Firstly, let me say "thank you" to everyone that has shared their stories, emails and comments. Thank you for sticking by me and caring. It really has helped me so much. It's time for the stigma of mental illness to go away. I wish that everyone understood that it is not about intestinal fortitude or the the lack thereof. It is not about feeling sorry for oneself, nor is it a subconscious ploy for attention. Major depression has nothing to do with those people who feel down in the dumps for a few days, but "pull up there socks" and carry on. I think that is the biggest misconception, and it causes the proliferation of great disinformation. I do not condemn people's lack of understanding, but I can tell you that it can be very hurtful, and has probably done more to keep mental illness quiet by carrying on the stigma of shame and silence.
I probably feel more passionate about this today, than I ever have. This bout has been so severe and stubborn. Hub and I realize how lucky we are because we understand the course of the illness, and we know that hanging in with the medication until it has reached it's peak of efficacy is the only thing to do. I am able to draw on what I know and I am fortunate in that respect. When I stop and think about the people who are suffering without help, or those who are just beginning their antidepressant treatment and wondering why they don't feel better immediately, I feel a sense of sadness and a desire to help in some way. It's frustrating. I don't think that we have come very far at all in educating patients about their medication.
Those early days of treatment when the side effects are at their worst, is such a critical time. It is little wonder that a large percentage of suicidal patients commit the act during the first few weeks of medication. Sometimes we get worse before we get better, and if someone does not understand that, then it is perfectly comprehensible why they would feel hopeless. Let's face it, not all General Practitioners are up to speed on mental illness. They prescribe antidepressants to people who are not really clinically depressed, they hand out benzodiazepines like xanax and ativan that can worsen the illness and create even greater problems down the road. I believe that most Doctors are well meaning, but it is hard to spend the time in educating patients about their illness, and just handing someone a prescription without asking the right questions and without proper followup can only result in a poor outcome.
We can't blame the families of those who are suffering for their lack of understanding. I strongly believe that all mental illnesses affect every single member of the family. Often it is only when the patient becomes ill enough to be hospitalized, that the families are included in the plan of treatment, and that is not good. It is my experience that when family members grasp the true nature of the illness, they become supportive instead of judgmental, and this can make all of the difference as to the eventual outcome.
My Story Continued: The Faulty Logic Of Depression:
Yesterday I talked about the events that probably left me vulnerable. It is not always a genetic background that is a factor in mental illness, but in my case it seems as if it would be so. The big turning point in my life came when I was assaulted by a cocaine addicted patient. The blow to the head further knocked the lid off the big stew of emotion that I had so carefully kept contained for a very long time. (In retrospect, I see that I had expended a great deal of energy up until that point in just keeping the lid intact). I had the diagnosis of post concussion syndrome for a very long time because PTSD was not very well recognized, let alone treated. Major depression often goes hand in hand with PTSD, and indeed, I eventually ended up with a dual diagnosis. It took a very long and painful time to finally get the expert help that I needed, but with the acknowledgment of what I had been suffering, and the cognitive therapy tools that I needed, I was ready to rejoin the world. It took years of hard work, and as I have written previously, I continue to call upon what I know every day.
Until the present time, I have had many remissions and exacerbations. As with many of us who suffer from depression, when you feel well, you forget about what it felt like to be depressed. The drug side effects become annoying and you tell yourself that you are perfectly capable of coping without the help of medication. I usually last about six months before the hell comes creeping in again. This time I am fairly sure that the prednisone for my RA flare had something to do with the extremely deep dark hole that I fell into. Perhaps it was the narcotics that I was taking for the pain. I will never be sure. I do know that I had stopped taking my antidepressant without telling anyone because I was worried that it had caused the RA. I won't be doing that again.
I do believe that my functioning, "normal"self is optimistic and fun loving. I have always been somewhat of an introvert in that I definitely have a need for my private and alone time. Some folks need to have people around them all of the time, and this has never been me. You might not realize this about me in a social situation because I probably appear friendly and outgoing, and indeed I think that I am. Some of us just have a limit as to how much stimuli we feel comfortable with, and I am not good with a lot of protracted interaction. My profession was perfect for me because it involved a lot of listening and interviewing. As I just said, if you didn't know me well, you would be surprised at this description of myself. Being an introvert is perfectly normal. There are lots of us around. Sometimes the line between introversion and PTSD becomes blurred.I can be very happy in my need for alone time, and it refreshes me and recharges my batteries. There is no joy or hopefulness in the seclusiveness of PTSD or depression, and that is the big difference. Also, introverts are not necessarily shy people and they can be just as happy as anyone else. I think that is a big misconception, and I just wanted to throw it in. So that's me. Silly, slightly sarcastic, compassionate and open minded with a need for alone time. Usually.
In the beginning of a depressive episode, I start to keep more to myself. I lose my interest in the things that normally excite me. My camera, my yard, ideas for the house all fall by the wayside. Soon my writing becomes a chore, and the negative thinking takes hold day by day. I start to think that I have nothing to offer, and I toy with the thought of deleting my blog because it doesn't measure up. I look at what every one else is doing, and I feel worthless. As time passes, guilt starts to creep in to my thinking. I examine every decision I have ever made it seems, and I come up with feelings of failure. Surely my family hates me. I have not been a good enough mother or wife, and I am a burden to everyone. I decide that I know what they think of me, and it isn't good. When this thought pattern gets bad enough, Hub has me speak to my sons and daughter in law. I cry and blubber, they assure me that my thoughts have no validity and they tell me how strong I really am. I don't really believe them, but I cling to the conversations like a life raft. This part of the depression always baffles me when it has passed. I have the most wonderful and loving family that anyone could ask for. I know that I am loved. Why does my brain always visit these thoughts of guilt and abandonment when I am ill? Feelings of guilt and worthlessness are well known symptoms of major depression, but when I am well I often wonder if during these times my brain is revisiting the helplessness I felt as a child?
The dark thoughts run over and over in my head. I wake up in the morning and begin to cry because I really did not want to ever wake up again. When I think this through, I realize that this is the illness speaking to me. I hold on. I fret about a recurrent fear. It is that I will be old, and deranged and no one will help me. Now that I am thinking more clearly, I can barely remember what this was about, but I remember the terror of the thought.
When I am able to get out of bed, I sit in the living room for short periods of time. I look around and see what a mess I have made of everything. This is equally true for the yard if Hub can coax me outside and my fear is not too great. Everything that I have accomplished looks terrible. In my depressed thinking, I compare everything to some arbitrary standard of perfection. I feel the weight and sadness of the world as though it was mine to bear alone.Of all of the symptoms that are slow to be resolved with medication, this is the one that is hardest to abate. From that, I deduce that this is probably more a trait of my normal character that becomes more pronounced during my illness. Perhaps my obsession with perfection has become an ingrained coping mechanism to deal with stress. It could be a left over psychological remnant from a mother that I could never satisfy. I just don't know. Whatever the reason, I am working hard to let it go and give myself a break; until this latest bout I have made some real progress.
Medication:
I know that there is a lot of strong opinion about medication. I can only tell you that long before I ever swallowed any antidepressant, I saw it change lives for the better. My council to my patients was to hold on and give the medication time to work. Did everyone get better? Of course not, but over and over I would see desperately ill patients come in, and leave with hope and optimism. Antidepressants, while not perfect yet, combined with counseling and compassion, save lives. Of course everyone is entitled to their own opinion. I see so many anti-psychiatric drug websites and I have no doubt that these people fell into the hands of practitioners who abused their patient's and just didn't give a dam. I hate the fact that drug companies push their medications to encompass ever widening use when the data does not seem to support their claims. Many patients have been harmed by the misuse and over prescription of psychiatric drugs, just like any other illness and many different drugs. Do we throw the baby out with the bath water?
Today I am on the road to my old self. I can't say that I am quite there, but just the fact that I am writing this shows me what progress I have made. I would not miss a day of taking my antidepressants. I know and understand the medication that I am taking, which in my case just happens to be Pristiq and Wellbutrin. Pristiq works on the neurotransmitters Serotonin and Norepinephrine. Wellbutrin not only works on Norepinephrine, but also Dopamine. Our brains normally function very well with these neurotransmitters, but it is thought that in depression, there is a deficiency of these chemicals in the brain's neuron synapses. These medications block the reuptake of these neurotransmitters in the synapse.
They have finally started to slowly let in the light. Some days are better than others. It will come. I can hypothesize all I want as to the cause of my illness. I can moan and complain about the unfairness of it all. I can detest the fact that I am unable to control this on my own. Maybe there was a time for that, but I am done. The only thing that I know for sure is that I am a strong person who has a family who loves and supports her. It is hard on me, and it is hard on my family. Yes, depression is my companion through life. Whatever the cause, it is a formidable foe that needs monitoring and vigilance. I won't let my guard down again.
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"FLORIDA SUE"
