Depression

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So I just called my insurance company and asked them what coverage would be like for seeing a psychologist, and it's a $900 deductible so it would be around $110-$120 per session (which is apparently a slightly reduced payment) for the first $900 and then 80% coverage after that. Plus meds if I were to go on them, of course. I can't afford that. So much for fixin my problems!
Then try the cheap route and look around for counseling centers or group therapy. The quality's going to be spotty, but it's worth a shot.
 
pretty sure its a low dose, not high

No.

Psycholytic therapy involves the use of low to medium doses of psychedelic drugs, repeatedly at intervals of 1–2 weeks. The therapist is present during the peak of the experience and at other times as required, to assist the patient in processing material that arises and to offer support when necessary.

Psychedelic therapy involves the use of very high doses of psychedelic drugs, with the aim of promoting transcendental, ecstatic, religious or mystical peak experiences. This approach differs strongly from the dialog-based processing of psychodynamic material upon which many other methodologies are based. As such, it is more closely aligned to transpersonal psychology than to traditional psychoanalysis.

Source: http://en.wikipedia.org/wiki/Psychedelic_therapy


In that article he also reported phenomena that only occur at higher doses of psychedelic drugs.

" “All of a sudden, everything familiar started evaporating,” he recalled. “Imagine you fall off a boat out in the open ocean, and you turn around, and the boat is gone. And then the water’s gone. And then you’re gone.” "

Which sounds like the classic ego death / dissolution experience.

Lower doses usually involve heightened sense perceptions and introversion, but not dissolution beyond a subtle level.
 
I want to improve my life, whatever it takes, but I can't seem to find it in myself to take the first step...whatever that even means.

Whenever you hear yourself say the word 'but' reverse the statement, in your case:

"I can't seem to find it in myself to take the first step...whatever that even means but I want to improve my life, whatever it takes."

There, that sounds much better.

On another positive note "wanting to improve your life" is the first step and you've already taken it. The second step is coming up with some idea of your goals. Do you want to improve your career, knowledge, hobbies/interests, friends, family, relationships, physical wellbeing, mental wellbeing? Some combination of the above or something else not listed?

Once you've identified some goals you can then start to think of some steps to achieve them.
 
Decided not to re-up my ZOLOFT substitute last weekend. Been 6 days clear but I've drank every day since and took Ritalin today. Body has felt fucked. Like I'm catching up to my movements so that I feel my body upon re-entrance. It doesn't make sense and it's made worse with GERD/heartburn.

Fuck the 27 club.
 

A bit of everything then. Cool. I had to rebuild my life from scratch so I have a good understanding of the whole process. I like the simple directness of your answer here, it shows a good attitude. You wanna explain your life situation? I can help you come up with a plan. Post it here or PM me.
 
Just had a talk with my mom. Told her that I've been depressed for a long time and that's it's gotten worse and that getting therapy will be difficult because my insurance sucks. She was of course supportive and wants to help and will be visiting me in a couple days. That was probably the biggest and hardest step I've taken in dealing with my depression ever. Wouldn't have done it without my only friend talking me into getting help and talking to my parents. She's a good friend.
 
Is it normal to think about suicide daily? To plan it out? I'm not really depressed and life isn't going that badly.. its just.. i never get as happy or excited about anything anymore.

Could it be a side effect of one of my medications? I'm taking ambien and zoloft... if anybody knows please tell me.. its very disturbing.
 
Wow, how nice of you to come in and let everyone know that their misery makes you feel better. What a great Christian you are.

And how nice of him to talk about embarrassing bladder problems in a depression thread. It just strikes me as really inappropriate to compare the two problems.
 
Is it normal to think about suicide daily? To plan it out? I'm not really depressed and life isn't going that badly.. its just.. i never get as happy or excited about anything anymore.

Could it be a side effect of one of my medications? I'm taking ambien and zoloft... if anybody knows please tell me.. its very disturbing.

I'm pretty sure you know it's not normal to think about suicide daily and to plan it out.
 
A bit of everything then. Cool. I had to rebuild my life from scratch so I have a good understanding of the whole process. I like the simple directness of your answer here, it shows a good attitude. You wanna explain your life situation? I can help you come up with a plan. Post it here or PM me.

Thanks for your concern. I'll sent a pm later.
 
I guess I have a mild case of it. It's more cause I have 0 friends and haven't had a date in 10 years. I just keep busy with other things to take my mind of it. It usually works. Find a TV show you like, work out(even though I haven't in awhile), game.
 
(Sorry for the long post) TL;DR: I've been on tonnes of medications.

What are some medication combinations for treating Bipolar disorder? Is there any of the types that doesn't come with the typical side effects of drowsiness and weight gain?

I had zyprexa for about three months or so and gained over 30 pounds (which i now have difficulties loosing). I was very skinny to begin with so 10 pounds wasn't a big deal but it was too much and has affected my self-confidence quite badly (i had a great self-confidence at least regarding my looks before).

I'm not certain i even have any Bipolar disorder since i tend to get sent to different doctors who puts different diagnoses every time. I've been to psychiatrists and psychologists for over 10 years.
(what seems to be established): ADHD without hyperactive disorder (aka ADD), Borderline personality disorder.
(what has been discussed over the years): Aspergers (which seems highly plausible), Anti-Social behaviour, Schizoid, Bipolar, GAD (generalized anxiety disorder, which is total bullshit).

I have severe issues with agoraphobia and tend to leave my apartment (at best) every other week.. Usually for my therapist.

I have never gotten a proper diagnose or have never done any tests. I did one like 8 years ago which i believe showed severe lack of motor skills (i find drawing and writing with pencils extremely difficult) and elevated results in mathematics (which is my favorite subject) and a little better than average in language.

EDIT:
Decided to remove some of the shit.
 
@accx

Effexor is no good. My husband started taking it only a month ago and his withdrawal symptoms were so bad i had to take him to the ER. It had no noticeable benefit at all.. have you thought about ditching it and taking something else?
 
@accx

Effexor is no good. My husband started taking it only a month ago and his withdrawal symptoms were so bad i had to take him to the ER. It had no noticeable benefit at all.. have you thought about ditching it and taking something else?

I know that the withdrawal is hideous. When i stopped taking Effexor a couple of years ago i had to be really careful not to completely stop. I think i was on 175mg at that time and started taking half dosage for a week or two, then half that.. then every other day, then half that and so on. I think it took several months before i was completely free from them.
The reason why i have begun taking them again is that they have been the most beneficial in terms of reducing anxiety and suicide attempts for me. It is a quick fix right now because i was waking up every morning with intent to kill myself. I have not had a single suicidal thought since i began taking them.
The head aches, blurry vision and lack of needing to eat is the only major side-effects, and it's starting to wear off now.
Not the head aches though which is starting to become more and more aggressive.
I can live with it though because at least i can now get out of bed without worrying about doing something stupid.

Something i wanted to add to my long post. When i was three months old i had a major meningitis (i believe it's called?) which, according to my mother, changed my behaviour.
There's been discussion with psychologists and psychiatrists that this could be one of the reasons.
If you look at my parents though you can easily see on my fathers side tendencies for ADHD (my cousin is diagnosed with it), bipolar, anxiety and suicidal thoughts (i have a couple of uncles who committed suicide).
On my mothers side on the other hand there's signs of borderline (my mother and my sister). My aunt suffers from agoraphobia (and is a "functioning alcoholic") and shows signs of aspergers.
As a child i also had ear infections every month. I'm immune to some penicillin because of this.
 
I've realized I've lived the future as my next ten years will be exactly like the last ten years horrible. If there was a God I would die in my sleep.
 
(Sorry for the long post) TL;DR: I've been on tonnes of medications.

What are some medication combinations for treating Bipolar disorder? Is there any of the types that doesn't come with the typical side effects of drowsiness and weight gain?

I don't see a mood stabilizer on your list, unless I missed it. If you're bipolar, and you aren't on a mood stabilizer, the antidepressants may be making things worse. Considering the go to mood stabilizer these days is Trileptal, which has an incredibly gentle side-effect profile, I'm not sure why someone hasn't put you on it. Talk to your psychiatrist about it. It's generic name is Oxcarbazepine. Other than having to be careful you get enough salt, I've experienced no noticeable side effects.

I'm bipolar II and I take it to stabilze my moods and Celexa for depression.
 
going out with a girl for a few days
shes cute, and nice

but im just too sick to do anything about it, and i think im going to call it off for both of our sake.

this is terrible :|
 
going out with a girl for a few days
shes cute, and nice

but im just too sick to do anything about it, and i think im going to call it off for both of our sake.

this is terrible :|

No man, you'll regret it later.

What do you mean "go out for a few days"?
 
Really feeling it right now.

I can't do.. anything. Fuck.


Same here. I'm drowning in the fact a guy I like has a boyfriend and I have no one. I wonder if I could ask my doctor for a way to destroy my personality

Really isn't nothing worth living for and life never gets better.
 
No man, you'll regret it later.

What do you mean "go out for a few days"?

consecutive dates i mean
and yes, i will regret it later, thats why im calling it off?
I haven't even told her that im like this, and im pretty sure its going to end horribly
Its really not fair on her, and its going to be more painful the longer it goes on
 
Honesty, like tell her. What else have you got to lose? If she deems you unfit, well, dump her. If not, then something is there. I have learned that just be comfortable in who and what you are. Like, not to sound cliche but different people are looking. Just try to be the what represents you.

I like who my close confidant is and, like, she is even a gaffer, but that is not the end. Learn to trust in those in those who have chosen to hear you out. It is painful and I might not actually believe it but is is....and they have shown me...even if it is an internet friend who I have only met virtually
.
Even if it hard, even if it is the last thing you want to hear. Just take a moment, go for a walk, read, watch a Richard Dawkinns or a Hitchens video...and learn that even though the end might sound clear..that even though McCarthy might sound justifiable, it isn't so. These authors's have actually fought the opposite...
 
I've realized I've lived the future as my next ten years will be exactly like the last ten years horrible. If there was a God I would die in my sleep.

Have you checked up on ECT?


Really isn't nothing worth living for and life never gets better.

Life can get better if you work to make it better. And by work to make it better, I mean seek every treatment option available before throwing in the towel.
 
Honesty, like tell her. What else have you got to lose? If she deems you unfit, well, dump her. If not, then something is there. I have learned that just be comfortable in who and what you are. Like, not to sound cliche but different people are looking. Just try to be the what represents you.

I like who my close confidant is and, like, she is even a gaffer, but that is not the end. Learn to trust in those in those who have chosen to hear you out. It is painful and I might not actually believe it but is is....and they have shown me...even if it is an internet friend who I have only met virtually
.
Even if it hard, even if it is the last thing you want to hear. Just take a moment, go for a walk, read, watch a Richard Dawkinns or a Hitchens video...and learn that even though the end might sound clear..that even though McCarthy might sound justifiable, it isn't so. These authors's have actually fought the opposite...

The problem being that I have no desire to look for it
Of course im a big dawkins and sagan fan, but that doesnt account for much in the way of being permanently ill
I have internet friends
I dont need to go for walks because I have a bike

I also told her about the situation and as i figured it dismantled everything :)
 
I've realized I've lived the future as my next ten years will be exactly like the last ten years horrible. If there was a God I would die in my sleep.

If there is a God, and that's an impossibly improbable if, he is certainly neither benevolent nor merciful. The Holocaust alone stands as incontrovertible proof that he's either criminally negligent, or a total fucking sadist.
 
Sorry for the late replies.. was a bit nervous to come back to this thread right away.

Oh yeah, it gets continually worse the less you do. For me it feels good in the first hour to quit my job or skip class or do some other irresponsible shit... Then the reality sets in and I feel much worse than I did before. Now everything's suddenly caving in for real.

Yeah.. same here. I've recently been putting off tons of homework.. cause of depression/lazyness, and now it's all biting me in the ass and making me even more stressed out, which certainly isn't helping my mood =P

For you personally, have you found out what life is worth living for?

Nope.. for a while I thought it was web design.. but i know it's not, but i still enjoy it a lot. but.. urgh... I just don't know. It was just a temporary happyness, finding something i liked. I was silly to think it was worth living for.

Embarrassed to admit this, but one of the reasons I like to play JRPG's, is it takes me away from the real world for a while. I get really sucked into the world/story, and then I get back to real life an hour or two later. Then reality hits you again. I start thinking about how there is people that are actually living out lives like that, I don't mean slaying monsters and saving the world, but I mean traveling around, and experiencing new experiences.

Meanwhile, I'm still sitting at my computer, rotting away, and depressed as hell. I'd really like to expand beyond this, but each time I try, my anxiety/depression kicks in and holds me back. I've been trying to find something new to get into, but I'm honestly not sure what.. I'm thinking something that involves physical activity and personal growth would be good.. but yeah..

Regarding Effexor, saw other people in this thread mention it.. my doctor prescribed it for me, I took it ONCE, and i started getting these crazy side effects and just generally not feeling well at all, so I looked up the side effects online and.. I was shocked at what i found, and what people were saying about it. I refused to take it after that one dose. Side Effects took like 3 days to fully go away.. only after one dose... scary stuff! I'd honestly rather deal with my problems, then be turned into a zombie by medicine.


edit; oh god, first post of the next page ;.;
 
I don't see a mood stabilizer on your list, unless I missed it. If you're bipolar, and you aren't on a mood stabilizer, the antidepressants may be making things worse. Considering the go to mood stabilizer these days is Trileptal, which has an incredibly gentle side-effect profile, I'm not sure why someone hasn't put you on it. Talk to your psychiatrist about it. It's generic name is Oxcarbazepine. Other than having to be careful you get enough salt, I've experienced no noticeable side effects.

I'm bipolar II and I take it to stabilze my moods and Celexa for depression.

Damn, i wish i had seen this post before my appointment today. When i woke up yesterday i was considering this because i've been noticing some sporadic manic feelings now on the Effexor. It's pleasant but it also fucks up the (already) little attention span i have.
I have been hesitant to mood stabilizers because they usually give me the kind of "downer"-like effect, which does not increase my activity and motivation level at all.
It does however create a somewhat better sense of coping and a sense of calmness in my otherwise sporadically chaotic psyche. But with that follows a lot of binge eating and usually a sense of "as long as i take this and be calm and warm i don't really give a shit". Kind of like smoking weed.
And as i said, it doesn't increase my motivation.
I got concerta prescribed today. I will start taking 18mg/day beginning of next week. I just hope it won't create anymore chaos (which i'm starting to worry about).
I will also meet my therapist next week and hopefully i can discuss this with her to see if i can see my psychiatrist just for a short while for perhaps that mood stabilizer. Otherwise i have to wait three months before i see him again.
I have multiple disorders . So the right kind of cocktail is really hard to find. I know that effexor and concerta had an positive effect. But before i didn't react as strong on Effexor as i've been doing now.
Like i described earlier. There's sign of Bipolar, borderline (although this is quite stable as long as i keep myself in check), ADD and possibly aspergers. Though no test has ever been done.



Effexor withdrawl is the fucking worst
Hear hear.
What i noticed (and worked for me) is taking half the dosage. But once the "brain zaps" and the feeling in your body that you're on a rollercoaster kicks in i took another dose. it stabilized the symptoms in about 20 minutes. Of course, you should ALWAYS refer to your doctor before quitting any type of drug.. I did not and experimented and found a way to minimize the withdrawal. At the end i could go about 5-7 days without taking it but once the withdrawal effects kicked in i took the minimum available dose. It took several months before i was free though.
Same with cymbalta although not quite as intense iirc.
 
How long does it usually take to determine if a medication is working well for you or not?
 
How long does it usually take to determine if a medication is working well for you or not?

1,5 months up to 3 months (if it's an antidepressant, SSRI/SNRI).
It depends on how sensitive you are and how self aware you are about the changes.
I can sense a feeling of altered mood state after a week or two though, but i'm really sensitive.
How to determine if it's working well for you is anyone's guess. Depending on why you're taking the medication (stabilizing mood swings) or just treating "common depression" it can be hard to really know.
Different SSRI's react quite similar to each other, with difference in strength of the side-effects and the same goes for SNRI's.
If you've been treated with something like zyprexa/mirtazapine (antipsychotic but also used as a stabilizer) you should feel the effects right after you've taken them. Same goes for "downers" (benzos and the like).
If it's an antidepressant you should feel the side effects in the first month, and it usually plans out after the initial month. Expect to feel a "better sense of coping with things" at about 3 months.
It's a double edged sword with antidepressants. it usually stabilize for normal persons within 3 months but after the 3 months you've become used to it (or "addicted" for lack of better word), so if the effect is not what you're looking for and you want to try another medication you have to expect at least a month (depending on the meds) to lower dosage until you're free from it and can start another treatment.
If you have hypochondriac tendencies i would be hesitant to read about all the side-effects but then again, it's really good to have that knowledge so you know it's actually doing something and what you're feeling (positive or negative) is normal.
Best bet is to consult with your psychiatrist/psychologist just to be sure. They're obligated (at least where i live) to tell you about the effects and side-effects.


It's been a few weeks since I stopped taking my medication. I can still hear my eyes move sometimes...

I hope you stepped down in dosage similar to what i described (and had consulted with your psychiatrist beforehand) before you decided to stop taking them. Going cold turkey is like playing with fire and for some individuals, lethal.
IIRC this can happen;
http://en.wikipedia.org/wiki/Serotonin_syndrome
And, from personal experience, Effexor is really dangerous regarding to that.

I found that effexor works for me but many friends and people i've talked to get really nasty withdrawal symptom and that's why it's MANDATORY that you talk to your doctor before you decide to stop taking them.
I had a friend who had the brain zaps and other symptoms even after three years of stopping with effexor.
It scares me that doctors are not aware of the sever withdrawal effexor tends to have and i think it should be handle with a lot more care than other prescribed drugs. I did not experience any permanent side-effects after i quit the last time but like i said, i had a friend who went through hell even after three years and i've read and heard about that many people have had similar reactions.
I have only used two SNRI's (effexor and cymbalta) and iirc cymbalta didn't have quite the severe withdrawal as effexor but it still was quite unpleasant. I wonder if this is common in all SNRI's?


EDIT:
If anyone's considering taking antidepressants because they cannot cope with whatever the shit they're dealing with but are still functional (with no severe diagnoses) i remember that my doctor recommended Escitalopram.
The side-effects were pretty much non existent and it kind of stabilized the ups and downs for me. I have severe diagnoses (probably) so it didn't give me the effect i was looking for but that particular drug could possibly be what you need.
It was easy to stop taking it for me as well. Iirc, i just stopped cold turkey (this is never recommended, talk with your doctor before), but it could help. I remember that my doctor told me that it was much more efficient than citalopram (which tend to be the go-to drug for mild depression). Anecdotal reports from various friends and family have had great success with it.


ALSO
For anyone considering prescribed drugs, demand therapy and weekly contact. Just getting the drug prescribed will not change your situation. It sounds idiotic and silly but it really helps having someone from the outside to talk to.
For the more "severe" cases, demand KBT/DBT. Hell, if things are really shitty.. Consider writing yourself into a mental hospital (it usually is shit though, they just pump you full of benzos).. but if you have suicidal tendencies it could be the best course of actions.

And for the different armchair opinions inside this thread that is telling us that we just need to "buckle up and deal with it". Refrain from posting in here at all. It does not help AT ALL and it infuriates me to no end. I remember when i was 14 that they recommended me to take a walk 20 minutes a day for my mental problems. So i did. The positive thing was i got some sunlight and a small exercise. Didn't do shit about my situation.
Yes, exercise and eating healthy can help (somewhat). But for severe depression and for people with severe diagnoses it's just a fucking insult.
 
I was on Paxil actually. I was on a low dosage and didn't feel like getting another refill, or going through the process of taking lower and lower dosages and getting off. If I was on a higher dosage I would have seen my doctor first definitely.

I don't think I need or want medication but I agree with you on therapy or weekly contact. For me, therapy is probably the best I can do.
 
I was on Paxil actually. I was on a low dosage and didn't feel like getting another refill, or going through the process of taking lower and lower dosages and getting off. If I was on a higher dosage I would have seen my doctor first definitely.

I don't think I need or want medication but I agree with you on therapy or weekly contact. For me, therapy is probably the best I can do.

Good for you!
As long as you're aware that it's withdrawal symptoms and that you can deal with them. Just be cautious.
If the withdrawal symptoms seem to increase and it becomes unbearable you might consider just taking half a pill for it to stabilize. I don't know the dosage and how long you've been on Paxil but consider having pills around just in case.

It's sad because usually you get the drugs prescribed first, and then have to nag your way to get the (imo) important treatment. And it seems to be common behaviour worldwide as well.
Going drug free is exactly what you should be striving for.. and if therapy seems to be working out then there's really no reason to take them.

EDIT:
Also, for those dealing with anxiety.. Try to refer from caffeine, nicotine, sugar and alcohol. Especially caffeine. If you need coffee to get up in the morning, consider tea. Or maybe try making smoothies instead. Smoothies with a lot of different berries and fruit gives you a boost and it also makes you feel a lot better. The sense of eating something that makes you feel healthy goes a long way.


Oh and one thing to note regarding alcohol. If you've just begun treatment with antidepressants.. Be wary of the effects of alcohol. My own experiences is that you cannot really tell if you're drunk or not and tend to drink a whole lot more for the desired effect, which then hits you like a sledgehammer.
This almost sounds like trying LSD or shrooms for the first time but if you're drinking alcohol for the first time after going on antidepressants, do it in a safe environment. Get a sense of how much you usually drink and how much you "need" to drink in order to get to the state you require. Drinking with close friends a couple of times before trying to drink and go out gives you a better sense of how much you need/want.
Know your psyche and body is a number one priority, and dealing with prescribed drugs is really just trial and error. This goes for caffeine, sugar and anything else.

If you like to use illegal drugs (especially amphetamines, ex, cocaine) note that antidepressants tend to diminish (actually not work at all) the effects. Antidepressants are inhibitors and since (especially x) work on serotonin, they block the effect.
This is purely anecdotal and from personal experiences of course.
 
Is it normal to think about suicide daily? To plan it out? I'm not really depressed and life isn't going that badly.. its just.. i never get as happy or excited about anything anymore.

Could it be a side effect of one of my medications? I'm taking ambien and zoloft... if anybody knows please tell me.. its very disturbing.

I'm not a doctor but from taking those myself I remember reading it's a known side effect of one of those drugs. Go read the, err, manual and hit up a doctor immediately.
 
ALSO
For anyone considering prescribed drugs, demand therapy and weekly contact. Just getting the drug prescribed will not change your situation. It sounds idiotic and silly but it really helps having someone from the outside to talk to.
For the more "severe" cases, demand KBT/DBT. Hell, if things are really shitty.. Consider writing yourself into a mental hospital (it usually is shit though, they just pump you full of benzos).. but if you have suicidal tendencies it could be the best course of actions.
Indeed. If it's really out of control then admit yourself. I remember finally hitting rock bottom.. My sister could've walked into the room, started talking and I don't think I would've known what she was saying.

They gave me celexa for a couple weeks since I wasn't exactly bouncing off the walls. It was a very mild effect; I could feel it working as I didn't wake up every morning dreading the day ahead, but damn did it ever make me tired. Had to take a two hour nap midday every time.

I stayed a couple weeks and got out August 19th, one day before my 25th birthday. The stay moved me to the top of the list with MHMRA (the wait time is usually around a year), so it got me the treatment I needed much quicker. After meetings with my doctor, she had me on 20mg of prozac for awhile. I've since stopped taking it for over 3 months and generally do feel like my old self, if not unequivocally better. I'm very aware of the risks involved.

All prozac did was keep me from extremes. Yeah I didn't want to kill myself anymore, but I didn't enjoy much else either. It made me sleep about 9.5 hours a night, too. I was on it for about 4 months and that was enough for me to say, "Nah". I view therapy as far more important, too, and they have you stable on drugs before they ever really talk to you in depth. I talked far, far more to my social worker than I ever did my doctor because she was purposely more available.

The approach they take is logical... But frankly you're going to be mired in yourself for quite some time even if they do look at you.

And for the different armchair opinions inside this thread that is telling us that we just need to "buckle up and deal with it". Refrain from posting in here at all. It does not help AT ALL and it infuriates me to no end. I remember when i was 14 that they recommended me to take a walk 20 minutes a day for my mental problems. So i did. The positive thing was i got some sunlight and a small exercise. Didn't do shit about my situation.
Yes, exercise and eating healthy can help (somewhat). But for severe depression and for people with severe diagnoses it's just a fucking insult.
90% of that comes from people who've never had any major depression or mental illness. If you had really fallen so far from grace, you'd understand that feeling. Not understanding is damn near psychopathic - I don't think many people telling us to bootstrap actually fit that criteria. They just haven't suffered enough to get it. I will attack their character and I will question just how bad they had things because those are all signs of experience.

I'm not comparing or playing the guilt trip card. Don't care about that. But I do care about people speaking on things which they know nothing about. Asking them to be human is not unreasonable.

Ultimately change comes from within. Wanting to change, acting to change, and maintaining that change (i.e. the hard part) are self-regulated. Nobody can do those things for you. You have to want them, and sometimes you have to see just how bad it can get if you don't want them.
 
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