Depression

TW: Group Therapy Sucked

I am in emotional pain. Certainly not as much as so many others, but I am hurting. I bargained my way out of being admitted to the psych hospital by agreeing to attend an Intensive Outpatient Program online. I ended up going for 8 days and then left because it was causing more distress than healing.

This is my Farewell Letter with minor distinguishing factors left out:

There was a time when I loved Group Therapy. I was in several at a time sometimes. Knowing myself now, it was 1) because I loved to talk about me and my issues 2) because it was voyeuristic hearing others talk about their issues 3) because, eventually (after 30 years or so), I knew enough to help others.
I cannot do any more group therapy.
I am meticulous with what goes into my brain. My tipping point for my Bipolar and Depression (and now PTSD) issues are low. I cannot watch the news, scary movies, hear scary stories… you get the gist. The world is filled with terrible things and I can only help in fractions of fractions of fractions of .000001%. The feeling of helplessness is a constant low hum in my existence.
In Group, I did not have control over the input into my brain and psyche. The PTSD trigger, we already talked about. But yesterday, the group was talking about someone who had been “Baker Acted”… as if she was some ‘thing’ to be acted upon instead of “helping her get treatment.” And when I asked that we not talk about someone who was not in the room, I was chastised that 1) it was not HIPAA non-compliant (which was not why I requested they stop) 2) that I “need to get used to these kinds of discussions because that’s life.” When that second statement was used was when the group had informally begun to discuss suicide and ways it can be done. I had to log out. That comment was also said to me when I had the PTSD trigger last week. No, I do not have to get used to people talking about exploding body parts or the terrors of war or looking at meat in the freezer and seeing their friend’s thigh.
I do not need to get used to these kinds of discussions because they do not happen in regular life. When someone talks about killing themselves, action occurs. If someone is put in the hospital for their safety, they are not “A Baker Act,” they are a human being in pain who needs help. The issue was not HIPAA, but kindness and understanding for a person unable to defend themselves in the room at the moment. When someone talks about the horror of war, I can find them some help to be in a safe place to unpack those memories. These topics are not in my every day world.
I talked to my therapist last night as well as my adult girls about what I should do and they all agreed with my self-assessment, that I would do better alone.
Therefore, I am withdrawing from the Program and will work on my own to heal. I will do SMART Recovery (which I love… that program helped me detox from opiates 5 years ago) and read… in the rotation right now is The Mindful Way Through Anxiety. Mindfulness and meditation have also been crucial in my substance abuse issues as well as pain relief, mental stability and finding joy in sad situations. I say this paragraph so you know I have a plan. I am not just going to drink or fall into a hole of incapacity. I am strong and power-full and intelligent. I can do this.
Thank you all for trying. I am just not a good fit for Group Therapies anymore and will be aware of that in the future.
Lastly, thank you for being there for those that need your knowledge and support. It is hard, hard work… being a therapist. Thank you.
Please be safe, stay healthy, wear your masks… and know you are all amazing.

As I write this, I am waiting to explain to my psychiatrist why I left and why I no longer feel I need to be hospitalized. It seems standing up for myself had a positive impact.

Solo therapy for me is it from now on.

Bipolar Diary: So, So Depressed

I can barely function. Writing has become nearly impossible. I see the Psychiatrist tomorrow morning at 8am. I am hanging on tightly until then.

Despite what I write next, I will not hurt myself. I will not vanish into death. I promise.

Visions of suicide float through my mind. Romantic images of dying like Ophelia (trite, I know) wander, unbidden, throughout my day.

I mentally count my meds, seeing if I have enough to make me fall asleep forever.

Even as I sleep 18 hours a day, unable to work, I am still always exhausted.

I cannot wait to get help tomorrow.

Bipolar Diary: New Meds for Depression

My psychiatrist, whom I adore, was great, totally understanding where I have been. I did tell him about the suicidal thoughts, said the standard line “I do not have a plan to kill myself and promise I will not” to quell any concerns he might have.

I forgot to mention in the last post that all my hallucinations have vanished. ALL of them. I cannot remember a time in 2 decades that I have not had at least one hallucination going on, usually olfactory. My world has quieted… and it is disconcertingly odd.

Medications

I was prescribed Paxil, 20 mg a day and see the doc again in 2 weeks to see if we up it or not. I also lowered the Cymbalta from 90 mg a day to 60 mg a day for a week, then down to 30 mg after that. Interestingly, I have never taken Paxil in all these decades with Depression and Bipolar Disorder.

Dr. Google revealed that Paxil can bring on hypomania, mania, insomnia, agitation and more. I read those side effects and thought, “Bring it on!”

It takes 2-3 weeks to really begin working in earnest and then another few weeks to settle into the system. Crossing my fingers things get better fast. I miss writing!

Bipolar Diary: Depression Deepens

The last 2 weeks have sucked even worse than when I wrote on July 13, 2017. Tears. Tears. Never-ending tears. The suicidal ideation is coming more often and is more vivid than when I started the Paxil. And the damn hallucinations are back.

sigh

Almost all of my time is in bed, either curled in pain (another post), staring at the ceiling or sleeping. I leave I Love Lucy on in the background. Sometimes Friends. I’m listening to Mists of Avalon (a book I love), but when I listen in bed, I fall right to sleep. I’ve replayed Chapter 6 four times already.

An Odd Sorta Depression

When looking for images about depression lying, I came across several pieces like this one below:

Not sure if I’m just more familiar with my depression than when I was younger or if it has really shifted, but I do not hear the lies the girl in the image does… nothing negative about my body, how alone I am in the world, how fat/ugly/sick I am. I did when I was younger, but not anymore.

I just feel sad. An overwhelming sadness. A pall of melancholia that separates me from the rest of you. I cannot even touch what I am sad about except for the endless distress I have about our country because of 45. But this joylessness is deeper than the fear-for-our-lives kind. I feel like I’m under the thick glass of my Nana’s cake pedestal, so close to others, but unable to penetrate the barrier of dreariness to make a connection.

Medication Changes

The psych doc upped the Paxil to 30mg after 2 weeks on 20mg. He said he still might have to increase it when I see him in 2 weeks. For fuck’s sake, can’t this stuff take effect already? I hate this waiting part.

I have weaned off the Cymbalta. Is that the reason for this huge dip? Who knows anymore. He wanted to increase my Risperdal, but I refused; the eating is out of control with more Risperdal… can’t abide by that.

An aside: I despise the new packaging that seems to be taking over the medication world. I am not stupid, can follow directions, but they are incredibly difficult for me to get into. I’ve asked the Pharmacy to open them for me and then I rip the inner blister pack out, throwing the outer box away. If you haven’t see them, let me introduce you.

slidepackgood — “Follow these 3 simple steps,” it says. Push the blister pack all the way in, then press on the “lock release button” on the left . Finally, pull the sliding pack out at the same time as pushing the spot on the left. I wish it was as easy as they make it sound! It’s almost worse that rubbing my head and patting my belly at the same time.

Suicidal Ideation

I’ve had lots of suicidal thoughts. A friend stayed with me one night when they were especially bad, reminding me every few minutes that Depression is a Liar. Hearing that, knowing it for certain, is what kept (keeps) me going. Hearing that so-and-so loves me doesn’t do much for my mindset because I rationalize that away easily. Depression Lies, however, works wonders.

The thoughts of suicide are so enticing. They call to me seductively as if they were sirens on the ocean’s rocks.

I try to block them out listening to various albums I have memorized. The Eagles, Carly Simon, Sting (Living Sea), and, of course, Hamilton: An American Musical.

I also try to find positive recovery-from-depression-and-suicidal-thoughts articles and posts online. This is one I go back to over and over:

Suicide Prevention: How to Help Someone who is Suicidal and Save a Life

“A suicidal person may not ask for help, but that doesn’t mean that help isn’t wanted. People who take their lives don’t want to die—they just want to stop hurting.”

When I had my first serious clinical depression in my late teens, I didn’t understand the “wanting the pain to stop” aspect and teetered really close to the edge of death.

As I got older and had some decent therapy, I was able to verbalize the inner turmoil and excruciating emotional pain that was drawing me towards dying. Understanding that I didn’t really want to die, but just to stop hurting… a pain that went so deep as to injure my soul… I was able to cling to those brief seconds of “medication will help remove the pain… hang on a little bit longer.”

Medication and therapy have not failed me yet.

Working/Not Working

Work has been nearly impossible the way I feel. I can do one call, then need 2 hours off to regroup. The calls are easy, mostly with regulars, but the energy expenditure exhausts me. Even writing this post has taken 4 days so far. Ugh. I need to be able to work!

Okay, I need to get this out to you all. It is not a cry for help, I promise. I will not hurt myself, have no plans to. It’s just those random thoughts that flow through my mind… sometimes like heavy cinder blocks and others like wafting vapors. As long as they continue moving on the conveyor belt, I think I’m okay and headed towards healing.

trudging along

Thanks for listening

depress help — Always reaching for help.

Bipolar Diary: Incremental Shift

Loving Nudge

After my Bipolar Diary: Depression Deepens post, I had several people tell me to call my psychiatrist immediately. I thought I could white knuckle it for another week, but others saw what I couldn’t. I trust those closest to me and picked up the phone, getting pushed into a non-existent spot in his schedule the next day. Wednesday, August 2, 2017.

Office Visit

The crying had been keeping me from functioning and did not abate while in his office.

I told him about the suicidal ideation increasing… then added the obligatory, “But I have no plans to hurt myself, am not stockpiling meds and promise to call 911 if I do find myself getting too close.” He replied, “I understand how frightening they (the thoughts) can be, even when you aren’t consciously creating them.” I breathed a sigh of relief that he seemed to understand.

I’ve had at least 8 different psychiatrists in 30 years and this one is one of the top 2. He listens to me, takes my preferences seriously like refusing the Risperdal increase and is infinitely patient with my continued distress.

I really am so blessed to have such a kind (and gifted) doctor. I know that is rare and how privileged I am to be able to receive quality medical and psychiatric care.

I OWE MY AWESOME CARE TO THE ACA/OBAMACARE INSURANCE I HAVE.

I would not be alive without it.

Medication Change… Again

I continued crying while he pondered, looking at his computer, typing some, then thinking again.

He found a medication I had not tried before… Latuda… which I’ve since read is used specifically for bipolar depression. Yes, yes… it does come with a laundry list of side effects, but I’m ignoring them, listening to my body instead.

I know it takes at least 2 weeks (in my body) to 6 weeks to feel the full effect of psych meds, but when I got home from the appointment, I took my first pill. Then the next morning, I took the second. (It is taken once a day.)

Whether placebo or really working that fast, I did not cry until late evening the next day. I didn’t cry the next night, either. And the ideation has slowed, the thoughts feeling more “transparent,” fewer hard imaginings. The images had been like mosquito bites, begging to be scratched. (Not sure I explained that clearly… I’m having a terrible time writing this, pardon spelling and grammar errors, please.)

August 6, 2017

I’m feeling better still. The doc told me that if I was feeling too sedated, to drop the Risperdal, which I did on day 3 after starting the Latuda. I’ve been on Risperdal since 1995, so it is a major thought process to not take it before bed. I do feel less sedated (I described it like someone spiked my drink), but there’s a lot more room for not dropping into a slumber at any given moment.

Let me get this out so those who are following along know how I am doing. Thanks for you care and attention, my dear friends. Thank you for your love.

Nuts & Bolts of Calling a Doctor’s Office

This subject seems to come up a lot, so I thought I would do a Tutorial on how to get in touch with a person and not a machine when you’re calling a doctor’s office.

My first and probably most important piece of information is:

CALL EARLY IN THE MORNING!

I cannot stress this enough. Even if you have to wait on hold for awhile. I tend to call about 9:45am. By then the logjam has passed and the way is pretty clear.

Calling in the morning gives the doctor the entire day to get your chart, prescribe meds or answer your questions. Lunch time is the usual time they read your message, so if you call in the afternoon, unless you are in the ER, you will be waiting until the next day for an answer.

If you are really in a crisis (psych, serious fever or infection), I would call back right after lunch. Be your nicest self! NO yelling about “Why hasn’t she called me back yet?!?” crap. Just kindly say, “I need help. I am so ill. Can I come in tomorrow morning? Or might I talk to the nurse or doctor this afternoon?”

“I need help” is a wonderful way of garnering sympathy for your situation.

A Practice with a Receptionist

If your doctor is in a practice with a receptionist, it’s easier to get a hold of the doc you’re needing because someone should always be available during the 9-5 workday.

You often will be triaged by a nurse before getting a message to the doctor. Still, the earlier you call, the earlier your voice will be heard.

Most offices close for lunch… either between 12pm and 1pm or between 1pm and 2pm. Calling then, you will get a machine. Leaving a message on a machine is like talking into an abyss. Call back when lunch is over.

Calling Mental Health Professionals

Therapists especially are meticulous with the timing of their appointments. They are 50 minutes long, beginning at the top of the hour, ending at 50 minutes after. I have great luck calling in that 10 minute window between clients. Some will listen to messages and call back during that time, but many pick up the phone, too.

Know what you are going to say. They have moments to figure out what you need before the next appointment starts. Write it down if you need to before you call. Be ready!

Psychiatrists’ schedules are a bit more wonky, so leaving a message might be necessary. Just as if you were talking to a person, have what you want to say ready. The more info you can leave in the shortest amount of time… being concise… helps everyone get their needs met.

Playing Dumb

When I really need to get through to someone (and you pick your battles here), I feign accidentally hitting the button that says “If you are a care provider and need to speak to someone now, press 1.” Use that sparingly, especially in the same practice. Really, judicious use, please.

Bypassing Automated Menus

If you’ve read this far, I get to teach you a trick I learned from another operator. Not specifically for doctor’s offices, but really helpful for banks, phone companies, cable companies, DMVs… any of the bazillion places that have phone trees you seem to be forever lost in.

Press 0 (zero) fast, over and over and over again. PressPressPressPressPress a dozen or more times. 8 out of 10 times, this gets me to a person.

Patient Portals

If you doctors’ office has a Patient Portal, sign up for it asap!

In the portal, you can email your provider, ask for refills, make appointments without calling and see your chart and most lab results.

Patient Portals are the best.

If I didn’t answer something, ask me about it!