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Re: depression, etc.

Posted by Elizabeth on February 3, 2002, at 23:42:49

In reply to Re: depression, etc. sid, posted by Elizabeth on February 1, 2002, at 18:41:55

> For the past 3 months I've started to talk about my (major) depression in the past tense.

It's a great feeling, isn't it?

> I feel it's far enough from me not to be scared all the time and not to constantly ask myself how I'm doing (like someone with a heart disease would check his BP or pulse all the time).

A hypochondriac with a heart disease, anyway!

> I think it's dysthymia I'm left with, although even that seems to be lifting.

I think that what I need right now is mostly to get my life back on track: depression has been incredibly disruptive to my education and my career plans. So now I'm trying to get on track, to salvage some scrap of those plans. A big roadblock is my inability to drive; unlike Boston and New York (and even, sort of, Jersey), this North Carolina town doesn't have any public transportation to speak of. My difficulties controlling my attentional focus (maintaining focus, or shifting it -- shifting is actually the bigger problem) have prevented me from being able to drive safely enough to get a license (just one screwup is all it takes). I haven't had a seizure since September, but that's something that's been at the back of my mind too. Anyway, I've gotten to the point where I'm just not improving with practice; the limiting factor is my attention problem. I worry about how this would affect my ability to work, too. But that's sort of moot at the moment. I could go back to Boston, but I'd need some money to pay the rent until I could find a job (rent in the Boston area is painfully high); so I'd have to work here for a while at least.

> From time to time, I find myself feeling as happy as when I was about 12 years old, and that was before the dysthymia. There is more joy and potential for craziness (in a good sense) in me now. I can have fun again, which I have not had in a very long time.

I think that a lot of people don't appreciate the effect that emotional blunting can have on a person. It is a joy to be free of it.

> I could function again, but nothing mattered much to me.

I was more functionally impaired by the anergia-anhedonia, I think. With the buprenorphine, I'm pretty much back to normal. That's why it's so frustrating to be held back for want of a driver's license.

> I moved back to where I grew up (the previous 8 years had been spent in foreign countries) and last summer I spent time with old friends, swimming on hot days, playing ball, etc... things I would do before I ever know what depression was.

I'm starting to get back in touch with old friends as well. It's nice to be able to hang out and not just be a downer. Being in NC is kind of tough because I can't get anyplace on my own, but it's also sort of a vacation, and of course a chance to be with my family.

> I never thought about it doing me good, I just went swimming one day and remembered how I was before. Somehow I found part of my old self back in that swimming pool, with pleasant memories of summer vacations.

When I was "down" -- when I had untreated residual symptoms, that is -- I found I wasn't able to enjoy things like that. I'd visit friends but I couldn't think of anything to talk about with them. I'd try going swimming (I like to swim too) but it just didn't do anything for me. Even reading, which has been a favorite passtime ever since I learned how (i.e., as long as I can remember), didn't come easy; I'd keep reading the same sentence over and over without really grasping the meaning, and I couldn't get myself interested regardless of what the material was. It's a thrill to be able to enjoy reading a good book or going for a walk or being with friends now that I can. I've even reviewed a bit of math and chemistry.

> Yes, I know. I find it weird that I am doing so well, although before starting the meds I was on an upward trend. So I am not sure if it's just the upward trend continuing or if the meds are doing me some good already.

How long have you been taking the 75 mg? I've been on 225 for a couple of weeks.

> I knew I could feel better and felt brave enough to try meds (I was and still am sh** scared of them).

Why scared?

> I felt strong enough to deal with the side effects, stick to a plan, discuss it with my doc and defend my point of view if I needed to.

Being able to advocate for yourself as a patient is crucial, and this creates big problems in doctor-patient relationships (especially in psychiatry, where patients are particularly unlikely to be able to speak up for themselves).

> As it turns out, I found someone I agree with a lot without arguing, so at least that's going well.

That's ideal. I find that so many doctors want to fight with me about the medication that I'm already taking, that I know works, and that I need, which is frustrating.

> I am not feeling 100% yet, but things are improving. I know that 150mg+ of Effexor XR is needed to treat anxiety, so I guess we'll get there at some point.

I don't think that's always true; it's possible that 75 will prove to be enough for you. Remember that generalized anxiety is a really broad diagnostic category; people with GAD are a very heterogeneous group.

> ... I FEEL like moving, like exercising, I am not forcing myself to. That's a major thing. My body is toning up, I lost some weight (still lots to lose, but I don't focus on that for now), and that's making me feel less tired and less prone to sleep too much and eat too much.

I'm eating more now that I'm feeling better, but I'm also more active. It's nice. One thing I miss about Boston is that I got to walk around a lot (I was about a 30 minute walk from Harvard Square and 15 minutes from MIT) -- there's not really anywhere I can get to on foot from here.

> As much as during the major depression I seemed to be on a downward spiral and after I seemed stuck at a less than happy place for a long time, now I seem to be on an upward spiral. I hope it lasts!

I'm still struggling uphill, but that's more a lifestyle thing than a mood thing. (Still, I wouldn't say I'm on an "upward spiral!")

> I read about Paxil too, but for now the Effexor XR is satisfying, so I'm keeping Paxil in mind in case Effexor XR poops out later on.

Any SSRI would be fine; it doesn't have to be Paxil. Remeron or Serzone could be good too. And the MAOIs (Nardil especially) are the best antidepressants for most anxiety disorders, IMO.

> I may ask you med advice as my treatment continues; you certainly are knowledgeable about that. Do you work/study in mental health?

I'm a mathematician by training, and more recently I was taking classes (a couple of the basic sciences that I didn't take in college) to prepare for the MCAT. I haven't worked in a while. But neurobiology and psychopathology (and the bridge between them) are among my interests(one could even call them hobbies -- I have a lifelong history of weird hobbies).

> In any case, I do hope you feel better soon. My experience has been that it takes time, and I often lost patience. I felt it was unfair for me to go through all this just to feel OK, which was the norm for most people, without any effort.

I have trouble even understanding what it's like to be "normal." You know?

> Let's all keep trying and hoping for the best.

Or trying in the absence of hope, if need be.





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