Is this the end of the road for my mental health with the NHS?

[Gormlessgorgon]

Started having a low, tearful mood with instrusive thoughts in my early teens. Was with CAMHS(?). My mother got the gp and then a psychiatrist come to my house at 18. I didn't have any friends and never left my bedroom. They told me I was anxious and had depression. Over the last 15 years I had gone through 5 antidepressants at a variety of doses. I have had three sessions of CBT including high intensity. I have been taken on two trips to a&e for suicidal ideation. I have seen multiple GPs over and over.

I have had severe social anxiety, low mood, fatigue, emptiness, numbness, lack of joy/pleasure etc etc for basically 20 years. I do all the right things that are meant to make me feel better, but they don't.

Is there anything else the NHS is supposed to be offering me but aren't for whatever reason, or is this it?

Also, my NHS app has me down as 'mild anxiety disorder and depressive symptoms', which feels devastating because what I have been through does not feel mild.

Have you looked at autism
I was diagnosed age 50 ,but had a similar history to what you described
Just recently I've been diagnosed with ADHD,the mix of the two is probably why I went undiagnosed so long .

NHS on knees - best thing you can do is get private therapy.

yes it will cost you but the best investment you can ever made in yourself.

most of the nhs interventions are short term cbt based and many people with long term issues need longer term psychotherapy that the nhd just rarely provides.

honestly - beg, borrow to fund your own therapy and set a course towards recovery.

Waiting on the nhs you will get worse and worse as resources are just not there.

harsh but true - you have to take control of your destiny and your therapy in order to get better .

I think autism / ADHD are worthwhile looking at as per PP. Have you been offered antipsychotics or mood stabilisers?

Thinking outside the box, have you heard of Flow Neuroscience headsets? "The NHS has used Flow in 10 NHS services across Northamptonshire, Leicestershire, West London, Rotherham Doncaster and South Humber, Norfolk and Suffolk and Practitioner Health"

Do you have any money to explore private options? (Possibly not as you're asking specifically about NHS). Or any family to help with funding non-NHS options?

I am so sorry, I forgot to mention I was diagnosed with autism 3 years ago. I meant to put that in my OP!!

Also, I have no money as I can only (just about) work part time.

To put it bluntly, they’ve tried everything and you’re still not better. This is often the case with mental health - it just isn’t something that can be ‘cured’ in many cases. It’s just management using the techniques they taught you.

I have never been offered anti-psychotics or mood stabilisers.

I'm definitely not hyperactive, but I have always zoned out constantly and can't finish anything. But I see those as normal problems, not ADHD?

I feared this. It scares me so much. I have just convinced myself that there be something else out there to help me.

Have you had your vitamin levels checked? Low Vitamin D can cause low mood, and then you get out less, so get less sunshine and the whole thing becomes a vicious circle. Other than that, I would press your GP for a referral to secondary services if after all these years they've not managed to find an antidepressant that works for you. Psychiatrists can prescribe things like lithium for treatment-resistant depression (which a GP can't).

There are many other therapies than CBT. CBT is useful and has a big evidence base but lots of other therapies are very effective. May be go back to the MH service and ask specifically to try a different model.

cBT is not for everybody, yes you gain lots of skills but sometimes integrative types of therapy help more. Also if you think you may have trauma you will need a different type which you may find really helpful

I’m a mental health nurse. I wonder if low dose quetiapine might help? It’s an antipsychotic that helps regulate emotions at low doses and so is often prescribed for people who struggle with suicidal ideation or dissociation (“zoning out”). You can take it in conjunction with any antidepressants, most of the time. GP is unlikely to want to prescribe, so it would need a referral to secondary services. Alternatively, you may have a primary care mental health team that works with your GP? Lots of GPs now have NPs that work with a few surgeries and can prescribe mental health medication that GPs won’t.

My area there are asd specialist psychologists that were brilliant.

i think standard cbt is very limited for people with asd and many need more generalised and person centred psychotherapy thst is tailored to their individual provile.

you may be lucky and get this on nhs but may need to look to private funding or charities specialising in asd to access this.

nit tight - but the reality of a very fragmented nhs.

if st imminent risk of sectioning / pych admission - you can try the CTR review under the autism pathway to get personalised support .

It sounds like you have been going through so much for so long, and it's understandable to find it difficult to hold much hope. The 'mild anxiety' label sounds like a particularly horrible kick in the teeth - I'm sorry you've been dumped with a label that does not reflect your reality.

Because you have suffered with these difficulties for so many years, I am guessing that this has shaped your life in quite a big way. I know that some people who face mental health difficulties are still able to thrive in life. This does, however, tend to be people who are lucky enough to get the right support and opportunities, whether that is from family, friends, mental health professionals, a career, a hobby, etc. Having poor mental health tends to make it a heck of a lot harder to build a life that you actually like and where you have the chance to feel valued, appreciated, proud of yourself, and to be able to grow and use your abilities to the full.

I therefore find myself wondering: are you actually feeling so awful because there is something 'wrong' with you? Or is there a chance that your life is just objectively not what you would like it to be, or that the people around you don't treat you in a way that would support you, and that your feelings are partly a genuine reaction to this? Medication, CBT and 'doing the right things' can all sometimes provide a boost to people, but none of them can change the reality of your life and the people in it. There is something called the Power Threat Meaning framework that really focuses on this theme and encourages us to move from asking people 'what is wrong with you?' to asking 'what has happened to you?'

On a more practical note, like some of the posters above, I find myself wondering whether undiagnosed autism and / or ADHD might play a role in your struggles. I am also wondering whether you have experienced either (or both) of the following in your life...?

• experiences that have been traumatic for you (and this doesn't have to be limited to the sort of things people tend to think of when they hear the word 'trauma', either). If you find yourself living as though you're in fear a lot of the time, and can't move forwards as a result, it might be that you would benefit from some trauma-focused work, such as EMDR. Sadly this can be difficult to access on the NHS unless you also meet the diagnostic criteria for PTSD. However secondary mental health teams and private therapists don't necessarily expect you to have PTSD symptoms in order to offer you treatment for trauma.
• painful experiences in your relationships with others - particularly perhaps with parents / early caregivers, or an experience of difficult relationship patterns repeating for you. A lot of people live with what might sometimes be termed terrible 'attachment wounds' and can benefit from support from a 'complex emotional needs' lens. However there are a lot of bullshit negative stereotypes about people who face these challenges which understandably put people off exploring this.

Whatever your experiences, I hope you are able to have some serious compassion for yourself. We aren't machines who can be 'fixed' by doing the right things or receiving the right 'inputs' from others, no matter how much this challenges the paradigm on which medicine is basically based.

Have you ever been tested for vitamin deficiencies?

My daughter has theirs medication along with Sertraline, it’s made a hell of a difference. A psychiatrist prescribes it, he diagnosed complex PTSD after the trauma of being under gynae for endometriosis and other gynae issues, absolutely awful. Some gynaecologists think they own your uterus and know your pain better than you do. Her psychiatrist also put her forward for an ADHD assessment, which she has, this week they’ll discuss the medication.

All this was done with psychiatry UK after a referral from her G.P, it is NHS, they’ve been great 😊

Op, what are your goals in therapy? Have you tried somatic exercises?

Unless I've missed it, it sounds as if you have only been under primary care OP?

I'd push for secondary team referral; there are many other treatment options out there, but if course I have no idea whether they are suitable for you. Speaking to a MH professional might well be helpful.

Deficiencies are common in autistic people - vit D, iron, magnesium, B12 are often low. So this is a good place to start. I am diagnosed ADHD likely autism too and despite a decent diet I recently discovered I was deficient in several aspects which rrally surprised me. I feel much better since starting supplements.

Cbt often doesnt work well for ND people.

Is the issue more anxiety of depression? I've found propanolol good for anxiety.

Yes, had a blood test recently and all in range. I take supplements as well.

Thank you, I'll ask for secondary services. I wonder why I've never been offered that though.

I will make a note of that and ask to try it, thank you.
I have no idea if there is a primary care mental health team. It upsets me that I've struggled for so long and I've never been told about these services. I wonder if that's because GPs are encouraged not to refer people on because of funding, or something like that.

Thank you for such a detailed reply. I believe initially, in my teens, my depression and anxiety both stemmed from my inability to fit in, make friends and the bullying resulting from that. However, I've found that in the last maybe 5 years, I've actually made peace with who I am and that I don't have friends and won't have a career etc. I live with a lovely partner (met online) and have my part time job. My partner ensures I go for walks and take supplements and eat properly etc.

Despite that, I still have strong symptoms of depression and the anxiety I feel is awful. I think if I never had to see anybody else, eg in work or social situations, my anxiety would be greatly reduced. But that's not possible. It is curious to me that I still persistently feel this way after so long, despite having quite a nice life on paper.

I believe so. I didn't know there was a thing such as secondary care. It has never been offered for some reason.

In your case I'd be tempted to try psychedelics.

Hi Gormlessgorgon. I have experienced similar issues. Awful mood swings from teen years, feeling very low. As an adult, diagnosed with ‘general anxiety disorder’ before being diagnosed as autistic at 34 and ADHD at 40. Also recently been told I meet the criteria for PTSD (complex). Waiting for therapy for that.
I think it’s important to note that ADHD is not just hyperactive (we have moved away from the perception that it’s naughty, disruptive boys in the classroom!). I’m mixed ADHD - I have hyperactive at times but am also inattentive. I tried various different antidepressants/anxiety meds and none really helped. Then I tried ADHD meds and I was like ‘Wait, this is how NTs feel all the time?’. Without meds, I felt almost catatonic. My days off I would struggle to do the school run then zone out in front of the TV for hours. Now it’s rare I put the TV on, or I’ll watch something for an hour then get going. it’s worth learning more about ADHD and seeing if you identity with the traits. ADHD_love have books, podcasts and social media content as a good starting point.
I’ve tried CBT style therapy. It worked to some degree but only made me analyse me thoughts. More recently, I had ACT (acceptance and compassion therapy). It was so much more useful! I felt like it started to unpick some of my thoughts and helped me to feel better. For example, I struggle with invasive thoughts. Before starting ACT, this was extremely distressing and traumatic. I had some yesterday and realised although it bothers me, I don’t have the same level of distress. I got this through the IAPT (integrated assessment pathway team). Sort of a middle ground between the basic counselling service and crisis team. I had no idea this existed until I was offered it.

I’d say, don’t write yourself off yet. Look into other causes of your symptoms. Also there’s an amazing body doubling called ‘dubbiI’, it’s so helpful to have that virtual support (there’s recorded videos and live sessions). I’ve been using it for a year! Get so much done.

If you are interested in a different way of thinking about mental health take a look at metabolic psychiatry which investigates mental illness and treats it based on possible metabolic causes and pathways.
A good place to start is Georgia Ede, a US based psychiatrist who wrote a book on the subject, and the Metabolic Mind YOuTube channel.

Best wishes.