Depression is like. . . asthma?

Drowning.
A roller coaster.
Being thirteen again, but in a bad way.

There are lots and lots of ways people describe depression. Usually we use these similes to explain what feels like a unique experience to people who have just never been there. Most often we use them to explain why the illness we have needs treatment or how the treatment we're using is working for us. Most often the comparison we use is, "Hey if I had diabetes or heart disease I would have to take a pill everyday and people would tell me it's a good thing. Why is it any different for depression?"

Now, this isn't a bad argument to make. But lately I've been mulling this one over and for me it doesn't really do the issue justice. Here's why:

1) There is an element of preventability (I think I just made that word up) with both diabetes and heart disease. Yes, there is Type I diabetes that just strikes, but I think for the average individual when they hear diabetes they equate it with Type II diabetes, which our most often spun as a lifestyle disease by our current media. The same thing goes for heart disease. If people would just eat better and exercise more they wouldn't have those problems. Unfortunately, the same kind of thinking bleeds over into how we think about depression. But depression isn't usually preventable. Life circumstances, some of which we have control over (how much we exercise, if we abuse drugs or alcohol) and some of which we don't (genetic predispositions and postpartum hormone swings). For me, comparing depression to preventable diseases makes accepting the things I can't control that much harder.

2) Depression isn't necessarily a life-threatening disease like diabetes and heart disease are. If you don't treat your diabetes you're going to go blind and lose your feet and die. If you don't treat your heart disease, odds are you are toast. Yes, people with depression are more likely to kill themselves and suicide is horrible, tragic, cruel and everything should be done to prevent it from happening. But I think there are a lot of folks out there with depression who would benefit from treatment that aren't necessarily in danger of killing themselves. Maybe eventually they would be, but ideally we would support these folks in getting treated well before they ever reach that point. I think a lot of the danger of depression is not just that folks might kill themselves, but rather the immediate collateral damage that's done. Damage to family relationships--especially to the children of the depressed, short term health consequences (insomnia, weight gain/loss), and long term health consequences (possible brain degeneration) are all reasons to treat depression now even though it may not threaten the individual's life. Linking depression to two clearly life-threatening illnesses implicitly implies that folks shouldn't get treated if their lives aren't in direct danger. That is wrong.

So what should we compare it to instead? Asthma.

See, recently Mr. J (my third child who is almost four years old!) has been put on a fairly aggressive asthma treatment plan. Those of you who have been reading my blog for years know that Mr. J has never slept through the night and that we've been chasing down a number of health problems with him. Since his doctors at National Jewish Health started treating him as an asthmatic his whole health has improved. His coloring is better, his energy level and appetite are more predictable, and (wonder of wonders!!) he is sleeping through the night. (Okay, to be honest, most nights he still wakes up once and comes and settles himself on my floor but he doesn't scream or have night terrors or multiple wakings anymore. At my house this is as good as sleeping through the night gets. And, in the name of full disclosure, I think it helps that we now have a good eczema plan and allergy plan in place along with the asthma.) In some ways it is like having a whole new child. Before we started treating his asthma things seemed off and he was always struggling. But we didn't know why. It wasn't something we could see (like his eczema) so we didn't think to worry about it until it landed him in urgent care multiple times.

I think this is how a lot of us look at depression. We know something is off. We know we aren't working at full capacity. But because it's something we can't see--or in the cultural at large it isn't a "sexy" illness and can't be dressed up with pink ribbons or little red dresses--we don't think to treat it. Sure Mr. J was surviving without his asthma medicine but he never could keep up with the other kids and never felt healthy. Without my depression meds, I can manage. I can white-knuckle through my days and tough it out. But something is off and I can't keep up with my life; everything is harder than it should have to be. Having emotional stability is like having enough oxygen. Sure you can get by with less, but you'll never be able to thrive.

Now, having written all this, there is still that little voice inside me that says, "If you can manage without your meds then maybe you don't really need them. Maybe you're just trying to do too much. Maybe you're just not meant to be doing all that other stuff. Maybe you just aren't supposed to be that good." This voice is hard for me to quiet. Those doubts are powerful. It takes a lot for me to remind myself that I'm not asking for too much out of life to want to do more than just survive. It's okay to want to feel pulled together. Just like it is all right to treat my son so he can breathe deeply and fully instead of just asking him to get by on limited oxygen, it's okay for me to want to experience life from a place of stability. Thriving is not just something other people should get to do.

Have I sold you yet on my new "Depression is like. . ."? If not, how come? How do you describe your mood disorder or emotional health issues?

Medicine and Confessions

Okay, so I've really been touting my feeling-good-all-the-time thing here lately. And it is true that I am enjoying better mental health than I have in years. And it's true that I'm happy. And it's true that I am loving life. And it's true that I'm reveling in it.

However, I feel like I should probably own up to the fact that I've been having some ups and down with my meds.

I've really shied away from putting this up here for a couple reasons but the biggest reason is that I really like pretending my recent stint of peace has very little to do with the medicine and everything to do with me. There's a big part of me that wants to say, "See? That depression thing was just a fluke. That's not really me or a part of who I am. I'm normal. I don't have problems." Never mind that normal is a basically undefinable (and impossible) state of being and that it would be abnormal (whatever that is) to not have any problems. It's just that there's this huge part of me that likes being able to live up to so many high expectations and doesn't want to admit that I need/have medicinal help.

Here's the situation: I take my meds (Paxil 10 mgs) every night right before I brush my teeth. Except for when I notice the bottle getting low. When I notice that there is only about a week left I start to take them maybe every other day. Then when there are no pills left I usually forget to call in the refill. I think part of this problem is because my psychiatrist will only prescribe two months of meds at a time and calling her office and asking them to fax in a refill request is a pain in the heiney. But I think it also comes down to me wishing that I didn't need medicine to be pulled together.

The first couple days off the meds I have this exhilarating feeling of freedom. Around day three I start to crave sugar--lots of sugar-- and my mood starts to cycle up and down faster. By day five vertigo sets in and I'm tired and grouchy and easily confused. So I work out the refill (which sometimes takes a few days) and start taking my meds again. Usually my irritability skyrockets those first couple days back on, but then I even out and I'm good for then next three-ish weeks.

I sort of talked about this with my psychiatrist and she made the comment that it seems like I'm using my antidepressant to manage my stress. She said it in passing but it made me panic a bit. I immediately said, "What? Oh no! Am I allowed to take this for stress management?" She looked at me quizzically and responded, "Well, I don't know what you mean by allowed." That was the end of that conversation. (My psychiatrist is not very chatty or interested in probing the depths of existential questions. She's more of a practical kind of gal.)

I think this too has something to do with my love/hate relationship with my meds. I think in my mind I feel like it's appropriate to take medication for postpartum depression. You know, that's a valid diagnosis. It's real. I'm a little more wishy-washy when it comes to taking it for run-of-the-mill, day-in-day-out depression. I mean sure that's a real condition but it's harder for me to accept it as something I have--especially when I feel so good! But taking a pill for stress management? That seems ridiculous. I find that I mentally chide myself for being too weak or dumb to handle stress without some crutch. And I berate myself for creating a stressful life. It's like my inner drill sergeant is saying, "You got yourself into this mess and now you need to get yourself out."

One thing I got out of all the time I spent in therapy a few years back was that labels are of very little use when it comes to mental health. Labels are handy for doctors and insurance companies and in general conversation, but they are not handy for individuals. When we accept labels their attendant definitions usually end up circumscribing us. The labels change how we see ourselves and who we will let ourselves be.

I was comfortable with the label of postpartum depression. I could mostly embrace regular old depression. And I thought that meant progress. But now I'm thinking it doesn't. I'm thinking the next step is learning to be okay with the fact that my mental health is an individual thing and that I am the source of acceptance. Regardless of the label my psychiatrist uses in my chart, what is important is that I have a plan that works for me. I don't need a label to tell me that the choices I am making for myself are good ones. I just need to trust myself--and take my meds.

Psychological Tweezing (and other thoughts on emotional honesty)

I've meaning to blog lately. Catch up on life and explain a little. Because I'm trying something new and it feels significant. But it also feels painful. Very painful. And personal. So it's hard to put it down here.

How's this for a really vague start? Some stuff happened a while ago that shouldn't have and the consequences just keep raining down.

An odd thing: every time I go off my antidepressants I have these same impressions about the "stuff that happened a while ago"--not like testimony meeting impressions--but like strong, emotional messages that require some sort of action. In the past the only action that has made sense is self-harming options. Like I used to get frenetically and abstractly suicidal. Or I would have visions of carving my arms and stomach up, like I was a surgeon cutting out some sort of contagion. Or like I was too full inside and if I could just bleed a little there would be some relief to the emotional congestion. At the other end of the violence was always the possibility for someone else to take over, for escape, for rest.

I never acted on that stuff, it was just always presenting itself as the answer. But, probably thanks to all my friends who tried to kill themselves in high school and my sister who got her undergraduate work in psychology and because my grandma tried to kill herself but went to a sanitarium instead and was open about it, I knew there was another option--a good option: medication and therapy.

And it was good. It was helpful. But it didn't make the impressions go away (which always disturbed me a little). The medication made the impressions quieter so that I could start to examine the pieces that didn't overwhelm me. Therapy gave me the tools I needed to figure out how to examine them. (The tools I use most often are self-observation techniques and self-questioning processes, in case you were wondering.)

So now I'm here and something clicked and I'm taking on those impressions. I'm looking those emotional messages square in the face and unraveling the facts from the fiction. Well, that's the ultimate goal. Right now I would say I'm just allowing the impressions their space. I'm hearing them. I'm accepting them. I'm letting them say all the things they've been trying to tell me for years--all the hurt, anger, frustration, desperation, and confusion. And, the hardest part, I'm relaying the messages to the other people who need to hear it.

That last paragraph makes me sound nuttier than a fruit cake, but I don't know how else to describe it. For the first time in a long time I know I'm not crazy. I saw my psychiatrist, just to be sure. And she agreed. She said, "You're not depressed. You're not overly anxious. You just have some huge things facing you. But you are handling them as well as any person could." I don't feel cosmically out of control or overwhelmed. I'm surprised by the intensity of the emotional torrents playing out but they feel honest and, surprisingly, empowering. Not in the moment of it all. But later.

This whole process reminds me of that aphorism, "Depression is just anger turned inward." That reductionist aphorism gets a lot play and I wasn't entirely sure how I felt about it until recently. I think I was afraid of certain situations in my life and of their consequences--emotional and spiritual and physical--and so I had to protect myself and my family. The only way I could protect us all was to hide the reactions and feelings and the only place to hide them was inside myself. I would never say depression is just any one thing, but we do put ourselves at risk when we inappropriately limit how we are allowed to express ourselves.

But you know, I was scared and alone and I think I did what I had to do at the time. And I'm doing what I have to do now.

What comes later, after the emotional swells and storms, is a cleaner feeling. A lighter feeling. The only way I can pin it down is to say it feels like honesty. I never thought such a simple idea would be so powerful in my life but I've come to realize that honesty is a big deal because it--our willingness to be honest with ourselves and the people around us, our integrity--is a large part of what keeps our agency in tact. Now that I'm being honest with myself and the people closest to me (which at this point is, like, two people) about what is really going on, I have so much more freedom. My choices are no longer limited to repression or desperation. Things like hope, forgiveness, change, and soul-restoring rest are finally, truly on the table.

When I was kid we had those Standing Tall tapes and there was this story that is pretty cliche but has stuck with me. I'm sure you've all heard it before, but I'm reiterating it because it has taken on new meaning for me.

This girl fell and got a splinter but instead of pulling the splinter out, she just put a band-aid on it and tried to tell herself she was better. But the splinter was still in there and her body was trying to push it out so the wound kept swelling up and filling with pus and aching. No matter how many times she replaced the band-aid the wound couldn't heal because of the splinter. She had to pull the splinter out--even if it was going to hurt a lot--because it was going to save her pain in the long run. It was the only way her wound would ever go away.

(This is similar to President Monson's talk about Hidden Wedges. Tangential, perhaps, but worth thinking about.)

I think this is how a lot of us function emotionally. We have emotional splinters that we keep trying to cover up, but the wounds will keep producing pus and swelling until we yank those nasty, infection-riddled suckers out. To be clear, medication and therapy are not the band-aids. The band-aids are our unhealthy coping mechanisms like anger, addictions, avoidance, overeating, overexercising, or dishonesty. Medication and therapy are the tweezers, the tools, that we use to extract the offending shard. They pave the way for healing.

There's still a long way for me to go and I'm still struggling with some very fundamental questions and I do still doubt my emotional stamina to see this process through, BUT there's a little hope out there now for me. I don't feel like I'll be stuck in the never ending spiral of depression. My wounds can maybe, hopefully, finally close. Counseling and medication may still be necessary for the long haul (my psychiatrist wants me back in a month), but they are no longer stop gaps for the suicidal eventualities.

And that feels good.

Mirthful Monday: Antidepressants are no laughing matter?

Since I'm now antidepressant free (it's been three and a half weeks since my last pill and I'm not entirely sure how I feel about that) I thought I'd look up some good antidepressant jokes for you. Turns out there aren't any. Apparently most people who take them don't like to joke about it. Weird!

So, in what may be a truly misguided effort, I'm going to attempt to modify one very unfunny joke in order to make it funny.

Knock, knock.

Who's there?

Norma Lee.

Norma Lee who?

I really don't know.

It's still not funny, is it?

Well, at least I found a funny pic:



For one woman's take on why you just can't laugh at antidepressants click here.

OR, if you need something truly funny to perk up your Monday, there's always Charlie Bit My Finger (Little kids with British accents! That's ALWAYS funny!) or David After the Dentist (Nothing like a kid on happy gas and Novocaine!). Those are always good for a laugh :)

Happy Monday!

Ch-ch-ch-changes! It's time to Mom Up

So. . . I'm pregnant.

I've been meaning to tell you for awhile, but I keep freaking out. I guess the miscarriage in June made me a little superstitious. I had just told a few friends and then--whammo--spotting, bleeding, sadness, etc. So every time I went to write this post I got nervous and decided to just wait. I told a few people because they asked me point blank or because I felt like I had to explain some bizarre behavior (like suddenly deciding to put my house on the market or getting too woozy and needing to hang out for an hour instead of just picking up my kid from the play date and leaving), but mostly I've just been obsessing about it when I'm on the phone with my sister. And when I can get my husband to sit still and let me whine about my morning sickness.

I'm only 9 weeks along. (Read: My chance for a miscarriage is still around 40%!) I haven't seen my doctor yet. (Read: have not actually confirmed existence of baby. Could be a blighted ovum. Or a chemical pregnancy. Or an, ahem, hysterical pregnancy--isn't that right up my alley!) I'm sick and tired. (Read: those are good signs that this is a viable pregnancy, but they don't really induce me to blog.)

I'm owning up to it now since I hear I was outted at a ward party and because well, this random telling-people-sometimes-thing isn't working for me anymore. This pregnancy has raised a lot of issues for me and I find myself wanting to blog about it but being too afraid of what that would mean. So it's time I man up, or mom up, as the case may be.

I've met with my psychiatrist and per my pregnancy plan, it was time to wean off my medicine. Since I was on the smallest dose available that meant stop taking it. As near as I can tell I haven't suffered any real physical symptoms. Everyone on the internet who takes Cymbalta and then quits complains of "brain zaps." Haven't had any of those. My sweatiness has actually decreased since I quit the medicine and I appreciate that.

As for mood symptoms, well, the jury is still out. Don't get me wrong. I've been moody. Actually, MOODY is probably more appropriate, but there's no real way of knowing if it's the pregnancy or the lack of SNRI or the horrible weather we've been having or what. I feel like my intrusive thoughts are back. . . and that's been a little bothersome. They're mostly pretty quiet, though. Surprising but quiet. Prayer--and music, any music with words--has been helping a lot with those. I've been having trouble sleeping, too. Falling asleep is the hardest thing. My brain just goes nuts when I lay down, spinning out all sorts of disaster scenarios. But I'm working on a mantra to calm it down. I'm kind of scared for what the next eight-ish months hold. Perinatal (and postpartum) depression really is a crapshoot. A lot of the time it feels like there's now way to win. Not taking my medicine is supposedly better for the tummy baby, but not if I'm crazy. But if I'm not really crazy, then being on the medicine is a pretty big gamble.

I've been taking my prenatals and some supplemental fish oil and vitamin B because those two have helped a lot of other depressed people going off their meds. But the vitamin B turns my urine electric lemon yellow (you wanted to know that, right?) and since it's water soluble the recommended dose for depressed people is really high--which doesn't seem safe since there's a bun in the oven. The fish oil is fine going down, but every now and again it gives me fish burps, which don't help with the nausea. And the recommended dose for depressed folk is again very high--which is absolutely NOT SAFE when pregnant because of fish oil's anticoagulant properties. I need to talk with my OB about it, but I don't see her until the end of the month.

So basically I'm a slightly fatter, very moody version of myself who is going sometimes-crazy trying to get her house ready to sell--while mentally crossing my fingers for good luck this time around. I hate being on the wrong end of statistics!

Anyway, I hope you all are in just as exciting places in your lives :) Let's make a deal: I'll keep my fingers crossed for you and you keep my fingers crossed for me and then we can all relax. . . After all, it's time to mom up and do this.

When the Monkey Falls Out of the Tree: inside a psychiatrist's office

On the front of her brochure, my psychiatrist (yes, I actually got one. . . it was a complete fluke; I happened to call right after a patient canceled an appointment so the receptionist stuck me in that slot. Really. And no. The psychiatrist is not covered by my insurance. *Sigh*) was tall-ish and blond-ish and smiling. In living color, she was lanky and gray-haired and frighteningly skinny. She also had glasses that she had to frown to see through. And she had a lot of bookshelves with oversized books about pretty much everything.

I think I liked her. When I think about the $400 I dropped for the two hour intake exam, besides feeling nauseous, I thinkI really like her. Finding a new psychiatrist would tantamount to burning money at this point.

For simplicity's sake I think I'll refer to her as my Personal Female Freud, or the PFF, from here on out.

I was a little nervous going in. The kiddos had swim lessons today and that is always stressful. (Three cold, hungry children plus one mommy multiplied by a germy, slippery locker room equals a gazillion bemused/horrified on-lookers and a lifetime of embarrassment. Someone please remind me of that next summer when I'm signing up for swim lessons.) And we had to run to the library. And my visiting teachers also came today. And the sliding door of our Toyota Sienna got a massive scratch--you can see it from far away--in the rec center parking lot. I was pretty tired and stressed--and late!--by the time I reached my PFF's office.

I sat down on her cushy couch, checked the clock, and immediately began talking--rapid fire style. I quickly listed all the dates of my pregnancies and deliveries along with my medicines and dosages. When she asked for a family history I listed in all the people with mental health issues in generational order, complete with relation to me and treatments received. I began giving her examples of my symptoms (what I am like when I'm raging, what I'm like when I'm truly down, what are my panic attacks like, what types of intrusive thoughts I have and what happens when they get too loud) when she interrupted me.

I was startled. My therapist, who is more of a BFF than a PFF, rarely interrupts me, which is a major reason why I like her. I have a real need to be heard and understood and I don't always get that in my life. So when the PFF cut me off, I was little offended. But then I realized that a PFF is not a therapist. She's an MD. A doctor. A diagnoser and prescription writer. I slowed down and began giving condensed, yet honest, answers. My PFF wanted specific details and a few big picture clarifiers, but not my memoirs.

After a few more history questions, she began getting out her big books and a magnifying glass. The big books were full of such small print that she couldn't read them without one. She opened her Physician's Desk Reference, held her magnifying glass about half an arm's length away, and began reading aloud about my medication and pregnancy and lactation. Here are my notes (which, I feel obligated to point out, don't serve as a substitute for a trip to your own PFF. Seriously. Get your own!):

*Cymbalta is new. As in, only two years old. The previous generation drug, Cymbalta's mommy, was called Effexor. There isn't a ton of research on Cymbalta directly, but there are some conclusions you can draw based on research about the older drug.

*In pregnant rats and rabbits who took 7 to 15 times the human dose of Cymbalta, there were issues. Duh! You could give them 7 to 15 times the human dose of water and they'd have issues. You know, when you consider that animals are spiritual beings too, well, that's really sad that some of them are experimented on that way. I'm grateful to them. I also think I'll have to search out quite a few vermin in the next life and thank/apologize to them. (That last part was my conclusion. Not the PFF's. The Physician's Desk Reference doesn't talk about spirituality. Even though it's so big it will hang off the end of your knees when you put it in your lap and looks like it's the actually the Big Book of Everything.)

*In women who took Cymbalta while pregnant there were some correlated complications, especially for those who too them during the third trimester. The symptoms the newborns exhibited (like an increased startle reflex, difficulty regulating body temperature, and shallow/irregular breathing) were similar to those in adults who were having a serotonin overdose. No one knows if that's what is really going on with the babies, but there is something different about some of them. No long term effects were mentioned. Probably because the drug is too new to know.

Then the fun started. The PFF started running a battery of tests that I believe she called a mental status exam. She asked me common sense questions (What's today's date? Who's the President of the United States?) common knowledge questions (Who was the previous President? And the one before that? And the one before that? And the one before that--at which point I told her I hadn't been born yet, but I was willing to guess. So then she asked me, "What's the capital of Spain?") and some non-sensical questions (What does it mean when someone says, "Even monkeys can fall out of trees?"). Then she had me draw some pictures, copy some shapes and repeat back lists to her. Then came the toughest question I have ever answered: Count backwards from 100 by sevens. I started to sweat. "It won't take as long as you think," the PFF intoned. I began to calculate and fumbled and tittered and lost my place. I shook my head. I closed my eyes, took a deep breath, furrowed my brow, counted on my fingers, and managed to get the answer right. Turns out the test, my PFF told me when I was done, was to test my concentration. Apparently a lot of people who have been treated for angry/anxious depression are actually ADD. My counting backwards skills proved I'm not that, but as the PFF pointed out, it sure "Looked like your performance anxiety got to you, huh?" Awesome.

As two hours wound down I was tired--it was draining to focus on my issues for that long--but good conclusions were drawn: in my case, particularly because of my perinatal depression, it's probably best to stay on an antidepressant with my next pregnancy. Cymbalta is not the best choice and it's worth trying to wean off it--slowly--and start a different drug near the end of the pregnancy (probably Prozac. Oy! I've never felt so cliche). Apparently there's some estrogen variant that is produced by the placenta that makes pregnant women feel good and we're hoping that will keep my mood adjusted for the bulk of the pregnancy. I'm supposed to call after a month on the reduced dose and we'll decide how fast to take it from there. If I get preggers before the Cymbalta is out of my system, that's okay. No need to cold turkey. It's only the third tri that appears to be a problem.

Walking out of the office, I felt good. we have a plan I can stick with. And the PFF is another supporting fixture in my life, which feels really good. After all, like I answered about the monkey falling out the tree, "Even when you're doing something that should be natural to you, that you should know how to do, you can still end up on your butt."

Oh, and the icing on the cake: one of my visiting teachers cleaned my house while I was at my appointment. The place was trashed when I left and gleaming when I came home. I cried a little. For real. The Visiting Teaching program is just one reason why I love my church.

The Hardest Thing About a Mood Disorder

What is the hardest thing about having a mood disorder? You might expect me to answer the fatigue or the weird looks I get from people when I tell them what I'm dealing with. Or maybe it would be the simple act of taking a pill every morning. The emotional implications of that are weighty enough, let alone the actual remembering. Heck, you might even guess it the few and far between yet very real suicidal hallucinations. But nope. It's not even that.

The hardest thing about having a mood disorder? Finding a psychiatrist.

All the articles and commercials and TV shows will tell you that the only responsible way to do antidepressants is through your psychiatrist. Sure you can get a prescription from your general practice doc, but he is probably so unaware of the ins and outs and complications that the odds of you getting something that actually works are pretty slim.

And then there's the self-medicating aspect. Having a psychiatrist is supposed to be keep people from doing dangerous things like going randomly cold-turkey off their meds or upping their dosage on bad days and lowering on good days. Psychiatric medicines aren't like Tylenol, people! Their effects take weeks to kick in and weeks to wear off. Psychiatrists are the dudes who are supposed to help us crazies navigate all that.

Of course, that means psychiatrists would actually have to be available.

Awhile ago my therapist recommended two psychiatrists for me. Neither of them were covered by my insurance but I thought I'd check them out. I had a few questions to ask them but I never got past the price. Intake exam: $300 dollars. Follow-up exams: $150. Out of pocket.

That sent me to my insurance website. I spent over an hour figuring out their system and how to tell who specializes in what and making a list of covered people and where they practiced. A couple weeks later I carved out the time to make the calls. After working through some bad phone numbers and crossing some dead-ends off the list, I got this lovely message:

Chirpy Robot Lady, "Press 1 if you would like to schedule a new patient exam"

(I pressed one.)

Chirpy Robot Lady, "We are not accepting new patients at this time." *click*

That's right, I got hung up on. Another hour down the drain.

I have some serious medicine questions--Husband and I are contemplating baby number four and want to talk with someone knowledgeable about the risks and medicine and other PPD issues--that I want answered and I know my OB and my family practice docs (and the internet!) can't answer them. I've spent the last couple weeks trying to drop my dosage--slowly, ever so slowly--and the results have been headaches, nausea, increased yelling (mostly at my kids), and fast-cycling, extreme emotions. That last one is usually a sign of big trouble.

I like to think I'm a pretty rational and responsibly disordered gal, but I'm beginning to feel like my hands are tied! My sister suggested figuring out if my insurance has a patient's advocate system that could help me muscle my way in to a psychiatrist. I've also heard that therapists can sometimes get you in, but I don't think my therapist is associated with anyone.

What's a girl to do? Do you guys have any ideas?

_The Road Back_ : a patent pending program to end all your psychiatric worries

As you all know I've been thinking about tapering off my Cymbalta. Most days the medicine is no big deal and most of the time I'm grateful that I live in a day and age where I can get effective help. But there's something in me that balks at having to take a pill every day.

Of course, I have friends who have been on psychiatric cocktails for years--through pregnancies and everything--and they always remind me of one thing: depression, especially the types of depression that are associated with pregnancy and childbirth, IS a biological illness. Like heart disease. Like diabetes. And just like a diabetic can't wake up one morning and decide her insulin levels are going to be fine without medicine, a person with a biological depression can't just choose to be happy.

So, I came across an online program called The Road Back that is supposed to help a person taper off her meds without having all the side effects. I was intrigued so I read the first few chapters and, I'm a little bummed about this, it's dubious.

I guess I should have expected that, seeing as it's a patent pending program. A copyright is one thing. But a patent? That screams marketing. You know, it's like when Dr. Phil announced his new diet program and simultaneously lost all his credibility by creating a line of nutritional supplements that were in every GNC, grocery store, and Walmart across America. Anyway . . .

The basic premise of The Road Back is a nutritional one; if you put the right things, whether they are "super foods" or super supplements, in your body it will function more perfectly--which is something a lot of people believe, but I'm not sure how I feel about it. The nutritional thesis wouldn't be problematic in and of itself but the kicker is this: they recommend only one company's supplements and the company charges HUNDREDS of dollars for them. The author spends several paragraphs plugging this company's superior supplements and saying you have to buy them for the program to work.

Fishy.

So I'm back to square one and still on my meds. It's probably time to consult a real psychiatrist and not just the internet ;)

P.S. Happy National Poetry Month everyone! Check out my post over at A Motley Vision!

What me and what's my medicine?

The most frustrating thing about having depression is that you can never get a straight answer to any question. Even the simple questions like, "Am I actually depressed?" or "How long have you been depressed?" can take entire therapy sessions to answer. The hard questions, ones like, "What are we going to do to treat this illness" take years.

This dearth of straight answers regarding mood disorders and mental illness exists for several reasons: psychology and psychiatry are sort-of soft sciences and therefore are constantly evolving, thanks to new technology our understanding of the brain is increasing and changing methodology, people are being more honest and that changes things too. The biggest reason, though, in my mind, is a hard truth: the answers are never straightforward because, well, there are no answers.

When it comes to the hard questions--the one that has been plaguing me most recently is "how am I supposed to deal with this for the rest of my life?"--there are no answers. At least not any that anyone knows. Not your therapist, not your doctor, not even you.

Case in point: this last weekend.

I took the last pill in my cymbalta bottle early Saturday morning. I was on my way to the temple--we always try to go in the morning so that we can get into a session without having to wait--and had to drop my kids off at the sitter so I didn't even notice it was my last. The next day was Sunday and it was then that I realized I needed a refill. I figured I was doing well enough that missing one day wouldn't hurt. Then came Monday morning with all its usual busy-ness and some lovely warm weather. I was completely energized by the sunshine and set about deep cleaning my kitchen. I cleaned all morning, skipped my nap and got some work done, and played with the kids the rest of the afternoon. I didn't realize I'd missed another pill until after Family Night. Tuesday morning (yesterday morning) I called the pharmacy first thing and picked up my refill as I left for storytime with my kids. I swallowed the cymbalta as I drove and prided myself on managing my life so well.

That good feeling disappeared about thirty minutes after I took my pill. As I loaded my kiddos back into the car after storytime I found myself swooning. While driving I felt like my eyes were disconnected from my hands and I wondered if it was actually me controlling the car. The disconnected feeling deepened as I picked up my oldest from school and got us all home. I tried to feed the kids lunch but I couldn't focus. My mind felt like a scratched DVD, skipping from scene to scene. I was sweating furiously and nauseous. I ate a third of a container of ice cream and felt a little better. I could focus enough to get everyone fed and settled down for quiet time. Then I crashed.

My oldest woke me up when her movie was done. My brain felt more stable and smooth but my limbs felt too heavy to lift. There was a lot of housework to be done but all I could manage was sitting outside while my kids played. After an hour or so I got up and made a little dinner. Then I mustered my energy and headed off to Enrichment.

After Enrichment I crashed again, but this time it wasn't my body it was my mood. I was so depressed. I felt awful. Every time my husband tried to talk to me it took a lot of effort to avoid crying or yelling. Finally I just went to bed cursing the medicine and cursing the mood disorder that makes the medicine necessary.

This morning I took my pill and my body feels fine but my mood is still struggling. It's like PMS except I'm not on that part of my cycle. My house is a wreck because I just don't feel up to tackling it.The little work I've done on the dishes and taking out the trash pretty much wiped me out. It's not that my body can't handle it. It's my heart and my mind. It's too much to wrap my brain around.

I was blaming the medicine until I realized that the last week has been textbook cyclothymic disorder. What if it isn't the medicine? What if it's me? What if I hadn't missed those two days of pills, would I have been more even-keeled these last few days? Or what if this is like my lexapro last summer and my body is suddenly interacting wrong with the cymbalta? What is really going on with me?

Unfortunately, those are the hard questions--the ones I'll probably never get answers to.

Depression Profile: Sue at Um, Thanks for Sharing

One of the best things about blogs is the discovery that you are not alone. My latest find: Sue! Sue is a warrior mommy--she's conquered perinatal and postpartum depression along with some generalized anxiety--with three kids and some truly insightful posts.

Confessions of an Anxiety Ridden Mother could have been my own story. I know what it's like to punch walls and yell at infants even when I know I shouldn't. I loved her honesty about how difficult it is to be a mom, a supportive wife, and a person in your own right. Be sure to look through the comments, too. Her post struck a nerve with several people. Here was one comment that really caught my eye:

Antidpressive meds were designed for the modern LDS woman! First of all, we all attempt to accomplish too much... and if you attend relief society on a regular basis, you try even harder. Calm down and realize that you are a wonderful person who is greatly loved and respected for all the tasks you accomplish.

I know Relief Society isn't meant to work this way, but sometimes it does. My personal solution? Just start admitting your flaws--the real ones, not just the cute quirky ones--when you make a comment. When one person gets real the rest seem to follow. I have to say, though, I'm not the first woman in our ward to do this. There are a couple sisters out there who really open themselves up and put themselves out there and I love it. (Nancy, Verna, De--you are ladies I so admire!) It is only when we are real with each other that I come close to understanding what the concept of Zion is all about.

Another post by Sue, If the Problem Gets Solved, Does it Really Matter How You Solved it?, is the story of how a nice girl with some solid biological issues ends up deciding to she needs medicine. It's a tough decision but Sue makes it deliberately and wisely.

One part I really appreciated was the description of her supportive husband:

I often think about how blessed I am to be married to Dan specifically because of his understanding and support about my treatment for depression. Not only does he have the scientific knowledge of depression, but he has also seen first-hand, from the time he was a little child, the effects of depression. And he knows that the meds work and that they are beneficial. When I started taking anti-depressants, I used them for about a year or so, then went off them during my pregnancy with Lily (not because they're unsafe, but because I was feeling pretty good and didn't think I needed them.) Then when she was about eight months old, I went through a bad time and Dan pointed out that he had watched the same cycle throughout our marriage, that I would fight and try to be positive for six or eight months, then I'd have a drawn out episode of depression that lasted for a couple months. It really caught my attention to hear him say there was a pattern to my behavior.

I was still feeling a little bit like I was weak for needing to take anti-depressants, that now that I was aware of my tendency for getting depressed, I should be able to combat it on my own with behavior modification, attitude adjustment, and lots of prayer. I worked with a counselor for 8 or 9 months and learned so much about my thought processes and emotional tendencies. But even with this knowledge, I still couldn't conquer the beast. I went on and off the meds two more times while Lily was a toddler. After hearing Dan tell me over and over that taking meds wasn't a sign of weakness, it was the same as a diabetic taking their insulin, I started accepting that for me, taking an anti-depressant wasn't a temporary solution to help me kick-start my system. It was something that my brain chemistry required regularly to stay balanced. I was a lifer.

Every depressed person needs someone like this in their life. Someone with knowledge and compassion. Someone who may not be living it but wants to be with you while you do. Someone who can reassure you when your resolve wavers. Sue is extremely lucky that this person is her husband. For me, that support has come through different people at different times. My sister has been there for me (thanks to our cell phones that we use more like walky-talkies!). My husband pulls me out of some sad, icky places when my mind is holding me hostage. Mommy friends,oh!, of course the mommy friends! Having someone to sit in the park/ice cream shop/coffee (except we only ever order steamers and sometimes a pastry) shop with and kvetch about the bad times, well, that's priceless. And, when I'm too afraid to tell anyone else how nuts I really feel, my therapist is there. She isn't fazed by anything.

Thanks, Sue, for your example and your courage. Telling your story is definitely blessing other people's lives. All us other But Not Unhappy Mommies are sending good vibes your way!

Book Review: Your Child in the Balance by Dr. Kevin T. Kalikow

I'm pretty tired tonight. I've been trying to keep up on the housework this week. Yeah. I'll be giving that up pretty quick.

So.

I have a book recommendation for you: Your Child in the Balance--an Insider's Guide for Parents to the Psychiatric Medicine Dilemma by Kevin T. Kalikow, MD. This was a great read for anyone on psychiatric medicine, anyone who is considering psychiatric medicine, and especially anyone considering medicine for their child.

Written by a prominent child psychiatrist, Your Child in the Balance comes at the issues from all sides. Dr. Kalikow approaches psychiatry from social, historical, economical and, of course, medical perspectives. He fills the book with anecdotes and examples that illustrate the many, many questions surrounding psychiatry and children. He avoids mincing words and doesn't give simple answers. What he does give is information. Lots of information. And even though that information is focused on children and psychiatric medicine it is easily applied to adults.

It was a frustrating book to read because it was frightening to realize how little we know about "psychopharmacology". Psychiatry is a relatively new specialization. Psychiatric drugs are even newer--Prozac was invented only 20 years ago. We know so little about the long-term effects. But it was also a great book to read because it was full of information. Considering how young the whole shebang is it seems that society as a whole and most doctors are being careful and learning from the research. There IS a fair amount that we know. The most important thing we know? Ask questions and work with your doctor.

Near the end of the book Dr. Kalikow gives what he calls
The Ten Commandments of Medicine:

1. Have your child (or yourself) appropriately evaluated by a trusted professional.

2. Before jumping to medicine as the answer, ask whether changing your child's (or your own) environment would be helpful. Understand whether psychotherapy would be helpful and how.

3. Never use medicine based simply on your neighbor's response to that medicine. Everyone is different. However, if closely related biological family members have responded to a specific medicine, inform your physician. Sharing similar genes might indicate a greater chance of success or side effects.

4. A diagnosis is not an excuse. Your child (or you) should understand that he or she is still responsible for his or her behavior.

5. Know what you're treating. Know whether you're treating a disorder or a symptom and if the medicine is FDA-approved to treat the disorder or if it's being used off-label.

6. Give the medicine time to work. Don't bail out early . . .Many side effects are mild, not severe or dangerous, and will disappear in time. Also, beware of polypharmacy (the use of many medicines or "cocktails").

7. Medicine must be monitored. Don't avoid your doctor. Make follow-up appointments.

8. Avoid the medicine rut, the use of medicine year after year without re-examining your decision.

9. Parents (or spouses) should be unified in the decision to take medicine. [To my mind, this is an ideal that may or may not be possible but it is certainly a good things to work for.]

10. Know when to quit your search for the medicine solution. Medicine is not the solution for every problem.

That's it! I quit!

(I posted last Friday but it looks like it got stuck back in December of 08 when I first started drafting it. For those of you who missed it you can read part three of my series on Support Where You Need it the Most.)

No, no, no, I'm not quitting blogging. I'm quitting my medicine. Well, maybe.

For those of you who have been reading for a long time now, you'll remember that last summer I had a Prozac poop-out. (I was on Lexapro, so technically it was a Lexapro poop-out, but you can't link to that term so what's a blogger supposed to do!) I met with a friend-of-the-family psychiatrist out in Utah during our family reunion. It was awkward but free so I went for it. She explained the Prozac poop-out phenomenon to me and recommended I switch to Cymbalta. She said it would do a better job at nipping my intrusive thoughts in the bud. I had reached the point where I was nervous to be alone with the kids so when I got home I dialed up our family practice doctor and she wrote me a prescription.

And it worked. It was a little rocky at first but it worked. I still get nauseous if I go too long without eating and I still nap 3 out of 5 days and since it's still winter I don't worry too much about my increased sweatiness--I just go without a coat--but most of the time I'm not depressed. That feels good.

Except for when it doesn't.

I have to admit those little blue and white pills are starting to annoy me. I hate having to remember them every morning. I hate having to call in for the refill. I hate how much they cost. I fantasize about how much I could get done if I didn't have to nap. I'd love to be able to lose my muffin top but the urge to snack is too strong. And, well, it's still winter now but it will be spring and summer soon enough and I don't want to have to carry around a pack of tissues just to soak up my extra perspiration. It's gross!

Of course, the real reason I want to quit my antidepressant is well, I want to quit being depressed. I want to quit having a mood disorder. I want to quit feeling less than normal because I have to take medicine every morning. I want to know if who I am now is who I really am. I think it is but how can I be sure when I'm popping this pill all the time? I'm just tired of being that girl.

I've gone off my meds before. I wean off them before getting pregnant. I tried to quit my Lexapro last summer (before it quit me. If I could argue with my medicine we'd totally have one of those "You can't fire me, I quit!" conversations). It's always ugly. My patience disappears and my anger comes back and then the guilt sets in. My intrusive thoughts get all noisy. I have to pray myself out of bed in the morning.

But this time is different. The first time I quit my meds I'd only been on an inadequate dose of Lexapro for three months--which research shows is too short a time and actually leads to worse depression. (I can't find a link to cite that last bit, but I know it's true. Ask your doctor!) The second time I weaned off was after eight months and a lot of the environmental factors of my depression hadn't changed.

So how is this time different? Well, I've been pursuing treatment that includes off-and-on therapy (the insurance only covers twenty visits a year so I've got to use them wisely) and SSRI/SNRI for over 18 months. I've actually been working with my therapist for over two years. Come to think of it, I should have sent her flowers for our anniversary last November!

I guess the big thing that hasn't changed is the environmental stresses. I still have three little ones, who are bizarrely unable to sleep through the night, and my husband is still in grad. school and working full time. He graduates in May so maybe I should hold on to those little pills until then.

It is such a wearying truce to strike. I'm so sick of having to act like I'm sick just to prevent the sickness, you know? It doesn't make sense to keep taking Nyquil just to make sure you don't get a cold. But depression isn't a cold. It's not something I can just get over. My body doesn't have a response system for this. Depression is a disorder that I will have to be aware of and manage for the rest of my life. That's what that pill means. And that's why I hate taking it.

Depression Profile: Kelly "Depression can't be fixed, it can only be managed"

Name: Kelly (name has been selected from a random name generator. Well, not really. But wouldn't one of those come in handy?)
Age: 33
Location: Utah

1. Have you ever been officially diagnosed? How do you classify your depression? (i.e. post partum depression, anxiety/depression, clinical depression, etc.)
I have been diagnosed by my doctor with clinical depression and anxiety disorder. I also suffer from post partum depression.

2. How long have you been depressed?
I remember being sad and having anxiety since I was about ten. I remember contemplating suicide often during my teen and early adult years. My symptoms became the worst after I had kids. When my life is overwhelming, then my symptoms become worse.

3. What are you like on your worst days?
My mind won’t stop. I think about way too many things in a very negative way. Everything sucks…Everyone sucks…The world is out to get me. I have the type of depression that makes it so I don’t stop moving and worrying about everything (versus the type where you stay in bed all day). On my worst days I am running around like a mad woman while I stress and freak out about everything around me. My body can’t keep up with my brain. This is frustrating to the point of me yelling and screaming and panicking over everything. I cry a lot, and feel so alone.

4.What are you like on your best days?
I am calm and can think things through reasonably. It occurs to me on my good days that this is what “normal” feels like. I can accomplish things. I am not annoyed by everything. I smile and mean it.

5. What kind of treatments have you pursued?
I have taken Lexapro and Zoloft without any great results. Lexapro made me gain 60 pounds so I decided to go get off it. I tapered off it slowly, but the withdrawals were still unbelievable. I came very close to killing myself while in the withdrawal stage. It was one of the darkest periods of my life. I decided, after that experience, that I didn’t want to be dependent on medication again. While initially it helped, and I am not against medication for anyone with depression and anxiety, it just isn’t for me.

Since then I have tried to take a more holistic approach. This approach takes a lot more time and effort, but the benefits have been positive for me. I exercise at least two hours a day and I take a combination of B vitamins, vitamin D, and a supplement called inositol. [Laura's note: Hi Readers--sorry to interrupt. I have never heard of inositol before. Drop me a line or comment and tell me what you know about it. I plan on doing a more in depth post on it in the future and would love your input.] I also get at least 20 minutes of sunshine/outdoor light a day. While I still have really bad days occasionally, and every day is a little bit of a challenge, all of these things I do make it better.

At one point this last year I was walking 12 miles a day and this made me feel better than I ever did on medication. But of course that kind of commitment is hard to continue on a daily basis.

I have also tried therapy and I have not found many benefits to this for me personally. I suppose I just haven’t found the right therapist, though I have tried several. I feel like they want to fix me and move on. Depression can’t be fixed, only managed.


6. How do you feel your depression has affected your spirituality? How would you describe your current relationship with the Church?
I once had someone of my faith tell me, “You’re kids deserve a happy mom.” It was said in a judgmental way. That sums up my feelings about the Church. Mental illness is misunderstood. I feel judged by most people of my faith. I also feel like the Church has way too many expectations to meet, and it is impossible for a depressed LDS person to meet all these expectations. This leaves me feeling less than whole and guilty and not quite up to par.

I have also been told to pray harder, read my scriptures more, have more faith. It is funny that these things are not told to people with physical illnesses, only mental illness. Sometimes this makes me feel bitter and lonely.

I hope to someday have the faith I need to make it through this life without being angry and feeling misunderstood. I need to look past other people's weaknesses and insensitivity. However, right now in my life I need more people to lean on and it seems there doesn’t seem to be many who are willing. Where is the Christ-like attitude we are all supposed to have?

Sometimes the thought of going through this illness every day is overwhelming to me. I lose faith, I become angry at God, I don’t understand why I have to deal with this lonely disease that very few people understand. I also see some signs of mental illness in my children, and this makes me angry that they will have to go through this, and I had a part in it.

So to be honest the last couple of years while my depression has been at its highest, my spirit and faith have been at their lowest.


7. What do you wish other people understood about depression?
The thing I wish people mostly understood is that depression and anxiety are real. They can be just as debilitating and life threatening as a physical illness. And for the most part depressed people just want someone to talk to without judgment.


I want to thank Kelly for this. I really appreciate her honesty about her relationship with the Church. There are so many demands on our time and energy and there are a lot of individuals who don't understand how consuming mood disorders can be. All that makes it so difficult to remember that we go to Church to worship the Lord and reconnect with our Savior--not to tell others what to do or judge them. Some Sundays, when I'm depressed, a spiritual experience feels impossible. I want to commend Kelly for persevering through this. She is woman of real inner strength.

If you would like to share your story (as anonymously as you'd like) please email me at lolapalooza AT hotmail DOT com. Please put "depression profile" in the subject line so I know you aren't a spammer.

Sometimes we all need a reality check

So, here's the funniest one I've come across in a long time! Enjoy! (Oh, and I'll send you a quarter if you can tell me which actor was formerly on So You Think You Can Dance. Okay, not really, but maybe if you look under your couch or in your car or something you can find yourself a quarter and buy a gumball. That'll make you happy ;)

See more funny videos at Funny or Die

p.s. Sorry for the dumb "scanscout" popup. You just have to keep closing it.

Since We're on a Roll with the Daddies . . .

I thought I'd mention this:

I came across this blurb from the BBC, Antidepressants "may harm sperm", and I couldn't resist commenting. One because it is informative (sort of) and two, well, I don't know, it was just too interesting to pass up! (I trust that we're all grown up enough to use the word "sperm" without giggling . . . well, that's all right. If you laugh no one will know. You can pretend you were mature about this in the comments.)

Basically the article talks about a study that found that men who were on antidepressants had a higher rate of defective sperm. The sperm in question weren't lower in quantity, just quality. That is, men who take antidepressants have a higher percentage of sperm with damaged DNA.

Now, reel in your disaster-scenario-seeking brains (my brain isn't the only one that does that, right?), because that actually means very little. The study was so small that it in no way supports conclusions like "men who take antidepressants have lower fertility" or even "ALL men who take antidepressants have harmed sperm". I repeat: those conclusions cannot be drawn!

Here are few facts worth keeping in mind:

*The study only looked at Paxil and other antidepressants in that family. It didn't look at any other type of mood disorder meds.

*The study didn't examine if the damaged sperm actually had an effect on fertility.

*The study didn't look if the effects were reversed when the medication was stopped.

So what to take away from all this? I think the one thing this new information points to is that antidepressants do a lot of things scientists and doctors don't understand. We need more research behind the meds and more research into treatments for mood disorders and into mood disorders themselves.

Also, keep in mind that past studies have shown that people with high stress levels (like depressed people) do have lowered fertility rates. If you are worried about fertility talk to your doctor (obviously!), but an antidepressant probably isn't a big factor.

Other things to remember: When it comes to serious illnesses like depression, OCD, anxiety, or any mix thereof, it is probably safer to side with taking the medicine if you need it. Since the Surgeon General required the "black box" warning to be put on antidepressants prescribed to teens, teen prescriptions rates have gone down and teen suicide rates have gone up. Nobody wants a crazy dad. Or a dead dad. And that's just the facts.

Heavy on my mind

So I've had suicide on the brain lately. Not because I want to kill myself--if I did I wouldn't post it on my blog--but because, well, suicide is sort of always around.

See, when I was really little my grandmother tried to kill herself. She was depressed after the death of my grandfather and she decided a big ol' bottle of pills was the best course of action to take. One of her sons had a premonition to check up on her. He called her house and she didn't answer so he went over. He found her passed out on the floor. He took her to the hospital and had her stomach pumped. After that she spent some time in a sanitarium and it came out that she had struggled with depression and bulimia/anorexia for most of her life. It was sad and she was sad. At the end of her life (she was killed a few years later in a car accident) she was almost always sad. Her suicide attempt left a strange legacy in my young mind. Like maybe suicide was an option.

Then when I was thirteen my best friend tried to kill herself. She too took a bottle of pills--but this time I was the one on the phone. I listened as she told me all about how her parents hated her, about how she had been sexually assaulted at a party, about how she couldn't deal with anything anymore--the pills rattling in the background as she dumped them out of the bottle and then put them back in, not sure how many to take. I listened as she cried and swallowed the pills. It never occurred to me to tell my parents. I just prayed over and over, "Please, God, don't let her die. Please God, don't let her die. God, don't let her die!" I started to cry and made her promise that she'd show up for school the next day. She didn't make it to school and I started freaking out. That evening I got a phone call. Her parents had found her in the bathroom piles of pills still clutched in her fists. She was calling me from the psychiatric unit of the hospital. She kept saying, "I just want you to know it's your fault I'm alive. You made me promise I'd come to school and I couldn't break a promise to you. This is the most horrible place. I just want to get out. But it's your fault I'm alive. It was your promise." I mourned her life and I mourned my promise.

In high school seven of my friends tried to kill themselves--none of them were successful, thank heavens, although my ex boyfriend did come close when he threw himself off a (small) cliff and took up driving with his eyes closed. It was strange, listening to all my friends' goodbyes and hearing their tales after the attempts. Sometimes I was sad. A lot of the time I was scared. Eventually, I got angry.

After awhile I began to draw cut marks on my wrists and have dreams about watching myself bleed out. It made me anxious because I didn't really want to die but, maybe, I did. Things were so overwhelming--AP classes, theater rehearsals, Young Women's responsibilities, I was Seminary class president--sometimes I just couldn't figure out any way to make it all slow down. Death seemed so still and quiet and sounded so peaceful. However, because I knew the plan of salvation, I knew that there would just be more questions to answer and more work to do on the other side. When I got my patriarchal blessing it said I had a long life to live and I took it as a sign. The suicidal thoughts were pretty much gone then.

Things were good for a number of years, but then I got hit with postpartum depression and felt crazier than I ever knew I could. I really wanted to kill myself because I deserved it. I was such a horrible mother and such a failure and a latter-day saint it just wasn't worth it. I figured I could pay the hell on the other side. The suicidal visions returned but with much more detail and color. They were scary. Anger seemed the best way to fight off the fright--until I started therapy and antidepressants.

These days the images come and go but I mostly ignore them. The medicine helps them disappear.

I guess the reason I've been thinking about this lately was the legacy all those attempts left me. I was sad and scared and angry for a long time--especially at my grandma and my best friend. They had introduced so much anguish into my life and for what? Even though I imagined I knew how they had felt I still didn't understand it. And I really didn't understand what part I had to play in all of it. I prayed a lot (and wrote a lot of bad poetry) about it. But, still, my feelings roiled around inside me.

Given some time, though, the sting lost its venom. The ache began to heal. I still don't understand all of it. I still have a lot of questions, but the anger is gone. I think what I struggled with was my own responsibility in relation to all of it. I began approaching peace came when I began trying to give it up to God. He was the one who was responsible for it. This life, is after all, a part of His plan. And, I came to understand, He was planning on being responsible for it. He planned for His son to come to earth and suffer, bleed, and die. God was in control.

I also began to feel better when I realized that my grandma, my friend, and I might all have had the suicidal thoughts simply because it is part of an illness--not because of what my grandma did or because I hung out with the wrong crowd or some other nebulous sin. It was an illness and illnesses are covered by the grace of Christ through His atonement and resurrection.

I still need the therapy and the drugs, but my testimony helps with the healing too. These days I admire my grandma. Her struggle and her faith are inspirational to me. She survived and I can too. I pray for my long-ago best friend. I don't have contact with her any more, but I know she is in God's hands. I pray for me, too. And I'm working on forgiving myself for my own weaknesses and self hate. And I'm working on accepting myself--craziness and all--for what I am now and for what God can help me learn to be.

Six weeks of Cymbalta

Well, it's been about six weeks since I started my Cymbalta and I figure it's time for another update. Six weeks is a sort of landmark in antidepressant therapy. At six weeks you should know how/if the drug is going to work for you and how bad the side effects will be. Sometimes you have to wait until eight weeks to really know, but by six weeks you should have a pretty good idea.

For me, things have gotten better. Since my last update my three big side effects (nausea, sleepiness, and sweatiness) have all lessened in intensity. The nausea is gone. Taking my pill in the morning with breakfast, instead of at bedtime, fixed that right up--thanks for the tip Elizabeth-w. The sleepiness is getting better. Most days I still want that afternoon nap but, if by some miracle, all of my children have slept through the night I don't need it. Since I usually get woken up at least once by all three kids (my five year old says she comes down for hugs in the middle of the night because her "love bucket just empties out too fast") I'm guessing that is the cause of my continued sleepiness. I haven't fallen asleep unintentionally in weeks, which is probably for best. After all, while being a narcoleptic makes for entertaining stories it was a little nerve wracking. As for the extra sweat, well, I've just started carrying around tissues so I can mop it up and I'm learning to live with it. Thank goodness it's almost fall, though!

My mood is still improving too--even though I'm having PMS (aren't you glad I share?). This last week I cleaned out all our closets and our garage. I even organized a garage sale (with the help of my friend Sarah!). I only made $65 but that was enough to pay for the chest freezer I wanted so I was happy. A few months ago I could barely navigate my dishes so cleaning out the garage felt like a gigantic accomplishment. Also, I've been more relaxed with my kids. My five year old (who has social anxiety issues and real-life phobias) started kindergarten and it's been a bit of a roller coaster, but I've been able to ride that ride without going nuts and for me that's pretty good.

The Cymbalta, unfortunately, has still not made me perfect (just ask any of the women who were at Enrichment tonight! Someday I'll figure out how to control my kids and leave a Church function without them having a tantrum, but I'm not making any promises at to when). I know it's silly but I do keep hoping that somehow the right chemical will make all my problems disappear. But no pill can tell me how best to deal with my anxious five-year-old or my volatile two-year-old. It also can't teach me how to manage my time better or increase my temple attendance. Those are things I have to do. But what my antidepressant can do for me is give me the mental space to work on those things instead of spinning my wheels over craziness* and that is good enough--not perfect--but good enough.



*Speaking of crazy, I had a mildly intrusive thought the other day where I kept shaving my head and tearing out all my hair--how Brittany Spears of me!--but I was able to laugh it off. In fact, I'm still laughing now. Our brains are so weird!

Depression Profile: It IS Okay

This is the story of Miss S (the "S" stands for surviving and smiling) an LDS woman living in California and dealing with depression. I am so grateful to her for sharing her story here.

Looking back, I've probably always suffered from some kind of mild depression. I was raised in a home (not LDS)with a lot of yelling and name-calling. I had my son when I was 17 and never married his dad. I went through two divorces before 25. (Sounds really crazy when I say that out loud!)

The first time I thought I had depression was in my second marriage. I was always angry at the man I married (although, later I found out my anger was misdirected. I was actually angry at myself for marrying him). I'd have anger episodes that felt borderline psychotic: breaking down, screaming, shaking, so much fury. I got a quick prescription for Prozac, took it 3 days and threw it out because I figured I wasn't depressed chemically, it was just my situation. So, "we" started marriage counseling together and I kept going by myself after the separation. I started learning about myself and what I needed in my life--how to be happy by myself and those kinds of things.

I met my current husband shortly after that, joined the church at 26, married him at 27, had baby #2 at 28 and baby #3 at 30. My youngest is now 8 months old. I noticed depression kicking in around my seventh month of pregnancy. I didn't realize that's what it was until later. In retrospect, I think I probably suffered from PPD with my previous pregnancy also. My depression was hard to admit to, and to realize that it was depression, b/c for me, I become angry when I'm down. Also, to admit to depression is taboo in my family; "nobody" has it, but looking at my mom, I'm sure she does too. Anyway, I thought it was just PPD and that it would wear off.

My oldest child's father committed suicide 6 years ago. He suffered from bipolar disorder and was suicidal from the time I met him at 13 years of age. Growing up with him, I thought he was faking it, trying to get attention, that he could control it, that it was all "in his head." I tried to get him to focus on other things to distract him from depression. I didn't realize it was a REAL illness until after he died at 24. It was a long road. He turned to street drugs to self-medicate and by the time he got professional help, the meds counteracted and did more damage than good. He died within a year from that time.

I've been on Prozac for about 5 months now and I've tried to wean off twice. I noticed the first time that the depression signs came back right away. The second time, not so much, but a little here and there. I'm nervous that I will need meds the rest of my life. I really don't want to "need" medication, but so far I've noticed that I'm a much better person, wife, mother, etc. with it. I feel better on the medication, but I don't like being dependent on it. I'm only on 10 mg, at one point I thought I'd need more, but I'm taking it every other day now and doing fairly well. Maybe I'm getting better?

But then the other day I was so tired all day, got absolutely NOTHING done at home and had to drag myself to the scout court of honor at church. I've been very tired lately and thought I might be prego again (not to my excitement), but found out that it was PMS (Yay!). I need my energy back.

I like Prozac for the simple fact that there aren't many side effects. I do have night sweats, but not too badly and I get tired off and on. I have some really good, energetic days and other times sleepless nights and dragged out days. My appetite is normal and I've succeeded in losing some weight that I've been working on--but I hear Prozac suppresses your appetite so that might be part of it too.

Spiritually, my depression has affected me a great deal. When I'm not on meds, I'm a monster and want to be left alone; I'm angry and ungrateful. When I'm on meds, I'm indifferent to emotion. I've only cried three times in the last 6 months: once was at church when the Spirit hit me and I couldn't stop crying. I was a mess! Another time I was talking to my good friend and told her I couldn't figure out why I was emotionless. Then the flood gates opened. Either way, I continue to go to church even when I don't feel like it. My husband has helped us stay on track there. I love being active in the church, but many times I feel like I'm going through the motions. I don't set aside the time I should to pray and read scriptures. I think if I did, it would help more. We haven't been to the temple as much as we should b/c of small babies, but my husband just heard a great talk about how we should make the time to go no matter what. He is going with our 13 year old on Saturday to do baptisms with the youth. I might go and do a session on my own if I can find a babysitter.

I wish other people knew (I'm still learning this myself) is that IT IS OKAY. It's okay to be depressed. It's okay to ask for help. It's okay to be on meds. It's not your fault for being depressed; you didn't do anything wrong, it's just a trial in life. I still have trouble going to the clinic b/c I feel weird. I feel uncomfortable, like a freak, like I don't belong and I'm always nervous there. But just because I'm depressed doesn't mean I'm crazy. I'm still learning this. I haven't told my mom or my sister or my son for fear that they will think I'm nuts and should be doing this on my own, without a shrink or meds. I'm so grateful to have a supportive husband. Without him, I probably would go nuts!

We (my readers and I) send you our support and prayers, Miss S! Good for you for building a support system and making an effort to include the Lord in your life and trials. Even if you can't make it to the temple, all the small and simple things you do make a difference. Thanks again for sharing your story.

If anyone else would like to share their story here please email me at lolapalooza AT hotmail DOT com. Put "depression profile" in the subject line so I know you are not a spammer!

Cymbalta Update

Here's the way my new depression medication was explained to me:

Imagine your depressed brain is the side of barn. On that barn there are three targets. These three targets are the neurotransmitter receptors for seratonin, norepinephrine, and dopamine. Antidepressants are like arrows being shot at the targets. Taking Lexapro, an SSRI, was like firing an arrow at the same spot on the seratonin target over and over. It works for awhile, but eventually you've shot arrows at the one spot for so long there's nothing left to hit. That part of the target is just a hole. If you switch to a different SSRI it aims at another part of the seratonin target and can help alleviate depression symptoms. That still leaves the other two targets untouched. What you do with those target depends on your symptoms. For me, my depression involves a lot of anxiety and intrusive thoughts so I needed the SSRI to take the edge off the anxiety but I needed something more for the intrusive thoughts. The psychiatrist I met with recommended Cymbalta because it is a SNRI (seratonin-norepinephrine reuptakte inhibitor). It works on two targets at once.

I started taking the Cymbalta on the 15th of July and the intrusive thoughts stopped after about a week. After about two weeks I noticed that I was hvaing more fun with my kids. I didn't mind playing on the floor with them or horsing around as much. I seemed to have more patience. Also at around two weeks I began feeling motivated to do housework (much to my husband's delight!). I'd never given up completely on the housework but I always found it overwhelming and it took a lot energy to work up to doing it. I could never figure out where to start and I spent a lot of time feeling distracted and forgetting what I was working on. After the Cymbalta had begun to kick in I was able to focus better and keep the house cleaner. (Notice I didn't say it was clean, just cleaner. If I could only get my kids to put their toys away!) I also started sleeping a lot deeper and would actually wake up refreshed on occasion. I've had a few crazy dreams. My favorite one was when I dreamed that my husband had to take all my friends as plural wives. It quickly turned into some sort of bizarre, pioneer-era Bachelorette show with me constantly protesting, "I get to be the first wife because I already had his children!" Like I said, CRAZY dreams. Anyway, Over the last week I've noticed an uptick in my energy level. I've even started working on my book again.

So that's all the good. Now here's the bad. The list of side effects for Cymbalta includes: nausea, increased sleepiness, and increased sweating. I have all those. So much so that I took a pregnancy test just to make sure I didn't have an accidental bun in the oven. (I don't. Thank goodness! I'm just not ready for more kids yet . . .) The nausea has been manageable but it still surprises me. The sleepiness has been almost comical. For the first week or so I HAD to nap every afternoon. One day I sat down to rewind a movie for the kids and just konked out. When I woke up two hours later my 2 1/2 year old was buck naked and snuggled up next to me eating candy while watching the credits roll. My five year old was just relaxing on the couch and my one year old was still napping, but I could tell I'd missed something. I'm still pretty sleepy but if I keep working I can get through it. It's odd to me that I'm sleepy but I have the motivation (and sometimes the energy) to do so much more housework and stuff. The sweatiness is, um, really kind of gross. I have to keep a towel nearby when I work out and I'm betting our electric bill will go up since I've been using the air conditioner a lot more. Oh, and I'm thirsty all the time.

When all is said and done I'm glad that I started the new medicine. It's been good to feel more functional and I just feel more relaxed since I'm not constantly combatting images of knives and blood (those are the intrusive thoughts). But the side effects are enough to make me want to wean off this as soon as possible. Which I think means at least six months. Maybe a year. The psychiatrist I meant with says maybe never. For now, I'm just taking it one day at a time.

Depression profile: Doc

Thanks to Doc for sending me his story. I found it quite moving. He is one courageous guy! I had to really cut it down to fit here so be sure to check out his blog to get the whole story.

Part I—The Pretender
I have always been painfully, exceptionally, extraordinarily shy. The technical term is social phobia. This has haunted and hamstrung me most of my life, but never at anytime more than when I decided I might have the ability, the drive, and the heart to be a physician.

After surviving the brutal application process, my medical career was born. In my mind though, I had fooled them. I slipped by the gatekeepers whose job was to sift out “losers” like myself.

I did quite well with the first two years of medical school which were all academic. I was a miserable third year for the most part. Surgery in particular was a meltdown month. Otherwise, I learned to keep a low profile and slide along. What I did not learn to do was to become comfortable in my own skin, put patients at ease, and feel like I had a clue doing a physical exam.

There was only one exception: kids. The intimidation factor was not there and I let my goofy self out. I had the patience to get farther with them than other students. My first exposure to them was in Neurology, where I had the luck of being assigned to the Children’s Hospital. I fell in love with it, was fascinated by it and, best of all, there was a massive shortage of pediatric neurologists. I found my calling in medicine.

Unfortunately, I was still compromised by my phobia: pacing around the hospital for 20 minutes to work up the nerve to talk to a nurse; avoiding waking up patients; being terrified of phone calls.

Then it was time to find a residency. I interviewed at every pediatric residency I applied to. Pediatric neurology is the red-headed step child of pediatric subspecialties. It’s claimed by neither Neurology or Pediatrics in training. It requires a partial residency in both which causes political problems.
The fate of the interns is determined by a computer—the infamous “match” system. It works by residencies interviewing great swaths of medical students and medical students interviewing with many residencies. Then the two parties form wish lists and the computer optimizes the list so both students and programs get the places they indicated they prefer to be. In pediatrics, 93% of medical students get one of their top three choices. In my case, due to politics I got into my fifth choice, my failsafe. It was a large program with all the clinical exposure I could want and a bunch of strangely unhappy pediatric residents. I had a deep sense of foreboding.

Part II—Meltdown
Life stressors #1 (the new addition) and #2 (the move): We learned early in my last year of medical school that we were expecting a new baby boy. He was due right about the time we would move, the month after graduation. In order to have him covered by insurance we had to have him before we moved. My residency began orientation mid-June. Thanks to an understanding OB, labor was induced June 6th. We packed up the moving van and my wife was discharged from the hospital 2 hours later. We moved to a computer matched assigned city which, like medical school, was hundreds of miles from any family. I also realized I felt strangely detached from my son, thinking of him more in clinical terms than fatherly terms. It disturbed me.

Life stressor #3 (the heart): In preparing for the move I went into the doctor for a checkup. He thought he heard a murmur (never identified by anyone since) and sent me for an echocardiogram. It turned out I have a rare condition where the pericardial sack that my heart sits in did not form completely. While often not discovered or the cause of any problems, on rare occasion, part of the heart can get caught in the opening, strangulate, and rupture, causing sudden death. I had an MRI done the day before my son was born. I received a call that my cardiologist was discussing it with a heart surgeon (yikes!). In the end, this was all much ado about nothing and I never needed the surgery, but that was up in the air for several months. Death became a consuming theme in my thoughts.

Life stressor #4 (the job): I began the first year of my residency on what was the most difficult rotation for the year, the Neonatal ICU. We had overnight call every third night and put in about 100 hours per week. My head was absolutely swimming. I had to learn emergency care for some sick infants completely on the fly. We dealt regularly with distraught parents in a variety of intense situations. I had to make the dreaded phone calls. I had to learn to speak to the nurses.
I performed miserably, telling myself that all interns perform miserably their first month. To some extent this is true, the learning curve is indeed steep, but I faltered more than most. I walked around like a zombie, constantly exhausted. Some of the nurse practioners became so concerned they had the residency call me one day and tell me to sleep. People were always asking if I was okay.

I moved from this to the general inpatient pediatrics service. It should have been a relief, but I didn’t feel it. I couldn’t concentrate. I would sit on call with the other resident telling me about the patients I would be covering and what I needed to do and I wouldn’t hear anything past the first sentence. My mind was spinning out of control, imagining disastrous scenarios one after another. (This feeling, I later learned, is a hallmark of generalized anxiety disorder.)
Too often, when asking for help the answer was, “Figure it out for yourself. I had to when I was an intern.” I felt incredibly alone. The many critiques and suggestions brought to me a new round of self-flagellation. I was miserable. I began having strange worries. I wondered what it was that made people into child abusers. I started having intrusive, unwelcome thoughts about hurting children. I somehow convinced myself that I was really a monster, hiding beneath a facade. This kind of fear is also a part of generalized anxiety. There was no danger of me acting on these feelings, but they seemed real and distressing. My life was enveloped in guilt.

My wife, desparate for help with the children, left to stay for an extended period with family. I came home to an empty house every night. I began watching the same depressing movie over and over and over. I was living on donuts, boxes of cookies, anything that came in a box really.

The low point came when I was presenting a patient whose mother had Munchhausen’s syndrome. In typical, cynical, burntout MD fashion, we got to laughing about some of the nonmedical complaints the mother brought. I began laughing hysterically. My laughs turned into tears that would not stop. All the pain, all the anxiety, all the insecurity, and all the misery of my training just burst out of me. The tears were unsatisfying and bitter.

My attending was shaken; she quietly and concernedly gave me the number of the medical school counselor and encouraged me to go. I resisted. My senior resident came and told me to go. I resisted. Finally, she went to the chief residents who told me to go. I agreed. But put it off. Then our evaluations came in, my program director became involved and I was dragged into the counselor’s office, immediately suspended from clinical duty.

Part III—Acceptance
Here’s the funny thing: They told me I was depressed and I didn’t believe it. I took a kazillion question test, scored 98/100 on the depression scale, and I didn’t think I was depressed. I mean, aren’t all residents tired? Don’t all residents do nothing but eat work and sleep? I was not suicidal, hadn’t even had the thoughts.

I only knew this because I had had those thoughts before. My medical education alerted me to the fact that I had been in the throes of major depression previously. Junior high was not kind to me. I was an outcast, I was lonely, I was miserable. Young and unequipped to recognize and sort out what was going on with me, I struggled. I am likely the only Mormon kid who ever used to sneak into the chapel when the building was empty and just pour my heart out to God, begging, pleading for him stop the pain. I used to sit, staring at the bottle of Tylenol, wishing, just wishing I could get up the guts to down it all.

I never could. I always came back to the thought, “How could I do that to my family?” I knew they cared.

I moved past it on my own. I maintained high function in high school, having some happy moments and involving myself in extracurriculars and a small group of friends. I graduated fifth in my class. I received a 4 year tuition scholarship to Somewhere Else University.

I served a mission which was no small achievement for a social phobic.I took verbal abuse on what I believed and still presented what I had to offer in a spirit of love. I grew and matured. There was a period at the end where it was hard to do anything. I didn’t enjoy missionary activity or our liesure day anymore. It was a relapse, but I recovered.

Of course, when I returned to college I had my rough patches: periods of melancholy, lack of enjoyment, excessive tiredness. But, hey, I still kept my grades and married my soulmate. I made it to medical school. Sure, I was really disappointed by the general peds rotation, because I was doing something I loved got no joy out of it, but still, I wasn’t tempted to knock myself off.

Well, it turns out you don’t have to be suicidal to be depressed. I was referred to a psychiatrist, started on anti-depressants, and felt totally defeated. I wanted to be mentally strong. I didn’t want my secrets out. I didn’t want the prejudice. I felt like my medical career was slipping away, now that the pretender was caught.
On medication, disaster scenarios raced through my mind and thoughts of ending my life returned, again rebutted by the quandary of how my wife and kids would fare. While this kept me from giving in to suicidal thoughts, it sure didn’t help my guilt.

It took several weeks, but one day I found enjoyment in my old hobbies, in music, in joking around, in my children. I suddenly felt alive again, even though I had no idea previously how dead I felt for so long. I eased back into clinical duty, with a couple of rotations and with supportive attendings my abilities grew. The workload was less intense, but I was moving and thinking a thousand times better. I began to see how counter-productive my fear of weakness had been. I felt like Moroni, a prophet in the Book of Mormon, whom God told “And because thou hast seen thy weakness thou shalt be made strong” (Ether 12:37).

This was so foreign to my previous mindset. I thought I knew all about the wonders of God’s love, and what it meant to be born of God. I thought I had witnessed the transformative power of the atonement. I had read the Book of Mormon; the power of the story of Alma was burnt into my soul. Yet, somehow, I didn’t really understand these doctrines. I wanted to be great on my own, to achieve on my own. I was proud (paradoxically in light of my poor self image) and I wanted to face down my shortcomings on my own.

Part IV—Fight the Power
As I recovered from depression it brought to light my anxiety. One of the first side effects the medication gave me was panic attacks. I worried incessantly about the future, about my patients, about the rumor mill, about the stigma.
My residency program had a reputation for regularly dropping people, but I slowly gained confidence as my performance quickly improved on lighter rotations. Still, as a resident, I was shuffled into new hospitals so quickly it was hard to adjust, which in most medical situations was dangerous. I reluctantly started a low dose benzodiazepine.

As my anxiety became more apparent, my counseling adjusted. I learned relaxation techniques, and learned to stop and evaluate my fears to see if they were founded in reason. I tried to learn to live in the now. While the consequences of failure were real, the doomsday scenarios in my head were excessive. It was more helpful to see what I needed to do right here and now. My anxiety was mitigated but still took a lot of energy to manage.

By the end of that rotation, I could see where my knowledge, comfort level and ability had skyrocketed. I felt competent, especially compared to other interns I performed alongside with. I was climbing out of a huge hole. I realized for the first time that medicine, even intensive care, was something I was capable of.

Unfortunately, the program began to feel maybe I just wouldn’t survive with my fragile mental state. Ironically, as the help they had me get started working and kicking in, the program’s willingness to let it work decreased.
In accordance with my career plans, I moved ahead with a child neurology interview. I was open about my issues. The interview went well. I felt my career was going to be salvaged. I was accepted to a program near my wife’s family. My local program director was not happy, but since I kept passing my rotations he couldn’t actually do anything to stop me.

That changed two months later, when I did the pediatric ER rotation. I wanted to really prove something here so without consulting anyone I stopped taking my benzos. In my mind, I was better now and needed to learn to perform without the drug. This was a horrible, stupid mistake. Things kept getting tougher and without the medicine the only coping mechanism I had was anger. I offended a lot of people and ended up losing my residency contract. I took some bogus limbo rotations and came up with a new plan. It had just one problem: I needed all the people who I offended to come to bat for me. It was awkward. But I knew I needed to reach a peace with them. I needed to forgive. I needed to let go of anger, which was eating at my soul.

Eventually, with a wealth of experience in the school of hard knocks, a dogged determination, a newly developed, hard fought self confidence, and a little luck, I pulled it off. I was accepted into a new child neurology residency and scrambled into a transition year. It was absolutely astounding.

I love what I am doing now. One deciding factor in making the plunge into medicine was the desire to force myself to overcome weakness. I don’t know if I could ever have comprehended what that really would entail. I really don’t know that I would choose to experience it all again if I had the choice, but I have undoubtedly grown.
I know not all bouts of depression end this way. Mental illness and its stigma destroy lives. I know of more than one doctor or medical student who have taken their life. I just hope that telling this story can in some way help others with either the stigma or the healing.

As always if you would like to share your depression story e-mail me at lolapalooza AT hotmail DOT com. Put "depression profile" in the subject line so I know you're not a spammer:)