Pressing reset (or maybe just pause)

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Last night I got back from a week-long vacation at an all-inclusive resort in Mexico.  The vacation came at a very good time.  I was starting to get really mired down in negative thoughts, thoughts that convinced me that I was being used, wasn’t cared about, and was a failure.  The rainy darkness that is winter in Vancouver certainly wasn’t helping.

Basking in the sun felt like being enveloped in a week-long hug.  I had a spa treatment, did some writing and reading, and started on a bullet journal.  It’s a lot easier to practice mindfulness when there are so many lovely stimuli to be aware of.  I had no “to do” list, and aside from checking my email once a day I was totally offline.

The thing is, though, that no matter how paradisiac the setting is, you can’t truly get a vacation from yourself and your illness.  There is always the knowledge that this sun-drenched escape is fleeting, and nothing about regular life has actually changed.  So while my vacation was generally good, it wasn’t all rainbows and butterflies.  The day that marked the midpoint of my trip was particularly plagued with rumination and self-doubts.  I don’t usually get sucked too deeply into comparing myself to others, but I found myself falling into that trap, particularly when it came to body image.  I was also catastrophizing about various things going in my life, even worrying that someone had called the local emergency mental health service about me regarding something that had happened shortly before I left.  A potential suicide plan briefly but seriously crossed my mind.

I found a few strategies to help settle me down.  I would move around, from beach, to family pool, to snack bar, etc., and somehow those little shifts helped me put a lid on my thoughts somewhat.  I maintained a very simple but consistent routine that minimized the need to make any decisions.  Every morning I went for an hour-long barefoot walk along the beach; on a couple of days the serenity of that walk that got hijacked by my negative mind, but mostly it was a peaceful, mindful, therapeutic recharger.  It was also helpful that one of the female staff at the buffet was the perfect cheerleader.  She always called me “sexy girl“, and was very free with the compliments.  She complimented me on how young I looked, and if I had on anything other than my particularly cleavage-revealing sundress, she would ask why I wasn’t wearing my sexy dress.  Being told I’m sexy while I was feeling ugly was exactly what I needed to hear.  I guess it’s good sometimes to be reminded that showing a bit (ok, a lot) of cleavage can be sexy and fun for my own sake.

I did this vacation on my own, and I’ve often travelled alone before.  I don’t have a problem with it, but I do sometimes struggle with others’ reactions.  In my everyday life, most people I encounter aren’t aware of just how much I isolate myself.  At an all-inclusive resort setting, where coupledom is very much the social norm and tequila makes people loud and chatty, I stand out in my aloneness, enough so that sometimes people felt the need to comment on it.  I was talking to an older couple at one point, and while the wife was saying it was great that I was on my own, the husband’a face told a very different story.  Disgust might be too strong a word, but not by much.  In some cases I’m pretty sure that the service I received was of a lower standard than the couples around me.  I was clearly not falling within the social norm.  Boarding the plane on the way home, the people ahead of me were talking about some guy who’d gotten in a fight with his girlfriend and hopped on a place to Mexico.  Apparently this guy was then lamenting there were no single gals to be found, and one of the women in front of me authoritatively stated “of course not, women don’t travel alone”.  Really?  So what the hell am I?

I also felt like I stood out as an oddity because I was drinking very little.  I’ve found that when I’m out in the heat and sun all day I get dehydrated very easily, and this makes me prone to more lithium side effects.  Add alcohol into the mix and it just makes things worse.  Minimal drinking was probably better for me anyway, but it was just one more little thing to add to the feeling-lesser-than pot.

All in all, it wasn’t quite the reset that I was hoping for, but it was a chance to put regular life on pause, at least for limited chunks of time.  Hopefully I’ll be able to carry some of that lightness with me as I get back into my everyday existence.

 

Addendum: It’s always good to find a little bit of humour in life.  Right now the very outer layer of skin is peeling off my butt cheeks and the back of my upper thighs, due to a combo of wet swimsuit rash, lots of sun, and insufficient sunscreen application.  I need to pick up a loofah to take care of this whole situation, but in the meantime I look absolutely ridiculous.  It’s the most unsexy thing ever, and it’s a good thing I’m not expecting any action in that department.  So I laugh at myself, and that’s a good thing even if the shower of skin flakes on my bathroom floor is a bit icky.

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It’s vacation time!

oceanfront beach

Wahoo!  Tomorrow I leave for a week at an all-inclusive beachfront resort in Los Cabos, Mexico.  Not a vacation from work, because I haven’t been working that much recently, but a vacation from my life.  A vacation from myself, to some extent.  A much-needed vacation from myself, at that; the last couple days in particular have been fairly bleak inside my head, and hope feels hard to come by.

But I get to leave both the internal and wintery external darkness behind for 7 lovely days.  I will bask in the sunshine and get vitamin D gushing through my body.  I’ll do lots of light reading and think about nothing.  I’ll bring my cell phone so I can check my email occasionally, but other than that I’m going to be completely off-line and tech-free.  I think it’ll be a great way to recharge my batteries, clear my mental memory cache, and hopefully get myself in a better frame of mind to make decisions about how I want to approach various things this year.

I’ll miss you all, but I’ll talk to you in a week 🏖

 

Image credit: Lou Liebau on Unsplash

Blog Award Mashup

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I’ve been nominated for three different blog awards by several lovely bloggers:

Blogger Recognition Award: Alys and Alicia

Blogger Appreciation Award: Nuclear Asteria.

Liebster Award: The Colour of Madness

A huge thank you to all of these ladies, who are fantastic bloggers.  If you haven’t checked them out yet, you should definitely do so!  I love these blog awards because they’re such a great way to discover new blogs, but I’m doing this as a mashup so it’s not as overwhelming for me.  Figuring out who I should nominate is always hard, because I love you all.  However, to keep me from spending too many hours on this, I’m picking a random assortment from this amazing blogosphere that I feel so lucky to be a part of.

 

Blogger Recognition Award

  1. Show your gratitude to the person who nominated you and provide a link back to the person’s blog.
  2. Give a brief story of your blog.
  3. Share two or more pieces of advice for beginner bloggers.
  4. Choose 10 other bloggers to nominate.
  5. Comment on each blog by letting them know they’ve been nominated and provide a link to your award post.

 

Blogger Appreciation Award

Here are the rules:

  • Thank the blogger who nominated you and provide a link back to their site.
  • Write a paragraph of something positive about yourself.
  • Nominate and notify as many bloggers as you wish.
  • Use the award image.

 

Rules of the Liebster Award 2018

The winning blog wins a prize. Each blog gets one entry. To enter you must:

  • Link to my blog post in your Liebster Award blog post.
  • Answer the questions given to you (if nominated, if you were not nominated you can use my questions).
  •  Create more questions for your 5-11 nominees to answer (judged on uniqueness and creativity).
  • Comment on this blog post with a link DIRECTLY to your Liebster award. (To make it easy for the judge to read them all.)
  • Entries start 1st Jan 2018 and ends on 25th Dec 2018. The winner will be picked on the 31st of December

 

Now that the rules are out of the way, here are my answers and nominees….

Blogger Recognition Award:

  • My blog’s story: I’ve always cared about challenging mental illness stigma, but for a long time I stayed away from social media because it just made me feel crappy about myself.  Last fall I had a lot of time on my hands because I wasn’t working much, and I was looking for something that would help give me a sense of purpose and feel less isolated, so my blog was born
  • Advice for beginner bloggers: Write about what matters to you, not about what you think other people want to read.  Engage in the blogging community and all the support that it has to offer.  These kinds of award posts can be a great way to get hooked into that.

My nominees for the Blogger Recognition Award:

 

Blogger Appreciation Award – something positive about me: I am a damn good nurse.  I work in mental health, and I consistently get feedback from my clients that they feel I listen to them and treat them with respect and compassion.  I’ve had more than one nasty manager who questioned my abilities as a nurse not because of my work with clients but because I spoke my mind and called bullsh*t on policies that went against my values.  Yet even at my most depressed, I knew that not only were they @ssholes, but they were just plain wrong.

My nominees for the Blogger Appreciation Award:

Questions from Kate at Colour of Madness for the Liebster Award:

  1. What is your favourite sense and why? (as in taste, touch, smell etc)  I would have to say vision because it plays such an important role in my passion, travelling.
  2. If you found $1000 in a bag at the local park and nobody seemed to be around, what would you do with it? I’d be torn between turning it in to the police station so maybe its owner could claim it, or donating it to charity.
  3. Do your friends and family read your blog? If not, why not and if so, how does it change the way you write?  No, and I prefer it that way because I don’t feel the need to check myself at all in my writing.
  4. What is the quirkiest little habit you have that you just can’t break?  It’s not quirky, but I do have quite the potty mouth, although I’m not sure the issue is I can’t break the habit or I just don’t give a sh*t.  Probably the latter.
  5. What is your favourite post from your own blog and why? I don’t have one, because they’re all about things that are interesting/relevant/important to me.
  6. If you could go back in time and speak to your 16yr old self, but only for 5 minutes, what would you say?  I’d say don’t waste a single day of being well.
  7. What is your favourite physical feature and why?  I like that I’m tall (5’8″), because it’s the one feature that there’s nothing at all I’d want to change about.
  8. Are you a Winter person or a Summer person? Summer.  Bring on the sunshine.
  9. If you could bring a celebrity back from the dead and take them out for the afternoon, who would you choose and where would you go? Nelson Mandela would be amazing to meet, but I might be tempted to go for someone scary and creepy.
  10. Who would have the best chance of survival in a Zombie apocalypse, you or your best friend? Why?  I don’t actually have friends any more, because I’ve pushed them all away.  I think I’d be ready to join team Zombie.
  11. This is the big one guys… The toilet paper roll. Under or over?  I’m militant about this one: over.  I just don’t understand why anyone would want under.  Over is like the toilet paper being presented to you on a silver platter – who doesn’t want service like that?

My nominees for the Liebster Award: I pass on the same questions to you.

 

If you’ve already been nominated for the award I nominated you for, please feel free to switch to a different award.  And if you don’t have the time/energy/inclination to do an award post that is 110% okay.  They can be exhausting!

I do hope, though, that people will check out all the blogs that I’ve mentioned, because they’re awesome.  Thanks again to Alys, Alicia, Asteria, and Kate for nominating me ❤️

What I’ve learned from my “psych patients”

Learning is not just for school, but for life

Having worked as a mental health nurse for many years, it would be easy to assume that I’m usually the one doing the teaching and my clients are usually doing most of the learning.  That assumption would be completely wrong.  Yes, I’ve learned a lot in school and through continuing education, plus I’ve learned a lot from my own experience of mental illness, but I have also learned so, so much from my clients.  (Note: my use of “psych patients” in the title is only because it’s conveniently concise.)

One of my regular clients for several years was a transgendered woman with bipolar disorder.  She was the first trans person that I worked closely with, and I had the privilege of being able to support her through sex reassignment surgery and the various pitfalls she faced along her journey with transitioning and managing bipolar.  In Canada, public health insurance covers genital surgery but not procedures that are assumed to be “cosmetic” such as facial feminization and tracheal shaves.  I have vivid memories of making calls on speakerphone with her in my office about various issues.  The person we were on the line with would refer to her as “sir”.  My client would say “no, actually it’s ma’am, not sir”.  A minute later, it was “sir” again.  And then again.  My client’s eyes, posture, and voice all reflected her frustration and defeat, and I grew increasingly outraged at the casual, everyday stigma reflected in this call centre agent’s use of pronouns.  Every time I’ve worked with a trans client since then I can’t help but remember those phone calls as a microcosm of the stigma against transgendered people, and how much this parallels the stigma against mental illness.  But my client bravely soldiered through, and her capacity to cope despite the challenges of her mental illness was astonishing.

I have had some very interesting relationships with clients over the years, and one in particular will always stand out.  She was an older women with schizophrenia who I rather fondly thought of as crusty and cantankerous.  She was chronically psychotic, and frequently called the police because she thought poison was being placed her room.  It drove the building staff crazy, and I would regularly get calls from them asking me to come by and check on her.  The client had a fun, quirky sense of humour, and this produced some amusing insults directed my way; she wasn’t too fond of me because a) I didn’t believe her about the poison, and b) I came to stick a needle in her every couple weeks.  In time she ended up being diagnosed with terminal cancer, and moved into hospice care.  The change in her was the most remarkable thing I’ve ever seen.  After years of being continuously actively psychotic, her delusions abated, and she was the most relaxed and content I’d ever seen her  She enjoyed my visits, and while she still had the energy I would take her out for coffee.  She found greater peace as she neared death than she had experienced for many, many years.  Sometimes the world works in mysterious ways.

My own experience with mental illness has made me a strong advocate for client autonomy, although I’ll freely admit that at times I’ve seen involuntary treatment work wonders.  I had one client who came to me after a long stay in hospital.  He’d originally been admitted because he was making threatening gestures with a weapon, triggered by an uncommon symptom known as Capgras delusions, which involves the belief that familiar people have been replaced by imposters.  The client was released on a community treatment order, which mandated ongoing involuntary treatment in the community, and he was on an injectable antipsychotic every 2 weeks.  He was cooperative with the conditions, but was never uncomfortable with the idea of having these restrictions hovering over him, and he didn’t want to take the medication by injection.  The psychiatrist was concerned because the client didn’t have insight into his psychotic illness.  However, the client did believe he had depression, and I was able to work with him around that and he agreed that continuing to take the medication in oral form would be a good thing.  So I supported him in pushing the psychiatrist for a switch to oral meds and eventually the discontinuation of the community treatment order.  And it worked.  The client thrived.  I like to trot out that story when I’m advocating for other clients, because it’s such a great example of how empowering someone high risk can turn out really well.

Sometimes people get written off as lost causes, but there’s really no such thing.  I had one client who had fetal alcohol syndrome, was psychotic, was a heavy crack cocaine user, and regularly prostituted herself to feed her drug addiction.  She was behaviourally erratic and would blindly wander into traffic.  Staff at the ultra-low-barrier residence where she lived were terrified for her safety.  She had been started on an injectable antipsychotic, but it was hard to track her down to actually get a shot into her.  Luckily, my office was only a couple of blocks from where she lived, and I became a bit of a stalker.  My persistence paid off, along with a few cigarettes as bribes; once she was getting her shot regularly, her behaviour settled down.  She realized that the shot “helps my schizophrenia”, and she would approach me spontaneously with a smile if she saw me on the street.  I will happily take those small victories.

I have also had other clients teach me never to lose hope.  I had gotten a call from a local homeless shelter about a man who was extremely paranoid and ranting loudly about his various delusions.  He was tough to track down because as soon as he found out I was from the mental health team he avoided me (can’t say I blame him).  Getting him to hospital was quite dramatic, involving chasing him down the street, miscommunication with the police, and handcuffs.  But we worked with him, got him stabilized on meds, changed his meds when he had side effects, got him good housing…  and now he’s doing great and running a fantastic peer engagement project.   Success stories like this give me hope, both for myself and others.

Those are some of the clients that I think of often because of what they have taught me.  There is always reason for hope.

 

Image credit: Geralt on Pixabay

Meds that can make you crazy (literally)

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We work so hard on our mental health, but sometimes we can get knocked down by an unexpected source: prescription medication.  Sure, we all know that some street drugs can adversely affect mental health, but there are also a number of prescription medications for conditions totally unrelated to mental health that can trigger symptoms of depression, mania, and psychosis.  The actual degree of risk varies depending on the specific medication and the patient context, and it’s always a question of risk versus benefit when deciding whether or not to take something.

Antibiotics:

There have been a small number of reports of depression associated with norfloxacin and sulfa antibiotics.

Antiparasitics:

Chloroquine and mefloquine, which are used in the prevention and treatment of malaria, can cause psychosis and mania.  My opinion is that there’s no reason for a person with a psych history to take either of these drugs, as there are other safe and effective alternatives.  If I’m visiting a malaria risk area, I always take Malarone, which is pricey but I can live with that to avoid psychosis; my second choice would be doxycycline.

Antivirals:

High-dose acyclovir, which can be used in the management or herpes or shingles, can trigger psychosis or depression.  Amantadine, which is used both as an antiviral to manage influenza and as an anti-Parkinsonian agent, can cause psychosis or mania, most frequently in the elderly.  Interferon is not technically an antiviral, but it is used in the treatment of viral hepatitis C; it can cause psychosis, mania, depression, and suicidal thoughts.  Luckily there are other treatment options available now, which is certainly more desirable for people living with mental illness.

Blood pressure and heart medications:

Beta blockers have been linked with depression and mania.  Digoxin can trigger psychosis and depression.  The calcium channel blockers diltiazem and nifedipine have been associated with depression.  Diuretics in the same class as hydrochlorothiazide have been linked to depression and suicidal ideation.

Gastrointestinal:

High doses of medications from the H2 receptor blocker class for acid reflux, such as ranitidine and cimetidine, can trigger psychosis, depression, and mania, particularly in the elderly or those with renal dysfunction.  Metoclopramide, which is used to boost GI motility, has been linked to mania and depression.

Analgesics and muscle relaxants:

Abrupt discontinuation of the muscle relaxant baclofen can bring on depression, psychosis, or mania.  Cyclobenzaprine can also trigger mania and psychosis.  Some NSAIDs have been linked with psychosis and depression.

Hormonal agents:

Oral contraceptives can trigger depression; one study found that this happened in up to 15% of users.  The initial doses of thyroid hormones like levothyroxine in vulnerable patients can trigger mania, depression, and psychosis.  Steroids, including anabolic steroids and corticosteroids such as prednisone, can cause mania, depression, or psychosis, particularly when used at high dose or in withdrawal.  Topical or inhaled steroids have much lower systemic absorption and thus carry far less risk.

 

This is by no means an exhaustive list, and it’s not intended as a “do not take” list.  For most of these medications, the incidence of psychiatric side effects is low, and most people can take them without any problems.  I take the beta blocker propranolol on a fairly regular basis to manage my lithium-related tremor, and I’ve never noticed it impacting my mood.  I also take birth control and in my case it boosts my mood rather than making me depressed.  I’d say the important thing is to be aware that meds for physical health problems can impact your mental health, and listen to what your mind and body are telling you.

As a final word of caution, I would say be careful with steroids that are taken orally; in my experience they’re the top culprit for medication-related psychiatric symptoms.  Generally with something like prednisone it’s the kind of thing that if you need it, you need it, but there should always be a discussion with your doctor on how to do it most safely and make sure you’re monitored appropriately.

As always, knowledge is power!

 

Image credit: qimono on Pixabay

Adjusting expectations

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I have a volunteer gig with a local community services agency doing presentations to high school students on suicide awareness.  There’s a pretty standardized format for these workshops, and they are usually done for various grade 9 classes a few times a semester.  I started doing this about a year ago to try to give myself more of a sense of purpose and hopefully aid in my recovery from depression.  I’ve done public speaking about mental health in the past related to my work as a nurse, and it was something that I typically enjoyed and didn’t get overly nervous about.  I’m not sure why I thought that ease of public speaking when well would translate into some degree of ease when depressed, because that has definitely not been the case.

Luckily anxiety hasn’t been too much of an issue; it helps that I know the subject matter well and it’s essentially the same spiel each time.  My feelings leading up to these presentations have been a strange mix of antipathy and forced pseudo-excitement.  I want to feel good about speaking to youth on suicide prevention.  It’s certainly a topic that matters to me and that fits with my desire to combat stigma, but wanting to care and wanting to be excited aren’t translating into actually caring and being excited, no matter how hard I try to convince myself.  I post about it on Twitter in an attempt to stir up some advocative fire, but it only fuels my apathy.  That in and of itself bothers me; I want to be able to feel corresponding emotions to things that are important to me in a cognitive sense.  It’s just not working out that way, though.

I did a presentation yesterday morning to a class of grade 9’s, and the kids were ok; not great about participating, but not terrible.  Once again I disappointed myself with my own performance; it was ok, but not what I would have expected of myself under normal circumstances.  My thinking is slow, and it’s hard to be spontaneous.  There were times when I lost my train of thought or stopped to search for words that I just weren’t coming.  I’ve noticed for some time now that in many situations when I’m having to think hard about what I’m saying, I look up at the ceiling as I speak.  This isn’t something I do consciously, and I’m guessing I do it to minimize visual stimulation in order to focus better.  Normally it’s just a quirk of depressed Ashley, but while speaking in front of a class of kids it certainly doesn’t add to my effectiveness as a presenter.

I’ve had to come to terms with having my level of functioning impaired by depression across multiple contexts, but it seems just a little bit harder when it comes to something like this that I want to be passionate about.  I feel like in a sense I’m letting down my values and ideals.  I’m fully aware that this idea is ridiculous, but there you have it.

I was able to give myself some credit, though, for an email I received yesterday morning from the editor-in-chief at the Journal of Psychiatric and Mental Health Nursing.  The email invited me to apply to be a member of their editorial board.  I’m fairly certain that this was a form letter sent out to anyone that has had a paper published in journal over the last while, but I still thought it was pretty cool.  That’s not to say I’m actually going to apply; without a PhD I’m not properly qualified, plus the workload would be more than I’d be prepared to take on.  Still, I have to remind myself not to discount the positive when I find it.  The email triggered a glimmer of an idea for a new research project looking at mental health blogging; I’ll have to give it some more thought and evaluate whether I have the energy for it or if I’d just be setting myself up for failure, but if I decide to go ahead with I’ll be asking fellow bloggers to get involved.

No matter what it is I’m doing I try to adjust my expectations based on what my illness will or will not allow at the time.  Sometimes I’m able to do that without too much difficulty, and in other situations it can be a real struggle. I guess what’s most important, though, is that I’m attributing my limitations to my illness rather than a fundamental flaw in myself, so it’s a dynamic work in progress.  And as Marsha Linehan would remind me in her DBT assumptions, I’m doing the best I can.

 

Image credit: Maximilian Weisbecker on Unsplash

 

Book review: No One Cares About Crazy People

No One Cares About Crazy People by Ron Powers book cover

I first heard of this amazing book in a post by A Journey With You, and immediately after finishing the post I put a hold on the book at my local library, eager to get started on it.  No One Cares About Crazy People is Pulitzer Prize-winning and New York Times bestselling author Ron Powers’ exploration of his two sons’ journeys with schizophrenia combined with a sweeping social history of mental health care and attitudes towards those with mental illness.  He skillfully interweaves these separate threads, drawing the reader along from the early days of Bedlam to the tragic loss of one of his sons.  The toll that mental illness has exacted on the Powers family and the obstacles that arose in accessing care for sons Dean and Kevin are heartbreaking, while the historical picture painted is both eye-opening and profoundly disturbing.

Bedlam has made its way into the modern English lexicon, but its origins were in England in 1247, and it was officially designated as a mental institution in 1666.  Powers starkly captures the abuses that occurred at Bedlam and other institutions like it, including overcrowding, poor hygienic conditions, use of shackles for prolonged periods, and physical and sexual assaults.  Such practices were slow to change, and as the book points out, even now the mentally ill are often mistreated, particularly in correctional institutions.  Powers deftly ties these elements together, giving the reader a strong sense of the connectedness between past and present.

Powers touches on social Darwinism and eugenics, which were practiced far more widely than is generally known.  It’s unsurprising that forced sterilizations of the mentally ill were carried out in Nazi Germany, but Powers informs us that in the United States an estimated 60,000 forced sterilizations of the mentally ill were performed in the 20th century.  Between 2006 and 2010, 148 female sterilizations were carried out in the state of California, and this practice was not made illegal until 2014, a jaw-dropping reminder that, as the book title suggests, those with mental illness are treated as somehow “less than”.

Powers covers a broad range of 20th century influences on mental health care in the United States, including the anti-psychiatry movement, “treatment” strategies such as lobotomies, and misguided  beliefs that antipsychotic drugs such as chlorpromazine could “cure” schizophrenia.  John F. Kennedy’s Community Mental Health Act began a wave of deinstitutionalization, which led to a ballooning of the homeless population and large numbers of mentally ill ending up in the criminal justice system.  Powers points out that in many ways this approach criminalized mental illness, and the effects remain widespread to this day.

As any questioning parent might, Powers tries to identify factors that could potentially have contributed to his sons developing schizophrenia.  Both Kevin and Dean were highly artistic and passionate about music, raising the as yet unsolved question of whether mental illness is linked to traits like artistic creativity or scientific genius.  In his teens, Dean was socially vilified after a female passenger was seriously injured when the car he was driving crashed.  He was falsely accused of drunk driving and made into a sort of social pariah, and Powers suspects that the stress related to this incident likely contributed to the development of his son’s mental illness.

Powers raises the contentious issue of involuntary treatment.  The precedent for modern legislation in the United States can be found in the era of former president Ronald Reagan; deinstitutionalization was a key aim and decision-making was placed in the hands of the courts rather than medical professionals.  This can mean significant delays in accessing much needed treatment.  Powers argues strongly that involuntary treatment should be more readily available before a mentally ill person reaches a crisis stage where they present a risk to self or others, as by this point it may be too late.  He addresses anosognosia, a common symptom of schizophrenia experienced by both of his sons, that impairs one’s ability to recognize the nature of their illness and the need for treatment.  This caused significant negative consequences in the Powers family, which Powers points out to strengthen his argument.

The powerlessness that can go along with loving a mentally ill person is heart-wrenchingly captured in Powers’ account of his son’s illness journeys.  Kevin was initially diagnosed with bipolar disorder before the full extent of his psychotic symptoms unfolded, leading to a delay in getting him started on antipsychotic medication.  Before his suicide, he had been seeing his treatment team regularly, and was still passionate about his music and future-oriented.  Not once did he speak openly to anyone of suicide, leaving those who loved him powerless to intervene.

Powers openly challenges the social stigma and lack of understanding regarding mental illness. He likens the mental health condition of schizophrenia to the physical health condition of cancer: “a predator without peer and impervious to cure”.  He identifies numerous ways in which those with mental illness can contribute to their communities, and emphasizes the importance of having the right types of supports that can make that happen.

The book concludes with a call to action: “The mentally ill people in our lives, as they strive to build healthy, well-supported, and rewarding lives for themselves, can show us all how to reconnect with the most primal of human urges, the urge to be of use, disentangling from social striving, consumer obsession, cynicism, boredom, and isolation, and honoring it among the true sources of human happiness.  To put it another way: the mentally ill in our society are awaiting their chance to heal us, if we can only manage to escape our own anosognosia and admit that we need their help.”

There are many voices that can contribute to the dialogue around mental illness.  It is essential to hear the voices of those with lived experience of mental illness, and those voices can’t be replaced by the voices of love ones or professionals.  However, embracing all of these voices can allow us to construct a more coherent social narrative regarding mental illness.  This book makes a strong contribution to that narrative by improving awareness and challenging stigmatizing beliefs, and it will also resonate deeply with those whose lives have been touched in some way with mental illness.

 

You can find my other book reviews in my blog index.

Finding safety without armour

woman wearing suit of armour

I’ve had a pretty shitty last couple of years.  There have been multiple people in a variety of different contexts who have treated me like crap, including people whose role (in theory) was to help me.  While I don’t have PTSD, I do feel traumatized by the things that have happened to me, and that (in combination with my depression) has made me really withdraw into myself.  I don’t trust people, and I don’t feel safe with people.  I feel like anyone could harm me or turn on me at any time.  I expect to  be thrown under the bus because I have learned that this is how people treat me.  So for the purpose of self-preservation, I opt to hide beneath a heavy suit of armour, hoping that people won’t be able to get through it to hurt me.

There is one exception to this psychological mess-fest of mine.  He’s someone I work with, and right from the beginning I felt safe with him.  To some people “safe” may sounds like an odd choice of words, but for those of us living with mental illness psychological safety is huge.  And I trusted him.  I’m not sure why, but it just felt right.  I told him about my illness very early on, and he was totally ok with it.   As time has passed I’ve shared with him some of the really messy bits, but it’s almost as though the more I show my imperfections the more perfect he thinks I am.  It seems like he’s able to look past the illness and see the real me, which helps me feel a little more connected to the real me that’s lying buried beneath the depression.  In a lot of small ways he takes care of me.  While I am fiercely independent, it feels nice to be taken care of once in a while, and it had been quite a while since I last felt that way.

holding_handsLately we’ve started communicating quite a bit outside of work, which has been really nice.  I’m not sure where exactly this will end up taking us, but I’m enjoying the ride.  It’s interesting to reflect on how easily I felt safe with this person despite my internal scars and deep-seated mistrust of others.  Is it possible to “just know” that someone is not going to hurt you?  Probably not, but I guess it’s reassuring that I am still able to trust, albeit highly selectively.  I’m not so completed disconnected from the world that trust is impossible, which on some level kind of surprises me.

I think we all put on armour as needed to protect our vulnerable inner selves from the world around us.  The challenge is finding some sort of balance so that we’re not completely closed off, and establishing a dividing line between self-protection and avoidance.  I have a lot more work to do on relaxing my own armour, but at least I’m making a start.

What sort of armour do you wear to keep yourself safe?

 

Image credits:

bstad on Pixabay

Elvis Ma on Unsplash

You always remember where you were when…

Sandy Hook elementary never forget sidewalk

There are certain moments in time that become etched in our memories, and we remember exactly where we were and what we were doing when an event happened.  Sometimes that’s because of the significance of the event itself.  For my parents’ generation, that might have been the assassination of John F Kennedy or the moon landing.  I remember that on the morning of September 11, 2001, I was in university but for some reason didn’t have classes that morning.  When I got up my roommates had the tv on, and we watched in stunned, horrified silence as the 2nd tower collapsed.

Then there are the moments we remember not so much because of the event itself but because of our own circumstances at the time.  For me, the Sandy Hook elementary school shooting was one of those moments in time.  Don’t get me wrong, it was a terrible event, but sadly these types of events occur with disturbing regularity.  I remember Sandy Hook, though, because it is burned in my mind what was going on for me at the time.  I was in the small psychiatric emergency ward in a suburban hospital near the city where I lived.  It was a single large room with curtained off beds and a small seating area with a tv.  There was nothing else to do, so I watched tv and picked at the rats nest that my hair had become during the delirious days prior to my admission.  The tv was tuned to CBC Newsworld, the 24 hour news channel of Canada’s public broadcaster.  As I watched the story unfold, I felt a curious sense of indifference.  The only thing that really struck me was that I wished Adam Lanza could have shot me rather than those innocent kids.  Why did they get to escape this world while I was stuck rotting on the psych ward? Aside from that thought, I just kept mindlessly picking away at my hair.

I don’t like the heartlessness that depression brings about in me.  I previously blogged about my own non-reaction to the Las Vegas mass shooting; I was disturbed more by my lack of reaction than by the event itself.  Indifference was not a “normal” way to look at such a horrific tragedy.

I find it interesting that my life’s chronology has come to be defined very little by external significant events and much more by illness events.  Hospitalizations and relapses form the major milestones as I look back at my life over the past 10 years.  Everything else is situated in relation to those milestones; either that, or it just blurs into a fog of meaninglessness.  I regularly watch the news and so am aware of major world events, but unless things somehow relate to my depression journey my brain relegates them to the discard bin.

Mental illness changes how we interact with the world around us, and that can be distressing and even frightening.  It can be hard to separate how much of our reactions are truly our own and how much are the illness.  Why are both 9/11 and Sandy Hook burned in my mind when so many other events have gone into the dusty filing cabinet of my brain?  Why did 9/11 trigger stunned horror while Sandy Hook triggered nothing?  It’s not something I try to beat myself up over, but I do find it curious.  As in so many other situations, I’m not really sure where I end and the illness begins.  On this journey of self-discovery I don’t think I’ll ever find concrete answers, and maybe there will always just be more questions.  Still, it’s important to keep asking those questions – and maybe that’s what I really need to take away from all of this.

 

Why research literacy matters in mental health

Caduceus symbol for medicine

We are regularly bombarded with news of the latest scientific research findings, and sometimes it seems like you can find a study to tell you just about anything.  My concern with news reporting of research is that many people (including members of the media) have relatively limited research literacy.  Research literacy refers to the ability to draw upon a body of knowledge about research methods in order to interpret and critically evaluate research findings.  Greater research literacy means, among other things, a more effective bullsh** detector.  In this post I’ll break down some of the terminology that’s often used in research.  The concepts involved are not necessarily intuitive, so it’s important to reflect on how we can most appropriately use the information we are given.  The randomized, double-blinded, placebo-controlled trial is considered the “gold standard” for much medical research, and it’s useful to understand why that is.

Peer review

Peer review is an important quality control step before research papers are published.  Reviewers are independent of the journal the paper has been submitted to, and they remain anonymous (except to the journal editors).  Peer reviewers are selected by editors because of their expertise in the field, and they will give feedback to guide the editor in making a decision about whether or not to publish a manuscript.  Most often reviewers will recommend improvements be made before a paper is accepted.

The peer review process can potentially get a little shakier when it comes to “open access” journals.  The articles in these journals are publicly available without a subscription, and instead the journal’s revenue stream comes from authors, who must pay a publication fee.  Some of these journals are credible and reputable, while others are predatory.  Because I’ve had work published in academic journals, my email address is out there in that world, and I regularly get emails from obscure open access journals asking me to do reviews for papers that are so completely unrelated to my research field it’s sometimes laughable.  Hmmmm.

Quantitative vs qualitative research

Quantitative research collects quantifiable data and generally uses statistical methods to analyze that data.  This type of research is the basis of much of the medical knowledge that we have.  However, numbers can never tell the whole story, and that’s where qualitative research comes in.  Qualitative research uses people’s stories to answer questions like what does it feel like to have mental illness, for example.  I’m particularly partial to a research method called autoethnography, which is a study of the self in the context of culture.  I used this in my masters thesis to examine my own experiences of mental illness, and it’s a really exciting way for the voices of people with mental illness to be heard.

Randomization

There is a great deal of person-to-person variability in health status, genetics, and many other factors.  By randomizing which participants are assigned to the intervention group and which are assigned to the control group, the likelihood decreases that one particular group will be stacked with people having certain characteristics.  Greater homogeneity between participants receiving intervention A and those receiving intervention B improves the validity of the results obtained.

Blinding

Blinding refers to who knows what intervention the patient is receiving.  In a double-blinded study, neither the patient nor the investigators evaluating the outcomes know this.  Blinding is considered desirable because it reduces the chance of bias in the results.  In practical terms, in a study of drug A, drug A and a placebo might each be contained in identical gelatin capsules.  Each participant would receive a numerically coded dose, and a member of the research team not involved in administering the drug or evaluating the participant’s response would be responsible for managing the codes.  Specifics vary from study to study, but the purpose is still the same.

Controls

Let’s say you give drug A to 20 people.  A month later 15 of them are doing better.  That’s great, but it doesn’t tell you the extent to which drug A is or is not affecting outcomes.  That’s where controls come in.  A control represents a comparison group that allows researchers to make some determination of what is causing what.  Using a placebo control is often the most desirable research design in separating out how much of the response is actually due to the drug being studied.

Sometimes another active drug is used as a control.  One example of this is in studies of ketamine for major depressive disorder.  Since ketamine is an anaesthetic, if a normal saline infusion was given as a placebo any attempts at blinding would go right out the window.  Therefore, studies might use something like intravenous midazolam, a rapid- and short-acting benzodiazepine, as a control.  Other types of controls include “treatment as usual”(the receiving whatever treatment is considered standard practice) or “wait list” (patients who are currently on a wait list to receive the intervention that’s being studied).

vials

Risk

Risk is often quantified as a percentage, but a number needs sufficient context to be meaningful.  Absolute risk refers to the probability of something happening, full stop, while relative risk refers to the probability of something happening in relation to some other designated population, factor, or situation.  Relative risk numbers are meaningless unless you know the reference point.  Let’s say drug A causes a 500% increase in the risk of cancer X.  Sounds scary, right?  But what if the absolute risk of cancer X is 0.00001%?  That means taking drug A increases the risk of cancer X to 0.00005%, which is a lot less frightening.

Reports on the news may talk about an increased risk of death from drug B.  Again, that sounds pretty scary.  Except the absolute risk of death is 100%, with no exceptions (at least thus far in human evolution).  That means we need more information.  What time frame are we talking about?  Risk of death within 1 year?  Within 20 years?  It makes a difference.

Correlation vs causation

Correlation refers to things that tend to happen together, and this can mistakenly be taken to mean there is a causative relationship.  If we looked at 100 people who had died, we would find that 100% of them had skin.  Does that mean having skin causes death?  Of course not.  This is a common type of mistake in the anti-vaxxer movement.  Autism can show up at around the same age as children receive some vaccines, but that doesn’t mean there is a causative relationship.  Causation can be difficult to establish definitively, which is why it’s important to have well-designed, rigorous, peer-reviewed research studies.

Significance

The term “significant” is used differently in research studies than it is in general usage.  Significant results in a study indicate that from a statistical perspective the results obtained were unlikely to be due to chance.  It does not mean that the results are large in scale (this would be described as a large effect size) and it does not mean that the results are necessarily important or meaningful.

Related to this is the concept of “confidence intervals”, which gives a range that expected results would fall within a certain percentage of the time, such as 95%.  As a completely arbitrary example, say placebo was associated with a 10% improvement in symptom x, with a 95% confidence interval of +/- 5% (i.e. 5-15%).  Study drug A was associated with 25% improvement in symptom x with a 95% confidence interval of +/- 5% (i.e. 20-30%).  Because drug A is associated with a greater improvement in symptom x, and the lower end of its confidence interval doesn’t overlap with the upper end of the placebo confidence interval, the results are considered statistically significant.  These numbers are completely made up, but hopefully this example gives you the right idea.

Systematic reviews

Review papers evaluate the existing research literature on a topic.  “Systematic” refers to clearly laid out criteria for inclusion and exclusion of studies in the review and elements used to evaluate the quality of the included studies.  Review articles are a great way to get a lot of information all in one place that has already been carefully scrutinized for you.  In a post here I discuss the findings of a systematic review on antidepressants.

Conclusion

So there it is, a quick overview on bringing a critical eye to research.  The best way to improve research literacy is by actually consuming research literature.  This is where Google Scholar can be your new best friend.  Full research papers often aren’t available for free access, but for the most part there is public access to a paper’s abstract, which is a concise summary of the key points including method, results, and conclusions.  PubMed is another great source of information, and often hits on Google Scholar are linked to the corresponding PubMed page.  Papers with the results of research funded by the National Institutes of Health (NIH) in the United States are available for free on PubMed.  I’ve read a lot of research papers over the years, and while they can be a bit dry  they can be also be an invaluable source of information.  And the more you read the easier it gets. Trust me.

 

Image credits:

GDJ on Pixabay

PublicDomainPictures on Pixabay

 

Liebster/Mystery/Awesome Blogger award nominations

Liebster award logo         Mystery blogger award logo

AwesomeBloggerAward

Ok, so this is very much a shortcut, but here’s the deal.  I feel so honoured to have gotten award nominations recently from several amazing bloggers for three different blog awards.  I find I have a hard time giving these kinds of posts the concentration they deserve, so I’m going to roll them all into one to make it a bit easier.

My nominations came from the following lovely bloggers that you should definitely check out if you haven’t already:

Liebster Award: The word liebster means beloved in German, which makes a nice name for an award.  For anyone who’s read a few Liebster award posts, the rules are always a little (or a lot) different – it reminds me of the kids game of telephone.  I’m just going to go with the simplest set of rules from among the nominations I received:

  • Create a new post thanking the person who nominated you.
  • Provide a link to their blog.
  • Include the award graphic.
  • Answer the questions provided.
  • Nominate 10 recently followed bloggers and share your post with them, so they can see it.
  • Make a new set of 10 questions for your nominees to answer.

Mystery Blogger Award: It’s an award for amazing bloggers with ingenious posts. Their blog not only captivates; it inspires and motivates. They are one of the best out there, and they deserve every recognition they get. This award is also for bloggers who find fun and inspiration in blogging, and they do it with so much love and passion.  It appears to have been started by Okoto Enigma.

  • Put the award logo/image on your blog
  • List the rules
  • Thank whoever nominated you and provide a link to their blog.
  • Tell your readers 3 things about yourself
  • Answer the questions you were asked
  • Nominate 10 – 20 people & notify
  • Ask your nominees any 5 questions of your choice; with one weird or funny question (specify)
  • Share a link to your best post(s)

Awesome Blogger Award:  “This is an award for the absolutely wonderful writers all across the blogging world. They have beautiful blogs, are kind and lovely, and always find a way to add happiness and laughter to the lives of their readers. That is what truly defines an awesome blogger.”  Created by Miss Maggie @ Dreaming of Guatemala

The rules are:

  • Thank the person who nominated you
  • Tag it under #awesomebloggeraward in the Reader
  • Answer the questions your nominator gave you
  • Nominate at least 5 awesome bloggers
  • Give your nominees 10 new questions to answer
  • Let your nominees know that they’ve been nominated

 

Ok, so here’s 3 things about me:

  1. Travelling is my biggest passion in life.  Not that I feel passionate about much of anything right now, but I hope to get that back.
  2. I think chocolate and peanut butter are a match made in heaven.
  3. I find laundry relaxing.  Yup, it’s weird, but it just feels so simple and domestic.

 

Questions asked of me: This is an assortment of questions drawn from the various questions that came to me.

  1. What changes would you like to see in the world within the next ten years?  I would like to see the stigma around mental illness dwindle away to nothing.
  2. Do you own any pets? If so, what kind? I have 5 beautiful guinea pigs, and to be honest if I lived in a house rather than a condo I’d probably have a mini-barn in the backyard with closer to 50.
  3. What is your least liked thing about blogging? I find it easy to get overwhelmed.  It wouldn’t be as overwhelming if I didn’t spend as much time reading, but at the same time I enjoy being able to read other people’s blogs just as much as I like writing my own.
  4. How in touch are you with your surroundings?  I am the most unobservant person in the world, and I would make an awful police witness.  But when I’m relaxed and not doing anything I’m much more mindful of what’s around me.
  5. What is your favorite social media site? I’m not a big fan of social media, but there is a lot of amazing content on Twitter.
  6. Do you wake up early or like to sleep late?  I go to bed crazy early and wake up early.  I like having quiet time to myself before the rest of the world wakes up.
  7. Where would you most like to visit and why? I would like to go to Lhasa in Tibet. It seems like such a different world, and in a spectacular setting.
  8. If you could have a drink (can be water) with anyone alive or dead, who would you choose? Nelson Mandela if I was looking for inspiration, or Sigmund Freud if I was looking for more of a bizarre, surreal, am-I-on-another-planet kind of experience.
  9. What is your favourite book? Pride and Prejudice by Jane Austen.  I like how feisty Elizabeth Bennett is.
  10. If you could be any animal what would you be? A dolphin – they’re intelligent, and it seems like a nice life swimming around in the ocean.  Or maybe a guinea pig – life is as simple as eat, poop, and sleep.

 

My nominations: It’s always so hard to narrow this down!  I’ve done up a little spreadsheet for myself to try to keep me a bit more organized, but it doesn’t really make it much easier!  Please consider yourself nominated for any or all of these awards, and if it’s a bit more than you’re able to take on I get it completely.  As for questions, I’m going to pass on to you the same hodgepodge that I picked above.

So there you have it, my own little awards menage a trois.  I hope you’ll have a look at the bloggers mentioned in this post – after all, that’s what makes this whole blog awards thing so cool!

 

A Prescription For Murder?

Prescriptionformurder

 

I have always been a big fan of the documentary program The Passionate Eye on CBC, Canada’s public broadcaster.  Until now.  On January 6, 2018, they aired “A Prescription for Murder?”, which was originally shown on the BBC; links are at the bottom of this page.  The program focused on James Holmes, the young man who shot and killed 12 people and injured 70 in a movie theatre in the United States in 2012.  The central argument is that the SSRI (selective serotonin  reuptake inhibitor) class of antidepressants can, in rare cases, cause people to become psychotic, violent, and homicidal.

According to the documentary, Holmes first started seeing a psychiatrist at his university’s student wellness centre 17 weeks before he committed the murders.  He reported social anxiety and intrusive thoughts of killing people; these thoughts were not new, but it was the first that he had disclosed them.  After the killings, he told a psychiatrist that he had experienced thoughts of killing people since his teens as a sort of social avoidance strategy.  The psychiatrist at the wellness centre started him on the SSRI sertraline, at a dose of 50mg per day.  Not long after, he described a theory he referred to as “human capital” that involved intentions to kill people.  The dose was increased over the next 4 weeks to 150mg per day, as his intrusive thoughts were increasing.  A little under 3 months after starting sertraline, he had made the decision to drop out of school, and declined his psychiatrist’s offer to continue treatment and start him on an antipsychotic.  It is not clear when he stopped taking the sertraline, but his last prescription would have run out 3 weeks before the shootings.  The journalist argues that because of the timing it is likely that Holmes’ homicidal behaviour was triggered by the sertraline.  Various psychiatrists are interviewed for the film, with several expressing the belief that the sertraline had triggered psychosis, which led to the killings.  One went so far as to suggest that if Holmes hadn’t been put on sertraline the murders might not have happened.

The documentary bothered me on multiple levels.  If someone wants to make a film arguing that SSRIs can trigger psychosis and people should be aware of that, okay, so be it.  But the choice of title is clearly intended to be sensational, as is the tagline “Is it possible that a pill prescribed by your doctor can turn you into a killer?”.  On the Canadian broadcast that I viewed, on multiple occasions a banner ran across the top of the screen warning that people should not stop taking their medication without first seeking medical advice.  It seemed utterly absurd to be including this message for a film arguing that SSRIs turn people into mass murderers.  If one pays enough attention, the more nuanced argument being made is that SSRIs can cause psychosis and this can precipitate homicidal behaviour; however, what’s missing is the key piece of information that the probability of a psychotic person committing homicide is extremely low.  That is a very different can of worms than simply connecting SSRIs and homicide.

Another flaw in the argument that is never acknowledged is that temporal correlation, i.e. things being related in terms of timing, does not necessarily imply causation.  I’ll talk more about this in an upcoming post about research literacy, but it is flawed logic to think that because Mr. Holmes took sertraline shortly before he committed a mass shooting, the only or best explanation is that the sertraline caused it.  The documentary does not even touch on alternate explanations, the most obvious (at least to me) being that he was started on the medication because he was getting sick, it didn’t work, he got sicker, and he became psychotic, which triggered him to act on thoughts he admitted he’d been having for years.

I worry that some poor person with mental illness is going to watch this and think oh, I don’t want to be on a medication that’s going to make me a killer.  And maybe that person will stop the SSRI they are already taking, or avoid going to see a doctor to seek help for distressing psychiatric symptoms.  Maybe that will mean they get sicker.  And maybe, just maybe, that could have disastrous consequences like suicide.  I have no hesitation whatsoever in saying that the risk of suicide from a depressed person not taking an antidepressant is higher than the risk of someone taking an SSRI and committing mass murder.  There is no indication that the filmmaker has given any thought to these sorts of outcomes that could snowball in response to the messaging that antidepressants can turn people into murderers.

There also seems to be no consideration given as to how this documentary might affect public attitudes toward mental illness in general and psychiatric medication in particular.  There is already more than enough stigma around this, and I for one do not want some random idiot thinking that I might fly into a homicidal rage because of my antidepressants.  Someone who hasn’t lived with mental illness might think this concern is overblown, but the stigma around taking psychiatric medication is very real, as is the potential of this stigma to cause harm.  By choosing to air this documentary, the BBC and CBC have chosen to move backwards in terms of stigma, exactly the opposite of where those of us blogging about mental health are trying to go.

I’m sickened by how irresponsible the BBC and CBC are for broadcasting this documentary.  The same issue could potentially have been explored in a way that utilized much safer messaging.  Being cynical, I’m guessing that this particular approach was chosen in order to generate buzz and viwership.  I can only hope that it won’t do as much damage as I think it has the potential to.

 

A Prescription for Murder? – CBC’s The Passionate Eye

A Prescription for Murder? – BBC One Panorama

My depression (lack of) style

shaggy buffalo

While many of depression’s effects are invisible, it has also changed the way I look on the outside.  I was never someone who spent a lot of energy worrying about what others might think about my appearance, but I liked to look put together and enjoyed dressing up for my own sake.  When I’m depressed, though, that goes out the window along with much of the rest of my self-care, and I tend to feel (and sometimes look, to be perfectly honest) like a shaggy buffalo.

Clothing

I live in Vancouver, Canada, the home of Lululemon and a place where yoga pants are definitely not just for yoga.  I wasn’t a perpetual yoga pants girl, though; I was a girly girl when it came to style, and my closet is filled with skirts, dresses, and feminine tops.  Those items now hang mostly untouched in my closet, and instead I live in yoga pants.  Not in a stylized, $100+/pair make-your-butt-look-great Lululemon kind of way; more of a $20 pair from Walmart plus old tanktop with a hole in it plus shapeless cardigan kind of way.  I used to wear leggings as a substitute for tights under dresses and skirts, but now I use them as a substitute for pants.  Leggings as pants is maybe not the best choice for a girl like me carrying some junk in the trunk, but I’m beyond caring.  My goal each day is to actually change from the yoga pants with holes in the crotch that I use as pyjamas to daytime yoga pants with no holes (or at least not in the crotch).

Undergarments

Perhaps this is TMI, but that’s just too bad.  Goodbye underwire, hello sports bra.  I used to wear a “real bra” most of the time, and certainly that gives the best look visually with the whole lift and separate situation.  I’ll still occasionally wear an underwire bra for work, but 95% of the time I’m in either a sports bra that keeps the girls sucked into a snug uniboob, or a bralette that’s just a small step up from going bra-free.  Sometimes I’ll look in the mirror and think oh dear, this is not attractive, but I almost never move beyond noticing to actually caring.

I used to try to avoid a little thing called VPL (visible panty line).  The collection of thongs that used to be a standard accompaniment with skirts and dresses now sits untouched in a corner of my underwear drawer.  There’s a lot of things I should be pushing myself to give a crap about, but shoving some fabric up my butt crack is not one of them.

Footwearhigh heeled boots

I used to like wearing heels.  Not scary unwalkable heels, but confidence-inspiring heels.  There’s something about that shift in posture that comes with wearing heels that tends to make me feel stronger.  During my last hospitalization I was getting ready for a review panel to challenge my committal.  I was wearing a pair of high-heeled boots that were quite noisy to walk in, and my roommate, who had bipolar disorder and was super spunky, said “Good for you, girl.  The louder your shoes are, the more they’ll know they have to take you seriously.”  Maybe I’ve lost sight of that, or maybe heels just don’t go well with yoga pants, but my footwear priority lately has been comfort, i.e. shoes that feel as much like slippers as possible.

Hair

I had curly hair when I was a toddler, but for most of my life I had straight hair with a little bit of a wave to it.  After my current episode of depression began last year and my body in general went a little haywire, my hair decided it was time to change things up, and I now have curly hair.  That has actually worked well with my depression.  No more blowdrying to make sure it goes where I want it to go; now I just give it a quick scrunch and let it air-dry.  Brushing it creates a frizzy explosion, so I just don’t.  Spending money on getting a haircut isn’t a priority these days, so I just cut it myself, doing a crappy job that gets hidden in the bounce of curls.

Makeup

I was never a full-face makeup kind of girl, but I used to enjoy playing around with eye makeup.  Experimenting with colours was fun, and I always thought I looked more awake with makeup on.  But now nothing is fun, and while I’ll sometimes wear some makeup for work because I feel like I should push myself, I really just don’t care any more.

Skin

I feel like I have aged significantly in the past two years.  I look in the mirror and see someone much older than I expect staring back at me.  My depression has affected my body in multiple ways, and I think it shows in the lines on my face.  I used to smile often, but that’s just not the case any more.  I have eczema, which primarily affects my hands and tends to be triggered by stress as well as general imbalance in my body.  My hands are a mess much of the time lately, and when I have open sores it makes me feel pretty self-conscious.

 

So there it is, my depression style à la shaggy buffalo.  It may not be pretty, but hey, we’ve gotta prioritize as best we can, and things that make me feel better on the inside are always going to be more important than what’s happening on the outside.

 

Photo credit: shannonsmith on Pixabay

I am actually getting stupider

THINC-it test results

Despite what the title might suggest, this post isn’t about me being self-critical.  I have been struggling for months with cognitive symptoms of depression, and on a daily basis I notice that it impairs my functioning.  But it’s not something I’ve ever had much of an objective sense of.

Until yesterday.  As a nurse working in psychiatry, I need to keep up my knowledge base, and my preferred way to do that is by watching webinars.  I decided I would get going right away for 2018, and watched a presentation on depression and cognition by Dr. Roger McIntyre, a professor of psychiatry at the University of Toronto who does some really interesting research.  So much of what he said resonated that I felt like he was talking about me.  He mentioned one study that found that people in their mid-thirties experiencing performed about the same on cognitive testing tasks as people with a blood alcohol content of 0.08 (legally impaired to drive).  Hmm, sounds about right.

Dr. McIntyre and his colleagues recently developed a tool called THINC-it to objectively evaluate cognitive performance in people with depression.  There are 5 elements: a short patient self-report, and then 4 different computer-based cognitive tasks.  As soon as I finished the webinar, I downloaded the THINC-it tool and gave it a go.

My results are in the picture above.  The ball on the left is my self-report of cognitive symptoms, and the next four balls represent the four different tests.  Green is good, and red is bad.  I performed abysmally.

It’s interesting to see an objective reflection of what I have been feeling for some time now.  It’s hard to be confident in my perspective of my own impairment when I’m stuck in the middle of it.  I do recognize, though, that I’m much lower functioning than I used to be, and the difficulties I have with basic tasks don’t match up with my high IQ and graduate degree.

One thing that Dr McIntyre mentioned that I’d heard before in other webinars is that vortioxetine is the only antidepressants that’s been show to improve cognitive functioning across multiple domains independent of its effect on mood.  I was actually saying to my doctor just the other day that maybe I should consider vortioxetine, but I’m not keen on rocking the boat by switching up my antidepressants.

Having the confirmation of this test, though, makes me think a little more strongly about making a change.  Depression is bad for the brain; there are cumulative neurodegenerative effects, and outcomes are worse for people who don’t achieve full remission between episodes.  For me right now the most prominent symptoms I’m having are cognitive, and while my current meds help somewhat, it just doesn’t look like they’re going to fully treat these symptoms.

So maybe it is time to try vortioxetine.  Yet the idea of a major med change terrifies me, because it was so hard to hit on this particular combo when I was really sick 5 years ago. This is perhaps the only time I have regretted that I’m seeing a family doctor rather than a psychiatrist.  I’m really happy with my doctor, and for the most part I’ve liked that I tell him what I’m considering and he gives me feedback on what he thinks is the best choice. When it’s something as big as this, though, a part of me wishes for someone who’s up on the latest knowledge in the field to take the lead.  Then again, I don’t trust very easily, and I trust my current doctor.

I’m not sure what I’ll decide, but I think I should make sure that I’m not just accepting the status quo by default.

Not-so-hygienic sleep hygiene

"Please don't try to sleep here" sign

I used to be that enviable person who could sleep anytime, anywhere.  In university I would regularly fall asleep in my first class after lunch.  When travelling, I would be able to fall asleep on planes, trains, and automobiles, making travel companions uber-envious.  And then mental illness came along and it was a whole new ballgame.  I rely heavily on my meds for sleep (quetiapine and mirtazapine), although at this point I’m not taking any that function solely as sleep meds.  I also try (at least sort of) to practice what I preach when it comes to sleep hygiene.  Here’s a bit of a personal report card on how I’m doing, based on the American Sleep Association‘s recommendations.

Maintain a regular sleep schedule

I’m pretty good at this for the most part.  I go to bed ridiculously early (think 8pm) and wake up around 3am.  It’s weird, but I’ve always been a morning person and it works for me.  Things get thrown off when I work night shifts, but I’ve found that if I split my quetiapine dose and take 300mg at around 4:30pm and then the other 300mg in the morning, I’m able to sleep for a few hours before work and then a few more hours when I get home.

Avoid naps

I love napping.  I generally have an energy lull after lunch, and if I can lie down for an hour I am a very happy camper.  I may or may not actually sleep for any or all of that time, but an hour is my sweet spot, and I’m not interested in giving that up.

Don’t stay in bed awake

This can be a tough call.  Sometimes staying in bed awake works out and I will get back to sleep, which makes me a little reluctant to get up if I’m still feeling sleepy.  Usually, though, I can tell pretty quickly if I’m up and there’s no way I’ll be getting back to sleep.  And then there’s other times I just feel like lying there zoned out rather than getting up and facing the day.  In the end, I think it’s important to get to know your mind and body and recognize what they’re telling you.

Don’t watch tv or read in bed

Fail and fail.  I don’t actually have a tv in my bedroom, but I do watch tv on my laptop in bed.  Reading in bed is one of the quickest ways for me to get to sleep, as long as it’s not overly stimulating.

In one of my little idiosyncrasies, I’ve divided my bed into the sleeping side and the awake side.  I spend quite a bit of time in my bedroom, mostly because that’s where my darling guinea pigs’ cages are.  All of my awake stuff happens only on one side of the bed, and napping and sleeping happens only on the other side.  Perhaps it’s a bit silly, but in my own strange way it’s how I incorporate the sleep hygiene idea that the bed should only be for sex and sleep.  Maybe it’s a good thing I don’t have a partner in the picture, because it would throw off my system.

Avoid substances that interfere with sleep

I’m usually pretty good about this.  I rarely have caffeine in the later part of the day, and if I’m having any alcohol it’s usually in the afternoon and at most 2 glasses of wine.

Exercise regularly

This is definitely an area where I could do better.  I find that in winter I exercise less because it’s wet and gross outside here in rainy Vancouver, and being outside just makes me feel miserable.  I’ve never been a fan of going to the gym to work out, and dance classes have always been my exercise of choice.  The cognitive symptoms of my depression have made it hard to keep up with choreography, so I’ve only been taking classes with teachers whose styles I’m really familiar with.

Establish a good sleep environment

I live in a very quiet neighbourhood, so there’s no bothersome noise to interfere with my sleep.  I keep my bedroom cool and dark.  My phone is usually at my bedside because I use a meditation app before bed, but I’ve got notifications turned off so there’s nothing to disrupt my sleep during the night.  I have an old-school alarm clock so I don’t have to reach for my phone to check the time.

Establish a relaxing pre-bedtime routine

I don’t have a set routine necessarily, but I take my meds half an hour before I plan to go to bed, and keep things pretty low stimulation for that half hour.  Bedtime has always been one of my favourite times of day, a time to escape from the real world into peaceful oblivion.

 

woman sleeping in bed

So, that’s my attempt at sleep hygiene.  I’m not doing great at it, but I think I’ve found the happy medium that works for me.  And after all, rules are meant to be broken, aren’t they?

 

Photo credits:

Maria Freyenbacher on Unsplash

C_Scott on Pixabay

 

Sometimes my body rebels

trees spinning dizzily

It seems like every so often my depression decides to remind me that I’m not the only one steering the ship that is my body.  For the last three days I’ve felt quite dizzy for no obvious reason; I’m well hydrated, and I’m not doing anything differently.  Also, I’m headachy and my intestinal tract seems to have slowed down to a crawl despite plenty of fiber.  I don’t seem to be fighting off a cold or anything like that.

I haven’t been able to identify a pattern for when this happens, but it is the kind of thing that my body throws at me periodically.  The last time was maybe 6 weeks ago.  I was dizzy enough that shoulder-checking while driving was challenging.  I was sufficiently frustrated with the constipation that I decided to go for the big guns and take some CitroMag, the kind of thing that might be used for pre-procedure bowel prep.  It made me feel horribly nauseated, but didn’t do what it was actually supposed to do.

I’m not feeling anxious or catastrophizing about it, and am not concerned there’s some underlying physical issue going on, but I’m just feeling yucky, and the dizziness in particular is quite unpleasant.  I’m hoping that in the next few days my depression decides to move to the back seat and let me have my body back under my control again.  Funny how mental illness doesn’t seem too interested in staying “mental”.

 

Image credit: Felix_Hu on Pixabay

Psych meds 101: Sleep meds

pills beside a glass of water

This is the last in the psych meds 101 series; I’ve previously posted about antidepressants, antipsychotics, mood stabilizers, and anti-anxiety meds, drawing on my perspective as a mental health nurse, former pharmacist, and person with depression.

While some of these meds are used  primarily for sleep, many have other uses as well.  The choice of medication for any given person will be based on their diagnosis among other factors, and sleep aids may no longer be necessary once the underlying mental illness is well controlled.

Benzodiazepines

I covered these in more detail in my previous post on anti-anxiety meds.  The choice of benzo will depend on whether you want it more for getting to sleep or staying asleep (i.e. shorter or longer acting).  I’ve found clonazepam, which is long-acting, to be helpful in the past when I was having problems with waking up early.

Oxazepam and temazepam do not have the same degree of anti-anxiety effect as other benzos, but they are useful for sleep because their half-lives match up pretty well with a night of sleep.  They are also are cleanly metabolized, meaning they don’t leave any active metabolites sticking around that can cause a hangover-type effect.  The key thing to be aware of when using benzos for sleep is that if you use them regularly you will develop a tolerance and they’ll become less effective.

Z-drugs

The so-called Z-drugs include zopiclone and zolpidem.  Their main therapeutic use is for sleep.  Like benzos, they act on GABA receptors (GABA is a calming neurotransmitter), but they act at a different site and cause different changes in the receptor.  As a result, they are less likely to result in dependence, tolerance, or withdrawal symptoms.  I’ve had moderate success taking zopiclone in the past, but I’ve needed 15mg rather than the most common dose of 7.5mg.

Anti-histamines

Histamine does a number of things in the body, but in the brain it promotes wakefulness.  Blocking H1 histamine receptors results in a sedative effect.  Most over-the-counter sleep medications include diphenhydramine, which is the drug found in Benadryl to treat allergies.  A downside of H-1 histamine blockers is that they can cause weight gain when used long-term.

A lot of the prescription medications that may be used for sleep block H1 receptors in addition to whatever their primary therapeutic purpose might be.  Trazodone is an antidepressant that’s used more often for sleep than as an antidepressant.  It’s used for sleep generally at doses of 50-150mg, and needs to be taken at higher doses for an antidepressant effect.  Tricyclic antidepressants like amitriptyline are quite sedating, as is mirtazapine.  Interestingly enough, mirtazapine is most sedating at lower doses, and at higher doses becomes more activating.  For me the sweet spot seems to be at 30mg.  Antipsychotics that affect H1 receptors may also be used for sleep, such as methotrimeprazine and quetiapine.  Quetiapine extended release can be useful if early morning awakening is a problem.

Anticonvulsants

Gabapentin is an option but not necessarily the most effective one.  It would tend to be most appropriate for someone who would also benefit from its other therapeutic effects, e.g. for neuropathic pain or anxiety.

Prazosin

Prazosin isn’t a sleep medication per se; however, for people with PTSD it can help tone down nightmares and thus improve sleep.  It blocks alpha-1 adrenergic receptors, slowing down some of the sympathetic nervous system fight-or-flight-related activity.

Melatonin

Melatonin is a hormone that is naturally produced by the pineal gland in the brain, and it’s involved in regulating the Circadian rhythm, i.e. sleep-wake cycle.  For some people melatonin supplements work well, such as people whose circadian rhythm gets disrupted by things like shift work.  For other people, taking melatonin doesn’t do much of anything; I happen to fall into this category.  Ramelteon is a drug that stimulates the same receptors as melatonin does, but I’ve never actually seen it used; melatonin is cheaper and more readily available.

Valerian root

This is a herbal product that may have some sort of activity at GABA receptors, although it’s not clear what exactly this is.  There isn’t a lot of evidence to back up its effectiveness, but it’s worth being aware of as a non-drug option.  I’ve tried it and personally didn’t find it helpful.

 

There are a variety of other non-drug options that are worth giving consideration to.  Tryptophan is an amino acid that is a precursor for serotonin production.  It’s the substance in turkey that’s associated with drowsiness, and can be taken as a supplement to promote sleep.  Herbal teas, particularly those containing chamomile, may be helpful.  There are also certain substances that it may be be best to avoid; caffeine is an obvious one, but perhaps not so obvious is alcohol.  Alcohol may help you get to sleep, but it decreases sleep quality and makes it more likely you will wake up during the night.  Sleep hygiene is very important, but I’ll address that in another post.

While ideally we wouldn’t need to take drugs to help us sleep, the reality of mental illness is that most of us will have problems with sleep at one time or another.  Given how hugely damaging poor sleep is to mental health, I’ll take drugs over insomnia hands down.  As with any kind of medications, knowledge is power, and knowing our options puts us in a position to make the best decision in our own specific circumstances.

 

Photo credit: pina messina on Unsplash

Awesome Blogger Award Nomination

AwesomeBloggerAward.png

The fabulous Ashley from Practicing Imperfection as nominated me for an Awesome Blogger Award which is… well, awesome!  Thanks so much!  She’s got a really good blogger, so if you haven’t check her out already you should!

Awesome Blogger Award Is:

“This is an award for the absolutely wonderful writers all across the blogging world. They have beautiful blogs, are kind and lovely, and always find a way to add happiness and laughter to the lives of their readers. That is what truly defines an awesome blogger.”

Created by Miss Maggie @ Dreaming of Guatemala

The Rules Are:

  • Thank the person who nominated you
  • Tag it under #awesomebloggeraward in the Reader
  • Answer the questions your nominator gave you
  • Nominate at least 5 awesome bloggers
  • Give your nominees 10 new questions to answer
  • Let your nominees know that they’ve been nominated

My questions from Ashley:

  1. What color eye shadow?  I like to play with colors, but a smoky brown look is always good.
  2. Do you like sandwiches? (If yes, please describe favorite!) I’ve really cut down my bread intake but for a greasy breakfast indulgence I love Moons Over My Hammy at Denny’s.
  3. Flats or heels?  When I’m well, heels.  Depressed, flats.
  4. How much water do you drink every day, on average? Probably 2 litres a day.  I always have my water bottle with me.
  5. What is the best coffee you’ve ever had?  Hmm, not sure.  Lattes are my favourite, though.
  6. How do you feel about the smell of rain? I live in Vancouver, Canada and we don’t really get nice rain smell; we just get ugly downpours.
  7. If there is one blog you think I must follow, which is it? No way could I pick just one.
  8. Corn chips or potato chips? Salt and vinegar kettle-cooked potato chips.
  9. Number one thing you want to do before summer 2018. I’m treating myself to a sunshine vacay in Mexico this winter.
  10. How long have you been blogging?  3 months – I can’t believe it’s only been that long!

My nominations: I just published a Liebster Award post where I nominated 10 of the folks that were in my WordPress notifications from today.  For this, I’m going to nominate people that were in my notifications from yesterday.  Thinking up new questions is a bit more than I can do right now, so I’m going to pass on the questions that Ashley asked of me.  These blogs are all beautiful in their honesty and in their courage to share the really difficult stuff.

Well, after 2 of these posts I’ve gotta say I’m pooped, but it’s always great to be able to give shouts out to some great bloggers.  Thanks again to my name-sister Ashley for the nomination!

xo

Ashley

Liebster Award nomination

Liebster award logo

It’s always such an honour to be nominated for awards like these.  This nomination comes from Sunshine and Demons and My Loud Bipolar Whispers; both are amazing, powerful blogs that tackle difficult mental health issues.  Definitely check them out if you haven’t already.

What is the Liebster Award?

A recognition award from one blogger to another. The word Liebster means “dearest” or “beloved.”

Rules of the Liebster Award (these are kind of like the kids game telephone and morph with each telling, but that’s ok)

  1. Create a new post thanking the person who nominated you.
  2. Provide a link to their blog.
  3. Include the award graphic.
  4. Answer the questions provided.
  5. Nominate 10 recently followed bloggers and share your post with them, so they can see it.
  6. Make a new set of 10 questions for your nominees to answer.

My questions:

  1. What is the goal and/or purpose for your blog?  My goal is to engage with others around mental health and related topics.
  2. How did you come up with the name of your blog?  It was floating around in my mind as a potential name if I start a mental health nursing private practice in the future.
  3. Name three things on your bucket list.  I want to go to visit Tibet; not really anything firm other than that.
  4. What is your favorite quote and by whom? “Our greatest glory is not in never falling, but in rising every time we fall.” Confucius
  5. What are your favorite types of books to read and why? I like nonfiction, because there’s so much to learn.
  6. What is your favorite movie and/or television show? Favourite movie would be Dirty Dancing.
  7. What is your best memory from the year 2017? Being able to use my animals to help others.
  8. What did you learn from the year 2017? That I could start a blog and people would actually read it.
  9. What are your hopes and goals for the year 2018? My greatest hope would be to get my depression back into remission.
  10. What is your favorite post you have written.  I don’t have one, maybe because they’re all coming from the same place.

My nominations: Now this is the part that always gets a bit overwhelming for me, so I’m going to keep it simple and nominate the 10 fabulous people that are currently in my 10 most recent WordPress notifications.  You may have already been nominated (and maybe already been nominated by me), but I’m not quite up to thinking it through that much…  Anyway, feel free to ignore if you’ve already done this;)

I’m going to reuse the same questions for my nominees as the ones I was asked, as I think they’re good ones.

Again, thanks so much to Sunshine and Demons and My Loud Bipolar Whispers for the nominations!

Starting the year off with some love

new year 2018

Happy 2018!  I never make new year’s resolutions because I figure if there’s something I want to do I should just do it, regardless of what the date on the calendar happens to be.

So instead, I’m going to start off the new year with some love for my fellow bloggers.  I’ve been blogging for about 3 months now, and I never cease to be amazed by what a fantastic community we’ve got going here.  None of us are alone in how we’re feeling, and there’s so much we can learn from each other (and stuff we already know that we can always use reminders of).  I’ve been surprised how completely safe it feels to share the most intimate of details, and there’s no need to put on an act or cover things up.  I haven’t had to deal with any trolls, although one of my posts did get a like from some yucky dude whose gravatar was of him, naked, penis in hand.  Hmm, not sure what the intended goal was there, but to each their own.

Anyway, getting back to the point, thanks to all of you for being completely amazing, and I’m so grateful we can share our mental health journeys with each other.  When I get caught in the web of my depressive thoughts, I can always count on some helpful feedback to help pull me out and get me grounded again.  I am inspired on a daily basis by what all of you have to say, and I feel honoured to be able to read your work.  You guys are all superheroes!  Here’s hoping that 2018 brings good things for all of us.

xoxo

Ashley

 

Image credit: Gellinger on Pixabay