Sunday, January 27, 2008

Delusions of Being Unloveable or Rejection Sensitivity?

I am not sure if what I experience are delusions, but today I received an e-mail from my sister. She had forwarded a letter from a friend we had in grades 8 and 9. This friend had been trying to contact me for the last two years via e-mail. I simply never returned her e-mails because I feel so ashamed of what I have become.

I felt she would be repulsed by me, like I was completely unlovable and such a loser for being so depressed for so long. I felt she would reject me, or even worse, make fun of me and who I have become. I feel embarrassed for not being able to work. I feel like a loser for never having kids, which I chose because I knew I could barely take care of myself, let alone a beautiful child. I feel like I am a bad person and no one will like me when they find out who I am.

In the letter my sister forwarded to me from our old friend the friend was so kind and empathetic. She said so many kind things about me and our times together. She sounded genuinely sorry that I was struggling so much. I don't really know what to believe about how people will react to me now. Maybe people understand more than I believe they do?

Saturday, January 26, 2008

The Music in my Head

I increased my Prozac last week to try to lift my mood. By taking 10mg Valium and 0.2 mg Clonidine a day I had managed to get the teeth tapping/grinding to slow down and the obssessive, relentless music inside my head had almost disappeared.

It is back with a vengeance. Since Thursday morning I have had the same 5 or 6 bars from the third movement from Sibelius' violin concerto in D minor, Op. 47 stuck in my head playing over and over and over and over and over and infinitum. While I love the music, it is wearing on me.

So I'm posting all 3 movements hoping to pass the music onto someone else. (a sort of magical cleansing from my head to yours). The part that is stuck in my head can be heard at approximately 1:28, and 4:40 in the third movement. The version I have on my ipod is a Deutsche Grammophon recording, Gil Shaman, Violin, with the Philharmonia Orchestra, Giuseppe Sinopoli conducting. It is so so powerful and there is something haunting about the piece.

I found a copy of all three movements on Youtube:

Concerto for Violin and Orchestra in D minor, op. 47:

Second Movement - Adagio di molto

Friday, January 25, 2008

In 2007 Disability Tax Credit are Available for Mental Illness For the First Time

I recently discovered that the Canadian tax laws were changed last year to include (for the first time) mental illnesses as a disabilities in regards to taxes. If you have a mental illness you may possibly be eligible for the Canadian disability tax credit (a approximately $6500.00 tax credit).

Not all people with mental illnesses will qualify as there are stringent qualifying criteria, but it is definitely worth asking you pdoc to fill out the required forms. I have included links to the form and tax information below.

Since I found this out two plus weeks ago I have wanted to ask my pdoc both if he thought I might qualify and if he would fill out the form, but two appointments went by without me asking because I was afraid to do so.

I find the whole act of asking for things I want incredibly difficult to do. When I worked this self esteem problem interfered with my ability to ask for promotions, or wage increases when I clearly was worthy of both. It was so bad that even when I had a physical illness (CMV) that caused hepatitis it was almost impossible for me to ask for a leave to take care of myself. When I did, I went back to work far to early, and immediately to full-time, because I was afraid of how other's would judge me.

This same dynamic played itself out when it took me more than 2 years of Major Depressive hell before I managed to get the courage to ask to take a leave from work due to my depression symptoms. I was suicidal and so sick, but I was unable to broach the subject to take care of myself. It is as though I do not feel worthy of help. So yesterday, I took the tax credit form as an opportunity to try to combat this dynamic. I forced myself to broach the subject in my session.

It was an exercise in asking for help, in approaching an authority figure for help, and in asking for what I wanted. I have been so stressed about this for 2 weeks. In the end, after I asked, it did not seem as difficult as I thought it would be.

Dr. X. was so open to my request. He told me it was important to understand what my rights as a citizen were and that he would be happy to fill out the form. He also said he couldn't see any reason I would not qualify. I asked him if he wanted reimbursement for filling out the form (Canadian health care does not cover these types of tasks). He said he never asks patients to pay to fill out medical forms.

The way he spoke with me about my request and the way he was so kind about filling out the form, made my experience asking for help such a positive experience. I am going to hang onto this memory, so when I need to ask for something I want again, from someone else, this will be the perspective I approach the request from. A perspective that believes a positive outcome is at least possible, and perhaps even likely.

Here are the links to the T2201 Tax form and two other information documents:

T2201 Disability Tax Credit Form:

Disability Tax Credit Info (from an organization that fights for our rights:

Detailed Info from Government re: disability tax credit:


Friday, January 18, 2008

Early Medical Intervention For Major Depression

I am sure I am not unlike many people with treatment resistant depression insofar as I am constantly wondering WHY? Why is no medication working? Why does therapy, while being supportive and managing to keep me here on this earth, not help me become well? Why do others get well with medications, or ECT, or therapy, while I continue to struggle?

I recognize there are no hard and fast truths to any of these questions. I do however, have theories about my own circumstances.

One theory is that I was not diagnosed, and "fully" treated for depression until I was 36 years old. Now that I understand what a depressive episode is I definitely had severe depressive episodes as early as 17 or 18 years old. From what I know of my history I had at least 7 or 8 major depressive episodes, lasting anywhere from 3-4 months, up to two years before my primary care physician recognized I was depressed and needed a referral to a psychiatrist. I moved around a lot, so I saw many family physicians between 18 and 36, it was my current Dr. who saw I needed help.

I say "fully" treated because between 19 and 36 I saw at least 6 different psychologists. Not one mentioned depression was an illness, or that there were medications to treat depression, or that I was having a major depressive episode.

The first I saw was during my first year of university when I was 19 years old. This psychologist told me my thoughts of suicide were because I did not have a clear "career path". They had me do career testing, which showed the profession I should choose was in the corrections system, that of a "Prison Warden" was at the top of the list. If you knew me you would see that this should have raised red flags. I am so left leaning that I do not even believe in the corrections system. I think this career came up because I was having severe "black and white , all or nothing thinking". Also, my father was a policeman, so I grew up in a world that embraced the corrections philosophy. The psychologist never once explained I was depressed, or that depression was a treatable illness.

Three years later I returned to university. That year I had another severe major depressive episode (MDE). I was suicidal most of the time, had a plan in place, visited the place I was going to commit suicide numerous times, found myself crying uncontrollably in class, was unable to do any assigned work, and was completely distraught for no apparent reason. I am not sure how I managed to take myself to the university's counselling department, but I did. I saw a psychologist who really helped me using cognitive behavioural therapy. She was very helpful, but again never spoke to me of depression as an illness, or told me about medications that might help.

For the rest of University I was well and upon leaving school, desperate for a job to pay off my student loans I took a position in a large corporation. Almost immediately I knew I had done the wrong thing. I did not belong in this kind of job. I owed $30,000 though and I felt trapped by my debt. Problem was, I was good at my job and I kept getting promotions. With each promotion and wage increase it became more and more difficult for me to extricate myself from the organization. Not because I was greedy, but because of my intense need to feel feel financially safe. Also, contrary to reason, with each promotion my self esteem seemed to sink and I feared I would be fired, or would never find another job.

In my 11 years working for that corporation I saw three different psychologists for three separate MDE's through the companies employee wellness program. I did not do well with any of these psychologists. During treatment not one of them mentioned depression as an illness, or that I may have an illness, or that medication might help, despite my repeating my depression history to each of them.

During my fourth MDE at the organization I began having anxiety attacks. I had been an intense "worrier" since as young as I can remember. As early as 9 I used to sneak into our medicine cabinet and take whatever I could find to help me sleep (neo citron, cold medicine, 292's, etc.) I could never seem to sleep because I worried about everything. This was different though, I began to feel like I could not breathe when I was having what I now recognize as anxiety attacks.

I sought out an external psychologist. I saw her for therapy once a week, for two years. It did not help at all. I gave up. Again, no mention of depression as an illness.

I was feeling so desperate. One day I was in a bookstore and was looking at books on the psychology shelves and I stumbled on the book "Listening to Prozac". I bought it and read it. It was the first I had ever heard of depression being a bona fide medical illness. I had never heard of anti depressants. I was dumb founded.

In the book the author discussed a theory about the "kindling effect" of untreated depression. His theory was that with each untreated MDE the episodes become longer, harder to treat and closer together. This has been my exact experience.

Why had no one told me about this? Maybe I was stupid for not figuring this out earlier on my own, but this was before there was really anything being written about antidepressants in the newspapers and the professionals I saw for help never mentioned a thing about medication.

After reading a few more books about antidepressants, some pro, some con, and some by people struggling with mental illnesses, at 33 I went to my family doctor and asked her to give me an anti-depressant. We tried two different ones. They did not help.

I went back to my Family Doctor and she referred me to an outpatient program at the hospital. They had me join a class that taught cognitive behavioural therapy and then had me join a 3 month psychodynamic group therapy group. Despite both groups being taught as part of a psychiatric program there was, from what I recall, NO talk of medications being an important part of fighting depression. At the end of the psychodynamic group I was still severely depressed and quite vocal in the group about having no support once the group ended. The psychiatrist leading the group knew I was still depressed. Yet, no one followed up with me after the group ended.

A few months later I became spontaneously well for approximately a year and a half. I began slipping into a severe depression the summer of my 36th year. I went to my Family Doctor again and she finally referred me to a mood disorders clinic, where I met, and began seeing, a private psychiatrist for the first time. He is and was a godsend.

Now, six plus years into this MDE I'm still searching for something that will help me, but I believe I at least FINALLY, in the psychiatrist I see, have the knowledgeable and completely supportive help I needed all along.

I often wonder, had I received help at 18 or 19, instead of 36, would I be better today? Would I be struggling so hard to find something to help me?

Sunday, January 13, 2008

Suicide is the Leading Cause of Violent, or Accidental Death

I find it so disturbing that in British Columbia, Canada we hear so much in the news about how car accidents destroy people and the families who love them. Every time you open the paper, or watch the news there are stories about car accidents, or drownings, deaths by fires or murders.
There is even a 60 person gang task force being set up in B.C.'s Lower Mainland to deal with the number of murders this past year in the Metro Vancouver area. I was unable to find statistics for the number of murders in Metro Vancouver in 2007, but I am certain in cannot have more than doubled since 2005. If it had doubled it would mean 62 people were murdered here in this past year.
By contrast, in 2005, 403 people committed suicide. Where is all the support and the task forces for these people? The people whose deaths go so unnoticed? I rarely hear about a person committing suicide. Imagine if, like the 60 person gang task force, we had the equivalent number of people investigating and trying to prevent suicides as were committing suicide. We have 60 detectives working on less than 60 murders a year, so why not 403 more health care workers helping people with mental illnesses, or people in difficult circumstances work towards recovery and a desire to live?
Maybe as a community we need to be more vocal about how often suicide is happening and the impact it has on those left behind. Maybe then we would get the resources we need, more pdocs, more psychiatric support, more information about how to get the help you need, when you need it and more funding to help stop all these sad and unnecessary deaths.

Monday, January 07, 2008

Emergency 911...Police, Fire, or Ambulance?

I often have the sneaking suspicion that I am a magnet for both bizarre things happening and bad things happening around me. Not sure if this is what a psychiatrist might label "magical thinking", but is it a psychiatric thing if it really happens?

Take today for example. I took my dog, Bert, out for a morning pee at 6:00 am. As I stepped onto our sleet covered deck I heard the sound of glass shattering across the street at the golf course. I looked over and there was a white van in the parking lot. Its interior light was on and it looked like someone was inside it reaching over from the driver's side to the passenger's side. I wondered if I should call 911 (the emergency #) and have the police come and check it out. To me it both sounded and appeared that the Van was being broken into.

You are probably wondering why I hesitated to call. I guess I was worried I was imagining everything. So I went inside and out the kitchen window I could still see the light on in the van. Still unsure of what to do I fed the dog and then looked back and saw the light off in the van. I went to the front door and turned on the front porch light in case the suspected perpetrator decided to head my way. As I did I saw a man ride by on a bicycle with a duffle bag on his back. That did it. It just seemed strange a man riding a bike in the snow on our scary road (a country rode that is narrow with huge ditches on either side) and the duffle bag was the kicker.

I called 911, apologized for calling over a seemingly trivial matter, but they were happy I called. Within 2-3 minutes two squad cars showed up. One headed after the cyclist and one went over to the car. It seems they could not find the source of the glass breaking sound, but told me I was right to call nonetheless. When I left they were investigating the house on the golf course.

This brings me to why I feel like I am around for more bad or bizarre things than most people. I called my sister and asked her how many times she had called 911 this year. She said none. "How many times in your lifetime", I queried. Again, the answer was none. This was the 5th time in the last year I have had to call 911. All but one of the times were for accidents that happened in front of me.

In the beginning of last year I heard what sounded like someone breaking all the windows in the house the next farm over. It also sounded like a domestic dispute was taking place with a man screaming at the top of his lungs. I called 911 and the police came. It was actually coming from 2 farms over and a tenant was smashing tons of glass windows that were placed up against a shop. He was drunk and the owner was trying to stop him.

About mid- year last year the car in front of me at a major intersection in town t-boned a car turning left in the intersection. I called 911. In mid summer I was coming back from a visit to the veterinarian critical care centre. My very sick dog was in the car. The car behind me switched lanes and accelerated as I turned right onto my road. The van coming towards us turned left after me and was struck by the car that had just passed me. The van spun out of control. I sped up and it narrowly missed me, but unfortunately hit a telephone post across the street. Both drivers were badly injured. I called 911.

Then approximately 1.5 months ago I was sitting in my living room and I hear a massive crash and all our power went out. I put on my boots and went outside and saw that a car had hit the hydro pole in front of our house. It had hit it so hard that the utility pole had split in half . The top half had javelined itself back into the ground and was still standing. The car was like an accordion. It was so squished up I could not imagine anyone in the car surviving. I almost threw up as I headed towards the car to help the occupants. Miraculously I saw the drivers door push open and a man stepped out without a single cut on him. Despite his pleas that he was okay. I called 911. He was in shock and I was concerned he might have internal injuries.

All that was this past year alone. Previously, I was behind a car that entered an intersection on a green light just as a motorcycle with both a driver and passenger raced through the red light. It was horrendous with both the bike and the people flying through the air. The passenger died immediately. The driver was so badly injured his leg was bent backwards. It was awful. I called 911.

When I was in university I was on a busy Vancouver street when a panel van went by with the sound of a woman screaming bloody murder and "help me" coming from the van. I called 911. A few years ago I was walking up the sidewalk on another busy street. Traffic had slowed down and I looked to see what was up. A car was positioned as though it were turning left, but there was no road to turn on to. All the cars were simply going around the stopped car. No one stopped.

I looked in the car and saw a man hunched over the steering wheel. I went over to the car and the man was having a seizure or a heart attack or something. I ran to the closest store, called 911 and went back to the man to stay with him until help arrived. I couldn't believe all the people around never stopped to help and all the cars just kept driving. It's a sad world.

Maybe that's why I'm always calling 911. It may not be because bad things seem to happen in front of me more than in front of other people. Instead, it may be that I try to help when bad things happen. It frightens me that others might experience the same number of opportunities to help others, but might not stop to do so. I think I was afraid to call 911 this morning because who I felt like they must wonder about me down at the precinct. How can one everyday person witness so many emergency situations in one year?

I will tell you about the bizarre things that happen to me another time.

Thursday, January 03, 2008

Prozac and Tardive Dyskinesia

I am intensely worried. Remember I was telling you about my teeth clicking and the relentless snippets of music running through my head? Well my problems in this area are getting worse, not better, despite taking clonidine to try to help the teeth clicking problem.

My teeth "clicking has turned into a "chewing" like motion. This triggered a worry in me that I may be exhibiting symptoms of Tardive Dyskinesia. Yesterday I went to Pubmed and WebMD and searched to see if it was possible to get TD from Prozac. It appears that both patients and Drs have experienced Prozac leading to this side effect.

I began researching more and found I am having numerous symptoms. Obviously, I am not a pdoc, so I cannot say I have or do not have TD symptoms, because, while I can read what they are, I do not have the knowledge to determine I the physical changes I am experiencing are TD...but I feel I am exhibiting enough of what I have read to be really scared.

Here are the psychological and physical changes I have experienced since starting Prozac:
  1. My mood has lifted. It's not great, but it is way better than what it was. Sometimes I even feel good. This is a huge shift for me.
  2. My mouth is moving in a "chewing" motion, or a "grinding" motion. At times my teeth are tapping to the music in my head. (more about the music later). My jaw feel clenched while this is going on. It is semi-unconscious". Meaning I can stop it for a while if I really focus on stopping it, but as soon as I stop focusing on stopping it the movements begin again. I thought it was happening constantly, but it seems there are times when it stops, starts on its own. I'm not sure if it stops when I'm sleeping. I think so, because when I wake up my immediate thought is..."thank god it's stopped, but then it begins again. If I take Valium at night, it slows down, or stops altogether.
  3. My toes are moving up and down, sometimes my feet "squirm" (move up and down, twist upwards) along with the tapping. This is not continuous...not sure what triggers it...maybe anxiety. They are doing it right now. This type of tapping has happened before in my therapy sessions when I get really stressed out. However, it is happening much more often since I began Prozac.
  4. My fingers tap...this is similar to the toes, and often happens at the same time as the toes. It appears to be doing it to the music in my head, and is very, very fast...sometimes outside music is playing, but it is not in rhythm with that.
  5. This one is weird...I am periodically making a weird, unconscious sound sometimes. It is hard to describe...the best I can describe it is air passing through my voice box, making almost a moaning sound. This is embarrassing as it comes when I'm not expecting a sound. I feel embarrassed that others might hear it.
  6. I have obsessive snippets of anywhere from 2-6 bars of music playing over and over rapidly in my head. These are not aural hallucinations. They are thoughts of the when you get a song stuck in your head. Early on it was 4-5 bars of a portion of the same Schumann piano piece playing maniacally through my head...for days. Now I seem to be picking up music from what I am listening to, or advertising jingles, but it is NEVER the whole piece of music, but an annoyingly tiny portion of it over and over and over and over...(you get the picture).
  7. I am having increasingly anxious and obsessive thoughts. By "obsessive" I mean I am not bringing them into my head. They are appearing like a constant negative feedback loop, rapidly firing bad thoughts at me. The strange thing is, while they, along with the music and my teeth/mouth problems are making me exceedingly anxious, I am not feeling the sadness, sorrow, or depression that usually accompanies them.
  • An example of the above I have been having suicidal thoughts, over and over and over, yet my mood feels okay. The thoughts are about how I could o/d on all my hoarded medications and my dogs heart medications. Usually I cry, or feel sad while having these thoughts. Now I feel anxious because the thoughts won't stop, but nothing in me feels sad about them. In fact, they seem pretty reasonable.
  • Another example is my having negative thoughts about myself. Bad thoughts over and over about how I'm crazy, I am becoming increasingly bizarre, I'm a bad person, I will never get well, there is something deeply disturbing about the person I have become, & (suspicious thoughts) my pdoc is not telling me everything, he is keeping something from me, he's not telling me the truth about my diagnosis etc. Again, the thoughts are causing severe anxiety, my heart rate is up to 78-80 while I'm having them (it's usually 60) and they are coming at me at a rapid rate, but I don't feel depressed, or sad, just really angry, irritable and really anxious.

My pdoc has told me he believes the teeth "tapping" is a Prozac induced "tic". The music he says is an OCD symptom (I have many of those anyways). I called him yesterday because when I went to Pubmed and Webmd, and began looking at TD symptoms, to me, the untrained "experiencee", it seemed I had a few of them. I recognize the difference between my untrained understanding of a description of an illness (TD) and the trained understanding/knowledge of a psychiatrist. I really KNOW nothing about TD and how it presents, and I should trust my pdoc does, but I still cannot help being frightened by what I am experiencing.

I phoned my pdoc yesterday to ask if I can stop taking Prozac. When I called I was anxious to the point of feeling distraught. I explained my fears. He said: "I have never expressed or thought of your Prozac side effects as TD". I asked him if he thought my fears were unreasonable, explaining the Prozac makes me feel better, but I am afraid I will have a permanent physical problem(TD). He said no I was not being unreasonable, especially if the symptoms were getting worse and not subsiding at all.

Some part of me wanted him to categorically claim that my symptoms were definately not TD and to keep taking the Prozac until I saw him again next week. I think when I phoned I was looking for reassurance that it was safe to keep taking it, that my fears were unfounded, not support to quit taking it. I really don't WANT to stop taking it as at least, for the first time in years, my mood has lifted. What if I never find something else that helps?

Tuesday, January 01, 2008

Retaining What I Learn in Therapy

Pdocs, patients, anyone with an interest in therapy I'd really be interested in any thoughts or experiences you have had, or have, about the following ideas:

I'm not sure what other people's experience is with therapy (drs or patients), but my experience is that I feel I have an incredible rapport with my psychiatrist. I think he would say the same about me. I feel like I can bring up anything in our sessions. I also feel there are so many teachable moments in every session I have. However, sometimes I leave the session and instantaneously lose the lesson.

A couple of years ago I had an idea to videotape my 50 minute session for maybe the first 15-20 minutes each session...and then, with my pdoc, spend the rest of the session reviewing how I act, what I say, how we interact, what's real, what's not etc. I thought it might be a good way for me to become my own therapist...which is what I see the goal of therapy to be. The whole point of therapy for me is to learn to help myself.

My pdoc said we could do that if I wanted and he even offered to bring in a video recorder. The next session he never brought it up, and with my low self esteem I thought it was because it was a bad idea. Probably, him not bringing it up was more about allowing me to discuss my agenda that particular day and not his. He generally never leads the conversations.

My latest idea is to get a digital voice recorder and record part of my sessions. I think in the beginning it would be a good idea to record portions of my sessions and dissect them together with Dr. X. This (hopefully) would protect me from my tendency to read into the meaning of things that are said. It would also allow me to to clarify any interactions we had before I left his office. Of course I would get Dr. X's permission to record the sessions. I really want to make the most of what I learn in therapy, and I think it would help me to be able to refer back to the things my pdoc and I talk about.

As an aside: I also think the digital voice recorder would be good for my creative writing, as ideas, dreams, interesting thoughts come to me all the time and I can never write them down soon enough, or fast enough to save them for my writing.