OK, I’m feeling pretty pissed off, frustrated, and hopeless right now. Today I had another appointment with my pdoc. I have regular appointments now, because she wants me to do that whole traditional “analysis” thing: lying on a couch, dream interpretation, unconscious motivation, free association, etc. I was skeptical at first, but decided that I may as well give it a go, since I’ve never tried this kind of therapy before. I have read before that the best predictor of a good outcome in therapy is whether or not the patient trusts and respects the therapist. I figured that since I trust my pdoc and have felt that she’s doing a better job than most other therapists I’ve seen, her methodologies would be of only secondary importance, so I should just go with the flow.
Today I wanted to talk to the pdoc about my sleep. Since I’ve been on the Lamictal, my sleep quality has been terrible. I’m still taking 15 mg Remeron for sleep, because it had been helping marvelously with my sleep. Not anymore, though. The pdoc wants me to regulate my schedule, come hell or high water. I haven’t been able to do this this past week because my sleep is so bad. I told her that I wouldn’t be able to regulate my sleep until my sleep quality improved, either by my getting used to the Lamictal or by using some other med for sleep.
She said that I have to do it anyway, just make myself do it. She gave me another benzo, Sobril (Serax in the US), to take as needed for helping me get to sleep, but she wasn’t happy about it. She says she doesn’t believe that we’ll get anywhere with this therapy unless I force myself to regulate my sleep. Now, bear in mind, this is something I’ve never been able to do successfully. Never. My moods go haywire when I’ve done it in the past–extreme anxiety and extreme depression. Very ugly. My life was barely able to withstand it then; now things are even shakier.
The major problem with my sleep is dreams. The Lamictal is giving me extremely vivid dreams. I mentioned this to the pdoc, and she asked what I’d been dreaming about. I did remember a dream from the other night, so I told her. She began to dissect the dream. What might I have in common with the people in the dream? Because all dreams are about us, she said. How did I feel about what happened in the dream? She suggested that I think about my dreams and maybe keep a notebook by the bed to record keywords to help me remember them. They are the best gateway to the unconscious, she says.
*sigh* Now my skepticism returns. I’ve been reading a lot lately about depression. Currently I’m reading Peter Kramer’s latest book, Against Depression, and I highly recommend it. Based on what I’ve read in this book and elsewhere, depression is considerably more biological than we previously thought. Modern neuroscience has gone beyond the whole neurotransmitter theory of depression; the theory now in vogue has a lot to do with genetic susceptibility and life stressors. It appears that a depressive’s genetic inheritance makes her brain particularly susceptible to damage by stress. When stress occurs, the brain is less able to protect itself from damage, and less able to repair the damage that occurs. This leaves the depressive even more vulnerable to damage from stress in the future. So depressive episodes cause brain damage that make more depressive episodes likely to occur in the future. Because of this, it’s extremely important to nip depressive episodes in the bud with effective treatment. The longer and more severe an episode, the worse the brain damage. And actual, physical brain damage, both at the cellular and structural level, as verifiable with MRI’s and microscopes, is occurring.
These theories mesh very well with my experience of my depression. My biological mother and her mother have depression. So do my biological half-siblings; they have circadian issues, too, just like me. My depression does not seem to be related to external events; it doesn’t even seem to be caused by my thought processes. Then there are those times when I can be depressed and crying, while at the same time laughing because the rational part of me is observing this physical breakdown and can see that it’s not attached to anything. Aside from the depression, I’ve had a good life. No trauma, a close, loving family, plenty of opportunities that I’ve taken, etc. I seemingly have no reason to be depressed.
So needless to say, I’m concerned. I’m concerned that I’m not being medicated properly, and I’m concerned that this therapy is barking up the wrong tree. I’m concerned because my pdoc says that I might get worse before I get better. I’m concerned because she’s instructed me to do something that has previously set off major anxiety and depressive episodes. She says that it won’t be so bad this time, because the Lamictal will help stabilize my mood–but I’m not on a high enough dose of Lamictal for it to be having that effect yet. I’m concerned because I know that being on hormonal birth control makes Lamictal 40% less effective, and my pdoc has never asked about whether or not I’m on hormonal birth control (which is, as a matter of fact, another potential cause of depression).
I decided to read online about psychoanalysis. Here’s a statement from CBS Cares that’s representative of what I’ve found:
It used to be believed that the roots of depression were in childhood experiences. According to this belief, medication could serve only as a band-aid, and it was necessary to undergo extensive psychotherapy to correct the underlying causes of depression. Depressed mood and anxiety were also considered to be the results of intra-psychic conflict, and therefore it was seen as necessary to resolve the conflict in order to truly treat the depression and anxiety.
Much of this thinking has been revised over the past 20 years…
…psychoanalysis is a multi-year, in-depth exploration of how a person experiences themselves and other people, relying on detailed understanding of early life experiences and examination of unconscious thoughts and feelings as revealed in free association, dreams, and other avenues. While it can be effective in helping people develop stronger and more mature personalities and making better decisions in life, it is not a treatment for depression.
Most statements about psychoanalysis aren’t even so generous as to allow that it might help patients develop as a person. In any case, from my research, not to mention my experiences with therapy in the US, it seems like the majority of Norwegian therapy, including that which I’m undergoing now, is based on pseudoscientific theories that are at least 20 years out of date. So, I’m concerned. I’m depressed now, and not getting better. I’m afraid for my brain, not to mention my body. So many of the symptoms of my depression are somatic: poor memory, problems concentrating, messed-up sleep cycles… You should read Kramer’s book; what he has to say about depression as a somatic illness is just terrifying. Well, for a depressive. I’m concerned that my therapy now is little more than medical malpractice, and that there’s nothing I can do because this entire fucking continent is 20 years behind the times.
I want a second opinion. I want to talk to a fucking scientist. A neurologist, or a psychopharmacologist. I just cannot help but think I’m being forced to wander down the garden path here, and I fear I simply haven’t got time for that kind of bullshit.