a Scarlet D

My mental health journey

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  • TMS, the second attempt

    Quick catch up:

    • Things seem about the same
    • My therapist accused me of seeming better
    • I don’t like good news
    • Still not eating much
    • About to run out of movies to watch

    TMS. Transcranial Magnetic Stimulation. It’s classified in the “we don’t know how it works, but sometimes it does..” therapy line, but this time I’m doing it at the Treatment Resistant Depression clinic, and they have more scientists than the last place, and it feels much more like something they may actually understand.

    Side track: After I was referred and confirmed for the TMS series, I got a call from a guy at the University. No idea why I picked up the call, but it was a good thing. He was from my psychiatrists lab, and they were running a study on the efficacy of TMS. Just single appointments before, during, and after. So Tuesday (apparently that’s only two days ago. Who knew) I went to the U and met Mr Study. (not his real name) and got to see my doc’s lab. I was expecting a huge, bright and white well lit lab with vials and people in lab coats and protective goggled. I don’t know why, maybe my brain just inserted that idea based on TV shows.

    What I got was a room about the size of two or three cubicles, with all sorts of computers and interesting looking displays. Wires criss-crossing the place. It reminded me of the student lab in Ghostbusters. It was just piled high with technology and a desk or two, but it was organized somehow. My station was a monitor, mouse, and keypad with 6 buttons on it. I was fitted with what looked like a bicycle helmet, with the addition of all sorts of electrodes poking my head. A couple sticker leads, two behind my ears and two on my chest.

    The study itself was a series if on screen exercises. The first was a display of three things. A house, A person, and a vehicle. You choose one and it tells you if you won a token. If you did, there was a possible likelihood of yielding a token the next time. Or not. So you play this choosing game and it modifies trends based on your behavior. The only thing was, it was a loooooong exercise. At some point I noticed a progress bar, and realized it was going to have 200 iterations. With a bike helmet poking your head. It tried my patience.

    The next exercise showed you a letter. And then another. If the current letter was the same as the first, you pressed the green button. If not, the red button. Fine, not so bad. But the next exercise wanted you to skip a letter and indicate a match. So it would show A (no), B (no), C (no), B (yes), B (no), B (yes) and so on. That was harder, keeping track of displayed letters. Next exercise? Skip two letters. Last exercise, skip three letters. Oh I forgot to mention each successive exercise speeds up. Needless to say, with my memory I simple randomly tapped red or gree.

    The final exercise had something to do with emotions. I can’t remember what the responses were, but they were effectively “good” or “bad.” They would show an image and you press a button. I was told, and the screen also mentioned, that the images may be quite graphic. Welcome to Clockwork Orange. Images that I remember:

    • Naked dead body being taken out of a house that had burned down
    • A pretty kitty
    • A topless woman on a beach
    • A charred body in wreckage
    • Children doing something cute and innocent
    • Two beautiful naked people having sex
    • Puppies!

    You get the gist of it. There were more good images but it was hard to remember with the dead bodies in my short term memory. Honestly that was the most interesting exercise. Seeing an obviously bad image but thinking “what if I was a serial killer? Would I press good?”

    Got a gift card for my efforts, and a handful of change for parking.

    Ok, back on track. Wednesday morning I went into the TRD clinic for my first TMS session, as well as the “mapping” to figure out where to shoot. Having done TMS a couple years ago at a different hospital/provider, I was excited to see the differences. And there were so many!

    A fabric cap was put on my head, and they trimmed it to fit. It would be my cap for the series. Lots of measuring was done, and there were strips of measurement tape on it, indicating how far in whatever direction the machine would be pointing. Then a doctor breezed in – a super cool exotic looking doctor. He had a cravat. Yeah, that cool. Had he told me he had hung out with Bowie I would have believed it. He adjusted the machine while the tech spouted out seemingly random numbers, His goal was to make my right thumb twitch, which would give him a reference point. More adjustments made, thumb twitched, all is well. After chatting with me for a bit, doctor breezes out. I seriously want to go to dinner with that guy. He’s got stories.

    Mapping being complete, it was time for my first session. As you may (likely not) recall from a previous post I’m too lazy to link, the last TMS experience felt like woodpeckers or hummingbirds tapping HARD on my temple. For an hour. This one feels like it’s fewer pulses or tiny little mallets tapping my temple, but like whomever is doing it kinda doesn’t care about their job. TAP, but not too hard. After each tapping there is 45 seconds of rest. Also, there are only 54 pulses like this in a session. So even though they strap a moderately heavy helmet to my head, it’s only 20 minutes and not too painful. Headaches and tiredness are potential side effects, but I haven’t had either, previous TMS or this one. (Although as I prepare to post this I realize I have a deep but not horrible headache. Will try breathing more). Another potential side effect is seizure, which sounds like fun to me, but that’s probably in poor taste. I was going to listen to music, but the tech is just sitting there, and it’s only 20 minutes, so we just chat. She’s really good at it. Guessing she spends much of her day

    So the TMS wasn’t bad. But there’s a gap I have to fill between TMS and Day program that’s too short to go home but too long to just show up early. So I got a haircut. And went to Target. Between all that and Day program, then the Ketamine uber shuffle (rush back to apartment, park, get uber to TRD clinic, trip balls, get uber back home, try not to think about having spent $80. Between all of that, it was a harried day. I’m on a new med – a stimulant – and it makes me feel manic. Which helps get through a day, but I don’t like how it makes me feel like I’m buzzing. Anyway, by the end of the day I was back to my old self. Stimulant having worn off, exhaustion crash coming back down on me, and my new eating problem: Being a little hungry but not looks like food. It’s all just cardboard, or worse, chicken.

    More as I continue my journey down the TMS road.

    Oh, I have pictures of me in both helmet getups, study and TMS. But you’ll never see them. Just imagine the dorkiest thing you can think of, and add wires.

  • Non Therapeutic Media

    In a post about a million years ago, I referenced something I call “Depression Porn” – I guess you could just say it would be media that’s triggering. After a productive day of being depressed, I thought I’d find a new movie that sounded interesting. A movie that’s been on my watch list has been “Aftersun” – it features an actor named Paul Mescal, he’s a cool Irish guy. Got nominated for best actor at the Oscars for this role. Had no idea what it was about.

    The premise is a father (Mescal) and his daughter (12 ish?) on a summer holiday to a resort in the mediterranean. That’s about it. Great character study, etc. Lots of good emotional moments. I connected so hard with the father, trying to be there for his daughter but clearly having issues. I could smell the depression right away. It was the little things like the look behind his eyes when he’s trying so hard to look like he’s having fun. The way he sags every so slightly when the focus is off of him, There were other more obvious things, but they were softly and slowly introduced to the storyline. And it was clear that this was all leading up to something bad. Every sharp noise was a tease.

    The end doesn’t solve or explain anything. I know I took my own ending from it, and I’m sure a lot of other people did too. But I’m guessing there are many different endings to the movie. Mine was, of course, that he committed suicide. It’s heavily hinted at but no clear indicator.

    I spent a long time during the movie and after thinking about grinning and bearing it with my youngest daughter. About the times where I put in all the effort I could muster to be able to be there for her. We had a lot of good times, but many of them were tinged with that gray crust that keeps me from feeling. Those times were some of the best and most important memories to me. Whatever’s left of them, anyway.

    I needed a palate cleanser, but then my addicted little mind started suggesting things like “Melancholia” or “Sylvia.”

    So I decided to go all in and watch Ordinary People. Holy cow, what a great movie. The first time I saw it was on the family black and white TV using headphones. There was something wrong with the TV or the headphones, there was bleed through from something else. So the whole time, there was this background noise like people talking. For a movie that is legendary for it’s use of silence, but broke that but somehow added something more. Successive viewings have carried that silence nicely. I wonder how many people adjust volume and check for mute as the movie begins in absolute quiet. These movies may not be the best thing for me to be watching, but they’re comforting. Like group, my co-patients bring up hard stuff, things that make ones mind wander to dark spots. It’s comforting because it’s people who get it. Like movies that understand.

    Anyway, Aftersun is great.

  • What is invaluable?

    I think of the different elements of past jobs and how I valued them. From the mentor back during the dotcom bubble, to the manager who taught me all about how Agile can actually work. My current boss has been nothing but supportive. He’s been clear that he wants to set me up for success, and in as much as I have shared my mental health issues, he has been completely supportive. “Just get better.” It sounds like a phrase I would write a whole negative ranting blog post about. But in this case he really means they want me to heal, to get better, and to come home to the job.

    My schedule firmed up quite a bit last week, with the addition of a series of TMS, combined with the Day program I’m in. Add in the ketamine appointments, the individual psychiatrist appointments, therapy, and the treatment resistant depression clinic and I have an extremely full schedule. It’ll be like that until the beginning of October when TMS ends, and go back to normal by the middle of October or so. I know I’ve written about this before. I think.

    The result was the need to talk to my boss. My therapist said I should do that sooner than later so my catastrophizing brain couldn’t rake me over the coals any longer than necessary. He got back to me in a timely manner and we just had a call. “Just get better.” He just wants me to take the time I need to be able to come back and succeed. My team is waiting for me, and things are pretty much the same as when I left a month and a half ago. He’s possibly going to get kicked upstairs, which is a bummer because he’s such an advocate, and I just don’t know his replacement that well. We’re talked and worked and such, but it’s different between coworker and manager.

    I’m in a really bad place. When I get pulled from program so they can talk about my safety, it’s feeling less and less like “hang in there, maybe do you need inpatient?” to “Convince us why we should let you go home today.” I had a pretty bad one of those on Thursday. It’s hard to argue with them, and honestly I’m really only about 75% open with them, because I feel like the other 25% they wouldn’t understand, and be next level concerned. (My brain’s been in this mode for half a decade now, and it’s all full of stuff that can be upsetting to others.)

    tl;dr Work still loves me, if schedule volume is what fixes things, I’ll be cured in a week. I still want to be gone. But I love all of my family, immediate and extended enough that it currently keeps me safe.

  • Day program and more

    It’s just turning into one big panic attack.  Can’t breathe, anxious, worrying. Getting used to days where I don’t eat at all.

    Left (graduated?) the partial hospitalization program because it’s only 15 days long. I have transitioned into the day program. Tuesday Wednesday Thursdays from 12:30 to 3:00. For like, ever.

    Seems like a great way to be able to introduce me back into the workplace. You know maybe working Friday Monday and then incorporating the midweek mornings, and so on. Except…

    My current hospital denied me for further TMS treatments because of my VNS. But the treatment resistant depression clinic does TMS and knows how to work their way around VNS as if needed. So I’m on for those starting next week, everyday of the week at 9:30 a.m.

    So much for going back to work.

    Between the day program and the TMS treatments I am not going to be able to go back until the beginning of October. FMLA will be long gone by then and I’m dreading having the conversation with my boss.

    On one hand, they’re so supportive and maybe they’ll continue to be supportive in an unpaid leave sort of way.

    But they wouldn’t surprise me if they basically said that was just too long and cut me loose. The first option would be great, maybe the TMS would even help me enough that I could go back to work and not end up suicidal again.

    If they decided to let me go, a collection of events would happen that would put my safety in extreme jeopardy.

    My confidence that I could find another job is pretty low, given my experience finding my current job. My cushy health insurance would go away and I would go on Medicaid. I know for a fact that my therapist and the treatment resistant depression clinic both don’t take Medicaid. I don’t even know about my meds psychiatrist. So I would have to try and find a new therapist that doesn’t know me and a new psychiatrist and someone who can do maintenance on my VNS.

    I would go back on disability, which would help, but I would have to move out of my apartment once I finished ruining my savings. Finding a new apartment, packing, moving, not living here. All of that just makes my heart hurt.

    I know I’m catastrophizing but all of those things are not unreasonable. I’ve recently trended from passive to active suicidal ideation. And I think all of that stuff above would be just enough to push me over the edge.

    Yeah, yeah, I’m safe right now. I do have a great care team at the moment. I love making therapists cry.

  • Last Day of PHP

    Last day of PHP and I’m growing increasingly sad about being done. I don’t know what I thought I was going to accomplish here but I guess I was hoping for some sort of miracle. I met some amazing people and got some great therapy out of the therapists.

    I’m moving on to a day program next week which is fewer days, fewer hours. Eventually I will weave work back into that schedule. That frightens me more than anything else. I don’t believe that I’ve gotten any more prepared to return to work.

    We’ll see how it goes.

  • Click. Click. Click.

    It’s a modern looking pen. The thrust device (I looked up pen nomenclature) was unique, almost a button and a lever combined. Push the button, Click. Push the lever, Click. Click. Orange metallic with black highlights. Normal length for a pen, maybe a little bit thicker.

    I noticed it the other day. The click, that is. It was a simple background noise, on the other side of the room. So it was quieter. click. Annoying, but drowned out by the rest of the noise in the room.

    Today he was sitting right next to me. Click. I’ve decided he’s a nervous individual in general. Thus the habit. Click. It wasn’t until after lunch that I connected to it. Click. In the past I’ve been sensitive to people eating food loudly, or other annoying noises, but I’ve had it under control in the last few years. Click. Today, however, it was too close, too loud, and constant but irregular. Click. I would watch his hands, waiting for him to set it down, to give me some time to recover and get my footing. But he always picked it back up. Click.

    It grew from annoying to highly distracting. Click. Eventually it must have plucked the right chord because the anxiety attacks began. Click. Flush, heart beating out of my chest, fire burning in my stomach. My concentration was focused on that one thing only. Click. I couldn’t understand why nobody else noticed it. It was so loud and so percussive. Click. I looked around the room and nobody even seemed bothered. Click. How was it that a room full of people in some form of mental health crisis weren’t picking up on this? Click. Why was it just me?

    “Urge surfing is a mindfulness-based technique, often used in Dialectical Behavior Therapy (DBT), to manage cravings and impulses by riding them out like a wave rather than trying to suppress or give in to them. It involves acknowledging the urge, observing its physical sensations and emotions without judgment, and allowing it to pass naturally, like a wave receding.” — google

    I’ve used urge surfing Click before, but it’s hard. To me, it’s like Click just letting the thing overwhelm you and wash over you Click as long as it’s near. So in this Click case it was just letting the Click anxiety flow through me Click like boiling water. Click Just have to endure it until it Click stops. In some Click ways it’s nice Click to know Click that’s as bad as it Click will be, and that Click it’ll end eventually. Yeah, I just Click read what I just wrote, whatever.

    So I spent Click the rest of the Click afternoon urge surfing and Click failing at telekinesis. By Click the time it was Click a problem we were just starting Click the last session, and I Click just white knuckled it through. Click Yes, I am well aware I could Click have politely Click asked him not Click to click the pen. But Click I was too far Click gone by Click then. Click So Click I Click just Click rode Click it Click out.

    It eventually stopped (he left) and I was left with sweet sweet relative silence. I still couldn’t believe nobody was bothered by it, so I asked a woman on the other side of the room. It was like she had been holding her breath. She had been going just as crazy as I was. Someone else piped up – and within a minute everyone in the room was talking about how maddening it was. I’m still going to be the one asking him to stop clicking, unfortunately. Everyone agreed.

    The moral is twofold. First, don’t click your damn pen. Second, just because someone looks like they can’t hear a pen clicking, it doesn’t mean they’re not dying inside.

  • Inpatient is trending

    Just got out of ketamine and had a follow-up with psychiatrist at the treatment resistant depression clinic.  He wasn’t suggesting I go inpatient, he was asking for a reason not to do it.  I was honest with him and we eventually settled on me remaining at home with check-ins. But it was touch and go for a while there.

    We also talked about deep brain stimulation, and given some time that sounds interesting now.  Like the VNS but easier (if brain surgery could be considered easy) and with a more conclusive set of outcome data. It would be a study, so free. Which would be nice. We’ll see.

    FMLA and short term disability approved finally!  That makes it easier to breathe for sure.

    Oh and I came out in group. NBD.

  • melancholia

    My therapist thinks I should check myself into the hospital for safety. Complicated. Last time I was in was an anxiety nightmare. Pass.

    Was referred for more TMS, got denied today because last time it made my depression worse. Also the VNS is problematic with the magnetics. Refuse to do ECT if they offer it.

    I can see the end of PHP coming next week and don’t know what comes next. Not better. Certainly don’t feel well enough to go back to work. Done everything, nothing works.

    All I want to do right now is cry at the end of A Star Is Born but the crying doesn’t work anymore.

  • Just as it is

    How it’s going

    The new PHP is going well. I’m getting something out of the group therapy sessions. I enjoy spending the time with people just as broken as me. Someone pointed out the other day that I appear to be running without filters or masks. I suppose they’re right. And it’s a bit refreshing. I’m still not sharing completely when it comes to suicidal ideation. They ask if it’s passive, active, or nothing. Active involves plans and intentions. I always put passive, but I have to admit I have a number of different plans. No intent yet, but the last week has tested me quite a lot.

    Last week was extremely hard. Still reeling from the news of our friend who committed suicide, I’ve had volumes of thoughts and feelings about that. But two events made my week go even further south. The first was a dinner with my eldest, just one of the things we do. This time it was fish and chips. We talked about our friend and she was pretty emotional. She didn’t even get along with him that well, but they had a connection anyway, and this was a tough loss for her too. She cried, but held it together enough to have a very good conversation about the implications of suicide. Mostly the usual (anger, sadness, resentment) which I’ve heard, and now felt.

    Her tears and feelings felt like a poorly masked commentary on my own suicidal history and the impact on my family. I could just hear more and more safety catches being placed on my own plans and intentions in addition to the locks already there. Family, my other daughter, my friends. Everyone I’m having to stay alive for, and now these additional perspectives. By the time I dropped her off I was livid, though I didn’t share my anger with her. I just wanted to drive my car straight into a wall. My anger tied directly to the things preventing me from dying.

    Next day, even worse. It was the day of the memorial. I’m glad I went, but it sucked in ways I couldn’t have imagined. It was a nice service, with family and friends telling stories of our friend. He was larger than life, and as such the source of great stories. When one of our friends told her story, I got a few sobs out but kept it together. What really got me was the first memorial. One of his nieces, about the same as as my youngest daughter, same hair, similar look. As she was sobbing through her memorial, she morphed into my daughter, standing there sobbing over her own words for me. From there, it became my memorial. Which of my friends would be there? Who in my family would host the memorial. Would it be a hassle of a task for them? I’ve never seen some of my siblings cry. Would they? How would my ex be participating? Would she speak?

    I tried to not make it about myself, but failed miserably. When the ceremony was over, I hugged my ex, told her I couldn’t be there anymore, and left. I just couldn’t handle small talk from the people I knew there. My current state does not lend well to the question “how are you these days” and honestly it just felt like I would be haunting the place.

    As I left and made a beeline for my car, I saw other people leaving. The hot summer day causing people to take off their ties and jackets. Throw them in the backseat and head back to the office, or to lunch somewhere. The memorial left at the service and the day must carry on. And that’s it. It’s over. My family would probably gather somewhere and drink and tell family stories. Someone would have to go through my apartment, clear it out. I wouldn’t want it to be my ex, but wouldn’t want one of my siblings have to do it. Nothing crazy to discover there, just wouldn’t want to inconvenience anyone.

    That’s about it. Those are the events of the week. They had a profound effect on me, and I don’t know how long it will be before I find my balance again back to my major depressive episode and anxiety spree. For now I’m just trying to stay out of the hospital.

    In the time since I have reviewed plans, researched more, and thought through logistics for a suicide. I’ve been doing that for months though. It has been the intent that has begun creeping in. Two nights I shouldn’t have been alone, but lucky you I’m still here. But I feel this chaos in my life that I haven’t experienced before. It’s not the comfortable depression or the painful anxiety, it’s that I can’t imaging the future, and working with the care team doesn’t give me much hope. The staff psychiatrist gave me that look that the treatment resistant depression clinic psychiatrist gave me. I’ve done a ton of meds, ECT, TMS, all sorts of things. They’re offering another round of TMS, which I guess couldn’t hurt. (except for the woodpecker) Of course, that would be every day for a whole bunch of weeks. Not conducive to going back to work. Layer on that they’ll likely refer me to an IOP, which will be three days a week for half a day — and the combination works out to two half days that I can work. And I can guarantee you that’s not going to fly. Not to mention I’m a people manager. So 5 days a week is pretty much the gold standard.

    Does this preclude me from going back to work? So that removes my income and health care. So that would lead to medicaid and disability. Goodbye apartment, travel and what else? I love my car and it’s paid off, but repairs on that model can be stupid expensive. So either I lose that or build up the credit card debt and sink my credit score. That’s hard to come back from. I know I’m catastrophizing, but tell me you can’t look at that and say it’s not a possibility.

    When I think of how mental health feels, it’s like a focal ring. When things are okay, low pressure, anxiety quiet, it’s a wide view. I can see my daughters, who I don’t want to hurt. I can see work, and some sort of future, however hopeless it may be. Which keeps me from hurting myself. But when things get bad, and the darkness clouds my vision, and the anxiety puts me in a cage, that’s when the focus narrows, all I can see is inward and ugly, and there’s no perspective but me. That’s when I can’t see the safety catches and my thoughts run to finally getting to the task of ending my life.

    So here I am with resentment for the people and things that are preventing me from stopping all of the pain. And an ever narrowing focus.

  • Good New Old Bad

    That’s probably the best way to describe it. The fact that it makes no sense sets the tone.

    It used to be easy. Wallow in The Hole with my depression. Let anxiety put me in a cage that make me want to freak out. That feeds the depression etc and so forth. They were separate but working together against me. Meds for anxiety and meds for depression.

    This go around it feels like I have some kind of hybrid anxiety and depression, but it’s so much patchier. Sometimes I can forget myself through them, even though they always come back. I don’t even know how to describe it. It’s not warm, it’s sharp and panicky but with a hopeless angle. My appetite is all messed up. We worked out that I eat 10 meals a week out of 21. And my suicidal ideation is pretty crazy these days. There are a few things I’m not sharing with my care team, mostly in research and stuff. Things are strange all around.

    Enough poetry. I’m in the new PHP, the same one I first attended so long ago. It feels a bit like coming home. The layout, the content, it’s all familiar. I’m sensing a warmth, but there’s a toughness there too. On top of program (check-in, processing, education) we see the nurse, the psychiatrist, and I think a third one I’ve forgotten.

    Group is what I need. A constantly changing group of people, most are profoundly messed up like me. I’ve found my people. They drag smiles out of me and listen to my pity party. I still don’t have much hope left. We’ve talked about more ECT or TMS. I said I’d sto ptaking my meds and never make another appointment again before I do more ECT. Not sure about TMS. I guess it couldn’t hurt.

    Talked about meds, there really aren’t many left that I haven’t tried. And yet again someone brings up Auvelity. I have a document outlining my reasons for never giving that a try. Wellbutrin has saved my life a couple times as they increased my dosage. I’m at the max dose now, 450. Auvelity is the combination of Wellbutrin and cough medicine. The Wellbutrin would be 105 or something, max. Oh and it’s cough syrup, so woozy, can’t drive, sleepy time comes as part of the package. I ran out of Wellbutrin once and spent. a weekend in steep decline. So I’m not trying the cough syrup cocktail.

    And before you mention Psilocybin, it’s not legal here. One of my team suggested I go on a Psilocybin Vacation. Sounds like fun, but not going to happen any time soon. Travel is hard. Hell, going to Target it hard. Thought I’d pass out tonight. It’s the mystery low heart rate (personal best is 45, but it’s usually 48-52) that I think is my body’s way of preventing me from having a heart attack and dying. One can dream.

    And finally, there is a phrase “death of a thousand papercuts,” meaning something fails because of many many problems. In my case it might be literal. The paperwork for everything is so overwhelming. Care team didn’t do their paperwork, great now I get to chase that down. And upload it and pray it all comes together. My motivation is in the toilet, so getting it all done is just painful.  And I’m doing this all alone. When I get back to my apartment, when I fill out forms, when I go to appointments.  That was my decision but it doesn’t mean it’s not hard as hell.

    I’m forcing myself not to think about work. Those thoughts take me to very bad places.