28 August 2011

What's REALLY behind the depression epidemic

From the 8/28/11 New York Times obituary for Budd Hopkins, an abstract expressionist artist and one of the first UFO abduction researchers:

"Many [abduction victims] who shared their stories with Mr. Hopkins had no conscious memory of their abductions at first. But they had lived for years, he said, with the nagging feeling that somewhere, something in their lives had gone horribly wrong.

...By his reckoning, 1 in 50 Americans has been abducted by an alien and simply does not know it."

23 August 2011

What other mental weirdnesses accompanied your depression?

by Nia, Pastor Jayne, and Soledad

Nia: In junior high I was given a diary for a gift and realized that I would feel jittery and distracted until I wrote the day's entry, even if I had nothing to say. I would feel compelled to write in it, even if didn't want to. Is that OCD? After about a month of that nonsense I decided to avoid the practice entirely and never took it up again.

The paranoia about personal safety I thought was just part of living in a high-crime area, but later I realized that it came and went separately from external circumstances. Being nervous about pulling into a parking garage got really old, as did replaying friends' third-hand accounts of violent crimes in my head.

The post-apocalyptic nightmares were the weirdest. If I had any other kind of nightmare, I don't remember them. There were two or three a year and the setting was always one in which the population had been reduced to about 1 in 1,000. The dreams were almost banal in their detail and it was more like experiencing a different reality than dreaming. Nothing horrible happened except for the constant sense of dread: you didn't know if you should go toward sounds of habitation or away. You'd think it would be entertaining, but over the years the dread crept into my waking life.

It did make me more tolerant of L.A. traffic. I could sit patiently without moving on the freeway for 20 minutes, thinking, "better this than no traffic at all."

I read later that feelings of doom, gloom and dread are classic signs of vitamin B deficiencies, which I think of whenever I see those homeless end-of-the-world crazy people downtown. The nightmares ended some time in the three-year period after I started taking a multi-vitamin every day but before the depression ended. I can't remember exactly when, though.

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Pastor Jayne: Prior to going on medication, my primary co-morbid condition (trichotillomania: chronic, repetitive hair-pulling disorder) was noticeably exacerbated by my blessed depth. Once the right dosage was achieved, I noticed a corresponding waning of my trich. Interestingly, though, once I got off the medication three years later, my trich got very loud. It was as if my body and mind were trying to figure out how to communicate again without a mediator (i.e., medication). I'm happy to say they are getting along very well these days. I still pull hair, but not to the ridiculous degree I did in the year prior and year post-medication.

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Soledad: Mental weirdness is a very appropriate technical term and excellent descriptor for the wackiness most of us find accompanies depression; when you don't feel right, everything just seems off. For me, depression was accompanied most definitely by anxiety. And when you think about it, that makes perfect sense. You're feeling badly about your life and yourself, and boom -- you start feeling nervous about a lot of things that may not have made you nervous before. It's sort of like the positive reinforcement you used to get has turned into negative reinforcement. So you start fearing situations that didn't bother you before. Before you were successful in those situations, so you had nothing to fear. Post-anxiety, you fear everything, even ridiculous things. I never had a fear of heights pre-depression. Then, post-, I was exceedingly afraid of heights, even in lofts or office buildings with dramatic drop-offs. These breathtakingly beautiful spaces actually did take my breath away and made me irrationally afraid of falling, even though I was nowhere near the edge of the drop-off. So depression and anxiety seem inextricably linked.

Paranoia in its most extreme form is something I never experienced. But certainly in milder ways I did. When speaking in meetings I became unbelievably self-conscious, as if I might have a heart attack. I began to fear the speaking more than an actual heart attack, as strange as that may sound. I couldn't accept any more negative reinforcement, and my flight response kicked in. It's a terrible feeling -- that your life is essentially free-falling, and no one is there to support you, or keep you from falling, not even yourself.

I guess the answer is to seek out positive reinforcement to help instill confidence. But how to do this in environments where positive reinforcement is not there for the taking? That is the quest, my friends. And I'd love to hear others' suggestions on how they have overcome it.

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Illustration: 19th-century phrenology chart. {{PD-old}}. Remix by M. Rhea.

17 August 2011

Debauchery: an unsung approach to depression

by Nia

In The Sun King, her history of Louis XIV, Nancy Mitford spends a chapter on Francois Louis de Bourbon, Prince de Conti (1664-1709), one of Louis' young cousins. When it became clear that the brilliant Prince was going to outshine the King's son and heir in every way, the King got jealous and threw roadblocks in his career for the rest of his life:

"...as the years dragged on uselessly and his hopeful youth was succeeded by a disillusioned middle age, the Prince de Conti became embittered and gave himself up to debauchery."

Why was I never told about this treatment option for my depression? I was asked by various therapists if I used a controlled substance or found myself hiding any personal habits from friends and family members, but I don't remember any doctor specifically saying, "We've found that wallowing in all the vices at once has had promising results. Do give that a go."

Is it considered too expensive? Debauchery has historically been the realm of those with limitless funds. But have you priced transcranial magnetic stimulation lately? Is a season of gambling, whoring, drinking, and opium- ...whatever one does with opium all that much more?

Is it a class thing? Am I too far removed from the French nobility? I for one am damned if I'm going to be judged less worthy than a bunch of inbred sots in satin pants who didn't bathe for weeks at a time. And those were the ones who weren't depressed.

And don't tell me it's a question of how much I've suffered. Excuse me for never being denied a regimental command or the governorship of a province. I spent a decade in a cubicle farm. I'd like to see Mr. Buckles-on-his-Shoes make it through just one week there.

I am willing to concede, however, that translating debauchery to modern-day life is not without challenges:

1. The illusion of wealth is still required. Depressives who stock their larders with Budweiser or complain about Netflix fees whilst entertaining visa-less Estonian strippers in the name of self-medication do not qualify as debauched. They are simply filthy pigs.

2. Without coachmen, it is much easier to inadvertently kill people. The debauchery game has changed significantly now that one is expected to drive one's own conveyance home after evenings spent in dissipation and depravity.

3. Strangers will butt in. Where in simpler times a family member might entreat the local minister to intervene in one's carousing, now more often attorneys, judges, and Child Services are involved.

4. There is the matter of wench identification and procurement. In the Prince's day the respectable debauchee found his wenches at taverns or the cheaper seats at theaters. I am not sure what the current approximation is: perhaps it is the type of gal who shows up at the bar of whatever hotel the Yankees are staying at.

5. The template for the female debauchee has, alas, yet to be perfected. The Marchesa Luisa Casati (1881-1957) came close: she strolled through Venice stark naked, served opium at tarot-readings, painted her house servants gold, and fished the occasional dead party guest out of her fountain. But she was also rather obviously off her rocker. Perhaps the great appeal of Angelina Jolie in her single days was the whisper of a hint of a secret hope that she was debauched.

6. Guilt is not an option. The debauchee's commitment to perversity, turpitude, and sin must not waver. One cannot succumb to feelings of shame or regret for mortifying one's family, scandalizing one's neighbors, and appalling one's friends. There is no crying in debasement.

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Image: portrait of Fran├žois Louis de Bourbon, Prince de Conti, Anon., French school, 17th century. {{PD-art}}.

09 August 2011

How did you respond to anti-depressants?

by Soledad (short), Pastor Jayne, and Nia (long)

Soledad: Anti-depressants, strangely enough, did more to mess up my system than to help it. I tried just about every one (the serotonin re-uptake inhibitor types). And they all left me sleepless, like I had drunk an entire pot of coffee. When I asked the doctor about this strange phenomenon, she said that she had never heard of that reaction before. Yet I have two personal friends that report the same sleeplessness on these drugs.

I know that sleeplessness, or any break in my normal routine, does more to dash my mood than anything. I am a nice person on sleep, and am more of a devil on a less than optimum amount. So you can imagine that living with me during the brief time I took these pills was less fun than a barrel of monkeys.

I don't recall feeling any less depressed, just less rested and lousier.

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Pastor Jayne: I did a lot of research before getting on an anti-depressant. It helped that my husband's friend was a psychiatric pharmacist. One of my main concerns was that I not gain 15-20 pounds as I'd heard can happen. (I was finally getting my body back now that the kids were 5 and 7!) Also, I'd heard that anti-depressants could affect your sex drive, and I didn't want my hubby to end up depressed so I wanted to avoid that renowned side effect as well. I eventually chose Celexa (Lexapro) because I learned it was a cleaner drug: (1) fewer side effects, (2) effective at a lower dosage, and (3) a shorter on-ramp. I found all of that to be true. The first two weeks I was incredibly sleepy, but after that I slept more normally than I had in a year, and felt much more like my old self. The fountain of tears also (mostly) turned off -- I no longer cried during Swiffer commercials.

One piece of critical advice my husband's friend (the pharmacist) gave me: even if the doctor suggests a certain dosage as you titrate up, if you are simply too drowsy to function, then titrate up more slowly. So I cut the pills in half and titrated up at half the dosages the doctor recommended. For my body type, weight, medication tolerance, etc. it worked better for me that way. TGFAD! (Thank God For Anti-Depressants!)

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Nia: I started Zoloft in May of 1996, two months after quitting my job in Los Angeles to avoid being fired for my deteriorating performance. I also quit because I'd run out of ideas for solving my 15-odd years of depression, and was basically saying screw it, universe, you take over. As my friend Dennis phrased it, I was looking for a paradigm shift, but I had no clue how to go about it.

In May I picked up Listening to Prozac, recognized myself in the patients the author described, grabbed the Yellow Pages and called the closest psychologist I could find in my neighborhood. After a 20-minute appointment, I had a prescription for 50 mg of Zoloft. The doctor told me to start at 25 and to not expect much for six weeks. I took my first dose when I got home. When I woke up the next morning, I felt different. And anyone who wants to tell me that was the placebo effect, let me kick you in the shins.

That thing they warn you about where strangers approach you for directions -- that happened a few days later on the sidewalk. Soon after that, I was asking a hardware store clerk about stepladders when an actor on the other side of the store called out to tell me where I could find them. Admittedly, actors are not the best gauge of normal human interaction, but still, that sort of thing never happened to me. I looked forward to waking up in the morning, talked more, went outside more, accepted more social invitations, started drawing again for the first time since junior high. It was an effing miracle. I experienced for the first time since I was in grade school what it is to be normal. I told everyone how much better I was feeling, and for a while thought my problems were over.

My sleep immediately fell to two hours a night from my usual three, and my already-terrible ability to concentrate got even worse. Upping the dose made it even more so, so I never went past 25 mg. But I was so happy I didn't care. However, after three job interviews on the Rx I realized I couldn't function well enough to work. I concluded that my life was the problem, that I was in the wrong place with the wrong friends, and I moved to Seattle. Sadly, the only change was in sun exposure, which tanked my mood and made me eat a lot more, and my weight increased 15% in 40 days.

A new doctor suggested my response to the Zoloft indicated I might be bipolar and that a different type of drug might be more helpful. (This sounds moronic to me now.) After 18 months of upheaval, with resumption of a normal life nowhere in sight, I asked my parents if they could take care of me until I figured this out.

At my parents' house, I saw two different doctors, got an Rx that made my eyebrows fall out, and stopped it, but continued to investigate the bipolar angle. One night I visited a local support group, professional adults with careers and families, plus two high-school students, who were gracious and welcoming and shared their experiences and histories. They were also the most wretched group of people I'd ever met -- and I'd met refugees from Argentina and Iran whose relatives had been tortured and murdered. They were not getting better; they just got a new prescription when their symptoms or side effects became unbearable. One woman, who rocked in her chair incessantly and talked like a machine gun, was on five different prescriptions. May Whoever Is Up There forgive me, but I thought I'd rather die than identify with them. I decided to exit that path of inquiry, and lost whatever faith I had in doctors who prescribed psychiatric medication.

I think it was around that time that I started tapering off my Rx, which I think was still Zoloft at the end. I had had a growing sense for several months that the meds were a Plexiglas-like bridge over the huge chasm of my mood, that the chasm was getting deeper and deeper, and that if I didn't get down to ground level, no matter how bad it felt, I would never be able to...something. Stop it from distintegrating completely, maybe, or figure out what the cause was.

It might have been during the tapering off, or soon after, that I experienced the sensation that Elizabeth Wurtzel describes in Prozac Nation, where she lay in bed screaming from the mental pain. Picture your brain as a NASA photo of the world at night, and all the lights are your neurons doing their neuron-y thing. North Korea, with no electricity, is that part of your brain that is depressed. Or causes depression. Or whatever. Somehow what is a void becomes a solid, energy-sucking, space-warping mass. In your brain. Or, alternatively, it's like having a faceless, shadowy, hooded wraith pinning your mind to the floor in a wrestling hold.

So that was fun.

Eventually I read an article in the Cleveland Plain Dealer describing celiac disease and listing depression as a symptom, which sent me down another road that finally paid off (despite the fact that I had tested negative for it back in Seattle). Without that Zoloft, though, I really doubt I'd have made it that far. For all the side effects, at least I got an idea of what life could be like.

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Image: photo of Chewbacca is copyright Lucasfilm Ltd. who I can say with a fair degree of certainty will never give me permission to use it but let's just see what happens shall we? Remix by M. Rhea.