Recurring depression - how many times have you been on ADs and how do you know when you are suffering again?

[Rumpel]

Hi all,
Just looking for some advice please.
I was diagnosed with depression about 4 and half years ago and was given citalopram. I cut down to 5mg when pregnant second time around then upped to 20mg then cut down and came off about 2 years ago now.

I have had CBT about a year ago and the past 6 months or maybe even more I have been feeling not myself IYKWIM. I get anxious too - think they go hand in hand TBH.

Anyway after long discussion with DH last night DH said that he was walking on eggshells all the time with me and that I am always in a rage and short -tempered. I feel really I knew I was narky but just thought it was due to lack of sleep, 2 small kids, being on my own a lot as he works away and we have no family nearby. It has made me think long and hard and I think I may have slipped back into depression - my anxiety is bad again and I just feel pretty miserable and unhappy most of the time and I am angry quite a lot .

Can you share your thoughts and experiences with me please?

I feel a bit insecure/embarrassed about asking my GP for Ads again - the problem being I am very good at hiding my true self and putting on an act and the last few times I have seen her I have said that I am fine .

TIA

Oh Rumple - it does sound like you may be having another bout of anxiety and depression - I totally agree that anxiety and depression go hand in hand and it's difficult to separate them. I am still trying to recover from a severe episode of depression last Easter and 3 months in psych word. I can be fine for 3 or 4 weeks then I get a blip or setback or whatever and I am flat, anxious, unmotivated, irritable etc - these days last between 5 and 15 days.

6 months is quite a long time to be feeling there is something wrong and not doing anything about it. I think the longer anx/dep are untreated the worse it gets. I am sure caring for 2 small children and broken nights and being on your own a lot are making things worse for you.

I honestly think you must go back to the GP and tell him/her exactly how you have been feeling (maybe writing down your symptoms in a list) Putting on an act and pretending you are ok is the road to nowhere because the person who is going to suffer or this is you, and from the sound of it your DH too and possibly the children if you are so anxious. It doesn't matter that the last few times you have seen her you have said you were fine, you must now tell her the truth and say you have been feeling miserable for a long time but didn't say anything as you thought it would just go away but that hasn't happeded. You can then discuss the anx/dep with her. It's no skin off her nose to prescribe ADs and she isn't going to make a big deal of why you were trying to hide it.

The meds will take the edge off the depression and slowly you will start to feel better and then maybe when you are feeling less miserable you will be able to find a mother and toddler group or pre school and meet other mothers there, making you less isolated.

Take care and keep in touch. NN x

Did you feel "better" while you were taking the ADs? How about going back to see your gp? Don't worry about saying that you were fine previously. I've done this alot and many times it is the truth (that's honestly how I felt at the time). It's only after the "crash" you realise that actually you weren't. Don't wait for the "crash" whatever yours is - it's so much harder to get back up. Equally, I've panicked thinking that depression is returning when in fact it's just life. Does your DH think you're depressed? Those close to you can often be more objective. I've been on ADs five times and I unfortunately haven't found it any easier to tell when I start suffering. When I was with my ex-DH he certainly knew before me but I was stubborn .

Hope you can get some good support.

Thanks DH doesn't really have a clue about things (not in a bad way in a typical man way IYKWIM) - he just wants me to go get myself sorted - he has enough problems of his own to deal with TBH.

Yeah looking back the ADs definitely worked - I have a strong memory of moving here and pushing my DD along in her pram feeling happy and confident.

I find it so frustrating as it is not something you can 'fix' yourself. I have had all sorts of alternative treatments, tried CBT, happy thinking/visulaisation, St John's Wort etc etc. It is strange how we think that we should be able to fix it and it is somehow embarrassing when if it was a physical problem - eg heart problems then we would think nothing of going to GP or taking meds for the rest of our naturals to keep things right - bizarre!

I didn't really notice myself slipping back so much - hence not having done something about it until now (although I did start taking St John's Wort a w hile ago so maybe I did). What made me finally realise is that my poor DH has been quiet and down when he gets home so I asked him about me.

You feel like such a shit as how you feel affects the people you love around you. Anyway am off to call GPs and get appointment - thanks for your help ladies.

Do you think once you suffer from depression (particularly when linked to traumatic events ) that you are more prone to suffer it for the rest of your life?

Runmpel - so glad you are going to see your GP. Afraid it is the case that the more episodes of depression you have, it becomes more likely that you will have another. Apparently there is a 50% chance of having on severe episode, that you will have a further severe episode. I think the operative word is severe and as far as I know mild/moderate depression does not carry the same risks.

You are right that it is bizarre that mental illness makes us feel so differently from physical illness - another trick that this horrid illness plays on us. And yes you do feel like a shit because of how it affects those around you. When I am in a "blip/setback" I am ashamed for anyone other than my DP or very close friends to see me. The thought of my grown up sons and families seeing me fills me with horror.

Chocattack is right - the longer you leave it the possibility of a crash is more likely and it takes longer to recover - I'm still waiting after my crash last Easter.....................

Sending good wishes and hope you get some help very soon.

Thanks Nina - I can't see my GP regarding this until the end of the month as she is so busy so jotted down a letter to her and handed it on to the surgery today. I feel better for having done something about it already.

I am seeing her to have a coil fitted on Friday and am now feeling anxious incase she brings it up then - am feeling a bit tearful about it as I hadn't realised how horrible I was being . I remember when I was first diagnosed crying as I couldn't actually believe that I was suffering from depression LOL. It led on from PTSD.

I think I am secrectly hopng she will just write me a new script and I can start to feel more positive about life sooner rather than later IYKWIM.

Poor you though - sounds like you have had a rough ride. Do you think you will need to stay on ADs for the rest of your natural then? I think we don't like to face up to that but the alternative is too awful to live with. I've only ever had 1 really bad bad time where I just stayed in bed for about 2 days - it was just so horrible to feel so much despair. Thankfully mine seems to be more moderate/low level buy enough to impair upon my life enjoyment.

It must be in some people that our endocrine system just cannot recover enough after a traumatic episode to be able to produce/process or recognise the necessary chemicals to enable us to feel joy. No doubt in decades to come they will discover the physiological reasons for this - they are making leaps and bounds in mental health these days.

It is such an amazing tool the internet and sites like this for support and helping each other too. At least if you can't make it out and have become isolated you can chat to others through this . Thanks again for your help and I do hope you are feeling like a new happier self very soon (( )))

That's great news about the letter. I should probably try that approach . Because you've responded well to ADs before I imagine it will only be a matter of time before you're feeling more like yourself. And as you're seeing her Friday she may just write you out a prescription there and then which might be preferable to waiting until the end of the month.

NN's statistics about depression reoccurence is really interesting. I had heard something similar (somewhere, sometime ago) but hadn't appreciated it was for severe depression. I've only ever been diagnosed with moderate depression so it's a bit of a shock to learn I've been that "unlucky".

"Leaps and bounds in mental health these days". Wow. It all seems like trial and error to me, lol!

Good luck with the appt.

Hmm Choc I know when you are in the grip of it it is frustrating but I always think about if we had lived in times gone past - PND/PTSD/depression = institutionlised and cast out. I think we are really lucky to be living now with central heating, medication a health service - even though it could be better at least we have the privelage of it
Yeah I find writing things down means you can verbalise your true feelings without vocalising them and worrying about saying the wrong thing or missing things out.

Chocattack - don't take my "statistics" to heart - it was only that a junior doctor told me that when I was on a psych ward last year. When I mentioned this to my CPN she wrinkled her nose and said "I don't think you can be that specific - some people only have one episode and others get continuing episodes" - the jnr dr was doing a placement with the consl psych so maybe he was not absolutely right. I mentioned it to my GP and she said more or less the same as the CPN, so I don't think you've been unlucky - I shouldn't have posted that as a bald statement - because there are obviously differing views - sorry.

^"...in times gone past - PND/PTSD/depression = institutionlised and cast out."

Rumpel, I see what you mean! Can you tell I'm not a glass half full person?

NanaNina, no need to apologise . Statistics are statistics, someone has to be one.

Yes I sometimes thank god I am not suffering in the days when people with mental illness were called "lunatics" put in an asylum and hosed with cold water etc etc. They often stayed there their whole lives didn't they.

But I also sometimes vaguely wonder what people with MH will be saying in 100 years times - maybe something like "well how did they manage with the pills - having to try different ones and see if they worked, or were in psychiatric wards where the nurses didn't really talk to you about how you were feeling etc etc" - because by then I'm sure there will be a swift and easy cure for allsorts of things, including MH. Shame we shan't be around to see it!

Ah Nana but nature will always be one step ahead! Choc - I am Devils' advocate a lot of the time . I am more half full than half empty.

Saw GP today for a coil fitting and she had just read my letter so I filled out a depression scale form and left it. She has put me in for double appointment later in month to discuss (no chance of appointment with anyone before then) but said if I felt I needed to start meds again to go ahead - I still have some citalopram left from last time. So once the pain/fainting of having a coil fitted passed I took 20mg. Hopefully I'll be feeling more 'normal' soon.

Thanks ladies - it's good to talk to other people

Incidentally I had a client about 6 years ago who's depression was so bad that she voluntarily went for electro-shock treatment - poor soul. This was before I had an understanding of depression in real terms.

Shame indeed! I'd love to be around to see MH illnesses diagnosed with biochemical tests etc. For example, serotonine, dopamine etc testing for depression, maybe MRI as routine.

I think it would be much more complicated than that. We are a sum result of our genes/nutrition/parent's health/lifestyle and all the stuff that happens in life that makes us us. How we deal with things from an emotional/mental/physical point of view and how our bodies process those events must be individual to us surely on a microchemical level? We may be able to determine if certain chemicals or chemical processes aren't working as well or if they are indeed present but how we as individuals react when given a drug to help must surely always amount to some trial and error.

We are evolving through life and life experiences as our brains and brain patterns at any given time so how we then react to certain events and medicines must surely be an individual thing too? We may be able to establish the chemical process but that doesn't mean that we will be able to forsee just how that will affect an individual from a personality point of view.

I had 3 clients in one week each of whom's partenrs had had brain tumours - 2 had since divorced due to their husbands total change of personality after surgery. The third one was much happier as her husband had changed for the better

Our brains are so complicated as are the processes that go on in our body - we'll never know it all. We can only do the best we can at any given time I think whatever era we live in.

Sorry if I have gone on a bit - thinking out loud as it were!

Yes you're right, very complicated! Maybe I was trying to simplify too much. I realise the brain is much more complex than say the heart but nonetheless if medicine is becoming more "advanced" perhaps at some point in time we might understand the brain significantly better than at present in the same way that other advances have been made elsewhere.

Well done for deciding to re-start the citalopram now rather than waiting. I'm pleased it worked for you before - hopefully it will again.

Can I just add, both as a MH nurse, and someone that has used Citalopram for many years to great effect the following:
The meds make us (usually) feel better. Once we use them and feel better, we think that we don't need them. It is hard to see that one little pill a day is making life bearable, even enjoyable. So we come off them. I've done this, (and in my field of work I should know better!) Then we feel ok for a few months, then slide back down that horrible slope again. So we go on them again....and repeat.

Please remember when you are on them again (and I think its right that you are back on them, well done for doing this), remember just how awful it is off them. THis is a cliche, but true: if you had diabetes, high blood pressure, you would accept that you would have to be on meds long term, perhaps even for life. So see that you need your AD long term.

Please also, remember that ADs don't make everything better. They give you a lift, they give you a bit of a break from the anxiety and depression, but they don't sort out the reasons why you are depressed/anxious. You sound like you have a lot on your plate - you need to try and factor some "me time" into your life. Some people's brains can't produce seritonin correctly, so it's a medial imbalance. FOr others though, it may mean that changes in their life can make them less anxious/depressed. I have no idea what category you fit into. But please give this some thought.

Go easy on yourself. After a couple of weeks they will help you again. And you've taken the first hard step. Take care.

Thanks saffysmum for a very interesting and informative post. I was on ADs (imipramine) for 14 years following a severe episode of depression (my first one at aged 50) following the sudden death of my dearest friend. I tried to come off them twice (was on 100mg) and quickly had withdrawal symptons so went back on them and was restored in about an hour. Second time with GP oversight and it took longer for the problems to start (a few weeks) but then I began to feel awful again and I went back to GP and she said I musdt stay on them and "no more messing around" long term. I was Ok about this as I had no side effects.

Then I began seeing a pyschologist who was an expert in coming off meds, particularly the benzodiazepams but also ADs. She got her PHd through writing a book on this topic. She advised me to reduce very very slowly and I reduced 10 mg per week - it took 10 months and I finally finished in June 09. I felt fine and glad to be off ADs. By December 09 I was starting to feel the symptoms of anx/dep but went back to the psychologist (she was totally against the medical model and meds of course) She was a psycho-dynamic counsellor and she spent 3 months trying to find some buried traum from the my childhood that wasn't there. I then gave the counselling up and I was feeling worse and worse and so went to GP and she prescribed imipramine again at my request. I nose dived just before last Easter and was again in psych ward for 3 months, and am not fully recovered (ups and downs) and on 200 mg of imipramine. Psych upped the meds from 150 to 200 to see if it would level out the ups and downs.

Sorry saffysmum I didn't intend writing all that it just sort of came out of my finger tips and am a fast typist (learned when I was 16 and never forgot how )

Rumpel - your post too was very interesting and you clearly have a comprehensive understanding of the relationship between the mind and body. I had to read it about 3 times before it sunk in. You mention"clients" - do you mind saying what your profession is. I was a social worker and tm mgr for - spent 30 years working for same LA am now retired.

NanaNina: Have you felt better since being on 200mg of Impramine?

The stigma surrounding mental illness frustrates me no end. Everyone I work with is "normal", yet so many of our patients see themselves as inadequate, as if they are ashamed of themselves. If I worked in A&E and dealt with patients with broken limbs, etc., I would see them as needing medical treatment. They wouldn't say, "sorry nurse, I am so ashamed that a car crashed into mine and I've got a broken pelvis". Yet so many patients feel guilty and ashamed for having a mental health issue,yet they need medical treatment in exactly the same way. Something is broken - it needs mending. They need to heal. It is normal, it happens.

Sorry, rant over.

Hi Safysmum - hard to say about whether the 200mg of imipramine has made me feel better. I started the higher dose on 1st March and had 20 good days and 10 bad days (which is about the norm) and so far this month I am on day 17 of good days, so could have a blip anytime soon. I suppose the only difference is that there has been a longer period now for the higher dose to kick in, but I have learned not to be optimistic, as I have been having these fluctuations for a year now, so it's difficult to be optimistic, will just have to wait and see.

I know exactly what you mean about feeling guilty and ashamed when we are mentally ill and not at all like that with a physical illness. I have come to believe that they are just symptoms of depression, in the same way that feeling flat, anxious, despondent, losing interest in anything, are.

What you are saying is totally rational and when I am feeling like myself I can agree wholeheartedly but when the blips come back, I start feeling guilty and ashamed again, and can therefore only assume that they are in fact symptoms of the mental illness.

I am always struck by all the medics (nurses on the ward) my CPN and the conslt psych all ask what the triggers are for the blips, and I really have no idea - they just come out of the blue. I can go to bed feeling fine and wake up in the pits of despair. They don't say so, but I always get the feelingthat they don't quite believe that there are no triggers. Likewise they ask me what makes me feel scared and why am I crying. If I had the answers to these queries, I would be wise indeed. I sometimes get cross after and feel it's like asking someone with pneumonia why they have chest pain or feel weak. It's only on these forums that I know that these symptoms are felt by so many of us, and that in itself helps me to know that others are feeling similar symptoms.

sorry Rumpel I am stealing a march on your thread. It's just that it's unusual to have a MN nurse on the thread so am taking advantage of her knowledge and I guess this could help you too.

Hi all,

SAFFYSMUM - I agree whole-heartedly. I don't believe in being a martyr and think that if we are fortunate enough to have medication or therapies to help then we should grasp them with both hands. I know that ADs are not the panacea to everything and very often the anxiety is till there - they just dim it somewhat so that you are able to function at a more 'normal' level and go about your life a bit more easily. In saying that my anxiety is not quite so bad these days it was/is just the terrible despair. It's like a deatheater sucking out all the joy in your soul - very sad .
Who wants to live like that when we are only here for such a short amount of time - I usually love life and live to learn and experience things - I find it hard to come to terms with this non-confident scared person that I have become these last 7 years .

NANA - I used to have my own business within a health care practice - I am a complementary health and beauty therapist. I was fortunmate enough to work with some amazing people - physios, cranio-sacral therapists, kinesiologists, acupuncturists - lots of different types of therapies. I have a very keen interest in human anatomy, physiology and spiritual/mental health. I learned so much from my amazing clients and colleagues too .

I have studied all sorts of therapies and used to be quite in touch with my spiritual self but I feel I have stumbled somewhat over the past few years - having little ones means not much time or energy for tuning in to your own self IYKWIM. I know it will get easier as they grow and become more independant.

I have also had the misfortune of spending a long time in various hospitals whilst my poor husband recovered from a serious head injury amongst other injuries - I used to do treatments for him whilst he was recovering and it was both amazing and horrifying to be part of that journey. Don't you think how weird it is that life's little nuances are there to help us on the way? Imagine how helpful the 3 ladies (who's husbands had suffered brain traumas) anecdotes were to me in my future life.

Here's hoping your 'blip' doesn't materialise and that you are on the road to long term recovery