Calmer…..calmer…..

There I was on Wednesday going 7000rpm in neutral! Crazy! There were Skittles and gas stations and possibly dancing hippos….the memory is vague. It was all very fun.
Or so it would seem.
It was also really scary. What didn’t get conveyed in that post was just how utterly freaked out I was. Sure, this week was bright and funny if a little overwhelming, but what about last week? Last week was also pretty manic, but in a really different way. Last week it was all exposed nerves and irritation and anger. I was impatient with everything, including myself. No one was fast enough, no one could shut up enough, no one could leave me alone enough. Everyone was pissing me off, I was manic, but in a really pissed off way. I also had PMS, which did not help anything and might have been contributing to the situation.
I went to my therapy appointment yesterday. I walked into the office, sat down and immediate barfed out ten thousand words. Mere mortals need things like ‘time’ so that they can spread out the things they are doing. They like it when things happen in some sort of order: first I open my mouth, then sound comes out, I control the sound and form words, the words form sentences and the listener forms judgments. But I am not like you mere mortals! No way! I can open my mouth and let a huge rush of sound just blast into existence! YEAH!!
Or so it would seem.
I went to therapy knowing that the symptoms I was experiencing were wrong and potentially dangerous. I went in hoping she could help me contact my psychiatrist and get the ball rolling on fixing my meds. I figured I would explain everything to her and then ask her. About half way through my second paragraph she assured me that 1: this was completely fixable and 2: how about we call my psychiatrist together from her office. Holy brain balls! I didn’t even have to ask! She knew this was the thing we had to do! She’s very good that way. She took notes and had me detail all the symptoms and behaviors I’d been experiencing. She was most concerned with the paranoia, obviously. Paranoia is not me. I am not a paranoid person.
I used to work with a guy who was always convinced that even the most regular or mundane events were somehow manipulated by other people to his benefit or detriment. I mean everything. Customers weren’t just random people looking to make a purchase, they were people intentionally sent to him by the people in charge of the facility as gifts or tests or punishments depending on how the transaction played out. What struck me was how utterly sure he was that he was that important in the minds of every other person or organization on the planet.
A huge part of the reason why I am not a paranoid person is that I recognize that no one gives a shit. I don’t mean that people don’t care, my friends and family obviously care a great deal. But the rest of the world? They got their own issues to deal with. They’re not interested in giving me the best damned hamburger ever because they secretly know me and want to reward my awesomeness.
It’s kind of like why I never appreciate conspiracy theories, most people, groups and organizations are just trying to get through their day to day machinations, they don’t have time to meet in secret basements in their special robes and hats. Fuck, they probably don’t have time to design the robes, let alone get order forms out to the group, get everyone to return their form ON TIME with the check made out to Consolidated Robe Manufacturers for the correct amount. Hell, if they even tried such a thing they’d spend all their time in a committee fighting over shades of red and how much piping to have on the finished project.
I am not paranoid and I don’t buy into conspiracy theories because I know that the minute people try to start planning something, it immediately devolves into either evenings spent talking about ass or a bureaucratic nightmare of guidelines and forms.
So, my therapist has me sign a release form, then she sets me up with color pencils and paper. I draw and color and she calls my psychiatrist’s office on speakerphone so I can hear what is being discussed. I know you probably don’t see the absolute sparkly awesomeness of that sentence. I got to sit and quietly draw and color while she called the psychiatrist’s office. Amazing. She was able to quickly and efficiently describe my symptoms in a way that made way more sense than me just word-barfing about minivans and corn dogs.
They had an opening in less than an hour! Could I make it? Absolutely! My therapist printed out maps to the office and I was off.
When I got there I had to fill out the regular ‘new’ patient intake forms (yes, I’ve seen this psychiatrist before but in a different clinic. Seems this guy has offices all over the place or something, this was his Thursday office). I was reminded that there was something wrong with me because as I was filling out the basic forms, health history, prescription history, family history I found myself thinking, “well, that’s just none of your business! Why would you want to know that? What are you going to do with the info?? Huh???”
You know those people who get all defensive and suspicious of the minimum-wage-earning cashier asking for their zip code? Because matching your zip code with your purchase of 2-for-1 toothpaste and clearance rack pants is totally going to allow them to figure out that in the last election you didn’t vote for a sheriff because you forgot the ballot was double sided!!! Yeah, I was being that person. I only filled out half the questions. I figured that the form was pretty similar to the form I filled out from when I visited him in his Tuesday office and all those forms had already been faxed to the Thursday office and were in my file so it would be okay to be the crazy lady since he already had the info he needed. Sometimes it is okay to give yourself permission to be crazy so long as you know your bases are covered.
I met with Dr H and did a better job of being less word-barfy and more coherent. Of course he was also very interested in my paranoid thoughts, noting with some surprise that paranoia is way out of line with my character (everyone I talk to about the paranoia seems to agree that it’s not like me…why are they so vehemently in agreement? Are they talking to each other when I’m not around?).
There are 3 options to take in this situation. The first is to add another drug, one that would diffuse the mania. The second is to cut back on the Nortriptyline and monitor the effects. And the last one would be to scrap Nortriptyline all together and try something new. As a rule, I’m not a fan of the idea of adding new drugs to deal with the effects of the other drugs. But on the other hand, Nortriptyline has been fairly effective at alleviating the depression so I am hesitant to stop taking it. So we went with option 2, I’m scaling my dose back by half and keeping track of the effects.
(Every few minutes I have to stop typing this and explain to Chester that the people filling the pot holes in front of the house are not in violation of the sacred covenant between humans and dogs.)
When I have weird setbacks or problems like this I start to get discouraged. I want to get better, but the actions taken in order to get better are causing their own problems. What if the rest of my life is just a looooong series of problems and setbacks? What if I never get to live but only endure? I don’t know, it’s too much to think about. There is still hope. This setback was addressed pretty quickly and it was not so crazy off the wall to be totally mystifying to the professionals. That’s a good thing. Right? Yeah, definitely.
In other, not-so-crazy news, Maddie has an ear infection, Chester has declared all pothole patching people to be “of the devil” and my backyard smells of lilacs.

Just because you’re paranoid…?

The good news is that my brain is working at at 1000rpm right now! Just bam bam bam! A million things going on in my head, it’s like fireworks in there. It is a very physical feeling, it’s like being high on learning.
The bad news is that it has a name and that name is hypomania. Well, crap. It is very hard to put into words, but if my brain were an engine it’s stuck in fast idle. Everything is revving up, the throttle is wide open and OH MY HOLY CRAP THE WORLD IS SHITTING RAINBOWS INTO MY SKULL AND I’M FARTING SKITTLES.
Seriously, I’m not making that up.
I’m in a very weird position here (and not just because Skittles keep falling out of my pants). Being in this state is “productive” and “energetic” and when you are depressed you would willingly trade entire portions of your body just to be even remotely productive or energetic. You sit there in a torpid stew unable to desire to want to do anything. You read about people with OCD and you think, “oh man, I’d love that! My living room would get SO VACUUMED! It would get vacuumed so hard that it would disrupt weather systems in the antipodes. Take that, other side of the world!”
Of course anyone with OCD would gladly come and slap you repeatedly (in multiples of 3) on the back of your neck and then explain to you all the ways in which their OCD is destroying them and you would have to agree that while on the surface your predicaments seem different, the reality is that you are both being crushed by the same monsters.
So, I’m a little hypomaniacal, the head’s running fast and hard and it would seem like the thing that I had hoped for, a fresh and functioning mind, had been granted to me. There are not hidden blessings here, only sandtraps and minefields.
My mind is running fast, but it’s not focusing. I have to make a herculean effort to read one paragraph after another. Line breaks cause the mind to wander. I have to pull it back in line over and over again.
Then there’s the “psychomotor agitation“. I didn’t realize it had a name, but there it was. My body will not…can not stop moving. I am rocking constantly and have been for days. I sit crosslegged most of the time and the constant rocking motion is causing my leg muscles to ache whenever I stop. My legs are shaky and weak when I try to walk because of this constant flexing and relaxing that they are subject to. The thing is, the rocking releases the dopamine, the dopamine relieves the pain AND fires the reward centers of the brain. The smack makes the junkie sick, but the reward is so very sweet, it hurts so much to come down but if you can just get another hit you’ll be good. I rock and rock and rock and my hands move and clench and seek out focused stimulation because the nerve endings are so concentrated there and if I can stimulate them enough I’ll get more dopamine.
And of course the anxiety. Where would I be without this anxiety? Actually, I’d probably just be here like always, but less anxious.
Recently, something new and tasty has popped in to visit. Captain Paranoia has been scuttling around the edges, making some headway into life.
Last week I had headed out with a little mission. Get some cash out of the ATM, pick up Anna, go grocery shopping, make delicious food. On my way to the ATM I noticed a minivan was following me. Not only following me on the road, but going so far as to follow me into the parking lot of the gas station where I stopped to get cash. Who was this man and why the hell was he following me.
More importantly, why did I think that a vehicle that happened to pull up behind me on a busy road would be ‘following’ me? If you know the Nokomis/Powderhorn neighborhood you’ll recognize when I say that I turned right onto Cedar Ave from 42nd St and that Cedar is a pretty busy thoroughfare. You will also note that going from 42nd St to the Shell Station at 34th St is 8 blocks or 2/3 of a mile. A normal and rational person would not think twice about a car behind them on a busy street for all of 8 blocks. A normal person might note that the car behind them went into the same gas station parking lot, but a normal person would also notice that a gas station is a public place of business and that people often go to these places for the same reasons any other normal person would go there, to get cash or to get gas or to buy a soda or to check the map in the glove compartment because surely they thought they’d have reached the cemetery by now? (just a few more blocks and you’ll be there, don’t worry).
Yesterday, David and I went to the neighborhood grocery. More than once the alarms rang with, “why are they following me? seriously, why?!” This is so very very hard to describe or explain. It is so hard to find the words to describe the completely irrational, especially when you have a very rational part of your brain going, “you know, this doesn’t even make sense. Why are you thinking this?”
Why am I thinking this? There are any number of completely logical and rational explanations for why I might see the same person in a little grocery store many times. And why are people looking at me? Okay, this one is kind of legit. My hair has been pink (or blue or purple or whatever) for years now, for so long that I actually forget it’s even a thing. In the same way you know you are a blond or a brunette and never think about it, I am a pink. On the other hand, pink hair is a thing to look at. If I see someone with pink or orange or whatever hair, I look. I look because it is interesting or awesome or fun. I have eyes, I see, I look. So yeah, throw some reasoning in there and it would seem that the people casting a second glance my way are not calculating my escape velocity, they’re just going, “oh…pink…hey, corndogs are on sale…” (corndogs were on sale, we got 2 boxes!)
So what the hell, why am I talking about this? Well, firstly, because I can. My blog, my topic, neener neener, also, when I type I can’t rock, but the typing motion gets just enough agitation out to allow for another dopamine release…sweet sweet dopamine. And I haven’t slept in some days and that’ll mess up your judgment big time. Today I’m sharing the secrets of my brain, tomorrow possibly the secrets of my pants. I don’t know!! Stay tuned!
I’ve mentioned this before and I do not take this lightly. I have been afforded some measure of grace, a blessing as it were. So many people suffer under the burden of these sorts of things and are completely lost within the suffering. They cannot see out. Right now I am lucky, truly lucky, I can see out. The clarity wavers at times, and everyday there is the possibility that I will open my eyes and only see in. But right now I can see the divide and that is not a thing that most people get to see.
I also have a great many friends, probably more friends than a person like me would deserve, but I have a lot of friends. Some of them suffer or struggle to some degree as I do with these issues. I write about this so that they know they are not alone. That even Auntie BubboPants has dragons to tame.
I have friends who know people who fight this. My ability to write is not something I take lightly, it is very much a part of who I am. The fact that it has been so very hard to write anything of substance lately is quite telling. What I truly hope to accomplish in some way is to make people understand how these thought processes evolve and devolve out of control. If I had a dollar for every time someone said, “but you know it’s irrational! so why do you believe it? why does it bother you?” I’d have enough to fund an eastern European olympic basketball team AND get a Ben and Jerrys flavor of my own!
What I want to show people is that even when every bit of logic and rational thinking is crystal clear and on point, you can still go mad. That this is not a choice, this is not a matter of deciding to be sane and healthy. I can make jokes about Skittles and dragons, but also I can say that this is a struggle. This is breathtakingly overwhelming. I do not want this, I do not want any of it. I do not want to be this person any more. But I am this person and if it were as simple as not wanting it then it would have been done. I do not want to be this person, this brain is an endless friction. I do not want it.
But I do have it. It is here, it is me. I cannot choose to be sane but I can choose what I do with this bug.
Today is such a beautiful day. The crabapples and lilacs are in crazy bloom. I can still recognize the beauty and you should too. Go outside, even if it makes you sneeze, go out there and look…just look at everything…
…but, um, don’t look at me or you’ll just confirm my suspicions that people are looking at me.

Spiderweb on my face

So yeah, I was feeling good there for a while, things were really looking up. Then they stopped looking up and things got hella tense and anxious and ugly. Whoa anxiety monster in my face.
Depression and anxiety often go hand in hand, but sometimes the depression is so overwhelming that the anxiety takes a back seat. The new drugs have helped my depression immensely and I was thrilled. I was not expecting, however, to be t-boned by a giant hoopty driven by anxiety. Bam! Right on up there, I’m feeling good, then suddenly I’m freaking out. I’m having panic attacks that I can’t control. This is key. I’ve had panic attacks in the past and I have almost always been able to stop them through breathing and forcing my brain to be calm. These past couple weeks, however, have been pretty brutal.
The anxiety or panic comes over me and as I try to talk myself through it, “this is anxiety, it causes a spike of adrenaline and that causes the heart to pump faster and muscles to tense and the brain to go on high alert. It’s just an errant reaction to something that isn’t happening.” I find that the words are not working like before. I can’t wrest control of my mind away from this lizard brain type action. The flood of adrenaline is not subsiding. Why not? what the hell? Is it because my medicine isn’t working? Holy shit! If my medicine doesn’t work then I don’t know what I’m going to do! oh no oh no oh no oh no! I’m never going to get better I’m never going to fucking defeat this shit. I’m going to spend the rest of my life in some sort of shit-limbo. DAMMIT.
Like that. Instead of being able to manage the anxiety I found it spinning out of my control and as it spiraled off it released more and more little tornados of fear (apparently the spellcheck dictionary has tornado but not tornados. The spellcheck dictionary has not spent an August in Minnesota). When it first started happening we (David, my therapist and I) decided it was probably PMS. People who know me know that my PMS turns me into both the Scylla and the Charybdis and those around me are forced to navigate their little boats through the treacherous waters.
But it kept happening, wave after wave of fear and tension, a complete lack of surety where once I felt positive.
Add to it a monster headache that will not go away. Day after day a persistent low grade pressure in my head.
So, I go to therapy yesterday and I throw it all out there. Oh my god! One million anxieties and nothing is helping and I feel like every nerve in my body is exposed and I can’t think rationally and I can’t concentrate on any one thing and dammit I was feeling so good and now everything is failure and what the hibbity-hell????
I really love my therapist, she is calm and insightful and can break problems down into component parts and show me how those parts fit together to make something larger than the sum of its parts.
I’d never experienced such consistent and persistent anxiety before. It’s not that it wasn’t there but that depression often trumps anxiety when it comes to brain resources. Now that my depression has eased up my anxiety finally has the room it needs to expand and really reach its full potential.
And that’s the thing about fighting mental illness. It’s never clear cut. You’re fighting an enemy that has a million secret weapons and just as many secret ninja soldiers. A successful campaign on one front exposes your vulnerabilities on another and once again you’re outflanked. It’s exhausting sometimes and it doesn’t help that you can’t see the end. You just steel your spine and put your head down and force your way through attack after attack.
The biggest weakness in my army is my own self defeating thoughts. I have a habit of analyzing my symptoms and immediately discounting them. I initially assess them as fake or psychosomatic. I am my own worst critic. If I become overly anxious to the point of physical discomfort I’ll tell myself that it’s because I can’t get my shit together, I don’t want to get better. Obviously this doesn’t help the situation and can often make matters worse.
A good example is this damned headache that I’ve been experiencing. It will not abate. For a few days it’s been beating my skull and for a few days I’ve been yelling at my own head telling myself that I have no reason to have such a headache. Brilliant. So, we’re out of advil and the tylenol isn’t making a dent in it. I mention it to David and he points out that last week I felt like I was coming down with a cold. I’d been tired, my lymph nodes were swollen and I had a bit of a sore throat. So I had that last week and a headache this week and he points out that it is spring and there’s pollen and persistently wet leaf littler that produces bits and bops of mold spores and maybe this is just allergies.
I have a strange relationship with allergies. When I was in high school and college I’d started reacting to some fresh fruits and vegetables like apples, carrots, cherries and some nuts. I assumed it was pesticides that I was reacting to because why would you be allergic to apples. But then I started eating more organic fruits and vegetables when I could and the symptoms and reactions didn’t abate. So then I was at a loss. Who the fuck is allergic to fruit? I’ll tell you who’s allergic to fruit! It’s hypochondriacs! Those are the people who are allergic to fruits and vegetables and door knobs and paper and whatnot. Ergo, I must be a hypochondriac. It’s obvious that I’m experiencing allergic reactions based on psychosomatic issues that I can’t trace. But I don’t need to trace them I just need to recognize that these allergies are my fault and not real.
Every year I have issues and every year I would send a barrage of self loathing into my own head. Stop having allergies, you’re just being a baby…no, you’re being a stupid baby! And it certainly didn’t help that I read a book that happened to take the same stance, that many chronic discomforts like sciatica, allergies and migraines were less physical in origin and more psychosomatic. And of course this all fit so perfectly with other experiences I’d had in my life. As a child I would go to adults and try to get help from them regarding my home situation. Time after time my efforts were rebuffed. I am a kid, I am experiencing great abuse in the home and I go to a teacher or a relative and I try to get help and I am told the same thing over and over, “oh, every kid thinks their home life is terrible. When you grow up you’ll see it was fine.” Basically, I was told that my issues, my discomforts, my problems were not real. I was told that my assessment of the situation was wrong. I learned to not trust myself, to always second and third guess everything. I learned to stop asking for help.
And we come full circle. I’m an adult that cannot accept that seasonal allergies are real despite all the evidence to the contrary. I am a person who can send her own anxiety out of control by berating herself for having anxiety in the first place.
This process of therapy will take a long time and I am okay with that. Yesterday, we were able to identify and outline this issue that I have with anxiety and self doubt. As hard as it is to know and accept this about myself, the pressure is alleviated by the knowledge that it is a thing that can be fixed and that I will one day know that I am not a stupid baby.

Time is a One Way Street

I take the brain pills, I’ve been on various brain pills since 2006. I’ve tried a lot of brain pills with varying results. Everybody’s brain chemistry and wiring is different and the sad fact is that no one really knows what those differences are or why they occur. To find the correct antidepressant and dosage it seems that a person will have to try a few different drugs and will have to vary the dosage. So, in 2006 we started down the path of finding the right drug.
I’d taken prozac as a teenager and the results were horrid. Prozac made me sleepless and paranoid, so we knew we could take that off the list. I had also taken Nortriptyline when I was 18 and the results were all around positive. We started out with Zoloft. I felt nothing, no effect at all. We raised the dose a few times and still, nothing. So we moved on to Celexa. Celexa was awful. It made me so anxious that I was becoming physically ill at even the thought of being around other people. We decided to take SSRIs off the list completely. I had asked about the Nortriptyline, it was something that had worked. Nortriptyline is pretty old school as far as antidepressants go and the side effects can be problematic. There was a newer drug, Effexor, that also worked on inhibiting the re-uptake of norepinephrine, but with easier to monitor side effects. Thus, at the beginning of 2007 I started Effexor.
Effexor is a hell of a drug. The side effects are phenomenal, brain zaps, weird dreams, weak muscles, dry mouth, dizziness, and the most insidious, apathy. Most of the side effects waned over time and over time we continued to increase the dose until, finally, I was taking 375mg a day. That is a pretty substantial dose. It did lift me out of the very bottom of my depressive slump, it brought light to the very darkest corners of my mind. It was a life jacket tossed to me at the very last moment. I grabbed it hard and held on.
But then that was it. The Effexor was acting as a stabilizer, it was keeping my head above water but it was not getting me out of the ocean, just preventing my drowning. And though I could remain calm as I surveyed my situation, I was seeing that I was not making any progress towards getting better. We continued to raise the dose and eventually we added Welbutrin to the mix. The Welbutrin was a dopamine reuptake inhibitor as well as a norepinephrine reuptake inhibitor. The idea was that it would enhance the anti-depressive qualities of the Effexor while adding more dopamine to the mix. Dopamine works on motivation and pleasure. It’s the ‘reward’ chemical that gives you that bit of a high when you do well at something, seeking out that dopamine high is what motivates people to continue to do well. There are some strong indications that many drug addictions are linked to the seeking out of that dopamine reward.
And so we kept marching forward adding more and more Effexor and Welbutrin to the mix. Effexor is a drug that requires a very long term commitment. Dosage increases have to happen very slowly and over long periods of time. You start at the lowest dose, 37.5mg and work your way up from there. Also, it does not start affecting the norepinephrine until you get up to 225mg. It could be months before you start feeling positive effects, making it a commitment not to be taken lightly. Once I got up to 225mg and beyond I patiently waited to feel better.
A few times I asked about Nortriptyline. It had the distinction of being the only antidepressant that I had tried that had very real and noticeable results. How was it different from Effexor? Why was Effexor seen as a better choice when the results so far have been not so spectacular? Remember the side effects I mentioned before? Remember the apathy? Yeah, that never went away. The apathy was huge. It was a catch-22 of amazing proportions. I was not getting better, Effexor was not helping me, many very important things in my life were falling apart and I surveyed all of that through a barrier of disconnect.
Should I have pushed harder to switch from Effexor to Nortiptyline? That’s the $64,000 question, isn’t it? I am not a doctor, I am not a trained medical professional, I am in no way an expert on neurobiology. I am just me, a sort of a goof of a dooflerumpus trying to navigate the world with a brain that seems determined to confound me at every step. I’m not an expert, and as much as I would like to buy into or believe in that new agey ideal of “it’s your body, you know what’s best” I just can’t. It isn’t true. I’ve known far too many people who have taken that sort of logic to its worst extreme and ignored sound medical and scientific evidence to the siren song of “alternative” treatments that were nothing more than sugar and hope. Add to that a pharmaceutical industry that advertises prescription meds on prime time TV and eventually you have an army of people who base their treatment plans on 30 second sound bites and a misbegotten notion of “natural = better”.
Many years ago I went to my GP with my insomnia issue. I’d been struggling with insomnia since I was a teen (keeping in mind, of course, that when a teen suffers from insomnia the only response they get is a condescending recommendation to go to bed earlier or some such nonsense). This isn’t just “a hard time getting to sleep” this was night after night of no sleep that would last 5-7 days and then I would sleep for a night or two and then no more sleep. When I asked my doctor about this she asked me which sleeping pill I wanted to try. What? Seriously? I’m not a fucking doctor, why would I know which sleeping pill was best for me? Well, this was at a time when Ambien and Lunestra were advertising pretty heavily on TV. Since I don’t watch TV I never saw those commercials. What was instantly clear to me was that doctors were willing to prescribe medication to people who were armed with nothing more than a preference for an advertising campaign.
As a patient I have to try to strike a balance between the knowledge that I do have (Nortriptyline has worked in the past) and the professional opinion of a person who is educated in that arena (Effexor has a higher success rate and fewer side effects than Nortriptyline). Once I was on the Effexor, however, it became harder and harder to find that balance. The Effexor was not working but I was apathetic. The Welbutrin should have helped with the apathy, but did not.
Then I lost my job and that should have been a great big giant sign that said, “HOLY CRAP! THIS ISN’T WORKING!!!” in flashing red neon letters. Instead we just bumped up the Effexor and Welbutrin.
Finally, at the beginning of 2009 I had a moment of clarity. It happened in the psychiatrist’s office. She’d been playing the role a therapist for me as well as psychiatrist and she was failing at both. Her therapy method was to take my larger issues (fear of making a big mistake keeps me from doing even the simplest of tasks, like grocery shopping) tease out the overriding logic (it’s pretty difficult to make a big mistake when grocery shopping, and whatever little mistakes there might be did not make a difference at all) and then say, “well, if you know this to be logically true then why are you still having a problem?”
Yes, indeed, how on earth could I still be having a problem if the logical answer was so clearly laid out in front of me? That’s why I’m in therapy you dipwad! If I were capable of being logical about these emotional issues I wouldn’t be in this big mess. My moment of clarity involved some yelling and some crying and an unfocused sense of determination. I stopped my sessions with her (which was inevitable anyway, I didn’t have insurance and the bills were piling up fast), I wrote a letter to the clinic describing my issues (which I’m sure just got pitched into the crazy lady bin) and I started weaning myself off the Effexor.
The next thing we know it’s September and things had gone all to hell. Time continued its relentless march, December happened and things got ugly. Finally, I got in to see a new psychiatrist. First we talked about what was happening in my head, we talked about my symptoms and my concerns. David came in as well to give his insight into the situation. We discussed the various meds that I had used over the years. Then he asked the most important question ever, “What medications HAVE worked for you?”. Nortriptyline! We talked about my experiences with Nortriptyline (i really hate typing the word Nortriptyline, it’s very difficult to type). As an added benefit, it was a medication on the Target $4 list! So we went over the possible side effects and the way it works and I got me a prescription for Nortriptyline!
I started slow, 25mg to start, 25mg bumps over 7 day intervals. Initially, I was a bit disappointed. I could feel no positive difference but I was feeling some very definite apathy coming back. Then about 4 weeks in it was like a vice grip had been released from my brain. The apathy was slowly burning away like fog in the morning light. More importantly, I was feeling motivation. I had not felt much in the way of motivation for years.
I take 100mg of Nortriptyline every day. I am not ‘healed’ or ‘better’, my depression has not been magically zapped away. It doesn’t work like that. What has happened is that I have looked down and finally saw the path that could lead me out of the forest. I still have months and months of hard work in front of me, but now I am able to face that work without the constant self defeating actions of my brain.
And what happens if I turn and try to look back? I see frustration back there. There is a part of me that feels angry over losing 3 years of my life to ineffectual medications. It is not hard to imagine where my life would be if only I’d spoken up or insisted on getting Nortriptyline. I’d probably still have my job, David and I would have bought a house. I’ve lost a lot of friends over these past 3 years because of my inability to maintain contact. Mostly, however, it pains me to think that David has had to live with this, that many of his plans had to be compromised because of my depression.
Time is a one way street. I can look back, but I can only watch it recede out of sight. Part of me is angry, part of me is sad. A greater part of me, however, knows that this life is truly finite and that the only thing I can control is what I choose to do next. If I could go back in time and change things, I would, absolutely, but I cannot. I will instead, try to be kind to my own self, to be forgiving and charitable to myself. My goals in life were never big, they were never along the lines of “be a big success” or “be famous”. My goals were always tempered with “do the best you can with what you have”. I am a journey oriented person, I revel more in the “now” of life than in the “long term”, perhaps this is why I love dogs so much, they only know right now and they love the hell out of every right now that they experience.
It is not easy, but I am turning away from what I have lost and will focus my energies on what I can be.

The Masterful Myth of Free Will

Part One: How I Spent My Winter Vacation.
So where have I been? Not been writing much, not been able to, that’s for sure. What happened?
By the time winter rolled around I had weaned myself completely off the Effexor. Effexor is not a bad drug, per se, but it was not the correct drug for me. I appreciated that it lifted me from the absolute dregs of depression, that it evened out my mood swings, that was awesome. The problem with the Effexor is that it made complacent with my depression. I knew things were not going well, but meh, I had a hard time caring about it.
Winter rolls around and I am completely off any meds at all. Let’s just take this moment to contemplate the idea of facing the holidays (and all the stressful nuggetry they entail) sans brain meds! I don’t even recommend that my healthy friends do this. Holidays should…nay MUST! be endured with some form of artificial fortification. To do otherwise is to mock the entire institution of holidays with the family! Suffice to say, things went from tolerable to not okay to entirely fucked in a few short weeks.
It happened mid December. The best way I can describe it is that my mind split into two parts. One mind was sick, very sick. That part of my brain was a whirlwind of anger, paranoia, hurt, suspicion, irritability and generalized craziness. While you might be tempted to say, “but, Heather, how is this different from normal?” and I would respond with a hearty, “suck it”. Seriously, though, it was pretty awful. My mind was thinking thoughts that I did not want to think, it was believing things that were completely untrue. My mind was suspicious of everything everyone said. The worst part of all this was that it was constant, it was uncontrollable and it was pervasive.
The other part of my mind stayed rational and mostly reacted in horror at the thoughts and ideas in the crazy part of my head. I was lucky, very very lucky. I imagine I was on a precipice looking over the edge at the abyss of mental illness and I almost fell. The fact that I managed to maintain that slice of rational mind is a miracle, nothing less. I stared into the face of true mental illness and it scared the holy hell out of me.
Unless you have experienced it, I’m not sure you can quite appreciate it. We tend to see our minds as an ineffable, unquantifiable part of our physical brains. We separate them, our brains are corporeal but our minds are non-corporeal. The mind is the essence of you. So what happens when your mind starts doing things that you don’t want it to do? How do you control the thing that you need to use to control itself…what? How do you use your mind to control your own mind and thoughts? What do you do when you cannot control your mind? What exactly does that mean about you?
There were so many horrid thoughts in my head, so many awful conclusions reached. It took a grand force of will during every interaction to not blow up at people, to not scream in anger, to not accuse people of secretly hating me, of conspiring against me. And even when I did limit my interactions with people these thoughts would not stop. They were like a hurricane in my skull, an unceasing force in my mind. At one point it got so bad that I found myself in the bathtub knocking my head against the edge of the tub. One good thump of the tub would give me 3 or 4 minutes of relief, would provide enough external stimulus to distract my from my mind.
My little slice of rational brain was screaming! I knew this wasn’t right, I knew this was unhealthy. Most importantly, however, I knew that I could lose that slice of rational brain. I told people, I called for help. I was losing this battle and I was sinking fast. And help was what I got. We bumped my therapy up to twice a week, I got a couple county social workers (which is a completely different post), my friends and family grabbed me by my hair and pulled me to the surface and they held me aloft until I was able to tread on my own.
What is free will? What does it mean if the choices you make are tainted by depression? mental illness? poor ‘wiring’ in the brain? The fact that the small slice of rational brain remained is the exception, not the rule. It was wholly terrifying to see how easy it was for my mind to become that black and oily snakepit. If I’d lost that bit of rational brain and fell off the edge there, would I still be operating within the parameters of ‘free will’? How free is your will? how many of the things you choose or act on or react to every day are truly free will? How many of your emotions and reactions are free and how many are the result of baser instinct? or brain chemistry?
The thing that scared me the most was knowing that if I lost that bit of rational brain I’d never know it, that there would be no way to recognize the loss of rational mind without the rational mind there to analyze the situation.
The good news is that I climbed out of that morass. I survived. I got new meds, I’m taking Nortriptyline and it’s working. It is really truly working. It is like a vice grip of fog has been removed from my brain. I went to therapy twice a week as needed and as the fog lifted I was able to bring it back down to once a week. I’m calling this ‘My Cautiously Optimistic Phase” as it’s true that I am feeling good but I know that it might be temporary, that it’s not enough to just want to feel better.
And while this won’t mean much to most people, it will mean something to those who have been close to me during this crisis: I cleaned my kitchen.