Here She Comes Again

It’s been a while…..

Early June 2009, determined to get rid of the debt chokehold and the daunting prospect of a mortgage that eats up my total income, I started to prepare my condo for sale.  All I could manage to think of is that, my thoughts went no further at this point.  When people asked what will you do, where will you live, I said that I did not know.  The one worry came from the realization that things would be very difficult with a dog.

My condo sold very quickly and at a very good price.  I was upbeat for about a month.  And then I started perusing Craigslist for a place where I could stay month to month with a dog.  Nothing in any safe/urban DC area that was much less expensive – if at all – than my mortgage.  I really did not think I could risk the far out suburbs.  I knew that I’d be guaranteed to be depressed if far away from “people.”

Slowly, the Beirut option started gaining status.  I wasn’t doing a rational list of pros and cons.  I felt like going to Beirut because that is where I let my hair down and my feet up.

In All This Time

I’ve been writing much less, here and in my other blog.  I want to pick up the other blog again, penseesnocturnes.blogspot.com.   This one was just about ECT.

I had needed the ECT again probably, after I stopped, but money, the headaches I was getting from anesthesia, the addiction I quickly developed on the opiate pain killers, made it not an option.  So, time passed while I was very depressed, hardly ever getting out of bed.  With family and friends, we decided that the best option would be for me to go stay at my mother’s in Beirut.

I have been in Beirut a year and a half.  The depression is still there but it is not depression which leads one to go for ECT.  I have a good psychiatrist here but no psychotherapy.  I don’t make any income so can’t afford it.  Ok, I tutor some.

The psychiatrist had me on Lithium and a small dose of Zyprexa.  On my insisting (because those weren’t enough), he put me on Lexapro.  I feel slighly better without any hypomania symptoms.  One new problem I have is insomnia, treatment-resistant insomnia.

The sun is very important.

I think that I will be going back to the States but in due time.  I miss it, miss my children, a lot.

And Before And After ECT

I used to keep a blog, a diary-like one.  If you wanted to know me outside of ECT, I’m at:

http://penseesnocturnes.blogspot.com/?zx=cb9a421522a3854a

or just penseesnocturnes.blogspot.com, I think….

What Next

My head is killing me.  I took Imitrex and Naproxen in vain.  Next….  narcs.  I still have percocet and hydrocodone, if not barbiturates.  I will try my best not to do it.

Yesterday, I saw my old psychiatrist/psychotherapist, the one I can’t afford anymore.  Nor can I afford a two-in-one talk and med management anymore simply because they are so hard to find.

She encouraged me to try ECT again.  She said I sabotaged it with the addiction.  I have a hard time believing it would not have left any beneficial effect on me once I got clean.

I am so depressed I can’t think clear.  I am under pressure to dispose of my condo and my belongings because my child support payments stop in July.

All I do is lie in bed.

Suicide

You can’t talk about it in your therapist’s office (or any other doctor’s for that matter) as much as you might need to.  One ought to be able to talk about suicidal thoughts, death wishes.  One ought to be able to vent.  Some of us also can be talked — key word: talk — out of it.  One ought to be able to share the sadness with their therapist, for God’ sake.  Yet, you can’t.  The laws and lawsuits are such that you’ll immediately be shipped to the psych ward.

Wtf does the psych ward do?  Cure an impulse by letting time pass on the impulse.  But that only works if suicidality is an impulse?  What if you’ve been entertaining it for years?  Where the hell do they get off thinking every suicidal person is just being impulsive.  And I love the preaching “it’s a permanent solution to a temporary problem.”  Temporary?  Temporary as in all your life?  These are the same people after all acknowledging that depression is a bio-chemical illness. 

And then there are the people who would hurt if you killed yourself.  They would, no doubt.  They may even be scarred.  So……?  You must keep suffering?  Yes, you must keep living in depression, where every minute feels like eternity, so as not to hurt those who love you.  You must hurt like hell so they don’t.  Would they hurt as much as I’m hurting right now and I’ve been for a few years now?  Do they think I’m getting better?  Do they want for me to hurt this much?  Can I tell them how much I’m hurting, or do I also need to spare others who love me that knowledge?

What if you could pretend you died naturally?  Then they’d just grieve.  They wouldn’t go crazy, they wouldn’t feel guilty.

You must have the right to die.  You must.  Why do religions take that right from us?  Why do doctors take that right from us?  Why do our loved ones take that right from us?

Spring Is In The Air

I don’t write much anymore because I don’t have much to write.  This was meant to be an ECT report.  I wrote all I had to say on ECT.  In the end, it was uneventful and I’m in the same place.

I am very depressed and don’t feel like keeping a journal about that.  I feel like dying.  I get nothing done, that was always what defeated me most, makes me feel shit about myself.

I must sell my condo as I won’t be able to make the payments any more very very soon.  Spring is the right time to sell.  But where will I go from there?  Am I going to end up homeless, with my dog?  I have no energy to do what it takes to proceed with planning for myself.

What Do You Think Of ECT

I found this article, which was quite discomforting, coming from someone more on the ECT side: http://www.ect.org/wp-content/uploads/2007/01/1301180a.pdf.  I had not realized, though was told by my shock doctor about maintenance, that maintenance was crucial.  Like most people, I thought ECT is a last resort and a one-time thing.

I don’t know whether maintenance is in order for me.  If I had more sessions, I would call them continuing the treatment.  Except for having felt good for about a week, I can’t tell that I benefitted from ECT.  I don’t even know if the shock doctor would go ahead with more for me.  I had no negative side effects either.  I forget things, but I would be hard-pressed determining it’s the ECT not the depression.  Anyway, what I’m trying to say is, I would define maintenance as sessions for people who had gone through a course of treatments and stopped after achieving success, not interrupting for other reasons, like me, before being able to determine an outcome.

Right now, what is going on situationally is so stressful.  It is why I’m anxious, don’t sleep, snap at people, and am so despondent.  I don’t like where my life is going and have a hard time thinking I am in control of taking it where I want it.  There was a week, during ECT, when I thought of all those things without being phased….  Placebo?  A flip into mania?

Then, there is the news, delivered by a friend, about new stricter regulations on ECT machines.  The latter news will probably not stop anyone, in my opinion, from proceeding with ECT.  It is clearly a logistical thing.  I can see people proceeding faster than they had planned.  When you want ECT, you have researched it, researched your psychiatrist, anesthesiologist, exhausted your options……  and you are very depressed.  What will happen in a few years, we don’t know yet.  I am sure that, in the immediate future though, the FDA regulations won’t make much difference.  They certainly don’t create a legal cause of action.

Here’s one link my friend sent me:

http://psychcentral.com/blog/archives/2009/04/15/with-fda-change-ect-may-go-the-way-of-the-dinosaur/

Here is another, about various devices, which would include ECT machines:

http://online.wsj.com/article/SB123920937438601763.html.

I wonder if anyone will lobby against these regulations.  To require the manufacturers of ECT machines to document their safety but mostly efficacy is an ominous task.  Really, how tricky it would be to assess whether one benefitted from ECT, to measure long-term effects when life and its millions of factors affecting well-being is going on, to isolate, in other words, the ECT impact, good or bad, from other factors, is unrealistic.

If I had to judge right now what ECT did for me, I would probably say, “very little,” whether good or bad.  But I would hate for that option to be taken away from patients.  I know people who have benefitted from it.  I know that the psychiatrist who was giving it to me was a good man and a smart man. 

ECT should remain an option.

Other Meds: Lithium, Lamictal, etc…

Still depressed, whether I’m 10 percent better or not, I am wondering what options I have.  As I said in my last post, I cannot take anti-depressants.  I also could never tolerate any activating medicine, such as Ritalin and its cousins, Provigil, Abilify, etc…  Again, I get the uncomfotable irritability and jitteriness.

As for mood stabiliziers/anti-convulsants, Topamax which worked magic on my migraines, made me suicidal.  That is to cut a long story short.  It had horrible effects on my mood, behavior with others, eating, twitching, etc…  I never noticed any improvement in my mood on Depakote and Neurontin at reasonable doses and when I went up I became very fat and very stupid.  We’re left with Lamictal.  Lamictal impressed me as it gave me a sense of peace I had never had on any drug.  This is more than less depression, I was serene.  Yet again, though, the side effects made it impossible to stay on.  Here I am accepting the Lithium side effects, tremors, weight gain, fatigue, hair loss, acne, but the Lamictal side effects were intolerable.  First, I got stuck again with a headache that just would not go and would not respond to anything.  Then, there was the not finding my words, twitching, also severe hair loss.  Well, the headaches alone kill it.

So, I feel like my back is against the wall.  Even with Lithium, I can’t go much higher than 450 mgs, or I’d really be shaking plus getting chills.

I wonder about ECT….  Even had I stopped a bit short, even had I messed up with the immediate results because of the butarphanol, shouldn’t I be feeling benefits now?  I mean, it’s supposed to have re-started/re-arranged my brain.  My headahes and subsequent addiction to butarphanol should not have undone that.  So, what would be the point of doing more sessions.  Besides, it’s not like, aside from the H/A and addiction, I needed more sessions anyway.  The doc was pleased with my progress and it’s only two final sessions that I skipped.  Where is that progress?

Where is that progress?

And if I were to do ECT again, I’d have to have support.  Ongoing support throughout.  And what about the financial decisions I have to take like sell my condo?  I am not supposed to take such decisions under ECT.

Anti-Depressants and Dysphoric Mania

There is no doubt in my mind now that I cannot take anti-depressants.  Whether SSRIs, SNRI, Wellbutrin, or MAOIs, they all made me either manic or, in the larger majority of the cases, dysphoric.  Dysphoric mania or mixed states (some people think they’re practically one and the same thing) is awful.  Hey, depression is awful. 

My dysphoric mania means I’m super-agitated on the inside, afraid, anxious, to the point where I want to scream, I want to climb the walls, I cringe, clench my teeth.  Often, I just curl up in my bed, immobilized by agitation.

Since I have been titrating Celexa down, almost done now, I have felt less and less of that.  I have anxiety, but it’s not that crazy irritability kind.

My depression seems a tiny bit better the last couple of days.  It could be the freedom from the dysphoric mania.  It could be the higher Lithium dose.  A week ago, I went up from 300 mgs to 450 mgs.  I am so sensitive that I am already having tremors.  I don’t mind that much.  I prefer that to being suicidal.  It just freaks my kids out how my hands shake.

I am now on 450 Lithium, 112 mcgs Synthroid, 120 mgs Verapamil for the migraines (don’t know if it’s making a difference yet), and 100 mgs of Trazodone.  Yes, Trazodone is technically an AD but hardly so, especially at this dose.  I take it for sleep and I may replace it with Rozerem.

I dream, sometimes, of not only not being depressed, but being happy, being productive.  It’s sad the way my life went by.  Thank God for my children.

Emotional Lability

I haven’t been writing, I don’t know what to write.  I am still very depressed.  I lie around a lot.  I have been numb.

I gotta break the stalemate.