Sunday, May 27, 2012

Am I copping out?

I broke down and took Buspar tonight. It seems that every time I say I am not going to do something recently, it means that in a day or two I will surely do it.

I am just so ready for this depression to be over. And it isn't going away like I want it to.

This morning I thought I was feeling better- until I tried going to the grocery store with my mother. I had to leave the store and sit in my car while she finished the shopping. How am I supposed to go back to work like this on Tuesday?

So I went home and took a half of the Buspar, like I'm supposed to start with. I didn't think I would feel anything- but I do feel something, that I don't know how to describe. I'm not sure I totally like it. Maybe just early side effects.

Earlier this week I was so bad that, if someone had suggested the hospital, I think I would have gone without too much resistance. One of the reasons I cancelled my therapist appointment- I was sure if I told her what was going on in my head, she would tell me to go. And, being weak, I would go. It's not that I wanted someone to stop me from killing myself- I wanted someone to take that out of the equation for a while, so I could have a break from thinking about it. From the constant battle inside my head.

Half of me wanted someone to fix me. And half of me thought that I was unfixable, so there was no point in going. Instead I wound up calling family, and now my mother is staying with me and I've had a few days off of work. It has helped, I think. I haven't had too many stresses (other than my mother being here 24/7...)

I am lucky. I have a family who cares. I didn't always appreciate this- in fact for many years was encouraged by my therapists to blame my parent's craziness while I was growing up for my own problems. But they have always cared, always loved me. And even when I was manic and calling them multiple times in the middle of the night to yell at them, they answered the phone. That is love.

I can think about the good things in my life, and it should be enough. Enough to defeat any depression. And yet it isn't.

So I'm putting my hopes on Buspar to help get me out of this, and the hell with D2 receptor antagonism and all that- at some point you have to stop worrying about things. I just want this to be over and done with. This depression, which is consuming much too much of my life. I want it to be over.

Yeah, if I wanted to take a couple of months off of work, maybe I wouldn't need to take the Buspar. I could let this depression run its course, and I wouldn't need to medicate it. I could just hang out here with my mom. But that is not me. My work is such a large part of who I am. To give it up, that would not be me. So, taking a pill- that is really what I need to do to be true to myself.

Saturday, May 26, 2012

Sometimes the problem is the medication

A couple of weeks ago my psychiatrist upped my Wellbutrin to 300mg. I wanted it to work, I really did. And so I kept taking it, even though it was making me anxious and agitated, hoping that this would go away. And the Wellbutrin did give me some energy, made me a little less fatigued, so I put up with it, although I was also taking Klonopin now every day.

But things didn't get better- they got worse. And now I have been back down to 150mg for 2 days after calling my psychiatrist- and I haven't taken any klonopin in 2 days either. My agitation is gone, and I think even my depression is better.

I have a prescription now for Buspar- which my last psychiatrist had suggested as an augmentor for my antidepressant. I asked my new psychiatrist about this, and he agreed. Tomorrow, if I am not feeling better, I am supposed to start it. But, I am not sure whether or not I want to. I might give it more time.

I had been feeling so agitated recently, I was all set to ask my doctor about low dose lithium, like my previous psychiatrist has been pushing for. But then I started reading about how lithium combined with antipsychotics can be bad news. So I ruled that out.

And now I am reading that buspar can affect the D2 receptor, and has a small potential to cause movement disorders. Well, that is precisely what I am trying to avoid. Raising my Zyprexa was always an option, just one I didn't want to do. So I don't think I want to take another drug that antagonizes dopamine receptors.

There is no perfect drug out there. No side effect free drug, safe for long term use.

What my current psychiatrist is suggesting is changing my Effexor to another antidepressant, like Cymbalta. But I am too chicken to do this, even though he would cross-taper. For me, changing antidepressants has usually involved the hospital.

But maybe I won't need to do this.

Maybe I will get through this without more meds. Although, I am tinkering with my supplements, so I am still looking for that biochemical assistance.

Monday, May 21, 2012

It has been a very bad weekend

I got a stomach bug over the weekend, and couldn't keep even water down (no meds) for 24 hours. Perhaps that is why I have been so bad. I had just started to think I was doing a little bit better. But between yesterday and today, it has been just horrible.

Klonopin to the rescue today, as I took the day off. I'm not sure it is the right drug to take. It is not really anxiety I am feeling, it is hopelessness. But the way I feel, I'll take any drug. And I think that it has helped some. I am starting to feel calmer, feel better, and the tears have stopped. For how long, I don't know.

We have drugs that will stop anxiety, or agitation pretty quickly. But not so for depression. Or, perhaps we do but such drugs are just illegal. And maybe they would have such a rebound effect that I wouldn't want to deal with them anyway.

I felt so depressed and despairing last night I almost didn't take my meds. I'm not going to take all these pills just so that I can feel this bad! But, as some of this bad mood may have been a withdrawal effect, I decided not to be stupid, and took them. This is not the time to try to go off of things. And not like that.

I sort of have this cycle I'm stuck in, where I keep questioning. To what extent am I depressed because my life sucks? To what extent does my life suck because I am depressed? Am I capable of fixing my life in any way? If I fix the depression (meds, therapy, vitamins, etc.), will I be more capable of fixing my life? Or am I just someone who is not capable of very much, ever?

I thought that when I got off of disability, my life would have some kind of a progression, that things would someday get easier. That I would begin to have more of a life. But that was eight and a half years ago. And things really haven't gotten much easier. And the excitement of the newness of working, living on my own, has worn off. I want more- but I don't know how to get it. Getting to work takes just about everything out of me. There isn't anything left.

I have days, occasionally, when my mood is good, my energy is good, and my mind is clear. And I have a vision of what life could be. But not my life, apparently. Those days are all too few.

I cancelled my therapy session for tomorrow because it seems that all I can do right now is complain. And I don't have any answers, and neither does she. And I'm tired of crying, which is what I have been doing in my sessions recently. I can do that at home.


Provigil has recently gone generic, so I figured that my insurance company might be a little more open to an appeal for a medical exception to cover the drug for me. They had previously denied Nuvigil, when Nuvigil was step therapy required for Provigil, but it no longer is.

Of course I got denied. So, I will keep buying it from overseas. Because, even though it is generic, it is a very expensive generic, and a lot more than the 100 dollars/month that I am getting it at.

I know Provigil is an expensive drug. I can respect the need for insurance companies to manage their costs. Believe me, if I could take a cheap generic stimulant, I would. I have in the past- but I have had too many bad reactions to the stimulants. And now, on the high dose of Effexor that I take, they give me serious tachycardia. So they are just not an option for me. 

I even thought about taking a beta blocker with a stimulant. But the one time I took a beta blocker I had swollen ankles and frequent chest pains. So that isn't something I want to do either. And given other medications I take, a drug like Straterra doesn't make much sense either.

So it is Provigil, or else I take nothing to help me with my learning disabilities. Sometimes I think that it is the only medication that I take that makes sense. But my insurance company doesn't agree with me.

Some days it is hard not to take things personally. 

Sunday, May 20, 2012

Good Tears

I got so depressed today, I was really thinking about ending it. How can life be this hard? Why didn't it ever get any easier... I thought that it would someday. And all that.

And on top of that, I had to go to work on a Sunday night to do charts. Perhaps that is the one thing keeping me alive I think at times, my paperwork is not up to date!

I did more crying than paperwork, but I did get the charts I really had to get done finished, eventually. But not before crying myself pretty much to exhaustion. Now I am home, and I think the tears are over for the night. I am tired, but not thinking crazy thoughts anymore.

It feels good to have cried- after the fact. While I was crying, I felt like the world was about to end. Or perhaps I just hoped that it would. I couldn't stand what I was feeling.

But tears do something, I'm not sure what. And I am strangely better.

Monday, May 14, 2012

Vacation is over...

My first day back at work was better than my last day before vacation, so I must be doing better. Not great, but better. Fortunately it was a very light day.

This evening I had another massage scheduled, although it may be my last for a while. It was really good. She did some different things for the depression, instead of the other things she does for muscle tension- and it was really good. But so far the effects aren't lasting more than a day (mood-wise), so this is an expensive investment to do too often. Physically, it has helped a  lot with my tight shoulders and tension headaches. I will go back, I just don't know when.

I am thinking of trying acupuncture. Great, something else my health insurance won't pay for. But they are not paying for my psychiatrist either (he is out of network), or for my provigil, either. There is a lot they don't pay for.

I know what I need to do is exercise. But it is easier to want someone to fix me.

Although, there have been a couple of times I was exercising a lot, and still was very depressed. So maybe that wouldn't cure me. But it might.

I don't even know what I mean by cured. It sounds like curing meat, or a ham.

I mean better. Better than I am now. In some way. Things haven't been great in a long time, but I haven't felt this level of despair in a while. The things I have tried to do to change my life in recent years just don't seem to be working! And I don't know where to go from here.

Even getting a personal trainer backfired. I still have back pain from it.

I know no pill can fix me. But sometimes I will settle for a little relief from suffering.

Saturday, May 12, 2012

From Zyprexa haze to a beautiful morning

Yesterday I took 10mg of Zyprexa, twice my normal dose. Which knocked me out, of course. But this morning I woke up early, feeling more peaceful than I have in weeks. Why does this peace have to come from a pill?

I won't be repeating the Zyprexa dose. At 10 mg, which I have taken in the past, I am a little too out of it. And, it is certainly not good from my brain. Interestingly, though, once I get up to 10mg the weight gaining effect levels off, or even decreases. Perhaps I am too blissed out (or numbed out) to want to eat. 5-7.5mg are the worst for me in terms of weight gain. I can't believe that there are people out there who take 20mg of this stuff. I can't begin to imagine how they function.

I suppose, though, if I regularly took 10mg, my brain would adapt. And soon it would take 20mg to get me to feel like this.

Since I have been going up on the Wellbutrin, I have had less lethargy, more energy, less depression. But also more agitation, more anxiety, and certainly no peace. I wonder how this is going to play out. Will these bad things go away?

I do wish I had just a couple more days of vacation. Enough time do do an overnighter. I could still do a day hike tomorrow, but that is it. Today I have to register my car and do some other errands that I didn't get to to this week. I just sent flowers to my mom for mothers day- thank god for FTD same day delivery.

Thursday, May 10, 2012

Went to bed crying... woke up better

I woke up in a good mood. Really. OK, not in love with the world, but not feeling depressed. And I went to bed crying.

It is day 3 of the increased Wellbutrin XL. And for me, historically, whatever it is going to do, it is probably going to do in the first few days. Or at least that has been how it was at lower dosages. This could always be different.

Of course it didn't hurt that I have been off of work this past week, and that I spent a couple of days with family- but I've done that before and felt no better. I think a lot of this is the Wellbutrin.

But I am still very anxious. I'm not sure how much of that is the Wellbutrin, how much is anxiety about all the things I have to do and going back to work next week.

Today my plan is to do a load of laundry, walk, and go to a support group. I don't get to it much when I work because it is an evening that I work late, and I'm usually tired, tonight I have no excuse.

But I think I have also been avoiding it because it meets in the cafeteria of an inpatient psychiatric hospital. It is actually in a locked area, they have to buzz you in and out. And that was just a little too- well, I was feeling so bad I was starting to feel like I belonged there- as an inpatient, not a visitor. It was just too disturbing to go there.

It has been almost 10 years since I have been in the hospital. I'm not going back. But I wonder, has anything changed for the better? Do they have treadmills or exercise equipment on units now, or do you still have to pace the halls? Do they have light boxes or full spectrum lighting for the SAD patients? Probably not.

Wednesday, May 9, 2012

Wellbutrin and Family

I saw my psychiatrist, who raised my Wellbutrin to 300mg. It was the right, conservative thing to do. But I left and went to my car and sobbed, because I didn't think it would work. Although, I don't think I would have beleived in anything else, either. I just wanted a magic wand, I guess.

So the very same day, I took a second of my 150mg pills. And I started feeling a little bit energized, and a lot anxious- but something! And historically, wellbutrin for me has started to work very fast, so that is a good sign.

It has been three days of wellbutrin, and I feel more anxious, more agitated, but less depressed. Thank god I am on vacation. I can take klonopin to try to wait the bad stuff out. The first night I didn't fall asleep until almost morning.

But I am also at my dad and stepmom's house, and they are doing their best to be good to me and distract me, and feed me good food. And that helps too. So what is the wellbutrin, and what is family? I may find out tomorrow when I go home.

I try not to think about going back to work next week, and wondering if I will be any better able to function than I was last week. I have to be. That is what is weighing on me right now. No one seems to beleive me when I tell them how dysfuctional I have been recently.

But it is what it is. And I guess I will find a way to deal with it, as everyone keeps telling me that I will. But I have lost all confidence in myself, even when the depression dims for a little bit. I don't trust myself to be able to function, that I can keep enough of the depression at bay. It becomes circular. I am depressed over the fact that that I am depressed, and anxious over how much it has taken from me, and whether I will be able to get it back.

Tuesday, May 8, 2012

Depression and Quantum Physics

I woke up and thought for a couple of hours that I didn't feel too bad, I really must be getting better. What an optimist. But now, as I try to do laundry, pack an overnight bag for a stay at my dad's, think about going to the gym, all before going to drive to see my psychiatrist this afternoon- I feel awful again.

Yesterday my therapist asked me how I know how depressed I am, how I judge it, how I know. I told her it was like Schrodinger's Cat. It was like the particle that is a wave that is a particle- and you don't know where it is until you measure it. And for me that measurement is, when I try to do something. If I am doing nothing, I often don't have a sense of how depressed I am, if there are no demands on me. But when I try to function, I am pinning down where that particle is, whether the cat is dead or alive. Poor cat.

When I try to function, to do even the smallest thing- I realize that I am still moving in molasses, not air, and I feel the resistance to any effort I make. And then I feel it in the pit of my stomach, the depression, telling me it never really went away. Perhaps someday they will find a way to de-enevervate those nerves, the ones that grab you in the stomach, and they will be selling that as a cure for depression. Can't be any worse than implanting deep brain stimulators.

Monday, May 7, 2012

According to my therapist...

I think too much. I make things too complicated. I try to find solutions for things that I should just accept. And I am not present, I am not in the moment.

And she is right- to a certain extent. But I am still trying to figure out what my version of mindfulness is. Except sometimes, it is much easier than others to be present.

Like when I had a massage this afternoon. I was just about as present as I get. And I didn't have to use mantras or breathing or anything like that (although I did start out like that). I just had to experience it. And it was beautiful. Although- not as "good" as the past two in a certain sense- my body is looser, I don't feel like I "need" a massage so much like I did the first two times. 

Sometimes I get so tense in my shoulders, my whole body even, I just feel like I need a massage. But until recently, I never got them (except for a couple of vacation). And yes, it turns out, that a good massage does fix the problem. At least for a while.

I did see my therapist today. I did somehow go to the gym- I walked a mile, did a few weights. I deposited some checks at the bank. I got a massage. I came home and collapsed.

Laundry remains undone. There is always tomorrow. I am on vacation.

Tomorrow I see my psychiatrist. I don't know what I want from him. The sensible thing to do is to give these med increases more time. I'm just panicking already at the thought of going back to work next week, that I still won't be able to function. I was hoping my therapist would have some magic suggestion, something I could do with my week off to make me better. Of course, she didn't. She told me to practice being more mindful. And I'm not knocking it- but it is not the magic answer I wanted.

And I wish I could say that walking a mile cured me. It did make me less anxious, but the depression unchanged. I wonder how many miles you have to walk to get out of a depression?

Massage was the best part of the day. I booked one for next week, too. What is money for?

It sounds like a better day, but I am not okay. If I have done slightly more, it only serves to remind me how far I have to go to get back to any kind of life that I would want to live. But that is not being mindful, not being present. That is analyzing. But that is who I am, I can't help it.

That is what I always hated about CBT. I have judged myself for my actions (or more likely inactions) very frequently in the past. But my thoughts- I never used to judge myself for that. Now, even my thoughts are wrong. Just another thing that is wrong with me.

But I know, I am supposed to judge my thoughts- not myself for having those thoughts. A very subtle difference when I am depressed.

Sunday, May 6, 2012

"Like a Christian Scientist with Appendicitis"

One of my favorite lines from Tom Leher.

And it is kind of how I feel. I don't believe in meds like I used to, and yet... what else to do when I feel like this?

Who do I listen to, the people who say meds work, at least for the severely depressed? Or those who say that they don't, and even make you worse in the long run?

I think it is too late for me to change course. I am on meds, my brain has spent more of its life medicated than non-medicated. There is no going back. Even though it isn't clear to me if staying on them is making me better or just saving me from withdrawal effects at this point.

If I win the lottery, and don't have to work anymore, I will try going off of my meds. But until then, I have to take them. I can't spend weeks (or months) disabled.

I do think that antidepressants have worked for me, at least in the short term. And I do know that at least 2 drugs, tegretol and zyprexa, have kept me from mania. Of course, I didn't get manic until years of antidepressant use and then being taken off of lithium cold turkey...

And the occasional quarter milligram of klonopin can help me to push through my bad feelings and do what I need to do for a little bit.

And the provigil helps me to concentrate- although it is short acting and I have to take it twice a day, and I get extremely depressed if I skip a dose. I hate that.

I hate that I take so many drugs. But if they were all "working," if my mood was good- I'd be okay with it. But it is hard to justify taking all of these drugs when I feel this bad.

Whenever I see a new psychiatrist, they always ask me if I have used illegal drugs. And I say, don't I take enough drugs already? No, I have never used illegal drugs. But maybe I should have. Maybe that was my mistake- my choice of drugs. I might have been better off with cocaine!

Actually, what I have wondered about recently is nicotine for depression. No, not cigarettes. But maybe the gum, or a patch. It can't be any worse for you than Zyprexa.

Meanwhile, I am megadosing on CoQ10. I have ordered some supplements the are supposed to support mitochondrial health, hoping that it will help my energy level. I also ordered DHEA, but I haven't decided yet if I am going to take it. I really should be getting my levels tested by someone if I am going to go that route- but that would probably mean another doctor. And probably another doctor paid out of pocket, and I am really broke. I just bought my car from my lease, I am really broke. And I don't want to see another doctor, anyway. I have the feeling that this new psychiatrist wouldn't be open to doing a blood test for my level.

Saturday, May 5, 2012

Easier said than done

I didn't keep to my plans for today. I spent most of the day in bed. It is so much easier to set goals than to do them. But it was kind of nice in bed, relatively speaking. Compared to the past week. Nice to stop fighting for a little bit. Although in the long run, I'll probably feel worse if I keep doing it. Or maybe not.

The past week, I kept thinking, I am so tired, and so tired of feeling this way, I can't wait for life to be over. And it will be, eventually. Perhaps that is what keeps me alive- knowing that I don't have to bare this forever, it will come to an end, whether I want it to or not.

The myth is that depression is just unhappiness. It's just a bad mood. It is so much more than that. It takes away your energy, your ability to feel joy, your ability to concentrate, your ability to function.

Everything becomes so damn hard. And when you push yourself hard enough, you find that you can do some things, some of the time- and so it is hard to understand or explain (even to yourself) why you are not doing everything. No one else can see that you are moving in a sea of molasses, while everyone else is moving in air.

I was supposed to go to a dinner today. I felt too guilty to cancel, even though I didn't want to go. But at the last minute, I realized I did not have one thing to wear that didn't need washing. I haven't done laundry in ages- I have even been wearing fancier tops to work because that is what I had left (and of course I'm" recycling" my underwear). I had nothing to wear. I cancelled, last minute, and feel very guilty- and relieved.

I'm feeling lonely tonight, but wanting people who would understand- and I wouldn't find that there. There is a DBSA group that I have gone to a few times, but that isn't until later in the week. I always wish there was something on weekends. I am so busy with work during the week- and work some evenings- so it is hard to make weekday meetings.

I am just complaining today. It is one of those days. Tomorrow I will be better. I have to be- there are things that I really have to do.

I think I hit bottom, I think I am going up (a little bit)

I had hit bottom. And as miserable as it was, it was almost comforting. I was coming to terms with the fact that I was going to have to give up. Maybe for a short period of time, with a leave of absence, or maybe on life itself- somewhere between there were my options. But it was time to stop fighting.

I sat in my therapist's office and cried the whole session. She asked me if I needed a "more intensive level of care." I told her no. But a part of me was saying yes inside- except that, I didn't think there was anything a "more intensive level of care" could do. I had a vacation coming up, and was determined to stick it out that long- then I could collapse. And maybe then I could figure out what I had to do.

My parents "made" me call my new psychiatrist (I was going to wait until the next appointment), and he had me raise another med. I was not optimistic. I didn't think it would make any difference, but at least I could say I was trying. So now, both my antidepressants have been raised in the past two weeks.

But in the last 3 days, in spite of myself, I think I am feeling just a little bit better. And it is almost worse than feeling uniformly bad.

Because when you are pretty much 100 percent bad, decisions are clearer. But what happens when you are 10 percent good? Then major conflicts start to happen. Maybe I'm not going to give up, maybe I can make it. But it is still so hard- and there is the fear that I am going to stay this way, the 10% is all I am going to get. And I am still not going to be capable of functioning.

But I am on vacation this week, so maybe 10% is enough to leverage into something more. Plus, there is more time for meds to work. I'm trying to get better about eating- while I still can't shop or cook, I'm at least drinking protein shakes, etc. I've ordered some new supplements that I think might help with my energy. I am determined to walk at least 1 mile each day this week. I can do it at the gym, on a treadmill- even though it would be better to walk outside- but I feel like I am going to collapse half the time, so having arm rails will be helpful and comforting. And this weekend I will go in to work to try to get caught up on paperwork. I can be alone, and if I cry, there is no one there to care. And if I sit staring into space half the time because I can't concentrate, there is no one to see.

I don't know what I will do if I still feel like this at the end of the week. But I don't have to worry about that yet.

I am hoping I feel good enough to do at least an overnight backpacking trip by the end of the week. That would be great. But it is not going to happen if I still feel this exhausted. If I still feel like this.

Tuesday, May 1, 2012

Something that Works

There are very few things that feel pleasurable when severely depressed. Eating ice cream is one of them- sometimes the only thing I can eat. Sometimes TV helps to take my mind off of things, but it doesn't really do that much. If my depression is too bad, I don't even like music. Sex can go either way, depending. If I am depressed enough, no.

Well, I think I hit the jackpot yesterday. Something that isn't even bad for you (except it is expensive). I had a second massage scheduled yesterday. I was so depressed I didn't think I could go, but I did. And it was wonderful.

You just have to lie there, while someone works on you. It is heaven. To be depressed it so be passive, so it works really well. You don't have to do anything. For 60 minutes, I wasn't depressed. And afterwards, I was much less depressed for the rest of the evening.

So even deeply depressed, I can enjoy a massage. I haven't lost all ability to feel pleasure. That is good to know. There is something in out there that works, and something in me that can respond. Even if it doesn't last, that is worth something.