Mental Health Thread

Not to seem like I’m piling on but psychiatry is different from psychology. I’ve heard stories like yours from people dealing with psychiatrists, a lot of them are overbooked with patients and basically just have enough time to prescribe something then have you come back in a few weeks to see how it’s going and change the prescription as needed.

+1 also. I was in a grad student support group that helped me get through. Coincidentally I was walking around on campus yesterday and it brought up so many memories I felt compelled to email the counselor who led our group just to see how she is doing these many years later and say thanks. She emailed me back later in the day and it was great to hear she’s still doing that work. It can be intense if people (helpfully) push each other. In our case some great friendships developed between group members. Definitely recommend this for those who have access.

Should we have a separate thread of advice for the lovelorn/loney/socially inept or is this the spot for that too?

I’ve been thinking a lot about something ChrisV said in the LC thread a while ago, that friendship is the one human relationship where we accept each other as we really are. At times it seems almost a tautology, at others profound. Partly due to time and distance but also a tendency to fuck things up, I find myself short of friends now and also afraid to put too much pressure on the precious few I care about who remain close and the one or two I want to be closer to.

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I’m fully aware of the difference. That is the entire point I’m making, and I will advocate to the bitter end for counselors, psychologists, and therapists to be seen first. I will +1 the PhD psychologist recommendation because the ones I worked with were extremely sharp and a good outside check on psychiatrists. Some of it is for the churning problem you describe which seems common.

An important piece is physiological causes presenting (sometimes only) with psychiatric comorbidities, especially endocrine and neurological disorders. Any single one might not seem too likely but the cumulative probability is substantial. My case isn’t some super rare thing and probably affects 1-3% of the population. Add a bunch of those up. They aren’t ruling all of this shit out.

My point was simply caveat emptor and to choose your path carefully. If you have a physiological problem and get tagged with a primary psychiatric disorder, it can be a lengthy, frustrating process trying to backtrack into the right area of medicine. It’s not that uncommon and diagnosis of exclusion is supposed to come last.

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ok, sorry, that didn’t seem to be the point you were making earlier. I don’t think this is the place for argument so sorry. I just have a violent reaction to people seeming to suggest not seeking out help. It’s literally never a bad idea.

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i say go for it in this thread, right?

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np I could have made the point clearer but was trying to avoid writing a novella. I’ve been through the medical system wringer and have permanent damage now from decades of misdiagnosis, so obviously I want people to be smarter and more strategic about it than I was.

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My wife and I start couples therapy next Monday. We have been married for 5 years and dated for 5 years before that. We love each other but the fire is completely out.

We need to start meaningfully communicating again. Right now our relationship is just ‘there’ and we are more focused on our careers and other external distractions.

I’m looking forward to making progress w her. Eager to reestablish our love but also super super nervous.

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Thanks.

I am conflicted on what advice to give about psychiatrists and therapists. I have had bad experiences with both, which I can elaborate on.

IMO the best combination is medication + therapy. One without the other is pretty ineffective. Medication doesn’t need to be long term - it can get you feeling better and motivated to make the positive changes and habits you need to be healthy in the long term, and then you can wean off.

I had a psychiatrist two years ago take me off a medicine that had helped me enormously with major depression, wellbutrin. He had lost a few patients from seizures so he had a policy of not prescribing it. Immediately my depression flared up again. Traditional SSRI’s are completely ineffective on me. I am still dealing with the fallout from that episode.

We’re coming up on nearly 3 years of this particular episode and it’s very discouraging. However, my current therapist, albeit not a super fantastic or professional one, is very knowledgeable, personable, and she gives kind of an asian mom vibe off of her that clicks well with me. That rapport is more valuable to me than anything else. Then again, I’ve had therapists where I had a great relationship with that steered me seriously, seriously astray. One gave me the advice to keep dating an ex until she cheated on me and I’m still dealing with the damage of that today. He also ghosted me.

So yea, it’s a mixed bag. You really need to lead your own therapy, don’t get bossed around or cornered into a diagnosis, challenge your therapist and psychiatrist. Speak up when something isn’t working for you. They don’t mind it if you are logical and clinical about it. If they do mind it, find another one anyway. The authoritarian ones are awful (unless you need that - I don’t respond well to it, I like to guide my own therapy).

I’d never say psychiatrist is a last line of defense. Medication can be enormously helpful in the short term. For me, I have learned I always need to be on it. I learned the really hard way.

I don’t know if I’ll ever “beat” my depression (my doctors think the crux of my problem is anxiety but don’t prescribe me anything for it) or have a normal life. Right now things look bleak to me. But I am planning on making big positive changes soon - thinking of buying a place, doing a little traveling, getting a new job. All on my list of things I need/want to happen in the next year and the medication I’ve started gives me the motivation to take the little steps I need to get there.

“Chunking” is really helpful when you’re sick/not feeling well. Take a goal or a task and break it down into the smallest possible sub-task you can. And do it. On some days all I’m capable of is getting into the shower and back into bed. So, I have to break that down. But I am getting something done. The nature of depression/anxiety is it paralyzes you, don’t be paralyzed, always be moving.

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Can anyone who has taken anti anxiety meds describe what the experience is like?

I had a panic attack yesterday afternoon at work. I felt it coming on and left my office building and basically hid in an alley around the corner. It’s very embarrassing and I have only been here a few months so I don’t really feel comfortable telling my boss like hey sometimes I’m gonna close my office door and have a little freak out.

I’ll weigh in on this, as my wife has been dealing with the mental health system ever since I’ve known her.

If you can find a good psychiatrist, they are literal lifesavers. Brain chemistry is very tricky, and the best ones – ones who will listen to you and not judge – can give you a quality of life that you wouldn’t have thought possible, with the correct prescriptions.

The problems start when your psychiatrist retires or moves on, which has happened frequently to my wife – it’s easy for a psychiatrist to burn out or need to move on for whatever reason. What should happen with a new psychiatrist is a complete review of your meds to see if they’re working, but this often requires an inpatient stay to mitigate the effects of going off meds, and there just aren’t enough resources to do that. So the new psychiatrist will look at your meds and maybe add one or two new ones based on their observation, maybe take one or two away. You may be able to get in to see the doctor once every 3-6 months, but there’s not much care as an outpatient. Then eventually you need a new psychiatrist, and the cycle repeats.

What happened in my wife’s case was that the combination of treatments from four or five different doctors, a combination that was never effectively monitored, ended up poisoning her brain. She was on a near-lethal dose of lithium that was causing brain damage, and no one really noticed. Fortunately, she got admitted and cleaned out, thanks to a lovely social worker who advocated very strongly on her behalf to have someone look at her meds, and the damage was reversed, but it was an absolutely horrifying experience.

To sum up – a good psychiatrist is often vital to treating mental illness, but things can easily go wrong with the wrong doctor, but you and/or someone close to you needs to be able to advocate strongly on your behalf.

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I’ve had limited experiences with them – they worked very well for me to ease my brain activity. Doctors are generally careful in prescribing them long-term because they can be habit-forming, though.

There are different classes of drugs that qualify as anxiolytics and people respond to them differently. But I assume you are probably asking about benzodiazepines. The ones I’ve tried had sublte muscle relaxation and calming effects.They have tolerance and dependency risk. Antidepressants are also anxiolytics but I could never discern any therapeutic effects from the 4-5 I tried, only side effects. Everyone is different.

Also want to say that I have several mid-to-late-30s male friends with demanding jobs (engineer, professor, surgeon) that have described to me almost exactly what you are saying in this thread so I don’t think it’s rare or unusual. Afaik one is idiopathic, one was secondary to epilepsy, and one was hypogonadal.

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I’m not really sure what I’m asking about. I couldn’t name an anti anxiety drug besides Xanax and have no idea what class of drug it is.

Thanks for the info, and for the anecdotes about your friends. That’s helpful to know

Yeah I went to a therapist earlier this year when I experienced a bout of panic attacks and she suggested the same thing in terms of grounding techniques. I’ve had mixed results with it - I think it generally helps me get through some of the depersonalization and just general confusion that comes along with it, but it doesn’t help me breathe or help my limbs from becoming numb or the intense fear.

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Sure. Xanax is a benzodiazepine (or “benzo”) like Valium and Ativan and what I think most people are talking about when they say anti-anxiety meds (anxiolytics). But as TrueNorth said, it seems like doctors are pretty careful with these since they can lead to dependency. Talk to your doctor obviously. What you are experiencing is absolutely more common than you think and you aren’t a melodramatic snowflake. My surprise level would be zero if it turned out to be an underlying physical cause.

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SSRI’s are usually first line treatment for generalized anxiety. Xanax is to treat symptoms of acute episodes, it is not a long term treatment.

I had PTSD for several years (probably still lingers) and I would get random as fuck panic attacks. I had a profession that had me responsible for the lives of 100+ people at a time, so this was not ideal. I had to train myself to just push through an entire panic attack. Grounding techniques can work but just taking extremely deep breaths through my mouth and exhaling through my nose, and reminding myself that it would pass helped a lot.

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Mid 30s male here, have suffered from anxiety and panic attacks.

The only effective instant treatment for anxiety is, in my experience, benzodiazepines. But they’re super addictive and getting off them once you’re dependent is beyond awful. I think it’s ok to have a few around in case of an attack but any kind of regular use is a terrible idea.

Have had success with therapy, meditation and exercise, but most importantly coming to terms with toxic parents and standing up to their nonsense.

Great thread.

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Those of you having moderate success with grounding techniques might benefit from also taking the time to appreciate and really take interest in your environment rather than simply noticing it. E.g., instead of just thinking/saying “that’s a tree,” take the time to examine the colors, study the shape of the leaves, and appreciate all the miracles of nature that even allow such a thing to exist. Essentially, the more deeply you’re engaging in your present, the less able your mind is to go elsewhere.

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If you have an anxiety or sleep disorder and SSRIs aren’t doing the job, it’s not uncommon to be on benzos / hypnotics long term. Being dependent on an anxiety medication is the same as being dependent on insulin. Don’t quit insulin if you still need it. You don’t get any Jordan Peterson bonus points for flushing your klonopin in the toilet to wage spiritual warfare on your nervous system. If you want to quit, taper slowly, in the vast majority of cases, not an issue, certainly not a good idea not to seek this treatment option because of senstionalist information on the internet.

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