Please, please help. Really needing some advice

[Bugsy73]

Hi,
My husband has suffered with depression for years and years. Had a rough childhood and I imagine there are attachment issues etc that impact.
He has managed with this, largely ignored it, for most of our marriage, however has really dipped over the last few months.
He is seeing the GP every few weeks for a check in and had a 6 week online CBT intervention over the summer, which he didn't find helpful.
He tried, with alot of encouragement, setraline for 6 weeks earlier last year but didn't like taking it and was really put off by the impact on his sexual function....He then tried a different AD (venflaxadine? I'm not sure) but stopped it after a few days.
He's being made redundant in a few months and its really impacting him.
He has agreed to discuss AD's again with the GP and maybe some private therapy?
Can anyone give my ANY advice about what might help - feeling so stressed.

Anti-depressants take a while to be fully effective. Months, not weeks. He needs to persevere. Any side-effects will often wear off.
He needs to face his childhood issues with a good therapist. Ignoring the underlying cause of his depression won't lead to proper recovery. You have to process trauma in order to heal from it.
Good luck!

I know it sounds trite but if he can find some sort of exercise that he enjoys and can become a habit he will almost certainly feel some major benefit. Even walking will help, especially if he can go to a park or woodland,

He does need to give ADs a chance to become effective. It doesn't happen overnight.

He does need to take the ADs for a minimum of 6 weeks to see if they help.
Exercise does help. As does getting outside. A walk is fine.
I find doing some of the things I used to enjoy helped me find my way back. I found o stopped listening to music when the depression hit.
Ultimately there is no one single cure. And he has to want to try and get better. (Eg CBT teaches techniques fo use every day. It’s not do a course and you’re done.)

I’ve tried lots of different antidepressants over the years, and they do generally take a while to kick in.

However, when I had post natal depression I was put on Prozac and after two weeks I really noticed the difference.

I also now realise I feel much much better mentally when my diet is good. Plenty of vegetables, fibre, variety. Not too much processed crap, no sugar and no simple carbs. I do believe in the gut/brain connection. Would pre and pro biopics be worth trying?

I also believe I suffer from SAD, so I have a SAD lamp and try and get fresh air when I can.

I think taking antidepressants is good but don’t just sit back and think they’ll be all you need. Try a bit of everything, diet, exercise, sleep.

Thank you for all the responses.
The main reason that he is against the anti depressants is that it impacted on his sexual function - which blows my mind a bit as surely not feeling as awful as he currently does should be prioritised. But I'm not him I guess....
He does exercise, goes to the gym a few times a week, this used to be a much bigger part of his life but he is a bit older now and pushing himself results in injury.
He works from home and is very isolated. He is aware that seeing more people and doing more things makes him feel better, and he is trying with this to an extent.
The weight of responsibility is awful.
I just really want him to stabilise a bit.

Do you think talking therapy would be helpful? Or more along the lines of trauma therapy? Would a psychiatrist be able to help? Sorry that I'm firing questions at you 😏

Therapist here.

I would strongly recommend looking for a UKCP Integrative therapist. In person is always best and he needs to know he’d be committing for a minimum of a couple of years. He needs to reach out to a few people, set up an initial call with them and get a sense of whether they’d feel like a good fit.

Thank you. What is integrative therapy? He has so much to unpick. I don't know if he has PTSD maybe?

I'm not qualified to say exactly what type of therapy would be best for him - counselling, psychoanalysis, psychiatry are all talking therapies. I'm sure there are others on here who are better able to advise. Counselling is perhaps easiest to access, especially if you can afford to pay. A first consultation is always for client and therapist to find out whether or not they are compatible. If either party feels not, you can find someone else or they may suggest someone else. You have nothing to lose by attending a first appointment - except the fee!

If the redundancy is a key part of his depression he needs to take some action, start job searching, looking at courses etc.

Also make sure you're prioritising your well being and not letting him drain you dry.

An integrative psychotherapist has spent 4-5 years studying a lot of different ways to do therapy and they integrate them into the work. (This is different to counselling training). They also integrate the parts of the person ie if you’re worried about a presentation at work and you feel like a child around the adults instead of an adult when presenting.

An integrative therapist has learnt a little bit about most modalities of therapy, but usually do them all badly. A CBT therapist does 2+ years of CBT training, a psychoanalytic therapist does at least 5 years of training, but integrative usually do a two year MA and that covers maybe five different modalities.

Also, someone said in-person is always better. Nonesense.

During Covid, all of my in-person patients went either online or on the telephone. Some really struggled with this, for some it made no difference and one did better over the telephone.
Everyone is different.

DH might need to either research types of therapy and decide what fits with his worldview, or try a few and figure it out. This place is full of people saying, "this worked for me, so it will work for everyone else," and therapists telling you that their type of therapy is what you need. Getting it right takes time and effort.

Finally, sexual function could be something he needs to prioritise. If he's being made redundant and feels generally useless with the depressed, pleasing his wife sexually might be the only thing he feels he has to contribute and makes him feel important.

When my husband took anti depressants it massively affected our sex life. He struggled to get an erection, struggled to keep it and struggled to orgasm. It could have broken him as a human being and it was a truly awful 6 months. I’m a medic and did loads of research into it and this change can actually be permanent even if you come off anti depressants, we reduced his dose to a very low dose and sex radically improved. I would not underestimate the link to your self esteem if you can’t be sexual or enjoy sex with your partner.

I was very vocal that his mental health was hugely important and more important than sex to me but I can’t tell you the improvement when we got the balance right.

I would say that he needs to work on all aspects of his life and find what works- we both take various multi vitamin, b vitamin, multi, extra vitamin D and I take HRT. We have an allotment and get outside daily for a walk.

would doing an art class or volunteering (we have a local alpaca farm that people volunteer at) give him some social connections local easy going community centre or something. Do you have a dog? Would that help? Company for him etc and he gets out daily??

Spot on
persevering with anti depressants
seek therapy -what is driving his depression ? Childhood / self esteem? Get a therapist who can work with the presenting problem !

I've been on Cipramil (Citalopram) for years - it's in the same family of antidepressants your husband has tried (SSRIs) and I've never had significant side effects when starting or changing the dose providing I've done it gradually. There is a newer version called escitalopram which I've heard good things about and might be worth investigating.

From a therapy perspective - I have some issues around my relationship with my mum (she has severe attachment disorder and separation anxiety which was not treated until it was far too well established to
have an impact so I bore the brunt of it from
childhood to early adulthood). I had a brief spell working with a counsellor who specialised in transactional analysis and found that really helpful.

Don't underestimate how important normal sexual function is to a person's wellbeing. If he has noticed bodily changes in his day to day life that can lower your DHs mood further.

Some ADs definitely blunt libido, so talk about this with him to reassure him that it isn't him and that if it really troubles him, support him in getting advice from his GP as it could be temporary and things resolve over time.

msinly, take his concerns seriously so he feels listened to. That said, look after yourself too, taking care of someone with MH problems is really stressful and exhausting.

Could it be complex ptsd? My husband had a difficult childhood and his long term depression was cptsd. Treatment for that is specialist and long term therapy (it takes a commitment of at least a year, if not much longer), anti depressants and maybe also a mood stabiliser if anti depressants don’t help on their own.

There are other treatments for straight depression though, including emdr, hypnotherapy, rtms (can be as effective as medicine, few side effects but expensive), and electro convulsive therapy. Whatever he picks, he won’t likely see an improvement unless he commits longer term

I think it could be this. He has really low self esteem, presents as confident and capable but the way he sees himself is quite scary. We've had some awful conversations this week.
Did your husband take AD's? He is going to discuss again with the GP, I don't want to encourage him to do something that he's not comfortable with, but I'm worried about him. He is also going to try Andys Man Club and we're going to look at private counselling of some kind. I think he is being as proactive as he can - his self awareness is much better than it was.
Its very up and down, the sadness and low mood are always there, he felt better over Christmas and now January is here he's the worst he's been in ages.
One of his main fears is struggling financially - this definitely stems from his childhood, and the redundancy is terrifying for him, although he hates his job so I'm hoping that a change might actually help.
Ugh, I hate it for him, and for myself. It's helpful to talk about it. Thankyou.

Be careful of self diagnosis …
diagnosis helps to inform an appropriate treatment pathway -
get the problem wrong and you could wasted time / make matters worse with the wrong treatment
CPTSD is quite a popular self diagnosis currently, usually taken up by those who have had a several adverse life events and have mental health difficulties
look up the actual diagnostic information. From a reliable source
it is actual PTSD symptoms - real flashbacks / nightmares - where people actually believe they are re-experiencing traumatic events in real time again. Etc etc
with multiple traumas

taking Time and gaining a real diagnosis / formulation is critical to treatment

we wouldn’t self diagnose a serious physical condition and source treatment on that basis would we ??

Trauma does not have to take months or years to resolve, nor does it require the person to relive the events that cause their distress; they are experiencing them every day. I recently worked with someone who went through eight years of psychodynamic therapy which did not resolve the problem. We cut the emotional ties to the past in three sessions.

I couldn't take antidepressants - the side effects were worse than the depression. Research has also shown they're not any more effective than placebos and the "chemical imbalance" theory has been debunked. That being said, my depression was mixed with anxiety and I saw a medical herbalist (who was also a NHS trained psych nurse) and she gave me stuff to calm my adrenals which (despite me thinking it was hogwash, worked) and then meant I could implement the CBT strategies.
The things that have also worked for me are daily walks in nature with my dog, eating better and looking at the whys. For many people there is something we are low about and we need to address the thing.

I hope your DH can find a way through this because its misery making.

Hi,
I have struggled with depression on and off for years to a greater or lesser extent. CBT did not help me at all, but I did find solutions focused counselling useful, it was more of a short term intervention as I don’t find it helpful to dig over past trauma as there is nothing I can do about it, it is easier to focus on what I want my life to look like now. I took the lowest dose of Setraline (25mg) as it made me feel worse (just having no motivation to do anything) being on 50mg and my GP recommended I try the lower dose for at least six months. I exercise every day without fail and take vitamin D.
I would find it really hard if I lost my job as I am a single parent but I also love my job and I need the structure. So I think for me the absolute initial focus would be something solutions focused (in terms of therapy) to get over that transition and into a place where I had another job which worked for me. I find social interaction really important so I do not work at home, I go to a coffee shop or the library if I am not in my office.
Most importantly, realising that this is a chronic condition I need to manage and that many people experience this and it is not a flaw in me.

I have the same problem with sexual dysfunction- I’ve been off and on antidepressants for years but even at a low dose they cause me sexual problems

im currently on 75mg of Venlafaxine

I once tried bupropion which doesn’t give sexual dysfunction - that was when I lived abroad and I paid privately for the medication, it is quite pricey, I want to switch back to bupropion but not sure whether nhs will give them

I totally sympathise, both as having lived with someone with severe depression and also having suffered several severe bouts myself.

The problem is that the illness saps one of energy, persistence and motivation which are exactly what is required to seek help and stay the course.

Sertraline worked for a while but am not on anything now. Good, quality, food for energy and nutrition are essential. Fresh air and country walking really help. A regular sleep routine as does anything that soothes and comforts, except alcohol. A regular daily routine helps me too.

I have seen a number of counsellors and therapists over the years and they have ranged from downright dangerous to ineffectual to absolutely life changing. Avoid anything AI based. It's a joke. Long term psychotherapy worked best and the lady I saw for several years was absolutely fabulous. She has now retired and moved away sadly.

He will need to try a few to see who fits best. Always ask about qualifications and what type of therapy they practice. You have to like the therapist or counsellor, I have found, and also it helps if you're of a similar educational background. Mutual points of reference really help. What works for some doesn't work for others. I found CBT a waste of time and that tinkly music that is supposed to 'balance the brain' infuriating, but others may find it helpful. I needed someone with empathy but who would also recognise when I was starting to wallow, and point this out.

My heart goes out to both of you. Trying to help someone who is in a pit of despair is really hard. I found even walking into the same room as my ex sapped my energy somehow. It was like the space was filled with a suffocating grey fog. I felt so helpless. That's why it's important to maintain your own interests and routine.

He is facing losing his job and the sexual dysfunction too must be very distressing. Suggest he looks around at the therapists available to you locally and encourage him also to persist with the medication for now - but it doesn't always help everyone and can initially make things feel worse.

Exercise does not need to be a full on gym routine. He is ill. Gentle walks and just doing one small constructive thing each day might be a good start.

All the best to both of you.