I Feel Depressed and Desperate

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Reader’s Question

I’m a 20-year-old male and I am deeply depressed. I’ve had a problem with depression almost all my life, but in the last year it has hit rock bottom.

I have lost most of my friends, and it is virtually impossible for me to meet new people, because I have no self-confidence and I live on my own. The few friends I have at the moment never want to see me, because all I do is sit around and say nothing. It’s terrible. I hardly ever see my family, and when I do, I try to explain to my parents what is going on, but they don’t understand me. I haven’t had a girlfriend in ages, and meeting girls or friends is impossible for me right now. At work, I sit alone in my office all day, and hardly ever communicate with anyone. I’m not happy with anything in my life right now. I feel as if I have no talent, drive, ability or anything useful. I am on antidepressants, but they do not seem to be working.

I think I may have manic depression, as I go through short periods (usually a matter of hours) of intense happiness, and during these periods I feel as though I can improve my life. But these are very short-lived, and I just fall back into a slump shortly after.

I feel that there is no solution to this problem other than drugs, either of the pharmaceutical type or the illegal type, and I often think of suicide. Please give me some direction. I am desperate.

Psychologist’s Reply

I want to tell you that I am glad you reached out, because that tells me that there is at least a small part of you that still has some hope. It is difficult to feel hopeful when you are clinically depressed, and many of the things you mentioned point to the severity of depression for you. You have described social withdrawal, a lack of motivation, a negative self-concept and low self-esteem (e.g. worthlessness), some hopelessness, a lack of feeling as if anything is worth it, and chronic suicidal ideation. In naming these symptoms, you have named many of the symptoms of a major depressive episode, which is the hallmark of major depressive disorder.

I’m glad you have been able to name the problem, and that you have sought psychiatric treatment in the form of medication. You have very eloquently described the problem, and as I read it I wanted to reach out to you. I cannot say for sure, obviously, but I wonder if others (e.g. friends) would also reach out to you if they knew the extent of what is happening for you. As you mentioned, it can be hard to communicate when you are feeling so low. However, connecting with others and obtaining social support can be helpful in battling depression, which often leads people to isolate themselves

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The good news is that many people who have experienced a major depressive episode, as you might be experiencing, have moved out of that episode. For depressed people, it can be difficult to see and believe that any other way of feeling is possible. Let me be the holder of hope for you for a moment, as I tell you that there are effective treatments for depression. You mentioned that your antidepressants do not seem to be working. In psychiatry, there is often a sense of trial and error as your practitioner locates the right medication (or medications) and the right dosage for you. My hope is that the medication would offer you some relief from the suicidal ideation. I would highly recommend that you contact the health professional who prescribed your antidepressants, to discuss what symptoms you are still experiencing.

I am very concerned that you seem to spend so much of your time on your own, that you feel there may be no solutions to your problems, and that you often think of suicide. If you find that you have intense, chronic suicidal thoughts, have thought of a plan, and have access to the means to harm or kill yourself, it is worth seriously considering whether you are able to keep yourself safe at this time. If you are not able to guarantee to yourself that you will not harm yourself, please contact someone who can be with you to keep you safe, or call 911. Until you find a treatment that works to get you out of this place, your safety is the priority. Suicide has been said to be a permanent solution to a temporary problem. I think this is a useful characterization, as it can be tempting to consider ending your life out of hopelessness or a need to end the pain, however, if you knew that this pain would end at a particular date in the future, or that things at some point would seem different to you, taking your life might not seem as attractive. So, if you find yourself in a moment of crisis, you could also call either the National Hopeline Network at 800-SUICIDE (784-2433), or the National Suicide Prevention Hotline at 800-273-TALK (273-8255). It can sometimes help to discuss what is going through your mind in the moment with someone who knows what to say.

If you are safe and stable, then a next step in relieving your symptoms might be to consider dosage changes, medication changes, or additional medications. There are also therapies that research has found to be effective in treating depression. Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have both been supported by research studies that have reviewed therapy outcomes. Beyond empirically supported treatments, therapy can be helpful also just simply through establishing a relationship with someone who can listen, understand, offer coping strategies, and support you through the difficult moments that you have described.

I hope that knowing that there is something you can ‘do,’ in addition to medication, is positive for you. Many people, through therapy, medication, or a combination, successfully manage and even resolve depression symptoms. Please do not give up.

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