Even if you don’t get it…

Lately, I’ve had what my doc described as a low-grade depression. So, you know, a livable depression.

Somebody close to me doesn’t believe that’s it’s actually abnormal since everyone goes through highs and lows.

Given that, I thought I’d share what even a “low-grade depression” feels like to me.

It starts as a sleep disturbance. I can’t get enough and more actually makes things worse. So I’m just left exhausted.

That exhaustion builds into an anxiety. I can’t focus, can’t remember, can’t talk, can’t think right.

Then the thoughts layer in. Anxiety already asks “but what if you fail?” Depression answers before I can even try. “Yup, you are shit and you’re gonna fail. Remember all these other failures?”

Those thoughts turn to internal screaming, interrupting me with all the bad decisions I’ve ever made, especially the really shameful ones. You know, the manic impulsive ones. The shame and the damage I’ve left in my wake.

It could be so much worse. And yet, it might get so much worse. Praying the meds kick in. If not, I’ve got paranoia, the itching want to self-harm, and way up there on my depression scale, that “why don’t you just…” question to look forward to.

I’ve got skills to help me sleep the right amount, mindfulness to calm the anxiety and the intrusive thoughts, and everything else I learned in DBT to accept and live with the difference between this feeling and the truth.

But geez, if it’s normal to feel on the edge of a cliff every given Tuesday, we need to have a talk about your quality of life. If it’s normal to need meds to remain “only” this disturbed, well, that’s another talk. And if it’s normal to need a year of skills to keep a job through the ups and downs, well, add that to the list.


Does it get better?

I want this to be my best prose and my most meaningful post, but I’m on the train and that’s unlikely.

But I’m on the train towards my job. My job with people and tasks I’ve grown to love (even with the disgruntled customers lately).

I feel a little strange, but that’s probably because I forgot to take my meds last night. My meds that actually stabilize my mood into this eerie calm. Don’t worry, I’ll take my meds when I get to work.

I slept a fairly normal amount last night. I’ve practiced skills towards living in a normal way for two long years now. I work on those skills daily. Dialectical behavior therapy saves lives.

I worry a bit, often health, finances, and work. Deeply I worry that my new found peace will disappear. But it doesn’t consume me most days.

I have low days where I can’t function. But I’ve practiced crawling my way out again and again. It’s easier now. Almost routine.

I feel I can say pretty unequivocally, it did get better for me. But only with expensive treatment, patient doctors, and a lot of time. Does it get better for everybody? Probably not. Mental breakdowns are expensive. Doctors are overwhelmingly clueless. And a lot of people run out of time.

I’m not here to convince anyone that anything is guaranteed. I’m not in this to prove I’ve been as bad as anybody else. But I think it’s a story that needs told.

So yes, I believe it can get better. Just not overnight.

So what am I now?

Well, it’s been a long two-plus years since I last blogged about my mental health.

And a lot has happened.  I don’t quite know what to write.

I’ve been manic. I’ve been depressed.

I’ve been medicated and completely med free.

I’ve been to inpatient.  I’ve finished outpatient.

I’ve had great days.  I’ve had dark days.

Today wasn’t great.  It was a down day.  I pretty much slept until 4pm.  It’s so easy to give into those thoughts. I had great plans for the day.  Now it’s 8pm and I don’t feel great.

My mood has two layers.  One is the big picture, where my mood cycles through large-scale depression and hypomania.  I am also sensitive to good and bad days.  I can influence these big swings through my daily actions.  Too many sleep-all-day days in a row and I’ll slide into depression.  Too many sleepless nights in a row and I’ll go hypomanic.

No pressure, right?   Just make the wrong decisions and my moods go haywire!  It’s not like I’m 20-something and make bad decisions all the time!

We’ll see what decisions tomorrow brings.

So Now I’m Crazy – Frequently Unwelcome Responses

Since nobody actually asks me any of my Not-So-Frequently Asked Questions, I’ve decided to address what they do say.  When I tell people about my illness and my symptoms, everyone has something to say.  Here’s what I would have liked to ask in response to your daft ignorance.

A: You used to be so [smart, happy, responsible, etc.].
Q: Would you tell a woman with cancer that she used to be so beautiful?  I know that I’ve changed.  In fact, that’s the point of a serious mental illness; it impairs my ability to be me.  I used to be intimidatingly smart, but now I can barely read.  I genuinely enjoyed so much of my life between depressive episodes, so of course I was happy.  I used to be much more responsible when my life felt worthwhile.

A: Just cheer up! Positive thinking is a powerful thing.
Q: If positive thinking is a powerful thing, how do you think I feel living with oppressively negative thinking?  I’ve tried cheering up.  In fact, I tried it for years and years and years.  And it does work on a certain level.  It works right until the underlying illness progresses to such a serious state that it rips through your facade.  When it’s just a bad day, faking it does work.  When your brain no longer produces the chemicals necessary for happiness, there’s nothing to fake.  Most often, people with depressive illnesses have faked happiness for too long.

A: Have you been taking your vitamins? Are you eating well and sleeping regularly? Do you get enough exercise?
Q: Have you?  Why do you assume that my mental illness can be cured so simply?  I take more vitamins than you can imagine: 2 fish oil DHA, 2 fish oil EPA, 2 Vitamin C chewables, 2 vitamin D capsules, and 2 multivitamins with iron each day and 1 GLA capsule a week.  I am 23 and I have a pill organizers.  This regimen was recommended by my primary care doctor not to address any diagnosed issue of mine but rather to mimic a fairly successful depression treatment.  As for my sleep, I’ve gotten better.  I have to force myself to get between 7-8 hours of sleep a night, but I have dreadful insomnia, frequently wake up, and feel absolutely leaden each morning.  I also do my best to eat fruit and vegetables, but making even a sandwich is an dumbfounding endeavor with depression.  Cereal is gourmet for me.  We all know I don’t get enough exercise, but I do my best to walk and move.  We are all doing our best.  I have an illness that makes sleeping, eating properly, and exercising extra difficult.

A: You shouldn’t take those pills.  You know they damage your brain.
Q: When did you get your medical degree?  You seem to know more than my highly experienced physician, psychiatrist, and psychologist.  But really, yes they could damage my brain.  All medicines have side effects.  When a doctor prescribes a medicine, he or she sees that the damage your condition is doing is worse than the risk of side effects.  My medications have horrifying side effects – go ahead and google the side effects of any common psychotropic medication.  Some of my favorite side effects are the nausea, drowsiness, dizziness, clumsiness, brain fog, dry mouth, jitters, and best of all, exacerbated mania.  But what’s worse is the actual damage depression does to my brain.  People have actually documented the degradation of the depressed brain resulting in impaired emotional response, poor memory, reduced decision making, and slow thinking.  Hell, even as I write this I feel the slowness of my thinking, the lack of attention and logic running through my thoughts, and my inabiliyt to remember simple speling.  I should take my pills because they make my life better.  They could damage my brain, but so does untreated depression.

A: Have you tried [ridiculous herbal remedy]?
Q: Did it work for you?  I’m thrilled you’ve experienced breakthrough in your illness with an herbal supplement.  However, my doctors have recommended that I stay very far from any substance that could influence my brain chemistry.  Yes, this even includes alcohol, pot, cigarettes, caffeine (although that’s impossible), aspartame (haha), and even some over the counter cold medicines.   My psychiatrist explained that my brain chemistry is very sensitive (also why I take fairly small doses of non-typical medications).  I seem to react opposite than expected with many psychotropic meds.  Therefore, my reaction to these substances on a day to day basis is unpredictable and potentially destabilizing.  I don’t get to fuck around with my brain anymore.  It’s having its turn fucking around with me.

A: Mental healthcare is terrible in the U.S. today.
Q: Did you watch the news last night?  Because duh, it is obviously terrible.  More importantly, I’m glad you took the opportunity to redirect my illness into your political agenda.  I struggle with finding good doctors who listen to my needs, I struggle with my insurance that determines just how much care I can receive if I’m not an imminent threat to myself or others, and I struggle with paying for necessary treatment that many consider a luxury.  This shit ain’t cheap.  I’ve had more bad doctors than good.  My insurance referred me to the same doctors that the court sends people to.  Please, listen to my struggle with the mental healthcare system before pontificating on the dangers of inadequate of mental health treatment.  Most importantly, don’t you dare imply that mentally ill people are dangerous.

So Now I’m Crazy – Not-So-Frequently Asked Questions

Mental illness is fun.  It’s fun to deal with persistent and debilitating symptoms that screw up my life.  It’s extra fun to hear how much you understand what I’m experiencing because of that month you were extra sad.  It’s super fun to know many people think I’m lazy and faking everything for sympathy.

I can’t show you how I broke my brain, but I can start to explain how my life is different because of it.  To that effect, I’ve compiled a little FAQ.  However, these aren’t frequent questions at all.  I think people are afraid to ask me how I’m doing because they’re afraid of mental illness and don’t understand.  I’m afraid of it too.  These questions represent the questions I’ve asked my doctors, google, and myself on my path to understand this illness

Q: What’s wrong with you?
A: According to more intelligent people, I have Major Depressive Disorder with atypical/mixed features.  In regular-person terms, it means I enjoy all the fun crippling apathy and lethargy of atypical depression mixed in with bipolar-like mania.  Mixed features and atypical form are both pretty good indicators of bipolar disorder. While I haven’t fully met the criteria for true bipolar disorder, the path of my illness, my lack of response to traditional depression treatments, and the odd behaviors I display between depressive episodes point in that direction.  As much as I’d like a concrete diagnosis, I do seem to be responding to a mixture of meds and therapy aimed at both conditions, so I’m not complaining.

Q: Then why did you tell me you were depressed/bipolar?  Were you lying?
A: Maybe, but not because I was trying to trick you.  First off, my diagnosis has changed a lot through time.  What I told you depends on what I knew at the time. Second, would you want to explain all that complicated stuff to everybody?  Since nobody really wants to know about my condition, I try not to burden people with more than they want to know.  Lately, I’ve stuck to the bipolar label because in one word it describes my reckless highs and crippling lows.  I’ve also been told I better learn to live with bipolar disorder since all signs point that direction – so I might as well accept it.  Depression and bipolar are both mood regulation disorders and tend not to be as clear-cut as we’d like.  Many cases of bipolar disorder are mistaken as MDD, creating a huge problem for treating mental health today.

Q: What does it feel like?
A: On a clinical level, my most prominent symptoms include sleeping too much, loss of interest, appetite changes, lethargy, feelings of paralysis, difficulty concentrating, inability to make decisions and take action, self-harm, and suicidal ideation.  This also comes with a host of unpleasant physiological symptoms like digestive irritability, muscle aches and weakness, nausea, and wicked headaches.  Since depression is my main problem, this is my reality more often than not.  However, I am often somewhere on the mixed/hypomanic spectrum too.  Those symptoms have included over-abundant energy, inadequate sleep, unbridled enthusiasm, extreme talkative-ness, racing thoughts, and reckless behaviors.  At their worst, these episodes have included mild hallucinations.

Q: But what does it really feel like?
A: On the depression side, other authors have captured it better than I ever could.  The endless negative thoughtsrumination, soul-crushing exhaustion, hiding, feeling alonebattles of treatment,horrors that could lie ahead, “logic” behind suicidal thinking all resonate with my experience.  In my own words, depression slowly eats away at my sense of self.  It steals my enthusiasm, my passions, my personality, my strengths, and tries to take my life.  It makes me redefine who I am every morning.  Where I was once a strong student, I now struggle to read or form ideas.  Where I was a warm and loyal friend, I now struggle to give a damn beyond my own problems.  Where I was a dream-driven passionate person, I am now fearful and pessimistic about my future.  It’s crushing to accept that at 23 years old I will likely struggle with these overwhelming issues for the rest of my life. Depression steals everything from you until you feel like you have no options.  At that point, suicide feels like a reflex (link worth reading).

On the more manic side, it feels like I’m no longer steering the ship.  While I’ve been lucky enough to anticipate most of the worst symptoms and get to safety, it’s scary to lose control of your mind and body.  I’ve charged another driver up the wrong side of the road.  I’ve spent gobs of money I don’t have.  I’ve jumped in the car and ended up 400 miles from home.  I’ve cut, bruised, and burned myself for fun. I’ve forgotten to eat or sleep for days.  Sometimes I feel the regret for these actions moments after, sometimes it takes days for the full consequences to sink in.  In these states, I do not consider myself lucid. It’s my brain overriding me.  It feels like waking up when these states end.  This is the scariest part of my illness because I’m not sure what trouble I’ll find.

Q: What can I do to help?
A: Well, if you’ve made it this far I might as well give you an answer to this question.  I’m not very good at answering this one, but people on the internet have done a pretty great job.  I might also have some suggestions for helping me:

  • Checking in to see if I’ve eaten and taken my meds recently.  If I haven’t eaten, suggest something I could have for dinner (because without working intuition I don’t really want anything).  If I haven’t taken my meds, ask me what I should take next (I know my meds schedule, I often just need someone to help me make the decision to take them).  I’m better at following orders than making decisions.  If you are concerned about my mental state, please suggest I call my doctor or go to the hospital (important names, numbers, insurance, and instructions are in my wallet).
  • Feeding me, taking me for walks, running errands, socializing, etc. I’m basically a ten year old that occasionally remembers to be an adult.  As I re-learn to care for myself, occasional help is appreciated.  Grocery shopping takes about 4,000 decisions from start to finish.  Having help with a few of those is a much needed hand up.
  • Give me an excuse to put on pants before noon.  Luckily, going out in public still motivates me to keep up appearances.  I can function fairly well in reasonable bursts in the outside world.  Getting me out of the house is 90% of the battle, so please make morning plans with me.
  • Understand that my symptoms are not me.  Sometimes I can be cranky, forgetful, inept, and all sorts of annoying.  Please call me out on it; I’m still responsible for my own behavior.  However, please give me a moment to collect myself and correct the behavior or to excuse myself to a better situation.  Please understand that I still do love you and appreciate all you do for me.