Friday, January 24, 2014


The week is done- sort of. I have to go in to work and do a lot of paperwork tomorrow. I am on vacation next week so everything needs to be in order and notes on all the patients for the per diem therapist who will be covering for me. I really need this vacation, I have been feeling really exhausted this week.

Sunday I am flying to Florida, where my dad and step mother have rented a condo for the winter. I will finally get some sunshine! I should have been gone this week, and missed the snow, but it will still be welcome. I will have a week to go to the pool, the beach, and walk in the sun. I just have a hundred things to get done between now and Sunday morning when my plane leaves.

I'm trying to decide right now whether or not to go to this hand therapy conference that I go to every year. It won't be paid for this year by my employer. I would normally have gone anyway- I have learned so much from this conference, I like going, and it inspires me with my work. But with the prospect of paying for my Provigil come April, I am hesitating. I have enough debt. But then a part of me says, the conference is in March- it will by my last hurrah for a while. Time enough to start being more frugal in April!

So I haven't decided what I am going to do.

I have to remind myself that the price of Provigil will fall, it is just a matter of time. It already has fallen since it went generic- it just started so high, and has fallen a lot less then I though it would in this time. I won't be spending all of my money on Provigil forever- I have to remind myself this or I start to get too angry and frustrated and want to do crazy things like stop taking it so that I get so depressed I have to be hospitalized and then my insurance company will really be out money.

But I don't want that. That is just stupid.

I am really obsessed with this Provigil I guess. I keep coming back to it. But I've looked at my insurance company's medical criteria, and they specifically exclude depression as an indication. I don't think I have a chance- and I don't think my psychiatrist uses the drug enough to know what to tell them (or works with insurance companies enough to know what to tell them).

My insurance company has a nurse hotline. I wonder if they can provide any information.

"They say" that when you are drowning the hardest part is the struggle, and that once you give up it can be peaceful. Maybe it is my struggle, thinking that there is a way out of paying for my Provigil that is driving me crazy. Maybe this calls for radical acceptance. Maybe that will give me at least a little bit of peace. Of course, the peace doesn't mean that you aren't still drowning!

Wednesday, January 22, 2014

The Dialectic

DBT is all about the dialectic. Here is one: mindfulness is good, mindfulness is bad. Both true.

There was a recent New York Times article about the downsides of mindfulness. It can apparently stifle the creative generation of solutions in certain situations and also decrease implicit learning of tasks. The implicit learning aspect had never occurred to me, but makes sense. But in my heart I always knew that my ruminations were a kind of creativity and worthy of existence and that mindfulness is great, but my brain was not designed to be mindful 24/7.

There is a balance to be had in most things. This is no different.

But I was very mindful driving home, which may have saved my life. I was driving on a back road that was still very snowy and icy. And then a deer stepped into the road. I braked right away- so I had a lot of time to pump the brakes (I don't have ABS) and not skid too much and not hit the deer. I stayed on the road. I made it home.

Winter driving is very mindful driving.

Sunday, January 19, 2014

Eagles and snow

I went on an all-day bird watching trip yesterday run by our parks and recreation department. We were looking for eagles, and we saw a lot of them. What I didn't expect was how cold and snowy it would be- we went north and up into the mountains. I got so cold, it took me a couple of hours and a couple of cups of tea to warm up once I got home. I just didn't dress right. And we were doing a lot of standing around- normally when I am out in weather like this I am hiking, so I don't get cold.

It was good, but is was a long day and by the end I was pretty ready to go home. I also forgot to bring my Provigil with me, so I didn't get my second dose- so in the afternoon my mood and energy really started to plunge. I hate taking meds in the middle of the day, just hate it.  Maybe I am going to have to give Nuvigil a try, as I will soon be paying just as much for my Provigil.

It was my first time going on a bird watching trip. Bird watching is something I have thought that I would like to get into- to complement my hiking. But I am not 100% sure that I liked it- I kind of see it as a way to commune with nature. These people seemed to treat it something like a competitive sport. It was fun, but a little too much counting. Still, I am glad that I went, glad that I saw 30 eagles, and I think I will go on more trips.

Friday, January 17, 2014

Tears in Yoga

The best part of yoga for me is the end, lying on the mat with the lights turned down low, for those last few moments of peace before the the instructor rings the gong to call us back to life and end the class.

Today as I lay on the mat my mind started to wonder, as it always does. And I tried to pull it back to the moment. And then I was suddenly overcome with sadness and tears came to my eyes. I was thinking about not sending out Christmas gifts, and it just seemed like the metaphor for my life: letting people down because of the damn depression. It was sadness, but it was somehow good sadness, and I was able to experience it and embrace it instead of pushing it away.

And I lay with the sadness for a few moments, and then is seemed tolerable, and I brushed away the tears before we were dismissed. But I felt freer. I had my yoga glow going as I walked back to my car.

I'm home and reading my kindle. I just finished "The Unwinding," which was really excellent. Now I am reading a book about the case against geo-engineering. I'm on a non-fiction kick right now. I used to read a lot of science fiction- but current events serves the same purpose.

Tomorrow I am going on an all day bird watching trip that I signed up for. I am not a bird watcher, but I would like to become one. To get more in tune with nature- before we lose it all. My other interest is Astronomy- but the stars we can't touch, humanity isn't a part of their story. A stray comet or asteroid, however, could be a part of ours.

I am sure that there is life- intelligent life- on other planets. But I also think that, given the limits of relativity- it really doesn't matter. This distances are too far and can't be breached. So for all practical purposes we are alone.

Thursday, January 16, 2014

Very moody but not like I have been

A part of me thought that when I made it to yoga again I must be "all better," whatever that means. Of course I am not. But I am better than I was last week, so I have to be grateful for that. I am trying to stay in the moment and use my DBT skills.

Yesterday I finally made it back to see my therapist. I hadn't been in a while between the holidays and my depression and the fact that I am now down to every other week. It was good to see her- although I think that I spent most of the session talking about my Provigil frustrations and how it is making me feel. I think I have enough to get me through most of March, and then I will be paying US prices for it- and I will probably have to stop therapy so I can pay for it.

Having health insurance doesn't always help a lot if you have a mental illness. All of my mental health providers are out of network, and my out of network deductible is $3600. There are hardly any psychiatrists around who take insurance, and I have had really bad luck finding in network therapists. And now with the Provigil, I am just really not happy with insurance companies. Plus, they are the source of most of my paperwork frustrations at work. I found myself wondering the other day if I am in the wrong field. Maybe I want to get into another line of work, something that has nothing to do with health insurance companies. I am tired of "the system."

I am not tired of my patients. I love my patients. But it was a discouraging day when I had to discharge two patients because I couldn't help them- I hate that, even when it is pretty predictable like with advanced hand arthritis. Well, I gave him one good compensatory tip, and grip strength did go up a tiny bit. I will have to console myself with that. I love discharging patients because they are better. I hate discharging patients because I can't help them.

Monday, January 13, 2014

Made it back to yoga- it was nice to be back

All morning I felt kind of sleepy and drugged- not a good feeling. But then in the afternoon I started feeling really anxious and irritable. But the last thing I was going to do was take klonopin the way I was feeling. So I just dealt with it, but I didn't like it.

I didn't want to go to yoga. I tried not to think about it- because when I thought about it, it just seemed like it was going to be too hard. And I kept thinking it would be all the harder because I hadn't been there in a while. So I just tried not to think about it.

I did go, and it was a good class. Not anywhere as hard as I had imagined- this is one case in which my thoughts were worse than reality. Although it could have been a tougher class, some times it is. It just wasn't today. It was good to be there, and I am glad that I went.

Tomorrow I see my therapist for the first time in like a month- between the holidays and me cancelling due to being too depressed to go. I wonder what I will talk about.

Sunday, January 12, 2014

A quiet Sunday, a busy Monday

Today I did a couple of loads of laundry and not much else that was productive. I watched TV, thanks to the "on demand" feature from my cable company. I watched  the Syfi Channel's "Helix" and then the movie "Closed Circuit." They were both good.

But mostly I felt too tired an drugged to do anything. I couldn't sleep last night and took a extra half of a klonopin- and it seems to have affected me more than usual. I felt really out of it today. I hated that feeling. Next time I think I'd rather not sleep.

I called my mother, who I hadn't talked to very much in a while, and told her I had been depressed. And I told me step mother, who I am close to. These are big steps- because really I haven't told anyone. Not even my therapist- except to tell her that I am too depressed to go to therapy. It feels better to have it out there

The next person I really have to tell is my brother, because I still haven't sent him and his family his Christmas presents. It is pretty bad. I think really I started getting really depressed over the holidays, and I didn't feel like telling anyone anything about being depressed around the holidays, and then I just kept up with the silence about it.

Tomorrow is a big day. I have work, and I have to go in early to do paperwork as I did not go in over the weekend. I signed up for an evening yoga class- my first in a few weeks. And then I really, really have to go grocery shopping because I am down to eating my backpacking food and there isn't much left of that. I have been drinking way too much coffeemate- I only use it when I am out of milk for my coffee, which seems to have been for forever.

Some people stock up on emergency food for natural disasters- and that is always what I thought I was doing. But I wind up eating my emergency food during my depressions. It is just a different kind of emergency, I guess. But I had better stock up before the next blizzard or hurricane! Or the next depression.

Saturday, January 11, 2014

Trying to figure out how hard to push myself. Maybe I'll just let myself be today

I had a wonderful massage today. In fact, my massage therapist convinced me to come in in 2 weeks, instead of my normal monthly, to help with the depression, to release endorphins and such. It did seem to help. Later I did a Pubmed search on my iphone and found that yes, there is evidence to support the use of massage for depression.

Afterwards I had Chinese food for lunch. I had planned on going to the grocery store- I really needed to go- but it was dark out and raining hard. Even if I had been feeling well, I might not have gone. Instead I went to a convenience store and bought milk. The milk turned out to be sour and expired. The only good thing is that I did make it to the bank for badly needed quarters. Now I can do laundry, which I also really need to do.

The one thing I have not tried for my depressions that I would like to try is acupuncture. I don't know what it costs- I'm pretty sure my insurance would not cover it. I don't think I could afford that with the massages. Especially in a couple of months when I will be paying a lot more for my Provigil. So maybe that will have to wait a while (probably a long while). Maybe I won't need it anyway.

Today I have to do dishes and organize laundry. And sign up for Monday evening yoga- yes I am going back! Otherwise I am going to take it easy today. It is ramon noodles for dinner tonight because I didn't make it to the grocery store. But I love them with soy sauce and hot sauce. Yum. I know, they probably don't even qualify as real food- but they are good emergency food to have around.

Friday, January 10, 2014

An easy day- I'll take what I can get

It was an easy day at work- most of my morning patients cancelled due to snow, and my afternoon patients went smoothly. My mood held up, and my energy was high enough that I didn't feel like collapsing on to the floor before the day was done.

I think I may be be coming out of this depression- but I am going to crawl out of it. I really miss the days when I would come out with a little bit of a bump. Back before I ever suspected I could be bipolar- when my antidepressants kicked in, they really kicked in. It probably  wasn't quite clinical hypomania, but it was more than euthymia. I just assumed it was normal exuberance after being depressed for so long- and suddenly I was smiling and laughing and making plans for the future that I couldn't even imagine a week ago. It made it so much easier to pick up the pieces of my life and go on.

I miss those days, before I was this well mood stabilized. Because after looking into the abyss that is depression, I need that bump. I need a reason to look towards the future, and to forget about the hell, to get over what this last episode has cost me. Both what it has done to my life- and to my soul. I swear, there has to be a limit to the number of times I can go though this. It will just kill me one day, my soul will die.

But tomorrow I have a very good thing- I am getting a massage. It is one thing that I can enjoy no matter how depressed I am, because nothing is required of me. I just have to lie there. You can't beat that. Of course I have had massages that weren't so enjoyable because she was working really deep. But I don't need that tomorrow. I just need easy.

Thursday, January 9, 2014

B12 or placebo? I think I'm doing better

Today was better. Still not great, but not like it has been. To what do I attribute this?

I have taken B12 in the past. I really should, because I take metformin due to the Zyprexa- and there is a lot of evidence now that metformin can really lead to B12 deficiency- which can have mood and cognitive effects.  But I somehow stopped, figuring that what is in my multi is enough.

My mood symptoms have been so extreme and so random that they have felt very biological. At times I am so depressed I think I will pass out. And then an hour later I am agitated and pacing. It makes no sense, and doesn't feel like rapid cycling- I am not manic.

So when I found my bottle of sublingual B12 under a pile of junk a few days ago it got me to thinking- and I have been megadosing on it since. And now I am starting to feel better. I don't know if it can work that fast, but I am just glad.

It would have been nice to get a B12 level before I started taking it. But that would involve calling doctors and a trip to the lab and putting off taking the vitamin when I couldn't wait another day. There was no way it was going to happen.

Today I still had a period of time when I felt depressed and extremely exhausted like I would collapse, but it lasted a much smaller portion of the day, and it only hit me once. Fortunately it was very light at work today. I even made some headway on paperwork.

I know tomorrow is not likely to be a walk in a park. I just hope the trend continues. It is almost the weekend- I have almost made it.

Wednesday, January 8, 2014

Better today at times? I think a little bit, some of the time

This is not saying a lot. Things are still very bad. But I'll take any improvement I can take, even if it only comes in bits and pieces- between my periods in which I feel so depressed I think I will collapse, and then when I started feeling agitated and like I am screaming inside.

I am limiting my klonopin use to the half milligram that I am prescribed (I take half of that at night, and half mid-day when the screaming becomes too intense). I have been on higher doses, but I think that higher doses are not good for working and driving and are potentially destabilizing.

I think I am afraid to call the doctor because I am afraid that, whatever he suggests will make me worse before it makes me better, and I cannot afford to be worse, to be less functional.  But also because my faith in medication is pretty low right now.

Tuesday, January 7, 2014

My mind is broken

I am feeling things today that I haven't felt in years. And I'm back up on the higher Zyprexa- not sure if that was a good or a bad move- lowering the dose did seem to help for a bit.

Then I am been doing stupid things like forgetting to take my Provigil for two days which put me into suicidal hell. Now I am back on the Provigil- but the screaming inside hasn't stopped.

I think I am eating badly. At times too any carbs, and then I will go and eat a meal with no carbs or skip a meal, and get low blood sugar.

Today I don't know how I made it through the day at work. But my therapist after work- that didn't happen. I just drove home. I coudn't go. I was to exhausted from the depression, and the screaming inside of me was too loud, I needed to go home and be in my safe familiar place.

I will owe her for the session. But what could I do?

I will call my psychiatrist if I have to- but first I really have to have a week in which my meds are constant and I don't mess them up or get sick and through them up, etc. I need to know what my baseline is. And somehow I need too get a week in which I get some exercise and eat healthy as well.

But really, I don't think the solution is more meds. But if it isn't, I don't now what the solution is, or if I have the strength to do it. It is a catch-22. Maybe my solution would be to take up long distance running. I'd never be able to do that.

I don't know what to do about next week's therapy. If I give less than 24 hour's notice, I get billed (and can't send that bill the insurance company). I can't predict ahead of time how I will feel- I didn't know until about an hour before that I would never be able to go. It seem silly to quit therapy in the midst of a bad depression, but I have done this before because it was too hard to get there.

Sunday, January 5, 2014

Depression again, very predictably

I didn't do anything this weekend. I am having such a hard time establishing any kind of routine or getting any kind of a life outside of work. It is particularly obvious on weekends, and this weekend I was particularly bad as I hadn't even gone in to work on Friday.

It didn't bother me until today about mid morning, when suddenly it did. And now I can't stand it. (I know, I'm not supposed to say that). 

With the winter, I really let go of what little I was doing outside of work. I have to change that. Easier said than done. I have had so little energy. But I need something in my life other than work. And, even the introvert that I am, I need more people in my life.

Friday, January 3, 2014

Snow Day

I was determined to go to work today. Hey, I used to live in Buffalo, what is a little snow?

But I got stuck in my driveway. My landlord had not plowed the parking lot and very long drive way at 7:30 am, and I got stuck. I tried putting cardboard under the wheels which didn't do that much- I still couldn't make it either to the road or back to my parking spot. I was stuck.

He is only plowing now- and it is my early day, so there isn't much point to going it. I cancelled all of my patients and I am staying home, although it seems pretty silly to be staying home when it isn't even snowing anymore. I feel guilty, but it is also nice to have an unexpected day off.

I think I need new tires. Or better tires. Or maybe it is just that my Civic, much as I love it, isn't as heavy as my last car was. I can't believe I got stuck.

But another day at home is good- another day for my brain to get used to less Zyprexa- which I have to say is going well.  My mood is actually improving and I have been able to do my paperwork much better.

One of the side effects listed I have seen for Zyprexa is euphoria. And I think that after a dose increase I do feel a little of that. But then it wears off. And it did wear off after that last increase- after maybe 2-3 months. But the euphoria makes me feel a little lighter- without it antipsychotics pull me down. And when the Zyprexa euphoria wore off it was pulling me down- which made me depressed. So it is time to go back down.

Do I just want to get back to 5mg? Do I want to try to go lower again? I don't know. For now, just 5mg. I do know that is the lowest my psychiatrist would prefer that I go- the FDA approved lowest dose for bipolar. But sometimes I think I could do 3.75mg. 2.5mg has never worked.

Wednesday, January 1, 2014

I ordered a dawn simluator

I have a light box, but I decided to kick things up a notch an also get this- so I can do two things in the morning (and the dawn simulator has the advantage of not taking any more time out of my mornings). I don't know if the research is there with the simulators, but I don't think it can hurt.

I think I did ok today with the less Zyprexa. I felt lighter. Towards evening I did start to feel a little anxious, but that is to be anticipated. Those H1 receptors are wondering where their Zyprexa is. I took a tiny bit of klonopin- but no more than I have been doing anyway recently.

I think I have tracked down another overseas source for my Provigil. It will be $320 a month- and I don't know if that includes shipping or not. I am used to paying $100 a month. I can afford the higher price, but things will be tight. It just makes me mad. I have a high deductible plan, and I use out of network providers for my mental health needs (as there are hardly any in the area who take insurance), so I am spending thousands out of pocket every year. And then they won't cover this.

I just read that half of all psychiatrists do not accept insurance- the highest of all disciplines. Why does it have to be so hard to have a mental illness? And I am not the best person to be mailing in my receipts to my insurance company. I think one year I was so depressed I didn't even do it. But that is what my insurance company hopes will happen- that I will be less than perfect with my claims. This years I have been better about it.

Goodbye 2013

I had wanted to stay up last night to see the ball drop on TV. To write in my journal. To make plans for the new year, to reflect, do dream. Instead I went to bed.

I was too depressed to stay up. I wanted the oblivion of sleep. I was tired of these mood swings.

It is common for depression to lessen towards the end of the day, it is a typical pattern. So after an agonizing day at work in which I decided I was going to have to either quit my job, take a leave or absence, kill myself- something- I suddenly started feeling better around 4pm. At first this felt like relief, and then I started to get mad. It is too confusing. How can I figure out what to do? How can I live my life? Make decisions?

My instinct tells me that more meds are not the answer. I need more sunlight- or more light therapy. I have upped my creatine, which I wasn't taking a full dose of- and which has been shown to help with depression. Maybe I will start taking B complex again. What I really need to do is exercise, and I think that I will today, if only for a little bit.

To many of my meds make me tired and want to do nothing- which is exactly what I am struggling with now. I can't raise meds that will increase my lack of initiation and agency- I can't be fighting both the meds and the depression. To fight the depression is enough. Plus I am already maxed out on my antidepressant and my Provigil. That only leaves my Zyprexa, lithium, or Zonegran to raise, which I would rather not.

If going up is not an option, maybe down is. I lowered my Zyprexa last night by a smidge- less than a quarter of a pill. I don't even feel the difference today. Hopefully this will work, and I will spend 2014 on less Zyprexa.  But I am a realist, so if it doesn't work, it doesn't work.