In episode 278, I received a question from an individual struggling with depression, unsure of where to turn next. In this post, I walk through some of the fundamental aspects to consider when tackling depression and discuss how there are still options to consider when faced with treatment-resistant depression.
Hi Dr. Duff,
I’m almost 21 years old, and I want nothing more than my life to end. I’m miserable in school, miserable in my living situations, horrible at making and maintaining friendships, and, most relevant to you, not making any progress in therapy.
I’ve been in therapy on and off since I was 14 years old, and in that time I feel as if I’ve made virtually no progress in improving my mental health. I still have the same problems and negative thinking patterns I did when I was a teenager, and at this point breaking out of them feels impossible. Every week when I go to therapy it feels as if me and my therapist cover the same subjects, but by the end of the session nothing has changed. I’m also terrible at doing the work outside of therapy. When I’m feeling this miserable, the last thing I want to do is put in genuine effort into something to make myself feel better. My question to you is: how do I make progress? How do I start actually utilizing my therapy sessions to improve my mental state and overall well-being? If change doesn’t start happening soon, I’m fearful that I won’t be alive for much longer.
Thank you for writing in. First off, I’m really glad that you’re still here. I don’t take the fact that you feel this way and decided to write into the show lightly. You want to live, but are having a hard time seeing how that will work out. But there’s a part of you that still sees a possibility of making it, otherwise you wouldn’t have written in. It would be a foregone conclusion.
If by the time this is reaching you, you do not feel safe, please reach out. I have crisis resources on my website that are easily accessible at duffthepsych.com/emergency. I’m not going to tell you that it gets better. That feels trite to me. But it can get better. It can change. And there are avenues that you have not yet explored. So, before you decide that you are hopeless and there’s nothing that can be done about your situation, at least give yourself the chance to something else. If you end your life, there is no chance that it will get better and there are people that will be impacted. I care very much that you are still here.
Finding the right fit
I say this a lot in therapy with my own clients, but you can’t be stuck if there are still unexplored options. I’m proud of you for carrying on and continuing to try, even though you feel like you aren’t making any progress. You are clearly trying to put in the work and I understand that can make it feel even more hopeless at times because you are doing what you’re “supposed to”.
A few things to think about here. One is how long have you had your current therapist. It could be that you don’t have a good match. It’s entirely possible that you’ve never had a good match even if you’ve had multiple therapists. Not trying to toot my own horn here, but it is pretty common for me to work with people that say they have just never gotten anywhere with other therapists that end up benefitting quite a bit from our work together. It’s also possible for your work with a therapist to start out pretty good, but stagnate over time. In those cases, finding a different way of working together can be effective, but other times you might need a fresh set of eyes and ears.
One thing you said that is really common is that you feel like you are terrible at doing work outside of therapy. That makes total sense. Depression is a tricky bastard. If you think about it, you have to find motivation to do things about your lack of motivation. It makes no sense in some ways. There are some ways around this. Sometimes hearing the same thing in a different way helps it resonate with you. Sometimes diving more into your values and why it’s worth it for you to make changes can help. Sometimes looking beyond the immediate problem into the past or the underlying issues can be helpful.
Other times, you need some damn drugs. You didn’t mention in your question whether you have been on medication before or are currently on medication. If you aren’t on medication, that may be something to consider. There are a lot of people who have mental health symptoms that are so significant that it actually makes it hard for them to benefit from therapy. In these cases, something like an SSRI might help lower your baseline level of crushing depression and raise your motivation enough to participate more fully and make life changes that are important. If you are on medication, but it’s being prescribed by a primary care doctor, maybe you want to consider seeing a psychiatrist. There are many options and it could be the case that you are not on the right meds for your situation.
When nothing seems to work
If you’ve done all of these things I’ve talked about and still nothing is working, there are still more options. I did an episode all about options for treatment-resistant depression for episode 107. There are options like transcranial magnetic stimulation, electroconvulsive therapy, and ketamine that are options. Things like ketamine are becoming way more accessible and even have home treatments that can be obtained. There are also in some places compounds like psilocybin that can be legally used to help draw a line in the sand and make significant mental health changes. You have options. There are more things that can be done.
I think all you need is to find one thing that starts to move the needle. Let’s say you have insurance that will cover TMS treatments and you see a psychiatrist about medication changes. Between the two of those, you might get an uptick and mood and motivation within a few weeks that allows you to start working on lifestyle changes such as your sleep and exercise. Maybe you finally get that physical you’ve been putting off to see if you have anything in your blood work that could be contributing. Those things would further improve your mood and stability. This might allow you to actually gain something from therapy. Eventually you might get past this emotional bleeding stage and be able to start addressing some of the underlying issues. That would be awesome. And it is possible.
Take some risks here. You are feeling like you are at the end of your rope, so let’s get creative and just throw some shit at the wall to see what sticks.
You can listen to this on Episode 278 of the podcast!
Thank you for the great question!
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