some things are different, some the same, some turn over, some don't change, time and music all forgive, and in the best of friends the spirit lives

Wednesday, 01/11/17, 8:29am, 10:14am

I was about to say "not much to update", but that's not true. I am still in a minefield of depression holes (as it feels), I cry literally at almost everything. The latest med situation has officially ended, as of Sunday. This med I was on has this low chance of causing a rash, which as it turns out, can become fatal. Wow, real great, right? But low chance, right? Well, I noticed a few rashy spots on my midsection on Saturday evening, so yeah. Medication no more.

So what's next? Transcranial magnetic stimulation, or TMS, hopefully. I did mention this one in the past, but wasn't sure if we'd get to this point or not. And here we are. Sorta. I haven't even met with the doctor who does this treatment yet, don't even have an initial consultation until after my doc has chatted with him and they all agree I'm a candidate for this treatment. Hopefully they don't decide that I'm not.

From what I understand, this would be an everyday (Mon-Fri) treatment for about a month or so. But some people are literally cured after having this treatment. So that's pretty incredible. And as described from the Mayo Clinic, "You can return to your normal daily activities after your treatment. Typically, between treatments, you can expect to work and drive." And that's really good, especially as compared to ECT.

And yet, I'm terrified. Maybe because this is a newer treatment, and maybe it's because I've read in too many places that the treatment doesn't necessarily work as well for people who've had depression for several years (yup, that's me), and maybe it's because this treatment is very different from things I've tried so far, and maybe it's because of all the unknowns. I suppose I don't even know for sure if, or when, I'll start the treatment. I have the right to be scared, even if there's hope in the situation too. There's no reason to beat myself up over feeling scared. But I do that too, thanks to the depression.

My therapist ran through a list of depression symptoms this week to help remind me that all these symptoms I have are truly due to the depression, and not my fault. So we're going to repeat some of those here.

From the Mayo Clinic, the intro on depression:

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychological counseling or both.

Hah, yeah, I suppose from that I'm not "most people". Ok so here's the symptom list:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren't your responsibility
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

Yup, yup, got pretty much all of them. woop dee doo. But it really helps to recognize that all these things I'm feeling are truly symptoms of my illness. I feel like I'm constantly reminding myself that yes, this is an illness, this is not my fault. And there's this really annoying part of my brain that is constantly like, this is your fault, you are a failure. Blech, I hate those thoughts, and I really do try so hard to fight them and to counter them, like with affirmations, and try to focus on the thoughts I do want, like with mindfulness, but it feels like a constant struggle.

And with the state I've been in lately, I've felt like I'm constantly complaining about this, and then that makes me feel like a burden to others. UGH, I'm NOT a burden. Sigh. I feel like these thoughts pop up, and my response to my brain is always, shut the fuck up, Alisa. I have such horrid self-talk. Nasser reminds me that at least I'm recognizing the negative self-talk more, but it still feels like a failure when I see it but can't seem to change it. As I've learned in therapy though, it all takes a lot of time and a lot of effort to change those thought patterns.

As usual, we're working on it, and I've really had a lot of support. Whether it's emails or texts of kind words or forwarded articles, or meals (omygosh a friend of mine set up a meal train for us right now which is absolutely incredible), or hugs, or just love. I am eternally grateful to every person who has ever supported me in any way, even if I have a hard time right now showing my gratitude.

There are still options, we are not out of hope, and my illness truly is NOT the end of the world. I know that, and I know I have so much in my life to be grateful for, and sometimes knowing that simply causes me to self-stigmatize even more. Blech. Blech. Blech.

It's ok. Or at least hopefully it's gonna be ok.

Again, it is an illness, not a weakness.

Here was me the other day on a tough day, with an attempt at a smile. I don't show my eyes to many lately, if I can manage to hide them, because it seems they constantly show recent crying. Oh well.

and some just clap their hands, or paws or anything they got now

Wednesday, 11/30/16, 8:15am, 9:37am

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...

teach your parents well... and feed them on your dreams

Tuesday, 08/23/16, 11:24am

I've gone back and forth on what exactly is my diagnosis. To be honest, I've never truly had a doctor independently diagnose me. I've always come to them and said, I have depression. A lot of the diagnosis is self assessment anyway. It really makes mental healthcare confusing.

I suppose in most cases, people present fairly clearly as having depression, or schizophrenia, or bipolar disorder, or obsessive-compulsive disorder, or anxiety, or alcoholism. But when you have multiple things going on and a variety of symptoms, everything gets a little murky.

I know that I often exhibit signs of depression as well as anxiety, although probably with fewer occurrences of anxiety. I spent some time reading definitions in Wikipedia and WebMD about these, but haven't felt all too satisfied with how everything is categorized. Even reading technical definitions of what is categorized as a "depressive episode" is a bit triggering.

I need to stop here and correct something that I've been writing for some time. I've been referring to "depressive episodes" for quite some time, here, here, and here, for example, but I've had the technical definition wrong. For me, what I've been calling depressive episodes, I'm going to start referring to as depressive breakdowns. For me, it's any time where I have debilitating feelings of worthlessness types of feelings which prevent me from being the person I want to be. Sometimes these events can affect me for half an hour and then I can recover (but that's rare and I think some of those times are the start of anxiety attacks, with some crying to relieve the buildup of stress). But sometimes these events affect me for an evening or a whole day or several days.

Here's the actual definition of a depressive episode, courtesy of WebMD:

An episode of depression involves feeling sad or blue, or getting no pleasure from life, plus at least five or more of these additional symptoms most of the day -- nearly every day -- for two weeks or longer:

Symptoms of depression:

• Loss of energy
• Feelings of guilt, hopelessness, or worthlessness
• Loss of interest or enjoyment from things that were once pleasurable
• Difficulty concentrating
• Low energy
• Feeling physically or mentally sluggish or restless and agitated
• Increased need for sleep or inability to sleep (insomnia)
• Change in appetite causing weight loss or gain
• Thoughts of death or suicide or attempting suicide

My therapist pulled out the DSM definition yesterday so we could discuss it together. I certainly present many of these signs when I'm feeling depressed, and some often, but I don't really meet that time criteria
regularly. So I suppose I don't really have chronic major depression. But maybe chronic depression (without the major) is more correct? That doesn't seem to be a true scientific term.

It's probably another discussion I should have with my psychiatrist.

Regardless, whether or not I have major depression or minor depression or some anxiety, a lot of the treatment is the same. It makes sense for me to be on an anti-depressant and to have some anti-anxiety medication for when it's needed, and it makes sense to be seeing a therapist regularly to work on cognitive behavioral therapy because that's been shown to help with both depression and anxiety, and it makes sense to be practicing mindfulness and exercising because again they help with both.

So does the exact diagnosis matter? No, but I do apologize for messing up the verbiage I use sometimes. I will try to start referring to depressive episodes correctly and will start to use my own non-scientific terms perhaps.

Today I ran for just under a mile with my littlest running buddy, TK. He started kindergarten but only goes every other day (for 2.5 days of each week), so he is home today.

We also prepped apples together and there is some applesauce cooking in the crockpot. (As much as it looks like he is about to cut off his fingers here, there were no casualties. And at least it's a special kid knife that's not nearly as sharp as our regular ones).

And since I'm on a picture kick, we have some nice ones of the first day of school yesterday, both before,

and after school.

2.5ish more hours until we get RG from the bus. Gotta be done with the blog and get moving on lunch, maybe some puzzles and practicing the alphabet, and perhaps a shower.

take my hand, we'll make it I swear

Friday, 06/17/16, 5:12pm

I suffer from depression. Major depressive disorder. My long-term readers know this, but for anyone just joining us, there it is. If you'd like to read about how my disease manifested, go here.

A friend passed along a video called "What to say to your friend who has depression?" This is the absolute best thing I've seen on this topic. Watch it. Watch it right now.

The first time I watched it, I started crying. Because every single statement spoke to me. I often feel like a burden, a failure, not enough.

I think this is a video everyone should watch. If you haven't already, click it. You don't need sound, and it's short. If you did watch it, maybe watch it again. Because we need to learn the language for speaking to people with depression. Those with mental illness. Most people have trouble knowing what to say to someone who struggles with something unknown to them, whether it be grief, physical illness, mental illness, sexual abuse, domestic abuse, etc, etc. So instead we say nothing. Maybe that's better than saying the wrong thing, but saying nothing doesn't show the person that you care. Every one of the statements in the video shows that person that you care.

If you've been following my last couple weeks, they haven't been going so well. Depression- mild at times, rather worse at others, but quite continuous, and fatigue- I actually went to a primary care doctor the other day about it and they're running bloodwork. I've been grieving my brother-in-law, but things have felt even more off. There's some things going on with medications right now, as I talk about here. Nasser and I have been discussing the possibilities of changing my anti-depressant around, if the bloodwork tells us everything's good, and if we rule out the new birth control, and if I'm just not improving still. We're talking at least 6 weeks from now, and if my depression goes on that long......... oi.

My depression isn't typically like this. It's typically well managed by my medication, therapy, mindfulness practice (agh, when I do it!!), and regular exercise. I get depressed, even with all that, but it's usually "short" (a morning, evening, a full day at most). I call those "depressive episodes" and they do range in severity. Sometimes I can break down in an anxiety attack (oh yeah, I seem to suffer from that too) for 5 minutes, take an anti-anxiety pill, and I calm down within 15 minutes. Booyah. But if the anxiety leads to mild depression leads to severe depression, pack it in for the night. But again, "the night". My depression doesn't usually last for 2.5 weeks straight. I'm definitely improving now, but not in the clear.

And, again, maybe it is just the grief, but the primary care doctor mentioned that my psychiatrist could adjust my meds during this time. And that thought hadn't really occurred to me before. So there's another possibility to look into. It helps me to have these potential hopes to focus on during this depressive 2.5 week rut. It helps me a lot.

Today I drove Nasser and the boys to the airport so they could go to Chicago. Nasser is staying through the weekend, but the boys will be visiting with Grandma for a week. Although not quite, because I fly in for a whirlwind trip Wednesday and Thursday, and I will see the boys then. They don't actually come home until Sunday, June 26th (agh, the same day as my triathlon!). Then we all fly to Seattle the next day. Busy couple weeks, although I'm going to have a lot of time on my hands this next week. Theoretically I'm supposed to be "tapering" for my race, I've got some serious workouts to get in and a big decision to make about my triathlon. I still haven't decided if I'm doing the sprint or the olympic distance. I went to Stroke and Stride at the reservoir last night; I did the shorter swim course (since the longer was a second lap and I despise lapping in open water for some reason. no problem lapping in a pool though, I'm weird) which was 750m swim and 5k run. Now it was rather hot last night, like still 90deg or close to it when we started. But man, it was tough. I think I was one of two people who brought water on the run (that made me feel like a wimp!) and I finished it before I started the last mile. Of a 5k.

I'm glad I went to the Stroke and Stride, but it really made me question my ability to do the olympic distance. My sister, Audra, recently gave me a lot of encouragement on it since I can certainly do each of the distances on their own, but I do think this next week will really decide it for me. I am so grateful to have so many days to focus on myself, ummm, maybe some working on the house and yard as well, but the heat wave we've got is not going to help with the outdoor stuff. Maybe I'll take long naps during the day, and do lots of later evening/ early morning activities.

One more thing about the Stroke and Stride. You have to understand, this is in Boulder, Colorado. Many of these people were wearing Ironman gear; you know, Olympic athletes train in Boulder. I felt rather out of place to say the least. A woman passed me by, with an Ironman tattoo on her calf, and told me "you could run a marathon like that. you look strong!" Yeah, that helped my mood a little.

whisper words of wisdom

Sunday, 03/06/16, 12:51pm

I recently blogged about the seriousness of my depression and how I hadn't really thought about whether or not I'm a "severe" case, etc. Well I think I am starting to figure it out.

I'm pretty sure I've been diagnosed in the past, not sure what I am now, with therapists (for billing purposes to insurance) as having "major depressive disorder". I once questioned whether or not it'd be considered "major" or "minor", more wondered out of curiosity, but didn't get much understanding from the therapist at the time (this was my very first therapist who I never really clicked with. To be fair, this was also before I started seeing a psychiatrist to truly manage my medication).

I think I understand it better now. I would agree with the diagnosis. Major. Depressive. Disorder. Doesn't that sound daunting? (Some of that is the stigma talking, please notice it, dear readers).

I found some statistics on the NAMI (National Alliance on Mental Illness) website which helped all this make a lot more sense. I've heard difference statistics in different places, but these I would believe are close to accurate. They say: "If you have a mental health condition, you're not alone. 1 in 5 American adults experience some form of mental illness in any given year. And across the population, 1 in every 20 adults is living with a serious mental health condition such as schizophrenia, bipolar disorder or long-term recurring major depression." (source)

I've always put myself in this category of 1 in 4 or 1 in 5 people are like me, but that's only in a given year. Many of those people have what I would call "acute mental illness". That's not what I have. I think I have long-term recurring major depression which manifested less than 10 years ago, and maybe I just had an acute episode of depression in my pre-teen/teenage years. (Yeah, I'm self-diagnosing here).

As I sort through social and news media portrayals of mental illness, I've been frustrated with various terms, words like "fight" and "overcome". We talk about "being in recovery", and I've mentioned before that I don't understand what this means. This makes sense if we're talking about someone with postpartum depression. This would be in a case where perhaps someone could take medication for a "short" (I would call that less than 2-3 years), most importantly, temporary, length of time. Now I'm not saying that postpartum depression is less severe, but I'm focusing on the point of it being temporary (for many cases at least). This is why we can talk about "being in recovery" with these cases. 

I can't talk about my illness as "overcoming" unless it's overcoming an episode. I can't talk about "being in recovery" because it's continually proven to me that episodes do occur on a somewhat regular basis. To those that don't understand about chronic mental illness, in which the symptoms do continually recur, it may sound like I am "giving up". Or I have a negative attitude about my mental illness and therefore it keeps happening. What I do know is that when I've gone a longer stretch without an episode, I fall harder when it does hit. I say things to myself like "I've been doing so well lately. How did I screw it up so bad?" It feels like a much bigger letdown because when I go a long stretch, I think I continually allow myself to hope and tell myself that I'm doing "better". But maybe if I accept that I have this disease, it's almost easier to get through a tough episode/evening/day/week. Recently, when I was "getting my period", I never actually fell into a full episode, even though I had a rough patch for a few days. I made it through without getting too too horribly into the hole. (Although perhaps to my readers, it sounded worse than that).

While I appreciate seeing stories in the media about mental illness, I think we could do a better job about reporting on chronic mental illness. Many people live with mental illness most or all of their lives. And I think our discussions do a disservice to those chronic mental conditions which cannot be "cured" (at least with the current treatment methods) and these people never are "in recovery" to the extent that widespread belief is about "recovery". At least when I hear the word "recovery", I think it's considered to be long-term.

I don't get that kind of recovery.

I don't blog about this today to be a downer. But honestly, to me I'm being realistic. And I think this post is a form of acceptance for me. I accept that I suffer from long-term recurring major depression. I accept that my disease is chronic and that I will forever require treatment.

It isn't weak to accept mental illness in one's self. I find it empowering, actually. I can name the condition that I have and somehow that allows me to be less afraid of it. Understanding the treatment options and seeing the benefits in myself, I also understand that having a mental illness is not the end of the world. Sometimes it feels that way, but accepting the condition helps me to remember that with this condition comes periods of "recovery" we could call them. Plenty of times in my life where I'm not fallen down the hole.

And that's something to be grateful for.

Just to be clear, today is a good day.

On a happy note, I am going to attempt an easy workout next. Maybe just some spinning on the stationary bike while I watch a show, or some walking around the neighborhood, or maybe some yoga, or maybe some combination of the above. I hope the ski injuries aren't bothered by it. But again, I totally accept that the ski fall was my fault, and my risky skiing. I learned some important lessons about speed on the ski slope- I'm lucky I didn't hit anyone on the slopes when I fell because then I would have caused injury to someone else, and I'm lucky I didn't get more seriously injured. Pretty sure there's nothing long-term in my injuries, but I'm being careful, I've found that ice helps the pains, and I'm taking it easy in the recovery.

Buddy the cat enjoyed hanging out with me while I iced this morning.