Quote:
Originally Posted by Yaowen
I think you are a very good BF and I commend you for that. It can't be easy for you.
There is a body of research* that has linked anxiety to depression. The stress hormones are designed for brief emergencies. But for genetic or other reasons, some people are unable to turn off the stress response. This is thought to bathe the brain in stress hormones which do actual damage to the brain {reduction in size, mass and density of certain regions of the brain, reduced regional energy utilization [glucose metabolism] and cerebral blood flow [can be seen often on real-time brain scans].
The damage can be to the hippocampi and the cerebral cortex. There appears to be a loss of protective glial cells in the brain as well. Damage can be microscopic too, affecting brain cell architecture, atrophy of dendrites.
Stress is often not obvious. Things people tend never to think of can be huge stressors. For example, people who are perfectionists tend to feel that only the perfect is good, anything less than perfect is bad. The drive for perfection in self, relationships and so on can lead to unrealistic expectations that are bound to be disappointed.
Perfectionism, and this is just one example of a hidden stressor, can lead a person to have a default attitude of "could be better, but isn't better." Of course anything and anyone can be seen and one can say: could be better but isn't better. This "could be better" attitude might operate at a less than conscious level in a person but tends to lead to a set of emotions: disappointment, aggravation, anger, guilt, sadness, joyless striving, even hopelessness. These are huge stressors!
To the person experiencing these things it appears that the world, others, events, things, even they themselves are "causing" their low feelings. But the truth is that the world is not causing this, it is their unrealistic expectations that are causing every bit of this unhappiness.
If I look at the past and present through the lens of "could be better" I can quickly become depressed.
But what happens if a person looks into the future, anticipates the future with a "could be better, but probably won't be better" attitude? That leads to anxiety. For a person with anxiety or panic disorder, the future is terrifying. This is because of perfectionism in part . . . the people here think I will not be good enough in the future, my relationship will not be good enough. I will not be brave enough, smart enough, good enough, attractive enough. So the future looks quite bleak. Things are not so good and don't look to be better in the future.
A person with anxiety and depression doesn't realize that there is whole OTHER way of looking at things . . . "could be worse, but is not worse." Everything and everyone can be looked at through that lens. And looked at through that lens, different emotions and moods are engendered: appreciation, gratitude, feeling blessed or lucky.
For whatever reason a person afflicted with depression, anxiety and panic cannot access that way of looking at things. They are "stuck" in the "could be better but isn't better" frame of mind.
Effective medication can sometimes heal the brain*. Sadly it is often a trial and error process. One med might help. One med might not.
Stopping a medication can sometimes cause a depression or anxiety to reoocur. One reason is because for some, depression is a chronic illness like epilepsy and one must remain on medication for life. For others, a medication has not fully resolved all the symptoms and so stopping a med can cause a person to revert.
Cognitive therapy can help a person to slowly realize how destructive a "could be better" attitude can be for some people. It is not a magic pill. Something like perfectionism or some other attitude that causes stress might be engrained in person from a lifetime of conditioning.
It isn't like changing from on to off on a light switch. Change can require months even years of effort. Often a person in a depression is not at their best. Often they are not really up the work involved in cognitive therapy. Often cognitive therapy alone is not enough and needs to be supplemented by medication.
I myself was raised to be a perfectionist by my parents who were raised to be perfectionists by their parents. I had to put little post-it notes all over my house, work space and even car with the message [B]"could be worse, but isn't [/B]worse, thank goodness" so I could constantly confront the attitude of mine that caused so much unhappiness and grief.
Some people believe that relying on medication is a sign of weakness or a character flaw. They rebel against the idea that the brain can become sick just as any other organ can. Often there is a kind of medical puritanism involved.
I once talked to a young person in college who felt she was the worst person in the world because she did not get straight A's. This is a good example of perfectionism. I told her that there were people like Adolf Hitler who caused the destruction of tens of millions of people through genocide. What is not getting good grades on the scale of good and evil compared to causing the genocide of tens of millions of men, women and children? It is hardly anything at all. It is far, far, far, far, far away from that kind of failure.
Yet for the girl, bad grades seen in the light of her perfectionism had a private meaning. To her it meant: "I am inferior, I am a failure. I am a loser. There is something fundamentally wrong with me. I am a waste of oxygen. I should not be alive."
Most animals have a stress response linked to life or death situations. In a life or death situation they will experience increased breathing, heartbeat, blood pressure. No need to be clam when a predator is chasing you to eat you or when you a chasing prey to prevent starving to death.
But once the emergency passes, the animals usually experience the end of the stress response. A gazelle might go into panic mode when a cheetah is chasing it. If it survives it will go right back to grazing as though nothing happened.
Humans though have trouble shutting down their stress response and can give a sense of life or death urgency to matters that are not life or death: getting ahead of other drivers on a highway, getting the shortest line at the checkout counter at Walmart, finding the "perfect" parking spot. People can stress about these things and experience the same physiological response as a gazelle feels when it is being chased by a cheetah.
I hope I have given you some food for thought. Wish I could have been more helpful.
*All scientific research is subject to caveats and limitations. Here a just a few: Size of research study, depth of research study, quality of study, objectivity of study, confounding factors, studies leading to contrary results, conflict of interest, new discoveries
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YES, These are literally everything that I have researched and found out. Someone has portrayed like a smoke detector on a false alarm and you can't turn it off.
It is not because someone with depression is weak minded or unmotivated, it's more serious problem where the brain function is lacking. To be precise, neurotransmitters like mainly serotonin, dopamine, norepinephrine, or even oxytocin and acetylcholine are lacking. They each serve different functions like peace and stability, willpower, vitality, love and dedication, and memory. But what's more complicated is that all these neurotransmitters are linked, they work together.
In normal circumstances, we are full of serotonin, which properly manages stress, it also helps lower norepinephrine and dopamine. Once stress comes, the cortisol rises, this is a survival instinct to respond to stimuli. When cortisol rises, the serotonin decreases, meaning that if serotonin plays in peace and stability, when outside stress (enemy) comes you can't respond to it. So we need to be alert and take action by decreasing serotonin and increasing norepinephrine and dopamine to be more active, focused, and will powered. A lot of doctors seem to rephrase it as fight or flight situation.
But problem occurs when the cortisol level keeps rising and never falling down. A lot of times depressed person's mind is full of negative thoughts which brings more negative thoughts called vicious cycle. Serotonin falls, and eventually norepinephrine and dopamine follows as well. They are left with no will, strength, they become more anxious and much more annoyed because the neurotransmitters all fell. Even though they physically look tired, no motivation, no will, but in the brain, it is being overloaded due to cortisol. This has nothing to do with them weak minded, they are sick. It is a disease. Ultimately you need to reduce the stress so that it will heal back up.
Today's world, there are so many stress going on and mainly I feel like they mostly come from, work or studies. It's gotten to the point that the brain cannot handle such stress, so it is the their way of expressing "I am stressed". So in normal circumstances, once cortisol decreases, serotonin comes back up and norepinephrine and dopamine becomes balanced. But, if the stress has been exposed for toooooo long, the neurotransmitters take such a long time to recover. That is why we have medicines today to bring those back up.
Not only there is medicine treatment, there are things like psychiatry, light therapy, ECT, TMS, mental ward, group treatment, or daily things like scheduled exercise, balanced meal and enough resting.
For medicines, it's said that it takes a long time for it to actually working so patient must religiously take the meds for at least 3 weeks or so (it varied doctor by doctor) to start seeing an effect. Then doctor increases the dosage to treatment level for about at least 4 weeks or more to see more effect. Do not stop taking the meds by your decision. It must be carefully done with doctor's advise that you slowly decrease the dosage again. Finally when the doctor says it should be okay to stop, then stop. But if you do not see it getting any better, you start changing the medication as doctors say some things work better than others.
Taking the medication can be easy. But there are so many side effects from taking antidepressants. Nausea, vomit, diarrhea, loss of sleep or increased sleep, loss in appetite or increase in appetite, dryness in the mouth, anxiety, and so much more. We have SSRI where it is "focused" on serotonin meaning it also touches dopamine and norepinephrine as well. Typical SSRI includes, paroxetine, fluvoxamine, sertraline, escitalopram/citalopram. Next we have NDRI where it does not affect the serotonin, but only dopamine and norepinephrine. Bupropion is an example where it effects interests, pleasure, will, and improvement on recognition. So patients who feel especially lethargy can take. But side effects include anxiety and insomnia so you need to really take consideration. Next we have SNRI, where it applies to Serotonin and norepinephrine. It helps with managing stress, so it helps a lot with dealing stress and anxiety. We have venlafaxine which helps with generalized anxiety disorder and duloxetine which helps with physical pain. Then we have Desvenlafaxine which is a newer drug from venlafaxine that has less side effects.
It looks like nausea is the number 1 side effect from taking antidepressants and its unbearable. In order to "deal" with this problem, it is preferred to take it while in meal or before sleeping. Also recommended to take sweets or teas like ginger tea. But recommendation was that take sugarless candy because you may have to take a lot of candy to relieve from nausea. Even after all of these doesn't work, lessen the dosage or change the medication.
In the contrast, there is a drug that has relatively lesser side effect called NASSA which includes norepinephrine and specific serotonin. We have Mirtazapine which is focused for antidepressant, nothing affected in the digestive area. One big characteristic of this drug is increased in drowsiness. It may be a side effect but people who are struggling to sleep may benefit from this. It also increases in appetite so people who's weight has been lowered due to not eating can benefit as well. One doctor states that drowsiness is the first of the side effects and gets better as time passes.
At this point, I'm becoming an expert at this, and I'm also surprised that I have never felt depressed my entire life. Because after studying for few days, the brain looks a lot more fragile than I thought it be.
From what I am viewing, extreme stress has triggered her depression again. She has a big dream wanting to be successful. With her being on a very long 2 months of business trip and finding out about some health issues while there, getting covid, a lot of stress from work especially due to constant worrying about results as she is in marketing, potential career change that could really impact her salary, huge promotion, late night meetings at 10 pm and on top of that relationship with me. Outside perspective, her ambition is actually causing so much stress that her mentality and body cant endure.
Its a little bit hard because we are not married so we have nothing tied together so my gf is pushing me away right now. She finally left her house to visit her family for mother's day. Im worried that her being alone (she lives alone) with her dog and cat will cause more vicious cycle. In a situation like this I am wondering if I should let her be or keep reaching out to her that I am still here for her and I still love you.