The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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This website seems to be frequented by a lot of mentally ill people. Let's discuss the torture that is life!
In late 2022, I started to feel a confusing lack of happiness and willpower. There was no apparent reason for me to feel bad. I was making zillions of dollars at work, was acclaimed as the most diligent and most innovative employee in my office, and was on track to retire at age 33. But the enjoyment that I was able to extract from my hobbies (primarily, playing video games and converting PDF and print books to HTML) and my tolerance of work gradually dwindled. I tried going to bed an hour earlier than usual, drinking more water (even though it tasted disgusting) rather than my usual drink of grape juice mixed with seltzer water, and taking relaxing walks of three to seven miles (five to eleven kilometers) on weekends. But those efforts had no effect. By late 2023, I was experiencing intermittent testicle aches and literally 24/7 headaches (both of varying intensity, from mild to severe), and semi-frequently couldn't even force myself to work after sitting down in my cubicle. After searching for possible headache causes online and getting a testicle ultrasound that revealed nothing suspicious, I was forced to conclude that I must be suffering from depression.
My doctor prescribed 5 mg/d of escitalopram to me. After a month, no effect was apparent, so the dosage was increased to 10 mg/d. And the clouds parted! My headaches and testicle aches receded to the background, and sometimes even disappeared entirely. I regained the ability to feel happy and to tolerate the taste of plain water. The only side effect was perhaps a month of intermittent severe stomachaches before those too receded. I genuinely felt like the Zoloft blob.
My willpower still is trash. I would say it has recovered from one-third of normal to two-thirds of normal. (I just upgraded today to the maximum escitalopram dosage of 20 mg/d, since the headaches have been returning a bit. I didn't do so previously because I was leery of having the severe stomachaches return.) But I just have to hold out for two more years so that I can retire, embark on fifty years of undiluted relaxation in my custom-built house, and finally recover enough willpower to convert the entirety of For Want of a Nail (including all the footnotes and bibliography entries) to HTML!
Two thoughts:
Your presentation seems pretty biochemical - rapid response to an therapeutic dose (5 is too low), somatic symptoms, a significant amount of side effects (the stomach is common and usually self limited and associated with specifically the initiation of medication and changes of doses). You should keep that in mind and inform your doctor if you need to make changes or you get a new one.
This advice will may mean less to you if your presentation is in fact pretty biochemical, but therapy and medication is superior to either alone. Our best guess for how SSRIs work (and you may not actually be one of these it sounds) is that they make your cognitive structure more flexible and allow good decisions and therapy to stick better. If you feel like you could do more to be better, get a reputable therapist.
Additional thoughts - also sounds like you have a decent chance of being the kind of person whose brain isn't good at listening to their brain or body, so you get random ass symptoms as your brain flails around in confusion. In those situations it may be wise to reach outside yourself to try and figure out if you are doing okay/how well you are doing. Of note it's not uncommon for successful people to be like this because they establish patterns of just puttering along and getting it done and burn themselves in the process.
I am highly skeptical of therapy after an annoying experience as a teenager (several sessions of mandatory therapy as part of a settlement of a frivolous prosecution for terroristic threats).
Also, Big Man Siskind says:
Why go for therapy when medication has already brought about "sudden, extraordinary, long-lasting change"?
He also says:
You may rest assured that I have been confiding in my favorite coworkers that my days of masochistically taking on extra work without being told to by my boss are over.
As usual blah blah I don't agree with Scott on most aspects of doctoring.
Therapy works, and it works great, and has a great evidence base. The problem is that unlike medication management and general medical care, it's very hard to tell if you are getting good therapy, or the therapy that is good for you - not only is proficiency level variable, but the match between the therapist and patient is important and that can be hard to manage (classically: a good chunk of men are not going to respond well to the more ooey-gooey therapists)*.
Quality therapy also intends to end, it's not open ended or indefinite.
That said it sounds like you are skeptical, had a bad experience, and aren't necessarily the best type of patient for it (plus the expense).
But it is something to consider in the future if you are not satisfied with where you at or slide a bit.
Alternatively you can use the classic man-therapy type approaches. Sportsball! Teams! Friends! Woodworking! Blah blah.
*Yeah I really don't know what Scott is going on about here. There are absolutely the type of patients who therapy isn't likely to work for but DBT for BPD is well validated, and every therapist I've ever dated (pro-tip: don't date therapists) will endorse patients with radical improvement or development, even if it's just catching a college student who needed to grow up. If Scott isn't ever seeing it work something about his catchment is fucked or he is exaggerating in an unhelpful way.
Fuckin' A, man. Fuckin' A.
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Jesus H Christ. Headaches yeah, fine, we all get them, but blue balls without the aching hour of unrealized foreplay, that seems like the curse of an angry god. Sorry to hear it.
If it takes the edge off what is already a blunt non-edge, I'm way past 33, not nearly retirement ready, feel like probably my whole life I've been depressed-ish but just lived it (no jibes meant against the truly nonfunctional depressives out there) and I just pre-ordered a tuxedo for a shit ton of money from my Sikh tailor. But my wife and I laughed at the dinner table tonight (lemon chicken pepperonccino pasta my recipe) my oldest son cut up a big pomelo fruit and ate it on tissue paper, and my youngest sang the melody to an old George Benson song (turn your love around) without prompting. What I'm saying is life, in the words of Anne Sexton, is a trick. Life is a kitten in a sack.
Edit: past, not passed
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I'm deeply jealous that antidepressants actually worked for you, and the very first one you've tried!
For someone who prescribes or oversees the use of plenty, I've had shit luck with them. Fluoxetine, buproprion and vortioexetine for about 5 years in the past 10 with no noticeable (positive) effect.
I did, however, start mirtazapine last week. I can attest to the sedating effect, which paradoxically is the maximum at the lowest dose. Let's see if that makes a difference, but I did feel much better when I fled Scotland after 5 months to spend a couple weeks at home. I've been back to work for a week or two, and things have been mildly looking up.
(What I'd give to retire by 33. Ain't happening with UK doctor wages I'll tell Ya)
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Here to mark my attendance. But seriously, this sounds horrible, I have no concrete suggestions but I can relate somewhat to your issues. Please take care, the conversion of books to HTML sounds like a very cool project.
Example file (must be downloaded to be viewed, since Catbox blocks HTML-file viewing in order to prevent phishing)
Quite nifty!
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