NHS & Second Opinions / Sources of Support or Therapy?

[logboy]

I've been concerned for a number of years about the complexity of tackling depression from within a system that is one size fits all.

I know this is perhaps a necessary compromise, or at least I've convinced myself compromise is more than likely, but some issues connected to my long-term depression repeatedly leave me feeling as though they're not fully-acknowledged or accepted. Primarily, this is connected to issues of memory, concentration, absent-mindedness. Doctor doesn't manage to state they're symptoms of depression, but denies they're effects of the medication. Doesn't help that some people don't see me as absent minded because they only experience shorter periods of time in conversation with me. One or two regularly see my flit between feats of intellectual dynamism and absolute failure to grasp or perform a simple task, others wonder why i am convinced a more complicated life would prove to be a greater disaster to me now (less patience or desire to risk coping with it) than it was in days when i was more youthful and energetic, willing to take risks, naive and so on. Doctor expects me to accept his ideas without acknowledging I've spent a great deal of time exploring, discounting and trying ideas and I'm in need of inspiration more than anything else - ten minute sessions don't give me this.

Essentially, wondering if there's hope or alternative directions for seeking more specialist NHS-based support for depression? Must admit that although I've seen numerous people, the nature of the NHS has often caused people to be moved around even after a short time. I've seen only one that particularly worked for me because the sessions were conversations rather than short questions attempting to veil some impression that as little was going to be given away as possible - to me, therapists like these seem more self-indulgent than helpful - but this was almost ten years ago and although i've mentioned this man to my doctor, nothing has been forthcoming as the majority of my attempts at starting a new therapist only result in me attempting to solve the puzzle of what on earth it is they do, ultimately.

Where do i go to enure a more depression-centric approach to the treatment i seek via the NHS? What can i realistically expect or find from varying therapists - are there people that would understand my lack of faith in that kind of approach that would actually be able to temper their approach to be more of a sharing of ideas and a fresh start over a situation where my past history / session notes were the starting point.

Feels as though I need to find a fresh start with my treatment. Don't know where to find it. Thanks.

[MINDFUL HELP]

I've been concerned for a number of years about the complexity of tackling depression from within a system that is one size fits all.

I know this is perhaps a necessary compromise, or at least I've convinced myself compromise is more than likely, but some issues connected to my long-term depression repeatedly leave me feeling as though they're not fully-acknowledged or accepted. Primarily, this is connected to issues of memory, concentration, absent-mindedness. Doctor doesn't manage to state they're symptoms of depression, but denies they're effects of the medication. Doesn't help that some people don't see me as absent minded because they only experience shorter periods of time in conversation with me. One or two regularly see my flit between feats of intellectual dynamism and absolute failure to grasp or perform a simple task, others wonder why i am convinced a more complicated life would prove to be a greater disaster to me now (less patience or desire to risk coping with it) than it was in days when i was more youthful and energetic, willing to take risks, naive and so on. Doctor expects me to accept his ideas without acknowledging I've spent a great deal of time exploring, discounting and trying ideas and I'm in need of inspiration more than anything else - ten minute sessions don't give me this.

Essentially, wondering if there's hope or alternative directions for seeking more specialist NHS-based support for depression? Must admit that although I've seen numerous people, the nature of the NHS has often caused people to be moved around even after a short time. I've seen only one that particularly worked for me because the sessions were conversations rather than short questions attempting to veil some impression that as little was going to be given away as possible - to me, therapists like these seem more self-indulgent than helpful - but this was almost ten years ago and although i've mentioned this man to my doctor, nothing has been forthcoming as the majority of my attempts at starting a new therapist only result in me attempting to solve the puzzle of what on earth it is they do, ultimately.

Where do i go to enure a more depression-centric approach to the treatment i seek via the NHS? What can i realistically expect or find from varying therapists - are there people that would understand my lack of faith in that kind of approach that would actually be able to temper their approach to be more of a sharing of ideas and a fresh start over a situation where my past history / session notes were the starting point.

Feels as though I need to find a fresh start with my treatment. Don't know where to find it. Thanks.

Hello logboy,

this is a great post and very interesting.

As a therapist, I’ve had a number of clients who’ve contacted me from word of mouth from other previous clients who have have NHS treatment such as CBT and they all have one thing in common. And that they all say that they don’t get enough time, the therapist doesn't have chance to build a good rapport with them. I’ve also have first hand experience with people who have schizophrenia and they see their psychiatrist every 3 month for about 15/20 mins. How can a therapist know how to effectively help a client, without getting to know or understand them? Just by talking to people and not treating them as "robots" helps. But don't get me wrong there's some good people in the NHS but they are limited on what they can do in a short space of time.

In addition to this, lots of clients tell me that they don’t feel as if they are being acknowledged or listen to. I’ve also been told that one particular client who came to us for help, say that all the therapist did was look at their watch.

There’s no way I’m knocking the NHS because they have set times and are under pressure however we can completely understand where you are coming from and I am sure this only adds to your distress.

Personally we believe that such a protocol approach in therapy does not help most people at all, after-all just because a person has mental health difficulties it does not mean that they are not human with feelings and any less intelligent than any other person. We therefore believe in a mutual respectful relationship that is certainly on an even platform. It sounds as though you would be looking for a ‘person centered’ or ‘humanistic’ approach as this considers you and regards you as opposed to treating you as a case.

I hope you are find what you are looking for and if we can help then please get in touch.

Thanks

[logboy]

last therapist i saw wanted to try mindfulness. i started reading the book and it sounded vague, kind of like prescribing a weekly visit to the church - all about faith, as far as i could tell, and a bit likely hypnotism when i tried it a couple of time - and the therapist wouldn't explain to me what it was intended to do, and didn't offer alternative ideas.

for me, what makes me feel like i'm not being heard is how the overall effects of depression reach into various parts of my brain, my memories and experiences, my personality, and i can often feel as though i'm repeating answers i gave to other questions. might not be a case of not listening as much as it is a necessary part of building a picture and reassuring one another of an effect or issue.

[Becky83]

Dear Logboy for a moment there I thought I was reading something I had posted! I know exactly what you mean. I to have issues with memory, concentration and absent-mindedness and because I have not always been this way, part of me wonders if the medication I am taking can be to blame. Indeed when I have gone through various forums viewing other topics about the same medication I am on, one of the current and ongoing entries which people complain about is memory loss and concentration and absent-mindedness.

Broaching the above with a Doctor is never going to prove to be of use I believe. The medication is there to stop you feeling depressed. And although it may have the above side effects they will not admit to it. Because if they do, were does that leave you? Not taking the medication? If that is not an option then it would appear that you would have to take the medication and unfortunately be exchanging one evil for another. The question is, which one is more debilitating and life destroying. The depression for sure -  so I would continue the medication.

However, I can also understand your frustration as it is something I feel myself. Having dreams, aspirations to do more and be more and yet know that you will never be able to reach your full potential due to the depression and due to the memory issues and concentration issues. Frustration in that it is not one thing a Doctor can outright cure or seem to pinpoint any firm ideas of facts as to how to cure it.
   In my new post one of my issues was that, although the tablets do help and they allow me to survive they do not allow me to live.
My  quality of life has improved in that I am not burdened day by day with the deep and debilitating pain of depression. But neither am I cured. And that is a very hard place to be in.  There are things that I know I have the potential to do, but fear of falling back into the unpredictable chaos of depression stops me. To start something, to be successful at something and feel that achievement warm you inside and then slowly watch as depression takes it all away....is soul destroying.
   The same goes for relationships. I say to myself that I cannot be certain of a year when I will not be bed bound for a couple of months and how is that fair to a partner? It isn't so again....single for life?

At the end of the day I have come to the conclusion that...Doctors have limited time, therapists have limited time. If all that time is spent dealing with 10-15 minutes slots for patients. How will they know what the current and up to date research is on medication and cures for depression. The answer is...they won't. This was further proven to me when I saw a doctor once, and explained about a new medication that I had researched. His blank look and "Well thats a new one for me." Just reaffirmed my belief. When he then went onto further Google said  medication in front of me with a "Google is our friend" joke....It makes me wonder what the difference between him and me are? I can Google medication and new therapies. Maybe that means I could be a Doctor. Or maybe it just means that your guess is as good as his/her's.

Again another appointment with my Pdoc, who I have to see now because my dosages are above was a normal GP can administer. I explained to him that the current high dose of one of my AD had side effects such as memory loss, loss of concentration etc and his reply was that "those are random tests done versus placebo with candidates possible not even depressed, the memory loss statistics were so low as to be non existent, so for you to say you feel the medication is contributing to your memory loss is not really a valid argument."
   It only made me annoyed to think that at home I had the print outs of the statistics and that it was a very real concern and it was also a noted side effect amongst patients at higher dosages. But when you go to see someone who specializes in mental health issues you do not expect to have to bring with you the research to back up your argument, you expect them to be aware of it as they are the ones prescribing you the drugs!

Anyway, I am not sure if the above has helped you at all. I have been doing research into stimulants rather than antidepressants as new research shows that drugs used to ADHD patients such as Ritalin may be beneficial to patients who duffer from depression, especially the kind that is fatiguing. But again, broaching this with a doctor or psychologist is perhaps only likely to get you a look which implies "drug seeker". When in reality all you are is someone who is desperate to get on with life and attain that ever elusive "normal".

Medical notes will always come to play  a part in how a doctor perceives you. They are only human, and although they are not supposed to be I don't see how they can remain unbiased. In my opinion I have drug resistant depression, but my current Pdoc when I broached this merely smirked and said "yes you HAVE been on rather a lot of different medication." His tone and facial expressions were insulting to say the least, but its hard not to give up in the face of continued opposition and skepticism.  He didn't even consider that I was drug resistant, but merely not allowing the medication enough time to work. The current medication I am on he has "told" me can take up to 2 years to be fully effective. How can anyone live with depression as debilitating as it is for that amount of time simply waiting and hoping for the medication to "kick" in.

I have never seen a therapist but I did see another Pdoc when my current bundle of joy went off on long term sick leave. And her argument to me getting better was "try yoga". Need I say more 

[lightenup]

Hi all great posts, and bang on, I told my therapist on the phone I don't think anyone can understand unless they have been through it.  How many times have we emphasied with people with a condition they have and we haven't........truthfully none us has a clue.  You can read all you like on something but experience is a great teacher. 

Truthfully regarding taking the drugs all they do is take the edge off.  The frustration of the memory loss, and concentration is just awful.  Take care all.

[logboy]

becky,

i've suggested my doctor that memory loss and concentration / absent-mindedness might be a result of my medication, but he says it's not a known side effect. i understand there's an issue with experience and knowledge, clarity when it comes to finding a doctor and getting a medication - i myself have read stories in the past year of patients feeling let down because the choices and side-effects are not given to them - but i think that these symptoms are mental issues related to the long-term circumstances of trying hard to figure things out. in other words : i'm so intent on solving the puzzle of depression that i pick myself apart and cause anxiety by not being able to apply focus on the day to day elements of life, even if i often don't realise i'm doing it, i'm usually picking up on lots of information on human nature and behaviour in attempt to solve what it is i don't understand that should be out there to make me happy / happier. maybe people with depression can quite often find themselves unable to live life well because they can't simply accept life as much as they want or need to understand or adjust it. this may be another cyclical behaviour that perpetuates the condition, as (seemingly) does avoiding changes in life that might bring a sense of reward, allowing unhappiness to continue because life is that little bit more the same as a result?

my own experience is that depression has been a part of my life for so long that a doctor can't easily come up with ideas that i've not thought of before and sometimes have also tried. as a result he thinks i'm uncooperative, despite having me down as analytical and intelligent. i suffered for 15 years without discussion or medication until i first saw a doctor 10 years ago. as time goes on, it's not just the condition that upsets me, but that it's now a long-term element of my medical records, and that the person i once turned to out of hope for a saviour simply becomes someone who can't grasp the intricacies, often doesn't seem to feel motivated in a consistent fashion, and that everything seems to turn back to me as though i am the only one who can ultimately change anything. nobody, not even me, seems to have the patience or imagination to figure it out, and i don't find anyone beyond a relatively young age finds that many opportunities in life that could be focussed as a more constructive form of real-life therapy on are even being offered up or making themselves visible.

as far as i'm concerned, one challenge of depression is to figure out the ways in which it may make someone seem to be their own worst enemy, but in fact it's usually the case that people have trouble seeing it's not the intention or the true desire of the sufferer - i often feel disappointed that initial fascination or concern just turns to impatience, misunderstanding and dismissal as more and more information is shared, not because of what is being shared, but because we've only so much capacity for concern for others. also, depression sufferers often have insights into behaviour non-sufferers only dream of, and this seems to indicate the ability to figure things out despite how there's also a lingering impression of being stumped / blocked / anxious about how the detail piles on but doesn't bring greater functionality to their lives.

[lightenup]

Logboy thankyou you put everthing down so well and all so true.  I have been told I over think things and the frustration I feel because how much my though brain process has deterioted, my son is a pharmacist and I want to ask him if the meds are problematic, but I don't want to harass him.  Also I still want to find any other excuse for my behaviour rather than depression.  I am afraid I will not get back to the way I was before, but they assue me this is all to do with depression.

[logboy]

Logboy thankyou you put everthing down so well and all so true.  I have been told I over think things and the frustration I feel because how much my though brain process has deterioted, my son is a pharmacist and I want to ask him if the meds are problematic, but I don't want to harass him.  Also I still want to find any other excuse for my behaviour rather than depression.  I am afraid I will not get back to the way I was before, but they assue me this is all to do with depression.

depression is such a puzzle that, as it's within our own minds (ultimately) it's hard or unavoidable to not try and think things through. since it's always felt to me that it was perhaps just a few thoughts and memories that are affecting the overall function of the mind, i'd guess that the frequent mentions for memory loss / absent-mindedness / lack of concentration is caused by there only being so much each mind can take on. since depression effects my sense of happiness, i'm inclined to focus on dealing with it, but it's the amount of focus it's possible to give that causes problems, and it can be hard to avoid leaving a part of the brain permanently dedicated to trying to figure it out to the extent it doesn't allow us to focus on daily activities in a way that lets us perform them successfully and accept them as the things which build the balance towards happiness. this is, as i mention, something i think of as self-perpetuation behaviour, and it's a sign depression intends to maintain a grip by getting us to feed it with too much attention within our own thoughts that we can't help but go around in circles, constantly finding the bad things that it hopes we will in an attempt to identify what's wrong, and this is exactly what we shouldn't be doing - but can't resist.

we've only so much we can take on, after all... i'd suggest that talking through ideas is a better way to resolve theories than constantly questioning ourselves. i've seen therapists of several different kinds, but found that the only one that worked particularly well for me was the one that was willing for it to be a discussion rather than clipped questions in expectation of detailed answers. when i'm left to do most of the talking, the temptation is to do no more than i would do when thinking alone. if wisdom is shared, which i often felt therapists resisted strongly, i feel more empowered to take solutions with me wherever i go, rather than rely on someone to spend one hour with me out of a week's worth of isolated self-analysis. this said, having watched a recent report on 'mindfulness' techniques on TV, i'm inclined to feel it's more persuasive now than when i was introduced to it a few years back - it seems to deal with this issue of how we focus within on very small portions of our brains activity, and allows people to learn how to spread their focus more evenly, allowing less dominance of only this small portion of difficult memories / behavioural patterns / self-doubts / fears that depression sufferers tend to have. it might feel wrong at first, but mindfulness, when not presented in a wishy-washy new-age manner (which is an unfortunate softening of issues i'm often seeing where i see depression discussed) seems to alter brain patterns in a manner visible with brain scans. worth looking into, i guess.