I have been open with my children about the fact that I am treating my Depression with anti-depressants. There are several reasons for this. 1. My children are not idiots. They know when things are wrong. My oldest once drew me a picture of a sea turtle and said, "Mama, when you are feeling sad you can look at this, think of me and smile." Crap. To have a three year old be more aware of your mental state than you are is a rude awakening. That sent me back into treatment. 2. I want to give the message that being treated for a mental health issue is not something shameful or something that needs to be hidden. 3. The grown-ups around me do not necessarily think carefully before they start talking about serious issues in front of my children. I don't want my kids wondering what the heck people are talking about when they ask me how I am doing. Children are perfectly capable of making up the most horrific realities when they are denied real facts. 4. There is a hereditary component to Depression and both sides of my children's family have a history of mental illness. (Whose family doesn't?) I would like to introduce a family history of actually treating the Depression. So I would like them to find the idea of receiving mental health care services as routine, or at least unremarkable. That said, there are times when I wish I hadn't said anything to my children. Like when one of the members of our Quaker meeting committed suicide after a long battle with Depression. Honestly that scared me. Because people kept talking about how hard she fought. I have been fortunate in not having to deal with suicidal ideation. And I have also never sunk so low into Depression as I did in the first major depressive episode I experienced in high school. I have very few memories of my senior year when I was spiraling into deep depression. I let so many things fall away before I sought help. I was tired of being in treatment. I had already been through outpatient therapy for an eating disorder. I wanted to be done. I was so determined to be Better that I let go of study and reading and music and friendship and the energy to do anything at all. It took all my power just to get up, drag myself to school and collapse on my bed when I got home. There was no learning happening. I was not connecting to anyone. There were no thoughts in my brain. This was not a fun place to bounce back from. I never want to do that again. However, I have been engaged for a long time in a sort of yo-yo diet of on again, off again treatment. And I am declaring that I am done with that. I am not saying that I will necessarily be on medication forever, but that I will seek regular care and oversight for this chronic condition: steady, constant, thoughtful treatment of this stupid-ass condition that wants to eat my brain. And the thing is, I like my brain. It is one of my favorite things. It contains many of my best qualities. Ugh. This feels all choppy and discontent with itself. I'm putting this blog post to bed. Daily Convexions
When I went to see my psychiatric nurse practitioner for the first time back in May she took my health history as it pertains to Depression. One of the first questions she asked was if I had ever had any head trauma. Nope. Never. Not even once. Except... When I was 20 I went on a camping trip. The plan was for me and my significant other (now spouse) to bike 20 miles to a campsite with all of our equipment (tents, sleeping bags etc.) in giant backpacks. Don't interrupt. I know it wasn't smart. We didn't have any panniers and even if we had there was no way to attach them because we were riding racing bikes with skinny little tires. This may have changed my center of gravity somewhat and may or may not have compromised my ability to keep my balance while going really fast down a hill carrying many pounds of extra gear on my back. In a freak accident I skidded out on a patch of gravel and somersaulted over the front of my handlebars. It took me 5 minutes to fly through the air (not really, but it seemed like it) during which time I thought "I should put out my arms to break my fall... I should put out my arms to break my fall... I should put out my arms to break my fall..." But instead I landed full force on my head. Then I put out my arms, scraping them up very badly on the gravel. Nice. My first thought was that my fall must have been terrifying to watch. To prove that I wasn't dead I called out "I'm totally fine." And then I wandered tipsily into traffic. I was bleeding messily. My head hurt a lot. But I said I was good to go. We were halfway to the campsite. Never trust a person with a head injury when they say they are good to go. I was a very convincing liar. I didn't even know I was lying, to tell the truth.We stopped at a grocery store to get some bandages and then proceeded on our trip. Only I could only ride for a mile at a time before I had to stop to rest because my helmet (which now had a big flat spot right in the front) felt like it was too small and my head was pounding. ...One month later back at college I was still having headaches so I decided to visit the campus doctor. She made me do all the brain bleed tests and looked for bulging eyes and told me horror stories about what could have happened to me. "You had a head injury a month ago and your'e just coming in now?!? You DESERVE to have headaches." This is an exact quotation.
I probably would not have mentioned this to my psychiatric nurse practitioner even if I had remembered it because it happened more than 20 years ago. But now studies are coming out about mild traumatic brain injury leading to a much greater chance of suffering from Depression and Anxiety even years later because there have been physical changes to the brain. This risk is increased in people who have a history of Depression (which I did, having been on anti-depressants for about a month as a teenager). Interesting. I don't know that the brain trauma had any impact on my Depression symptoms. I don't know that it would change anything about my treatment plan now. I will share the head trauma information with my nurse, though. My acupuncturist advised me, when she found out I was suffering from Depression, to look at my child and smile more. Ha ha ha. Clearly she had not experience with true Depression and just thought I meant I was kind of sad. Her English wasn't so great and a lot was lost in translation. Then I read (in Malcom Gladwell's book Blink) about two researchers studying facial expressions. They sat around all day making faces at each other-- they had a list of expressions that they were working their way through. Days they made happyish faces they felt happy. Days they made saddish faces they felt sad. Turns out if you make a grimace (like clenching a pencil between your teeth) even that may have a positive effect on your mood. Sheesh. Smiling when I don't feel like it is difficult. Smiling when I am looking at children is easier. And I can't see using the pencil clenched between my teeth as appropriate anti-depressive therapy. But I do need to remember that doing things that make me smile and things that make me laugh counts as work in the fight to Kick Depression's Ass. And I need to remember that this is a fight that I don't get to stop fighting. So I better get used to smiling. And I will spend some more time working on my Convexitive Currents page. Convexitive Currents
I have been reading about the correlation between all-or-nothing thinking and Depression. Apparently this black and white way of looking at the world is common among people suffering from Depression. And it causes a vicious cycle. Even in people with unipolar Depression (without the excess happiness of mania) don't need much to experience an upswing in mood. We are likely to see everything as either wonderful or terrible. The day is a complete disaster. I can't do anything right. I didn't accomplish anything I wanted to do today. Okay I have to stop coming up with examples of this because it is making me feel terrible. And the one bad thing that colors the whole day can make you sink into your shell and not engage in the things that help your brain fight the Depression. When in recovery for my eating disorder if I had one "bad" day I would give up for the rest of the week because that week was already ruined. Until one of my level-headed friends suggested that I just start the week over the next day. Who's to say that the week has to start on Saturday? Start the week on Wednesday. Brilliant. It isn't more happiness that we need as people suffering from Depression-- it's more calm. Emotional intensity feeds that Depressive state. What we need is more evenness. Less dramatic ups and fewer plummeting downs. One of my college roommates told me he never wanted to see me drunk because he had seen me at my highest (so to speak) and at my lowest without any chemical help and whichever way alcohol took me he didn't want to see it. I agree. So how do you combat the tendency to think in black and white? Moderation moderation moderation. And while in a major Depressive episode I don't get to experience the highs because I am stuck in the lows, it isn't soaring into the stratosphere of happiness that I need. It is something less. Something more sustainable. Something without the inevitable crash. We are addicted to the rush of intense emotional experience. It can be hard to let that go. Daily Convexions
I learned to sail when I was in junior high. I sailed a 19 foot boat that could seat two people or five people comfortably. I couldn't take it out solo, because I couldn't reach all the ropes without assistance. But I could sail it with one other person who didn't know a single thing about sailing. I could just say: hand me the rope that's cleated on the other side... In one of my final lessons before I was allowed to take the boat out without an adult I got a lesson in skippering. The main job of the person in charge of the boat is to make sure everyone thinks you have everything under control. Because having panicking passengers is not helpful to anyone and can endanger the whole crew even in calm waters. So no matter how nervous you are, no matter that the wind has come up and your racing a storm and you aren't quite sure where home port is through the fog... don't let your passengers know. This is more than just putting on a good show. It is an important safety lesson. Then I think I overgeneralized that rule. I made it part of my mission to convince everyone that I was completely in control and everything was just fine. We weren't going to capsize. I wasn't concerned about the waves or the fact that the boat was improperly rigged and my passengers were completely inexperienced swimmers. It didn't feel like lying. It felt like the thing you do. Because it isn't safe to let people know that you need help. But what if you're not sailing. What if the building is on fire? If that's the case, then pretending that everything is under control and encouraging people not to panic is not going to work for you. In fact you'd be much better off yelling: HELP! FIRE! EVERYBODY OUT! I think I've been smoldering for some time with my sailing gloves on, ropes in hand declaring that everything is just fine while the smoke curls around me. You'd think it would be easier to determine whether I was sailing or standing in a burning building. Help. Fire. Daily Convexions
Or overextending myself. Not sure. Today I feel terrible. Headachy and hermit-like and discouraged by my lack of doing anything constructive today. Which is rubbish, because I got out of bed, got dressed, fed children two meals so far (then farmed them out to grandma), took out several tons of recycling from garage and put out to the curb, watered and weeded in the dirt garden, completely re-organized my messed up files on my computer (throwing away old things no longer in use) and eliminated duplicates in my iphoto library. The glass that is half empty: folding laundry, cleaning kitchen, mucking out refrigerator, cleaning bathroom, letting my spouse know what the plan was for the day (since I was sleeping the sleep of the departed) and writing the great american novel. (Although I have been told that my novel-in-waiting is a "lovely Canadian novel.") I am chalking this up to one of the steps back days. Two steps forward, right? I am feeling like my real self more days now than I used to, but I am not impervious to the stressors of physical exertion and social interaction. Even pleasant social interaction. With people I really like. Too much fun even without alcohol catches up with me the next day. It probably doesn't help that my two year old is whiny and has a bad cold that makes her cough like a 70-year-old smoker. Doesn't she know that I am the only one who is allowed to be pathetic and needy? Daily Convexions
Forgot to take my meds in the morning before leaving the house for the day. Which meant that I necessarily would not be taking my bupropion. I realized halfway through the trip and I am afraid that I swore. When I went back on meds for the first time as an adult (pre-children) I was extremely compliant. I took my medication every day at the same time. I went back on medication after I was sent home from work since I couldn't stop crying. I wasn't sad about anything that I can remember. And I tried to insist that I was perfectly fine to go teach English to the Hmong kindergartners. While weeping uncontrollably. Right. It's possible that the worsening of my Depression symptoms coincided with my attempts to conceive a child. I don't remember. It seems likely. I was an infertility patient, and experiencing fluctuations in hormones for the first time made me feel like I was losing my mind. Nope, said my doctor, that's just normal. I am ashamed to say that my reaction to this was: "This is what normal women go through every month? No wonder they don't let us become fighter pilots!!!" Because the medication was so obviously beneficial I became a born-again pill-popper. I took them faithfully every morning. Except three times that first year I forgot. The first day I missed my dose of medication, there was a catastrophic computer crash at work. Only catastrophic to data, not people-- but I was the one involved with the data collection (not the crash) and it felt like a landslide. The second day I missed a dose we got word that my friend and co-worker's brother committed suicide by hanging himself. I felt irrationally responsible. The third day I missed a dose was September 11, 2001.
Daily Convexions
Yup. That's what today was. Good day. A walk in the park with family. Laughter and stories, good food. A little warm, but the shade felt great. Took pictures with new/old camera. It felt pretty good. Thursday is my last day on 150 mg of bupropion. Then I switch to 300 mg. This seems to be the usual therapeutic dose, at least to start off with. I will reassess after six weeks on the two meds to see how things are going. It is helpful to have that milestone in site. I have more of a reason to be faithful to my daily pill schedule and to pay attention to my symptoms since I am going to have to report on them. I think that anti-depressants should not be prescribed without some very concrete method for follow-up care. I suppose I shouldn't make blanket statements like that. But I think at the very least some kind of scheduled nurse phone follow-up would be nice. I have been called several times by a nurse to check on my asthma, which is well controlled and I only go back to see my allergist on an as-needed basis. I don't think I have ever received a check-in on the anti-depressants. Seems like a no-brainer and probably quite cost-effective. Office visits might not be necessary for everyone but checking in... key. Daily Convexions
If I had been diagnosed with Depression in Babylonian times, they might have used exorcism techniques to drive out the demons causing my affliction. Beatings, restraint and starvation. The Middle Ages gave rise to a Christian population that saw Depression as a sign of demonic possession that might be contagious. People suffering from Depression were drowned, burned, and locked away in "lunatic asylums." Nineteenth century depression cures included water immersion (think water-boarding), spinning (to induce dizziness and rearrange the brain), an early form of electroshock therapy (brought to us by Benjamin Franklin), horseback riding, enemas and vomiting. Had I been severely depressed in the early part of the twentieth century they might have removed my frontal lobe. Who doesn't want experimental brain surgery after all. The first anti-depressant medication was iproniazid, a drug originally designed to treat tuberculosis. They discovered its anti-depressive qualities after finding that patients were no longer lying in bed listlessly, but playing cards and dancing in the hallways. There has been a very long-term argument about the nature of Depression and whether its roots are biological, social or mental. The best research and the best treatments consider it to be a combination of many factors. And since the complicating factors are varied, the treatments must be as well. A physical treatment, a mental treatment, a social treatment. You cannot rely on just one. Daily Convexions took pills (150 mg sertraline; 150 mg bupropion) almost drank enough water (I'll go get more now) shot macro photog I wonder if there is any similarity between what it feels like to have Depression and what it feels like to have ADD or senile dementia. The inattentive piece is certainly a factor in ADD. And the short term memory difficulties might resemble "senior moments." Today I have felt much less fuzzy. Much more clear. And it even seemed to be in terms of vision. Almost like I had been wearing glasses with the wrong prescription before and now I have corrected that problem. I fit into a skirt today (one of my favorites: a Frida Khalo print cotton A-line that I made years ago) that hasn't fit me in about three years. I am no longer trying to lose weight and just focusing on the brain health. But I have found that I am no longer self-medicating with sugar to get my pitiful amount of neurotransmitters buzzing. And so I am naturally getting back to a "healthy weight." The weight I am when I am healthy. I guess bupropion is also used to treat obesity as well. I wonder if the weight loss is a side effect of the medication or a side effect of decreasing the amount of sugar because the need to feed the brain isn't there... or a side effect of the fact that it increases energy levels and allows people to have more activity. Do they know? So far, aside from the dehydration I am liking the bupropion. I am drinking more water and being careful not to overheat. I am also looking for a car with air conditioning before next summer. It's a pity we chose the van with the great motor (mechanic said it could go another 200,000 miles) but with a mysterious leak in the AC that would cost more to fix than the car is worth. On the hot days I long for the poorly built Ford Windstar with the awesome air conditioning. Daily Convexions
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K. BuchananQuaker, teacher, parent, |