Month: August 2017

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Recovering from Major Depression and a Bad Day Do Not Mix Well

I did not sleep well last night after working a full day and thinking about my baby starting 2nd grade today, so I must begin with that. My recovery from my latest depressive episode has been what is classified as “normal.” A few good days and then a bad one. A few good hours and then a few bad ones. Today has been what I would characterize as bad. I was exhausted when I woke up but was so enthusiastic to share in my daughter’s excitement to go to school.

From there I had to bring her medications to school and when I walked in the office I completely forgot the nurse’s name even though I have known her for a couple of years and have been in touch with her quite often during the years. I could not believe it. I remembered it once I left. As I got to my car, I dropped my phone, which happens often, only this time the front was completely cracked. Fantastic.

I stopped at the supermarket for a few things and saw someone I know but, again, I could not remember her name so I pretended I didn’t see her and kept walking.

From there I went home and took a walk thinking the fresh air would help. I heard my name from someone walking toward me and she hugged me and we said hello. I had no idea who she was and after a minute of talking and figuring out who she was, I could not remember her name. In fact, it took 10 minutes more for me to think of her name. I felt terrible.

I had time and decided to get a manicure since I had money from a discount to use. That went well. Then I came home and read an email from the school nurse that the doctor’s orders were not with my daughter’s medications. I did not notice as I thought my hubby had put them in. I then faxed them over to her. After that I went to yoga. I was able to focus on myself with the intention of being nice to myself. That was a very good hour. I then went to the Verizon store to deal with my phone. $149 later and I will receive my new phone tomorrow. Got home and took in the mail. I opened a plastic package with a scissors and hit part of my nail and therefore ruined the manicure on that finger. I started to cry and yelled out loud how this day sucks. I wasn’t planning on leaving the house again for the day but I went back to the nail place and they fixed the nail.

I am home now and I am not going anywhere. I am DONE. What is the point of me sharing my bad day? Everyone has bad days where it is as if everything that could go wrong does go wrong. There are feelings of frustration and exhaustion. This is a lot harder for me to tolerate right now. I am exhausted after yesterday and last night so that added to my difficulties today. The 6 Electroconvulsive Therapy (ECT) treatments I had in July have brought on those cognitive side effects that can take months to decrease in severity. I have trouble finding words at times and my memory is impaired (cue the difficulty with names today). These frustrate me to no end. The other “little” things like breaking my phone, having to take time to fax medical forms and ruining my manicure are just those dumb annoying things that happen. Think about how annoyed you would be if those “little” things happened to you…now multiply that by about 1000 – that is how I experienced those “little” things today.

I have said this before and I will say it again: recovery from a major depressive episode is not a straight line and it can take months. There is no question that I am feeling better and functioning better but there are days like today that remind me to take it easy on myself. It also reminds me that I should not be filling my days off from work with too many errands. I need to rest and relax. I am able to do that now without feeling complete anxiety and I must do this more. This is not up for discussion. If I do not do this, I am simply not helping my recovery and that will not benefit me or my family.

So, it was a crappy day and even though a lot of tears were shed, I made it through. I can’t wait for my daughter to come home from her first day of school and to hear every detail. I also can’t wait for my husband to come home so the three of us can have picnic dinner while watching the Food Channel (my daughter’s latest obsession!).

Tomorrow is another day. Tomorrow I vow to take care of myself a bit more than I did today. Tomorrow is a brand new day and I will take it on with more self-care and more patience.

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What’s Good for the Body is Good for the Brain?

I have sacrificed my body for the sake of my mind and I have mixed feelings about it. I have taken medications to combat my depression since I was 19 years old. They have either helped me feel better or they have made me feel nothing or they have given me stomach issues, a severe dry mouth, headaches, anxiety, irritability, insomnia, weight loss, etc. It has truly been luck of the draw. Additionally, I have had treatments that were quite invasive and terrifying at times.

ECT (Electroconvulsive Therapy):  I began ECT three summers ago while inpatient on a psychiatric unit. I was as scared as I have ever been about anything as I began these treatments but I was desperate to feel better after suffering for months with a severe major depressive episode that was medication resistant. I did 24 treatments over the course of 5 months and it brought me out of my depression and kept me well for several months. Unfortunately, another major depressive episode took over which prompted another course of ECT. I had 21 treatments over the course of 5 months and was well for a few months after this. The aftermath of having ECT consisted of short-term memory loss where I was not be able to find the words during conversations and would think a thought only to forget it seconds later. This went on for years and while it decreased in severity over time, it still lingers. Additionally, the experience itself of having ECT has traumatized me, not because I received poor treatment, on the contrary my doctors and nurses were stellar and I always felt safe and cared for. What was traumatizing was going under anesthesia for each treatment and seeing other more severely ill patients. These memories linger and there are times when I need to discuss it with my therapist in order to move on.
I also underwent 6 more ECT treatments just over a month ago which was prompted by another psychiatric hospitalization as a result of my 4th severe depressive episode within 3 years. My memory issues and word-finding difficulties resurfaced but not to the same extent as in previous treatment cycles.

TMS (Transcranial Magnetic Stimulation): In the fall of 2016 I began a new treatment during my third major depressive episode which does not requite anesthesia (bonus) and allowed me to drive myself to each treatment. Magnets are used while pulses knock on one’s head for about 40 minutes. I underwent treatments five days a week for 6 weeks and then had maintenance treatments before finishing after a total of 8 weeks. I would sometimes have mild headaches after a treatment but otherwise I did well. I began to feel better after 4 weeks of treatments and was brought out of this 3rd episode. Unfortunately after only a few months, I was overcome by another major depressive episode. I began another course of TMS but after a couple of weeks of treatments my thoughts started to change and not in a positive way. My therapist noticed and after consulting with my psychiatrist it was deemed in my best interests to stop all TMS treatments.

Ketamine Infusions: Directly from there, I began ketamine infusions. I began with four treatments which consisted of receiving an IV infusion for 40 minutes. I ended up having 6 treatments where the one positive effect was feeling more focused but they did not help my mood. They also were emotionally painful during the treatments as the medicine heightened all of my negative thoughts and feelings which resulted in some traumatization. After my last infusion I was immediately hospitalized on the psychiatric unit. That’s when I agreed to a few ECT treatments as I had to wait while my old anti-depressant was being washed from my system before starting my new anti-depressant which comes from a class of medicine I had never tried before due to dietary restrictions. Luckily the form of this new medication is a patch that I change daily and because it is transdermal and it is a lower dose I do not need to worry about the food restrictions.

So what has my body been through in just that last 3 years? I have had numerous induced seizures, magnetic pulses to my brain, a hallucinogenic and many medications all of which have affected my brain and every other organ and part of my body. When it comes to psychiatry there are many mysteries that remain but I am sure of a few things most of which involve having the best and most appropriate care:

1. I have received the best care possible from my first therapist in New York City to my current therapist whom I have seen on and off for well over 20 years. My current psychiatrist and the doctors, nurses and social workers who helped and guided me these past few years are simply the best of the best.
2. My body has undergone a lot and there have been consequences, medically and emotionally, but I ask myself was it all worth it and I honestly can’t give a straight answer. I wish I responded easily to medication and I wish I did not have to have any of these invasive treatments but the bottom line is this: there is no cure for depression. What choice did I really have, especially when I have a husband and daughter to consider, not to mention myself and the rest of my family and friends?
3. I can’t say I would do it all the same if I had to do it over but I would still trust my doctors just as I have over the years. Even while at my sickest, I would only tolerate excellence on the part of those who treated me. My therapist who probably knows me better than anyone else is the best of the best, hands down, no question. She is highly intelligent, witty and can read between the lines like no one else. With each depressive episode over the past 3 years she has cared for me in the most humane and attentive way as one would want to be cared for during such a threatening illness. The nurses and doctors in the ECT suite were warm, friendly, smart and always tried to create a sense of peace while I was internally fighting my anxiety. The psychiatrist who follows my care whenever I am inpatient is quite brilliant but he is down to earth and he not only works with me, he considers me as a team player. My outpatient psychiatrist listens to me and takes into account my experience and never takes over as the “expert.” I would not have it any other way.

While every inch of my body and being has been through more than anyone should have to endure I am now recovering and as I am I am reclaiming my body and soul in a way I haven’t before. I am taking yoga classes that incorporate mindfulness and after only a couple of weeks, I am starting to feel more in charge of my self, more like the captain of my being. It makes me feel strong and forces me to stay in the moment when that can be very difficult as I try to deal with thoughts and memories of the past 6 months of a horrific illness. By no means am I saying that yoga is my savior but for now it feels good at a time when not much has felt good. My body and brain have suffered unimaginable terror and it is now time for a well deserved break.

I can’t say what the future will hold in terms of my depression but for now I am taking over and I am the one making the decisions regarding my being. This is what is good for my body and my brain.

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Caution, Caution

Five weeks later, after a week in the psychiatric unit and several ECT treatments and new medication, I have begun to feel better. What exactly does that mean? Well, for one thing, I am thinking more clearly than I have in about 6 months. Thoughts are clear and follow a pattern and for the most part are not negative toward myself. I can also be and feel more involved in conversations and feel present in social situations as well as at work. Time will go by and instead of me feeling misery with each passing second, I surprise myself when hours have gone by without my tracking them. My mood is definitely better which was sparked by the clearer thoughts. My mood is more reality based and not as negative toward myself. I can be “with” my husband and daughter and really be there. I know they both feel the difference, just as I do.

With this renewed sense of clarity though comes with it a review of the past 6 months and realizing and recognizing how ill I was. Thoughts occur to me that are deeply painful and there are moments I need to write them down as part of processing them. My therapist says I will need to let them go but since it’s only been a couple of weeks of beginning to feel better, I need more time. I am not ready to let go yet as it is important that I process certain thoughts and occurrences in order to be able to let go and move on. Because I was so ill, it was difficult to understand or even acknowledge my thoughts when I was in it. I knew I was quite ill but at the same time it became my “normal.” As I come out of it, the realization of how confused and painful my thoughts were is overwhelming at times and I need to let myself process, cry and mourn. I do feel I am in a period of mourning–the time that was lost and the reality of what this horrid illness did to me, physically and mentally, represents a huge loss.

It is a lot to absorb and I think it is vital to those around me to understand that just because I have had an upward swing these past 2 weeks, and I do believe that will continue due to this wonderful new medication, I am currently enduring something very deep and existential the likes of which I have not experienced before and if I did, I simply do not remember. There is no magic act where I have been cured and all is wonderful now. I have to find my new normal, just as I have after each of my other episodes of severe depression. This is a true process and I know I am on the right track, I just think it is important for those around me to understand that this process is ongoing. I may not have those ongoing feelings and thoughts of harming myself but I am not cured. They sometimes lurk in the background and luckily I now have more strength and understanding and can talk to my therapist and psychiatrist about them. I am very well aware that I am at risk and luckily I have a husband who is on guard and a therapist and psychiatrist who also are taking stock of what I have been through and where I am at now.

It is a good place to be, certainly a better place than the past 6 months. I have endured treatments that were invasive and, at times, terrifying. Transcranial Magnetic Stimulation (TMS), Ketamine Infusions and Electroconvulsive Therapy (ECT) held their own stress and hope and represents how I have and will continue to jump through those hoops that my therapist, psychiatrist and other doctors at Yale present to me. I am a good patient and I always have been. I listen and I advocate, even at my sickest. It is a true collaboration and I consider myself extremely lucky to be part of this amazing collaborative team; not only that but I am considered an important part of this team. I know many people who do not have this experience and feel on the periphery of their treatment team which, in my mind, is a sin. I know how lucky I am and would not be where I am now if I did not have a respected place within my own team.

I will give myself the time needed to process the many thoughts and memories of the past 6 months that come up. I will talk things through with my therapist in order to understand and course through these memories and thoughts so I can let them go. I know I will need time to get there and I know I have the support of my family and friends as well as my therapist to get me through to the other side. I will always have memories: certain smells and sounds may bring me back to those moments immediately before I was given anesthesia for an ECT treatment. I just need to allow them and talk about it in order to process it if I need to and/or let it go. This is easier said than done right now which is why I will repeat the importance of doing this on my own time. The past 6 months have been pure hell and has affected my family and friends but as my therapist has said to me numerous times, it affected me the most and the worst: I was the one with the severe depression. There is much to process, feel and mourn and I know I will get to that next stage of letting go within my own time frame and with the support of those around me.