How does therapy work?

[insomnie]

I've never been a very happy person, but this past year I've found myself slipping further and further into a dark abyss. I feel like I am incapable of having emotions, unless they are feelings of worthlessness, anxiety, guilt, and a vague sense of insanity =(. I have horrible insomnia, too: I alternate between weeks of not being able to sleep at all followed by a week or two of sleeping all the time, up to 15 hours a day.

 

For some reason (probably because of my cultural background) I used to have the notion that therapy and medication is for weak people and that being sad all the time was just the defining aspect of my personality. But lately, I've realized that it's interfering with my ability to be a functional person. I have lost interest in every aspect of my life, I am failing out of school, in financial trouble, I have alienated my friends and family (for whom I cannot even summon enough emotion to care about) - all because I just don't care. I seem to have no interst in living - and occasionally I have suicidal thoughts, too, that go as far as practically thinking about what I need to take care of before I OD on the giant stash of Oxycontin I got a perscription for a while back. The only person in my life I care about is my boyfriend, and although I try to act like that's not the case, he probably feels the pressure of being the sole reason I wake up in the morning, and I doubt he's happy about it.

 

So I realized today...I need help. My school offers one free counseling session, and I heard from people that have gone that they will promptly issue perscriptions. I can go that route, or I can talk to my parents and see if I can use their insurance to go somewhere else. However, my parents would probably be opposed to this idea, and I am positive if I used their insurance wihtout asking them first they would find out about it, and then I would have to deal with all the crap that would ensue. I am also worried about co-payments etc - I really can't afford anything right now.

 

So my question is, what do you think I should do? Would anti-depressants likely be enough to snap me out of my dark place, or is counselling usually a better option? Also, how does counselling generally work? You show up and what do you talk about? What kind of input does the counsellor offer? Does it help?

[Geishawhelk]

For goodness' sake, do not go down the medication route without first trying to access the root of your anxiety!

The old adage "A problem shared is a problem halved" is extremely apt and pertinent...

By all means open your heart to some close friend, and tell them you need some counselling or advice....

See your local pastor, or some adult you look up to, but please please - never medicate unless it's absolutely diagnosed or necessary! Thereby leads a slippery slope.....

 

PM me if you need to.... but speak to someone!

[dropdeadlegs]

Take the one free session offered through your college and explain your financial situation. They will know if there are other sources of help that work on a sliding scale. Mental health assistance is offered in my area for as little as $1 per visit. That's all I paid for my daughter and she went weekly for about three months.

 

You have the symptoms of moderate depression. Antidepressant medication can be a very useful tool, but without counseling to figure out what is contributing to the depression, it would be like giving someone a gun to protect themselves, but not giving them ammunition. It's only half a solution. Sometimes depression is greatly helped by balancing the chemicals in the brain, but usually there is a lot under the surface that contributes to the depression. It can takes several months to find the right medication and the correct dosage. If you have side affects that are bothersome adjustments may be necessary.

 

Good luck. I think this can be accomplished without your parents knowledge if that is needed. As a legal adult, you have privacy that an underage person may not have the right to.

[Wedded25]

Antidepressant medication can be a very useful tool, but without counseling to figure out what is contributing to the depression, it would be like giving someone a gun to protect themselves, but not giving them ammunition. It's only half a solution. Sometimes depression is greatly helped by balancing the chemicals in the brain, but usually there is a lot under the surface that contributes to the depression.

dropdeadlegs speaks the truth. Here's a quote from a post I wrote on another board about the issues surrounding AD's:

 

(1) Very rarely is a depression exclusively situational or biochemical; it's hard to pin down an exact cause when you're dealing with hopes, fears, dreams, loves, hatreds, opinions, prejudices, wounds, passions, fancies (yes, even prayers!), and so on. An antidepressant is strictly a neurotransmitter intensifier; there's no pill made that's so fine-tuned it can take down only the negatives in that list and leave (or intensify) the positives, so AD treatment can easily be overbroad -- somewhat like killing a fly with a shotgun.

 

(2) Given this, the big risk with AD's is not so much organic brain damage as having neurotransmitters "all dressed up with no place to go," so to speak. If a patient has been carrying the scars of deep trauma all her life, and is terrified of functioning in the real world, that issue has to be addressed. AD's alone will give her souped-up neurotransmitters but never touch the whys and wherefores of her underlying pain, and they certainly won't bring her any inner peace by themselves; in fact, they could actually increase her anxiety and terror if she doesn't have competent, compassionate help with her trauma issue. I have no doubt that this factored into many of the cases in which people taking AD's committed suicide or other violent acts. They likely had a lot of intense feelings stirred up and poor (or no) psychotherapeutic support in handling them -- and/or couldn't reach their psychiatrist to talk about the physical effects they were feeling.

 

(3) Unfortunately, the psychopharmacological school of thought is often hardcore in its belief that nothing more than pills are needed, so you have lots of psychiatrists handing them out indiscriminately without truly examining or caring about the patient and his/her issues. Of course, insurance companies love to "pill" problems away, as it's far less time- and labor-intensive than talk therapy.

 

(4) A corollary to the above is that doctors often hand out pills without trying to assess whether there's really cause to believe a chemical depression is present -- so-called "cosmetic psychopharmacology." This is especially so because any doctor in the US can prescribe any pill without having to be a specialist in the area the pill is used for, so you get general practitioners handing out Prozac to anyone complaining of mild lethargy, or anyone who says "I'm depressed" in the generic sense of having the normal blues of everyday life.

 

I'm sorry if this post seems unduly frightening. AD's can indeed be very helpful if they're prescribed and monitored wisely. Make sure your psychiatrist is willing to go the distance to handle your concerns to your satisfaction; any doctor too busy or uncaring to do so is the wrong one. Also, don't fall for a doctor who holds out AD's as some all-purpose miracle cure for all your problems and the perfect pathway to eternal peace and happiness. It's more realistic to think of them as "fog-lifters": Imagine yourself as the captain of a vessel surrounded by thick fog that makes travel in any direction impossible. AD's will often lift the fog, making navigation possible again, but they won't set your course or pilot your vessel for you, and no reputable psychiatrist will imply otherwise.

 

For a more impartial look at the issues, I'd highly recommend two sources:

 

(1) There's an episode of PBS's Frontline called "Welcome to Happy Valley" which explores the use of AD's in Wenatchee, Washington, sometimes called the "Prozac Capital of the World"; prominently featured is one of those indiscriminate prescribers.

 

(2) There's also a book called Living With Prozac and Other Selective Serotonin Reuptake Inhibitors (SSRIs) : Personal Accounts of Life on Antidepressants (edited by Debra Elfenbein).

{{{{insomnie}}}}

[EricOnTheWeb]

I've never been a very happy person, but this past year I've found myself slipping further and further into a dark abyss. I feel like I am incapable of having emotions, unless they are feelings of worthlessness, anxiety, guilt, and a vague sense of insanity =(. I have horrible insomnia, too: I alternate between weeks of not being able to sleep at all followed by a week or two of sleeping all the time, up to 15 hours a day.

 

For some reason (probably because of my cultural background) I used to have the notion that therapy and medication is for weak people and that being sad all the time was just the defining aspect of my personality. But lately, I've realized that it's interfering with my ability to be a functional person. I have lost interest in every aspect of my life, I am failing out of school, in financial trouble, I have alienated my friends and family (for whom I cannot even summon enough emotion to care about) - all because I just don't care. I seem to have no interst in living - and occasionally I have suicidal thoughts, too, that go as far as practically thinking about what I need to take care of before I OD on the giant stash of Oxycontin I got a perscription for a while back. The only person in my life I care about is my boyfriend, and although I try to act like that's not the case, he probably feels the pressure of being the sole reason I wake up in the morning, and I doubt he's happy about it.

 

So I realized today...I need help. My school offers one free counseling session, and I heard from people that have gone that they will promptly issue perscriptions. I can go that route, or I can talk to my parents and see if I can use their insurance to go somewhere else. However, my parents would probably be opposed to this idea, and I am positive if I used their insurance wihtout asking them first they would find out about it, and then I would have to deal with all the crap that would ensue. I am also worried about co-payments etc - I really can't afford anything right now.

 

So my question is, what do you think I should do? Would anti-depressants likely be enough to snap me out of my dark place, or is counselling usually a better option? Also, how does counselling generally work? You show up and what do you talk about? What kind of input does the counsellor offer? Does it help?

 

Here is what you do

Take this post you just wrote to us,and print it out. Take it to that councellor and let them read it,because you just told everyone here what you feel and the councellor can make a referal or help you based on what you just wrote. That is a great first step in getting help for yourself:)

 

Someone told me this also,and it is exactly what I did..My councellor appreaciated that alot. Also I agree that medication is the last step,or only if you need a QUICK relief from the symptoms.. Your councellor will talk with you and make a referal on if you should see a more qualified professional. Don't ever be embarrassed about seeing a therapist...it takes alot of will-power and you are very smart to want to get help..

 

Does any of your family have work benefits?...sometimes councelling sessions are offered free to family members through these union benefits.

Please don't let money stop you...You HAVE to get this out of your system...there are places and people that can help,and don't settle for one therapist...If you don't like them,then get another one.. My therapist and I go and have lunch together now,lol...He'll be a friend of mine for quite some time.

 

Don't put it off...you're doing great:)

 

(Eric)

[oppath]

Medication isn't a last step, it's just not the only step. Understand that if you suffer from depression and anxiety, it can takes weeks and months for therapy to kick in too. Often, it is difficult to internalize cognitive coping strategies when you feel depressed and anxious. It is too much. What medications typically do is relieve some of the physical symptoms so you can more easily work on the cognitive aspects. The best treatment is a combination of medications and therapy. Neither one is sufficient.

[dropdeadlegs]

Medication isn't a last step, it's just not the only step. Understand that if you suffer from depression and anxiety, it can takes weeks and months for therapy to kick in too. Often, it is difficult to internalize cognitive coping strategies when you feel depressed and anxious. It is too much. What medications typically do is relieve some of the physical symptoms so you can more easily work on the cognitive aspects. The best treatment is a combination of medications and therapy. Neither one is sufficient.

For the most part, I agree, although not every person will need medication. I think of the pills as something to get you over the hump, but not something that will be required for life for most people. Still, it is pretty realistic to expect to take meds for 9-18 months. What I see as a problem is that many people are taking meds with NO therapy at all, and many doctors are not following up with the psychologists to ensure that therapy is continued. I don't think that works out for folks in the long run and I don't think meds should be relied on as THE solution.

[EricOnTheWeb]

For the most part, I agree, although not every person will need medication. I think of the pills as something to get you over the hump, but not something that will be required for life for most people. Still, it is pretty realistic to expect to take meds for 9-18 months. What I see as a problem is that many people are taking meds with NO therapy at all, and many doctors are not following up with the psychologists to ensure that therapy is continued. I don't think that works out for folks in the long run and I don't think meds should be relied on as THE solution.

 

Yeah,I agree. My therapist told me outright that he only uses drugs if it is absolutley the last resort or an immediate relief is needed. I was kinda disapointed at first because I was hoping for some "instant" relief from some prescription..

Amazingly though after my first session I felt alot better...I actually went home and did something hobby wise after my very first session.

 

Insomnie....Are you going to do it?..keep us posted/