Sunday, August 24, 2008

Best Advice on Depression (Part 2)

While I usually don't post on weekends, I would like to thank everyone who responded to Josh in Best Advice on Depression (Part 1), including: Gianna, PJ, Duane, Dirk, Merelyme, Naturalgal, Dixon, Marja, and Howard. As a way of seeking closure on this, I'm posting Josh's response, and my response to him.

"Wow. Thank you all for your support, advice and kind words. It means a great deal, especially during times like this.

"I spoke to my psychiatrist yesterday and described the difficulties I have been experiencing lately. It's anyone's guess whether he'll be able to help, but he's a nice man who seems to be genuinely concerned about his patients. That, in itself, is comforting.

"To offer more information about my ailments and current treatment, I am currently on Lamictal, Effexor and Zoloft. I have been on Effexor for two years at varying levels. It had been very helpful for a while, but it gradually lost its effectiveness. I've continued to take 150mg in case it still had a minor effect, nonetheless. Lamictal was added in February. I started with 25, then increased to 400mg eventually. Since it wasn't working all that well, it has since been reduced to 100mg. It will be eliminated as soon as possible, though I feel part of why I have been feeling so terrible lately is due to withdrawal. I'm going to take it slow. Zoloft was added only one month ago.

"The Doc suggested replacing Lamictal with Depakote, sticking with the Zoloft and continuing eliminating Effexor. I've become ambivalent to medications since they have largely been ineffective. Instead, I am convinced that I need to take matters into my own hands. That's not to say I will shun them entirely. I will accept the doctor's recommendations for a while longer - at small doses since I feel I've been overmedicated in the past - but vigilance in my daily life will impact matters more, I believe. It's going to be very hard, though. I had hoped to be given an initial push by medications, but I cannot count on them any longer.

"Another obstacle is obsessions of mine and, to a slightly lesser extent, compulsions. Cleanliness is a huge issue for me. It makes daily life rather difficult. If I am in the comfort of my own home, without any external influences, I am OK. It's difficult welcoming visitors or letting the outside world in, so to speak. The regimens I undertake are arduous.

"I have no idea how I will deal with the obsessions and compulsions. It would be wonderful if everyone else would change, but that's not likely. First, I need to achieve greater happiness. Other difficulties will partially improve as a result.

"Finding the time to exercise has eluded me in the past. Any free time I've had I would usually spend in relaxation because my days are typically so exhausting. I've been organizing my garage lately in an attempt to create a mini-gym. It still won't be the same as playing a sport, which I was always accustomed to doing, but I'll have to force myself. Anyone live in NJ? I haven't played hoops or challenged anyone 1 on 1 in ages.

"I've rambled on quite a bit, for that I apologize. I'll leave all of you with a few questions that I've struggled to find the answers to. Maybe someone will have some suggestions that will push me in the right direction. I felt better today than I did when I initially wrote, and I need to carry this sliver of momentum forward, as I cannot afford to sink any lower.

"I'm not a morning person, and am inclined to exercise at night when my boys fall asleep. Yet, as a person who has difficulty falling/staying asleep, doing so before bedtime is not a wise decision. How do I balance one against the other?

"I know some of the things I need to do to become healthier. How do I remind myself of these things in the midst of a hectic day?

"Once again, thank you all so much for your willingness to respond to my concerns. It warms my heart knowing that others care so much about the health of a stranger. Hopefully I can return the favor in some way. Finding this forum has been uplifting. The initial response by Susan meant a great deal. Subsequent posts by Gianna, Marja et. al. has overwhelmed me."

Many, many thanks.
Dear Josh,
I'm glad to hear from you, and you're welcome. I, too, was delighted with the response of my readers, many of whom have become good friends. It makes me feel really good that so many people responded to you--with such empathy, compassion, and good advice.

In terms of the medication, it's difficult to know why things work and then "poop out." But, in my experience and in reading other blogs, it's fairly common. Gianna has recently withdrawn from Lamictal and you might want to read her post on her blog about it--if you haven't already. As Howard has written, Depakote works for him--at a much higher dose than he was originally taking. With all medication, finding the right dose is critical and very personal. What works for some people doesn't for others. Dosage is something that most psychiatrists should have a handle on.

After reading what you've written, I wonder if you're being treated for Obsessive Compulsive Behavior as well. While I don't know anything about it, your daily routines would suggest it's an issue for you. While I dislike labels, I do believe that knowing we are "presenting" certain behavior is the first step in identifying patterns that impede wellness. After that, it's much easier to research the condition, and find ways of controlling unhealthy behavioral patterns in order to diminish or eliminate the symptoms.

In terms of exercise, I've learned it's as important as taking medication. So, I treat it as a critical part of my wellness program rather than an optional activity. What that means to me is that just as diabetics take insulin, I exercise. Hopefully, your home gym will work. But perhaps it's equally important for you to find a YMCA or other venue where you can shoot hoops. Personally, I have always felt that athletics (rather than exercise machines) can be a truly healing activity. I enjoy the socialization, competition, and exercise.

When you write you're not a "morning person," have you read about Seasonal Affective Disorder and Winter Blues? If not, it's another important topic to explore and one I will write about next week. After all these years, I am now convinced that my "illness" truly is SAD rather than bipolarity. I'm currently rereading Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder by Dr. Norman Rosenthal, one of the preeminent researchers in this field and someone who suffered from this malady and overcame it.

In terms of sleep-related problems, there is a lot of research on the importance of sleep in bipolarity, as well as depression and seasonal affective disorder. You might want to start at the Sleep Research Society, and go from there. This is a topic I don't know a lot about, but since it's a very important part of wellness, I'll be researching it and writing more about it in the future.

When you ask, "How can I remind myself to do healthier activities in a hectic day?" I would recommend meditation or deep breathing. One of my favorite book for handling stress is The Relaxation and Stress Reduction Workbook, which I think is a great resource. When things get tense and I'm with other people--I excuse myself and go to the bathroom. While I'm in the stall, I take a few minutes to breathe deeply, and it truly works. This book provides great advice and you can learn important stress reduction techniques.

I also recommend keeping mood charts (I've written a five-part series on this) because I believe it's critical to understand your behavior, figure out what triggers stress or depression, and identify recurrent patterns so you can change them.

From my own experience, I know that changing behavioral patterns, and incorporating wellness activities into my daily life "cured" me. The medication provided me with the feeling of well-being that enabled me to pursue wellness. But the "cure" was centered around making lifestyle and behavior changes.

Josh, finally, I guess my best advice is to recognize that whether or not your original depressive episode was caused by external factors over which you had no control, I believe we can control the present. Behavioral and neural patterns that impede wellness can be changed, stress can be regulated, and symptoms for most illnesses can be diminished--if you're truly devoted to pursing wellness.

All my best!



P.J. said...

Well, Josh, I think that if you follow these wellness tools, you'll be more than on your way to someplace great!! I am glad you shared your experiences with us - that's what this blogging this is all about. It's great to help other people, and learn from other people. All the best to you on this journey!!

Susan, I totally understand what you mean by going into a bathroom stall and breathing deeply for a few minutes!! I've been doing that for 10 years now, and it works!!

And, great advice for Josh!!

Wellness Writer said...

PJ, thanks for your comments both days. I really appreciate it. I do believe that our community can provide terrific support to people.


Catatonic Kid said...

Wow, some really great wellness tools have been mentioned here. It's amazing how much you all know - seriously, more than a lot of so-called experts I've talked to!

One thing did spring to mind when reading about your struggles with obsessive-compulsive behaviours, Josh. I struggled with that a little when I was younger, from a different source but nonetheless I just wanted to say that it can sometimes work in your favour because fighting Depression is a lot about consistency.

And one thing being obsessive gives you is a lot of insight and capacity on that front. If you can make the tools you fight Depression with into habits then it helps a lot. At least for me it does, though it is of course a matter of finding the right balance for you.

But I have found it's much easier to rely on something that feels reliable even when you, more generally, don't feel that way.

I wish you lots of luck, Josh!

Wellness Writer said...

Dear Catatonic Kid,
Thanks for providing a perspective on OCD. Again, it's not anything I know about and it sounds like your take on this would be quite helpful!


Dirkmonster said...

Susan and Josh - thanks for sharing this discussion for the benefit of others. Josh, I use a written set of affirmations as a tool to get rid of "stinkin thinkin" during the day. If I notice myself feeling anxious, worried, depressed, or thinking negatively I turn to a section in my day planner that contains positive statements I know (in clearer moments) to be true. For instance, one of the statements is: "God blessed me with a wife that loves me, encourages me and believes in me." A business associate said once, "I'm always honored to network with the best". I wrote it down. When those times come, I try to change my thinking pattern with positive thoughts I know to be true and then add one more to the list. Keeping a "gratitude list" works the same way. Maybe something like that could be helpful to you. It certainly couldn't hurt to try. Have a great day.

Wellness Writer said...

Thanks Dirk. I believe all of the things we learn in order to deal with depression can help others. And I do think a gratitude list is a great idea!