please help- when to seek hospitalization?

Hello- I hope this is the right place to post this. I am really in need of help. The short of it is, I am trying to decide whether I need to admit myself to a psych ward. I am, and have been for the past two months, extremely dissociated and depressed.

Specifically, I cannot get out of bed or leave my house for the most part- I've been making it to therapy three times a week. I've been living off of dry oatmeal and sleeping for most of the day. I missed time on a few occasions and wound up wandering outside in the snow. I cannot stay grounded. I can't feel anything emotionally, even though I know I should be. I quit my job in early January and can't function to look for a new one, or even make it to my one class a week. I live with a roommate and when he comes into the house I can't leave my room for fear of having to interact with him. I feel like my head is full of cotton. I always have multi-party 'chatter' in my head, but now even that has been covered up by static. I am not even remembering my nightmares anymore, even though I wake up in cold sweat so I know I'm still having them.

I've had recurrent bouts of this my whole life and it usually lasts a week at most, but I've been like this since the new year.

More info, IDK what's relevant here:
I'm 20 years old. Last year I dropped out of school and moved away from my family because my father became increasingly violent and I began to have flashbacks of early childhood sexual abuse. I had been in the psych system since I was about 11 with a diagnosis of Major Depression and occasional additional diagnoses of social anxiety disorder, GAD, panic disorder, ED-NOS. I was hospitalized when I was 15 for major depression and panic. I've been prescribed every major SSRI, effexor, lithibid, nortriptyline, cymbalta, and those in combination with lorezapam, klonopin, abilify, xanax, etc. NOTHING has worked. I began seeing a new psychopharmachologist last year and he also has given me a major depression diagnosis. He knows my therapist, who is in trauma and has me down as PTSD. I have also been attending a women's trauma group, and I am 99% sure that trauma and PTSD is my problem. My symptoms are spot on for that diagnosis, and I know from other people that I was abused and neglected as a child, but I cannot remember anything about my life before I was 10 and things after that I remember very little.

I have always assumed I had depression because that was how people translated my symptoms, but I feel much more dissociated now than depressed, and no anti-depressant has ever helped me. I need help. I can't function, and I feel like I'm not even in my body except for the three hours a week I have therapy. I know the talk therapy with my trauma therapist will help me ultimately, but the drugs are not helping me and I can't get myself out of bed or concentrate or care about anything and everything is too loud and too sudden.

The last time I was this unable to function I was admitted to the psych ward as a minor- should I admit myself now? Will they just tack me on another anti-depressant? I'm not actively suicidal; I'm too dissociated to care, but I have been having moments of clarity where I know I cannot live like this. Please help.

Hi there, your post really touched me, your pain and confusion comes through so clearly it hurts!

The thing that struck me is that you've been 'diagnosed' and medicated from an early age, and still feel dysfunctional. I am a lot older than you, but in my teens was prescribed meds to deal with my depression, they didn't really work. It took me a long time to realise that most of my 'emotional' problems came from my upbringing and through therapy I came to understand that my way of seeing the world was skewed by my experiences. No amount of drugs was ever going to change that experience, maybe they could turn the feelings off, but could never tackle the root cause. I spent many years just being dead to feelings which is pretty crap to be honest.

Is there any way you can access counselling or therapy? I always knew that there were demons lurking in my head, but letting them out in a safe way changed everything.

Hi,

First, I'm glad to hear you're in therapy. You're obviously motivated, that's a good sign! However, if you're going three times a week, are on meds, but are still in this state, there's a real issue, as you suspect.

If we could speak, I'd ask- does your therapist know about this state of yours (lying around at home etc.)? Have you been feeling any better (I realize you're not exactly great right now) since you've begun therapy? What kind of therapist do you have? Psychologist or MFT (=Master degree)? With very few exceptions, MFT's are not trained to deal with the type of severe issues you're facing.

The key to getting better under your circumstances is:

1) Finding a psychologist (Ph.D. or Psy.D.) you trust who uses CBT (Cognitive Behavioral Therapy) AND has a background (ask!) with trauma/PTSD victims. Ask if they specialize in trauma. Also, find someone who's been trained in CBT, not just has a CBT 'orientation.' Again, you have to really ask about their background. Note: CBT is considered to be the Gold standard treatment approach for depression, anxiety and trauma. If you can find someone who knows what 'behavioral activation' means, that's a real plus. For severe depression, Behavioral Activation therapy has a 75% success rate (which is high compared to ANY kind of therapy). Google the term if you're curious.
2) You don't mention Wellbutrin (although I wouldn't be surprised if you have been prescribed). For the kind of depression you're in, this might help.
3) Find out about a local crisis line, so that you have someone to reach out to 24/7. You say you're too depressed to 'care.' That's common considering how you're feeling now, but suicidal thoughts could begin to occur (based on what you're describing) at any moment.
4) Beware that psychiatrists can overprescribe (i.e. too many medications), and that many medications can have serious side effects, that ironically, mimic depression (classic example is fatigue and lethargy). Be aware that research indicates SSRI's (Prozac/Paxil/Zoloft) take around 3 months to actually begin to have a serious positive impact.
5) Hospitalization: I don't recommend it unless you've become suicidal. I used to work at one. Most places are simply a place to contain you, give you new meds, and hope for some kind of stabilization. Frequently, trained psychologists/licensed therapists are completely absent (this is true even for 'well respected' places- which are often run by MDs=psychiatrists- who, as a rule, prescribe meds only, and haven't practiced- as a professional group- psychotherapy in 20+ years - contrary to their portrayal in the media, like 'Dr. Drew'). In case you deteriorate further, if there is a friend or family member who can call you daily to check in on you, bring/prepare some food, that would be of great help.
Currently, what you need is someone that knows how to get you out of bed, get you moving, and help you face your demons.

Best of luck,
Dan Litov, Ph.D.
Los Angeles, California
USA