PHP, Round 2

PHP, or Partial Hospitalization Program, is like inpatient treatment but you go home at the end of the day. Lasts from 10 to 15 days total usually. Due to COVID, it’s now virtual. Which is a shame because they had these awesome chairs:

Something like this, but better. Wide, comfy, and tall.

So it’s virtual, and the schedule is the same thing, check-in and group and lessons and such. The staff are all very nice, and some even welcomed me back. I didn’t have the heart to tell them I don’t remember any of them. I do miss getting to know my fellow PHP folk between sessions. That’s how I took up knitting last time!

No direct word on the short term disability, but the wife has checked in with work and they’re being super supportive and I don’t feel like I have a looming deadline of “PHP is over, back to work” any more. Which should help, but hasn’t yet.

No word on TMS yet, either, but there’s no rush and I am pretty sure I’m on the list. They’re just checking with insurance.

As for me, it’s been a hard week. Cabin last weekend and I was in the most idyllic place, calm and peaceful. Brain didn’t get the memo though, so I was rocking the anxiety hard, and when it went to sleep depression clocked in. Literally exhausting to be this wound up. It’s like you’re in school and have to read a paper you’ve written and it’s 90% of your grade. Except you didn’t write it. And you wore pants that don’t fit. And your bully is in the front row, right next to the classmate you’re crushing on.

That feeling. From the moment you wake up, to the moment you realize you’ve been falling asleep during this episode of Superstore. And as I said, if the anxiety quiets, you have depression to fall back on. And the internal monologue (not voices) is saying all sorts of things about how you’re a failure, and you’re a drain on those supporting you, and the ones that love you are just saying that to make you feel better. Garden variety nightmare stuff.

The depression is like an old friend. I can slide right into it, warm and secure in the knowledge that things can and likely will get worse. It’s the anxiety that puts the fight or flight instinct in you and then tells you to wander from the kitchen to the living room without telling you what you were meant to do there. And back again. I think I referred to it as “the screaming mimi’s” in a post forever ago. But I have memory issues, what do I know?

So I have my routine, and tasks that I need to plan and then carry out. It’s the simplest of existences, technically very calm. Almost Zen-like, I guess. Except for the Anxiety and Depression, of course. They never forget me, so I should never forget them.

A familiar rabbit hole

So last Monday it all came to a head. I had an appointment with my Psychiatrist followed immediately by an appointment with my therapist. Wife came to both to help out.

I had some pretty comprehensive notes so I wouldn’t forget anything. I had it broken into four sections: Physical, Work, Mental, and Suicidal Ideation.

Physical. Bunch of side effects from going on and off my latest meds, all per doctors orders. Also, the memory and cognitive issues.

Work. How it’s affected me and how my condition has affected it.

Mental. All the stuff in my head – both real and hyperbole. I had just spent some considerable time alone in my head and that didn’t help much.

Suicidal Ideation. Not to go into too much detail, but someone somewhere said something like “I don’t want to end my life, I just don’t want to live this way.” That really resonates, and sometimes it feels like “live this way” won’t ever change, and that’s what makes you want to give up. Here’s the suicide hotline, if you need it. I haven’t ever called it and don’t quite understand it. If I’m ready to go, I don’t get why there would be enough of my to call someone for help. That’s the whole point – you can’t imagine help or a solution. So why am I going to ruin my last moments cranking up my social anxiety having to call a stranger?

I was really honest. Possibly the most honest I’ve been with a psychiatrist, and definitely my wife. It was a wonderfully concise summary of the issues, but I wasn’t holding back, either. It was a little dark.

The general consensus was that I have a loving and supportive wife, and that’s what kept me out of the hospital. I hate having to put that on her, but appreciate it to the moon and back. So rather than checking into the “grippy sock hotel” I’m starting the partial hospitalization program again. Same place, same program, only this time it’s virtual. Which will be interesting. I really liked the neutral environment of the PHP in house last time. On my initial intake I asked if many people do the program more than once. The woman on the phone said “oh yes” with a bit of a chuckle. Not in a negative way, but in a “yeah, don’t worry about that, we got you.” sort of way.

We’re also going to loop back to my ECT doc, and see what he thinks we should do on the “electricity shot into your head” front. The ECT likely helped, but it wasn’t immediate or even quick to help. So we’ll talk about TMS.

Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective. This treatment for depression involves delivering repetitive magnetic pulses, so it’s called repetitive TMS or rTMS.

Much like ECT, the summary of the procedure involves phrases like “why [it] works isn’t completely understood” and “appears to impact” and “seems to ease” and of course “techniques may change as experts learn more” so it’s literally a magical magnetic medication for your malady. I’ll give it a shot and we’ll just see what happens.

And for the PHP and potentially some of the TMS, I’m taking a leave of absence (short term disability) from work. The clock started ticking at 4 weeks, and the fuse to this dynamite is all of my PTO. So I’ll be PTO bankrupt when I go back to work. RIP paid vacations. That said, if the short term disability comes through, that will help quite a bit on the financial hit of this whole thing. As I write this I’m all of 4 days in and the mere thought of work gives me a low grade panic attack. Which is pretty often. I’m hoping I start to forget about it at some point.

It’s not that I don’t like my job, the company, or the people. It’s my memory issues making me lose confidence that I’m doing it right, and the cognitive issues make the diagnostic/ part of the job a nightmare. And I don’t want to not do a good job, so the pressure hurts.

So yeah, we’re back to where we started, possibly on a faster timeline and spending less time lollygagging and going right into it all. It doesn’t make it feel any better (yet) but it’s something.

But apparently that’s enough of that

Let’s just say there should be a trigger warning on this post, and leave it at that.

On March 1st or so, work ramped up. New partnership, new technologies, surge of customers, and the fact that our COVID business had been going full bore since last spring. These things all led up to a record breaking case of anxiety, and in the quiet moments, depression. Back to square one, apparently.

My memory issues from the ECT and major depressive episode (referred to as “the event” from here on out) meant that while I was living in the moment, there was really a lot of forgetting about the moments before and after. 2019 is pretty much gone. I can recognize pictures of things I did back then, and remember some things, but so much of it is simply gone. People tell me stories about myself that I find interested or know that I would have enjoyed, but the memories just aren’t there anymore, even when jogged. As 2021 unfolds, I’m finding parts of 2020 have some holes in them, also.

I also feel like I can’t learn as well, and like so much just goes over my head. Forget programming, that skill is just gone. I played with Arduino this past year and it was a grueling, copy and paste heavy exercise. So it feels like the self taught skills I had that allowed me to be successful in the world aren’t able to help anymore.

And sometimes I get confused. I’ll be sitting in the living room and suddenly get a sense of not knowing where I am, and then in a handful of moments I’m back in the room and understanding. That’s a little distressing. I’ve been having “lost words” since the ECT where I’ll be talking and just not able to remember/access the word I need. Sometimes it’ll pop in, but most of the time I have to use the internal thesaurus, and do the best I can with the words I can find. I’ll also lose my train of thought or intended task. Right in the middle of a sentence everything resets and I have no idea what the original question was, or what I’ve been saying so far. As you can imagine, that’s tough in a business conversation with a customer.

So that all sucks. It’s required me to double my therapist appointments, we’re changing up my meds, I’m back on some of the more evil (but helpful) meds from 2019 that I really didn’t want to go back on.

I have a great care team, and I’m seeing my Psychiatrist, Therapist, and support group on the regular. The support group even has a text chain for instant access as needed.

But for the last month, the anxiety has ranged from low grade always-there in the pit of your stomach, all the way up to rolling panic attacks. When things are quiet, the depression rears it’s lazy head. I’ve dropped all hobbies except practicing concertina (mostly because I have weekly lessons and feel the need to practice) and I’ll play a little bit of simple video games. But I find myself just wandering around in them.

And the suicidal ideation. It’s tough to talk about because it’s been with me since before high school. Just a constant thought about it, sometimes just a tiny echo in the back of my brain, and others it’s at the forefront of my attention. For most of 2020 I didn’t even think about it. I could walk across a street and not think about the timing it would take to get in front of that bus, or I would refill my pill containers and not even consider which ones would get me a good overdose.

I think of it like this: The depression and anxiety are always there. Always have been.

Sometimes, it’s like this:

90% happy, a little anxiety in the background, a little depression hiding out somewhere.

Those are good times. Yes, there’s a bit of the brown and red in there but the vast majority of the time I’m happy go-lucky.

Other times, it’s like this:

That’s where the anxiety spikes. Gives me all the horrible it can, and it takes up so much more of my life than happy does.

This can go on for days or even weeks. Which usually leads to this:

The exhaustion of the anxiety collapses into depression. Which then takes over my motivation and happiness.

When the work anxiety started to grow, I got in touch with my care team and worked aggressively to stop the process. Worked with my employer to remove the afterhours / on-call stuff that was causing me the most anxiety, and focused really hard on my tools.

Unfortunately, that just wasn’t enough. I’m not back to square one, but I’ve been set back a huge amount. Just the everything: mood, motivation, exhaustion, increased memory and cognitive issues from stress of it, and also the suicidal ideation.

I tell people I’m safe, and generally I am. I understand that if I killed myself, it would be directly hurting my children and family. It would be like taking my problems, chopping them up, and then sharing them out to everyone who cares about me. I get that. And that’s my failsafe. But I still think about the bus, or the train, or which meds aren’t dangerous. If I feel like that’s not in place, I will do whatever I need to remain safe, beginning with communicating with my wife and therapist. (Still holding out for COVID, or a quick cancer, or a satellite falling out of the sky on me.)

The thing that makes this feel worse than “the event” is that I was doing so well for so long. I knew I hadn’t kicked it, but it felt like I had it under control. The ratio of good years vs. bad is not an impressive one, and that just reminds me of how chronic mental health issues can be. I feel like someone is going to suggest more ECT, or another run at partial (or even actual) hospitalization, and that scares the crap out of me given the repercussions on my job, my relationships with my family, my memory issues, and everything else. So I feel like I have more challenges, fewer options, and a pretty bad record of success.

But summer is coming and I can hear the birds out the window. Gotta stick to that moment when I can.

A year on, successfully

So it’s been about a year since I “turned the corner” and really started to improve. I spent the lockdown and following time doing really well – dancing in the kitchen, doing crafts, going to the cabin and really enjoying it, etc. Being mindful, focusing on the moment, using my tools, and the after effects of the ECT and the ongoing meds all came together to make things work! I was happy, with so little anxiety and depression that by year’s end my therapist and I had to discuss what to focus on, as my immediate issues had resolved. I completed a PHQ-9 with a score of zero, which I hadn’t seen in years – and just a year ago was pegging with a maximum score.

Happy, well, healthy, and quite stable. Despite the world.

Let’s run down what’s happened in the last year..

  • Global Pandemic
  • Ending ECT (due partially to COVID)
  • Ending DBT (due partially to COVID)The George Floyd event and subsequent uprising
  • Presidential Election
  • Attempted mugging/increased crime
  • Coup attempt
  • COVID-19 vaccines on the rise
  • A return to normalcy
  • A second career

Global Pandemic

So obviously, COVID-19 showed up and threw a wrench into everything – except for me. Getting locked down was an introvert’s dream. Even with a bunch of people in the same house, the ability to just work and not have to commute, do lunch, etc. really made it easier for me to focus on my mental health. I’ve always been fascinated by the 1917 Influenza pandemic, so this was actually an exciting time for me. And I really like working from home.

Ending ECT (due partially to COVID)

By the time of the lockdown, I was showing enough improvement that we were considering stopping ECT maintenance. Coincidentally, the ECT clinic was locked down and had to make changes to their process — so when they called to tell me that I let them know I was “good to go” and thanked them for all their help.

Ending DBT (due partially to COVID)

Again, DBT locked down with COVID, but after a few weeks they were going to go virtual with Zoom. Because I just wasn’t clicking with the group, and the stress of going was greater than the benefit I was getting out of it, I decided to hold off on rejoining. I would like to join a different group some time, but ideally that would be in person (post COVID) and closer to home. I need some urban peeps in my support groups, not just suburban folk.

The George Floyd event and subsequent uprising

We live a mile from where the initial George Floyd incident took place. As a result, we were front and center for a lot of the events of the city — the uprising, the riots, the curfew, everything. George Floyd square is close enough to walk to – and I find myself going there almost as if it’s a spiritual place, or a church of the mind. During the riots, the fires were close enough that it always smelled like smoke, and it was constant sirens and helicopters (some military). National Guard convoys motoring up Nicollet avenue is close and scary. Businesses were burned to the ground just a few short blocks away from us, and tensions were high. Most businesses in Minneapolis boarded windows, and there was evidence everywhere of what was happening.

Similar to the days following 9-11, things changed for a bit in the city. When the helicopters and sirens quieted down, the COVID lockdown and the city curfews made for some extremely quiet evenings and nights. I really enjoyed going out on the front step just before bed, and listening to the uncommon quiet of the city in the summer heat.

Throughout, I was following everything on the news, Unicorn Riot, reddit, etc. It was odd to hear explosions in the neighborhood and then hear them in a 15 second delay on CNN.

Presidential Election

When the election hit, things were still iffy in the city, but the national issues were bigger. We weren’t sure if the voting locations were going to have protests or even attacks. All summer we’d been hearing about domestic terrorists, and even seen some during the riots. So going to vote was actually a little scary. But turned out to be fine.


After the riots, it felt like the police just disappeared. Muggings, carjackings, car theft, catalytic converter theft – they all went up quite a lot. On a walk in the neighborhood I joked that I would likely get mugged. And they tried. A car pulled up, a kid got out, put something in my back and told me not to move or he’d shoot. Long story short my Marine voice came out and in the end they went running off with looks of confusion and terror on their faces. I found it quite cathartic. But technically it was stressful, I suppose.

Coup attempt

Watching Washington DC and the coup attempt we were all thinking about the previous summer and the issues we’d seen here. And it’s safe to say we were all worried about how big the coup and related attacks would get.

COVID-19 vaccines on the rise

Vaccines finally got created, approved, and started to get shared. Family members work in essential roles, and got their vaccines quite early in the process. I got mine finally, and I still think it was because my psychiatrist flagged me for it. But it could have been one of many reasons. But one day in MyChart my care team notified me to make an appointment. I have to admit that my inherent passive suicidality was disappointed to get the vaccine, as it meant I was less likely to get COVID and die. Which would really be the best for everyone, in my mind.

A return to normalcy

Some places started opening up, and everyone talked about “getting back to normal” but it’s really going slowly. Every time someone says “normal” I get a slight wave of panic, as the lockdown and pandemic has been so good for me, keeping me home and focused and able to work with some reduced stresses. But it means the family is getting out more, and the house has some quiet moments.

A second career

Finally, I’m working on a skillset that might lead to a retirement career, or a side gig that could maybe even turn into something real with a few years work. Less of a stress point and more of an exciting opportunity.

No news is good news

Not much new to report. Back to work full time, only getting ECT treatments in maintenance mode – once every three weeks. Last one switched to Friday so my second day is on the weekend instead of having to take two days of work off.

Between the latest meds change and the ECT things are fairly stable. My mood is much improved, and I’m doing things like hobbies and getting out of the house on a regular basis. Granted, most of that is for therapy. I am taking a DBT course (Dialectical behavior therapy), weekly individual therapy sessions, and the Face-it men’s depression support group. Add the periodic ECT and I have a lot going on. But it’s all working together, and I’m looking forward to spring.

Work is hard. Both physically and mentally tiring, and I still feel I’m playing catch-up. As we get busier I’m sure it’ll get better, but I’m plugging away and time will make everything better. My care team was against just going full bore full time, but things are slow enough that I feel I’m being eased into it.

How’s it going?

It’s a question I dread. Most of the time it’s someone asking me literally how it’s going. Like, a normal “Hey” question. They’re not trying to figure out if I’m depressed or anxious or where on the scale I am, mentally. It’s usually just a greeting.

I’ve landed on “It’s going.” as a standard response. Because if they don’t want to know how it’s _really_ going, I don’t want to go into it with them. And if they _do_ want to know exactly how my mental state is, they’ll ask more probing questions.

I haven’t gotten a ton of “How’s it going” with the corresponding sad eyes and tilted head – but I’m always waiting for it. But it’s such a loaded question and there are so many things to say. But half the time I’m not even sure, myself. So having to answer it is having to look deep inside my current psyche and figure out just what’s going on in there.

Long Answer

The med changes have shaken out and things are looking up. Wife reports that my slow decline between ECT treatments isn’t happening in this iteration, and my spirit is actually positive. I had an intake interview for a DBT program today and had to explain what it’s like when I’m depressed – and I’m enough “not depressed” that it was hard to actually verbalize. But we got through it and I’m starting their program in two weeks. Happily, it’s in the evening once a week so it won’t impact work.

That’s the other half of how it’s going – work. I’m working as much time as I have available, which means near full-time with the exception of ECT days (which are going from 2 to 1.5) and the odd appointment day. (An appointment day is when I’ve jammed all of my latest appointments into one single day so I can minimize time away from the office.) My energy is back up so I’m not soul-crushingly tired until mid-evening, rather than mid-morning. And I’m getting back into the workday groove, which is nice. When I was on the day program I was leaving before lunch and that just wasn’t feeling like actual work days.

Fun side note – the ECT has been affecting my memory, but most conspicuous is my memory of media. Movies or tv shows that I don’t remember having seen. So I just recently binged season three of Fleabag (again) and loved every (repeat) minute of it as a completely new experience. Episode 3 is the best episode of the entire series.

Short Answer

It’s going. 🙂

My New Therapist

Met with the new shrink on Friday and it went well. We spent the whole time going over my history, and she seems cool. The weekly check-in isn’t the standard PHQ and GAD form, so those trends won’t be in the system for me as regularly anymore, which will be odd. I’ll still do it for my psychiatrist, but that’s monthly at best. Maybe I should do it myself at home just to keep a frame of reference. My numbers have been crazy high lately, so it would be good to watch them (hopefully) go down.

The stress about going back to work has to do with an expectation that I’ll be back up to full speed by the end of the month. ECT treatments and followup days aside, going to full time that fast is scary. My care team universally feels that schedule is too aggressive. Unfortunately, they haven’t offered a “preferred” schedule. I’ll push for one this week. The team at work has grown enough, and the theory is that off hours coverage will be assigned, so the environment isn’t exactly as intense as it was when I left. But going from light hours to full time will be an interesting challenge. I do look forward to walking home from work on the regular, though.

Holy Cow!

Had a maintenance ECT session today and it was a whopper! Dizzy and woozy all day, slept for hours and hours. Still not quite steady on my feet.

It hasn’t been going very well recently, so we’re going to stick with a two week repetition for the maintenance sessions.

Saw my psychologist for the last time last week- she’s moving on to a different position. I’ll miss her dearly, as she really “got me.” I see my new one on Friday, stop fingers crossed she’ll be a good one too.

Every time I see a doctor (primary, psychologist, psychiatrist) at my clinic I fill out a survey on my anxiety and one on my depression. This wow score was the worst ones I’ve ever had. Partly because of the changes in therapist, but also because I’m stressing about going back to work.

It’s not the holiday, it’s the disruption

While the Holidays can be tough for some people because it highlights family, or loneliness, for me it’s the disruption. Days off or working from home, events and dinners to be planned and executed, family expectations and time spent killing time. It’s the break from normal routines and schedules that can be trying.

Don’t get me wrong, I love the holidays and my family, so it’s a special time of year for me. But there are times when it’s difficult to escape if you’ve overloaded on stimulus or just need a break. And when it’ all over it’s always a bit of a letdown, staring down the barrel of the rest of winter.

So here’s to hoping I can stay awake for midnight on New Years.

Gut Wrenching Cry For Help

I saw my psychiatrist in passing the other day and we had a nice exchange of smiles and waves and both went on our way. Pretty typical, especially since I’m at the hospital often enough that I’m seeing my care team in passing.

What was different about this one was that this was the first time in at least a year that I saw a member of my care team, either by appointment or coincidence and didn’t have an immediate gut wrenching feeling of desperation. I didn’t instinctively want to throw myself at them and plead for a solution. There were times where simply seeing my primary doc or my therapist made me want to burst into tears for no reason. There were times where I just wanted them to lead me to check into the hospital.

It’s nice to have something feel “normal” again. But I’m still waiting for the other shoe to drop.