I was going to write more about all the components I evaluate, but I've decided to try and summarize the process. The way I usually do this is by writing lists, and coming up with action items. While I shared my process on Tuesday, perhaps this post is more to the point.
1. Trigger. My depression started in October because there is always a seasonal element to it. So, my first step is to reread Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder by Norman E. Rosenthal. I've read it before, but I need to read it more carefully now.
In skimming the book, it's clear that October is a "start" date for some people suffering from Seasonal Affective Disorder. The reason my mood worsened a few days ago was that we set the clocks back for Daylight Savings Day, and that is also a problem for people with SAD. So...that's clearly the trigger.
2. Medication. While increasing the Adderall to 40 mg. has helped, it also presents problems. The increased dosage causes symptoms I don't have with lower dosages, including shortness of breath (periodically), increased perspiration, dry mouth, and certain hypomanic behavior (if I don't monitor it carefully) in the later afternoon.
Also, I can't fall asleep until 1:00 or later, and I don't sleep as well. For the past two nights, I've awakened in the middle of the night feeling very depressed (something that hasn't happened to me in years). Last night, I decided this was a real problem and I took 1/2 mg. of Ativan, which solved the problem. While I dislike taking this medication, it's better than the alternative, which is feeling terrible.
My goal is to come up with wellness activities that will allow me to reduce the amount of Ativan I'm taking, and eliminate the Ativan.
3. Diet. I need to read the chapter from Rosenthal's book on Diet, and come up with a new marketing list. I've skimmed that chapter and I know I need to begin eating more protein in general, particularly for breakfast, and I also need to try and eliminate sugar. He also recommends snacks, so I'll go and buy string cheese and nuts, which I enjoy, and which can help.
4. Sunlight. I've got to begin spending more time outdoors each day, starting today. So, I've talked with my husband yesterday and he's going to buy paint for the garage door, and I'm doing to start painting it today. We've come up with a list of other outdoor projects that I can work on for the next few months.
While Rosenthal recommends a light box and a dawn simulator, I've tried both and neither works for me. However, we have done other things to the house that make a difference. When we recently remodeled, we bought new shades for the bedroom, which make it much brighter. We've repainted the interior in a warmer white color (and I have noticed the difference). We have a much lighter carpet, which also makes a difference.
Action Item: I need to read more about light therapy.
5. Exercise. While I discussed this on Tuesday, I need to check out the hours of the indoor swimming pools in the neighborhood, and check online to see if I can find a used bike. Also, I need to see what exercise classes are available through Emeritus College. I will need to buy a new bathing suit (Ugh!).
6. Wellness Activities. In the next few days, I will look at my list of wellness activities to determine which ones I feel might help.
7. Research. I realize that while I have spent years researching depression, bipolar mood disorder, and related subjects, I have spent very little time researching Seasonal Affective Disorder. So, I'm going to begin researching this topic so that I can put together a SAD Wellness Program for myself. Also, I will see if I can identify online sites as well as blogs that deal with SAD.
8. Finding a Doctor. A number of months ago, I had intended to write to Dr. Rosenthal to determine if my initial diagnosis should have been SAD rather than bipolar disorder. Then I decided it didn't really matter because since I'm not big on labels, I felt my wellness activities would apply to SAD. But now I realize it's important to meet with a doctor who specializes in SAD to see what, if any tips, that person might have. So, I will contact Dr. Rosenthal to see if he has a recommendation.
9. Health Insurance. While this is the topic for another post, about five years ago we had to drop my health insurance because we could no longer afford it. We were paying $12,000 a year because the only insurance we could get was through HIPPA--since I had a previously existing condition. And that insurance was not only exorbitant, but it barely paid for any of the services I used. They paid only $33 for a $100 psychiatric visit. I applied for a less expensive policy and it was denied. I never went to arbitration, although I should have.
Anyway, as a result, I have not seen a primary care physician in five years and have not had a physical in ten years. (I do regularly go to my gynecologist, and I do see a psychiatrist a few times a year.) But I want to have a full physical examination as well as covering myself for catastrophic illness. So I need to take care of this.
10. Setting realistic goals. Since my list is fairly long, I need to come up with a realistic "To Do" list. It is as follows:
Thursday. Begin reading Winter Blues again. Plan to finish it by the weekend. Start painting the garage door. Use diet chapter in Winter Blues to write marketing list. Begin eliminating sugar in my diet. Walk around park every day.
Friday. Draft letter to Dr. Rosenthal to get a referral. Begin finding SAD sites/resources. Market for new items for new diet. Go online to see if I can buy a used bicycle. Buy a bathing suit.
Saturday. Send letter to Dr. Rosenthal. Go to the library and to a bookstore to check out books on Seasonal Affective Disorder. Draft letter to insurance company seeking arbitration.
Sunday. Send letter to insurance company. Look at what I've learned. Redo my "To Do" list. Evaluate how I feel after spending more time outdoors each day, increasing my level of exercise, and changing my diet.