You Won't Die From Not Sleeping!

My pdoc said this to me, jokingly, this morning. I am WIRED for sound right now. I cannot sleep. Last night I went to bed at 9:30, because I had a busy day ahead of me today. So much for "sleep management" at 11:30 I was still awake, 12:00, still awake, somewhere around 12:30 drifting of and then 2:30-ish WIDE awake and could not, no matter how hard I tried, get back to sleep.

It has been awful...all week I finally fall asleep only to wake 2,3 or 4 hours later (one day 5 hours...WOOHOO!!) I maybe drift off for a few minutes here and there, and although I don't seem to be sleeping, a couple times I dreamt, so I must have been....but I look at the clock...and barely any time has gone by. By the third night of not sleeping I took some muscle relaxants to try to help me (thus the 5 hrs sleep)...but tried again the next night, and then again last night, and nothing.

On top of it I have so much more energy, but it is just racing through me. I don't feel like I am appearing/acting that odd, or that my actions are expressing the amount of energy I feel inside. I'm still having motivation problems....but inside I am explosive, heart racing, anxiety ridden, irritable to raging angry and then depressed, but the depression is not laying on me like a fog, it's coming at me like a raging river, pouring out of me at inopportune times. In between I feel elated, excited, energized...even with no sleep. I don't know what's going on?

Withdrawal from Valium might explain some of the symptoms...like maybe I am having rebound sleeplessness, irritability and anxiety. I was taking 10 mg for almost 10mos and then about 1-2 mos ago I increased it to 15 and then sometimes 20mg. I started taking more because I just couldn't face how I was feeling.

I did come off 15-20 mg rather quickly (over a week period), but I knew, psychologically I could not go off slowly...I have tried and always fail. I believe I have had excessively happy hypomanias years ago...where I did not sleep and did some bizarre things that I cannot imagine myself doing now. This is different though.

I am really wondering if this might be my first "true" hypomanic state, since I started to see a psychiatrist. Usually, when my mood has gone up, it only lasts 1-2 days and most of my other symptoms just disappear...no anxiety, no irritability...still no sleep, but basically the depression disappears and I am replaced with a joyous counterpart who exudes strength and charisma.

This time I am all over the map, and it is not making sense to me that I have this much wild energy racing through me, but still feel so many bad feelings...(depression, guilt, sadness, anger, anxiety). All I want is to sleep, but I asked my pdoc what to do and he said he did not want to take all this energy away from me. I was hoping he would give me something to help me sleep...Why can't I ask more directly?

He said he did not want to sedate me when I finally was feeling more energetic. He wants me to look at it and use it in a positive way, because I have been so depressed for such a long time with no break in my mood.

He said, he doesn't want me to feel like he is not supporting me, or dismissing how difficult not sleeping is, by saying that, but he wants me to really try to use this time to push forward.

I understand what he's saying, but I feel like I'm losing my mind. I don't really have a choice though, unless I go get some OTC sleep aid.

It just so happens I "gave up" my hoarded old meds to him last week...trusting I would get medication if I felt I needed it. If I had not given them to him I could be sleeping right now as I had some trazadone. I do recognize that OTC's and/or "self medicating" with old meds would be counter-productive to what my pdoc is saying...I just don't know if I can keep up this racing pace, with no sleep, for another week. Argh...God, please...let me be normal again!!!

It All changed this Morning

I woke this a.m. to go see my pdoc. All I wrote yesterday seemed like gibberish. I felt more stable this a.m than usual. So I abandoned the plan to get him to read how I'm feeling and decided to act on an important thing we have been working on in therapy..

Last week, after entreating me for 2 weeks to bring in my hoarded meds, he made a direct request for me to do so. He never does that. It got me thinking all week about what he has said to over the years about my suicidal thoughts and how hoarding old meds and especially sedatives was an unhealthy "safety net".

My safety net was what I called them...because I felt if I just couldn't go on I would have a way out if I saved as much as I could. The problem becomes I start obsessing about whether they will work or not, whether I will actually die if I take them, whether I had enough to die and not do just physical damage to my body, how I can ensure I die. The other thing these hoarded meds do is tempt me to misuse the old sedatives to help me calm down. It's not fair to me or my pdoc. How the hell is my pdoc supposed to assess me if I'm start taking things he doesn't know about, on top of what he's prescribed.

So today I put the meds in my bag, took them out, put them back in...then I exited the house, went to his office and told him I had them with me, but I was not sure if I could give them up.

He never insisted, in fact the opposite. He said it was my choice. I felt good about that understanding that I require autonomy and reflected on how them sitting in my dresser taunting me to take them was truly unhealthy.

I handed them to him. It was a good decision. Last time I did this I had a fairly large amount of epival and I realize that as soon as I handed in that hoard I immediately stopped obsessing about killing myself with Epival.

I feel more honest now. I feel like I am learning to trust that should I need something to help me again my pdoc will be there for me still. I think for some reason I fear being left with no way to feel even a bit of relief. Like what if he left and all my support systems broke down. He said he's not going anywhere. I'm going to try to trust that statement and let go of the fear I will be abandoned and desperately ill, with no one willing to help me.

Preparing for my Therapy Session Tomorrow

So many feelings, thoughts, worries, constant ruminations have rapidly passed through me this week that I think I need to write out what I want to say so I have some understandable piece of information to share with my pdoc tomorrow. Also, I don't know why, but I feel it is not my place to ask Dr. X. to reveal some of these things...so maybe I can do it on paper.

Throughout the week I've been writing my ruminations out as they happen, They are coming at me rapidly and feel intrusive, as opposed to my consciously trying to think about them. I wake and the flood of thoughts starts. Often I can't remember what it was I was thinking by the time I get to my session, or something there distracts me from what I wanted to ask/say...so I'm going to try to consolidate some of these:

1) Something simple Dr. X. said in my last session triggered massive stress about going to the hospital. Although, when he said it, I felt he was being thorough and I was really being cared for.

I'll paraphrase: He said, the hospital might be a good place for me to be observed by others in case he has missed something. Panic and distrust set in a couple days later.

I started wondering what Dr. H. said about me 2 yrs ago, (he was the Pdoc who interviewed me for ECT and my stay at the hospital), then I worried about what Dr. R. (Pdoc at a couple outpatient programs I attended) said about me, then I started worrying I would get a Pdoc in the hospital who was not my advocate, like I feel Dr. X. has been, then I started to worry about being diagnosed with a personality disorder, or some other uninsurable illness, or worse they would miss my depression altogether and I would feel like a fraud, because my mood is so bizarre, labile and reactive to things around me, then I started to worry about my insurance company seeing this as a good opportunity to cut me off, then I started worrying about ending up without enough income to take care of myself....and it just kept getting worse from there.

What did these Dr.s' say about my depression? Did they send Dr.X. a report? If so, can I know what was in them?

2) I am afraid if I go into the hospital the same thing as last time will happen and it will misrepresent my depression and how bad I usually feel. This is what happened last time I went in for ECT.

My mood lifted almost immediately, long before ECT could explain it. Placebo effect? I'm not depressed? Something else is going on? Who knows why?.. .although I wonder who can tell if it was ECT that affected my mood during the latter part of my stay after receiving the requisite # that usually affect people's mood. Also, when I review my mood diary my mood did stay up for a few weeks after ECT.

What if I get some dogmatic, or unknowledgeable Pdoc and they really do miss that I really am depressed. I get so much feedback that I don't seem like I am depressed on the outside. This I can't even understand myself. Even the Occupational Therapists who see me at the studio keep saying more than once or twice that "[I am] so high functioning when I am in class teaching, or involved in other group projects, that it is hard to see [I am] unwell"...except that I've been breaking down in tears most of the time I meet privately with them...so I feel confused by their comments.

My mood swings feel out of my control. The only thing I can liken them to is a, seemingly, inactive volcano. It sits and looks innocuous, like a beautifully functioning mountain. It seems safe and normal for a period of time. All the villagers living at the base of the volcano think everything is fine and then suddenly boom. The thing explodes and like the lava my internal depression comes flowing out, much to the surprise of those around me. (other than the people who really know me...they KNOW the lava is always at the surface). How the hell can I switch on and off like I do and this be an illness and not something I am in control of?

Also, I know that if I went into the hospital and my depression was dismissed as not real I would be even more confused and depressed than I feel now. I have struggled, (unsuccessfully I might add), for so long to accept, what Dr. X. tells me...and I trust him. What about someone I do not trust?

What happens if all that falls apart and I have to start again believing or accepting some other diagnosis? The majority of me still believes all this is my fault, that it is my own self that continues to make me sick.

3) I am becoming increasingly paranoid:

(but if I really am paranoid...how is it that I have some insight into the idea that some of my thoughts might not be real? So I feel here, like with my depression, my symptoms are inconsistent with the idea of feeling paranoid or depressed)

• That the Clubhouse staff thinks I am not fit for teaching the next session due to all the breakdowns I keep having in their offices and when talking with other members I trust.
  
• At the same time I feel they see my reactive "functioning" mood as a sign that I'm in need of no help. (I know...another contradiction). The constant reminder by the OT's that my "high functioning" is in direct conflict with my diagnosis is stressing me out beyond belief. I feel like I'm fake, or my depression is a delusion, or something else...I don't understand what.(I hate the terms high/low functioning, but don't know how else to say what they are referring to)
  
• That my sister's, my step mom and husband are colluding against me...I have overheard them talking about me on the phone and my husband has told me they talk about my treatment making me worse.
• I have a lot of internal conflict about whether therapy is good for me too. I have never felt cared for like I do in my sessions and maybe that is unhealthy? Maybe I stay sick because I have no other source that cares in the same way and I am afraid of losing that support? I often wonder if I were to have no reminders I was unwell...no Pdoc, no medicine, no mental health community (i.e. Art Studios, my friends, etc)...if I would just magically get well.
  

4) I feel like my mood is cycling so fast right now:
As of tonight I will be off my last medication. I don't think my mood cycling is related to that though....I think it's related to my above worries. I'm up for class, feel more energy at the start of the day, get anxious, or irritated, agitated, or enraged and depressed, as the day goes on...sometimes within an hour or so of feeling a different way/sometimes all at the same time. My sleep is very interrupted. I wake up and all the above thoughts go over and over in my brain. I feel better in the early morning (more awake)....but worse as the day progresses and exhausted by 1 or 2 still. I am having difficulty concentrating and making tons of mistakes everywhere; at home, with my art and my driving is scary because I seem to disappear and can’t focus.

• Eg.: On Friday I went into the clubhouse to do my own art (no teaching that day). When I went in I felt so irritable...on the verge of rage, but I forced myself to go thinking I would feel better if I could get distracted by my art. While there I was asked by one of the OT's when I would be available to volunteer after the Aug 6-17th break (they're closing for 2 weeks). I just broke down crying. I feel so confused about how I am feeling. On Thursday at a meeting I felt like I was going to blow up inside.

The feeling like I'm in crisis, but no one is noticing. I have explained to them that I may go into the hospital. I want to be fair to them so they can make up the schedule and decide if I am allowed to help teach drawing classes and be a Mentor for others in September or not. I don't understand what they want me to say when I don't even know if I will be in the hospital or not.

I am confused about Dr. X.'s suggestions of a hospital stay. I have no idea if he is serious or if it's just an idea, and if he is, when it would happen....so I don't know what I can/cannot commit to. (ask him for clarification and a more definitive plan) Also, his bringing up the bipolar/ECT study and cognitive problems makes me wonder if ECT is a good idea. Is that what he was saying? I know I don't have bipolar, but Dr. X. has said I have a "bipolarity" to my depression. Does it concern him I may lose some more cognitive abilities if I have ECT?

So, to conclude: I feel like I appear "normal" on the outside to most people, and explosive, depressed, suicidal, irritated, can't think straight, on the inside and every once in a while that volcano of emotions allows itself to come to the surface.

The explosions usually happen: a) when I'm on my own, b) when I'm talking with someone I feel safe opening up to. c) When I feel really misunderstood and/or the severity and impact on my life my depression has had on me is dismissed or misunderstood. Although I feel like I cannot control when they explode to the surface I must be able to to some degree, otherwise how am I seemingly okay one minute and not the next?

I was thinking last night how some people believe in God - something else being in control of their destiny. It is like I cannot accept I have a mental illness and that I have little control over some aspects of how I feel or act. I feel like it is my personal responsibility to make myself feel better and I am failing miserably. When I go high....I can see it is like a light switch gets turned on and I did nothing to affect my high mood, but when I am low, I feel like I did, or am doing, it to myself.

God, I need a shut off switch on my brain.

I am so lucky to have the Pdoc I have

The following is what I remember about part of today's session. I know I didn't entirely capture all that was important, and I may have made some mistakes in remembering as I wrote them down 5-6 hours later:

I went into my session feeling apathetic, hopeless...like I will never be well, or have a chance again. I ruminated about suicide almost the whole 45 minute drive to my session.

Last night I printed off my last blog post and this a.m. I asked my pdoc to read it, because , in my sessions, I often feel I get so overwhelmed by my emotions that the message I need him to hear is lost. I often remember what I needed to say when I get into my car to leave. I feel like I can express myself more clearly in writing.

He read it, and then silence. I felt intensely ashamed and embarrassed. Once again he suggested the hospital. I told him I would be willing to go after the 19th of August, when my commitments are complete. I expressed concern and a strange feeling about "planning" a hospital stay.

Dr. X.: Why?
Me: a) What if I show up and my symptoms are no longer there? I know what will happen. I will show up, my symptoms will temporarily disappear(because as I usually seem to manage around strangers I will try to be normal and no one will believe I need help. Also, I do not trust other Pdocs/Dr.'s. In fact I only trust [him]. What if they won't let me out?
Dr. X.: The chronic nature of your illness is understood. Yes, you may show up with no symptoms, but I will do all I can to help you while you are there. (I think he meant he would express to the inpatient Psychiatrist what I've been feeling) and how I am really depressed despite this mask I can often manage to place on my feelings and despite being actually able to enjoy brief and sometimes extended moments in time. (My mood is VERY reactive to the situation sometimes. At other times nothing will bring me up.)
Dr.X.: I really think a hospital stay would be a good idea. I like to think I am a good Psychiatrist, but maybe I am missing something. It would be good to be assessed by someone else.
Me: I have never once thought my not getting better had anything to do with your competence. I believe you are doing all that is possible to try to help me. I know you are a good Pdoc. In fact I would say you are the best Dr. I have ever had.
Dr: X.: I want you to bring your hoarded medications to your next session. I rarely make a direct request to you, but I think the amount of medication, and having it around the house is unhealthy and impeding your mental health.
Me: I see it as a safety net. If I cannot take it anymore I have a way to end it all.
Dr X.: Your safety net is unhealthy. Use the hospital or the health care system as your safety net.
Me: I would never go to the hospital.
Dr. X.: Why?
Me: Because, I would get there and within minutes of talking to someone I would laugh, or seem better and they would send me home. I would feel totally dismissed and feel like my needs were dismissed.
Dr. X.: I will give you my home phone number. If you are headed to the hospital call me and I will call/fax ahead and explain your circumstances.
Me: (at that moment I felt so trusted and cared about) I would not feel comfortable with your home phone number. I am not going to intrude on your personal time. I would not call.

I guess what I'm trying to show is how openness and honest dialogue with my pdoc, (about symptoms, med problems, eg. hoarding for suicide and I've been "sneaking into my stash to try to sleep"), directness, explaining my fears about the hospital and feeling trusted and cared for can be so therapeutic. I left today thinking I can hang on for a while longer as long as I have my pdoc for support.

P.S. I will tell you about the dream I had last night and our interpretations tomorrow.

I Cannot Take it Anymore.

I am so depressed right now I feel like I am not going to survive. I spent more than 3 hours last night with my husband yelling, blaming and berating me for my illness, and my unsuccessful attempts to get better, (never mind that I have tried all kinds of things to help myself), tons of different meds, hospital stay, psycho education programs, different psychologists/counsellors, Group therapy ECT, weekly therapy...the list could go on forever.

He says I haven't done enough about trying alternative therapies like acupuncture, diet, hypnosis etc. That I do not follow my pdoc's recommendations about diet, exercise and supplements like B vitamins and salmon oil.

I tried to explain to him that part of my symptoms are extreme fatigue and amotivation. I have tried the food thing, I try to cook from fresh foods and cut out white flour, rice etc., but most days now I can barely cook so I have been cheating and buying pre-made dinners. The effort it takes me to eat better and eat low glycemic foods, or seek out a nutritionist who even can conceptualize what I am going through is overwhelming to me.

I believe Major Depressive Disorder is an illness. I also believe there are far too many unqualified people trying to push unproven "cures" on people with major depression. So I feel really vulnerable and believe I will be taken advantage of by an unqualified, uninformed purported healer. Maybe some of the things can make a small difference for people whose depression is less severe, or situational, but I don't believe changing my diet completely, for instance, will make me well.

What makes me really sad, and angry about my husband's self proclaimed "supportive" comments is my feeling like even with the awful, life destroying symptoms, recently I have really pushed myself to try to get better.

For the first time in years I have managed to start, and maintain something resembling work (albeit only volunteering)... even when my symptoms are at their worst. Although, even here I am flailing and not "there" (in my mind or enjoyment) like I was in the beginning.

Thankfully, one position ended for the summer and I managed to give notice for another. I do still have two more classes for one position, and I've volunteered for a summer mentoring position at the Studio until August 9th. I'm also trying to force myself to get to the studio as much as possible, but I am having a hard time with that.

Consistently getting all this negative feedback from my husband makes me feel like all is for nought. I feel like I try as hard as I can and no one gets it. Everyone thinks I'm just lazy or deluded about being depressed, because, according to them I am up when they see me...so if I can manage that, why can't I be like that all the time. I even think my pdoc must wonder sometimes because I can go from distraught to laughing in a matter of minutes. Even I do not understand that.

"Everyone has there up and down days" is the statement of the day from those I try to explain what's going on inside my head. If they believe my depression is anything like an up or down day...they have no clue what this internal hell is like.

I have gotten to the point where I've given up. I feel suicidal almost all day, almost everyday. I think of what I would say in my suicide note, think about what I would say in personal letters to my family members and pdoc. I count all my hoarded medications. I try to figure out if I would die if I took them all, but can never find consistent information about that. I don't want to survive and be both physically and mentally ill because of some stupid miscalculation I make about what I need to take and do to die.

I go over and over how I could kill myself and have it look like an accident, so my family is not left with the stigma that I committed suicide. I even try to protect my pdoc and think of ways to commit suicide where no medications he prescribed are involved. Basically I want out so bad, but I do not want to hurt anyone else.

I cannot take life anymore. All I do is sleep/crawl into bed to avoid life. I am so tired all the time I literally feel sick. I feel anxious about everything. I walk into the grocery store and just disappear. I'm sure it's anxiety. I have needed new clothes for months now, but I cannot manage to get myself out of the house and to the store. I can never sleep through the night, because I worry about getting a job, getting better, how others perceive me, and being a constant burden on my family and even my pdoc. I also ruminate over and over about getting myself out of this hellish, unlivable existence. I see no hope of fixing or changing any of these things anymore. I really am ready to give up.

Paranoia

Just now I started thinking about the whole scenario I just wrote about yesterday. What are the chances that a person I am a volunteer with at the studio would have the exact same thing happen to them at the exact time when I need to do exactly what they were able to do, i.e. stand up and say my symptoms are making me too ill to continue the commitment I made.

Then I started thinking maybe the whole thing was a set-up. (...because of course the world rotates around me....not!). I live in a pretty large city. At the studio there are about 400 members, approximately 20 of whom come in fairly frequently, like my co-worker and I, and some who come in very rarely if ever.

What are the chances one of those people would volunteer to do the exact same position as me and then have such similar circumstances, but be able to follow through on their commitment to themselves, while I tread water and try to save myself from drowning. I suggest highly unlikely and improbable.

I'm feeling paranoid again. (Can you be paranoid if you you think you might be paranoid???) I'm unsure about that one??? I think I'm feeling spied on again. Like the person was checking me out on behalf of my pdoc. I have to say, given what my pdoc is like, this does sound strange as I'm writing it and even highly unlikely.

I always feel like no one gets how I can be so depressed, yet become the person other's need me to be in the moment. For example, I am amiable, conscientious, caring, seemingly energetic during my classes...then I crash the second I leave the situation. Everyone, except those close to me, says I don't act or seem depressed. I think I worry my pdoc doesn't believe how much I am suffering. I am scared I am going to slip through the cracks and end up with no psychiatric help, still severely depressed, no job and no way to be able to take care of myself.

Why Can't I set Boundries and Say No?

I am a member at an place that offers art classes, art supplies and studio space/time for people (members) with particular major mental illnesses. At this studio you can be a participant in classes, help teach classes, or be an instructor. Most of the classes are taught by members. I have been a member and taken a few classes over the past few years, but this year I pushed myself to do more.

My pdoc and I discussed creating a community for myself. I love this studio. The members are great. Also, there are occupational therapists who are, in my view, the best I've seen. I feel like members are treated completely as equals by the O.T.'s, something I haven't experienced before. I feel valued and cared for. It is a great community for me.

This year I applied to be an assistant instructor. I am near the end of my second class and I love it, I love the people, I think the instructor is great too. It also gives that day some structure; gets me out of bed, provides me with a reason to leave home, etc. On top of that it gives me a sense of accomplishment, and my life a small sense of purpose and meaning. So I decided to do more.

I now volunteer to help with another class as well. I also attend an array of planning and information meetings. I just finished taking another course there and now I have volunteered to help people move from structured classes to working at the studio on their own. On top of that I have committed to volunteering once a week at our city's Shakespeare festival.

The problem? I am completely overwhelmed and depressed right now. For the past maybe 9-10 weeks my depression has been worsening and I am as close to suicide as I have ever been, maybe closer. Every therapy session for at least the past 6-7 weeks Dr. X. has either asked, "Have you considered ECT again?", or "Have you considered a hospital stay?".

Dr. X. is not the type of pdoc to TELL me what to do. I can only surmise these queries are his way of "suggesting" these options. I have thought of both and I think I need both. I have, however, made commitments to Studio and to the Shakespeare festival. I am loathe to break commitments, even if I know they are getting in the way of my getting well. It is almost an obsessional urge to keep my word, but also because I fear the consequences.

I believe I can manage to back out of the Shakespeare festival after the required 7 shifts and feel okay about that. I have just completed week 4. The real problem is that I just cannot, and will not, break my commitments to the studio. I fear there will be repercussions if I do. I worry I will lose the O.T's faith in my reliability. I also am afraid I will lose the connection and respect that I have worked so hard to gain with other members in this community. I fear the loss of future opportunities at the studio, for instance other instructor opportunities. There are a million reasons why. I told my pdoc my commitments end August 19th. That is when I would consider a hospital stay.

Now the real reason I am writing this is because one of the other studio helpers called in sick last week and then this week called to say they will not be returning to help because of their symptoms. (They told the OT to explain that to us).

I am so proud of this person. I am also jealous that they understand their boundaries, that they are able to say no to take care of themselves, that they put themselves and their mental health first. When will I get there? Why do I not put me first? Or why do I have such a warped view of what putting me first looks like. (i.e. avoiding judgement and punishment). I hope my co-helper will be okay, and I hope I can learn from this person's strength.