It's been a long, strange month. July started with beauty and serenity in Colorado, melded into eternal days of disinterest and gray, before it crawled slowly up the slopes of relative normalcy. The peaks and valleys of July replicate the peaks and valleys of depression. Depression is not a straight line illness. It is a sine wave illness. Considering that fact, I guess July wasn't so strange after all.
Depression Marathon Blog
- Diagnosed with depression 16 years ago, I lost the life I once knew, but in the process re-created a better me. I am alive and functional today because of my dog, my treatment team, my sobriety, and my willingness to re-create myself within the confines of this illness. I hate the illness, but I'm grateful for the person I've become and the opportunities I've seized because of it. I hope writing a depression blog will reduce stigma and improve the understanding and treatment of people with mental illness. All original content copyright to me: etta. Enjoy your visit!
Friday, July 31, 2009
Wednesday, July 29, 2009
Things are coming around. I'm slowly feeling better. I think the assignments my therapist gave me are a large part of this healing process. I've written out two schedules. On one schedule I've got boxes to check if I've done 30 minutes of exercise, taken Puck out for his exercise, and if I've avoided chocolate for the day. Oh yah, I've given up chocolate for awhile. When I feel mentally bad, I tend to over-indulge in the yummy stuff, and then I end up feeling worse! So I get a star if I've made it through the day without devouring chocolate. So far, so good. In fact, knowing I've got boxes to check every night seems to be helping me stay on track and feel better.
The other schedule I've started is a running schedule. I'm thinking about doing The Richmond Marathon in November. I'm following a Runner's World training program rather than using my own--less thinking for me. I haven't yet decided if I am going to actually run the marathon, but I figure having the schedule will help get me out the door and focus my training. It's only been two days, but so far the schedule has nudged me forward. It's working.
I don't necessarily like having a regimented, scheduled life. However, right now it seems to be what I need. Being accountable to my therapist and myself, physically putting the check in the box, and having someone else tell me what to do (i.e. the running schedule) seems to take a little stress out of my day. It's a good thing. I guess I'll keep keeping the schedules for now.
Monday, July 27, 2009
If it hadn't been for the assignment, I know I wouldn't have gotten out the door. I went for a 33 minute run/walk this evening. It was very, very slow, but I went. I went despite a hellish-ly long and busy day at work. I went despite collapsing on my bed and immediately falling asleep as soon as I got home. My dog, Puck, finally woke me up 2 hours later. If he hadn't had to pee, I might still be asleep. But since he got me up, instead of sleep I slowly ran and walked for 33 minutes.
My therapist gave me an assignment last week. Actually, she gave me a couple tasks in an effort to get me out of my house and back on track. The first assignment was to contact Renee and set up our running date. I did that. The even more difficult task was to exercise at least 30 minutes per day. That was the assignment on my mind tonight as I stumbled around my house in a sleepy stupor. It was putting a check in that box on my calendar, the one labeled 30 minutes of exercise, that got me out the door. Simple.
Why is it something as simple as checking a box can get us to accomplish things we wouldn't or couldn't otherwise do? Being held accountable, I think, is exactly what I needed. I was tired, groggy, and sore, but I exercised so I could put a check in my box. It worked. Thanks, Deb.
Saturday, July 25, 2009
Thursday, July 23, 2009
This morning I went for a run with my friend Renee. Sounds simple. No big deal. But this was a gigantic big deal! Renee didn't realize this, but right up until the time I left my house I was filled with trepidation. It is so scary for me to make plans with anyone when I'm in the midst of the darkness. I can't keep my own schedule let alone involve another!
But when I scheduled a 6:00AM run with Renee, I did involve another, and that was the key. I wouldn't have run if Renee hadn't been waiting. In fact, I probably wouldn't have gotten out of bed. That's the easiest way out, after all, to roll over and go back to sleep. But Renee was waiting. I couldn't sleep. I had to go. This morning marked only the fourth run I've accomplished since Grandma's Marathon one month ago. Without Renee, that number would still be three.
Renee's initiative broke up my isolation. Renee didn't allow me to stay away. She sent two e-mails offering a bike ride, swim or run. She didn't offer advice. She didn't suggest she could fix things. She offered to share her time with me doing something I typically enjoy. So despite my trepidation, I scheduled the date. I am so grateful for Renee's initiative. Without her offer, I'd still be in bed.
One of the most common questions people ask me is, "What can I do to help my depressed friend or family member?" This week I was blessed with two friends who demonstrated the answer to that question. Be kind. Do what you would do for any other ill friend or family member. Pick a bouquet of flowers like my friend Cindy did. Her flowers acknowledged my current struggle, which was validating and encouraging. They were a bright fragrant addition to my home. Everyday they reminded me someone cared.
Renee cared enough to share her time with me. She got me out of the house and out of myself. Once we were running we just had fun. And isn't that what friends are for--to get outside ourselves? To have fun? It's so simple, I say. Do for your friend with depression exactly what you would do if your friend had cancer. Be kind. Offer encouragement. Cook a meal. Mow the lawn. Do something enjoyable with your friend. Don't advise. Acknowledge their reality. Resist the urge to fix it. Take a moment to be with them while also allowing them to just be.
I'm grateful for my friends today.
Tuesday, July 21, 2009
"This is when you must have faith," she said. "Even though it doesn't feel better in the moment, the cumulative effect of getting out and exercising will be positive." I had just explained how painful it was to go to my favorite state park and feel nothing, which is exactly what happened on Saturday. I made the effort. I went to a place I love. I expected it would help. It didn't. Nonetheless, my therapist encouraged me to continue getting out despite this unmet expectation of relief.
It's so hard to get out when getting out is not reinforcing. If I feel no benefit from something which used to bring multiple benefits, how can I continue to do it? Why would I continue doing it? Isn't that a bit like banging one's head against a wall? Except instead of BANG--OUCH, BANG--OUCH, I get BANG--NOTHING, BANG--NOTHING. The whole point of forcing myself out is to feel something...anything, please! Right now, I'm feeling nothing. Nothing is not reinforcing.
As usual, my therapist is correct, I think. On some level I think I know that. Yet, I don't trust it to be true. How do I know for sure that getting out--exercising--will eventually bring relief? How do I know it will ever feel good again? Why can't it feel good now? Why do I have to wait? How can I be expected to continue pushing when pushing yields no results? I want to believe her. I want to have faith, but faith is a leap.
Positive steps should yield positive results. I know I have to keep pushing myself. I know I have to trust in the cumulative effect, just like she said. I have to take that leap of faith--one day, one moment, one action at a time. Unfortunately, the hole of nothingness has swallowed me whole, and positive reinforcement feels a long, long way away.
**picture: Black Hole by Hikari Riku
Monday, July 20, 2009
I don't have much new to say. I'm still disinterested, and I'm a bit tired of complaining about it. Instead, I thought I'd share with you a gift I received from my friend, Cindy. The flowers above are all from her yard and were arranged by her. When she gave them to me she wished my current struggles away, and she hoped the flowers would help. They did. Thanks, Cindy. Aren't they beautiful?
Friday, July 17, 2009
Perhaps I mentioned this just a few days ago. I know I've written about it in the past. It's disinterest, and it is one of the subtle, invisible symptoms of this illness.
Disinterest, unlike many of depression's manifestations, is quiet and sneaky. It hangs in the background--a backdrop for depression's more visible symptoms. It is noticeable only when I notice the absence of other states--the absence of interest, the absence of concern, the absence of opinion, joy, anger, or pain. Disinterest is not as blatant as the tears of sadness. It doesn't rattle the soul like anxiousness. It doesn't send me to bed like fatigue. Disinterest is more subtle than all that. Absence marks its presence.
Disinterest works behind the scenes. It's the reason phone calls have not been returned. Talking requires interest in what you, or even I, have to say. Disinterest keeps the running magazines closed, the e-mails unread, and the television channels jumping. It's hard to focus or care when one can't focus and doesn't care. That's disinterest.
Life, when disinterested, lacks meaning, direction, or purpose. The body craves relief. Drinking, drugs, self-harm, psychosis, sex...anything which alters the monotony is preferable to the disinterested state. Feeling anything, we think, is better than feeling nothing. The body, the brain need that relief. It may be a subtle, invisible symptom, but disinterest often leads to very visible scars of relief.
Thursday, July 16, 2009
In 1996, Hilary Clinton made famous an old African proverb, "It takes a village to raise a child." Similarly, I believe it takes a village to cure depression. Fortunately, in Minnesota, there is a new initiative proving this point quite successfully--The DIAMOND Initiative.
Depression Improvement Across Minnesota, Offering a New Direction, or DIAMOND, began in March, 2008. Since then, 234 patients in 10 Minnesota clinics have been enrolled in this unique, collaborative program. According to a recent press release, "The program is the result of a unique collaboration between dozens of Minnesota medical groups, six regional health plans and the Minnesota Department of Human Services. Their efforts have been guided by the Institute for Clinical Systems Improvement (ICSI), a non-profit organization that brings medical groups, health plans, patients, health care purchasers and other constituencies together to develop solutions to problems in health care."
“'DIAMOND is the first depression treatment program in the nation to integrate a collaborative care model with an effective, sustainable reimbursement structure that enables medical groups to provide outreach and enhanced care support to patients with depression,' said John Sakowski, interim president of ICSI."
The solution they've discovered is collaboration. That is, a team of professionals collaborating results in significantly improved outcomes for the patient with depression vs. a non-collaborative approach. It's such an obvious finding, I find myself sadly wondering why it took so long for someone to discover and quantify it? The answer, of course, is stigma. Teams of cancer and cardiac professionals have been using this approach for years. Nevertheless, I am overjoyed that someone has finally taken the initiative to apply the team concept to depression!
I've been lucky. I've had a collaborating treatment team for years. My psychiatrist, psychologist, social worker, MD, and even AA sponsor are all responsible for my recent streak of depression remission. They've always been willing to listen to and confer with each other. It is certainly no coincidence that I've felt significantly better since this team has been in place. Of course, it took me years to build a team of competent, caring professionals. It appears The DIAMOND Initiative does the team building for the client, and that's definitely a bonus.
Not surprisingly, outcome studies of The DIAMOND Initiative have proven beneficial. Check out these results, which are quoted from an ICSI press release, "Clinical trials have demonstrated that use of this model in the primary care setting reduces the incidence of suicidal thoughts, puts patients in remission faster, results in 100 additional productive days over a two-year period, and reduces health care costs by more than $3,000 over a four-year period compared to patients who receive the usual primary care treatment and/or referral approach for depression." Hopefully, results like these will lead to an expansion of this model and improved quality care for those of us with depression.
Tuesday, July 14, 2009
Monday, July 13, 2009
it's not always what you'd think.
sometimes it's just this.
it's not always what you'd think.
sometimes it's just this.
Sunday, July 12, 2009
The weekend is concluding, and I am briefly awake. That's not been normal this weekend. I've mostly been asleep. The past two days have looked a lot like this:
Wake up. Eat cereal. Watch the Tour de France. Sleep. Eat more cereal. Sleep. Look at my housework. Sleep. Look at my unmowed lawn. Sleep. Watch TV. Sleep. Think about making something for dinner. Eat cereal instead. Sleep. Watch TV. Sleep.
As you may have guessed, this is not a satisfying pattern in which to be. I'm hitting a wall. Every task feels monumental. Nothing seems interesting. People are becoming painful. I am heavy. I am slow. I am isolating. This is a scary place to be. I think the chronic fatigue is getting the best of me. I feel my mood sliding down. I feel the abyss rising up. I am afraid I'm sinking into the hole.
But I'm trying my hardest to stay afloat. Despite myself, I somehow got out for a bike ride yesterday and a run today. I'm really not sure how I got out the door. Neither activity felt good. I'm sure neither looked good, but I got out there. Gotta give myself credit for that. I'm trying hard to stay afloat.
Tomorrow, I have to get back to the world. I'm dreading work. With people becoming painful and my brain moving slow, work could be long and excruciating. I guess I better bring my life-preserver.
Friday, July 10, 2009
After work this evening, in the muggy sunshine, my car stopped working in the middle of an intersection 40 miles from home.
Did I mention I was in the middle of an intersection?
That's about all I can say for now.
Thursday, July 9, 2009
Another tired, tough day. Except for the time spent in the doctor and dentist offices, I spent most of the day in bed. My first appointment of the day was with my psychiatrist. Guess what we discussed? Yup, fatigue. I'm so tired, I even agreed to give another anti-fatigue med a try. If you've been following along, you know that I quit taking the previous stimulating med because it elevated my pulse and made running virtually impossible. I quit that drug in December, and by spring my resting pulse rate had dropped from 90-100 bpm to around 60 bpm. It's no coincidence that my running improved significantly this year as well. My doc and I are hoping this drug, a cousin of the original, will cure the fatigue and won't have the same side effect. Please, God, let that be so!
Wednesday, July 8, 2009
I mentioned in this space yesterday how negative my work environment has been lately. That's what the meeting was about. Well, actually, that's what it ended up being about. I have no idea exactly why it was started, but we ended up airing resentments and concerns. I've been feeling the resentments floating around, so I guess it was good to air them, but I hate crying! Fortunately, I did get to say what I needed to say--that I was feeling nit-picked to death, that I felt we weren't working together as a team, and that I was tired of hearing only criticism, never anything positive. It was when I told them I was doing the best I could that my voice cracked. God, I hate that.
The fact is, I am doing the best I can. I'm no longer very good at multi-tasking, thanks to depression and ECT, so I often miss a line on a form, forget to deliver a copy of some paperwork somewhere, or miss my productivity expectations. The amount of paperwork I need to do is overwhelming, and I frequently don't do it perfectly. Furthermore, I no longer care about perfection. Unfortunately, my colleagues value perfection and seemingly nothing less. They never miss an opportunity to point out the missed line, the forgotten copy, or the lesser productivity--none of which effects the treatment I provide my patients.
So, I said, "I'm doing the best I can," and my voice cracked. I stopped talking, but I couldn't stop the damn tears. They rolled down my face. I was embarrassed. I wanted to be anywhere else but there, but I stayed. The tears eventually stopped, and we actually got a couple of things resolved. As for the overall tone of the place? Too soon to tell. I hope it changes. I can't stand the negativity much longer. And I don't want to be reduced to tears at work ever again.
Tuesday, July 7, 2009
It could be worse, but who likes to hear that? My therapist is right, of course. We've looked, and looked, and looked for a cause behind this 3+ year battle with fatigue. I have a bit of sleep apnea, but the cure for that didn't cure the fatigue. It wasn't low vitamin D, which was also a hope(?). I don't have any screwed up labs. Everything is normal or better than normal. I'm just tired, and the only cause left is depression.
Of course, I don't want to accept that. I don't want to accept depression as the cause. After all, if depression is the cause, it means there's nothing left to do. I'm taking meds, which are certainly working--for everything but the fatigue--so I'm not going to change those. I'm doing the best I can to work and play around the morass. What else can I do but accept?
But this is hard to accept. It would be so much easier if something was physically wrong! But as she pointed out, there is something wrong. I have depression. I'm fatigued. It's a symptom of depression. I need more sleep than most everyone I know. I'm in good shape, yet I need to sleep during the day. Sometimes my body aches with fatigue if I can't lie down. It's frustrating. It sucks. And yet, I know, it could be worse. But acceptance? I don't know if I'm there yet...
Monday, July 6, 2009
Maybe it was returning to work--a fairly negative environment which sometimes sucks the life out of me. Maybe it's being home alone after spending more than a week surrounded by others. Maybe it is my continued fatigue despite recent interventions. Maybe it's just a normal reaction to returning from vacation. Whatever the reason, I'm feeling a bit blue.
Blue worries me. I don't like feeling blue. Blue is tiring, and I'm already tired. Blue may mean a depression relapse is on the way. Feeling blue is a little like living in suspended animation--I'm waiting to see what comes next. Will it go away? Will it get worse? Or will I just stay suspended, waiting? Blue worries me.
I don't know why I'm feeling blue. I don't really care to figure it out either. I'd rather it just went away. I'm glad I have a day off tomorrow. I can rest, visit my therapist, and hopefully go for a run. I'd like to get back into a running and exercise routine, although I don't feel like doing much of anything. Lack of motivation--another symptom of feeling blue. Damn, I hate feeling blue!
Sunday, July 5, 2009
The view from the cabin.