Monday, March 18, 2019

Depression and Exercise

Tired topic, right? We've all heard that exercise might help fight depression. Most of us probably believe it, whether or not we practice it.

I came across this article published yesterday in the Washington Post - Exercise seems to help alleviate depression, but not for everybody. I like a big but and this has one. Exercise might not be for everyone.

It kicks off with findings from a study published in 2007 - Exercise and pharmacotherapy in the treatment of major depressive disorder. It found that 45% those who participated in supervised and monitored exercise programs for four months reported higher "remission rates." Compare that to  home-based exercise = 40%, medication = 47%, and placebo = 31% and there's something to talk about.

Back to the Washington Post article. The reporter talked to experts and cited a few anecdotes about the benefits of exercise. I won't get into it; you can read the article yourself. The conclusion is like those adds for cold cereal that claim their product may be part of a healthy breakfast. For best results, exercise could be a part of a mental-healthy diet of lifestyle, medication, and/or therapy.

Try it, you may like it.

I've tried it. Here's what my research has shown.

First, I hate exercising. There are active things I enjoy - biking, for example - but I generally hate the idea of a regular workout routine. I tend to do the things I like the least first so when I'm trying to exercise it's generally the first thing on my schedule. This makes getting out of my snug, depressive bed all the more difficult. Hating it also makes it so easy to skip. So, the thought that there's one more thing I've failed to do for the day inhabits my brain. This is not a good mood buddy for a depressive.

However, if I can stay with it for a while it does tend to improve disposition. I've never stuck to it long enough to say whether or not it helps with major depression, but the feeling of accomplishment and incrementally improving health does help stave off or lighten the load of the depressing episodes of life. Here's the rub though. I have to keep at it because giving in to the temptation of skipping one, two, three, and then all the days can toss me right back into the pit.

If you look at the numbers from the study, medication actually wins. It beats supervised exercise by two points and self-motivated exercise by seven. But that only looks at depression - pure, straight up, diagnosable depression.The point I'm trying to get to is that this is a narrow view and only over a short period of time. What about those studied after a year? Five years? I've ranted here before about the side effects of meds. One of the biggest ones for me was sexual. The few times I've tried the typical prescription depression meds I had a significant drop in my sex drive. There's no balance to strike there. Perhaps in time I could report "remission" in the major symptoms of depression, but that's a pyrrhic victory if the price is the loss of sex.

There are other downsides to meds. There's cost which is rarely brought up in studies like these, but it's a very real aspect. I don't have any polls at my fingertips, but I'd hazard a guess that for most people money is one of the top five causes of anxiety. Meds costs will always go up. Then there's the cascading effect of meds. Take the sex thing, for example. Sure, I could go back to my doctor and ask for a viagra script which is can lead to more cost and more side effects to worry about. Or I could grab my walking/running shoes and find the outside.

This is supposed to be about exercise, right? Is it the answer? Maybe. Maybe for you. I think it's probably more effective if your depression is life-episode based like a breakup or family death. For depressives like me it can be a little trickier. It's probably not my silver bullet, but it can't hurt.

It's a nice day. I should check the air in my bicycle's tires and maybe take a ride later on. We'll see...

Friday, March 8, 2019

Gardening, 2019

It's 2019. It's hard to believe this is really a year, I mean one that exists. I remember looking at a book in the school library during my early years that told all about how things would be in the year 2000. This is definitely not that future. In other words, where's my friggin' flying car?!

Okay, gardening. I'm a zone higher than I'm used to. I mentioned in the post Still Pursuing that I'd moved to a bigger city. That move took me from zone 5 to 6. This time of year in my old zone I'd generally be turning my dirt, tending any volunteers, and driving slow past the nurseries to check out what new plants were starting to show up on the shelves. Now I'm significantly poorer and there is still snow on the ground. Although I've secured a couple of gardening spots, I'm still waiting impatiently for the world to thaw. My internal rhythm says it's time to get ready to plant. My reality says it's barely time to get ready to get ready to garden. Being poor sort of helps. I can't afford to buy tiny plants so I've had to settle for seeds. The way this helps is that I got to scratch my gardening itch earlier this week by planting my indoor-start seeds. It won't be long before I see those two-leafed little seedlings pushing their way up through the soil and my soul will be lifted a little.

That's not really why I'm here today. On the depression front I took a pretty bad hit earlier this year. I just thought you might deserve a break from my normal whinging on before I got into that. Happy gardening done. Now, let's get into this.

I'm going to try to keep this one brief for two reasons. First, there's a lot and I don't want to burden you with every detail all at once. Second, I'm not entirely sure what happened and I haven't even begun to deal with it. It's hard to write about something one doesn't understand and hasn't processed.

Let's start here. In early January I nearly drank myself to death. This isn't a tale of a drunken night, this is the condensed saga of the months and years of self-medication with booze that landed me in the hospital in January.

I'm not sure how much I've talked about alcohol here but it's played a big role in all my adventures. For me there's no quicker solution to a depressive episode than the numbness that is readily available in any cheap bottle of vodka. I know, I know, alcohol is a depressive. I know it's the last thing a person with depression issues should turn to. However, it's also a beautiful temporary solution when the valleys get too dark. This isn't to advocate drinking, it's just my reality.

So, I'd been drinking and drinking. Then this and that happened and my pancreas shut down. By the way, this is where I'm going to start glossing over the events. For reasons you'll soon see, I'm not sure what happened to me during the last half of January.

So, I'd been drinking and drinking and I started getting sick. First it was vomit and lots of it. Then it was black vomit, which means I was bleeding internally. My wife forced me to go to the ER which tuned out to be the beginning of a nearly two week stay in the hospital. The nurses and docs took a look at me and declared I was staying. They put drugs and hoses in me then started asking questions. In my state my usual filters were down and I mentioned something that I soon regretted.

This is one of the things I'm sure of. I told them about my woman who isn't there. This is my joking way of referring to a very real thing that's been happening to me for years. It comes from the poem that mentions the man who isn't there that the poet keeps meeting on the stair. My woman who isn't there appears to me by peaking around the corner or doorway of wherever I am. She smiles at me and then is gone. It's never dramatic and never frightens me. I should mention that I don't believe in ghosts although I do think about them a lot. I think it's just my imagination that delivers this odd little haunting three or four times a year.

So, I mentioned her and they jumped on it. It's almost like I was feeding a need they deeply craved. A drunk with failing internal organs and hallucinations?! They were ecstatic! At least that's how it seemed to me. They peppered me with questions while I tried to downplay it. No luck. They had they teeth in my damaged psyche and they weren't about to let go of that morsel.

The next few days are a complete blank and the rest of my time there was spent in a crazy hallucination filled fog. From what I've been able to piece together they tackled the pancreas problem first, as that was an immediately life threatening problem. After that was resolved they tackled the mental stuff. They pumped me full of brain drugs that were supposed to help me stop seeing things. Instead I was tripping my eyes out and seeing people and monsters everywhere.

To add to the fun, I developed c-dif during my incarceration so I had to be quarantined.

I swear, I'm trying to tell this quickly.

My memory returns gradually from those first few days during which I didn't exist. It's full of confusing visitations by fantastic monsters, nurses, and impossible-that-they-would-actually-be-there people from my recent past. It's really hard for me to admit that last bit because the visits from those people seemed so real. Maybe I'll expand on this in a future post.

Soon I got enough of my brain back that I began to realize what the game was. More than anything, I wanted to go home where I could rest and there would be no one forcing me to take those mind scramble drugs. In order to get signed out, I had to act sane. Otherwise they were talking about transferring me to a more permanent situation. I don't remember what they called it but I was definitely picturing One Flew Over scenes when they discussed it. Time and my attendees' patience were working against me.

Once or twice a day the doctor who would ultimately make the judgement call against me appeared before me. While the monsters and phantoms danced behind him I would answer his questions. The month was January. The president was Trump. The state I was in was Missouri and I as in a hospital. I got to where I could recite the answers to his questions correctly and in order before he asked them. Finally he would ask if I'd seen any hallucinations recently and I would soberly say no. I was always careful not to oversell it nor giggle along with the creatures of my mind that were laughing hysterically at my lies just behind him.

I guess I was eventually no more fun for the staff and they finally signed off on my release. It had been 13 days, but it felt like the only reality I'd ever known. In fact, for several days after returning home I wasn't sure that I was actually there and not just dreaming in my hospital bed.

I'll stop there. You're a hero for having read this far. I have plenty more to tell you about this event and my - hopefully - recovery. There's my relationship with my wife which changed in a lot of ways as a result of all this nonsense. There's my perception of healthcare and my time there. There's alcohol. There's drugs. And on and on. Plus, more gardening as it progresses.

Keep fighting the good fight, sisters and brothers. We may never achieve pure happiness, but isn't there fulfillment in the pursuit? Well, I least I hope there is. I wouldn't know what else to do.

Tuesday, August 28, 2018

Depression: Two Triggers

 This one is probably going to sound a little uniformed and scattered. Admittedly, I’ve been living with depression for a long time, but I’ve done far less research on it than I should have. At least that’s how it feels. I’ve talked to a number of doctors and I’ve read a lot of research. I still haven’t cracked it so maybe that’s why I feel like I haven’t learned enough.

This blog isn’t about that, happily. It’s just about my journey and that’s comparatively easy to put down in print.

My experience has been that there is usually one of two triggers for a depressive episode – and I’ve had some doozies. The first is that impossible to fathom, internal tide of terrible that just wells up with chronic depressives. Trigger is an inaccurate word in this case. It just happens. I can be watching a tv show that I really enjoy, attending a social event, be at a job, or whatever and all of a sudden there’s overwhelming sadness. This is one of the biggest problems that I struggle with and it’s been getting worse. I don’t know the answer; my wife says it’s just chemicals and I think she probably has a point. Doesn’t make it feel any better, but at least it’s something I can tell myself. 

Second are external triggers. Everyone deals with these. Death of a loved one, financial problems, politics, the evening news – all these things can be depressing however I’d hazard a guess that they hit chronic depressives harder. Bad news can bring a person down for a bit, but they can usually dig down and figure out what they need to do to get past it. Chronics, on the other hand, wallow. It’s actually kind of comfortable. So when there’s an external trigger it provides an excuse to wrap oneself up in a big burrito of sad.

At least that’s been my experience. I certainly would never claim a monopoly on depression. A facebook acquaintance of mine who happens to be one of the most upbeat people I know was recently diagnosed with depression. He’s in his fifties, an avid weight-lifter, great cook, hugger and all around happy dude. He went in for a regular check up a couple weeks ago and his long time doctor recognized some differences in his general demeanor. Doc asked him the standard questions then prescribed what I assume is a common depression treatment – my friend didn’t say what, only that he was comfortable with it. He shared that he’s recently lost some friends and family members. I’m sure he’s going to pull through pretty quickly. His personality and strong support network will see to that. 

Here’s another example of external triggers. I’m a bit of a perfectionist. You might not think so if you’ve been following this blog for a while. I try to write fast and honest here so I’m sure there’s more than a few grammatical errors. Otherwise, though, I’m pretty careful – as much as I can be – in my personal and professional conduct. Consequently, when I do screw up it bothers me. Most people, as far as I’ve observed, seem able to shake that kind of thing off in a few minutes, hours or, at most, a day. Me? It can destroy a week and, worse, if my mistake affects other people else it can destroy the relationship. Not from their perspective but from mine. I read or assign too much into their disappointment and find myself entirely avoiding them. 

I realize that, that can be more of a self esteem thing, but as far as I see it it’s all part of the same problem. More to the point, it can trigger a depressive episode. That’s the point I’m trying to make. If something happens that makes me feel bad about myself it seems to trigger the chronic. Instead of just fixing the mistake and moving on, I crawl inside of myself and spend too much time thereafter hating myself and everyone around me. 

I don’t have any answer or advice in this area. It’s just about where I live. 

Thursday, August 9, 2018

Some Thoughts About Depression, Autism and Being an Introvert

I think I may have mentioned this before – I’m not going to go back and look – but over the last several years I’ve wondered if I have mild autism. It was once called aspersers, but I think they just say you’re on the spectrum now.

Here's a pretty good digestion of what Asperger's
 is or was, depending on your approach. It doesn't
 fit me exactly. For example, I think I'm a fairly
 sympathetic person, but I do have many of the other
 characteristics listed here; enough, at least to think
 that there's at least a light spritzing of Asperger's
 on my brain.

Semantics aside, I was thinking about that this morning. I definitely have depression. That’s well established. I’m certainly an introvert, again, something that takes no argument if you were to meet me. And I’m a pretty good candidate for autism. If one were to draw a Venn diagram of this mess there would be a big pile of me sitting right in the middle.

What does this mean? Well, if you subscribe to Temple Grande's way of thinking maybe - see below - I’m not damaged. Maybe I’m just on the spectrum of being a human. Depression, obviously, can cause damage in the form of self-harm and suicide. Being an introvert and/or mildly autistic, however, of themselves don’t cause damage. The problem with those two is how our society can make them harmful in the way individuals are treated.

In my head, all three are holding hands. It’s more than a Venn diagram; it could be called a coexistence. If I have low-grade autism it could lead me to be an introvert and that leads to the depression which further feeds the autism and being introverted. And, so, the snake continues to eat its own tail.


This doesn’t really produce any kind of solution, at least not for me, but it’s something to think about. If it’s a global problem – my depression – maybe there’s a global solution. If St. John’s Wort only helped for a while maybe I need to tackle all three problems at once. I don’t know what that looks like. I don’t even know if it’s realistic. Still, there might be something there.


All we can do is lie down and give up or keep looking. It's hard not to get tired. 

Saturday, August 4, 2018

Stand-up Comedians

So, there’s a sudden gear shift, right?

I’ve been ruminating on this post for a while. I have loved stand up comedy for as long as I can remember. As a kid I loved to listen to my father’s LPs of Bill Cosby.

I know. But back then, who knew?…

Anyway, point is I’ve loved stand up comedy for a long time. I’m actually envious of stand up comics, which I know is a cliché. I’m a fairly funny guy in real life and wish I had the courage and mental organization to translate that onstage. I don’t.

If you look back at my posts on this blog you’ll see that I went dark sometime in 2012 and only recently started to blink back to life. That’s not because life got better or my depression regressed. Shit got way worse and in other ways shit got way better. We might talk about that later; probably not.

Comedy helped me survive. It really did. That might sound ridiculous, but it’s true. Without stand up comics…

Here’s the thing. I’m never surprised when a comic kills herself/himself, either actively or via self-destructive behavior: John Pinette, Greg Giraldo, Robin Williams, Richard Jeni, Mitch Hedberg and Maria Bamford’s very public struggle – happily she survived. Stand ups are very often broken people and when you look past the punch lines it becomes glaringly obvious. Once you realize that, it’s hard not to hear the pain in their performance. I sometimes find myself crying in the middle of an hilarious bit.

In that way, comedy helped me survive from 2012 something to 2017 something. I pretty much freebased stand up comedy during that time. The catharsis it provided helped me so much. Here were deeply damaged people suffering through the same disappointments of life. Laughter is the best – well, you’ve heard that one before.

I’m not saying this is any kind of solution to chronic depression. If I knew the solution I’d definitely tell you. But it helps. Comedy, specifically stand up, has been a balm for me my whole life and continues to be.

Find your place of retreat, is my advice. Figure out what fixes you in your moment of crisis and know how to get there when you need to. This works for me. 

Tuesday, July 31, 2018

Social Anxiety, Let's Talk About It

In my last post I promised that I was done talking about prescription meds as related to depression. Well…

This isn’t exactly that but it’s peripherally relevant. The point of this post is in interest of getting you caught up on where I am. It’s probably more important to me than you so just roll with it or skip it. Reader’s choice.

So, the problem was this weird sensation of feeling breathless, but actually being able to breathe fine. I never put it next to my depression. I figured it was just part of my generally declining physical health. I couldn’t eat. I vomited a lot. My weight went up and down 10 to 15 pounds a month. I was a mess. Still am. At my next doctor’s appointment I described the problem. He asked a few questions.

When does it happen? Usually mid to late morning.
Where does it happen? Work
What’s your work environment? [at the time] I have a private office but I tend to keep the door open because people often need me to help with their projects.

It went on like that. After a lengthy interview he said it sounded like social anxiety. I’d always been a little disgusted by this phrase. It just struck me as silly. Plus there was that stupid tv ad a few years ago where a pencil drawn cartoon circle with a cowlick lumped along feeling all blue because of social anxiety. Doc said that it’s not always quite so pronounced. Without even consciously realizing it, I could be experiencing the symptoms without understanding where they came from.

Here's a more exhaustive discussion of social anxiety
 from the National Institute of Mental Health (NIHM)


This doctor liked to talk. He also liked to brag. He told me a few stories about other patients with similar problems and how he saved them. Arrogant prick or not, he wasn’t wrong, at least in my case.

Propanolol. Apparently it’s a drug that’s been around for a while. Initially it was intended to be a heart medication. However, it’s been discovered as also useful for anxiety disorders. It’s been the only prescription drug that’s helped me in the head-space. When I feel an attack coming on I take the pill. A bit later I realize the attack never came on. That’s it.

This piece published by the Journal of 
Psychopharmacology, Oxford in February, 2016
 provides a great deal of research
 that's been done over the years on propanolol
 as it relates to mental and emotional disorders.

At first I hoped that, perhaps, social anxiety was the chief cause of my depression. I’m introverted. I was a shy kid. I avoid social situations as much as possible. It all made sense. If I’d built up emotional defenses to social situations over the years, I might not even be noticing problems that were right in front of my face. They built up then suddenly I’m having anxiety attacks that were leading to global depression. Unfortunately, propanolol wasn’t the magic bullet. It did solve one problem and I’m glad for that, but I still have a basketful of others.

I think, maybe, there might be a range of social anxiety – kind of like being on the autism spectrum or the Kinsey scale. For instance, say I’m a number 4 on the social anxiety ladder where someone having a harder time of it is a number 7. I don’t know. Just a thought.

That’s it, I promise. I’m done talking about prescriptions. Never fear, there’s plenty more to discuss. I have a whole list sitting here on my desk next to my mouse. If you like my whining there’s plenty more to come.


Thursday, July 26, 2018

The Saga of Remeron/mirtazapine

I mentioned in my last post that, despite my distrust, I tried prescriptions, plural. But, I spent the whole post whining about Prozac. The other one I tried was remeron. Let's talk about that.

About ten months after my experience with Prozac, I was referred to a mental health clinic. I was well into my second year being unemployed so I had to go on the first available Sunday and their community clinic. In other words, I showed up for the first come, first serve, free service. You just try to find more depressing circumstances!

Anyway, the psycho-whatever guy took in my story. I know, sounds irresponsible to not remember for sure what his title/position was, but at this point in my life I was emotionally and physically exhausted. Also, I liked and trusted the doctor who referred me to him. We’ll talk more about her later.

I was so in the depths of it at this time that walking to the end of the block was a major accomplishment. Driving the fifteen miles or whatever to this guy’s office was nothing less than herculean.

So, I told him about my struggle with depression. In those ten months it had become so much worse. After Prozac, the episodes of heavy limbs, crying helplessly and days of endless sleep continued to come and go. I’d have a good week then two days of useless paralysis.

I put it to him plainly. I was ready to try another prescription. I had two conditions: 1) Don’t say the P word and 2) I wanted the meds that had the lowest incidences of sexual dysfunction associated with them.

Sidebar: Sex is incredibly important to my new wife and me. We met some months after my divorce and her separation on one of those hook-up apps. It was literally meant to be a one-night - well, one-morning - stand. Turns out, we’re still standing.

So, back to it. He, the psych-whatever guy, totally understood. He listened to my whining and worries and suggested Remeron (mirtazapine). Said it had one of the lowest incidences of sexual problems and was good at smoothing out one’s depression/emotional issues.

In an FAQ on the Mayo Clinic's website they list mirtazapine as one of the antidepressants with the lowest incidence of sexual problems. However, they don't go so far as to say that there are no sexual problems associated with it. A study published by the National Institute of Health in December, 2005 reported that patients suffering from sexual issues while on other antidepressants saw improvement when they tried mirtrazapine

We filled the prescription and, after staring at the bottle for about a week, I finally started in with the recommended dosages. I stuck to it for two weeks before my wife asked why we weren’t having sex anymore. I hadn’t even noticed but we’d gone from twice a day and ten on the weekend to maybe once a week. MotherFuck! (Well, actually, quite the opposite.) I hadn’t even noticed.

The standard information/disclosure information about mirtazapine says nothing about the possibility of sexual side effects. Whether it was real or some kind of messed up placebo thing, I'm obviously in the minority or their studies sucked. 

We tried paring it down. Half a day, then half every other day; no joy. Having no libido and disappointing my partner is no solution to depression. At least in my world it’s not.

So, I’ve let mirtazapine go, too.