As for antidepressants, i have terrible luck with them. I was on Effexor for a while, and while it didn’t kick me into mania I did get resistant to it very quickly. I had a good run on Luvox for a while, but have recently had to come off it and try something new, again.

I’m glad you got help that worked for you, OP. I hope, someday, that so many others can get the help I’m so terrified of losing.

The people I work with mostly suffer more from poverty than mental illness in itself. And since I only work with severely mentally ill people, they suffer a LOT from their illnesses. The “lucky” people who qualify for disability insurance get about $400/month to live on typically. Rent for a bed (not even a room) in the worst, filthiest boarding house in the town’s most dangerous neighborhood costs $395/month. Housing assistance waiting lists range from 2-8 years in length. State based medical insurance doesn’t cover more than five psychiatric drugs per diagnosis, only the oldest and cheapest. Patient assistance by pharmaceutical companies requires that you count the incomes of all your unrelated boarding house mates as yours. Which biases it toward people with higher incomes / outside help who can afford to live alone. They also count unpaid child support or alimony as income, even with evidence that it is not being paid.

And for a person with more income and medicaid, any income OVER $400/month results in a “spend down” of the rest of their income for the month before any treatment is paid for. So a person who has a benefit of $700/month has to spend $300 on medication or visits before one dime is covered, then all of it is. Living expenses are not allowed for – ALL “disposable” income is fair game. No money for bus fare, or soap, or toilet paper. Toilet paper is always a big concern. At the same time, a person with a higher benefit won’t be approved for food stamps.

CBT is a lovely treatment, and I agree that it typically requires *already being fairly well on meds* to work if your illness is severe. Given that, CBT helps you unlearn negative thought patterns and identify who convinced you of them and how to tell them to STFU. It can help you learn that you don’t can’t know what other people are thinking unless you ask. It’s genuinely amazing for straightforward situational depression actually caused by negative assumptions and thinking, especially in couples not on the verge of divorce. But I’m both a psychiatric social worker of 16 years and a person with severe recurrent major depression, PTSD and one horrifying episode of steroid induced psychosis that gave me nonstop visual hallucinations of people killing my twin babies. And CBT is neither the only proven effective therapy nor worth fuck-all to me personally when I get really ill. If I’m sick enough to be in the hospital, forget it.

All of the standard therapies, including non-professional support groups and talking out one’s problems with a caring and supportive person are effective. Just as with medication, different people need different things at different times. CBT just had huge financing from pharmaceutical companies twenty years ago to do bigger studies, just as a fad dismissing clinical observation and qualitative studies altogether came to a head. This meant that third party payers started mandating it and nobody’s ever had the chance to get funding to replicate therapy-spectrum studies.

CBT has a central flaw: depression and mania are not thought disorders. Emotions CAN arise from distorted thinking. But emotions can CAUSE distorted thinking as well. Happy new lovers see no wrong in each other – as distorted a thought as any you’ll find. No illness needed, just emotion. People who feel shame are prone to all kinds of specific, culturally derived distorted thoughts.

When I’m well or juuuust starting to feel depression or experience PTSD symptoms, the thought habits I learned in CBT work very well indeed. But both professional observation and personal experience have convinced me that it’s like gentle massage – excellent for a sprained ankle, and not nearly as effective for a partially severed ankle.

In fact, when I was inpatient in December, one of my fellow patients finally said to our therapist after myriad glances between group members (not including me) “Please don’t insult us. If we could just think our way out of the hospital we would never be here in the first place. We’re not stupid or lazy, we have real illnesses just like any other.” The group cheered.

The downside is that now I’m afraid to go somewhere else! Having this illness & the issues that go along with it have really limited so many of my options. I’d originally planned to go overseas to teach English when I finished my MA- but I realized the difficulties in trying to get treatment in another country, specifically the difficulty of getting the same medications. I really want to go on & get my MFA (the terminal degree) but worry that if I have a problem in another state I won’t be able to get the care I need. Also, in both cases, I’d be far away from any kind of support system if anything did happen. While my adventurer spirit loves the idea of going somewhere new & interesting, the practical side of my brain worries I’d destabilize like I did when I went back to school. And while my family is sometimes skeptical about it all, they do still help.

So while I appreciate hearing about other people’s experiences with specific medications, I think of being applicable only to that person in that situation. The nearly infinite number of influential variables mean that the experience will be significantly different for me.

Kayline, I am a huge fan of Cognitive Behavioral Therapy – it helped me identify my self harm behavior as a coping strategy for overwhelming emotions, which let me anticipate when I’d want to do it and make lists of less destructive coping strategies I had to try first. That’s the kind of thing that CBT is great for and it made all the difference for me in identifying and changing some super self destructive behaviours.

That said, I would not have been in any shape to learn and apply CBT if not for the medication. I was so down and lost that without the lift of the medication, CBT would have been like trying to teach rock climbing to someone who could not get out of bed, just totally beyond my abilities. For me, the combination of therapy and medication was essential. Figuring out the necessary combination and having access to those different modalities of treatment was part of the privilege so essential to my recovery.

The meds thing is bizarre, one person’s miracle drug is another person’s poison. I actually take Effexor as well, and it is by far the most helpful anti-depressant I’ve ever been on. Combined with Wellbutrin, it allows me to be functional and sometimes even happy. And yes, if I miss a dose I can feel the withdrawal within hours. Also, I now have extra-vivid dreams, which for me usually means nightmares. I’m still grateful to have it. I take Klonopin some nights to manage the night terrors, and overall things are going really well. If some misguided git tried to take away my medication because they thought the side effects were worse than the disease, I’d be forced to whap some sense into them.

I’ve noticed that some people find a drug that works great for them with minimal side effects, and assume that a similar drug exists for everyone if they just look hard enough. It’s important to remember that for some people, the right drug doesn’t exist (at least not yet). For us, it’s a matter of piecing together the best cocktail we can, with the least disruptive side effects, and then getting on with things. You can lose months or years of your life pursuing better medications, and the transition process is hard.

I’ve started to delve into some of the research on mental health treatment, and overall Cognitive Behavioral Therapy is one of the most effective treatments that exist for depression and anxiety. Complete treatment should always include a med consultation, but if you can’t access or can’t afford complete treatment, you can at least get good books on CBT which may help manage the worst of the symptoms. Not a substitute for needed medication, obviously, but a coping tool.

This conversation makes me wonder what mental health funding will look like in the promised health care reform legislation?