Mental Malaise (I'm so Blue-ue-ue-ue-ue!)

These days, I have to admit, I am a very blue berry. I had several days in a row last week that were the epitome of ennui and a couple evenings that bordered on downright depressed. It was amazing to me how quickly my mind and emotions fell into old depressed habits. I fought with my husband. I cried for no reason. I yelled at my kids. And the thoughts were back. Over and over, "You're a failure. Nothing you do will ever matter or make difference. Everybody thinks you're stupid. They're laughing at you all the time. You can't fix any of it. It's pointless. You might as well give up. Suicide is always an option . . ."

Grrr.

I was fitful and restless and moody. I hated it.

Sunday morning I purposefully said to myself, "You can go either way here. You can choose to figure out what's bringing you down and change it. Or you can choose to deteriorate. What are you going to do?" It was a strange moment of clarity in which I was either channeling my therapist or the Spirit. Or both.

My sister and my husband had both asked me earlier in the week what my problem was. I always responded I didn't know. But as I thought about it there were quite a few things that were probably contributing to my mental malaise. I've been on my SSRI for almost a year and they tend to poop out on me around the prescription anniversary. The Little Cannoli was cutting back on her nursing which was precipitating a drop in my oxytocin levels--less contented hormone = a less contented mommy. The kids were sick and waking up more at night so I was getting less sleep. I'm stymied with my writing; nothing I have written to this point in my life has been what I wanted it to be and I don't know how to fix it. I hadn't been reading my scriptures or praying. I'd just finished a month of Primary Sharing Times and Cub Scout Pack meeting. Really, there were a lot of reasons and it was probably a combination of things that was pulling me down.

So Sunday, I decided to take it slow. Give it my best effort to tune in to the Spirit and let everything else go. I also decided to go back to napping in the afternoon for a week or so.

I feel better. I am not in that blissful state of mental health that I previously was, but, you know what, I'm not doing too bad either. This is my life and it's okay. My problems haven't changed--I certainly haven't solved them--but just being able to name them and observe them was helpful. My therapist used to tell me that I need to be the journalist of my own life. I needed to observe my life and emotions, figure out the story, and report it. I didn't need to solve. I just needed to note it. It's amazing how much that can help.

Well, that and napping.

What do you do when you feel yourself slipping? What helps you right yourself?

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?

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.

Pregnancy and Depression--how it's going thus far

I am now eleven and half weeks pregnant. I saw my OB on Monday and she got some good shots of a squiggling, half-alien, half-frog (but soon to be human!) creature--complete with beating heart. Never has any whooshing been so calming to my mind.

Mostly I've been trying to not think about this pregnancy so far. I mean, my family has already outgrown our little 1400 square foot home so we've been caught up in the busy-ness of putting our house on the market and my husband has been crazy-busy at work and we had a family sealing to go to last weekend and, well, I've pretty much been thinking about everything but the blessing/complication that is currently inhabiting my womb.

Of course just because I wasn't thinking about it doesn't mean I wasn't worrying. Every night as I go to sleep I chant "Grow little baby. Grow little baby. Grow little baby." And in every personal prayer I can't help but add, "Lord, if it's thy will, please help the tummy baby not to die!" I know it sounds little nutty, but worrying is what I do.

So, the appointment went well and I'm almost out of the first trimester danger zone and I'm starting to think about this pregnancy as a person. I can see the light at the end of the nausea and fatigue tunnel. I've never been visibly pregnant during the winter so I get do some (frugal) shopping. I'm starting to get excited. This is starting to be fun.

Especially when I remember that this is most likely my last. Barring any divine intervention I don't plan on treading the path of pregnancy again. It's too hard on my chemistry. And therefore my family. And therefore me.

So far the chemistry is doing okay. It was a little wobbly the first couple weeks off the meds, but I think it's mostly settled. My ups and downs are more intense, though. My temper seems to flare up more often. I screamed at the kids at bedtime. I cussed out my husband. I had to pray for the patience to make it through Church. Whenever my kids do something cute or someone does something nice for me I cry. I tear up at cheesy television voice-overs and commercials. I decided--unilaterally--the put our house up for sale and my husband got on board, but I was just overcome (consumed?) with the urge to find a better home for our family. It wasn't a bad urge, but it was an awfully powerful one.

I'm trying to stick with the supplement regimen that my psychiatrist and OB agreed to. I did a bunch of internet research and then called them both to get their okay on it. It was a lot of work and it made me wonder what most depressed chicks do. Knowing how bad it can be, having some pretty solid, scary memories of my own personal insanity, I was pretty motivated to figure something out. And I was lucky that I'm good with the internet and have a pretty good network of other depressed folks to hit up for advice. And that I live in an area where supplements are part of everyday life for most people; the people at Vitamin Cottage were full of info that correct and germane(!).

Here's what I'm supposed to take:

*AM: 1 prenatal vitamin (I've got the kind where you take 3 a day) which includes inositol. My OB had never heard of it but psych had; both agreed it was safe to take during pregnancy because it is a naturally occurring substance and (I think) similar to B vitamins so it's water soluble and you can't overdose on it. 1 fish oil For info on fish oil and mood disorders read this article at Webmd and this one at from the Mayo Clinic. 1 vitamin B. For info on vitamin B and mood disorders here's another article from the Mayo Clinic or try this one from the Linus Pauling Institute, you'll have to scroll down a ways to read about depression.

*NOON: 1 prenatal (inositol included) and 1 vitamin B.

*PM: 1 prenatal (inositol included), 1 vitamin B, and another fish oil. I'm thinking of switching out this second fish oil for a flaxseed one. Fish oil is an anticoagulant and so is potentially dangerous to the fetus when taken in large doses--which it usually is when being used for depression. I'm wondering if using flax oil instead would be better. . .

I asked both my docs about vitamin D and they both said that was an unsafe supplement to take during pregnancy. For info on vitamin D and depression read here. Actually the whole article, which is about nutrition and depression, is really excellent so here's a link back to the beginning!

It adds up to a lot of pills each day. I feel like I'm always popping something--especially when you add the probiotic yogurt smoothly I drink to ease the morning sickness. (Probiotics are also supposed to be good for your mood disorder. Seriously. Read this. It's only an abstract, but it's got some good info. It's also supposed to help my unborn baby avoid eczema--which is a total bonus given the saga we've gone through with J and his eczema. According to the internet probiotics are the source of all good things. I admit that all that enthusiasm makes me a little suspicious, but I like yogurt so I'm going with it. Anyway, back to the point here . . .) All those pills are a much bigger hassle than my one Cymbalta and my one mulitvitamin and if I get busy I do forget to take them. They were also very expensive. All the supplements added up to more than twice the cost of my monthly Cymbalta prescription. Now, that's mostly because my insurance covers most of the cost (lucky me!) after we meet our deductible--which we usually do in January when I fill my first month's worth of SNRI. Some of the supplements came in big bottles so they should last longer than a month, but still, it adds up. However, I do feel better when I take them so in my mind it's worth it. Because I'm getting a baby out of this.

So it's all worth it--mood disorder and all--it's worth it.

Depression in the Ensign: Elder Marlin K. Jensen?

Sorry I've been neglecting you all lately. The farm that I have a share in has been ultra productive this year and I've been doing a LOT of canning. It's a lot of work! Also, I feel like things around my house have been extra intense over the last couple months and I've sort of been shying away from blogging--actually from writing in general. Thanks for being patient with me :)

So last week I was hunting around lds.org for something to read for scripture study and I happened upon "Living After the Manner of Happiness" by Elder Marlin K. Jensen. You all might remember him from the PBS special on us Mormons. I think I swooned over some of his awesome answers to tough questions. He's a general authority and serves as the Church Historian and Recorder so imagine my surprise when he admits--in the first line of his talk-- that,

"although I am richly blessed and have every reason to be happy, I sometimes struggle and do not always have the natural inclination toward happiness and a cheerful disposition that some people seem to enjoy."

What?!? General Authorities are not always sublimely happy and contented?

Hooray! That means there's hope for the rest of us!

His talk goes on to list nine principles of happiness gleaned from Nephi's account in the Book of Mormon. My favorites: plant a garden, keep a journal, and work (which he defines as especially with your hands).

This talk was definitely a good read :)

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.

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.

Support Where You Need it the Most! (part one)

No, I'm not talking about that kind of support (although you all do know how much I love my veggies!). I'm talking about an emotional support system--how to build one and how to use it.

Building a Support System
I think we all know what a support system is and, if you all are anything like me, we fantasize about that perfect spouse/friend/parent/home or visiting teacher who intuits our needs so well that we hardly have to do anything. But building a support system isn't something that is easily done. It takes time and effort. The big thing I've learned a long the way: *Honesty* In order to build a support system you need to be honest with yourself and with those close to you about how your mood disorder affects you. Both of these things can be difficult.

Being honest with yourself is hard because you likely over-estimate your faults and your worthiness. You likely believe you should do things on your own and that because of the way you struggle you don't deserve the love and attention of others. You may even believe it is more righteous to struggle on your own. This is not true. Even in the throes of the bad days, especially in the throes of the bad days, you deserve to have someone there to help. There's a reason God organized us in families and wards/branches. We are meant to help each other out. How else are we supposed to fulfill our baptismal covenants? (See Mosiah 18:8-10)

Being honest with others is hard for a couple reasons. First, you don't know how they'll react (my favorite: "When I get down I know that's just Satan inside me and if I repent he'll go away." Great. So now I'm depressed and possessed. That's super.). And second, you may lack the words to describe what you are going through. The only way to figure these two things out is through trial and error (or as I like to say, trial and effort). Therapists are a really good place to start with this. They've heard it all so no matter what you say you can't weird them out--or if you do you can always find another one! They are also good at aiding introspection. They just seem to know how to help you hear yourself better and the better you understand yourself the easier it will be for you to explain all that to others.

Not everybody you know is going to be the right fit for you. This website has some nice tips to help you figure out who to start reaching out to (disclaimer: I'm not so sure about their tip to include stuffed animals in your support system. I mean, for me, personally, it's hard to talk to a teddy bear when I know my preschooler is doing the same thing in the next room).

Another great idea to aid you in building your support system is one I got from Coffinberry. She got this table from her brother and I think it encourages some good thinking and communicating. It is called "Mad Maps". In a Mad Map, you make a list as such:

*In Every-day Times
Things you should do:
(For example)
Bring me herbal tea
Tell me how great I am

Things you should not do:
(For example)
Give me Caffeine
Make me stay up late

*In Times of Crisis
Things you should do:
(For example)
Help me find a quiet place
Sit with me and listen

Things you should not do
(For example)
Tell other people what's going on


Coffinberry said, "This list would be available for those who wish to support you in times of sadness or crisis. This seems to me like a great tool for care-teams. It helps people to know how to support you, but it also helps you explore how yourself and what kind of support you need. It also gets you in the mindset of building a support network for yourself."

So whether you start with a therapist or with a Mad Map, take a good look at the people around you and see who you can depend on because as a good friend once told me, "We're all waiting to love you. Just give us the chance!"

If your little apple doesn't fall far from the tree

then your family is probably like mine: you are not the only one who struggles with moods and emotions. Odds are that one of your kids does too.

In our family it is our oldest (5 years old) who has struggles. She has a lot of anxiety and spends a fair amount of time trying to manage it. She has a therapist (you all know how much I LOVE therapy) and we have seen some good results there. However, since she is so young we have to spend a lot of time at home going over (and over and over and over!) the concepts she learned in therapy. There is a lot that I have to remember for her and help her do. Some days it's pretty hard.

Thankfully, I recently found some books that have proved helpful: What to do When I Worry Too Much (overcoming anxiety) and What To Do When I Grumble Too Much (overcoming negativity). I came across a these books at Parentbooks and we have started using them as Family Home Evening Lessons. Our whole family benefits from practicing the concepts in them and the books make it easy to explain cognitive behavioral therapy ideas to small kids.

These books are written by a child psychologist and there are a whole bunch of titles in the series--covering things from bad habits to OCD to anger issues--many of which are available used and new at Amazon. So if you have kids whose emotions take a lot of energy to regulate and you'd like them to learn a little self-mastery these could be a great place to start!

Oh, and good luck!
And, you are not alone! (Michael McLean doesn't technically own that phrase, right?)
And, remember: we're aiming for progress not perfection :)

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!

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.

Mmm . . .Cilantro . . .mmm

Nothing says summer like fresh herbs and salad--which is exactly what came in my first CSA box. Actually, it was a lot of salad. As in five heads. Half our box. The other half was spinach and cilantro. There were also a few onions, some celery, rhubarb, and garlic scapes. Most of the lettuce I gifted to some neighbors since there is no way our family could eat five heads in one week. Well, we could try but we'd probably make ourselves sick. (Salad shooter, anyone? Sorry. It's an old joke that Husband's family used to tell.) Most of the spinach I froze because I use it in everything from meatloaf to spaghetti to omelets. The rhubarb got made into freezer jam (which was so simple it was like falling off a horse. That was a bad analogy. Quick, somebody call the analogy police!). The onions and celery I just stuck in the fridge. There were only a few scapes so I figured I'd just use them like regular garlic.

That left the cilantro. A lot of cilantro. Between what I harvested from our own herb garden and the pile we got in our box I had a large mixing bowl full of the fragrant greens. Calling allrecipes.com!

I am not so good in the kitchen. I don't so much cook as I experiment. So, allrecipes.com is a must for me. I love their website but, truth to be told, I have a hard time telling a good recipe from a bad one. I am also willing to eat any number of new foods--as long as they involve lots of veggies. Cilantro, me, and allrecipes.com are a match made in heaven (or spirit prison, depending on how you feel about cilantro). Anyway, I found a couple recipes I liked: Cilantro Lime Dressing and Cilantro Pesto. My whole family liked the dressing, except for Number 1 who categorically hates cilantro. The pesto was a toss up. I enjoyed it, as did Number 2 and Number 3. The baby actually had two helpings. But Husband did not. And of course, Number 1 categorically hates cilantro so you can guess what she had to say.

I bring all this up for two reasons. 1)To give you all relief from the pity party I've been holding for my poor, hormonal self. 2) Because it made me happy! Honestly, I was surprised how much the kitchen activity lifted my spirits. Maybe it was just the energy of the chopping and rinsing or maybe all the good herby smells (anyone else read this article about pot and depression?), but I felt better. So who knows. Maybe the next time you're feeling down spend some time "experimenting" (or actually cooking, if you are that good!)in the kitchen. It just might help--especially if you use chocolate!

That's Why People Have Psychiatrists!

A little while ago I did a post about antidepressants. When I wrote it I was pretty positive about using medicine as part of a treatment plan--and I still am. I like my Lexapro, but I feel like I only told half the story in that post. And, in the name of honesty, I feel like I should own up to the other half.

Antidepressants are a commitment, which is why so many people are afraid of them. I think this fear sometimes manifests itself as a worry about addiction or dependence, but those aren't the effects of antidepressants. For anyone who doesn't know I'll offer a short explanation of how my drug, an SSRI, works. (For those of you who do know, feel free to skip this. Or you can read it and then correct me in the comments!)

SSRI stands for selective serotonin reuptake inhibitor. Serotonin is a neurotransmitter in your brain. This means it helps your brain pass different signals back and forth. These signals help regulate things like mood, anger, sleep, and, according to wikipedia, even vomiting! (It did say "citation needed" on that last one.) When there isn't enough serotonin in the brain it starts to go a little haywire. What an SSRI does is stop some of the serotonin in your brain from being absorbed thereby making more of the neurotransmitter available for use. Also, the theory goes, neurotransmitters like serotonin are produced by the body on a supply and demand basis. The more you have of it, the more you use, and therefore, the more your body makes. If something goes awry and your body slows down production of it for just a little while it sometimes forgets to start making it again. SSRIs help the body reset the right levels in the brain. Although even the Mayo Clinic is quick to point out that no one is exactly sure if this is what actually happens.

Anyway, that is why you have to stay on the drugs for a while (at least six months). It takes time for your body to train itself to the right production rate. That is also why it is hard to go off the drugs. You can't just quit taking them because if your body isn't ready it makes you more sick than you were to begin with.

I've actually done this a couple of times. You'd think I'd know better, but I guess I don't. Take my last couple of weeks. I've been pretty emotional. I've had a lot of ups and downs--which the SSRI allows for, it just makes them less severe--and I was beginning to think I was crazy. However, I know I am not a good judge of how crazy or uncrazy I am. The crazy has a habit of sneaking up on me so I've taken to tracking it on my calendar. I mark my down days and make notes if they are especially bad. I also note if I miss a pill because it helps keep the bad days in perspective.

In the last month--maybe because school let out and our schedule is all crazy or because the baby's acid reflux has been acting up again and he's been having a hard time sleeping--I've missed four doses. Also my prescription is running out and it's been a year so I figured now would be a good time to start weaning off my medicine. So I took myself down to half a pill a day.

The result? I had one afternoon a couple weeks ago where I was a wreck. The day started out rough (not wanting to get out of bed, yelling at the kids during breakfast, getting pooped on at the park--okay, that last part isn't depression, just life with a baby) and only got rougher (fleeting suicidal thoughts and excessive fatigue and weepiness). It took all my strength just to feed the kids and keep us all going until Daddy got home. I checked my calendar and sure enough I had missed a dose just a week earlier. I decided to go back on my full dose. It took a few days but things got better.

Then last week I was at Enrichment having a marvelous time. We were painting blocks for the Church Humanitarian Services and chatting and I was loving every minute of it. Although after a while I felt like I was talking awfully fast and laughing a little too much--like I was myself in Technicolor. After Enrichment I was still feeling pretty bubbly so I decided to swing by a friend's house to play some Dance Dance Revolution (Hi Kelly!). It didn't take long until I crashed. Right in the middle of "99 Red Balloons" I got all anxious and weepy and I had to go home and tuck myself into bed. (If I wasn't so pathetic I'd laugh at myself.)The results of my medicine experiments? I think so.

Of course it's not all the medicine. There are other contributing factors when it comes to my down days. I was in charge of the service project and had been pretty worried about whether or not anyone would show up. Also, there's my baby and my chronic lack of sleep. And some days, regardless of any other factor, the crazy just crops up. But the medicine is a part of the mosaic that is my mood disorder.

So, to be fair about medicine here's what I say: Don't rule it out. It may be that you have a genuine physical need that it can meet. Of course, don't mess around with your meds. Take it the way your doctor (even better, your psychiatrist) says and talk with your doctor about weaning off it and how it is working for you. Depressed people, especially those with bipolar disorder, are notorious for medicinal inconsistencies--don't be that person! Instead, get the treatment you need and be the person you want to be.

Staying up all night is GOOD for you!

I'm feeling down today. We had our carpets cleaned this morning and the flurry of activity related to that held the blues at bay until this afternoon. I was in the grocery store with my oldest and she was being so sweet and wonderful that I got depressed. I know, it doesn't make sense, but it was like all my love for her filled me up to bursting and it overwhelmed me and left me feeling, well, depressed. It was strange. This has happened on a few other occasions and I'm still trying to figure it out.

Anyway, I came home and tried to explain it to my husband. He gave me a hug and said that it was probably just the stress of trying to get the house clean for the carpet cleaners (yes, we had to clean for the cleaners!) and staying up late last night trying to finish my entries for the Irreantum contests. I told him he was probably right.

After all, it is conventional wisdom that if you aren't getting enough sleep you will end up depressed. I remember when I was leaving the hospital after the birth of my second and the nurse in charge of discharge information advised me to get at least five hours of sleep. She said that women who don't manage at least a five hour chunk of sleep are much more likely to end up with postpartum depression. Sleep, she said, was key to mood management.(Having had PPD with my first and perinatal depression with my second, I had a hard time not rolling my eyes. The story of PPD is so much more complicated than the amount of sleep a woman gets!) Then, just a couple months ago, when I was talking with my daughter's "feelings doctor" about whether or not my meds were still working for me, she suggested that I get 24 hours of sleep to give my system a boost. (Again, it was hard not to roll my eyes. How am I supposed to get 24 hours of sleep when I have three children?) The basic gist seems to be that sleep renews the body and refreshes the mind. But for depressed people this may not be the case.

It started in the late 1970s when a Swiss neurobiologist, Anna Wirz-Justice, recommended a sleepless night for a severely depressed patient. The results were quick and decisive. In the wee small hours of the morning the patient, who had previously been nearly comatose with depression, began talking and acting like, well, a normal person. Since then numerous studies have been done to test the effectiveness of sleep deprivation as therapy. The conclusions are intriguing. Supposedly 60% of depressed people see improvement within hours of skipping sleep.

Why it works is still a mystery. Some researchers suggest that glucose metabolism in the brain is the reason. Others say it has something to do with the way the depressed mind interacts with the REM cycle. Others suggest it has something to with how thyroid hormone is produced. (Sorry I lost the link to that last one.)

Counterintuitive as it may be, the whole sleep deprivation thing makes sense to me. I am constantly tired. I usually get around six hours of interrupted sleep and I'm yawning before I've finished dishing up my kids' breakfast. I almost always need a twenty minute power nap around 2:30 pm. I can usually rally for the bedtime reading and snuggling routine, but I'm exhausted by the time they are all down. I am always telling myself that I am going to get to bed early. But I don't. Turns out by about 9:00 pm I start perking up. My brain kicks back into gear and I find that I have a couple of hours of working time before I turn back into a zombie.

Of course there are couple hang-ups with sleep deprivation therapy. First, in almost all the studies, when patients returned to a normal sleep pattern (which is recommended since sleep deprivation is linked to diabetes and obesity) the depression returned. Second, it really isn't practical. Most of us live in families and work jobs. Staying up all night would work for me as long as I didn't have to drive anywhere. Or deal with children! Most experts seem to agree that this isn't a long term solution to depression. But, if you have a doctor that will supervise you and you are waiting for your meds to kick in or other therapy to start, this may be a treatment that works in the short term--it may give a glimmer of hope to someone who thought there wasn't any.

What do you guys think? I know some of you readers are way better educated than me and have more experience, any of you tried this? Be sure to comment and let me know.

To medicate or not to medicate?

Antidepressants are the most prescribed drug in America. Which is understandable, considering that an estimated 18.8 million American adults (or 9.5% of the 18 and older population) struggle with some form of depression. But here's the amazing part, 80% of people with depression are not recieving any treatment for their illness. Most of us are toughing it out on our own.

Now, I am currently on an antidepressant. (For the story on why read here.) And I honestly believe it has helped me. However, every time I have started taking the pills I always start trying to calculate when I can be done taking them. I think that's because there are still so many myths out there about antidepressants and it complicates the issue.

So here's my attempt at debunking some of the myths surrounding antidepressants:

Myth #1. If you start taking an antidepressant you have to take it forever. Not true at all, you can quit taking them when you're dead! No, in all seriousness, while 9.5% of the adult population may suffer from some form of chronic depression 25% will suffer some sort of temporary depression. Many of people with temporary (or situational) depression take the medication for a only short time (six months is the shortest recommended time) to help their body readjust its chemistry. However, if you are like me and have the genuine crazies instead of temporary insanity, you usually stay on the meds for longer.

Myth #2. Antidepressants are only as effective as a placebo. This one is only sort of false. Back in 2002 a study was done that concluded a sugar pill was just as good as an SSRI. According to the study, it didn't matter what kind of "medicine" a participant was on. They all saw improvement. Some people take issue with the study because of all the extra care involved. Study particpants got checked on so frequently it basically amounted to therapy--and we all know that therapy is good for almost anyone!

Myth #3. Antidepressants are only for really crazy people. Let's just say that if they are the most prescribed drug in the nation then there are a lot more really crazy people out there than we thought. Oh, and most of us really crazy people look just like you.

Myth #4. Antidepressants are a miracle pill that will solve all your problems! I wish. Actually, antidepressants are most effective when combined with talk therapy. Turns out to manage this illness you have to do some hard work--usually solving the situational/environmental problems that contributed to your depression in the first place. Let's face it, when we're sad, there's usually a reason.

Of course only a doctor can help you figure out what's right for you. But I say, if you're struggling, why not try them and join one of the biggest clubs in America (but don't worry, we won't tell anyone who you are. We know you want to appear normal)! What myths have you guys come up against when considering antidepressants? I really want to know!

Something to Be Grateful For

For our ward's quarterly Enrichment meeting we decided to focus on gratitude and President Eyring's talk "O Remember, Remember". For part of the program we asked several sisters to keep gratitude journals for one month and then report on the experience. Their stories ended up being the highlight of the night!

One of my favorites came from one of my visiting teachers, De. De has been with me for a few years now and has listened to me jabber through a lot of ups and downs (I talk A LOT and my poor VTs just listen. I love having a captive audience!). She is a wonderful listener and I'm grateful for her gospel insights and patience. De also happens to be blind. She has some residual sight which allows her to see contrasts but she has a hard time going from low light to bright light and, I think, most things are just a blur for her.

Here is what De said that night:

I was asked to keep this journal to record things I'm grateful for. I'm not a gifted writer, but I started out trying to write something each evening. I think I was trying too hard to think of things that were "out of the ordinary" (maybe bordering on the miraculous), but there were a lot of days that were just ordinary. So I decided that I was overthinking it. I don't have to try that hard to think of things to be grateful for. So I started thinking about all the blessings I receive every day. I'm alive - what a wonderful gift that is. I wake up every morning in my warm, cozy bed in my own home. I can hear the birds singing and I don't have to worry about where my next meal is coming from. I should be on my knees constantly thanking God for all the wonderful blessings I have. I was ashamed to realize that I had been taking all these things for granted.

Diana [our RS pres.] mentioned in her lesson Sunday that we should be grateful for everything in our lives, even the bad things. That got me thinking about the trials in my life...have I ever felt grateful??? When I bang my head for the 100th time in a day or lay something down and can't find it again, do I feel grateful, or do I mutter, "Lord, life would be so much easier if I could just see."

I hadn't given that a lot of thought before, but I did find some things to be grateful for. I should be grateful that I haven't had a concussion or permanent brain damage. I can't see the grey hair, wrinkles or turkey neck, so in my mind I'm still the same person I've always been--I'll never get old! I don't have to spend a lot of time worrying about what to wear. If I get dressed and my clothes are on right side out and I don't have on 2 different shoes, I'm good to go.

Seriously, there are blessings. I see things with my heart instead of my eyes. When you can't see what people look like, you see who they really are on the inside. I think being visually impaired has made me a better person. I'm more patient & compassionate & I've had to develop a sense of humor. If you don't laugh, you cry. So once again, I don't have to look very hard to find things to be grateful for.

And now for the really big blessings (and this is miraculous). Because of the atonement, I will be resurrected with a perfect body and I'll be able to see. And because of temple ordinances, I've been able to do baptisms for my parents & my son, and I'll be able to see them again.

So what the gratitdue journal has done for me is to make me think seriously about all the many blessings in my life, and to be truly grateful for every one of them (even the trials) If I actually made a list of all the things I'm grateful for, this little notebook wouldn't be big enough to hold it. It's my prayer that I will always be aware of the many blessings in my life and never take them for granted and I hope that someday I will be worthy to return to live with Heavenly Father & Jesus Christ and to be able to thank them personally for the life they have given me.

Maybe it's because I know De personally that her story meant so much to me, but I don't think so. I think it was meaningful because she whole-heartedly embraced what gratitude can do for us. Gratitude is such a powerful state of mind. (Even WebMD thinks of it as a part of depression therapy!) Not only does gratitude makes us more alert, enthusiastic, determined, optimistic, and energetic, it also opens our hearts to God. And for that, I'm grateful.

Have I Done Any Good in the World Today?

I've been thinking a lot about what "Jer" said in her profile about getting outside of herself.

As Church members we are constantly encouraged to get outside ourselves--mostly through service. And, consequently, as Church members we are subjected to a barrage of service opportunities. Sometimes I feel like I'm a bad Mormon if I don't sign up on that third clipboard making its way around the room. It's for that reason that, for me, service can be a double-edged sword.

But, service has its benefits and Church leaders aren't the only ones to notice that. A study done in 2007 by the Corporation for National and Community Service found that people who volunteered had greater longevity, higher functional ability, lower rates of depression, and less incidence of heart disease. Interestingly, the study also found that people who benefited about 100 hours a year (or two hours a week) were those who benefitted the most. There were no increases in benefits for people who volunteered more than this. (That last part might serve as a cautionary note to those of us who try to over-magnify our callings!)

As an active member of the LDS church, and especially as a member of the Relief Society (the errand of angels is given to women! Does that intimidate anyone else?), service is something that I can't avoid. I have a calling (Enrichment Committee) and I'm a visiting teacher. I'm also on the substitute list for Primary and Nursery (because I secretly like it better where I get to play games and sing songs and eat snacks). Also, since I have three little kids I am usually grateful to babysit other people's kids because then mine have someone to play with.

Most often, though, I don't think of those things as service. They are just part of my life. Service, I tell myself, is something big and it probably should be hard or it doesn't really count. President Thomas S. Monson spoke on this subject last fall during the General Relief Society session. He said, "You are a mighty force for good, one of the most powerful in the entire world. Your influence ranges far beyond yourself and your home and touches others all around the globe. You are, of course, surrounded by opportunities for service. No doubt at times you recognize so many such opportunities that you may feel somewhat overwhelmed. Where do you begin? How can you do it all? How do you choose, from all the needs you observe, where and how to serve? Often small acts of service are all that is required to lift and bless another: a question concerning a person’s family, quick words of encouragement, a sincere compliment, a small note of thanks, a brief telephone call. If we are observant and aware, and if we act on the promptings which come to us, we can accomplish much good."

So, tell me, what good have you done in the world today? What ways do you all work in your two hours a week? I need the ideas for the next time I feel the blues setting in!