Back on meds, day 20, and they are working

It’s been 3 weeks since I started back on Zoloft, and the initial side effects are definitely fading.  I feel like drugs are starting kick in already, but that might just be because the moodiness that made me want to stab everyone in the face is almost gone.  Still, historically I tend to start feeling some results in 2-4 weeks, the warm weather is making me happy, and so I’m not going to question it much.

Eating is still hard, really really hard.  I’ve lost 12 pounds since starting back on Zoloft and it sure as hell isn’t on purpose.  Tuesday evening I realized the only thing I’d ingested the day before was 3 cups of coffee, and that I’d only had a cup of tea that day so far.  (I am drinking plenty of water, not to worry.)  So, the “not hungry, eating is weirdly unpleasant” side effect seems to be WAY worse this time around, and that sucks.  I love food, cooking and eating out with friends, it’s one of my great joys in life.  I miss food so much, but even my favorite foods taste wrong or different or something.  EVEN CADBURY CREAM EGGS.  EVEN BACON.  EVEN KALE.  That’s just wrong.

If anyone has advice on eating when you really really really have no appetite and food tastes weird, I’d totally appreciate it.  I’m not averse to dropping a little weight but I’m pretty sure that the whole “calories, vitamins, and minerals are necessary for life” thing still holds true. I’ve got a doc appt on Monday so hopefully co can shed a little light on the subject or tell me to stop being so batty and move on with my day.

Back on meds, day 8

I forgot how much the first two weeks on Zoloft sucks.  Really, really sucks.  While antidepressants take 4-6 weeks to impact mood, the side effects (for me) kick in almost immediately.  Oddly, none of these early side effects will stick beyond the first 2 weeks or so; the one that stays with me long-term (reduced sex drive) won’t kick in for about 4 weeks.

The first side effect, exhaustion, kicks in about 2 days after the first dose.  I always need a bit more sleep than the average human, 9 or 10 hours is about perfect.  The first 2 weeks back on Zoloft I am literally asleep more hours than I am awake- I fell asleep at 1 pm Friday and woke up at about 7 am on Saturday morning.  It’s 5 pm on Saturday and I’ll be shocked if I’m still awake at sunset.  But my work schedule is flexible these days, and sleeping a lot helps me cope better with what comes next.

Day 4 brings the mood swings.  It’s ironic that for the first 2 weeks on mood control meds my mental state is more unstable than it’s been in years.  I hate everyone and everything in the world.  My anxiety is through the roof as well, so I hate AND fear everyone and everything.   Hibernating and avoiding humans makes it bearable- I’m both too mean and too raw to interact comfortably with even my closest friends.  I could probably deal with the bad mood easier if it wasn’t for the weird breakthroughs of other intense emotions- 30 minutes of excitement and hugely productive work on a pet project, 10 minutes of being painfully lonely, 15 minutes of being convinced I’ve ruined my life with all my radical beliefs and that everything would be bearable if I went back to church and the bible.  There’s not much to do but wait for it to end, but it’s easier this time around- the first time I started on Zoloft I was afraid I’d feel like that FOREVER (or at least till I stopped taking the drug).  I’ll take more Valium in the next 2 weeks than I have in past 6 months

5 days in and the weird stomach stuff starts.  My stomach (or brain) is convinced I’m full even when I haven’t eaten in a day- I eat 1/4 of a normal meal and I’m stuffed.  I’m clearly not going to starve to death in a few weeks, but as I’ve written about before, my body responds badly to skipping meals and crashing blood sugar.  Eating for the next 1-3 weeks will be a complex balance of getting enough of the stuff my body and brain need to function well without feeling full to the point of nausea.  Today I walked past the half price Easter candy bins without buying anything because I couldn’t fathom ever wanting to eat again.  (I am addicted to Cadbury cream eggs, so this is especially weird.)

Now it’s day 8 and I’m strangely grateful.  The short-term side effects will be at their worst for the next couple of days, but they’re reassuringly familiar.  They mean that the chemicals are definitely impacting my body, that soon my brain chemistry will start shifting.  I’m looking forward to not having to work so damn hard for the barest minimum  of stability, to having more time and energy for friends and projects and cooking and travel and LIFE, to having enough serotonin circulating for me to actually enjoy it.  Today I’ll take a nap and another valium (probably not in that order), and in a month this will all have been so so worth it.

I am uncomfortable writing about my mental illness, which is why I do it anyway

(This post isn’t a subtle cry for help or anything like that- I’m pretty good at obvious cries for help. This is a theory piece discussing why I write about my own struggles with mental illness even though some people will think I am attention seeking whiny pants.  It’s been languishing in my drafts for a few months but since I’m likely to post about going back on meds a lot in the next few weeks this feels like an appropriate time to post it.)

Most people who struggle with chronic mental illness look perfectly normal when you pass them on the street.  We don’t wear big signs that say “this is the first time my anxiety has receded enough for me to leave my apartment this week,” or “I’m in the midst of a downward spiral and see my therapist 3 times a week,” or “my anti-depressants are finally working but I can’t bear human touch and haven’t had sex in 6 months.”  We grapple with our (largely) invisible illness and sometimes it’s terribly, terribly lonely.  Reading about other people’s struggles (and successes) in living with mental illness has made my own struggle more bearable, has given me hope, so here’s my story.

It took me a long time to start using the phrase “mentally ill” to describe myself- I used to talk about my “crazy” or my “issues” because it felt more jokey and light, more socially and culturally acceptable.  I finally decided to start using the phrase because I think it’s important to humanize and give a face to mental illness as we work to destigmatize it.

My life became easier when I accepted that I have a chronic mental illness, that my depression and anxiety weren’t going to magically disappear after 6 months, when I owned the fact that this is who I am and how my brain works (for better and for worse).  The reality of my life is that over the past 4 years  the thing I have spent the most time, money, and energy on is not a romance or a job or a home, it’s managing my mental illness.

Neurologically, I was pretty “normal” till I was about 12.  That’s when I started having partial-complex seizures in my left temporal lobe which went improperly diagnosed until I was 17.  (That’s bad; uncontrolled seizures have a bunch of negative effects like brain damage which Google or Wikipedia will be happy to tell you all about.)  Seizures in this part of the brain have a strong correlation with depression- one theory is that the same lesions and malformations which can cause seizures may cause depression, another is that the electrical seizure activity itself causes the mood issues, or that the damage caused by the seizures makes it more difficult for the brain to regulate mood. To put it bluntly, I’m brain damaged and it contributes to my mental illness.  It’s more complicated than that, depression is if nothing else complicated disease, but on good day my brain is still more likely to be depressed than a “normal” brain on a bad day.

Stability nowadays comes from a combination balance of diet, supplements, exercise, therapy, massage, and prescription meds.  Sometimes finding the balance is easy, sometimes it’s hard, sometimes it’s impossible and Valium and I hang out together for a few days.  Even on easy days it’s always there, needing to be managed and worked around.

There’s no neat ending to this blog post, to the story of my mental illness.  I keep writing because it helps me, because I hope it will help someone else, because on bad days I can look back and remind myself that good days happened and will hopefully come again.

Back on my meds, and feeling ok about it

Last October I decided to try going off my anti-depressants (Zoloft, to be specific).  I’d been on meds for over 2 years at that point, and it felt like the right time to try the experiment.  I’m glad I tried it, because I’m reassured that if/when the zombie apocalypse comes and I can’t get my meds anymore I wouldn’t go totally apeshit and try to burn down a library or something.  (It probably says something about me that burning down a library is one of the most terrible things I could imagine doing.)

But staying stable when I’m off my meds is a lot of work.  So so much work.  I can be functional without meds, I can sometimes be more than functional, but I’m seldom great.  Getting sick or falling off track with my Tools and Techniques for Controlling the Crazy throws me out of whack for days or weeks at a time.  Managing my mental illness leaves me with little time or energy for anything else, like friends, or romance, or the many exciting projects I’m currently involved in.

When I went on Zoloft for the first time (in June 2010) it felt like a failure, like if I’d just tried harder or was stronger or smarter I wouldn’t need meds.  This time around I feel better about it- the results of the experiment are in and my hypothesis that I would be just as stable (or nearly as stable) off Zoloft was incorrect.  It’s not a personal failure of my willpower, simply the way my brain chemistry functions, and I’m ok with that..  Now to wait the 4-6 weeks for it to kick in…

Grumpy depressing personal post

I am having a grumpy week.  It started out with a long train ride home from Philly, where I had fun but realized that 12+ hours of train travel to spend less than 72 hours visiting friends is not a healthy ratio for me.  Then I got a cold or something like that- a sinus headache, nausea, and I’m really tired.  Finally, the combo of travel and being sick threw my always slightly fragile brain chemistry off track so I’m in the midst of a super anxiety crash spiral thingy and doped up on Valium for the past couple of days.  Fun.

To make things more complicated, a few of my friends got great news- an awesome grad school offer, being accepted to nursing school, a new house, a promotion at work.  I’m (obviously) thrilled for all of them but I feel even more pathetic and useless in comparison.

So of course because it’s ME I don’t think “oh it’s a crappy week but next week will be better,” I think “my whole life is pointless and pathetic and it’s never going to be different.”  This makes it difficult for me to figure out if I’m just having a shitty week or if this part of a bigger spiral that I should be talking to a doctor about.  Then I remember that doctors are fucking expensive and that I don’t have health insurance anymore, and I’m back in pathetic anxious freaking the fuck out land.

Time for another Valium and searching (hopelessly) for insurance I can afford that will also cover my health needs.  Like I said, this is a grumpy depressing personal post.

Tools and techniques for controlling the crazy Part 4 of 4: Scoring the crazy, tracking the progress

Look, this is my experience.  It’s clearly not scientific, meant to be medical advice, or apply to everyone.  If it’s helpful to you that’s AWESOME, if it’s not please just move on with your day.  Above all, don’t be a douchebag and tell me how wrong I am- I’ve got a bunch of experience being crazy and even more being me.

When I started to get better after my most recent complete spiral into crazy (about 3 years ago now), I realized that the only thing that would keep me moving forward long term was being able to tell if I was making progress.  I am a nerd- I love spreadsheets, graphs, and data.  I want to be able to SEE progress over time and gauge how new self-care strategies were (or weren’t) working. I also need to be kept honest- it’s easy for me to tell myself that I exercised recently when in reality it’s been 10 days since I’ve done more than walk around the block.

After some trial and error I settled on using a free online tool called Joe’s Goals.  It met all of my important criteria- it let me track if I did something positive, if I did something negative, and keep short written logs.  It lets me assign positive and negative points to actions, like leaving the house, working out, hanging with friends, and eating healthy meals.  I can “archive” goals I don’t track anymore, and even run reports on my progress over time.  I can’t emphasize enough how helpful this tool has been to me and highly encourage anyone struggling with maintenance of mental health issues to try something like it.

In good times this is a simple checklist that I spend 2 minutes doing before bed- it keeps me in touch with my progress and needs.  In bad times it’s a literal list of what to do every day- I start following it when I wake up and stop when I go to sleep.

This is what my current chart looks like- it’s dorky, mildly embarrassing, and the most important thing I do for my mental health right now.  My goal is to hit 13 points a day at minimum, preferably 15.  Enjoy my geekiness laid out before you, and that’s it for my “controlling the crazy” series of posts!

My current goals

Bad science in the news: Correlation =/= Causation

CNN posted an article today which is a bad science interpretation of a bad science study.  In brief, the study concludes that “People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.”

The problem?  The study’s methodology: “We analysed data collected from interviews with 7403 people who participated in the third National Psychiatric Morbidity Study in England.”  In layman’s terms: a bunch of people filled out surveys and scientists involved in the study read these studies and drew conclusions from them.

This study is bad science in (at least) two ways: First, people lie in self-reporting surveys.  The study does not demonstrate causation- there is no control group, no demonstrate which item is the cause and which is the effect (if either).   Second, there are other conclusions that could have been drawn here: I could theorize that people who identify as religious and have mental health issues are less likely to access mental health care services and support, or that religious leaders actively discourage those with mental health issues from seeking diagnosis and treatment.  This study’s conclusions appear to be based on the scientists’ own ideology around religion & spirituality, not on the scientific method.

I have no wrap-up conclusion here, I just hate seeing bad science and wanted to kvetch about it.

Tools and techniques for controlling the crazy Part 3 of 4: Counseling & Therapy

Trigger warning for non-explicit references to sexual, emotional, and other types of abuse. 

Look, this is my experience.  It’s clearly not scientific, meant to be medical advice, or apply to everyone.  If it’s helpful to you that’s AWESOME, if it’s not please just move on with your day.  Above all, don’t be a douchebag and tell me how wrong I am- I’ve got a bunch of experience being crazy and even more being me.

Counseling has been an important tool for me in the journey to long-term stability.  I’ve used “traditional” paid therapy but that’s not the only kind of counseling out there, as I’ll be discussing in this post.  I divide my therapy experiences into three big parts- professional, peer, and online, and in this post I’m going to focus on how I use each of these kinds of counseling.

Professional therapy has been the hardest for me to access.  It’s pricey, it can be hard to find a counselor who I click with, and when I move to a new city my counselor doesn’t go with me.  I’ve found that professional are most useful when I need to be shoved hard to explore painful issues, such as my experiences being sexually molested as a child and being in an emotionally abusive romantic relationship.  That kind of work is grueling and usually makes me hate my therapist- I don’t think I could do that kind of work with a friend.  At the end of a tough session I literally hate my therapist and wish they were dead- they are brutal, painful sessions and worth paying for.

Peer counseling, either formal in a co-counseling type class or informally with friends, is most useful for me to address issues rooted in my current reality.  I find it’s easier to work on issue like why I’m being such a prickly, distant bitch to my new boyfriend with a friend who has a holistic view of my world.  Being counseled by someone with a rich knowledge of my life and the players in it means they’re more likely to suggest connections between the different parts of my life.  For example, peer therapists can see how stressors at work might be making me less excited about a new romance, or a messy breakup our friends are going through might be making me especially clingy with my long-term sweetie.  Peer counseling is also dangerous- if my friends messes up it can hurt not only my mental health progress but also a friendship I very much value.  It’s also cheap which is AWESOME.

Online counseling, which I generally access through community forums and message boards, is a good balance between professional and peer counseling.  It’s free, it’s available and easy to access at any time of day or night, and it’s secure and usually anonymous. I mainly use After Silence which focuses on support for survivors of rape and sexual assault but also has forums for survivors of domestic violence as well as partners of survivors.  It’s the place I go when I’m in crisis and need support from someone who gets it at 3 am, but feel too raw or neurotic to call my friends.  Having support from other people who are abuse survivors has been important to me as I work through a bunch of my shitty history- knowing that I’m not alone in the aftereffects I experience and the scars that still haven’t faded makes me feel less broken and hopeless.  It’s also a great way for me to support other people going through a painful time, which is often as important to my healing as the support I get myself.  Other good online support sites include IMAlive which has live chat and the Hope Line which has phone, chat, and email.

Tools and techniques for controlling the crazy Part 2 of 4: Pharmaceuticals

Look, this is my experience.  It’s clearly not scientific, meant to be medical advice, or apply to everyone.  If it’s helpful to you that’s AWESOME, if it’s not please just move on with your day.  Above all, don’t be a douchebag and tell me how wrong I am- I’ve got a bunch of experience being crazy and even more being me.

I hate taking antidepressants; I’m also entirely aware mood control medication saved my sanity and possibly my life more than once.  I see meds as one tool I use to keep control over my depression and anxiety.  I divide the meds I’ve taken into two groups- acute and short-term such as Valium and Xanax, and long term such as Zoloft, Prozac, et al.  (I’m not going to offer advice on which drugs are the best, as that’s a discussion for you and your doctor.)

I’ve generally taken acute meds (mostly Valium and Xanax) for anxiety.  Not “oh I’m nervous” anxiety, but “I’m so anxious I haven’t left my house in 4 days and can’t sleep because I am terrified and convinced that the girl from ‘The Ring’ movies will come out of my closet and literally kill me.”  Anxiety alone isn’t what hurts, but anxiety makes it impossible for me to do and access the OTHER important self care things that keep me sane, like healthy food, exercise, fresh air, sleep, and contact with other humans.  Acute meds are not ideal- generally they are habit forming, make me feel dopey, and can get pricey fast because most physicians I’ve had require close monitoring to prescribe them.  They are also AMAZINGLY useful- an anxiety attack that can take 7-10 days to work through without meds is over in a day with meds.  The meds break the fear-anxiety-exhaustion cycle (at the times when I can’t do it myself) and let me get back to my self-care routines.

Long-term meds are a different story.  In my antidepressant travels I’ve been on Depakote (4 years, for a combination of seizures and depression), Celexa (1 year), and Zoloft (2.5 years).  Taking antidepressants, and trying to figure out if they are working, is HARD WORK.  I generally start experiencing side effects, usually sexual side effects and weight gain, less than a week after starting meds.  I don’t see full effects of the drugs until I’ve been on them for 6-8 weeks.  Those middle 5-7 weeks are brutal and in a lot of ways feel WORSE than not being on meds- I’ve got all the bad sides and none of the benefit yet.  But when the meds work they are SO IMPORTANT.  I usually don’t start meds till my depression has spiraled so far out of control that I’m a complete mess- like “don’t get out of bed except to pee for 3 days or leave the house for a week” mess.  Being on meds doesn’t make me magically not depressed- they lift the weight of depression enough that I can start doing all the OTHER things I can do to improve my mental health like diet, talk therapy, massage, exercise, meditation, etc.

Today I’m off long-term meds.  I have the fantasy that I’ll be off them forever- that I’ll never let myself spiral that far down again, that I won’t need that tool.  I’m also aware that I don’t have complete control over that- I have many years of history of temporal lobe seizures which are an organic cause of depression and permanent damage to my temporal lobe.  I also hope to have babies someday and know I’m at even higher than normal risk for post-partum depression.  My current strategy is to enjoy not having to deal with medication side effects right now, stay on top of my self-care routines, and accept that being medicated is sometimes better than the alternative.

Tools and techniques for controlling the crazy, Part 1 of 4: Diet and Supplements

Look, this is my experience.  It’s clearly not scientific, meant to be medical advice, or apply to everyone.  If it’s helpful to you that’s AWESOME, if it’s not please just move on with your day.  Above all, don’t be a douchebag and tell me how wrong I am- I’ve got a bunch of experience being crazy and even more being me.

Most of my life I’ve been poor or near-poor. Because of that diet and OTC supplements are often the only things I can really afford to deal with my depression and anxiety.  That said, I’m constantly surprised how quickly and intensely changes in my diet can impact my mood (for better and for worse).  Here’s what I’ve discovered has the most intense and immediate impact:

  • Eat full meals, sitting down, at least twice a day.  When I’m spiraling I often forget to eat, or end up grazing on unhealthy crap because the thought of cooking is too exhausting.  Investing in a Crock-pot probably saved my sanity, and a rice cooker wasn’t far behind.
  • Eat meat, don’t eat gluten, minimize sugar.  I’ve tried every diet from vegan to macrobiotic, and the best I’ve found for my mental & physical health is a modified paleo diet.  I eat as much organic, pastured, and wild-caught animal stuff as I can afford.  I do “cheat” occasionally- I have an eating disorder history and getting too intense about sticking to any diet isn’t a healthy pattern for me.
  • Snack whenever I’m hungry. My blood sugar doesn’t tend to crash out when I’m sticking to paleo, but when I get hungry I eat something healthy QUICKLY.  I’ve found that trying to only eat at official meal times is the worst thing I can do for my mental health,  and I avoid getting really hungry at all costs.
  • 1 cup of coffee and 1 alcoholic drink a day (averaged by week). I don’t drink booze or coffee every day, but it tends to average out.  I find that much more of either of these hurts my sleep, and less means I miss out on my much-loved coffee drinks and nice wine.
  • 1000-3000 IU of Vitamin D3 per day.  This is the single most useful supplement I’ve ever taken and I credit it with being able to taper off of Zoloft after 2.5 years on it.  My experience is that no other supplement is worth the money.