meddling with mood meds

It seems that my depression, anxiety, or whatever it is you want to call my struggle with my emotional state, is no longer responding to my meds. This is really frustrating. I started going to a specialist for my mood meds, rather than just my regular doctor, shortly after Samuel was born three years ago. I had maxed out my dose on Zoloft during the pregnancy, since I seemed to need more as my blood volume and weight increased. But after Samuel was born, even the max dose didn't seem to be working. The psychiatric ARNP put me on Effexor, and with follow up the dose was increased slightly past the manufacturer's max dose (the psychiatric community recognizes that more than the max dose can be safely used and is necessary for some people). Some time later, when it seemed that Effexor was still controlling most symptoms, but I was experiencing a sort of bleed-through on certain symptoms, she added Wellbutrin to address those specific symptoms. It seemed to work reasonably well. One can't really expect symptoms to vanish 100% with antidepressants. The medicine is supposed to help level emotions so that they can be dealt with constructively, not to prevent ever feeling any negative emotions.

So, I've been on this Effexor/Wellbutrin combo for a while (a year and a half, two years?), and I had decided it was probably the best regimen available for me for now. But lately, it doesn't seem to be working at all. If it is actually improving my emotional stability and moods, then I can't imagine how I would be acting and feeling without any drugs.
So I have to assume it is working very little or not at all. I had heard medicine burn-out was a common problem with SSRI's like Zoloft, and you might need to switch between them, but I've never heard of it with Effexor or Wellbutrin. I'm not on the max dose of Wellbutrin; perhaps increasing it to the max dose would be more effective for me. But I am wary of trying new meds or new doses or combos of meds. Part of my wariness is simply the fact that I am tired of going to the doctor, tired of checking in and reporting on something that is hard to quantify with results that seem to fluctuate. But I am also wary of trying anything new because I am not sure if taking medicine has helped enough to offset the depression- and anxiety-inducing side effects it causes.

The roots of my emotional/mood issues are difficult for me to sort out. I got on Zoloft about five years ago after going a year and a half with no mood meds. It was at a time when the stress in our lives had increased, and I was not coping with it well. However, prior to that, during the year and a half I was not on meds, I had been steadily losing weight, about 3 lbs a month. This contributed very positively to my emotional state, since my concern about my weight is typically a big part of my anxiety and depression. So when I went back on meds, I knew it would probably cause me to gain weight again, which it did, but at the time I thought it was a necessary evil. But now I wonder, did the emotional upheaval of gaining weight cancel out the positive effect of the medicine? Did I require a larger dose to compensate for the upsetting side effect of weight gain?

Then there was my pregnancy, with a huge increase in progesterone (a natural sedative) and 50% increased blood volume. It is no surprise I needed a higher dose under those circumstances. Similarly, after Samuel was born, and we had difficulties nursing and low milk supply requiring time-consuming pumping and bottle feeding in addition to nursing, it was no surprise I needed something stronger to deal with my unstable emotions and moods. Breastfeeding Samuel successfully was a pretty important expectation and goal for me, and on top of that I was also going through some difficult times with my two older boys - Ethan arriving at his contrary three-year-old stage and five-year-old Jacob still dealing with fears of being alone or even out of sight of me. I began to wonder if my medicine wasn't working because my stress level continued to increase beyond what I could bear even with medicine.

Now, as I consider asking my doctor to change my medicine again, I wonder again if I am just at a point where even with the strongest medicine available, I can't deal with the level of responsibility and stress in my life and remain emotionally stable. Not that no one could deal with my level of responsibility and stress and remain emotionally stable - clearly many people do - but that I, with my personality/temperament/inborn resources, couldn't. Beyond that, I wonder how much my continual struggle with my weight is contributing to my depression, and if getting off medicine would perhaps help more than staying on it, by causing me to lose weight. I wonder, too, what other side effects of the medicine actually exacerbate my depression and anxiety, particularly a tendency of both my medications to not only increase your energy and motivation (good) but make you jittery (bad). If I feel jittery and get into a potentially anxiety-producing situation, I don't do well holding myself together.

The other thought I must address is that of going to therapy. Everyone seems to think it is a great, wonderful thing that almost anyone could benefit from. People I highly respect have gone to therapy themselves and recommended it to me. I've been to three different therapists, two in college and one just last year. I discontinued my appointments at the beginning of this year because our insurance deductible started over, and I wasn't sure I was going to get $1000 worth from my continued sessions. The therapist and I had talked and dealt with some things, and it seemed somewhat helpful, and I know from his reputation and referrals that he is an excellent therapist. However, it was hard for me to see that there was a lot more we were going to discover or achieve than what we had already discussed. I suppose that is the nature of it, that you can't see how you might change or what insights you might gain until after it has occurred - otherwise you would be affecting those changes yourself. But nonetheless, I couldn't justify the monetary expense nor the expense of time and effort to get to the appointments and find someone to care for the kids during them.

Now, we have met our insurance deductible and even paid the coinsurance because of my gallbladder surgery. So I could go to therapy again without paying $1000 out of pocket. But I'm still not sure it's worth the effort. I am skeptical of how much it could help.

So, I'm left with mostly skepticism about any treatment, whether drugs or therapy, helping me very much right now. I suppose that is a poor attitude on my part, and I know it is typical of people who are struggling with depression to have trouble getting help because the symptoms of their depression make it difficult to find the motivation or optimism necessary to seek help. I also don't know if my life is actually any more stressful or my responsibilities greater than they have been before or not. In many ways, the kids are more independent and require less physical micro-management, so there are fewer stressful situations involving providing for their basic needs of full stomachs, clean bottoms, clothed bodies, and adequate sleep. But there are still many stressful situations involving enforcing appropriate boundaries and rules and being referee to their conflicts. As for Samuel, he is in the contrary three-year old stage his brother went through not so long ago, so although he is capable of caring for many of his own physical needs now, he is requiring micro-management of his behavior that he didn't require before.

I had more to say about how home schooling and then not home schooling, and doing day care and then not doing day care have affected my depression and anxiety, but it has gotten too late and this document too long already! It was basically something about how doing those difficult things added stress because of more complications and expectations in my life, but quitting doing them caused me to lose a source of satisfaction at having done something well and at pursuing a goal that was important to me. So did doing them or quitting them contribute to my depression more?

If you have managed to stay interested this far, thank you for reading and caring. I'm obviously to a point with all this where I don't care what anyone knows or thinks about me needing treatment for depression and anxiety. I just want to find a way to not feel this way and not put my family through the drama of me feeling this way anymore.