Origin: Silent programs are no longer silent
One morning in the summer of 2015, I woke up in my rental house, and before I could hear the noise in the alley, an unquenchable thought was shouting in my head: "I need to see a doctor." ”
The rental house was a ten-minute walk from the hospital, and after I finally understood what the voice in my head meant, I hesitated to pick up my phone and ask the leader for leave.
On this day, I was finally diagnosed with depression.
In fact, I knew very early on that I was not an easy person to be happy, whether it was when I was a student or later in my social life, I was happy to be in my own small environment, and I could not go out without going out. Perhaps as early as high school, a melancholic program was quietly generated in my brain, silent in the background of the brain, absorbing and storing the unhappiness that I had abandoned: sad things I always stopped thinking about after two days of depression.
Realizing that I may have depression was when I was two years old. At that time, the vomiting that lasted throughout the pregnancy still did not disappear, and every meal was eaten with constant psychological construction and self-compulsion and a large amount of soup, and the first thing an acquaintance said when he or she saw me was that you were thin again, although maybe she/he had just seen me the other day.
It was also at that time that I saw some popular science of depression, and I judged that I had symptoms early and worsened after giving birth. But I still boil it down to life pressures and want to take time to heal. After all, although I always think of death, I do not have the courage and action to die; Although there is always the idea of jumping into the river with the child, there is no other idea of harming the child if it is not by the river.
Visit: "Patient is emotional"
I calmly queued up at the hospital, and because it was my first visit, I waited for more than two hours in the small waiting area outside the examination room, and I didn't think about anything during this time.
After arriving, it took another forty or fifty minutes to do a set of assessment questionnaires, followed by consultations. The doctor started asking questions, and when he asked how he was feeling lately, my tears suddenly welled up, and I remember a hint of consternation in the doctor's eyes. Later, the doctor asked me if I had experienced a major setback, and I hesitated to deny it, because although I had a setback, I didn't think it was a major setback, and it was long gone, wasn't it.
图 | Keenan Constance/pexels
The final diagnosis was congenital depression, the medical record book was stamped with a blue square seal, summarizing several of my characteristic values were 0, and in the half-page diagnosis, I clearly saw that "when the patient was emotional."
Before returning the medical record book to me, the doctor looked at me and said, "It will be cured, it may take three or five years or more, but it will be cured." After healing, you will feel relaxed and will change a person. ”
I also believe that I can be cured. So, I nodded and took the medicine.
Take medicine: a flash of hope
After getting the medicine, I unexpectedly found that it was not expensive, and the amount of medicine in a month was only about a hundred.
The first time I took the medicine, fortunately I hardly encountered side effects, and the effect of the drug was very obvious, and on the third day, I had a feeling of light body and mind, happy mood, no longer vomiting reaction when eating.
Unfortunately, the good times did not last long, and at the beginning of the third month, the mood was heavy and depressed, and the sense of ease disappeared. After the company's personnel changes, the working environment began to become increasingly depressed. After another three months, I couldn't help but tell the doctor that the drug was not working well, so I switched to a more expensive drug with more obvious side effects.
Over the next three years, I took my medication on time and in quantity, followed up regularly, and considered myself a model patient. However, the original relaxed mood never returned, in addition to the matching buspirone hydrochloride tablets have been eating, venlafaxine, escitalopram, etc. can only bring a short (0~70 days or so) calm, the light of hope flashed, and never ignited.
Escape the workplace
In the second year of my diagnosis, I no longer had the luxury of relieving my depression and continued to take medicine with a calm attitude. At the same time, I realized that the company environment was likely a source of depression in my moment. I have no dissatisfaction with this job, even gratitude, but office politics overwhelm me, I am not sociable, and I have not met someone who needs to be coaxed to work to give a good face, and I am not surprised to be targeted.
The financial pressure from the mother and the guilt that the child became a left-behind child, coupled with the inability of the working environment, the grievances could not be spoken, and the person also fell into the delusion, repeatedly thinking about some of the mistakes of the past and trying to answer what would have happened without them.
During those times, naively I also revealed my condition to some friends, and the comfort I got was that you need to exercise more... Because a circle of friends who forgot to block was also said by colleagues to pretend to be sick and sympathetic.
Three years after her diagnosis, after learning that she was unexpectedly pregnant and had miscarried for more than a month, a conflict with her colleague finally broke out in public, although she later apologized to her leader and admitted that she had misunderstood me (shouldn't she apologize to me?). But I knew I couldn't hold it.
I don't understand why I resigned knowing that the consequences of resignation were unbearable, but the mood of escaping is still clear.
That state of mind of escape is still clear | Daniel Reche/pexels
I left the office, left the workplace, and continued to take medicine that didn't work with reluctance and anger.
Discontinuation: I suspect I'm not sick
After leaving, I couldn't move physically and mentally. Anything, as long as it goes through it in the mind, must not be done. I can only complete some actions when my brain does not have time to react, such as going to the supermarket, and I can go immediately, as long as "going to the supermarket" flashes in my brain, then I am doomed to not go today.
Far from the city, far from the hospital, no income, the more desperate the medicine is, and it is natural to stop the drug. This is the second time I stopped the drug, the first time because I was busy and because of disappointment with the treatment for half a year, I could see the doctor's helplessness when I came back, but maybe I saw too much, he only shook his head slightly.
After all the social apps were muted and my phone was constantly in airplane mode, I felt like my vitality had vanished.
In the first few years of my child's life, I had everything I needed to meet her needs, but now I am powerless to respond to her cries and accusations. I repeatedly told her, "Mommy is sick," but couldn't answer her when I would be fine. Even after repeatedly thinking about suicide, he asked the child, who was not yet four years old at the time, "Is it okay that my mother will never come back?" Watching her say yes with tears in her eyes, I wanted to cry but couldn't.
I suspect that I am not sick, I am perverted.
Struggle and abandonment
Two years after stopping the drug, maybe the people around me got used to me, maybe I got used to the surroundings, and my mood stabilized and I started looking for a job. In the general job search environment, it was easy for me to find a job based on experience, but after joining the company, problems appeared: ability is still there, pressure is difficult, and I can't balance family and career. After two or three jobs, I gave up again.
I knew I wasn't okay, but I wasn't sure if that was the way I was. I'm not sick, I'm just a hurried and lazy waste.
I feel that I have no hope.
After writing this article, after a period of treatment and rest, the author has a new experience and perception, which is published in today's two articles.
Doctor reviews
Zhuo Kaiming | Attending physician of the Mental Health Center Affiliated to Shanghai Jiao Tong University Hospital
Thank you to the author for writing about his difficult journey of suffering from "depression" and fighting it. As a healer, I can understand the author's desperation of searching hard but unable to do anything. However, skinny depression treatment studies have shown that about 30%~50% of depressed patients may eventually develop treatment resistant depression (TRD), and treatment failure also puts doctors in the pain of exhaustion.
However, are patients with treatment-resistant depression really not saved?
The so-called "freezing three feet is not a day's cold", it is imperative to re-examine the diagnosis and treatment of patients with treatment-resistant depression and actively find the causes of "refractory" depression.
First, past diagnoses and clinical features must be carefully evaluated. Some people may ask, for so many years, the patient has been unhappy, and has taken so many medicines, "depression" can still be wrong? In fact, this situation really happens often, such as the "close relative" of depression - "bipolar disorder type II", which is often shown with the appearance of depression, but its manic characteristics are not significant. This requires the healer to act as Sherlock Holmes, carefully searching for clues with the patient. Take the author, for example, "the first time I took medicine ... On the third day, there is a feeling of physical and mental lightness", in the sound of psychiatrists, there may be many doubts - antidepressants have a slow onset, fast 7 days, usually 2 weeks, slow 1 month is not unusual, in this regard 3 days is obviously counterintuitive. In addition, childbirth and miscarriage are mentioned several times in the text, and for women of childbearing age, the physical conditions that may occur in this may also bring a lot of difficulties to the treatment of depression.
Second, whether the long-term treatment process is reasonable also often affects the final outcome. From the definition of treatment-resistant depression, two antidepressants need to be met in sufficient doses (at least the lowest effective dose) and a full course (at least 6 weeks) of treatment failure. Whether the dose and course of treatment are sufficient, whether the patient takes the drug well, whether the time and method of taking the drug are appropriate, whether there are adverse drug reactions during the medication, etc., will affect the final treatment effect. For example, the author has taken venlafaxine, escitalopram, etc., each time can only obtain a short-term effect and quickly relapse, it is urgent to explore the causes of failure: whether there is insufficient drug dose - leading to residual symptoms and relapse, whether the dose is sufficient but adverse reactions cannot be tolerated - reduce the dose and fail. Sharpening the knife without chopping wood by mistake, before patients with treatment-resistant depression choose medication, taking a moment to review and evaluate the previous medication situation may achieve twice the effect with half the effort.
Finally, let's talk about the choice of treatment regimen for treatment-resistant depression. In addition to replacing different antidepressants, some other second-generation antipsychotics (such as quetiapine, aripiprazole), mood stabilizers (lithium salt, valproic acid, etc.), psychotherapy, and physical therapy, etc., can be used as alternatives when the efficacy is poor, alone or in combination with antidepressants, may achieve better treatment results.
For refractory patients, the impatience of lay relatives, friends, and family members is sometimes as heavy as the "last straw". But there is no denying that there are still too few professional doctors and counselors who can find the right direction for patients and give necessary guidance to patients and non-specialists when they encounter difficulties. And accompanying TA to the end of victory is only these non-professional relatives and friends. Only they can truly understand and tolerate patients, supervise and encourage them from beginning to end, and give patients the greatest motivation to adhere to treatment.
Personal experience sharing does not constitute diagnosis and treatment advice, and cannot replace the doctor's individualized judgment of specific patients.
Author: Dust
Editor: Odette