Saturday, June 30, 2012

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.

Monday, June 25, 2012

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?

Sunday, June 24, 2012

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.

Saturday, June 23, 2012

Did I make a mistake?

I am an occupational therapist. I love my work. There are aspects of my job I do not like- mostly having to do with paperwork and insurance companies and such, but I love being an OT.

But I was once a physics major. Only, I wasn't that great of a physics major, so I only got a BA, not a BS, and didn't do anything more with physics. In fact, I double majored with psychology- the only degree I could take where the courses didn't have to be taken in order, so I could still graduate on time- and tried doing research psychology for a while. Until I became too crazy, and had to drop of of grad school ABD. When I finally got myself together again somewhat, I went back to school for OT.

When I left physics, I wasn't quite so worried about our future. I mean, our whole civilization, even our species. And I was sure that there were other people, much smarter than me, already working out the solutions to what to do after the end of cheap oil, and how to stop global warming.

But it doesn't seem to be happening. First of all, people in power don't even admit to the severity of the problem, so they are not funding the correct research. And then- there may not be any solutions, at least that are politically palatable. Everything I read just tells me more and more that we are screwed.

Maybe I should have stayed in physics, in some capacity.

I no longer believe that people will change their ways enough to stop global warming- if we ever could, at present numbers. We couldn't go back to the stone age if we wanted to, there just isn't enough land to support all of us. And I see too many people telling us that if we just buy a Prius, or have meatless Mondays, we can stop global warming. Environmentalism lite.

We can't get people to change, not on the time scale that we need to. And the worst consequence might not even be warming- it might be acidification of the oceans. That is where most of our oxygen comes from. Mess with that, and we are dead.

As for the climate, it is a non-linear system, and it is difficult to say what is going to happen, and how fast. Only that we are adapted to the state of the world as is, and we are no longer nomads who can pick up and go when the weather changes. We are nation states and property owners and renters, and most of all, we are farmers. We depend on agriculture.

Peak oil, and the resulting collapse of industrial civilization, is predicted by some to save us from ourselves. Humans are to clever, we will find a way to keep going for a while, longer than it seems possible, and prop up the status quo. I can think of two things that can save us: a new technology to give us CO2-free energy, and geoengineering to get some of that CO2 our of our atmosphere and de-acidify our oceans.

Of course we could also destroy ourselves with these pursuits. But we need to be thinking about it, we need to be studying this. We need to have options for when things get bad enough. And I think that they will, eventually. But right now the environmentalists are telling us that we can get where we need to get by changing our ways (and if not, then perhaps we deserve our fate). The climate change deniers tell us there is no problem at all. Neither are right, in my opinion. Both have their heads in the sand.

My dad's mother lived to 92. My mom's mother is 92 and still going. If I live that long- I wonder what the world will be like. We here in America have been living in a time of relative climate stability and environmental abundance. I think that will be coming to an end.

Sunday, June 17, 2012

10 years later

My step mother is about to turn 70 next week. She has a lot of relatives coming in to town, including her sister. Her sister made a comment about whether or not I would be there- given what happened 10 years ago.

Yes, 10 years ago on my step mother's 60th birthday, I overdosed. It was very bad. Intensive care, a week in the medical hospital, then involuntary transfer to psych hospital.

I felt very bad about the timing, but I just couldn't stand one second more. In fact, the last thing I remember saying before I threw up on the EMT and then passed out was to not tell my step mother.

Of course she did find out. Of course she had her birthday ruined. She spent it at the hospital with my dad where they told them that they didn't know if I would live or die, or have brain damage, but that they would do everything they could do.

Unfortunately, the psychiatrist came around too. Even though I was unconscious, they decided to get involved- and interrogated my parents. They asked them what they had said to me, that they must have said something. They blamed them for this. That was very mean, and not true. I had even written a suicide note saying that this wasn't anyone's fault.

What was going on? I was getting extremely depressed again, even on Parnate, the best of antidepressants (for me). So my doctor raised it from 90mg to the super high dosage of 120mg, which just made me depressed and agitated, even worse. So I decided the hell with this, it is making me worse, I'm just going to stop taking it. And I need to do a washout anyway, if I want to do another antidepressant. And my doctor was out of town and unavailable. But in 48 hours I found out that things could even be worse off of Parnate, which I didn't think was possible, and I couldn't bear another minute of this- and decided I had enough of living. And hence the overdose. Topamax and Lamictal, that is what I took.

But that has been my last hospitalization. It has been almost 10 years since I have been in the psych hospital (or any hospital). What changed?

Well, partially, it was meds. Much as I hate the Zyprexa, I have never been manic on it, even on antidepressants. And much as I complain about Effexor at times, it has also been an awesome antidepressant, especially with respect to my obsessions. Plus, there are a lot of ways to augment it, change doses, prop it up and keep it going, and that is what we have been doing over the years. The MAOI's didn't have that kind of flexibility.

But partially it has also been work. I started working as an OT 8.5 years ago, and that has been a very stabilizing force in my life- from the regular hours to social interaction to feeling needed, work has (mostly) been a good thing.

I have been living closer to family too.

I also started recognizing that I am my own best expert, and that I have more at stake in this than any psychiatrist. I started trusting them a lot less, and myself a lot more. Unfortunately, no one will give me my own prescription pad yet!

10 years since I have been in a psych hospital. Maybe I should stop complaining about my current meds, given how many hospitalizations there were in previous years.

I am not going to ruin my step mother's birthday this year. I told her I can't guarantee next year, but this year's should be fine!

Thursday, June 14, 2012

Miserable Day

Totally miserable day, I feel like I am just screaming inside- not even my normal depression.

I know I am stressed, and with having to take off work to do a couple of things, and now to go to the funeral, no time to get caught up at work, which is what I desperately need to do. Is that all that is causing this? It seems like it has to be more than that, but I can't think what.

I actually took half a zyprexa at work today, and it didn't even knock me out- which shows how bad I was feeling.

Tonight, though, I'm not going to get much sleep. I stayed as long as I could stand it at work to do paperwork, and I have to leave super early in the morning to get to the airport. And I can't just come home and fall asleep.

Someday, I tell myself, life will be better. Somehow. For now, it doesn't matter how I feel. I just have to keep going. What is the alternative?

Wednesday, June 13, 2012

No change

I took off from work early today to go see my psychiatrist. And I told him I am better, and I do not want to make any changes to my meds.

He was kind of saying that we still could, if I find that things are not quite as I would like them to be. And I told him, no, things are not quite as I would like them to be, but I don't think that it is meds right now, it is my life.

I have learned not to ask too much of my meds. And they can never give you a life, anyway. They can only make it possible to do the things to get a life.

So when I am barely getting out of bed to get to the toilet, let alone anything else- give me meds. When I spend half the day crying and don't even know why half the time, give me meds. When I feel like my body is so weak, my legs won't even support me, and I am going to collapse, give me meds. When I can't concentrate on whatever is in front of me, because I can't stop thinking about killing myself, give me meds.

But once I can get myself to work again, I can find some things I enjoy again, I can think of things other than death, and the tears become less frequent- and I can walk into a grocery store and not get so overwhelmed and paralyzed that I have to run out- I think they have pretty much done what they can do for me. The rest is up to me.

Why am I better? I think he attributed it to going back up on the Effexor, but I am not sure. Usually it works quicker than that. The Buspar didn't work, the Wellbutrin increase didn't work, made me worse in fact.

Maybe part of it was just time. There is this myth that depressions never go away on their own. I don't think I've ever had a depression that lasted more than a year- but I did have one very severe one that lasted almost a year (and destroyed the life that I had). And of course mine keep coming back, which is the problem. And maybe I'm a little dysthymic between depressions... But the worst of it, the really bad, can't get out of bed depressions, even in the years before I was medicated, always went away in a matter of weeks or months.

So, while I do know that my depressions are likely to go away, I also know that they are just as likely to come back, so I can't really comfort myself by this line of thinking.

The thing that hasn't come back is the mania. For a miserable two years after being taken off of lithium cold turkey I was manic or rapid cycling- but I was so mis-medicated. Once I got back on a therapeutic dose of Tegretol, no more mania. Even with antidepressants. Now, even the hypomania's seem to be going away- which were always mild, anyway.

If only the depressions were so easy to banish.

Sunday, June 10, 2012

A Death

I had finally managed to drag myself into work, not easily, on a Sunday afternoon (I'd had the whole weekend but had procrastinated), and was doing some much needed catch-up with my paperwork.

And then I got a call on my cell phone, it was my mother. She told me that my uncle was gone. Where did he go, I wondered? Was he missing? No he is dead.

Died in a house fire, probably from smoke inhalation.

I never felt very close to this uncle. And yet, I started to cry.

What a horrible way to die. I just hope he never woke up. I hope he was drunk- he drank. I hope he didn't suffer. I hope he is at peace, as he really hasn't been for a long time.

Of course no more paperwork got done.

I feel like this should be telling me something, teaching me something, giving me some kind of insight. It isn't. After the initial tears, I'm surprised at how little I feel.

There is a part of me that isn't surprised that this is how it ended for him.

Maybe he is finally at peace.

Saturday, June 9, 2012

Why psychiatry gets no respect

One of my options has been to switch antidepressants. But, as my psychiatrist says, there is no way of knowing if anything I switch to will be better or worse than the Effexor that I am on now.

There is no study, there are no guidelines, to tell me what to switch to. Should it be another SNRI like Cymbalta? Or maybe an SSRI like Lexapro- as I did well on Prozac in the past. Should I revisit some of the drugs I've been on in the past, but then stopped working? Or should I stick to things never tried? Should I try the TCA's again? Or maybe the MAOI's, which worked well in the past, the best antidepressants, if you can forget the washout period, the orthostatic hypertension, and the fact that they each stopped working rather dramatically eventually, and there aren't a lot of things you can augment them with to keep them going.

Almost everything I read tells me that differences in efficacy of antidepressants for depression are minimal. The main differences are in side effects. And it is all trial and error.

So now that things are bearable again, I think I'll stay on the Effexor as my main antidepressant. I want better odds than this.

It seems to me that psychiatry should have progressed to the point where, based upon the severity of your depression, the specific symptoms you are having, and the number of depressions you have had in the past, they could tell you that you are more likely to respond to an SSRI, SNRI, MAOI, TCA, etc.

But in psychiatry, depression is depression. If you can check off all of the boxes, you meet the diagnostic criteria, and that is it. So they are incapable of doing any kind of research to determine who would respond best to what drug.

If the drugs work at all, which is the other possibility. You have to admit. If an MAOI has the same efficacy as Prozac as Wellbutrin, maybe it is because they are not doing anything. Maybe if you threw in aspirin, it would work as well. Either your effect sizes are so small that you cannot make comparisons given the size of the studies, or the studies are poorly designed when it comes to finding differences. Or these drugs are working in ways we know nothing about, and not the ways we think.

Wednesday, June 6, 2012

It's just a computer

My work will put an extra 100 dollars into my health savings account if I complete an online health assessment on my health insurance company website. Among other things, I discovered that I am at high risk of depression due to "depressed feelings" and "treatment for depression."

Well, that is the type of information that I got. I'm sure Artificial Intelligence has progressed further than this, but this program was pretty limited.

For everything I am doing wrong- not exercising enough, not eating enough vegetables, etc., I was asked how ready I am to change that. I have so recently been wanting to be dead. How to answer these questions? Sort of like why I haven't gotten a mamagram this year- which I was reminded I am overdue for. First of all, they can't even agree if women under 50 should be getting them. And secondly, when you don't want to live, what would you do with the info if you had cancer? That's just a decision I don't want to have to make.

Interestingly, while it told me that I am at high risk for heart disease due to weight and borderline high cholesterol, it was unable to add in depression as a risk factor. Depression is a major risk factor for heart disease, possibly as bad as smoking.

Really, this was a pointless exercise. Just a way for my health insurance company to spy on me. Like I didn't know I am overweight and need to exercise more and eat more vegetables and have less stress in my life. What was the point of this?

Well, my last insurance company decided that I have diabetes because I take metformin (to try to help with the weight gain from the Zyprexa). They put me in their diabetes management program, and I kept getting notices asking me if I was on a statin yet, and that I should be on one due to my diabetes.

Is this the future of medicine? If so, we need better computer programs. We need true AI.

Which reminds me- Ray Bradbury died today. Farewell to an author whose books where such a part of my life when I was younger. Along with Asimov, and the other greats. People who, for better or worse, shaped my view of the world and our future.

I haven't read much sci fi recently. I almost feel like I don't have to. Or, perhaps the things that I am reading are sci fi, but just not labelled as such. I read a lot of books and blogs about people's views on the future, mostly the near future, of the world. I think things are going to change so drastically in my lifetime (if I don't keel over tomorrow from the heart disease that my insurance company predicts). We are reaching an age of limits. The difference this time is that it is global- certainly countries and civilizations have hit limits before. What will we do when we run out of water in California? What will we do when we run out of cheap oil? Rare earth minerals for solar panels?

Everyone has their own speculations of how society will adapt, or won't adapt. That is the sci fi I read now. And the sci fi in my head. The future.

Sometimes I think that is reason enough to want to live. I want to see how things turn out, one way or another.

Alone at last

My mother finally left, and not a day too soon. It was good that she came. It was very good that she cleaned. But then, it became too much. Finally, I have my apartment back to myself.

My moods have been all over the place, but generally getting better, even thought I stopped the Buspar after a few days. It was making me feel flat, restless, and gave me insomnia.

I told my mother the other day, "I don't think that I am depressed. I think that I am just miserably unhappy." Which made her upset, but to me, was progress. The depression is easing, I am down to just the unhappiness. And really, the unhappiness makes complete sense to me. I don't feel crazy anymore.

As for the unhappiness, I am in a bit of a bind. I have too many things I need to do in too much time, too much pressure on me, and not a lot of fun in my life. And not enough money (and still too much debt) to quit and take some serious time off and do some travelling or some backpacking.

But I am no longer looking for the answer in a pill. I've decided no more med changes. At the same time, I've decided not to try to get off anything or lower anything further for the moment. I have to take one variable out of the equation. And, if I can't get off of meds, I've thought that perhaps the kindest thing that I can do to my brain might be to be consistent about them, so that at least my brain can find a way to adapt.

I don't know if it is placebo, but I do feel like adding pyridoxal-5-phosphate to my supplements seemed to help with the depression (and I might be B6 deficient because I take the pill). Or maybe it was just time that helped.

When you get depressed, you don't do the things that you need to do. And I have been depressed, to a certain degree, on and off for quite some time. And so, I am so far behind with some things, and a lot of things I needed to do did not get done. I am in a very big hole- but most of it is my fault, for not doing things.

And the worst part is, I have used up most of my PTO being depressed!

I just want a vacation now that I could appreciate a vacation.