The Oil Slick, by Dorothy Donald

This is another guest post by Dorothy Donald.

The good news: the sertraline seems to have quieted The Voice In My Head That Hates Me. The bad news: instead of A Voice In My Head That Likes Me, what’s replaced The Voice In My Head That Hates Me is nothingness.

This means I haven’t been writing. I haven’t really been doing anything much. Mostly I’m in an endless Netflix/Twitter loop. I go to the shop sometimes because I’m told it’s important to leave the house. My kitchen cupboards are embarrassingly well stocked.

I miss writing. I miss the feeling I used to get when an idea rattled around inside my head – no – grabbed me by the scruff of the neck and marched me to my computer and wouldn’t let me leave until it had received some sort of words-in-the-right-order justice.

I miss feeling like I had something to write that people might want to read. I’ve got nothing.

If the inside of my mind had a colour, it would be grey. A texture, cheap scratchy cotton wool. A sound, somewhere between radio static and tinnitus. Smell and taste, a stale fucking rice cake.

I used to laugh and make other people laugh. I used to be capable of excitement, anger, desire – maybe all at once if it was a really interesting day. I used to make plans. I used to look forward to things.

I also used to worry a lot, so I guess it’s not all bad that I’m basically cardboard now.

“But do you think this is the medication, or the condition?” asks my GP.

How the fuck would I know? We have a sample size of one and a lot of uncontrolled –

I sigh and say “I suppose it could be the condition.” That’s what he wants, and it seems easiest to go that way.

But in my previous, unmedicated episodes, I still wrote. I don’t think I wrote especially well – please, nobody ever give me that ‘oh but doesn’t mental illness produce such great art?’ line – but the fact that I sat down and typed something gave me hope that there had been something inside me. Even if it was a twisted and miserable, self-loathing hot mess. There was something.

I’m not saying I regret choosing to take the meds. I just –

I miss writing, that’s all.

A less crazy New Year?

Happy New Year Depressed Academics,

I know it's only January, but I can feel in my bones that this year is going to be different. Maybe that's just optimism speaking, but really, I'm actually excited to see what this year brings.

A little update since my last post: My doc is swapping one of my old time mood stabilizers for a different one with less side effects and specifically, it has no weight gain side effects. Anytime I have a medication change, I feel uneasy. What if this medication isn't as effective? What if I feel worse? Would if I have to go back on the Depakote and my efforts amount to nothing? I had a week to think about whether I wanted to try this different medication, and I figured I might as well try it. I mean after all, a medication with less side effects is always going to appeal to me more than one with more.

The thing is the Depakote has always been a staple in my (most) stable med combo. Also, I have been on this medication before. It's called Tegretol and for me, it was a little less potent than the Depakote but I was also on it with a couple different meds than I am on now. So who knows! All I know is I am willing to try and if it doesn't work it out, so be it. I figure if I remain the same as I am now on the Tegretol and without the Depakote, I'll be content. If I crash, I know I am resilient and can always go back on the Depakote. My mum pointed out one outcome I didn't think of: Would if I actually feel even better than I do now? All I can do is marvel at that idea. We will see.

Now, onto this New Year business... I don't like the notion of New Year resolutions. It seems like a set up for failure or a trap to only plan your self-improvement projects for a once a year time frame. And that's silly to me. I am just telling myself to do what makes me feel good: restful sleep, exercise, healthy foods, routine. With those aspects in line, the rest will fall in place.

So maybe it will be a less crazy year. Maybe not. I still have to figure a lot of things out. I am aiming to complete my Masters thesis by March. Around that same time, I plan to notify of my potential return to my studies. It's really not a lot of time before March, and just thinking of these two things brings me stress! And then I simply remind myself to breathe and do only one thing at a time.

The medication dilemma (again)

It's been a couple weeks since I took a medical withdrawal from my university. I decided to move back where I am from and to stay with my family for the time being. After all, I won't have to pay rent and can focus on my health. 

I do have to admit I feel more stable now that I am home. But sometimes I am just so overwhelmed by anger I can hardly breathe. Mostly about the medications I am on and the side effects I am experiencing from them. The thought to go off my medications crosses my mind several times a day. But I know that going off my medications abruptly would only bring more problems. 

I know if I were to attempt to taper my medications again (with the help of a medical professional, of course), I would have to make major modifications to my lifestyle. And what about sustainability? Is it even possible for a person with a mood disorder to live medication free (or at the very least at low dosages)? 

I hate my stable but blunted moods. I hate how hungry I am and how it seems like I can't stop eating. I even crave different and unhealthier foods. I sometimes can't even look at pictures of myself without grimacing because of how much weight I have gained. I dislike people asking about why my left hand moves so much (from the tardive dyskinesia). 

The thing that bothers me most about medications is the fact that my symptoms are still there, sometimes in full throttle. And then the additional coping I have to do with the side effects.

Instead of feeling empowered by medications, instead of feeling like I have a greater grasp on my emotions, I feel dependent, discouraged, disappointed. 

The manic who forgot she was a depressive, too (and more)

I know when I am depressed. It's in my long hair. It gets tangles and knots. Sweat. Dirt. I know when I am hypo/manic. My hair is perfectly brushed several times a day. Combed clean. I don't know what it's like when I am stable. But I do think it's a little bit of both, maybe on the same day or different on different days.

I was stable. There was a time, yes. When I was eating light, doing light exercises, walks in the mountains. Quiet at times and at other times, connections I never imagined could exist. I did not speak the language well, or barely at all without some notes of some sort. I did not have a phone at all. I had limited access to email, but I was researching.

Research is critical to me. Speaking to the PhD choir here, I know. But you see, I start my PhD in August. I am nervous as heck, I will be honest. Will I start and fail? Will I fail before I start?

Anyhow, back to the research. I was researching important issues to me, deeply personal, deeply emotional, one might even say spiritual whatever that means to me. I was in my element. In all senses of the word/world.

I can't tell you what I was researching. For a time, I had no idea what I was researching. This is a semi-joke, all loving of course. But there was consistency in our spontaneous system of research. There was also consistency in my thoughts and actions. All along, I had wanted to document lowering my medications when I returned home. Because in the mind of my heart, I knew there was a little something off. Now, as I mentioned in my last post, I am documenting my madness. It's all the same. To me anyway. Because with medication withdrawal, there comes some withdrawal effects that can be and are dangerous.

Did I experience these withdrawal effects? I can't say for sure. But there was social pressure. To drink. To smoke cigarettes. There was R with his own issues. There was other systems of instability whether I was in the city of 2 or at my original home.

Also: Am I just someone who needs and should be medicated with high dosages of psychotropic medications? 

I do think I need a medication or two for this transition. To achieve my goal: my PhD studies. Even in madness, it was there. But I don't think I need to be ashamed anymore of my emotions. I don't think I need to coat over the symptoms always.

I am grounded, but angry. Angry at a lot of folks. (The whole lot: docs, people, past partners, old friends) Angry at myself for not taking better care of me. For letting it get this far.

But something I learned from f. Forgiveness is possible. And if I can forgive someone, I can most certainly forgive myself. 

The thing for me right now is that I have to listen to me. I have to listen to what's inside. (And outside, too). I have skills that I have learned from years and years of therapy, from friends, from past relationships, from f. I am an adult. I can take care of me. I will take care of me. Depressed, Manic, Schizo, Borderline, whatever name they throw at me next. Because I am a whole.

Now for you all, whatever your diagnosis may be. I have some questions:

1. Do you have identity issues with the medications? (I.E. not knowing who you are or who you could be?)
2. How do you cope with an illness diagnosis? (Note: I am having to relearn everything.)

Those are my two big concerns/questions. I have more. But I will just see what happens.

Thank you so much for reading. I applaud all of you for just coming to this site. Thanks thanks and more thanks.

The process

Note: Hopefully this is not too scattered. I tried writing this out earlier but due to a Klonopin fog, I became confused. Also, the opinions I have about medication usage are mine and mine alone. I respect your views if you respect mine.

May 2013 (yes, I know the month and year, but maybe not the exact date ha)

Victory moods don't last long. It turns to absolute suckage. Sucakge meaning stigma in my own circle of f. I have been documenting my mental health. On recordings. On notes, receipts, folders. I forget you see. I forget everything I say and don't say. Actions too. Not impulsive ones but movements. I've been moving slow. It takes a good deal of time to write this NOT just because of the klonipin.

I am termed "hyper verbal" "hyper observant" YET and there's always a yet, I am not aware. I am confused, scared....  The partial hospital care I am going to now knows I am doing well because:

1. I am high functioning
2. I can spell world backwards (in an amount of time) -- mostly a joke about this being why I am in partial care and NOT a hospital hospital (Note: there is nothing wrong with a hospital, only not for me at this time)
3. I can recite my medications like nobody's business
5. The higher anti anxiety meds help.
6. I am lowering (doctor's orders) my antidepressant--- This causes mania in me. I am coming out again as a manic-depressive. But manic right now.

Anyhow, some other observations/comments/helpful tid bits:

1. I check with my f & f. I ask "Did I just tell you that?"
2.  The partial care program is great. The doctor is fantastic super fabulous. She is lowering my antidepressant-- because I am too hyper/wound up.
3. Pets are great!
4. Art therapy is great except for when they want to stunt my artistic ability (I use to draw dinosaurs in  grade school)-- person might have been surprised by my art, not because it was great or anything but because it had literary references and said I am not schizo on it or something to that affect. I don't know if I have schizo. I do write a lot and in circles. Memory is returning!
5. Alpha-stim has helped me tremendously: with anxiety, depression, mixed states. I have it on all the time because it is safe to do so. Fine motor skills are coming back too. So is relaxation.

May 30, 2013 (I know the date, the Klon-fog has cleared)

I was admitted into a partial hospitalization program last week due to extreme anxiety, social phobia, paranoia and bursts of panic attacks. Ironically, my note on my art piece about not being schizo might not be entirely accurate; I have acquired a new illness apparently......

Schizoaffective bipolar. 

The result of this partial hospitalization was no one's fault. Not mine--though I sometimes believe that. Just a series of unfortunate occurrences. My usual pscyh doctor was not available over the weekend (which one I don't know). So I became worried and scared. I called everyone. And I mean every mental health resource center until I landed at a prestigious center in 2, and it was awful. I mean stressful, intense, nerve-wracking. For the first time in my life, I did not want to be in a hospital. In the past, hospitals were my safe places. But this time, they did not understand when I told them about my hard-to-find veins and my tardive dyskinesia on my left side so of course, I freaked out when they poked and could not find my vein in my left arm. Needless to say, they released me on the condition I would take Klonopin to "kick out" the mania and they upped my mood stabilizer. The one doctor was amazing and very understanding of my concerns about the hospital, too.

I am not against medication. In fact, I think medication can be an effective treatment. But I also think there are other alternatives that we should consider for our mental health care. I will address this when I am less tired.

The last moments of May 2013 & the start of June

There is more to tell, more to share. But I can say this: The depakote increase (back to my original dosage before a trip to Country Y) is hm, interesting. Doc says it will take four days to be back to my stable self since the other meds did not pull through. What I think? Can I have an opinion Expert Doctors?

I think medications are covering up something. Now this could very well be the paranoia. But there is something to memory loss. I am just beginning to figure it out.

The process: therapy. Therapy in every sense of the word. I am trying my hardest to do every possible thing for myself. CBT (with a DBT concentration). Sunshine. Exercise. Nourishing Food. Sleep regulation (no naps). Connecting to self and others (in safe and harmonious ways).

It is past May now. It is a new day. If the etymology of June is correct, if I believe in those signs (which I do and don't) -- then I can say this: I have a chance to be young again. To believe in the possibilities. To be my own version of a goddess.

I do have hope. Thank you so much for reading.

And every so often, an off day

Yesterday my brother-in-law got married.

Yesterday was also and unrelatedly one of the first bad days in at least a week or two.

Yesterday, families came together and celebrated. Got to know each other. Pleasant times all around.

Yesterday, I could find no joy in anything. I could not mobilize myself. I'd follow along and obey instructions, but doddered around fumbling at tasks when I try to start them myself.

I didn't feel much anxiety, but I didn't feel much joy, or interest, or energy for anything. Eventually S suggested my functionality might improve from my anti-anxiety pills.

Like a flash, the pervasive, crippling sadness vanished. And as the families gathered and the ceremony took place, I was able to be pleasant, have fun, and be involved in conversations and activities.

Yesterday was a great day.

Yesterday was a ghastly day.

Yesterday was an off day.

Effects and side-effects — an update

After about 2 months on Fluoxetin, we adjusted my medication.
Since mid-March, I have been taking Fluoxetin and Voxra (Wellbutrin) together.

I am now getting to the point where observations can be written down; where I have more than a few days worth of a sample.

First off, the really good: my mood is much more normal now. On Fluoxetin alone, I turned flat; I kept being sad for much of the time, but the crashes went away. I just was bored, dull, apathetic instead of having daily anxiety attacks. Improvement, sure, but not up at good just yet.

With the combination, my dull flatness has gone away. I have my ups and downs — I had a fullblown classic breakdown a few days ago, but it's once in 2 weeks, not several times a week. And I'm happy and energetic far more often than earlier in the past year.

So as for the primary effects, the combination seems pretty much spot on. Sure, it would be nice to get more stable than this, but it is already an incredible improvement on Before.

Now for the side-effects. I have gotten rid of some, retained some, and gained a couple of new ones.
My grinding and chattering teeth are remaining. Last night, it was apparently bad enough it helped keep Susanne awake at night.
I am far more sensitive to alcohol than I was before. On the other hand, I have always tried to pay attention to my body signals when it comes to alcohol consumption, so this doesn't really worry me.
I wake up several times each night. This is new.
I am tired. A lot. I grow almost uncontrollably tired around 9pm; we used to have a family diurnal rhythm with bedtime at midnight. Now, I go to bed between 10pm and 11pm instead. This, too, is new.

Stepping it up

As of today I am adding Wellbutrin to my Fluoxetin.

Fluoxetin alone did quite an alright job in reducing the severity of my bad moods; but did not so much in decreasing their frequency. Instead of crashing and burning daily, I have been apathetically dull daily.

Being anti-depressed: My experience taking setraline (Guest Post)

By Evgenij Thorstensen from his blog Journey is return.

Quite a lot has been written about what being depressed feels like. However, I have seen comparatively little about what taking an antidepressant feels like. Note the "feels like": There's plenty of information about the risks, effects, and side-effects in clinical terms, on wikipedia and beyond. When I went to see a doctor about my depression and started taking an antidepressant, I had done my research, but I can't say that I knew what it would feel like.

Backstory

In retrospect, I remember having depressive episodes since the age of 14. I am now 25; I finally sought medical treatment about a year ago. My doctor prescribed me setraline, initially 50mg/day, a low therapeutic dose. I took this for about two months with initial positive effect that gradually died down. My doctor then proposed to up the dose to 100mg/day, which I accepted and have been taking for about seven months (with persistent positive effect) before gradually tapering off over a month. At the time of writing, I am no longer taking setraline as of three weeks ago. The reason I decided to stop taking the drug was basically to see what would happen, since I had been free from depression for eight months or so, and since the (mostly sexual) side effects, while bearable, were nevertheless unpleasant. These, as they say, are the facts; the goal of this article is to describe what effect taking setraline had on me, and more specifically, what it felt like.

The phrase "anti-depressed" in the title of this article is from an article by Johann Hari, which I found a few months after starting treatment. In it, he talks about his experience taking an SSRI (paroxetine) for many years. The whole article is worth reading, but in particular, he reports, from his own experience, that

You enter a new state that I think of as ‘anti-depression’. We are not depressed, but nor are we like the undepressed. We are different. Whatever we do, wherever we go, we will never be truly, madly, deeply unhappy. It’s like we have been inoculated from the miseries of life.

I relate strongly to this. For me, a large part of being depressed was that nearly everything had strong emotional significance. The smallest experiences had intense emotional affect attached, whether good or bad. During the first month of taking setraline, I noticed my emotions gradually lose some of their intensity. The small things and experiences in my life no longer had much emotional impact on me.

As an illustration of what I mean by that, consider the song "Breaking the habit". It's a favourite of mine (Linkin Park seems to be high on the "depressed people's choice" list of bands), and has plenty of emotional significance. Before taking setraline, I remember listening to it on repeat (ten times? fifteen?), raw emotion going through me, without abating even after the song had repeated a few times. Sometimes this (or other) songs would play in my head as background music, with vivid emotions attached. On setraline, listening to it no longer immediately brings a strong emotional reaction. The memories I associate with this song feel more detached, less vivid. Most days, it's now just a song I like. Putting it on repeat becomes boring after one repetition, maybe two.

Before taking setraline, strong emotions were my constant companion. In retrospect, it was like the stereotypical description of being fourteen --- an intense level of emotional affect attached to everyday things. I felt in tune with the universe, but with a constant and consuming undercurrent of being not of this world, of not belonging. This undercurrent would rise to the surface from time to time (sometimes triggered by something, sometimes not), and presto! Depressive episode. On setraline, this "in-tunedness" went away, only making appearances in settings that should have a strong emotional effect on a person, say upon reading a particularly emotive scene in a novel, or having a deeply heartfelt conversation with a close friend.

Apropos friends, the second effect I noticed was that I felt less affected by other people. In particular, I felt less connected to people around me, perhaps less empathic. It doesn't sound very nice, but bear with me. Empathy, in one sense, is feeling what someone you're interacting with feels. Before taking setraline, I felt a strong sense of connection when interacting with my friends, and it seemed to me that I felt what they felt when it came to emotional situations. On setraline and looking back, however, it seems that in such situations, rather than feeling what somebody else was, the feelings on my side were a lot stronger --- a kind of magnified empathy, out of proportion to the other person's actual emotions. When a friend told me about something bad that happened to them, I felt strongly for them, even when the incident hadn't affected them very much. If someone was upset, it felt to me like it was a big deal for them, even when it was actually small and insignificant.

Before taking setraline, wronging someone felt like the end of the world, and being apart from people felt like crushing loneliness. After, the strength of emotion that other people's experiences and stories inspire in me seem more proportional to the strength of their emotions. It has become easier to apologise, since doing someone a minor wrong does not feel like the end of the world any more. I feel much less lonely, even if I have seen less of my friends recently, rather than more. In short, everything is less intense, which echoes the quote from Hari's article above. However, his article continues:

People who cannot feel physical pain end up getting into terrible accidents. They burn their hands without realising it, crush their legs in doors, contract illnesses that eat away at them unawares.
There is a similar process when you cannot feel searing mental pain. Like all the anti-depressed people I know, I have racked up big debts, been crazily casual about my health, and allowed myself to continue in emotionally damaging relationships for years, all because none of it really hurts.

Here his experience and mine part ways. I would instead liken my experience to having my pain threshold go from an extremely low level (everything is emotionally significant) to a moderate one. Likewise, the part about it "none of it really hurting" has not been true for me. Everything does hurt less, and it has become much easier to push away something that's on my mind. So far, however, a lot of the worrying in my life has been what I call worrying "on idle", like a parked car with the engine running. You're worrying about something, but not actually getting anywhere or doing anything about it, mainly because there isn't anything that can be done, at least for the moment. Instead of leaving it be and doing something else, however, we worry and ruminate. I knew how to deal with it even before I started setraline, but...

On setraline, this "idling" is pretty much gone. Pushing something that I don't want to think about away from my mind and doing something else (productive or otherwise) is much easier. As for the things that do need attention, I find that they are still amenable to rational thought, without as much anxiety and worry attached. Such thought then either leads to a plan and then to action, or to pushing the issue away, without the idling. It does sometimes require effort to not ignore something I'd rather not think about, but I haven't found it to be a problem. So far, my life hasn't slid out of control as per Hari's description, anyway. And as for everything painful hurting less, I'd say it's less rather than not at all. Breaking up with my ex-boyfriend hurt, for example, but instead of sending me into a depressive episode I spent a week in a funk, then gradually went back to normal the week after that. From what I hear, that is the healthy emotional reaction to an amicable breakup.

Actually, re-reading this paragraph I am reminded of the serenity prayer, which goes

God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And wisdom to know the difference.

Ignoring God and the wisdom part, there's a more general point to be made here. Of the things I tend to worry about, there are more of the kind that I can't do anything about, at least in the short term. Consequently, given an issue that is on my mind, letting it slide is the right decision more frequently than worrying about it would be, and so erring on the side of letting things slide seems to have the higher expected utility. Other people's ratio of things worth worrying about to things worth leaving alone may of course be different, and that may be one possible explanation of why my experience differs from Johann Hari's.

Now that I am no longer taking setraline, some of the emotional intensity of everyday things has come back, but (so far) nowhere near the original level. Likewise, putting something out of my mind requires more effort. Picture a line from "nothing is emotionally significant" to "everything is". Taking setraline took me from the latter end to somewhere closer to the middle, rather than to the other end. Now that I am no longer taking it, I can feel myself slowly move in the "everything" direction. This, again, is similar to what Johann Hari reports experiencing, and his article concludes:

It feels real. It feels human. It feels like me, after all these years.

For me it feels more like "old me", which would be the depressed me. However, as of yet there isn't a non-depressed (rather than anti-depressed) me to compare to. I hope that there soon will be.

P.S: I very much recommend Johann Hari's other articles about depression.

This post was offered to Depressed Academics by Evgenij Thorstensen.  It originally appeared on his blog Journey is return. It is published here under Creative Commons and Evgenij retains copyright. We thank Evgenij very much for this very interesting and personal post.