What happens now?

[putonyourwarpaint]

Struggled with my mental health as far back as my earliest memory. Periods of my life where there was more stability I felt at my happiest but there has been an ongoing up and down throughout my life.

I had been on sertraline for approximately 5 years and felt normal for the first time in forever so slowly tapered off and was ok. Then we moved house and kids had to move schools etc which was a huge palaver and I was struggling again so went to new docs and got re prescribed. Felt ok-ish again, tapered off. Something else happened so went back to docs and they said I should go back on for 6+ months and have talking therapy.

Went to counselling for 1.5 YEARS and although it was cathartic to talk, I don't feel anything has changed about the way I am/feel. I've now come off sertraline again as I feel it is just masking who I am and I don't want to be on it (or any other medication long term) as it dulls my emotions.

I feel I have very strong emotions and that is my "issue" - I get super sad and cry easily at simple things, extremely excited, intensely happy, absolutely livid - every emotion is extreme to the situation.

What do I do now? I don't know that I necessarily want to live like this without knowing WHY I'm like this if that makes sense? If I go back to the doctor and explain all this what will they do? Will they say it's sertraline or nothing, can they refer me to someone?

Sorry if this makes no sense.

Bump

Hey op, I'm on meds and talking therapy but honestly there's no miracle. You've got to put work in yourself. Are you doing things for you? Reading, yoga, exercise etc? I started to go for little walks and having bubble baths instead of 3 min showers. All mindful things can help. Hope you're ok tonight

Have you had any therapeutic input that addresses specifically how you respond to and manage trauma and stressful events, and how you could do so differently in the future? Something more focused than general taking therapy/counselling - maybe CBT or ACT - that focusses on moving you through those negative thoughts or traumas rather than talking about them, may in time may allow you to develop coping mechanisms which don't require you to go back onto medication each time you have a set back.

Thank you - I have put work in - lots of it - but I'm almost 45 and I've been struggling with this since I was a child. I need someone to explain to me why. Counsellor doesn't really have any answers.

Thank you for replying.

I've chatted to my counsellor about this a bit. We came to the conclusion that CBT wouldn't be helpful. I don't know what ACT is.

My question really is if I go back to the GP now is there anything they can do? I cannot afford any more private therapy.

ACT is similar but different to CBT. CBT they help you to reframe traumatic experiences. ACT you accept the traumatic past and move through it.

Can get CBT on NHS IAPT referral (I think it's 6 or 12 sessions initially), but you may be waiting a while - GP may be able to signpost you to free or subsidized services. Not sure about ACT sorry. If you are in employment, do you have an employee benefits scheme that includes therapeutic input? A lot of bigger companies and local authorities/nhs/civil service/emergency services etc will have this.

I just don't feel like I've many (any) traumatic experiences. It's just things like moving house, moving job, kids unsettled at school, kids minorly unwell etc - they all set me off into a tunnel of despair.
I've been over 'reframing things' with my counsellor many times over the past two years but nothing changes.

I'm not in employment no.

The GP can really only give you SSRIs and refer you for NHS talking therapy which is CBT based and is a lot more about how to cope in the here and now than answering why you might feel as you do.

Do you mean that you want some kind of diagnostic label? I guess you would need a psychiatrist for that but it doesn't really seem likely you would meet an NHS secondary care referral threshold from what you have written. You could ask for a one off private psych option but I'm not sure what you are hoping to hear.

No I don't want a diagnostic label. I just want to understand why I feel the way I do when no-one else around me (friends,family, anyone online) seem to feel the same. I feel like if I know why then it will help me deal with it in the here and now.
I've done lots of talking with my counsellor about my childhood etc but nothing that screams out a reason.
What I'm asking is, is there someone more specialist in mental health that the gp can refer me to?

Actually I think I would like a diagnosis of some sort (you threw me off with "label" which I actually think is slightly offensive).

I feel like knowing WHAT is wrong with me would help me access the best tools and strategies to help myself.

No unfortunately I doubt your GP can do much more for you. I'm having counselling through NHS in primary care, and was told the threshold for referral to secondary care is things like suicide attempts, hearing voices, dissociation - things like that. If you're generally managing your life and keeping yourself safe, your GP won't do much more. Also unfortunately they'd expect you to stick with medication, not keep coming off it.

Have you considered you might be a Highly Sensitive Person? Look into it. While I don't think there's much that can be done about it except counselling and generally adapting your life to manage being that way, it may help to understand if you feel this fits you.

I've never attempted suicide but I've felt suicidal at times in the past as well as self harmed.

So no real point in going back to GP then.

I don't really function in life. I don't work due to it being too overwhelming, can't handle stress, cry all the time, often can't look after my children properly or even see friends.

So I either stay on emotion numbing medication for the rest of my life or have to put up with being this way with no explanation for it?

I will look into the sensitive person thing.

The GP only suggested going on the sertraline for 6 months, not indefinitely.

I spent decades quite like that and had years and years of therapy. Turns out at 56 that I have adhd. Even my counsellor when I suggested it before Covid said no she didn't think it was that ... but it bloody is, and the relief of knowing why I'm like this is immense. Could it be that?

Maybe? But how would I ever find out? Seems like there's no help unless things have got to crisis point. I'd quite like some help before it gets that bad again.

I wonder if this might not be mental health but neurodiversity eg autism or adhd. The way it presents is different in females but definitely relate to some of your posts and that has rang true for me.

It might be worth looking up autism/adhd and see how they present in females and in turn if it feels it fits take it from there.

You can certainly ask your GP for a referral if neurodiversity is what you suspect.
In many places in the country there either are no services for adult ADHD or autism or there are very long (more than a year) waiting lists but if you are prepared to wait you will eventually be seen. The other option is to look at a private assessment

There was nothing pejorative intended in my using the words 'diagnostic label'. That is something a psychiatrist (or indeed any kind of Dr) would provide. I meant it as distinct from 'psychological formulation' which a psychologist would provide. For me diagnosis and diagnostic label are exactly the same thing.

Not necessarily just neurodiversity but is it something from childhood that I can't remember which is causing ptsd, bipolar, depression, personality disorder - I don't know? I would just like someone with the relevant knowledge to assess me and tell me what my issue is.

My counsellor is lovely but doesn't seem to have much knowledge beyond being a listening ear.

Adult diagnoses you probably need a psychiatrist. I don't know what the threshold for refferal is though. Mental illnesses are part of very complex processes in the brain and body and although progress has been made in understanding them its very incomplete knowledge currently. You could be ND, some ND people can suffer trauma from masking and struggling to live in then NT world and not knowing why they always struggle and can't cope. It could be genetics, parts of the brain not doing things well enough, sluggish neurotransmitters. https://www.health.harvard.edu/mind-and-mood/what-causes-depression

How do you go on the setraline? If it helps but you find the side effects too much, like it's numbing you Id ask to trial something else. There are many antidepressant and different classes of antidepressants that work in different ways. Some people do need to keep taking them, but that can be worthwhile if that's what you need to cope in life.

Gently, I think your expectations would be very difficult for anyone even 'with the relevant knowledge' to meet eg if you can't remember any possible traumatic event and therefore can't tell the assessor about it then it would not be possible to diagnose PTSD which requires one or more traumatic events to be identified.

I would suggest that you don't dismiss CBT out of hand and that you self refer to NHS Talking therapy which I think you can do in most parts of the country. Even if you don't go ahead with the therapy they would do a psychological assessment and come up with a formulation which might be more meaningful and helpful than a diagnosis and they could also refer on to secondary care if they felt there was something they can't handle. This is a more realistic route than referral to secondary care psychiatry.

Thank you this is all very helpful.

There have been periods of my life where I've felt that I've flourished and been on no medication so I know I can be ok without it.

I'd just like to be able to understand myself better so I can live a life without meds. Even on medication there are still issues that occur that are difficult for me to deal with.

I'm suggesting exactly that - a psychiatrist would be the "relevant person to assess you" and find out what is or is not going on.

Do adhd online tests. Read up about it. See if anything clicks for you. Then seek a referral accordingly