Nursing & Depression - page 32

While visiting in the lounge one day, we discovered that every nurse there was on an anti-depressant. I have had 'Treatment Resistant Depression' for about 20 years--as long as I've been a nurse. ... Read More

  1. by   VivaLasViejas
    I'm glad to see this thread is still going after all this time.....haven't chimed in for awhile, but I think I need some advice at this point. As I said some time back, I've been on Paxil for about 18 months, and done pretty well until the past 2-3 months; but my job and other circumstances have been getting to me over time and I think I'm depressed again....only I'm not sure this time since I still can laugh and enjoy some things. However, I've been overeating for months..... get crabby and anxious at times...... plus I'm dealing with a lot of physical pain from muscle tension and God-knows-what is going on in my lower abdomen (started having hot flashes/night sweats about a yr. ago, periods are about as predictable as the weather etc. and I feel like I've got a 50# lead weight down there).

    I know I need to go see my doctor, but part of my problem is thinking I'm in all this pain only because I'm severely overweight and it would go away if I could just lose about 70 pounds. I'm also afraid to find out that I need a hysterectomy, not that I care in the least about losing my uterus (I'm almost 44 and it's time for grandchildren, not more of my own), but because I literally cannot afford to take the 4-6 weeks off to have the surgery and get through the recovery process. So the end result is, I don't go to the doctor.

    In the meantime, my job as a LTC resident care manager is nothing but stress, stress, stress, even though I really love the residents and the people I work with. We had a terrible survey, and even though most of our F-tags were for things that previous employees did or failed to do, guess who has to fix all of it?!

    The fact that I am able to function as well as I do probably has a lot to do with the antidepressant I'm already on, but my emotions have been somewhat flattened by the meds so I can't really tell if I'm depressed. It feels a lot like it, and my sister says she thinks I am, but this is so different from all of the other depressive episodes I've gone through in my life that I just don't know for sure what's happening to me.

    I guess this all sounds pretty mixed up, but I'm bouncing it off you guys because you too are nurses and know all the same stuff I do, and I know enough not to trust my own perspective right now. The peri-menopause angle complicates matters somewhat, because this could be hormone-related as much as anything else at this point in my life, but I do NOT want to take anything for it if I can possibly help it, not just because of the recent studies but because I never could tolerate birth-control pills, so I'm really leery about anything with estrogen in it.

    Anyway, if any of you can toss a few nuggets of wisdom my way, I'd sure appreciate it. I am NOT having a good time these days.
  2. by   sphinx
    Thought I'd pull this thread up to update anyone who may be interested (ie, has read all my many ramblings and has wondered what the heck I've done about it).....Well, I last posted my new dx of bipolar. New med still not helping, and no sign of any "highs", although some intense irritablility, which tends to be a big sign for me. Anyway......so, still been very depressed, and so much stuff keeps piling on at home, then I was back at work last week. Because of the date my disability ended and the holiday, I only worked 3 days, but in that time, was given a case load of 23 brand new patients, only 3 of which I knew from before. So, my stress factor has been kicking in, trying to sort out who is who, what their diagnosis is, what are their needs, when do they need a visit, etc etc......all the while, depressed, and you know how it can be hard to concentrate when so low. Monday was busy, and I was oncall, so worked 12 hours total. Now, get this.....my son had been sick since the day before turkey day. I figured a cough and cold, give it time to go away, he was at his Dad's Thu and Fri, and our house the weekend. I noticed his cough wasn't better, but it hadn't been too long, so I figured, oh I'll give it till the beginning of the week, it's certainly not anything to call the oncall doc about. Monday he was starting to look crummy, and still coughing bad. Feeling guily and not wanting to call in after being out so long, I dosed with cough suppressant and sent him to school (mom of the year!). Tuesday he was indeniably not well....coughing very badly, just looked awful, rings around his eyes, complaining of tightness in his chest. I listened to his lungs, but he was coughiong so hard.....I thought it sounded funky in the LLL, but wasn't sure. My hubby had to go in, as his boss was off, and he had to do several things at work, so I reluctantly called in. We spend several hours waiting at Dr office, Radioilogy office, pharmacy......he has pneumonia LLL, of course. Dr says he should stay home a couple days at least to rest. Vince was upset because the next day he had a field trip he soooooo wanted to go on. My husband was able to arrange to work from home that day, because I had to go in for mandatory education day (all our mandatory stuff in 1 day per year).One part of the day was a staff member, who I know works with bereavment groups, but also other stuff, and has been having "gripe sessions" at these education days, all confidential, to give feedback, so hopefully changes can be made (that is one good thing about my agency, when change is needed, we get heard, and steps do get taken, and we often reap the rewards. She went round the room having everyone say something about the job that they found stressful or made them unhappy. I was next to last, and trying so hard not to break into tears. I decided honesty was the best policy, knowing that my words wouldn't leave that room. I said that I have been depressed lately (didn't say it was long term, though), and had some things at home recently, and that right now, work is overwhelming me so much. That I can't concentrate or get organized, that I felt I wasn't giving as good care as I ought, etc. Of course I'm all weepy too, but didn't drag on (I don't do that when talking, only writing haha). I said that I'd considered asking my supservisor for decreased hours after I got back from disability, but when I got back, found out that in the 2 weeks I was out, 2 nurses had left for other jobs in the agency, and I felt I couldn't ask, as our team is already short staffed. Well, as you may guess, everyone told me to take care of myself first, that she can only say no, I wouldn't know unless I try, etc. Another girl suggested I may even try a job in the office, if one is available. So, even though I have been told these things MANY times (sound familiar), hearing it from my coworkers (including 2 members of my team who would be inconvenienced if I went part time) bolstered my confidence. I decided to talk to my boss as soon as I was in the office. My son stayed home yesterday, and I took him to my moms at 11:30, so I saw patients, but just late, didn't get home till 6:30, and the office closes at 5. I had left a message on my supe's voice mail, quite tearful unfortunatly, that I needed to talk to her. Well, my son was still sick today (ugh) (but improving, cough is now productive, and though he still c/o his chest hurting, he looks a lot better after sleeping late) . So.......I am stuck calling in again. Did some phone visits from home though, so did do somethings, but not much, considering. My boss called me, and even though I'd have rather talked to her in person, she wanted to talk as soon as possible, as I had sounded so bad on my message. I told her basically what I'd told the group at education day. She told he that the absences were hard on the team, yadda yadda (I knew that already), but that I need to take care of myself first. She said she would have to talk to one of the "higher ups" (I guess that's what she'd be) and get back to me, as she is not sure what is possible. And if all that is available is evenings, I just can't do that (that is the only time I see my kids, and why I left hospital nursing). So, we will see. But-wanted to get you up to date and let you know I finally overcame my fear of making this step, and am trying to put myself first this time.
    Thanks for all the support you've given me.
  3. by   sphinx
    mjlrn....
    wanted to let ya know I did read your post.........want you to know I'm not ignoring you or anything, but just that I don't have much advice. I haven't exacly been doing so well myself. You mentioned perimenopaus.....couldn't the mood problems be related to that (hormone fluctuations, bla bla), which may be why it feels different than your past depressions?? Just a thought, I'm clueless. Why is it you are afraid you'll need a hysterectomy? Is it just the heavy belly, or are you having other problems?
    Anyway.....what do I know? Just wanted to offer my support, whatever that is worth.
    Hang in there
    Heather
  4. by   sanakruz
    Sphinx this is good news! I've seen many people get well on lamictal- It's pricey- the rash is serious, tho. STOP if you get it- The big risk is Stevens-Johnson syndrome- Let some one SEE the rash to actually CLEAR you to keep taking it.
  5. by   sanakruz
    mjlrn- Many of my folks have gained weight from Paxil, but not prozac- The drugs are chemically very similar; paxil has a short halflife which may explain the withdrawal syndrome. Think about asking for a change to lexapro- like celexa without the usual complaints( which off the top of my head I cant remember...) Constipation? It's escitalopam vs citalopam (celexa) Celexa was only available in Europe while prozac was only available here. Very similar drugs. If you switch to prozac take only the brand name.
    Lifestyle changes also need to be considered. Black Cohoosh is highly recommened for menopausal symptoms. I am considering trying this myself,I'll be 47 in Mar. and wake up sweating about 3x weekly and cant get back to sleep. These are early morning wakenings and I lie there and worry about money, my kids, stuff from the past that I have no frigging control over or abilty to change. I have considered anti depressants also- many years ago I took protipytaline. Effective but awful side effects. Major depression recurs in 50% of those with a single episode,so.. I think it's often hard to tell with women our age because "issues "overlap. I have cried at work 3 times in the last 2 weeks. I really dislike my boss. That is a gentle word for my feelings about him. I am the only nurse here. I love my patients and most of my co-workers. So a definative dx would be nice, dont you think?
  6. by   sphinx
    Well, I am hoping the lamictal will work.....my doc seemes to think it will. So far I am still on lowest dose, but increase starting tomorrow. Have had no rash so far, so I've got my fingers crossed!!!! As for pricey, my insurance, I pay 20$ for the month. The same as my Wellbutrin and Topamax. Trazadone is 5$. It's the Nexium that kills me at 35$ a month, hoping I can get off that soon!!
  7. by   sphinx
    Well, I am hoping the lamictal will work.....my doc seemes to think it will. So far I am still on lowest dose, but increase starting tomorrow. Have had no rash so far, so I've got my fingers crossed!!!! As for pricey, my insurance, I pay 20$ for the month. The same as my Wellbutrin and Topamax. Trazadone is 5$. It's the Nexium that kills me at 35$ a month, hoping I can get off that soon!!
  8. by   mattsmom81
    I am not sure how I feel about docs that multidose drugs and add more and more varied drugs to someone's med tx....anybody else feel this way??

    My psych doc started this with me and I had to stop him....mood altering drugs do exactly that...how could I know how I was 'really' feeling with so many drugs in me???

    Maybe I'm thinking overly simplistic here...but I would rather take one antidepressant and one sedative at HS than be juggling different meds with different side effects...how does one keep it all straight??

    Just some rambling thoughts...by no means lucid nor intended as advice... LOL!

    I find this so often in elderly patients as well where their doc has them on so many different kinds of drugs...and I question why they have not found a way to get the desired responses from newer and better( and hopefully fewer) drug(s).

    Hoping the Lamictal helps as well, Sphinx, and that your son gets well soon!

    As for me I seem to be doing well on a small dose of Prozac..helps me keep things 'in perspective'.

    And mjlrn...I can relate to your 'female problems' ...I have similar symptoms and have uterine fibroids and adhesions. Don't put off a doc visit for too long...need to make sure nothing more serious is going on down there too...

    (((HUGS))) all as we enter the Holiday season where depression can worsen for many of us.
  9. by   sphinx
    Well, in my case, Mattsmom, in regards to multiple meds, over the years, I have found out the hard way that taking a single antidepressant just doesn't cut it. I have tried VERY many, going from minimal dosages, up to max dose, with either no change, or it will work and then "poop out". It has only been since my doctors started "augmenting" my meds that I have been able to pull out of any deep depressions. Even then, it hasn't always been successful. My current psychiatrist is very conservative, and doesn't like to mess with my meds too much. This most recent change was made when he realized I fit into the bipolar category (if you are bipolar it's not real good idea to take an antidepressant by itself anyway).....because of the high risk of side effects (rash) with lamictal, which the risk is higher if you taper the med up too fast, he is being very cautious and taking me up to a therapeutic dose very slowly. It will be several more weeks before I am at what is considered a baseline dose. He said once I am at a dose that helps me, he will look at taking away my other meds.....I am guessing the Topamax, as it is another med often used to stabalize mood. I believe he left me on it for now, because if it is helping even a little, it will stabalize me somewhat until the lamictal kicks in. I'm not sure if he'd take me off wellbutrin or not? That's been my base antidepressant for years, the one I've had the most success with. SSRI's are helpful, but only short term, and on the doses that I require, I tend to develop terrible bruxism, and at one point when I was on zoloft, my jaw was so out of whack it popped out of joint!! (ouch!). The trazadone of course is just to help me sleep. He won't have me take a benzo for sleep (thank goodness, I have friends who have been prescribed ativan for sleep, and can't get off it)....took ambien , which is really only intended for short term, and I found it lost it's effectiveness after a time.....and even that I found hard to get off. Trazadone isn't like that. I love it. I take it when I need it, when i don't, I am ok.

    On the other hand, a few years ago I was being treated in the clinic associated with our supposedly great university teaching hospital. The psychiatrists there treated me with a drug of the week approach. One doc put me on serzone. After a while it wasn't helping, so he took me off and tried something else....which wasn't working.....and a few weeks later says "why don't we try serzone"......all this with my chart and med list right in front of him! (that was when I decided it was worth paying the extra money to see a private doctor, even if it would cost a lot more!) I can go one about those yahoos there, but I won't bother, lets just say that they don't seem to know their a** from a hole in the ground!! haha.....

    Anyway, that's my little story. I wish it wasn't that way. I know people who do fine on one antidepressant for years, maybe need a tweak or change after a few years. I am so envious. Plus, the cost adds up. Sure, 20 a pop isn't bad, but when you think about the yearly cost, it's like-UGH.

    (((hugs))) to you as well, you are right, as much as I love Christmas, it is getting harder, and this year will likely be the hardest ever due to circumstances......hope you and everyone else will be well.
  10. by   mario_ragucci
    This is interesting and informative. Sometimes I overhear people talking about meds they take. It's hard to fault anyone for taking a brain med, or mood med, or personality med, because everyone is different. I couldn't dream of talking about this in real life because talking about emotions is personal, and usually taboo.
    Just like some laxatives take several days to work, life and excess chemicals can build up in us. Drink 1 liter of H2O, bid, and > HR >140 BPM, depending on age (x30minutes) =>4x(per week), try to go to a sauna and sweat once in a while. Eat at least 50/50 raw foods. Try for weeks. Attain baseline. 'm sorry :-(, I have no right to be hear and shouldn't talk :-(
  11. by   sphinx
    mario, once again I find myself wondering what the hell you are talking about? Is this the same tired rhetoric of eat well, exercise and everything will be ok? Can I ask you something? How do you know any of us depressed people don't already take care of our physical selves? I personally have neglected physical exercise the past few months due to my low pain tolerance and recent surgeries....but I do eat right and am hydrated well. I believe others here have pointed out that these methods are good at *staying* stable (great for stress relief, for sure), and for people with less serious depression. But believe me, when you are so far at the bottom of the pit, that you pray to die every day, when you try to hasten that along by attempting suicide.......no amount of water, exercise or good healthy food will "bring me to baseline". Meds help you get to a point where you can help yourself.....therapy can help you look within yourself at where your troubles lay, and help you deal with them......and taking care of your physical self becomes important, but not until you can drag yourself to a point where you can actually *do* what needs to be done. When you are so depressed a shower or meal is an effort, aerobic activity is darn near impossible.

    BTW, my 10 year old says seagulls are rats with wings. We live several miles from the lake, and they hang around anyway. They hang out at McDonalds. I think they are pretty, until I decide, heck I'll be nice and throw one a piece of my bun. Then all of a sudden my car is surrounded by masses of screaming birds who climb everywhere, on my windshield, on my roof, peering down into the window, etc. Just thought I'd share that with you.

    Oh, and you have a "right" to post wherever you want, but you have been in this thread posting the same thing frequently....been told the same thing by many people often.......you have no experience professionally nor have you yourself suffered depression. I'd respect you a lot more if you had the life experience that most of us here have had. See, we *know* how it feels. This thread has turned into a support for us, not an "ask Mario" advice column.

    sorry to be so snippy. I've been quite the little witch lately.
  12. by   mario_ragucci
    Originally posted by sphinx
    BTW, my 10 year old says seagulls are rats with wings. We live several miles from the lake, and they hang around anyway. They hang out at McDonalds. I think they are pretty, until I decide, heck I'll be nice and throw one a piece of my bun. Then all of a sudden my car is surrounded by masses of screaming birds who climb everywhere, on my windshield, on my roof, peering down into the window, etc. Just thought I'd share that with you.
    Your 10 year old does not know that much about gulls. First off, gulls can fly, so they would NEVER get depressed. The metabolism of a typical Herring gull, or Glaucous-winged gull, makes us seem simple. A gull will eat most anything, including small mammals and young left unattended where they colonize. Only a gull can injest either fresh or salt water, where I or your son would die on salt water alone. Gulls are truely wild, and won't let you come near them.

    I am willing to get smacked down on depression, and usually do so I disclaim myself in totality. I know I can get stuck up physiologically when I don't exercise, as has happened in nursing school, blah blah blah Many people are scrunched down in life with inactivity when they genetically should be more active.

    The gulls communicate more visually, and see things differently than you or I, and when it comes to food, they all have to scavange at the same time. People and nature both offer a bountiful life for most gulls. 'm sorry
  13. by   VivaLasViejas
    Mario---WTF is all that about the gulls?! And what does it have to do with what the rest of us are talking about? (I read Jonathan Livingston Seagull many years ago---is this an allusion to the book or its greater message?)

    As to what some of you were saying about perimenopause, I think it has a LOT to do with what I'm going through these days. I'm not at all afraid to have a hysterectomy---in fact, that would be wonderful---but I can NOT afford to be off work for 4-6 weeks, no way, no how. My husband makes nowhere near enough to support all 6 of us on his own, there's no savings, and no one we could borrow from to help us get by if I were to be out of commission for that long. So surgery is completely out of the question, unless of course there's something life-threatening going on, and I doubt that.

    I did call and make an appointment to see my doctor for a full physical next Tuesday, though. Gotta start somewhere, I suppose. The other good thing I did was ask for a demotion last Friday---I was a resident-care manager for a SNF, and I've had a bellyful of the grueling hours, the paper work, and the 24-hour-a-day responsibility. I'm staying on at my facility, but I'm creating a "utility player" position, in which I'll be doing wound care, some QA and overflow stuff for the RCMs, and admissions. I think that's going to do a lot for my mood, especially since I will get PAID for putting in 14-hour days, if I have to do that at all (nurses, don't EVER let yourself be put on salary if you can help it---it sounds good, but when you put in 50-60-hour weeks routinely, you're making only about twice the minimum wage). The thing is, when I go home at night, I'll be able to focus on my family and some of the other aspects of life I've been neglecting since being in management, and that will also be a good thing.

    So, hopefully things will start getting better soon, but I'm still gonna follow through with my medical and psychological issues. Thanks to all of you who have offered your words of wisdom and support--I'll keep you posted. And Sphinx, thanks for thinking of me even in the midst of your own pain---hang in there!!!!!!

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