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Figuring out the cause of depression?

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Well I'll try to get right to the point but brevity is not my strong suit...


Lately I've been wondering, how can you (ideally on your own) figure out WHY you're depressed??


The obvious things:

  • A traumatic event like death or divorce
  • An illness
  • Toxic thinking patterns
  • Postpartum/hormonal
  • SAD
  • Chemical imbalance (?)

I've been depressed to varying degrees since about 2006... 7 years :( It's gotten significantly worse in the last year. I've tried therapy, multiple medications, attempting various natural approaches/lifestyle changes (light therapy, diet, exercise, sleep), marital counseling.


I can't really identify any good specific reason to be depressed... no traumatic events really. I did have a baby 15 months ago and felt good for about 3 months, and then my depression got as bad as it's ever been, but I doubt that's the whole picture since I was previously depressed.


Toxic thinking, SAD, may have some impact... and of course without an obvious reason, most sources point to chemical imbalance. And that could be it but medications just haven't helped so far (I know that's a very long trial and error process); in the last year, I've tried prozac and zoloft with zero effect. I went to my pdoc lately and he basically threw up his hands and said he was running out of options.


I've read more about CBT... I'm still fuzzy on it, and I was hopeful, but the more I read I just don't think it would help me. I do find myself making some knee-jerk reactions to perceived negative events, but I look at things in a pretty much "it is what it is" light. I quickly realize my reaction was silly, or at worst get angry, but I don't feel that I misinterpret or internalize those things to the point that it changed my perception of myself.


There's a few exceptions... around the time my depression started, I had several bad career experiences in a row (basically got fired 3 times in a row). In at least 3 of those cases, I really believe it was probably 75% my fault. Although it was generally because it was a bad fit... I don't really believe I was bad at those jobs; the end result was feeling like I was basically screwed over. 


Despite having a pretty good life situation right now, I'm very busy and tired and have tons of stress. Is that enough to do it? I feel like they're pretty "normal" stresses, that they're not causing the depression but my depression makes me focus on them and not cope well.


I just don't know where to go from here. So far therapy hasn't helped at all (but I probably need a better therapist).


Sorry for the novel... any thoughts here???

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Sorry you're in a rough patch right now.


Zoloft and Prozac are both SSRIs.  Have you tried any other class of meds?  I'm surprised that a psychiatrist would quit so soon.  A GP probably isn't qualified to go much beyond SSRIs, but a pdoc should have a lot more tricks up his sleeve.


It might be time to find a new pdoc.  There are a lot of meds to try, and it's very possible to find a good med or good med combo that will lift you out of the depths.

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 So far therapy hasn't helped at all (but I probably need a better therapist).


Yes.   Along with working meds, you need working therapy.  It can take a while to find a good therapist just like it takes time to find the right med. Keep looking, ask friends for referrals, ask therapists themselves.  The right match is someone you feel safe with and willing to do the hard emotional work necessary to get into all that stuff. 


I'm sorry you are feeling so bad.  Starting a blog here might help.  There are also many topics about exercise, food, nutrition, suggestions for crazy people like us.  And yes, being tired, stressed and busy is enough to bring out depression. There are sometimes when all it takes is the wind blowing my hair in my face to set me off.

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Just because 2 ssris have not helped you, doesn't mean you are out of meds.  That is just bad practice.

As far as the other stuff, sure it can contribute, but I have found that MOST of my misery is depression>  I've had tons of stressors over the past year and a half, but man, I am SAD about them now, not depressed.


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You definitely need to try a different medication.  SSRIs do nothing for me---I might just as well be taking an aspirin.  I would find a new psychiatrist who is interested in helping you to stabilize and have a good quality of life.  There are literally dozens of medications that you haven't tried.


I also agree with the others that you need a new therapist.


If you think none of this will ever help, and you are destined for a lousy life----well, that's the depression talking.  We all are entitled to a good quality of life, but we people with MI issues have to learn to be our own advocates and actively seek effective treatment.  Get on the phone on Monday and do what you can to get a more effective treatment team.



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Well I'll detail my med history a little more... right now I'm on adderall (I have ADHD), lamictal (a previous attempt as an atypical antidepressant; doesn't help the depression but very helpful for moodiness/irritability), klonopin and zoloft. 


My doctor did switch me to Wellbutrin at my suggestion, instead of the zoloft, but I haven't switched quite yet.


In the past, I've tried wellbutrin, celexa, lexapro, effexor, cymbalta (plus ritalin, concerta, strattera for ADHD)... feel like I'm leaving something out :-P Wellbutrin was for smoking at the time as well as depression, and it had a mild effect on my depression. Celexa and lexapro also had mild/moderate effects (I don't feel like I "felt" a ton better but my friends/relatives said I was), but the fatigue was unbearable. I don't remember cymbalta much, I think it just did nothing. Effexor I TOTALLY flipped out on... I don't even remember what happened, reminds of the time I got roofied in college, I ended up getting fired from my job. And he wanted to give that one another try!!


So I guess it's not that the pdoc gave up with 2 meds; I started with him several years ago, and then stopped for a few years; since last year I went back and have been putting in very aggressive effort to figure this out. So, he didn't want to try anything I'd taken before.


The only thing that makes me hopeful is that every single medication I took before I got pregnant has reacted completely differently postpartum. Very weird.


I guess I do need therapy to figure it out. I've had an even worse experience with that than meds. Probably saw 4-5 different ones once or twice and didn't like them... went to one last year for almost 6 months, and had doubts on and off... he seemed to just listen to me talk. I expressed how I felt and he explained that I need a LOT of work, and that it would be helpful to stick with someone so I could develop a relationship of trust with someone. That made sense so I stuck with him for a while... ugh. I got so annoyed I stopped. I need to find someone a little more interactive...

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It can take time to find a good therapist. One of the things that predict if therapy will work for you is if you click with the therapist, so it's worth looking for one you are comfortable with. 


If your Pdoc is out of suggestions, he should be sending you for a second opinion. I tried a lot of meds with very little result, and a brand new pdoc while I was inpatient suggested Lithium which lifted me out of a very deep depression. 


Stick with it. There's still hope. 

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  • 3 weeks later...

My therapist discourages trying to sort through the rubble of my past and discover the "reason" I'm depressed.

It is pointless and a waste of energy. Regardless of the reason (while I agree I also enjoy trying to solve that mystery)---it's more valuable to work with the symptoms.

I started working on my symptoms of depression. Taking compliments, disrupting negative thoughts, trying to notice when my thoughts were happening and label them as thoughts and not reality.....

I have noticed/recalled some of the reasons for my self hate, depression this way. There are a lot of things I do that I didn't realize that I did and by focusing on these symptoms and uncovering more symptoms I was able to pin point some of their causes.

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The Wellbutrin / Lamictal combo I've been on for the last four years has literally been a lifesaver for me.  I feel like I have my old, good self back again.  I had been on Wellbutrin in combo with several other anti-depressants over the years, and have had several episodes of major depression, along with some dysthymia thrown in. 


My current pdoc said even if I've never been recognizably hypomanic, there's a good chance I actually have bipolar II, and a mood stabilizer might help.  Wow, was he definitely right!  In the (probably inevitable) event I get depressed again, the plan is to throw some lithium into the mix.  It's famous as a mood stabilizer, but also has good anti-depressant properties.


It wouldn't hurt to get a second opinion.  You don't have to suffer, it is possible to get better and back to normal with the right treatment.  I think it's important to get the symptoms under control before therapy is going to do a lot of good.  Obviously I'm not a doctor, just my opinion and personal experience. 

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