On the mend

I met with my psych doc this morning – a follow-up to last month’s med increase. I scored a 4 on the PHQ-9, which is still mild depression, but better than last time I saw him.

I told him that I could tell I was on the up-swing. I’m not feeling hopelessness anymore. My husband and I are dealing with a major life event, and it didn’t send me plummeting; I’m handling this stressful situation without succumbing to great distress.

I’m able to track a whole Netflix show – that’s improvement. I’m reaching out to relationships again instead of wanting to isolate – I joined a women’s Bible Study. I haven’t gone back to volunteering, but I hope to soon. I’m sleeping through the night again, instead of the 2-hour-middle-of-the-night insomnia.

I’m still struggling to concentrate when reading. I’m trying to follow Noom, but can’t seem to stay in my calorie allowance, so I’m a bit discouraged at my lack of self-discipline. That’s an improvement, though; before, I didn’t care.

I’ve mentioned my new therapist and our difficulties in timeliness. But I’ve decided that I really like talking to her, so I’m just going to build in some extra time around our appointments, knowing there will probably be some delays. It feels good to have that decided.

My husband and I have some major changes coming up in our near future, and I need to manage those with gentleness. I’ve asked friends to pray, and we’re following God’s direction for our next steps. I know that if I’m seeking His will, He will direct our path. Today’s blog post from Fresh Hope was very timely – about managing a mental health diagnosis in the midst of change. Just what I needed to hear. Thank You, Lord, for those reminders.

Wishful thinking.

“Just pray harder.”

“Why don’t you take a walk in the sunshine?”

“Count your blessings!”

“There are so many who are worse off than you.”

And my mantra: “This, too, shall pass.”

All of these are perhaps well-intentioned, but unhelpful pieces of advice for a depressed person.

I can’t think myself out of depression. Though this time I really tried.

Each day, I answer a mood question, “On a scale of 1-9, how’s your mood?” And when I’m in a healthy mental state, my mood runs at 7 or 8. (9 and 10 are reserved for “extremely good” and “exceptional,” which usually happens when my husband and I are on an adventure or my whole family is together.)

Shortly after Christmas, my mood started running at 7 and 6. Then it dropped down to 6 and 5. Then it was solid days of 5.

I felt like I was handling 5. I didn’t see it as concerning. I was still going to my job, my volunteering. I came home and was tired, but that’s not unusual – it’s the middle of winter, so of course my mood is down a bit.

I started having trouble sleeping – waking at 2am or 3am for a couple of hours, night after night. I wrote it off to being in my mid-50s, that time in my life, etc.

I stopped reading my books, including ones I had been excited to devour. I couldn’t concentrate. And some of the Netflix shows we watched didn’t hold my attention for the entire hour. I’d get up and get a snack: “No, don’t pause it; it’s ok; I’ll be right back.”

I told my friends that I was fighting depression. And I thought I was. But in reality, I wasn’t doing anything but letting it take me further down the tunnel.

I thought it would go away. I thought I would bounce back. For six weeks I let it push me deeper and deeper, but I kept denying it. Or at least minimizing it.

The thing about depression is – my brain is broken during an episode. I don’t think clearly. So I couldn’t see that depression wasn’t going to go away by itself. Even though I know better, I somehow thought that I could will myself out of depression.

I told my husband that if my mood dipped to 3, I would see the psych doc for a med adjustment. And my mood dipped to 4, for several days in a row.

At the same time, I caught a bad head cold, so I continued to “write off” my mood – this time because I wasn’t feeling well.

And then, I tanked. My mood hit 3. I left a message for the doc that I needed to see him.

On our way out of church Sunday, my husband encouraged me to not beat myself up for taking so long to see my psych doc. He reminded me that I gave myself parameters, and I abided by those guidelines: mood = 3 means call for a med check.

I admitted that I am beating myself up a bit. I know better! I know depression doesn’t go away by itself. But he’s right – I did what I said I would do.

I met with the psych doc this morning. He doesn’t want me to plummet (too late), so we’re boosting two of my meds. And because I took my fine sweet time getting in to see him, I’m going to be on these adjusted meds for several months. Hopefully, it won’t take that whole time to begin to feel better.

It is true: “This, too, shall pass.” But not without a helpful push from the doctor.

Again?

Yesterday, I took the PHQ-9, which is the short questionnaire that doctors and psych docs give to determine if depression is present. I scored a 6, which means mild.

I’ve felt it for a little over a week. The downward pull towards feeling flat. So far, it’s just been moments each day, not all day every day. It’s actually depression if the symptoms are over the course of two weeks. So maybe I overestimated and my score is less than 6. But even 4 indicates mild depression. And the fact that I took the quiz in the first place is a red flag to me that I’m concerned about my mental health. I’m noticing that something is “off.”

In church this morning, I was wondering “Why?” I’m doing all the right things. I’ve been replacing negative thoughts with God’s truth. I know I’m deeply loved. I’m using my blue-light lamp. I’m writing daily in my gratitude journal. I’m in God’s Word every morning. I’m trying to make healthy food choices, mostly. So what caused this change? Why would it come back?

Maybe it’s that time of year – mid-winter. Even in VA, with warmer weather and more sunshine than in the Midwest, it’s still clearly winter, with all the naked trees and cold winds.

I just read an article that says that January 24th is the hardest day of the year. That’s right around the time I admitted to my husband and best friend that I was struggling.

My first psych doc told me that February is a very hard mental health month. Maybe I’m anticipating that. February has traditionally been a tough month for me. So maybe it’s “mental muscle memory.”

But for whatever reason, I’m fighting depression again. It’s not bad, not yet anyway. I promise not to wait too long, to call my psych doc if it continues. But he’ll just up one of my meds, which I don’t want to do!

I see a new therapist in two days, a Christian counselor. Maybe he’ll be able to help.

In the meantime, I’ll be honest with my husband about how I’m feeling. I’ll keep doing what I’m supposed to be doing to fight it off. I’ll work up the courage to ask others to pray for me, combatting my own feelings of stigma and failure that I didn’t keep it away. I’ll remind myself that I didn’t fail – it’s just something I have to deal with, my cross to bear.

“This, too, shall pass.”

The trouble with medicine…

Ugh!

It’s almost 3am, and I’m sipping Sleepy Time tea and writing this blog. Because I’m wide awake! I’ve freaked myself out, and need to calm down before the Sandman might dare to reappear.

When I woke up this morning – I mean yesterday morning – I felt a little off. A little funny in my skin, but I didn’t really know how to describe it. But by bedtime, it was a raging all-over-body itch. Like I’d just rolled in long grass and my skin was tingly-itchy, even inside my mouth. No visible rash, but definitely needing a scratch. As we were going to bed, my husband said, “Maybe it’s a withdrawal symptom.”  And I’ve been freaking out ever since.

Last week, I discovered that I had missed the “expiration date” on one of my medication refills, but figured it wouldn’t matter, since I was seeing the doctor on Friday, and I would tell him then. I mentioned during the appointment that I was going to run out, but neither he nor I grasped the potential significance of that statement. As I knew he would, he wrote me a new prescription, then gave it to one of his staff to send in – I get my meds by mail. That was Friday.

I got a notice today – Thursday – almost a full week later – that the prescription-filling company has received the doctor’s order and they are processing it to be filled and sent on its way.

In the meantime – two or three nights ago – I ran out of those pills.

No biggie, they’re on their way. But wait, I’m heading out of town on Saturday for a week, so they’ll arrive while I’m gone. Again, probably no biggie – it’s just a med I take to help me sleep.

I’ve been on a very low dose of this med for 10 years.  Tonight I learn that it’s a benzodiazepine – a central nervous system depressant. (Shame on me for not exploring this sooner.) My original psych doc first prescribed it when I was struggling with the anxiety portion of my depression, and I was having trouble getting to and staying asleep. He assured me that there was no problem taking the med at such a low dose. And I needed the sleep in order for my brain to heal from the depression and serotonin toxicity.

That was 10 years ago. Two psych docs since, and I’m still on this med. No one ever mentioned any concerns with it. Over time, I’ve considered coming off of it, but why? It works so well, I’m sleepy within 20 minutes of taking it, and I rarely struggle with insomnia; I can usually get back to sleep pretty easily if I wake in the middle of the night. I have no ill effects in the morning – I can get up just fine without any residual tiredness. On a couple of occasions, I looked into the process of coming off the med – just reading “how to” on the web – and saw several stories of horrific troubles with reducing the dose. But I figured my dosage was so low, when it was time, it would be no problem.

But here I am. Itchy all over. Woke up after an hour’s snooze and can’t fall back to sleep. So I googled this medicine and withdrawal symptoms. And there are all those scary stories again. Itchy body is very mild, when you consider hallucinations, loss of appetite, return of depressive thoughts, panic attacks, insomnia, muscle tightness, headaches, seizures – I think pretty much everything that could happen, could happen! And the process for weaning off – with a doctor’s supervision – is very slow – like 6-12 months to get off 1 mg. And I’ve accidentally gone cold turkey!

I’m honestly not sure what to do, besides call my psych doc first thing in the morning. I’m not sure what he can do for me, as I already have a prescription in process. Will I be allowed to have a few pills to tide me over? Will he help me get off this horrible drug, weaning me off properly?

Will I sleep at all tonight? Can I pray and breathe my way through my increasing anxiety as I consider the potentials while I’m out of town next week, without this med?  The “what-ifs?” are so scary at night, anyway. And they just got more terrifying as I read all about this med on the web.

Red Flags

Over ten years ago, I was diagnosed with Major Depressive Disorder – Recurrent, which means that I’ve had multiple episodes of depression. It’s important for me to learn to recognize the symptoms of an episode quickly, because the faster it’s treated, the sooner it goes into remission.

According to psychiatry.org,

Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite — weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide
  • Symptoms must last at least two weeks for a diagnosis of depression.

Given these symptoms, it’s critical for me to know my red flags – my warning signs – that an episode might be lurking. These are my indicators prior to actual depression symptoms – they tell me it might be coming.

Here are some I’ve noticed.

  • Listening to music loudly –
    • in an effort to drown out my negative or ruminating thoughts.
  • Desire to be alone, or in the dark.
  • Not wanting to go to my regularly scheduled activities – anhedonia.
  • Saying “I’m sorry” a lot.
  • Difficulty concentrating when reading a book or even watching a t.v. show.
  • Wanting to stay in bed, even if I’m not tired.
  • Feelings of self-pity.
  • Crying – maybe. Sometimes I can’t cry, which is also a red flag for me.

When I see several of these characteristics, or if someone close to me notices, it’s time for me to contact my psych doc and let him know that I might be headed into a depressive episode.

[Side note: even though I know these things about myself, I am always surprised. You’d think that after ten years, I wouldn’t be shocked to discover the journey back into depression. I guess it’s a good thing – I don’t ever want to get used to it. I need to accept it, and make every effort to be mentally healthy, but I don’t want to be resigned to a life of depression.]

Over the 10+ years that I’ve battled depression, I’ve gotten better at seeing these things quickly, which means we can modify my treatment and get me the help I need so that the episode doesn’t deepen. Maybe that means adjusting my meds. Maybe it’s increasing my therapy sessions.  Maybe it’s simply monitoring them, being self-aware.

It’s a call to pay attention.