Tag Archives: Major depressive disorder

Psychiatric Medication: A Primer In Medical Frustration

Imagine you have something like leukemia.

In order to know you have that the doctor has to in effect prove that you have it. Which can be done (though I know nothing of the complexity involved in diagnostic).

Now think if the doctor had to diagnose leukemia without modern instrumentation, so he’d have to just watch you and see what happens.

Look up the signs and symptoms of Leukemia and take out all those that require physiological testing outside of visual analysis.

http://en.wikipedia.org/wiki/Leukemia#Signs_and_symptoms

“All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.”

So if you don’t have medical tests, you have nothing to go on.

Now think about the brain. How do we know what part of the brain does what? Two ways that I know of are analyzing case studies of people who had brain damage at a specific location and look for deficits or stimulate that part of the brain and analyze what the person says he or she is experiencing.

And that’s just the low level analysis.

Consider than how difficult it is to diagnose something like bipolar, which is diagnosed via the DSM IV (or V if it’s out yet).

 

  • The presence of a hypomanic or major depressive episode.
  • If currently in major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of a major depressive episode. No history of a manic episode.
  • Significant stress or impairment in social, occupational, or other important areas of functioning.[13]\

 

How many of those do you think can be explained via medical testing? The answer is, at present, none. The other problem is that it’s not at all clear that bipolar II has the same cause in all cases.

So we now approach medication.

In our leukemia example, there are treatments that attempt to control it to the point of remission. Granted, this is very very hard to do and leukemia is a terrible disease, however…

How does a psychiatrist pick a drug for bipolar II?

He can’t. Or at least, he can’t obviously pick one. Except possibly in the case where only one medication exists for the specific noted behaviors. In bipolar II this is not the case. Further consider that a few of the major drugs for bipolar were originally used for epileptic patients to keep their seizures controlled or at least lower the occurrence.

This is not to say that psychiatric intervention doesn’t work. I myself am currently on a medical cocktail that seems to work (although lately I’ve been experiencing a level of depression that I haven’t felt in a while…).

But I’m on Pristiq, Wellbutrin, Lamictal, Provigil, Adderall, Cogentin and Abilify.

That’s a lot of meds.

Now what do I do when something goes bad like it has recently?

All of those drugs are working to keep my bipolar in check.

So how do you figure out which one is failing to help? Or how do you switch out one med for another?

It’s not easy. On the patient or the psychiatrist.

This becomes extremely frustrating.

And this is all without mentioning the fact that many of these medications have extreme side effects. In many cases the patient has to decide what they’re willing to live with. Do you accept the possibility of Tardive Dyskensia? Or do you accept psychosis? Do you accept the possibility that one of your drugs will stop working, because at the moment it works pretty well?

These are all hard questions.

And I don’t know the answers.

 

unconstructed

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Why am I sad???

Depression isn’t fair.
Mental illness isn’t fair.

We shouldn’t require happiness of ourselves. Depression is not about emotions, not at its core anyway. Depression is an illness, depression screws with brain chemistry.

It’s like if you had a glass of wine, and suddenly someone replaced it with a glass of cod liver oil. No matter how much we “should be happy” about getting wine, we’re not getting wine. We’re getting cod liver oil, and there’s no real way to choke down the stuff and think it’s wine (at least, I don’t think so, I’ve never had cod liver oil ><).

I see this in myself and in some of my compatriots at times, we’re mad at ourselves for not being happy in a good situation.

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Speech: The Strong Indicator

An inability to speak, or even just a speech related malady, triggers something profound in us. The only comparable feature I know of is the face. Disfigurement of the face is more disturbing to me than spasticity, even though spasticity would (most likely) physically have more challenges.

But everything is speech to us.

So much so that we demand a freedom to speak.

Think about that. Think about the utter necessity of self expression and aphasia. Broca’s aphasia  or Weirnecke’s aphasia. In my case it was psychsomatic aphasia.

I also had bouts of muscular retardation, which was incredibly embarrassing, but it wasn’t nearly as frustrating as not being able to speak.

Think about people with Down Syndrome. We can identify them by facial aspect and vocal affect. Or at least that’s what we relate to them.

For some reason pathology in speech, even though I have had it myself, instantly provokes a strong disturbance in me. I assume, sadly, that the person is retarded. How wrong is that? I mean people with aphasia can be perfectly intelligent but I personally for an instant assume retardation until I think about it for a second.

I wish this weren’t the case.

But I don’t think I can help the immediate assumption, just the one second later understanding.

Perhaps internally we don’t want to understand that speech can be lost and all other faculties maintained. Because that means it could happen to us and we would be, in some sense, trapped inside a broken machine.

If there are any of you that don’t like the use of the word broken, I do not apologize, you either are trying to be stupidly optimistic or just lacking understanding of the magnitude of the damage.

I would say the same thing for those who don’t like the idea of the “illness” part of mental illness.

If someone is a paraplegic I sincerely doubt you would say that he wasn’t broken.

Broken has nothing to do with intrinsic self worth. Broken is the condition. They are worth everything anyone else is worth intrinsically.

For the love of all that is good and holy never use the phrase “handicapable”.

A broken leg is broken. It’s not some strange “feature”. This truly is a bug and not a feature.

I’ve heard this sort of thing before. Usually talking about bipolars in particular because there is, in some cases, an artistic aspect that seems to be connected with the manic stage.

Remember that those are just the ones you hear about. Most mania and depression is far from an “inspired” state.

Yes, I am sometimes more productive in hypomanic states, even the very minimal version I have these days with medication. I also am more irritable. I often have trouble concentrating to the point of not being able to read. I often sustain a hypersexual state that generally is just an incredible annoyance if not worse.

I’ve mentioned this before. Most mania is not a “good” mania.

Yes, I do live in a fog. Yes, there are severe side effects of the medication. But I don’t have another acceptable choice. Suicidal is not an acceptable state. Severe depression and severe mania are not acceptable states.

This post seems incoherent. Could be since I’m on very little sleep.  And hypomanic.

If nothing else maybe this will give an understanding of uncomfortable and unwanted mania.

Sometimes I just need to vent.

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Concentration and Mania

Have you ever not been able to read during your adult life?

It’s extremely frustrating. To look at a page and just having a mental wall you can’t seem to get over.

It’s hard to even write this post, it takes a lot to keep my concentration.

I think, though I’m not sure, that this is a product of hypomania (bipolar II version of mania). I just can’t concentrate. My mind will not let me. Even these small sentences seem to show this.

I took two tylenol, hopefully it’s just a tension headache.

Sadly even if it’s that it could be a result of hypomania.

I hate this.

I don’t want to go through this anymore.

But I don’t have a choice.

I’m going to try to write a few more lines but my body is trying to stop me.

Hopefully I can make it.

I hope people have an amazing week!

I’ll try my best to have one…

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It’s just in your head

Mental illness is a condition. We must remember that. A recent comment on a post led me to make this a post, since it was getting a bit long for a comment and contained issues that I wanted to express to the general public readers.

Some people have “pulled themselves out” of depression. But what does that mean?

If you pull yourself out of mental illness and get back to normal functioning… I don’t know, I’d be hard pressed to call that mental illness. Sure, you might be able to get to some form of function, but completely recovering by yourself to the same place you were before in my opinion is not mental illness.

Clinical Depression is mental illness.

Mental illness is by definition highly debilitating.

“In addition, for a diagnosis of major depression to be made, the symptoms must not be better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.”

http://psychcentral.com/disorders/sx22.htm

One of the problems with depression is that people treat it differently than bipolar or schizophrenia, because for one reason or another only bipolars and schizophrenics are “crazy”.

For many people I would argue that they cannot get out of it themselves. I mean, think of a broken leg. Ya you can let it heal, but you’ll often be debilitated for life because of very badly healed bone.

People often do not treat mental illness and “physical” illness the same way. For some reason antidepressants are a “crutch” that isn’t necessary, while a physical crutch is at least temporarily necessary if you want to be able to deal with anything more than laying down. Antidepressants are more like a wheel chair in many cases. A paralyzed person can work without a wheelchair, but it’s damn near impossible. I don’t see why people assume depression or bipolar or schizophrenia is necessarily different.

There are cases of temporary mental illness, that is, mental illness that seems to be healed after a certain amount of time. And I do believe that can be real depression. Just like pneumonia is a temporary illness if you get it dealt with, in some cases depression can be temporary.

We must be careful though. Depression is not just the feeling or the apathy. If it is truly a brain chemistry issue, fixing your own physical brain is extremely difficult or possibly impossible. Depression can entail a lot of things that are very hard to deal with. In my case (with bipolar) I had psychosomatic aphasia and paralysis. I also have Tourette’s and OCD. Those two are often comorbid.

Attempting to deal with it completely by yourself is what people usually do before they get help. No one wants to think of themselves as mentally ill. You have to get to the point where you can’t get out of it yourself and are willing to admit that you’re ill. Or to the point where you’re a danger to yourself or others.

I really am not trying to single the commenting person. First, the position given was vague and I don’t want to impute intent or meaning when I’m not completely sure. Also it’s a common position and should be addressed to everyone. I’m not mad about what the person wrote. Honestly it gave me the inspiration to write this post. And I certainly do not impute all these beliefs to that person, I’m relatively sure that person didn’t mean everything that I wrote down. It just reminded me and I wanted to write out the possibilities thoroughly.

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Depression does not equal sad

Someone sent me an article to post on a comment so it could be seen by my viewers as additional information. The article is so false I will include it here and properly dismantle it..

http://www.istheendsoon.com/2012/01/13/our-modern-lifestyle-causes-depression-and-anxiety/

Depression and Anxiety in their clinical forms are NOT sadness and stress.

Sadness gives a reason. If you’re extremely sad, in the pit of despair, then you have something that is putting you into the pit. Usually a very good reason. There are legitimate reasons to be sad. There are also legitimate reasons to be stressed. Stress is part of life, you learn to live with it and minimize bad sorts of stress when they come.

With clinical major depression or generalized anxiety disorder, there are no reasons. They are brain issues. They are instabilities in the human mind.

Think of it this way. When you exercise your muscles you can have microtrauma, small injuries to the muscle that are essential in building it. When you tear your ACL it’s not microtrauma. It’s not even close. It’s an entirely different sort of injury, and even calling them both injuries seems to degrade them.

Think about your response to sadness. You grieve. Grieving is natural, your mind and body are processing a strongly emotionally disturbing event, such as the death of a loved one. Or stress. You get stressed at work. Sometimes it’s bad stress, it can cause serious problems. But you don’t have panick attacks with normative stress. You don’t start cutting because of reasonable sadness. Perhaps that’s the best way to think of it, though it’s quite a dark issue. You don’t cut when your mother dies. Unless you have a serious problem outside of a death, you don’t cut. You wouldn’t think to. It is depression, it is the abyss for which there seems no lowest point, it is the neverending darkness, it is emotional depth. It often gives the person a sense of apathy. Grieving people don’t usually get apathetic. They’re sad, they have a reason to be sad, they are processing that event.

Clinical depression is very hard to understand for a non-depressed person. Sadness we can all relate to, if even only a little bit as we haven’t ourselves experienced that.

Cutting, in my experience, is a method of control. I can control pain. It is the answer to an endless morass of emotional distress and pain. It is the depressed individual shouting at the abyss.

Actually that sort of also explains why it’s not helpful even though it may seem so at the time. Shouting at the abyss won’t get you anywhere.

Depression and Anxiety in their clinical forms are not the result of societal pressures. Higher levels of stress, higher levels of distress, maybe. But Depression and Anxiety are not. Just as injuries sustained in football are culturally accepted as normative, breaking ones back in a horrific accident is not.

We need to realize this dichotomy and not confuse the two.

We need clarity, we need understanding, and we need knowledge. And that’s what I’m trying to provide, if only in a small way.

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How do you tell someone to keep going?

I talk to a number of individuals with mental illness. A question that comes up a lot, and for the life of me I can’t think of a good answer, is

why keep going?

This can mean several different things. Why keep taking medication? Why keep going to my therapist?

… Why keep living at all?

I see the argument that many people make is that many people will be sad if the individual does one of these things. The standard “A lot of people will miss you and be sad if you die…”

But what kind of answer is that?

I mean that’s basically saying “You’re in incredible pain, we all know you’re in incredible pain, but we’d like you to stick around in incredible pain because you’re our token ailing person who ‘keeps pushing on’.

I realize this can work. But at the same time I feel like a horrible person using that argument. It’s not constructive. It’s almost belittling the person’s condition by comparing it to other people being “sad”. I mean really… “sad” vs “clinically depressed”…

It all comes back to that weird view of

“Stop doing this! You’re hurting…

ME!

ME!

I NEED TO NOT BE HURT!

YOU CAN SUFFER AND DIE BUT DON’T HURT ME!”

There’s got to be a better answer than this. And sometimes they’re not terribly hard to find.

But imagine the piss poor state of mind in which you are alive for someone else’s sake.

Also what if that person dies? Is that the red line? “Well, they’re dead so now I won’t make anybody sad”.

In the end I guess what I want people to think about is the meaning in the words they use. Words are important. Semantics are everything. It’s easy to give a procedural answer and feel better about yourself for having “helped” another individual. It’s a lot harder to really look these problems in the face. It’s hard to look into an abyss. It’s hard to look at depression closely because it’s darkness is all enveloping.

There is no light there.

Trite answers really don’t cut it.

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Convincing Doesn’t Work

Imagine for a moment you saw a big rabbit wherever you went.

And imagine, for a moment, that no one else could see the big rabbit, even though it talked and told jokes and was generally a well mannered rabbit fellow.

They’d tell you you’re crazy.

But you’d still believe in the rabbit.

They’d stick their hand through the air where the rabbit was.

“Oh, he moved” you’d say.

They’d tell you you’re talking to the air.

“Excuse me! Me and Harvey were chatting before you so rudely interrupted!”

Nothing they could do could convince you of the absence of Harvey.

Now consider the case of individuals with any number of conditions, from Anorexia Nervosa to Body Dysmorphic Disorder to severe depression.

These all have their Harveys.

Except in these cases Harvey is now some litigious demon Herod.

People see you’re feeling down. They ask you “what’s wrong”? or “why are you so sad? you’re such a good person!”

Herod of course whispers in your ear that you’re the scum of the earth. That there’s no one worse than you. That everyone would be better off without you. Even when people confront that directly, and say they would be very sad if you were no longer with them, Herod comes up with articulate reasoning that reminds you that they’re just lying. That they just pity you.

And I want my readers to think about that for a second.

When you tell someone with a disorder “I’d be very sad if you died”.

What exactly are you telling them? Are you telling them “Don’t kill yourself! Nono, nothing to do with your internal value or your personhood, just for ME! Don’t leave ME!”

I lived on that argument for a while. I took quite a while for me to accept my own internal value.

But that last one also sounds like the “snap out of it!” or “STOP!”  ejaculations.

What do those really say?

“What are you doing?? Don’t do that you’re hurting yourself!! Snap out of it! Why are you doing this to….

…ME????”

I have to say I do not know the solution. But I think people without mood disorders should know what these things sound like.

–Unthought

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Relationships and Mental Illness Part II: Platonic Relationships

What can mental illness do at the nonromantic level? What might come up when a man talks to his mentally ill friend?

Perhaps you must see as we see, and hear as we hear.

Mental Illness can make small annoyances into large conundrums. Irritability can be both a symptom of the disease AND a side effect of the medications used.

Imagine you’re on a busy freeway. It’s very irritating, it’s easy to get frustrated. Now reconsider. What if when you got off a freeway you were still in traffic. What if traffic never seemed to end from the beginning of the excursion til the end? Irritability would probably rise to boiling levels in many people. Are we going to do something stupid in this condition? Probably. Is it still our fault? Yes, but it would be more than a little stupid to mess with someone showing signs of extreme irritability. The worst thing you can do is meet irritability with more irritability.

What you do when a person is in this state depends highly on the situation, and I hope that you can read body language. Perhaps the best thing to do is not to immediately ask what’s wrong and continue after one “I don’t know”. If you keep pushing A) you’ll get irritated and B) the person you’re asking will be embarrassed because the anger and irritability FAR outranks the cause of the state. That’s more or less what a propensity towards irritability is. That’s what mania and hypomania can be.

But consider the depressed individual aas well, don’t leave him out. He may find himself in a place where he does not want to talk. You may provoke a serious reaction if you ask him what’s wrong. Especially when you know very well that he’s depressed. If you KNOW the reason, perhaps it isn’t the best idea to ask.

Perhaps that’s the best advice I can give. Avoid conflict with a mentally ill friend over something that’s causing him pain. Certainly don’t tell him “Oh, it’s not so bad”. That is the WRONG idea. Of course the situation’s not so bad. There’s always a worse situation one can come up with. But that’s not the point.

Remember this above all else. Clinical depression is clinical for a reason. Ifit were an appropriate response to a situation then it IS NOT CLINICAL! That’s normal! Any doctor worth his salt makes sure that there is no overriding condition that makes actions rational. Now a rational person with a very bad situation may need counseling. They may even need meds to get through it. Like an antianxiety medication or something. Clinical depression is clinical, it is not reasonable, that’s the point. If your brain chemistry is compromised, reactions may very well not be rational in extent.

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Understanding Suicidal Thoughts

I think when some people hear that some schizophrenics hear voices they think to themselves, “Well, just remind yourself they’re not real, it’s voices coming from nowhere.

The same can be said for clinically paranoid individuals, people will think “Well, if he just thought about it rationally he’d see he was just being paranoid”

But that’s the trouble with schizophrenic hallucinations and paranoid ideation.

They don’t know it’s not real, nor would they question it.

I will make a comparison with clinical depression and suicidal thoughts, since I’m far more familiar with it than schizophrenia.

There’s an idea that floats around that the clinically depressed just need to “snap out of it”.

But that’s the thing….

We don’t see abnormality in ourselves

The clinically depressed individual does not see themselves as having an illness or having an abnormal condition.We truly believe that we are a piece of shit. We truly believe that the world would be better without us. At least, when we’re symptomatic we do.

And that’s the problem with suicidal thoughts.

I think there’s an ambient idea that suicide is selfish. Nothing could be further from the truth. Others might call it cowardice. This is also a false characterization.

We all have a limit to what we can handle. The human mind copes with extreme depression until it can no longer cope. In that way it’s like a terminal disease. The body fights and fights and fights but eventually can no longer fight and the individual succumbs to death.

People may say that the suicidal individual is just thinking of themselves. Is the cancer patient just thinking of himself when his body gives out? No, and most would agree that someone who accused the cancer stricken individual of selfishness is not thinking straight.

Think of a man trying to lift a barbell off a friend’s chest in a serious gym accident. Is it selfish if they cannot pick up the weight? No. There are some weights that a person simply cannot lift.

There are some emotional weights

that cannot be lifted

and suicide is the expression of the weight of black and cold agony coming to a place where they can no longer lift it. We should never accuse a suicidal individual of selfishness. We should mourn the individual as we would a cancer patient who passed away.

But that thought is unthinkable…

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