Yes, it’s been literally months since I posted anything. My writing light has dimmed. And it’s been a couple hard months, going from normal bad to very bad and back and forth. But not much new.
Eye movement desensitization and reprocessing is a form of psychotherapy developed by Francine Shapiro in the 1980s that was originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder.
The way I describe it to people is something about remembering a traumatic event, talking about how it makes you feel right in that moment, and then remembering a pleasant event while getting an external stimulation (eyes following a light moving side to side, or holding two devices that alternate giving you a slight vibration, or even tapping your shoulders with your hands in a repetitive movement. Once the stimulation is done, blink hard three times and talk about how you feel about the traumatic event again. Rinse, Lather, Repeat.
I got this therapist as a reference from my personal therapist. At first meeting I wasn’t sure about her, but she seemed ok. I was pretty amped up, so that can make judging someone difficult. The second meeting I was actually more jacked up, but I really started to like her. She was funny. She’s fairly old, but dresses well with enough style but not so much it’s generationally inappropriate. But the thing that cemented her as a therapist I could really like was when we were talking about how I was feeling at the end of that second session. One of the things I mentioned was being scared I wasn’t doing it right and it wouldn’t make me any better. She looked over her glasses and said “And scared you’ll get better, right?” And that’s not a concept many people understand, much less will call me out on it.
I had my first proper session, and we started super light. I actually went to my list of bad memories and couldn’t find one that didn’t mess with me just by reading it, so I just picked a memory that wasn’t so horrible, but memorable.
I had trouble coming up with the “pleasant” memory, but rather than trying to think of a memory, I just went into my internal pile of stories. As a storyteller (before it became hip) I’m thinking this part will be the easy part. I even used a memory that wasn’t a happy story, but one about my father that literally made me cry, but it was a happy sad. Sort of.
I did feel different after a few iterations, and it’s difficult to describe. When we started, I felt like the little kid who was feeling so much horrible in the memory. After the process, I felt less connected to the kid, and more like I was looking at the memory.
We only did two memories, and it took a lot of the “happy” stories to do that. So we’ll see how things go in future sessions. Unfortunately it’s almost 3 weeks until my next, but we’re trying to get me into a weekly rhythm. That and I’m short listed for filling cancellations.
I was a mess going in. Disheartened, hopeless, anxious, scared, wanting to flee the office. When I left I was still a good mess, but I guess it all felt just a tiny bit lighter.
My therapist has challenged me with writing a post for the blog, despite my depression induced writer’s block. For better or worse, here it is.
I’ve had my fair share of appointments. I used to only have one per month. Other times in my life (like right now) sixteen or more per month.
In the days pre-COVID, everything was in person. For meds, you needed to see the psychiatrist. For therapy, the psychologist or counselor. You go to your GP (general practitioner) for a physical, and of course that’s in person. In fact, I can’t think of any medical appointment that I would attend in the past that wasn’t at a physical location with the actual care giver.
Then COVID came around, and suddenly we’re all going online to take care of our health care and mental health issues. On one hand, it’s nice not to have to actually go somewhere, but I do miss the excuse to go through a drive through and get some overpriced coffee for a treat. In this post I’ll be giving my experience and opinions on the good and the bad of the virtual care world.
In person care
First, the pro category.
I enjoy meeting my care team in person when possible. I feel like they can get a better sense of me, my current mood, and pick up on any finer body language I may be throwing at them. It also helps me build trust. I haven’t had many I didn’t like, but the few that I wasn’t comfortable with have been in person. I don’t know if that means I have a poorer intuition with the few members of the team I haven’t actually met in “real life.” I not only build relationships with my primary docs, but with the staff, too. I like it when I go to check in and they know me by name. It makes it easier to get me checked in, but it also makes me feel a bit more like someone the organization cares about. The nursing staff are often there long enough to recognize me, or at least I can recognize them. If you’re going to get a shot, it’s better to get it from someone you feel you know than from a complete stranger.
Paperwork and diagnostics are easier in the physical world. When I get my PHQ-9 and GAD-7 (mental health inventories) they usually give me a clipboard. More novelty, but I like it. Meds, too, are easy to procure when you’re coming out of a physical visit. Pop on over to the local pharmacy, or in my case if I’m at the hospital I can just stop by the pharmacy there, prescriptions all ready to pick up.
For my GP who is downtown, I get to walk around and pretend to be a contributing member of society, maybe get lunch at one of the places I used to frequent. For those suburban appointments it gives me an opportunity for that drive through coffee I mentioned, or just driving around listening to music too loud. It can be a great way to kill an afternoon.
When it comes to doing group in person, I think there are some important advantages. Group therapy usually has some rules about what you can or cannot say in order to protect privacy, but more often prevent triggering behaviors. Rather than saying you were researching suicide, you have to say you were engaging in a problem behavior. It makes sense. But before and after group, or on a break in the middle if it’s a long one, you can actually chat with your group-mates. Not to talk about anything the program doesn’t want you talking about, but just life stuff. I’ve made more than one good friend on those breaks. That’s something I miss about virtual.
And the Cons..
Of course, if you don’t want to kill an afternoon, that can be problematic. Those in-person appointments require you to actually get there. So tack on a half an hour or whatever before and after the appointment. What was an hourlong appointment now takes up two hours of your time. This also makes scheduling the appointment more difficult. Can’t just slot it in an hour between meetings. It can actually block three of your hour slots, if you have any. And mileage and gas and whatnot counts too.
Remember what I said about prescriptions? The pro is also the con. If you don’t have them routed to your favorite pharmacy, you need to take the script there, and then wait for come back. Wait in line, as well. I actually get mine mailed to me, so I avoid all of this at the cost of waiting one or two days. And yeah, it’s only one or two days, if you can believe it. Something is super efficient in that system. Of course, I expect my next refills will take two weeks now that I’ve jinxed myself.
Getting dressed is another con to the in-person appointment. That sounds like a joke, but if you’re in a state where getting out of bed is difficult, taking a shower and putting on clothes (hope you did your laundry) can be a herculean task. If you have social anxieties, going out can trigger those.
Ok, enough haranguing on reality.
Let’s get Virtual
Most points are just opposite mentions of the above. If that’s an actual phrase. So these are pros and cons, all muddled up
You only have to technically dress from the waist up. Pajamas and the largest sweater I own seems to work for me. That doesn’t do a lot for my motivation to shower, unfortunately. And I find when I shower and dress at least I feel a bit more like a human being. Also, it doesn’t get me out of the house. While it’s only an hour block I get anxious beforehand and don’t want to go anywhere in case I’m late. I don’t get the return home trip to blow off steam or have some physical activity. As a result I’m usually pretty down, deflated, and crash hard after calls. You just can’t win for losing, I guess.
You don’t really get to see the care team or your group therapy peers very well. Yeah, there’s on screen, but I usually run in gallery view, so they’re at most half the display. And I find if I turn the view to only one specific person I feel like a creepy guy. That, and a quarter of the time it seems like someone is not showing video that day. Or is in such a way that you can’t really see them very well. (I’m looking at you poorly backlit with a virtual background on..) As for care team members, I can see them but I wonder how well they can see me. My DBT coach did say she noticed I avoid eye contact when I talk about safety or suicidal ideation, so apparently they can see somewhat well.
The video platforms are varied and extreme. Google Meet is quick and dirty, but seems sensitive to network issues. Zoom feels heavy handed and, well, heavy. My psychiatrist’s clinic uses their own flavor, and it’s super simple to the point of too simple. You never know if you’re waiting or need to click somewhere, or what. Quality is okay though. The end result is that it feels like a different experience for almost every clinic you work with.
The technical skills of the people on the other end of the line can be a real pain, too. The ones who don’t know how to mute, or less annoyingly don’t know how to unmute. Good microphones and bad microphones make it feel like everyone doesn’t have an equal ability to share. One peer has a mic so bad I just can’t understand anything they are saying. I don’t know if a facilitator has mentioned it, but I certainly am not. Which makes me wonder – how does my mic sound? It’s a high end mic and I record myself often, but on that platform do I sound like a duck talking through a toilet paper tube? It’s like wondering if you have bad breath.
That paperwork I used to do in the clinics are either no longer used, or done through an online tool. If you thought video platforms were a mess of differences, online assessment tools are even worse. Did you finish the assessment? Or did it not register so you have to do it again? Got your login credentials handy? I had one clinic switch systems and I’m honestly not sure which system was better or worse. What I am sure of is the fact that I have yet another account to keep track of. It’s health information, so you don’t want your browser to save your credentials, but LastPass doesn’t always remember to save your information. And if it does, you may have three different entries to pick from next time you log in. (Tip: It’s not the one you chose)
Meds are another one of those things that can go either way. As I mentioned mine are mailed, so the doc just puts it in the system and it shows up in the mailbox a couple days later. But if it’s something new I’m wanting to start right away, or a med for an acute issue, waiting for it isn’t always a comfortable option.
Honestly, virtual just isn’t real life. It’s easier, yeah, but that doesn’t make it better. The unhealthy side of me likes virtual so I can hermit better. But the other unhealthy side of me likes getting my Lattes in the drive through. I feel a bit like this was a bit of a pointless post, as virtual appears to be here to stay. I still get to go in for therapies that do something to me, like Ketamine, electroconvulsive therapy or upping my VNS. At least until they figure out how to do that remotely..
What do you think? Big fan of either direction? Got any good horror stories to tell – or better yet success stories? Take the fifteen microseconds it takes to share something in the comments. Thank you for reading!
Often, when I’m standing in the shower making the most important decisions of my life (i.e. staring off into space) I have helpful thoughts, and not so helpful thoughts. Today I had a thought that comes back to me often. Maybe I don’t have depression and anxiety – maybe I’m just lazy?” My mind loves that one, and usually just runs with it. The depression is just being tired. The anxiety is just not sucking it up and dealing with the world like everyone else.
But then little thoughts start jumping in with proofs. Reasons why maybe I am actually depressed and anxious. Things like…
The pile of meds I take everyday
The enormous pile of meds that weren’t effective
The Psychiatrists I see on a regular basis seem to think I an afflicted
My personal therapist, who’s been in the deepest reaches of my mind and assures me that, yes, I have some serious issues
The Care team at the Treatment Resistant Depression clinic – for even seeing me
.. and their prescription of Ketamine
.. and their recommendation and assistance in fitting me with a Vagus nerve stimulator (VNS)
.. and their medication prescriptions working in concert with my regular Psychiatrist
The tremor in my hands and legs from the most effective medication I’m on
That VNS, which is surgically implanted in my chest and neck. It gives me a zap every five minutes for 30 seconds
Two rounds of Electroconvulsive therapy (ECT)
One round of Transcranial magnetic stimulation (TMS)
The feelings of failure, dread, and hopelessness
CBT, DBD, IOT, PHP, MAOI, and every other acronym I can think of
You know what? That list doesn’t matter. You don’t need to prove it to yourself. If you have depression, you have depression. If you have anxiety, you have anxiety. Depression imposter syndrome feels very real to me, but I look at the evidence and feel how I’m feeling, and I’m assured it is real. Which is actually depressing, but that’s a different blog post. Don’t let those little shower (or elsewhere) thoughts try to impact your disease. They’re just thoughts going through your head, getting washed down the drain as they continue on.
Forever ago I found a cable knit sweater at Target. It was mustard colored and I loved it. It fit well, and it just had a sense of comfort. I went back and over a few weeks collected as many colors as I could find. Blue, green, beige. Sad I never found a red. The off white sweater was one size larger than the others but that made it even comfier.
I wore it all winter. I wore it to work and I wore it at home. In the summer I would find the lamest excuse to wear it. When I went into the “grippy sock jail,” aka hospital it was one of the few items of my own that I had.
Wearing that sweater gives me comfort and security. It was armor and it was what I knew.
Depression, for so long, feels like that too. It still makes me want to die, but it is also familiar, something I know, and at times, something that keeps me warm.
Last week, I visited my sister, who lives in a kind of remote paradise. My daughter was living there for part of the summer, and some of my trips purpose was to help my daughter move back home. It was an amazing visit. I spent time with my daughter, but also with my sister and her wonderful family. I took walks, I sat on a porch and read, and just sat there appreciating peace. I wrote about my childhood and about canoe trips, in an actual book.
I had two days of.. Nothing. Depression and anxiety weren’t there. At the end of these days I would be so exhausted that I could feel them, but it was only as I was going to sleep.
The closer I got to home the more the anxiety grew, and the depression poked its head out. Remembering that I had nothing to be, except broken.
“Getting better” has always scared me. So this development is very overwhelming. I worry that people will see me being more alert and active, and think “Great, he’s better now!” I worry the life I awaken to will be so very different from my old life. I will have to recreate myself, learn who I am and how I live my life.
I do know that I have more energy, but that a lot of it goes to wearing my “human face” and interacting with others. Ironically, the better I look, the better I’m putting on a good show. It feels a bit like I’m just going back to the time I was depressed but able to convince others I was fine. Back into the sadness closet.
I’m not there (“Better”) yet, obviously. It’s a long road. And I’m still not sure how I feel about walking that long journey. Or even if I’m willing to.
I’ve thought about sharing or not sharing this account, but it’s had such an impact on my whole life that I really want to get this one out. This is why I’m anonymous, and thus keeping everyone else in the entry anonymous.
When I was in high school a million years ago, I used the BBS systems extensively. They were servers you would call with a phone line and your computer. You could discuss things, or on some systems you could chat live with multiple people. The community was small, and we all ended up getting to know each other well. As a result, many of my friends were mostly met online. Back then, it wasn’t a familiar concept, so people didn’t always understand how you can be close to someone you’ve never met, or how we can all communicate in general.
One of those friends was the only kid I knew with a proper punk mohawk. He was a little obnoxious, super creative, and pretty sensitive. He made music and even handed out cassettes of his work, which was usually a little bit out there for my tastes, but it was cool nonetheless.
I was on one of the chat systems one night, and eventually it was just the two of us chatting. He was going through some stuff, I was going through some stuff, and we were both just mostly commiserating. Ironically, my “stuff” wasn’t that bad, as it usually was. I was talking philosophically about the pointlessness of life, using the example “I mean, what’s to stop us from just driving into the monument by the river and ending it all?”
I thought I was pretty clear.
The next day on the way to school, he hears something over the speaker on the school bus about a suicide. He went to the public school, I went to the private. But all he heard was “suicide” and remembered our conversation. So he was pretty upset. He told his school counselor who called my school and I got called into the counselors office.
I don’t remember most of the conversation but I think he just made sure I was safe, and then gave me a speech about seeing ahead to the future and not living with “blinders on.” I went back to class and didn’t give it much thought. Again, I didn’t feel very depressed.
After school I walk home with a different friend, and at one of the intersections I see my mom’s car. Odd. But I’ll take a ride home any day.
“Don’t you ever do anything like that again” she snapped, when I got in the car. I was taken aback but she explained the school had called her and told her all about it. She was mad. Not just irritated, but the kind of mad that’s a little scary. And that was the moment my respect for my mom was permanently marred.
She thought it was a prank or something, I guess. Regardless, that’s not how you’re supposed to respond in a situation like that. Make sure I’m okay first, maybe? Ask me more about what happened to understand it better? As a parent I know how hard it is, especially when they’re in high school, but what she said comes back to me often, and did even more when we were raising our kids. It hurt to my very core. And it still does.
In the end it actually helped me later in life. I did my thing, and didn’t worry much about what my mother would think or say of it. Joining the military, dropping out of college, moving in with this girl I really liked, etc. I just did them and let her know about it, but I didn’t ask her advice or opinion. That one statement so many years ago made me feel emotionally cut off, and it allowed me to just be with my own emotions. And those decisions all turned out to put me on a really good path in life, surprisingly.
I’ve since had much worse times, including my own actual attempt and threats. So many therapies and meds and doctors have passed, but I still think of that day. Mom died a decade ago or so, and as a result she wasn’t around when I was going for ECT, or in the hospital. I sometimes wonder how things would be different if she was still alive.
The friend who caused all of this committed suicide a few years ago, and I think about him often. What he was going through, how long he persisted, and what the darkness felt like falling from that bridge.
I’m traveling. It’s the same trip I took last fall just before my suicide attempt, just in the other direction. It has given me so much to think about from the past nine months. Hospitalization. Semicolon. A second round of electroconvulsive therapy. Ketamine therapy. Surgical implant of a Vagus Nerve Stimulator. Hours of therapy. So many meds and the good and bad that they do.
Bright flashes of forgetting what’s hurting inside me. Long stretches of being mired in those feelings and that despair. So many things I’ve forgotten, and others I’ll never be able to forget. The support my wife gives me with so much love I can’t find any adjectives strong enough to describe it.
When I’m in travel mode I am on a mission and follow a schedule, getting to the right places at the right time and acting and looking like just another passenger. I’m good at it, but when things get quiet I can stop, breathe, and remember myself. 3,000 miles this month so far either driving or being driven. When I got here I was so tired. It was the numb yet also painful tired you feel that shuts everything else down until you sleep. But standing in a train station on a fresh air break, waiting to reboard I fell to my thoughts. It was a difficult time, and I have now decided that I can’t be that tired anymore. It’s the same reason I stopped drinking. The effect is a horrible one, and it pushes me toward unsafe.
I had a perfect night of sleep, and spent the day with my daughter. The evening with my brother, his wife and her parents as well as my toddler-niece. I was social. We are a family of stories, and I told many of my own, making people laugh and smile. I’ve trimmed down a bit, I’m trying to dress well. Fashionably, even. If I can’t feel good I want to look good. But when you peel back the tinfoil on the dish you find the hot mess that’s my mind just beneath the surface.
When I see someone after a long time, they say I’m looking so great, my demeanor and animation show how well I’m doing. For those who know what’s happened in the last year they think how much I’ve improved. I’ll never know what to say to those comments. Because some things have changed, but it’s still pretty bad in here.
It is very nice to see family I don’t get to see often, and to spend time with my daughter. The trip is something I’ve looked forward to for a long time, and it is going well in many respects.
(Gonna start with a quick apology for not writing in a while. My writing machine is not working well these days. Also, I’m just out of a Ketamine appointment so if there are misspellings or things that don’t make sense, I will refund the money you spent reading my posts..)
A million years ago, give or take a million years, my psychiatrist at the University of Minnesota Treatment Resistant Depression clinic mentioned a VNS. A VNS is a vagal nerve stimulator, and I think I’ve covered enough of it in the blog that I might not have to explain again. The tl;dr is that it’s a little thing the size of a car key fob, and then implant it in my chest. For me, just on the left, an inch or so down from the collarbone. It’s also a wire that goes from the fob to my Vagus nerve. It’s a special (expensive) wire, and it wraps around the nerve so the fob can give 30 seconds of an electrical impulse every five minutes. Scar on chest, scar on neck, but they’re not so bad.
To prepare for the surgery I was given a nice list of things to do. Now, I’ve never had surgery before so I’m assuming this is typical. I had to buy expensive pre=surgery soap, and after a complete shower, had to apply said soap to myself and then wait a minute before rinsing it off. You know how sometimes you’re in the shower and you have to get out for a second or go to the other end of the bathtub for something, and you’re totally soaked, but in open air? Yeah, that was pretty much the deal, except I was covered in an eerily non-sticky or bubbly soap.
That night, I had to fast from 8pm on, skip my meds, and take that first shower. The next morning, rinse and repeat – literally. The one thing the two showers had in common was the fact that they were both in the dark. I was due at the hospital at 5:45 or something, so I had to get up at 4:30 to get ready. Waking up that early isn’t so bad when you haven’t really slept the night before, though. At least we know my evening meds are helping me sleep. When I get to take them.
One thing I did know about surgery is that there’s an awful lot of sitting around the house while you’re recovering. So I made a trip to the grocery and stocked up on comfort food and snacks. I still have a lot of them. Eating hasn’t really been something I’ve been doing very well lately. I make a good show of it, though. It’s not as bad as in this video, but I think about Cassie a lot:
Day of procedure we got up at zero dark thirty and made out way to the University. The ramp we parked in didn’t have great access to the hospital, so we got to wander around in the light drizzle. But when we got to the right place, it was an instant intake machine. Go here, get checked in, go here and get your wristband, wait here and someone will take you to your room. Very little waiting and the only time I got grumpy is when the lady at the second checkpoint called me by my last name. I’m surname deficient, so it happens a lot. But it pisses me off every time it does.
I was taken back to my “little room” – three walls and curtain. Comfy though. Bed, chair, nineteen computers, etc. I was given the requisite gown to put on, but it was easy to do and covered me from every angle. No cold butt and back. I met everyone on the care team, from resident to anesthetist to neurosurgeon himself. Answered a million questions, some of them the same. And gave my birthday about 20 times. That’s not unusual though. I was given a plastic bin to put my personal effects in, it was efficient and handy.
One of the things that came up in my many interviews was that I am a normal, boring, uncomplicated patient. None of the comorbidities that could complicate things, no history of many different maladies. But I hoped that would make everything go so much smoother. I had lost hope that my surgical team would screw up and I’d die on the table, but I’m working on that with my therapist. When the anesthetist came in to put my IV in, he had quite a bit of trouble finding a good vein. When the chief anesthetist came in to ask some more of the same questions, he said that I was the most anesthetized patient he’d met. And he was old, with gray beard and everything, so he’d seen a ton of patients. Given the face that I had dozens of ECT sessions, and each one they put me under, I’d say yeah, I have some experience there. In the end they did have to get the lasers out to find a vein.
I was finally ready and got on the bed, ready to stare at a variety of ceilings. We headed down a couple hallways and into the surgical theater. I don’t know what I was expecting, but it was quite light, spacious, and had an impressive display of devices and `s. I was in there for maybe 30 seconds before they said they were going to put me under. No mention of potential pain. In the ECT sessions, they’d say they were putting me under and that I might feel some heat/pain in my arm. And sometimes I would. But not for this serious surgery. In fact they said it and I woke up after the procedure. Really bummed, as one of my favorite parts of anesthesia is when your eyes roll back and you feel a flipping kind of feeling before going out.
While I was out, they made an incision in my chest and placed the key fob of despair in my chest. Then they made an incision in my neck, sorted out my Vagus nerve and prepared to attach the wire. The post procedure notes said I had a “very large Vagus nerve.” So I’ve got that going for me. Somehow they missed a vain, it was hiding behind the very large nerve. So there was a tiny bit of bleeding and they found it and fixed it. Wire from neck to chest and then they turned on the device, so make sure it’s working. And it did. So they turned it off. More about that later.
When I woke up back in my little room, I was a little groggy, but not that bad. Within a minute or two I felt really clear. I could see the chest incision at least, and it was gnarly. All red and swollen and covered in surface glue. Once the glue wears off and the incision chills out a bit, it eventually fades into a scar that you don’t notice anymore. We’ll see about the scar on the neck though.
Turns out there were actually dissolving stitches inside me and the incision was glued shut and covered in the protective surface glue. Felt like rubber cement. The wounds hurt as much as you would expect, but honestly not that much. I mean, the first couple days they hurt like I’d been cut open and poked and prodded. But at no point was I curled up on the floor screaming and moaning at the pain.
That was just me though. My curtain was open, so I could see the nurses station and a couple other “little rooms” in the unit. They brought a man in who was moaning and groaning and deep-sighing so much it was a little alarming. He calmed down eventually but never stopped wanting to get up out of bed and go somewhere. In stark contrast, there was another older gentleman who was in the bed, but sitting up a bit. He had a dedicated nurse, so I assumed something might be wrong or complicated. A bit later when I was able to hear him better, it turns out he was talking recipes with the nurse. Go figure.
They wanted me out of bed and into the Immensely Comfortable Hospital Patient Chair as soon as I could, to help clear any remaining fog. But I was wide awake. They let me get dressed and then the wife came in. We had a chatty nurse for discharge and at some point I asked if, after I healed, I would be able to play the piano. I admit it was about as dry a delivery as they come. But she said only if I could play before. So joke defeated, but that’s ok. I regretted not asking the doctors and such. I may be devastatingly depressed, but I can throw bad jokes out any time.
Here’s a picture of me in the chair. I figure the mask anonymizes it enough, and I really don’t care if it doesn’t. So that works out.
Sent home with antibiotics and opioid medication. I asked the wife to be incharge of the Oxy. The last time I’d had some on an autumn evening on the porch didn’t work out quite like I wanted/expected. I did sleep a ton, but within a day or two I was up and able to go downstairs (slowly) and do something besides lay in bed.
So what’s happened since?
First, the scars. Healing nicely, glue came off after a week or so, which helped. All of the drawing they did near my incisions had been sealed in with the glue, so just getting those to go away also helped. I think I’m more than a month out and they look so much better. Just little pink lines and some persistent swelling on the neck scar, but that’s going down bit by bit. Right after I got out and the scars were pretty gnarly, I would wear a winter scarf (it was still snowing, after all) so I wouldn’t scare small children or put anyone off their dinner.
After two weeks we went to my psychiatrist at the treatment resistant depression clinic. I keep specifying that because I have enough psychiatrists in my life that I need to clarify these things. Anyway, he’s a really good doctor, nice guy, and is an exact clone of Stephen Mangan.
He handed me a wand – like a giant tv remote with a big circle bit at the end. I held the circle bit over the fob of despair in my chest, and he activated it. He started at .25ma and I’ll go back to him every couple weeks to get it turned up to .5, then .75 and finally 1ma. I couldn’t feel anything while he was firing it, so he turned it up to .5 for a moment to let me feel that stimulation. Ideally I’ll just get used to it as it happens. It felt like someone was standing on my chest. But not in a bad way. It also felt like there was some electiricity being zapped into my neck, but just a tiny bit. It also had a sensation that is extremely hard to describe. Like there was a collection of (like 8) stiff wires and they were all not so much as painful, but felt. Like I said, hard to describe. But no voice modulation, didn’t sound like a robot or like I was talking into a fan. There are, as usual, a long list of possible side effects, but that was the one I was most concerned about.
For those times when I feel it firing and it’s problematic, I have some rare earth magnets that I can place over the fob location in my chest, and a reed switch is pulled which prevents the device from firing. So if my speech is affected at some point and I need to give a speech or record something, I can turn it off for those times. Carrying the magnet 24×7 is recommended, but this device is also used to epileptics to control siezures. With theirs they can activate it so it fires at will, or
BTW, that psychiatrist is an apparent clone of Stephen Mangan, sans accent: (also, I don’t think he’s a cad like the character.)
Going in and out of stores is fine, Target didn’t beep at me as I entered or left. I do wonder how the TSA will deal with the little electronic device I’m carrying.
I also wonder when it’s firing. It’s 30 seconds every five minutes. There are 1440 minutes in a day. Divide that by five since it’s only happening every five minutes – that gives 288 times a day that it fires. Multiply by 30 for the duration, and you get 8640 seconds. Divide that by 60 for a number of minutes and I get 144. Divide again by 60 to see how many hours that is, and I get 2.4 — so for two and a half hours every day I’m getting these shocks. But I can’t feel them, so that’s ok I guess.
While I would love it if I had an app to go with it, I understand the battery life would suck, and I’d need an operation every month to recharge. As it stands, the device can last up to four years on the single charge it has.
I can’t remember the last time I felt this physically horrible, excepting legendary hangovers of the past. Perpetually awake, the insomnia just drags me through the night. Occasionally sleeping, only to awaken – wide awake for who knows how long. And then I wake up bright and early. Despite my near-legendary ability to sleep in and get back to sleep whenever I want, when I wake up I am awake for good. With tension, headache, and pressurized psyche.
Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant developed. They’re effective, but they’ve generally been replaced by antidepressants that are safer and cause fewer side effects.
WebMD, I think
It’s the nuclear option of depression meds. There are so many side effects, bad interactions with so many meds, and a restrictive diet that reads like my shopping list for a weekend with the wife out of town. Hot Dogs, bacon, many cheeses, bologna, sauerkraut, pickles, caffeine, alcohol, and so on. They’re not completely off the menu, but if I eat the wrong food, or too much of one of the possibly-wrong foods, or just a randomly bad food, my blood pressure could go all the way up. And then I have some seriously horrible pain and problems. In the meantime, if the food doesn’t get me, I enjoy low blood pressure. Like, actually too low. Which brings lightheadedness, dizziness, confusion, dry mouth, and such. Not to mention the possibility of Serotonin Syndrome. But that’s all just a sample of the litany of complication that is an MAOI.
I was already rocking the dizziness and a world of other junk, but this latest med has brought insomnia, a tension in my neck and shoulders that I haven’t felt in years, headaches, nausea, and some complicated “side effects that might just be in my head.”
Regardless, I feel wound up. I need to remember to take the deep breaths. My stomach is a knot. I’m waiting for the next thing. Could be nothing, could be passing out, could be many things. I’m sure I’ll relax a bit as time goes by and I don’t actually keel over. Until then, I feel awful, on a path to hopefully feeling mentally better. Despite the insomnia, I’m wide awake half the day, then drowsy fatigued until mid evening when insomnia jitters kick in. Sleep, energy, and appetite may improve with 2 weeks. Mood, depression, anhedonia may need up to 6-8 weeks to fully improve. That sucks.
In other news.. I’ve had my last session of ECT last week and I don’t think I’ll miss it. I love going under the anesthesia, and getting a great noontime nap. But not the confusion, memories being erased or dizziness, etc. I had my second to last Ketamine session, I think. That I will miss. But I have to admit the last two sessions were.. weird.
And finally, in a week and a half I get a mental pacemaker installed. That could take up to a year to see benefit.
It’s always good to end on a high note, or a funny note. Leave them smiling. Sorry, not this time. My mood is still not great – just more jittery – which doesn’t make things better. When I’m depressed, all of the many many things we do through our days are grueling. But if I hit a roadblock – Hit my head on a cabinet, spill food, pick up my phone and not know why – there’s an internal meltdown. And if I could, I would allow that internal meltdown to use the dangerously loud voice, to kick something hard, to put my fist through a wall. But I can’t do those things, so they just kind of sneak into the depression and make it all seem worse.
And then there’s the suicidal ideation. They ask me how it is and I prefer not to give a solid answer. It’s .. different. I’m safe. No plan, no intent. But you know what? I have hope. Hope that the surgery goes wrong. Hope the meds clash and cause me to drop dead in an instant. Hope that I’ll go away and I won’t hurt any more. But I guess the point there is that I’m hoping for fate to do something to me. I’m not thinking about how I could do it myself. That’s an improvement, right?
I have filters for everyone. Back to the classic “how are you” question – that’s a great example of the filters. A friend asks? I’m ok. Doctor? I give a bit more detail. Therapist? She gets pretty much everything, just one tiny step up from my wife. Whom I love and sometimes will hold back on the really painful stuff because I don’t want to hurt her. And yet I know how bad that sounds.
My therapist, who I “see” on Thursdays, got a really long answer to how I am. She asked some interesting questions this week, though of course I can’t remember them. But after I talked about My Morbid Hope (good band name) she started asking some very subtle, very well covered questions. I talked about how I had just started the MAOI, etc. And finally she asked me point blank about whether I had any plans or intentions. And through all of this, she’s never called me out to see if I had a plan, or if I was considering acting on it. Which I wasn’t. I figure so much is messed up with meds and therapies, I’m taking time off from thinking about how I can die. But I’m keeping an eye out for nature.
I have a bunch of things going on. Depression, some anxiety, med side effects like dizziness, GI issues, memory issues, and seasonal allergies on top of it all.
The depression gets in the way of everything. If I have even the slightest little moment of “less bad” the depressive elements like fatigue, lack of motivation, self doubt and lack of optimism all get it in way of something good shining through.
An example: Showering and thinking about yesterday. It wasn’t a horrible day, and I was trying to process the whole day and figure out how all of the auditioning I did and the walk in the evening, and even the time on the porch all fed into the overall soup that is my soul. While those were all good things, my depression is a rock star at punching holes in things. None of the auditions were fruitful (anyone need a voice actor?), the walk was tiring – but actually the problem was seeing everything for the first time and not being able to remember familiar things. And the time on the porch? It’s currently gray, cold, rainy, and will be for some time now. And then there was forgetting for a moment that my dad died 25+ years ago. It was just a bit of a flicker, but that sucked *hard*.
I also have an upcoming trip on my mind, one in very much looking forward to, but I’m wrestling with the logistics of train travel. Apparently ticket prices are “market” prices and just go up with time. So I’m getting further and further from my goal as each day goes by. But I’m working to not think about all of that and hope it works itself out.
I was asked about my SI, and didn’t know how to answer. It’s been a part of my constant running narrative for so long it’s difficult to measure.
So it’s a bit of a fight to keep everything in perspective, and hard to figure out how I’m doing with all of that conflict going on in my head.
But I did have those few good moments, and I did see the future for a bit there. So when I’m asked how I’m doing (which is already a hard question to answer) today’s answer was “weird.”. Best I can do.