Depression 101

Sorry for the delay, I have been and am a little depressed. Depression takes hold like quicksand. It feels like being tied down by invisible straps. You can kick and scream, but the straps keep you paralyzed. And, when you have had depression as many times as I have, you no longer kick or scream because you now know that this has to pass through you, just like the anxiety or the anger, the sadness. So, I have been paralyzed. Again, the longer you combat depression, the better you get at living with it.

But, being a seasoned depression-fighter does not change the depression, I am changed. The depression is still: sadness, loneliness, helplessness, fear, doubt, self-loathing, hopelessness, dread, guilt, negativity, exhaustion, pain, and deep apathy.  I still feel all those feelings, but I know them each very well. I have also been taught that feelings are not things. I am not literally walking around with a ball of fear, though it does feel that way. I am feeling fear, while also walking around because I am alive. For me, that is a great definition of depression-being alive when you want to be dead.

In the winter of 2008, I was fighting depression with all I had. And, I was losing. The crying would not stop. The thoughts of ending it all were becoming more and more enticing and more and more plausible. My family would never want me to feel the way I did. They knew how much I was struggling. My husband at the time would move on, we had no children. I was home from work-one of the MANY days I could not make it in, which I knew was wrong and felt incredible guilt and humiliation about, so very much. Home alone, I pulled every pill bottle I had in the house out and set them all on the coffee table. I was in therapy. I was being seen by multiple psychiatrists and physicians. I had a lot of pills. A lot. And, I knew if I took these pills, I would be free. Free from what was coming next. Free from what wasn’t coming next. Free from worrying. Free from crying. Free from exhaustion. But, before I could open the first bottle, my dog walked into the room. My dog was most often in his bed when I would be home from work, sad and/or anxious. And, my dog walking out bolted me into the reality that leaving him would be more selfish than leaving my family and friends. I could not do that to my dog, who I chose to have and love and care for forever. And I thought, for longer than I would like to admit, maybe I should just take him with me. To say it was a low point is an understatement. But, then I was introduced to a woman in a mental health facility who’d put herself in similar situation. We bonded even before we knew each others’ stories. And, while our stories were different in almost every way, our answer to the problem was the same, only she had children. It may sound drastic and incomprehensible, but so is the thought of living a life of constant pain, sadness, and depression.

I am not anywhere near the depression of ’08, but I wanted to write about it to remind me (and any others who may stumble upon this) that depression is extremely hard to climb out of unscathed, but it is NOT impossible. It takes some serious inside work reminding yourself why you are still here and why you are strong enough to have gotten here. Even when “here” is no where near where you want to be. Here is something. Do as much with being here as you possibly can muster, even if it is just sleeping. Stay here. Fight back. Remind yourself that you are needed, even if it’s just by a dog. Stay here.

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Therapy and Therapists

My inspiration for taking on this topic is something I heard that made me wish I could shout my knowledge from the rooftops; this person said, “I don’t want to go talk to a stranger about my life and problems, that’s what my friends are for!”. No, emphatically no, that is not what your friends are for, ever.

In an earlier post I described mental health therapy as the feeling of drowning in the deep end (of your mind) where a lifeguard can swim out to you, but they can not pull you to shore. All they can do is tell you how they might get to shore or how you can tread water until you figure out how to get yourself to shore. And, maybe you belong in the deep end, where you have to just live with the waves and learn to always tread water. The analogy could go forever, because it is the exact feeling: drowning, with help that can not help you. Therapists are lifeguards, essentially, in-training. They can swim out to you and help you not die, but you have to get yourself treading water or to the shore.

I was 14 when I saw my first therapist. It was 1992, there was only one place in town to even get mental health therapy, and that place was old and sterile. The green, scratchy fabric chairs and florescent lights buzzing did not help the situation. I went in, and the lady asked me why I thought I was there. The first of MANY to ask me that, and every time after that first time, I thought, here we go again. And, I love to talk. But, having to recount the very things that you don’t really understand yourself to a person who knows zero about you, your family, or your life-only what you tell them is super taxing and stressful. Pay attention here: if you are going to lie in therapy, do not go.

However, if you are ready to be bold and honest with a stranger to better your life, therapy and therapists are who you need. Our friends are our friends for a reason; they accept us and they are most likely to agree with you or feel similarly to you, because they know you. Your friends know your family. Your friends know your co-workers. Your friends are there as a support system, not a life-saver. The only life-savers out there are us. Only you can save you. And, you’re there to support and enjoy your friendships-not make them be work. Friendships are not work. Therapy is work. The work you do for yourself, with or without the help of a professional, is what saves you. You are who keeps yourself above water and treading or swimming to that shore. Despite the swelling and crashing waves, this is your job in life.

When I was 29, I saw my (probably) 15th therapist and she told me I had low self esteem within the first thirty minutes of meeting me. I was too depressed to laugh at her, because she was dead wrong, but I never saw her again. Just like every other relationship humans have, a therapy/client relationship must be built on trust and mutual understanding. So, if you struggle with those two things, finding the right therapist could take years. It is an investment. It is a commitment. It is hard. It is hit or miss, which is frustration amplified when you are already dealing with chemical imbalances in your brain. It is very easy for a doctor to prescribe you a pill, but a therapist is who helps you manage all that comes with trying to balance freaking brain chemicals! It is not diabetes; there are no strips or devices to detect how much of my anti-depressant to take each day.

Then, 2011 brought the most rude of diagnoses, and only after meeting once for MAYBE sixteen minutes. She said the words coldly and frankly, leaving me in a million confused pieces. “You have Borderline Personality Disorder.” Usually I could just add them to the list, the diagnosis list was already pretty lengthy, but this was different. Basically, BPD is a nice way of saying you are inherently batshit crazy with little chance of change. This is my opinion, not fact, about Borderline Personality Disorder. I did not have that, and if I did, I was going to figure out how to fix it, and started with never seeing that therapist again.

At 32, I had my last therapy appointment. I had been seeing this particular therapist (I think he was my 24th one) for over a year and our rapport was quite helpful. I was an old pro at being in therapy, which I am sure helped, but he also stood out for me because he never diagnosed me with anything. He would always say, “you are a very thought-provoked woman, and a seeker” and never once spoke of me HAVING a mental illness. It was a new feeling and I did not quite understand it for a while. On our last visit, I came into his office like always, with my purse and a bag carrying my books about mental health, anxiety and depression, dressed in whatever I had slept in the night before and ready to cry. He greeted me, we said our pleasantries and got into the session. A few minutes in, he stopped me and said, I have your diagnosis, Wendy. I was then diagnosed as “smart and careful, intuitive and empathetic, and introspective to a fault’. He said, “You could easily run a major bank or company if you wanted. Stop reading about what you have been told you have for twenty years. Stop. Or, go back to college and become a psychiatrist.”.

I went home, put all my books away, and kept treading my waters.

Xanax

In 1996, my general practitioner of one year, prescribed me .25 milligrams of Alprazolam, generic for Xanax. I had no clue what a Benzodiazepine was or even why I needed it, really. My doctor said, take one a day along with the Prozac I had been taking. I did as I was told. I was eighteen, I was a nervous wreck, what’s it going to hurt?

Let me tell you what hurts: depression. I did not know about sadness and depression until I was 21 years old. I can not medically or scientifically prove this; but, I am 90% sure Xanax introduced depression to my mind and brain chemicals. All drugs are different for all people, this goes without saying, however in my experience and now speaking with a better pharmacological understanding of the drug; Xanax is extremely effective in managing panic and anxiety but with a slight come down after its half-life (length a drug stays in the body) which can be from 11 to even 40 hours. While in your body, only a few hours are devoted to blocking the dopamine that is causing anxiety, so the rest of that time in the body and brain it is slowing everything down. And slowing so gradually, that you do not immediately feel the ‘come down’ for lack of a better word.

At 22, I began drinking alcohol pretty frequently, as most college kids do, only I can no longer remember a lot of those years. I have the highlights, but zero details. The depression was cyclical then, and the anxiety was constant so the Xanax had to stay, I felt. And, my doctor continued to prescribe-explaining the proneness to black outs when mixed with alcohol. I was warned, but given no alternative or any discussion of addiction. Zero. Also through those years I was switched to multiple different SSRI/anti-depressant drugs (the Prozacs, the Paxils, the Zolofts, the Cymbaltas, the Celexas, the Lexapros, the Luvoxes) which meant basic emotional and physical hell for every pill I had to ween off and every pill I had to ween on, wash, rinse, repeat. For years! If you’ve ever been on the Tilt-A-Whirl or the Grav-A-Tron at a fair or theme park; just imagine that feeling right when the ride starts and right when it stops repeating over and over, with no reprieve, and, you’re not on a ride. You’re in your every day life, with the very stressors that have you on the medicine. It’s the cruelest Catch 22 ever put into play.

By my 30th birthday, I was no stranger to depression and still suffered with severe anxiety and less, but still present, panic attacks. Add a dash of PTSD, due to the Hurricane and I was on a lot of medications. My Xanax dosage was up to 1 milligram as needed, because of course, your body gets used to the drug and then you need more. And, the doctor gives them to you and sends you on your way. I’d had therapy on and off, its importance not as harped upon as the drugs and for a few years uncovered by insurance. But, I was getting all the help I could and I was still suffering. My marriage was suffering because I could not work due to deafening negative thoughts, only curbed by sleeping. The breaking point was going to the Intensive Outpatient Therapy my clinic and my insurance offered, and my psychiatrist pretty much insisted.

Intensive Outpatient is a three week group therapy, individual therapy, homework, 9am-4pm, job working on yourself. We had a nurse on-hand, and two psychiatrists oversaw our progress and prescribed and altered medications more directly. It seemed like a really important place for me to be. I benefited greatly from the therapy and the group (see entry COMPASSION for more) and the program really helped me figure out some healthy coping skills. I had gotten so bad, that when I was in that dark, sad place I had to feel something else. Until then, I never understood self-harm, but I dug my fingernails into my forearms until they bled–so I could feel different pain than I felt, even if just for minutes. It is embarrassing to admit, but I have to say it, to say that the alternative I learned in that program has saved me from the shameful act of inflicting pain of a different kind on yourself to gain some semblance of control. Ice cubes. Put an ice cube in your hand and squeeze. Sometimes I use both hands. It hurts and your mind is seared with a very different kind of pain, and, when you are ready to drop them, you are ok.

I made it about two months after the Intensive Outpatient ended. I had my ice cubes. The doctor had upped my Xanax to 2 milligrams twice a day, yes that’s 2 milligrams. Yet, I still felt the urge to run as far away as possible. I would hold my breath, defying my body’s innate defense to smothering oneself. I cried. I worried. I took all the medicine as directed and I still cried and worried, felt sick, exhausted, doomed, worthless. My husband came home to me sitting at the coffee table with all my medicine bottles on the table and a bottle of Fiji water. Just staring at it all. Needless to say, I was in the Intensive Inpatient Treatment the next morning, for more help.

By day six of my second round of group therapy, the doctor had me up to 3 milligrams of Xanax…wait for it…twice a day. They’d added another SSRI/anti-depressant, I have blocked out the name of it. It was horrendous. I felt completely done with everything that was happening to me. Pulled out of group therapy because of my obvious tremors, I went to the doctor, with just an insane amount of fear inside me. I could tell these professionals did not seem to know what to do next. Scared doesn’t even cover how I felt when he looked at me and said, ‘it’s time.’ Dazed, yet shaking like a leaf with panic and nerves, I ask, ‘for what?. I can not remember any movie I watched from the age of 29 to 31, thanks to doctor- prescribed Xanax, but I will never forget the words that came out of this doctor’s mouth.“You have to go to rehab, we have you on too much Xanax, and in order to take you off, we must monitor your vitals 24/7 and withdrawal can be very hard for some.”

 

Diagnoses

In my family, you go to the ‘lady doc’ when you hit eighteen or when you start having sex. Both happened for me at the same time, so I had to make the dreaded appointment. A doctor was going to be poking around my hoo-hah and getting some type of smear. Smear is just the worst of words. Ew. I did not want to be smeared.

This is well before cell phones, so no pleasant distractions in the waiting room besides eavesdropping on others and in the hoo-hah doc, it’s all whispering so you have to hone your ears and sit close to your target. I try to take my mind off the fact that a doctor is going to probe me, but to no avail, and the anxiety hits. Mack truck slamming into your clueless, stationary body making it a shaking, sweaty mess of anxiety.So, within minutes I had to poop. You know what is more fun than having a poop-inducing anxiety attack in a public place that you can not leave? Having a poop-inducing anxiety attack in a public place that you can not leave and doesn’t have a bathroom.

I got to the bathroom and anxiety pours out of me as I remember someone is about to be in that very area, up close. Inspecting it. Post poop! I wanted to die a thousand deaths. I wanted to run out of the bathroom and not stop until I reached my bedroom. I wanted to never be inspected! But, just as the jelly legs subside and I am physically able to move again, the nurse knocks on the door saying ‘we’re ready’. Yeah, y’all are not about to be spread eagle for inspection, of course you’re ready. I was no where near ready, but at that point I knew I never would be and knew I couldn’t stay in their restroom for the rest of my life, as much as I wanted.

Easiest part of the visit…being spread eagle and inspected. My doctor was fast and worked with ease and a sense of wisdom. Almost no discomfort. Hardest part of the visit…my first diagnosis. The first of many, many similar conversations happened while I was being probed. She was making small talk to take my mind off of the probing and of course small talk with me led to an hour of me explaining my thoughts and feelings, openly and honestly. And then, as she was labeling the smear tubes, she tells me, ‘you have Generalized Anxiety Disorder and seem to be borderline Agoraphobic.’. I did not know what agoraphobic was, but I knew what phobic meant and that I felt phobic about a lot of things. And, now I learned one more new thing, I learned that being naked and probed and smeared is easy compared to a diagnosis like that.

During the clothed part of the visit, she explained the anxiety disorder and told me that my fear of leaving home, my stomach aches at restaurants with lots of people and my general fear of the public was an actual chemical imbalance in my brain chemistry that would last forever, but could be altered with medication and make me feel more ‘normal’. Well, I thought I was normal. Until that moment, I assumed every human got a stomach ache before school and felt sick or uncomfortable a lot of the time. I had no idea people were walking around not obsessing about where there might be a bathroom, or how many people might end up in the store they’re in, checking for exits and always thinking of a way to excuse themselves quickly and successfully.

In the 21 years since, I have been diagnosed with the following additional mental illnesses: Post Traumatic Stress Disorder, Severe Depressive Disorder, Acute Anxiety with Panic, Major Depressive Disorder, Borderline Personality Disorder. But, what I feel like my diagnoses should’ve been was guinea pig. I have been put on and taken off more medications than I can count. Doctors have tried to balance my brain chemicals without ever looking at my actual brain for my entire adult life. Now, I say, diagnose away–I still have to live this life in this brain. Diagnoses change nothing.