In episode 289, I received a question from an individual who has struggled with depression over the past 20 years, coping with intrusive thoughts and suicidal ideation, while feeling as though this struggle is not taken seriously by their therapist. In this post, I address these concerns and dive into the options available for persistent depression, and talk about how you are within your right to search for other providers if you don’t feel your current match is working for you.
Hi Dr. Duff. Thanks so much for your podcast. I find so much comfort in your show and am grateful for all you do. I have been depressed on and off for the past 20 years. This last “on” has been the worst and, with the exception of a couple of good months last summer, lasted for the past 2 years. I have been seeing a counselor for the past year and am on yet another SSRI. Neither of these things are new for me. I think I walk a fine line between intrusive thoughts and suicidal ideation. Most days, I think I’d like to be hit by a small car, be incapacitated for a few days, things like that. I’m an elementary school teacher and by the time I get home at the end of the day, I have no energy left to pretend or care for myself or stop the thoughts from coming. That said, being with the kiddos all day is also a great distraction and often better than the weekends.
When I’m low, I feel this strong pull to revert back to my old coping methods of self-harm. Usually, I’m too exhausted to act on anything though. Again, I want to emphasize that I have no intent in ending my life. I still find times to look forward to the future and make plans to travel, visit family and even one day be a mother. I’m exhausted of always feeling this way though and it’s taking a huge toll on me. I’ve spoken to my counselor (and past counselors) at length about this and they always brush it off as no big deal. Am I wrong to be concerned about this? I really like my counselor but I also want someone to acknowledge how much I’m hurting and that it’s not going away. Or maybe this is just my normal? Should I stick with him or look for someone new? Sorry for the long question. Thanks in advance for taking the time to read it.
Thank you for this super raw and honest question. A lot of people are afraid to bring up issues like this, so I’m super proud of you for just putting it out there. That’s awesome and a great model for people.
One thing that I want to say about situations like yours is to be very cognizant and in-contact with your providers regarding starting any new medication. The reason I’m saying this is that you said you have desires to fall into an old pattern of self-harm and you have passive thoughts of death but feel no motivation to do anything about it. We don’t exactly know why SSRIs cause some people to become suicidal, but this is one of the theories. That it helps to overcome that lack of energy and motivation that would typically cause someone to not harm themselves. BUT it sounds like you’ve been on this SSRI for a little bit now, so we are probably out of the woods when it comes to that in your specific case.
Your point about walking a fine line between intrusive thoughts and suicidal ideation is a great one. Both of these are possible and the line between them isn’t always super well-defined. I think in your case, they are probably more on the passive suicidal ideation side than intrusive thoughts. Intrusive thoughts are typically understood as unwelcome thoughts that crash into your awareness and cause you discomfort. They are often inconsistent with the way you see yourself or your typical behavior patterns. For you, that’s not necessarily the case. It’s not like you are doing great and suddenly have this intrusive thought that you might like to run yourself off a bridge in your car or hang yourself. You ARE already suffering. You have had experience with harming yourself. Your thoughts of dying or being incapacitated are consistent with the way you view yourself. To be clear, I believe you that you don’t want to die. But you DO want some form of relief. You want respire and rest from the intensity and the sadness of your life. You are overwhelmed.
I’m sorry to hear that you have had providers that seem to not take your issues very seriously. You have been through this for a long time and you definitely deserve to be heard out about your concerns. It can be normal in a sense to live with passive or transient suicidality that is never played out. Some people do experience this over time on and off. But the thing that I’m concerned about is that you are suffering. You are out of gas. You are tired. And you are concerned about these symptoms. If you are concerned, then I am concerned.
I’m proud of your for getting professional help through therapy and medication. I’m not sure if it’s ever been considered that you might have what’s called treatment-resistant depression. This is depression that doesn’t respond well to normal treatments. I did a whole episode on options for treatment-resistant depression such as TMS, ECT, Ketamine etc. on episode 107.
If you feel like you are not being taken seriously, you are well within your rights to look at other providers. That goes for both therapists and psychiatrists. At the very least, I think you should recognize that these symptoms are trying to tell you something. They are trying to tell you that your trajectory may not be sustainable. That you are doing too much or that life is not balanced enough for you. I have talked about this many times, but you can approach the same situation in different ways. Sometimes subtracting requirements, obligations, etc is necessary. At other times, you can add in positive experiences, treatments, or self-care to balance it out. Things do not sound like they are in a favorable balance. You are clearly a strong person and you are able to hold on and get through, but you might need to take a look at your life and really consider if there are any changes that need to be made to make things safer and more sustainable for you. You don’t have to freak yourself out by thinking that this is a massive thing that needs to be fixed instantly, but you also don’t need to commit the same sins as providers that have minimized your experience. You are allowed to take yourself seriously.
You can listen to this on Episode 289 of the podcast!
Thank you for the great question!
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