Wellness Plan Toolbox

The first step in writing my wellness plan is determining the helpful steps I already have in my daily life. When I am healthy, what is it I’m doing to make me that way? What are my day-to-day activities that signify health and wellness for me? “What things do I already do to help myself be well, stay well, and live in the way I want to live?” (reference: WRAP Plan app)

This toolbox of activities is critical to my Wellness Plan, as I’ll draw from this list at different stages along my path from wellness to illness and back again. When I feel stressors, or triggers, that might signify a depressive episode is coming, what can I do to alleviate it? Are there any tools in my toolbox that I can pull out and implement to avert an episode?

If I’m further down the path toward depression, and an episode is imminent, which activities can I use to lessen the severity of the episode?

If I’m on my way out of a depression, which tools will I use first to help me post-crisis?

My initial list was 14 wellness tools:

  • time alone with God in Bible reading and prayer (TAWG)
  • taking my meds
  • journaling
  • eating well
  • good sleep hygiene
  • spending time with friends
  • sufficient down-time
  • seeing my therapist regularly
  • keeping my psych doc appointments
  • blogging or writing
  • taking naps
  • reading
  • watching movies
  • Fresh Hope Support Group

But as I thought about steps I can implement in a pre-crisis, I realized I have several more tools, even though I’m not currently using them. Things like savoring a cup of tea, or coloring, or taking a walk in nature. I certainly need to tell my support team that I’m struggling, so they can help me watch for warning signs.

One thing I’ve learned about depression is that it clouds my thinking. I can have this wellness toolbox, but in the midst of a crisis, I’m paralyzed and don’t know how to get out of it. That’s the reason for writing a wellness plan when I’m mentally healthy: so when I’m not thinking straight, I can look back and see what I recommend to myself.

I intend to share my wellness plan with my support folks (husband, sister, therapist, friend) so that they can help me remember to reach into my toolbox when I need to. As soon as I’m done writing the whole thing, I’ll pass it on to my care team.

The cost of mental health meds

I don’t want to get political here, but I think this blog might be. How does anyone without insurance do this?

I’m temporarily without prescription insurance, and my psych doc phoned in some orders for meds that I don’t need to refill immediately. But I didn’t tell that to CVS, and the pharmacy filled them and sent me a text that the meds are ready for pickup. I looked up the prices on their app. Two that I take are name-brand, not yet available as generics. A 30-day supply of one of them is over $2900, and the other is over $800. That doesn’t include the ~$150 for each generic drug!

I’ll be able to afford my meds once my new insurance kicks in, so I’m not concerned for me. But I truly wonder about this for others – for those with less or on fixed incomes.

I have a couple of friends who don’t have the insurance to help offset the costs of their antidepressants. I’ve seen their tears of frustration as they struggle for mental health and feel defeated, which just adds to depression misery.

What about folks on a fixed income with reduced medical benefits? How are they supposed to pay for their mental health medications if insurance companies remove effective medications from their approved lists?

What about newer medications that are improvements over what’s currently available, but they aren’t the reduced price of a generic drug? Many people are denied access to those improved meds, simply because the cost is out of reach.

What’s the pharmaceutical companies’ responsibility in this? Their research takes years and costs gazillions of dollars to find formulas and get meds approved, but do they recoup those costs on the back of the ill? How should this really work, and be fair? How can we get mental health medicines to the people who need it, in an affordable and timely manner? I don’t have answers, am not pointing fingers to blame. I’m truly asking – how can this be affordable? Is it the PollyAnna in me that wants this to be equal and easy?

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.”