Apparently I'm not severely depressed?

[Psion]

My CPN mentioned today that they don't consider me severely depressed or anxious for several reasons

1. I am still keeping myself and home clean

1. I am still eating properly

1. I am not abusing alcohol, recreational drugs etc

1. I am still interacting with people (albeit on a much more limited basis)

1. I am sleeping pretty well

But I feel so terrible inside, and the suicidal ideation is frightening and draining. I wake in the mornings filled with dread. I cry a lot, often for extended periods.

How bad do you have to be before your symptoms are considered severe? I assumed my symptoms must mean I was severe, but was getting by on strength of will alone.

But CPN says if I was severe then I'd lack strength of will.

Any thoughts?

You can do the Goldberg Depression Test online. That is really accurate.

Does it really matter what the CPN thinks - surely the important thing is how you feel, and whether you are getting the right sort of support and meds that will help.

You're severely depressed within your frame of reference.

You're not severely depressed within the frame of reference of mental health services, no.

Mild/moderate/severe are clinical definitions and there are published scales we can use to 'measure' depressive moods for example

www.bipolaruk.org/Handlers/Download.ashx?IDMF=31588211-4997-4499-84a3-0590b245206e

psychology-tools.com/zung-depression-scale/

It just sounds like you and your CPN are using the word 'severe' to have different meanings- you're using it in the typical sense (very bad compared to what would be normal) and they're using it in the clinical sense (would score as 'severe' on a clinical mood/depression scale).

Perhaps they were trying to be reassuring?

When I had severe pnd, to the outside world I was coping.

But: I wasn't keeping my house clean, doing laundry etc (dh did). I wasn't cooking. I wasn't sleeping. I wasn't proactively contacting friends. The suicidal thoughts were all invasive and I couldn't go into town/anywhere without being overwhelmed. I was looking after dd.

As others have said, it comes down to your frame of reference. What matters is you're getting the help you needed. If you don't think you are, then go back and ask for more.

I'm.starting to think it must be me.

Spoke to another CPN this afternoon (only met them once before) and reiterated that after 9 weeks on meds I am very worried that I still feel so low and desperate 90% of the time.

Last weekend I self harmed for the first time ever. Something I would never have dreamed of doing 2 months ago. Today, it feels like I am silently screaming inside all day, and I feel nauseous with anxiety.Tfewe this shows that my meds aren't doing what they're designed to do. I keep a diary and out of the last 9 weeks I have only experienced 7-8 good days. That's all. Surely I should be experiencing more than that by now?

But this CPN just kept saying that 'it's not just all about the medication'. Well surely it should help more than this?

He kept insisting that my Trazadone + Quetiapine was a very effective combination, and that perhaps I am 'self sabotaging' it's effects by allowing myself to get stuck in 'negative thought traps'.

I agree, when I am bad I do have a constant stream of negative thoughts, which magically disappear on the very few good days I have had. But I thought the whole point of ADs and especially Quetiapine was to chemically inhibit these negative thought patterns?

He also said that whilst I might not actually feel any better, objectively he and the team had seen signs of improvement??? But how can that be when I have now tried self harming, and told them the suicidal thoughts were more present???

I got the impression that he thought I was a bit neurotic and was a slightly hysterical, middle class housewife who needed to get a grip I think I actually heard him sigh at one point

I hate to think that's how I am thought of by the Crisis Team Yet a couple of weeks ago the senior CPN fully agreed with me that I'd given these meds a fair crack of the whip and maybe a change was in order.

I feel so hopeless inside. I am not expecting the moon and stars, but I was expecting to feel stronger and more positive after 9 weeks on medication.

mrgrouper The Goldberg Test just diagnosed me as "Moderate to severe depression". Do you know many people that have used this test alongside a medical diagnosis. There are a lot of severe mental health illnesses in my family, including some being hospitalised, so I worry I bury my head to the idea sometimes.

Go back to your GP and let them know you have not experienced any significant improvement while on the current meds. Antidepressant meds are renowned for varying in effectiveness between individuals. What is "very effective" for one person may not work for another. GPs are used to changing the meds in these cases as some folk need to trial a few antidepressants before they find the one that works. There's an established protocol for how exactly to do it. You should be experiencing some improvement at this stage, not going downhill. Just go to your GP.

But won't that offend the Crisis Team, if I go behind them and see my GP? Would my GP prescribe in 'defiance' of what the CrisisTeam psychiatrist has had me on?

Crisis team said I wasn't depressed either. I actually agree and think I have a different MH disorder. Could this be the case with you? It's hard because even though you might feel like you don't want to cook/clean/go to work you can't just stop doing everything so you're strong enough to keep functioning. It's awful isn't it, basically saying its normal to feel the way you're feeling but really you'd do anything to make it stop. Hope you get some help, try speaking with someone else. I self referred to a local 'wellbeing' place, not sure if it's a Charity or what but hopefully it's going to be a lot more helpful than GPs have been.

It's only a "very effective combination" of medication if it works for you. Different medications might work better for you and there are several you could try. Are there other professionals available for you to discuss this with? Could your GP or psychiatrist help?

In my experience the GP might be reluctant to mess with your meds whilst you are being seen by a crisis team BUT could advocate for you if you are (understandably) finding this hard to do. Yes meds aren't all but are you being offered alternatives as well? Hope you feel better soon

It is the Crisis Team psych who has kept me on Trazadone + Quetiapine. Started me off onow doses and gradually titrating up.

So, as a follow on to my previous post (battery died), why do you want to be severely depressed? Aren't you relieved at your diagnosis?

Ok, so if you're not on the full dosage yet it might be too early to say. When will you be up to the full amounts?

Can you ask to see the crisis team doctor to review your medication?

I am sorry that you are ill. Depression is a wretched condition and sometimes labels like mild, moderate and severe do not help.

I don't think that the label of severe depression means how wretched you feel, its more how disabled you are by the condition. If someone is so depressed that they are catatonic (ie. motionless for extended periods.) then they have less in the way of mental reserves to pull themselves out of the depression.

Jamix, no I was relieved but I was just surprised as I assumed I would be considered severe as I felt so awful and desperate much of the time.

Barbecue, according to several websites 150mg - 300mg is the therapeutic dose of Quetiapine for anxiety/depression. So I'm not sure why the psych started me on just 25mg, and has very slowly titrated up to finally 150mg, 4 days ago.

Trazadone therapeutic dose is 100mg - 300mg, I think. Started on 100mg 9 weeks ago, and very slowly titrated up to 250mg 4 days ago.

What dose of quetiapine are you on? As you probably know, quetiapine is a mood stabiliser, not an anti-depressant, and so helps with impulsive behaviours and intrusive thoughts. It can be prescribed specifically to help with self-harm, so if you've started self-harming it might be worth discussing a dosage increase- the maximum quetiapine dosage is over 1000mg. As for the severity labels, remember that a CPN's job is really to keep you safe. If you can manage appropriate self care then you should be proud of yourself IMO, but lots of people can't and that's what she's comparing you to.

Antihop, I had a review with the CT psych 5 days ago, when they increased my dosage for the third time in 9 weeks.

My GP wouldn't have anything to do with my AD prescriptions as I was under the crisis team.

What extra do you want/need from the crisis team to help you feel better? I found it better to look at that aspect rather than focussing on how I was labelled.

At the point I was admitted to hospital I wasn't eating/washing/leaving the house/interacting with the children/had suicidal intentions.

Unfortunately the mental health services say that it's not unusual for people to have thoughts of suicide, and that in itself doesn't seem to be taken that seriously.

Hang in there.

Thank you ReallyTired. I must admit that for a couple of hours in the very early morning after I wake, I feel so low and hopeless that I lie there virtually motionless.

But somehow I manage to finally drag myself into the shower and get dressed. Do a brief tidy up. Put some washing on. But have no real reserves left for much else. I struggle to even respond to text messages or emails and find it a real effort to carry on a conversation.