Need some feedback, please help!

Finding the right medications is a trial all in its own. Since every brain is unique, medications that work well for some people may not work at all for others. There are many different medications for depression alone, even more when trying to treat other disorders too. Because of this, it can be extremely difficult to find the combination of medications that will actually help. It comes down to trial and error, and it is a slow process. In order to start feeling the effects of anti depressants, you have to work your way up to what is called the therapeutic dosage. You have to this slowly, over a course of months in small increments to allow a gradual shift in brain chemicals. A rapid shift can have very bad results. So imagine this; you get your new medicine. You spend a couple months working your way up to therapeutic dosage, then another few months there to see if it is working. It isnt. You then have to spend a few months weaning yourself back off that medication, only to start the process all over again with a new type. All you can do is hope that maybe this one will work. Maybe 3rd, 4th, 5th times the charm.

On top of this, you have to deal with the side effects. Because of course, all medications have side effects. The side effects of most SSRIs, the most common type of anti depressant, can be grueling. They include but are not limited to;

Drowsiness

Nausea

Dry mouth

Insomnia

Diarrhea

Nervousness, agitation or restlessness

Dizziness

Sexual problems, such as reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction)

Headache

Blurred vision

In some cases, anti depressants can even cause an increase in suicidal behaviour, especially when doses are missed or when weaning off a medication.

Lets talk about a few of those side effects. Drowsiness and insomnia, nervousness, nausea and diarrhea, headaches. Not only are these some of the most felt side effects of anti depressants, they are also some of the symptoms of depression and anxiety. So in trying to make depression better, we have to suffer through worsened symptoms during treatment. So often the medication that is trying to help just makes it worse. Which is why its so hard to find the right medications and the right dosage. The balance where an increase in mood is worth the side effects. Its a difficult balance to achieve, and a dangerous one. But we have to try.

Just as depression and anxiety can have actual physical causes, they too have actual symptoms. The brain chemicals out of balance are responsible for many bodily functions. Seratonin regulates mood, but is also responsible for regulating sleep, appetite and pain. People with anxiety and/or depression have been shown to have consistent increased levels of a stress horomone called CRH. This is responsible for the adrenal response in the body, causing spikes in heart rate and blood pressure as it triggers the bodys fight or flight response. Discounting the mental symptoms, the physical symptoms of depression include;

Fatigue or exhaustion

Insomnia or hypersomnia

Physical pain, aches

Changes in appetite

Psychomotor empairment

The physical symptoms of anxiety include;

Stomach pain, nausea and digestive issues

Headaches

Insomnia

Weakness and fatigue

Sweating or chills

Shaking

Muscle tension and pain

Rapid breathing or shortness of breath

Increased heart rate and blood pressure

Extreme anxiety, or panic attacks, can cause symptoms that are commonly mistaken for a heart attack such as;

Heart palpitations

Tingling and numbness

Chest pain

Difficulty breathing

Dizzyness

I want to elaborate on a few of these symptoms, starting with fatigue. The word fatigue doesnt even come close to describing the levels of exhaustion that come with mental illness. I dont know of a word that can. Mentally, emotionally and physically drained to the limits. This is a kind of fatigue that neither rest or sleep alleviate. It is constant. Not even a full nights good sleep can relieve the tiredness. And a full night's rest can difficult to achieve. Nothing i can say will properly describe the exhaustion that comes from constantly waging a war inside your mind. Even when you havent physically exerted yourself, when you've taken all the necessary steps for care and are well rested, you are exhausted beyond belief. It is so frustrating because you feel like you have no reason to be this tired, but you are. The medications often make it worse. And nothing you do fixes it.

Another key symptom is the changes in appetite, nausea, stomach pains and digestive issues. Its a knot in your stomach, that feeling of dread. It makes you physically ill, throwing up. It causes indigestion, dirreaha, and heart burn. You can feel the pain of your stomach clenching, turning, bubbling. It becomes very difficult to eat, even when you know you are hungry. It hurts to eat. Sometimes the lack of appetite makes it so that you dont even feel the hunger. Not the growling tummy, nothing. No food makes your mouth water, nothing is appetizing. For days you might not feel the desire to eat. But still you know you have to, so you try. A few bites of your favourite food ever, and it turns disgusting in your mouth. Physically repulsive. You feel that if you eat any more you will start gagging and throw it back up. The medications often make it worse. And nothing you do fixes it.

The final symptom i want to touch on is pain. Actual, physical pain. Many people dont realize that this is a symptom of depression and anxiety. Seratonin is responsible for pain relief. Dont produce enough, and you get no relief. It aches all over, like the aches you get when you have a bad flu. But all the time. In additon to that, and the stomach pains, stress causes muscles in the body to clench and tighten. You hold stress in your shoulders, back, jaw and neck. When anxiety causes a prolonged increase in stress hormones, these muscles clench and stay clenched. This causes muscle pains, fatigue, and reduced blood flow. Headaches, muscle spasms and pain. Crying too causes muscle cramping, sinus congestion and pain and tension headaches. Headaches so bad it feels as though your head will explode. The medications often make it worse. And nothing you do fixes it.

All of these symptoms, combined with the side effects of medications, are bad enough. But honestly they pale in comparison to the symptoms that go unseen. Being inside the mind of someone with depression and anxiety is a very dark, ugly, confusing and terrifying place to be. These symptoms are the hardest to explain. It starts with sadness, but the word cannot explain the depth and profoundness of sadness a person with depression endures. It can come up slowly, building and building until you eventually burst. Or it can come on sudden and hit you like a truck. Sometimes you know why, an incident or memory, something sets it off. But the response is not proportionate to the cause. An emotional video, a sad song, a bad social encounter. Sometimes you have no idea why. You can be feeling just fine, having a great day, everything going well, and suddenly you are thrown into the darkest depths of despair. Im talking full on bawling your eyes out sobbing hysterically, and sometimes you dont know why. I cant tell you what thats like.

Sometimes it is more subtle, a dull ache instead of a sharp pain. Like a cloud, looming over you. You dont cry, and you can mostly function. Sometimes you can even ignore it. But its there, weighing on you, dragging you down. Sometimes its not so much sadness, but emptyness. You feel nothing. Not good, not bad, just nothing. Nothing brings you happiness. Not your favourite food, book, movie, activity, animal or person. Nothing. You feel like a shell, a ghost. Nothing has meaning and it can be so difficult to force yourself to do the things you usually enjoy because you know it will bring you nothing. Some medications have this as the goal. You cant feel sad if you cant feel anything. That, to me, is worse than the sadness. Not being able to find any joy, or to feel anger. No excitement or surprise, not even fear. Just nothing, a void. It is hopelessness. You feel like nothing will ever change, like you will never get better.

Medication after medication has failed, you've fought with everything you have left, and nothing is better. Some people never get better, and you start to lose hope that you ever will. You start to feel like there isnt even a point in trying. Like you should just give up, give in. Let it swallow you whole and devour you from the inside. You feel worthless, like a failure. Like you should be better than this, but you arent. The guilt worsens when it becomes harder to function, to do the simple things other people seem to be able to do with ease. Self loathing, hatred turned inwards. Feeling so frustrated with yourself because you feel like you should be doing better, you should able to fix this. Just toughen up, deal with it. It gets hard to deal with when your goal is just functioning. Not living, enjoying or thriving, but just simply functioning at minimum required levels. And you cant even manage to do that right. You feel like a burden, a failure, a drain on the people around you. Like everyone would be better off if you weren't around. Therein comes the thoughts of suicide and self harm. Like you'd be doing the world a favour. I cant tell you how many times ive felt this way.

@Maunakealoa Yes, this is a lengthy statement.

I imagine your former employer will hire a medical expert to evaluate it, and your statement contains a lot of information that any medical expert will already know. It seems to me that your statement would be stronger if it could focus on your particular case, without telling people stuff that medical folks already know. This would make it a lot shorter and more useful in the hearing.

Unfortunately, not everyone believes in the serotonin theory of depression any more. If your former employer hires a medical expert who does not believe in that theory, then it seems to me everything you say about serotonin will turn out to be unhelpful to your case. But of course if you have test results going back to early childhood when these troubles began, and they show that your serotonin levels have always been abnormal, then it does make good sense to mention serotonin.

If I've correctly understood what you write, it looks like you have tried many medications, but medication after medication has failed. It seems to me it might be helpful to list the medications, if it's possible for you to remember them. You could also indicate whether each of the medications affects serotonin. Many of the effective medications for depression are not SSRIs, and instead they work in different ways. You could indicate whether you have ever tried an SNRI, a tricyclic, an MAOI, and so on.

Also, psychotherapy is another a very common and effective treatment for depression. It seems to me it might be useful to mention whether you have ever tried psychotherapy. If you have, it would be helpful to identify what kind of psychotherapy it was, and why it failed to help.

I very much hope your hearing is successful. If you'd like to chat to me about any of this, feel free to click on my profile picture and message me. I'll always reply as soon as I can.

Charlie