Lithium

The types of thoughts, and manner of thoughts I was having when I wrote the post, ""How are you? "I'm Okay."" seem to have slowed right down since I increased my Lithium dosage.

A few weeks ago I was having extremely rapid suicidal thoughts, mixed with a rapid self deprecating/loathing "voice" inside my head telling me how awful I was, and how my boyfriend was trying to leave me, and how I should just end it all. The best way I could describe my mind at the time, with it's "machine gun" like thoughts, is to say it was "manically" depressed.

Like the referenced post I had a piece of music relentlessly, rapidly and repeatedly playing over and over in my head. My thoughts were so distressing and so unforgiving I really wanted to just remove my brain from my head. I thought I was really going mad, so I increased my mood stabilizer: Lithium.

Almost immediately after increasing the Lithium I felt some relief. A few weeks later I still feel depressed, but I am having more moments of relief and the bad "noises" in my head have slowed right down. With the demise of all that negative energy I feel a sense of hope again. I feel like maybe I can feel better. This is a huge relief. Thank you god...whoever you are.

What Does a Depressed Person Look Like

The entire time I have been off work I have been sure that my insurance company is spying on me. This fear has caused me so much stress and grief. Dr. X. has really tried to encourage me to keep trying to play, smile, do things that I enjoy doing, despite both my depression and my concerns about the insurance company seeing me enjoying myself.

He says, act like they are watching you and do it anyways. I have tried really hard to do just that, but my worries about the insurance company misconstruing my joy in the moment, with wellness, and my ability to return to work, keeps me feeling terrified about doing things. It seems I may be worrying for a reason.

Over on Shrink Rap there is a post that will scare the hell out of anyone who is depressed and on disability. It tells the story of how a woman placed photos of herself on facebook showing her having fun and vacationing. Her insurer removed her from disability benefits for her depression partially based on how happy she appeared in her pictures.

The article made my me outraged, but it was the 668 comments after the article that made my blood bubble and boil. I could not believe how little so many people understand about what it is to live with and try to survive, and recover, from major/clinical depression.

I organized the comments by "agree", and the fourth most common agreed upon comment was:

• 525 people agreed: "...it is clear this woman is a scam artist".

Not far down the page were more unbelievable "agree" comments...

• 262 people agreed, "...I hate to be cruel but from the facts presented, I'm leaning towards support of the insurance company's side. If she's ok to take trips, have parties, and go bar-hopping, how is she not ok to report to work every day? "
• 212 people agreed..."Oops, looks like you got caught to me !!! Back to work we go....like the rest of the depressed workforce of today"
• 143 people agreed..."This woman sounds like a real go-getter"

How is it "clear this woman is a scam artist"? She posted pictures of a smiling self, enjoying the company of friends and a vacation on the beach. Do depressed people never go out with family or friends? Does major depression always preclude smiles, laughter and enjoyable moments on vacations?

I know for me, smiles come easily sometimes, and must be forced or faked other times. Even if I am severely depressed, I often find myself in situations where my mood suddenly lifts for a short period of time (when I teach art is an example). I have been so depressed I felt suicidal, unable to get out of bed, and was sure I was unable to get to my class...and then I walk through the door, see a student and my persona suddenly switches into high gear, and no one in the world would ever guess I was depressed. The problem is, afterwards, I almost always need to nap because I exhaust myself.

Does my ability to lift my mood mean I am not really depressed? I have wondered about this a lot. I cannot reconcile my depressed self with its thoughts of suicide, plans for suicide, hopelessness, and intensely low mood, with the persona that seems to be bubbly, personable and for some moments maybe even "happy".

I know that others have a difficult time believing I am depressed sometimes because I often am able to hide my sadness, or even become "unsad" for short periods of time. This has caused me a great deal of stress, because people are constantly underestimate, and often dismissing, how sad I am, and how much my depression impacts and continues to destroy my life, and my desire to live.

Another commenter writes, "If she's ok to take trips, have parties, and go bar-hopping, how is she not ok to report to work every day?" Can a person, who is truly depressed go on a vacation and enjoy any of it?

For me my depression often stops me from doing things, going places, being with people, but I still push myself to participate in these activities. Sometimes I even enjoy the activities I do. Can you believe I am depressed and actually enjoy some things? I do sometimes go away on a vacation.

Most of the time I still feel as depressed as I would be back at home, often the stress of being away from home is too much, but sometimes, the vacation provides me with moments of relief, and a break from myself. Do moments of relief mean wellness? Does it mean I can work?

Whether I am able, or not able, to work is complicated. When this depressive episode began I was severely depressed and somehow still managed to work at a job that required a great deal of energy and effort. My fear of losing my job pushed me to keep working well past the time I should have kept working. I struggled for two years to maintain my work, but near the end I shut down completely and would sit and listen to people at work explain things or discuss things...yet I could not understand what was going on anymore.

I know for me stress really triggers me and increases my depression. Currently I do some volunteer work, but only a few hours a week. I know I am not able to manage more than a few hours right now. Even with just those few hours it takes me a long time to recuperate.

I feel so scared I will not be given the time I need to get well, that I will be told I need to go back to work before I feel well enough to manage working. I question myself everyday about how it is that I am able to participate in life; write in my blog, volunteer, take singing lessons, see friends, yet am unable to manage working. I guess the simplest explanation is that the singing lesson is an hour long and then I can go home and sleep. My volunteering is a few hours a week, then I can go home and be alone, and sleep. My blog is just all the thoughts already in my head, being typed onto the page. It is cathartic for me to write...and then I can sleep. My friends know I am depressed, so I can just be most of the time.

I don't think that my sleeping after every little increment of work, at a job, would be very acceptable to any company. There is a term called "Presenteeism" that is replacing "Absenteeism" as what a company is not looking for. A person who shows up for work, yet is not well enough to fully participate in work costs companies a lot of money in lost revenue and work accomplished. The "Presentee shows up, does very little, and gets paid. It does not help the company to have a worker who is unable to fully participate in work.

Anyways I ramble...but I want to show that people who are severely depressed can sometimes lift themselves enough to do things others might perceive to be impossible to someone who is unaware what depression is really like. This just points to the resilience of the people pushing themselves to help themselves move towards wellness.

Invalidated

Sometimes my therapy works to help me understand why certain patterns repeat in my life over and over again. Today's therapy was like that.

Therapy always leaves me feeling "heard", and (mostly) understood. This is something intensely important for me. I think today's session revealed why these two things are extremely interconnected and even more importantly, why they are so important to me and my well-being.

I just returned from a short vacation at a horse ranch and spa in the B.C. interior. I went with my beau, my friend E and my sister and 2 nieces. I haven't seen my sister for a while. When she came to my house in preparation to leave she told my boyfriend and I that my Dad might "pop in" to the ranch to visit.

This information put a damper on my vacation from the start. I love my Dad, but he is often not very nice to me. I find him very difficult to be around. To me it seemed intrusive for him to jut show up.

When I mentioned my stress about Dad coming my sister began saying things like:

• "He's not like that".
• "You need to give him a chance".
• "He does not treat you poorly".
• "He is always nice to you".
• "You know Dad, he just doesn't know how to talk, and you make it worse by getting hurt by him"
• "You have to get over your problems with Dad"

I felt completely letdown by my sister. She has seen my Dad reduce me to tears more times than probably I can remember. She hears and watches him ruthlessly tease me and belittle me. I thought she recognized why I so often feel hurt by how it treats me. Apparently, according to her, Dad isn't the instigator, in fact, he does not treat me poorly at all. It is just my wrong perceptions that hurt me.

I am willing to concede, that after years of emotional, and at times when I was a child and a young teenager, physical abuse, that I am sensitive to how he treats me. I know sometimes I overreact to small triggers. I believe though, that this overreaction is not my fault, but the fault of a man, who is supposed to be my father, continuing to abuse me, and destroy what little self-esteem I have left. At times I think he belittles me, and holds back his love from me, for the fun of it, just to watch me fall apart and cry.

It is funny (not ha, ha...but strange funny) that this weekend when my sister and I were canoeing near my Dad's canoe, we sped up really fast and in unison yelled, "Dad, look at us". We both cracked up when we realized some small child inside ourselves was still screaming, "Daddy, Daddy, look at me, look at me".

To make things worse my sister also began lecturing me on how:

• "no wonder you are depressed. you sleep so much, how are you ever going to get well if all you do is sleep?". (this comment came 1/2 way through the vacation, just when I was marvelling at my ability to do as much as I was, when I felt as depressed as I felt)
• "If you did more you would get better" (neglecting that to do more I would need to have the missing motivation, energy, and mood, and ability to do more...all these have been ripped from me throughout this MDD
• " You are never going to be someone unless you get doing things." Translation: your life will never amount to anything if you do not get back to work. You are choosing to stay depressed. You are only an important person if you are working and contributing to society.

There were more comments like these throughout her lectures...the thing that really hurt me, was that I thought she was the sister that understood how hard I try. I thought she understood how depressed I am, and how that impacts my ability to do things.

On top of this my boyfriend talked to me about how, "You are not sick, nothing is wrong with you" A statement that left me feeling really unheard, and misunderstood. It is not that I want to be sick, or seen as sick, but I also do not want others to think nothing is wrong with me, and I am just to lazy to try harder in my life.

I talked to Dr. X about what went on with my sister and my boyfriend, but I could not really place why I felt as hurt as I did. Dr. X said maybe it was because I felt invalidated by their comments.

That is EXACTLY what I felt and feel when these kinds of discussions take place. My family is not listening to me. They are not understanding how difficult this battle is for me. I feel like I am battling for my life, but they do not even acknowledge I am in a battle. They see my difficulties as a character flaw.

Dr. X and I discussed how both my sisters', and my Dad's expectations of performance are mirroring the malevolent feelings of guilt I have about not working; how the family belief system is so ingrained in all of us that it just keeps replicating this guilt, and guilt inducing, behaviour in everyone in our family. It is true. I belittle and poke and prod myself to do more, do something, get going, get active....Get better...get back to work. I have become the voice of my father, and the voice of my sister...that why it hurts so much to hear. I am hearing the same guilt producing words I hear every single day from myself.

I know my sisters both love me. I think my Dad probably does too. When I realize their voices are replicating negative patterns that are held deep within our family's psyche. I recognize these thoughts and feelings are held unconsciously, and so deeply they may always be there.

On many levels I know my sisters, my Dad, and my boyfriend are really trying to help me. I understand they may see their comments as encouraging, and helpful. I think they want what is best for me. Sadly, when I hear these kinds of comments I feel he exact opposite: I feel unbearably guilty, alone, unheard, and invalidated.

Things That Make You Go ...Huh???

I usually let these kinds of ideas wash over me, but this article, "Depression is Not an Illness" is so draconian, and, from my experience, mistaken that I had to respond.

The writer claims to be a retired , licenced psychologist. I worry others will read his post and feel their illness is their fault, or that somehow they are to blame for being depressed. I find it hard to believe that a person could be in the field of helping others...especially as a psychologist, and be so judgemental and mistaken in their understanding of a very difficult to deal with mental illness. My experience has always been that the major depression always shows up before all the activities he suggest cause depression show up/or disappear. My depression leads to my eating poorly, isolating, becoming inactive etc. Not the other way around.

This was my comment to him about his article...long-winded, but in support of all who struggle with MDD (or any other mental illness, I needed to say what I said...

"[My comment on his site...]
I am actually flabbergasted by this post. Not sure if it is satire (I hope so) or for real. I hope you post my response so others like me do not feel blamed for not relieving and avoiding their MDD. In case you don't I am going to post it on my website.

I struggle with MDD. I have had numerous clearly defined episodes throughout my life. Until this current episode I was the epitome of what you suggest makes a person happy, yet I still fell into severe and often lengthy depressive episodes:
good nutrition
- fresh air [I routinely biked, skied, swam outdoors and indoors, hiked, camped, canoed, gardened, walked everywhere was outside much of the time]
- sunshine.[.see above]
- physical activity[...ditto]
- purposeful activity[...worked(loved it), went to school(really, really loved it), danced, played music, created art, wrote, helped others]
- good relationships, [beautiful friendships, very open, nothing we could, and did not talk about.]

For me severe depression really did just pop out of nowhere. There was nothing wrong with my life during these episodes...I had a great life. It was the depression that stopped me in my tracks, not the other way around.

When you wrote, "When things are going well in our lives, we feel good"...I understood immediately that you misunderstand MDD. The sad thing about MDD is that even if things are going well this illness destroys a person's ability to feel good.

I find it difficult to understand how you treat people with depression when you place so much distance and dogma between yourself and your patients. When you say,

"Many of these individuals lived on a diet of soda pop [I can count on my hands the number of sodas I have drank in the last 5 years], cigarettes[don't smoke], and salami sandwiches[I think the last salami sandwich I ate was in high school...I'm 44]. Others drank enormous quantities of alcohol [I used to drink periodically...like many other happy people I know...until I got as severely depressed as I am now. In which case it drove me to drink more to try to help my symptoms]. Few ate vegetables regularly[ was vegetarian.so did well here]. Many stayed indoors almost all the time [see my above list of favourite and common activities]. Physical activity was almost always minimal [ditto]. Purposeful activity – i.e. activity directed towards some kind of goal – was seldom present [university? , and good honest, open relationships almost non-existent...[great friendships?]...

...Chronically depressed people, however,are individuals who have been neglecting these areas for years. They spend the vast majority of their lives indoors, watching television and eating snack food. They are often over-weight, have no goals other than the next TV show, and although they may have many acquaintances, they do not share their concerns and worries in an open and honest manner"

...it struck me that you believe very strongly that "we"are so very different from you. We just don't try hard enough to be happy. If only "we" would try harder, "we" could be as happy as "you".

Have you ever really worked with someone with clinical depression? Contrary to your statement that we are indoorsy, crappy food eating, inactive, solitary, lazy, unfocused, fat, slobs.. [actually slob is my word...it's how i sense we seem to you) people with MDD are a wide range of people...some of us even active, outdoorsy, friendly and friend supporting, anti-t.v., fit and interested and interesting people.

It becomes clear you have never understood what it is to be depressed when you state, "Depression or despondency is not as acute a sensation as pain". In the past I broke both my elbows at the same time, had a severe case of CMV related hepatitis that required hospitalization, have broken my leg, my ankle, my wrist, had three concussions, was injured in a car accident, had a doctor drill into my leg bone for bone marrow, basically have suffered a lot of physical pain.

NOTHING is as painful as severe and chronic MDD. When I broke my elbows I had just come out of the hospital after having ECT. For the first time in years I felt mentally well. I REFUSED any pain medication for my physical pain, for fear that my psychic pain would recur. NOTHING hurts like mental pain...NOTHING.