Ask HN: Depressed and I want to start therapy, but struggling

I think it's difficult to simply recommend one type of therapy and expect it fit everybody's needs. Having said that, I would recommend CBT just because as far as I can tell, its effectiveness seems to backed by a lot of science.

I'm kind of in the same boat though. Finding a therapist takes a lot of work, and building up the motivation to do the work is especially difficult when you're depressed. It's a catch 22. When the depression passes, so does the motivation to find treatment.

Maybe if you have somebody close you can confide in, you should ask them to help you find a therapist. If you have any friends who are seeing therapists, their therapists may be able to refer you to others. In the US, many have sliding scales.

Good luck!

> it seems that free therapy on the NHS is not an option.

This is a mistake! There is something like "community based psychological therapies" which will be long term talking therapies for people with severe MH problems.

But there's also therapies available under something called IAPT - improved access to psychological therapies. Your local primary care trust should have something called a PCAT (different name in different areas) - PCAT is primary care and assessment team. They have publicity names - so in Gloucestershire they're called "Let's Talk".

PCAT take self referrals, so you don't need to get access via your GP. But you can ask your GP for details if you want.

There are a bunch of therapies. I'm a fan of CBT. This is not medical advice! I'm not a doctor, and have no qualifications. I think a good working relationship with the therapist is important.

You can also get private therapy. Check for BCAP registration.

Short version:

1) Ask a GP at the surgery where you're registered for information about the local IAPT services (or do a web search for them)

2) Have a look at MoodGym (https://moodgym.anu.edu.au/welcome) or some books. "Mind over Mood" is often recommended.

3) Consider private therapy. BCAP registration is good. CBT is good. £30 to £40 per session, for about 8 to 12 sessions, seems good. (Depending on area and stuff. )

Please feel free to email me if you want. And good luck!

Sadly it seems that IAPT isn't available in Scotland. They are working on a similar scheme but it is yet to be launched.

Thanks so much for your other thoughts though, really helpful!

1. regular exercise (find something you enjoy): it's almost impossible, biologically speaking, to feel depressed if you're active.

2. meditation (if non-religious) or prayer (if religious): to steady and tame your brain.

3. Do some research about mood enhancing diets. Many pop foods can cause mild depression in the long run.

4. Therapist and/or friend to bounce your ideas off of. You need someone to tell you that reality is not as bad a you think it is. It seems silly but it makes a tremendous difference.

5. Most important --> baby steps

NLP has its roots in Ericksonnian hypnotherapy, and can be good for thinking in new ways and a very effective tool for a therapist, but is clouded by the claims of so many new-age bullshit practitioners that it struggles to gain credibility, which is a shame.

CBT is good for mild disorders, but requires a lot of conscious effort to make work.

The difference is, CBT works by "overwriting" the thought processes that result in the depression by repetition of new behaviours and thoughts. It takes time, and works.

NLP / Hypnotherapy works by discovering what leads up to those thought processes (which, a lot of the time, is out of our conscious awareness) and changing that, so the depression never kicks in.

From personal experience, both work, and both don't, depending on the therapist, which studies you read, and how committed you are to making them work for you. However, it's much more important that you find a therapist that you can connect with personally and trust. If you have that, the exact modality of a therapy will result in pretty much the same outcome - some kind of turning point in your own thoughts and outlook which sets you on the mental path you wish to go down.

(source: I train NLP and Hypnosis, practise CBT, and have seen hundreds of clients.)

I think your first step should be counselling. If you try one and it doesn't 'click', try another. Counselling can be unbelievably helpful.

Someone said to me once that she thought everyone should see a counsellor once every few years. She meant it as a joke, but after sitting with a good counsellor once myself, I agree completely.

A good counsellor can help you put everything in perspective. One helped me out of an EPIC rut a few years back. Really: JUST DO IT.

Get your annual exam and see if you can check your vitamin D levels on your blood test. Most people are lacking in it. I'd recommend taking 2000mg a day. There are two kinds of vitamin D. D3, cholecalciferol, is the one you want to take.

Also, like other posters have suggested, try going to the gym. It does wonders for your mood.

You might also want to look into interpersonal therapy in addition to CBT. From what I've read, it's about the same as CBT when it comes to treating moderate depression. http://en.wikipedia.org/wiki/Interpersonal_psychotherapy

There was a good article in the NY Times about evidenced based therapy. Tl;dr: <= ~30% therapists do pure CBT. http://well.blogs.nytimes.com/2013/03/25/looking-for-evidenc...

If you want to find an accredited CBT therapist, search here: http://www.cbtregisteruk.com/Default.aspx

Resources:

Moodgym - free CBT course by Australian National University https://moodgym.anu.edu.au/welcome A few studies show it reduced depression versus a control group.

http://www.bmj.com/content/328/7434/265

http://bit.ly/XexrR9

Another free course, recommended by the NHS: http://www.llttf.com/

Note vitamin d3 doses are in iu not mg. It is very hard to overdose.

In my experience, the question "what kind of therapy is appropriate" is less important than it seems. What matters more is the personal chemistry, or lack of it, between you and the therapist. An empathetic connection creates a space where things are able to change and heal. Conversely, lack of it makes the work more mechanical and one can keep at that for years without improvement. Not everyone can help everyone.

If I were you, I'd look around until I found a practitioner that I felt a connection with. That doesn't mean finding someone who tells you what you want to hear. It's more whether you have a grain of feeling that this person might be able to help you through whatever process you need. That seems to vary a lot with who they are (edit: or rather with the tuple <you,they>). Best of luck.

The best therapy for me personally is taking some time off. Just go some place where you can relax, leave your cellphone inside the safe of your hotel room and don't try to think about work.

There were times in my life when I thought I had it pretty good and felt pretty good. At that time we went on a vacation and there I noticed how stressed out I really was. So being stressed was 'normal' for me. Just don't go spiraling into a negative loop where you walk around thinking constantly about how depressed you really are. Try to focus on the positive things in your life (there are more than the negative ones, really).

If it's a light depression, my advice is to just get away from things for a while and come back refreshed.

Which sort of therapy would be appropriate depends on your depression and on your personality. You should get assessed by a mental health professional and then recommended a particular type of therapy based on that. (I am not a mental Health Professional.)

(e.g. When I had depression I was eventually given a course of Cognitive Analytic Therapy, which is similar to Cognitive Behaviour Therapy, but more suited to people which more analytical personalities, such as me.)

(Btw, I am surprised your GP did not offer you Prozac as a first resort.)

plesae go and see a medical doctor first before you get mixed up in some strange unappropriate therapy that costs you an arm and a leg and enriches no one but the therapist. they will do some tests to rule out things like vitamin deficiencies or other things that may be causing these feelings. go to a medical doctor and tell them everything and let them decide whats best for you. it will be cheaper and youi will get where you want to go faster good luck

I solved it for myself by looking directly into depression for what it is, looking into feelings and where and how exactly they are being felt.

This is akin Eckhart Tolle teachings, I guess. Worked magic for me.

Depression is work. If you haven't done the things your doctor has told you to do, and at least given them an honest effort, that should really be your first step.