How to help DH

[OneMoreFish]

DH has suffered from depression for many years although had been well-controlled on ADs and not had an episode for about 5 years. He decided to stop taking the ADs last summer and reduced very gradually with the support of the GP. He has now crashed and in a very acute phase and feeling very down. He doesn't want to go back on ADs and also doesn't want counselling. He has had it before but he feels like it doesn't help. He says a counsellor won't have any answers and just talking won't make the problem go away.

There is no obvious cause for the depression, no identifiable trauma earlier in life and no major stress currently. It very much runs in his family though.

I don't know how to help. I don't think I'll convince him to go back on ADs, he's determined not to take them forever and feels he should be able to manage normal life without them.

Counselling might help but I don't know what kind. Is there a more active kind where the focus isn't just giving the person space to talk but actually giving advice and coping strategies? I am at a loss as to what to do but it is heartbreaking to see him suffering.

He needs to see his GP and get professional help. CBT could be useful. I'm no expert but it's about changing how you behave and think about things.

What could the GP do though? My understanding is that they are not able to suggest any form of therapy that isn't available on the NHS and neither of us feel online CBT is the right approach. We are happy to pay for it but I don't think the GP is allowed to recommend anything beyond the very limited NHS options that are not medication.

We do very much want professional help but I don't know who that is given the GP can't help.

I had CBT over the phone through the NHS referral from my GP. They did also offer one to one face to face CBT.
GP first. If they can't help then you could find a private route.

There is no trauma that you are aware of, he may be in complete denial about something. Or something happened when he was so small that he has no clear memory of this. You say there is a history of MH issues of a similar nature, have any relatives been sucessfully treated?

I do believe that he is genuinely unaware of anything specific that is the root of this, it's more an amorphous all-pervading feeling he doesn't know what to do with himself or what he wants from life on a long-term but also minute by minute basis. It may be related to the way he was brought up but more of a Stately Homes way than outright abuse. I have no idea whether any other family members have been successfully treated it is absolutely Not Talked About even though it is obvious in some people we are close to and we are aware of a number of suicides in the family (cousins) although not people we know personally.

I take anti depressants like your husband I came off them with the help of gp reduced slowly etc and it didn't work for me. I went back to how I was felling, so I went back to the doctor and she put me back on them and I'm back to normal thank goodness! I also have had CBT and have no massive trauma that started it but do have family with MH problems (controlled by meds). I'm happy to take the meds I am me when I'm on them and don't see an issue with them being on them forever if I have to be it

Thank you for the reply Grow. One of DHs feelings about ADs is that he feels 'dulled' and not his true self on them. Is that your experience? He has also obviously done a lot of reading about the new data that suggests they are nothing more than placebo for a lot of people. Thing is, placebos work! He has also had manic phases in the past which are hard to deal with for me although he is having an amazing time until he crashes again. Privately, I do think the ADs are what he needs to keep him on an even keel but he thinks he should be able to be normal without them. It's very hard.

Has he tried any of the other natural things suggested for depression eg meditation, yoga, walking in nature? I think even small steps like breathing exercises can start to help. I have a good app called Calm.

He has a meditation app that he does regularly, eats well, does exercise (although not yoga), reads up a lot on how to change thought processes etc. It's all good but never seems enough. The previous episodes have all lasted 7-8 months ish and only resolved with meds. Although obviously we don't know whether they would have resolved without them. He is terrified of being like this forever or else coming out of it but a repeat episode being a risk as he feels he won't have changed anything to solve the underlying problem, whatever that actually is.

I don't know what to suggest about how to identify the underlying problem. He has had years of counselling from different people before but no real conclusions have ever been drawn and he feels it's a waste of time now. I don't know whether that's because he needs a different type of counselling but I have no idea what that would be.

Maybe he would benefit from a therapist who can explore identity/purpose with him. I have found that it’s very difficult to find the correct therapist and at one point thought it was all a load of bollocks - but then found one who was helpful.

Maybe try a life coach who's also trained in counseling? They're more action and suggestion oriented. My nephew went to one for his low self esteem and she was excellent.

What about trying Reiki?

I watched a program about Celebrities retiring to India based on the "Marigold Hotel" movie. In one episode Sheila Ferguson - Three Degrees singer went to see a reiki practitioner.

She said that her life felt balanced, happy but went for the experience. During the session she started crying as the experience of her decision on leaving the Three Degrees had in reality been unresolved. It had been shelved and she hadn't realised that the pain was still within her. She felt calmer and happier after the session.

Could he ask for a referral to a psychiatrist? Not saying this is what's happening here but my partner was misdiagnosed with depression for years and you mentioned manic phases so...

He'd avoided ADs for years but went back on them out of desperation and also got a referral to counselling. The counsellor suspected it was more complex than depression and referred him onto a psychiatrist, who diagnosed bipolar 2. The ADs had not just not been helping but had actually been making him worse. Now he's on mood stabilisers which have made a massive difference. I'm not going to pretend to diagnose a stranger over the Internet but I think there is a tendency within the NHS to treat any non psychotic mental illness as depression without digging in to what's really going on.

I have started a new anti depressant. They are NOT all the same. This one hasn't dulled me at all.

OMFG notfucking, I have just read about bipolar 2 and it describes him exactly! That must be a new diagnosis as it never came up when I was researching this kind of thing about ten years ago when he was under the care of a psychiatrist before. Although by the time the first appointment came around he had stabilised and they didn't do anything other than monitor, he was never given a diagnosis other than depression as the manic periods didn't fit into any of the then definitions of disorders such as bi-polar. Meds were left as the GP prescribed also. The closest I came with my own armchair diagnosis was cyclothymic disorder but even then the manic periods were so few and far between that it wasn't exactly right. Bipolar 2 seems to have a much more flexible pattern of manias and fits exactly. Do you think the GP would refer without current manias?

Even if not, it gives us something concrete to go on and ask therapists if they have experience in treating. Depression is such a catch-all term for so many different situations that he hasn't really recognised his issues in a lot of what he has read. Thank you again, it might not be the answer exactly but gives something to go on.

I don't know the trick to getting a GP to refer unfortunately :( This time round he hasn't seen a GP at all as our local practice has a specialist mental health nurse who prescribes ADs and makes psychiatry referrals. We're in Scotland and I'm not sure if this is particular to our area or standard as we've only ever been registered at this practice since moving from England.

Actually getting the diagnosis came about because the ADs were causing him to rapid cycle through manic phases so it became much more obvious that something wasn't right. He went through a year of that though while waiting for the various referrals to come through and it was awful, so I hope you don't have to take the same route.

Well, we've made an an appointment at the GP so we'll see how it goes. I'm hoping mentioning the previous psychiatric appointments will help him be taken seriously. It's a different GP practice though so who knows. I think he's thinking about restarting the ADs as utterly desperate .

I'd think very carefully before going down psychiatrist, bipolar, medication route. Its very disempowering compared to other therapies, as if there's something 'wrong' with him. These issues are much more.likely to be created by his personality reacting with his childhood.environment current environment thought pattern etc. A very good therapist or life coach can help him to empower himself and discover WHY he feels this way, not mask it all with medication and a label, frankly.

It's not that we have any interest in a psychiatrist or a label per se and definitely not meds that are any different to the ADs he's been on before but I have no idea where to start looking for a good therapist. How do you know whether they have the right approach and experience for this kind of problem? I don't know what to do apart from picking an accredited one from the BACP website and then having a few sessions them? How many? DH can't see the wood for the trees at the moment so not sure how objective he would be. It just all feels so random, we could spend £££ and months and not make any progress. I just don't know what to do for the best. None of the counsellors he's seen before have had any kind of 'active' approach from what he's told me, it's all just an opportunity to talk without any real structure. He says they've never taken notes or recapped from a previous session or even remembered what the previous session was about so each week is like starting anew. Is this the usual approach? He has seen at least 3 different ones for long periods and some he didn't like much in between. I definitely think he needs help in working things though but I have no idea how to find that help.

if he is having manic episodes then it doesn't sound like depression though he can have periods of depression. It sounds like bipolar. My realtive has bipolar at the incredibly strong end of the range. As far as I'm aware if AD's are given to people with schizo affective disorders its not a good idea.

I would suggest a life coach because they are action oriented and structured, particularly a life coach who is also trained in counseling. This can even be done by Skype. You could do trial sessions with 2 or 3 and they should present you with a treatment plan. Your DH can then choose who best appeals to him.