Navigating Depression: Medication Concerns and Seeking Help

I would like to inquire about medication-related issues?

Dear Dr.
Ding,
I have a long-standing tendency towards depression, but due to my difficulty in opening up to others, my previous visits to doctors have ended unsuccessfully (I couldn't express what was wrong with me).
Two months ago, I experienced a significant shock, leading to a severe outbreak of my depression.
A friend introduced me to a doctor who is very gentle and has made it easier for me to express my situation.
I was prescribed Mirtazapine and a tranquilizer, and I need to continue weekly follow-ups.
However, I keep having thoughts like "I just want to slowly disappear," which creates a sense of uncertainty about the treatment that I find hard to face.
As a result, I have not returned for my appointments.
Yet, I often imagine having conversations with that doctor, as if I were in a therapy session.
After taking Diazepam, I feel extremely fatigued and weak for two consecutive days, as if my soul is being held captive.
However, I am trying hard to engage in professional matters that I hope to turn into a career, and not being able to do anything causes me panic.
Therefore, I stopped taking it on my own.
I have some Wellbutrin left by a friend who was also treating depression, and I have started taking that instead because it helps me feel more energized to face others.
Initially, I had very little sleep for a week, but I only take one pill a day, and I take two pills in the morning and evening only when I am out all day.
I have checked, and this is not an overdose, but since last week, I have been feeling very fatigued, and Wellbutrin seems to be less effective.
I have also experienced numbness in my hands and slight tremors, but I continue to take Wellbutrin to try to boost my energy.
Most of the time, I still feel very tired.
In the past, I have intentionally put myself in dangerous situations, pretending they were accidents, which led to two hospitalizations.
I also have thoughts about the process of dying.
However, I have a very caring older brother, and I don't want to make him sad, so I keep trying to pull myself back.
I do not have schizophrenia; I just often experience extreme conflicting thoughts.
Of course, I haven't told my brother about any of this.
My medical history includes asthma, pneumonia (hospitalized twice and resuscitated once), low blood pressure, and internal bleeding.
I am currently worried that my actions may be a way of intentionally putting myself in danger, but it seems to have reasonable justifications (to get closer to normal).
I would like to ask the doctor if the dosage of medication I am taking could be causing these symptoms purely as side effects? Is this considered dangerous? Can I continue taking this amount of Wellbutrin before my follow-up appointment? I have decided to return for a follow-up, but when I checked for an appointment, I found that the doctor is fully booked this week.
The afternoon slots are not available for online booking, so I need to go in person to see.
After hesitating for two days, I decided to reach out for your advice first.
Thank you very much, and I hope you stay healthy and happy.
Thank you.

hellogoodbye, 30~39 year old female. Ask Date: 2015/10/04

Dr. Ding Shuyan reply Psychiatry

Hello, most people tend to think that their discomfort is due to the side effects of medications they are taking.
While this is not entirely incorrect, the symptoms you mentioned, such as fatigue, numbness in the hands, and slight tremors, could also be manifestations of anxiety or depression.
However, it is best to have medications prescribed by a physician rather than self-medicating.
Any reactions to the medication, whether positive or negative, should be discussed with your doctor during follow-up visits.
Especially since your current physician is very gentle, it is a rare opportunity for you to discuss various matters with them, which is a very positive development.
I believe having a doctor accompany you through this process is much more effective than trying to navigate medication on your own; my experience has shown this to be true.
Depression can be very challenging, but it will improve.
Consider it like dealing with the symptoms of a severe cold; when it comes, face it without putting too much pressure on yourself.
Temporarily lower your standards to reduce unnecessary mental strain, which can help prevent you from feeling more exhausted and unhappy.
During depressive episodes, thoughts of giving up, including self-harm or ending one's life, may arise.
At such times, it is crucial to redirect your attention and avoid dwelling on these thoughts.
A depressive episode can feel like being trapped in an unpleasant dream; once you wake up, it will pass.
It is not worth harming yourself over a nightmare-like experience.
Instead, let the doctors handle your illness, so find the nearest outpatient appointment and go ahead and register! Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2015/10/04

More Info

Navigating depression can be an incredibly challenging journey, especially when it involves medication management and the emotional turmoil that often accompanies mental health struggles. It’s commendable that you are seeking help and trying to understand your situation better. Based on your description, it seems you are experiencing a range of symptoms and concerns related to your current treatment plan, particularly with Mirtazapine and Diazepam, as well as the use of over-the-counter medications like Wellbutrin (assuming that's what you meant by "威克倦").

Firstly, it’s important to acknowledge that feelings of wanting to "slowly disappear" can be a sign of deep emotional distress and should be taken seriously. These thoughts can be indicative of your depression worsening, and it’s crucial to address them with a healthcare professional. The fact that you have a supportive brother is a positive aspect, and it’s important to lean on that support system while navigating these feelings.

Regarding your medication, Mirtazapine is an antidepressant that can help improve mood and sleep, but it can also cause sedation and fatigue, especially when you first start taking it or if the dosage is too high. Diazepam, a benzodiazepine, is often prescribed for anxiety and can lead to feelings of fatigue and weakness, particularly if taken regularly. The combination of these medications may be contributing to your feelings of lethargy and weakness. If you are experiencing side effects like hand numbness and tremors, it’s essential to discuss these with your doctor, as they may indicate that the medication is not suitable for you or that the dosage needs adjustment.

It’s understandable that you might feel hesitant to return to your doctor, especially if you’ve had a difficult time expressing your feelings in the past. However, it’s crucial to communicate any side effects or concerns you have about your treatment. If you feel uncomfortable discussing these issues directly, consider writing them down and bringing the notes to your appointment. This can help ensure that you cover all your concerns without feeling overwhelmed in the moment.

As for your use of Wellbutrin, it’s important to be cautious with self-medication, especially if you have a history of placing yourself in dangerous situations. While Wellbutrin can be effective for some individuals, it can also have side effects, and its interaction with other medications you are taking should be carefully monitored by a healthcare professional.

In terms of your current situation, it’s not advisable to continue taking any medication without consulting your doctor, especially if you are experiencing concerning side effects. If you cannot get an appointment with your doctor soon, consider reaching out to a mental health crisis line or a local mental health service for immediate support. They can provide guidance and may help you find a way to see a healthcare provider sooner.

Lastly, remember that you are not alone in this struggle. Many people experience similar feelings and challenges when dealing with depression and medication. Seeking help is a brave step, and it’s essential to keep advocating for your health and well-being. Your life matters, and there are people and resources available to help you through this difficult time. Please take care of yourself, and I hope you find the support you need soon.

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