Hi, Linda. Thanks for the extra information. I believe I can now be of help with this issue.
First let me say that I can imagine how difficult and frustrating this situation must be for you. You are clearly an intelligent woman. You have done well with medications for 20 years but now they are no longer doing the work you want them to.
And this is actually the key to my answer to you that you need to think about and consider and act on. That you are still hopeful and seeking help is a very good thing. My answer, therefore, is going to focus therefore on three things: first, on the role of 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 and/or anxiety.
I'd like to make sure it's clear that I view the medications as being vitally important tools in the treatment of depression and anxiety disorders. But it is also important to 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. And this is the tradeoff with medications when they are successful: they relieve SYMPTOMS but they relieve them while they are in your system. They don't actually TREAT the disorder. With pharmaceutical "solutions" you are getting relief from symptoms. That can be very important so that the anxiety from the symptoms doesn't overwhelm you. But if you want to treat the disorder itself--why it's happening, what is it telling me about myself, what changes do I need to make to not feel as I do?--to do that, you would need to explore yourself in a more human way.
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 panicked about being with people and anxious 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 60,000 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.
Now on to the second part about psychotherapy. You are no longer staying stable with meds. Okay. Then, you need to find a psychologist or psychotherapist to help you with how to change your behavior and your thinking to relieve these symptoms instead of strengthening these symptoms. You need to feel comfortable with the psychologist or psychotherapist and I don't want you to accept just any psychologist. You should focus on psychologists or psychotherapists who practice more structured, practical, skills oriented therapies like Cognitive Behavioral Therapy (CBT). And from what you write, this type of practical, action based therapy is what you can use most effectively. You have the right to interview them until you find one who you feel comfortable with and confident with.
So look for someone practicing CBT psychotherapy who fits that description. 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 CBT strongly in their orientations.
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 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.