Hiya! I suffer from major depressive disorder and generalized anxiety disorder. I'm fortunate to have a psychiatrist I trust, and usually we have been able to intervene with meds at the times when I've needed them and cognitive behavioral therapy for the rest of the time.

Lately I've begun to run in to this one peculiar hitch in my therapy. I talk with him about my domestic life. (My partner and I are college aged, I just graduated and she's got a few semesters left) I talk with him about feeling horribly insecure about my own and my loved one's future in a particularly economically unforgiving part of the U.S. I talk with him about fears of whether we'll ever get out from under my partner's student debt. About income inequality. About the struggle of finding adequate medical insurance where employers are eager to jump through hoops to avoid insuring my self or my partner. I talk about the fact that modern political discourse looks like a Kafkaesque nightmare.

I've run into a hitch because my psychiatrist is having trouble distinguishing to what degree the depression and anxiety I'm experiencing is just founded in cold reality. Yes, I'm more anxious right now than I was a year ago, but there are threats to my health and my livelihood that truly are bigger and closer to me now. Yes, I'm more depressed now than I was a year ago, but the environment I'm living in is objectively worse than the world I lived in a year ago.

Has anybody here developed an effective lexicon for talking with your therapist about how your mental health can't be disentangled from horrible, tangible, societal, existential problems. I take alprazolam for anxiety, usually quite infrequently. But I have needed it more this year than ever before, and I don't think it's because my anxiety is unresponsive to treatment. I don't think my mental health is getting worse, I think reality is getting worse. I think my partner and I are going to spend our entire lives suffering from an economic and social burden that was forced on us by a privileged clique of avaricious monsters for their economic and political sociopathy. What do you do about your mental health when reality gets worse? Do you ask your therapist to up your dosage?