Major Depressive Disorder

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    Grace K.
    Grace K. @grace-k
    contributor

    How I Found the Right Treatment Plan for My Challenging to Treat Depre

    Growing up, I always felt a little off and sort of sad, but it wasn’t until I reached junior high that I realized I needed to talk to my doctor. With medication, good friends, snowboarding and lacrosse, I was able to have a pretty normal high school experience. College, however, was a different story. What I had expected to be the best years of my life were plagued with ever-worsening depression. I had watched my two sisters thrive in their four years attending universities, making lifelong friends, and traveling to far-off countries, all while maintaining good grades. I couldn’t understand why I was so miserable when I had done everything the exact same way. There was one pillar of the perfect college experience that I did excel at: partying. I found myself going out more and more, and self-medicating – doing anything I could to escape the reality I had created for myself. Although my grades didn’t suffer, my state of mind, outlook, and friendships did. Eventually, it was all too much; I was drowning. I withdrew from all my classes and moved back home. I tried to keep going as best I could and enrolled in courses at a college in my hometown, but my depression made me feel like I could barely keep my head above water. Most people may not realize that depression can rob you of the different pieces of your life, big and small. Depression takes things little by little, so slowly that you don’t even notice at first. Then suddenly everything is gone: hobbies, passions, a sense of belonging, even family.  What used to bring you happiness, the things you loved most, have all been stripped away. Eventually, you reach the point where you can’t do the most basic things. You can’t get out of bed or take care of yourself. It becomes more than you can handle. Everything is a colossal challenge. Every day is so exhausting, and it takes everything in you just to survive. That’s how I felt, day in and day out, for the better part of a decade. Then two years ago, amid the worst depression I’ve ever experienced, I made a promise to myself that I would do everything in my power, try every medication, every type of therapy and every treatment I could find to save myself: for me, this included 16 different antidepressants, acupuncture, reiki, transcranial magnetic stimulation on the left and right sides of my skull, and 12 courses of electroconvulsive therapy. After electroconvulsive therapy failed, I gave up. I was out of options. With nothing left in my arsenal, I started to accept that there had to be something wrong with me. It was the only conclusion that made sense. Maybe I was just meant to be unhappy, and overwhelming depression was going to be my life forever. Grace was diagnosed with major depressive disorder (MDD) with suicidal thoughts or actions after years of battling her depressive symptoms. It is not known if SPRAVATO ® (esketamine) CIII nasal spray is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions. If you or someone you know is struggling emotionally or has concerns about their mental health, please call 1-800-273-TALK (8255). Then I came across an article about SPRAVATO ® (esketamine) CIII nasal spray. It immediately piqued my interest. The most well-known and most commonly prescribed treatments for depression focus on the same neurotransmitters in the brain and have for decades. This medication is believed to take a different approach, and while the way it works is not completely understood, it is thought to act on a different neurotransmitter, called glutamate. After hours of research and speaking with my doctor, I decided to make an appointment with a certified provider to learn more. They warned me that SPRAVATO ® has risks and benefits and explained that this treatment’s risks and potential side effects included the potential for suicidal ideation, abuse or misuse. Dissociation and sedation can also occur while using the medication, so it is essential to have medical supervision during treatment. (Please see Important Safety Information including BOXED WARNINGS and a list of side effects below. Click here). And while this medication may not work for everyone, combined with my oral antidepressant, it was the right choice for me and has become an essential part of my treatment plan, which also includes talking with my therapist and loved ones, getting outside on a hike or finding a creative outlet in art. Treating depression is difficult because it’s hard to see any effect in the short term. It takes months for traditional antidepressants to build up in your system, and if a dosage increase is necessary, it can be months until you feel true progress. When I am struggling with depression, days feel like months, and months feel like years. There were so many times when I felt like I was taking one step forward and two steps back. At first, I didn’t see a difference in myself, but I think a good gauge of how your treatment is going is by talking to those around you. While I didn’t notice a difference right away, my family and my boyfriend did. I remember watching a movie with my mom, and I looked over at her and she said, “You’re laughing! You’re actually laughing again!” Within a month and a half, I felt my depressive symptoms had improved. I noticed a difference in wanting to be a part of things, engaging in conversation, going to family events and even to the store. Then, I eventually started painting, writing and taking care of myself again. Just doing more than surviving was huge, and I felt like a weight was beginning to lift off my shoulders. For so long, my only concern was getting through to the next day, so when I started to make plans and my future wasn’t so blank, I began feeling optimistic about the future again. It was slow at first, like planning a hike for the upcoming weekend, but now I’m finally able to imagine where I want to be in five years and have hope and faith in myself that I will be able to accomplish my goals. And yes, I still have bad days. But I’ve learned new strategies to deal with them. One thing that helps me is to list five things I am grateful for and five things I like about myself. It sounds simple but sometimes all you need is a reminder that you are worth it. The days, weeks and months can be long and hard, but keep trying. Finding the right treatment plan is hard. During the process, it’s easy to blame yourself and feel like you must be the problem. But now looking back, I know that simply isn’t true. I’m in a place that I never thought I would be in. I want to do more with my life, and I now know that I can. INDICATIONS What is SPRAVATO ® (esketamine) CIII nasal spray? SPRAVATO ® is a prescription medicine, used along with an antidepressant taken by mouth to treat: Adults with treatment-resistant depression (TRD) Depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions SPRAVATO ® is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if SPRAVATO ® is safe or effective as an anesthetic medicine. It is not known if SPRAVATO ® is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions. SPRAVATO ® is not for use in place of hospitalization if your healthcare provider determines that hospitalization is needed, even if improvement is experienced after the first dose of SPRAVATO ® . It is not known if SPRAVATO ® is safe and effective in children. IMPORTANT SAFETY INFORMATION What is the most important information I should know about SPRAVATO ®? SPRAVATO ® can cause serious side effects, including: Sedation and dissociation. SPRAVATO ® may cause sleepiness (sedation), fainting,  dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your  thoughts, feelings, space and time (dissociation). Tell your healthcare provider right away if you feel like you cannot stay awake or if  you feel like you are going to pass out. Your healthcare provider must monitor you for serious side effects for at least 2  hours after taking SPRAVATO ®. Your healthcare provider will decide when you are  ready to leave the healthcare setting. Abuse and misuse. There is a risk for abuse and physical and psychological dependence  with SPRAVATO ® treatment. Your healthcare provider should check you for signs of  abuse and dependence before and during treatment with SPRAVATO ®. Tell your healthcare provider if you have ever abused or been dependent on alcohol,  prescription medicines, or street drugs. Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction. SPRAVATO ® Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, and abuse and misuse, SPRAVATO ® is only available through a  restricted program called the SPRAVATO ® Risk Evaluation and Mitigation Strategy (REMS)  Program. SPRAVATO ® can only be administered at healthcare settings certified in the  SPRAVATO ® REMS Program. Patients treated in outpatient healthcare settings (e.g.,  medical offices and clinics) must be enrolled in the program. Increased risk of suicidal thoughts and actions. Antidepressant medicines may increase  suicidal thoughts and actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed. SPRAVATO ® is not for use in children Depression and other serious mental illnesses are the most important causes of  suicidal thoughts and actions. Some people may have a higher risk of having  suicidal thoughts or actions. These include people who have (or have a family  history of) depression or a history of suicidal thoughts or actions. How can I watch for and try to prevent suicidal thoughts and actions in myself or a  family member? Pay close attention to any changes, especially sudden changes, in mood, behavior,  thoughts, or feelings, or if you develop suicidal thoughts or actions. Tell your healthcare provider right away if you have any new or sudden changes  in mood, behavior, thoughts, or feelings. Keep all follow-up visits with your healthcare provider as scheduled. Call your  healthcare provider between visits as needed, especially if you have concerns  about symptoms. Tell your healthcare provider right away if you or your family member have any of the  following symptoms, especially if they are new, worse, or worry you: suicide attempts thoughts about suicide or dying worsening depression other unusual changes in behavior or mood Do not take SPRAVATO ® if you: have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal  aorta, arms and legs) have an abnormal connection between your veins and arteries (arteriovenous  malformation) have a history of bleeding in the brain are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO ®. If you are not sure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO ®. Before you take SPRAVATO ®, tell your healthcare provider about all of your medical  conditions, including if you: have heart or brain problems, including: high blood pressure (hypertension) slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness,  or fainting history of heart attack history of stroke heart valve disease or heart failure history of brain injury or any condition where there is increased pressure in the brain have liver problems have ever had a condition called “psychosis” (see, feel, or hear things that are not there, or  believe in things that are not true). are pregnant or plan to become pregnant. SPRAVATO ® may harm your baby. You should not  take SPRAVATO ® if you are pregnant. Tell your healthcare provider right away if you become pregnant during treatment  with SPRAVATO ®. If you are able to become pregnant, talk to your healthcare provider about methods  to prevent pregnancy during treatment with SPRAVATO ®. There is a pregnancy registry for women who are exposed to SPRAVATO ® during  pregnancy. The purpose of the registry is to collect information about the health of  women exposed to SPRAVATO ® and their baby. If you become pregnant during  treatment with SPRAVATO ®, talk to your healthcare provider about registering with  the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at  https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/. are breastfeeding or plan to breastfeed. You should not breastfeed during treatment with SPRAVATO ®. Tell your healthcare provider about all the medicines that you take , including prescription and  over-the-counter medicines, vitamins and herbal supplements. Taking SPRAVATO ® with certain  medicine may cause side effects. Especially tell your healthcare provider if you take central nervous system (CNS) depressants,  psychostimulants, or monoamine oxidase inhibitors (MAOIs) medicines. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. How will I take SPRAVATO ®? You will take SPRAVATO ® nasal spray yourself, under the supervision of a healthcare  provider in a healthcare setting. Your healthcare provider will show you how to use the  SPRAVATO ® nasal spray device. Your healthcare provider will tell you how much SPRAVATO ® you will take and when you  will take it. Follow your SPRAVATO ® treatment schedule exactly as your healthcare provider tells you  to. During and after each use of the SPRAVATO ® nasal spray device, you will be checked by a  healthcare provider who will decide when you are ready to leave the healthcare setting. You will need to plan for a caregiver or family member to drive you home after taking  SPRAVATO ®. If you miss a SPRAVATO ® treatment, your healthcare provider may change your dose and  treatment schedule. Some people taking SPRAVATO ® get nausea and vomiting. You should not eat for at least 2  hours before taking SPRAVATO ® and not drink liquids at least 30 minutes before taking  SPRAVATO ®. If you take a nasal corticosteroid or nasal decongestant medicine take these medicines at  least 1 hour before taking SPRAVATO ®. What should I avoid while taking SPRAVATO ®? Do not drive, operate machinery, or do anything where you need to be completely alert after  taking SPRAVATO ®. Do not take part in these activities until the next day following a restful  sleep. See “What is the most important information I should know about SPRAVATO ®?” What are the possible side effects of SPRAVATO ®? SPRAVATO ® may cause serious side effects including: See “What is the most important information I should know about SPRAVATO ®?” Increased blood pressure. SPRAVATO ® can cause a temporary increase in your blood  pressure that may last for about 4 hours after taking a dose. Your healthcare provider will  check your blood pressure before taking SPRAVATO ® and for at least 2 hours after you take SPRAVATO ®. Tell your healthcare provider right away if you get chest pain, shortness of  breath, sudden severe headache, change in vision, or seizures after taking SPRAVATO ®. Problems with thinking clearly. Tell your healthcare provider if you have problems thinking  or remembering. Bladder problems. Tell your healthcare provider if you develop trouble urinating, such as a  frequent or urgent need to urinate, pain when urinating, or urinating frequently at night. The most common side effects of SPRAVATO ® when used along with an antidepressant taken  by mouth include: feeling disconnected from yourself, your thoughts, feelings and things  around you dizziness nausea feeling sleepy spinning sensation decreased feeling of sensitivity (numbness) feeling anxious lack of energy increased blood pressure vomiting feeling drunk feeling very happy or excited If these common side effects occur, they usually happen right after taking SPRAVATO ® and go  away the same day. These are not all the possible side effects of SPRAVATO ®. Call your doctor for medical advice about side effects. You may report side effects to FDA at  1-800-FDA-1088. Please see full Prescribing Information , including Boxed WARNINGS, and Medication Guide for SPRAVATO ® and discuss any questions you may have with your healthcare provider. cp-170363v1 For more information about SPRAVATO ®, please visit www.spravato.com. This information is intended for the use of patients and caregivers in the United States and its territories only. Laws, regulatory requirements and medical practices for pharmaceutical products vary from country to country. The Prescribing Information included here may not be appropriate for use outside the United States and its territories. cp-266083v1

    Laura Bower

    5 (False) Things People Assume About Depression

    Depression is often misunderstood and unless you have lived with this horrible monster, it’s hard to grasp the reality of this unfortunate condition. Here are five things people often assume about depression. 1. Everyone who has depression is in bed all day. Someone you know may be battling depression and you may not even know it. People with depression aren’t always noticeable — they may not be sleeping all day or even seem sad. The truth is, many people can learn to hide their depression quite well and sometimes the happiest people are the ones battling demons within themselves. 2. It’s easy to just be happy. “Just be happy!” If I had a dollar for every time I heard this, then I’d be on my way to owning my own private island.When you battle depression, it’s not as easy as “just being happy.” We would love to be happy — to feel “normal” —but for some reason, we just can’t. 3. Being outside and exercising will “cure” depression. There’s this meme floating around on the internet about going outside if you are depressed and how it will help your mood. People without depression often assume a quick fix to getting rid of said depression is to just get outside or simply exercise. It’s not that easy. While those things are great for the mind, when I was in my darkest days of depression, the last thing I wanted to do was to move my body or even leave my house. And I wanted to… very badly. 4. People with depression are “crazy.” If you live with depression or any form of mental illness, you probably know the stigma surrounding it. There’s a big misconception that people with depression are “crazy.” Not true. We can be some of the most normal and well-rounded individuals with successful careers and can be the best parents. We have an illness. We aren’t crazy. 5. People with depression just want attention. I can assure you this couldn’t be further from the truth. When you battle depression and you are reaching out to someone for help, that is the most vulnerable thing you can do. People with depression don’t seek attention… they seek help. Comfort. A friend. Before I battled my own depression, I had no idea how misinformed I was about it. I hope I was able to shed some light on things that are often assumed about depression.

    Paid content from Takeda Pharmaceuticals and Lundbeck
    Jesus O.
    Jesus O. @jesus-o
    contributor

    'Aha Moments' Pushed Me to Seek Professional Help for My Depression

    The only way I could describe how I was feeling with depression was that something seemed out of place. Over the years, I continued to feel sad and lost interest in things I once enjoyed. I also noticed a considerable change in my weight. These and the other symptoms made me realize that I couldn’t continue like this forever and I needed to do something about it. I remember thinking I should talk to a doctor, but had a fear the doctor would laugh at me or think my symptoms weren’t valid. I remember also feeling ashamed around my family and friends; the prospect of having depression was taboo and not something I would want to share with anyone. There were two “aha” moments that happened while I was in college, which pushed me to take action. The first was when I was confronted by one of my mentors, who was diagnosed with depression and recognized that I was struggling. She discussed the importance of speaking with a doctor about the signs and symptoms of depression. I didn’t act on this right away, but it made me think about whether I should talk to a doctor. The second turning point was when I was attending a lecture about Major Depressive Disorder (MDD), a type of depression, in pharmacy school. My professor discussed how MDD manifests as a complicated set of symptoms including (but not limited to) depressed mood, loss of interest or pleasure in things once enjoyed, trouble thinking clearly, being tired often, and being restless or moving slowly. The tricky part about MDD is that each person’s experience can be different. Once I began to understand more about this specific type of depression, I knew I needed to talk to a doctor about what I was experiencing. After a thorough medical evaluation, my doctor diagnosed me with MDD. I talked to him about my feelings of depression over the years, and asked myself, “Do I need to keep living like this?” That was an important moment for me – everything I’d been feeling for years finally seemed to make sense. My doctor took the time to walk me through several treatment options and encouraged me to take an active role with him in my treatment plan. He explained that MDD treatment plans can include medications, like antidepressants, as well as talk therapy. After I graduated college, I moved to Austin, TX. After a number of years of being in a new city, I was wondering why I continued to struggle with my MDD. I decided I needed to have another conversation with my doctor. When my doctor told me about an antidepressant prescription medication called Trintellix ® (vortioxetine) used to treat MDD in adults, he explained that it could be a good treatment for me to try. He helped me understand what I could expect while taking Trintellix and explained all of the risks and benefits, like how Trintellix may increase suicidal thoughts and actions in some people 24 years of age and younger (of note, Trintellix is not approved for children under 18). My doctor also advised that I should call him or get emergency help right away if I have new or worsening depression symptoms, new or sudden changes in mood, behavior, thoughts or feelings, or suicidal thoughts or actions. My doctor also said that I shouldn’t take Trintellix if I’m on a monoamine oxidase inhibitor (MAOI), or if I am allergic to vortioxetine or any other ingredients in Trintellix. Scroll below for additional Important Safety Information, including Full Boxed WARNING for Suicidal Thoughts and Actions. Click here for Medication Guide and discuss with your doctor. Along with safety considerations, my doctor went over the positive treatment results from the clinical trials in adults with MDD. In multiple short-term studies, Trintellix was shown to help reduce the overall symptoms of MDD, based on an overall score on a standardized depression rating scale versus sugar pill. Also, he explained to me that there were no significant changes in weight seen in clinical trials with Trintellix. Some reports of weight gain have been received since product approval. I appreciated that my doctor took the time to explain that, while antidepressants are known to be effective based on clinical trials, there are also potential side effects of these types of medications, including nausea, vomiting, weight gain, changes in sleep, treatment-emergent sexual dysfunction (TESD), and suicidal thoughts and actions. The most common side effects of Trintellix are nausea, constipation and vomiting. Serious potential side effects include serotonin syndrome, abnormal bleeding, hypomania (manic episodes), discontinuation syndrome, visual problems, low levels of salt in your blood, or sexual problems. On my current treatment plan, I feel my MDD is pretty well managed. I have good days and bad days. I’m proud to be a dog dad, a friend and an amateur karaoke singer. I also enjoy spending time outdoors and running. I am now prioritizing my health by having open and honest conversations with my doctor. My life motto is to “try and find the good things, even in bad situations.” My number one recommendation for others living with MDD is not to give up hope, because things can change for the better. It’s so important to be your own advocate and to have an open and honest relationship with a healthcare professional to find a treatment plan that works for you. Visit Trintellix.com to hear more stories like mine and learn about other patient resources. *Jesus is a paid contributor for Takeda and Lundbeck. Last name withheld to protect subject’s privacy. IMPORTANT SAFETY INFORMATION (continued from above) Suicidal Thoughts & Actions TRINTELLIX and other antidepressants may increase suicidal thoughts and actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed. TRINTELLIX is not for use in children under 18. Depression or other mental illnesses are the most important causes of suicidal thoughts or actions. Pay close attention to any changes, especially new or sudden changes in mood, behavior, thoughts, or feelings. Call your doctor or get emergency help right away if you have symptoms such as suicidal thoughts or actions, impulsivity, aggressive or violent actions, depression, anxiety or panic attacks, agitation, restlessness, anger, irritability, trouble sleeping, an increase in activity or talking, or other unusual changes in behavior or mood; especially if they are new, worse, or worry you. Who should not take TRINTELLIX? Do not start or take TRINTELLIX if you: are allergic to vortioxetine or any of the ingredients in TRINTELLIX take a Monoamine Oxidase Inhibitor (MAOI) have stopped taking an MAOI in the last 14 days are being treated with the antibiotic linezolid or intravenous methylene blue Do not start taking an MAOI for at least 21 days after you stop treatment with TRINTELLIX . What should I tell my doctor before taking TRINTELLIX? Before taking TRINTELLIX, tell your doctor: about all your medical and other health conditions if you are pregnant or plan to become pregnant, since TRINTELLIX may harm your unborn baby. Taking TRINTELLIX during your third trimester may cause your baby to have withdrawal symptoms after birth or to be at increased risk for a serious lung problem at birth. Tell your doctor right away if you become or think you are pregnant while taking TRINTELLIX. if you are breastfeeding or plan to breastfeed, since it is not known if TRINTELLIX passes into your breast milk Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements, since TRINTELLIX and some medicines may cause serious side effects (or may not work as well) when taken together. Especially tell your doctor if you take: medicines for migraine headache called triptans; tricyclic antidepressants; opioids (such as fentanyl and tramadol); lithium; tryptophan; buspirone; St. John’s Wort; medicines that can affect blood clotting such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin; and diuretics. What are the possible side effects of TRINTELLIX? TRINTELLIX may cause serious side effects, including: Serotonin syndrome: A potentially life ‐ threatening problem that can happen when you take TRINTELLIX with certain other medicines. Call your doctor or go to the nearest emergency room right away if you have any of the following signs and symptoms of serotonin syndrome: agitation; seeing or hearing things that are not real; confusion; coma; fast heart beat; changes in blood pressure; dizziness; sweating; flushing; high body temperature; shaking, stiff muscles, or muscle twitching; loss of coordination; seizures; nausea, vomiting, diarrhea. Increased risk of bleeding: Taking TRINTELLIX with aspirin, NSAIDs, warfarin or blood thinners may add to this risk. Tell your doctor right away about any unusual bleeding or bruising. Manic episodes: Manic episodes may happen in people with bipolar disorder who take TRINTELLIX. Symptoms may include: greatly increased energy; racing thoughts; unusually grand ideas; talking more or faster than usual; severe problems sleeping; reckless behavior; excessive happiness or irritability. Discontinuation syndrome: Suddenly stopping TRINTELLIX may cause you to have serious side effects including: nausea; sweating; changes in your mood; irritability and agitation; dizziness; electric shock feeling; tremor; anxiety; confusion; headache; tiredness; problems sleeping; hypomania; ringing in your ears; seizures. Eye problems: TRINTELLIX may cause a type of eye problem called angle-closure glaucoma in people with certain other eye conditions. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are. Call your doctor if you have eye pain, changes in your vision, or swelling or redness in or around the eye. Low levels of salt (sodium) in your blood: Low sodium levels in your blood that may be serious and may cause death can happen during treatment with TRINTELLIX. Elderly people and people who take certain medicines may be at a greater risk for developing low sodium levels in your blood. Signs and symptoms may include headache; difficulty concentrating; memory changes; confusion; weakness and unsteadiness on your feet which can lead to falls. In more severe or more sudden cases, signs and symptoms include: seeing or hearing things that are not real; fainting; seizures; coma; stopping breathing. Sexual problems : Taking antidepressants, like TRINTELLIX, may cause sexual problems. Symptoms in males may include: delayed ejaculation or inability to have an ejaculation, decreased sex drive, or problems getting or keeping an erection. Symptoms in females may include: decreased sex drive or delayed orgasm or inability to have an orgasm. Talk to your healthcare provider if you develop any changes in your sexual function or if you have any questions or concerns about sexual problems during treatment with TRINTELLIX. The most common side effects of TRINTELLIX include: nausea constipation vomiting These are not all the possible side effects of TRINTELLIX. Tell your doctor if you have any side effect that bothers you or does not go away. What is TRINTELLIX (vortioxetine)? TRINTELLIX is a prescription medicine used in adults to treat a certain type of depression called Major Depressive Disorder (MDD). You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1 ‐ 800 ‐ FDA ‐ 1088. For additional Important Safety Information, click here for Medication Guide and discuss with your doctor. ©2021 Takeda Pharmaceuticals U.S.A., Inc. All rights reserved. TAKEDA and the TAKEDA logo are registered trademarks of Takeda Pharmaceutical Company Limited. TRINTELLIX is a trademark of H. Lundbeck A/S registered with the U.S. Patent and Trademark Office and used under license by Takeda Pharmaceuticals America, Inc.

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    Using a 'Wheel of Emotions' to Help Identify What You're Feeling

    I’ve always described myself as an “after-reactor,” meaning I don’t typically react to things as they’re happening. I intellectually process what’s happening, whether it be bad news, an overwhelming task or a hard situation, but can often have a hard time feeling it. I can’t lie, this has served me well. I can be pretty great at handling stress, compartmentalizing and temporarily putting away feelings I’ve deemed unhelpful. It’s easy for me to “leave things at the door” when I go to work, because you can’t be distracted by things you’re not processing, right? This is how I learned to function in high school. This is how I juggled so much in college. This is largely still how I function now. Avoid bad feelings. Suppress and move on. Emotions can’t hurt you when you don’t feel them… It doesn’t take a psychologist to guess where this is going. Because of course, feelings you don’t feel don’t simply go away. They don’t seep into the ground never to return again. In fact, it’s more like the water cycle. Whatever the earth absorbs eventually comes back as rain. Except in this version of the water cycle, the more water that goes unused and unprocessed, the bigger the storm. Water you ignore comes back with fury, demanding your attention, raining big, angry drops on your head. For me, this rain can manifest physically through stomachaches and back pain no amount of stretching relieves. It comes out in bad thoughts, like, “I want to kill myself,” a sentence that sometimes (although, thankfully, not recently) runs through my mind, a placeholder for whatever negative emotions I didn’t process that day. Then, it comes out in bursts of emotion, triggered by seemingly “little” things. A change in dinner plans leaves me sobbing on my bed. One off-hand comment from a friend (combined with too many drinks), and I’m fighting self-harm urges in a public bathroom. Something happens in a TV show, and I cry as if it’s happening to me, suddenly unable to breathe by a fictional plot that is vaguely related to something personal. But yet, as things are actually happening, it’s still hard for me to feel. It’s as if my brain is trying to protect itself, working in overdrive so I can still function. It makes it hard for me to identify how I really feel about things. It makes it hard for me to process emotions in real time. During a fight with my boyfriend, he begged me to tell him how I was feeling. “Nothing,” I responded. And I meant it. “I feel nothing.” Later, while we were in the car, I screamed. I talk about this in therapy, but only after my wonderful therapist called me out. Even in her office, I tend to recount stories as if they didn’t happen to me, intellectually analyzing events and avoiding discussions about how things actually made me feel. My therapist isn’t big on worksheets or homework, so I was surprised when after one session, she excused herself to get something for me. What she handed me was a piece of paper I didn’t know I needed: a Wheel of Emotions. It’s a simple chart, with different levels of color-coded emotions, meant to help those who possess it identify how they’re feeling. I stared at it, and was hooked. My “Wheel of Emotions,” crinkled up from being in my purse. Maybe it’s because I’m a writer, or maybe it’s because the colors are nice, but I’ve found this to be one of the more helpful tools I’ve been given for my mental health. For me, what makes the Wheel of Emotions so great is that it starts out relatively vague, and then moves on to more specific, intense emotions. Now when I, for example, reference this tool when talking to my boyfriend (yes, this has happened), I start by looking at the emotions in the middle. Even if I think I feel nothing about what we’re talking about, I can usually at least choose an emotion to start. My options are: Bad, Fearful, Angry, Disgusted, Sad, Happy, Surprised. If I can’t pinpoint exactly how I’m feeling, but know, at the very least, I feel “bad,” I can then move on to the next layer. ( Do I feel Bored, Busy, Stressed or Tired?) Then, I can even go one step deeper. If I feel Stressed, do I also feel Overwhelmed or Out of Control? Do I feel both? Even if there isn’t one “perfect” label  to sum up how I’m feeling, it sets me in the right direction. It gives me some language to talk about how I feel. It’s better than “nothing.” According to American psychologist Dr. Robert Plutchik, humans can experience 34,000 distinguishable emotions. He developed a wheel of emotions that looks a little different than mine, which you can find here. As stated in the resource about navigating Plutchik’s Wheel of Emotions, the “deeper” you get on the wheel, the more intense the emotional response. No matter what your Wheel of Emotions looks like, the concept is still the same — humans are capable of so many vast and complicated emotions. Identifying them is a practice. Dealing with them can be a strength. I included a bigger (and hopefully easier to read) version of my Wheel of Emotions below so you can take a look: Click here to view full size version. Image via www.classtools.net. Even before I was given my new favorite piece of paper, slowly but surely I’ve been getting better at feeling my feels. Anger has gotten a little easier to process. I’m trying to take away shame from feelings I think are “illogical” or “wrong.” I’m trying to own myself as an emotional person, and remind myself that while burying “bad” emotions is tempting, and even “helps me” in the short-term, it always bites me in the end. It inhibits my growth, rather than helping it, and just because I can push through bad feelings doesn’t mean I have to. The magic thing about processing and identifying emotions while they’re happening is that afterwards, I often feel lighter. I can deal with what I’m going through without giving the storm festering inside of me more fuel. Identifying my emotions, with the aid of my dear wheel, has been a big help on my own mental health journey. If you’re someone who struggles with identifying emotions, I hope it’s a tool that can help you too.

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    15 Things People Said That Were Code for 'I'm Struggling Today'

    Oftentimes, when someone is struggling with their mental health, they won’t come right out and say it. Some may hint at what they are feeling, hoping others pick up on the clues. Others may use language that means “I need help” without actually saying the words — because saying them can sometimes make it feel too real, or you might be afraid of how others will react. No matter what reason someone has for using “code words,” it’s important we talk about what kinds of phrases to look out for. Talking about these phrases can help us identify loved ones who are struggling and get them to the resources and support they need. To find out what people said when they were having a hard time with their mental health, we asked members of our Mighty community to share one thing they said that was really code for “I’m struggling today.” Here’s what our community shared with us: 1. “I’m not feeling well.” “It’s not untrue and I don’t have to explain myself. People automatically assume I have a cold or something.” — Mackenzie C. “It’s true. Majority of the time, depression keeps me exhausted and anxiety keeps me awake, so I get no respite from my brain. Top that with the stress of nursing school, and I literally don’t feel well.” — Bria M. 2. “Well, I’m alive!” “ I just realized that whenever people ask me how I’m doing, I say, ‘Well, I’m alive!’ or ‘Well, I’m here!’ It’s basically my way of saying that somehow, I am still alive and carrying on even though I am so exhausted and fight every day.” — Kellyann N. 3. “I didn’t sleep well last night.” “ It’s more acceptable to be tired from a bad night’s sleep than it is to be too exhausted to deal with life today.” — Ciara L. “It’s an immediate response I turn to because I’m just always tired of my depression, but I’m not the best at lying.” — Max W. 4. “Eh, you know.” “ No, they probably don’t. But are they still able to identify with you? One hundred percent. And that makes them think you’re OK.” — Josie S. 5. “It’s too much.” “I say this whenever all my thoughts overwhelm me and I have no way of truly telling anyone how bad I really feel.” — Erin R. 6. “I’m exhausted.” “Just not the kind that can be cured by sleep. Some days I get so tired of fighting to survive and don’t want to fight anymore.” — Alecia F. “It’s the truth, every illness I have exhausts me to the core, but they usually brush it off as mom exhaustion (which also plays a part).” — Joanna G. “‘I’m tired’ usually means a lot from not feeling well to being emotionally exhausted.” — Breeanna M. 7. “I’m just out of it today.” “Code for: I really don’t feel myself right now and it’s scaring me. Those days don’t happen often but when they do, I’m afraid I’m relapsing and I will need to readjust my medication.” — Christa M. 8. “I’m fine.” “‘I’m fine, honestly.’ There are many times I’ve been struggling and even though I’ve been asked if I’m OK, I just can’t always seem to be honest and explain that I’m not. Usually because I can’t even make sense of it myself to tell someone else. Then I kick myself afterwards for not saying something. Can’t win.” — Amy W. “[For me], fine never means fine. If I’m vague like that, then I’m hurting but won’t admit it. If I’m good, I’ll say that but won’t openly admit to struggling.” — Jackie S. 9. “I’m bored.” “ Meaning that I’m so sick and tired and I’ve had too many struggles today and I don’t feel very good.” — Denisa 10. “I’m having an ‘off day.’” “Code for I don’t feel like me today, today is harder than other days. I may not act like I need you checking in on me, but I actually really do.” — Jenna L. “‘Off’ means I need time off from any responsibilities and wait for the feeling to pass. Hopefully.” “I’m just a lil off. It’s my code for: ‘I feel like I’m imploding but I don’t want to burden you.’” — Jace P. 11. “I’m hanging in there.” “Usually said because I don’t want to bother anyone with the things that are going on in my head.” — Katie S. 12. “I’ve been listening to music a lot today.” “Music is how I get away from the nightmare in my head. And when I can’t listen to it, I’m just quiet. Unfortunately the people around me don’t recognize either of these. Ever.” — Megs G. 13. “I don’t want to be alone.” “That’s when it’s really bad and I really need someone. Otherwise I’m usually silent and not my bubbly self.” — Milly S. 14. “I’m all good, don’t worry about it.” “It’s just what I do. [I] don’t want others worrying about me — gotta help fix them before I fix me.” Alexis D. 15. “I just can’t today.” “ [When I’m] not feeling too good.” — Scarlett E. What would you add? If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741 . Unsplash photo via Timothy Paul Smith

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