Saturday, December 28, 2013

Missing a certain kind of community

When I lived in the city there was a really good mood disorder support group that I went to semi-regularly. It was big- they had to break it up into different rooms. The people were interesting, and ranged from psychotic manics and just-out-of-the hospital depressives to people with families and professional jobs. It was never boring. I could always find someone in the group to relate to, and I made friends there.

Now I am living in a much more remote area. There is one club house type organization in my town. I went there one day when I was so desperate to tell someone who I really was- I was severely depressed, and tired of the act I was constantly putting on, feeling like an imposter (and an increasingly bad one).

But I went there, and the people were nice and welcoming, but no one else there worked. No one else was an imposter- they just were. And while I was worried about keeping my job, they were worried about SSI benefits. I have been there- I was on disability. But that is not were I am now. These were not my issues. I didn't fit in.

There is another, slightly further away meeting just for mood disorders. I have gone, but not usually felt like I connected very much. But I should try to go again. Maybe it will be different.

There is a cost for being "high-functioning." And that cost is that I feel like the real me isn't known. If I make it in to work, I must be okay. That is what the world thinks. I may have spent 2 hours to get myself to stop crying so I can get dressed and in to work. It is this huge denial of self sometimes, it feels like quite a cost.

The cost is worth it to me, of course. At least so far. I love my work, can't imagine my life without it. But what I do is not without cost. I suppose that could be said of anything. Maybe I am just complaining.

But I would like to again find the company of people who understand this cost, and who understand the sometimes precarious nature of our recovery. Miss a few light sessions. Throw up a couple of nights worth of meds. Things start to unravel for the smallest of reasons. I think I am starting to mend- but it has meant two days of not doing much paperwork at work, and I will have to catch up. Am I supposed to tell my boss that? I never want to use my illness as an excuse. But it is a reason.

I am mending. I like that word. It sounds like an active process and not some kind of passive thing.

Kept my meds down, feeling much better

I think maybe I was in a little bit of med withdrawal from all my GI distress the past couple of days. Last night soon after I took my night time meds I started to feel so much better. And no vomiting, no diarrhea last night- I kept them in my system. I woke up feeling fine.

The only good thing I have to say is that between my GI problems and being too depressed to grocery shop I have finally lost some weight- 5 pounds in the past couple of weeks. I hope it wasn't all water, I hope I can keep it off.

It seems that I am a lot more sensitive to dairy than I used to be. I used to be able to get away with a little bit- which was what always got me into trouble. A little would turn into a lot. So this morning I went to a Dunkin Donuts which is the only thing near me and got a bagel with egg and cheese, and a coffee with milk. My stomach is not happy. It was too much. I have to make it to the grocery store today.

It feels like it is going to be a better day than I have had in a while. And yes, I remembered to take my morning meds.

Friday, December 27, 2013

Really bad day

I've been missing my morning meds too many mornings recently. The reason is that I don't have any food in the house, and I don't like to take meds on an empty stomach. So I put them in a container to take later when I can buy a breakfast sandwich or protein bar on my way to work. Only sometimes I will forget to take my meds then.

The solution is to eat breakfast at home- which means being less depressed so I can go grocery shopping. It also means figuring out what I should be eating for breakfast. My IBS has been so bad recently I am really tired of it. And I wonder even if I have been able to absorb all of my meds. Last night I woke up in the middle of the night and I had diarrhea and I threw up a couple of times. Maybe I ate something bad.

My moods today were really bad. I woke up feeling not too bad. Then I started feeling really bad- but realized I forgot to take AM meds. I did, and felt better. But then, unexpectedly, my mood crashed again. I got out of work, could barely walk to my car, and just sat there in my car just trying to figure out what to do for 10 minutes. Finally I summoned up the energy to drive home. No banking done, no food purchased, no yoga. Just home.

This would definitely be an ice cream day if it weren't for the IBS and my lactose intolerance. It is all that I can really think about eating, and I don't have anything at home to eat anyway.  There is a convenience store about a half a mile away that is my only hope of food tonight.

Tuesday, December 24, 2013

Christmas Eve- and my trip to my shrink

In healthcare we don't get too many holidays. Not only was I working, so was my psychiatrist. I had an early morning appointment before work. We agreed that I am improving and I just need to get back on track with light therapy and keep the previous scheduling of my meds and get back to my yoga and such, and I will probably get out of my funk. No med changes for the moment, which is good. He also gave me another idea about how to get my Provigil- although he couldn't be too specific for legal reasons I am sure. Of course one day it will be affordable in the US, but I don't know when that will be. It has been generic for over a year and a half, it seems as though it should be cheaper than it is.

He didn't seem too concerned about the quarter of a milligram of klonopin I am taking in addition to the ambien to sleep- but did say that when I am feeling better I could try to get off of it. I didn't push the Lunesta- I am ambivalent about it. I tried it before and it worked very well- but I thought it made me more depressed- but I'm not sure. I was very depressed anyway at the time.

Work was surprisingly busy, all of my appointments were filled. One of my patients brought in some goodies that she had baked- which made me all the happier to know that she had made them, because I have been treating her for a very bad injury to her dominant hand. She is doing so much better.

With my mood I have not been feeling very Christmas-y this year. I was going to go to church tonight but I think I will just go to bed. Tomorrow I will drive to my dad's for Christmas dinner. I still have to wrap presents.

Sunday, December 22, 2013

A really important program on C-SPAN2

I think I watch the most TV on weekends. And most of it is C-Span and C-Span2!

This weekend seemed to be an energy themed week. On C-Span there was a really important talk by two people whose names escape me on whether or not geo-engineering should be part of our thinking about what can save us from climate change. Basically one person was saying that cutting CO2 emissions would be great but we will never do it in time- so this will buy us some time and will help to mitigate some of the damage. And the other person argued that we shouldn't even be talking about geo-engineering because it takes our eye off the ball- lowering CO2 emissions, and lets us think there are alternatives.

I fall into the geo-engineering camp. Which is to say that I think we should be at least researching it. I see no evidence that we will lower CO2 emissions significantly, meaningfully, in time. And perhaps by talking about geo-engineering we can get climate change deniers into the conversation. Because if there were an alternative to a massive scale down of industrial civilization, they might be willing to open their minds to what is happening. I think geo-engineering is going to happen. I think it is our only hope. I only hope that we don't mess up the earth too badly in the process. I do admit, though, that simply cooling the planet does not undo all the effects of rising CO2 emissions. Ocean acidification may have to be addressed as well.

On C-Span there was also a forum on the energy forecast for 2014. A lot of talk about natural gas and shale oil and fracking for the near future as alternatives to oil. But no one was talking about EROEI- energy returned on energy invested- which is becoming much less favorable. And no one was really talking much about alternatives to petroleum. Because there aren't good alternatives. We are screwed. Peak oil vs global warming: which will hit first?

After that I watched "Elysium" which I rented from my cable company. That is my new resolution. Watch one movie a week. It was an okay film. But Earth- where all the poor live in the movie- really didn't look that terrible. I mean, it wasn't like the garbage pickers living in the slums in India. People had apartments, and there were hospitals. In fact, I couldn't help noting the irony- one of the main characters is a nurse. And at the end of the movie, they get the med pods from Elysium to come to earth- so that means they no longer need nurses and hospitals and some of the few good jobs there are.

But I guess if you are like me and you work in healthcare, your dream is really to be out of business, because no one is sick or injured. I remember when I worked inpatient at a hospital with a 4 bed stroke unit. It was right next to the rehab unit, so I walked by it every day. And every now and then I would walk by, and it would be empty. And I would smile, and think, today is a good day. No one is having a stoke today.

A little better today, I think

I am feeling a little better today- but it could just be because I did a second night of increased Zyprexa and I don't have to work today. Tomorrow is the real test, when I go back down to my normal dose- and then go in to work and try to have a normal day. I have to to the last of my Christmas shopping, which has been particularly difficult this year.

I have been doing some thinking about what got me into the place. Unfortunately insight only goes so far if you are too depressed to make changes. I hope I am not.

I see my psychiatrist on Tuesday. I really hope I am feeling better enough by then not to want to change anything. I don't want to raise anything. And I am not confident that I could change anything and  maintain my ability to work through that process. I just want this depression to go away.

Saturday, December 21, 2013

When little things feel like big things

Getting dressed is a drawn out process today. Getting clothing from my closet, then going back to lie on my bed some more. Then taking off pajama top. Looking for my bra. Going back to bed. Pulling on a sweat shirt. Back to bed. I have finally managed to put on my jeans, but I am dreading my shoes. When I am depressed, I hate to tie shoes, but it is too muddy outside to wear anything slip-on. And then there is brushing my teeth. Forget a shower- but thankfully I glanced in the mirror and my hair doesn't look too terrible. It can wait another day.

With depression, sometime the little things are the hardest things for me. I have called out sick because I couldn't get dressed. Usually, but not always, once I get to work or out of the house, it is a little bit better. But getting started is the really hard part. Initiation. That's what I lose. Like a car that won't start.

I really have to go grocery shopping today. I ate my last can of soup for lunch.

No matter how depressed, I can still eat- thank you Zyprexa. To think that I used to stop eating when I got depressed. That was a long time ago. In my pre-Zyprexa life. Every depression I would lose weight. Now I continue to be hungry, even when depressed- although when depressed I do have this sense that I can't figure out what I am hungry for and nothing is quite right. And sometimes I get so depressed that I will eat nothing that I have to chew. Just yogurt, pudding, ice cream, protein drinks, etc. Sometimes some creamed spinach will be acceptable.

What I find very hard to do when depressed is to grocery shop- I think it is even harder than cooking for some reason. Sometime about making decisions and suddenly I'm thinking about the future and whether I even need to buy food for next week because I don't know if I will be around for it. It is just very hard.

So now I am off to put on shoes and go grocery shopping.

Wiped out

I went up on my Zyprexa by 2.5mg last night. Sometimes if I do that for a few days I can get myself out of a dark place. But I am really wiped out today, more so than I expected- or maybe it is just that I had wanted to do things today, and usually I am content to spend the time in bed.

I am sleepy. My body feels weak. I don't want to move. I didn't go to yoga on the grounds that I think I would be a fall risk. I am hoping that by late afternoon I will be up to a walk and a quick trip to the grocery store.

On the other hand, the screaming inside of me has stopped, if only for a little while. My mind isn't going to those dark places. But the price is too high if I can't get out of bed. I won't be doing this again tonight.

I found myself wondering if I could get the same effect by lowering my Zyprexa for a few days- (if I was able to survive the lowered dose period), and then my body would be less adapted to the Zypexa, and so when I went back up, it would be like an increase to my brain. And ditto for my antidepressant. It seems like a better solution than ever increasing dosages.

I do think there are things for me to learn from this depression- beyond the lesson that I can's skip light therapy sessions. But my life has seemed to be in s rut after what felt like progress, I do have this sense of, "is that all there is for me?" in life. I have to figure out what I really want in life and what I am capable of. And I have to get out of this rut. I had to stop giving in to winter- which is leading me to run home after work instead of doing the few things I had started to do.

Friday, December 20, 2013

Another rough day

Looking back, I can see a lot of things that have added up to darken my mood. I haven't been that consistent with my light therapy. I missed morning meds twice in the 2 weeks- usually it is no more than once a month. I have been exercising less with the cold and dark. Missing yoga sessions. Worrying about paying for my provigil. And trying to change the timing of meds to lessen my morning spaciness. Oh yes, and cutting down on coffee, my favorite antidepressant, due to headaches.

Maybe it is these things- or maybe it isn't. My depression tells me that it isn't. My depression tells me that it is my life- how empty and futile it is. And if I want to stop the depression, I have to "fix" my life (whatever that means). I wonder if I am having a mid life crisis. Is this all that there is? And is this the most I am capable of?

So do I fix my brain or my life? Right now I don't know how to do either. I just want to lie in bed, although I know that is not the solution.

Tomorrow yoga. And walking along the river. And Sunday church and going in to work to do paperwork, and going to the gym to swim. That is my plan. And somehow I also have to get to a grocery store. I should have known I was getting depressed- it has been getting harder and harder to grocery shop.

Thursday, December 19, 2013

Very moody these days

I've been very moody. I think it doesn't help that I am cutting down on my coffee, or that I am changing time timing of one of my meds to try to reduce the spaciness factor (it seems to be working). But the past two days, although in some ways I don't feel terrible, I am having terrible thoughts.

I don't seem to be depressed enough to be thinking so much about suicide, but I spent much of the day thinking about it. No, I am not going to do it. I think my brain was just kind of window shopping.

DBT teaches distress tolerance skills. But the premise is that you want to survive the distress. What if you don't? That has been my problem with DBT. That when my distress seems very existential- I am trying to figure out why I should be alive- it really isn't about distress tolerance. I guess that is what DBT's Wise Mind is about.

And sometimes I think that the best answer for why live is this: we all die. I will be dead soon enough. But life it a one time deal- so I might as well stay on the ride until the very end to see what happens. Death will come to me soon enough- I don't have to go looking for it. 

Tuesday, December 17, 2013

I'm giving up coffee

I had been drinking too much coffee lately, and my headaches are back. It is also worsening my heartburn. Today I did not have my afternoon cup of coffee- my headache was so bad I left work early, but I didn't have to reach for the Tums that I keep in a drawer in my desk at work. So I have decided, no more coffee.

Well, I'm not going cold turkey. I'm going to keep drinking just one cup until the new year- then no more. Maybe I will drink tea instead. I need my waking up ritual. My cup of coffee was always that. Tea still has a little caffeine, but not too much.

I want one less drug that I am addicted too. Caffeine. I really consider myself addicted to all of my psychiatric meds in that I would be very scared to go off any of them cold turkey. I hardly ever miss a dose, because if I miss my meds I go into withdrawal before the end of the day The joys of being on Effexor.

I think I will actually wait to talk to my psychiatrist, for once,  but I do think I do want to try going back down to 5mg of Zyprexa. I just feel too fuzzy on the higher dose. I think I was drinking more coffee in part to deal with the hunger from the increased dose, and in part because of the fuzziness.

There is the possibility that some of the fuzziness is not from the Zyprexa, it is from the lithium They were both raised around the same time. But my lithium level is low enough that I suspect the Zyprexa.

The other med change I want to make is to go from extended release to instant release lithium, for a number of reasons. And I want to ask about changing from ambien to lunesta, because Ambien no longer works unless I take a quarter of a milligram of klonopin along with it. Which I would rather not do. And I want to ask about which amphetamines are least likely to cause tachycardia, and if they are worth trying before I start spending almost as much as my rent on Provigil

Monday, December 16, 2013

Therapy or meds?

I didn't realize that I would have to choose, but I think that by April I will have to choose between continuing therapy or continuing to take Provigil. I can't afford both. And I will choose Provigil- I don't think I could continue to function at the level at which I do at work without it.

I'm not sure it is entirely a bad thing to be quitting therapy. Sometimes I have found myself wondering "when I will be done" with it. How will I know? Although really I have started and stopped therapy multiple times in my life, so if things change, I might go back to it. If something comes up. I'm sure that eventually something will.

Stopping therapy does not mean that I am totally satisfied with my life and am not trying to make changes. It just means I do that on my own. Just like using mindfulness and DBT skillls- I will be doing that on my own too.

And I will still have my psychiatrist who I am currently seeing every two months or so.

Therapy is actually cheaper than my Provigil. But it will work. I will be better with money. And I will stay in this tiny apartment instead of moving.

But I have 3 months of Provigil left, so three months of therapy.

Sunday, December 15, 2013

Movie night

I watched "Oblivion" tonight, I rented it from my cable company. It was a good movie, just up my alley. It took a while to figure out what was going on in the story. Now my brain won't turn off. How will I sleep?

I was looking up the movie on Wikipedia (and made a donation to them- who knows how much longer I will be able to do such things). It stated that one of the actresses had been in the the movie "Never Let Me Go." I did not even know it was ever a movie! It was a truly disturbing, haunting book that I couldn't stop thinking about when I finished. But it was a really good book. Another book where the reader really doesn't know what is going on until the end. But if I knew it had come out as a movie, I would have gone to see it. I think..

I suspect that my cable company doesn't have it. I may have to get netflix.

While I was looking at the on-demand menu on my cable, they were showing scenes from Homeland. The female agent is being told by her father that she didn't miss something or other because of her meds- but she is saying that she missed catching something because of what her meds do to her. And in the next scene, there is the obligatory toss your meds down the toilet that any story about people with bipolar has.

I have stopped meds, but I have never tossed them down the toilet. I just stick them in the back of the panty. Hey, I might need them someday- even if it is to overdose the next time I decide to kill myself. But 5 years after the expiration date I will toss them.

It is not crazy to want to stop your meds. It is hard to know if you are more impaired on your meds or off of the. I do know that Provigil helps me to be less impaired by my meds. If I have to take less Provigil, I think I have to take less meds.

Back to my provigil dilemna. I think that if I quit therapy, I might be able to afford my provigil. And if I really, really find myself needing some kind of therapy- maybe I could try harder to find someone in network. It hasn't worked so far. But I could try.

But what I really want to do is try to appeal it again, and write in a letter myself, detailing my problems with ritalin, detroamphetamine, and adderall. I just don't know if my insurance company will take a letter from me- but my current psychiatrist was not my doctor during the times when I was on these drugs- so how would he be the better authority?

Just when I thought my meds were set

I have been doing really well recently. I am trying to resist all urges to lower meds because I am in a really good place, and I don't want to lose this. Maybe in the future. For now, I just need this.

Except that it seems more and more like my overseas source for my Provigil is no longer reliable. And I don't know what I am going to do. It is a really expensive medication, and in recent years I haven't done well on amphetamines, which would be the logical alternative. My insurance company has very strict criteria for Provigil coverage which I do not meet. They denied me for both Provigil and Nuvigil.

Provigil has gone generic, but the price in the US is still pretty high. I take two 200mg pills. The cheapest price I can find is $344/pill, with a coupon- and I am assuming I could get that coupon every month. Maybe not. That is $688 a month.

I have about 3 months worth of Provigil left, I can only hope that the price will continue to drop, and will do so significantly in that time period. I have tried cutting down on my Provigil before, but never felt good. I could afford 1 pill a day maybe. I'm paying $100/month right now. I'm sure it will be a long time before it gets that cheap in the US.

I was just starting to feel financially secure. I was paying off debts. Making plans to move from my efficiency apartment into a full one bedroom. Not going to happen.

I think, maybe I should try lowering my Zyprexa and see if I need less Provigil to function on a lower dose of Zyprexa. I think maybe I should try a stimulant again and hope it doesn't give me anxiety and tachycardia. (I had thought of taking a beta blocker for the tachycardia, but the one time I was on a beta blocker I had swollen ankles and chest pain). There really aren't good options. And then I think that maybe the antipsychiatry people are right. I just don't want to be on meds, if for no other reason than because I don't want to be in this vulnerable position.

I am just frustrated. Maybe my psychiatrist will have some ideas. I think last time I brought this up he mentioned one of the new amphetamines.

Saturday, December 7, 2013


I've had a birthday this week. I cannot believe that I am 47- but not really in a bad way. Not until 50- then I will freak out. But this almost feels good, like an accomplishment. There were so many moments in my past when I didn't think I would make it this long, and nearly didn't a couple of times. So I guess it is an accomplishment.

My late 20's and early 30's were really awful and I was so awful. And I think half the time the meds I was getting was being given were only making it worse. I never knew I could get that bad. It still scares me when I think about how bad I was. Mania turned me into someone else, someone I didn't even know, and someone who was totally out of control.

Then came Zyprexa, and I have not been seriously manic since. Only seriously fat. You can't have it all I guess.

I have found, like most, that the mania's are easier to keep at bay than the depressions. That is where
I still struggle.

Still, I have much to be grateful for. I have a good job, a wonderful niece, a car that is paid off, parents who love me in whatever way they can, and relatively good health. I think that 47 is going to be a good year.

Wednesday, December 4, 2013

Too much lithium?

All summer I drank water constantly. Suddenly, as the seasons have changed, I am no longer drinking a lot of water any more. And today I feel really weird, really out of it- and like I did when we tried going up even higher on my lithium (which I decided was too much and went back down).

Drinking a lot lowers lithium levels. Maybe I was keeping mine very low with all of the water, and now it is higher. I don't think it is toxic, as my level was only .59 when last tested- it could double and I wouldn't be toxic. But it could be enough to be making me feel not very good.

Or it could be the fact that I didn't eat breakfast this morning...

I have decided that I must be on too much Zyprexa because my mother was here for over a week and we did not fight. Well, I did yell at her once when she did something very stupid and dangerous, but otherwise no fighting. I did kind of zone out during some of her lecturing but I did so mindfully, if that makes any sense, and just let her talk without really hearing her.