Sunday, June 08, 2008

Managing my Depression Getting Through the Toughest Days

In a previous post I welcomed my 5000th visitor to ask me a question, or suggest a topic for a post. Deepblue being my 5000th visitor posed the question/s:

"I guess the question I'd have to ask is: what has been the most helpful thing you have done to help manage your depression? or, how do you get through your
toughest days? I guess you can answer either of those".

I am not sure how long Deepblue has been following my blog, or what s/he knows about my situation. I have had Major Depressive Episodes (MDE) since I was 17 or 18. I always managed to pull out of them either on my own, or with a small amount of counselling, until I was 31 or 32 (I'm now 42). At that time I sought long term counselling (2 years/once a week), and then I was referred to an outpatient Cognitive Behavioural Training (CBT) group and then a group therapy program, both of which did not help me at all. I had tried CBT in therapy when my MDE's were mild to moderate, but this time my depression was become far worse than ever before. For about a year my MDE went into remission on it's own (with some residual symptoms...not sleeping, irritable, fatigue).

In the summer of 2001 I became despondent and requested more help from my family Dr. She referred me to the Mood Disorders Clinic and on October 3, 2001 I met my pdoc. He invited me to become his patient. I knew as soon as I began talking with him, that were a perfect match. I agreed and began seeing him for therapy and a search for medications. He and I have worked for 6.5 years to try to help me manage my symptoms and my depression. It has been a brutal and tough journey. No medications worked for me; and I tried almost everything you can think of (more than 35 different medications in total, either alone or in combination with other medications) Part of the problem was that not only do I have MDD, I also have anxiety and OCD problems. I think this makes my depression harder to treat.

Back to your first question: " What has been the most helpful thing you have done to help manage your depression?

Until the last month or two, I would not even say I was managing my depression. I was literally trying to "Survive my Depression". There have been a few things:

1) The first most helpful thing I did was find a pdoc that I could receive both therapy and medication advice from. A pdoc who was supportive, authentic, available, hopeful, intelligent, and who I connected with on a personal level. There were weeks and weeks where all that kept me going were thoughts that "I have an appointment in three days. I can survive until then".

In some of my worst moments I would visualize myself laying on the floor in Dr. X's office (no I have never really laid on his floor). The thought of just being near his calming presence helped me calm down.

I never have told Dr. X. this, but one day he left a message on my voicemail at work asking me to call him. I never erased that message until the day I left work. Whenever I was so stressed out I wanted to kill myself in the staff washroom, instead, I would go to my phone, pull up the phone message, listen to his voice, maybe repeat it a few time and something about his voice magically helped me survive...I know it's weird...but it helped

2. Medication that worked is the second thing.

Years of therapy and support helped me survive and try to get going and begin to "live with my depression", but as soon as I found a medication that helped, I was suddenly able to make a huge transition. Suddenly my anxiety dissipated, I lost most of (not all) my fear of people. I wanted to leave the house (vs.having to force myself out of the house), I wanted to see people, I wanted to experience new things. I felt hope. I saw the possibilities. I became more motivated. I began sleeping better. My mood lifted.

I would not say the medication was a miracle, because I had been working so hard on setting up a foundation to begin with, but suddenly, along with medications that worked, my foundation became like rich soil feeding growing plants and I was finally able to grow and blossom very quickly.

I have to say, the bloom has fallen off my plant a bit lately, but I still feel like I am strongly supported by the medications. I think in the beginning, when the medications first helped my mind was so blown that I actually could feel okay, that I ran with it above any of my expectations. Now I feel more like I have a long way to go to get well, but the medicine will help me get there.

3. Build and Create a life that has meaning and purpose. I have always been angst ridden about my life. Except for the time I was in my third and fourth years of university, and doing EXACTLY what I thought mattered, and exactly what supported my feeling that I was doing something meaningful and purposeful, I have always had a sense that I am wasting my life; that I will die and my life will have been meaningless.

I am really interested in existential psychology, because it speaks to this exact thing. So Dr. X. and I have worked really hard to help me slowly build a life full of meaning and purpose. It began slowly, but initially I thought, maybe if I give back to the world somehow I would feel better about my existence. So I began volunteering to walk dogs at the local SPCA. It was a start. I felt that no matter how depressed I was being around a dog would help me, and it was a flexible, drop in when you can situation, so days I couldn't leave the house, or even my bed, I didn't have to.

I realized I needed something more meaningful than walking dogs, so the next year I volunteered for our city's Shakespeare festival. This time I had to commit to one shift a week. That scared the hell out of me. It meant even if I was sick I had to go. It came with many therapeutic moments. I worked with people who either did not have a mental illness, or were not "out" about it. I struggled. My medication and medication changes made it difficult for me to think straight sometimes. I felt really self conscious. I was terrified. I did it anyways, and I got through the first season. The second season was less difficult, except I became so severely depressed part way through the season that I left, thinking I was going in for ECT. Even though I had to leave it helped build my confidence to try something even more challenging.

I began volunteering at the Art Clubhouse for people with severe and persistent mental illnesses. I took classes there, and eventually I began volunteering to apprentice classes with an O.T. and now I am volunteering to teach classes there. This all during the period before my medications worked.

It was hell, but I also loved it. It was hard to manage my responsibilities when I was so sick, but the structure really helped me leave the house, get out of bed, relearn to communicate with people, learn to lessen my social anxiety by exposing myself to more and more social situations: meetings, classes, and teaching. A structure to depend on, and one that was meaningful, and purposeful to me, helped me live with my severe depression.

4. Writing in this blog

For lots of reasons. First I have met some really interesting and caring people in the blog community. I feel like I able to be so open and honest here. It feels purposeful to me. I really hope that people who come here and are struggling with mental illness see what I write and realize they are not alone. I never want to provide false hope, because so many times I have written about feeling completely hopeless, but I know for me there is something about knowing I belong to a shared human experience that lessens my load. I hope that is what I help people with; providing a sense that we are not alone in this world, or in this battle.

The last question you ask is: "how do you get through your toughest days?"

I wrote a post a while ago titled: "Coping Strategies for Treatment Resistant Depression (TRD)"

probably provides my most comprehensive answer to this question. Honestly, some days I just cling to my life; curl up in a ball and just get through the obsessive suicidal thoughts, plans and urges. Those thoughts always pass eventually, and they always come back too, but I try really hard to just get through each tough moment as it comes and try to not think it will always be this way. Ant then there is always the thought...."three more days until I see Dr. X." I can last three days. I can manage knowing I have his support.


Annie said...

Aqua, This is a wonderful and comprehensive post. Congratulations with the response to your site. It is incredible how much work you have put into your health and healing. I am glad you have Dr.X, he sounds like a genuinely caring person and the relationship is obviously very helpful. Take care! Annie

deepblue said...

Thank you so much for your response to my questions. I've only been following your blog for a month or 2 - so that was a great summary for me. I really appreciate your candid and honest approach to discussing these issues. It definitely helps all the rest of us who are struggling. Thanks again.

jcat said...

You are so right in what you say...

Aqua said...

Thank you.

Deepblue: for suggesting the topics. I was feeling down today and writing about this made me realize how much I have progressed.

Annie: When I left work I decided this was my fulltime job; getting well and doing all I could manage each day towards that goal.

Jcat: I have been thinking so much about you. It is so strange that both of us have stepped into a better mind state around the same time...I just wish I had myself one of those "dudes", but I also see the difficulties you are worried about in your situation. I am rooting for you and your m. health to be on a solid upward path.

Sarah Ingaard said...

I went through so many months, years when I wanted to kill myself and stuck through for similar reasons. Mostly I didn't want to hurt my sister. I've been through psychoanalysis, CBTherapy, and been through a few different drugs and everything else under the sun. I've had drugs that worked that stopped working as well after a while. There is so much well meaning B.S. out there it can be incredibly frustrating. I went back to school and studied psychology, clinical psych, neuropsych. I worked as a health researcher for years. Have you heard of the Pfeiffer Treatment Center, Orthomoleculer therapy, Julia Ross, or Gracelyn Guyol? I am not suggesting that this will work for everyone. However, I believe this kind of therapy can change lives and truly cure. They can supplement pharmaceutical drugs with certain amino acids and make the pharma drugs work better or if feasible, the amino acids and other supplements can be taken on their own. The mainstream medical world doesn't talk about it because they are ruled by big Pharmaceuticals and big Pharmas don't make money when people do orthomolecular therapy. I believe we are on the edge of huge change because depressed people are doing huge amounts of personal research through the internet and demanding better answers. I am working up the courage to take part in Julia Ross' program. I am in a prepatory phase. Let me know. Best! Sarah

Michelle S. said...

Thank you for sharing with such honesty and insight. I wish I could be as open and honest on my blog. I just try to go with the mantra "this too shall pass" some days it works better than others but knowing others are out there making it work (and that not everyone is one of the eternall happy joneses) is so helpful