Me and ECT

Today's post was inspired by a blog posted today on the Dr. Shock MD PhD blog. Dr. Shock has a very interesting blog on which he addresses Treatment Resistant Depression and Electroconvulsive Therapy (ECT), among other fascinating things. Today on his blog he has posted videos by people who have first hand knowledge of ECT, because they have received ECT treatments.

I did not create a video when I went through my ECT treatments, but I did the next best thing; I wrote about my experiences with ECT on a Bipolar/Depression Discussion Board as I was going through the 8 treatments I received.

After viewing the videos on Dr. Shock's website I went and found those old posts and I thought I'd share them with you:

written 1/18/2004

I will be in the hospital all this week (voluntarily) to receive the ECT treatments Mon, Wed and Friday, then I will go home for the weekend and, if all is working well, will go back to the hospital the next week. I am able to leave the hospital on non-treatment days so I will update the group if I can on those days. If not I will do so on the weekend.

My 1st treatment was Friday. As my brain is super important to me I had all sort of concerns about the procedure and its effect on my intellectual abilities. I read tons. The document on this website: http://www.mheccu.ubc.ca/ has lots of info. The Drs told me that I may have some short term memory loss for around the time of the treatments, but that most of those would come back within a few weeks of the treatments ending. The literature and studies I have read say the same thing.

On Thursday, I was given a physical, blood work, chest x-rays (I had a cold) and they checked my heart with a heart monitor. I met with an anaesthesiologist to discuss the process. She said I would be under anaesthetic for approx. 10 mins and would be given a muscle relaxant so my body would remain still through the process. The Dr who does the actual ECT then visited me and I asked him tons of questions. He calmed my fears about my brain and the process.

On Friday morning at 9:30 I went into the treatment room. I panicked when I saw the Dr and nurses...thoughts like, "I think I've made a mistake, I don't think I want to do this, I'm scared", were going through my mind. The anaesthesiologist held my hand and said, "it's okay [Aqua] we are all here to make sure you are safe". I was still terrified, but that made me feel better.

The next thing I knew I woke up to the sound of myself crying (I had been crying as I went under the anaesthetic. The doctor said this sometimes happens during the first treatment). For a few moments (seconds) I was pretty scared. It felt like I was in a nightmare crying and trying to get up, but my body was still asleep. Within a few seconds I opened my eyes. I felt really drowsy and it took maybe 3-4 minutes for me to fully come to. I was in the recovery room, it was approx 10 minutes after I went in for the treatment. They took me back to my room and I rested for about an hour. I then got up, had breakfast and woke up a bit more.

At 1pm my husband came and took me out for a walk and some lunch for a couple hours. I really enjoyed the walk. The rest of the day I had a bit of a small headache and some muscle tension. All in all I felt pretty good. In fact by the evening my mood had lifted considerably. Dr said this might be a placebo effect as the treatments generally take 3-4 treatments to start working.

I haven't had any memory impairment from the 1st treatment and I feel much more confident about tomorrow's treatment.

written 1/20/2004

I had my 2nd ECT treatment yesterday. I was quite a bit calmer as I knew what to expect. I will find out the name of the muscle relaxant for next time I write here. Yesterday I did not have the crying when I woke out of the treatment. It took a bit longer to come out of the anesthetic, so they may have given me a bit more relaxant than the time before.

I was a bit more confused yesterday while I was coming out of the anesthesia. For instance forgot the nurse had given me my medicine, forgot when I had come back to my room. Every once in a while I can't find the word I need to complete a sentence. All in all though it hasn't been that bad and I don't think someone who didn't know me would even notice.

My mood feels quite a bit up today. I visited with my regular psychiatrist today and he said it is probably too soon for this to be the result of the ECT treatments. Generally it takes 6-8 treatments to feel better. It may be that I feel much better on the mood disorders ward than I ever expected to feel. I feel safe. I thought I would feel bad about being here [in the hospital] (i.e. like I'd failed, I was never going to get better etc.). In fact, I feel like I can be me for the first time in a long time.

[At this point in my posts on the BP Discussion Board a member posed a question]
1/24/2004

"Dear Aquamarine,
You don't give all that much of your history - 2 1/2 years of trying various antidepressants doesn't seem all that long - personally, I would rather keep trying other treatment options. Have you tried cognitive therapy, or some of the older antidepressants?
You must be in a lot of pain to risk permanent brain damage. Hope it works out for you.
Best Wishes
V"

written 1/24/2004
[My Response]
Hi V,

I have been struggling with my depression for at least 20 years. I have been through so much, and so many kinds of therapy and nothing has worked. I do not believe I am risking any kind of "permanent brain injury". I did not take this step lightly. I read tons about the procedure. I asked lots of questions, I spoke with others who had gone through it.

[Also, in my city the Mood Disorders Ward/Clinic is at the forefront of research on depression and bipolar disorder...this, along with the fact that they treat so many people with depression and bipolar disorder, and the fact that I trust my own pdoc's opinion 100% made me confident I made a sound choice]

I have been in the...hospital for a little over a week now and it has been a great experience. I cannot believe how much better I feel. The ECT has given me back my hope. I can see that there is something to live for. I was getting pretty desperate before I went into the hospital. I couldn't keep going the way I was.

I have had 4 treatments now. I am having some short term memory difficulties. For instance when I came out of the anaesthetic yesterday I had no idea where I was, or who the nurse was. Once they told me it came back to me. I have taken to writing my plans in a daytimer because I cannot keep everything straight in my head like I did before.

This is a small price to pay when the reward is feeling like living again. Over the past few days all my suicidal thoughts have disappeared. I feel hopeful again. I feel like I have been given back my life. This has been an incredible experience for me...and I hope others might consider this path when they see how it has helped me.

written 2/17/2004

It has been two weeks since my last ECT treatment. (I had 8). I have had very little memory loss. Maybe just a bit of confusion about things that happened around the treatment times, but even then I do not feel I lost much, and nothing that important. When I came home my Pdoc started me on some lorazepam to help me sleep(because I have been so anxious and wired for so long) and lamotrogine to stabilize my mood.

Before I came home I had a bit of a hypomanic episode for 8 days in the hospital (1/2 way through my treatments). I thought it was the ECT, but the Pdoc said no way, not so soon. Anyways, the day of my last treatment my mood crashed ...This is usual for me as I have been rapid cycling for a couple years now.

I went through one week of really bad depressive symptoms, then voila, my mood lifted and I feel AWESOME!!! Maybe verging on hypomanic, but that feeling you get when everything is perfect. I have tons of energy. Tore my house apart, from top to bottom and cleaned it like crazy. I've been going out with friends and generally feeling like life is so good. It has been 5 days of this incredible feeling. Everyday I have been waking up and thinking, "Am I okay still?" Each day I breathe a huge sigh of relief when I realize I still feel WELL...Please, please, please, let this last!!!

written 3/16/2004

[In response to a later question]:
I had 8 ECT treatments..(each Mon, Wed and Fri for 2.5 weeks). Since my last ECT treatment approx 2 mos ago 2 things have happened:

1. It appears the ECT helped medicine finally work. The medication I am taking (Lamotrigine, Lorazepam and Trazadone) seems to be working. I had tried the lamotrigine before and it had not worked. ...(I have tried so many meds. without success...it would make your head spin if you saw the list!!!)
2. I have had more GREAT or GOOD days in the past 2 mos. than I have had in the past 2 years. There has been a lot of really rapid cycling with my mood since the ECT, however:

• My "downs" are not quite as low as they were before..3 or 4 on a scale of 10 vs. my lows (before 1 or 2 out of 10)...10 being manic/1 being suicidal
• My downs are definately not lasting as long as they were before...usually 3-4 days then I go up again. (my ups have been high, but not TOO high!)
  

My theory:

• I may be cycling because my meds are trying to lift me out of a very long-lived and very awful depression.
• I get up, but my brains natural tendency is to take me back to what I am used to (i.e. Major Depression).
• I've used the learning to ride a bike analogy before(cycling...ha, ha): Each time I get on the bike and try to ride I get a bit better, and go a little farther, but I fall down a bit before I take off and KNOW how to ride!
  
  One really important thing for me is the fact that I do not feel like I have lost any of my intellectual or cognitive capabilities at all. I have had some memory loss, but nothing that I have felt was important. In fact I think when I am depressed I have a much harder time remembering things. For me, ECT was a godsend. I cannot believe my progress since I left the hospital.
  
  written 4/14/2004
  
  Couple things about my experience following the procedure:
  
• I was having many good/great days following the ECT...for approx. 1.5 months.
• I did however rapidly cycle up and down. I tend to cycle, but in the past my cycles had been tons of depression, with a day or 2 a month being okay.
• After ECT I had more okay/good days than bad for approx. 1.5 mos, but cycled up 4-8 days, down 2-4 days over and over.
• For the month or so following the treatment I did not see much memory impairment...
  I am now having a bit of difficulty in that area (remembering words sometimes, or someone telling me something and two seconds later it is gone...

HOWEVER... I'm not sure if these were caused by ECT because:

1. Could be side effects of the meds I have been taking for my depression / anxiety (one of the side effects of ativan can be confusion/attention difficulties).
   
2. I also broke both elbows in the interim, so that stress and all the pain meds I have been on may be contributing to these difficulties.
   
3. I have had to withdraw from all sorts of pain meds and I am withdrawing from my ativan right now...this is/has been hard.
   
4. As well, I am depressed again...so that can cause memory/attention dificulties.
   

Sorry I cannot be more definitive about the ECT and how it affected me...
All in all...I think it was worthwhile and I am hoping that once the pain, frustration and limited mobility caused by my toasted elbows disappears, that my meds will work again. I do believe the ECT helped the Lamotrigine work for me...a miracle given I have tried 20 different medications with no success.

Written today:

The Lamotrigine did not work again, and was causing balance problems, so I stopped it. I would definately try ECT again if I needed to. This time I would ask for maintenance ECT, where they give ECT once a week, then once a month and maybe even less frequently, in order to keep the depression at bay, or the medications working. I am confident it was, and is, a good treatment option for me.

Why Do Doctors Say these Things?

I do not know if it is me, or if everyone has stories like this, but here is an example of what NOT to say to a patient:

I decided to go to the walk in clinic two days ago because I was unable to get in to see my GP until mid-January. I went because about a 10 mos to a year ago I got this small bump on my right eyebrow. I had no idea what it was, but it did nothing until about 4-5 weeks ago when it began growing rapidly. It had also become very itchy. I looked at it the other day and wondered if it was ring worm, although it didn't quite look like that because it wasn't exactly round like ringworm is. It was more uneven around the edges. Anyways, I had ringworm from my cats years ago and I didn't want it again, so relatively unworried, (because it's completely curable), I went to the clinic.

The doctor looked at it and said it definitely wasn't ringworm and that she wanted to get a second opinion; so she asked another doctor to come look at it. He looked closely at it and said: "There is a type of skin cancer that is very deadly, and it kills a person very quickly". He then paused for what seemed like an eternity.

During that pause I think, "Great, I have found medication to stop my depression and suicidal thoughts, only to find out I am going to die in the next few months". The irony of this situation is not lost on me.

As my panic begins to build he pipes in, "...but this isn't that type of cancer". I think: "WTF?" He leaves and I cannot remember what he said after he said it isn't the deadly cancer. All I still hear is "deadly cancer" and "kills very quickly". This phenomenon, not hearing things after devastating news, happened when my Mom was diagnosed with pancreatic cancer. I used to carry a notebook to my Mom's Dr's appointments, because I'd leave the appointment and not have a clue what had been discussed.

I asked the initial Dr. what the consulting Dr. said. She said, "it is either Basal Cell Carcinoma (BCC) or it is a wart (although it does not really look like a wart)". She said it does not matter because BCC is a very slow growing cancer and the treatment for both is the same...freeze off with liquid nitrogen over a period of 4-5 weeks. I let her freeze it and booked another appointment, but when I got home I felt really angry at myself.

Why had I not insisted on a biopsy? What if it was cancer, how am I going to know if it is gone? She seemed really unsure about what to do if it was cancer. She even asked the other doctor if she should refer me to a dermatologist. I do not feel confident about the projected treatment.

I also have read that BCC can be really disfiguring if it is not dealt with in a timely manner and can metastasize if not treated properly. The growth is on my face, on the far right of my right eyebrow. I do not want a huge scar on my face. Something happens when I am faced with an authority figure. I shut down and do not have the ability to stand up for what I want.

I got home and decided I needed to see my Family Doctor. I phoned and told them what had happened and I have an appointment late next week. I am going to ask for a biopsy and a referral to a dermatologist. Even though I really trust and like my Family Doctor this request will be so hard for me, because it means questioning the original Doctor's authority. A task I dread.

The Mood Whose Name Cannot Be Spoken

I'm afraid to say it, because everytime I do it seems to jinx how I am feeling. I am feeling that mood that begins with "W" and ends in "L"; otherwise known as feeling that word that begins in "G" and ends in "D".

This feeling has come about very quickly, like my switches in mood from severely depressed to almost hypomanic. According to my pdoc though it is a medication induced switch. I have been taking Tegretol (carbamazepine) for the last few months to stabilize my mood. It is so great in that it has had no negative side effects and had been helping me sleep without feeling at all drowsy. That great sleep you get where you , fall asleep easily, dream and upon wakening often remember your dreams. I love that.

The Tegretol helped stabilize my mood a bit, but I still felt severely depressed, so two weeks ago my pdoc added prozac at my request. I had tried all the other SSRI's, but not this one. I never had any luck with the other SSRI's and they made me so fatigued/tired I could hardly move (although that could have been the continued depression).

Within a week and a half on the Tegretol/Prozac combination I began feeling a change; more energy, elevation in mood, more interest in life and those around me and I felt more attractive, even magnetic. God I even asked my husband for sex. Sex has been really lacking in the past year. I am usually highly sexual, so this was a good sign.

There were a few problems with this mood switch. I have developed what my pdoc called a "tic". I have relentless snippets of music; four or five bars, playing over and over and over inside my head. Attached to this is a constant "clicking" or "tapping" of my teeth to the music. It is not a conscious thing. If I try to stop my teeth from clicking to the beat they stop while I am thinking "stop", but I quickly lose focus and they begin again. The music is even less responsive to my will. It simply will not stop.

I also find myself having way too much internal energy. A sensation that I am racing. Not neccesarily my thoughts, but a physical sensation that I am really speedy inside. I find myself unconsciously tapping my fingers, my leg is shaking like I have to much energy or am restless or agitated and I have an increase in my heart rate. My regular resting rate is 60 bpm. When I have measured my resting pulse rate while I feel like I am racing inside my pulse rate has been 70, 75 and 78 bpm.

This change quickly led to my craving alcohol again to slow myself down...(why do I do this)...so I began to drink again; drink, take valium and take muscle relaxants to try to calm down and slow down. This should be so predictible to me. Every single time my mood starts to go high I begin to drink/take benzodiazepines. I cannot manage the intensity, anxiety, agitation and speed of this mood state.

I told Dr X. about my self medication (thank god I trust him enough to be honest). I also expressed to him that I am afraid this mood that cannot be spoken is temporary, and, like my mood switches before, will disappear, or is precarious. He said it may be precarious, and may become lower, but he does not think it is like my switches before. He said the quickness of the switch; the fact that my mood responded to the antidepressant so rapidly, points to a bipolarity in my mood disorder.

I asked him if maybe the rapid switch was a placebo effect, in the same way that I think maybe my rapid response to ECT was, or how I seemed to respond to Lithium for 5 weeks after I was on 1200 mg and then lost my good mood entirely. He said no it wasn't a palcebo effect. That a placebo effect would not come with the particular neurological effects I am having (the tic). Maybe he is just saying this to keep me hopeful...but if so it worked. I do feel hopeful. Another sign that I am feeling w**l.

Yesterday Dr. X. prescribed Clonidine to me to try to help me sleep and to stop the music and teeth clicking tic. He mentioned it was used for helping people with heroin and smoking addictions come off those drugs...so I think maybe he is hoping it will help me stop drinking and taking valium. As I left yesterday he did quietly suggested that maybe this medication will help me slow down and sleep so I do not feel the urge to slow down in other ways.

I took the Clonidine last night, and I became sleepy about an hour later and soon fell into a deep and restful sleep. I woke up this morning and the music and teeth clicking was gone. Unfortunately it returned shortly thereafter, but I am hopeful it will go away over the week.

I had a great pdoc appointment yesterday. I felt cared for and listened to and it is always an incredible experience to spend an hour with Dr. X when I feel that word that cannot be spoken. Here's hoping we have hit upon the right combination of medications.

Breathe Deeply This Magic Elixir

Early last week I had one of those dreams that seem to be passing me messages. The kind I know I need to listen to:

I had 2 kids and an ex-husband. The ex-husband was violent. He drove by the kids and I and then he began chasing us. After a long, terrifying chase we got away.

We went home. It was supposed to be safe, but I worried the ex would find us. The doorbell rang. I was sure it would be him.

I told my husband not to answer the door, but he did anyways. It was my brother. He too was violent. He was also mentally ill. He had schizophrenia.

My husband invited him in. He needed a place to stay. I was scared.I didn't think it was safe to have him in the house.

I opened the door to the basement and I pushed my brother into the darkness. The basement was terrifying. I locked the door behind me.

After a few hours I got up because I knew my brother would be scared. My husband gave me an elixir. "Place two drops in your hair and it will put him to sleep", my husband explained. I was worried I would breathe some in. Just before I went downstairs I placed two drops in my hair. When I reached him he got up and came to hug me.

As he hugged me he smelled my hair. He loved the smell and breathed in deeper; as he did he began to slip into a deep sleep.

I felt so sad that I had to drug him to feel safe, but it worked. I did feel safe and I fell asleep as soon as I crawled into bed.

1. First I have no exhusband and no kids. My pdoc pointed out that a very close friend of mine has 2 kids and a husband so evil he would stalk her if she ever left him...(well the "evil" part was my word).
2. I am my brother. I'm mentally ill and sadly I feel I have a huge and uncontrollable capacity for rage when severely ill and I am really afraid I may have a capacity for violence in that state.
3. I especially have violent and obsessive suicidal thoughts in this state. Therfore the violent men may represent those suicidal thoughts.
4. I think him having schizophrenia represents me having an mental illness that is clearly an illness and accepted by mainstream people as an illness (vs. depression often being seen as a lack of strength of character, or as my fault, or its change within my grasp).
5. Maybe I am the brother because my Dad was full of rage and anger and sometimes violence. I see that trait as masculine. I hate and fear that side of myself.
6. Pushing my brother into the basement = my fall into my scariest depression...angry, agitated, violent suicidal thoughts...and there is no escape when I am there...the door is locked.
7. The locking of the door may also represent locking out my mental illness (the female me feels safer when the door's locked).
8. "I felt so sad that I had to drug him..." = my sadness about needing medication to help me and about being mentally ill in the first place.
9. However, on some level "the elixir" represents my desire for a drug that will calm me, allow me to sleep and to feel safe.
10. "Place two drops in your hair and it will put him to sleep"...reminds me of the magic potion in the old fairytales Snow White, Sleeping Beauty, The 12 Dancing Princesses etc. In these tales each falls into a deep "deathlike" sleep. I find it interesting that I am both the one afraid I will fall asleep (i.e. afraid of death) and the one transferring the "death" elixir to myself (i.e committing suicide). This whole transferring of the elixir represents my ambivalence about suicide.
11. The metaphorical me (the mentally ill brother) loved me and reaches out to hug me. It is poignant that I am killing my loving self. Interesting that such a loving gesture comes from one I perceive to be so violent. I guess all that violence goes when you die...but all the goodness goes when you die too.
12. The metaphorical me loved the smell of death...like me...I love the idea of death setting me free.
13. Also, he breathed that death in deeply. He really did want to die. Do I?

Inertia and Shame

I often notice myself avoiding eye contact with Dr. X. Almost every appointment I begin by explaining how I am feeling and what has taken place the past week. During this time I always look away, staring at the corner of the door, or the books on his shelf; looking anywhere else but at the person I am talking with. During this time I almost always feel ashamed of myself. Ashamed for not getting better, ashamed of the way I act, ashamed for not doing the things I know I need to do to get better; like exercise, eat better, and spend more time with other people.

Usually about half way through my session I begin to feel less anxious and my gaze moves towards Dr. X's face. Yesterday this never happened. I spent almost my whole appointment staring at the bookshelf. I recognize this is a problem. My avoidance of eye contact is a reflection of my fears of being rejected by Dr. X., my low self esteem, and how much guilt and shame I carry inside me.

The last two sessions I have noticed that my chair has been positioned so it is directly facing Dr. X. If I sat in the chair as it was I would have a hard time avoiding Dr. X. Both times I have repositioned my chair so it faces away from Dr. X. I never thought he might have positioned the chair facing him on purpose until last night. Now that I think about it I think he intentionally positioned the chair so, when I sat down, I would have no choice, but to face him.

I have thought about this before. Part of why I move the chair is because I feel like I am too close to him (proximity wise) when facing him. I need more space. This feeling happened when I first began seeing him in another office. I began thinking he was moving closer and closer to me to test the veracity of my claim that I felt uncomfortable when others got to close to me. Now that I know him I do not think he was doing that. I believe he simply became more comfortable with me over time. I do however think he repositioned my chair the last few weeks. The chair was too sharply angled towards him.

This post is not to fault him for that, but to help myself participate in his scheme. I think it is unhealthy for me to avoid eye contact with him. I believe my doing this only serves to reinforce the feelings of shame and guilt I have about my increased inertia. My feeling this shame and guilt is like my buying into the scorn others heap on me about my not trying hard enough, not doing what I need to do to get better. This shame about who I am when severely depressed ignores such depressive symptoms as the severe inertia and amotivation that encompasses me when I am depressed and even the fact that the shame itself is a symptom.

I am going to address this in my next session. I have a difficult time challenging my avoidance of eye contact when I am in the moment. It is only afterwards that I regret missing the opportunity to address it. I will ask Dr. X. to help me take a behavioural approach to this problem, to help me redirect my gaze towards him when I speak; especially when I speak of things I feel bad about.

I believe if I can look at him while I tell him the things I feel ashamed about it may help dissipate those feelings of shame and guilt. I also believe by looking at him while talking I am asserting my self esteem and acknowledging that it is my illness, and not some lack of character on my part, that keeps me from becoming well. I am hoping a behavioural approach to this situation will reduce the amount of self-stigmatization I feel about having treatment resistant depressive symptoms.

Rating my Mood

"I think you are telling me you are feeling better than you actually are". When Dr. X spoke these words in my session last week they struck me as funny and I started to laugh. Why would I do that? It seems more likely I would tell him the opposite; that I am feeling worse than I am, out of fear that I would be told I was better before I felt ready to take on more responsibility.

I thought about it. I am so afraid I will lose his support; or that he will become so bored with my ongoing struggle and my seeming inability to motivate myself to actually DO something to help myself. Read: socialize, call my sisters', exercise, eat well, i.e. no more bowls of cereal at night, mashed potatoes, chocolate, chips, bread, all those things that are threatening to pack on the pounds, but seem, at the moment I eat them, to fulfil some void inside me.

At the moment he suggested I may be sugar-coating how I feel I thought maybe that was the case. The past three weeks I had come into my appointment, sat down and told him I thought, while my irritability (hostility/rage) and anxiety were worse, I felt my mood was a bit better. Immediately upon stating this I would start to cry uncontrollably. It did not seem far fetched that I was I was trying to protect him. To give him hope. To protect myself by telling him I was on the road to recovery.

We talked about this again in my appointment this week. I no longer think that is what was happening. I think there is a component of my mood that is feeling a bit better. I measure my mood in very strict terms, rating 5 things: mood, anxiety, irritability, fatigue and sleep. Each of these has a clearly defined rating system:

Mood: 1 suicidal, 2 suicidal thoughts, 3 severely depressed, labile or cycling mood, 4 depressed, 5 flat/apathetic, 6 feeling okay, (Target = 7...Feeling good most of the time with moments of feeling great), 8 feeling really high, 9 hypomanic, 10 manic

Anxiety: 1 panic attacks, 2 severe anxiety attacks, 3 severe-moderate anxiety attacks, 4 severe anxiety(no breathing problems), 5 moderate anxiety, 10 none

Irritability: 1 rage, 2 hostile, 3 agitated, 4 irritated, 5 moderate, 10 none
Fatigue: 1 extreme, 5 moderate, 10 hyperactive

Sleep: Number of hours

When I review my mood since I have been taking 800mg Tegretol I notice 2 things: my "Mood" fluctuates between 3 and 4, whereas for most of the last 6 years it has been sitting mostly at a 2 and occasionally a 3...so it is up a bit. Also, I have noticed my mood has not been cycling as much. This is a relief. So I think, although my mood is not good it is clearly better than it was. That too is a relief.

If I am so relieved, why do I burst into tears upon telling Dr. X I think I am feeling a bit better? I believe it is for two reasons. I cry because it is safe to cry in his office. He accepts me, so the crying is like me relieving all those tears that build inside me throughout the week. All the tears I cannot cry. The other reason is because I am afraid. I am afraid that getting better means I will lose Dr. X and his support. I need to trust him when he says I can see him when I'm well. He even says that may be the most important time to see him.

5 Reasons I Look Forward To Therapy

1) My pdoc really "gets" me. I always (99.9% of the time) feel listened to, cared for and understood.

2) If I I feel misunderstood or not heard by Dr. X. I feel he has proven himself to be so trustworthy that I feel 100% safe addressing my concerns. My best learning has taken place when there has been a misunderstanding that I am able to address. I believe that the best therapy happens, not through the words we speak, but through the behaviours that take place between us and the therapeutic relationship we are building and developing.

3) I can be raging, agitated, anxious, suicidal but after I am with my pdoc for 5 or 10 minutes I almost always begin to feel calm. It feels magical, but I think it is his calm presence that invites calmness in me. When I am extremely anxious I sometimes try to visualize myself sitting across from him in his office, hoping I can capture some of that energy outside our sessions.

4) It is clear to me that my pdoc loves what he does. Sometimes I sense a childlike joy when we are working together. It's not just when I am feeling better either. It seems to be when we both come upon an idea or a solution that will help me.

5) He accepts the mad, sad, angry, glad, close to hypomanic, irritable, dull, and wide awake me. Basically he accepts me any way I am. Never judges, never seems surprised, or shocked. Always seems to like me however I am. That makes me feel safe to be open and honest about everything I feel and everything I do.

5 Beautiful Things

From here on in I am going to try to make at least half my posts positive and life affirming. This blog has dealt with so much sadness, anger and anxiety that I think, in order to push my mental health into a healthier space, I need to make at least some of it life affirming.

Dr Shock MD PhD in his/her post, "1 Myth about depression mostly not covered", wrote a post in response to my questioning the myth that states "depression is a treatable illness", acknowledging that this is not always the case.

Some people do not get well with treatments for their depression. For those people it is important to help them live with chronic depression, in much the same way others with other chronic medical conditions (heart disease, diabetes etc.) learn to live with there conditions.

He talks about many of the things my pdoc does: creating a meaningful life in spite of being depressed, mindfulness, and creating a sense of well being in spite of my illness.

It's an interesting post. Anyways, I've decided to show another side of myself.

Here are "5 Beautiful Things" that create meaning in my life:
1) Beautiful Speech
(The below speech by Nelson Mandela was originally written by Marianne Williamson):

"Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us.

We ask ourselves, who am I to be brilliant, gorgeous, talented, and fabulous? Actually, who are you not to be? You are a child of God. Your playing small doesn't serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you.

We are all meant to shine, as children do. We are born to make manifest the glory of God that is within us. It's not just in some of us, it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others."

2) Beautiful Art:
Beata Beatrix. 1864-1870. Oil on canvas. Tate Gallery, London, UK. More. Dante Gabriel Rossetti. (Above image)

3) Beautiful composer with beautiful music

4) Beautiful City

5) Beautiful Song (although I cannot figure out how to get these videos to not sound like mickey mouse is singing)

Canadian Insurance Companies Bullying Depressed People

I found the memo below on the internet after I posted my post about my insurance company requesting detailed notes from my pdoc. It is a memo from the Canadian Medical Association's general council meeting in Winnipeg.

I am really mad about this now and I may contact a mental health advocate to challenge my insurance company's request. It seems Canadian Insurance companies are bullying people who may not have either the energy or the resolve or the financial resources to challenge them. Now I'm mad...look out!!!

Here's the memo I found:

"Insurance company demands concern MDs" http://www.cma.ca/index.cfm/ci_id/8394/la_id/1.htm

Isolation

Yesterday I managed to get out of the house to meet an acquaintance, M, at a restaurant. When I walked into the restaurant I saw two people who I used to meet for lunch on a weekly basis.

They were friends I had met in a psychodynamic group therapy group a number of years ago. They were people I have been very open with about my ongoing struggle with depression. I felt safe with them as they had both dealt with depression on an ongoing basis as well.

About 3-4 months ago they simply stopped inviting me. I admit that I am not good (read really bad) at initiating any meetings, but I always was excited to meet with both of them. In the weeks just prior to their stopping calling me I was in a severe downward cycle and my pdoc was talking seriously about my being admitted into the hospital.

As the weeks went on I felt they had made a conscious decision not to call me. I recognized that I was so depressed all the time that I burned out the people around me. I cared for them and, in my depressed mind, not calling them was protecting them from me.

Today when I saw them I felt so ashamed and guilty for not calling them. I felt this tremendous sense of responsibility for the friendship having failed. I started to cry when I went up to them to say hello, and I felt so much tension in the air. I thought I was going to be sick.

I want so badly to meet with them again, but I feel so ashamed for being the way I am. My husband yelled at me when I came home and tried to explain what had happened. He said, "You have to stop being so down. You cannot be constantly in a downward spiral"

WTF??? It is as though he believes I could change if I only chose to change. It is how I think everyone sees me and why I think most of my relationships fail. Others believe I am burdensome and I feel that way, so I give up the relationship because I do not want to hurt others.

I feel like that at the Art Clubhouse too. I feel like I'm the only one who never seems to get well. The head OT's telling me I need to change I cannot be crying etc. was akin to my husband telling me to stop being depressed. Now I do not feel safe at the clubhouse to be myself. I feel constantly on edge, afraid I will disappoint. Because of my fear I hold back and keep so many thoughts to myself, because I want to belong, I want to be more supportive and less of a drain on people.

I despise this illness. It has destroyed my sense of self, my sense of self worth, my ability to be resilient and my sense of connection to others. I cannot imagine that I chose to be this way, that I chose a life that makes me want to die every single day I exist.

One Therapy Session a Week Will Not Make Me Well

Dr X. and I met this a.m., like we do every Tuesday morning. His office is the one place I feel safe. I knew I was anxious this morning, like all week, but I thought my mood was a bit up this past week, at least up from where I spend most of my time.

As soon as I began to talk a flood of tears began pouring out of me and as they came I felt so alone, helpless and hopeless. I started to feel like I was a burden to Dr. X. I started to feel like I was going to lose his support if I don't get better faster. I started to feel like it is my fault I'm still so depressed. It's my fault the medications are not working.

By this time I was sobbing and having a hard time breathing I was so anxious. Dr.X told me I am not burning him out and he will be here for me to celebrate and embrace the days that I feel good, but also to support me on the days that are bad.

We talked a lot about creating a life where there are all kinds of opportunities for that kind of support, because one therapy session a week is not enough to keep me on the path towards wellness. I need a life that does that too.

So ideas were to get a personal trainer again to help me get back on the exercise path. Also, to have a set schedule for these things so that everyday at a particular time I exercise, or grocery shop, or meet friends, or cook dinner. Cooking a healthy dinner everyday is another idea...a good way to add more vegetables and healthier eating into my diet. Take my vitamins and supplements everyday, meditate etc.

The art clubhouse I go to is important too, even though I am really struggling since the OT incident. I feel really angry about this still because I no longer feel safe there. I feel scrutinized and devalued. I know I love art and I really enjoy some of the people there though so I am really trying to use a behavioural approach to my fear and anger and face it even if I am feeling that way.

Dr X. says he understands how hard any one of these things is, but if I am going to get well I need as much support as I can muster. Having a healthy body, eating well, being around people at the clubhouse...these are all systems that can contribute to my getting and staying well.

Psychiatric Confidentiality: Our Laws are Only as Good as Our Resolve

I wrote the following in response to a question about confidentiality on a Mental Health Discussion Board/Support Group I belong to.

In the thread about effective treatment someone had written they were afraid of their employer or potential employers finding out they were depressed. The site is managed by a psychiatrist and he wrote, in part, the following:

"It is medical malpractice to release your medical records to anyone without your permission. The only exception is that your psychiatrist is expected to send your referring family physician a consultation letter, and then progress notes every few months.

Employers, schools, government officials are not allowed (at least in the western world) to have access to your private medical records."

This has not been my experience.

First, when I went off on disability my employer was given my diagnosis and medical info because I had to consent to their receiving it in order to receive short term disability payments which they paid.

Second, I am on LTD and receive some of my money from the government. In order to receive those payments I had to provide my health information to the government and I had to sign a release form allowing the government access to my medical records.

Third, I have recently had a serious dilemma in terms of my employer's Long Term Disability Insurer. I will describe what follows as "coerced consent":

Last year my employer's insurance company sent me a document requesting that I release ALL my psychiatrists notes to them, not just a brief description or progress report...instead, every single thing he ever wrote about me.. In the release form they explained I could only continue receiving my insurance payments if I signed the document. Given I have no income without their payments and I have to eat/live and am unable to work; because of my precarious financial situation I did not have the resolve to say no to the insurance company. I feel I was COERCED into signing the document.

Lucky for me my pdoc does have the resolve to stand up and say no. My Pdoc has refused to send his notes to them. He says he will send what he has always sent...a brief recap of treatment, but he will not send his notes.

I feel I am very lucky to have a pdoc who has my best interests in mind, but I am not certain many Pdocs would take his stance, especially when the patient has signed such a broad ranging release form.

As you can imagine, the Insurance Company's request has impacted what I feel safe talking about in my therapy sessions. Even knowing they receive ANY information is upsetting and makes me very cautious about what I say in my sessions. Knowing they could potentially receive every note my pdoc writes makes it impossible for me to talk about some things.

Fourth, the other difficulty I have had in terms of confidentiality and potential abuse of power is that while I have been off on disability my employer's disability insurance company has changed 3 different times, so now, rather than one huge Canadian insurance company having my disability/mental health records, the three biggest insurance carriers in Canada have my mental health records. I find this very disturbing.

It may impact my ability to find work when I am well, especially if my potential employer uses one of those insurance carriers. I know the psychiatric records are supposed to be confidential, but employer's and insurance companies are well versed in finding ways around this and I just want everyone to be aware of this.

Independence

I think lack of independence has, in many ways, led to my depression and kept it from going away. My husband is away and I am noticing that I am free in a way I have not allowed myself to be in a long time.

I am free to turn on the heat when I want to without being afraid he will criticize me (I pay the bill...so not sure why he cares either way). I am free to go anywhere, with anyone, without being afraid he will get mad at me. I am free to do the things I like to do without feeling guilty about doing them. These things are informing me that I allow my husband to control me in so many ways. I give up independence to keep our relationship comfortable, to avoid conflict. I don't like that I do this.

I feel like I give away bits of myself by giving up my independence. I notice that whenever he has gone away I feel a sense of freedom that I do not feel when he is home. Alternately, my strong sense of needing my independence can be a big problem. I push people away because I feel suffocated, or feel like I need my space. I think this is a defense mechanism. I push them away before they get the chance to push me away.

I struggle so much with my fear of being rejected by others. I believe this stems from two things in my life: As a child and teenager I had to move with my family to different parts of the country every 2-3 years. Each time I moved I had to make new friends. I think I gave up some of my independence and became who people needed me to be in order to make and meet new friends.

Also, I had a father who dismissed my ideas all the time. He was the most important male role model in my life. His dismissiveness was heartbreaking as all I wanted to do was please him. I am 42 and he still dismisses me and I still try to please him. It still hurts me every time he rejects me. I do not know how to become independent in this relationship, other than avoid him, which is what I end up doing.

I have replaced my father with a husband who does the same thing. It is strange, but the more I feel dismissed, the more I struggle to be close to the person dismissing me. This affects my independence. I do not feel safe being independent because I fear I will be rejected.

Is it a Love Hurt Thing?

1. My husband hates pharmaceuticals, especially psychiatric medications and especially if my pdoc augments or mixes medications to try to help me. He says the meds have kept me chronically depressed. We get in HUGE fights over my being on meds/trying different meds.

2. I understand/believe I have an illness. I believe, and my pdoc has told me he believes, my illness is biological and/or genetic.

3. Two days ago my husband came to my therapy session with my pdoc. He sounded much more rational and understanding about medications when talking to my pdoc than he is when he talks to, or yells at, me.

4. Today I went and saw my pdoc again and he says he thinks I should go off all medication for a while and really work on my relationship with my husband and other non-medication things (like exercise, eating well etc.)

5. I lost it...I feel so ashamed of how I reacted:

• At first I thought he was concerned about me using medications he prescribes to commit suicide. I said something really stupid like, "I can commit suicide without the medications. I don't need them for that"...partly because a couple weeks ago he was asking me about whether I was hoarding meds again. He caught me off guard and I felt really embarrassed that I had been saving any leftover meds. I have not been hoarding meds that I am supposed to take...When I left his office I was worried he might have been left with the impression that I have been noncompliant with my meds. Not so. I (almost) always take my meds the way he prescribes them. The ONLY times I have not is with benzodiazepines and sleeping medications...I sometimes have increased them, or reduced them on my own, either because, I feel like I can't calm down, or sleep on the dose he prescribes, or alternately , I start to feel addicted, and want off them "NOW".
• Then I felt like it was too much of a coincidence that he makes this decision right after he met with my husband and myself.
• I really do not think my marriage is fixable. I do not even know if I want to be married anymore given how my husband has treated me while I have been struggling so hard. The last few days I believe I have come to terms with the failure of our marriage. So why do I want to risk my well being for something I do not even know I if I want to preserve?
• I feel like my life is finite and I want to get well as fast as I can. I do not want to waste six months not trying to find medication/s that might help only to find that time off meds was a waste of precious time.
  

6. My pdoc says no medications will be able to help me if I am constantly having battles with my husband at home about the medications.

7. I felt like my pdoc was taking my husband's side and my family's side.

8. I already feel let down by the therapist at the clubhouse I go to. The feedback she gave me has increased my paranoia and suspicion about all the therapists and the members there and what they think of me. I feel like a couple members may have complained about me...(they are nice to my face, but talk negatively about other people)...so I extrapolate that to... "They talk bad about me". Plus, I feel like all the therapists must have been involved for the head therapist to say something...especially given the day prior to being talked to it was another therapist who talked to me when I was upset. I feel like I am an outcast.

9. Now I feel like my pdoc is on someone else's side. Except, I am pretty sure, based on my past experience with him, he is on my side...but I'm feeling really confused by this reversal of our previous discussions.

10. I feel like my husband and family are underestimating how depressed I've been, how much it impacts my life and the consequences and potential consequences of my being severely depressed for this long (six years...almost the whole time) Their "Get out and do more things" comments make me feel like they have no idea what it is like to be INCAPACITATED by depression for this long.

11. Now I wonder what my pdoc is thinking? I thought he understood how desperate I am to get well and how important it is that I get well as quickly as possible. I am really upset by this sudden turn in his treatment plan. For months we have discussed treatment plans in terms of medication and maybe my going to the hospital and maybe ECT. He has never pushed medications, but has always talked in terms of our eventually finding a medication, or medications, that would help me . I know I need to do more than take medication. I need to work hard to get my life back, but I cannot manage to do those things when I am this depressed. I need something to help lift my mood enough so I can manage to become motivated to begin living again.

12. I have never, ever read "stop medications" as a strategy to treat Chronic Major Depression, or Treatment Resistant Depression. It feels like he is giving up on me.

13. My husband says he is looking into his future and does not think he wants the rest of his life, what life he has left, to be impacted by my depressed and unstable mood. We have talked several times in the last 4 days about my moving out.

14. I love my husband and I feel so sad I have impacted his life in such a negative way. It was me who initially suggested I move out both because I know my not getting well in a timely manner is hard on my husband's wellness. He is depressed now because of it. Also, I feel I will not get well with us constantly fighting over my medications.

15. I asked my pdoc to let us first try increasing my Carbamazepine to 800mg for 3 weeks to see if that will help my mood. It has not helped thus far, however, I have also had no bad side effects and that's good. My pdoc agreed to try, but he did not sound very hopeful.

16. I feel so confused, sad, angry, and abandoned by my husband, my family, my pdoc, the art clubhouse I go to, my friends (all of them have given up on me), even my dog, because he is really sick again and I know he will pass away soon.

17. Over the past couple days, it's hard to explain, but I have a cloak over all those emotions. I feel nothing, despondent, like I have no emotions anymore...nothing left to feel. Everything is so bad in my life right now that I see no hope anymore.

Thank You Dr. X.

Thank God I have a psychiatrist who cares about me. I was so stressed out all Tuesday day and night about the OT thing. I cancelled my volunteering at the Art Clubhouse on Wed. as I just couldn't face the staff. On Wednesday morning I finally got the courage to call my pdoc to see if I could meet with him before Friday so I could manage to get to the Friday class I co-teach at the studio.

He was so nice. When I phoned I felt really uncomfortable...because I have this intense sense of responsibility in terms of keeping the boundaries of our therapeutic relationship really strict. I see him on Tuesdays...and everything is supposed to wait until then (according to me).

When I called he readily booked me in first thing this morning. I said, I am sorry for calling, but I really don't want this incident to stop me from going to the Art Clubhouse. You know what he said? He said, I am glad you felt comfortable enough to call me. He is so compassionate.

This a.m., once I explained what had happened, he said there is absolutely no reason for me to apologize for crying, or for feeling down at this place. He said it was not my problem. The OT is mistaken about the therapeutic value of my behaviour.

He explained that if you take a child who is extremely socially shy or phobic, afraid to go to school, to be with classmates, and you show them another child (a model) who is AS shy/phobic, but is managing to do the shy/phobic tasks (go to school, talk to playmates etc.), the first child will learn from the experience that maybe they can do it too.

It does not work if the model child is only a little shy and manages the task. The model has to be AS shy/phobic for the first child to see that maybe they to can go to school, or be with classmates.

He said my crying, and then managing to get myself together again and starting doing my artwork, or teaching classes, or volunteering is modelling that behaviour for others. It is helping others see that even if I am really depressed and feeling hopeless I can do things. Maybe, just maybe, one of them will see me doing that and believe they can too.

Dr. X. I wish you could read my blog. You made me feel so much better today. I still feel scared about tomorrow, but I feel much more confident about who I am and how it is okay to be me, despite what others say. Thanks for that.

Fatally Flawed

I was reading the Dinah's latest post on the "Shrink Rap" blog. The blog is titled "Are you my Patient"...and I very well could be. She writes about patients who come to see her yet never seem to follow her advice, or manage to make any meaningful changes in their lives. Although I follow my pdoc's medication advice for the most part... (I have said no to some things only to end up trying them out of desperation later on). I try to change, but amotivation, apathy, severe depression...where I can't seem to get out of bed for my life, all seem to get in my way.

My pdoc likens change, under these difficult circumstances, to a symphony. The music appears repetitive. It seems like the the music is not changing, but it is. With each movement the music builds and changes, rises and falls, sometimes ever so slightly, until finally it is something, not altogether different, but definitely changed, and developed into an even more beautiful piece of music.

Do you ever feel like you will never be able to change? Never get better? or that you have always been this way only it is getting worse?

I feel like no matter how much I try I will never get my normal life back. Even in my normal life I was so afraid of everything. I would get a great promotion and all I could think of was how I was going to fail, even though I worked extremely hard and was fairly intelligent, was proactive and had lots of drive and ability to do well.

I feel fatally flawed. Like all I will ever be able to do is serve coffee somewhere (for those of you who enjoy this work I am not that that is a bad thing...it just is not what I want to do), but have so much work experience and have worked so hard my whole life to get well paying and intellectually challenging positions. Now I feel like I can't do anything.

Yesterday I looked up what I needed to become an Occupational Therapist...something I'd be interested in, and I saw all I needed was 3 more credits from university to get into the OT program. Then I read the next line and it said 50% of my entrance requirement was a panel interview"...and I knew I couldn't do it.

I knew I couldn't manage the stress. I knew I couldn't explain why i haven't worked for 4 years, I knew I didn't have the confidence to sit in front of a panel of interviewers. Then I knew even if I did pass the interview I couldn't manage the stress of school...the exams and essays and even the classes with all the other people.

So I feel like there is no hope for me. I will never be anything. I don't know how to move forward, to change, to gain more self-esteem. I don't want to live the life I have, and I will never be able to achieve the life I want. I wish I would just die.

Exploding Pumpkin Head

Warning: Gruesome images...may trigger

I've been hiding under the covers for two hours...trying to hide from the voices inside my head; those brutal, self-critical, damning voices that won't go away and are continuously pushing through my head, intensifying both my anxiety and irritability and occasionally making me cry.

A sampling of the voices..."Do the BDI"(Beck Depression Inventory)...because I have no idea what I'm feeling right now. I told Dr. X I wasn't feeling depressed anymore, but I think rather my depressive symptoms have changed and the sadness is less, but the rest are worse. Am I depressed? Dysphorically manic? Anxious? Irritable?

So I do the BDI and I score 44, well, I think...it's better than when I was at the Outpatient Hospital Program...but my voices say, "both times the scores seemed way too high to be right". "Look up what the scores mean", they say. So I go online and it says, "...anything above 40 is unlikely and is indicative of either an exaggeration of symptoms, Borderline Personality Disorder, or Histrionic Personality Disorder". My voices tell me I have heard this type of criticism of my scoring on these types of tests before...remember the psychologist who tested me for vocational aptitude. I feel judged. I also feel like the veracity and intensity of my symptoms and the despair they cause me have been dismissed

I sit shocked...feeling like I was trying to answer the questions as honestly as possible and I know I was more depressed when I was in the hospital program. I try to be okay with this outcome and think, " Well, the questions are really open to interpretation (and I always over think the questions) and they are highly subjective. The questions and interpreters of my responses don't see/hear what goes on in my head"...but a huge part of me doubts myself and thinks, "maybe I'm not depressed, maybe this is just the way I am...and there's no hope for me in terms of being able to change".

Then the voices start asking, "Why won't Dr. X just tell me I have a personality disorder"? The question that I do or don't always seems to come up in my head. I do have a poor sense of self, I think of suicide all the time, a couple of my relationships are all over the map, I feel lost, empty, depersonalised and dissociated from my world and the people in it.

Many times I have asked Dr. X. if I have borderline personality disorder (BPD). He always answers, "I have never even considered it, you have some of the symptoms, but if you look at the general population almost everyone will have some of the symptoms". This, and the fact that when I am well I lose all, or almost all, the symptoms of BPD should console me. When well I rarely have interpersonal difficulties. In fact, I have been praised for my diplomacy and relationship or team building skills (at work) throughout all my jobs. When well I am alive, a bit wild, and have what is called a "hyperthymic temperament".

But I am not well...I start to feel really stressed out. I can't breathe. I'm having so much anxiety I feel like I'm losing it. Then the voices tell me I should kill myself. I start to visualize myself shooting myself in the head, over and over and over. I feel intensely angry at myself. I visualize myself taking a thin piece of wire between two sticks. I wrap the wire around my neck and I pull as fast and hard as I can until my head pops off. Then I pick up my head and I smash it into the cement over and over and over, until it breaks apart like a pumpkin exploding on a sidewalk.

Then I think...This is an impossible scenario, though comforting in some macabre way. So I think about how I could leave the party tonight, go swimming in English Bay and keep swimming until I drown.

I Know Who Lila is.

Ha, ha...last night as I was going to bed I realized who Lila was in my dream.

• Lila was a girl I knew who became a camp COUNSELLOR


• Lila is my family DR


• Therefore: Lila is a Dr. and a Counsellor

Lila = Dr. X (he's my Pdoc and therapist/counsellor too)

So I thought...why am I trying to save my psychiatrist in the dream? or is Lila a shape shifter in the dream?... because at the same time Lila went outside two wolves appeared...and when I was trying to get her back in the house...a pile of clothes was left at the door when a wolf snuck into the house.

Am I concerned that my pdoc isn't completely on my side? I don't think I'm trying to save my pdoc. I think I am afraid of losing him, because in the dream I go to great lengths and at great risk to myself and others I hold the door open for a magical 10 seconds hoping he will come back inside.

My counting to 10 represents how the unpredictable nature of my illness makes my important decision making almost impossible. For example, how do I decide to get a job, or even quit my old job, when every time I seem to begin to begin that climb towards wellness I end up crashing and burning a few days or sometimes a week or two later?

So I am left making my decisions by other means...i.e. counting to 10 and praying I've made the right choice. It is impossible with my illness to make a rationally based decision so I am stuck making decisions based on dreams or some kind of magical thinking.

I know if I could just get my mood stable I would make these choices and move on with my life. I think that's where my fear of losing Dr. X comes in. If I just get stable I won't need to see him anymore...and I would really miss him and his support. I wonder sometimes if my connection with him is so strong that it impedes my growth? He says I can continue to see him, even when I become well, but I think he just says that so I don't not get well for fear of losing him.

Wolf in People's Clothing

I have been having vividly realistic and frightening dreams over the past few weeks. In a few of them I have been violently violated and I swear I can feel the pain and the sensations and smells from the dream sequence seem to linger when I wake up. When I do wake I am absolutely terrified. Last night I again had a nightmare. It wasn't about being raped, but it was nonetheless terrifying.

I dreamt I was in my house. The house had an open design with windows everywhere. I went outside and out of the corner of my eye I caught a glimpse of a huge black and grey wolf. I was scared and went back in the house, but I thought I might have imagined it.

It was after dinner and my dog Bert had to taken for a walk. I started to take him. He peed, but as I was about to take him farther a wolf stepped out of the woods. I put the lead on Bert, and, even though I knew the walk was important, I backed up and quickly went into the house.

It was dark, the house was now an office of the huge corporation I worked for before I became too ill to work. The windows and sliding glass doors were wide open. I glimpsed a gigantic (3X normal size) wolf. It's hackles were up and it was snarling and vicious. I ran and locked the door, closed and locked the windows and sliding glass door, but I was terrified it was going to break through the glass. I started to close the blinds, hoping the blinds would create the illusion of a more solid wall, rather than a window.

Two more wolves came snarling out of the trees. At the same time I heard someone say Lila had gone outside. I was terrified and yelled, "get her back in here". I ran to the back door and started letting people in - but I knew the wolves were coming.

I started counting down from 10 and was going to permanently lock the doors when I reached 1. I reached 1. People were pouring in, but I knew the wolves could shape shift and was afraid some of the last people would be wolves.

As I reached the #1 I went to slam and lock the door and simultaneously I looked down and saw a set of clothes crumpled on the floor. I knew there was at least one wolf inside the building. I woke from the dream absolutely terrified. Heart racing, sweating and afraid to get out of bed for at least 2-3 minutes.

I have had these wolf dreams before and they are always so frightening. Usually the wolf has me pinned to the ground and is growling ferociously in my face, about to tear me to shreds, when I finally wake.

What was the dream about?

1. Before I fell asleep I had been thinking of returning to work part time...the wolf could represent the job that terrified me, filled me with anxiety and depression and threatened to kill me (via suicide).
2. The wolf could be my LTD insurance company as I am so at odds with being paid for being ill from a job that I know I cannot return to , even if I become well...because I will become ill again.
3. I had been thinking of how I could survive on my government disability...about the hidden costs of giving up my employer's disability...the cost of my medications for example (the wolves were hidden in the woods, kept appearing magically and disappearing in the same way)
4. I was thinking about how I haven't been depressed (but instead extremely anxious, irritable and not sleeping) for 3 weeks, no depression = a return to work...but would I survive that?
5. I was thinking about my depression disappearing, reappearing, the unpredictable nature of the course of this illness and how it makes it hard to make a decision to quit work, try something new, or return to work, or stay off work and on disability. The wolves in my dream are unpredictable like this...magically transforming, disappearing, reappearing etc.
6. Lila...I once knew a girl named Lila who went on to become a camp counsellor and saved a six year old from being dragged out of camp by a cougar. Lila is also my g.p's name.
7. I had been thinking about what Dr. X. thinks about what I am able to do, or should be doing now that my mood is better. Of course, my first thought is he thinks I need to work...and that scares me because I am afraid I won't stay feeling better.
8. I think all the glass in the house and the corporate office represent people watching me, tracking me, judging me...my old fear of being spied on and seen to be more competent than I feel...and in the end forced to go back to work before I am well.
9. Shape shifting wolves: again...my fear of those around me (Dr. X., husband, insurance company, company etc.) transforming into the enemy and forcing my hand when it comes to working.
   

What I have Enjoyed in my Life: Meme

I got this meme from Jame's blog @ "Letters from the Sanitarium". Thought it might show me as more of a 3-dimensional character:

Thanks James....this was good for me...to think of the things I can do, can accomplish and enjoy.

Four Jobs I Have Had or Currently Have in My Life:

1) Currently Volunteering as an Art Instructor/Mentor: At an Art Studio that is a rehabilitation clubhouse for people who have severe and persistent mental illnesses (schizophrenia, bipolar disorder, major depression). I have co-taught printmaking classes and helped with teaching an older adults pottery class (handbuilding). I am about to start co-teaching a beginner's drawing class and just finished the 8th of 10 lesson plans yesterday. I love this place and am a member there as well...so get to use the space to do my art and attend classes.

2). Just finished volunteering at my city's Shakespeare festival...I worked in the concession last year and was a bartender this year. I had to quit because of my symptoms this year, but hopefully can go back next year.

3). "Facilitation and Development Specialist"...at a HUGE, massive, gigantic corporation. I developed training material and classes, as well I facilitated workshops for managers. Before that I had been a trainer in the organization for years. This job took me down. It was so high stress and involved travelling across the country to deliver workshops. I left this job and went on disability. Ironically, the last day I worked was the day I completed and did my first workshop around ensuring the organization creates a workplace that is open and accessible to people with disabilities. They speak the speak...but when it came to walking the walk...What a joke. I saw so many people with mental illness treated so poorly...it was sad. Glad I left.

4). Bartender, hostess, waitress at a busy restaurant. Did this throughout University and I loved it. The place was fun, always busy and relaxed. The people I worked with were amazing. The restaurant might as well have been a bar on Thursday, Friday and Saturday nights. It was one of the busiest places in the city and I just loved working there. Kind of weird because now something like that would terrify me.

Four Countries I Have Been to:

1) British Virgin Islands: My husband and I rented a 34 foot motorboat with another couple and cruised around the islands for 2 weeks. Can you say BLISS. It was the best vacation I ever had. I spent most of my time in the water. As you may have gathered from my name I am a waterbaby. The second I touch the water I am free.

2) England (London): Visited my best friend for 10 days. I love this city...Even after 10 days I did not even scratch the surface of what is available to experience there. I was blown away by the National Gallery and the Tate Gallery. Also, their underground is amazing and easy to figure out. They have the simplest maps of the city at the underground...they fit in your back pocket. Truly a city geared to tourists.

3) France (Paris): Did the whirlwind one day walking tour. It was so incredibly beautiful. I have never seen anything so gorgeous. It was a beautiful spring day and we walked all over and ended up in the park that encompasses the Louvre. The day was exhausting...but worth it. I want to go back for a longer period of time.

4) USA (Washington, Oregon, California, Nevada, Utah, Idaho, Montana, Arizona, New Mexico): Took many different trips. Camping down the Oregon/California coast, to San Francisco when I was 22...loved it!!, to the Grand Canyon a few years back...unbelievably gorgeous...especially the North end (I think...the undeveloped end anyways...stunning). I always had a great time in the US but, I'm scared to go to the states now because I'm afraid to cross the border. It freaks me out how much power those uneducated people have. They have more power than the police...scary. Not that I'd do anything illegal, but I get scared nonetheless.


Four Places I'd Rather be Right Now:

1). Canoeing and Camping on Sakana Lake...I go there in my head when I get really stressed out.

2). London, England...I love that place

3). Tofino, B.C....I got married on the beach there and it is beautiful...the huge wave, the sound of the ocean, the seclusion....ahhhhhh!

4). My pdocs office. The second I get there I feel safe. About 10 minutes into my sessions I usually become extremely calm. He soothes my soul.


Four Foods I Like to Eat:

1). Chinese... especially Schezuan

2). Japanese...sushi...yum

3). Indian

4) Mexican

Four Personal Heroes-past or present:

1) My Mom...she was all about being caring and compassionate. I don't think I ever heard her say a bad word about anyone. She had this incredible ability to see from other's perspectives. I loved her more than anyone on earth.

2). Jesus...the man...I'm not religious at all, but when you read about Jesus in the new testament it is amazing to see a man so accepting of everyone. This is where it makes me sick that Conservative Christians twist his words and deeds into hatefulness for people who are different from them. Jesus the man accepted all and was kind, compassionate and good to all. I think (if he existed) he was a great role model. Even if he's made up, he's still a great role model.

3) Mahatma Gandhi: Peaceful Resistance...need I say more.

4) Buddha: Any being who helps others survive their suffering is a great being in my books. I am struck by how much Buddhism is like western psychology...interesting.

Four Books I have Read or Are Currently Reading:

1). A Fine Balance by Rohinton Mistry...If you want to smell, see, feel what it is like to be lower caste and struggling to survive in India...this book will take you there. Beautifully written.
2) Heavier Than Heaven: A Biography of Kurt Cobain....This man suffered...The book is well written and will make you think twice about the benefits of fame.
3) Existential Psychotherapy, by Irvin Yalom...This book got me to finally leave work and helps me take responsibility and move forward in spite of my mental illness. He writes fiction too that makes some of his theories more accessible (read: "When Nietzsche Wept"...It will make you take charge or "Lying on the Couch"...a play on words...the book is a really fun and sometimes disturbingly honest look at psychiatry).
4) The Heart of Buddha's Teaching: Transforming Suffering into Peace Joy and Liberation, by Thich Nhat Hanh...an easy to read, easy to understand introduction to Buddha's philosophy. I was awestruck both by the author's writing and by Buddha's teachings. I love the way Thich Nhat Hanh views the world. It makes you want to survive your suffering.

Is it me? You know that hypomanic charisma...

I'm not sure what's happening, but today two separate men at the studio where I volunteer and do my art at started talking to me about how I "have a sexy figure", how "hot" I looked in the clothes I was wearing....jeans and a t-shirt...go figure.

While it is nice to be noticed, I feel really uncomfortable with their comments. The Studio I go to is a place for people with mental illnesses to go and do their art in a safe and comfortable place. It is bringing up issues I have had previously. Issues that almost cost me my marriage.

A few years ago I was in group therapy and one of the men was coming on to me in a big way. I guess because I was having marriage troubles, and because I hadn't had that kind of attention in a long time, I played along with the flirting. I thought it was harmless and had no intention of acting on the flirting. Then it got totally out of hand and the person threatened to commit suicide if I didn't see them. My pdoc recommended I completely cut contact with the person for my own safety and well-being. I did, but not before my husband caught wind of what was going on and went ballistic.

Now I try to be more clear about my intentions and boundaries, but one of the people today seems to want to push the subject. I have made it clear that I'm married. As well, I do not think I am acting flirty or anything to attract this kind of attention.

I don't want to make a big deal out of it. I just want them to stop saying those things to me because it makes me feel a bit scared of going to the studio and I don't want it to stop me from going.

I'm not sure how to deal with it because one of the people has confided in me that he says things sometimes, pushes the limits in a conversation and then feels intensely bad about it afterwards. I do not want to make him feel bad. I just want him to understand that I am not comfortable with the way he talks to me. What do I say?

If he says something again I was thinking maybe I could say, "because I am married, I feel uncomfortable with that kind of comment from another man"...but then I may hurt his feelings as he might feel like he has done a bad thing. I think if he says something again I will just jokingly say...hey, that kind of talk makes me uncomfortable...please stop it...or I'll have to beat you up...ha, ha!!"....or something "funny...so he gets the point, but saves face.

What is Happening to Me?

I don't understand what is happening to me right now. I haven't slept more than 2 hrs straight and and average of 3-5 hours total a night. I have more energy, but it is BAD energy. I am feeling so much anxiety that today I began panicking at the laundromat. I couldn't breathe and I began feeling like my body was swirling and I was going to faint and then I just felt dissociative...like I was outside myself, or covered in foam or something was between me and reality.

I went on a trip to a dude ranch/spa last week. I did lots of things that should have been relaxing and fun; horseback rides, hayrides, ATVing, massages, facials, body wraps, swimming...all things I would usually enjoy and find relaxing. I went with my sister and her kids who I always love to be with. This time it was different though. I did not feel anything good at all.

I could not feel any of the enjoyment...all I felt was intense anxiety and bad energy surging through me. I felt disconnected from every thing I did and everyone I did it with. I enjoyed nothing. I was so anxious the whole time I couldn't sleep. If I did manage to fall asleep it was for an hour here and there. I would wake up having anxiety attacks all through the night.

I can't take much more of this. I don't know what to do. I feel like I have tried every medication out there...like all has attempts to become well have failed and there is nothing that will help me. I feel helpless, hopeless and lost.

My husband is after me for not enjoying anything anymore. I tried to explain that is a symptom of my depression and anxiety...the joy disappears from life. He keeps talking to me like I'm choosing to be this way. Get a job and you will feel better, he says. He just doesn't get that I am ill and if I felt like I could manage a job, I would be the first one to go get one, but I can barely manage to get out f bed, or do the dishes, or the housework. How can I get a job when all I want is to die?

I am trapped. All I want is to die, but I cannot hurt my sisters by allowing myself to die, so I stay for them. I am trapped in this hell forever. God I hate this existence...please just let me die.

Can the Dead Talk to You?

I just came back from taking my dog for a walk in the flower field. Any elation in my mood has disappeared and is quickly being usurped by my anxiety and my depression. As I was walking I started thinking about suicide again...visualizing myself jumping off the city's highest bridge ...that would give me something to be anxious about....as I see myself hit the cement like water and break into a thousand pieces. I already feel that way. Broken into a thousand pieces.

...And then I look up, and in front of me, at the end of a row of dahlias, is a lone "Shoo Fly" plant.

My mom and I went to a "Seedy Saturday" a number of years ago, and she found seeds for this plant. In her loving care they ripened and sowed their progeny everywhere in her garden. She was delighted and told me I needed some in my garden, as she, in her giddy, funny way sung:

"Shoo fly don't bother me,
Shoo fly don't bother me,
Shoo fly don't bother me,
'cause I belong to somebody..."

I took some seeds for the next year and delighted in them popping up in my own garden as they had in hers. Eventually, they disappeared, stopped sowing themselves and I have not seen any anywhere in the garden for years.

My Mom died a little more than a year and a half ago. I can barely write those words. She was too lively, too caring and compassionate, too needed by all of us who loved her...to die so young and too soon. She had three months to prepare herself and her family for her death. One of the things she said to us before she died was, "I will see you in the moon, the stars and the sun". It was a powerful image that left me with the impression she would always be around in one form or the other.

Recently, I was laying in bed at 2:40 a.m. still wide awake, hardly able to breathe I was so anxious and agitated. I tried to make the anxiety stop, but it held my chest in a vice grip, suffocating me. I wanted to die.

I started imagining myself stabbing my chest over and over with a huge knife until finally my chest deflated and the anxiety dissipated. I think thoughts of suicide calm my anxiety sometimes. I see this in the thoughts I have of slitting my wrists and watching all the sadness pour out of me.

I got out of bed and stepped outside. What should be the first thing I see, but a huge full moon. I could feel Mom passing me a message of hope. I went back to bed and thought about it...scoffed at the idea but, finally, fell asleep.

I woke again at 5:40...thinking what a dumb belief. Mom's dead, she's gone...god why couldn't it have been me. I have no life and nothing to live for. She was needed and wanted and her life was priceless to our family. I wish it had been me. I would give anything to have her return.

The sun had just started to come up and the sky was that dusky shade of twilight blue. There, framed between the fog encased blueberry bushes and the the wide open sky, sat the full moon, huge as it began setting into the horizon. The image, and my belief Mom was trying to be there for me again, was haunting.

This afternoon as I walked through the flower field I came upon that row of blood red dahlias; and at the very end of that row, reaching out to touch me as I passed, was that lone "Shoo Fly" plant. None had been planted in the cutting field, and none had been in my private garden for years. I felt Mom brush up against me as I walked by...and I swear I heard, "...cause I belong to somebody".

My Senate Hearing on Guilt

This past week I have been really thinking about how to rid myself of the guilt I feel for not working and relying on disability payments from my work to take care of myself. I have been off work for more than 4 years now due to my depression and it's symptoms. I swear everyday I feel bad about not working, about not getting better so I can get back to work, about collecting money for doing nothing, for being a drain on society in this way.

So in my session today I tried to get rid of this obsessive guilt once and for all...but the guilt is so huge...it is unreasonable to assume getting rid of it that easily is possible.

However, my pdoc used a good metaphor for working through this problem. He said there were varying opinions in my "senate" about the best way to deal my guilt and the factors contributing to my guilt. So we spoke of having a hearing and giving voice to all those opinions so I can see everything clearly defined and then vote.

Factors contributing to my guilt:

1. I have a strong work ethic and I want to work. In fact I have never not worked since I was 15. When I am well I love working and feel good about contributing.
2. While I can see other people on disability because of similar symptoms and accept that it is okay, and in fact beneficial, for them to not have the pressure of working while they are trying to recover or become well; I think I should be able to work despite my illness. (Don't ask...even I don't understand how/why I can feel this way).
3. I know that it took 2 years of coaxing and coaching from my pdoc in order for me to feel I could leave work to take care of myself. I also know that when I finally got the courage to leave work to save myself, I was the closest I have ever come to committing suicide. Still, there is a part of me that thinks it was just too convenient that I was able to leave a high stress job that was killing me and still be receiving money.
4. I have a very black and white view of what is considered work..."being off disability, and making enough money to take care of myself" ...volunteer work is not work...I need to make enough money to feel safe.
5. I know, that even if I become well enough to work again, I will never be able to return to my employer's workplace. The work and the company is just too stressful and competitive for me to stay and remain well while working there.
6. Although I enjoyed the teaching aspects of the job, I felt a complete and total disconnect with the moral structure of the organization. Everyday I went to work I felt like I was doing and being the opposite of who I believe I am. This destroyed me. I require a job that is meaningful, purposeful and fundamentally in line with my belief systems.
7. If I know I cannot go back, then I should resign. If I do not resign, I am not telling the whole truth and am receiving money under the pretense that I will go back to work when well.
8. I worry I am not getting well because of this existential nightmare...Maybe because I hated my job, I got sick because of that, and I remain sick because I am afraid I will be forced to return to the job I hated.

If I feel so guilty...why not quit my job and discontinue my disability payments?:

1. I worry that I will quit to relieve my exitstential angst and guilt...and it won't help. I'll still be sick and in an even more stressfull situation...(i.e. sick, unable to work, and have no income). I honestly cannot handle getting more sick than I already am.
2. My symptoms are as bad as when I left work...intense anxiety, suicidal ideation, mood cycling up and down, fatigue, lethargy, amotivation, irritability, agitation, difficulty concentrating/focusing, memory problems (ECT related? depression related? and/or often medication side effect related....remember Epival? Benzodiazepines?), poor sleep.
3. So far my depression and its symptoms have remained treatment resistant to all therapies and medications... and I've tried tons...Antidepressants (SSRI's, SNRI's, Novel Anti-d's, Trycyclics), Mood Stabilizers Anticonvulsants, Antipsychotics, sleep medication, Benzodiazepines, and stimulants, weekly/or twice weekly therapy, hospital stay, ECT, outpatient day program, group therapy...etc., etc.
4. If I am still sick, but I am continuing to try to get well, but nothing is working...is that my fault?
5. Isn't the disability insurance there to protect me when I am ill and unable to work?
6. What if I never get well, or it takes years more to get well...I need to eat and pay for my rent. If I just give up disability and do not become well enough to work I will run out of money and end up mentally ill and living on the street.
7. I am trying...so why do I feel bad about feeling too sick to work?
8. My pdoc, although he said it would be a powerful decision for me to make, said it would be rash to call up the insurance company and cancel my insurance given the symptoms that made me leave work are still with me.

What are my options?

1. Resign from my job, lose my benefits and my disability insurance...I think this would be the dumbest move. It may relieve the guilt, but I can see it would increase my anxiety about not being able to care for myself, and my frustration with not getting well/ or even better, in a timely manner. I think overall, this would destabilize my mood even more.
2. Return to work while still in a MDE and unstable...I would kill myself.
3. Continue on disability leave until my pdoc/ or my self decides I am well enough to return to work, and then resign and look for another job. Note: If I choose this option...I have to know I will be able to do it "guilt-free" and accept I am sick, this illness is disabling, I have disability insurance for this very purpose. Accept that.
4. Phone the insurance company and tell them I will not be able to return to my workplace regardless of my health and ask if their is any provision for retraining into another occupation. (maybe Dr. X. would help me call, or meet with an insurance representative?). Note: If I choose this option I still have to be well enough to learn another occupation. I have been practising with my volunteer work, but even with the work I love to do I have been plagued with symptoms. Also, the stress of making commitments and then being unsure if I will be able to follow through is overwhelming.

Hypomania? Benzodiazepine Withdrawal? or Just a Messed Up Personality?

I did not sleep again last night. I went to bed at 10:00pm and tried . At 11:30 I was still wide awake, tons of energy buzzing through me. Then the rest of the night I would fall asleep for 1/2 hr to 1.5 hrs and each awakening couldn't get back to sleep for 1 hr or more.

By 5:30am I was freaking out about not sleeping, but fell asleep for 45 mins sometime after 7am and then was wide awake and, once again, full of energy, albeit extremely anxious energy.

I feel this drill seargent inside me....go, go, go!!! I am flitting from task to task, rushing, pushing myself to go faster. I walk the dog, try to read the paper to relax, can't focus on any one story so I skim and get no relaxation and no information, check my e-mail, write a this quick, but very long (is "pressure to speak" through writing viewed as pressure of speech???), blog and get out and garden. I am high, irritable, anxious and untrusting all at the same time

As I was walking the dog I started to think of my last therapy session. Thinking of how Dr. X., asked me if I thought I was hypomanic, but he didn't allow the energy I have right now to be seen as something negative. "Use this energy to push ahead", he said. I like that he does not pathologize everything.

I have mixed feelings about one thing though. When I gave up my hoarded meds it was with the belief that he would help me if I had trouble sleeping or with anxiety. I feel a bit annoyed that I trusted him enough to give those meds.

He knew I had no sedatives at home. He knew that I had , over the previous week, stopped taking all of the 15-20mg Valium I had been taking. I'm sure he knew I was going to be anxious and have trouble sleeping. The first week of no sleep I recognize I was probably having some withdrawal, but I wonder if that is still happening? Or am I hypomanic?

What I would have liked is for him to acknowledge I was having, or going to have withdrawal symptoms. I guess what I'm trying to express is I would have liked to know this is what would happen if I went off Valium too quickly. He did try to get me to go off it slowly, but I always fell back and ended up increasing, because I would get so stressed out and not sleep. I would have liked an open/honest discussion about my "addiction" to Valium.

I would have liked him to express what I suspect he was thinking...that now that he had all my hoarded meds, I had no sedatives to sneak into, to "self-medicate" with, and now was an opportunity to get me off Valium for good.

Which is what I want...even though I'm whining and freaking out about not having any...it really is what I want. I suspect wants me off the Valium too.

What's my point? I just want him to talk to me, about me, like I am a colleague. I want to know exactly how he sees me, exactly what he thinks my diagnosis is, exactly what he would tell another health care worker about what is stopping me from getting well.

Why he is letting me go through all this mixed high, both intensely powerful and horrible at the same time. Powerful, because finally, I have leaped out of my cocoon like bed and started doing tons; horrible because of my mounting anxiety/irritability and no sleep.

I am glad he stood his ground and did not give me sedatives, but at the same time I feel like I really need to sleep. Is he doing it to see if I do have bipolar? Maybe before I was always sedating my hypomania, so I never went up and stayed up for an extended time? I just want to know what he is thinking when he makes these decisions...but I feel it is not my place to ask, or I feel like he is not telling me the whole truth.

Next day...
I'm scared too because I'm going away with my sister and her kids next week and I can't be totally psycho around them. Plus I want an enjoyable holiday, not one filled with the agitation I was feeling all day today. I just lost it today. I feel explosive inside...so anxious I feel like I'm being suffocated by someone squeezing my chest shut.

I am so irate I am mumbling and talking to myself in angry tones (even in public!!)...how embarassing. My mind is on high speed, I can't concentrate. I kept messing up at my volunteer job last night...dropping thing, distracted, miscalculating things, missing what people were asking for, just not getting it at all. All day I have been ready to blow up at everyone around me.

We have a house guest right now and this a.m. I went from excited and energetic (but really anxious), to severely anxiousand agitated in the same hour. Within the next hour I became so agitated I could not sit still. He started noticing my behaviour was getting bizarre and he came up to me to try to calm me down and help me relax with some type of yoga relaxation technique...as I was doing the exercise I just broke down crying and having the worst anxiety attack. I have way to much raging, racing energy inside me for how little sleep I have had. I'm scaring myself.

I won't last like this for 2 more weeks. I can feel that any "elation", caused by finally having some energy over the past week or so, is quickly disintigrating and becoming an anxious and agitated depression.

I don't want to ask for sedatives. I don't want to start or ever take any benzodiazepines again. I don't want to lose my energy. I just want the energy, without all the bad feelings. I want to enjoy my time with my sister and neices next week when we go horseback riding. Is that too much to ask? And what do I ask for? A new brain?

Hypomanic? Can I keep up this pace?

I have not had this much energy in a long time. Problem is I am sleeping on average 2 - 4 hrs/night (and that's with it being an hour here and there and awake the rest of the night), but I have more energy than I have had in ages.

It has not all been good energy. I am so anxious it is brutal. I've been having some of the worst anxiety attacks I've had in a long time. I feel this anxious energy racing through me. It feels really physical...I can't breathe, get a deep breathe, chest pains. It is not stopping me from doing things though, like it usually does. It is almost like my anxiety is pushing me to do things..

I keep thinking of Dr. X. saying... "I want you to use this energy to push forward". It has become my mantra since I saw him on Tuesday.

• On Wednesday:

I volunteered at the studio all day. The older adults pottery class I was helping with was having an "end of class tea". I was so energized setting up for class and had to try really hard to SLOW down during the class (didn't want to freak anyone out...but I was extra bubbly/effervescent quite a few times...just can't contain the energy). By the end of class I was just pacing like a caged cougar....let me out!!!!

I thought I would be bagged by lunch...but my energy kept increasing and was so bad (anxious/irritable/depressed) and high (surging energy inside, can't sit still, want to just go, go, go), both at the same time, I thought I was really losing it. I thought about going to the hospital or calling Dr. X. (something I rarely do...I've called him maybe 3-4 times in 6 years), but I kept thinking...push forward, push forward.

I managed to get back to the studio and help interview a secretary for the position we posted. (I love that they involve me in these things...what a great place!!!). I was ON....I really felt that even though I was feeling REALLY distractable. I saw and shared so many things that were important during the interview...things I don't think my slowed down mind would see. I felt productive and intelligent again...a combination I have not felt in eons.

• On Thursday:

I got out of bed early...after no sleep and was just racing with energy again. I was so stressed out/anxious/irritable, but I managed to think about how I could use all this energy positively. Swimming is my favourite thing in the world, but when I'm depressed I just cannot motivate myself to go. With my mood mixed with depression and this energy I had the energy, but was having trouble with motivation still. Jim said, "just go to the pool and swim one length". I felt so supported and thought, yeah, I could do that.

So I went to the pool and I swam MORE than 1.2 km... that's 48/25m lengths ...I lost count after that, but kept going for quite a few more. I finally stopped because I thought...Oh god, I'm going to be sore tomorrow, given I haven't swam a single length in more than 2 years. That thought only occurred AFTER I had done the damage...I was in pain that night...but felt so good about what I had done.

• On Friday:

Even though I had tons of energy in the a.m. it was all mixed up anxiety/depression/irritability. I still managed to push forward. I went to the studio all afternoon. I was so up, high and talkative. Maybe verging on annoying and/or obnoxious at times. I get a bit pushy/overexcited/interruptive when I feel like this. So I really had to try to back off and slow down in a meeting I was attending. One of the O.T.'s said I was so high I was energizing her. And she meant it.

• On Saturday:

I leaped out of bed after 3.5 hrs of sleep in my hour here, hour there fashion. Did the dishes, tidied the house and then more...

I have needed to go shopping for some clothes and things for months now, but get so much anxiety about getting to and being in the stores (anticipatory anxiety) that I just cannot get myself to go. Today I went, despite feeling even more anxious than normal...use this energy, push forward, push forward. Wasn't that enjoyable, but I went to 2 different malls. That's pretty motivated., because I hate malls and I was severely anxious and I got there anyways.

Then I came home and mowed the lawn (this is no tiny lawn and not easy to do), then I finished that and off to the BIG grocery store to buy some food....something that usually takes me forever to talk myself into....and I am, as you can see by the length of this post, still going a million miles an hour. All on no sleep.

This week I have done more than I have done in ages. I felt like I could barely get out and stay out of bed two weeks ago...so I don't know if this is hypomania, or if I am having this rebound energy after going off valium fairly quickly 2.5 weeks ago...or is this normal and my depression just disappeared?