Hi! I believe I can be of help with this issue.
First let me say that I can imagine how difficult it must be for you and frustrating that you do not feel well. That you are still hopeful and seeking help is a very good thing. My answer is going to focus therefore on three things: first, on medications, second on the type of psychotherapy I recommend for you. And third,I will also at the end of the posting give you a technique you can use on your own as well for when you are in the throes of depression. The technique will mention anxiety and I know this isn't your problem but when you are in that dark hole, it is very much like anxiety and this will help you get relief on your own and you can use it continually.
First, medications. You've been on Zoloft for less than a month. You should be feeling some difference but you're not yet. It might require adjusting the dosage. Or it might require a different medication. But I urge you not to give up on the medications. You need immediate help and that is the strength of the meds. Therapy takes longer but doesn't have the side effects that meds will have with prolonged use. Your relationship is in trouble and so you need to act quickly.
But at the same time as I need you to keep working with meds with either this nurse or going to a psychiatrist (better option), remember: medications work on SYMPTOMS, not on what's going on with you as a human being. The problem with just focusing on symptoms is that we are human beings, not biological machines. So very often, when a medication treats one symptom, the underlying human condition that causes you depressed emotions pops up some other way and you are continually chasing after symptoms with your doctors. The research has shown (and my experience as a psychologist has certainly shown this) that psychotherapy WITH medications is much more effective than medication alone. Sometimes it can help the person reduce medications.
So I want you to reorient your focus from the medications being your main "work" on your anxiety and depression to your exploring your emotional reactions of feeling so anxious and being in such a depressed dark place as being your MAIN work and the meds as being the boost you need to help you not be so depressed and in a dark hole so that you CAN work on what's going on inside. Do you see this reorientation? The idea is that YOU ARE A HUMAN BEING and human beings don't just have emotions because they hit 27,000 miles like a car or like tires! We have emotions because they are part of how we grow and learn and become more fulfilled. But if we keep running from them and trying to get them just to go away without ever exploring what's going on, we NEVER get that chance to get anything from them. They just make us feel terrible year after year.
Okay, on to the second part about psychotherapy. You need to find a psychologist to help you with the underlying CAUSES of these symptoms, who can help with the depression itself. You need to feel comfortable with the psychologist and I don't want you to accept just any psychologist. You've started therapy with someone but I don't know if this person is qualified or not. But one thing I do know: you are not treating the therapy with enough commitment. Your prospective marriage is on the rocks and this is the BEST chance you have to save it. Yet you are not giving it the priority it needs to make sure you make every weekly session. And you may need more than once a week at first.
So decide how much of this lack of commitment is your own sluggishness and how much is a lack of confidence in the therapist. Because if you are not feeling comfortable and confident, then find a psychologist who can work with your problem. You have excellent insight into your depression: you know it has to do with your mom's passing and the resulting family situation. That's big. Not many people have this awareness. So use it in therapy.
I have found that with your situation you will do better with a more psychodynamic, humanistic approach in therapy. If we actually look inside, we can find great relief and meaning. And we can feel whole in ourselves in ways that we haven't for decades.
If your therapist isn't giving you that sense of going into this introspective area you need to, I would like you to interview psychologists who have a more humanistic focus. If you don't have a good referral source, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list psychodynamic and humanistic therapy in their orientations.
The idea here isn't that these types of therapy are magic. It's that I want you to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions and all or nothing thinking. You need to explore this if therapy will be ultimately worthwhile.
Now, I want to give you a tool to use for when the depression is overwhelming or there is anxiety. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.
I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in depression and anxiety is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.
So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?
- After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
- Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
- Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
- Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
- Continue down your body, repeating the procedure with the following muscle groups:
- entire right arm
- right forearm and hand (making a fist)
- right hand
- entire left arm
- left forearm and hand (again, making a fist)
- left hand
- entire right leg
- lower right leg and foot
- right foot
- entire left leg
- lower left leg and foot
- left foot
- for the shortened version, which includes just four main muscle groups:
- neck, shoulders and arms
- abdomen and chest
- buttocks, legs and feet
Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.
What You Need:
- A comfortable place.
- Some privacy.
- A few minutes.