Treatment resistant depression and ASD

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Hi,

The past few years, I've been fighting against depression. This time is different.
I think I have a combination of depression and burnout.
I don't know which of my symptoms are caused by depression, which by burnout. Probably there is some overlap.

After having tried escitalopram (cipralexa), mirtazapine (remeron), trazodone, zolpidem (ambien), nothing seems to help. In consultation with my psychiatrist, I decided to stop taking meds altogether, because benefits -if any- were far outweighed by the negatives. At the end of pharmacological treatment they only seemed to make me more suicidal.

Stopped completely for about a month now.
The withdrawal symptoms have almost left (brain zaps), however, nothing else changed (lost 4kg of weight).
My mood is still low, I have serious energy shortage, can't accomplish anything, special interests don't give me joy...
Sensory tolerance is minimal.

All the while I am more and more becoming aware of my shortcomings (socially).
My psychiatrist says we've run out of options. My therapist has experience with ASD, but doesn't fully understand me. The 45 minutes of therapy every two or three weeks barely do anything. As you all know, therapy is expensive, and I can't afford more frequent help.

So basically, I'm stuck...
no improvement whatsoever in the past month's. My second university study is on hold.
I'm sick of sitting at home accomplishing nothing, and don't know what to do to get better.

People around me think I'm fine, but inside I'm dying.
Because the health system can't help me, (nor do I), I feel like I've run out of options.

Please, is there anyone that has experienced my situation that found a way to get out of depression/burnout?
The last month's my main goal was to make it to the next day. I don't have anything to look forward to. Future doesn't look very bright.

I'm not asking for compassion. However, I would be more than happy to take any solid advice.
Walking in nature and working out temporarily elevate my mood, but I don't find the energy to do this every day...
Pharmacological treatment is not an option (have tried so much meds, in the past even more than the extensive list above).

I would like to hear your advice and experience

^^ THIS IS BURN OUT



Oh wow, I totally get where you are at from what you're saying. I've been there, and I survived, only by learning a lot about how to address the root of the issue.

I'll address the psychiatrist first.

It's telling that they worked their way around to "that's all I can do". Their mistake may have been to think that ASD is a condition that needs fixing with medication. I'd encourage you to keep engaging with them, I benefit from an SSRI (fluoxetine) and will be asking to try stimulants for ADHD symptoms soon.

Just as a quick aside, I understand my "executive function issues" and "traits of ADHD" more and more as the natural outcome of over-using my cognitive resource for a lot of stuff NT's do on instinct. That means, this also is partially addressable by taking a social-model approach, but I'll still accept chemical help from a doctor steeped in the medical model approach, because I'm pushed to my limit keeping up with it all.

I'd encourage you to keep engaging with the psychiatrist as a long-term thing, perhaps they offer some treatments that can make your life better, just recognize a person with drugs to offer is ill-equipped to solve all that's wrong here, so to benefit from their treatment, let's look at getting the rest in order -

Therapist

Is your therapist a clinical psychologist whose practice specializes in autism? Do you feel like they really get what your life experience is like being on the spectrum, because they've worked with lots of others in a similar situation? If not, you probably need to look at swapping them out for someone who fits the above description - even if you have to save up to see them once every three months. Your family should also consider any assistance here as an investment that will pay dividends in the form of your long term functioning and self-support, should they be willing to help out with costs. Search out a suitable professional and get referred to them.

If you are trying to keep up with a relationship, also note ASD-aware relationship therapy is an enabling factor for long-term success there.

Depression

I've been there.
I've been unable to go to work, I've been just one impulse from achieving suicide, I've been bedridden, I've been paralyzed.
Of course there are emotional components there, which just underscores what I said above about the psychologist. There are also very real and significant factors of burn-out and energy depletion there, which brings us to the meat of the matter -

Burn Out

My recovery didn't start until I recognized and addressed the need to address my problems as stemming from burn out.

I was trying to succeed. I thought I just needed to push harder.

When my ability to keep going started break down, I realized I was at risk of losing it all. That's the first time I seriously started contemplating suicide.

My recovery began when I read a book that's about how people sustain high performance (a masking/working/studying autistic fits this description) without burning out.

It's called Peak Performance, it's written by Brad Stulberg and Steve Magness.
Even when I found myself unable to read much (unprecedented) I could still listen to it on audio book during my commute - check it out.

The reason I was facing a problem that I couldn't solve, was that all I could think of was to try harder. I couldn't give myself permission to rest better, didn't know how to rest better.

I didn't realize that DESERVING to rest follows naturally existing in a world that wasn't made for me, and trying to succeed on merit in that environment. People around me didn't understand that well enough either - I needed to build up my self understanding of the problem and the solutions, to the point where I could self-advocate effectively.

Having people around who can help advocate (^^ psychologist) would be nice too, but too many of us seem to find such quality of support to be in short supply.


I have to finish my post here, but please don't miss the importance of checking out that peak performance book, reply back with a reaction, more information and any questions.

Best of luck!

Online college

Go to an easier school or major, fewer units, study group

Khan academy

Adderall

Meditation

Progressive muscle relaxation

Electroconvulsive therapy

There is a prescription treatment for depression in Europe that is available over the counter in the US;

https://www.mayoclinic.org/drugs-supple ... t-20364924

Instead of serotonin it works on a methalation cycle.

Though I cannot compare myself to you, I can relate to some of what you are saying. After having lost my father in 2015 and my mother here in 2019 after a lengthy battle with insurance companies and trying to get home health care, etc. etc. etc., I believe I have come out of this with PTSD. I too feel burned out and sometimes get depressed. I often get a lot of anxiety over things that are not part of my routine. I have a job evaluation coming up that has pretty much wrecked me since I fear those kinds of things. I feel like I am trying to penetrate a brick wall.

Anyway ... you mention not being able to accomplish anything. I think I can join you on that one right now. But I am trying to fight it. I love to write and have a few projects I'm working on. I used to be able to pump out a lot of pages in a short amount of time, but now am lucky to get a paragraph in a week. Why? I think I have lost some motivation due to some depression. But ... I still have the desire to get stuff published. Do you still have the wish to accomplish things, but the motivation of trying to accomplish things is the problem? If so ... that's me too.

One thing I have done is to keep a few projects open so I don't get bored. And even though I can't get the amount of work done that I used to, I will try to write maybe at least one sentence on a story a day. At least that way I am moving forward and feel like I have accomplished something.

About not being able to look forward to things. Yeah, I can understand that. The holidays are coming up, and I don't get into them like I used to. But I am going to try to relax. Sometimes just resting on the couch and watching some old movies helps me. Do you need to relax? I try to find things that are soothing. On Youtube I have found a guy and his girlfriend who play miniature golf. It is so relaxing because they are such laid back people and there's no anxiety involving them. His name is Brooks Holt and you can find him on Youtube. I think you have to find some things like that to relax with. And that can help a bit with depression and burnout ... at least it does for me.

I wish I could help. But this is a tough road ... but it is one that can get better. One thing that helps me is to try to get my mind off of being depressed when I get there. That's where the relaxing stuff helps me. As I am routine driven, I try to set aside a time for me to be alone, lay on the couch, and watch some of the movies and shows that bring me comfort. Best of luck to you. I hope you get feeling better. You are not alone.

A disproportionate number of autistics are unemployed or underemployed

A disproportionate number of autistics have no friends or romantic relationship

A disproportionate number of autistics claim depression, anxiety, bullying, GI issues,


A disproportionate number of autistics are socially awkward and reserved

Sensory overload



Hence treatment refractory depression