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i need a reality check. i've spent too much time alone lately and some of my warped "depressed" thoughts are too real now.

pull up a comfy chair or skip this post - i totally cannot be concise, ever.

i have a long long history of being treated for depression unsuccessfully. until this year, nobody would acknowledge my bipolar sx. now a lovely pdoc has finally done so, and i'm quite happy to be getting away from anti-depressants forever in favour of seroquel. i also discontinued benzos less than a month ago, hopefully won't be needing them for awhile.

this spring i was IP for a month because i was thoroughly suidical. after the change in meds and dx, things changed so drastically i thought for sure i had found the magic combination. i went through six weeks of daily outpatient therapy. i knew i wasn't entirely well, but i thought i was on my way there, and just a little more seroquel would fix up what depression/anxiety was left. i was so freaking hopeful about my future! seriously, i had a game plan for the next six months that if i could force myself to follow, it could bring me some stability/happiness/money.

since then i've had my lamotrigine increased to 300mg, and now i'm increasing seroquel to 225. relatively low doses of each, really, i know i still have lots of room to go up. but my hope has fizzled.

i've had two pdoc appointments since leaving the outpatient program. even though this pdoc is probably the best i've ever had, i am still VERY hesitant to tell her that... that i'm actually a lot more depressed than i let on. and a lot more anxious. the momentum i had built up has slowed to a crawl. i actually do have "is life over yet" thoughts a few times a day - a sharp contrast to the positive pollyanna thoughts i had only weeks before. using the phone takes me hours to build up to making a call, if i even can get there. i could go on and on but y'all know what it's like when you've reached that point where you aren't getting anything done anymore and you're starting to care less and less.

but... i can't tell pdoc. i am SO convinced that i'm about to get yelled at and thrown out of her office or something, because i am SUPPOSED to be better right now. the whole freaking world cheered me on as i got out of the hospital proclaiming that I WANT TO LIVE! WOOT! i felt so proud of surviving the whole ordeal, i felt like finally i was a "good patient", that i was responding as i should be to meds and therapy. somewhere i lost that momentum and things are sliding backwards. i CANNOT stop blaming this on myself. somehow it is my fault. somehow i am going to get in trouble if i'm not well.

i knew even while i was outpatient that things weren't as okay as they "should" be... suddenly my energy and motivation were gone. one week i was really enjoying all the exercise i was getting, then the next i started getting more and more tired, and i just couldn't do it anymore. since then everything else kind of went the same way. all the good stuff i was so proud to be able to do... i can't do it anymore. i'm so ashamed.

i don't know how to fight this idea that it's my fault. it is interfering with getting proper treatment, i know that. i have so much guilt that i can't see what is a sx anymore and what is "me". i don't want to be back in that place where i no longer care what happens to me. i'm so scared that's where i'm going. but i'm even more scared to say it out loud to pdoc. whatever imaginary scenario i seem to be expecting if i'm honest is obviously even scarier than deteriorating further. i can't seem to inject logic into the equation and have it stick.

i don't know what i need besides a place to say all that. i guess i need to hear some magic combination of words that will stick enough for me to be BLUNT with pdoc. i am sick of being terrified i'll be punished, but i'm also sick of not being well (okay that's an understatement). my life has come to almost a grinding halt again, and it seems i'm my own biggest obstacle. if anybody can relate and has learned to get over this, please share with me how you did it. i'm about to throw in the towel on myself.

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oh, lysergia. I am so sorry you're going through this.

But it is the depression talking, not yourself. An easy way to check is to ask yourself "if someone else said this about themselves, would I say it was too harsh or would I say it was understandable?"

Everything you said above was pretty much wayyyyyyy too harsh on yourself. In my mind, that's a pretty clear red flag that it's the depression talking and not the real you.

I know what it's like to have that brief euphoric moment of "omigod, I'm cured! I'll never have to go there again!" when you get out of the psych hospital. And I too came crashing down again, less than 2 months later. Just because I couldn't sustain my recovery doesn't make me a bad person, or mean that the MI is my fault. It means I have a mental illness, and it's not under my control sometimes.

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I'm sorry you're feeling this way, too. It is so disheartening to think that you're getting better only to find yourself smacked down to the ground again. I've had times when I wished that I wouldn't have *any* healing progress, because I knew that it would inevitably fall away and leave me miserable again.

BUT, that's the way mood disorders go! We have mental illnesses, as sys said, and we are not in complete control of what happens with the course of the illness. We can do our best, and it sure sounds like you have been. Taking your meds, going to counseling, seeing your pdoc, those are all valuable work you've done to improve your life and get to a point of being symptom free. It takes time, hell, sometimes it takes years, but you can get better.

However, you need to tell your pdoc & therapist about the full extent of your symptoms. It is their job to help you manage your illness, and they can't do their work if you they don't know what's really going on. They will NOT get angry with you for not being all better by now. They know the cyclical nature of your MI, and they know how badly off you were not too long ago.

I've been working with my current pdoc for 6 years, and it has only been the last few *months* that I have shown some improvement. We have been changing, rearranging, tossing out, bringing in all sorts of meds for 6 years, and he has never ever gotten annoyed that I continued being batshit crazy. The only time he said anything about it was when I apologized for being such a pain and he said, "It can be frustrating for everyone involved when meds don't work." And his frustration stems from wishing he could help me, not from being mad.

Please tell your pdoc and therapist exactly how you are feeling. Write it down if you find it difficult to verbalize-- I do that quite often when I feel horrible. Sometimes I print out writings I've done, or it can just be a list of Sx (which I often will have scribbled on an old emvelope or something- it doesn't have to be fancy or time consuming).

And finally, you are not a "bad patient"! Bad patients are the ones that don't take their meds, don't go to appointments, don't actually give a shit about getting better. You are not like that. I hope things improve soon, lysergia. They can, they will. Give yourself time to climb up out of the Pit. You will be standing in the sunshine again, I'm sure of it.

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So you think you are a bad patient because you're not getting well? Nothing could be further from the truth. You just have to be open and honest with your pdoc because your pdoc is your link to getting better. Don't think that you will disappoint your pdoc. Pdoc are professionals, and they know that the road to wellness is not straight. Your pdoc will not yell at you.

The fact is that you are not doing well. It is what it is. It certainly is not your fault, and your pdoc knows it. Tell your pdoc.

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I felt like a bad patient a lot when I was in day treatment. Most of the time I didn't have a clue how it was supposed to help me. I didn't know what I was supposed to do. I felt baffled by other patients who were getting all sorts of insights in therapy; I wasn't having any insights, at all, and most of the time I failed at doing the weekly 'assignments'. Most of all, I wasn't getting any better. I had brief periods of feeling better after each increase in my Effexor, but it would just crash down again within a few weeks (placebo effect, I guess), and admitting that I was feeling lousy again was disheartening. But unfortunately there's only so much anyone can do to get better. If you are taking your meds, showing up for therapy and for meetings with your pdoc, you are heading in the right direction and you are being a good patient. It's just that there are inevitable ups and downs, med adjustments to be made, different approaches to be taken in therapy, depending on your situation. I'm sure no one in your treatment team is expecting your recovery to be one smooth upward line. If you can't bear to say these things to your pdoc out loud, write it down, or just show them this post. Sometimes I find it helpful to somewhat impulsively, in a good moment, fire off an email. Can't take it back after it's been sent. :) I'll regret such emails all the way to our next appointment, but at least it's been said.

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Dedoubt is right: the bad patients are the ones who don't try.

There isn't any reason you couldn't try adding a small dose of some AD to your current mix. You could also try fish oil. The important thing is to be honest with your doctor and keep trying. I think you should print out your original post and take it to your next appointment.

I wish you all the best.

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It's not your fault, and you're not going to get in trouble for getting depressed again. If your pdoc yells at you for not feeling better, then he/she needs to be fired. I highly doubt he/she's going to yell at you, though.

You still have a lot of room to go on your Seroquel, so that is definitely a starting point. And there are plenty more meds to try if that doesn't work. It's a process. I initially felt better when I got the Bipolar dx and was put on Lamictal along with the Effexor I was taking. That didn't work out so hot, heh. It's been a bumpy road since then, but things have gotten progressively better. Just hang in there, and speak up!

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You should admit that you're feeling worse, so that your pdoc knows that he/she needs to change something. If your provider makes you feel guilty about your lack of "progress," that's not very professional of them, and you should start looking for someone else.

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I'm not sure I can add a lot to the support already expressed by the other good folks here. I'm confident that your doc is fully aware of your complex treatment history and expects that no med fix is going to be a cure-all. Breakthrough symptoms happen. That's a bitter reality. But it sounds like your doc is a good match for you. Help her to help you. Set aside the negative thoughts about your qualities as a patient and focus more on how to improve the collaborative effort. It's not your fault if depressive symptoms return...unless you're noncompliant with your treatments. And she's not at fault...unless she has grossly misdiagnosed you. I don't see any evidence of either scenario. Printing your post could help you convey to her what has been to difficult to say to her. I'm confident you can recover the wave of improvement you experienced earlier this summer.

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Lys, it's fairly rare for the newly dx BP person to hit on the perfect combination of meds right away, it really is. And you are still sub therapeutic for Seroquel to function effectively as an AD for Bp at the dose you are at.

It's also common to have that depression happen when structure and support is less which is what happened after IOP and etc. It's really, really normal and common. It truly is.

Please cut yourself some slack and be honest with pdoc (yes, blunt) so she can help you.

Anna

Hell, I'm still obviously not on the right combo, the ups and downs happen with BP and expecting them not to is unrealistic. Learning to cope and get through them quickest is not.

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thank you all so much. you're right that i'd never tell anyone else that not getting better was a moral failure. like all disordered thoughts, i suppose, it's hard to apply that to *me* (yanno, cause i'm a special snowflake that's an exceptionally bad patient somehow).

i'm sorry i can't remember who said what (it was all valuable)... but i do feel like i wish i hadn't had any hope at all, either, i mean i don't want to be suicidal for sure but... i don't know, if i hadn't had some sunshine briefly then maybe the clouds wouldn't feel so heavy. :(

i suppose i expected a lot more than reality allows. i feel like a fool every time i think "this is it! these meds work and i'll be totally fine now!", only to be proven wrong post haste. like i said, special snowflake.

i'm going to read your replies several times before i go back to pdoc in two weeks. i don't quite believe i'm not failing treatment somehow, but i respect all of your opinions and i know y'all wouldn't hesitate to tell me if i was slacking. :rolleyes:

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Lysergia, if it is any comfort, my dad was very close to some of his most "difficult" patients. This wasn't across the board, of course. But he saw people after they had already been screwed with for years, and then himself would spend years working with them in order to get them someplace tolerable. That can be a very intimate relationship, and of course I don't mean sexually.

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My experience with lamotrigine is that I would feel my mood elevate for a bit after upping the dosage, but it would even out after time. Although it's great for bipolar depression, I've needed an additional AD to help it along. Just a thought.

Are you going to therapy or a group at all or just the pdoc? It seems natural that changing from daily reinforcement & positive actions to nuttin would bring about a mood change. Any way you can do a few days of IOP and not everyday?

We cannot get better unless we are honest about our moods to our docs. They can't do their jobs without all the information. You are NOT a bad patient for not being 'better', if anything you are a GREAT patient because you are ensuring the doc will have your 'business' for a while. You're med compliant & open to change. How boring is it for docs to treat patients that are fine & stable?

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I like my Lamictal / Wellbutrin combo a lot, and my previous dx before BP II was MDD, recurrent. When I recently suggested to my pdoc that I drop the Wellbutrin since the Lamictal has helped me so much, his immediate response was, "No, that would be a bad idea for you." So maybe adding in some Wellbutrin would help you, as it's activating. I was a total zombie on any of the SSRIs.

And definitely call your pdoc. My pdoc has repeatedly told me to call him at the first sign of slipping into the abyss because he said it's a lot easier to control some breakthrough symptoms, compared to letting it turn into a full-on depression. Contrary to your pdoc being annoyed or disappointed, I think she'll be pleased that you're doing your part and paying attention, and are trying to help her help you, which is the reason she chose to be a pdoc in the first place.

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