Tuesday, February 28, 2012

So far, so good

I'm down to 7.5mg of Zyprexa. I did not fall apart yesterday, I did not fall back into severe depression. In a few days, I'll try to get myself back to 5mg. And then? Do I try to get myself off of it, or at least lower than I had been? I don't know.

I think that the increased Zonegran is helping- a lot. But, it is too high for me. I can't even describe how it makes me feel. It supposedly raises serotonin and dopamine- what's not to like? But it makes me feel like not me. It doesn't make me feel sedated. It doesn't hit me over the head like an antipsychotic- but on a very subtle level, it makes the world feel more distant. Even my body feels wrong. I don't have the words to describe this. But, if I didn't mind feeling like not-me, if I didn't mind the distance from the world, it might almost be pleasurable. But it is not-me. And while I want drugs to take away the depression, I want the me who remains to be recognizable.

So last night I reduced my Zonegran dose too. I know, too many changes at once, too many variables. But this is not a lab. This is my life.

I still am depressed, but the trajectory is good. It's not like I was. I can get out of bed, I can make it to work, and I'm not running into the bathroom several times a day to cry. Perhaps just as important, I'm starting to think about a future which involves me in it, rather than thinking about how to kill myself.

Two weeks ago, I couldn't have imagined that I could feel better this quickly. Two weeks ago, I thought I would be depressed forever. Why do I always think that when I get depressed? That this time it is going to last forever. I will never feel better.

Sunday, February 26, 2012


Today I got on the scale. I have gained 5 pounds since I went up on the zyprexa. And just as bad- I couldn't do anything today. Not because I felt depressed- I really didn't. I just felt tired. I felt drugged. I felt nothing.

I had even cut back on the klonopin as of last night, so I thought I would have more energy. It didn't help- but I'm not taking very much anyway. I did increase my Zonegran a couple of days ago, which I think it also helping with my depression, so this could also be sedation from that.

So today I start cutting the Zyprexa down again. The 10mg was always meant to be temporary, and the longer I wait, the harder it will be.

I did raise my Zonegran to 400mg- there are some open label studies which suggest that it can be helpful with bipolar depression. And it is the one anticonvulsant I have taken that doesn't have too bad side effects. There is no way I am going back on lithium (I say now- but I have gone back and forth on that a bit in my mind).

This is why I spend big bucks on my psychiatrist. Because the next time I call him, I will have to ask him for new scripts because I have to tell him I went up on the Zonegran, down on the Zyprexa, and no to lithium. And he is good about it, because I (generally) don't do stupid things.

I think that the stupidest things I have done, for the most part,has been agreeing to do what my doctors have suggested. Because sometimes they suggest really stupid things.

So tonight it is down to 7.5mg of Zyprexa. I had hoped to wait until next weekend to do this- not the night before I have to go to work- but between the way I felt today, and getting on the scale- there was no choice. It has to be now.

I have to say, though, I really wasn't that depressed today. I was just very nothing. Which is an improvement over a couple of weeks ago- granted. I didn't want to be alive. But then your standards start to rise, and numb is no longer enough.

The Zyprexa served its purpose. It got me out of a very bad place. It kept me alive.

Saturday, February 25, 2012

Why Bother to Watch the News?

People are talking about gas prices. Politicians, pundits, newscasters are all talking about it. And no one in the main stream media is mentioning peak oil. Isn't anyone even thinking it?

Yes, there is the conflict with Iran. Yes, there are a couple of refineries that are off-line. Yes, we have a lot of wall-street speculators. But even without this- did we think we would have cheap oil forever?

Whether we have truly reached peak oil in terms of production- it is still a matter of debate, but we are close if we are not there yet. But in terms of per capital demand, we passed it a while ago- and the population is only increasing. And the developing world is, well, developing- and expects to live a more energy intensive lifestyle.

Why won't anyone talk about the bigger picture?

It's Not Just Meds

I have been using this iPhone app to track my depression, and for the first time it told me that I have moderate severe clinical depression, instead of severe clinical depression.

Last week I called my mom, wanting some sympathy, I think. She told me that she had just read this article which said that, if you have bipolar and your meds are not working, you need to exercise everyday. I hung up on her.

If you have severe clinical depression and you are making it to the gym, you almost have to question the diagnosis. I suppose that there are some people who can, but I am not one of them.

I know I need to exercise, for many reasons, but don't tell me that when I am not capable of it.

I know that there are a lot of things that have contributed to this latest depression- but I also know that I got to a point where I needed meds to get me out of it. In fact, at times in the past when I felt this bad I would have been hospitalized. I really haven't had the energy to exercise- sometimes I couldn't even make it to the pharmacy to refill a prescription. I have spent way too much time in bed, thinking about death. Envying Whitney Houston for dying without even trying. How did she get so lucky?

But yesterday afternoon- and it is always in the afternoons- I really felt better. And I realized that I need to use those times that I have when I do feel better, to make the most of them. So I went and got a haircut- something I had needed to do for months (I've been looking terrible). And I went into a grocery store- something I normally find too overwhelming to do when I am depressed, so I kind of stick to convenience stores. It wasn't easy- either of these things- especially when the person who cut my hair kept wanting to make small talk- but it was possible. I was successful.

I felt so much better after getting a haircut. I look human again. And I have a freezer full of food-I am not thinking that I am ready to cook yet!

And this morning, with no work to drag myself to, I am going to the gym to see my personal trainer. Even though I have to admit that I haven't been in 2 weeks since I last saw her. But it is something just to go today.

The more the meds free me up to act, the more I have to take advantage of that and do things to help myself. And hopefully, eventually the balance will shift, and my life will be better, and it will be less about the meds. And maybe I can take less of them. But for now, they are getting me out of a very deep hole.

Friday, February 24, 2012


I somehow made it through another week.

I am starting to feel better in the late afternoons- but the first part of the day really isn't that much better. Maybe I just need to give it some time. I tell my patients that all the time, but it is hard to accept.

And I have this anxiety that is so bound up in this depression- I am up to 1mg of klonopin a day, taken in various bits throughout the day. I am not happy about the klonopin- but even less happy about the increased Zyprexa. How long will I need it? I tried going down a tiny bit the other day, but the next day was awful. Maybe it was just withdrawal, but it is too soon for me to be able to handle withdrawal.

But I am not just fighting depression, I feel like I am also fighting the effects of the klonopin and (especially) Zyprexa.

There is an app for the iphone that lets you track your depression using the Goldberg Depression Scale. I started using it last week. One of the questions is about feeling lifeless, more dead than alive- and I know that my score on this one is a lot higher because of the meds. Also, there is a question about sleep- do you sleep too much or too little. I sleep too much right now, again because of the meds.

What worries me actually is that I am starting to adapt to the increased dose, and be less sedated, less sleepy. My brain is getting used to this- and now it is going to be hard to go back down on it.

I still haven't decided what to do about lithium. This morning I felt so awful, I was like, bring it on! I don't care about side effects, I just don't want to feel this way! I just want to be able to go to work and function!

But now it is evening. I don't have to be at work until Monday. I think, I can give this some time. I don't have to function for two days. The pressure is off.

Well, I do have to do a couple of things. I didn't cancel my personal training session at the gym for tomorrow morning. Somehow, I am going to get myself there. And I have mountains of laundry to do. Really. I have nothing to wear that is clean.

Wednesday, February 22, 2012

I think I am starting to get better, but it is so slow!

I'm starting to feel better, I think, especially by late afternoon. Mornings are still pure hell- although, I have to admit, I did not have to go to the bathroom to cry even once today at work. That is progress.

But my mind is slow, I'm not on the ball, especially in the mornings and early afternoon. Then is starts to get better. I find myself wondering- is this the depression getting better, or is this the drugs from the previous night getting out of my system? Is it time to cut down on the Zyprexa? Maybe so. At least a little bit.

I feel like this is going to take a really long time. I am in such a deep hole, such a bad place, and I really have not been this depressed for some time. And in the past- when I would go on an antidepressant to get over my depressions, I would usually have a few days of hypomania when I came out of them. And it was so nice to suddenly have so much enthusiasm for life, when you have just made this big mess of it while depressed. But it is not to be this time, not if Zyprexa and possibly lithium are going to be what saves me. I am going to crawl out of this one, and then have to face the mess that is my life. I just want to run away.

What I can't deal with is the fatigue- although even that is better. The feeling of paralysis, that my muscles won't hold me up- that is better. Now it is more general fatigue, if that makes any sense.

That I am still working is because I have a wonderful and understanding boss. And the worst advice my therapist gave me was not to tell her what was going on. I have, and it is better. I still expect that I might wind up on probation for my paperwork, but I guess I'll handle that when it happens. I think I am improving, and as my depression improves, it will improve even more.

So many questions. Should I keep taking 10mg of zyprexa or go down to 7.5mg? How long should I give the zyprexa before thinking about lithium? What blood pressure medicines can I take with lithium- as the ones I take interact? What about DHEA? I guess I just need to talk to my psychiatrist every day! Not going to happen in my world, unfortunately.

Tuesday, February 21, 2012

Back up again

Back up to 10mg of Zyprexa, and feeling a little better. I'm going to give the Zyprexa all the chance that I can, because I have decided that there is no way I am going back on lithium. I had such a bad experience with it last time. Both my blood pressure medicines interact with it, and I take a fair amount of NSAID's for very bad headaches, cramps, and various aches and pains. And the last time I was on lithium, I was very depressed anyway.

I'm thinking of asking my doctor about DHEA. I wonder what he thinks about it. And, I may try going up on my Wellbutrin again first. I got bad anxiety last time I did, but now I have so much Zyprexa in me plus I am taking a milligram of klonopin a day on a regular basis- hopefully that will protect me from any anxiety.

I have so many reasons for not wanting to be on lithium- but I have a rebellious one too. I don't want to be on a drug where my levels are tested and adjusted periodically by a doctor, and someone would always know if I am taking my meds. Even though I have taken such drugs in the past- I just don't want to do that now. It just seems to give too much power.

I have almost always taken meds as prescribed, except for when things get really bad and I can't imagine that life could be any worse off of meds. And then I sometimes play with my dosages- a little more when I am feeling depressed, a little less to see if I can decrease something. Otherwise I am very "compliant."

If you buy in to the biochemical basis of mood disorders- and I think it is a lot more complicated than that- but if you do- and you believe that the treatment for it is medication, it really doesn't give you, the patient, a whole lot of power. Because I don't have the prescription pad, my doctor does. Fortunately I have a really great psychiatrist now, but it has not always been the case. But even then, if I feel like I can't take another minute of it, my depression is so bad, and I have to wait for a phone call from my psychiatrist before I can make a med change- that is pretty dis-empowering.

So going up to 10mg of Zyprexa, that was my doing. But then my doctor kept me there- i thought it might be a temporary thing. And it made me feel enough better that I am agreeing to do that. I am still hoping it is temporary, but I just can't go back to where I was.

But lithium- I have decided that I will not do. I don't know- tardive dyskinesia vs. acne, shaking hands, "mental dulling" and constantly going to the bathroom. How to choose?

Sunday, February 19, 2012

Down on Zyprexa- well, a little

Last night I decided that raising the Zyprexa to 10mg really wasn't working. And I was so out of it during the first half of the day, that not only was I fighting the depression, I was also fighting the Zyprexa. So I went down to 7.5mg. I woke up on my own this morning with no alarm this morning, but I still slept well. I thought I was feeling better- until I starting thinking about doing anything. Now it is apparent that the depression is still quite bad. But it is no worse, I think.

I'm still above the 5mg that I had been taking for the past few years. Prior to that, it had been 7.5mg. I have taken 10mg at times in the past, but I never felt right on it, I was always too out of it.

The question is, how long do I give the increased Zyprexa to see what it does for me? My doctor had wanted me to give it 3 weeks. I don't know if I have 3 weeks left in me. But that also coincides with the time I see my primary care doctor to see if I can change blood pressure medicines and get off my diuretic- so I can go on lithium. Fun stuff.

Saturday, February 18, 2012

If not meds, then what?

I've been reading a lot of anti-medication stuff recently. I've really been questioning things a lot. Not that I hadn't before, but it had mostly been confined to the Zyprexa and perhaps the Effexor. Not the idea of meds, just the ones that I am on.

I have even been trying to wean myself off the last bit of my Zyprexa- but as usual it didn't work, and my have even worsened things. I had been going into a bad depression- and ran out of Zyprexa (too depressed to make it to the pharmacy, then they didn't have it for a couple of days). I decided this was a sign for me to get off of it entirely. Well, a few days off of Zyprexa I started to feel great (maybe mild hypomania?), only to crash soon after, to a place I haven't been in a long time, and can't get out of.

So now I am not only back on the 5mg of Zyprexa I've been on before, I'm even on 10mg. But you can't put Humpty Dumpty back together again, and this didn't fix me- or at least not in a week. It just made me numb, and stopped some of the constant negative chatter going through my head. Which is helpful, I guess, but not enough. But even that is starting to wear off.

I saw this depression coming (before the Zyprexa business). I didn't know what to do about it. I hired a personal trainer- somehow I thought that would fix things if I got to the gym. I tried to keep going. I went to therapy. I tried to do what the first therapist I ever had told me to do, which is to "fake it 'till you make it." I tried to keep going and act like everything is fine.

Now I am in a place where I really don't know what to do, other than to take a pill. Sometimes I'm not even capable of doing that- twice in the past two weeks I have run out of meds. But that seems to be about all that I am capable of doing.

I'm not willing to sacrifice my job, my career, right now. Any energy- and there seems to be less each day- goes to that. And already I have called out. But we are so short staffed over the next few weeks, and I am so far behind on my paperwork anyway, that taking time off is just not an option.

Besides, if I didn't have to go to work, I'd probably just stay home in bed.

I think that the worst part of this depression is the fatigue. My muscles feel like they won't hold me up. It's hard to sit up straight, let alone stand, let alone walk. I try to make myself walk across the room as much as possible at work, just to get some activity- but it is so hard. It is hard to move. Thankfully my personal trainer was away this week. I don't think I could have done it.

If you are feeling anti-medication, but too depressed to do anything else to help yourself, you are, to quote Tom Leher, "like a Christian Scientist with appendicitis." And so there I am. It is time to look to meds again, at least for now.

Much as I hate the Zyprexa, I was hoping that it would do the trick. It has taken a little of the edge off of things, that is all. The next thing my psychiatrist wants to try- and which I agree is the logical next step- is low dose lithium. I really don't want to go there, but I don't see any other good options.

I was on lithium before. I had terrible side effects. I developed lithium toxicity at one point and was taken off of it- which lead to a terrible manic episode. I just don't have good memories of lithium. But maybe a low dose I could tolerate.