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. 

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. 

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. 

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.

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.

Tried Prescriptions

I know. The original point of this blog was to chronicle my battle with depression without prescription drugs. Well, since we last spoke I broke down and tried a couple of prescription antidepressants. Let me tell you about that.

First, a few background details that may or may not be relevant and may or may not be further explored later. As you know, I’m not a big fan of prescription drugs. Obviously, they have their place but I think today’s western society overuses them. From antibiotics to emotional and mental medications, I think that patients and doctors alike are too quick to turn to them. This isn’t either parties’ fault, the system has simply been set up in such a way that there’s not enough time in the doctor/patient relationship to explore slower – even if more effective – solutions. Also, there’s the pharm industry… There are a lot of rabbit holes to fall down here. Point is, I’m more reluctant than the average patient to accept prescriptions. Let’s leave that there for the moment; maybe we’ll get into it later.

I may be a bit paranoid in this area. For a more balanced view of the issue of prescription drugs in the US, check out this article in the Washington Post from November 2015. It points out that, among other things, prescription drug use is up possibly due to increased advertisements and an aging population. Happily, it also mentioned a decrease in antibiotic use.

Second, my wife doesn’t necessarily agree with me on this.I’m not saying she’s trying to shove a pill down my throat every time I feel a little ouchy, but she’s seen antidepressants help people in her life before and she didn’t like to see how much I was suffering. Besides my natural proclivity to depression, having lost my job and my home left me in a pretty bad place. So, when I needed to get a prescription re-upped – heart thing, not gonna fight that one – she came along with me to the clinic to talk about these squishier issues.

The nurse practitioner we saw was compassionate and took the time to listen to my story. She patiently asked questions and encouraged me to tell her everything. It was painful. Anyway, after it was all said, she proscribed Prozac. Obviously I knew about the big P. It’s an old drug and I’ve heard a lot of people have been helped by it. After some convincing I decided to give it a try. (Not much convincing, mind you. When you’re as low as I was then it doesn’t take much.)

It was a disaster. I took the prescribed dose for three days. It shut me down. I mean it literally turned me off. I’ve told this to doctors since and, save one, I can see clear skepticism in their eyes. But that’s what happened. I stopped functioning. For a week I could only get out of bed to urinate or vomit. The rest of the time I slept all day and all night. I was in a black/grey fog. My arms and legs felt like great weights that were impossible for me to lift. Had it not been for my wife – then fiancé – keeping me hydrated I might not have come out of it. Dramatic, I know, but it was really that scary. Aside from a few auto and flying incidences, my lucid moments during this episode were some of the most terrifying I’ve encountered.

According to this study published in JAMA in June, 2018 "between 2005 and 2014, the estimated overall prevalence of US adults using medications with depression as a potential adverse effect was 37.2%.The adjusted percentage of adults with concurrent depression was higher among those using more concurrent medications (eg, estimated 15% for ≥3 medications)."

Obviously, I dropped the Prozac after this. The incident left me with a strange side effect. My left ear was completely plugged up. My right ear was, too, to a degree, but at least I could hear out of it. The left? Nothing. Strange, right?

Still Pursuing

It’s been a while…again.

A lot has changed in my life since I last published an honest post; although, to be honest, none of these posts are entirely honest. They may be more or less true chunks of my reality but to call them honest is probably a stretch.

But you already knew that, I’d wager.

Okay, to summarize: I lost my job, twice; I got divorced; I moved four(?) times; my car blew out its engine and the truck I bought to replace it was stolen a few weeks ago.

In other words, I now have legitimate real-life reasons to be depressed. No longer am I a guy with a chemical imbalance; I’m a guy with real problems and I honestly don’t know what to do about them.

For a while there St. John’s Wort was doing the trick. Regular doses kept my keel more or less even. When the ship started to list, however, it didn’t seem to be enough.

Well, hang on. There are a few positives I forgot to mention. Most significantly, a few months after the divorce I met a beautiful woman. We hit it off and got married way too soon, but we’re in our forties and we know what we want and what we’re doing. So far, so good. And, one of those moves I mentioned took me out of the backwater village that I endured for over 20 years for my ex to a proper city where I’m much happier.

Anyway, back to the listing ship. When I was laid off from my first job I started to slip. I managed to hang on for a bit but after about six months of job searching it got bad. I went to the doctor and, for the first time in my life I went on prescription antidepressants. Prozac, to be specific, and it was a disaster – wouldn’t be the last. It completely put me on my back. For a week I couldn’t wake up, much less get out of bed.

That’s where it started…again. Looking back, some of the best therapy I got was from writing this blog. Maybe it can help me again so I’m going to try to pick it back up. I know I’ve made a lot of vague allusions here. We’ll get into to some of them later. Some of them, I’m just going to let drift. You’re welcome to take the ride with me.