2011-06-15

A Summary of my Mental History

In fact a Letter I Sent in Response to General Request on Facebook for Experience with Psych Meds* **

[Dear] X,

Given that your request for info on psych drugs was quite a while back, I have no idea if this is still of interest to you. The reason for the delay is a personal preoccupation with how I perceive others perceiving me: if I believe my credibility is approaching zero, then why bother? Lately I have been trying a different tack however: to express myself when I believe I have something to share and to leave it until later to decide if the recipients are assholes (doubtlessly less of the threat it may seem). So far my new approach has made me conclude that people are mostly indifferent and that their indifference has absolutely no impact on the sheer delight of accomplishing things.

I have been taking psych meds since my early 20s. I have been diagnosed with dysthymia, bipolar disorder and major depressive disorder. I have been hospitalized a few times, each for "suicidal ideation." The most notably hospitalization, and longest, took place just before I started at [a company we worked at at the same time]. I have taken endless depression assessment tests; I have done personality classifications (at the time: INTP); I even did a Rorschach test once: I saw vivid images of giants with penises that had been crushed by hammers, alternated with images of myself sitting alone on a ledge way above the world. The examiner's professional opinion was that I thought too highly of myself. In retrospect it seems obvious that if one has been bullied all through school, mainly by boys, one might take refuge on a cliff from where one might lodge the occasional hammer. The examiner failed to address what I considered my main issue: an all encompassing apathy, that, for months on end I would be unable to do anything. She looked down at her papers, looked at me and said, "I don't see that here." Now, after 14 years I believe that my sadness, depression and anxiety stem from the sense that I am absolutely useless: I cannot be trusted to hit deadlines; show up at people's parties; or even return books to the library. I can't tell which came first, the lack of motivation or the sense of incompetence, but they appear to reinforce each-other.

For me going to the doc's office tends to be absolute useless. Just having someone to talk to -- possibly about new and different treatment options -- cheers me up and masks my normal demeanor. I don't know if you have ever noticed, but when you feel good and hopeful it's really hard to remember how shitty you felt yesterday. I have often felt let down by doctors because of this, even though quite a bit of the failure to communicate can be laid at my feet.

I started out on Prozac, but have been on Depakote, amitriptyline, Wellbutrin, Lexapro, Lithium, Effexor, Topamax (and probably other drugs I can't remember) in different combinations and at different dosages. They all have had very limited impact on what I consider my main problem to be. They have, however, often successfully treated the anxiety associated with not being able to get stuff done. Some of them have increased the apathy but introduced the sense that it doesn't really matter -- I have spent years numb and bored. They have evened my mood out, but have ultimately failed to prevent re-occurrences of deeper depression.

Last year I was diagnosed with moderate sleep apnea. No, no, it's wasn't because of the tireless effort on part of my psychiatrist, it was because Ted reminded me that I stop breathing when I sleep and suggested maybe I should have that checked out. So, I read about sleep apnea, and armed with scary hopefulness - because sleep apnea causes depression big time -- I went to a specialist. Ten months later I am still trying to get used to the fucking CPAP machine. The cure I was hoping for has not been forthcoming, but it makes some kind of sense that if I can end the war with the machine and improve my sleep things may improve.

Then because some friend did it (and I am the very gentlest of sheep), I started buying Provigil online. Provigil is a stimulant used to treat narcolepsy (incidentally also often prescribed to sleep apnea patients) that's very popular come exam time. At first I took it just now and then, but then I decided to take it every day. Since then the apathy has receded into the back of my mind; I am not tired all the time; I can actually think straight; when I switch windows I don't sit there staring blankly for 15 seconds while I try to figure out why; when I get home I don't immediately go to bed; most weekends I now am awake at least 20 hours.

My psychiatrist refused to prescribe Provigil. She suggested I try persuade the sleep specialist. She said, "of course you feel better, you're taking a stimulant." She offered no advice on how to take it safely, and shooed me out of her office while I was crying helplessly. The office of my sleep specialist is hard to get to because I don't drive. I haven't been back since I got the CPAP machine, even though I was supposed to. Already being a bad patient I don't relish having to go through all that again: "Dr Y, I decided to buy drugs online to see if it'd make me feel better. It worked. Could you please write a proper script?" If she turns me down or gives me that stare of utter disgust it'll just send me back down into hopelessness and despair.

I the meantime I have been weaning of my "real drugs", lithium and Effexor. The Lithium was nothing, but the Effexor was fucking awful. The cold turkey withdrawal is very physical: diarrhea, vomiting, exhaustion, intense mood swings. So, I switched to a slower approach, I took the capsules apart and poured a bit out and then a bit more, but you still get withdrawal. The most lasting effect -- even now after being off it for weeks I still have them -- are electric sensations in the body and the head. They make you feel you're about to keel over, or that you just barely managed to prevent having your arm chopped off.

If you have been told by your doc that you function better on drugs than off, and that you'll probably be taking them for the rest of your life (yes, that's what I have been told), then Effexor might be worth it. Or as a last resort, just before the ECT.

If I had known that my depression might be caused or contributed to by something other then me being so very, very sensitive, such as sleep apnea, then I would have insisted that the docs try harder to find that cause. If I had felt more secure in myself and more certain that what I was feeling was in fact not normal, then I might have insisted they toss away the Men are From Mars and Women are From Venus treatment manual.

In essence this is what I have concluded:

  • you need a doctor you trust and respect (if he opens mail during the sessions he is not for you),
  • when told it'll take some time to get to a proper dosage make them tell you how long (8 years of experimentation is fucking BS),
  • be honest about drugs/therapy that doesn't work, if you're not sure, it probably doesn't work,
  • if you always have had trouble with sleeping too much, or too little, perhaps you need to figure out why,
  • don't underestimate or downplay how you feel (if you recently received an eviction notice because your anxiety prevented you from paying the rent then you don't feel well),
  • cut people out of your life that make a habit of dismissing what you say (because they might convince you it's really not that bad and then not be there when you find yourself with your shit on the street),
  • your friends are not therapists. You'll alienate them all if you insist on treating them as such.
It's been a very cathartic email to write, thank you. Hopefully it at least made you smile.

Btw, it's a regret of mine that I made you embarrassed by hitting on you. It's not that I didn't, it'd certainly be rude to deny that, but I mostly found you fascinating and wanted to get to know you better.

  -- Kagero

* I spent some effort on this letter and it seems doubtful that I'll ever receive a response AND because I seem to have misplaced the motivation to write actual blogs entries AND because the Interwebs exists to re-republish personal communication AND because I haven't posted anything substantial in a while.

** Yes, I know that I strayed from the topic somewhat.

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