Wednesday, August 29, 2012

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.

Thursday, August 23, 2012

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.

Saturday, August 11, 2012

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.

Wednesday, August 8, 2012

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?

Tuesday, August 7, 2012

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.

Sunday, August 5, 2012

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?