My birthday gift

I was in a good mood today. I did not feel physically exhausted, light headed, etc. No joints or muscles hurt. I did not have a headache or stomach ache.

My mind felt good, my body felt good, and I had energy. What more could one ask for? It was a gift.

And I broke all the rules, at least in terms of eating things I would think I shouldn't eat, like sugar and wheat and dairy. I still feel good.

I'm 46. There were years I never thought I would make it this long. I wonder if I will live as long as my grandmothers. Then I'm really at midlife. I would have 46 more years. But I don't if I will live that long. They didn't take all these meds.

But I am kind of glad I made it to 46. Although a few days ago, I wouldn't have been so glad. I was going through a rough patch. Today is a good day.

New day, better day

I did have that glass of wine last night. It turns out I had a bottle of wine from when my mother was last here- we bought a couple. I made some improvised sangria- I filled a wine glass half with raspberries, drizzled them with honey, added cranberry juice cocktail, and then filled the rest of the glass with red wine. It was good. And I chilled out. And went to bed early.

Today was a much better day. I managed not to hold on to yesterday's depression. I did find my mood plummeting pretty badly in the early afternoon for some reason, but then it got better. And I was at a course all day, I have no idea what was going on. I think I am too tired of trying to figure my moods out. Is it food? Is it sleep? Is it life?

That is one of the dialectics- just going with the flow of my emotions vs trying to control them. I use medication, do light therapy, get enough sleep, try to eat well, etc. I try to control things. And yet, at the same time, in the moment, I have to just go with the flow, and accept that no matter how much I try to do right, it will never be enough to always be feeling good. It can be hard to accept.

My first really bad day in a while

Today a lot of little things and a couple of big things, plus not too much sleep the night before conspired to put me in a terrible mood today. I actually left work 15 minutes early, as my last patient did not show up. Paperwork will be finished on the weekend.

It was the first day I really felt that bad at work. I couldn't finish my notes. I had to get away, once I no longer had my patients to distract me. I actually felt good while I was treating patients, I just couldn't deal with the down time.

I didn't really know how to make myself feel better. I ate dinner, and sat and watched the news- not recommended. I suppose this is when you have a glass of wine or a drink, but I am not in that habit. Instead I had a crumb of a klonopin, which took the edge off of what I was feeling, but didn't really make me feel good. Next time I think I'll go for the wine.

I wish I had a bathtub. Then I could take the warm bath that everyone talks about. I felt too guilty to eat ice cream or anything bad- so I just ate too much of regular food. I should have gone for ice cream.

I just feel exhausted. Physically exhausted. Like I don't want to move. I'm lying in bed right now, listening to music. And I want something more.

What did I think, that the depression was never going to show its head again? That going back to work would be a piece of cake? There are reasons why people go on disability, there are reasons why I was on disability.

But one day is just one day. As they say, tomorrow is another day. I'll try not to prejudge it. It could be awesome.

Would you die for freedom?

No, I'm not talking about a war or battle. I'm talking about healthcare.

There was a time when there wasn't much that doctors could do for you other than set a broken bone. Times have changed. For many people, modern medicine is life-saving.

There was also a time when, if you were willing to work hard, you could probably get a job with health insurance. That is increasingly not the case. And, unless you are healthy and wealthy, buying a policy privately is not possible.

So do we want the government to step in?

Republicans love to say that you can always go the nearest emergency room and get care. Well, that is only true because of federal law, which demands that all patients receive emergency care without regard to the ability to pay. If you really want the government out of health care, that safety net will be gone.

I used to think I had a libertarian streak in me- but I know that there is no way private insurance would ever offer affordable health care to the elderly and the disabled without some kind of government intervention and support. Insurance companies want to cover the well, and that is their right in a capitalistic system.

I don't know what I think of "Obamacare." In many ways, it is a terrible bill. But is it better than doing nothing? I'm not sure.

Healthcare was changing, anyway.

Health insurance companies are getting more intrusive, too.  They give you rewards and penalties.

I just got a letter in the mail today from my insurance company. I guess I have been an expensive enough patient this year that they are offering me a health coach. I am supposed to call to either accept or to turn them down. I can't imagine they have anything useful to offer.

My trip to my shrink

I saw my psychiatrist yesterday- and it was the most uneventful appointment I'd had in a long time. I really had no complaints. We did determine, however, that I have a mild tremor in my left hand (very minor), since going on the lithium. Do I care? No.

I like this guy. He is the first person who actually looks for things like tremors and tardive dyskinesia, no other doctor has. What I really think is, if I psychiatrist can't be a doctor, then let psychologist prescribe. You have to be a doctor if you are a psychiatrist. These are powerful meds you are giving people, with often terrible side effects.

I asked him my question, which I know he doesn't know the answer to: what are the odds that I can stay on 5mg of Zyprexa the rest of my life and not get tardive dyskinesia? And he hedged. He said, a lot better than with the older drugs, but that the odds obviously increase the longer I am on the drug. He said that the important thing would be to catch it early.

I am kind of at peace with my meds right now. I don't want to think about making changes, getting off of things. Other than the Effexor, I am not on a high dose of anything. Side effects are pretty manageable, and my head feels clearer than it has in years. I can concentrate. However bad the meds can be for your mind, depression is worse. I have been wanting to blame the meds for my inability to concentrate the past couple of years- even though I was pretty continually depressed during this time. I even tried coming off of things. But what gave me my mind back was actually going on lithium.

No my life is not perfect. I still really struggle with a lot of things. More that I would like. But perhaps if I didn't, I would complain that the meds made me flat.

Meds don't fix everything. DBT doesn't fix everything. But I am glad that they have fixed some things.

I did it, I shopped. And at Walmart, too.

I made it through black Friday without shopping, but then today I gave in, and went shopping. Even worse, I went to Walmart- and it was Small Business Saturday. But I needed to do some grocery shopping, plus I needed some non-food items, and a couple of little things for my niece, and I knew that I could get them all in one place if I went to Walmart.

The store was not very busy, I was very surprised. Maybe the customers had all come on Black Friday. Or people were out frequenting small businesses. I started to feel guilty.

I don't think I have ever been Christmas shopping this early before-  But I never had a niece before. That changes things.

I will be seeing her in 2 weeks, and I am so excited. I know that I have missed so much in the past few weeks, I can't wait to see how she has changed.

The fiscal cliff gets personal

I downloaded a budget spreadsheet, and I was trying to figure out how much money I was going to have this coming year to pay off my debts and replenish my savings- which were totally wiped out by going to the hospital (high deductible plan).

But I don't know what my take home pay will be. Because I don't know what the tax rates will be. How much is my pay check going to go down? It would be nice to know.

For those who believe in austerity, the fiscal cliff should be a good thing. Yes, it might shave a couple of percentages off the GDP, but it will have a long term good effect on the deficit, and reassure business and the world that we are serious about the deficit. Aren't we always telling other countries that they need to do austerity? And yet, when in comes to ourselves, we call it a fiscal cliff.

Europe hasn't done too well under austerity, but how well would it have done with continued uncontrolled spending?

I wish that economics were truly a science, and we could actually figure out what it is we should be doing, instead of just guessing. But economies are so large and complex, how can we understand them? It is like trying to predict the weather a year from now.

Realizing how bad I was

I studied today. Okay, I just read a chapter in a book. But it was, well, easy to do that. I think I must have spent weeks trying to read that chapter, in the previous months- and now I did it in an hour.

I was so cognitively impaired. I was really scared to go on lithium, scared of cognitive side effects. But really, there is nothing as bad for your mind as severe depression. And besides, I am on a pretty low dose, not like last time. My level is only 0.4.

It's funny. I have been feeling like I am not as sharp- although objectively, that is so totally not true. And then I realized, I think my brain was interpreting the state of heightened arousal, that anxious depression I was in, as mental sharpness. But it couldn't have been further from the truth. And my relative calmness now is certainly not a sign of dumbness. I just have to get used to it being different.

Did you have to go back to work?

I went to a mood disorder support meeting last week. I hadn't been in maybe 3 months. I told them that I had been in the hospital, taken a leave of absence and was back at work. And then the leader asked me "Did you have to go back to work?"

Well, yes if I don't want to be homeless. I don't think I'm quite long term disability material yet (or rather, again, as I was on it before). I would have to fail a lot more times before I give up on working.

Unfortunately, at these meetings most of the people are not working. I had my not working years too. I think that too many people give up though, once they get on social security disability. They see it as a permanent destination. I don't think it has to be for everyone. But working is definitely a stress, I will admit.

It is hard to explain, that going back to work has in some ways been easier, and in some ways harder, than I have expected. I'm glad that I didn't stay away too long- I didn't forget how to do my job. Treating patients just came right back to me.

But I have these constant apprehension- just waiting for the overwhelming depression and anxiety to return, that I had been feeling for so long when I was last at work. I am waiting for all the bad feelings to return. So far they haven't- but I can't get rid of the apprehension.

I hope as time goes on, this fear will go away.

Going too fast to slow down

I got pulled over for speeding on my way to a massage. Pretty ironic, really. It was on the road where I really have to watch my speed- because I am turning off of a 50mph road onto local 25mpr roads. If I don't watch my speed, I am going too fast. I wasn't watching my speed. I wasn't being mindful. I was going too fast.

The police officer was very sweet. And very young- I felt old! He gave me a ticket for a technical offence instead, so I am very grateful. It is too bad that driving turns civilians and cops into adversaries.

But it was a lesson in the importance of mindfulness. I could have spared myself the experience if I had been paying more attention.

I made it to my massage with a couple of minutes to spare. I'd like to say that the massage was wonderful- they used to be. But recently she has been going a lot deeper, and it isn't always as pleasant. Afterwards my body feels great, and the normal tension that I carry in my neck and shoulders just isn't there. But the experience isn't as nice.

Which makes me wonder what the purpose of a massage is, or should be. I have had so much tension in my neck and shoulders recently that I wanted her to go deep- it worked. But I do miss the sheer pleasure that I used to get. I have scheduled one again towards the end of December. I'll see what I am feeling like getting then.

I don't get it!

I don't get the Republican hatred for Obama, and all the end of the world stuff. I mean, the world was ending way before Obama, and Romney couldn't have stopped it. For some reason, Obama has just become a symbol.

Obama didn't start Medicare or Medicaid or Social Security. He didn't start CHIP. He didn't start food stamps or welfare. He didn't put us into two wars and cut taxes at the same time. He didn't introduce a new Medicare drug benefit without funding it. OK, so he shoved Obamacare down the Republican congress's throat- but it was based upon Republican ideas.

All of these trends- growing dependence upon the government, spending more than we have, out of control deficits- they were decided long before Obama took office. Perhaps it was all settled when we started Medicare/Medicaid/Social Security. What looked quite doable at the time- with changes in demographics and health care costs is now bankrupting the country.

The Republicans argue that we now have more people on government programs than ever before. Well, between an aging population and a recession with a jobless recovery, that is not surprising.

But cutting taxes would not have fixed the budget deficit- it would make it worse. If I thought that Romney could have fixed the budget deficit, I would have voted for him, despite all the things I disagree with him on. Plus, I think that Romney would be more likely to get us into additional military conflicts- again, not paid for- and which would have no good outcome.

I wish there were truth in political advertising. "Candidate A has been a disaster, but Candidate B will be more of a disaster!"

Our country is going bankrupt. I don't think it is fixable. Perhaps if Ron Paul had been elected, but it was probably too late even then. We will probably wind up inflating our way out of our debt at some point. This, of course, will make all the money I have saved for retirement worthless. But if our country is going to go bankrupt, I rather go bankrupt paying for head start and healthcare than more tax cuts.

Back at work- post Hurricane

I am back at work- I went back right after Hurricane Sandy. Perfect timing? I was scheduled to go back on a Wednesday, as I did not want to work a full week my first week back- and we were closed on Monday and Tuesday, opened again Wednesday.

Going back to work has been both harder and easier than I had feared. I think the worst part was facing up to how impaired I was right before I stopped working. Plus, I have this tension- I keep waiting to feel the overwhelmed, severe depression that I was feeling for the past few months at work. So far, it hasn't come back. But I find myself expecting it. But I am working with my therapist to not let things get so bad again before I do something. I let things go too long, trying to hang on.

Personally, I was out of power for a week. No electricity, no water, no heat. I managed, because there were other places that did have power. I could take a shower at my gym. Charge my phone at work. Etc. And I have a warm sleeping bag and hand crank radio! But I was very relieved when my power came back. Everything was so effortful when I had no power. it wore me out.

I kind of see this as a preview of peak oil. Or Mad Max! Someone pulled a gun at our local gas station! And at one point, all the gas stations in our town were closed or out of gas. Fortunately, I had topped off my tank before the storm- and felt pretty silly doing it- but I am so glad. I haven't had to buy gas yet. I think I will today. The gas situation is much better now, I think most of the stations are now open.

Managing Expectations

I will be discharged from my day program soon and going back to work. My leave of absence is almost over.

I know that I am so much better than I was when I went to the hospital. I really am. And yet, there is a part of me that is disappointed in myself. There are things I wanted to accomplish during my leave of absence that I didn't. Studying, hiking, going in to the city, etc. It seemed like if I was only doing a program 3 days a week, I should have all this time- and yet, I didn't do a lot else. Some thing, yes. And probably a lot of things compared to how I had been living my life recently. But I certainly did not become superwoman.

And then there is the realization that, despite DBT, I will continue to have a good deal of angst in my life! And that the DBT strategies can feel pretty tiresome when I am having a really bad day. Like when I hardly slept for 2 days after dental surgery. By the second day I was having massive anxiety and mood swings over really nothing, and DBT wasn't working too well. Or maybe it did- I can't know how I would have felt if I didn't try, maybe it would have been a lot worse.

I don't know why I didn't sleep- I really wasn't in much pain, as long as I took Tylenol  So I started to wonder if the tylenol was causing insomnia. The third night I didn't take it, and slept fine. And the next day, all was well with my mood.

I guess I am just wishing I had made better use of this time, and come further. But really, I came pretty far. I really did. I just have this fear that the only reason I am better is that I am not working- and that as soon as I go back to work it will all fall apart again. But only part of me thinks this. Another part of me is really ready to get back to "normal life," whatever that is.

I think I am ready to be done with the program. But not DBT, just the day program. DBT I will keep using.

I'm going to be a nicer person

Well, maybe just at work. It's not that I'm not already nice to my patients. I think that I am very kind. But I have been on the receiving end of much kindness from various health care professionals recently, and it suddenly hit me what a difference it can make. So I will be kind with a new perspective.

It actually hit me yesterday, when I was at the oral surgeon. I had to get a wisdom tooth with a very bad cavity pulled. Not a good situation. But they were kind to me. Not that I was there for very long- I was surprised how fast it was- but for the short period of time I was there, they were so nice about everything. And it made a difference. If they were nicer to me after seeing my medication list- well, I wouldn't complain. But they were just nice. And they made the procedure seem like no big deal.

Kindness can make a difference- whether it is when you are miserably depressed or about to get a tooth pulled.

Awareness of What?

We recently had mental illness awareness week, apparently.

Is this a good thing? And what is it that people should be aware of?  Perhaps mostly that human behavior is very variable, and as long as people aren't doing anything dangerous, we ought to be a little more accepting and charitable towards each other.

OK, so that is not going to be the message of any campaign in the real world. Acceptance of deviant behavior does not sell more drugs. And I am not ready to totally dismiss the idea of mental illness, although I haven't really figured out what it means.

I am bipolar. I guess I am willing to say that, and it makes sense of a lot of things for me. My mood is very sensitive to everything from medications to the amount of sunlight I get to diet to various stressors in my life. And when things go wrong, I can react with extremes of depression or mania.

But it is not just biological, although there is that component. It is not just like diabetes, no matter what NAMI says. Taking meds may be a piece of the answer for some people, like myself, but they certainly don't give you a life. You have to do that for yourself.

So what would I want my friends, my family, my co-workers to be aware of? That people with mental illness often struggle, but often succeed. That it comes and goes. That there are things I have lost due to this damn illness, but in the struggle I have also learned a lot.

And lastly, and very personally, I would like people to know that I never weighed anything near what I weigh now before I went on Zyprexa! No, really!

Getting off of klonopin

During a manic period I was  once prescribed 10mg of Klonopin a day. I rebelled, eventually, because between that and 500mg of Seroquel I was sleeping 20 hours a day, and during the 4 hours a day I was awake I couldn't speak in complete sentences. I cut it in half, and then for a number of years was taking about 4mg a day. Then another psychiatrist told me that klonopin causes depression, and that I should try to get off of it- but he wrote me whatever I asked for. So I tried to get off of it, at my own pace- if it causes depression, it is the last thing I want to be taking! I got down to about half a milligram. And I have really taken half a milligram a day, on and off, for the last few years- occasionally more during PMS, etc. 

Any time a doctor gave me a hard about giving me a script for Klonopin, I would get angry and a little scared. I'd feel the lack of power I had. I'd get mad. I'd decide I needed it all the more. The times I have cut down was when I was under no pressure to do so. I'm sure if a doctor had given me a tapering schedule, etc., I would have rebelled. And it would have felt too threatening.

So when I was in the hospital, I told them my meds, which included half a milligram of klonopin 1-2x/day prn- but I had been taking it pretty much daily for the past few weeks. And the psychiatrist wrote the order for that. I could take it if I wanted to. But once I decided to go back on the Ambien (the lesser of 2 evils), I decided enough is enough. I am done with klonopin. Forever. 

Again- if there had been any external pressure not to take it- I think I would not have made the decision. I would have argued to keep taking it, tried to get the psychiatrist to prescribe it.

I keep thinking that it really wasn't that hard stopping the klonopin- but there were two nights I could hardly sleep because of cramps in my legs. I wonder if that was a withdrawal effect. I was attributing it to all of the pacing I was doing, after spending so my of my life recently in bed. 

I was also able to stop the stimulants without much trouble- I was just a little tired and hungry for a week. But miss a dose of Effexor, and I go into a very miserable withdrawal. And as for Zyprexa- forget it. I have given up, for the moment, trying to get off of that. I think that the wrong medicines are controlled substances!

The couple of times that I did feel like taking klonopin recently it wasn't due to anxiety. It was due to agitation. And because of how out of control I was when I was manic- even though it was many years ago- my agitation still scares me. If I am anxious, okay I'll just suffer. But mostly I haven't felt like taking it.

I know I haven't really been tested. When I next have my period (every 3 months the way I take the BC pill). If I get hypomanic in the spring. Or my next serious depression when I am trying to still function. We'll see how easy it is to forget about klonopin then. But for the moment, it is a non-issue. 

Don't let the perfect be the enemy of the good

The first time I heard this phrase, I had no idea what it meant. Sort of like when I heard the phrase, "A stitch in time saves nine." I imagined someone stitching up the space-time continuum of the universe, and wanted to know what kind of needle they were using!

But I frequently let my inability to come up with the perfect plan stop me. It is my excuse, perhaps, to do nothing. And it is so easy for me to do nothing. If I have any doubts in my head about what I am doing, it is not getting done.

Right now I am looking for a church, and so I am not going to any church. I want the perfect church, but I know the church I want doesn't exist. My problem is that I love the music and the intense spirituality of some of the more fundamentalist churches- but I am not fundamentalist in my beliefs. And that type of worship just doesn't exist in less fundamentalist churches.

I have gone to Pentecostal services a few times. They know how to do religion! And if you are going to do religion, then do religion! I once went to a Unitarian Universalist service and it just seemed like the minister was tying so hard not to say God or offend anyone's beliefs, and it seemed totally empty. Like we might as well have all stayed home and no one would have been offended.

 I went to this one church a few times- trying to ignore their messages about end times. And then I read their literature and found out that I wasn't even baptized per their rules- because it was not by immersion. I was just "sprinkled."  Like the Quakers, I think we are baptized by the Holy Spirit, if we are baptized at all.

It is not that I don't think that humanity has some really rough times coming up ahead- I think that it does. How we are going to manage peak oil and environmental degradation and the huge populations that we have- all at a time when we have access to advanced weapons and weapons of mass destruction- I don't know. But I think that Revelations is a really lousy guide as to what is in store for us.

Learning to live in the gray

My mood has been rocky recently, and I have to fight the thought that my depression is no better, because I really know that it is. But it isn't always. I have good times and bad times- before, it was pretty much all bad times, there weren't any good times.

I have to learn to accept that I can have these bad times but it isn't the end of the world. I am never going to be perfectly happy, and my brain knows all too well how to be depressed. But I can try to learn not to get caught up in the bad feelings, and to treasure the good feelings more. And that is what I am trying to do. 

It all sounds good, but it is hard. Because I know that this week my mood is worse than last week. And it is discouraging. I think it is partially the seasons changing. I think it is partially that my mom is still here. And maybe partially because I was trying to go down on the Effexor- but we cut it down by such a small bit, it shouldn't matter. However, I'm giving up on that.

And in 3 weeks I am going back to work! But I actually want to, I actually miss it. I'm just scared that this depression isn't done with me- that going back to work is going to bring it back full force. But otherwise, I really want to go back to work. Well, in 3 weeks. No need to rush things!

So probably 2 and a half more weeks of program. 2 and a half more weeks to learn DBT! 

A Day Off

I have a day off from my program today. I wanted to do all of these things- instead I napped. My mom is still here and woke me in the middle of the night, so I didn't sleep well.

OK, I did call my psychiatrist to make an appointment. I did my light therapy. And this evening I will go to yoga class. But hiking will not be happening, instead I will go walk along the river for a little bit. I have never been superwoman, why should I expect that I would start to be now?

When I don't have things scheduled to do, I don't use my time very well. People are telling me  that I should work fewer hours, and I have thought of asking for this- but I am really afraid that I will just spend this time doing nothing, perhaps in bed, as I have been spending too much of my time in the past few months. Until I know how I would spend my time, I am hesitant to ask for fewer hours. Especially when it means less money! I mean, I could make it work if I had to with fewer hours. But if I am not sure...

I haven't decided what to do.

I am trying to plan structure into my life for once I go back to work. Trying to find that balance of not too little but not too much.

Bad Day

Okay, I had a bad day. It is not the end of the world, although it feels like it.

I know that some of it is seasonal. My SAD is hitting me. I need to move to Florida.

At program, I was very irritable. I didn't want to listen to anyone else's problems. I really didn't! And the skill section didn't seem helpful. I just didn't have the patience to be in a group.

When my mood goes, I start to think I am no better. My depression did not get any better, and as soon as I go back to work, I am going to find that things are just as bad, and it will be over. My life will be over. Because it is not like I am doing this again!

That is what I find myself thinking. What I have to tell myself is that things are better than they were, but that doesn't mean perfect. And things doing have to be all better before I go back to work. I have the rest of my life to work on perfect! Things just have to be better, and they are.

Better

I am a lot better than I was a month ago when I was admitted to the hospital. In fact, I have a hard time admitting- even to myself- how much better I am.

First- it is hard to admit that just taking a break from my life made me so much better. It is almost embarrassing. Second- it is hard to admit that the lithium is working- and I had previously said no to lithium (in fact fled my previous psychiatrist who recommended this). The last thing I wanted was to go on lithium again. But it is true- at low doses it is a much nicer drug. It is not like the last time I was on it.

But I suppose that things had to get so bad, get to a crisis, before I would consider either taking a leave of absence or taking lithium. I thought I could tough it out, as I usually do. I was wrong.

But hopefully this will not just be a break from work. I will go back stronger. In terms of meds, I will have the lithium on board. And I will have the DBT skills I am learning. And I will have some non-work activities in place. And I will have perspective, I hope. Nothing is worth getting myself worked up so much that I put myself back in the hospital. It's really not that fun a place! Pretty boring, really.

If I take time off from work in the future, I hope it is to do something more exciting that to attend a psychiatric day program. Like hike the Appalachian Trail, or volunteer in a medically underserved area, or backpack in Europe. But right now, this is what I need to do. And the program is better than any program I have attended in the past, it is actually useful- not just glorified babysitting. The programs I went to in the past were good for getting you out of bed, on a schedule, etc., but the therapy content was pretty limited- or at least I found it so. But this program is useful. Not always, not all of it- but enough of it.

I think I am becoming a DBT convert!

The Dialectic

I am in a day program right now that is very DBT-based. And I am liking it. Which is strange, since the last time I tried DBT, at least 12 or more years ago, I hated it. But I think it was a bad program, and I was in a very different place. They even kicked me out of the group!

My therapist would kill me. She has been trying to talk DBT with me for a while, and I have been resisting it. And now I am open to it. I am just in a different place.

DBT is all about dialectics. And I think I was missing something about DBT. I thought they were telling me to not judge- which is just idiotic. For me the dialectic is that I can't judge in the moment, minute by minute, second by second of my life. That is not being mindful, not being effective. That is not even possible- in the moment you can't judge what is effect very often. But eventually you do have to judge. you do have to make decisions.

So if my first day of the program I had decided to judge whether or not the program would work, I really wouldn't know. I might have said no. Or yes, but I really wouldn't have known. But a few weeks into the program, yes it is time to judge. Is it helping? If not, then I have to make decisions, do something else. Like when I decided to leave a job I hated.

Acceptance vs Change. Judging vs Non-judging. Living in the moment vs planning for the future. Letting go vs Control. Some of the dialectics.

I do like DBT, and I really didn't think that I would.

No More Benzo's!

Over the weeks preceding my hospitalization, I had started taking klonopin on a daily basis. Not a lot, maybe half a milligram a day most days, but that is a lot for me. Part of the reason was I stopped the Ambien due to morning fogginess- and the Lunesta that my doctor gave me in it's place was even worse (so I took klonopin- makes no sense). And part of it was the growing anxiety I had- which was really secondary to the depression. I was too depressed to do what I needed to do- so I was anxious about things. I wasn't happy I was taking it, but it seemed to get me through the moment.

I took my last klonopin my first night in the hospital- at 1am because I couldn't sleep. The next day I had switched back to ambien. And I no longer had to function- if I felt anxious, I could just pace (which I did). And as the lithium has been raised, I think that it has also had an anti-anxiety effect.

So I decided while in the hospital, no more benzo's. Ever. They make me depressed in the long run, they have cognitive side effects, they have rebound effects. So no more. So far, it really hasn't been much of an issue- I haven't really wanted to take any klonopin- but I know that I haven't been tested. Also, I am taking Ambien, so I am sleeping really well.

I also came off the Wellbutrin. I told my doctor in the hospital that I am on so many drugs that if I am going on one drug (lithium), I have to get off of something else, and I wasn't sure if the wellbutrin was doing anything anyway.

Still too many drugs. If I had more courage, I would use this time away from work to try to get off of my Zyprexa. Or at least to reduce it. I don't think I will. I just got off of benzo's, I can't get off of two "downer's" at once!

But we are trying to reduce my Effexor, and I don't know if I am out of my mind for doing this or not. I was just hospitalized for depression, why try to reduce my antidepressant? Because I take an incredibly high dose. And less meds sounds good to me- and I am not working, so now seems like the time to try it.

What I really need to decide about is the ambien. I tried taking 7.5mg a couple of nights ago, but my body wasn't having it. I didn't fall asleep until I gave in and took another 5mg pill. Perhaps I gave in too soon. Perhaps I just need to have a few sleepless nights and then ambien will work great at 5mg. But my other plan is to try Sonata, which has an extremely short half-life, and is much less likely to make me fuzzy the next morning.

Other meds- I will probably stay on for the moment. Just the effexor and the ambien I will try to reduce for now. And the lithium- I am not sure about my dose. My doctor at the program raised my dose from 750mg to 900mg because my level was so low. I said sure, because I figured having a therapeutic lithium level would put me in a better position to someday get off of the Zyprexa and not get manic. But since the increase my stomach has not felt good- and I don't know if is the reason. I don't think I need 900mg of lithium for antidepressant augmentation purposes, and if I am going to have side effects- and I'm not trying to get off of the Zyprexa right now anyway- then it is just not worth it to be this high.

So I put in a request to see the psychiatrist today at the program, but I was not seen.

Back from the Asylum

I had even gone to work that day. But I knew it was bad. And I knew I didn't want to live to see the next day. But I had a therapist appointment after work. I told her what I was thinking. Not surprisingly, she suggested the hospital. Surprisingly, I agreed.

She even went to the ER with me. Stayed until I got taken into triage. I went to the hospital where I work- I was very worried about seeing someone I knew. But otherwise they were very nice to me there. I spent the night there while they tried to get me into a psych hospital. The next morning I was taken by ambulance to the hospital where my therapist had wanted me to go.

I spent 8 days inpatient. I was on the general psychiatric and dual diagnosis unit. It was a pretty nice place as hospitals go, and unfortunately I have seen a bunch in my time. They ramped up my lithium. I went back on Ambien, so I started sleeping well again. I did a lot of pacing/walking- so much so that my legs hurt. 3-4 times a day I got to sit outside in the sun in a courtyard with the smokers. I talked to people. I even went to groups, although they were totally useless. Perhaps it helped that my roommate was the scariest person on the unit! I spent very little time in my room.

I was able to catch my breath. I got away from my life. It helped. It is sad to say that being locked up for 8 days is helpful, but it was. Even knowing that the choice to kill myself was being taken out of my control- that was a relief. I could stop thinking about it for a little while.

Well, I had made it for 10 years since the last hospitalization. I thought maybe I wouldn't go there again. But I did. I also thought I would not take lithium again. But it seems to be helping- and the dose is lower, so the side effects are much milder.

I took a leave of absence from work. So I have a little more space to breathe. And I am doing an IOP program, which is very DBT oriented. It seems useful. Like emotional kindergarten.

I'm not a Vulcan

Mr Spock was always my favorite character on Star Trek. I wanted to be a Vulcan. And the worse my depressions are- and the more dysphoric I feel- the more I think I should have been born a Vulcan, or at least a robot. And I wish for a pill that would take away all feeling, but let me function.

Except that it doesn't work that way. If you take away emotion, you take away any motivation, as well as any reward. Somehow Vulcans are permitted to keep curiosity, but not much else. But for me it is all or nothing. And make me numb, and there is no reason to keep going, no reason to push on.

And that is what I feel right now. Between adding on the lithium and a little klonopin at night, I have been pretty numb for 3 days. And I was kind of content to lie in bed for 3 days. Nothing got done, and things needed to get done. But a large part of me doesn't care.

To trade a piece of the depression for apathy isn't much of a bargain.

The side effects start

My 3rd night of lithium. I slept well last night- and no napping today. But tonight, after about 3 hours, I have woken up, somewhat wide awake, feeling sick to my stomach and with a cramp in my left calf. I wish I had some ginger ale, but I don't.

I have been trying to figure out how much my ACE inhibitor is likely to raise my lithium level, and I can't find a good answer- I have seen estimates from 30-60 percent to 2-4 times. I take a HUGE dose of Lotensin. I wonder if my psychiatrist realizes how much I take. And I am wondering if 600mg of lithium will still be "low dose" given my ACE inhibitor. Maybe I shouldn't go up that high. We actually didn't even discuss the Lotensin. I was too busy crying to think about it during the session. But he has all my meds, so I will assume that he knows at least that I am on it- and he has that electronic medical record that probably flags all drug interactions.

Lithium is one scary drug if you read all of the side effects. But then again, I took the MAOI's, and I was glad to take them, because they worked so well on my depression (for a while). Anything is better than severe depression. Even life without cheese!

Day 1 on Lithium

My psychiatrist gave me a prescription for Lithobid, which is extended release. However, when I got home and looked at what the pharmacy had given me, it looked like they had given me regular, instant release generic lithium carbonate. At least that is what the label said. Oh well- I wasn't about to go back. I knew the price was too cheap. And they are not open on weekends.

So I started with a 300mg capsule last night. Which made me feel- strange. Sleepy, but I couldn't sleep- until about 4am, even though I took a klonopin. But then I napped half the day. I felt calmer. I felt less depressed, I think- but mostly I felt numb. And that feeling is still with me today. Maybe I don't care enough to feel depressed.

I don't do illegal drugs. But when I start a new drug, and I am looking a bottle of brand new pills, wondering how it is going to make me feel- I know there really isn't much difference. I am doing drugs. Let's see what this one does!

I am supposed to do 5 days at 300mg, and then go up to 600mg. I think I will have to wait until next Friday night to make the increase.

I know that meds are only half the story-my life is a mess- but my life is a mess because I have been depressed for so long. I can't fix my life if I don't fix the depression. But then, sometimes I think my life is too broken, I am too broken, that even if lithium turns out to be the wonder drug, it is too late.

But this is just day 1. I have to be a little more patient than that.

Doing what I don't want to do, part II

Well, raising the Zyprexa didn't work out too well. All of the side effects I expected, sedation, being out of it, eating everything in sight. But when I couldn't focus enough to study or do paperwork, I knew it was time to stop it.

The past week has been miserable, but I have kept myself together (as much as I could), as my dad was having surgery. Today I saw my psychiatrist again. And he is recommending the same thing that my last psychiatrist did, and what I didn't want to do: low dose lithium.

Well, that is two doctors recommending something that makes sense. I'm just scared of lithium because of the last time I was on it- a very long time ago, and at a very high dose. I had bad side effects. I got lithium toxicity- bad, because it was not recognized. And then I was taken off of it cold turkey, and became crazy manic, for the first time in my life. I really think that changed the course of my illness. It sure changed the course of my life.

But this will be low dose. I will take it all at night, so hopefully the side effects won't be too bad. I will try it. And if it doesn't work, or if I don't like the way it makes me feel, I will come off of it VERY SLOWLY.

But I will try it.

My psychiatrist also had good advice- just as good as a prescription, I think. And that is to stop studying for this exam. There is no way I can do what I need to do to be ready to take it this year, so I am only beating myself up every time I try to study. He said it was like a marathon runner with a knee injury who keeps trying to run instead of resting it, only to prove to himself that he can't run right now.

It was the best advice. It was what I needed to hear. It was giving me permission to do what part of me knew I needed to do, but couldn't admit.

When my head is working better, when I can concentrate again, I will start studying again. On my terms.

I do think I will wait until Friday night to start the lithium. No work the next day.

Doing what I don't want to do

I am raising my Zyprexa. This is that last medicine that I want to raise- I don't even want to be on it- but at some point, when things are bad enough, the hell with future side effects and neurological problems- at this rate I am not even going to live long enough to have those things.

I am re-thinking antidepressants. Maybe they are making me worse. For people with bipolar, they often do. But the one time they tried not giving me antidepressants- just piling on the mood stabilizers, I became so depressed I got psychotic. So I have been so sure that I need antidepressants. But maybe they make me worse in the long run. Maybe I need to give it another shot without antidepressants. Maybe there is no answer for me, and I am just screwed.

What is pretty clear to me is that in the last 4 or so years, my depressions are more frequent, and I don't get as good as I used to between depressions. There are probably some situations reasons for this too, but still, it is enough to question both my life and my meds.

Creatine has not turned out to be the magic answer that I had hoped for. If anything, I feel like I have been more emotionally unstable since I have started taking it. So it is not necessarily making my mood worse, just more reactive. Which I don't need right now. Still, I will probably try continuing with a small dose of it.

I have my escape fantasies. Quit my job, live off my 401K money, backpack and travel for a year. If I was debt-free, I might do it. I have too much debt. And having been on disability once, I am so scared that if I stop working, I won't go back.

I saw my therapist again last night- she asked me again if I "need a higher level of care." I hate that kind of talk. And that kind of language. Just say it. Am I suicidal enough for the hospital? Dysfunctional enough for day treatment? What?

My psychiatrist is on vacation this week. so I'm limited with med options. I can either raise things or lower things that I already have. Which is a little frustrating. I think I want to try switching my Effexor for Prozac, which worked in the past, and which is a lot easier to get off of- if I do decide to try to get off of anti-depressants.

I went on Prozac back when it was new. I switched from amytriptaline, which was making me too tired. My psychiatrist told me, there's this new drug out, prozac, with much less side effects, and it even has this very nice side effect called hypomania...

Of course at the time my diagnosis was depression, not bipolar. And hypomania, as she described it, did sound very nice. Pretty ironic.

A lot of drama at work

As if I didn't have enough drama in my personal life, I've had a lot of drama at work. Just a difficult work week with patients not doing well, etc., and having to call doctors more than in the past 2 weeks than I think that I ever have.

But I made it through the week, and no I did not quit. But I was quite grateful for the week to be over.

This week I also swallowed my pride and called my therapist- yes, the one I just quit, to go back to therapy. I will see if it helps.

And I am doing something that has me very hopeful. I read about a study conducted in South Korea in which they gave depressed women Lexapro, and then either 5 grams of creatine or a placebo as an add on. The people who got the creatine got much better, much faster. And no, they did not try the creatine by itself. That, of course, would be too radical. Much less radical to say that creatine augments antidepressants than to say that it is an antidepressant.

So I went to the local Rite Aid after work yesterday, and found some in the body building aisle (yes, there was a whole aisle for body building). I felt strange buying it- like I wanted to tell the cashier- no, I'm really taking it for depression (as one look at me will tell you that I am not a body builder).

Just what I need, another expensive supplement to add. I take too many supplements, I think. If I didn't take any medication, I don't know if I would take any supplements. But now that I am in the routine of taking pills every day, and in the mindset of "better living through chemistry," why not add on more pills to take? At least these supplements I control, and I don't need a doctor's okay or prescription for them. I like that. The downside is no insurance reimbursement.

I didn't know what to expect with the creatine. I took my first dose last evening, my second dose this morning. And I think I actually feel it. It is a little energizing, it feels good. I feel a little better. Without any of the agitation of something like wellbutrin. So I am hopeful. I just hope that this is not a temporary effect.

Also good news. I just got back the results of lab work for my physical. As someone who takes Zyprexa and is overweight, I am terrified of diabetes. But my blood sugar and A1C are still in the normal range- in fact even lower this year than last year. Something I attribute to the large dose of resverotrol I am taking, I think. Because I have been eating horrible the past few months with this depression, and it shows- my cholesterol is up. But still in the borderline high level, so hopefully my doctor is not going to try to put me on a statin come Monday.

Today was (very slightly) better

I am on day 2 of increased Wellbutrin, and feel a tiny bit better. But really, it has to get better than this. But I have to give it more time, I know. I am not very patient.

I called my psychiatrist to make a appointment- progress. But the week I want he is on vacation, so it will have to wait. Why do all doctors go on vacation in August?  Is it some kind of rule? The surgeons that we work with are all going on vacation now too.

I am going to break down and call my therapist (well, technically now ex-therapist), and try to get back in. Maybe it will help.

Exercise: I'm giving up on it, at least for this week. If I can make it to work each day, not kill myself or anyone else, then I have done more than can be expected of me. Really, sometimes I think that if my pain were physical, they would give me morphine.

I am getting really tired of feeling a little bit better, being a little bit more functional, a little more dry eye'ed. When is life not going to suck? When am I going to feel joy? Be glad that I am alive?

Meanwhile, I am trying to decide if I am more tired or more hungry. No food in the apartment except for a bit of left over Chinese food that I ate as soon as I got home (I had no lunch). I am still hungry. But really don't want to go out. Which force will win?

What is the purpose of therapy?

After all these years, I never figured that one out.

There are times I have used it to vent, to tell my story, to grieve over the life I lost, to plan a new life. And that was all good. But beyond that, what is the point? I hated DBT and CBT. When someone mentions "coping mechanisms" I want to strangle them. I don't want to cope. I don't want to just get through life. I want life to be better. And except for one time in my life, when my therapist really helped me to put my life back together after I had lost everything, I don't think it has ever been that life changing. Not what I am looking for.

So I think maybe I made a mistake, by quitting therapy, because I am doing so badly right now- although I really don't think it had much to do with therapy, and I don't know how that would change anything. I just feel like going to therapy would be "doing something." Even if it isn't. But then there is another part of me that doesn't want to admit that I may have made a mistake in quitting, doesn't want to admit that I may "need" therapy, that I can't handle this on my own. The idea of going back to therapy makes me feel weak.

When I went in to my last session, I told my therapist that I was re-thinking therapy. And I thought we would have some kind of discussion about it. I thought she would tell me what therapy could do for me, etc. But she didn't. So maybe she agrees, I am not someone who can be helped by therapy. I feel like she should have said something in defense of therapy- if not with her, than with someone else- if she thought it would help me. But she didn't. So perhaps this is not a modality that can help me.

So I am seeking the biological fix right now. Today I decided to give a wellbutrin increase another chance- because until my depression gets to be a little bit less, I really can't do much else. Yesterday at the end of the work day- a day when nothing bad happened, and my mood "should" have been better- I was so depressed I just sat at my desk with my head in my hands, feeling like I did not even have the energy to get up and walk across the parking lot to get to my car to drive home. Of course, I eventually did muster up the energy- but felt like I would collapse every step of the way.

And nobody knows how bad it is. I put on a pretty good show, most of the time. Sometimes I even fool myself for a few minutes- I think how bad can it be if I am doing such and such? I remember one of my first therapists told me, "fake it 'till you make it." And then he criticized me for not showing my feelings. Well, you can't have it both ways. If you spend a good portion of your life faking it, it gets hard to turn on and off. It becomes second nature around other people.

But do I want to spend $125 a week so that I can have someone know how bad it is? What is the point of that? It is true, my health insurance plan is "working." If there were good people "in network" and I just had a small co-pay, I'd probably still be in therapy. But to be private paying for therapy- it just really makes me want to know why.

It's a Catch-22

I've been going through some real craziness the past 3 weeks. Really bad. And now it has finally settled down into a really anxious and really bad depression. Every time I think I might start to be feeling a little better, that day something very bad happens. That is how my life has been.

And so, while there was a biological trigger- running out of the birth control pill- I should have been over that by now. It is life that is keeping me down. So, I don't think that a drug is going to fix this.

That is why I haven't called my psychiatrist, which is what my family wants me to do. But you don't  call your psychiatrist unless you want a new drug- and I'm not sure that I do. Meanwhile, as I say this, I am taking tiny bits of klonopin and zyprexa to get me though the day without totally losing it. But that is different. Maybe I just have to wait this out until life gets better again.

But the Catch-22 part. I know that I need to exercise. I know that would probably help me. And yet, it feels like the last thing in the world that I am capable of doing. I'm not saying it is impossible to be severely depressed and exercise- but it is improbable. Enough to make you question the diagnosis. Especially if daily exercise has not been a well established habit before.

I went in to work today to try to do some paperwork- I didn't last too long. But I made myself get up and walk around a lot while I was there, and that felt good. A little bit. But I got too agitated to stay at work, I had to leave.

Tomorrow is Monday, and I hate Mondays. Because on Monday, everyone asks how your weekend was, and what you did. And if I were to tell the truth, it would be that I spent most of it at home, in bed, (with nothing to eat except almonds and energy bars because of no food in the house), and went in to work for 2 hours. I hate to lie, but this is a truth I don't want to tell either. Depression sucks.

There was one good part of the weekend, however. I watched Olympic women's weightlifting. The "plus size" category- 75kg plus. Live, online. And it was great. The Russian woman won, and she broke the world's record- twice. Amazing. Some strong women.

I want to be a strong woman. How do I do that?

The week from hell is finally over

I am so glad that it is a Friday.

There are a multitude of reasons why this past week was so terrible. Some of them biological- like not have a medication, and then going on Lunesta (turns out, it is even worse than Ambien for me), and then my reactions to my various failures of the week.

I think I finally understand my frustration with therapy. They have been trying to get me to be more resilient, so that I won't react so much when I lose things because I am disorganized, when I can't get my paperwork done, when I run out of medications. I want fewer things to be reacting to. I want to get more order in my life. I want a different brain. But that isn't coming. And mine, according to neuropsychological testing (that I just had to find again to bring to my psychiatrist)- my brain is fucked up.

I remember when I was in graduate school. I felt like I was getting depressed- and hoped to avoid a med change. So I dutifully hauled myself off to a CBT therapist- supposedly someone very good. I remember trying to explain my frustration to her about not being able to find a shoe- how I had a fit after being unable to find it for 15 minutes. I lived in 1 room at the time! And she kept telling me that this was normal. And it was not, so many of the things that I told her were not. (Like scheduling my awake time during the few hours of the night when I was the least depressed to do my studying- when I couldn't call anyone to find out what the homework was- which I had invariably lost).  But I think she either thought I was exaggerating- or she meant that the feelings were normal, not the situation.

It didn't work out so well. I got worse. I quit therapy, as it got too hard to get there on top of trying to study. The homework assignments did not prove helpful, but I think the fault was mine. I was too attached to outcomes- and still am. If I could have told myself- whatever happens, either you will be okay, or you will be dead (in which case nothing matters), then maybe I would have had a chance. Then maybe I could get through it being 2am and not knowing what the homework is and not feeling like killing myself. But I wasn't there then, and I am not there now. Whether the thoughts were logical or not- it all depended upon your assumptions. Whether they were useful or not- another question- but not one that I found very interesting at the time. I wanted to know what was true. I really didn't like CBT. It seemed to tell me that even my thoughts are wrong. It is not enough to criticize my behavior, now you have to go after my thoughts.

Anyway, running out the birth control pill is bad news. Losing my thyroid hormone pills for a couple of days and not taking it- bad news. Accidentally taking my PM meds instead of my AM meds, and winding up with a double dose of Zyprexa- bad news. And taking Lunesta for 8 nights, thinking it would get better- really bad news.

So even if there had been nothing going on in my life beyond the biological, I would probably be pretty messed up this week. And I really have been.

I found myself thinking today. We call people who feign illness malingerers. What do we call people who feign being well? I suppose we call them normal. At least if they are successful. And I was certainly doing a lot of anti-malingering this week! I'm surprised that psychiatry hasn't come up with a label for this yet, they have for everything else. I'm sure the next version of the DSM will remedy that.

Maybe I quit therapy too soon?

I've been going through a tremendously bad time the past few days. I can't seem to get my equilibrium back, even though I'm back on my BC pill.

I have learned over the years not to call my mother wanting sympathy or understanding. It's not that she doesn't mean well, it is just that she doesn't understand at all (but thinks that she does), and that she is so needy herself.

So today she called to tell me about all of her problems and the ongoing problems of everyone living in her household (Grandma's house) - now up to 5!. She needs someone to talk to, and I can't always deal with it. I was particularly unsympathetic today, and cut the conversation short. I think she needs a therapist.

When I think about the last time that I saw my therapist, it was weird. I wasn't even sure that I wanted to quit therapy. Maybe I thought I'd reduce the frequency, or change the forcus, or something. I went in and said that I was re-thinking therapy. Thinking that we would talk about it. But which she took as me saying that I was quitting- she asked me why- I told her that the past two sessions I really had not felt like I had anything I needed to say, and that I wanted to focus on studying. And then she thanked me for coming in to tell her, and told me that she wouldn't charge me for today- and asked her if there was anything she had done or said wrong,etc.

So it is a strange situation.

I did something so strange today- I accidentally took my nighttime meds in the AM. So I went to work on 5mg of Zyprexa. Not fun. Fortunately, no sleeping pill in the mix- not that it has been working too well. I did manage to make it through the day, but it was a struggle. But maybe it helped me to be more mellow. No tears today. And then I came home and napped. Maybe, though, this double dose of Zyprexa is just what I needed to get me out of whatever I have gotten into these past few days. I do feel less crazy today. But it is not something I want to repeat.

I have definitely wanted someone to complain to the past few days- just like my mom. But then to talk about a work issue too. Is it better to be though crazy, lazy, or incompetent? I mean, being mentally ill is not an excuse for not getting your work done- you are still responsible for it, and you can still get fired if you don't do your job. But at the same time, it is an explanation. I tried going in this past weekend, I got myself there, I just couldn't keep myself together- I was feeling too crazy. And perhaps that truth is better than people thinking that I just don't care. Or maybe not.

What has changed

It has been 10 years since I have been in the hospital, 8.5 years since I have been on disability.  What accounts for that? I have patients who need to be seen, who need to be treated. That is one major thing.

I ran out of my birth control pill last week- which I take so that I get my period only every 3 months, because that is about all that I can bear. Most of my hospitalizations have happened right before getting my period. And so what should have been 7 days off turned into 11 days (had to call a doctor who was not in, get it filled at a pharmacy that is not open on the weekend- but i forgot to pick it up on Friday, and so on...)

By Saturday I was miserable. But then that night I hardly slept, and by Sunday I was feeling crazy. Yes, crazy. I really don't know a good way to describe it. I tried to go in to work on Sunday to do charts, but I couldn't do more that a couple- I just felt too terrible- alternating between sobbing and rocking and wanting to throw things. I went home, stopped for ice cream (yes, I know, not good), and took klonopin. And I still didn't sleep very much. Of course, I did sleep towards the end of the night- so I didn't get up to go in early, like I wanted to. I went in, but was barely keeping it together. When my last two patients cancelled, I was out of there. I stopped for my my pills at the pharmacy, went home- more ice cream and klonopin, and cried and rocked myself to sleep.

This morning was pretty rough- but I know it would be. A lot of tears on the drive in to work. But I pulled it together in the parking lot. I talked to myself. I can do this. I chose to do this. And really, my patients were great- it was a good morning work-wise. Until lunch.

I decided to check my e-mail- and a message from my boss about my charts that were not done- the ones that I tried to do on the weekend and failed to do. And then I just lost it.

I had to run out of the office, the tears were coming so fast. I went to my car- I started to drive- not to anywhere, just to get away. I sobbed, I screamed, I was screaming that I was going to crash my car, which is what I really wanted to do. I was crying so hard I didn't realize I didn't have my glasses on.

Eventually I found a parking spot, and I pulled in and cried. No, crying does not begin to describe it. I sobbed- I cried myself to exhaustion. And then I wondered what I should do. And my thought ranged from killing myself to taking the afternoon off- but then I remembered. While most of my afternoon's patients could wait, my last patient of the day was a new post op patient who really needs to be moving ASAP, and I have to see him- there is no one else working today to see him. So I had to go back. I had to finish the day.

So somehow I did. I was so exhausted from crying, I don't know how I did. But I did. And I am glad I did. I think.

Because sometimes I am conscious of the small death that it feels like, when I push this big part of me away for the sake of function- even if it is for a good thing. Something that I want to do. That I chose to do. And I wonder how many times I can do it, and what it is doing to me.

But the few times I have really surrendered to the crazy part of me- and I have- and given up on function- that has had a pretty bad outcome. And yet, for a little while, it felt so liberating. I think even that first month I lay on the couch, that terrible depression I really gave up- and gave up on trying to do anything- it felt like such a relief. To just stop fighting for a little while. But the feeling didn't last- and the months got worse and worse. It didn't work out so well. That's how I landed up on Zyprexa.

But I want that feeling of liberation again, somehow. I feel anything but free, now. Even though I am living the life I am living because of my own choices. I could choice something else, but I don't know what to choice. What choice would satisfy all parts of me?

I thought I was exhausted, but it is looking like another sleepless night. I just took half a klonopin, to see if that can do what the Lunesta did not do- get me to sleep.

The Drug Dealers Won

I saw my psychiatrist this past week. I often have more sleeping problems in the spring/summer, and that is true this year. I have also been especially anxious. The ambien just isn't doing it for me anymore- at least not the half dose that I have been taken recently since I realized that this was the medication that was making my concentration so bad in the mornings. Strange, since when I take a full 10mg of Ambien, I usually wake up feeling amazing. And not sleepy or drowsy. It is just concentration that is off. I can't do my paperwork until about noon. But the 5mg stopped working, and I had started supplementing it with a little klonopin at night, particularly with the anxiety. 


So I though I would ask for Sonata, which has a shorter half-life. Maybe I could take the whole dose, and not feel it the next morning. At least that was my thinking. And I looked it up- it was covered by my insurance, and generic, and only cost about 14 dollars a month anyway.

But my doctor didn't like my suggestion. Perhaps because I sometime have trouble staying asleep, and Sonata is not very good for that. Or perhaps because the Lunesta drug rep had just been in his office. Because I went home with a week's worth of Lunesta samples, and a prescription for Lunesta, along with a card that gives me up to a $50.00 discount each month.

That's right. I wasn't thinking at the time, but Lunesta is still branded. And when I looked it up, it would be costing me $200 a month! It is covered by my insurance, but I have a high deductible plan, so I will be paying the full cost for a while (unfortunately I have high enough medical costs that I do hit my deductible each year). Is that worth it for a sleeping pill?

Well, I thought I would try it. I have the samples. And I like it. I have been able to stop taking any klonopin at night- which means no rebound anxiety during the day. And I have been able to sleep. And no mental fog the next day, no trouble concentrating. And I don't understand why, because its half-life is even longer than Ambien- it should be giving me more trouble in that regard, but it is not.

I am less anxious on Lunesta than on Ambien. No more klonopin. Which is enough reason that I am going to pay the money for it. I suspect Sonota would not have this effect. I was reading that if you take double or triple the dose of Lunesta, it is almost like taking a small dose of Valium- so perhaps I am getting just enough of this effect to sooth me and less of a rebound effect than I would have with the Ambien (and I do get rebound effects from benzo's).

So there may have been good reasons for me to be given this drug- still the drug dealers (sorry, pharmeutical representatives) won. And just when all of my meds had finally gone generic, I am back on a brand name med. Well, I tell myself that the cost will just get me to my deductible that much faster- I'd go through it anyway- and then things won't cost so much. Perhaps after my exam I'll give Sonata a chance- I just don't want to be playing around with meds right now.

I'm rather at peace with meds right now. I know I can't do anything drastic with them until I take my exam in November, so I am not even going to try. And I have also realized that my concentration is not as bad as I had thought- I have periods of time when it is very good. I just can't sustain it. But maybe that, too, will get better.

As I can't make any major med changes for now, I'm not struggling with it. Not  now. That could change in a heartbeat.

I did quit therapy last week. I really didn't feel like I had anything much to talk about, the second week in a row- so I knew it was time. My main hesitation was the fact that I liked herhas a therapist, and she has been helpful, and it is rare that I find a therapist that I like (so I haven't been in therapy much of the past 10 years). But she said that I can always come back.

But then she said something which bothered me. She asked for feedback- was there something that she said, did, or should have done differently?

I should have said, IT IS NOT ALL ABOUT YOU! What I told her was that I didn't have anything to talk about, and wanted to focus on studying- which was the truth.

But someone quitting therapy is in a potentially vulnerable state. It is a personal decision. Don't assume that it is about you. Don't ask what you did wrong. That is unprofessional. This isn't an exit interview.

Life isn't all roses

That's what my grandmother has told me so many times. Trying to lower my expectations about life, thinking that I am depressed because I expect too much. Is she right?

I had a very good studying week, when I all I wanted to do was study. And then I came home Friday after work feeling burnt out, and did nothing. And I have done nothing all day Saturday, pretty much. OK, I cleaned for 15 minutes. Yes, I timed myself.

And I went online and read my blogs and news sites about the end of the world (no wonder I am depressed) and then tried to get some basic info on the oxygen content of our atmosphere and how rapidly it turns over and how vulnerable it is to things like deforestation and the burning of fossil fuels- but that will really have to wait until a later date.

The end of the world is coming- it''s just a matter of timing. And timing makes all the difference. Are we good for a decade or a billion years?

The problem is, the human species has been given way too much power to change our environment- but as individuals, we have way too little power. In a world of 7 billion people, it makes not one drop of difference if I get rid of my car and become a vegan- and I am not powerful or well-connected enough or charismatic enough to get the majority of the world to follow me in any kind of a movement. As individuals, we can't solve this. And collectively, we can't solve anything.

But I am not intelligent enough to figure out if we are in for a slow or a fast collapse. Is anyone? I know there are a lot of people out there who think that they know one way or another.

But it will be slow enough that I need to study for this exam! And I can only live in this world, in this society. I'm not going to cash out my 401K and buy some isolated property and learn to farm and "prep." Not because I don't think that is a realistic thing to do- but because I think I would be lousy at it.

I think all these things- but it doesn't change a whole lot for me. I haven't figured out how to live my life differently, or to what extent I should. I still have the daily grind. I still drive a car. I still eat meat. Actually, I was a vegan for a while, until I went on the MAOI's and then there were so many foods I could no longer eat, like soy, that it just became too complicated, that I stopped.

I think life is too complicated, that is what I think.

I don't believe in Santa Claus anymore

My mood is really not good. There was a time I would be all about the next antidepressant- let's try something else.

But I've become disenchanted with meds over the years. I'm in a strange place- too scared to try to go off what I am currently on, and too skeptical to want to try anything else.

My current thought is to try to change my sleeping medication. I can't take a full dose of Ambien, because if I do I cannot concentrate enough do do paperwork until about noon the next day. So, I take half. And it works in the winter, when all I want to do is sleep, but not in the summer. So now I am supplementing it with a little klonopin- but I don't think that is helping my mood, even though it is only a quarter of a milligram. And some nights, I still don't sleep.

But Sonata has a shorter half life. Maybe I could take that and take the full dose and be fine the next morning. Maybe that would help my mood, if I could reliably sleep- and no klonopin.

There are two different types of people in the antipsychiatry camp. Some say that the drugs don't work. And I am starting to think that they are more right than wrong. And then there are others who say that it is not just that the meds don't work- there is no such thing as mental illness. It is not just that we are overdiagnosising, there aren't any diagnoses- we are just pathologizing human suffering.

This is where I don't know if I can go. It is true on one level, there are no diagnoses- it isn't clear what we are treating. We are just trying to put our own categories on natural variations of behavior. But that doesn't mean that there isn't anything to treat, ever.

It is quite possible that if I had a very different life- if I was living in a hunter gatherer tribe, or if I was a nun during the Middle Ages, there would be very different demands placed upon me and I might not be experiencing the kind of distress I am experiencing now. But I do live in the now, in this present world and society. And it is this society that I have to function in- and in this society I am depressed. Maybe it is not a good fit.

Do I label what I am feeling as depression? What does that buy me? And if it is not depression, if it  is just that I am not up do the demands of living as an adult in the modern world- well then I guess I should just end it all now. Because after 8 years after getting off of disability, it hasn't gotten any easier. So I call it depression, because that somehow sounds more fixable, but I'm not sure that it is.

What else would I do?

I have been having pretty extreme moods recently- something I attribute to my inability to sleep well most nights recently, but who knows. I was at work today and feeling sorry for myself. Feeling very anxious and overwhelmed. This is too hard, I thought, and it just doesn't get any easier. Not for any length of time. And now I have to function on top of how I feel!

OK, so what? Go back on disability? I was miserable then- at least as miserable, if not more than I am now. So I can be miserable and doing something useful and interesting (and self-supporting), or I could be miserable doing nothing. I'd rather be miserable doing something, I decided. Even if it is hard- which it is.

And the day did somehow get better by the evening- I was in a much better mood for my last couple of patients. And on the way home I even managed to get myself to stop and walk once around the park. OK, only once, but you have to start somewhere. I cannot tell you the amount of effort it took to get me to do that.

Some people think that if you can get yourself to work, you are all better. I have tried telling myself that. It isn't true. It only means that I can get myself to work most days- and barely at that.

I want life to be easier, but I don't think that is quite what I mean. I like challenges, at least to a certain extent. But I am tired of fighting myself and my moods. I am tired of so many things being such an effort, that I don't have anything left over.

I am also not feeling well physically, either the past few days. I am having joint pain in my hands and feet. A few days ago I had a lot of wheat, that seems to have preceded my last bad episode of this. However, I have tested negative for celiac disease. But I still think I need to really give gluten free a try.

It's really hot today... does that mean anything?

One hot day, or even a hot decade, will never "prove" global warming. We can never have enough data points to perfectly model something as complex as the earth's climate. And even if the climate does dramatically change, and everyone is agreeing that it has- can your really prove that we did it?

By the time we reach the level of certainty as required by the skeptics, it will be too late. Science doesn't work that way.

But scientists need don't really understand people either. A huge portion of Americans still don't believe in evolution. And whether or not we "believe" in CO2 based global warming may not matter very much- we simply don't know any other way to live than dependent upon fossil fuels.

And then there is the game theory aspect to it. Unless you could get all countries to agree to cut emissions simultaneously, huge power changes will develop. If America decides to somehow cut fossil fuel use by 50% in 10 years, but China does not, China will rise in relative power. At least until the fossil fuels run out. (Peak oil is another matter... but one that I think will not happen in time to avoid major climate change).

Cutting emissions significantly was never going to happen. The cynic in me saw it all along, and people told me I was being negative. But if we look at nature, life changes the environment. Species use the resources at their disposal. That is why we have oxygen in the atmosphere- because plants changed the environment. Why should we think that a species as populous as human beings would be any different?

And if it isn't CO2, we will find another way to change the environment. Or, the environment will change on us, due to natural cycles of cooling and warming. We are just making things happen that much faster. We are spoiled, we are living in a sweet spot, and we don't even know it. But our civilization is adapted to the world as it is, it likes homeostasis. The people who argue that global warming is a good thing are being ridiculous. Yes, most people don't like cold weather. But if Siberia became the new bread basket of the world instead of America, a lot of people would starve.

I think that part of the solution, if humans are going to continue to inhabit the earth for a long time to come, has to be geoengineering. I know that is not a popular solution, especially among environmentalists. We could really mess this planet up. But if we do nothing, we will eventually wear this planet out, at least for our purposes. We will change the climate too much, or acidity of the oceans, or the oxygen content of the atmosphere, something.

That doesn't mean we shouldn't try to scale back our impact on the environment- we should. It will give us more time, and make the job easier. There will be less that we have to fix. But to think that voluntary changes in consumption, or even environmental regulations are going to save us, I think is naive. I think that the environmentalists are naive. The only thing that might "save" the environment is a total world-wide economic collapse, but that is not a popular message. Instead, the popular media gives us the message that we can buy our way out of this- just buy a Prius instead of a pickup truck, and use recycled printer paper, and you are "saving the environment".

We humans may have to save ourselves from ourselves. And I think it will eventually require geoengineering. Because it is easier to change a planet than to change global human civilization.

I must be stupid or something...

I remember my first job doing hand therapy. I had just been transferred from doing inpatient rehab to the outpatient clinic with no warning. I had no experience in hand therapy, I was worried.

My predecessor told me that it really wasn't that difficult. She learned everything that she needed to know in 1 year, and after that, she really wasn't learning anything more. She had been there for over 5 years.

Well, I have been doing hand therapy for a good bit over a year, and I still feel like I am learning something every day- whether it is a better way to make a splint, or greater appreciation for a  patient's pain, just something. It has been more than a year, and I am still learning. So was she that much smarter than me?

Then again, I was replacing her because she had been fired, so maybe I shouldn't use her as a good comparison.

When I feel like I am no longer learning it will be time to change jobs, as it was once before.

I tried something different with an elbow splint yesterday, it worked really well. It was a pretty cool splint if I do say so myself. I learned something. That makes it a good day.

If I still have things left to learn because I am stupid, then I am enjoying my stupidity. Life would be boring if I knew it all by now.

I remember when I had just come back from a continuing education course, and we were trying to explain where I was to my step-niece. And she said, in amazement, "do adults still have to learn?" If only she knew- that is the good part.

I found an old picture of myself

It was my freshman year in college. I was skinny! OK, so by any BMI table I was not- but I have a large frame (no, really!), and I looked fine. Freshman year of college I was unmedicated. That would all change in the second half of my sophmore year of college. I would never be that weight again, as the meds, and the pounds, increased.

I actually did briefly get skinny one more time in my adult life when I had pretty much stopped eating during a very long and protracted depression when no one wanted to give me an antidepressant because I had just been manic. And then I was put on Zyprexa, and I blew up- I didn't know a medicine could be so bad for weight gain. It was pretty new, maybe no one knew. And when I tried to fight the hunger and diet, I started binge eating, something I had never done before. Eventually I stopped gaining, after about two years, but by then the damage had been done. I was morbidly obese.

I have lost some since- mostly with the help of metformin. I have not been able to get off of Zyprexa. I seem to have a new, slightly lower set point now on the metformin. I am no longer in the "morbid" category. But not by much. I start a diet several times a year- usually weight watchers online or calorie counting recently, but "fall off the wagon" when my mood dips, as it so often does, and then I regain what I lost. The new normal for me on Zyprexa is that, where as I used to lose weight while depressed, I now gain weight.

So far I have escaped diabetes. I take metformin to try to counteract the metabolic effects of the zyprexa (I just wish I had known about it years ago). I take resverotrol. I take chromium. I try not to eat too much processed food or sugar- but have the occasional ice cream lapse. I would like to say I try to exercise, but most of the time it doesn't happen, so I am not trying that hard. I know how vulnerable I am, and I could be just one blood test away from finding out that I have it.

So now the question is, do I want that to be a matter between me and my doctor, or do I want my employer involved? Here is the question. Would you give away your medical privacy away for $500?

I have a high deductible health insurance policy with a health savings account, and I spend a lot out of pocket every year. I can get up to $500 extra in my health savings account by doing 3 things. First, getting a "biometric screening" from occupational health (weight, blood pressure, and various blood tests). Then, I can go online and fill out a health assessment- but only if I have done the biometric screening first. And then, I can get more money if I get my yearly physical- something I was planning on doing anyway.

Well, the biometric screening has to be done in July. In fact, a nurse will be coming from occupational health to our site to do weight/BP checks, and give us lab slips so we can get our lab work done. I wonder if she is just going to tell me my weight, or if there will be any kind of a lecture involved as mine is "not optimal." My physical- which I scheduled 6 months ago, is in August- and will probably do exactly the same- take my blood pressure, weight, blood work (plus a few other things like gyn exam), it makes no sense to do all this twice. Unless you are thinking in the strange logic of an insurance company.

I have to admit, there is a part of me that wants to say to my employer, if you want me to lose weight, fine then. I'm just going to stop taking my Zyprexa, and you can see how quickly the charges add up for an inpatient psychiatric hospitalization.

Because, really, I haven't had many medical charges due to my weight. Yes, I have high blood pressure, and I probably got it younger than I should have- that is about it. I see my primary care doctor 2-3 times a year for this and take a dirt cheap generic ACE inhibitor.

Extra blood work for glucose levels and lipids, etc., would have to be done anyway due to the Zyprexa and my other meds.

Will I give up $500 for my privacy? When I was looking for car insurance, I could have got a better deal with Progressive if I had just agreed to put a gadget in my car that would monitor my driving. NO WAY! But GEICO wasn't that much more, no gadget involved, so the choice wasn't that hard.

$500, and tax free at that, which I know that I will spend (I use up my HSA every year), is hard to pass up. I think I will swallow my pride and see how bad it is. Even though I weigh myself almost every day, I will let them weigh me. Even though I have a blood pressure monitor at home, I will let them take my blood pressure at work. And even though I am scheduled for my yearly physical the next month, and already have an appointment to come in the week before for blood work, I will let them take my blood. It will be interesting to see how results compare- how stable are values over short periods of time, between labs, etc.

What I won't let them do is lecture me. My weight, my blood pressure, my lab values- those are to be discussed between me and my doctor. Someone who knows all of me, my history and my meds. No one else is qualified to tell me anything.


Still, I am selling out. I should tell them what they can do with their $500. I suppose privacy is now a luxury- one that I haven't figured out how much I am willing to pay for yet.

A day off

I have a day off so I have been trying to study. And succeeding for only a couple of hours. How did I ever manage in graduate school? I don't know how I am going to get all this studying done by November. My only consolation is that I can take the exam over again if I fail.

I think I have another couple hours of studying in me, but not quite now.

I am feeling under a lot of pressure these days. Among my pressures, now- to keep it together so I do not become a problem again for my family, because on my mom's side of the family, they are having just one thing happen after another! A death, a very bad car accident, the need for multiple surgeries and problems with insurance, and now someone in jail. All in the past month, and all in addition to the usual troubles of no money, people with no jobs, cars breaking down, people fighting, and my grandmother steadily losing her hearing and her memory. It is just craziness. No need for me to be crazy!

And I have been, really, not too bad. Mildly depressed. Although mild depression doesn't get enough respect. When I am seriously depressed, I know to a certain extent that this is not how I always am. It can get better. But mild depression is not that far off from normal, at least for me- I spend a good portion of my life there- and it can really be the most hopeless state, sometimes. It just eats at your soul, whispering in your ear that this is all there is to life, don't hope for anything more.

My manias were so severe and so destructive I spent years terrified I could go back there- it was years before I could begin to trust myself again. But with the right meds, they haven't come back, just a little hypomania that is really nothing to fear. It is the depression that I can't keep away, that keeps coming back. Mania never felt like me, I became someone else. Depression feels all too much like me.

I am trying to lower expectations for myself. Telling myself that I am going to be a little bit miserable until November. Until I take my test. But I am finally dedicated to taking it, to studying, to really doing it. I had been on the fence about it for so long- just prolonging the agony. I just hope I didn't wait too long.

But come December, life is going to get a whole lot better. (assuming I passed...)

Meanwhile, I will try to not be a source of trouble for anyone!

Rethinking therapy, again

I was in therapy a bit as a child and as a teenager, for all the good it did me. Not all of the time, but at times. And then, from my sophomore year in college on I was in therapy most of the time until my early thirties. I didn't always find it useful, but I felt like I was "doing something," and trying to get better. With the majority of therapists, I would give them a few months, maybe a school year, and then move on, having not felt like I was getting much from them. But then there were a few who were good and useful, and I stayed with them until I moved, etc.

I often took the summers off, or quit when things were so bad that I know I wasn't going to be able to get myself to my appointments regularly and didn't want to get charged. At least with a psychiatrist, you come out of the appointment with something tangible, a prescription in hand. But getting to a therapist on a regular basis when severely depressed and can't get get off the couch, much less out the door- that is sometimes asking too much.

Once I started working again and was no longer on disability, I no longer had Medicare/Medicaid, and I no longer felt like I should ask my parents to help pay. So for a while I tried finding therapists "in-network" with my new private insurance. And I have generally been disappointed. I didn't put up with them for very long. And for the most part, I have not been in therapy.

But since I have moved to where I am now, I have been pretty socially isolated, and decided to give therapy another try. After trying an "in-network" therapist twice, I agreed to let my parents help me to pay privately for someone. Yes, I have out of network benefits, but the out of network deductible is so high that I might as well not.

And I like her. She has been providing what I need at the moment- which is social support, someone to tell my story of my crazy history to- which is something I seem to feel the need to do periodically, and some good ideas about being in the moment. She was my sounding board during my year of seriously questioning meds for the first time.. She is really a DBT therapist, but I had a bad experience with DBT in the past, so she is not pushing it too much.

I have had every kind of therapy there is: psychoanaysis, CBT, DBT, you name it. I feel like I really shouldn't need therapy anymore. I don't believe in therapy forever. And it seems pretty pathetic that at the moment I am really just paying her to be a sympathetic ear and give helpful suggestions and feedback.

It is rare that I find a therapist I really like. I think she is maybe number 4. And yet, there is a part of me that feels like, if I am in therapy, it means I am dependent, defective, not a grown-up. Somehow, it bothers me even more to rely on a person than on a pill.

My right?

I was reading on an article on a website for physicians about support for NYC's ban on large size soda's, and saying that this could be just the beginning. With the epidemics of obesity and diabetes, there are a lot more regulations that could/should be put in to place to regulate people's food choices.

Should somebody have stopped me today? Every now and then, not very often, when I am very depressed, I just really want ice cream. And I will eat an entire Hagen Daas pint. I stopped at a convenience store on the way home and got one. Ate it all once I got home. I don't have diabetes, but I am obese. Was this my right?

I calculated the calories later. Because I ate only coffee and cottage cheese for breakfast, and a Lean Cuisine frozen entree for lunch, I still didn't do too badly in the calorie department for the day. But nutritionally, it was a pretty bad day.

There is only so much you can do to save people from themselves. Also, a calorie is a calorie, You can be fat on health food or skinny on junk food. I don't drink soda or juice much- most days I try to avoid sugar. But I am a big milk drinker- something I am trying to cut down on. Will you ban that?

From the macro to the micro

I worry about the future: unsustainable debt, peak oil, peak water, popoulation increases, global warming and ocean acidification- I can really be quite a doomer at times. And during the past 2 years, at times I was quite obsessed with all of this. However, I am now a little more accepting. On the macro level, what will be will be. We can only try to be adaptable in our own lives. Perhaps eventually I will find a way to do something with these concerns, but for now, I just need to live my life.

I spent the weekend accomplishing very little. It felt like what I needed to do- and yet. I am disappointed in myself. By Friday, I felt exhausted and really just burnt out from life.

I would love to work fewer hours. I think it would really help. But I think I would have to find a new job- and move- and all that, and it is more than I feel capable of at this time. Plus, I like my job. And, at 40 hours a week, I am making a lot of progress on paying off my debts. Once those are gone, I could really afford to work fewer hours.

I am waiting to see what happens with the Supreme Court ruling on health reform. I don't even know what I want the outcome to be. From a personal level, if I could buy subsidized health insurance from a pool without being penalized for my pre-existing condition, while working part time- that would be a dream. And yet, this bill will bankrupt the country (even more than it already is), and does nothing to control costs. And there are always those unintended consequences. It could spell the end of employer-funded health insurance. And you know that salaries are not going to rise enough to make up for the difference when we have to buy our own. We could still be left with a lot of people without insurance, simply because it is unaffordable. Paying the penalty would be cheaper.

I think my episode of inner anguish- depression, agitation, just generally feeling crazy inside- has stopped. And I think I realize what it was: the sun. I had been making a really good effort to get a lot of sunlight, even eating my lunches in my car at noon during the workday, to try to get rid of the last vestiges of my depression. But it backfired. And I got a kind of mixed depression- something they will probably put in the next DSM. I got ARG! Just screaming inside, for no reason, and it didn't seem connected to anything (although I have plenty to be depressed about).

So I have had less sunlight recently, and things have settled down. Hopefully this won't mean a decent into the other kind of depression.

It seems very unfair that you should have to titrate sunlight.

I want to be a low maintenance person, I really do. I don't style my hair. I wear eyeliner on a good day, that's it. If I need to iron it, I probably won't buy it. But I take all of these meds. And supplements. I have to do light therapy in the winter. Not get too much sun in the summer. I have gluten sensitivity (I think). I have irritable bowel syndrome, so I need to take fiber and probiotics and watch what I eat. I take the BC pill because even my hormones are apparently too much for me to handle in their natural state.

Let's face it, I am high maintenance.