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.

Advertisements

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.

Doctor’s Appointment

Today, I am grateful to my psych doc for our appointment yesterday.

I had wondered how I was going to describe what I’d been feeling. I couldn’t understand the emotions myself, so how was I going to express it so that he would get it? I prayed several times that God would give me just the right words to describe these vague feelings of down-ness.  Not just the specific days where I really struggled, but the funk I’ve felt for a couple of weeks.

When I got to the office for my appointment, I was given my med list, and a short  questionnaire.  It asked me, on a scale of 0-3, about  the last two weeks, exactly how long I’ve been feeling a little down.

On the questionnaire, zero stands for “not at all,” one is “several days,” two is “more than half of the days,” and three is “nearly every day.” The questions were:

  • Little interest or pleasure in doing things.
  • Feeling down, depressed, or hopeless.
  • Trouble falling or staying asleep, or sleeping too much.
  • Feeling tired or having little energy.
  • Poor appetite or overeating.
  • Feeling bad about yourself – or that you are a failure or have let yourself or your family down.
  • Trouble concentrating on things, such as reading the newspaper or watching television.
  • Moving or speaking so slowly that other people could have noticed.
  • Thoughts that you would be better off dead, or of hurting yourself. 

Turns out, it’s based on the Goldberg Depression Test, used by NIMH. It’s a standard in the field, a quick assessment tool to help doctors determine the severity of depression in a person. I scored 8.  Not bad, but not a 0, either.

And it allowed me to express myself and what I’ve been feeling lately.

So when I entered the doctor’s office, he asked me how I was. I said I really didn’t know, but the quiz sure helped. I told him I’d been in a funk for a couple of weeks, even before my husband went on a 10-day business trip, which I was sure didn’t help my mood. I told him that I’d been feeling down, but not hopeless.  He asked some of the questions I’d already answered on the questionnaire, for clarification.

He said I’m right on the edge of when these issues become a concern – two weeks.  He told me that for a person who has recurrent depression, and has had it as long as I have, he likes to be a little aggressive in treatment. He’s glad we caught it early, because waiting could make it worse – depression gets deeper and harder to get out of.  I told him that I just recently pulled out my light box and had begun using it.  We also agreed to increase one of my meds; it’s one that I’ve been on for a couple of years, seems to have been working well for me.

He said he sees a lot of this mood at this time of year – the onset of winter, the holiday season, the longer darker days.  He thinks that I should be feeling better in 7-10 days.

I’m relieved. It was good that he understood me, and that the questionnaire helped put into words what I had been unable to express. I’m looking forward to feeling better soon.