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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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.

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!

I’m not sure yet…

As my previous post indicated, the doctor added a new medication – Rexulti – to my antidepressants cocktail. I started 3 weeks ago, for 2 weeks at 0.5 mg, then this week at 1.0 mg, and up to 2.0 mg before I see him in a couple of weeks. And he said that if I feel better at the 1.0 mg level, I can stay there.

But how can I tell? I’ve been having such a good time!

My kids have been here – my daughter last week and my son stayed on another week, so my days have been full of family and laughter. We had a wonderful Christmas Day, and my son’s birthday, and all the days surrounding. We saw the new Star Wars movie, played games, watched movies and shows on Netflix. We shopped a little, the guys went hiking on the Appalachian Trail, and we’ve eaten delicious food. We tried a brewery and a distillery. In my mood app, where I rate every day to keep track of mood trends, each day with my children here has been a 9. A 9! I usually live at a 6 or 7, so 9 is significant, especially for a full week.

So what happens when we all go back to normal? When my son leaves to go back north and my husband goes back to work and my days become just me and the cat? Where will my mood be?

The Bible reminds me not to worry about the future. That “each day has enough trouble of its own. (Matthew 6:34)” That “… neither the present nor the future, … will be able to separate us from the love of God that is in Christ Jesus our Lord. (Romans 8:38-39)” It’s only a waste of my present time to worry about how I’ll be feeling in a few weeks.

It will be a week and a half from the time my days get quieter until I see my doctor again. That should give me enough time to assess my mood and any effect of these new meds.

In the meantime, I’m really enjoying the moments!

Wishing you a Happy New Year – full of physical and emotional health!

Flat

In depression, between descending into the dark or coming up into the light, there is flat.

Flat affect. Flat enthusiasm (an oxymoron). Flat attitude. Flat outlook. Flat energy.

For me, it usually happens when the meds aren’t quite right.

A month ago, I had been on the edge of a depressive episode, so the psych doc and I increased one med and I’ve been using my blue light. He said that I’d feel better in 7 to 10 days.

It’s been a month. I don’t feel better. I don’t feel worse, either. I feel flat.

Flat is a lot like depression – indeed, it’s part of it, but I tend to feel it more distinctly – as its own symptom – on the way out of depression. Even though the effects are similar, depression has a downward pull, where flat is flat, not down.

Like I could take it or leave it. All of it. Nothing really matters. I don’t have strong feelings of sadness or anxiety, nor do I feel excitement or joy. I don’t really want to do anything. I eat because I’m supposed to; I’m not usually hungry. I’m able to do the things I need to do, be around the people I need to be with, can even overcome the apathy to run errands or attend the ladies’ Bible study. I don’t really want to, but I will.

In depression, the desire to stay home in my pajamas, is so strong! In flat, I can go out and do. In all truthfulness, I go out and do during depression, too. But it’s way harder; I really have to fight myself. In flat, there’s just the barest speck of desire to go and do, so it’s just a hint easier. I can hardly tell the difference myself.

Last week, I accompanied my husband on a business trip, and got to hang out with my kids while he worked. I wanted to go, but wasn’t overly excited like I’d think I would be normally.  I trusted that I would have fun once I got there. And I had a wonderful visit with my kids – was able to live in and enjoy the moments. Our entire family laughed a lot, especially on a relaxed Friday night. But those feelings didn’t stay with me, nor can I reach back to retrieve them. They simply were. And now they’re not.

This flatness happens on my journey up and down with depression. It’s often a first indicator that something is wrong, that depression is threatening to return and wreak its havoc. That’s flatness with a downward pull.  And it comes back when I’m recovering, emerging from the darkness and into God’s light of hope and expectancy.

Usually a tweak in meds will do the trick, and I can bounce the rest of the way up. So I’ll tell my psych doc on Friday that I’m not where I thought I’d be in my recovery, and see if a small adjustment will fix it.

And I’ll remind myself, yet again, that God is with me through my depression. He has not abandoned me, even when I descend into the dark thoughts of depression.  He’s with me in the flat.  And He rejoices with me when I emerge on the other side. He’s my constant companion – I am never alone.