I’ve been dealing with depression (and anxiety) for well over 5 years now. I’ve tried so many different medications and treatments with no apparent success. Inevitably, in the course of the treatment, the doctor will ask if I’m starting to feel better to see if it’s worth continuing the treatment, up the dose, or swap to something else. And… I never know what to say. If it’s not going to get dramatically better all of a sudden, I don’t really know how to recognize any incremental progress if it’s happening at all and without being able to do that, I might be passing on treatments that could have helped if I gave it more time.
So if you’ve been in this situation, how did you recognize progress? To the extent that you can put it into words, what did it feel like to slowly get better as you were treated?
Felt like I churned up FoV from 60 to 130 and fps from 15 to 240. I did some drastic changes though, so it wasn’t exactly gradual. Unless you count a year being gradual. A lot of it wasn’t the result of my own merits though, but rather being surrounded by good people. The rest was happenstance.
Short answer to your precise question, for while you’re transitioning to a new treatment:
What triggers for you a strong, negative emotion, every time you’re exposed to it? I knew I was recovering when they stopped hitting the same way. In my case, I was extremely sensitive to my friendships and was ultra-tuned towards any suggestion they were growing distant from me. A late reply to a text (bad), or two friends hanging out without me (devastating) really hurt. I knew something was up once those stopped bothering me so much.
Longer ‘answer’ detailing my whole experience:
Since I was a young child I was always unhappy, worried, etc. Suicidal ideation started in my early teens. In my late 20s, at the start of the pandemic when I was unemployed, living alone, and friends I had made in grad school were all ditching town to quarantine with their families, I was in an emotional crisis and I had real doubts I’d survive. I sought out treatment again (attempts years earlier failed for BS non-medical reasons, not worth getting into). I was initially prescribed with bupropion, which while it tends to be a good first choice for many people, in my case it enhanced my negative emotions. That was very, very bad. I was quickly switched to venlafaxine (FYI while it has terrible side-effects when getting onto it they usually resolve after a couple of months).
Anyway, after a few months of being on it / some dose increases every few weeks from the initial low dose, I started to feel better. I stopped craving the endorphins I’d feel from the extreme emotions of suicidal ideation, and I stopped overreacting to negative events / perceived slights from friends (say friends A & B played golf together and didn’t invite me, even though they know I hate golf and maybe just wanted their own 1:1 hang). This is sounding like “he stopped feeling anything”, but once the stress & anxiety & rehashing of the bad parts of my childhood disappeared, there was finally room for me to become the person I had always wanted to be (goofy, care-free, smiling, relaxed). The depression & anxiety didn’t fade into numbness, it got replaced with happiness. I can honestly say I feel happy a majority of the time and I’m one of the happiest people I know; I recognize bad events but they just don’t affect my baseline all that much. It’s like - if depression is always feeling bad, and while good events momentarily help they don’t last, then I have “anti-depression”. This whole process probably took about a year.
With the supervision of my doctor I am in the process of getting off venlafaxine. There’s nothing wrong with staying on it forever if need be, but some of the newer theories of how these drugs work suggest that your brain grows new neural circuitry as it adapts to the drug, and it’s the new circuitry that actually helps. If that’s true, then once the new circuitry is grown the drug isn’t actually needed anymore. We’ve been slowly decreasing my dose, monitoring my mood, and so far I’m still feeling great. I’m now on the lowest dose, and if things continue as they have then I won’t need a refill in 2 months.
Every time I share my experience I want to clarify a few things:
- For those who may get onto venlafaxine - it’s terrible side effects should fade over time. I almost quit taking it at first but I’m glad I continued.
- Some medications work for some people and not for others, while others work for them but not for the first group. Probably depression & anxiety are just symptoms of different afflictions. We can see the common symptoms but we don’t know which affliction causes it, but each affliction needs its own treatment. As a result the best you can do is keep trying treatments until you find one that works for your affliction; there are so many out there that there’s probably one for you.
- Related to the above, but therapy may help. It wasn’t super effective for me but it didn’t hurt either, but depending on the underlying cause you may have better luck with it.
- I’m going off venlafaxine because whatever underlying cause of my symptoms appears to have been permanently cured. That won’t be true for everyone - some diseases require ongoing medication to treat. Don’t go off your medication without your doctor’s supervision & approval; you’ll need your mood monitored to ensure it doesn’t worsen and some of these medications should never be abruptly stopped.
- One of my biggest regrets was not pushing harder earlier in my life for treatment. While my baseline is happy, I do get pissed thinking about how much I unnecessarily suffered and that I didn’t get to enjoy most of my 20s. If a reader (yes, you) are chronically unhappy and unsure whether to get treatment, just go for it.
This will likely get buried in all the other replies and you may well have already done what I suggest. But I have to say this because it doesn’t seem (from me skim reading anyway) that anyone else has really touched on this but have you been to a psychiatrist, ideally more than one? Done any research yourself beyond just the depression?
I ask because it seems like so many people just label themselves as having depression and that’s it. They don’t think about there being an underlying cause that has to be examined and worked on/healed, they only focus on that one depression symptom.
I’m a huge example of this, I’m in my early 30s and spent my whole adulthood so far thinking I just had depression and anxiety, that’s it. A few years ago I found out I had ADHD and thought that was the answer. But it really wasn’t what was causing bad feeling so much. And so over the past year I discovered I have CPTSD. Bad. A lot of trauma over my life that I wasn’t aware of and living as a shame-bound person was making me feel, think and behave the way I do, for the most part. Knowing that made it so much easier to know what path to take to heal.
And in contrast to what so many others have said here, I’ve healed for the most part and it happened very suddenly, over the course of a month or so actually. I won’t go into details as it’s long and not needed but yeah it came from going through a very horrible, abusive struggle for most of the past two years. I got out of it and did had many realisations about myself and life because of it. I saw that, despite what I thought all those years, I am a strong and good person and my life is, in fact, beautiful. It’s like I can hear music and see colour again after so many years without. I’ve never felt so genuinely happy and contended with myself and life. That’s simplifying it too, I could write an essay on my experience and the difference
There’s still more work to be done, of course, but I was blown away by how much change I’ve felt and in such a short space of time. This isn’t me saying you should seek out and also go through some terrible ordeal at all, of course. I just wanted to get across the importance of looking at potential underlying causes and mental conditions, not just trying to treat one or two symptoms. And also that healing isn’t always a slow, linear journey. There are people who have major depression and take a psychedelic once and they don’t feel that major depression ever again after. The human psyche is a powerful and not well understood thing that has a huge range of difference from person to person
have you been to a psychiatrist, ideally more than one? Done any research yourself beyond just the depression?
Yes. Quite a few at this point. A few that just diagnosed and managed medications, but then there was also a clinic that did a brain scan to try to help figure things out, this is where I learned I was also autistic, but that didn’t really lead to anything useful. I also went to try TMS and Ketamine. Lately I thought that I might have ADHD, so I went to go get tested for that, but they decided that wasn’t it even if I did have some attention problems, they were just more related to the depression symptoms. After that, I’ve started doing ECT. I’m still in the early stages, but I’m starting to get to the number of treatments where people supposedly start feeling it helping and they of course ask me every time I go and I just never know what to say. I can’t really tell if I feel any different. At some point if it’s not helping I’m gonna have to stop because this is easily the most painful, disruptive treatment I’ve had so far. At least with the Ketamine I was basically just zonked out listening to music for like an hour. The ECT involves going to a hospital that’s like a half an hour away, not eating for 8 hours, not drinking for 2 hours, getting a needle stuck in my arm for anesthesia, then getting my brain zapped. I feel like shit the rest of the day. So if it’s not working, more than any other medication or treatment I’ve had, I need to end it. But I don’t want to miss my chance at what feels like the last thing that might help.
I will say my experience with ketamine and ect were both more distinctly positive than this. ect didn’t last as long, but both made it easier to weather the day and take care if my obligations. Nothing was curative, I still have problems with anhedonia, but they did both help. ECT didn’t help until they were doing it bilaterally with a high level of stimulus for me though. If you aren’t at that level yet, I’d recommend trying a bit longer.
I used to have depression before I started HRT. I would dwell on all the world’s problems, and feel despair, and cry at night, and be quicker to anger when people annoyed me. Then within a week of starting HRT - not saying this would work for everyone, but it worked for me - my baseline magically got higher, most of the time I felt ok, found it easier to enjoy things, ignored the world’s problems, was calmer and less judgemental.
I’ve been diagnosed with depression twice now and I’ve been on Sertraline/Zoloft both times, smallest 50mg/day dose.for about 6 months each time. Towards the end of it I had clear signs that I got better.
Main two observations:
- I no longer got angry or frustrated. This was especially noticeable when I was looking after a 1 year old and then 3 year old on the second time. Specifically when the little one screamed irrationally.
- Good days Vs bad days. Before starting the meds I think I had no good days for 3 months or so. Even when I did fun things or family days out. I wasn’t able to enjoy the good parts of life. After meds for a few weeks. I started to have good days, and then more and more of them. I still don’t have all good days but there are definitely more than when I had no meds
Anyways it was a slow and gradual progress for me and never that obvious in the moment, but upon reflection over the last few weeks it was usually visible.
Hope you manage to get better!
When I was an arrogant asshole teenager I had made up my mind that I was too smart for counseling to help me and I needed antidepressants to fix the issue. I received both and just told the counselor things he wanted to hear me say until I could be on my own. I make no claim that the meds do not have real, meaningful benefits to many people, but in my case I feel like they were marketed to me.
I am still on bupropion, but I strongly suspect the difficulty in stopping it is withdrawal symptoms. I decided many years ago that I’ll have a serious discussion with psychiatry about going off it once I have some sort of stability in my life, but thinking that might come anytime soon was pretty naïve.
Counseling was what really helped me, once I matured enough to be open to the idea. In particular, the benefit came from just being forced to articulate my thoughts and argue vehemently against whatever piece of advice I am given and then accept that it actually is good advice a couple days later once it has finally sunk in. This is still how therapy works for me, I have not matured one iota.
To answer your question, what recovery feels like is walking out of a therapy session and realizing that the past few months you’ve mostly been spending these sessions shooting the shit and unloading random thoughts and emotions that are not explicitly sad. In my opinion it is worth continuing to go (although maybe with reduced frequency) because depression can return just as silently, and having regular sessions helps maintain stability.
It’s like boiling a frog in water or weight change over time. You don’t notice it until one day it hits you. It like, faded away but you didn’t notice because you’re so used to it. So you relish it and enjoy it until it inevitably comes back. It’s like a roller coaster but slow and shitty. Gotta have the rain to appreciate the sunshine as they say.
When I first started lexapro I would find myself just having a good time. I’d be sitting somewhere and realize “Huh, I feel… okay.”
Not happy or excited or interested, just… okay.
And then I would think “Wait, do other people feel like this all the time?”
That’s how it is for me, and I was somehow able to do it without medication where medications would help for a little while, then didn’t. But I spent about three months largely to myself, stopping substances, and doing some really horrific shadow work, so there’s that. At first I was definitely on a high, now it’s just mostly level. I still have the highs and lows but graphing it on x-y axes would look like long stretches of straight line with a few small hills and dips spread out here and there.
Nicotine withdrawal upcoming and oh boy …
The meds were part of a whole treatment plan that included therapy and meditation. I was able to stop the meds and therapy once my toxic ex moved out, and being alone and eating simple meals got me into the best shape of my life
My depression was lifted dramatically, but not by anti-depressants (I had a hormone issue), so for me a bunch of symptoms went away at once and in it’s place I felt normal, effortlessly happy more frequently, and life just wasn’t as hard - I felt more motivated to do things, I didn’t need weeks of recovery after a stressful event, I didn’t need a weekend of social isolation after going to a grocery store. I had less of a tendency to need or crave simple rewards, like food or video games. Food became less necessary as a reward, and my behavior towards food became less obsessive.
There was a sense of feeling so “normal” and like what you imagine other people must feel like. You start to understand why your colleagues and others in your life don’t seem to be struggling so much, how they can fit so much into their lives.
I didn’t really understand depression until these experiences - I thought what I experienced was just normal up until then, and blamed myself for being lazy or grumpy or ill-tempered by nature, rather than suffering from depression and other issues.
I have taken buproprion before, and it made me have mood swings where I became manic and filled with energy, then inevitably I would crash and feel awful. It also gave me TMJ from all the extra grinding my teeth were doing, so I had to quit (so painful!).
The first thing I noticed when I started Bupropion was changes in behavior and motivation. First keeping up with self maintenance (showering daily, flossing, etc) became easy. Then I started going for walks and later started working out. I noticed an increase in my capacity for emotion, I wasn’t sociopathic when I was depressed, but I just kind of didn’t have it in me to deal with other people’s emotions, I had little empathy. That changed pretty quickly. I gradually found myself self medicating less, some bad habits started to fade. I had the ability to complete tasks I wanted to complete. I surprised myself when I lost weight, again when I quit smoking, then completed a degree, then a masters, and I was just able to keep rolling like a normal person. I kind of caught up with people my age after a decade of not accomplishing anything except surviving.
I feel better, but I don’t think there was ever a moment when I was like “oh shit I’m pretty happy now”, it was more that my life just started to improve as my capacity increased. I’m not smiling all the time or anything but now I look at what I’ve accomplished, my degrees, my career, my little family. I’ve got a pretty good life. All of that has happened in the 10 years since I started bupropion. I can’t put a finger on when I felt better, but I do.
Good luck stranger.
It feels like the floor is lifted, honestly. The low isn’t as low, and there’s maybe some more energy to do basic tasks. That’s the level of incremental progress I look for. It takes forever, and is super frustrating, but patience over a couple months is key, and always remember the side effects come first. Look for some kind of incremental change at least 4-6 weeks later. Don’t be afraid to advocate for yourself either — if your provider (hopefully a psychiatrist and not a PCP) isn’t listening to your concerns, find one who will. Best wishes to you, and I hope something clicks soon.
Depression is so very hard. Its unbelievably hard. I spent most of my life depressed. 13 to 50. Not being depressed is weird. I don’t know who to live without it. I tried drugs, they made it worse. Suicidal tendencies made it hard to take drugs. My first break was laughing at a kids movie, it was a real laugh. I broke down and cried. It was the beginning of getting rid of depression. Maybe 10 years before I was out of it. Things slowly changed. Lines like, “it is what it is,” helped. I work on mindfulness. I avoid thinking about anything that has negative emotions. Really, I avoid thinking. Mostly, you need to change the way you think and behave. I am not the person I was. I act and do things differently. Be willing to change anything to get out of it. Fear of change kept me in it for a long time. Good luck. You are not alone. You might be able to become a survivor. Keep trying.
Hey, hang in there. Keep searching. I’m still on the journey. I’m over 40 and recently diagnosed with ADHD and some form of bipolar/manic stuff.
Finally found a good head doc, meds etc. up until this, it was a slow but increasing downward spiral. I just became apathetic…to existence.
At work, I constantly felt imposter syndrome, couldn’t stay focused. Any minor mistake felt like the world was ending. At home, minor family drama felt like I was a complete failure as a husband, father and an adult.
Now? Most of all that is fading away. Still a ways to go but hope is in sight. I’ve began to recognize things that would have put me in a dark place. Now it mostly rolls off me.
So, to answer your question: It feels like every little mistake, insecurity etc is nothing more than a memory of shit that got to me. It’s a sorta weird poetic justice. Like seeing a bully get out in their place.
Edit: I’m sure you have but get some blood work done. Hormones, and Vitamin D levels. I’ve been struggling with vitamin D for a while now. It absolutely will cause issues if too low. It’s an “easy” fix with simple supplements. None of this is quick. Takes a few weeks generally to even begin to notice. But in time you should.
I’ve lived with depression for most of my life, but in the past year or so I finally feel like I’ve started to get a handle on it with treatment. It’s been like the weight I’m dragging just lightened up some. What would break me down before I can weather a bit better now, and it’s not as taxing to just do the basic parts of living. It took trialling a variety of meds, magnets to the head, shocks in the head, and ketamine for me to get to my current stable level, but most people don’t need nearly that much.
I’d say if by the time you’re asked you’re still feeling depressed and you can’t tell if it’s better, its probably not better enough to warrant continuing at the current dose. But! I’m not a doctor, so grain of salt.
Low feels more numb than dark. More like being on pause than everything is terrible. More “I’ll try again later” and less “this is never going to get better”.
I don’t remember the transition. I can’t tell you how long it took. I was only on antidepressant medication for about 18 months.
Peace.