The Depression Thing

Prescribed Zoloft before I was diagnosed Bipolar II, without lamotrigine & methylphenidate I've lost jobs, been kicked out of college, spent 6 months with major depressive episodes (~20 down days, 4 up days on avg,) and Zoloft was absolutely insane. My ideology is already if you're not successful by 29 and still depressed, might as well suicide. Zoloft brought that down to thinking "41 steps to the loaded shotgun" and a lot of preparation for it. Lamotrigine & methylpheniate have been good for me for the 6 months I've been prescribed them, but recently methylphenidate has not been helping, and i'm starting to spiral again.

See, I both agree and disagree with your statement.

Exercise itself has never produced results for me. Generally, it meant I was still stuck in the house doing something I hated. I haven't always had the luxury of going on regular walks or anything like that. I don't get a rush from being physical. Until recently, I couldn't even afford sports bras for running. Without the bras, anything too "jumpy" was physically painful. (I wear a special size, even when thin like I am now, and they generally cost between $60 and $100 when I can find them. Pre-internet, I simply couldn't find them).

All this said, having better physical health does help a bit. But eating well and feeling some pride that you've changed your diet for good? Yeah, that has benefits. The hardest part was finding the combination that worked for me (mostly vegetarian with the exception of fish). Losing weight? Yeah, that had definitely helped (I, too, have lost a great deal of weight and kept it off for years). Walking as a main form of transportation? That is my physical activity and I take some pride in being able to do it regularly. I still hate exercise for the sake of exercise, though.

It definitely wasn't a cure at all - that took actually changing my life. And it was hard. And i'm gonna guess that your exercise was a combination of things - like being able to use the coping mechanisms better. Simply growing up (I started a lot of my life changes in my late 20's, and I'm 39 now) I got out of a bad, stressful relationship with a schizophrenic man. I learned that a lot of the negative feedback I had gotten from others over the years wasn't necessarily true and the few friends I have are positive influence. Heck, I actually have a couple friends that aren't family.

Some of it was pure luck - I wound up moving overseas to a place that I fit in better than I did in small-to-medium towns in the midwest. I'm able to completely be myself at home: A weird bisexual artist that spends a lot of free time at home. I learned how to relax.

Admittedly, I'd not recommend some of what I've done to folks since I'm pretty partial to hallucinogens and visit Amsterdam every once in a while, both with my spouse and by myself. I'm gonna guess some of my crap wasn't depression, though - I completely understand why MDMA is seeming like a wonder drug to the researchers. I had a marked change in thought process after doing it once. By the time I tried it, though, I had already come a long way.

CBR wasn't helpful for me at all.

The only thing I really do on that list is avoid alcohol. If I am in a good swing, I can sleep at regular times, but I don't exercise. I eat whatever is around really, and in severe down times I've been kicked out of college or lost jobs because I couldn't leave bed to eat or use the bathroom until it was unbearable, let alone leave my house. I also normally ate around a meal a day, at 5pm or so and might have had some apple slices, grapes, or something similar before.

The only thing that has ever helped is medication. I have bouts of severe paranoia & hallucinations, but haven't mentioned it to anyone. Lamotrigine & Methylphenidate have been the most helpful, taking me from 5-15% functioning on an average day to 80% or higher. That's worked for me for 5-6 months, but over a month I noticed that my methylphenidate became less effective, and to improve it I had to redose during the day. This was a self-medicating (horrible, i know) method, but then it came to me running out of it for the rest of the month (10 or so days.) So I was low functioning then, but I still had my lamotrigine, so I was around 30%. Then I got my refill and started my day out, and ended up feeling nothing... So I redosed, and still after an appropriate amount of time felt nothing. I kept redosing for the next 40 hours until I had taken 500+ mgs of methylphenidate. I even spent time researching and turned it into IR methylphenidate, and even boofed 81mg of it at one point. Not my greatest hour. I finally passed out at about 60 hours or so, thank god. Then I woke up and realized what happened. That was yesterday. I'm still trying to find out what to do. I've been looking for people with my combination of bipolar II and adhd for input, but I fear that with my hallucinations and paranoia that have come and gone my entire life, there may be more wrong. I don't see an issue with upping my dosage of methylphenidate, but swapping to another med is what I feel may be a better option, but I also fear that my condition will worsen, as only the combination of methylphenidate & lamotrigine helps. I've been considering dexmethylphenidate, but definitely am trying to find more answers.

And a quick search of Cochrane shows that when you look at good quality research the benefits of exercise are hard to find.

http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depre...

> Exercise is moderately more effective than no therapy for reducing symptoms of depression.

[...]

> The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.

[...]

> The evidence about whether exercise for depression improves quality of life is inconclusive.

I haven't been through the US system.

I currently work in the bureaucratic end of the English system. I meet very many people who have been through, or are going through, treatment for mental ill health. This includes all settings, from secure (forensic) units, through regular MH hospitals, or community treatment, to primary care. It includes common "mild to moderate" illnesses and severe and enduring mental illness, and also personality disorder.

I talk to a wide range of mental health professionals: health care assistants, registered nurses, AMHPs, doctors (consultants, T3 and other junior doctors), speech and language therapists, occupational therapists, art therapists, psychological staff. I talk to people from band 4 (NHS England agenda for change pay banding) through to band 8d, and also directors.

I'm a member of the South of England Collaborative for Mental Health Quality and Patient Safety Improvement. https://iqmentalhealth.co.uk/

I'm a member of the Q community. https://q.health.org.uk/

Being polite: I know more about this than you do.

The reason I linked to specific twitter accounts is so that you can ask them what their opinion is. You don't have to take my word for it - maybe I would distort their views.

> you tell your GP

I was very clearly only talking about psychologists. I wasn't talking about GPs. If you had asked me about GPs I would have spoken about the frustration I have that they rely too much on medication, and not enough on talking therapy. Even though in England talking therapy is free and easily available.