I need to get out of this minefield of depression holes. And I'm working hard to do so, but it often feels like I'm not making progress.
And the thing that's making me most worked up this morning is some trolls on the internet. Sigh. Not important stuff, not worth getting worked up about, and yet I still do it.
More importantly though. I had a psychiatric appointment yesterday, on a really awful day depression-wise. We talked about my depression levels, we talked about the newer medication we recently added for anxiety, we talked about my mood tracking app which I've been incredibly good about, and we talked about what is an acceptable level of mood. We are trying one last antidepressant. One that is a different class of drugs than the others I've tried. It's a last ditch effort, one we don't believe has a whole lot of likelihood to work (enough), but we need to prove to the insurance company that we really have tried a good gamut of meds and we're ready to call this treatment-resistant depression.
Treatment-resistant depression.
I'm sure most people can figure out what that means, but for more of a definition, as per Wikipedia:
Treatment-resistant depression (TRD) or treatment-refractory depression is a term used in clinical psychiatry to describe cases of major depressive disorder (MDD) that do not respond adequately to appropriate courses of at least two antidepressants.
As from WebMD though:
Some researchers define TRD as a case of depression that doesn't respond to two different antidepressants from different classes. Other experts say that a person needs to try at least four different treatments before depression can be truly considered treatment-resistant.
Interesting, no really clear definition and criteria for this. I think we're trying to be sure that we're following whatever criteria the insurance companies have, which is almost certainly on the stricter side.
For my experience, I'm currently on tries #4 and now #5 antidepressants. #1 for me increased suicidal thoughts, with little depression relief, #2 caused weight gain without enough depression relief, #3 was a branch into a different class of antidepressants, helped a fair amount but required adding an anti-psychotic to really help and eventually wasn't enough after Adam died, #4 is in the same class as #3 but also not enough relief, does very little (for me) for anxiety which is why we added a daily med for anxiety. Now #5 is another class of drugs, one in which I've not tried before. Some of the side effects could increase anxiety potentially, but hey, now I'm on the increased dosage of the daily med for anxiety, oh and I also have the increased dosage of the "as needed" anxiety med.
Jeez, I'm on a lot of meds. For reference, here's my daily meds currently, morning and night. My doctor actually apologized yesterday for how many medications I'm on. But it's not like it hasn't been necessary.
Let's get back to the treatment-resistant depression thing. So if we try this last antidepressant with little relief, then it's time for some more serious treatment options. The one my doctor would like us to try first, is called Transcranial Magnetic Stimulation (TMS). From the Mayo Clinic,
Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven't been effective.
It doesn't sound nearly as scary as the other option. TMS would be an intense treatment though during (45 minutes a day in the office, every day, for a month) but has the potential to remove all depression symptoms, which of course, sounds incredible. But then, it's less likely to work for someone who has depression which has lasted for several years.
The more scary treatment option, which has had some good success, is called Electroconvulsive Therapy (ECT). From the Mayo Clinic,
Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.
Honestly I knew very little about ECT before yesterday in the appointment, but it is terrifying enough that I am choosing not to read all about it until that becomes a more serious treatment option. My doctor told me with ECT, the treatment would be 3 times a week, for a month as well, but it basically takes you out for the day, obviously you can't drive to and from, and I would bet that I wouldn't be able to care for my children on those days. ECT has a common side effect of reducing memories made just before and during treatment.
Now, I know, I know, I may be getting ahead of myself in even discussing these treatments, but they were both discussed in rather serious detail in the doctor's office yesterday. I'm thinking they may not be too far off on the horizon, but again, I'll give this new antidepressant a fair chance. I'm two pills in only, but yeah the post antidepressant treatments are already scaring the shit out of me.
But we keep trying. Oftentimes Nasser is the only one of us who can hope for me; I rarely have that hope anymore when it comes to my depression. I suppose I need to expect that I will continue to live with depression, even if I end up trying TMS or ECT. If something works, it would be life-changing, but hoping for it can make my depression hit that much worse, when it inevitably hits.
Sigh, my hopeful message today is simply "we keep trying."
And some cute pictures of Buddy the cat to cheer us up a little. He really missed us when we were in Steamboat, although we had some awesome cat sitters checking up on him almost every day, and we missed him too. He gets a bit worked up when I wear long skirts apparently and wants to play underneath them...
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