My counselor asked me today which is bothering me more, the PTSD or the depression. How do I tell them apart?

I'm sitting on my sofa right now anxious about going to bed, as I am almost every night. That is the PTSD.

I go out of my way to avoid people, even people that I like. I have my solitary routines and I like them. When I purposely avoid people, though, I feel a feeling that's almost fear at the thought of encountering them. What is that?

I'm tired a lot, when I get home from work I feed the cats and myself and eventually go to bed to toss and turn all night. That could be depression.

I am on Facebook almost constantly, trying to feel connected to people there like I can't do in real life. What's that?

How in the world do you untwine PTSD and depression? It's been my understanding that you can't, depression and anxiety are symptoms of each other with PTSD being the basket they get carried in. Is that wrong?

It looks like I'll be having questions for my next session. Which is at 8:00 on a Monday morning, it was either that or wait for a month to see her again. She looked a bit taken aback at my attitude on that matter. Good, she got to see some emotion from me. I'm also going to ask her if she called the dog people yet, I forgot today. If she says no, I'm going to have to explain to her that she's blowing my trust with this delaying that she keeps doing. It hasn't been a good start.

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Comment by koshersalaami on September 30, 2016 at 8:20pm

No idea how you separate them

Comment by Zanelle on September 30, 2016 at 8:43pm

You always bring such an in depth perspective on problems.  I think PTSD changes you physically and mentally while depression can come and go leaving your center intact altho damaged.   That is just me winging it from what I have experienced and read about it all.   Make a list on Monday so you don't forget to ask about the dog.  My heart goes out to you (and to me).  Peace.

Comment by nerd cred on September 30, 2016 at 8:56pm

Depression & anx - they go together for me. Depression helps to quell anx. But apart from that, they're totally intertwined. It's different for everyone, though. I'm climbing out of the depression and when I do things I get all anxious. Pisses me off. Rescue remedy is helpful without adding more meds. They have it at amazon, too. I'm also taking Trazadone for sleep - it's an antidepressant that also works on anx and makes you sleepy so they rx it for sleep. It makes me sleep too long, though. (I have to start taking it earlier.) Not sure it's that, though, because even on 1/2 tab I slept too long. One of the best things about it: $2.10 for 30 tabs.

I'm so old too that when I don't sleep now, my whole body aches. That's how I feel tiredness often. (And I desperately need a new mattress & pillows but that's a whole nother story. Soon.)

The thing is, I'm notorious for being able to sleep easily and well. My son once said I wouldn't wake up for a freight train running through my bedroom. Even anx didn't keep me awake, depression made me sleep a lot. Now I can't sleep. Sometimes even with a med I can't sleep. I think it's the depression lifting and I want to get on with all the many things I've backed up over the last 2 years so the anx is related to focus, too.

I often can't bear to face people, too. Facebook is a nice half way. You want it, you fear it, fb lets you have it sort of with a boundary. No need to put on a social face or even respond if you don't feel up to it. Social face takes energy and people are looking at you!!!! Not sure about that but there are people in my family who can't bear it absent other developed neuroses. My son for one. Even when he was a quite confident kindergartener, he would make himself late for school refusing to go in because he thought he was late and everyone would look at him. For me, a good sign. Last night I called a friend just because I wanted to talk to someone. I literally called and said, "Will you talk to me?" I guess it's time to start going to the dog park. I can control the face to face talking there. And dogs. There are dogs.

So I don't know about PTSD. For me it mostly amounts now to feeling always watched, expecting to be criticized even when I'm alone, thinking my (not seen hardly at all for 20+ years) ex and my (dead) mother to walk in. I can just live with that and remind myself to cut it out. (I hope I can go outside more easily now. Am going to try some yard work tomorrow.)

And good for you for making the counselor explain and recognizing your reaction. Doesn't that feel good? Doing it, I mean.

Sorry for the length. grrrrr Hope there's something you can pull out of it that useful.

Comment by nerd cred on September 30, 2016 at 8:58pm

p.s. knowing I won't be able to sleep, or fearing it, makes it hard to go to bed, too.

Comment by Zanelle on September 30, 2016 at 9:16pm

I was just thinking that the B12 I take for my facial nerve pain is helping with my nerves in general.  It is subtle but I have more energy and I am calmer.  I put a tablet in my mouth every day now and my motivation is to avoid the most painful pain I have ever felt..facial pain.  Seems doctors ignore these nice natural ways to help...there are many.  

Comment by Dharmabummer on October 1, 2016 at 3:41pm

Hi, Phyllis. You are suffering and I feel for you. I don't know if you want advice or are simply venting but here are a few thoughts, for what they're worth.

With regards to your therapist: compatibility or "rightness of fit" is the best predictor of positive outcomes in therapy. No judgment on your therapist but it doesn't sound like you trust her. If you continue to feel this way then you should find another therapist. Also, if you can only see her once a month, that is a problem. I want a client with acute PTSD to meet with me at least once a week for the first few months. 
With regards to treatment itself: EMDR, or Eye-Movement Desensitization & Reprocessing is the best evidence-based treatment for PTSD. I did this work in grad school and it's intense therapy but very effective. Maybe this therapist provides that, I don't know, but I would look for a therapist who is trained in that. 
I have been on both sides of the couch and I live with anxiety and occasional bouts of pitch black depression.... And avoidance adds to the feeling of isolation but the anxiety makes the thought of social engagement overwhelming. Yup. I feel you. 

Please keep writing and updating us. I wish you well. 





Comment by JMac1949 Today on October 1, 2016 at 5:13pm

I hope you make her understand that PTSD presents as mixture of anxiety, depression and hypersensitivity that is as you wrote here intertwined.  I went through this for  decades and still encounter bouts with depression and anxiety.  I've been living with it for so long that I can manage without medication, but there are days and some night when I wonder if there might be something to take the edge off.  I distrust Big Pharma anti depressant medications.  I believe we lost James Emmerling to the side effects of Welbutrin withdrawal and I have no desire to ever put myself on that path.  Take care and if you can't find any kind of balanced understanding with this therapist, look for another.  Be well be better.

Comment by Phyllis on October 2, 2016 at 2:11pm

Hi, kosh.

Zanelle, I've started the list. I am also writing things down every day so I'm prepared for this question next time. 

nerd, I've only ever heard of Rescue Remedy for pets, I will keep it in mind for if I need it. I don't worry about any exes or my mom walking in, I just have them on auto play in my head. :) I am definitely on an upswing right now; feeling better, no migraine, wanting to sort out my house and decorate it as a home and even get new furniture, but I know that the downswing is just waiting on me which dampens my enthusiasm. At the same time, I don't want to go out in public, I don't shop for groceries like I should, I am exhausted at the end of the work day though this last week was a little better. Maybe my adrenal supplements are kicking in? It's scary to feel better like this, better than I have in a very long time, because the crash is going to be that much worse.

Zanelle, there are many! I found an herbal adrenal supplement and I am taking hyaluronic acid and the swelling in my feet is gone. That is amazing for my mood. And I'm not in pain when I wake up in the morning, I take them before bed, which is major. I'm glad that B12 is making you feel better in general.

Terry, that was helpful. I've been reading on the PTSD again just to refresh my memory. I'm glad your stress didn't go chronic, I hate prescriptions because they are addictive.

Dharmabummer, I am having trouble trusting her. She got her PhD where I work, before I started working there, and she keeps interrupting when I mention things from work to ask about the faculty. Then there's the fact that she seems to have already reached a decision about me, thinking that I'm not in bad shape. It's hell meeting her when I'm on an upswing, but I'm also not talking like I should. Our appointments are all about how's the weather and she keeps bringing up the CPT I did last year. I'm taking that with me next time, we'll see what happens. I'm feeling, though, like it's up to me to direct the meetings and that doesn't work. My last counselor made me work.Also, I go in every 2 weeks for appointments, not once a month. I'm scheduled out through December to get the day and time that I want. Thank you for commenting.

JMac, I know you understand. As I said above, I'm back to journaling daily for the next two weeks so she can see what my days are like. I'm glad she got to see my testiness, I don't think she thought I had it in me. If she keeps dismissing me, she'll get more than she bargained for. As to non-pharmaceuticals, I highly recommend Theanine Serene. I've been taking it for 2 years now, I was popping a LOT right after Puff died, which is when I started it. That almost killed me when she died. Now I only take it at bedtime because it relaxes me for sleep. It doesn't always work but it does 95% of the time. Good luck.

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