Depression
- Thread starter Jea Song
- Start date
- Status
Are there any prescription drugs to make me feel not myself? I am afraid I am going to still in this place for another 5 - 10 years still going to therapy and nothing will ever change. Stuff like this eat at my mind and soul and makes me want to just say to hell with it all and do something regretful. At night I pray to help me change my life or even just die in my sleep. To die actually would be best as I don't have to think or feel anything and nothing will be missed. I'm not exactly going to meet anyone or have some impact on anything. Life isn't worth living. I feel like I wasted my time trying to do the right thing going to college getting a job only to live in this hell in my mind. This is probably how people go crazy and become psycho killers or something. I feel like I rather just die as myself now than do anything irrational in the future. Therapy isn't going to help they will just keep saying the same crap for years as long as I pay the bill then if I go insane I'll become the state's problem. Therapy doesn't help at all it's seems to be a joke.
I have no talent no interests I am not good looking or creative or anything at all. I have no skills. I'm pretty much a loser in every way. No ambition nothing to show for anything I've done. Who wants to date a loser like me. Maybe if I did die it would show my mother how horrible she is and maybe make my sister start living her own life.
I have no talent no interests I am not good looking or creative or anything at all. I have no skills. I'm pretty much a loser in every way. No ambition nothing to show for anything I've done. Who wants to date a loser like me. Maybe if I did die it would show my mother how horrible she is and maybe make my sister start living her own life.
I look back at my own life and have felt the same at one point. Well now I have most of the things I dreamt of. It didn't happen over night and was a long trip, but here I am enjoying life. You are blind to the potential "bright future" where you are now, but only getting up and changing your ways of life can help you. Therapy and medicine helps, but are not the ultimate solution.
Realise that there is no grand power helping you or stopping you from getting healthy and happy. Just you and the world and you can stop living someone else's life right now.
I recommend completely changing your daily routines. Get rid of your addictions.
Out of Working Order
Member
Neojubei, you say you have no interests or talents, but depression can make you uninterested in things you do normally enjoy. I know that is the case for me.
If you can lift that veil of depression, you can find something you are good at. Find something to enjoy.
If you can lift that veil of depression, you can find something you are good at. Find something to enjoy.
I can't speak for you but it was very apparent you had interests and things you enjoy doing.
Maybe you don't think much of them which I can understand with though.
Also you're not ugly at all
Charoncaori
Member
I decided I'd rather spend the night on GAF again instead of going out with my friends... Sucks. I can't even catch up on games like this because I don't have any desire to play anything.
Depression is horrible for backlogs. Hoping I can motivate myself to keep my intake appointment on Thursday...
Depression is horrible for backlogs. Hoping I can motivate myself to keep my intake appointment on Thursday...
I see a lot of people talking about anti-depressants, and while it's obvious, I wanted to stress the importance of doing some kind of therapy in conjunction with the medication. I've met so many people who take the pills, feel a bit better, and then go back to how they were before without really changing. Now while this may not apply to everyone, it definitely does to the people who are struggling with depression.
Being alone is so much easier and less stressful, but so much worse in the long run. Then again, pushing ourselves to be with other people all the time can be just as destructive. I guess we gotta find a balance.
Visualante2
Member
I think the core thing is to have people around you that actually care about you. Surrounding yourself with people who don't understand or care about you is completely worthless. It shouldn't be an effort.
It took me a couple tries before I posted anything in this thread. You want to say something but at the same time you don't, lol. I figure a lot of people experience that, but fuck, no one in here is going to judge you, we've all got similar problems.
I get anxiety attacks too, and they come on pretty randomly. It's like I think I'm ok being a certain situation and then one day, bam, I feel like I can't breath.
Charoncaori
Member
I can't handle this anymore. I can't take any responsibilities. I can't even watch a fucking movie without being reminded of shit I have to do in the middle. I can't fucking relax and I'm just shutting down. I snap at everything. I just fucking want to be left alone. If I could drive I would just find a fucking motel and sleep for a few days. I can't do this.
Admitting you have problems until the depression turns into bad mood and some frustration, is the first steps. I'm kinda stuck there currently... it's loads better than depression though.
Actually I think my depression many years ago started with bad mood and frustration. I didn't know what to do with it and just turned it inwards, against myself or something.
Actually I think my depression many years ago started with bad mood and frustration. I didn't know what to do with it and just turned it inwards, against myself or something.
You answering to me or just in general?
I know i suffer from depression, i could list all the things indicating it but just take my word for it ok? (No diagnosis done, probably should visit a therapist but...)
Just wondering if being easily discouraged is one possible symptom of depression.
Oh and as i asked earlier, can depression affect memory? There are many things i know happened in the past but unless i somehow deduce the times somehow, i cannot tell how long ago something happened.
Just in general.
And I think you should focus on the current.
But I'm not sure.. I might need therapy.
Yes, i should focus on the present and the future. But i bothers me i cannot remember properly. It bothers me because i'm not sure if it is due depression or something else. Something else would be worse, naturally.
Also, fuck nostalgia. I feel more at home thinking about my memories. I keep thinking what could have been. I keep regretting certain decisions.
At least there are things that can be rectified later on... but when that doesn't work, i'm discouraged instead keeping trying...
ThisWreckage
Banned
Most therapists laugh at people while cashing checks. Don't be naive. There are better alternatives than a therapist. I've known therapy to make people worse, actually.
Thanks for your incredible insight! It's interesting that while "there are better alternatives than a therapist," you somehow neglected to name a single one. That's curious. I'd love to hear your brilliant, measured thoughts on this topic!
I find talking to my parents about my problems more therapeutic than an actual therapist. I'm pretty sure I inherited all my mental issues from them, so they know exactly what I go through.
ClassyPenguin
Banned
I think you are the one who is naive if you really believe that.
When in therapy, the patient is the one who has to open up about their lives and experiences. The therapy isn't magic, it takes a lot of effort to be truthful and honest with basically, a stranger.
Absolutely. There's even a putative physiological reason for this. If you look at the hippocampus - basically the brain structure responsible for transforming short-term memory into long-term memory (among other things) - in depressed people, it actually shrinks. This was first noticed in autopsies of people who had suffered from untreated depression (often suicides) but has since been demonstrated with MRI.
The hippocampus is one of the areas of the adult brain that continues to form new neurons thoughout life (you'll often hear that the human brain stops growing new neurons at some point in your life. We've known this isn't true for over 10 years. It's just that there aren't many brain regions that do so). One of the many recent theories explaining how antidepressants work is that they promote neurogenesis. This has been shown in some animal models, and you can see an increase in hippocampal size in depressed individuals who have been successfully treated, but it hasn't really been definitively demonstrated.
So there you go. At an initial visit with a psychiatrist, you'll be given one of several mini mental status exams. Depressed people often do poorly on the parts related to memory.
From personal experience, the periods of my life associated with the worst depression are all pretty hazy. I remember key events almost as if they happened to someone else, and I was watching from the outside.
I started keeping journals when I was first diagnosed with depression, and looking back at them, I'll find all sorts of stuff that I had forgotten had happened. I highly recommend keeping a journal, for many reasons, really, but at the very least, it can be helpful in filling in hazier bits of your memory.
I hate to break it to you, but your parents are laughing all the way to the bank as they cash your checks.
Kidding aside, you make a good point. When someone suggests you see a therapist or physician, I don't think they ever mean you should ONLY talk to those people. Professionals can obviously offer professional advice, but family and friends who share your problems can offer insights that a relative stranger can't.
Depression runs in my family, too, and I've learned a lot from talking to my parents, aunts, uncles, cousins. My best friend also suffers from depression, and is a neuroscientist to boot, and she and I watch out for each other and have served as better therapists for each other than our actual therapists.
The only caveat is that many people don't understand or "believe in" depression. I used to talk to another friend about what I was going through, but he just fundamentally doesn't believe in medications for depression, or really in depression in general, so he'd just end up pissing me off. It took me a while, but I finally though, "maybe I shouldn't try to get help with my depression from someone who doesn't think it's real."
Okay, I'm getting trolled right?
1.) If you're suffering from depression, why would that make you want to take up a career duping other depressed people?
2.) Depression is a chronic condition. I'm not sure you can actually "cure" it. I prefer to say I'm "in remission." Depression can and will reoccur in most people. Even if it doesn't, it takes constant vigilance to head it off. You learn about all of this stuff in CBT.
3.) How much do people think therapists make? How much would you want to be paid to listen to someone talk about being abused as a child, being depressed, crying, complaining - basically your job is to talk exclusively to sad, deeply broken people. How much would you charge to listen to an hour of nothing but negativity? Factor in the fact that this is what you'll do all day, every day. Got a number? Okay, you're not getting paid close to that.
4.) Most psychiatrists don't practice much talk therapy any more. There are some residency programs that focus almost exclusively on talk therapy, but modern psychiatry is a team-based practice, with a psychiatrist overseeing your care and managing your meds, while psychologists and various therapists handle things like CBT. Part of the reason is money, absolutely (an hour of talk therapy is not reimbursed nearly as well as a shorter visit for medication management), but it's also about specialization. If you want to get really good at using psychoactive drugs to treat even a subset of disorders - say mood disorders - you basically need to focus on just that. The same goes for ECT, or child psychiatry, or forensic psychiatry.
5.) Psychiatry is considered one of the "under-paid" specialties. I know - boo-hoo. Poor doctor has to settle for the C-class Mercedes instead of the S-class. Still, if you're in it purely for the money, you go for dermatology, radiology, plastic surgery, anesthesiology, or ophthalmology. Not saying those people are all in it for the money (except for dermatologists), but if you are in it for the money, and you choose psychiatry, you fucked up.
Well, i guess i'm sort of happy to know any memory issues i have are due to depression, not something else (i'd rather not even think what that "something else" might be).
I think my depression was really triggered when my father died... I really don't remember when that happened. I have no idea what year it was and... well, it was probably 2008. But i cannot remember anything from that year. The next things i remember are from 2010... I think, based on some message time stamps anyway.
Duh, now i'm staring this text and trying to remember stuff.
I feel the same way... so tonight I ordered a stress ball and some stress putty. I am very intrigued by the putty. I enjoy having something to fiddle with while I'm just idling around, watching TV, or browsing the web, etc... (no penis jokes please). It does help relax for some reason. That coupled with some rainymood or rainfor.me will hopefully be helpful.
http://www.amazon.com/gp/product/B0044V7BE4/?tag=neogaf0e-20
http://www.amazon.com/gp/product/B001CS5GAI/?tag=neogaf0e-20
I got a stress ball that has Meatwad from Aqua Teen Hunger Force printed on it. Its pretty cool.
I don't use it though, I use those little hand grip things that people squeeze to strengthen their forearms for the same thing.
I was thinking about getting some of those. A while ago I had a site bookmarked with some really tough ones. I work with my hands so I'd probably be better served by using a grip strengthener... but come on now... PUTTY.
I'd still recommend getting examined by a professional - a neurologist or psychiatrist would be best, but a primary care doc can also do some simple tests of the various aspects of your memory.
I don't want to freak you out, but in medicine you need to simultaneously think of the most likely cause of a particular problem, as well as the things you absolutely would not want to miss. If you do have another reason for your memory loss, it's important to find out as soon as possible because a) it could be due to something that's treatable (including depression) or b) it could be something more worrisome. In the latter case, there are treatments to slow the progression of some diseases or even cures for other problems.
At the very least, see a psychiatrist or your primary care doc if you think you might be suffering from depression. There's no reason to walk around with impaired memory when you can get that problem fixed.
la flama blanca
Banned
Anyone deal with emetophobia? I've been sick for a few months now, questions lingering between whether my daily nausea is psychosomatic or if there are real issues with me. Just not too long ago I was having a panic attack over feeling like I had to vomit. I can't remember the last time I vomited and fear the possibility of choking to death while doing it. I've been so depressed because of all of this, I've somewhat ventured into the suicidal thinking aspect of my emotions and feel very guilty because thats not a place I want to be.
Many people suffer from both anxiety and depression, so I thought I'd try to provide a brief overview of the pharmacotherapies for both anxiety and depression - drugs that work for both problems and drugs that can be added to antidepressants to control anxiety.
So, first post: general information about meds for Generalized Anxiety Disorder. Second post: information on individual meds.
The information is all condensed from summary articles last updated in April of this year, with my own little comments sprinkled in. I've tried to make it very clear where I'm editorializing or providing my own anecdotes.
Generalized anxiety disorder (GAD) is characterized by excessive worry and anxiety that are difficult to control, cause significant distress and impairment, and occur on more days than not for at least six months.
Generalized anxiety disorder (GAD) is a relatively common disorder, most often with onset during adulthood and a chronic course. The disorder can be effectively treated with medication, psychotherapy, or a combination of the two modalities.
FIRST-LINE MEDICATIONS — First-line medications for GAD are selective-serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
Selective serotonin reuptake inhibitors — SSRIs are all thought to be more or less equally effective - the big differences are in the side effect profiles (and cost). Your individual biochemistry will determine what drug(s) work/don't work for you. Paroxetine (Paxil) is the best studied SSRI for anxiety.
Therapeutic doses of SSRIs are approximately the same as for the treatment of depression. Starting doses from the lower end of the recommended range should be used to avoid initial agitation.
Time to onset of clinically meaningful action for an SSRI varies by patient, but averages approximately four weeks. A concomitantly administered benzodiazepine (eg, lorazepam 1 to 2 mg/day in divided doses) can be used to treat agitation and anxiety during this time. After four weeks, if a patient has shown a partial response, the dose can be slowly increased. If the patient has not shown any signs of improvement after six to eight weeks on a therapeutic dose, the medication should be tapered off and another medication should be tried.
If treatment with an SSRI is not effective, typically a second trial with a different SSRI would precede a switch to use of a second-line medication or augmentation of the initial SSRI.
Serotonin–norepinephrine reuptake inhibitors — Serotonin–norepinephrine reuptake inhibitors (SNRIs) inhibit serotonin and norepinephrine (noradrenaline) reuptake.
SNRIs are comparable to SSRIs in efficacy and tolerability for GAD. As of now, the only generic SNRI is immediate release Venlafaxine (Effexor), which has more side effects than the extended release, still under patent, Effexor XR. So if cost is an issue, you're probably not going to go here. I will say that, looking back over my own history with medications, I've done the best with drugs that have norepinephrine reuptake inhibitory properties (the 'N' in 'SNRI' is norepinephrine (also called noradrenaline)). Effexor XR is covered on my insurance, so it's $20 a month for me.
If you don't have insurance, or your insurance sucks, make sure you tell your health care provider. Consumer Reports placed the out of pocket cost for generic Prozac (fluoxetine) at $4/month. Cymbalta, which is still under patent, was $200/month.
I'll dump the antidepressant Mirtazapine (Remeron) in here, too. It's a tetracyclic AD, which is kind of neat, but it's basically as effective as any of the other ADs. The one unique thing worth mentioning is that it can dramatically increase your appetite. So, if you need to gain weight, or just don't feel like eating, this may be the drug for you. I gained 15 pounds while I was taking it, basically because I NEVER felt full. I just ate everything in the house. When I stopped taking it (I had an improvement in mood for a few weeks, but it wore off), I lost all the weight just by eating normally again.
SECOND-LINE MEDICATIONS — Second-line medications for GAD include tricyclic antidepressants, benzodiazepines, and certain anti-convulsants.
Tricyclic antidepressants — SSRIs and SNRIs are generally preferred over TCAs because the latter have an increased risk of cardiotoxicity in overdose and less acceptable tolerability profiles. Tricyclics and SSRIs (or SNRIs) are all basically equally effective in treating depression and tricyclics are dirt-cheap. SSRIs are preferred not because they're more effective, but because they're way safer in suicide attempt by overdose. Nick Drake, whose album "Pink Moon" is probably my favorite artistic work "about" depression (you can hear how physically painful it is for him to sing each word), killed himself with an overdose of a tricyclic.
Benzodiazepines — Benzodiazepines have been found to be efficacious in the treatment of GAD, generally leading to a reduction of emotional and somatic symptoms within minutes to hours, depending on the specific medication. However, concerns about risks of dependence and tolerance have contributed to a decline in their use. Where I'm studying, the shrinks prefer Klonopin and Ativan, which have longer half-lives, so you can take one or two small doses a day for maintenance therapy, and they're not as addictive as some of the other benzos. In many countries, benzos are THE most abused prescription drugs. The pharmacological effect is similar to that of alcohol. Benzos reduce your anxiety, lower your inhibitions, relax your muscles, and just generally make you feel good. With that in mind, there's a clinical pearl that the first 'x' in Xanax is to tell you not to prescribe it, and the second 'x' is there in case you missed the first one - do not prescribe it. Xanax acts very fast, has a very short half-life, and produces a "high" in many people. It's crazy addictive. Personal opinion: Unless it's the only drug that works for you, or you experience severe panic attacks with rapid onset, do not take Xanax. Unless of course your objective is to abuse and potentially become addicted to prescription drugs. The caveat there is that benzo withdrawal is apparently one of the absolute worst, beating out even things like heroin.
One important side effect of benzodiazepines (aside from a general drunk-like state - people suspected of drunk driving who have negative breathalyzer tests are often found to have healthy doses of benzos in their systems) is amnesia ("roofies" are the benzodiazepine flunitrazepam). Dependence and withdrawal symptoms after long-term treatment, and rebound anxiety after short-term treatment. Withdrawal and cognitive or learning impairment are more likely for persons taking higher doses.
In contrast to the antidepressants discussed above, which are thought to exert their primary effect via either the serotonergic or noradrenergic system or both, the benzodiazepines act mostly via gamma-aminobutyric acid (GABA). Antidepressants take several weeks to exert their effects, whereas your first dose of a benzo will have an effect within 30 minutes. They're very different drugs in that regard.
Buspirone — has been shown in several randomized trials to reduce symptoms of anxiety in patients with GAD, offering similar efficacy to the benzodiazepine oxazepam without the risk of dependence. Buspirone’s FDA approval for “anxiety disorders” preceded the tendency of FDA to assign indications according to specific psychiatric disorders, but it is generally considered to apply to the diagnosis of GAD.
Buspirone’s time to onset is longer than the benzodiazepines’ and similar to the antidepressants’ average of four weeks.
Pregabalin — It has recently been approved for the treatment of anxiety in Europe. Pregabalin is not approved for treating GAD by the US FDA. Side effects include sedation and dizziness. Tolerance, withdrawal and dependence are possible, but pregabalin is generally better tolerated than benzodiazepines.
OTHER MEDICATIONS — Over 40 percent of GAD patients fail to improve or have residual symptoms in response to multiple trials of first and second-line medications. Thus, a number of medications have been used as monotherapy or augmenting agents for treatment-resistant GAD despite variable levels of supporting evidence. These include other antidepressants, buspirone, and atypical antipsychotics.
Antipsychotic medications — Another potential pharmacological treatment strategy for treatment resistant GAD involves the use of second-generation antipsychotic medication. Several randomized clinical trials support the use of atypical neuroleptics in GAD, either as part of an augmentation strategy or as single agents. Quetiapine has been used for GAD, but has not been approved for the disorder by the US FDA. The neuroleptics can have some serious side effects, so deciding to try one is something to think about only when you've exhausted your other options. I tried two different neuroleptics as off-label sleep aids. I have major problems with insomnia, so we tried using all sorts of drugs that have sedation as a side effect, at low doses. A few months on Seroquel and my cholesterol went crazy high. It came back down when I stopped the drug, but I don't know what I would have done had it given me restful, regular sleep.
Hydroxyzine — appears efficacious for GAD, though the studies that have been done may have suffered from inherent bias in their design (I don't know anything about this. This is just what the article says). Hydroxyzine was found to be more sedating than benzodiazepines and buspirone, and thus potentially useful for treating insomnia associated with GAD.
COMPLEMENTARY AND ALTERNATIVE TREATMENTS - just remember that the fact that something is "natural" does not necessarily mean it's safe. The natural world is full of incredibly potent toxins. Also, alternative medications can interact with pharmaceuticals. When your health care provider asks for a list of your current medications, include herbal supplements, folk remedies, and that raw human placenta you've been injecting into your spine. Dosing is all over the map, too. Have that information for your doc. Your best bet is to bring the actual bottles with you. There is SOME information out there about the actual effective dose of various herbs and things in different brands' formulations. Also, keep in mind (with all treatments) that more is not necessarily better, and 'a whole lot more' is almost always terrible for you. You can poison yourself with mega doses of vitamins. Even moderately large doses can be hazardous. As the importance of vitamin E was discovered and filled in, people began taking large doses in the belief that it would fight aging and prevent disease. Except that, when large studies were finally conducted, it was found that large doses of vitamin E are actually associated with INCREASED morbidity and mortality.
Kava-kava, valerian root and passion flower have been used in the treatment of anxiety. However, there are no adequate randomized trials of these agents in GAD. Kava-Kava has been linked to acute liver failure and was temporarily taken off the market. Herbal remedies have been also associated with significant drug interactions.
Acupuncture for GAD has been studied in several randomized trials; however, methodologic problems limit the conclusions that can be drawn from these reports. I've never tried acupuncture (or seen a chiropractor, etc.) for any condition, but some people swear by it.
Preliminary evidence suggests that exercise reduces anxiety sensitivity and may reduce generalized anxiety. The clinical implications of these limited data are yet to be determined.
DURATION OF PHARMACOTHERAPY — If effective, antidepressant treatment for GAD should be continued for at least 12 months rather than the six months supported by previous research. In a randomized trial, 136 patients with GAD who experienced reduced anxiety during six months of treatment with venlafaxine XR were assigned to continue the medication or to placebo for an additional six months. Patients continuing venlafaxine XR had a much lower rate of relapse during the second six months than patients receiving placebo (9.8 versus 53.7 percent). Incidence rates of side effects during the second six months compared to the first six months were lower, did not differ statistically between drug and placebo patients, and included no new side effects.
If the patient experiences a relapse following termination of an effective medication, the length of treatment can be extended. After two relapses when tapering off the medication, ongoing maintenance treatment should be considered.
COMPARING MEDICATION TO CBT — There is insufficient evidence directly comparing the effectiveness of medication for GAD to cognitive behavioral therapy (CBT), the best studied and most effective psychotherapy for GAD. Meta-analyses comparing the effect sizes of the two modalities have found largely equivalent results. We (the people who wrote the original article, not the faculty of the Bagels Medical Institute) suggest that the choice between them should be based on treatment availability and patient preference.
I'll plug Mind Over Mood again. It's often used in both the inpatient and outpatient settings AND it's set up as a workbook that you can go through by yourself.
COMBINED MEDICATION AND CBT — Two trials have found the combination of a benzodiazepine and CBT to be more effective for GAD than a benzodiazepine alone.
While they can be beneficial, treatment that integrates medication with CBT should be administered with caution to avoid counterproductive interactions. As an example, benzodiazepines and, to a lesser degree, sedating SSRIs can disrupt the learning of new coping strategies, a mechanism that is fundamental to CBT. Several principals should guide combined treatment:
Stabilization of medications prior to starting CBT
Avoidance of “as needed” or large doses of benzodiazepines
Avoidance of other medications that have sedative effects (eg, sedative SSRIs) while CBT is in progress.
More in part two!
So, first post: general information about meds for Generalized Anxiety Disorder. Second post: information on individual meds.
The information is all condensed from summary articles last updated in April of this year, with my own little comments sprinkled in. I've tried to make it very clear where I'm editorializing or providing my own anecdotes.
Generalized anxiety disorder (GAD) is characterized by excessive worry and anxiety that are difficult to control, cause significant distress and impairment, and occur on more days than not for at least six months.
Generalized anxiety disorder (GAD) is a relatively common disorder, most often with onset during adulthood and a chronic course. The disorder can be effectively treated with medication, psychotherapy, or a combination of the two modalities.
FIRST-LINE MEDICATIONS — First-line medications for GAD are selective-serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
Selective serotonin reuptake inhibitors — SSRIs are all thought to be more or less equally effective - the big differences are in the side effect profiles (and cost). Your individual biochemistry will determine what drug(s) work/don't work for you. Paroxetine (Paxil) is the best studied SSRI for anxiety.
Therapeutic doses of SSRIs are approximately the same as for the treatment of depression. Starting doses from the lower end of the recommended range should be used to avoid initial agitation.
Time to onset of clinically meaningful action for an SSRI varies by patient, but averages approximately four weeks. A concomitantly administered benzodiazepine (eg, lorazepam 1 to 2 mg/day in divided doses) can be used to treat agitation and anxiety during this time. After four weeks, if a patient has shown a partial response, the dose can be slowly increased. If the patient has not shown any signs of improvement after six to eight weeks on a therapeutic dose, the medication should be tapered off and another medication should be tried.
If treatment with an SSRI is not effective, typically a second trial with a different SSRI would precede a switch to use of a second-line medication or augmentation of the initial SSRI.
Serotonin–norepinephrine reuptake inhibitors — Serotonin–norepinephrine reuptake inhibitors (SNRIs) inhibit serotonin and norepinephrine (noradrenaline) reuptake.
SNRIs are comparable to SSRIs in efficacy and tolerability for GAD. As of now, the only generic SNRI is immediate release Venlafaxine (Effexor), which has more side effects than the extended release, still under patent, Effexor XR. So if cost is an issue, you're probably not going to go here. I will say that, looking back over my own history with medications, I've done the best with drugs that have norepinephrine reuptake inhibitory properties (the 'N' in 'SNRI' is norepinephrine (also called noradrenaline)). Effexor XR is covered on my insurance, so it's $20 a month for me.
If you don't have insurance, or your insurance sucks, make sure you tell your health care provider. Consumer Reports placed the out of pocket cost for generic Prozac (fluoxetine) at $4/month. Cymbalta, which is still under patent, was $200/month.
I'll dump the antidepressant Mirtazapine (Remeron) in here, too. It's a tetracyclic AD, which is kind of neat, but it's basically as effective as any of the other ADs. The one unique thing worth mentioning is that it can dramatically increase your appetite. So, if you need to gain weight, or just don't feel like eating, this may be the drug for you. I gained 15 pounds while I was taking it, basically because I NEVER felt full. I just ate everything in the house. When I stopped taking it (I had an improvement in mood for a few weeks, but it wore off), I lost all the weight just by eating normally again.
SECOND-LINE MEDICATIONS — Second-line medications for GAD include tricyclic antidepressants, benzodiazepines, and certain anti-convulsants.
Tricyclic antidepressants — SSRIs and SNRIs are generally preferred over TCAs because the latter have an increased risk of cardiotoxicity in overdose and less acceptable tolerability profiles. Tricyclics and SSRIs (or SNRIs) are all basically equally effective in treating depression and tricyclics are dirt-cheap. SSRIs are preferred not because they're more effective, but because they're way safer in suicide attempt by overdose. Nick Drake, whose album "Pink Moon" is probably my favorite artistic work "about" depression (you can hear how physically painful it is for him to sing each word), killed himself with an overdose of a tricyclic.
Benzodiazepines — Benzodiazepines have been found to be efficacious in the treatment of GAD, generally leading to a reduction of emotional and somatic symptoms within minutes to hours, depending on the specific medication. However, concerns about risks of dependence and tolerance have contributed to a decline in their use. Where I'm studying, the shrinks prefer Klonopin and Ativan, which have longer half-lives, so you can take one or two small doses a day for maintenance therapy, and they're not as addictive as some of the other benzos. In many countries, benzos are THE most abused prescription drugs. The pharmacological effect is similar to that of alcohol. Benzos reduce your anxiety, lower your inhibitions, relax your muscles, and just generally make you feel good. With that in mind, there's a clinical pearl that the first 'x' in Xanax is to tell you not to prescribe it, and the second 'x' is there in case you missed the first one - do not prescribe it. Xanax acts very fast, has a very short half-life, and produces a "high" in many people. It's crazy addictive. Personal opinion: Unless it's the only drug that works for you, or you experience severe panic attacks with rapid onset, do not take Xanax. Unless of course your objective is to abuse and potentially become addicted to prescription drugs. The caveat there is that benzo withdrawal is apparently one of the absolute worst, beating out even things like heroin.
One important side effect of benzodiazepines (aside from a general drunk-like state - people suspected of drunk driving who have negative breathalyzer tests are often found to have healthy doses of benzos in their systems) is amnesia ("roofies" are the benzodiazepine flunitrazepam). Dependence and withdrawal symptoms after long-term treatment, and rebound anxiety after short-term treatment. Withdrawal and cognitive or learning impairment are more likely for persons taking higher doses.
In contrast to the antidepressants discussed above, which are thought to exert their primary effect via either the serotonergic or noradrenergic system or both, the benzodiazepines act mostly via gamma-aminobutyric acid (GABA). Antidepressants take several weeks to exert their effects, whereas your first dose of a benzo will have an effect within 30 minutes. They're very different drugs in that regard.
Buspirone — has been shown in several randomized trials to reduce symptoms of anxiety in patients with GAD, offering similar efficacy to the benzodiazepine oxazepam without the risk of dependence. Buspirone’s FDA approval for “anxiety disorders” preceded the tendency of FDA to assign indications according to specific psychiatric disorders, but it is generally considered to apply to the diagnosis of GAD.
Buspirone’s time to onset is longer than the benzodiazepines’ and similar to the antidepressants’ average of four weeks.
Pregabalin — It has recently been approved for the treatment of anxiety in Europe. Pregabalin is not approved for treating GAD by the US FDA. Side effects include sedation and dizziness. Tolerance, withdrawal and dependence are possible, but pregabalin is generally better tolerated than benzodiazepines.
OTHER MEDICATIONS — Over 40 percent of GAD patients fail to improve or have residual symptoms in response to multiple trials of first and second-line medications. Thus, a number of medications have been used as monotherapy or augmenting agents for treatment-resistant GAD despite variable levels of supporting evidence. These include other antidepressants, buspirone, and atypical antipsychotics.
Antipsychotic medications — Another potential pharmacological treatment strategy for treatment resistant GAD involves the use of second-generation antipsychotic medication. Several randomized clinical trials support the use of atypical neuroleptics in GAD, either as part of an augmentation strategy or as single agents. Quetiapine has been used for GAD, but has not been approved for the disorder by the US FDA. The neuroleptics can have some serious side effects, so deciding to try one is something to think about only when you've exhausted your other options. I tried two different neuroleptics as off-label sleep aids. I have major problems with insomnia, so we tried using all sorts of drugs that have sedation as a side effect, at low doses. A few months on Seroquel and my cholesterol went crazy high. It came back down when I stopped the drug, but I don't know what I would have done had it given me restful, regular sleep.
Hydroxyzine — appears efficacious for GAD, though the studies that have been done may have suffered from inherent bias in their design (I don't know anything about this. This is just what the article says). Hydroxyzine was found to be more sedating than benzodiazepines and buspirone, and thus potentially useful for treating insomnia associated with GAD.
COMPLEMENTARY AND ALTERNATIVE TREATMENTS - just remember that the fact that something is "natural" does not necessarily mean it's safe. The natural world is full of incredibly potent toxins. Also, alternative medications can interact with pharmaceuticals. When your health care provider asks for a list of your current medications, include herbal supplements, folk remedies, and that raw human placenta you've been injecting into your spine. Dosing is all over the map, too. Have that information for your doc. Your best bet is to bring the actual bottles with you. There is SOME information out there about the actual effective dose of various herbs and things in different brands' formulations. Also, keep in mind (with all treatments) that more is not necessarily better, and 'a whole lot more' is almost always terrible for you. You can poison yourself with mega doses of vitamins. Even moderately large doses can be hazardous. As the importance of vitamin E was discovered and filled in, people began taking large doses in the belief that it would fight aging and prevent disease. Except that, when large studies were finally conducted, it was found that large doses of vitamin E are actually associated with INCREASED morbidity and mortality.
Kava-kava, valerian root and passion flower have been used in the treatment of anxiety. However, there are no adequate randomized trials of these agents in GAD. Kava-Kava has been linked to acute liver failure and was temporarily taken off the market. Herbal remedies have been also associated with significant drug interactions.
Acupuncture for GAD has been studied in several randomized trials; however, methodologic problems limit the conclusions that can be drawn from these reports. I've never tried acupuncture (or seen a chiropractor, etc.) for any condition, but some people swear by it.
Preliminary evidence suggests that exercise reduces anxiety sensitivity and may reduce generalized anxiety. The clinical implications of these limited data are yet to be determined.
DURATION OF PHARMACOTHERAPY — If effective, antidepressant treatment for GAD should be continued for at least 12 months rather than the six months supported by previous research. In a randomized trial, 136 patients with GAD who experienced reduced anxiety during six months of treatment with venlafaxine XR were assigned to continue the medication or to placebo for an additional six months. Patients continuing venlafaxine XR had a much lower rate of relapse during the second six months than patients receiving placebo (9.8 versus 53.7 percent). Incidence rates of side effects during the second six months compared to the first six months were lower, did not differ statistically between drug and placebo patients, and included no new side effects.
If the patient experiences a relapse following termination of an effective medication, the length of treatment can be extended. After two relapses when tapering off the medication, ongoing maintenance treatment should be considered.
COMPARING MEDICATION TO CBT — There is insufficient evidence directly comparing the effectiveness of medication for GAD to cognitive behavioral therapy (CBT), the best studied and most effective psychotherapy for GAD. Meta-analyses comparing the effect sizes of the two modalities have found largely equivalent results. We (the people who wrote the original article, not the faculty of the Bagels Medical Institute) suggest that the choice between them should be based on treatment availability and patient preference.
I'll plug Mind Over Mood again. It's often used in both the inpatient and outpatient settings AND it's set up as a workbook that you can go through by yourself.
COMBINED MEDICATION AND CBT — Two trials have found the combination of a benzodiazepine and CBT to be more effective for GAD than a benzodiazepine alone.
While they can be beneficial, treatment that integrates medication with CBT should be administered with caution to avoid counterproductive interactions. As an example, benzodiazepines and, to a lesser degree, sedating SSRIs can disrupt the learning of new coping strategies, a mechanism that is fundamental to CBT. Several principals should guide combined treatment:
Stabilization of medications prior to starting CBT
Avoidance of “as needed” or large doses of benzodiazepines
Avoidance of other medications that have sedative effects (eg, sedative SSRIs) while CBT is in progress.
More in part two!
ThisWreckage
Banned
Therapy tremendously harmed my college roommate. I'm not going to write off the entire field of psychiatry, but going to therapy can definitely make one worse. It has the ability to make one better, worse, or it may have no effect on the person whatsoever. If you're disputing that I have no idea what else to say to you.
Therapy never helped me. It made my roommate worse. I got better by exercising. I got better by staying busy and involving myself in hobbies. I got better by discussing problems with honest to goodness friends that have known for me for some time. Paying a stranger a hundred bucks an hour wasn't going to jack shit for me.
If you had said "[Therapy] has the ability to make one better, worse, or it may have no effect on the person whatsoever. Therapy never helped me. It made my roommate worse." That would have been a valuable contribution to the thread. Instead, you said, "Most therapists laugh at people while cashing checks. Don't be naive. There are better alternatives than a therapist. I've known therapy to make people worse, actually."
ThisWreckage
Banned
I believe it is a field that preys on the weak just as much as it potentially helps them.
Insane Metal
Member
Not exactly depression, but I'm feeling so fucking weird today, for a couple of reasons.
First and mostly, cause a girl I'm into is having trouble with her ex. He keeps going after her, and she probably still feels something about him. Although she and I went out already, and have been talking to each other a lot, she clearly feels something about him yet. And I told her she needed to do something about him if she wanted to get rid of him. She said she'd talk to him. And he's at her place right now. She sent txted me saying he was there, and she'd call me as soon as she could. That was 2 and half hours ago. I'm so confuse/anxious/10 other things right now.
Also, I ran out of my depression/anxiety medicine yesterday and I only managed to buy it 1h ago. Damn, my head was spinning and I forgot where I put stuff. Fucking madness. :/
First and mostly, cause a girl I'm into is having trouble with her ex. He keeps going after her, and she probably still feels something about him. Although she and I went out already, and have been talking to each other a lot, she clearly feels something about him yet. And I told her she needed to do something about him if she wanted to get rid of him. She said she'd talk to him. And he's at her place right now. She sent txted me saying he was there, and she'd call me as soon as she could. That was 2 and half hours ago. I'm so confuse/anxious/10 other things right now.
Also, I ran out of my depression/anxiety medicine yesterday and I only managed to buy it 1h ago. Damn, my head was spinning and I forgot where I put stuff. Fucking madness. :/
Freeza Under The Shower
Member
There are a number of discourses that we need to separate here:
1. the actual scientific field of psychology, including the early days of Freud and Jung.
2. the psychological discourse that resonated far too comfortably with the '60's counterculture and has created a view of man as being constantly 'at risk' (Therapy Culture by Frank Furedi)
3. the power discourse that propagates and uses the second one to get certain things done. Neo-liberals who want to make everything about choice, must use a ploy to make everything that isn't a choice (which is nearly everything) into a choice anyway: they specifically trap people into thinking that everything they can't control is psychological, and that's just a matter of "attitude". This is exemplified in positive thinking. (Smile or Die, or the other recent books for that matter, by Barbara Ehrenreich.
Your singular sentence already points to all of these: the second is evidenced by how it reinforces the idea of mental weakness, a constantly being at risk (which is the ultimate 'blemish of character'), the third, the economical / power discourse, is displayed in the "preying on", which would be partially true.
The real problem is that 2 and 3 are far more dominant than 1, but that 1, the actual field of psychology has issues of its own. In order for there to be subjects, it has to create them. Psychology, as Michel Foucault has demonstrated quite thoroughly, began with asylums. Which is really the ultimate prison. Not only do you control the body (prison, dungeon), you exercise power of the mind as well (behave, or else).
But! In that last sense the field was not a happy accident. It was a kind of semi-secular kickstart of a dying religious discourse, that exercised power through the fate of the soul. Without fire & brimstone or a soul, there is nothing to control, and the people roam free. Too free, since the people are not truly able to control themselves beyond small groups anyway. This is a paradox without a neat solution, so we have democracies with neo-liberal capitalist economies and psychology, which also competes with religion.
Ultimately, it really is all about power. There is no way around that. It is however, quite possible to regain the awareness that anything relating to you directly, is yours to control.
The reason I brought all of this up is a) vanity, and b) to say that every proper psychologist knows damn well that the discipline walks a very fine line between scientific study and exercising undesired control over people. (this is one problem all social sciences and philosophy share)
Most actual researchers therefore turn to things that are as far away from people as possible: genes, brains, food and even physics and math.
And the results that comes out that are genuinely interesting and fairly valid, even in the moral sense. I do not agree with Bagels that depression is a predominantly chemical problem (at least not the chemicals isolated to neurotransmitters). As he stated earlier, the literature only demonstrates positive, significant effect of AD's on the severely depressed. Everyone else might as well just take a placebo, there is no difference in effect.(the statistical word "effect" btw, not the personal report of an effect of 'doing something'. If I bump my head, I will be dizzy and report an effect as such. But the statistical effect of bumping our heads is always the same: being dizzy. Which means no difference between cases, and thereby no statistical effect)
So whatever models explain the symptoms that are classified into 'depression' have to be different from being purely chemical. Some might relate to other conditions, most will probably relate to lack of nutritional substances and blood flow to get those in the right location at the right time. This last bit is relatively new, but already gaining quite promising -or horrifying, depending on your viewpoint- results.
More than a few effects of modernization seem to reflect themselves in our bodies, how they behave, how they feel, and in my view equally important: how civil and thoughtful, quite literally, they can be.
We now know that adding proper nutritional substance to the diets of inmates, reduces the likelyhood of aggressive encounters AND their severity. We also know that vitamine shortages and cancer occurrence are heavily correlated. And we also know that cognitive faculties improve when shortage are dealt with.
One of the biggest lies you can see in any store is when a supplement claims to "improve your cognition". If it can do that, it means you have a shortage, not that the supplement has some kind of magical effect. The effect exists because your food isn't getting you what you need.
Other needs, however, are exactly the stuff the fraudulent Freud was talking about: Being loved, giving love (in return, not by demand), being thankful instead of sorry, and talking about the deep stuff going in your mind.
Science is one thing, the "soul" quite another. If you say: "what I say defines me", I will call you full of shit. That's like a river saying it's defined by its water. It's defined by the ground it flows over, and the rocks that block its intended path. Most of the time, and this is what everone has known, learned, figured out, and so on before us, we are defined by what we don't say. By our shame. Or the things we think we need to be ashamed of, but that are really trivial.
The only thing that can be done about that, is to simply a good, deep conversation with someone. It used to be the stranger, but internet has sort of eradicated those. It may turn out to be a priest, rabbi, imam, whatever floats your boat (unless one of them is the source of your problems), it could be friends, family, a teacher of some sort, or just a (good) therapist. The only reason the therapist is slightly more problematic, is because they can never cross over the line of professionalism, and are completely dependent on what you tell them. There is a somewhat unreasonable demand on the therapist to know you while they only know what you told them.
Just to throw in my two cents:
SSRIs/SNRIs have generally helped my anxiety (and depression) but at large cost. They make me dissociative and hazy. The doses that it took to control my anxiety completely simply lopped off the top and bottom end of my emotional spectrum and made me into a zombie. Not to say that they don't work well for some people. I've been on Zoloft (SSRI) and Cymbalta (SNRI) and am currently on a low dose of Lexapro (SSRI).
Buspar (Buspirone) changed my life. No joke. Apparently for many its a placebo, but for me it wiped out my anxiety completely with very minor side effects. I had never even heard of it before it was prescribed to me - I have no idea why no doctors try it any more. It's non-addictive and available generic so it's safe and cheap to trial run. I highly recommend trying Buspar for those with GAD. On the downside, my dose has slowly crept up from an initial 20mg to 45mg over the past year, but I've gone through a large variety of lifestyle and medicinal changes that may be to blame for the increased need.
For me, however, Buspar does NOT help existential anxiety / panic. I still have to take 0.5-1mg of Klonopin every evening to stave off nighttime panic episodes, but that's a very small dose of what is considered one of the safer Benzos.
So, Benzodiazipines...I've been on two of them, Xanax and Klonopin. What Bagels says about Xanax is true. It's a miracle drug. It works amazingly well. But that's the problem - it works too well. I never got into a cycle of addiction / dose inflation with it but many do, and I can see why. I genuinely missed Xanax for a while after I stopped taking it. Not craved it, but missed how well it worked.
Since then I've been moved to Klonopin. It's...interesting. Not as effective in controlling my anxiety, doesn't help me sleep all that well, takes much longer to kick in (45m - 1hr) and causes retrograde amnesia. But it still mostly prevents nighttime trouble and its longer acting nature removes any of the instant gratification that would tempt one to take more than prescribed or abuse it. I can see why someone would abuse Xanax...Klonopin, not so much. It's a pretty effective anxiety medication. It's certainly not 'fun'.
And then there are Antipsychotics. I spent two months on Seroquel and two more on Seroquel XR. Above all else, it was strange, and while they had some beneficial effects I quickly felt the need to get rid of them. Seroquel was one of two medications I've ever been on (out of 12) that really felt like it was rotting my brain. When I took it, I could feel it slowing down my mental function - it's a drug for schizophrenia, after all. For the first week I was on Seroquel I needed 10-11 hours of sleep a night and my IQ dropped by a third. I slept SO well that I would wake up sore in the morning from having not woken up and adjusted at all the night before. It sucked. The side effects improved but the lethargy never went away completely. That said, it did relieve a lot of anxiety, but at huge cost.
Seroquel XR...I was switched to the extended release hoping that it would maintain the positive anixolytic effects without the brutal sedation. It did, sort of. Instead of being knocked flat every night, the sedation was spread more evenly throughout the day. It did eliminate my anxiety, but again, at a heavy cost - the first week taking it I had no personality and I was always a tad sluggish, both mentally and physically, while I was on it. It greatly affected my creative abilities.
Risperdal (Risperidone), another antipsychotic, was considered as a next option but I never jumped ship to it. From what I was told by several doctors, for many it can wipe out anxiety and agitation without any of the heavy side effects associated with most antipsychotics. So I won't damn the category completely...but I'd say tread with caution.
Okay, so your problems were close enough to the surface that simple lifestyle improvements and introspective conversations helped. Most of the people in this thread are in much more serious trouble than you were.
A good therapist can connect the dots in ways you're not able to; a good psychiatrist can provide you with tools towards your own betterment. I'd have likely attempted suicide several times over the past few years had it not been for the professionals guiding me through.
Really good therapists can read between the lines far beyond what you tell them. And know when what you tell them is a load of shit.
I was on seroquel for a year and abilify for 3 after it. Are you bipolar? I didn't realize how bad antipsychotics were until it was too late.
My hands still shake a little, and I'm pretty sure my brain is permanently damaged. I'm constantly typing wrong things, I'll be talking and in the middle of a sentence I can't think of a word. My short term memory is basically non-existent. I have to write everything down, I will literally think of something and 10 seconds later forget it and its not a rare thing, its with everything I think of practically. I feel numb to things still after being off of abilify for almost a year. I space out so bad.
I read they cause brain atrophy within a year. I'm curious as to how small my brain is after 4.
Oh and I can't handle anything. I'm sure you know how they numb you to everything and since going off them any small thing stresses me out so bad. I'm breaking out in hives because of how stressed I get from any tiny thing. I feel like I'm going insane as of late but I honestly feel its better to have ups and downs than be numb 100% of the time.
la flama blanca
Banned
I feel like I want to just give up right now.....
Feeling nauseous and sick everyday for the past few months with no clear diagnosis from any doctor has me really depressed right now. And to top it off, with this fear of choking on my vomit, I've just plummeted into some really dark areas of my mind. This really sucks.
Feeling nauseous and sick everyday for the past few months with no clear diagnosis from any doctor has me really depressed right now. And to top it off, with this fear of choking on my vomit, I've just plummeted into some really dark areas of my mind. This really sucks.
akachan ningen
Member
just forgive yourself already!
la flama blanca
Banned
Don't understand what you mean..
I'm really sorry to hear that. I've met patients whose lives were completely changed - for the better - by the newest generation of antipsychotics. But I've also seen the other end of the spectrum - people whose lives went from bad to absolutely miserable. It's an area of psychopharmacology that scares the hell out of me. This hospital is EXTREMELY conservative about the use of psychopharmacology in child psychiatry, but that's certainly not the case everywhere. Who knows what we're doing to developing brains by slamming them with potent and poorly understood drugs. I'm just a tad too old to be part of the first real surge in the diagnosis of ADHD and the subsequent treatment of young children with drugs like Ritalin. I will get to see those kids as adults and find out what happens to their brains. I'll also get to see what happens as a result of the huge fad of diagnosing kids as young as 2 with bipolar disorder.
I really hope you find a way to recover. The last two decades or so have really demonstrated how amazingly plastic the human brain can be. An organ that we thought became basically fixed somewhere around your early twenties, and just slowly died off over time, is actually capable of making all sorts of new connections, snipping off old ones, basically rewiring itself and even growing new neurons right up until the day we die. There's tremendous interest in neurogenesis and neuroplasticity. Hopefully we'll see the basic science make its way into entirely new kinds of treatments in the coming years.
You also reminded me of this story from a few years back. The human brain is just absolutely amazing.
Finally, related only by the fact that it's also a story about brains being amazing, dolphins can put half their brain to sleep at a time, and use the other half to do whatever it is dolphins normally do. Hard as I try, I haven't figured out how to do it yet ("it" being putting only half my brain to sleep at a time, not doing what dolphins normally do).
I'm starting to feel incredibly low right now, especially since this week (or next) I'll be starting my first full-time job.
Things just look dark for my future right about now, and to have so many regrets going into it makes it all worse.
I'm scared, regretful, and just generally not feeling great. The thing I've feared since graduating from college has finally crept up on me, and now it's all downhill from here.
I've grown up before I even had a chance to live my youth at all, how depressing.
Things just look dark for my future right about now, and to have so many regrets going into it makes it all worse.
I'm scared, regretful, and just generally not feeling great. The thing I've feared since graduating from college has finally crept up on me, and now it's all downhill from here.
I've grown up before I even had a chance to live my youth at all, how depressing.
CrocMother
Banned
Dude this is just a shot in the dark but I had a friend that had similar symptoms and the doctors couldn't figure out what was wrong for months.
Turns out she had that disease where you can't eat gluten. Apparently it can come out of nowhere and is relatively common.
vatstep
This poster pulses with an appeal so broad the typical restraints of our societies fall by the wayside.
I have lived with this at a couple of different times in my life, most recently last spring, where for several months I was nauseous more often than not, generally exhausted, dizzy/weak, and otherwise had my typical migraine symptoms, just without the aura/headache. I saw a bunch of doctors, had an MRI and other tests done — nothing. For other reasons mostly (but also at the recommendation of my doctors), I started exercising daily and eating better and within a few weeks, I felt worlds better (physically, at least). The first few days of getting off my ass were really hard, since I just felt like, "I'm sick, I can't exercise." But I took it really slowly, and eventually realized that I was probably sick because I wasn't exercising.
la flama blanca
Banned
My sister has asked about this and I've been trying to eat gluten free foods lately, the nausea fluctuates so it's hard to pinpoint whether it affects me or not, but will talk to my doctor tomorrow. So far, what I know is that I don't have Celiac disease or some other diseases, but will get an endoscopy and more blood work done soon.
The idea of exercising has been running through my mind lately as I've been pretty inactive for months due my job and stress and what not. I will try and motivate myself to do more, hopefully it helps me a little at the very least.
Woke up in the ER last night/early morning. I don't remember much but a lot of drinking and smoking. Made it home somehow (I didn't drive) Family said I was acting out of character. I see an IV hole and some bruises and cuts all over my body. I feel pretty empty right now. I really don't know what I tried to do or what I said all night. Family won't talk to me. Oh how low I've sunk.
Depression, come at me brehs
Depression, come at me brehs
- Status