Vignette: My head is screaming

And my feet are slowing down.

Tonight ended with an anxiety attack. I had been fighting internally to stay sane and not go to pieces for a few hours, sometimes successfully, sometimes losing the battle. For whatever reason I ended up wanting to get myself sane rather than actually talk to someone (say my wife, right next to me) about what I was feeling.

Towards the end of the evening, it felt like the inside of my head was screaming with the pressure of an anxiety attack that wanted to take over everything, to the point where it was getting hard to hear anything outside. Hard to hear my wife's conversation.

And then I started slowing down. I kept putting one foot in front of the other. I was even able to guide our path. But it was getting harder and harder, and my steps kept getting shorter and shorter. After outpacing me three-four times and not noticing for a while, my wife decided to walk behind me instead, to make sure she wouldn't leave me behind.

Now we're home. I've grabbed one of my anti-anxiety pills, for when I can't quite handle things on my own even if I try. One of the last-resort shouldn't-really-be-taking pills. Getting hold of water to swallow with was a struggle. Calming down my grimacing facial rictus to the point where I could put things in my mouth was a struggle.

And then things got better. I swallowed. I took care of our laundry. My wife unpacked our shopping. So of course, now that I can move again, the feelings of guilt are creeping back in. Guilt for making such a fuss. Guilt for not being able to control my feelings better. Guilt for all the sadness and upset this brings my wife when she has to see me suffering.

Guilt that doesn't help anyone with anything in any way whatsoever.

Vignette: frozen grin anxiety

Last weekend I had an anxiety attack. It came out of the blue and struck like a hammer blow.

We'd already gone to bed, when suddenly I start imagining that S doesn't want to as much as touch me. This happens a lot when I crash out. So I nudge away, and then my emotions just go into free fall. Horrified with myself and the audacity of daring to stay in the same bed as S, I sneak out. I sit down on the floor, trying to collect myself. I eat a banana because I realize, intellectually, that this might all just be blood sugar. And I take care of putting more clothes in our hampers, so it's all ready for the laundry early next morning.

Through all of this, I feel a fuzzy, ill-defined utter terror. I feel a deep and consuming despair. It gets strong enough that I can feel my face contracting into a grinning rictus of horror. It'd be hilarious if it wasn't so bad.

I sit there for quite some time. 10 minutes maybe. Maybe 15. Then suddenly, as if a light switch was flipped, my face relaxes, my whole body relaxes, and I am able to move again. I go back to bed, sit on the edge. S stirs, asks me how I am.

And I explode into hulking sobs. It takes me several minutes to even get any words out.

This one was scary.

Vignette: I think I am getting a baseline…

You know the saying about how when a noise suddenly stops is the first time you can perceive how loud it was?

That.

I have been now on a combination of fluoxetin and voxra/wellbutrin for about 2 months. And I realize thinking back on the recent weeks that I have been feeling… normal. Or at least what I imagine normal might be like.

Gone is the constant work trying to figure out whether there were any subtexts I should have picked up on.
Gone is the constant worry someone, somewhere might not like me and what I do as much as I hope they do.
Gone is the constant conviction that nobody, nowhere, actually likes me particularly much.

I feel now that what I observe is far more in harmony with how I represent it internally. People's emotional states match up better with what I think that they are.

Vignette: Doing So Well

I was doing so well.   Not super super well, but coping fine with everyday life.  In fact I have a pretty good way of telling if I am doing fine or not.  Do I feel guilty about posting to Depressed Academics, because of feeling I'm not depressed enough to be here?

Today I did ok at work, even had time for a nap, and somehow the afternoon and early evening passed, and I hadn't got a lot done, I found myself getting irritable, I was not happy, and I hadn't done the minimal family responsibilities I felt I should have done.

This is not a crash even in my terms - and my bad days are not that bad compared to many I have been reading about since starting the blog.  But that doesn't mean I'm delirious with joy about letting my family down.

Vignette: Toleration gone

Last night a friend texted asking to go for a run together at 6.15am.  My first reaction was "In your dreams, or to be more precise in my dreams."   But then I thought I have often wanted to run early, so let's see if it works.

Sadly I hated it.  I've run in the snow before (it was snowing) but somehow the early start took all the fun out of running a 10K in the snow :-)

After that all day I've felt very tired, so I won't be doing it again.

But I've noticed this evening my tolerance has gone.  I just react much more quickly to mild annoyances than I normally would or wish myself too.    E.g. I've been reacting to things on facebook with long comments and as a result just burnt the family's supper - which my wife is at this minute taking care of because I can't cope with it.   Fortunately I seem to be coping ok with not being ridiculously miserable about this failure.

It's not a big shock that being tired all day makes one irritable.   But it is interesting to get an insight into how fragile everything is, even when you think your mind is working generally well.

Update, 21 March

Barry sent me a link to a paper this post reminded him of, writing: "From my experience, it is important to take tiredness and irritability seriously."

Psychosocial determinants of recovery in depression, Fava & Visani, Dialogues Clin Neurosci. 2008 December; 10(4): 461–472.

Example quote:

"The majority of residual symptoms were present also in the prodromal phase of illness. The most frequently reported symptoms involved anxiety and irritability."  

I had to google "prodromal".  To save you the trouble, Wikipedia says "In medicine, a prodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur."

Vignette: This makes no sense

I'm not going to go into details here because they're irrelevant.

In writing my most recent post, I was reminded of something which made me google it, and I found the result depressing.  And for the next two hours I've been depressed and miserable.

This makes no sense and here's why.   The facts of the situation are that somebody who wasn't me made a perfectly rational decision 34 years ago, which most likely has no discernible effect of my life as it is now, and it's guaranteed that it has no provable effect on my life.

I know it makes no sense, after the first pang of a second or two I realised it made no sense, and yet I've been miserable for two hours.  

I suspect that if it had been my decision, I could have shouted to myself "I love SMBC!" and I would be ok.  Maybe I need coping strategies for other people's decisions.

Vignette: Re-reading text

Consider this text about high-functioning depression:

So high functioning depression is cool, right: I can do my job?  Well, not so much. This year I have been much happier than for a while.  And in the first few weeks of the year, apart from starting this blog with Mikael, I've got involved in helping the community save the youth theatre group my kids take part in, and am winding up to launch onto an unsuspecting world the most ambitious project of my career so far.   All of these have seemed far easier than I expected, perhaps because I haven't been worrying about them, just either doing them or not.  Maybe of course that is overconfidence, but in the past I have noticed a high correlation between when I'm confident and when I do my best work: not necessarily by best work technically but my most ambitious work.    

Tidied up today, but basically written a few weeks ago: I've been wanting to write about this for a while and finding it hard to publish. 

Just at the minute I'm not so cheerful as I was when I wrote that.  It's interesting to me that I read it now and think negative thoughts automatically.  I'm not actually that miserable now, maybe a 2 on my 10 point scale.   But I read that text and think "I haven't been writing many posts for this blog, that's rubbish."   And "this project is probably rubbish and anyway I'm not the right person to do it."

It almost but not quite reads like text written by somebody else. 

Vignette: Quick as a flash

What set it off?

Most likely just plain hungry. Raised stress levels. Feeling lonely with Susanne out on vacation, and not dealing with that very gracefully. Increasingly stressed once we DID get around to talking. Ended up with her being annoyed that I wasn't paying enough attention to all the glorious things she was talking about.

So afterwards I just crashed. I haven't dove this deep since I started medicating. I couldn't contain myself — I walked around my apartment, crying in jagged hulking sobs, getting some food started so I could try to do something concrete about it all. Wanted to call Susanne, to have her help me through it, but also didn't want to dump this on her lap.

And then. Suddenly. It all just stopped again. Right now, my eyes still burn a little from the tears, and I feel hungry and stressed, but the sobbing is gone. The absolute conviction I am a bad husband who deserves nothing of what I have is gone.

Quick as a flash it shows up.

Quick as a flash it leaves again.

Leaving a trail of emotional devastation in anyone who had to witness it.

Vignette: What's enjoyment again?

Up and down a bit. Well down.  Not particularly depressed, maybe about 2-3 on my 10 point scale of depression (actually it's a 21 point scale from -10 to +10, but negative numbers are mythical.)

Driving into work I listen to a podcast I enjoy.   And I'm sitting in the car thinking "why am I not enjoying it?"

Vignette: Over-interpretation

I just posted about this in a comment thread, but it strikes me that it is worth pulling to the front page.

One of the things I do when I am down is that I start over-interpreting. I start picking up on minute body language or subtextual cues from Susanne or other close friends. And then imbue the cues with monumental significance and upsetting emotional charge.

I'll see Susanne glance at something, or fail to glance at something, or grow distracted because — say —  she remembered something about her work schedule for tomorrow, or whatever. And in my mind, before I am able to do anything about it, this minute gesture. The glance, the distraction, whatever it was, has blossomed out into something hugely significant. In spite of everything she says and does — enthusiastically listening to me or talking about something — this subtle sign tells me her true emotional state: annoyance, anger, boredom; and I am the cause of it. She is angry with me, and I don't know why, but clearly she is — otherwise she wouldn't have given me that glance. No matter that I didn't do anything to anger her, or have any other signs that she might be angry — the subtle sign overrules all the unsubtle signs.

So I'll grow worried. Anxious. Sad. Afraid. Apologetic. Desperate for reassurances, for physical contact, for consolation. At the same time, especially if I am magnifying Susanne's projections, as much as I desperately crave reassurance and affirmation, I grow utterly terrified to articulate the need, to actually seek the contact I want. What if I just would make it worse? What if she gets angrier with me?

These are the times when I feel just as Depression Quest so beautifully put it in one of the character dialogues:

I feel like you forget I love you sometimes. 

These are the times I forget that Susanne loves me.

Nowadays, I am getting more and more tools to deal with it. Luckily, Susanne plays no social games. Ever. She is utterly unsubtle in her communication. And so, I am able to detect when this is happening by realizing that whatever I think requires for her to either be a telepath, or at the very least have some bizarre reason to hide her feelings under a façade, and instead communicate them through very subtle, almost non-existent cues. Since she never does that, whenever I react to a subtle cue, it is in fact my own brain lying to me.

More Finely Tuned Depression Detection Machine

This year - and I suspect not coincidentally following founding Depressed Academics with Mikael - I have been pretty happy. 

I can't see this corresponds with an increase in smarts or concentration or ability to get things done.  But it does seem to correlate with an increased level of confidence.  Things I would normally be scared to try seem easier to try at least, and if they don't work out, so what?

One of those things is the most ambitious project of my academic career.   It is - I'm not joking about this - meant to be what I'm remembered for and to change the field (of Computer Science).   Not quite ready to tell you what it is yet, sorry!

But suddenly I find myself thinking "I can't do this, I'm not the right person, it doesn't matter anyway", and thinking how convenient and simple life will be if I just don't bother. 

I don't really believe that, but even though I'm still pretty happy, it does seem to indicate my brain is becoming a more finely tuned machine to detect depression.   Not even knowing I had depression till it was diagnosed a few years ago, and now I can detect it just like that!

Vignette: Quick as a flash…

Quick as a flash it comes.
I'm worthless. The things I do are bad.
But Susanne just told me how good she thinks I cook.
It'll be bad. We won't like it. I'll have spoilt an entire huge pot of food.
She praised it. What am I on about?
And I'm ugly. I'll just curl up here and hope nobody sees me.
Y'know, I am curled up in her lap. And she's kissing me.
I just want to be alone.
She's offering me food. Drinks. Candy. Kisses. Kisses are welcome. Even now.
I'm not paying attention to our movie. I'm a bad husband. I'm inattentive.
I am lying to myself.

Quick as a flash it goes. I cried a bit. I whined a bit about how I especially wanted to be good and stable tonight. And all of a sudden, it is as if nothing had happened. My face is streaked with tears, but that's just moisture by now.

Vignette: Alone in a crowd

Valerie Aurora writes on suicides, and on the torrent of well-meaning advice that comes in its wake.

Read the blog post. She writes eloquently and with personal insight on how much of the advice that shows up — “Remember all those who love you”, or “Just TALK to someone” — can be counter-productive, even exacerbating a bad situation for some depression sufferers.

She also writes concretely on things that do help:

• Reducing the stigma of mental illnesses — this, by the way, is the main reason I write in this blog, the main reason I speak out as an academic with a mental illness. If we are invisible, how will anyone else realize they are not alone?
• Share information on trained assistance.
• Support and push for research into prevention and treatment.

There are things that Valerie describes that touch concretely on my own experiences.

Less than a week before I actually got started on my current treatment, I had a bad dream. It sounds oh so trite when I describe it now, but what I remembered from it when waking up was that my mother was disappointed in me. My brother was upset that I had not kept a promise. And my wife was disappointed in me.

So there I was. Awake. Sad. Upset. Weighed down by the accumulated disappointments. Well aware that these were things that happened in a dream, that had no concrete relationship to my family. My wife slept right next to me — but rather than reaching out, talking to her, seeking her comfort, I grew disgusted with myself. I was convinced the dream disappointment carried over to the real woman, and could not conceive of her tolerating my presence. So I sneaked out of bed. Cried for about half an hour before I could pull myself together well enough to get dressed and put on clothes. Barely managed to convince myself it was really a dream, and was not related to the real world.

Then she woke up. Overslept by well over an hour from what she expected to sleep. Her first words were

“But why did you not wake me up when you got out of bed?”

…and I just cracked.

…

She is my loving, supporting wife. She will drop everything to bring me back down to earth. And while I knew this even at the depth of my distress, I could not for the life of me remember the immediate implication: if only I were to talk to her, everything would have gotten better. Earlier. “Just talk to someone” does not help as advice here: I knew it. I thought of it as I was fighting with my own anguish. And it did not help me actually reach out, actually talk to anyone.