[johnward]

It's not that I want to avoid medication I just want whatever can help. I am talking about when you see your general practitioner and they prescribe you the usual antidepressants. A psychiatrist can prescribe much more powerful drugs and probably provide a better diagnoses too. I have not been referred to one of them. I've been to a clinal therapist and while it helped a little bit I'm still no where near what I feel is normal. Going to a therapist is a major time and money commitment. I luckily have a job that is pretty flexible. The most helpful thing for me is exercise which gives me a temporary relief for a few hours afterwords but sometimes I don't have enough energy. I also keep injuring myself and that prevents me from being able to get a good workout.

[wdewind]

Yeah, I don't mean to imply there is anything wrong with medication, but what you've found is that you've exhausted the limits of what your GP can do for you. So it's time to move on to a specialist. I would suggest starting with talk therapy simply because it's the less extreme response than psychiatry + drugs and it's always easier to escalate, but I really don't know you and I don't know what you're going through.

Going to a therapist is absolutely a major time and money commitment and those are the things that stopped me from doing it for way too long. My basic experience finding a therapist was that there were two kind: one that was in my network, and one that could see me at a reasonable time. I ended up just paying out of pocket and getting somewhat reimbursed later by the insurance company. It wasn't great, but it was totally worth it and I really wish I'd done it sooner.

I don't mean to sound pretentious, but this line:

> I'm still no where near what I feel is normal.

Tells me that you hardly scratched the surface of what therapy can offer you, at the very least in terms of perspective.

It sounds like you're in a rut, and you aren't making progress. Regardless of if you enter therapy, it's time to try something else. If you happen to be in NYC feel free to email me and I can set you up with a great therapist who really helped me. Either way, best of luck to you and keep up the good fight.

[thinkharder]

As someone who has had, what sounds like a very similar experience to yours, I understand and feel your pain. Folks who have never had to deal with it think it's as simple as going to the doctor. Folks who live in SV tend to forget that in the vast majority of the rest of this country, good mental health help is really hard to get. Outside of the major US cities, your typical family doctor has about the same level of understanding of mental health issues as he has about quantum physics, but he thinks he knows everything he needs to about it. And the vast majority of Mental Healthcare professionals require a referral from your PCP or they won't take you as a patient. The scenario typically goes like this: I go see my Primary Care Physician and complain about depression or some other mental health issue. He listens for a couple of minutes then wants to prescribe zoloft (or celexa or whatever). I ask about seeing a Psychiatrist and get something like "well, he's just going to have his intern ask you a bunch of questions then prescribe the same drug I would..." I ask about seeing a Psychologist, and after some pushing he grudgingly gives me a referral. The psychologist is a really bad fit with me, and isn't helping so now I've got a open-ended prescription for zoloft and no fucking help. Been thru slight variations of the same theme with 3 different primary care doctors. And no, I don't really think any of them believed I actually had a problem, but they'll give endless supplies of zoloft et al., to anyone, for any reason. And they'll happily prescribe it for you forever, without also setting you up with some form of counseling, which is specifically warned against in the drug literature.

What I finally had to do, was talk to a close friend who knows a lot of Mental Health practitioners, partly from using their services, partly from the fact this guy knows everyone in town. He was able to call a friend who is a retired Psychiatrist, who was able to help find someone who would take me without a referral, and further refer me to a good psychologist. There's also the issue that most insurance plans have pretty crappy coverage for this stuff. And since I can't get an in-network referral to an in-network doctor, I'll be paying for most of this out of pocket.

My advice, for the little it's worth, is first... Don't Give Up. It's a fucking absurd pain in the ass, but it is possible to overcome. Think about finding a doctor the same way you would about hiring an employee, that's basically what you're doing. Use your social network, do you know anyone who is in a high-risk group for depression or other mental health issues? It's likely you know someone who has struggled with this and just never said anything. Ask around. It sucks to have to reveal yourself that way, but it's really not as bad as it seems in one's imagination. You will probably be surprised how many people not only get it, but want to help. Try a doctor out, if he isn't working, fire his ass and get another. No different than hiring a contractor. It's easy to load a lot of emotion into the process, but avoid doing this and stick to business. And try not to get sucked into the psychiatry vs psychology wanking contest. They're different approaches, have different tools, and different efficacies for different issues. CBT is great for moderate depression. There's much less evidence it's helpful for ADHD. There's a whole class of medication that's quite effective for ADHD. There's much less evidence that zoloft and friends are useful long term for depression. Extrapolate that out for all the other possible mental health issue a person might have.

At any rate, you're not alone, my friend, and you're not the only one who has had to go thru this shit. It is possible... Email is in my profile, if you need someone to talk to, feel free to contact me. Best of luck.

[wdewind]

> And the vast majority of Mental Healthcare professionals require a referral from your PCP or they won't take you as a patient. The scenario typically goes like this: I go see my Primary Care Physician and complain about depression or some other mental health issue. He listens for a couple of minutes then wants to prescribe zoloft (or celexa or whatever). I ask about seeing a Psychiatrist and get something like "well, he's just going to have his intern ask you a bunch of questions then prescribe the same drug I would..." I ask about seeing a Psychologist, and after some pushing he grudgingly gives me a referral. The psychologist is a really bad fit with me, and isn't helping so now I've got a open-ended prescription for zoloft and no fucking help.

Holy shit. That is so fucked up dude. I'm sorry.

For what it's worth the vast majority of therapists do not require referrals, but not having a referral can make it impossible to get reimbursed via your insurance, which I know can make it a nonstarter for some.

> There's also the issue that most insurance plans have pretty crappy coverage for this stuff. And since I can't get an in-network referral to an in-network doctor, I'll be paying for most of this out of pocket.

Yeah, it really sucks.

> My advice, for the little it's worth, is first... Don't Give Up. It's a fucking absurd pain in the ass, but it is possible to overcome. Think about finding a doctor the same way you would about hiring an employee, that's basically what you're doing.

I agree 100000%. It's so worth it. I also love using our existing startup skills as a platform for addressing these issues, nice.