Playing catch-up

laptop_cell

This has been a busy week for me.  I worked the last four nights in a row (11pm-7am), so my sleep schedule has been shot to hell, plus I’ve had appointments with clients for my other job during the day, which has left little free time.  What I’ve noticed most about that is that I feel so behind in all things blog-related.  Normally I really value the time I spend each day to read people’s blog posts and keep up with all the great stuff that shows up on my Twitter feed.  I also really enjoy answering mental health-related questions on Quora.  But this week it’s been hard to find time for that, and I’ve hardly done any writing.  I guess for a lot of people who are working full-time and juggling busy lives this is par for the course, but because of my depression I’ve only been working casual for the last year.  I am really easily overwhelmed, which turns my brain into mashed potatoes, so any disruption to the stability and comfort of my regular routine really throws me off.

So today I’m starting to play catch-up.  I’ve got so many web browser windows open with things I want to read that it’s slowing my computer down – and slowing my brain down too.  I guess one of the downsides of trying to keep engaged with the world online is that it can start to feel like an un-winnable race.  Ive got the next couple of days off, though, so I’ll get settled in, make a few pots of tea, and read and write to my hearts content.  And while I’m at it I’ll remind myself that none of this is really a race at all, and I just need to let my depressed brain relearn how to walk as it tries to heal rather than trying to race to a non-existent finish line.

 

Photo credit: FirmBee on Pixabay

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Psych meds 101: Antidepressants

pile of assorted medications

I can be a bit (okay more than just a bit) of a geek, and one of my big interests is how medications work.  Throw in the fact that I’m a mental health nurse, former pharmacist, and person who has tried piles of different psychiatric medication, and you get someone who will quite happily watch hours of continuing education webinars on the topic.

It can be really useful to understand how medications work, because it can make both the therapeutic effects and side effects make more sense.  This is the first of a series of psych meds 101 posts I’m going to write that will break down different classes of medications.  I’ll also address antipsychoticsmood stabilizers, anti-anxiety meds, and sleep meds.

Mechanism of Action

Most antidepressants affect the three major neurotransmitters implicated in depression: serotonin, norepinephrine, and dopamine.  Nerve cells (neurons) communicate with other neurons via connections known as synapses.  The neuron sending the signal is referred to as presynaptic, and the neuron receiving the signal is referred to as postsynaptic.  The presynaptic neuron releases neurotransmitter molecules in the synaptic cleft (the space between the two neurons), and the neurotransmitters act at specific receptors on the postsynaptic neuron.

diagram of synaptic cleftWhy does that matter?  Many antidepressants are reuptake inhibitors, meaning they block recycling pumps on the presynaptic side that would normally take up and recycle some of the neurotransmitter that had been released.  This means there is more neurotransmitter floating around the synaptic cleft, available to act at receptors on the postsynaptic neuron.  Over time, this actually changes the number of receptors that the postsynaptic neuron produces, which may explain the delayed onset of action for antidepressants.

Other antidepressants may block certain types of receptors on either pre- or post-synaptic neurons, and this may influence the release of one or more types of neurotransmitters.

Side Effects

A lot of medications are messy, in the sense that they don’t only do want them to.  Some antidepressants affect histamine receptors, and this can cause side effects such as sedation and weight gain.  Activity at muscarinic receptors can cause sedation, dry mouth, and constipation.

There are multiple different kinds of serotonin and norepinephrine receptors, and they impact various processes in the body.  When serotonin gets busy at certain types of receptors it can do things that we don’t want it to, causing things like insomnia, weight gain, or sexual dysfunction.  Norepinephrine can act at certain receptors to affect things like blood pressure, causing lightheadedness.

Classes of Antidepressants

Selective serotonin reuptake inhibitors (SSRIs):

These inhibit the activity of the presynaptic serotonin recycling pumps.  Escitalopram is the most “clean” in that it does what it’s supposed to and not much else.  Other medications in this class include citalopram, sertraline, fluoxetine, and paroxetine.

Serotonin and norepinephrine reuptake inhibitors (SNRIs):

These inhibit the presynaptic recycling pumps for both serotonin and norepinephrine.  Some people are not as responsive to meds that act on serotonin alone, and respond better when there is action on norepinephrine.  Drugs in this class include venlafaxine, desvenlafaxine, and duloxetine.

Norepinephrine and dopamine reuptake inhibitors (NDRIs):

Bupropion inhibits the presynaptic recycling pumps for norepinephrine and dopamine.  Because of the different mechanism of action, it can be used in combination with SSRI for a triple-whammy sort of effect.

Tricyclic antidepressants (TCAs):

These inhibit the recycling pumps for serotonin and norepinephrine.  However, they are quite “messy” and affect a number of different receptors, meaning they tend to cause more side effects.  They are dangerous in overdose because they can potentially disrupt the heart rhythm.  Several years ago a psychiatrist wanted to put me on nortriptyline, and while I reluctantly agreed, I soon stopped it because I didn’t think it was a safe medication to have at home given that I do get suicidal thoughts in the context of depression.  Other examples of TCAs include amitriptyline and imipramine.  This class of medications is also used to manage nerve pain.

Monoamine oxidase inhibitors (MAOIs):

These inhibit the monoamine oxidase (MAO) enzyme, which acts inside neuronal cells and is involved in breaking down serotonin, norepinephrine, and dopamine.  They are an older class of medications and despite being very effective antidepressants they are seldom used because of the need to restrict dietary intake of tyramine.  Tyramine is normally broken down in the gut by MAO, but if MAO is blocked by medication, tyramine is absorbed into the bloodstream and sends blood pressure through the roof.  This condition is referred to as hypertensive crisis.  Tyramine is found in a number of different foods, including aged cheeses and fermented foods.

Tranylcypromine is the most commonly used MAOI.  Moclobemide is a variation of an MAOI called a RIMA (reversible inhibitor of monoamine oxidase) that acts reversibly on the MAO enzyme, so that tyramine is still able to get broken down safely by MAO in the gut.

Other

There are a variety of other medications such as mirtazapine and vortioxetine that work in novel ways, which I won’t get into here.  The combination of mirtazapine and venlafaxine is sometimes referred to as “California rocket fuel”; this is part of my current treatment plan, and while I’m not getting a rocket fuel effect it has helped.  There are also other medications that can be used to augment antidepressant therapy, including lithium, atypical antipsychotic medications, and liothyronine (a form of thyroid hormone).

There are also new outside of the box treatments being studied such as ketamine, which affects the action of the neurotransmitter glutamate.  I am really excited about this, and will write more about it in future posts.

In conclusion…

If you’ve made it this far, good for you!  I hope you’ve found some of this useful, and maybe it’s even given you some added insight into medications you have taken or are taking.   In the upcoming post Psych Meds 101: Mood Stabilizers, I’ll talk about the treatment of bipolar depression, and why antidepressants have a limited role to play.

 

Photo by freestocks.org on Unsplash

This one flew over the cuckoo’s next: ECT in real life

faces

Ask anyone of a certain age what comes to mind first when they hear the term electroconvulsive therapy (aka ECT, aka electroshock therapy, aka shock therapy), and chances are they will mention the film One Flew Over the Cuckoo’s Nest starring Jack Nicholson.  Given the lack of more realistic portrayals of this treatment, ECT may be viewed as a dangerous, obsolete treatment.

Except it not.  ECT is a very effective treatment option for depression, and can also play a role in mania and psychosis.  One of the biggest benefits is that it works fast, much faster than antidepressants could be expected to start working.  That’s why I first received ECT; it was my first hospitalization, I was highly suicidal, and the treatment team just wasn’t prepared to wait the weeks it would take to see if I would respond to the antidepressant that had been started.  I was too ill to be able to remember any of those first few weeks, and I was being treated on an involuntary basis, but being a mental health nurse I probably knew at least on some level that this was a good idea.

The ECT process itself is fairly simple, and very different from Jack Nicholson’s ECT scene in One Flew Over the Cuckoo’s Nest.  In the movie a bite block was roughly shoved in his mouth, a shock was applied with no anaesthetic, and he began wildly thrashing about.  None of this is representative of current ECT practice.

As a patient, they put you out cold with a general anaesthetic (such as propofol) and a muscle relaxant (succinylcholine).  These are given by IV and knock you out within seconds.  I had the odd experience of getting a yummy smoky sort of smell after they injected the meds, even though the only thing coming through the mask on my face was oxygen.  One of the reasons I like ECT is because I love that smell.  This is not something I’ve heard anyone else report, but I experienced it every single time.  Once you’re anaesthetized, they fit the rubber bit guard into your mouth to protect your teeth and tongue.  The shock is delivered via two electrodes placed on the head.  The muscle relaxant means there is not a visible seizure; instead, the intensity of the seizure is measured via EEG (electroencephalogram).  You wake up feeling fairly clear-headed (at least in relation to how you were feeling beforehand); sometimes I haven’t even realized the ECT had already been done.

cuckoo_clock

There are various parameters that can be adjusted in the delivery of ECT, one of which is the electrode placement.  Unilateral ECT, which involves both electrodes being placed on the same side of the head, is less likely to cause side effects.  Bilateral ECT, which involves one electrode on each side of the head (on either the temples or forehead), is more effective but also more likely to cause side effects.  Unilateral didn’t work very well for me, so after my first few treatments I’ve always had bilateral ECT.  I’ve also required relatively long courses of ECT; instead of the typical 8, I’ve needed 15+ during a couple of my hospitalizations.

I am one of those mental health professionals who tells clients that ECT typically doesn’t have significant effects on memory.  That’s absolutely true, but my experience was not typical.  I have experienced a lot of memory loss from ECT, although it hasn’t impacted my ability to form new memories after completing treatment.  Mostly it was short-term memory that was effected, but some of the memory loss has gone farther back.  There have been substantial chunks of time that have gone missing from the months leading up to my first hospitalization.  Some of these eventually did return, but many didn’t.  It was truly  bizarre to have people tell me things that I did or even show me photographs taken of me, and I would have sworn that these events never occurred.  I feel absolutely certain I’ve never been snow-tubing, yet there’s a photo of me doing exactly that at a local ski hill.  My family tends to notice the memory loss the most, as I say the same things and ask the same questions over and over.  On a lighter note, after each discharge from hospital after a course of ECT, it was kind of fun to return home to an assortment of what seemed like brand new clothes/shoes/household items that I had no memory of purchasing.

Despite the disruptive effects of the ECT-induced amnesia, it remains very much on the table as a treatment option for me.  I would probably ask for outpatient ECT right now if it weren’t for the requirement that someone be available to take you home after treatments and keep an eye on you (a safety precaution because of the use of general anaesthetic).  This is just not feasible in my circumstances right now, and it bothers me that this restriction limits my access to effective treatment.

So, that’s my journey over the cuckoo’s nest.  A lot less movie-worthy than Jack Nicholson’s, but a lot more real.

 

Image credits:

Kellepics on Pixabay

OpenClipart-Vectors on Pixabay

My depression’s love-hate relationship with the internet

typing on a laptop computer

 

We probably all have a love-hate relationship with the internet, at least to some extent.  Toss mental illness into the mix, and it can amplify both the love and the hate.  That’s certainly been the case for me.  The opportunity to connect with information and other people can be a great thing, but it can also cause its share of problems, particularly when it comes to social media.  If you are looking for ways to feel sh•tty about yourself, social media can deliver in droves.

I was never a big social media user.  Facebook used to be my platform of choice, although that was mostly because I got sucked into FarmVille.  When my second episode of depression hit me, my relationship with Facebook completely changed.  What once was a harmless past time became an edged blade.  It is so easy on social media for people to make their life out to be happy and wonderful and perfect (regardless of what their actual circumstances might be).  When I got depressed, all I could think about was how pathetic and inadequate I was that my life wasn’t happy/wonderful/perfect.  Instead of wallowing in that for too long, I decided to run away.  I shut down my Facebook account, and remained almost entirely social media free for about 5 years, aside from very brief dabbles in Twitter and Pinterest.

Earlier this year, as I was grasping for things that would help pull me out of a lengthy depressive episode, I started trying apps to support my mental health.  I have a list of those that I have found particularly helpful on my mental health apps page.  I was using Pacifica’s discussion forum regularly, and was surprised by how much I appreciated being able to share stories with other people.

About six weeks ago I started my blog.  This depressive episode has lasted about a year and a half, and it has significantly impacted many aspects of my life.  I haven’t been able to work very much, so I’ve had a fair bit of time on my hands.  I decided that writing would be a productive and perhaps even therapeutic way to spend my time.  I’ve previously had work published in several academic nursing journals, but blogging was a whole other creature that I would have to get familiar with.  I was also interested in connecting with other people’s stories, because it seems like in-person communication is just a bit too much for me these days.

When I first made my blog public, I didn’t think that anyone would actually read it.  I remember how excited I was when I got my first follower, the fabulous James Edgar Skye, The Bipolar Writer.  I decided that if people were willing to read my posts, I might as well set up some social media accounts that I would use only for the purpose of putting my blog out there to the world.  I didn’t use those accounts to connect to anyone that I actually know in person, and likewise I didn’t tell anyone I know the name or URL of my blog.  I like the sense of intimate anonymity this creates.

Facebook login screen on a cell phone

Of the social media accounts I’ve created, Twitter is the one that seems to resonate with me the most.  It’s not all smooth sailing, though.  I’m following some amazing organizations and individuals, and I’m really interested in reading what they have to say, but it feels like I would have to spend hours on Twitter every day just to keep up with everything that turns up in my news feed.  I’m a bit too deer in the headlights at this point to even think much about writing my own Tweets.

I continue to be surprised when more people read my posts, but this has prompted me to think of other ways that I could get out there and engage in the online community.  The mental health blogging community on WordPress feels very cozy and comfortable, but the broader world out there is much more daunting.  Since I have no idea what I’m doing and am just sort of fumbling along, it seemed reasonable to have a look at articles on how to increase blog traffic, and check out blog indexing sites and aggregators.  That’s when the wheels started to fall off.

Things aren’t as bad as they were a few months ago, but I continue to have cognitive symptoms from my depression.  I am easily overwhelmed with new information or multiple different kinds of information.  The internet is both of those thing to the gazillionth degree, and that has really been a struggle for me.  I spent all of this morning looking at various things related to increasing blog traffic, and as things got muddier and muddier in my brain I realized that I really had no idea what I was looking at.  I couldn’t even navigate my way through the basics of various websites, which made me feel like the village idiot.  It got to the point where I realized I needed to just close all those browser tabs and do a mental reset (facilitated by some Ben & Jerry’s ice cream).  I’m trying to make myself feel better with this whole blogging thing, not worse.

I think what I need to keep reminding myself of is my purpose.  It’s very easy to get overwhelmed and lost in the vastness of the internet, but I didn’t start on this blogging journey to try to be everywhere and get involved in everything.  My purpose is to write my stories and to read other people’s stories, and I need to just keep bringing it back to that.  If I can do that, I can stay away from the hate side of my relationship with the internet, and use the love side in my journey towards recovery.  Because no matter how out of control that internet might make me feel, I have the power of choice… and I can choose to use it.

 

Photo credits:

Glenn Carstens-Peters on Unsplash

William Iven on Unsplash

How do you say antidepressant in Uzbek?

border control sign in English and Russian

I guess I should start by explaining what Uzbek is.  It’s the language of Uzbekistan, a former Soviet republic in central Asia that was part of the Silk Road that once wound through Asia.  It’s an area of the world where there are still people living the traditional nomadic lifestyle involving yurts, riding horseback, and drinking fermented mares’ milk (a delicacy I just couldn’t bring myself to try).

So how does this relate to antidepressants?  That’s where I have a story to tell.  In 2015, I spent 5 weeks backpacking in Uzbekistan, Kazakhstan, and Kyrgyzstan.  During that time, I was hauling around a veritable pharmacy: a sufficient supply of my 5 different psych meds, plus my standard round-up of just-in-case backpacking meds to cover motion sickness, travel’s diarrhea, and other such fun adventures.

I landed in Tashkent, the capital city of Uzbekistan, around 10pm.  I was exhausted from the long flight, and just wanted to fall into bed somewhere.  I thought it seemed a bit odd that the customs declaration form asked for a list of any medications I was carrying, but I dutifully listed them all.  The rather ghetto-seeming airport wasn’t inspiring much confidence, but I hoped that as is often the case my Canadian passport would get me waved right through.

When my turn in line came, I handed my declaration form to the customs officer.  He stared confusedly at my mammoth list of medications.  Then he wanted to see them, although I’m not sure why, as that didn’t seem to make things any easier.  He appeared to have no idea what to do, so he consulted some of his colleagues.  I told them that they were for depression, but they didn’t seem to have any idea what I was talking about.  There was much talking, looking confused, and phone calls until finally they waved me along.

I thought that would be the end of it; if only I could be so lucky.  I hadn’t booked a hostel room because it hadn’t struck me as necessary; I was an experienced traveller and had never had problems before.  Tashkent is no great tourist mecca, so that might have worked out okay, except there was some sort of international sporting competition going on in town and everything was booked up solid.

Central Asian yurt

By midnight, I had given up on Tashkent and instead turned up at the Uzbekistan-Kazakhstan border, thinking I might have better luck across the border.  Except that meant another customs declaration form, and much more confusion over my bag of meds.  The customs officers tried to be nice, but spoke very minimal English.  They wanted to know what the meds were for, and I didn’t think antidepressant would be in their lexicon, so I kept pointing at my head.  Maybe that made them more confused, or maybe it made me look more like a psych patient – who knows.  When they saw I’d just arrived in Uzbekistan that night, they decided they needed to call customs staff at the airport.  Talk about the blind leading the blinder.  Eventually I think they just took pity on me and let me go.

Travelling with psychiatric medications in non-Western countries can be a bit dicey, even aside from the issue of border crossings.  Replacement meds can be hard to come by if meds get stolen, and that’s something I always try to remain cognizant of.  That saved my butt on one occasion in India when I was sleeping in an upper bunk on an overnight train.  My backpack was shoved underneath the lower bunk, and during the night someone stole everything in the backpack other than clothing.  If my bag of meds hadn’t been tucked in beside me on the bunk, they would’ve been gone.

I haven’t really been well enough to travel in the last couple of years, but hopefully I’ll get back into it even with the depression.  I still may be able to pull off my 40 by 40 goal: 40 countries visited by age 40.  And next time I go somewhere off the English-language track, I might look up the local word for antidepressant ahead of time… just in case.

 

Photo credits:

3dman_eu on Pixabay

Oziel Gómez on Unsplash

Let’s talk about sex (and mental illness)

couple kissing

What do mental illness and sex have to do with each other?  Quite a bit, actually, both in terms of the illness itself and the medications to treat it.

Let’s start with meds.  Antidepressants that affect serotonin (such as the SSRI class) can do a real number on sex drive/function.  This tends to be mediated by a particular type of serotonin receptor known as 5HT2a, which means that some antidepressants that affect serotonin are less likely to cause this problem, such as mirtazapine and vilazodone.  Another option is something like bupropion, which doesn’t act on serotonin receptors.  I talk more about antidepressants in my psych meds 101 post.

Antipsychotics can also be problematic (more on this in psych meds 101).  Antipsychotics work by blocking dopamine receptors, but if there is too much dopamine blockade along a certain pathway in the brain (the tuberoinfundibular pathway to  get really geeky with it), you disrupt levels of the hormone prolactin, and boom, you get sexual dysfunction.  Different antipsychotics vary in their potential to affect prolactin, so having sexual side effects with one doesn’t mean you will necessarily have the same effect with another medication.

Some mood stabilizers such as valproic acid are quite teratogenic, meaning they’re likely to cause fetal malformations.  This means reliable birth control is something that has to be considered along with everything else that goes with a mood disorder.  This is easier said than done for a woman in the midst of a manic episode.

woman lying in bed

Then there is the illness itself.  As a nurse, I’ve spoken to clients who are deeply ashamed of reckless sexual behaviour they’ve engaged in while manic or psychotic, things that under normal circumstances they would never even consider doing.  At the other end of the spectrum, depression can shut down sex drive and sexual function.  These are issues that it’s not easy or comfortable to talk about, so they tend to hide in the shadows, but they can have a huge effect both on an individual level and on a relationship.  I don’t have any great insights or answers to share with you, but I do think it’s important to talk about it.  It’s also worth considering sex as a potential barometer of your mental health.  I remember at one point when my depression was starting to improve I met a man who actually made me feel turned on, and I thought wow, this is the most normal thing that I’ve felt in a very long time.

I’ll close with a quick word on autoerotic activity, to borrow a term from Seinfeld.  Orgasm releases happy hormones like oxytocin and dopamine, so it seems to me a little bit of self-love once in a while can’t hurt.  And really, we all deserve some self-love, whether it’s in an erotic sense or not.

 

Image credits:

efes on Pixabay

Berzin on Pixabay

 

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The other #metoo: Experiencing workplace bullying

bully-graphic.jpg

Lately there has been a wave of tremendously courageous women (and men) who have raised their voices against sexual harassment and sexual assault.  Something that was once hidden behind a veil of silence is now out in the open, and the careers of perpetrators like Harvey Weinstein and Kevin Spacey are quickly disintegrating.  There is so much power when one voice becomes a chorus of voices, and I applaud each and every one of those people who have used their voices.

Attention has been brought to the issue of bullying by such tragic stories as that of Amanda Todd, the young woman who took her life after experiencing torturous bullying.   Bullying doesn’t only affect youth, though, and workplace bullying can have equally devastating consequences.  That’s where my #metoo story comes in.

More than a year has passed since the workplace bullying that I experienced, but it hasn’t gotten any less painful.  I saw on Twitter that it’s #BullyingAwarenessWeek, and felt compelled to add my voice to the mix.  Yet as I contemplated what I might say, my stomach began to churn, and all of a sudden those events from over a year ago felt like only yesterday.  To be honest it took a glass of wine (ok more like two glasses) to get started on this post, but here we are.

We tend to think of bullying as occurring mostly among youth and being fairly overt and recognizable.  Workplace bullying can be much more subtle, making it difficult to recognize whether you’re actually being bullied, and equally difficult to convince others of what is happening.  This can foster a deep sense of shame and self-doubt.

The bullying that I experienced came from multiple individuals, but the one leading the charge was in a position of power over me.  Everything I did was consistently undercut, and I was made out to be something I wasn’t.  Because the leader of the attacks was in that position of power and very much a smooth talker, others bought into the picture this person painted of me.  When I started to speak up about what was happening, no one believed me.  Instead, I was the one that was the problem.

shame_graphic

I was crying daily on my drive to work, desperately wishing I could be driving in the other direction.  After I found myself sobbing uncontrollably in a bathroom at work, I decided the only way that i could begin to take back control of my life was to resign.  However, the champion bully was not content to leave it at that; instead, the same lies and misrepresentations followed me like a horrible smell.  And who were prospective employers going to believe, me or this person?  Well, whoever and whatever they believed, it definitely wasn’t me.

I was unemployed for months.  When I did eventually find work, it wasn’t because it was what I wanted; it was based on these being the only people I could find who hadn’t been exposed to the malicious lies about me.  The whole situation triggered a relapse of my depression that still hasn’t lifted.  I have cycled through various phases: blaming myself, being angry at the perpetrators, and hating the entire world for allowing people to get away with this.  At my lowest lows, I have even considered physical harm to others, because at these low points, jail time didn’t seem like it could possibly be any worse than the house arrest imposed by my depression.

While in graduate school I became familiar with a research method called autoethnography, which involves examining the interplay between culture and one’s own experience.  I thought that writing might help, so I put together what I think is a pretty good autoethnographic paper about my experience of bullying.  Months later I still haven’t submitted it to an academic journal because of my fear that editors or peer reviewers would tear it to pieces and invalidate my experience, just as it seems like everyone has since the bullying first started.

Bullying has in  many ways destroyed major parts of my career and my life.  Bullying that remains swept under a rug of silence allows the practice of bullying to continue unfettered.  That is why I choose to raise my voice and say #metoo on #BullyingAwarenessWeek.

 

Image credits:

johnhain on Pixabay

 

 

 

Do I look fat in this Seroquel? – Mental illness, meds, and weight

scale

Society is obsessed with how we look, and in particular what size we are.  Even people who are generally quite polite feel entitled to comment on our weight and body shape, without having any idea what the backstory might be.  In the case of mental illness, there is often a great deal of backstory.

Over the last 10 years, there’s been about an 80 pound span between my lowest weight and my highest, and I’ve ranged from a size 6 to a size 16.  When I’m depressed, I tend to lose my appetite, and at times have lost significant amounts of weight because of this.  When I’m really unwell, I could easily go days without eating, but I know that I should eat, so I try to force food down.  When this is too hard I try to choke down something like Boost instead.  The only time I have ever counted calories was when I was pushing myself to cram in 1000 Calories a day, about half of what I should actually be taking in.  When people complimented me on my weight loss, I would have thrown those bottles of Boost at them if I had the energy.  Why did these people see skinny sick me as somehow better than curvy well me?  It was almost certainly done out of ignorance rather than malice, but that shouldn’t make it okay to essentially say “you look better when you’re sick”.

capsules and tape measureFor the last several years I’ve been on a trifecta of weight gain-inducing meds (quetiapine, mirtazapine, and lithium) that tipped the scales to over 200 pounds.  I had mixed feelings as the weight piled on.  I wasn’t thrilled about the changes in my body, especially since it felt so out of  my control.  Still, that med combo kept me well for a few years, and that was really my priority.  After a solid period of stability on this med combo, I decided to try going off the Seroquel, hoping that would bring my weight down a bit.  What actually ended up happening was that I had a relapse of my depression.  At that point I decided it was time to just fully accept my new body, because if I wanted to be well I needed these meds.

Earlier this year I began seeing a naturopath.  I had gotten depressed again despite my med cocktail, and I was willing to try anything that might help.  Based on my history and bloodwork, one of her recommendations was an anti-inflammatory diet.  It’s not a weight loss diet; instead, it’s all about putting healthy foods into your body and keeping unhealthy things out.  I have ended up losing some weight as a result, and I’m feeling more comfortable in my body, but I’ve faced the issue again of people commenting on my weight loss.  Yes, the weight loss is a healthy thing this time around, but people don’t know anything about that when they make comments.  My body should not be theirs to pass judgment on.

I don’t recall ever actually saying anything in response to the people have commented on the changes in my body.  There’s just too much backstory to be able to fit into a one-line zinger.  Our bodies may reflect to some extent what’s going on inside of us, but often not in a way that is consistent with societal expectations around body size and shape.  From anorexia nervosa to depression to binge eating disorder, our bodies can be warped by our illnesses.  I just hope that someday more people will understand that.

 

Photo credits:

TeroVesalainen on Pixabay

mojzagrebinfo on Pixabay

Navigating mental illness and childbearing

pregnant woman in shadow

For much of my life I haven’t wanted children.  In many ways this has been selfish; I wanted to live my life for me, and I wanted to be able to travel and do things that would be hard to do with a little one in tow.  My perspective began to shift after my first episode of depression, particularly after it became clear that it was going to be a recurring illness.  Safety became a flashing neon sign that there’s no way to ignore.

You occasionally hear horror stories of mothers who killed themselves and their infants due to postpartum depression, and I seriously worry that I could be that next horror story.  If postpartum depression can wreak havoc in the lives of women who don’t have a pre-existing mental illness, what is likely to happen to a woman with a history of depression with psychotic features and multiple suicide attempts?  I’m inclined to look at depression during pregnancy and/or postpartum as almost a foregone conclusion if I were to get pregnant, and while I might be exaggerating the risk to some extent, there is very real cause for concern based on my history.  It doesn’t help that this is not something that easy to talk about.  There is so much stigma around this issue, despite the courageous women who speak up and share their stories (like the amazing ones here on WordPress).

Medications are also a safety issue in pregnancy and, to a lesser degree, in breastfeeding.  Most of the meds I’m on are relatively benign, but lithium is known to increase the incidence of Ebstein’s anomaly, a type of heart defect.  In my case, the risks of going off lithium would almost certainly outweigh what is still a small absolute risk of this birth defect, but the idea of putting something in my body that is known to pose a risk to a fetus is disturbing, to say the least.  I can’t even imagine what women stabilized on highly teratogenic (i.e. likely to cause birth defects) psychiatric medications like valproic acid must struggle with when planning for a family.

parents' hands cupping baby feet

Electroconvulsive therapy has been shown to be safe and effective during pregnancy, although it is not often used.  ECT has been helpful for me in the past, and it’s likely something I would turn to again if I got pregnant.  I have to wonder, though, what level of stigma would go along with that.  I would imagine that most people’s initial gut reaction would be that this must be dangerous for the fetus, and to be honest, I would probably have a hard time silencing that thought in my own mind.  Postpartum, I would be concerned about my ability to care for a child if I was getting ECT, since I tend to have significant memory problems as a side effect.

Then there’s the issue of passing on genetic susceptibility to mental illness.  I don’t want to put a child through what I’ve had to struggle with.  The interplay between genetics and mental illness is complex and not well understood, and there are genetic counselling services available to get a more realistic evaluation of the risk, but I’m not sure if that would set my mind at ease.  My own family psychiatric history consists of one great-uncle with schizophrenia.  Period.  Yet I ended up with major depressive disorder.  Why did I get sick?  Who knows,  Maybe there is no rhyme or reason to life kicking your ass.

For the time being this remains an abstract question for me, but with my biological clock ticking and my most fertile years behind me, it’s likely a question that will continue to nibble away at my mind.  Maybe I won’t have kids, maybe I’ll adopt, maybe I will have biological children, but regardless of which path I take my illness will never be far from my mind.

 

pink baby booties

 

Photo credits:

Joey Thompson on Unsplash

marusicova on Pixabay

TerriC on Pixabay

Mashed potato brains and other adventures in depression

mashed-potatoes

This has been a busy week for me.  I mean that very much in a relative sense rather than an absolute sense, as I doubt anyone else looking at my calendar would use the term “busy” to describe it.

I have always found the cognitive symptoms of depression to be among the most disruptive to my overall functioning.  When I’m really unwell it feels like I can’t think my way out of a paper bag.  I tend to describe the effect on my thinking as “mashed potato brains”; it seems like a fairly apt analogy.  My current depressive episode has stretched over the last year and a half, and the cognitive symptoms have ebbed and flowed over that time.  When my thinking starts to get clearer I’m able to feel a bit of hope and optimism, but then a week like this week comes along.

It wouldn’t bother me as much if there was something stressful that triggered the decompensation (I use this psychiatry term because it’s the only one that comes to mind).  That might seem logical.  But no, I don’t have that excuse.  I have just asked my brain to do a little bit of outside-the-routine thinking, and I get totally overwhelmed.  Hello mashed potato brains.  When I went on Pixabay to look for an image for this post, I couldn’t even remember how to spell potatoes (although I did realize that potatos looked a bit funny).

Just before I started writing this post, I was looking through my WordPress Reader feed, and I saw the post Losing My Mind on Travis and the Brain.  I felt relieved – relieved that I’m not the only one losing my mind, and relieved that even if we’re drowning we can help pull each other out of the water.

drowning_hand

 

Photo credits:

422737 on Pixabay

Photo by Ian Espinosa on Unsplash

Liebster Award nomination!

Liebster award logo

I’m used to expecting any news to be bad news, but today got a lovely piece of good news: Mentally(Un)Qualified nominated me for a Liebster Award!  Thanks so much Chelsea!  Her posts are genuine and make you feel like you’re talking to an old friend.  She is able to inject hope even into difficult topics.  If you haven’t checked out her blog yet, you definitely should.

Part of accepting this nomination is to mention one of my own favourite blogs.  While it’s hard to pick just one, I’m going to go with  Be Your Own Light, which was recently nominated for a Liebster award herself, along with a Sunshine Blogger Award.  Eleanor is lovely and kind, and a great advocate for mental health services.  She brings in some interesting guest bloggers to spice things up.  Always a good read.

Here’s what I’ve come up with in response to 10 questions posed by Mentally(Un)Qualified:

  1. Why did you decide to start a blog?  Because the best way to fight stigma against mental illness is to talk about it.
  2. What is your favorite passion that helps you relax? Cuddles with my pet guinea pigs – I have 4 and am well on my way to becoming a crazy cat lady-type person.
  3. Best concert you’ve ever been to? I really enjoyed a local symphony’s performance of Carmina Burana by Carl Orff.
  4. Which animal do you feel you are most like?  A mongoose.  I don’t even know what that is, but it just popped into my head.
  5. If you could live anywhere, where would you live and why?  I would live exactly where I already live in Vancouver, Canada
  6. Favorite guilty pleasure snack?  Cheese if I have wine to go with, otherwise Cheezies.
  7. What movie makes you cry every time you watch it?  The Lion King, when Mufasa dies.
  8. If you were stranded on a deserted island, what 3 things would you need most?  Toilet paper, a blanket, and a book to read.
  9. What is your biggest fear?  Spiders
  10. What is your favorite memory?  Any of my memories from travelling, even the gross 3rd world toilet stories.

 

Spreading the love…  Here are some fabulous mental health-related blogs that I would like to nominate:

For these rockstar nominees I have 10 questions.  They’re a bit odd but I’m having a hard time being creative at the moment:

  1. Do you have a tattoo?
  2. What is the strangest toilet-related experience you’ve ever had?
  3. If you had a farm what animals would live on it?
  4. What’s the best tv/movie portrayal of mental illness that you’ve seen?
  5. If you had to be either blind or deaf, which would you pick?
  6. What country is at the top of your list to visit?
  7. Do you ever drink pickle juice straight out of the pickle jar?
  8. How old is the plant you’ve had in your house the longest?
  9. If you were to pick one canned food to stash in your earthquake/flood/etc survival kit, what would it be?
  10. What public figure makes you the angriest?

Here’s what’s involved in a Liebster Award nomination:

  1. Thank the person who nominated you, and put a link to their blog on your blog. Try to include a little promotion for the person who nominated you. They will thank you for it and those who you nominate will also help you out as well.
  2. Display the award on your blog — by including it in your post and/or displaying it using a “widget” or a “gadget”. (Note that the best way to do this is to save the image to your own computer and then upload it to your blog post.)
  3. Write a 150-300 word post about your favourite blog that is not your own. Explain why you like the blog, provide links.
  4. Provide 10 random facts about yourself. (This year I’m making this optional. If you wish to engage with your readers it’s a great idea to include random facts about you.)
  5. Nominate 5 – 11 blogs that you feel deserve the award, who have less than 200 followers. (Note that you can always ask the blog owner this since not all blogs display a widget that lets the readers know this information!)
  6. List these rules in your post (you can copy and paste from here or simply link to this post). Once you have written and published it, you then have to.
  7. Inform the people/blogs that you nominated that they have been nominated for the Liebster award and provide a link for them to your post or mine (Jack Henry) if you don’t have all the information so that they can learn about it (they might not have ever heard of it)! Post a comment in the comments below (on the website https://theglobalaussie.com/blog/liebster-award-2017/ ) so Jack Henry can view your post and check out your blog. Jack Henry personally visits each and every blog. He visited a few hundred last year!

Thanks again to Mentally(Un)Qualified, and I hope you can check out some of the blogs I’ve mentioned.  Happy reading!

Ashley

Lessons in love and mental illness

hands forming a heart shape framing a sunsetI met Ron 10 years ago, during my first psychiatric hospitalization.  He had schizophrenia and had been around the block many times before, but it was my first experience on the patient side of the desk (I’m a mental health nurse).  At a time when everyone else could only see my depressive illness, somehow Ron was able to see past the illness to my true self, the self that I thought I had lost.  He served as an anchor of sorts to help me reconnect with myself, which played a significant role in my recovery.  I would say that he was probably more instrumental in my recovery than any of my treatment providers.

In part because he had a good heart and in part because he struggled with mental illness himself, he accepted me completely and unconditionally.  He just got it.  It seemed like the more he saw my imperfections, the more perfect I became to him.  I can’t even begin to describe how comforting it was to have this kind of connection, and how much more whole it made me feel.

That’s not to say there weren’t challenges.  Besides schizophrenia, he struggled with addiction, and there were some problematic behaviours related to that.  His mental illness was only partially controlled, and it was hard to watch him wrestle with his inner demons.  At one point he attempted suicide by overdosing on my stash of psych meds that I’d been hoarding rather than taking.  I felt tremendous guilt over that, and spent as many hours a day at his bedside as the ICU staff would allow.  I tried to stay out of his psychiatric treatment, especially since I knew some of his treatment providers in a professional context, but it was heartbreaking to see him not getting the help I knew he deserved.

heart outline in rocks on beach

There was also stigma.  I’m a nurse and very high functioning when well, and people didn’t always approve of my relationship (first romantic and later just friendship) with someone they saw as a schizophrenic addict.  My parents didn’t approve, which caused a lot of tension.  During one of my later hospitalizations a psychiatry resident, who read something in my old chart about my relationship with Ron, asked “why would you get involved in a relationship with a schizophrenic?”

Ron passed away 2 years ago from an accidental overdose on fentanyl-laced drugs.  I miss him every day, but I always knew that the reality of being close to someone with serious mental illness was that I would quite possibly lose him prematurely.  I have learned from him that I deserve someone who truly sees me and truly accepts me, and I thank him from the bottom of my heart for that.  Maybe I will find another person like that and maybe I won’t, but I will not accept anything less.

 

Photo credits:

Jack Moreh on Freerange

AnnaER on Pixabay

“It’s all in your head” is as real as it gets

brain depicted as computer chip

Your chest feels so tight that it’s making it hard to breathe.  Your heart is racing, and a quick check of your pulse confirms this.  Your partner says “relax, it’s just your anxiety”, and that only makes you feel more agitated.  Your body feels like it’s ready to explode, you have no idea what’s going on, and the pain is only getting worse.  You feel terrified and powerless, and for lack of a better option you decide to go to emergency to get checked out.  They run some blood tests and do an ECG.  The doctor comes in, gives you only the briefest of glances, and says “everything came back normal.  Looks like it’s all in your head.  Go home and get some sleep”.

If you’re anything like me you’d probably feel like slapping both doctor and partner upside the head.  But before we run off in that direction, let’s think about those phrases: “it’s just anxiety” and “it’s all in your head”.  I would like to unpack them and consider them in terms of what we know about the brain and the body.

electrocardiogram

The human brain is astoundingly complex.  It ultimately controls almost everything that happens in the body through multiple mechanisms.  What is particularly relevant in terms of anxiety is control over the autonomic nervous system, consisting of the sympathetic nervous system (responsible for the fight/flight/freeze response) and the parasympathetic nervous system (responsible for resting and digesting).  If anxiety kicks the sympathetic nervous system into overdrive, this can make the heart race as the inner caveman gets ready to react to the bear outside the cave that might be looking for its next meal.  It also suppresses parasympathetic activity, leaving your gut an unhappy place.  None of this is under conscious control, hence the term autonomic.  The brain is capable of generating and distorting all sorts of sensory information, and it often doesn’t make us consciously aware of what it’s up to.

So to brush something off as “all in your head” is to forget that a powerful brain actually lives inside that head.  What is useful, though, is to know the origin of the problem.  If chest pain originates in the heart, that’s where treatment needs to be targeted.  If the root cause of the problem is in the brain, targeting the heart is a waste of time.  There is simply no excuse for ignoring a problem because it originates in the brain; that would be like saying epilepsy isn’t valid and isn’t worth doing anything about because the root cause of a seizure lies in the brain rather than the limbs.

neuron networkThe same people who might say “it’s just anxiety” are probably also likely to write off talk therapy as a valid and important form of treatment.  What’s crucial to understand here is the concept of neuroplasticity, the brain’s ability to make changes in how it functions and form new synaptic connections between neurons.  Talk therapies, in particular cognitive behavioural therapy, have been shown to bring about neuroplastic changes in the brain, meaning new connections can be formed that bypass the old circuits that triggered physical symptoms of anxiety.

So, is it all in my head?  Damn right it is, and that is just as real and valid and potentially debilitating as any other medical condition.  So let’s get down to business and treat this thing.

 

Image credits:

GDJ on Pixabay

Pixabay on Pexels

geralt on Pixabay

“You can be a real bitch” – Is it me or my illness?

man holding up an irritated face sign

I can get pretty irritable sometimes because of my depression.  I seem to lose access to all of my more mature self, and revert to what may have worked best when I was five years old.  This can have a major impact on my behaviour, and sometimes I have let fly with yelling, screaming, and swearing.  This has occurred most often when I’ve been hospitalized, and has been directed at nurses and doctors whom I perceived as making things more difficult for me.  One of my former community psychiatrists once told me “you can be a real bitch when you’re not well”.

Several years after my first hospitalization, I learned that one of the diagnoses on that first discharge summary was borderline personality traits.  Subsequent psychiatrists have disagreed with that diagnosis, as the maladaptive coping mechanisms only make an appearance when I am ill, as opposed to personality disorders involving traits that are consistent over time.  It begs the question, though – to what extent do our coping strategies and behaviour when ill reflect (or not reflect) our core selves?

ostrich with grumpy faceI am not generally an irritable person, so when I become irritable due to my depression, I’m not sure if things are suddenly bothering me that I never would have noticed, or if I’m just more disinhibited about expressing irritation that I would normally just brush off.  In other words, is something new happening, or is there just an amplification of what’s already there?  While in the end it probably doesn’t make a whole lot of practical difference, it’s worth thinking about in terms of self-identity.

Is my mental illness part of me or is it something that happens to me, a monster on my back that I have to carry around?  I have always tended to lean toward the latter view, because I don’t think my illness should define me.  Perhaps it’s also in part because I don’t want the real me, my core self, to be responsible for my bad behaviour.  Then again, no one is responsible for my actions but me, although the options I have to choose from seem to be very much influenced by my illness.

The perspective that I’ve sort of settled on is that we all have our inner caveman brain, including bits like the amygdala, and in times of stress and difficulty, that is what gets activated.  Our prefrontal cortex, the most advanced part of our brain in terms of evolution, is what generates our most adaptive coping mechanisms.  In personality disorders, factors such as trauma can impair the development over time of these sorts of adaptive coping mechanisms.  In conditions such as mood disorders, our ability to access our adaptive coping mechanisms seems to be impaired in the acute illness phase, leaving us to default to what caveman brain can provide us.

So am I a bitch, or is it my illness?  In the end, probably some of both.

 

Photo credits:
PDpics on Pixabay

chezbeate on Pixabay