Finding Hope: Navigating Depression and Mental Health Challenges

Q: Finding Hope: Navigating Depression and Mental Health Challenges

Hello Eunice： Thank you for your hard work! From your situation, it seems that you really need a stable doctor-patient relationship so that the physician can understand your condition and provide you with the most suitable treatment. <br>If you frequently change doctors (even if

Will I really get better?

Hello Doctor, I have been diagnosed with depression or persistent depressive disorder, and I have a history of social anxiety disorder which has since resolved.
Recently, my physician suspects I may have hypomania.
Although I am relatively young, my medical history is extensive; I was first hospitalized involuntarily in the ninth grade, and I have been on medication for five years.
I have taken a wide variety of medications, and here are the combinations I found with their daily dosages:
Antidepressants:
- Lustral (Sertraline) 20mg
- Lustral 10mg + Wellbutrin (Bupropion) 112.5mg
- Wellbutrin 150-225mg
- Cymbalta (Duloxetine) 50mg + Wellbutrin 75mg
- Cymbalta = Lexapro (Escitalopram) 100mg
- Remeron (Mirtazapine) 10mg + Lexapro 50mg
- Remeron 20mg
- Effexor XR (Venlafaxine) 150mg + Remeron 20mg
- Pristiq (Desvenlafaxine) 30-90mg
- Prozac (Fluoxetine) 50-100mg + Pristiq 60mg
- Pristiq 60-90mg + Remeron 50mg + Lexapro 50mg
- Remeron 30mg + Remeron 10-20mg
- Remeron 30mg + Remeron 20mg + Adderall (Amphetamine) 25mg
- Remeron 20mg + Adderall 25mg + Effexor XR 300mg
- Ritalin (Methylphenidate) 150mg + Adderall 25mg + Effexor XR 300mg
Antipsychotics:
- Abilify (Aripiprazole) 2.5mg
- Seroquel (Quetiapine) 25-200mg
- Trazodone 50mg
- Ativan (Lorazepam) 0.5mg
- Klonopin (Clonazepam) *2
- Latuda (Lurasidone) 40mg
- Depakote (Divalproex) *2
- Zyprexa (Olanzapine) 5mg
- Risperdal (Risperidone) 1mg for sedation and sleep
I have never stopped taking medication, but due to geographical factors or incompatibility with physicians, I have switched doctors many times.
In just a few years, I have been hospitalized long-term (1-2 months) three times, and I have had many shorter hospital stays.
Aside from medication, I underwent 20 sessions of rTMS therapy about a year ago, but I feel my condition has worsened.
I cannot get through a semester without breaking down, which has led to my continuous withdrawal from school.
The last time, I reached a point where I could not move; I could only lie in bed and even had difficulty going to the bathroom.

Regarding counseling, I have been using free or low-cost resources, but the downside is that I have to keep switching therapists, leading to gaps in care, and the availability of the next resource is uncertain.
After undergoing so many treatments, I do understand my situation well, but my distress has only intensified.
My difficulty in going out has not improved; even if I force myself to go out every day for 2/3 of a semester, I still feel afraid.
This has caused me significant practical issues, as I cannot attend classes, buy food, or even purchase daily necessities, and I struggle to fill a water bottle.

I feel hopeless and do not know what else I can do.
I wonder when my seemingly endless condition will improve, and during my illness, the academic requirements and living expenses do not wait for me.
As my doctor said, if I cannot return to normalcy, am I not just a burden? I should have been financially independent by now, or as another doctor said, if I truly wanted to commit suicide, I wouldn't be here seeing him; if I wanted to die, I could just go outside and get pneumonia in the rain.
He also mentioned that the state does not let you die because you are a source of tax revenue.
The counselor under that doctor often tells me not to waste their time, and my difficulties have long gone unacknowledged, leading me to constantly question whether I am wasting medical resources (since I frequently return for follow-ups).

When I am in pain, I hesitate to go to the emergency room and think twice about seeing other specialists.
When I find out that my blood test results are normal, I feel like I must have done something wrong, as if I am one of the culprits causing the healthcare system to go bankrupt.
Additionally, my financial situation is unclear; I have applied for medical fee waivers, and although I genuinely need help, I still feel like a sinner.
Even during my time away from school, I feel I do not have the right to spend money.
I believe the only responsible thing I can do is to die, and I cannot think of any other way out.

My thoughts have been very extreme lately, especially regarding various abortion rights issues, which scare me to the point where I genuinely wish for sterilization.
I would go to any lengths, even if it means taking poison, although I do not have a detailed plan yet and may not necessarily act on it.
However, this is enough to demonstrate the extent of my fear and extremity.
Thank you, Doctor, for taking the time to read this long letter.

eunice, 20~29 year old female. Ask Date: 2023/12/15

Dr. Lin Mianzhang reply Psychiatry

Hello Eunice: Thank you for your hard work! From your situation, it seems that you really need a stable doctor-patient relationship so that the physician can understand your condition and provide you with the most suitable treatment.
If you frequently change doctors (even if it's not your choice), it can be quite challenging to maintain continuity in your treatment.
Your treatment requires not only medication but also long-term psychotherapy.
Regarding medication, it appears that you have not tried mood stabilizers such as lithium, Depakote, or Lamictal; perhaps you could discuss with your doctor the possibility of trying these.
As for psychotherapy, although the sessions provided by the National Health Insurance may be shorter and the therapists may change frequently, I still recommend that you continue with the treatment, as it seems you have made progress after your sessions, which indicates that you have gained more awareness of your condition.
I believe that if you continue with the treatment, you will continue to improve.
Keep it up! Wishing you peace and health!

Reply Date: 2023/12/15

More Info

Navigating the complexities of depression and mental health challenges can be an overwhelming journey, especially when you have a long history of mental health issues, including depression and social anxiety. It's clear from your description that you have been through a lot, and it's understandable to feel hopeless and desperate at times. However, it's essential to recognize that there is hope and help available.

Firstly, it’s important to acknowledge the severity of your situation. You have been diagnosed with depression and possibly other mood disorders, and you have a history of treatment that includes various medications and therapies. The fact that you have been proactive in seeking help, such as undergoing rTMS therapy and engaging in counseling, shows your commitment to improving your mental health. However, it seems that despite these efforts, you are still struggling significantly.

One of the most critical aspects of managing depression is finding the right support system. It’s concerning to hear that some of your experiences with healthcare providers have been dismissive or unhelpful. Mental health professionals should provide a safe space for you to express your feelings without judgment. If you feel that your current providers are not meeting your needs, it may be worth seeking out new professionals who specialize in treating complex cases of depression and anxiety. Look for therapists or psychiatrists who have experience with patients who have a long history of mental health issues, as they may be more understanding and equipped to help you.

Additionally, it’s vital to address the feelings of guilt and shame you have regarding your mental health and the resources you consume. Remember that mental health care is essential, and seeking help is not a waste of resources. You deserve support and treatment just like anyone else. The healthcare system is designed to help individuals like you, and your struggles are valid. It’s crucial to shift your mindset from feeling like a burden to recognizing that you are taking steps to improve your life.

In terms of practical steps you can take, consider the following:
1. Establish a Routine: Even small daily routines can provide structure and a sense of accomplishment. Start with simple tasks, such as getting out of bed at a specific time or taking a short walk outside.

2. Mindfulness and Grounding Techniques: These can help manage anxiety and depressive symptoms. Techniques such as deep breathing, meditation, or grounding exercises can help you stay present and reduce overwhelming feelings.

3. Limit Isolation: While it may feel easier to withdraw, try to maintain some level of social interaction, even if it’s minimal. This could be through online support groups or connecting with understanding friends or family members.

4. Explore New Therapies: If traditional talk therapy hasn’t been effective, consider exploring other therapeutic options, such as art therapy, music therapy, or group therapy. Sometimes, different modalities can resonate better and provide relief.

5. Medication Management: Since you have a complex medication history, it’s crucial to work closely with a psychiatrist to find the right combination that works for you. Don’t hesitate to discuss any side effects or concerns you have about your current medications.

6. Emergency Plan: Given your thoughts of self-harm, it’s essential to have a plan in place for emergencies. This could include a list of emergency contacts, crisis hotlines, or a safe space where you can go if you feel overwhelmed.

7. Educate Yourself: Understanding your conditions can empower you. Read about depression, anxiety, and coping strategies. Knowledge can help demystify your experiences and provide you with tools to manage your symptoms.

Lastly, please remember that recovery is not linear. There will be ups and downs, and that’s okay. It’s essential to be patient with yourself and recognize that healing takes time. You are not alone in this journey, and there are people and resources available to help you find hope and navigate through these challenges. If you ever feel like you are in crisis or have thoughts of self-harm, please reach out for immediate help from a mental health professional or a crisis hotline. Your life is valuable, and there is a path forward.

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