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.

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Fighting for Mental Health

I’ve had several down days in these past couple of weeks. I cried in my therapist’s office. I beat myself up about my past parenting. I’ve caught myself using self-deprecating words to myself, speaking negatively to me about me.

My husband has noticed – he’s very tuned in to my moods. In fact, he saw it before I did. But I’ve noticed a lower rating on my daily mood scale. So I’ve known something was going on.

We had a week or more of rainy days, so I was lacking in natural Vitamin D (I take a supplement anyway). I had some serious self-evaluation going on, and had to fight my own negative voices with God’s truth about how He sees me. My left leg is causing consistent shooting pain; it could be lumbar stenosis, which doesn’t really get better except with pain relievers and gentle stretching – when whatever inflammation exists subsides. Walking hurts, so exercise is hard(er) for me.

I realized today the foundational truth of Fresh Hope, the peer-led support group we’re starting at our church. Their mission is: To empower individuals with a mental health challenge, along with their loved ones, to live a full and rich faith-filled life in spite of having a mental health diagnosis.

I can choose to live a life that is rich and faith-filled. I can choose mental health vs. mental illness.

I have a mental health diagnosis – Major Depressive Disorder, Moderate to Severe, Recurrent. But that doesn’t mean I’m always depressed. Right now, my depression is in remission, and I’m relatively healthy (except for my leg pain).

It means, like I told my therapist today, that I realize that sometimes I can coast, and other times I have to fight for my mental wellness. So I’m fighting for it a bit right now. That’s ok.

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.

I am not my depression

This is the subtitle to my blog.

It’s also a concept I’m grappling with right now.

Years ago, toward the beginning of my therapy, when I was healing from the blackest, deepest place of my depression, my therapist taught me to consider depression as separate from me, like it is its own entity. Like something else in the room.

Not “my depression.” Not “I’m depressed.”

Instead, more like “me struggling with depression.” “I’m battling depression.”

This seems like just semantics, but words are very powerful – especially the words I use with myself and to myself.

The first set of phrases makes me the owner of the depression, or certainly the victim of it. The second group places depression apart from me, not on nor within me. I’m not a victim – I’m a warrior.

The second set of phrases is more empowering. Stronger. More hopeful.

I’ve noticed that in the past several weeks, I’ve gone back to referring to depression in the first person – those first phrases. And I’m not sure why.

It could be a subconscious reaction to the biographies I’ve read recently – folks who wrote about their personal battles with “the black dog” of depression. Some people call those biographies written by “depressives.” That wording is really self-defeating!

It could be the ongoing (4 weeks and counting) of back and leg pain that is plaguing me. The diagnosis is lumbar stenosis – a narrowing of the openings where the nerves of the spinal column come through the spine itself, causing pressure on those nerves and then the nerves responding with inflammation. So far, neither stretching nor ibuprofen nor massage nor chiropractic are helping. (Next steps: yoga and stronger meds.)

It could be because I’ve been thinking about my journey through depression a lot lately: in writing, in therapy, in my Fresh Hope workbook. It’s been on my mind.

Whatever the cause, today is the first day I really caught myself speaking of depression in first person – “my depression.” I need to change that. I need to change the words, change my thinking, put distance between me and the illness.

“…but let God transform you into a new person by changing the way you think…” Romans 12:2b, NLT

Feeling Good

A couple of years ago, I told my therapist, Ted, “It feels good to feel good.”

I met with my psych doc today, and told him that I think the new meds are working. Even after the wonderful Christmas break with the kids, and my concerns about sorting out the effect of the new meds vs. my family fun, I can say that the new cocktail is effective. Yay!

It’s sunny today, and I noticed! I feel lighter, more quick to smile. I actually asked after my doc, instead of making the appointment all about me. I’m signed up for a book club at the library. I’m looking forward to my week. I’m ready to try a new knitting project. I’ve inquired about a volunteer opportunity – I just need to pick up the application.

I really like my new therapist, Pam, at Valley Hope Counseling Center. At last week’s appointment, she challenged me to look at these different experiences, and try one. I came home and investigated all of them! Knitting groups, book clubs, volunteering at an adult care center. She pointed out that I’ve been talking about volunteering at the hospital for a year, but I haven’t done anything about it…why not? Good question, and I think it’s because I know it won’t result in on-going relationships, which is what I long for. But a couple of weeks ago, as I turned into the parking lot at the grocery store, I saw the Adult Care Center, and my curiosity was immediately piqued. Volunteering there – talking to guests, playing games, building relationships, maybe making a difference in someone’s life. Now that’s appealing.

The point here is that I have energy again. I have enthusiasm. I want to do stuff. Anhedonia is gone.

God is good. He is patient with me as I struggle in and out of depression. He is waiting for me to come to Him so that He can pour His love into me. He puts people and medications in my life to heal me (at least for now). And I’ll take it!