depression and anti-depressants

The depression that I’m currently dealing with seems to have gotten its start almost a year ago.

When I returned from my visit with Gawan last August, I was (as expected) physically fatigued from the travels and adventures and flights, and given my ongoing difficulties with fatigue, it took a couple of weeks to recover. Wolf recalls that for the first while my mood was better than it had been, but then it slowly and steadily started to tank. Depression didn’t so much “strike” as it sidled up, slipped up onto my shoulders, and then gained mass with aching slowness.

I had been seeing a counsellor regularly a couple of years earlier during a previous depressive episode but as I found my even keel, the sessions were no longer useful.

By December last year I was struggling again, and one day was especially draining. First there was an appointment to get two fillings replaced. The dentist is very good but I have needle phobia, and had a dental dam making me a little claustrophobic and causing my jaw to ache. I was tired. Then later that day I got a call about a health test and the results were not great. Now I was brittle.

I don’t know what set me off the next day, but I had a meltdown and was simply unable to cope. I realised that I needed some help again and called to make an appointment to see my counsellor, but to my dismay she no longer worked for the service that provided my benefits. Dammit. I was going to have to decide who to talk to. It was challenging enough to make a phone call, but making a decision too? Ugh.

So I made a decision, hung up, almost immediately changed my mind, eventually worked up the nerve to call back, and agreed to talk to the first counsellor who was available, that evening.

I wasn’t looking forward to having to start at the beginning again with someone new, and a one-hour appointment hardly seemed long enough for me to tell the story, never mind having a discussion and getting productive feedback. But I tried.

It played out as I’d feared. I was irritated to have to explain that I’d tried all of these suggestions already and I needed some new input. As I talked, he would from time to time flip through a file looking for a sheet that he thought might help. By the end of the session, I was holding four or five pages; I’d been polite and accepted them, mostly out of a desire to get on with it.

At the end of the session, he asked me if I wanted copies of any of the sheets he’d handed me (they were his originals). I declined. By way of conclusion, he asked me whether the session had been helpful, in a sort of “I have a customer satisfaction questionnaire to complete” way. I had gone into the session feeling depressed, anxious, and in need of help and now, on top of that, I was emotionally drained and out of fucks to give. I knew he’d wanted to be a help. But his approach was too simplistic, too conventional, too amateur. I’d read more insightful blog posts than the material he presented to me. I didn’t have the mental energy to be anything other than blunt. Helpful? “No, not really.” He wished me well (sincerely), and I made my escape.

I was disappointed, frustrated, and a bit angry about how little the counsellor seemed to know. My subconscious kept chewing over the session and I’d intermittently fume to Wolf, “And another thing about the session…”

But the utter uselessness of the session had, improbably, brought me clarity. All of the counsellor’s suggestions were based on an assumption that I was thinking incorrectly: that I was dwelling on negative things (gratitude journal!), that work stress was taking its toll (do activities you enjoy!), that I was unintentionally ignoring certain needs (work-life balance!), that I was bottling things up (find a creative outlet!). I know all this. I’m doing all this. It’s not working. Or it’s not working enough.

Maybe I had finally reached the point of needing medication.

The next day I made an appointment with my doctor. In the week that I had to wait (this was over Christmas, of course), I compiled the following list of symptoms (omitting the perennial fatigue issue that he already knew about):

  • having trouble coping
  • decision-making
  • motivation
  • self-doubt
  • feeling of moving backwards
  • difficulty retaining new info, memory
  • feeling like abilities are shrinking
  • every task feels difficult
  • indecisive, then second-guessing
  • anxiety? depression?
  • brain not working well
  • sleeping 9+ hours a night
  • frustration that it’s so hard
  • lack of resilience, brittle

When I met with him, I rattled off the items.

“Yep, you’re depressed,” he said with a compassionate smile.

It was interfering with work, my ability to enjoy life, and even do the simplest things around the house. Unlike the previous depression, Wolf was with me, and my work situation was pretty decent, all things considered. In other words, it wasn’t situational.

So just before New Year’s, I got a prescription for citalopram (aka Celexa), starting out at 10 mg for 10 days, and then increasing to 20 mg indefinitely. I noticed an improvement in mood quite quickly, but it plateaued well before “good”. The day after I got home from my Europe trip with Gawan in March, my dosage was increased to 30 mg. In the middle of May it was upped to 40 mg.

For me, the most frequent symptoms of depression are lack of motivation and indecision, although there are other reasons why I might feel unmotivated or indecisive, such as fatigue, so as symptoms go they’re more subtle than I’d like. Also, things that are at best a bit challenging for me, like calling someone on the phone or starting on a new work project, become excruciatingly difficult. I could focus for 20 minutes, willing myself to start, and still not be able to. I might as well be practicing my telekinesis.

After the Europe trip I had a week of downtime before a work trip, during which time I’d expected to be tired and planned to be taking it easy, but in my travels I’d picked up a seriously nasty cold and a week was nowhere near enough time to recover. (I ended up being sick for another almost two months.) After the work trip I was utterly wrecked. It was only when I looked back at the pattern of fatigue and changes to the dosage of anti-depressants that I put two and two together and concluded that at least some of the fatigue was likely attributable to the increase in dosage of the anti-depressants.

But how would they affect my sex life?

things I’ve learned about and from depression

I was diagnosed with depression some months ago, but this wasn’t the first time I had been depressed, nor was it the worst episode.

Wolf and I had been inseparable for ages until he started his doctorate at a university overseas almost five years ago. The first year was bad. The second year was worse. He hated being away from me, hated his dorm where there was never enough privacy or quiet to satisfy his hermit soul.

Meanwhile, I was having difficulties with someone at work in our family business. I walked on eggshells around her and on a few occasions when I tried to discuss things with her, it ended in explosive arguments. Wolf and I were in touch daily, but the most obvious consequence of his physical absence was that the psychological buffer he created between me and the ordinary hardships of life began to dissolve. It didn’t take long before my heat shield was completely stripped away and my soul was bare to the elements.

Tensions at work were escalating. I just couldn’t do Christmas and I mostly skipped the whole thing. After being home for a month, Wolf went back overseas, and within three weeks I. Just. Couldn’t. Handle it anymore. I had a breakdown.

I couldn’t face going to work, and the counsellor I’d been seeing told me to take a month of stress leave. (It didn’t quite play out that way. I dropped the work that I found soul-sucking but still had assignments — just the really important stuff </sarcasm>.) The month passed and I finally managed to extricate myself from all work for about a month.

I had lost myself. I was crying a lot and could barely do anything for myself. The immediate problem was my work situation, and I spent some time thinking about what I wanted to do, without coming up with any answers. And how could I when I didn’t want to do anything at all? I wasn’t interested in anything, which was weird and distressing because I had always been interested in all kinds of things. I peered into myself looking for interests and found… nothing. An echoing void.

I had started doing some reading about psychology to try to gain some insight into what had gone so wrong with this family member. My counsellor suggested a couple of books and ideas as a starting point, and as I read, I developed new leads and followed where they took me.

I had been thinking about sex a bit as well. I had always been uncomfortable about sex and had predicted that while Wolf was away, my very effectively suppressed libido would come out of hiding, and so it did, though it took longer than I’d expected. I hadn’t yet found the sex blogging community, but did find a reference somewhere to Nancy Friday’s My Secret Garden, a book of women’s fantasies so I got it from the library.

In the middle of all this not giving a shit about anything, I was actually interested in sex, and specifically in learning and reading about it. It was unfamiliar and I wasn’t entirely at ease with it, but it was the only thing I was interested in and that was valuable. It helped lead me out of the woods like a trail of breadcrumbs.

(The reading on psychology and personal growth work I’d been doing came together with the research about sex and resulted in my epiphany that June.)

All of which is a long-winded way of saying: I have experienced a serious depressive episode. But I knew it was situational. I knew that I couldn’t allow the work situation to stay the same so when I started working again, I worked from home to avoid the conflict. I knew I’d feel better when Wolf was home, and I did.

I spoke to my doctor at some point in the middle of all of this and told him that I thought I was depressed and he agreed but no diagnosis was made because in the same breath I said I didn’t want medication. I hate taking pills: the body is a delicate ecosystem, and throwing things into the mix can have unintended results. I prefer to err on the side of caution by keeping the chemistry simple.

(I learned this lesson when I was about 20, on birth control pills, and getting recurrent yeast infections. When I confronted my then-doctor about it, he acted as though it was common knowledge that the pill can cause yeast infections. But neither of my (male) doctors had ever told me that when writing me a prescription. I’m still irritated about this.)

In retrospect, I’m not sure that avoiding taking anti-depressants was the best decision. It was situational, I toughed it out, and yes, eventually I got better. I remember having the sudden realisation at some point that I felt like myself again. Which  meant that I hadn’t felt like myself for quite a long time, actually.

I suffered for months, and to what end? Aside from the obvious drop in quality of life while I was stuck in the middle of it, I may have become more prone to depression in the future. I’m usually very rational and I take good care of myself, but guess what? Depression fucks with the way you think.

Since then I’ve been trying to have more of what I like and less of what I dislike in all areas of my life, which doesn’t come naturally for me. When it comes to people, what I look for now is feeling of real connection, and when the other person expresses clearly and warmly that they enjoy my company. I’m learning to trust my gut more and follow up on those connections.

When depression hit, I had no support and no one to talk to. Well, there was Wolf of course, but he was going through his own shit. Up until then, we had each been the other’s only real support.

The single most important new person is Gawan, of course; he’s simply wonderful. And there’s also my friend Pippa, who has since become a close friend. Building up relationships with people who I genuinely like and who genuinely like me is a reward in itself, but I’m also creating a little support network too. Emotional support is essential, and only more so when depression strikes.

thoughts on fatigue

There’s another post that I’ve been trying to write for, oh, a couple of months now, and it’s not an emotionally difficult topic or anything, so I was struggling to write, struggling to understand why I couldn’t, and frustrated with the (total lack of) result. Blogging was starting to feel like work, and I wondered what the hell my problem was. I think I might have figured it out…

I organize my life around the fatigue that has dogged me for over five years now. I’ve always had fairly low energy, but it now interferes with all aspects of my life. It feels, I think, like how you might feel if you had a had a shit sleep or had to get up hours before your usual wake time, except that I feel like this every day.

I usually sleep for about 9 to 10 hours a night, sometimes even more. If I’m feeling (relatively) alert when I wake up, I can get out of bed within 20 minutes. (I say “relatively” to mean alert according to my personal scale.) If not, I might feel groggy for up to an hour (this is “sleep inertia”) or very occasionally for the rest of the day. I like to catch up on social media for a while because it engages my brain and helps me to wake up.

I eat shortly after I get up: breakfast before 11:00 feels almost “early”. I start my day doing things that I like (reading, looking at coffee table books, drinking a mocha while looking out the window, etc.) and/or things I don’t mind (laundry, folding and putting away clothes). My energy level at this time of day tends to be (relatively) good.

Right around the time I feel like I can face doing some work, my energy and motivation drops. In order to do any work, I need my brain to be functioning well and if it isn’t, there’s not much point in pushing myself because I can’t accomplish much, and I lack the motivation to force myself to do it anyway.

The fact that I work with family members and that I can work from home gives me a tremendous amount of flexibility (including the ability to take a nap if needed), which is great. (If I had a regular job, I’d struggle miserably.) On the other hand, these same family members are also workaholics, and it’s really difficult for me not to compare myself to them and get frustrated with myself and my low output. Also, since my family tends not to talk about difficult things at all, just because I haven’t heard any complaints about my low productivity doesn’t necessarily mean that everything is fine.

Months ago, I used to have one- to two-hour naps almost daily. I always benefit from a nap: I wake up feeling better, and it doesn’t seem to keep me up at night. If I can’t shake the morning groggy feeling, I usually end up having a nap. I’ve been napping less lately though, maybe once or twice a month.

Most days I feel guilty because I didn’t work more. Getting started on work feels difficult at best and excruciating at worst, depending on the day. With the right work and highest energy, checking my email or writing a list can be all I need to get rolling. An average day (if there is such a thing for me) might involve me sitting at the computer doing nothing and allowing myself to get bored enough to start. If my motivation and energy are low and the work to be done requires problem solving, I might not be able to force myself to do anything. Sometimes the amount of work I get done in a day is embarrassingly little. Or none at all. I hate that.

In this culture, busyness is a virtue. If I run into an acquaintance, they almost always say something like, “Keeping busy?” and everyone knows that the correct answer is “yes”. Not being busy is an anomaly, and choosing to relax is a radical act. I used to grit my teeth to give the correct and yet wrong answer, but now I say I make an effort not to fill my schedule. Though I suppose I could in all honesty say that I’m busy, as long as I know that this means I’m doing as much as I can, and not that I’m doing as much as the next person, measured in hours and sweat.

I rarely feel really alert. Maybe that’s why it’s hard to distinguish between “My energy is too low for my willpower to function” and “I don’t really like this job and I suck at making myself do it”. It frequently feels like laziness.

After supper I usually feel pretty good, though I can’t face working in the evening, and besides, that’s when I do my important fun stuff, like my bi-weekly two-hour Skype appointment with Gawan.

Then there’s the exercise issue. During the school year I’ve been teaching two dance classes a week, and over the summer I’ve taught one and been a student in another. It’s important to me to stay active, but I don’t recover quickly and I may still feel wrecked the day after a particularly vigorous class. I also have a daily exercise routine of an hour or so (maybe 1h20 if I do every single exercise) to manage my various aches and pains. My health is top priority.

Although I aim to go to bed around 11:30, I sometimes don’t turn out the light until 12:20. I don’t tend to feel sleepy until fairly late unless it’s a dance class night, in which case blood flow, reflexive analysis of the class, and earworms conspire against me. I take a sleep aid to help me with falling and staying asleep, so those issues don’t currently vex me.

Up until my trip to Europe this past spring, my leisure time was spent mostly on the blog. After I got home (and recovered), my writing and photography slowed down, and then pretty much stopped. I thought the issue was that I just didn’t feel like blogging for a while — I had picked up a couple of old hobbies that I’d dropped some time ago, and it seemed that I was just choosing to spend my time differently — but now I’m not so sure.

Over the last couple of months, I had gotten seriously bummed about the fatigue; it’s deeply frustrating when my body can’t keep up with my mind, but my mind has slowed down too, and I mostly don’t feel like doing anything. Also, because I can’t predict when I’ll have a good day versus a bad day, I avoid making plans in order to avoid the sense of failure and frustration when I don’t have the energy or motivation to do what I intended to do. If I have a good day — that is, a day during which I feel almost normal and I do an ordinary number of ordinary things — there’s a fair chance that I’ll be exhausted the next day. I had started to resign myself to the fact that I may be suffering from chronic fatigue syndrome, a diagnosis that my doctor has been hesitant to make since there’s no test and no treatment and thus potentially no benefit to me to be labelled in this way.

However, since I started looking at the details more analytically in the process of working on this post (which has, unsurprisingly, taken much too long to write), I realised that the nature of the fatigue has changed. It was bad last year but then I did actually see some improvement. I discovered that the timing of when the fatigue started being especially problematic again roughly corresponds to adjustments to the dosage of my anti-depressants.

Part of the difficulty I had in pinpointing the problem up to now is that I experience a lack of motivation as one of my more significant symptoms of depression. Now I suspect the lack of motivation is being caused (at least in part) by the lack of energy. In other words, lack of motivation may be cause by the anti-depressant dosage being too low or too high. This is… not helpful.

So now I’m cautiously optimistic that my recent lack of interest in blogging is due, not to an authentic desire to stop, but rather to a sense that I just didn’t have the energy or brainpower to put into it. And if lack of energy and brainpower can undermine my interest in a hobby that I know I have enjoyed, then it’s possible that my disinterest in work is also primarily an issue of energy and not that I hate my job. I have a doctor’s appointment this coming week and will see about adjusting my meds.

With any luck, I’ll be blogging more regularly again in the not too distant future.