Monday, August 28, 2017

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.

Friday, August 18, 2017

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.

Wednesday, August 9, 2017

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.



Friday, July 14, 2017

Welcome Home! You're All Better?

I have been home from the psychiatric hospital for a week now and, at times, I am overwhelmed by very small things. It is a wonderful thing to be discharged from the hospital particularly when there is a good plan in place and one feels safe. That was certainly my experience. To be honest, though, it is not easy. One may think being back in the comfort of one's home would feel soothing and relaxing but for me, I have not consistently felt that. I certainly sleep better in my bed with my life partner by my side and I certainly like not being checked on every 15 minutes. The stresses that brought me to the hospital are still there although dulled. I am still experiencing weird occurrences of remembering different aspects of being in the hospital as brought on by smells or sounds. I need to be careful when that happens not to allow it to take over my thoughts in those moments as it will not accomplish anything positive.

I am still not feeling great so I still need to monitor my symptoms. That can be difficult at times. There are times when I feel like everyone in the entire world is texting or calling to check on me and it feels too enormous to respond. That then brings on tremendous guilt and its own version of negative self-thoughts. The truth is nothing about this is easy for anyone involved in my life.

My therapist had used the term that I needed "a break" and classified that as me going to the hospital. I told her this week that I could not continue to describe my hospitalization as "a break" as it was not as if I took off a few days to go to Canyon Ranch (I wish!) or took a few days at the beach. In my mind, it was not really about taking a break but rather keeping me safe. That was the bottom line and the reality of my hospitalization. That is the new language now that I will be using. While I may have also needed a break from reality, the intention of going into the hospital was to keep me safe, simple as that. I talked with my husband about this language and he agreed. I am learning a lot right now about how important it is to let others in. It was important to tell my therapist that I did not agree with her language and we were able to talk about it and come up with a solution. Also, just as important, I knew to bring this to my husband's attention in order for us to be on the same page. Semantics can carry a lot of meaning and it is so important for me to be understood. It is a very empowering feeling.

What would be helpful right now? Certainly hearing from my family and friends is important, I just may not respond if I am not up to it. It is not personal. I need to let others into my world a bit more as I have been unable to do so for months. This is very hard for me as I have not felt others "with" me in that emotional way in several months as my depression has fought against those feelings. Cut me some slack while I find my way. Yes, it is great to be home from the hospital but there is still a lot for me to acclimate to socially, emotionally and rationally. I need to try to give myself a break, too, during this process and for me that is like delving into the unknown. It scares me but I can intellectually see how important it is to my ongoing recovery.

My new medication is holding a lot of hope and during this waiting game of a few more weeks as it kicks in, I have chosen to have a couple of ECT (electroconvulsive therapy) treatments to help me get through. This was not an easy decision to make and although I originally told my doctor in the hospital I would not have more treatments as an outpatient, I came to it on my own once I was home for a few days. I felt empowered and terrified making this decision as there is so much anxiety for me before each treatment. It was helpful though while I was in the hospital and I need to give myself every opportunity to feel better. As my very eloquent therapist said to me this week, "it's enough already!"

Yes, it really fucking is.

Thursday, July 6, 2017

Hospitalization: One Week

A week ago today I went for my early morning ketamine treatment at the hospital and never left. The plan was set in motion last Wednesday. I needed to be hospitalized and I needed to be safe. I was not thrilled with the idea but was the one who made the call to push things forward.

I met with the doctor who always follows me when I am inpatient and we came to an agreement: I would have 3 ECT treatments before beginning my new medication which I could not begin until today. I had the ECT treatments which brought back a level of anxiety in me I would not wish on anyone. They seemed to help my mood though so I am holding on to that positive. The first ECT was difficult though as ketamine was used as the actual anesthetic which I had never had before. I had difficulty walking after the treatment and even required 2 counselors to help me in the bathroom which was one of the most humiliating moments of my life. I was shaky all day but was told that they would go back to using the anesthetic they used in the past for future treatments.

I went to groups, talked with other patients, counselors and doctors and took care of myself. It was a difficult 7 days. I was away from my daughter, whose only understanding of me being away was that I went somewhere to get new medicine for my depression. I missed her more and more as each day went by. My husband visited as did my parents.

Evenings were the most difficult for me. I felt desperately alone and ached to hold my daughter. I worried about the burden I had become to those I love. I perseverated about these things over and over again.

I knew I needed to be in the hospital and did not waste time going over that. I needed to be in a safe place with little responsibility.

I am home now and very happy to be here. I feel exhausted and a bit overwhelmed. I still need to take things slowly and moment by moment. No extra pressure needed here!

I began my new medication this morning which comes in patch form (MAOI). I pray for positive results. I only agreed to a few ECT treatments to lift me up enough out of my misery in order to hold me until this new medication kicks in. I am terrified of doing more because of my memory issues and because of the great anxiety that is conjured up prior to each treatment. Again, I am focusing on moments at a time right now while I transition back to home life.

I will say it again: depression is a mean and horrible illness and I will continue to fight it with everything I have. I am lucky to have my treatment team in place and my family and friends are right by my side. It will take me some time to thoroughly process the past 7 days and I know I need to give myself that time and opportunity. Honestly, it's a lot. A lot transpired during the past 7 days and while some was inspiring, some was downright terrifying and brought me to a place of pure despair and loneliness.

If you see me, if you want to contact me, just be positive and be supportive. I honestly cannot handle anything more or less right now. Just be real.

Tuesday, June 20, 2017

Ketamine Infusion #6

The past few days have been very difficult. I am almost completely off of my anti-depressant and I feel it (need to go off of it and then wait 2 weeks before starting new anti-depressant). I have been extremely irritable and anxious. I have had brief moments of brightening, especially yesterday when I picked up my daughter from the camp bus stop. As we drove home, I blasted "Dancing Queen" and we sang at the top of our lungs. That was a good moment.

I was definitely not looking forward to today's infusion. During the infusion, I was more "with it" and felt part of my surroundings. When the nurses and doctors talked to each other, I could hear them and felt I was in the room with them. It was the last 10 minutes or so, though, when the tears flowed and I felt alone and terrified. All of the negative thoughts that I have on a daily basis were magnified X1000. I sobbed thinking the terrible things I think of often they were just swirling in my brain all at once: I am a terrible wife, my husband chose the wrong woman to be with, my beautiful daughter is losing out with a mother like me, I do not deserve to feel better, and so on...

I was relieved when the infusion machine beeped signifying that I was done. As I came back to myself, the nurses kept checking on me, cleaning away my used tissues and reassuring me. I felt better as the minutes passed and was happy to be done.

The plan is to have one infusion next week and one the week after, to make up for the two weeks without an anti-depressant. As of this exact moment, I feel better, more aware, focused and my mood is definitely a bit elevated. Of course, I have little stress to fuel my negative symptoms today as I am home and on my own schedule for the rest of the day.

And so it goes...