Pill Popper RN

horde of flying tablets and capsules

The title is a kind of weak ripoff from the Seinfeld-ian Pimple Popper MD, but still, it’s fairly apt.  I have major depressive disorder, and I take a boatload of pills.  Because my memory isn’t that great and I don’t want to forget to take them, I have them all laid out on a shelf in my bookcase.  If anyone comes into my living room chances are they’ll notice the mini pharmacy I’ve got going on, but I am so beyond caring about what people think about that.

In this post I’m going to break down the various things I’m putting into my body to try and stay afloat with my depression.  Medications will never be all of the picture, but for me they are an important part of my treatment plan.

Mirtazapine 30mg and venlafaxine 300mg: These are my two antidepressants.  I have always responded better to antidepressants with more activity related to norepinephrine than serotonin, so these two fit the bill.  The combo is sometimes referred to as “California rocket fuel” because of its potency.  Mirtazapine is actually most sedating at lower doses, so I’ve settled on the middle of the road 30mg dose because I didn’t sleep as well on higher doses.

Lithium 1200mg: I don’t have bipolar disorder, but lithium has actually been recognized for a long time as an effective augmentation strategy in major depressive disorder.  If I start feeling worse one of the first things my doctor and I consider is increasing my lithium, since I tend to respond fairly quickly to dose increases.  When my serum levels get higher, though, I tend to have increased problems with tremor and coordination, turning me into a complete klutz, complete with wipeouts on the sidewalk and falling down stairs.

Quetiapine 600mg: Atypical antipsychotics are also effective for treatment augmentation in depression.  Of the ones I have tried, quetiapine has been most effective for me.  It helps with my mood and is very reliable for getting to sleep.

Dextroamphetamine 15mg: I first tried dextroamphetamine a year and a half ago when I was really slowed down in both movement and thinking.  It helped, but I wasn’t keen on taking “speed” any longer than needed, so I only took it for about a month.  I restarted it earlier this year when I got really slowed down again.  It helped, but when I tried to decrease the dose my mood dropped.  Research has shown that it tends to be effective as an antidepressant augmentation strategy for only a couple of months or so, and then the effect tends to wear off; however, I’ve tried several times to decrease the dose and it makes me feel worse.  My doctor has a good attitude about it, and has no problem with me taking it on an ongoing basis when it’s clearly working.

Propranolol 10mg prn (as needed): Lithium gives me an intention tremor, which occurs with intentional movement as opposed to a resting tremor.  It’s worse if my lithium level is higher or if I’m worn out, and probably the dextroamphetamine doesn’t help either.  Propranolol helps keep it in check, and I tend to use it mostly for days that I’m working, since patients generally aren’t reassured about getting an injection if the nurse drawing it up has shaky hands.

nurse administering intramuscular injection

Lorazepam 0.5-1mg prn: Anxiety is generally not a prominent feature of my illness, so I’ve never needed to use lorazepam (Ativan) on a regular basis.  I find for me it’s most effective to get a bit of a numbing effect when I’m going into particularly stressful situations.  Since I use it so seldom, I’m able to get away with a small dose.

Min-Ovral: I have spent much of my adult life on birth control, but decided a couple of years ago to take a break.  When I got depressed last year, my hormones went crazy.  I was getting my period every 3 weeks and PMS was having a big impact on my mood.  Now I’m back on birth control and my hormones are steady and happy.  The estrogen in the Min-Ovral may also give my neurotransmitters a bit of a boost.

Omega-3 fatty acid plus vitamin D supplement: There have been research studies that have shown that omega-3’s have some beneficial effect on depression.  Vitamin D may also play a role in depression, and since I live on the Wet Coast of Canada where it rains for a good chunk of the year supplementation seems like a good way to go.

Multivitamin/mineral/antioxidant supplement: Besides helping my overall health, the goal with this is to have some effect on decreasing oxidative stress, which may play a role in depression.

L-methyfolate and vitamin B12 supplementation: I get these in an intramuscular injection every 2 weeks from my naturopath.  Both play a role in the methylation cycle that’s involved in neurotransmitter synthesis, and L-methylfolate in particular has been shown to be useful in depression.

So that’s me, Pill Popper RN.  What’s in your medicine cabinet?

 

Photo credits:

Qimono on Pixabay

huntlh on Pixabay

Advertisements

Organizing my way through the darkness

day planner book

I will freely admit that I’m a bit of an organization nut.  It’s a trait that has served me very well in terms of maintaining functioning while bogged down in an episode of depression.  I’ve been doing this depression thing long enough that I know what my deficits tend to be when I’m unwell, and I draw on that knack for organization to create a sort of safety net for myself.

Mental illness can wreak havoc on memory.  When I’m ill, my brain feels like a strange hybrid of Swiss cheese and mashed potatoes.  Since I am aware of this, I can try to plan ahead for it.  I do this by setting up an organizational system that can compensate for some of my deficits.  When it comes to important things, my backup plan needs its own backup plan, since I know that I might not always remember to put things in my calendar, for instance.  This has come to the rescue a few times, including saving me from being a no-show for visits I’d booked with my patients for my home care nursing job.

I rely heavily on my Google calendar.  Everything goes in there as soon as it’s arranged (unless I’m really scattered and forget this crucial part of my system).  I use color-coding to separate work and personal, and have recurring reminders set up for things like bill payments.  I’m also a great lover of lists, and use Google Keep along with Apple Notes.  I’ve got checklists breaking more complex tasks into individual components for those days when I’m feeling too overwhelmed to know how to do anything.  The goal is to rely as little as possible on my brain to remember things.  Working on getting/staying well is hard enough, and any brainpower I can free up is a good thing.

2017 calendar displayed on a smartphone

When depression muddles my thinking, making simple decisions can seem overwhelming and impossible.  If I haven’t decided ahead of time what kind of yogurt I’m going to buy, I might stand in front of the yogurt section at the grocery store for 10 minutes with a blank stare on my face and absolutely no idea how to make a decision about what to buy.  It’s not a matter of anxiety over what the right decision is, but more like that part of the brain that knows how to make decisions has decided to close up shop and take a siesta.  There has been many a time that I have simply left a store empty-handed, because the default decision is do/buy nothing.  I’ve learned that when I’m feeling like this, I need to decide exactly what I’m going to get ahead of time, when I’m not faced with an array of options.  It feels a bit silly to be so rigid, but it’s a lot less silly than staring stupidly at a sea of yogurt containers.

Mental illness can warp how we see the present in relation to both past and future.  It can be very hard to see a pattern in our symptoms and what might be triggering them.  Technology can be a powerful tool to gain insight into what is happening both inside and outside the mind and body.  I use apps to track almost everything I do: sleep, mood, diet, activity, menstrual cycle, medication changes, alcohol, stressful events, work, etc, etc.  Again, it feels kind of silly to be this rigid, but it helps me understand how I’m doing, and makes it s lot easier to answer questions that my health care providers might ask.  When my depression leaves me feeling totally powerless, tracking things on my apps can help me feel a little bit more in control.

cup of coffee, cell phone, and book sitting on a tableHaving a routine is very important to me, especially when I’m not well.  It gives me a sense of peace, and makes it easier to turn down the volume on my thoughts.  Most important is my morning routine.  I drink tea, tea, and more tea, read the discussion forums on a mental health app I use, meditate, and do crossword puzzles.  Even my pet guinea pigs support me in sticking to the ritual – they know that their veggies come at the same time as mama’s first and second cups of tea, and if I happen to forget, they will give me loud squeaky reminders.

We all have our little tricks to help us cope with the day to day experience of mental illness.  These are some things that have worked for me, but it’s always great to learn new strategies from other people who are dealing with the same sorts of issues.  Together we can be stronger, and our bags of tricks can help us make it through.

 

Photo credits:

stevepb on Pixabay

geralt on Pixabay

Juja Han on Unsplash

When taking a shower is like climbing a mountain

silhouette of a mountain climber

 

We’re supposed to dream big, aim high, reach for the sky, and all that crap.  But what about those days when your mental illness is kicking your butt and you barely have the energy, motivation, interest, or presence of mind to haul your a** out of bed, much less hold yourself up for the duration of a shower?

Let me be clear, setting goals is a good thing.  Pushing yourself to do more than you think you’re capable can allow you to do things you thought you could only dream of.  However, the goals you set should be realistic, and what’s realistic is going to change based on how your illness is currently affecting you.  If you’re setting yourself up for failure, how is that doing you any favours?

When my depression is severe, just getting out of bed can be a gargantuan effort.  If I were to try to go outside for a walk because that’s what you “should” do when you’re depressed, I probably wouldn’t make it beyond the front door.  That would make me feel even more negative about myself, and reinforce the thoughts that I’m useless, pathetic, etc., etc.  I find that I don’t tend to devote a lot of energy to comparing myself to others (perhaps because I hate people when I’m depressed), but I do compare myself to my level of functioning when I’m well.  Realistically, though, that’s not a fair comparison.

The way I try to look at it is that goals should be proportionate to the amount of energy you have and the amount of energy it would take to complete a task.  If depression is sucking the life out of you and your energy level is so low that if it were a gas tank you’d be running on fumes, is it reasonable to plan on going for a 4-hour drive on that empty tank?  Hmm, not so much.

triumphant_silhouette.jpg

So I say, if taking a shower when you’re severely depressed takes about the same amount of energy that it would take you to climb Mount Kilimanjaro when you’re well, then taking a shower is a huge goal and an accomplishment worth celebrating.  The fact that showering when you’re well is easy is totally irrelevant.  It’s not an apples to apples comparison or even an apples to watermelons comparison; it’s more of an apples to mountains comparison.

As I nurse I try to tell both myself and my patients to aim low and dream small when feeling really unwell.  Achieving a “small” goal will serve you better than failing at a bigger goal.  And don’t forget to congratulate yourself for that mountain-summit-equivalent shower that you didn’t think you could do.  You absolutely earned it.

 

Photo credits:

Sam Mgrdichian on Unsplash

Catherine McMahon on Unsplash

The depression Grinch who stole Christmas

Christmas lights through a rainy window

Growing up, I absolutely loved Christmas.  The tree, the traditional Christmas baking and other yummy treats, Christmas carols, the excitement of Christmas morning, turkey dinner… the list went on and on.  As I grew into adulthood, some of the sparkle faded to more of a soft happy glow, but there was a new form of sparkle in things like rum and eggnog and ice wine.

My first non-Christmas, or Christmas that wasn’t, happened in 2008, when my partner at the time was in ICU following a suicide attempt.  My Christmas dinner that year was a hotdog from 7-Eleven, because nothing else was open near the hospital.  My next non-Christmas was in 2012, when I was locked up in the psych ward.  My family chose to have Christmas at my parents’ place in another city, which I understood but couldn’t help but feel some resentment over.

Depression next stole Christmas away from me last year.  I was completely indifferent, and joined a friend for turkey dinner more because I thought it would satisfy her than out of any desire on my own part to celebrate Christmas.  This year seems to be headed toward another indifferent Christmas.  The large collection of Christmas tree ornaments that are a mix of childhood favourites and new additions is tucked away in my closet, and I haven’t felt any desire to fire up my old ritual of Christmas tree decorating accompanied by carols and eggnog.

While I don’t feel much of anything about Christmas itself, I do feel a sense of loss that something I used to care about and enjoy so much now means nothing.  Maybe if I forced myself to follow the rituals anyway the Christmas spirit would sneak back into my life.  Or maybe it would all just feel like a farce and remind me that I am broken.

I have a small family, and our Christmases have always been intimate affairs rather than a chaotic bustle.  My parents almost always host Christmas, and they live 4 hours away, so I have the options of just not going.  They haven’t said anything about it yet, and I know they’re worried that if I feel pressured it will scare me off.  I probably “should” go home for Christmas, but shoulds just don’t really hold water with me these days.

I suppose what I have to accept is that my depression makes it almost impossible for me to enjoy anything at this point.  Whether I put up a tree or not that isn’t going to change.  But that doesn’t mean some rum and eggnog and butter tarts can’t lighten things up a little bit.

blurry Christmas tree lights

Photo credits:

Guillaime Jaillet on Unsplash

Clem Onojeghuo on Unsplash

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

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

“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