Thursday, February 28, 2008

A Race Against Time

I had one of those therapy sessions today that used me all up. I am so depressed I can't handle it. I feel like I have some huge personality problem; like I have two seperate personalities. The bubbly, effusive, effervescent me and the other me, the me that clings to life by a thread, can't sleep, is so depressed and fatigued she feels like she can barely move half the time.

Dr. X. and I had a discussion about my personality again today. He says I absolutely do not have a personality disorder. He says he would describe me as an extremely social person who has a lot of anxiety around performance, people being judgemental of me, being embarrassed, a lot of social anxiety, and generalized anxiety, yet I still come across as very social. He said both sides of me; the sad, isolating, depressed and tired me, and the bubbly, social me, are the real me. I can encompass both.

He said many people with bipolar disorder will describes experiences of being extremely social and then being exhausted by the interactions afterwards. That is exactly how I feel. My high personality always comes with a cost, and that is fatigue and wanting to isolate.

We spent much of the session discussing medications, as I feel like giving up. He said it is like a race against time, trying to find medications to help my depression. We will get there. He said there are many things I have not tried and we will make the medication decisions as a team...I really like that he said that, and through my tears I felt like I could keep trying if I had a team member helping me.

Wednesday, February 27, 2008

Reviewing Treatment Plans for TRD

This post is inspired by a recent post on the Dr Shock MD PhD blog. The post titled: "Management of Depression" brought up a number of issues that I generally discuss with my pdoc, but also a couple I avoid because I am scared. Each of the nine section titles below are taken directly from Dr. Shock's article.

He talks about: "...the components of a comprehensive management plan and factors associated with increased risk for recurrence of depression". I found the article very interesting and I'm bringing it to my therapy session tomorrow to thoroughly discuss my treatment plan with Dr. X.

Being the inquisitive person I am I have discussed much of this with him already, but I think the information Dr. Shock posted about the "[c]omponents of a comprehensive management plan for depression. Adapted from American Psychiatric Association and World Federation of Societies of Biological Psychiatry guidelines" is a really comprehensive list of discussion points.

I will try to relay how they relate to me, my treatment plan, and my continuing difficulties working to find a solution to not simply Treatment Resistant Depression, defined as resistance to at least two medication trials...but a depression that has consumed me for years and been resistant to more than 30 medications and years of therapy:

1)"Determine the pharmacological or psychosocial treatment":
I've tried (numerous times) different CBT therapy treatments, Group therapy (twice), individual therapy(with numerous different therapists). I think my current supportive therapy has "saved" my life. I believe it gives me the strength to keep trying in the face of continued failure.

I feel I have a very valuable therapeutic alliance with my pdoc, stronger than any I have ever had with any therapist I have seen. I do, however, often question the value of continuing as it really has not put a dent in my depression. I wonder sometimes if I should try another therapist, but I have seen at least 7 or 8 different therapists since I began having depressive episodes at 17 or 18.

The therapy I am involved in now is better than any of them and some of the therapists I saw were so awful I do not even know how they remained to do what they do. So I really feel like I am in a better situation right now despite not making much progress. I feel safe, can talk about anything, feel advocated for and supported by my pdoc 100%.

  • Pharmacological treatments have been completely unsuccessful to date despite trying 30 plus medication alone, in combinations and using augmentation. This is so frustrating and I feel like it has to be my fault. Why do others get better, when I feel like I try so hard and never seem to succeed?

2) "Determine the treatment setting": I assume this means outpatient/inpatient/day program etc. My pdoc tried numerous times to get me into the hospital last spring/summer. I seemed to go into an up phase, just as I was about to concede so decided against it. He suggested maybe a hospital stay would allow a second opinion. Problem is I have had second opinions two other times before and both of them said I had Bipolar Disorder. My pdoc says I am somewhere in between Major Depression and BPII. I get what looks like hypomania, but it does not impacts my life in any negative he believes I sit somewhere at the end of Major Depressive Disorder and at the beginning of BPII.

It doesn't really matter because our we have used treatment approaches for both illnesses and somewhere in between and still we have not had success. To me, and to my pdoc, diagnosis is a means by which we develop a treatment plan and I trust fully that that is being done. My pdoc has experience working in a mood disorders program, and I feel confident in his skills.3)

3) "Establish and maintain a therapeutic alliance": I feel this is perfect and could not be better.

4) "Monitor and reassess the patient’s psychiatric status in the course of treatment": This is a question I would like to ask my psychiatrist. How do you monitor and reassess my psychiatric status over the course of the treatments we try? I sometimes feel like we stop trying medications too soon, or that we may miss an opportunity for a combination to work even if a particular medication is not working. Eg. Now I am going off concern is that I feel it has helped me a tiny bit "sometimes", and I understand the treatment of TRD and/or BP disorder generally utilizes a mood stabilizer. I have no side effects with Tegretol and really would like to keep trying to find something that works with it.

5) "Monitor the patient’s response to treatment"...this seems like the same as above. No?

6) "Reassess the adequacy of diagnosis when appropriate": This is a biggy for me. I have often asked my pdoc if maybe I have a personality disorder; especially Borderline Personality Disorder, given my fears of abandonment and all my suicidal thoughts. Dr. X has told me numerous times that he, "...has not even considered BPD as a diagnosis for [me]".

He is however, cryptic sometimes when I bring up the question of whether or not I have a personality disorder. For example, one time I asked him if I had a personality disorder and he asked me, "what would it mean to you to have a personality disorder?"

I am not a psychiatrist so I had no idea what to say, except maybe it means I have a pattern of behaviour that is embedded so deeply in who I am and that is why the medication is not working. I have asked him if he would be honest with me if I had a personality disorder. He said he believes that honesty is very important and that he would not hold back information from me. Given how trustworthy he has proven to be over the years I have to believe he is being upfront with me, but I have this niggling feeling that something beyond a mood disorder is impacting my ability to become well.

7) "Monitor possible side effects and physical condition": I used to keep a daily mood calendar tracking mood, irritability, anxiety, exercise, medications, side effects, etc. A couple years ago I began feeling like maybe my micromanaging of my symptoms what keeping me sick so I stopped doing it. I go into my appointments with less clear information than before, and I often forget to tell my pdoc things. So not sure if I should begin my mood charts again.

I did ask my pdoc last week if maybe we stop medications too early because of side effects and don't give my body enough time to work through the side effects. He said maybe sometimes we have done that, but many times it becomes really clear that the side effects are unmanageable, or that the small benefits the medications give me are not enough for me to suffer the side effects. I almost always want to keep trying a medication longer even if it isn't working, because I am afraid I might miss out on that time when they might begin helping me. Usually we decide together.

8) "Enhance treatment adherence": I always take the medications Dr. X. and I decide on. I am not one to just go off my medications and not tell him. I do understand that I have some problems that may impact the medications working as well:

  • With Benzodiazepines I find they help with my anxiety at first, but then I sometimes (not always) begin increasing them slowly because they stop working. I recognize their is a fine line between controlling anxiety and perhaps inducing a worse depression because I am too fatigued to do anything. Recently I was told to increase my Diazepam to 20mg (from 10mg)...I tried it a couple days and decided I did not want a repeat of last summer where I came of a fairly high dose of Diazepam and ended up have severe rebound anxiety and insomnia (for 3 months last time). I always inform my pdoc when I increase or decide against our plan though. How can he treat me properly if he doesn't know what I am taking?

  • This is so hard to write and for some reason I feel so ashamed for being weak like this...I rarely talk about it, except with my pdoc)...When my Mom was diagnosed with pancreatic cancer I moved in with her to help her. I was so depressed, and on top of that grieving, and I began to drink to help numb all my feelings. Honestly, with no medications working it was the only thing that helped. I recognize now that I have had alcohol problems intermittently throughout my life, since I was 13. I have gone years without drinking hardly anything, maybe a drink here or there, once in a blue moon, but there have also been years when I was stressed out that I have been a binge drinker, starting with my high school years. Anyways, since my mom's death I have struggled with alcohol and I know that has impacted my wellness and made my depression more difficult to treat. In the last year I am really trying hard to change that, and I believe slowly, I am getting there.

9) "Educate patients and their families about the nature of the illness (psychoeducation)": I feel I am very educated about my illness, but I still have not accepted it. I'm not sure if I ever will be able to. Despite believing others like me are ill, and have a bonafide illness I continue to feel intensely guilty for not being able to work, for having an almost impossible time getting motivated to do things, for many things that my pdoc has taught me are "symptoms" of depression.

I also know that it would really help me if my family, my husband, my sisters, and my dad, would learn more about Major Depression, and especially about Treatment Resistant, and/or Chronic Depression. My pdoc likens my husband's negativity to medications to a "negative placebo effect" My husband rails so much about medications hurting me as opposed to helping me, that his insistence in this area could very easily impact the ability of the medications to help me. I really believe in the medications, so I am pretty sure I override his negativity, but you never know. The rest of my family seems to think I should just go see a naturopath and I'd get better, or I'd miraculously get better if I just got a job. Wouldn't that be great? I find their being unsupportive of the therapy I have decided on to be so frustrating. I wish they would come to a few therapy sessions with me, but that just isn't going to happen.

I do not even want to think of the "[f]actors associated with increased risk for depression recurrence." as listed on Dr. Shock's blog, because I have every single one. I cannot afford to focus on whether my depression will recur, until I can manage to get rid of the episode I am currently in.

Sunday, February 24, 2008

What is a Mood Stabilizer Supposed to Do?

What exactly are you supposed to feel like if a mood stabilizer is actually helping you?

The beautiful graphic design above here (not!) is my paint version of what I think Tegretol has done for me. I am at odds with my pdoc because I think it has helped me a little bit. It has slowed some of the cycling.
However, when I created my beautiful work of art here (not neccesarily to scale) it became painfully obvious to me why my pdoc wants me to come off this medication. While it has no side effects for me, and it has slowed some of the cycling between really severe cycles, it has done absolutely nothing to stop my mood from dropping into extremely severe major depressive cycles; all the cycles down feel severe, but the really low drops are cycles in which I feel as though I am in great danger of killing myself.

On top of it not stopping the suicidal depression the mood stabilizer has stopped my mood from going up at all, so, whereas, before the Tegretol I had a day or two of my happy hyperthymic temperament appear here and there, that has not happened since I have been on the Tegretol.

I find going off and on, and off and on, and adding and subtracting medications so stressful. Every time a medication is deemed to be not working it feels like another failure on my part. I asked Dr. X if instead I could increase the Tegretol, to try to lower the low cycles, but he says my blood tests show I am on a very robust dose and he does think increasing it is a good idea.

To "simplify" my medication regime I am stopping taking Clonidine,which we were trying to use to stop my teeth tapping, but it has done nothing. This side effect of Prozac is so bad I am afraid I am going to break or hurt my teeth. The music in my head, and the teeth tapping just keeps getting worse each time we increase the Prozac.

After I am off the Clonidine, in 6 days I will lower my Tegretol slowly (I have already lowered it to 600mgs), then I really want to stop taking Diazepam as at 10mgs it isn't helping the teeth tapping and music in my head anymore. It helped when I took 10mgs for 10 mgs of Prozac, but even at 20mgs Diazepam to 20mgs of Prozac it did not seem to help.

On top of that I do not want to end up where I was last summer, having to come off a high dose of Diazepam. That led to months of intense anxiety, panic attacks and hardly any sleep. Dr. X always explains taking Diazepam or any benzodiazepine is like borrowing money...there is always a debt to pay back. I hate debt. Always have and always will. I'm one of those people who never carries debt. I have really struggled with benzodiazepine withdrawal numerous times before and on top of that I often end up drinking to compensate for how painful the withdrawal is.

This time I tried 20mgs Diazepam for a few days and decided the long term pain was not worth the short term gain. (I always end up having to increase my dosage for it to help me anymore than a few weeks). I cutback to 10mgs again, and will wean myself off that too.

The problem after I stop those three medications will be that I cannot see myself taking my Prozac levels any higher because I will break my teeth, and/or go completely insane with the non-stop music in my head.

Also, at 30 mgs I am beginning to feel that SSRI fatigue set in. Every other SSRI has made me so apathetic, fatigued and unmotivated to do anything that any lift in mood was countered by the side effects. All I wanted to do was sleep all afternoon. That's how I feel when depressed what is the point?
I am really considering ECT again. I may stop teaching art classes next term so I can take care of myself without the fear of disappointing the Art Clubhouse Staff. For the last year I have really been unable to take care of my needs and go to the hospital when I really needed to, or go have ECT when I wanted to because I take my responsibilities and the commitments I have made to other people so seriously that they override what I really need.

I am so confused and disappointed. How am I going to keep trying? What the hell do you do when nothing works?

Sunday, February 17, 2008

100 Positive Things About My Life

"Write 100 positive things about your life" .

Last week this was a writing exercise in my creative writing class. I hit # 17 and could think of nothing else until the instructor said positive things, or things we like to do or love in our lives...then I got to #43. It has taken me a week to finish, but here I go:

100 Positive Things in my life: Things I like about myself, love about myself, like doing etc.

1. My niece "A" is a miracle child. To correct two hips that were undeveloped at birth she endured numerous unsuccessful surgeries, and finally one successful one in the first few years of her life. She spent much of the first 5 years of her life in full body casts and partial body casts. After one of her surgeries she came home in a body cast and asked her mom to place her on a skateboard. She then proceeded to pull herself and manouver around the house on her stomach on top of the skateboard. At nine she is an incredible role model, so determined and a beautiful loving girl. I love her. She loves me.

2. My niece "B" is spunky and funny and her laugh is so contagious it is impossible not to laugh with her. She has gorgeous soft long red hair and in some picture I see a resemblance between her and me. She reminds me of my free spirit self when I feel well. I love her. She loves me.

3. My neice "C" is serious, bookish and far too intelligent for a 7 year old. She is sensitive and thoughtful with a smile like an angel. She asks the hardest questions to answer. She often perplexes me and on a deep level reminds me of me as a child. I love her. She loves me.

4. My niece "D" is a wild thing. She cannot sit still, wants to wear pink dresses all the time, even when hiking and beachcombing (much to the chagrin of her mom, who doesn't want her to fall into the "stereotyped", pink dressed little girl), but she is far from a stereotype... She is strong willed, has a tomboyish spirit, loves to run, and is sweet and impish all at the same time. I love her, she loves me.

5. My sister "E" is quietly strong and independant. She owns and runs her own business. She knows how to think clearly and can seperate her emotions from a situation. She is beautiful with soft, curly red hair. She loves music and has a beautiful voice. We sing all the time when we are together. Her and I take vacations together with her and the kids and we always have a great time. She adores her children and is an incredible mom. I love her and she loves me.

6. My sister "F" is strong and extremely independant. She let's nothing get in her way. She has a great sense of humour and loves her kids more than anything in the world. She is stunning; 6 ft tall, long blonde hair, and skinny as a rail. There is nothing she cannot do. She climbed down her well to fix a pipe on her own, she builds things in her shop by herself. She makes me laugh, will take no nonsense from anyone, not even me. She tells me like it is, but loves me in her own quiet way. I love her too.

7. My Mom died two years ago, but I was blessed to have the Mom I had...she was a beautiful person inside and out. She was independant too, sometimes I would say she was stubborn (I am starting to see a familial pattern here). When she wanted to do something she did it. She adored all her children equally. The was crazy about her grandchildren; loved her parents, was extraordinarily loyal to her friends and family. She was the best Mom anyone could ever asked for. I think of her many times every single day. I loved and love her more than anything in this universe.

8. I love my husband. We fight, we ignore each other. My depression has been hard on him. It has been hard on our relationship, but he helps me everyday in big and small ways. He helps with the cleaning and cooking. He takes over tasks I am unable to do because I am so depressed. Also, while there is something to say about the excitement of anonymous casual with someone you completely trust is extraordinary and allows me to feel safe trying new things.

9. My pdoc...He is amazing, consistent, supportive, empathetic, and a gifted Dr. and therapist.

10. My friend "H". She is artistic and thoughtful, interesting and inspiring. She has been my friend since I was 19 and we have been through a lot together. I love her like a sister.

11. My friend "D". She is a powerful woman. She is fiercely independent and a talented high level people manager. I have known her since I was 13...and we seemed to follow each other around the country for the first few years out of school. We are like sisters too. One of those people you may not talk to a lot, but can always pick up where you left off.

12. My friend "J". I only met her recently online, but I feel a sense of connection to her. We really seem to struggle with almost identical's eerie sometimes how often she writes something that relates to me. I am glad we have connected.

13. Even on my worst days I can find some moment where I can laugh.

14. I love my dog. Even though he is very, very ill not a day goes by where he doesn't do something that makes me laugh and/or adore him even more. I never realized how important having a dog was to me.

15. I love my two cats

16. I live on a farm, but can get into the city in less than 20 I get the best of both worlds.

17. All summer long my house is filled with flowers, because I live on a flower farm.

18.. All summer long I can eat as many blueberries as I want because the farm is also a bueberry farm.

19. I am a water baby. I used to swim competitively and I am a great swimmer. I feel more at home in the water than I do on land.

20. I do not need any more material things. In fact, I could do with less things in my life.

21. I have enough food to eat.

22. I have clean water to drink.

23. I have a huge cozy king-sized bed to sleep in everynight. My husband made it as a wedding gift for us. It is made of huge slabs of beautiful old growth pine and is stained a honey colour. It sits high off the floor (maybe 4 feet) and I feel like a queen in it. I always joke it is the only piece of furniture I want if we divorce.

24.. I have a passion for music. My tastes are eclectic. and am just as happy listening to classical music as I am listening to alternative rock.

25. I love the colour of my is long and strawberry blond.

26. If I practice and focus I draw very well.

27. I have a gift when it comes to helping people learn. I am naturally a great teacher.

28. I am empathetic.

29 I care immensely about other people.

30. When my hyperthymic temperment decides to come out I am a wild woman, love to have a good time and become the life of the party.

31. I cannot remember how many people I have slept with...yikes! , but I loved every minute of every encounter. Some psychiatrists have taken my encounters to mean I was hypomanic, but I just love sex. I have no regrets about enjoying all my sexual relationships. My pdoc gets that and I really appreciate that.

32. Having said the former...I am a faithful wife and have been for 16 years and would never cheat (unless he wanted me to;>).

33. I like that it is the person that matters to me and not the gender. When I fall in love it is with the person.

32. I am a good Aunt.

33. I am a good Sister.

34. I am a good Daughter.

34. I am polite. I always say thank you if someone holds the door open for me. I always hold the door open for others. I always send thank you cards (albeit when depressed I sometimes procrastinate)...but I always eventually do it.

35. I send hand written letters to people and I love writing and sending them. There is something romantic and old fashioned about the process that I love.

36. I have good elbows on the table, know how to use all that extra cutlery...ha, ha.

37. I am a good conversationalist...even when I am having bad depression or anxiety. This actually hides my anxiety from others...very few people can believe I am depressed or anxious unless I tell them.

38. In keeping with being a good conversationalist I always search the room for people who look like they need someone to talk with. I reach out to others.

39. I am an intellectual soul. I love to learn and suck up information like a sponge sucks up water. (The past few years I am having trouble retaining info, but I still love to learn).

40. I have read hundreds of books. I am passionate about the classics, about psychology and psychiatry books, I love a good autobiography or biography and I enjoy some murder mysteries . (again, right now I cannot seem to read as I cannot retain plotlines etc.), but I read the newspapers daily to keep up on world and local news, and to keep my mind thinking.

41. I have a bachelor's degree in English Literature. I loved taking this degree as I love to read, but I took it to balance out my philosophy degree. People do not understand the value of philosophy, but they understand the value of an english degree.

42. I have a bachelor's degree in Philosophy. This was my passion in university. I was spellbound by epistemology and metaphysics. My favourite class was "Philosophy of Mind" a whole year studying theories of how the brain/mind works. I loved that. I was also especially interested in applied ethics (environmental ethics, animal rights, etc.).

43. I am a great cook. When well I love cooking...I can barely manage that now, but once in a while I get a spurt of energy and cook a fancy meal.

44. I love canoeing. The silence and the slight sound of water slipping across the paddles and the bow. I love that.

45. I love camping. The fresh air, sitting by the fire, being one with nature.

46. I love encountering the pack of coyotes with their pups at the back of the farm. They are fascinating.

47. I love watching the bald eagles soar above the farm. They have a nest down the road and I search for them there every spring. I saw them today. Beautiful.

48. I love the feeling of my bare feet in warm sand.

49. I loved snorkelling in the British Virgin Islands. I could have stayed in the water there all day.

50. I love diving into the pool and staying below the surface, encased in silence, as long as I can.

51. I love the feeling of water rushing over my body when I swim. Especially when I am gliding in the water and it is quiet.

52. I love watching the plants come up in the garden.

53. I love watching the flowers bloom.

54. I could stare at some flowers forever (especially dahlias). They are so perfect it makes me wonder how such perfection is possible.

55. I love all animals and cannot even kill a fly...I take them outside. (although I have contamination fears about lice and bedbugs...not sure can't say I'd set them outside!!)

56. I have great breasts. Ask anyone who has seen them...and they are all mine!...ha, ha!

57. I have an hourglass figure...I like that.

58. I love the feel of the wind rushing across my face and through my hair when I ride a bike. I hate wearing a bike helmet and I sometimes don't because it feels good to take some risks and to enjoy the fresh air.

59. I have been across Canada numerous times and have lived literally from coast to coast at different times in my life.

60. I love playing the guitar.

61. I love dressing up to go to the symphony, or the opera. It is part of the ritual for me.

62. My favourite colour is the colour of fresh new growth green moss.

63. I love walking through the forest and seeing red cedar trees with my favourite coloured moss growing amongst them...the red/brown against the green is sublime.

64. I love watching others be creative. In my beginner's drawing class today I watched as people's compositions turned into pieces of art, They were all so beautiful and I could see so much pride in the people who were creating the drawings.

65. I really love volunteering at the Art Clubhouse I belong to.

66. I love Shakespeare plays.

67. I love all kinds of writings, plays, and poetry from the 17th century...Christopher Marlowe, Ben Johnson, John Donne, John Milton (Paradise Lost is full of profoundly beautiful imagery).

68. Given that I love the above...I love period films or plays.

69. I love the whole renaissance period.

69. I love going into old churches. They just feel good to be in.

70. I never buy trashy magazines...ever, but when I go to my sister's house I secretly love reading all the magazines she has laying know curious minds want to know!

71. I am great with kids. They are much easier than adults to be around. My neices adore me and I them. We always have such a great time together and they keep me in stiches.

73. Although he doesn't show it, and although our relationship is often strained, I know my Dad loves me. He would give his kidney to me if I needed it. He just does not know how to accept he has a mentally ill child.

74. I love my Dad.

75. I knew all my grandparents very well and for a long time. I spent a lot of time with each of them. They all survived into my thirties and my one Grandma just passed away last year. I adored them all. I am very lucky to have known them.

76. I live in a city that was named "the most liveable city in the world" the last two years in a row. It is a great city.

77. I do not have to worry about money while I work towards becoming well because the company I worked for has a great long term disability program and I qualified for my country's disability pension.

78. Today I am happy to be alive.

79. I love the smell of fresh cut hay.

80. I enjoy writing in my blog. I like the anonymity and the ability to get everything out in writing. It helps me think things through and understand myself better.

81. I can be really funny when the mood strikes me.

82. I saved my sister's puppy's life when it was attacked by two 150 pound Husky/Wolf/Akita cross dogs. I fought for ten minutes trying to beat the dogs off her as they bit at her and tried to drag her through the fence. The fence was short, maybe four feet and they could easily have leapt over it and attacked me, but I never gave up. I finally got her away from them. She was bleeding profusely from her face and neck. I got her to the vet in the nick of time and she just made it. I have PTSD problems because of what happened, but I am so glad I got involved. I would never have forgivven myself if I hadn't tried to save her.

83.I survived a horrific car crash when I was 18. A drunk driver went through a stop sign at 60 MPH and crushed the car my best friend, her mom and I were in. My friend had and has a severe brain injury, I had some cuts and a concussion, but we all survived. I can still hear the sound of a gigantic tin can being crushed if I think of the crash.

84. I never drink and drive.

85. I love the crashing of gigantic waves on the seashore. I especially love stormwatching.

86. I have the most interesting, detailed, and meaning filled dreams. I love my dreams, even the scary ones. They teach me so much about myself.

87. I look forward to my therapy sessions, even in my deepest, darkest moments. In fact, maybe especially in those moments. I find the ability to sit and talk with someone who is completely non-judgemental and completely advocating for me and my wellness to be an intensely cathartic and life affirming experience.

89. I am so happy I bought a digital camera a couple years ago. It is one of the best things I ever bought myself. No more crappy pictures click and they are gone. I find I take way more pictures than I did before because it is so easy to get great pictures when you have no concern for the quantity of pictures you are taking.

90. The next best thing I ever bought myself was an is awesome and I am addicted to it and to i-tunes. I have never had anything electronic that was so easy to figure out how to use and is it is so easy to download songs, podcasts, books etc. I take it with me everywhere.

91. I am proud to say I DO NOT own a cellphone. I never answer the phone when I am at home. Why the hell would I take one with me. I find them annoying and intrusive. I've lived this long without a phone attached to my hip, can't see why I would want one now.

92. I love taking long, really hot, showers.

93. My favourite vegetable is green beans. I would eat them everyday if I could.

94. I always try really hard to not hurt anyone's feelings. I try to make all my encounters with people positive.

95. I love it when I wake up one morning and my depression is completely gone and I feel like I could do anything. At these times it is as if the whole world appears differently. It is like I can see the life force in everything. Colours look more intense, everyone loves me, I am beautiful and charasmatic. I have no anxiety and am willing to try anything. I really love those days. I haven't had one in a long time.

96. I love skiing.

97. I love chocolate...but not too much, just a little bit at a time.

98. I love Haggen Dass "Cookie Dough Dynamo" ice cream and green tea ice cream.

99. I love going out to eat...any kind of food. I like the experience.

100. I was able to find the strength, somehow, somewhere, despite my severe depression, to move in with, and help, my mom through the last three months of her life. All she really wanted was to die at home and I was there as she passed away. I never thought I would survive those months, but I did and I was there for her. I will never forget what it was like watching her pass away, but I am so glad I was there to help her go. I love you Mom.

Saturday, February 16, 2008

Resistance is Futile

I would like to say that I follow my pdoc's advice all the time, but I do not. I think he is brilliant, trustworthy, knowledgeable about medications, and a gifted therapist; so why do I resist what he suggests so much?

Here is a classic example. The appointment I had three weeks ago, before he went on holidays, I was feeling depressed still, even after increasing my antidepressant (Prozac). About 5 weeks prior to that, for a few weeks Prozac seemed to help. Then it just stopped working. So about 2 weeks before said visit we increased the dosage...and nothing occurred except an increase in teeth tapping and annoyingly repetitive snippets of music in my head.

I asked if I could stop taking Tegretol. I was thinking maybe it was interferring with the ability of the Prozac to increase my mood. Made sense to me. If it stabilizes mood, it must take both the highs and the lows away. Really it seems to have MAYBE stabilized my moods fast cycles a tiny bit. I don't break out in tears over every tiny little thing, but my longer cycles are still there, however I only go severely low and never get high at all anymore.

When I say high, I do not mean manic or even hypomanic. I mean my regular, hyperthymic temperment never seems to show itself anymore. I am mostly moderately depressed to severely depressed, spending almost all my time in the latter type of mood.

Dr. X. looked at me sheepishly; giving me that look that means "are you completely out of your mind???" Well I'm sure he was not thinking that exactly, but that is the meaning of the look. As he flashed it to me I imagined all the people who sit in his office arguing it's the mood stabilizer that is the problem...honest! Ha, ha.

I explained how I thought maybe it was keeping my mood from lifting. I also expressed my desire to be on as few medications as possible. Given I am on four at the moment I thought simplifying the mix might be better for me. He suggested I stay on the Tegretol. So I followed what he said and he went away for three weeks.

Then this week, after I explained how poorly I had been doing, he suggested I begin to go off the Tegretol. My reaction: "WHAT? It's the only thing that I am taking that I think even works at all. At least with it I do not feel as labile. I manage to get through my Art clubhouse volunteering without breaking down everytime I step through the door".

I am insane...

Was it not me who previously had asked to do the very same thing he just suggested I do? Why do I do that? Why do I resist him so much?

I am so stubborn. That has been both a blessing and a curse. It has kept me alive and trying despite so many medication failures. The problem is I do not know when to resist and when not to. I resist all the time.

Could be a father issue. Dr. X. being a man in authority could be a reminder of my extremely authoritarian father. Dr. X. is about as opposite a man you could get from my father...he is nurturing vs. terrifying, caring vs. demanding, empathetic vs. ridiculing, kind vs, bullying...the list could go on forever, but you get the point. He's more like my Mom was than anyone else. That is the highest statement of regard I can give anyone. So not sure why I resist.

Anyways...I am going to start decreasing my Tegretol. What is the point of seeing a great Pdoc if I do not listen to his advice? Yeesh.

Thursday, February 14, 2008

I Felt Like an first

This morning I went to my first pdoc session in three weeks. I told him I wanted to tell him something, but I was afraid of what he would do if I told him. I was open and completely honest about what I have been doing, planning, thinking; about how depressed I've been, about feeling imminently suicidal, about obtaining and hoarding my dogs medications with the intention of committing suicide, that I was not at this moment feeling suicidal. I felt better yesterday and today and I told him that.

Dr X. said, "What would you like me to do with this information to keep you safe and to help you? I just sat there thinking..."Duh, what do I want him to do and why did I tell him all that"?

I explained to him I told him all this because I feel intensely guilty about being disingenuous in terms of planning and successfully obtaining all the serious medications I did from the pharmascist. I feel guilty for planning my suicide and taking all those steps towards achieving that plan.

He said: "If you carry out your plan it will really impact our ability to continue therapy". Ha, ha!! I really laughed when he said that...because it was such an absurd, but true comment. It was risky for him to say that, because I am really sensitive and could have felt like I was not being taken seriously, but he seems to know me well enough to know when a bit of humour can lighten a really dark situation. I like that he knows me that well.

I found it harder to tell him what I wanted him to do with the information than what I did not want him to do with it. I did not want him to tell my husband. (There is some talk at the university about setting a policy to notify one's parents (or next of kin) when a person is suicidal or expresses suicidal thoughts or plans) Dr. X. and I both disagree with that policy. I would simply never speak up and express my suicidality if I knew that was going to happen.

I did not want him to put me in the hospital, for a few reasons:
  • I am completely freaked out and grossed out about sleeping in a bed where someone else has slept.
  • I have major contamination fears about lice, bedbugs, just yucky things in general.
  • I am worried about losing my freedom.
  • I am worried I will be treated poorly or misunderstood, because that has been much of my experience with mental health care people. (Although overall last time I was in the hospital most of them treated me very well).
  • I don't want to sleep in the same room with someone else. I had such a great roomate last time I was in the hospital, but it could really be a nightmare if you did not get along with someone.
  • I do not think I need to be in the hospital. I feel better today and yesterday.

    Dr. X let me know it was an option. I explained I have been considering ECT again. He told me I could go into the hospital without having ECT. I appreciate he was providing options for me.

    I told him about my dreams and that I thought they were telling me it was okay to commit suicide. He explained that I may have been projecting suicidal meaning on the dreams, when perhaps they were dreams telling me I needed a transformation in my life, but not neccessarily transformation via suicide. That makes sense to me. When I am depressed and feeling suicidal it seems like everything is telling me to kill myself. I read that meaning into what I read, into music I hear, videos I see etc.

    In the end he expressed that he was concerned about me, and did not want me to think he did not take my actions and thoughts very seriously, but that it was important that we made the decision about what I should do to take care of myself together. He would not send me to the hospital if that was not what I wanted. I appreciate his trust in me. Times like this strengthen our therapeutic alliance.

    In the end we decided to increase my Prozac, and increase my Valium to offset the Prozac induced teeth tapping and the repetitive music playing over and over in my head. At first I felt like an idiot for telling him all I thought and did over the past few weeks, especially when he asked me what I wanted him to do about it, but in the end I am really glad I was open and honest, and I feel like I can get through another week because I trusted him enough to talk and because he trusted me enough to let me make choices for myself.

Wednesday, February 13, 2008

Do I Tell my Pdoc the Truth?

Tomorrow I have my first pdoc appointment since three weeks ago. Both before and after my last appointment I have/had been feeling increasingly suicidal. Three weeks was a very long gap between appointments given how poorly I have been managing.

I have taken to sleeping much of the afternoon. I cannot get myself out of the house, so I have been really isolating myself. I have avoided the Art Clubhouse I go to except for the two half days I volunteer. Even then on one of those days I have been getting there late and leaving early. I just don't want to do anything.

This is gross, (and very unlike me), last week I couldn't even manage to shower for 5 days straight. The effort to get into the shower, and then brush my hair afterwards seemed overwhelming. I haven't been able to cook, or clean. My husband has been cooking dinner, thank god. He hasn't been yelling, or screaming at me for being so sluglike. In fact he has been very supportive, which is a change I really appreciate.

All those things I can tell my pdoc. The truth I am afraid to tell is how deceptive I have been in regards to my dog's prescriptions. I have been amassing very large amounts of two types of heart medications and a very large, and definitely lethal dosage, of Phenobarbital My dog does need these meds, but I have been getting the pharmacist to give me all his refills at once under the guise that I do not want to pay the dispensing fee for monthly doses.

That is not the truth. I want to use the medicine to commit suicide and have been stockpiling the medications for this purpose. I know I will never get better, never find medications that will help me for any length of time. I've tried almost everything there is to try.

Today I do not feel suicidal, but most of the last month or more, and many days in the months prior, I have. There must be some part of me that wants to keep trying because, today I think it might be important for me to tell Dr. X. what I have been doing, but I am afraid about what he will do if I tell him.

I am afraid he will tell my husband what I have been doing, or worse, not let me leave my appointment tomorrow. I recognize that I am moving closer to action in terms of killing myself, but I believe what I do with my life is my prerogative. If I tell him I also understand I am reaching out for help and some part of me wants to do that; wants to live. I have always trusted him to trust me, but I don't know if he will if I tell him my recent plans and actions. I want to tell him, but I want his assurance that what I do about it will be my choice.

Saturday, February 09, 2008

Dreams of Death

I believe my dreams are telling me that it is okay to die. Yesterday I fell into a deep sleep in the late afternoon. Suddenly, I was in my truck driving on the freeway. I was speeding, driving 120-130km/hr and passing all the cars. I began to feel like I was falling asleep at this speed. As I began to lose consciousness my foot pushed harder on the accelerator; 130, 140, 150km/hr. My truck began driving so fast it was unstable. I could feel it begin to shudder. I felt myself losing control of the vehicle. It began weaving in my lane.

At this point everything became a blur and I had one eye barely open. Everything was foggy and going in slow motion. I felt drugged and felt I had no control over how I was driving. I knew I was going to hurt someone else and to save them I managed a slight movement to take my truck into the grassy median. As I did the truck began to flip and I began to crash. I woke up with my heart and mind racing, shaking in the same way I would have had this really been happening. It took at least a minute or so to get out of the dream state and realize it was not real.

I fell asleep at 7:30am this morning. I was walking along my road. I could barely walk there was so much snow. Cars were speeding down our snow covered, already narrow, water-filled ditch lined road. A van passed another car, missing me by inches. I gestured angrily at the driver. It looked like he was going to stop and chase me. I began running towards home, but looking back I saw he kept going. I kept running, but was going to fast on the slippery road to turn into my driveway. As I passed my driveway I gleefully leapt into the air, spun around and landed splayed on my back with my arms open like a snow-angel in the soft snow bank at the side of the road. My eyes were closed when I landed. I lay there for a few moments and then opened my eyes.

When I opened my eyes all the snow was gone. It was a warm sunny day. I lifted myself up and started walking towards my driveway, but it was not there. I looked ahead and did not recognize any of the houses. I thought to myself, "I'm not very observant sometimes, I must have walked farther down my road than I thought, and it just looks different from the perspective of walking, as opposed to driving, down the road".

So I walked on and I came across a woman. I asked her if this was "X" road. In a British accent she said no it was "Y" road. I asked her if she knew where the intersection of "X" road and "Z" road where. She looked puzzled and said she had never heard of them. I started walking again, but kept wondering how the snow could have disappeared and how I could be on a different road than I had been before. I began wondering if I was dreaming. It was so real though that I thought there is no way I am dreaming. I still was suspicious it was a dream and I tried and tried to stop the dream, but the road ahead of me never changed and if it was a dream I was trapped in it.

Why do I think my dreams were about my death and it being okay to die?

The First Dream:

  • The first dream I believe was a metaphor for my committing suicide. When depressed I often drive at high speeds hoping I will crash. The only thing that has stopped me from crashing is the fear I will hurt someone else, or that I will survive in worse condition than I am now.

  • In real life I worry that my suicide will harm other people. I think this dream reassures me I can commit suicide and take steps to ensure my family (like the drivers around me in the dream) will be safe and okay.

  • In my dream I woke up shaking and fightened, but during the dream I was exceptionally calm (that extreme relaxation you feel when you have taken medication that makes you finally relax and let go). I felt ready to go.

The Second Dream:

  • The second dream was about being in hell and ending up in heaven.

  • I hate the cold and the winter. When I ran and "gleefully" jumped into the snow bank into the guise of a snow angel I was leaping from hell into heaven. The angel being the being by which I made the transformation.

  • When I awoke all my surroundings were unfamiliar, yet it was sunny and a gorgeously warm day. That is my idea of heaven.

  • Perhaps the British lady was a representation of the Anglican Church, the church I was brought up in?

  • This dream felt like a reassurance that my fears that if I commit suicide I will go to hell are unfounded. I don't really even believe in this stuff...but there is a small part of me that fears..."what if it's all true?"

  • The dream represented being lost, even at home, where I am supposed to feel safe.

  • It felt like God would understand that I am lost where I am...even when I am at home.

Thursday, February 07, 2008

Psychosis and Insight?

A few sessions ago I asked my pdoc if he thought that sometimes my depression might be psychotic? He said he has wondered that sometimes given some of the suspicions I have. I know what he means, sometimes when I am in the midst of these suspicions I don't seem to have insight that I am suspicious. It really seems like what I am suspicious about is going on. Other times I am suspicious that my suspicions are suspicious. Are you following?

Take today for example. About 4 months ago, out of the blue, a member of the Art Clubhouse for people with mental illnesses I belong to phoned me while I was teaching a class and asked me out to lunch. I thought it a bit odd at the time as I had only met him a couple times. I agreed to meet him in a public place, but he offered to pick me up at the studio after my class. I felt uncomfortable, but for some reason couldn't say no.

He picked me up and we went to a cafe. I made it clear I was married by talking about my husband a few times. During the initial meeting I found out he had worked for the same national police organization, in an HR capacity, that my my Dad, my Uncle and my Cousin all worked for, or were retired from. He said he knew my Uncle and Cousin.

I don't remember right now, but I believe he mentioned knowing my Cousin and Uncle, before I mentioned they worked for his employer. We talked a lot about this the police force and my Dad, my Uncle and my Cousin. It made me feel awkward, like he was fishing for information, either about me, or my family.

After the first visit I began to think he was undercover either for the police, or for my insurance company. Things he said didn't make his employer had no disability insurance...I doubt that is true given how huge this employer is.

He invited me out again a few weeks later. This time I felt more guarded, but despite my "suspicions", he seemed like a really nice person and we had a good visit. I let my guard down and was, I think now, too open about myself and my family.

Now, four months later, I have not seen this person once at the Studio. I am increasingly feeling like he is not a member at all, but a police plant trying to get information from me. A tiny part of me (maybe 2-3%) thinks maybe I am being crazy about this...but a huge part of me is really stressed out and worried about it.

This type of suspicion is a kind I often have. I get really suspiscious that my insurance company is spying on me. So suspicious at times that I close all my curtains so no one can see in. I was even on the ferry once when I thought two men were following and watching me. In fact I was certain one of them was taking pictures of me with his cell phone.

At the time it was happening I was 100% suspicious, but as I thought about it more and more, I started to wonder if it was my mind playing tricks on me.

About the last 6 months I was at work I became increasingly paranoid that all the people I worked with hated me and wanted to see me fail. It was brutal. I could barely get into work because I felt like everyone was out to get me. Any interaction with the people I was worried about was painful and filled with so much anxiety I could barely manage it. The pressure I felt to change their minds about me was overwhelming.

I look at it now and I can see that I may have been exhibiting strange behaviour, resulting in people thinking I was weird and therefore they may have thought I was not good at my job and then they reacted strangely towards me, which I picked up as their being against me.

Anyways, I guess what I am wondering is a few things:

  • Am I paranoid about this Police person being a plant (I am really concerned about this given things I said about my family to this person...and give their sudden abcense from the disability arts clubhouse)? It was like they knew how to draw information out of me.
  • Was I psychotic at work? On the ferry?
  • Does that mean I do become psychotic?
  • Can you be psychotic if a tiny part of you suspects you might be mistaken?

P.S. My blog spellcheck isn't anyone else having the same problem? Please ignore my spelling mistakes.

Monday, February 04, 2008

I Wish I Would Die

Caution: Open discussion about suicide, may trigger some people. (Please read this first)

This is just a rant. It's how I'm feeling, thinking, how I am this week. I will survive. I just need to get all this out of me and my pdoc's away.

The short version: My mood is cycling into an extreme low again. I have hoarded medications, including a HUGE amount of heart medication and phenobarbitol I managed to get at the pharmacy for my dog, Bert's, cardiomyopathy, low blood pressure and the seizures he's been having.

I talked the pharmacist into giving me months worth of his meds. I want to die. That was my intention when I picked Bert's medication up. I can't take this anymore...I'm hanging on though. Not sure how, or why.

The Long Version:

I am severely depressed again, after feeling a bit of a lift in mood for a few weeks. My pdoc is away for three weeks. It is the first decent amount of time off I have seen him take since I met him 6.5 years ago, so he deserves it, but I still miss the sessions and feel like I really need someone to talk to right now. I may not seem to get better with therapy, but I find his support each session invaluable.

I have no energy, or motivation. All I want to do is hide under the covers all day.
I have obssessive suicidal thoughts much of the time. Even when my mood lifted for a while I was having thoughts of suicide. In the past I have never acted on these thoughts, although I have come very close. I plan, get all the things in place to do it, write the note, and then, while writing the note I think of how devastated I would be if one of my sisters committed suicide. At that moment I curl up into a ball and try really hard to get rid of the thoughts and to hang on.

Dr. X once gave me a metaphor for hanging on, and I use it when I feel like this. He told me to think of myself being on, and a part of, a strong and sturdy ship in a stormy ocean. The wind and waves (like my depression and all the bad thoughts) may batter this ship, and push it off course, but it will not sink. My job is to hang onto the rudder and steer in spite of the storm. I find this a powerful image. So far I have hung on.

My suicidal thoughts differ depending on the symptoms of the depression. If I am extremely anxious or irritable they are often more violent in nature. When I am in an anxious, raging mood I have images of stabbing myself over and over again, or jumping from a tree out back and hanging myself, or shooting myself in the head.

All these thoughts act like some kind of release for me. The stabbing presents me with images of all the blood flowing out of me, and with it all my sadness. The hanging seems to be an image to snap me back into reality, and the gunshot provides me with a violent image to stop the rage. Dr. X. likens my thoughts to cutting. The thoughts provide me with some form of release.

For years I have horded all my extra medications so I will have a way out if I cannot manage anymore. My dillemma has always been that I do not want to use medications prescribed by Dr. X., because I respect him too much to kill myself using what he has provided me, to help me. Due to this I have always given in and brought in my piles of pills to Dr. X.

This changed recently, because my dog is so sick that he requires heart meds, pain meds and seizure I now have collected a massive amount of phenobarbital, sotolol, and lotensin for my dog...but I purchased the medications in quantity, so I could use them to go if I can't take it anymore. So I now have the means I need to disappear. I wish I had the will to make that happen.


Because I can't take not getting better for any reasonable amount of time. A couple weeks a year is simply not worth living for.

Because I am trying so hard to get better and nothing works, not medicine, not therapy, not my volunteering and trying to do some resembling work.

Because, all that ever seems to happen when I begin teaching again is I get so anxious, stop sleeping, stress out about how the classes are going, obssess about all my mistakes, obssess about why I cannot engage everyone, obssess about how I cannot do this, obssess about whether or not I am helping people...I feel like I'm trying so hard and it just isn't working.

Because, all my husband and I ever seem do do is avoid each other, or fight. I try so hard to get along, but he keeps telling me I just have to stop being so angry, just stop being depressed, or sad, or anxious...and I don't know how to do that. I'm trying, but nothing works. I hate who I have become.

I hate myself so much. I do not understand why this is happening to me. I do not understand how I worked so hard my whole life to get through university, to develop myself in my career...and now I'm nothing. Nothing, but depressed. Where did I go?