What would you do if you were phase 3/4 below?

[deepest]

Hi All,
I am tipping into my 5th bout of depression in 12 years.

First was PND after dd3 was born (had 3 under 3), then another after dd4 was born 4 years later, again when my mother died suddenly 2 years later and then when we were bankrupt by rececession 3 years after that...each lasted 2 years - so I feel that it has been nearly continuous. 4th episode was the worst - was nearly hospitaised - now slipping down that trough again for a 5th time. I work FT in a very Sr demanding job as major breadwinner afterworking exceptionally hard to pull ourselves out of debt. Also 3rd child has MH issues (under CAMHS) which have blighted our family life. Feel like I am failing at every turn. Work is overloaded and I have made careless mistakes recently and got emotional and defensive when challenged. Marriage is on the rocks. Have recently been diagnose with high blood pressure. Looked at this and see myself as 3 almost 4. What do I do? Am I in crisis. Do we just sell up, downs scale and move away - or battle through.

www.ccohs.ca/oshanswers/psychosocial/stress.html
Phase 1 Early warning signs are often more emotional than physical and may take a year or more before they are noticeable. feelings of vague anxiety
depression
boredom
apathy
emotional fatigue making a change from regular activities
taking time for yourself
Action: talk about feelings - take a holiday.
Phase 2 - Mild Symptoms
Warning signs have progressed and intensified. Over a period of 6 to 18 months, physical signs may also be evident. sleep disturbances
more frequent headaches/colds
muscle aches
intensified physical and emotional fatigue
withdrawal from contact with others
irritability
intensified depression more aggressive lifestyle changes may be needed.
Action: short-term counseling
Phase 3 - Entrenched Cumulative Stress
This phase occurs when the above phases continue to be ignored. Stress starts to create a deeper impact on career, family life and personal well-being. increased use of alcohol, smoking, non-prescription drugs
depression
physical and emotional fatigue
loss of sex drive
ulcers
marital discord
crying spells
intense anxiety
rigid thinking
withdrawal
restlessness
sleeplessness
Action: The help of medical and psychological professionals is highly recommended.
Phase 4 - Severe/ Debilitating Cumulative Stress Reaction
This phase is often considered "self-destructive" and tends to occur after 5 to10 years of continued stress.
careers end prematurely
asthma
heart conditions
severe depression
lowered self-esteem/self-confidence
inability to perform one's job
inability to manage personal life
withdrawal
uncontrolled anger, grief, rage
suicidal or homicidal thinking
muscle tremors
extreme chronic fatigue
over-reaction to minor events
agitation
frequent accidents
carelessness, forgetfulness
paranoia
ACTION: Significant intervention from professionals.

Oh deepest I've never seen that list before and so I'm not too certain of where you might be, but you certainly sound like you are in urgent need of help and support. Can I ask if you are on any meds, or have been in the past and did they help? It seems clear that "something has got to give....." you are under such an enormous amount of stress that I can't see how you can just "battle through it" - do you know what the options might be to try to alleviate some of the stress. Working full time in a demanding senior job on it's own must be stressful without all the additions.

I'm sorry I'm only telling you what you already know, but didn't want your post to go unanswered.

You are under an incredible amount of stress due to your life circumstances. I suggest you see your GP. Medication might help a bit in the short term and counselling will also be beneficial. However unless you can change some of the stressful circumstances, in the long term things might only get worse. How much support do you have? Does your husband do his share? Are there friends and family who can help with the dc's? Is downscaling an option? Then I think you should definitely consider it.

I am currently on a low dose of venlafaxine 37.5 twice a day - I was on this with mirtazapine and quitiapine when I went thru the biggie in Nov 12....got off mert and quit by June 13 - was feeling OK - but trying to reduce the venlafaxine since the NY and think this has spun me into episode 5....so have just started to go back to ven 37.5 bd. Really gutted that this is happening again. I wonder if it is my work/life or BPII. I suppose I can only know if I sort the w/l balance. Have no family support and I am a bit of a high functioing coper - so dont bore others with it (only Mners!!)....so dont bother my friends. Issues with husband - I go to Relate on my own which is great. We could downsize - but I have no energy to take on getting my house ready for sale, putting it on th market, selling, finding another and moving ... I think I need to drop some of my work load iy is the only "moving part" of my life that i can control atm...maybe things will settle - or I will find the energy to get organised to throw in the towel....before I crash and burn

I wonder if you are one of the people who need to stay on ADs for the rest of your life. I certainly wish I had done that. I had my first severe depression in 1995 (at the age of 51) following the death of my closest friend. I was on a psych ward for 3 months and made a complete recovery. I was on an old fashioned drug (imipramine) and was on it for 15 years without any problems and held down a responsible job. I started to come off it with the help of a psychologist (had tried a few times before with and without GP oversight but had withdrawal symptoms so went back on it) It took me 10 months and I was off.

Four months later I relapsed and was back on a psych ward for 3 months but haven't made a complete recovery. I have mirtazapine added to the imipramine but it hasn't made much difference and I have frequent and recurring fluctuations. I wish I had never come off the AD that kept me well for 15 years. People seem to be afraid of ADs but for me they were a lifeline.

It seems like the only option at present is to drop some of your workload so maybe that's what you need to do. However I think you need to stop trying to reduce the meds as this seems to be what has caused this latest dip - isn't it worth taking the meds if they are going to give you the chance to be free of depression. You don't say very much about your husband except to say your marriage is on the rocks. Is he refusing to go to Relate I wonder. Does he care for the children and household stuff while you are out earning.

Your last sentence is worrying about "throwing in the towel" and "crashing and burning" - you really do need to somehow decrease the stress in your life (easier said than done I know) Can you go off sick for a while or would it be more stressful being at home.

Thanks Nana Nina - Sorry poor choice of words my "throwing in the towel" and "crashing and burning" - is about giving up work and falling further down this pit to a depression crash -- trying to put the breaks on it. But I suppose it reflects how desperate I feel and how deep down I am that it is all or nothing black or white - I find the prospect of walking into work tomorrow and giving in my notice and walking away (flight) much more attractive than negotiating reduced hours or reduced workload (fight) - primariliy because I have not the mental capacity to think through a sensible plan as to what I can off load at work.

I remember you gave me similar advice 18 months ago after 4th episode in Nov 12 (I have NC since) - yes I think that this 5th episode has all come about by me trying to cut out the meds - maybe I just need to face up to the long term need for them. I keep thinking that I will conquer this -get thru it - get over it. I am truely gutted that this is my permanent state....but I suppose I just need to accept this.

I've been in phase 4 most of my adult life and realistically haven't worked for almost all of that. Some people can function well with depression and continue relationships, work etc, but ime they have a much milder type and the stress of maintaining a facade when you have genuine severe depression will get to you in the end. ADs just aren't enough at this level and you need to manage it like any other illness, change your lifestyle and minimise stress triggers. I would suggest getting a referral from your GP for talking interventions, or you may be able to access it through occupational health. I only really started getting useful interventions when I was referred to my CMHT and got advice from OT, psychologist, psychiatrist and care coordinator.

Seen my GP doubled my dose of venlafaxine to 75mg bd....also starting CBT. Having a terrible time at work have ended up emotional irrational and tearful with my boss 3 times in the past month been working around the clock - up at 5am and still not making a dent in it, She has suggested that I that time out to get some perspective I have not told her I have a history of depression.