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Warning: a lot of swearing. Suicidal ideation (I'm not actually going to do it or I'd force myself to go to the hospital).

I'm so fucking scared I'm going to relapse. Or maybe I already have.

I feel semi-decent (still depressed but can do stuff with moderate amounts of effort) when I take my adderall, but as soon as it wears off I get suicidal, and I have to let it wear off at night or I can't fucking sleep. I'm having panic attacks again on a regular basis, after months of not having them.

On top of all of this, my school wants me to submit paperwork verifying my disability, and my appeal for Social Security is now at the Administrative Law Judge stage and my lawyers seem to think my hearing will be scheduled soon. Since I've been doing better (enrolled in college, taking two classes), I'm terrified that my fucking appeal will be denied and I'll be right back where I started, only older and battle-scarred.

I can't hold down a fucking job because of my depression and because I'm lazy and unfuckingmotivated. I sleep 12+ hours a day, I have anxiety to an incredible level when dealing with authority figures and I have panic attacks when I get criticized. (God only knows what my reaction to my grades is going to be, considering that I fucking haven't studied and it's my own goddamn lazy fault.)

I'm running out of different medication to try. We're down to MAOIs and ECT, basically. (I'm already on an anti-psychotic, a stimulant and an antidepressant.) Maybe a med adjustment is in order? What the hell is my pdoc going to adjust to get rid of this? And I've failed him again by getting depressed again after doing so well. I'm crying writing this because all my doctor wants is for me to get well and all I want is for the pain to be over. I just want to die. If I knew of some fucking method that would safely kill myself, I'd do it, no hesitation.

I don't want to go to the hospital. I don't want to be locked in and away from my family and friends. What if the pain gets so bad I have to kill myself? I can't do that in a hospital. I just want to feel better or better yet, not feel anything at all because happiness is a lie.

No one can stand to be in a relationship with me. I've destroyed every relationship I've ever been in with my black hole of depression. I'm infatuated with someone who doesn't return it and in fact doesn't want to be in a relationship. (He told me in as many words, I'm not projecting.) He probably meant he just doesn't want to be in a relationship with somebody so fucking mentally ill. He hasn't even contacted me in a week, because he's tired of me.

I'm also pretty sure my therapist is tired of me and my stupid inability to ever get better.

I'm so fucking tired of trying to fight every single day just to feel halfway close to "marginally shitty" as opposed to "really shitty."

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And I've failed him again by getting depressed again after doing so well.
If you were in your right mind, you would see how crazy this sounds. He's your PSYCHIATRIST. How in the world are you failing him by being depressed? It's not a character flaw and he's a professional. If anyone is failing it's him! kwim? And he is exactly the one to provide information to your school about your limitations. Him and your therapist. Have you done that?

I don't want to go to the hospital. I don't want to be locked in and away from my family and friends. What if the pain gets so bad I have to kill myself? I can't do that in a hospital. I just want to feel better or better yet, not feel anything at all because happiness is a lie.

Call your pdoc--today. No, you can't kill yourself in a hospital though god knows people have tried and a few have been successful. No one WANTS to go to the hospital. The hospitals are there to protect us from ourselves when we are really sick. And you sound really sick. Happiness is not a lie, but I understand how you get to that place of feeling like it is. Despondency is a bitch.

In the past, every few years I let my crazy go to the point of hospitalization and it sucks. There are so many measures in between, really, that can give relief. It doesn't have to be all or nothing.

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I have just been in hospital. I have days like today where I am depressed and suicidal as fuck, and it really is a good idea to call a professional. I have done. In fact I am handing in my stockpile of meds to a pharmacist today so I don't have the option to kill myself anymore.

This is the illness. It's not your fault. None of this is your doing. Your illness directly affects your ability to cope. This is the point where your illness had the upper hand on your ability to cope, and that my friend is the time to call your pdoc, tdoc, best friend, family, the hospital, crisis lines, anyone you can get your hands on.

I know it feels counter intuitive to shout this stuff from the rooftops but we gotta take of ourselves.

Hanging in there with you.

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As someone on a MAOI, they are not so bad, especially if they work for you! PM me if you have any questions.

I echo what S9 and karuna said - it is not your fault. It sounds like you want nothing more than to get better, and it your pdoc's and tdoc's job to help you get there.

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Yeah, whatever you do, don't blame yourself for "failing" your healthcare providers... If that isn't "the depression talking," I don't know what is...

Have you been an in-patient before? OK, honestly, I haven't, but I think it can be helpful if there's a decent psych facility that you can get into (bad ones can be bad, I think). I have had a chance to visit one as an observer, and I was pretty impressed. (I didn't feel that it sucked any more than being a medical/surgical in-patient at the same hospital. There are limitations to your freedom to leave a not-locked unit, too.*)

(I think several people also recently pointed out that being hospitalized as a minor sucks a lot more than being hospitalized as an adult. Adults do have more rights.)

I'm not sure if such programs are available to people who haven't already been in a psych unit, but perhaps there are "partial hospitalization" or "day" programs where you live? That way, you wouldn't be completely "stuck"...

You should definitely talk to your psychiatrist about the problems you're having with Adderall.

*Sure, you can technically sign yourself out against medical advice, but if you end up having complications, your insurance company will likely refuse to pay for those. They'd argue that if you stayed, the complications would've been avoided...

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Thank you guys so much for your caring and thoughtful replies. Last night, obviously, was a really bad night.

I also think I may have forgotten to take my antidepressant and anti-psychotic yesterday, which definitely could've contributed.

I'm feeling much better after sleeping, and I just gotta return to my pillars of medication, therapy, and self-care.

I'm going to print out what I wrote here and give it to my psychiatrist on my next appointment (which is next week, and I don't think I could get one any sooner) so he knows a little bit more about what I feel when I'm really down.

Edited to add: I really, really appreciate your replies. One of the worst things about depression is feeling like no one understands or really cares, and I know that here, people care and understand.

Also, it seems like paperwork (especially legal stuff) is a major trigger for me. Just knowing that makes me feel a little better, because it's something that my depression has grabbed up and used to make me feel bad, NOT reality.

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Yeah, whatever you do, don't blame yourself for "failing" your healthcare providers... If that isn't "the depression talking," I don't know what is...

Good point. I just gotta keep repeating to myself that it's the depression talking, not the truth.

Have you been an in-patient before? OK, honestly, I haven't, but I think it can be helpful if there's a decent psych facility that you can get into (bad ones can be bad, I think).

I have been an inpatient in the local hospital (which is where I would be if I went to the hospital now), but I was not there for a sustained length of time, because my anxiety was SO BAD at being in there that I felt I had to get out immediately and so I lied and told them I was feeling much better and that it was just a crisis which had passed. This was (at least) 5 years ago.

I'm not sure if such programs are available to people who haven't already been in a psych unit, but perhaps there are "partial hospitalization" or "day" programs where you live? That way, you wouldn't be completely "stuck"...

Yes, there are programs available where I live that do outpatient therapy, but I've already been in one and found it really hard to keep attending because of just the difficulty of getting out of bed at that early an hour.

You should definitely talk to your psychiatrist about the problems you're having with Adderall.

Is it a problem that I'm having with adderall or with the withdrawal from adderall? I'm a little confused as to what to tell him.

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And I've failed him again by getting depressed again after doing so well.
If you were in your right mind, you would see how crazy this sounds. He's your PSYCHIATRIST. How in the world are you failing him by being depressed? It's not a character flaw and he's a professional. If anyone is failing it's him! kwim? And he is exactly the one to provide information to your school about your limitations. Him and your therapist. Have you done that?

No, I haven't given him the paperwork for my school yet, but I will on our next appointment (which is conveniently the day after I see my therapist, so I can talk to her about it too).

I guess I feel like I'm failing him because his job is to make me feel better and he wants to see me in complete remission, and I'm not in that stage yet--it feels like I'm not doing that, rather than the illness isn't letting me, if you see the difference.

I don't want to go to the hospital. [...]
Call your pdoc--today. No, you can't kill yourself in a hospital though god knows people have tried and a few have been successful. No one WANTS to go to the hospital. The hospitals are there to protect us from ourselves when we are really sick. And you sound really sick. Happiness is not a lie, but I understand how you get to that place of feeling like it is. Despondency is a bitch.

I'm feeling better and I'm a little ... confused ... about whether I should go to the hospital if I start feeling the way I did when I wrote the first post. What if I think it's only temporary? If I can treat it myself with some klonopin and sleeping, should I really go to the hospital? Or should I reserve it for when I have a concrete plan to kill myself and the means to do so, which is kind of where I'm standing now? (I'm confident I will not kill myself, but if I have a plan and the means then it's definitely time for the hospital.)

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Is it a problem that I'm having with adderall or with the withdrawal from adderall? I'm a little confused as to what to tell him.

Honestly, I have no idea which it is. I suspect it's the former because I think enough Adderall would still be left in your system for it to prevent such a sharp mood crash. But I'm not completely sure.

I think you need to describe to your psychiatrist how and when it starts making you feel like shit. Have you tried other stimulants before it? Perhaps something else would work for you better...

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Honestly, I have no idea which it is. I suspect it's the former because I think enough Adderall would still be left in your system for it to prevent such a sharp mood crash. But I'm not completely sure.

I think you need to describe to your psychiatrist how and when it starts making you feel like shit. Have you tried other stimulants before it? Perhaps something else would work for you better...

I have tried other stimulants: namely Provigil and Nuvigil. They worked, but not very well. I suppose my other options are Ritalin, which I kind of feel won't really work (it's not as strong a stimulant, for one, and I'm already on a pretty high dose of adderall).

About half an hour after it wears off, I start getting hungry again and about an hour after the Adderall wears off, it feels like my entire mood crashes. I no longer have any energy, I just feel shitty in general, and life sucks like a hoover.

Ugh. I just want to bash my head against the desk until the depression goes away. I'm starting to understand why people consented to lobotomies.

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I would *not* wait until you have concrete plans in place as to how to commit suicide; it may already be too late for you to convince yourself to go for help. If you feel like you did in the first post again, you should at least get your p-doc's opinion as to what your next step should be. S/he may or may not think it is a good idea to hospitalize you.

I would have a lot of trouble getting up early in the moment for outpatient treatment. Do all outpatient services require you start the day early?

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I would *not* wait until you have concrete plans in place as to how to commit suicide; it may already be too late for you to convince yourself to go for help. If you feel like you did in the first post again, you should at least get your p-doc's opinion as to what your next step should be. S/he may or may not think it is a good idea to hospitalize you.

I would have a lot of trouble getting up early in the moment for outpatient treatment. Do all outpatient services require you start the day early?

That's a good idea, and I'll ask him about it. -writes down in questions to ask psychiatrist log-

And yes, all the inpatient programs around here require you get there at 8 (or maybe it was 9). There's just no way I can do that consistently.

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I guess I feel like I'm failing him because his job is to make me feel better and he wants to see me in complete remission, and I'm not in that stage yet--it feels like I'm not doing that, rather than the illness isn't letting me, if you see the difference.

I do see the difference, but that doesn't make your thinking process rational. kwim? No matter how long you've been with this doc, it's not up to you to make a decision about being well or not. I mean, yeah, there are a ton of smaller decisions we make all the time that impact our wellness overall, but to say you are failing because you are inconsistently well, is itself a great example of how flawed the rational thinking becomes during active disease process. Or something. yanno?

I'm feeling better and I'm a little ... confused ... about whether I should go to the hospital if I start feeling the way I did when I wrote the first post. What if I think it's only temporary? If I can treat it myself with some klonopin and sleeping, should I really go to the hospital? Or should I reserve it for when I have a concrete plan to kill myself and the means to do so, which is kind of where I'm standing now? (I'm confident I will not kill myself, but if I have a plan and the means then it's definitely time for the hospital.)

My short answer is this. If you have someone else in your life whom you trust and can rely on, they can help you make that decision. BUT, and it's a big but, we have to be honest about where we're really at. In my life, my tdoc is that guy. He has dispatched me only once to the psych ward and let me tell you, I totally needed to be there. I was probably waaaaaaaaaaaaay past needing to be there. VE gives the best advice on the question of to hospitalize or not, "if you're thinking about it, it's probably a good idea."

One of the larger pills for me to swallow over time has been that it is so unfair that when I feel the least fit I have to do the most work to ensure ongoing survival. But you know what? Too bad. My illnesses are chronic, not fatal. I have a duty to myself and my children to stay alive. And not just halfassed alive either, very alive. It's all over so soon and to miss any of it is terrible. To miss all of it is a tragedy. There is sooooooooo much good in this world.

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I guess I feel like I'm failing him because his job is to make me feel better and he wants to see me in complete remission, and I'm not in that stage yet--it feels like I'm not doing that, rather than the illness isn't letting me, if you see the difference.

I do see the difference, but that doesn't make your thinking process rational. kwim? No matter how long you've been with this doc, it's not up to you to make a decision about being well or not. I mean, yeah, there are a ton of smaller decisions we make all the time that impact our wellness overall, but to say you are failing because you are inconsistently well, is itself a great example of how flawed the rational thinking becomes during active disease process. Or something. yanno?

I'm not sure I follow. Sorry. Can you explain that a different way? (Part of the reason that my psychiatrist is considering the possibility of psychotic depression for me is that my ruminations become very delusional... I start thinking I'm a bad person and NOTHING can convince me otherwise. So you might be making complete sense and I just don't get it because my thinking has become rigid and delusional, or something.)

I'm feeling better and I'm a little ... confused ... about whether I should go to the hospital if I start feeling the way I did when I wrote the first post. [...]

My short answer is this. If you have someone else in your life whom you trust and can rely on, they can help you make that decision. BUT, and it's a big but, we have to be honest about where we're really at. In my life, my tdoc is that guy. He has dispatched me only once to the psych ward and let me tell you, I totally needed to be there. I was probably waaaaaaaaaaaaay past needing to be there. VE gives the best advice on the question of to hospitalize or not, "if you're thinking about it, it's probably a good idea."

One of the larger pills for me to swallow over time has been that it is so unfair that when I feel the least fit I have to do the most work to ensure ongoing survival. But you know what? Too bad. My illnesses are chronic, not fatal. I have a duty to myself and my children to stay alive. And not just halfassed alive either, very alive. It's all over so soon and to miss any of it is terrible. To miss all of it is a tragedy. There is sooooooooo much good in this world.

You're absolutely right. I'll discuss with my therapist and my psychiatrist when they absolutely want me in the hospital, and when I should contact/need an unbiased observer (like one of them) to make that call.

By chance, have you and your pdoc discussed trying a mood stabilizer? Many ppl with recurrent, treatment resistant depression have improved, with Lamictal in particular. -Lav

Oh god, the drug options. Here goes.

My psychiatrist and I have discussed lithium, but I'm not willing to try lithium without blood tests which due to my insurance situation (i.e. uninsured, psychiatrist / therapist paid for by the state but the state doesn't pay for blood tests) are unavailable.

Classes of medication I have not tried: MAOIs, TCAs, and mood-stabilizers, any antipsychotic other than Abilify.

Mood stabilizers all seem to have severe side effects or other reasons I don't want to try them: Dopamax, I'm scared stiff of getting The Rash from Lamictal (also I'm already hypersensitive to some perfumes, for one thing, and I don't want it to escalate to a full blown epi-pen-requiring allergy and there's evidence Lamictal ups your sensitivity to irritants), Depakote is really only effective for mania, Neurontin is unlikely to work at all, Keppra might make me even more suicidal, Tegretol needs regular blood tests so that's out, Gabitril will probably work for two weeks and then make me feel worse.

The other atypical anti-psychotics all seem to cause weight gain, and I'm already morbidly obese (of course). Also, they all fucking cause you to sleep more which again, I don't need any help with, since I'm already averaging 11 hours a day.

So fucking sick and tired of the med go round. I can't seem to figure out if this is a problem with Adderall OR my anti-depressant is not really fucking working, Adderall is picking up the slack, and then when Adderall wears off, BOOM BANG go the guns. I'm leaning towards the second option.

Right now I'm leaning towards asking to go back on Wellbutrin and Valium to counteract the anxiety from the Wellbutrin. That's what I was on while I was working and it worked pretty damn well for awhile. I'm hesitant to up the dosage of Abilify because when I first started taking it I had severe akathisia, but that might also be an option.

------

Note: I'm sorry if this post is long and rambly, as you might be able to tell, the Adderall has worn off and I feel like shit again.

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I'm not sure I follow. Sorry. Can you explain that a different way? (Part of the reason that my psychiatrist is considering the possibility of psychotic depression for me is that my ruminations become very delusional... I start thinking I'm a bad person and NOTHING can convince me otherwise. So you might be making complete sense and I just don't get it because my thinking has become rigid and delusional, or something.)
This was basically my point, that at some point in a downward spiral we (I) lose all ability to be objective. I get the ruminating and self-loathing.

I stopped taking Ritalin for my ADD. In part because I think it contributed to my mood swings and depression overall. I realize that stims can actually boost an AD but that was not the case for me. Even with concerta I still had a bit of a roller coaster.

My current combo is Lexapro/Wellbutrin. Together they are the bomb for me. I don't have BP though so I know that it's more complicated for you as regards your med cocktail.

I feel for you. You sound totally miserable. I have been at that place and it's pretty fucking dark. But, I'm doing very well currently and even a year ago I don't think anyone could have convinced me that my fucked up life would ever be anything but. It does get better. Much, much better. So hang in there.

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I'm not sure I follow. Sorry. Can you explain that a different way? (Part of the reason that my psychiatrist is considering the possibility of psychotic depression for me is that my ruminations become very delusional... I start thinking I'm a bad person and NOTHING can convince me otherwise.)
This was basically my point, that at some point in a downward spiral we (I) lose all ability to be objective. I get the ruminating and self-loathing.

Oh, okay.

I stopped taking Ritalin for my ADD. In part because I think it contributed to my mood swings and depression overall. I realize that stims can actually boost an AD but that was not the case for me. Even with concerta I still had a bit of a roller coaster.

Yeah, the stims have definitely helped my AD but when they wear off it's like a bomb goes off, it's that bad.

My current combo is Lexapro/Wellbutrin. Together they are the bomb for me. I don't have BP though so I know that it's more complicated for you as regards your med cocktail.

I don't have bipolar either... I'm a little confused as to where you got that idea?

I feel for you. You sound totally miserable. I have been at that place and it's pretty fucking dark. But, I'm doing very well currently and even a year ago I don't think anyone could have convinced me that my fucked up life would ever be anything but. It does get better. Much, much better. So hang in there.

The killer for me is I was doing so much better just recently and now I'm dealing with this shit again and I just want to cry all the time. But this passes. Right? Right?

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Well, I have an appointment with my therapist, my psychiatrist, and my supportive community living social worker all this week, so I guess this recent depression couldn't have come at a better time. That's one good thing!

I'll definitely update you all with what they say--you have all been SO much help and support and I really needed it.

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Notes from my psychiatry / therapy visits:

Psychiatrist (saw him today):

  • Agrees that the "Adderall crash" I'm experiencing is too much. Suggests spreading out the dosage so that I take 30 mg to get me going in the mornings and then 15 mg in the afternoon and 15 at night so that any "crash" happens after I'm asleep. (Can't believe I didn't think of that. Guess that's what they pay him for.)
  • Prescription Added: 150mgs of Wellbutrin for "residual" depression symptoms*; agrees my anti-depressant is just not effective enough despite what we currently have added to it. *(my "residual" symptoms even with all this medication are still enough to get me a diagnosis of severe depression according to the Goldberg inventory)
  • Prescribes also an additional 30 minutes of SAD-lamp light in the afternoons.

Therapist (saw her on Wednesday so my notes are a little less than complete due to memory loss)

  • It is better to try than to give up. Even if you do a shitty job, that can be improved upon. Not trying gives you nothing to start improving on.
  • Try to sleep just 8 hours, make sure you GET OUT OF BED when you get out of bed in the mornings—ideally, leave my room (and my precious computer, sadness) so that I am not tempted to get back into bed, at least for the first half hour or so. Set alarm for 8 1/2 hours after I get into bed. (She also suggests going to bed at the same time every night, yeah, I'll... work on that.)
  • Go through the motions, even if I don't feel like it. The effect, not the motivation, is what is necessary. The motivation would be nice. Maybe it'll come. Maybe it won't.
  • Add/encourage structure to my day as it seems to improve my mood.

Thanks for following my saga, all.

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