Posted by Pfinstegg on October 17, 2002, at 13:58:07
In reply to Re: For Blah..please try everything, posted by Blah on October 17, 2002, at 1:54:26
was that you have the three things women like best: a warm, loving heart, intelligence and sexiness. But right now, these are so covered over with shame, discouragement, lack of self-confidence, exhaustion, and just an extremely severe depression that you are not able to even begin to use what you have. You've got to know, yourself, that those good things are there, even if you're often not quite sure, in order for things to improve for you socially. It sounds to me as if you are so depressed now that you are convinced that you are somehow fatally lacking in everything.
What to do...
1. The medications. Nardil may begin to be helpful, as you say, or if it isn't, you have nothing to lose by trying all the MAOI's. These sometimes help, even if only partially, when all the SSRI's and mood stabilizers don't.
2. rTMS. Since you don't want to take ECT, why not keep rTMS open as an option? I think there are about 15 centers in the US studying it right now. It is supposed to act like a defibrillator, making all the neurons fire simultaneously, which seems to have the effect of resetting the functioning of all the neurotransmitters.
It is probably not a "permanent" treatment, either, but getting back to a brain that functions normally, even for a few months, would allow other ADs to work more effectively, and also allow you to view yourself more favorably as you work in psychotherapy. If I find that I need it, I would join one of these trials, rather than undergo ECT- I'm with you on that. I would go to Emory University, because they have such an excellent reputation for research and knowledge in mood disorder.3. Cortisol. I decided to find out what my cortisol levels were after four years of rather unsuccessful treatment of major depression with twice-weekly psychoanalytic psychotherapy combined with Prozac, Paxil, Zyprexa and Wellbutrin. The endocrinologist I saw found that the 24-hour levels were abnormally high, and that they got higher and higher during the day, rather than gradually lower, as they are supposed to. When I took the DST (dexamethasone suppression test), there was no suppression. This all meant that I have pseudo-Cushing's syndrome; apparently about half of depressed people do have varying degrees of it, and probably close to 100% of those who have suffered severe childhood trauma. The next question was- what to do about it? We are in the process of thinking this out; a 7-day trial of mefipristone is the most likely possibility. In the meantime, with the support of both my psychiatrist and the endocrinologist, I have been taking tianeptine, a French AD, which, while it does not lower circulating cortisol, does protect one's brain from its damaging effects. It is such a quiet medication, like an aspirin, but I have noticed a slow but steady improvement in my mood, self-confidence and energy levels over the past 7 weeks- nothing earth-shaking, but a definite improvement.
4. Do you have a really good psychotherapist? If you can find the right combination of drug/physiological treatment to get feeling better enough to feel more hopeful about therapy, then you need one skilled enough to help you begin to have new, positive experiences with him/her so that you can build on those to develop a satisfying life for yourself.
All this doesn't have to take 20 years; it could take two. The really, really hard thing is to find all the elements you need so that it will happen. I personally really want to know what happens- will you keep in touch?
Pfinstegg
As for romance- well, that's the hardest thing for anyone, well, or ill! Why not give yourself a little break in your expectations in that area until you feel better? You said your spirits are lifted by even small human encounters- you could concentrate on the least-stressful, rewarding and brief of those for the time being. When you feel better, there'll be a lovable girl(s) out there for you.
poster:Pfinstegg
thread:117296
URL: http://www.dr-bob.org/babble/20021012/msgs/124025.html