Tuesday, December 6, 2011

A Life in the Making: Two Years Later

This past weekend, I celebrated a unique anniversary.

Two years ago last Sunday, I acknowledged that the way I was living my life was not working anymore.

I was unmotivated, doing only the bare minimum to get by in my classes and at my job. I was fearful of everything: that I would never graduate, that I would be a failure, that my friends didn’t like me, that the people I loved would leave me. Despite the presence of all of the people in my life, I felt alone and slept my days away to avoid this feeling of emptiness. I was either agitated or anxious most of the time. The changes in my mood came on suddenly and were often unpredictable. I got worked up over the most miniscule things. Sometimes a perfectly good day would be ruined because someone looked at me the wrong way.

Somewhere, deep down, I knew this was no way to live my life.

Two years ago last Sunday, I stood face to face in a local bookstore with the man who would later become my husband. We were in the middle of an argument and were about to walk away from the whole thing when he asked me, “Do you think you’re depressed?” I tearfully replied, “Yes. Things that seem easy for other people just aren’t easy for me.”

And so began the journey. We even nicknamed 2009 the “Year of Health.”

Two years ago last Sunday, I named my depression for what it was. There would be no turning back, no more denying. I took the first step toward getting my life back.

And now?

Do I still struggle with depression? Yes, of course. But now I have the tools and the resources to separate the disease from the real me, hence the title of this blog: “I Am Not This Disease.” The art of self-awareness has been an invaluable tool for me in this journey. This might be the most important thing I took away from my time spent in Cognitive Behavioral Therapy. I had to re-learn how to think: how to logically process my thoughts, how to use situational evidence to uncover rational information, how to recognize when I am falling back into the old, destructive thought-patterns of my past.

And medication? Once I found a combination of drugs that worked for me, I can honestly say in amazement that my brain chemistry has changed. To think that I used to feel guilty and ashamed for taking anti-depressants is astounding. Now, I look at that little pill in my hand and feel nothing but thankfulness. I’m thankful for developments in science and medicine. I’m thankful for my doctors. I’m thankful that I’m insured and can therefore afford my medications. We all know that this simply isn’t the case for all people living in this country, and I eagerly await the day when universal health care will be able to touch the lives of people who so desperately need mental health care.

The greatest gift this journey toward mental health has given me was quite unexpected. I have emerged from this experience with a greater appreciation for the people in my life. I now find myself reaching out to others in ways I would not have during my illness. Lately, I notice I have within me a new-found desire to help others. Recalling how so many people sat and waited quietly with me through some of my darkest hours, I now want to be that kind of support for others. I want to give back because I spent so much time on the receiving end.

I also think my depression has made me a better listener and therefore a better partner and a better friend, or so I hope. Now that my life is not consumed with my anxiety and depression, I have the capacity within me to consider the needs of others in ways I have not been able to before. Finally, I am present. Really present. To myself and to others.

I am currently reading a wonderful book written by Methodist minister Susan Gregg-Schroeder called “In The Shadow of God’s Wings: Grace in the Midst of Depression.” I came across a chapter entitled The Gift of Living with Paradox. I had never thought about my depression in this way. She explains that our culture thrives on instant gratification, so living within a paradox, or a mystery as some might call it, does not come easily to us. But this is exactly what living with depression is like. We constantly find ourselves between two polarities: sickness and health, rationality and irrationality, darkness and light, until we can learn how to achieve a balance in our lives. This doesn’t always come easy for a depressive because so often we think in black or white terms, or what some therapists might call “all or nothing thinking.” But this isn’t a life at all, is it? All of us, depressed or not, must learn to accept what Susan calls the “intermingling of the darkness and the light and learning to appreciate the areas of gray.”

Anyone who has gone to battle with a major illness knows that the journey toward health is never fully upward. We take a few steps forward, and a few steps back. Wash – rinse – repeat. And yet this is how we learn. We must come to appreciate all the steps of the journey. Perhaps Susan sums this up best when she goes on to say that:

“The paradox lies in the fact that the parts of ourselves that we have buried in the shadow of subconscious are essential to our becoming integrated, whole persons. When brought into the light, these qualities we have rejected are transformed by God’s grace. They, in turn, strengthen our whole personality.”

So, here’s to living with paradox.
Here’s to two years of journeying toward sound mental health.
And here’s to you and your journey, wherever you might find yourself at this very moment.
May 2012 be another “Year of Health” for us all.

To our health,

Thursday, October 6, 2011

Listen to me!

It was now early spring, just a few weeks before Easter. It became clear to me that my elevated anxiety was at the heart of my most recent and lengthy depressive episode. For some time, I had suspected that my medications might be at the root of my problem. Maybe my system had built up a tolerance to them overtime? Maybe they were never the right combination of meds to begin with? Whatever the case, I was at a point where I knew I was feeling no different. It made me wonder why I was taking them at all.

At this time I was taking Wellbutrin, a unique anti-depressant that I had been on for over a year. I was also on Buspar – an oldie but goodie – for my anxiety, but looking back now, it never worked that well for me. If I took the highest recommended dose, I felt sick to my stomach. I tried to tell my psychiatrist on more than one occasion that I didn’t think my meds were helping me like they should. His next step was to prescribe Levothyroxine – a thyroid hormone that when taken at a very low dose was said to help elevate mood. When I contacted him again after several weeks hoping for yet another option, he told me we were running out of choices. Knowing that my body did not respond well to SSRI’s (Prozac, Lexapro, Zoloft), he said our next step might be a low dose of Lithium.

I never called him again.

I may have been depressed, but I knew there had to be other options out there before we pulled out the big guns. Lithium? Now that IS crazy!

I asked my therapist for a referral, explaining to her that I just couldn’t believe Lithium was my last option. She agreed. I knew there had to be another way. I knew my doc just wasn’t listening to me. I was screaming out to him: “Treat my anxiety! Treat my anxiety!” and his solution was to prescribe a drug normally given to patients with bi-polar depression. I had always known I was not bi-polar. My depression just never worked that way. It didn’t happen in extremely high and low fits. I never had the urge to stay awake for days or find myself maxing out my credit cards. It was more like a constant, undulating pulse that weighed me down – some days more than others. I only wanted to sleep. Besides, my therapist assigned me a formal diagnosis of Major Depressive Disorder (MDD) back in February. (For more information on MDD, check this out: http://www.dbsalliance.org/site/PageServer?pagename=about_depression_overview).

My therapist eventually put me in contact with a psychiatric nurse at a local mental and behavioral hospital. Finally – a new plan! The only drawback was that she was booked until mid-May. One evening when my anxiety was particularly horrible – racing thoughts, short of breath, pacing, etc. – I gave in and drove myself to an immediate care center. I told them every med I was on and my entire mental health history. I asked to be put on something that would help calm me down until I could get in to see this new psychiatric nurse.

No help whatsoever. They wouldn’t prescribe me any anti-anxiety medication and proceeded to inform me that if I needed further treatment I would have to go to the local hospital, admit myself, and stay overnight for evaluation. I was seething mad and completely discouraged – again. I just needed some help. I felt like no one was listening to me – again. Even after the doc inquired if I was suicidal, which I have never been even in my darkest moments, she still turned me away. Unbelievable. I knew I couldn’t go home. I would be alone with my thoughts and I wouldn’t be able to calm myself down. When I managed to finally pull myself together again, I took myself to a concert at the music school. A three hour event, it helped soothe my anxiety and lifted me up to a better place. I knew I could return home to an empty apartment and maybe get some sleep. I was going to be okay.
*                       *                       *
Since seeing my psychiatric nurse, who took my complete mental and family health history in handwritten notes, I was prescribed a drug called Cymbalta. Ads for it run on TV all the time: “Depression hurts. Cymbalta can help.” In my case, this is true. Cymbalta is in a class of drugs known as SRNIs, which target serotonin and norepinephrine. I began at 30mg daily, and eventually worked my way up to the full 60mg dose without any problems and minimal side effects. At 60 mg, Cymbalta is said to treat the symptoms of GAD, or Generalized Anxiety Disorder. She also prescribed me a daily low dosage of Klonopin, commonly known as a “benzo,” to further aid in the treatment of my anxiety since I told her I thought this was my most immediate problem. I was told to take a pill in the evening before bedtime; the idea being that I would wake up a little less frazzled and edgy.

So I had a new med cocktail that overtime proved to be effective for the treatment of BOTH my depression and anxiety. All of this arrived at a very providential time in my life. By early May, I had been on my new meds for about two and a half weeks. I also graduated from school – finally – after nine years of work. I even attended the ceremony, which I didn’t do as an undergrad. I felt it would help bring closure to what seemed like an unending chapter of my life. I woke up every morning and could breathe just that much easier knowing that I would never have to go back to this particular school. No more pressures of academia, no more constant evaluation, no more grades assigned to my art. This chapter was done. Over. FINITO!

Some weeks later, my husband and I decided to relocate to the small town in which he was teaching. We found a small house to rent, which for someone who has lived in apartments for the last nine years, this was very exciting! Around this same time, I found a great part-time position at a Methodist church about 35 miles away from where we had chosen to live. I felt so lucky to have found meaningful work during this time of transition. Moving to a small town immediately begs the question: “What the hell am I going to do around here?” But I had been given an opportunity, and for that I am grateful.

Most importantly, it was summer, and I decided to make it a REAL summer vacation. After all my husband and I had been through, after all I had been through between doctors and meds and recitals and this and that, it was time for my mind and body to heal themselves over. This meant no recitals. No conferences. No special projects. I limited myself by taking a very part-time job at a local ice scream shop to give myself a little something different to do during my last few months in town. I spent time with friends and family. I read and caught up on all the stupid TV that I missed during the school year. I joined the local YMCA. Some days, I gave myself permission to stay in my PJs until dinnertime. Big deal, I thought. I earned this. I also kept up on my therapy through individual and couples sessions, still journaling like crazy. I even tried writing some poetry. On the whole, it was a great summer. Without challenges? Of course not. But these challenges were all the more bearable now that I had an advantage over my depression. I had finally – with the help and support of my doctors, my husband, and my family – found a combination of drugs that worked for me.

It took over a year and a half, but we found each other.

To our health,
"The moment you can visualize being free from the things that hold you back, you have indeed begun to set yourself free."---Unknown

Sculpture by: Zenos Frudakis "Freedom" 

Saturday, September 10, 2011

Growing pains...

(Continued from July's post:)

In the weeks that followed my father-in-law's death, my husband and I found ourselves in different worlds. He needed time to grieve, time to sort, and time to think. Of course these are all complicated learning processes - especially for someone who has just experienced a major loss for the first time. My depression was still raging. No matter how hard I tried to push it aside or keep it at bay for the sake of my husband's grief, it still managed to rear its ugly head at the most inopportune moments. I wanted to give my time and attention to my husband during this extreme time of need, but my support wavered in and out as I tried to be available to him while remaining attentive to my own emotions - a direct result of my depression and anxiety. Again, I found myself confused. I was still caught up in the fact that I had tried to do everything "right" for myself and for my healing process. I took my meds, I kept my regular therapy appointments, I constantly journalled through my feelings, and I reached out to my friends more than I ever had. No matter how much I hated to admit it, the hard truth was at the end of the day, I wanted to husband to take care of me - to make me feel better - as he had done for the past three years. My disease did not want to allow him the time he needed to tend to his own wounds. We were totally and completely unavailable to each other. 

As a result, the weeks that followed were some of the most trying and difficult times in our infant marriage. Some days we could not hold a normal conversation that did not lead to arguing and screaming. Doors slamming. Hurtful words dropping like bombs. Various things flying across the room. It was terrible. We later admitted to each other that it was during these times we both considered leaving the relationship. Maybe our marriage had been a mistake. Maybe we would become a stereotype of our generation by continuing to prove that marriage just does not last. In my heart, this was the last thing I wanted, but I was too sick and he was in too much pain and no longer able to fulfill the role of caretaker that I had come to depend on. What was harder was for me to accept this fact and figure out how to finally do something about it. 

My therapist was a great help and trustworthy advocate to me during these times. We began to meet frequently - once a week. I remember feeling so reassured and empowered after our visits. It was as if for a few moments I was able to access the real me again. Even if people close to me did not understand what I was going through or told me I could not change, I was still shedding a skin - still making positive changes in my life despite the fact that I was still very ill. The process was painful. I had to face harsh realities about myself, my self-worth, and my issues with dependency. I had to relearn and rediscover who I am. The real Me. I had to learn that I was never only one thing at any given time - never only a wife, never only a student, etc. The only thing I could ever wholly be at any given time is myself. This is what my therapist helped me to discover. 

I had to do some re-evaluating: What were my goals? (With and without my husband). What did my progress look like so far? Where was this progression going? What new cognitive tools did I now have? What were the warning signs that would alert me that old habits and behaviors might be setting in? She also taught me to remain hopeful and proud of the fact that I had already come so far! That those undermining, self-deprecating, negative thought-processes were slowly being chipped away and replaced with affirmations: "I am a good person. I have done good work. I am capable of change. I am capable of healing. I take responsibility for my health. I am allowed to fail and learn from my mistakes." This is at the heart of cognitive behavioral therapy. At the time, these statements were - and still are - the stepping stones that allowed me to walk towards my goal of stability and sound mental health. 

There was still one thing that did not add up. In the midst of all of my progress, I still experienced profound bouts of depression, or what I sometimes call episodes. I had little motivation to do anything. Even my music was unsatisfying most of the time. If I was out of the apartment, I was usually social and active, but most of my remaining time was spent in front of the TV or in bed asleep. My husband and I still argued and fought frequently, which over a period of time added to my already high anxiety about the future of our relationship. In our couples' counselling sessions, I vowed to work on this and that, but in my head I still wondered if I could really trust my husband to stay by my side. What if I had another horrendous episode? Would he tire of me? Of my depression? Would he leave? Or would he stay out of duty or guilt and end up angry and resentful toward me? I did not know which was worse! I was torn, and these destructive thoughts flooded my mind every time I found myself alone. And since my husband was still teaching classes in the next state over, I had a lot of alone time - especially in the evenings. It wasn't long before this way of thinking became unbearable. I had anxiety attack and anxiety attack. I tried to busy myself and distract myself with the larger world, but I could not stand being by myself and fighting with my own mind. Days were hard; nights were harder. 

I needed help.

(to be continued...)

Sunday, July 17, 2011

"Must the Winter Come So Soon?"

This past winter was a tough one, but I got through it.

Now that I have come out of a semester-long depressive hibernation, I can look back and understand with more clarity what happened to me and how I was able to break through one of the longest, roughest episodes I have ever experienced.

In this post, I am going to try my best to write simplistically about a complicated topic. I realize I do not need to go back and rehash every little event, conversation, or argument that was intermingled within my overall experience. I will attempt to draw attention to the major events that outlined this most recent depression and how I was able to slowly push through it with the help of family and friends, medications, and a steady dose of cognitive behavioral therapy.

*        *        *

I remember feeling extraordinary for the few weeks that followed our September 2010 wedding. I now know this is the definition of the “honeymoon period.” After that, I admit I have trouble remembering a whole lot from the fall semester, which I now recognize as a sign in itself. Four months into our marriage, my husband and I had to make a tough decision. He was offered an interim position for the spring semester at a community college. We knew the teaching experience and the income would be great for him and for us, but the position was in the next state over, which meant we would have to live apart during the week. Together, we decided he should accept the job, and I settled in to my last two months of preparations for my final graduate organ recital.

The next two months were tough. I found out quickly that I did not favor long distance relationships. I felt alone and then ashamed for feeling dependent on my relationship for any sense of stability and contentment. I pushed through and tried to focus on my work in spite of my feelings of despair toward my marriage and toward my looming recital.

February 28, 2011. The recital day. A total of four years of graduate work put on display for one hour of just one evening. I felt the insurmountable pressure rising within me and I began to experience some serious nerves. My forehead dripped sweat, my breath shallow, and my hands shook uncontrollably. If I had ever had a surreal experience, this was it. It was like being outside of myself – like an observer. My body was seated on the organ bench just trying to make it to the end, but my mindful self was off to the side in a fog observing my every struggle and evaluating my every wrong move.

I do not know how I finished, but I did. It may have been what I consider to be some of the worst public playing I have ever done, but I got through it. Still, I was devastated. I felt the tears forming before I let up my final chord. I tried to hold back my emotions as audience members came through my receiving line. I do not remember anything that was said, only the people I saw that night. I just wanted to go home and lie down in a quiet room and rock myself into a long, deep sleep.

Four days later, my husband’s father passed away.
(to be continued…)