Saturday, October 22, 2011

Living with depression

This is something I really haven’t given much thought to. If you were to look back at this blog, which constitutes pretty much all my thinkin about depression since I started it, you’d probably find that around 75% of it are posts featuring me whining about my self-diagnosed chronic depression, around 20% about one or another alternative cure I’ve considered, 5% about miscellaneous stuff, and the remaining 37% about how bad I am at math. But, actually coping with depression, living day after day with this dark companion, is something that I’ve avoided altogether both in my head and on this blog, at least as an explicit topic of conversation. I’ve been so concerned about how much it sucks and how great it will be when I get over it that I’ve missed the obvious. To quote Jack Nicholson’s line, “What if this is as good as it gets?” What then? How have I coped and survived until now and how will I continue to do so?

A few weeks ago, I got an email from a teenager in Australia. Let’s call him Tom. He is also depressed. It appears to be chronic and he’s getting help. He’s not hiding it and, under the Australian health-care system, he has access to real help. So good so far, right? He emailed me because he felt that I, being someone more than twice his age with roughly the same set of problems, could provide some insight that the best of his counselors haven’t so far. To paraphrase because I didn’t ask permission to quote him, he basically had two questions based on the single premise that, since he seems to be stuck with this depression thing for life: 1) Is it really worth it to go on? 2) If so, then how does he cope with it because all the meds and counseling in the world, though they can help, might never make it really go away.

I didn’t ask his permission because I didn’t know if I would respond at all. I’m still not sure, as I type this sentence, if I can come up with something worth saying. I’ve been pretty flummoxed since I got his email. Given that I’ve never really considered question 2, it gave me a lot to think about. How have I coped? Do I really know or do I plod through the day, fearful of the alternative? I’m still not entirely sure.

Let’s tackle question 1 first. We’re talking about suicide although he never said it. It’s something to talk about. Most professionals and patients seem to treat suicide as the no-no, hush-hush alternative that we must never speak of or even allow ourselves to consider. I don’t really have a problem with it, I really don’t. Who’s to say that a person in a severe depressive episode is in any less pain than something who’s body is failing from a terminal disease. Your conclusion about whether or not someone in the latter situation should be given the ability to kill herself may be different from mine but, in the post-Kevorkian world, I think that we can all agree it’s something that should be considered and discussed. Ah, you say, depressive episodes pass and the person has the chance at life beyond it. True, but a life punctuated by random, unpredictable depressive episodes may be too much for one to deal with. Ultimately, the moral positions on suicide are not unlike abortion – they are too wrapped up in personal ethics, religious beliefs and societal mores for there to be a clear, universal answer. I believe it should be a personal choice. I do not consider someone who commits suicide to be immoral or even wrong. (The exception in my mind is when one commits suicide when he has obligations, financial or otherwise, to his friends or family. It is condemnable to leave behind someone to clean up the mess that he was too cowardly to clean up himself.)

But, none of that really addresses Tom’s question, does it? Is it worth it to go on? Here’s the answer that seems to have evolved in my life. Yes, for the most part, it’s worth it to go on. I have more good days than bad and, most of the time, I’m hopeful about the future. I’m also curious about the future; I really want to know how things will turn out. It seems a little silly to base my mortality on seeing the plot through but it works for me, somehow. I’m also damn scared of killing myself. At my lowest moments, the thing that kept me from doing the deed can only be described as pure cowardice. So, is it worth it to go on? As I said before, so far, for me, it beats the alternative.

Okay, then, on to Tom’s second question. How to cope with it? This is the bit that really stymied me. I really don’t know how I’ve coped. As I turned this question and the answers I could think of over in my head I began to realize that I was writing a commencement address – seek your happiness, be true to yourself, love your family, blah, blah, blah. Like I said, Tom’s a teenager and he’s set to graduate soon enough. I’ll leave the platitudes for the C-list actor who happened to graduate from Tom’s high-school and gives that speech the year he graduates.

So, I tried harder to come up with real answers. The thing about depression is that it is our problem. It is fairly well defined and we kind of have a list of things it does to us. However, everyone has problems, right? I heard of a study a few years ago that says that babies and toddlers feel the same level of anxiety over their little dramas as we adults do. It seems silly to consider that a missing toy leads to the same amount of stress as trying to figure out how to pay the utilities on a limited budget but, apparently, it does. My point is that I think humans tend to look for and focus on points of tension in our lives. We depressives are lucky in a twisted way in that we know the source of our tension and we sort of know what to expect from it. Other people with a different set of less definable problems are trying to deal with them as best as they can. I’m not sure if I’m making my point very clearly here or if I even really had one to begin with. Let’s move on.

As I’ve stumbled through life, I seem to have settled to two key points that guide me.

The first is to know your depression. This means that it’s important to learn when depression is making you feel a certain way or real life circumstances are. Rage, anxiety and sadness are all occasional symptoms of depression. They are also symptoms of the human experience. Whenever you feel extreme emotions, take a beat and try to identify if it’s a result of real life or some meaningless, internal storm. I’ve lost friends and alienated family members over not being able to tell the difference. Innocent comments can be misinterpreted when observed through a depressive filter and turned into insults.

My second best bit of advice is never blame your depression. I’m talking about both externally and internally. Externally is easy. Just don’t do it. Never use your depression as an excuse for your actions. If you are an ass to your best friend because you misinterpreted an innocent comment while you were having a particularly low day, don’t say you did it because you are a depressive. Your depression might have influenced you but final decision to lash out was yours. Apologize, hope he accepts it and move on. This isn’t to say that you never talk about your depression – your friends might be a great source of support for you - just don’t rely on it as an excuse for your bad actions.

More importantly, never tell yourself that you acted a certain way or made a bad decision because of your depression. Once again, depression might have influenced you but, ultimately, you are responsible for what you do. Blaming depression becomes a crutch, relieving you of all responsibility and that can become a vicious cycle: I’m even more depressed now because my life sucks because I made bad decisions because I was depressed at the time so now my decisions are going to be even worse and my life will suck all the more. Depression may be a part of who you are until the day you die but never let it define who you are.

I tried to avoid platitudes but that last sentence came dangerously close, didn’t it.

So, Tom, there’s my answer. I’m sorry it took so long but you really threw me on that one. You gave me a lot to think about and I hope I gave you a little insight, too. Best of luck, brother!

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Saturday, October 15, 2011

Fabulous Folic Acid? - A folic acid update from another perspective.

This is a guest post from my buddy JL. She discovered folic acid around the same time that I did and has had much better success with it. So, to avoid yet another gloomy "things still suck" post from me - which is the case - I asked her to tell us about her experiences with it. And, when you're done reading this, go subscribe to her blog, From Manic to Mindful.
In my 32 years, I can say with full confidence that depression has dominated over ¾ of my life: I was an incredibly angry and sad little girl (oh, how the therapists love to hear that!) , who grew to become an overly eager-to-please, must-be-perfect-at-all-times teenager, who finally came down hard at age eighteen, only to be kept afloat on a cocktail of anti-depressants and anti-anxiety medicine until about eight weeks ago, when I stumbled onto the blog I’m writing for now. Through this blog I found another blog, (Methodical Musings of an Unbalanced Woman) and I discovered Folic Acid- specifically, 5-MTHF.

I’ve spent a lot of time on anti-depressants. To name a few: Lexapro, Cymbalta, Zoloft (thank you very much for landing me in the hospital), Paxil…and those are just the ones I remember. I spent my longest time on Lexapro, and I was pregnant with all three of my children while taking it (after my doctor’s decided that the “benefits” outweighed the “harm”. So far so good with my little ones, but I guess time will tell). Here’s the funny thing about anti-depressants: I was never really not depressed while taking them. I was cushioned and functioning better, for sure, but I still always fought that depression. So when I had the epiphany, if you will, that the anti-depressants were not really doing much for me and acting as a placeholder solution, at best, coupled with increasing difficulties with health insurance to even GET said anti-depressants, I needed to finally go on that search to nip my depression in the bud, or at least keep it in check, on my own.

I knew that an answer must be out there.

When I stumbled on the information about 5-MTHF, all I had to read was “there are studies that show that a large amount of the population cannot properly break down and absorb Folic Acid, and those who are unable to do so are prone to depression, anxiety, and anger (among other diseases and issues),” and I was sold. I emailed said bloggers about it and asked them for more information. As a girl who loved her illicit drugs while in high school and college, not to mention her booze, (NOT ENDORSING that behavior, just being honest with you…) I had zero problem with taking a vitamin supplement I ordered over the internet.

Methylated Folic Acid, in it’s L-methylfolate form, is already broken down so that, basically, the work has already been done for those people who are not able to do so because of their genetic deficiency. I can’t say whether I have said genetic defect or not, since I have not been tested, but I do know that depression runs very heavily in my family, and not only has it been obvious that my maternal grandmother was/is severely depressed, so is my mother, me (obviously,) and I see it in my seven year old son ( a little more about that in a bit). I readily ordered my methyl-folate and anxiously awaited its arrival.

In its early days, (and still, today, because I guess we can still say it’s still early since almost none of the physicians that I’ve discussed this with have any clue about it…though evidently research about this began FORTY YEARS AGO…) methylated folic acid was (and still is) prescribed to go WITH anti-depressants, to make them more effective. I can confirm that this was the case for me, right away. Happy, Joy, Grateful-wow. A whole new world opened up for me immediately. I attributed this to the folic acid and (combined with the fact that I was so desperate to be off of my meds) quickly made an appointment with my doctor to discuss coming off of my antidepressants (Cymbalta. 20 mg twice a day)-I am not one to wait around for things to happen. We agreed on a plan (well, she told me a plan and basically forced me to agree, though in my many years with anti-depressants I knew that “her” way to come off of the pills was too fast…) and I began decreasing my dosage of anti-depressants, and kept with the 5-MTHF (which she knew nothing about, but because she had heard of folic acid, said was “fine”.)

Coming off of those first 20 mgs a day was unusually easy. MUCH, much different than coming off of anti-depressants had ever been before: I was still very much content and yes, even happy. This was a very new experience for me. But I guess I should also stick in a disclaimer: along with the 5-MTHF, I began practicing mindful meditation and using the Silva Method of Meditation, which I have committed myself to doing once a day. I also stopped drinking alcohol as much as I did before- only about a glass a day. This wasn’t so hard, though, because something interesting happened: I didn’t WANT to drink. I don’t know if it’s the folic acid or the meditation or what, but I can’t write a truthful post without putting those other parts in as well.

I have to say that the final 3 (that’s right. A mere THREE mgs) of the Cymbalta were the worst. I felt like a crack whore coming off of the hooch (I have a really good imagination). It was awful and I began to wonder if the folic acid really helped at all. But I had to remind myself that I have been on anti-depressants for MORE THAN A DECADE, and that my adult self has never existed without them, so of course it would be incredibly difficult and that I really needed to cut myself some slack.

Here’s what kept me going during that (not so long ago) time:

My son, who I mentioned before, is seven and has displayed anger and anxiety ever since he was three. Part of me always chalked it up to my divorce from his father when he was one, and his anger about my re-marriage and the two baby sisters he got as a result of the remarriage. But after four years, I finally confronted my excuses for his behavior and accepted the realization that he is probably a “depressive,” just as I am. I do not want this kid on prescription, synthetic, medication, especially at such a young age, and yes, he has been to therapy. Still willing to give 5-MTHF a fighting chance, I decided to see how he would do on it.

In my research and discussions with other people who take the 5-MTHF, I learned that this is one of those supplements that have almost no side-effects, and that it benefits basic human functions on so many ways that it is just fine for almost anyone to take, even children (but I would definitely research that more before you give our two year old methyl-folate.- or anyone for that matter ) My son is a big 7- at 85 lbs I felt okay with giving him 2 mgs of the 5-MTHF a day. Not right away, but after a few weeks my son slowly evolved into being a happy kid. Finally!!! As a parent, this is the one thing you want for your child. Seeing my guy like this is such an incredible relief for me. He still gets angry at times and is as difficult as any other 7 year old boy I hear about, but for the most part our home is so much better. He even told me himself that he “feels so much nicer when he takes his medicine.” (Of course, we have many discussions about how it isn’t really a “medication” but a food supplement…) Just knowing, and seeing what the folic acid has done for him really got me through those incredibly tough days I spent ridding myself of Cymbalta.

Now, I come from a family of researchers- my father has his PhD in Chemical Engineering, as does my brother. Most of my parent’s friends are either chemists or physicians of some sort. I am merely a graphic designer, who has a passion for all things psychological (does it matter that my minor in college was in psychology???) but I do love to do my own research-and empower myself by doing so. I strongly encourage others who are considering anything like this to do their own research as well. My father has been so impressed with what he has seen from both myself and my son (we are all very close) that I have had the fortunate experience of being surrounded by my own personal research team. Therefore, based on my own experience, I feel really confident with my personal dosages, method of coming off of anti-depressants, and giving the supplement to my son. I am not telling anyone to do the same without doing their own research, attempting to discuss this with THEIR doctors, etc. etc. I’m sure I don’t have to tell you that depression is an extremely serious disease, so please view this blog post as food for thought but not the official go-to place for information. Be your own responsibility and look into it yourself.

That said,

A couple of key points I would like to mention:
1. Research shows that pretty much everyone can benefit in some way from taking Folic Acid. However, those who are not able to absorb the folate (genetically) vs. those who are will react differently and have very different experiences. For those who CAN’T absorb it, and who take the 5-MTHF, it will work drastically better than those who CAN absorb it naturally and whose depression is not biologically based but perhaps more psychologically or experience based instead.
2. As with any supplement or drug, amounts are key. One person (and these are “random” amounts I’m naming) might “need” 15 mg a day, another 7, and yet another, 5. I have been playing around with quantities (DANGER! YES! I’M NOT A DOCTOR!) and it seems that I do best when I take twice as much as I initially thought (based on my research) I would need.
3. Many physicians have no damn clue about this. And it’s really frustrating but hopefully through blogs and other word of mouth, more doctors will become interested and look into it. But I have to admit I get really annoyed at people who say “okay, I’ll discuss it with my doctor” and then the doctor has never heard of it and the idea is dismissed. I am not “pushing” the 5-MTHF here so much as I am encouraging people to be their own health advocates. After I looked into and actually READ the 42 pages of disclaimers of Cymbalta, I was shocked that the stuff is on the market. And yet, doctors wanted to keep me on it.
4. Traditional blood tests might not show that you do not absorb the folic acid. It might show up, yes, because it’s in your system, but the indicators will not be there whether it is actually being fully absorbed and processed correctly or not. So you can’t really see whether you can or can not genetically absorb the folic acid by saying “oh, I had my blood panel done and my folate levels were fine.” It goes deeper than that, folks. You'll need the actual genetic testing.
5. NOT ALL FOLIC ACIDS ARE THE SAME. Chances are, you will not be able to find the proper L-methylfolate in your local healthfood store. The “L” is the important bit here, which is the folate in it’s “purest” form. Yes, taking folic acid is good. But there is a “good, better, and best” and it turns out, for the “extreme” cases, ie, the people who don’t absorb it, that the “L” is the way to go.
6. There is an entirely different discussion to be had (which I don’t really understand) that has to do with Folic Acid and the B-vitamins. Turns out that it is HIGHLY recommended that you take a B12 with the folic acid (I found a methylated one that both myself, my husband, my mother in law, and my best friend now take because it is AWESOME and the energy you get from it is amazing.) Just thought I’d throw that in there.
7. The drug Deplin is a prescription of methyl-folate and comes in 7.5 mg. and 15 mg pill form. I am mentioning it because it comes up a lot when researching MTHF. I am honestly on the fence about it and can’t entirely trust that it just is what it says it is or whether it has some of the synthetic neuro-transmitters in there that the other antidepressants have, which, of course, is what I’m trying to avoid. There seems to be different information on it all over the place so it’s left me stumped-which means I won’t take it. I’m sure it’s fine and completely legit but I after coming off of the Cymbalta I am so wary of anything prescription anymore.
I know this has gotten pretty long so I need to wrap it up, but I want to everyone to know that right now you’re reading something from someone who has had a pretty rough time. I’ve had the world tell me that there is no reason for my depression, that I have everything to live for, blah blah blah. Yes, this is true, but there is this little thing called CLINICAL DEPRESSION that is very real and still exists no matter how smart you are, or pretty you are, or tall or short or thin…or if you have a loving family or not, a supportive spouse or dog or whatever. It’s like cancer-it can get anyone. To say that I am thrilled to find 5-MTHF is an understatement. Wonderdrug? Probably not. Nothing comes without work: you’ll have to stay on it, to find the dose that works for you, and also be willing to examine your life and make whatever changes that are necessary in order to help yourself. No pill will do that, but it might motivate you to.

I can’t pretend that I know everything about folic acid, and my life isn’t 100 % (or even 90 or 80 percent) rainbows and butterflies since I’ve started taking it, but to me, it is an incredibly huge step and I am so grateful to Ray for this blog, and to Melanie from Methodical Musings of an Unbalanced Woman, for introducing me to this supplement (and also being my depression support group, in a way). My life (and my son’s) has taken its most drastic change to date and it’s really exciting for me. I actually feel like, for the first time ever, that life might be worth living after all. Go figure.
In my own blog, From Manic to Mindful, I write about my experiences with depression, with coming off of antidepressants and how I did it (and my struggles with it), and all of the proactive steps I’m taking to rid myself of depression-without the “aid” of the medical community. Some of it is helpful, I’m sure, but admittedly, some days I just b*tch about how I hate Costco milk containers and how I get so angry at them that I want to throw them across the kitchen. After all, I might take 5-MTHF now and meditate daily, but that doesn’t mean I’m not human.