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Circumstantial Depression vs Clinical Depression - At what point is crying deemed excessive? What treatments am I missing?


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i recently dropped an ssri after transitioning onto lamotrigine. i'm in my 30s and there has not been any point in my life under psychiatric treatment, some 25 years, that i have not been taking an ssri/snri. it came thus as a major surprise when i found/find myself crying all the time. this seems not to be the type of crying where one sees a touching movie and sheds a tear, but rather an introspective moment or five accompanied by waterworks. there is something to be said about crying as a cathartic outlet, but at what point is it excessive? i have cried nearly daily beginning about a week or so after discontinuing escitalopram.

my life at present is not anywhere near ideal nor embodies a happy compromise of reality and an idealization held within my head. i am thus wondering at what point the crying is attributed more to the disorder more than external factors. i'm far from happy; i don't smile or laugh naturally but rather only do so to not be detected as, well, very depressed.

an important note to make is that my level of depression has not subjectively worsened since discontinuing escitalopram, i just feel everything more intensely due to the lack of blunted affect; it was realized that ssris/snris truncated the emotional spectrum to a significant degree, but the magnitude was absolutely shocking after stopping the medication. so, yes, the thoughts of hopelessness, helplessness, self harm -- they're all still there and they don't seem to be any more profound, i just now cry and i cry frequently but i don't sob for hours.

i don't deem this reason to restart the ssri as, again, the depression isn't deeper but just differently expressed. what i am concerned about, though, is the lack of efficacy of lamotrigine in reducing depressive symptoms. i described this all to my psychiatrist today who wanted to place me back on an snri and i told her that i have been depressed and treated with ssris/snris since diagnosis with little to no effect on depression (anxiety is another story, but the side effects are terrible). she wasn't having it, but i wasn't either and i declined duloxetine.

is there, thus, some other treatment that i should be looking into? as i stated, my life circumstances are really unfortunate given the state i find myself in, but i very likely would have been in this state regardless of life circumstances. depression is holding me back and i'm not sure how to move forward with treatment. i did some investigative work on TMS but i dunno, it seems as though that procedure isn't performed outpatient. esketamine isn't an option because i'm taking lamotrigine which is somehow holding the anxiety together. psilocybin isn't readily available.

perhaps this is the tradeoff that i must make? the clinical psychologist i'm seeing is really rather unhelpful, so she's no great source of assistance. the people of reddit and here have been much more empathetic.

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2 hours ago, basuraeuropea said:

i recently dropped an ssri after transitioning onto lamotrigine. i'm in my 30s and there has not been any point in my life under psychiatric treatment, some 25 years, that i have not been taking an ssri/snri. it came thus as a major surprise when i found/find myself crying all the time. this seems not to be the type of crying where one sees a touching movie and sheds a tear, but rather an introspective moment or five accompanied by waterworks. there is something to be said about crying as a cathartic outlet, but at what point is it excessive? i have cried nearly daily beginning about a week or so after discontinuing escitalopram.

my life at present is not anywhere near ideal nor embodies a happy compromise of reality and an idealization held within my head. i am thus wondering at what point the crying is attributed more to the disorder more than external factors. i'm far from happy; i don't smile or laugh naturally but rather only do so to not be detected as, well, very depressed.

an important note to make is that my level of depression has not subjectively worsened since discontinuing escitalopram, i just feel everything more intensely due to the lack of blunted affect; it was realized that ssris/snris truncated the emotional spectrum to a significant degree, but the magnitude was absolutely shocking after stopping the medication. so, yes, the thoughts of hopelessness, helplessness, self harm -- they're all still there and they don't seem to be any more profound, i just now cry and i cry frequently but i don't sob for hours.

i don't deem this reason to restart the ssri as, again, the depression isn't deeper but just differently expressed. what i am concerned about, though, is the lack of efficacy of lamotrigine in reducing depressive symptoms. i described this all to my psychiatrist today who wanted to place me back on an snri and i told her that i have been depressed and treated with ssris/snris since diagnosis with little to no effect on depression (anxiety is another story, but the side effects are terrible). she wasn't having it, but i wasn't either and i declined duloxetine.

is there, thus, some other treatment that i should be looking into? as i stated, my life circumstances are really unfortunate given the state i find myself in, but i very likely would have been in this state regardless of life circumstances. depression is holding me back and i'm not sure how to move forward with treatment. i did some investigative work on TMS but i dunno, it seems as though that procedure isn't performed outpatient. esketamine isn't an option because i'm taking lamotrigine which is somehow holding the anxiety together. psilocybin isn't readily available.

perhaps this is the tradeoff that i must make? the clinical psychologist i'm seeing is really rather unhelpful, so she's no great source of assistance. the people of reddit and here have been much more empathetic.

Is this crying distressing or just something that happens and then you move on? If it’s not causing lots of distress I’d be inclined to not start a new treatment 

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28 minutes ago, Iceberg said:

Is this crying distressing or just something that happens and then you move on? If it’s not causing lots of distress I’d be inclined to not start a new treatment 

hi, @Iceberg. it's not causing a lot of distress and i don't think lamictal is worth dropping nor do i think restarting an ssri/snri would be beneficial.

the pervasive chronicity of the depression is oppressive, though, and i'm just wondering if TMS might help? or something non-pharmaceutical. i exercise nearly daily, i practice mindfulness, breathing techniques, progressive muscle relaxation, eat super healthily, take b12 and vitamin d, and see a clinical psychologist. i'm doing everything i'm supposed to be doing, but drugs have only helped to certain degree and that degree isn't enough. maybe i'm missing some piece of the magic contentment puzzle.

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2 hours ago, basuraeuropea said:

hi, @Iceberg. it's not causing a lot of distress and i don't think lamictal is worth dropping nor do i think restarting an ssri/snri would be beneficial.

the pervasive chronicity of the depression is oppressive, though, and i'm just wondering if TMS might help? or something non-pharmaceutical.

i exercise nearly daily, i practice mindfulness, breathing techniques, progressive muscle relaxation, eat super healthily, take b12 and vitamin d, and see a clinical psychologist. i'm doing everything i'm supposed to be doing, but drugs have only helped to certain degree and that degree isn't enough. maybe i'm missing some piece of the magic contentment puzzle.

@basuraeuropea We're at the exact same juncture. I've remained on Effexor, but the depression is so pervasive / chronic, it's still there. Meds just sort of dull the lability...Over time, the meds do less & less for me.

One thing I've observed (being on all the SSRIs/ SNRIs for the same length as you) is that when I attempt a break from antidepressants, the lability (crying blips) get much more erratic & unpredictable.... I imagine the brain is trying to get back to some kind of homeostasis, but there is none to be found anymore.

I would love to do TMS (hope for a reset) but I've no insurance coverage for it, crazy expensive out of pocket. I suppose you could look for a study to enroll for? The newer treatments psylocibin, etc are not available to me... At this point, I've been experimenting with Nootropic hacks because i exercise, see my docs, take vitamins, exercise... Hate to imagine enduring this for another 30 years.

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4 hours ago, Blahblah said:

I would love to do TMS (hope for a reset) but I've no insurance coverage for it, crazy expensive out of pocket. I suppose you could look for a study to enroll for? The newer treatments psylocibin, etc are not available to me... At this point, I've been experimenting with Nootropic hacks because i exercise, see my docs, take vitamins, exercise... Hate to imagine enduring this for another 30 years.

@Blahblahyeah, that's the particularly difficult part: the possibility of this all lasting for the rest of my life, however long that may be.

TMS is covered by my insurance carrier now, but i'm switching carriers next month, so it may or may not be covered and i know it's not first-line treatment. i also don't know if one has to be hospitalized in order for an insurance company to deem one depressed enough to cover it. in your case, without insurance, perhaps ketamine infusions would be worth looking into?

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i've made it down to 25mg/day of pregabalin and maybe i'll be able to discontinue the drug? i have no idea if it's playing any role in depression/anhedonia, though. i have had an extremely rough time tapering pregabalin the past but this past decrease from 50 to 25mg/day has thus far not been horrific. this may be due to lamotrigine preventing a glutamatergic rebound storm? i dunno, but thus far i haven't been stuck at the bottom ring of dante's inferno with regard to withdrawal.

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1 hour ago, basuraeuropea said:

TMS is covered by my insurance carrier now, but i'm switching carriers next month, so it may or may not be covered and i know it's not first-line treatment. i also don't know if one has to be hospitalized in order for an insurance company to deem one depressed enough to cover it. in your case, without insurance, perhaps ketamine infusions would be worth looking into?

I have researched TMS extensively, because it has been recommended to me by several pdocs.....

TMS is covered by most insurances here in the U.S., because it has been FDA approved for treatment-resistant depression, although the co-pay might vary according to your insurance carrier....So you could check if your new insurance covers it.......It is not a first line treatment for depression, but to qualify for it, you have to have failed multiple antidepressant drugs.....So you probably would qualify for it, if your new insurance covers it.

According to mayoclinic.org. it is performed on an outpatient basis, but it is a very intensive treatment, requiring you to go to a TMS clinic 5 days a week, for 5-6 weeks....An individual session lasts about 40 minutes on average, according to what I was told.....You are not required to have a driver after the sessions, although some individuals do choose to have a driver for the first session, just to see how they react.

Statistically, about 50-60% people experience at least some improvement, with about 1/3 of those people experiencing a lot of improvement.

Unfortunately. I am not able financially to try it......Although my insurance does cover it, and I would easily qualify to try it,  the co-pay is too much for me to afford.

Edited by CrazyRedhead
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2 hours ago, CrazyRedhead said:

I have researched TMS extensively, because it has been recommended to me by several pdocs.....

TMS is covered by most insurances here in the U.S., because it has been FDA approved for treatment-resistant depression, although the co-pay might vary according to your insurance carrier....So you could check if your new insurance covers it.......It is not a first line treatment for depression, but to qualify for it, you have to have failed multiple antidepressant drugs.....So you probably would qualify for it, if your new insurance covers it.

According to mayoclinic.org. it is performed on an outpatient basis, but it is a very intensive treatment, requiring you to go to a TMS clinic 5 days a week, for 5-6 weeks....An individual session lasts about 40 minutes on average, according to what I was told.....You are not required to have a driver after the sessions, although some individuals do choose to have a driver for the first session, just to see how they react.

Statistically, about 50-60% people experience at least some improvement, with about 1/3 of those people experiencing a lot of improvement.

Unfortunately. I am not able financially to try it......Although my insurance does cover it, and I would easily qualify to try it,  the co-pay is too much for me to afford.

thank you for the information, @CrazyRedhead . i am so sorry that you are unable to try it. at this point, i'm willing to take out a private loan because if it works, it may save my life, and if it doesn't work, then i don't have a loan to worry about.

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