually at the root cause of your illness? Just for the sake of clarity, I'm well aware people often experience Depression without there being any obvious underlying cause, but I also find that frequently there are environmental and lifestyle factors exacerbating or provoking it, and usually it relents only if those are addressed in combination with help from the medical model.

Drugs simply didn't work for me, but making difficult choices did.

I was on Citalopram for 18+months, I didn’t give up in a few weeks. As I said in my OP, the side effects lasted the entire time. Insomnia, dry mouth, restless legs, inability to cry etc. The rest I could deal with but 18 months of 3-4 hours of broken sleep a night eventually became too much. Good sleep is one of the most important things for good mental health.

What is you experience of chronic clinical depression whilst being high functioning? What meds do you take for it, if any? What did you find helped?

Any reason why you haven’t tried setraline?

The lifestyle changes you mentioned sound fantastic and exactly the sort of things needed to help with depression in the long run. However, the likelihood of success getting/keeping it going while also being actively depressed is going to be low, sadly. In terms of your best chance of success, finding an antidepressant that works for you and using in the short term whilst you establish a routine for your life is what I'd do. Even better if you combine with some sort of talking therapy. Then when things are stable and settled for a decent chunk of time you start removing the crutches slowly and let your new routine hold.you up. Do you have a good social network? If not, I'd add finding some sort of thing that can meet those needs too - could be a social based exercise like a walking group or something.

I've been able to overcome mild to moderate depression using CBT and other talking therapies, lots of walking, quitting alcohol and gradually building up to using exercise and yoga. It was hard but I found it possible. I'd been prescribed a range of antidepressants over the years and I found them to be of limited use and actually the side effects were pretty awful plus feeling like my recovery was dependent on them just wasn't for me. Wishing you the best of luck!

I'm not an expert, but I think if you're committed to the lifestyle improvements and proactively seeking more, you are a good judge of your wellbeing. Well done!

Fluoxetine, therapy and running (I started with walking) was the recipe that worked for me after debilitating anxiety and depression. Your GP can try you on a few meds (I really didn’t get on with Sertraline). I can’t tell you how unwell I was and I’m very happy to say I was weaned off the meds completely about a year ago now and only go to therapy 4 times a year.

I have ADHD and autism - I've struggled my whole life with anxiety and, as a result, some depression symptoms.

Sertraline has hugely helped, and I'm annoyed at myself for holding off medication for so long!

I did everything I could - healthy diet, weight, exercising, low stress job, but once I accepted I needed help (like you, no one would ever guess I struggle,cor that I have AuDHD) life is SO much more enjoyable.

I'd give medication a go and see how you get on - you deserve to feel better and not struggle on.

I think it is very difficult to claw out of clinical depression with self-care practices. Therapy (not CBT) combined with anti-depressants is your best chance. I would research other SSRIs and give something else a go. (Mirtazipine would be my last resort.) Sertraline has worked very well for me on more than one occasion. Fluoxetine is also effective for me. I've learnt to start with a quarter dose for a few days and work my way up, so that the initial side effects are manageable. When I've stayed on it for a year or so I am usually then able to come off it for a couple of years before I gradually slide back, even with a lot of good lifestyle changes and insights gained from counselling. I've reached a stage in my life where I've accepted that I might just need a bit of support.

Meds are a tool. And there are others you can use if you don't get on with one

You don't need to be told how hard depression is to recover from. Please use all the tools you've got. Including meds

Hi op I hear you.
Similar in that I struggle with intrusive thoughts and ruminating but hate being on medication.
Ive given in and have started talking escitalpram.
You can access therapy free if you self-refer online to mental health services. I am going to do that.
If you can do this without meds then that’s great, but we owe it to ourselves to find out if a medication can help us x

I tried for years and years without medication. I did everything I could - tackled it from all angles - spent a fortune in the process. Honestly, I regret it. Getting the right (prescribed) medication was lifechanging for me. I'll be on it for life and I no longer give a damn.

Personally I'd lie to the GP and say you tried the Mirtazapine and had side effects. I wouldn't want the weight gain that it causes. There are better medications out there. Also, Citalopram isn't the best; if you have severe anxiety then Escitalopram would be a better choice for most people. A lot of this is to save money.

I have had sertraline for periods of time when things re particularly bad- bereavement, severe illness in the family. I find I can cut it out slowly as things get better.

I currently take a low dose medication for a different condition which ant an higher dose also has antidepressant effects. I’ve spoken to GP and gone up a dose, as I’m not doing well at the moment.

Remember your depression may well be leading you to be overly negative about medication. You probably could manage to try an SD for a couple of weeks to see if you can tolerate side effects- which often reduce with time- and get some benefits.

ADs increase in effectiveness over time. DM has taken them for a few days then stopped as they ‘didn’t do anything’. Lord I wish she had,

As a daughter of someone who should have taken them please give it a go. It’s great you are reflective and proactive, but you could find life much easier.

It is not a good idea to lie to your GP. You sound very poorly @MessyNDepressy . So sorry. Anxiety and depression are hell. I would go back to your GP and discuss your concerns about Mirtazapine. It may be that you can have something else, or that you can start on a lower dose of it.

FWIW, I have been on Mirtazapine for over 2 years following a traumatic bereavement and a prolonged health scare. But I’ve dipped in and out of depression and anxiety all my life. As an adult, I’ve never pulled myself out of depression without antidepressants or therapy or both.

I did get a small weight gain initially on Mirtazapine but only 3 kg before the weight gain stopped. I think that being slightly heavier and enjoying life is far preferable to being slightly slimmer and wanting to not be alive. I sleep far better on Mirtazapine - it is known to be good for sleep - but nothing like 14 hours that you’ve read about. 7-8 hours a night. I feel a small side effect which is hard to describe- kind of very mild dizziness- but it’s likely this is due to an interaction with something else I take. Again, this is far preferable to enjoying nothing and thinking about suicide. It’s reduced while I’ve been taking Mirtazapine anyway.

You sound poorly enough that I think you need some help from an external source, and I urge you to work with your doctor. @PrizedPickledPopcorn makes a good point about the depression may be making you view ADs negatively.

Wishing you well 💐

OP, I urge you to go back to the GP. There are many many antidepressants out there. Side effects often abate after a few weeks and finding the right antidepressant is a life changer.
You've mentioned suicidal thoughts so the potential cost of living without medication is beyond grim. You son is happy and settled and he needs you to be here for him.
Lifestyle changes are brilliant but I don't think they're enough right now. Not if you've been feeling suicidal.
Try and find out who is the best MH practitioner at your practice and speak to them before making a decision.
Sending a 🫂.

unfortunately I think you do just have to keep trying different types of anti d's to find the one that works for you.

I had some weird experiences with sertraline, which dr's recommend as one of the meds with fewest side effects - I felt so extremely ill, so quickly that I assumed I'd caught Covid. Tried Mirtazapine which was very similar but not quite as bad, and yes did make me very hungry. However with citalopram I had hardly any side effects and those that did went after a day or two, despite that being an SSRI like sertraline.

It doesn't necessarily mean you have to be on them forever, but from what you've said I think they would really help for a few months while you also try all the other life changes etc.

Just reread my post - there was a screen freezing issue while I was writing it and it appears that a couple of sentences were lost.

They were relevant to what I said so here’s the gist: my mood is far better, in fact I can’t remember feeling depressed at all this year in spite of some very difficult family circumstances and another bereavement. I’m enjoying life again and feeling good about myself. I don’t think I’d have got to this place without Mirtazapine.

I have adhd. The posts above are too long for me to read but can share experiences.

I've tried mirtazapine, sertraline, citalopram and escitalopram.

Mirtazapine - I couldn't do it - I was so hungry and because of the ADHD I couldn't control it. However I slept beautifully for the week I took it. But no.

Sertraline- it killed my focus and motivation. It did work when I took it consistently every single day at the same time and exercised and ate well. Was a nightmare to taper off - lots of IBS symptoms.

Citalopram / escitalopram - by far the best and least symptomatic for me. Not hard to come off. Difficult to taper up but I've gone very slowly e.g. 5mg a week, only increase at weekend. Escitalopram is cleaner.

Op, you mentioned insomnia, did you actually try anything to help with that? For example my adhd coach suggested magnesium glycinate 20 mins before bed - really helps. Also - promethazine is a drowsy antihistamine and is OK for bad insomnia once or twice a month. Insomnia in summer - with adhd we don't produce enough melatonin in summer - so melatonin (off label from america) could be an option, getting daylight first thing (natural or via a SAD lamp) can help with evening melatonin production, good sleep hygiene, an Epsom salt bath soak (excellent for anxiety, as is magnesium), dim the lights at night and pull curtains in evening helps. You can also do sleep specific CBT
There's a good book called Why We Sleep which I also recommend.

Vortioxetine - my adhd psychiatrist recommended this one as meant to help with focus and motivation

I tend to take anti depressants for 6 months to get myself back on track then stop for 18 months, been in this cycle for about 5 years now.

I find CBT can also help with goals - but if you pick only one goal at a time (for example wanting to improve sleep, or wanting to exercise more).

Tracking impact of hormones helps a lot too.

Diet wise - there is some evidence for improvement of adhd with a mediterranean diet - protein and healthy fats. Some favorite adhd friendly meals that pack so much nutrients for me are baked mackerel mixed with avocado and penne pasta and olive oil. Or seabass, new potatoes and greens, so much nutrients. Making up a big roast chicken at the weekend in one pot.

If I'm honest I probably use food more than anything (alongside adhd meds) to regulate and focus - always same rough timings for breakfast, lunch and dinner (in the Why We Sleep book it explains that this helps sleep, for example it's one reason why blind people don't all have insomnia).

Re. Adhd diagnosis, is 3 years via Right to Choose pathway?

Edited to add --sometimes you have to think of it as what are the least worst side effects I can live with. As everything has them. I can't stand gastro issues for example but dry mouth I can live with - sucking sweets, keeping up electrolyte balance can help.