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.