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  1. Thought stopping is a good theory but it’s practice is outdated. As jt said, it requires a huge amount of energy and attention. It also doesn’t work very well, tends to lead to an increase in the frequency of the thought you’re trying to stop. Weird, right? I’ve had better luck with acceptance and redirecting. Don’t be afraid to offend your tdoc! You are partners working toward a common goal. It is always okay to ask questions about treatments/approaches of ANY doctor. If she’s worth her salt, she’ll be fine with exploring alternate paths or explaining why she thinks this is best. If she (or any other doctor) expects you to take her word as gospel to be followed unquestioningly this is a good time to run far away.
  2. @thunder, I think your feelings are pretty normal. My therapist went away for a month and wasn’t available by phone/text during that period. I struggled with that, though it is very rare for me to reach out between sessions. There’s definitely a comfort to knowing she’s there and would respond if I reached out. I am potentially moving out of the country in a few months and though she has said she would help me through the transition, including seeing me by Skype or something, I am anxious to leave her. Do you have anything to remind you of him? My tdoc gave me an acorn from a bowl she has in her office, but I also carry one of her business cards in my wallet. The physical touchstone seems to help me. I hold it when I’m having a hard time and think about what she would say. In some ways I think one of the (perhaps intermediary) goals of therapy is to be able to have conversations with your therapist all in your head. Don’t stop! It’s great that you have internalized him so well. Our relationships with our therapists are deep, intimate and real. That means you’re going to need to grieve the loss of it. He was (and is) an important part of your life and your journey with MI. I hope your move goes well.
  3. I think that approach makes a lot of sense. That's how I did it too. I hope the TMS helps!
  4. For me, the ECT helped while I was getting treatments 2-3 times a week. As we tapered off to once a week treatments, the effect seemed to taper down too. Eventually the costs (the bills, and the time off work) seemed greater than the benefit... but I plummeted when we stopped completely. The doctors wanted me to try a course of bilateral ECT where I did a few weeks of 2-3 sessions/week, but I couldn't take more time off work. I had some memory loss. I mostly don't remember stuff that happened shortly before or during the period I was receiving treatment. I saw movies with friends... no memory of them (which makes sequels a little confusing). My best friend came from out of state to visit... which I only know because I have dated photos of the weekend he was here. I have vague memories of my parents visiting for a weekend. The memory loss was worst when I was getting multiple treatments a week. During that period I stayed with friends. After a while, we tapered down to once a week maintenance treatments, at which point I was well enough to move back home (where I live(d) alone with just my dog to look after me). I worked 4 days a week for 3 months, getting ECT on Fridays. I kept copious notes of what I was working on, my reasoning for decisions, and so on. My work did not know I was getting ECT, just that I was getting "medical treatment" for a chronic illness. I had a lot of feedback that they were happy with my work and I received a substantial raise about 3 months after returning to work full time. These days, I have occasional moments where it's obvious I'm missing something, but they're unusual and minor. Example: Recently, I was unloading the dishwasher at my friends' house, where I lived for 5 years. I couldn't remember where a couple of lesser-used items lived - plates, cutlery, etc. were fine, but somehow I couldn't remember where to put the box grater and the pie server. Weird, right? But nothing I couldn't brush off. They showed me, we laughed, and I moved on. Things that were "big", I held onto. My memories of my childhood, for example, are as clear as ever... I remember why I am estranged from my mother, why I made choices like where to go to school, what to study, where to work, where to live. ECT is a big, scary decision. I totally get that. My pdoc pushed it for a year before I gave in (shortly after TMS failed), and I was terrified. My brain/intellect is a prized possession to me. But depression was fogging it up, making it harder to think and harder to remember stuff as it was. The losses from ECT were not insignificant... but they were minor and worth it, in the end, even though it was not a cure for me. If I someday have the financial resources to be able to try a round or two of bilateral ECT, I will. Remember, the effects are cumulative. If it starts to be too much you can just stop going, or try spacing out the treatments. Studies show that while there is a cognitive impact, function generally returns in the months after you stop the treatments.
  5. I tried TMS in the spring of 2016. My pdoc was pushing ECT, but I was scared. TMS seems more approachable. Yes, NeuroStar is a brand of TMS machine. The place I went used the Brainsway Deep TMS system. My employer-sponsored health insurance covered the costs, though I had to pay some share of it (I don't remember how much the copay was, sorry). The great thing about TMS is you don't need an escort/driver for your appointments. You have to go very frequently, but you can drive afterward, so no depending on loved ones for transportation/aftercare. Most people find it is no big deal. You sit back in a comfortable chair, and they strap a helmet to your head. Some places have Netflix or something for you to watch while receiving treatment (20-40mins/day, depending on the system and so on). You'll hear a tapping sound when the machine is on. They adjust the frequency based on what makes your thumb twitch. I only received 4 dTMS treatments. I found the tapping very painful, kind of like a woodpecker with a ballpeen hammer on my temple. Even when they had the frequency well below the therapeutic threshold, it was still very painful. My experience is highly unusual. I tried ECT after I couldn't do the TMS treatments. I don't regret it, despite the costs (had to take a leave of absence from work, I have some memory loss, and I'm still paying the bills). The benefits of ECT didn't last for me, though they do for many people. I would do it again.
  6. When I was chronically suicidal, an extreme danger to myself and had tried a range of meds (broader range but fewer in number than the OP, I think), I tried ECT. I don't regret it, despite the costs (both financial and physical). I had some initial benefit from it, though yes, it didn't last. I would try it again if I had the social and financial support to do so, because I didn't give bilateral ECT a fair shake (only had three treatments spaced far apart). It has been recommended to me that bilateral is more effective (though with more severe side effects, often), but I would need to give it a few sessions of 2-3 times a week to see if it could really help. Severe depression had stolen much of my ability to think clearly or concentrate (including my ability to read even for pleasure and do mathematics - and I have a college minor in math!). Depression does that. I, too, call bullshit on the claim of 30pt IQ loss. Feeling hopeless is also a symptom of depression, and in my experience is only strengthened by the failure of treatments - especially something that requires as much investment as ECT. Honestly? I am not so attached to my memories of childhood or whatever that I wouldn't risk losing them in order to be able to live without the incessant pain of intractable depression. I lost some memories, mostly of what happened while I was receiving treatment but also some from before that. It was worth it. How often would I really think about the short visit from my parents (who live in a different country and I see rarely) or a movie I saw, compared to the emptiness and hopelessness of depression? I did not lose knowledge. I can still do my job (again, I'm an engineer - my job involves complex cognitive tasks, mathematics, etc.). I am not saying ECT is a quick decision or should be a first line treatment. Everyone here has acknowledged that, like all treatments, ECT has some side effects. I have seen no convincing, peer-reviewed research that shows it is more damaging than prolonged, untreated, severe mood episodes (or psychosis). As others have said, testimonials (particularly unsolicited ones) are always going to be more negative than positive, more extreme than common. Given that, the only thing that can be trusted is repeatable, peer-reviewed research. There has been plenty of that done on the safety of ECT, and you have yet to share much beyond garbage from a known anti-psychiatry nut and a bunch of titles to articles (not peer-reviewed research citations, and lacking links to the reading). I found this review study from 2012 citing the one peer reviewed article you quoted. Their conclusion, after reviewing all studies of the cognitive effects of right unilateral brief and ultra brief pulse ECT (including the one you quoted), is as follows: "The results indicate loss of autobiographical memory and impairment of verbal fluency, anterograde verbal and non-verbal memory immediately after brief pulse RUL ECT. To a lesser extent impairment of working memory and reduced speed of processing is found. Autobiographical memory is the only domain still being impaired between one and six months post ECT, but improved in this period. Verbal fluency normalized to baseline performance between one and six months post ECT whereas anterograde verbal and non-verbal memory normalized or even improved. Speed of processing improved within six months after ECT." J Affect Disord. 2012 Nov;140(3):233-43. doi: 10.1016/j.jad.2012.02.024. Epub 2012 May 15. "Neurocognitive effects after brief pulse and ultrabrief pulse unilateral electroconvulsive therapy for major depression: a review." Verwijk E1, Comijs HC, Kok RM, Spaans HP, Stek ML, Scherder EJ. Also check out this excerpt from a study published in 2016 (emphasis mine): "Thirty-one patients with MDD were assessed with the MATRICS Consensus Cognitive Battery (MCCB), the Everyday Memory Questionnaire (EMQ), and the Montgomery-Åsberg Depression Rating Scale prior to, 6  weeks, and 6  months after ECT. Compared to baseline, the speed of processing, attention/vigilance, and reasoning/problem solving test results were significantly improved. The depression score was significantly reduced. There were no changes in subjective memory complaint. There was no significant relationship between the EMQ and the MCCB subtests, but a significant correlation between current depression level and the EMQ. Six months after ECT the cognitive improvement reported at 6-week follow-up was maintained and extended. The corresponding decrease in depressive symptoms and stability in subjectively reported memory complaints suggest that the antidepressant effects of ECT do not occur at the expense of cognitive function" Front Psychiatry. 2016 Dec 19;7:200. doi: 10.3389/fpsyt.2016.00200. eCollection 2016. "Maintained Improvement of Neurocognitive Function in Major Depressive Disorders 6  Months after ECT." Mohn C1, Rund BR2. Note that they observed a significant correlation between depression levels and performance on the memory questionnaire. Finally, ECT does not cause brain damage. You must support your claim that it does. There are no structural changes to the brain because of ECT (source, source, source). No cell death. Memory loss and attentional issues are not brain damage. You are conflating a medical term with an emotionally-laden self-diagnosis.
  7. I take 45mg of Remeron, titrated up in 15mg increments one week at a time. I find the Remeron doesn't make me sleepy, except the first couple nights at a given dose. Then my body got used to it and it's no problem. I have trouble sleeping though. Now I take it with trazodone at bedtime. I do find that I get hungry at night (like, after I went to bed) and have weird, vivid dreams about food. This all seems to wear off by morning though. I struggle with reduced appetite. I hope the Remeron helps you! Note that the lower doses are generally more drowsy-making while the higher doses are more effective at antidepressant stuff, so you're moving in the right direction for that. Don't give up hope on it just because 15mg wasn't enough
  8. Anyone here have OSFED or EDNOS as a dx? I recently had a brief physical for a depression/ketamine trial I'm participating in. The doctor recommended I consider treatment at the local eating disorders treatment center. She seemed concerned about my eating habits. I suppose it makes sense. I just don't see how I meet criteria even for something as broad as OSFED. I am morbidly obese. I eat a very restricted number of calories a day. I have for years and I only gain weight. In order to lose weight I, deceptively, need to eat more like double the number of calories that feels "right". I don't obsess about my weight or counting calories/tracking intake. I simply don't eat. I am not very good at "listening" to my body so I don't usually know when I'm hungry. If I only eat when I notice that I'm hungry, I end up with far too few calories a day. I don't binge or purge, just restrict. The doctor with the trial suggested that perhaps food doesn't taste good. It's true, most food tastes pretty bland. I end up preferring sweet or salty foods and even then eating is not something that typically brings me joy. I struggle to care enough about food to want to spend time preparing it because even home-cooked food does not feel appealing enough to be worth the effort and expense of cooking for one. As a result, these days in my half-hearted attempts to eat something close to "enough" I eat a lot of prepared/frozen meals. In my saner moments, I realise that I am probably not eating the most healthy diet, though it is not pure sugar/junk either. I certainly know lots of people who eat as badly or worse but are much thinner. The doctor at the trial suggested I might be nutritionally deficient which would contribute to the lethargy that I have always identified as a depression symptom. I struggle with the idea of eating more than I do because it's stuck in my head that to lose weight you have to eat "less" and while I don't obsess over my weight I would certainly like to be substantially thinner than I am. My parents were very restrictive in what I was allowed to eat as a (overweight) teenager, and made liberal comments when they felt I was eating too much. I was 13 when they enrolled me in Weight Watchers for the first time (and I lost weight, but could not keep it off when my parents had me stop WW due to $$). Even then I found that eating the number of "points" per day was a struggle, but it's only gotten worse. Thinking too much about food makes me feel like a bad person for not being somehow more in control of my weight, and like it's all my fault I'm a fat loser with no friends and on and on and on... I don't know what I'm looking for here. Maybe just solidarity to start with. Has anyone had symptoms like this and been diagnosed with something like OSFED? Received successful treatment? What was it like? I have been fighting depression for so hard for so long but this GP with the trial was pretty insistent that the two could be intertwined. I don't know what to do. I don't have money for more treatment. I don't have money for time off for PHP/IOP, which is what the website for the ED treatment center suggests they mostly do, at least initially. I also feel utterly hopeless and helpless and like what is even the point of bothering.
  9. I was pretty depressed throughout HS and it was untreated. I'm actually a HS dropout. I went to college though based on SAT scores, and while I struggled with depression I also eventually received treatment that helped (not 100%, but substantially), including both AD and an ADHD dx that got me access to stims. I had a psychological assessment done while I was in college that gave me accommodations to lower my stress/anxiety around tests as well as somewhere quiet/less distracting to do tests rather than in the classroom. I graduated in 5 years with around 3.8 overall and a 4.0 in my major (engineering). I'm 6 years out of school now. My depression has since gone careening out of control including multiple hospitalizations and ECT that didn't work. I've taken extended short-term disability leave/time off work for it. My work has been supportive and given me the time off even though they're small enough that FMLA doesn't apply and they are not legally obligated to. I seem to, largely, meet or exceed their expectations even though I am generally unhappy with my performance. It's hard to tell how unreasonable my expectations are because I *know* I can do better. I don't expect many people to have my experience. It has been a problem when trying to get providers to understand the extent of my illness because I can manage to look like I'm keeping it all together. I live alone and the things that slip as my MI ebbs and flows are generally things that aren't noticed (e.g. housework, some hygiene, eating) because no one is close enough to see.
  10. I agree that there's a sweet spot. I am an introvert and find just being around people to be draining (even if it is also rewarding). I need alone time to recharge. But I definitely find that too much alone time and I get stuck in my head with the negative self-talk and it feeds the depression. Depression, however, really is like swimming through molasses.
  11. So, if I were you, I would go to work on Tuesday like usual. If she calls you out and says she needs a doctor's note, ask for two things: a) to see a copy of company policy (such as an employee manual) stating that policy and b) for the request with her reason in writing. Note explicitly to her that while you disclosed about a potential medical issue (not mental health, medical issue), you have not taken any unplanned/sick time, just used planned vacation days. Personally, I would disclose a lot less about the MI stuff, sounds like she is less comfortable with it than your old boss. Depending how things play out you want as much of this in writing as possible. You may well be an at-will worker but there are protections for medical health needs under ADA. Keep logs of phone conversations and your interpretations of what was said. Get everything in writing and keep copies not in your office. Stress that this is a medical issue. Even though you probably work for a company too small to qualify for FMLA you haven't used or asked for any leave. This stinks to me of prejudice. -- Do your best to keep your cool with her and the higher-ups in your meeting. It doesn't sound like they have enough to justify firing you. Point out that everyone makes mistakes, you stayed late to fix it, and that you have received no feedback that your performance has been a problem or on the decline. Ask for any policy statements in writing. If this is some kind of performance review, ask for a summary of the concerns and the changes they want from you in writing. Keep copies of these papers at home. I think your boss has not thought through what she's said to you. It's going to be a stressful week but I bet it will work out.
  12. This should be covered in the employee manual you got (and signed/agreed to follow) when you first started at this job. At my work any unplanned absence of more than 4 days requires a doctor's note before we're allowed to return. The unfortunate thing is that if we were talking about a physical illness, e.g. pneumonia, you could in theory go to a walk-in clinic to get a return to work note. That's probably not the case here, due to a variety of factors not the least of which is the stigma surrounding MI. What's odd to me, is that your saying you couldn't meet during off-hours shouldn't then require a doctor's note for return when you haven't missed much work. How many unplanned/sick days did you take off before this week that the office was closed? My employee manual says at 4 or more full days of work they need a doctor's note. So if you take time off for an IP stay or use FMLA for a long absence. Check your employee manual, it might be with the papers you signed when you started your job. Feel free to ask your boss for clarification in writing as to why they require a medical certificate when you didn't end up taking time off - you just weren't available during off-hours when the business was closed anyway. How dare you have a life and make plans such that you're not at their every beck-and-call. Ask if there is an employee manual that states this policy.
  13. Welcome to CrazyBoards! Most of the time nausea occurs when starting or stopping a med. Your doctor has you on a very conservative/slow titration so it is unlikely that you will experience nausea if it hasn't started already. Once you've been on the Brintellix/Trintellix a while if you abruptly stop taking it you may get nausea/dizziness as part of the withdrawal symptoms. That always sucks. There's no way to predict if you will get withdrawal symptoms though, and the best way to avoid them is a careful titration down. The upside is that withdrawal side effects can almost always be quickly eased by just returning to a higher dose of the medication in question. Then you can try weaning off again but knowing you'll have to go slower. I took Trintellix for about 3 months last year. I experienced no significant effects, positive or negative, on either my depression or anxiety. Basically, I suspect you're unlikely to get nauseous from the Trintellix since you've been okay so far. It sounds like you're doing good things to help mitigate any side effects, so keep doing them if you think it helps. Hope the Trintellix works better for you than it did for me! P.S. Brintellix was re-named to Trintellix in 2016 to prevent confusion with a similar named antiplatelet drug.
  14. I also have a very harsh inner critic. I hold myself to exceptionally high standards and then beat myself up relentlessly when I fail to meet them. As others have said, a good approach to treating this is CBT. This is the workbook recommended/used by a CBT-based IOP program I have done. It's written by David Burns who is kind of an authority on CBT. Don't let the title fool you though, it will take more than 10 days to get through the workbook - it's tough work. I have some good skills from it though. Maybe worth a shot for you?
  15. Yeah, my therapist has suggested that I spend too much time here. She is not supportive of my belonging to MI-related groups, she seems to think it encourages the idea in my head that I'm broken. She thinks it makes the cost of getting better too high. Another therapist I've worked with, on the other hand, while my tdoc was on vacation, really encouraged me to find an in-person MI support group. She thought it would help with the feelings of isolation and "other"-ness. I'm very closeted about my MI and she thought it would help me to have somewhere in-person where I was "out" about it, and it was "normal" and okay. So far I haven't managed to join an in-person support group (due to a combination of scheduling and finding one and social anxiety), but I haven't left CB or related sites either (nor do I plan to).