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Watching Wellth 16/10/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Function,Managing Depression,Medication,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies,Social Supports & Networks,Therapies — jillnottelten @ 10:30 am
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The journey’s oft’ rough as one travels the road

with one’s mood apt to upset the cart;

And if climbing back on aft’ one spill weren’t enough –

Alas – staying on top is an art!

For most of us who have passed though one episode of depression – or other forms of mental illness and come out the other side, a common concern draws us.  We don’t want to go back there.

Some have a harder battle ahead of them than others.  Some have different forms of depression; different forms of anxiety; different forms of mental illness that are more or less responsive to the things that we do to treat them.  Some are more vigilant than others – often this makes a big difference … and sometimes life’s not fair.  Some do all the ‘wrong’ things and yet never have another episode – but that’s unusual.

What’s usual is hard work with a need to use a range of strategies to stay well.  Things like good sleep, exercise, a nutritious diet, keeping up social support networks and getting out of the house, exposure to sunlight and fresh air, use of medications and talking therapies are just some examples of these.

But how do we know that we’re winning?  What can we do at the times when we’re worried about how our mood is going to try to prevent it from tipping over the edge into something we can’t manage?  How do we know if that new medication is doing anything to change anything at all?

One of the things that is helpful to do at times is to track your mood.  How do you do this?  You use a mood diary.  Ever done it?

The purpose of a mood diary is essentially to get a profile of what pattern your mood is following on a day-to-day basis.  At their most basic level, a mood diary will ask you to rate your mood on a numerical or incremental scale every day while you keep it.  Some will additionally ask you to record other information such as your anxiety levels, your irritability levels, how much sleep you had the night before, significant events and triggers throughout the day and/or the medication that you took.  The good thing about doing some of these other things is that they provide a much fuller picture of what is going on.

If you don’t already know what they are – this process can help you to work out what your early warning signs are as well as your triggers.  If you know your triggers and early warning signs, this can help you to monitor them. For that reason, I recommend choosing a mood diary that records significant events in the day.  I would also recommend one that includes the amount of sleep that you had the night before as this tends to be pretty universal and fairly influential.

Talk to someone close and ask for their help if you have trouble working out if you were irritable or if they noticed anything in particular that seemed to set you off if you are having trouble identifying these kinds of things – but the object of the exercise is to make observations about yourself – so do what you can on your own as well.

However, asking someone close to you whom you trust to help monitor your mood and to help you get to know your warning signs and triggers is a good strategy.  They sometimes see things that you are not in the right place to see or notice when you’re not well because your self-awareness can get a bit skewed.  They also see the ways that you differ from the way that you would normally be – so they can measure you against you and not somebody else.  Yes, it might be their perception – but it will still be your behaviour and actions and the things that you say and the responses and facial expressions that they are used to that are part of you.  Choose someone who you trust and talk with them and let them tell you about what they noticed changing last time and as you have been working through your recovery.

Do I use a mood diary and self monitoring systems all of the time?

Not on a daily basis.  When I am well I keep regular tabs on how I am going by talking about it with a good friend and checking over my early warning signs and triggers list regularly to ensure that my awareness of them is good and that I am alert to high risk periods.  I use what is called a WRAP – a Wellness Recovery Action Plan where I have identified what I am like when well, what my triggers are, what things are hints that I’m not as good as I could be, my early warning signs and so on …. I go through this regularly.  Some people do monitor their mood daily and find that it works well for them.  People with things like rapid cycling Bipolar disorder often find that they need to until it slows down and is brought under control.  At first I needed to chart my mood a lot more than I do now.

When I am in a high risk period I watch things more closely and have recently resolved to keep a mood diary through high risk periods because I still find myself at sea sometimes and feeling like I’m losing my grip.  I am particularly vigilant about my warning signs and triggers as well as their corresponding action plans during periods of high risk.  I have to be.  Recently I let things go at home and let the dishes and the housework pile up around me – a sign that things are getting away from me and didn’t act and it triggered me (it becomes a cycle).  I couldn’t face getting up to look at the house.  I didn’t want to go into the kitchen to prepare a decent meal because it was a mess and I didn’t feel up to cleaning it up – so of course my nutrition level went down, my budget blew out and thus the cycle continued.  In the end it took a cleaning weekend to put me back on track, followed by a week of very early nights and a lot  of discipline.  It’s too easy.  So I have decided that I need to do something to catch myself more quickly before it gets away from me.  Not simply cleaning, just lots of little things.  This time of year I need to be very careful about relapse prevention.  It sounds minor when I talk about dishes – but when it snowballs, I just keep sleeping and if I sleep through work or go in late consistently and am still going around in circles while I’m at work and don’t have energy or concentration to work – I could lose my job.

I’ve attached today some links to some self monitoring resources and different mood diary sites.  I know there’s a lot, but different things suit different people and I think these are important tools.  Most mood diaries have room for the full spectrum of mood disorders – both mania and depression.

Warning signs and triggers are important.  Monitoring your mood is tedious sometimes – but there are times when it is necessary.

General

http://breeze.blackdoginstitute.org.au/keepingwell/

Mood Diaries

http://www.bipolar.com.au/common/pdf/mood-diary.pdf

http://www.blackdoginstitute.org.au/docs/MoodChartforDepressionandhowtomonitoryourprogress.pdf

http://www.blackdoginstitute.org.au/docs/DailyRatingScale.pdf
http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=mooddiary

http://www.moodscope.com/ for those who like online resources

https://www.moodtracker.com/ another online resource

http://itunes.apple.com/au/app/moody-me-mood-diary-tracker/id411567371?mt=8 for those who like apps

Mood Monitoring & Relapse Prevention Programmes

http://www.cci.health.wa.gov.au/docs/KYB-3-Self%20Monitoring.pdf

http://www.idamaecampbell.org/files/40263519.pdf (WRAP personal workbook)

Early Warning Signs

http://www.health.qld.gov.au/rbwh/docs/early_warming_signs.pdf

http://www.blackdoginstitute.org.au/docs/20.WellbeingPlanforBipolarDisorder.pdf (can be used for depression too)

Healthy Lifestyle

https://www.mindbodylife.com.au/Downloads/index.cfm

 

 

 

Just One Moment … 14/10/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Function,My Black Dog — jillnottelten @ 10:50 pm
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The alarm clock rings.

Perhaps.

I drool.  I roll.

The dog opens an eyelid.

I haven’t moved yet.

The dog opens another.

I am snoring lightly.

His head lifts.

Tilts.

He listens.

I am breathing.

Not that he cares.

The dog rises on his haunches – quietly – all the while waiting for me to stir.

The song changes on the clock radio.

The dog waits.

But I don’t move …

… and slowly, slowly he rises to his legs and creeps out of the room.

The black dog roams free in the house.

And I sleep on.

Eventually, much later I wake.

I look at the clock.

%##@@

And then I see the empty patch on the floor …

and I know that something worse seems to be afoot.  I haven’t just slept through an alarm this morning.

The dog is at large in the house.

I fall back on the bed and close my eyes in dread.

What awaits me?

How awful will this become?

Can I face it again?

I pull the covers up over my head and try to snuggle back down to sleep.

It’s not really happening.

But I can’t do that anymore.

I’m not the same person that I was last time I found myself like this.

Bloody Dog!

Now I have to go and clean up this mess.

The mess.  Can I face the mess?

Sooner or later I have to.  I’m really just putting it off lying here in dread and imagining.

He’s only been loose a little while.  How bad can it be?

Bad.  It’s been bad quickly before.

Come on.  This is getting us nowhere – time to move.

So eventually.  Eventually.  Eventually – I do.

I was right.

He’s been everywhere.

But unlike before, I can catch him and rein him in reasonably quickly.

Sure, this leaves me tired.  But not defeated.

There are muddy prints where the dog has been – but all they are are the traces of his lies upon my consciousness.  I can clean those.

Tonight the dog is back on his leash.

Tonight is evidence of what gains I have made with the help of my psychologist in learning to be conscious of my thoughts, emotions, my actions and how my body is responding to situations and to be deliberate in how I respond to this.  Tonight I remember how these things used to crush me.  How encouragement was drowned out by self-derision.

Today my dog got off the lead.  Today I caught him again.

Yes, it made a mess of my morning.

Yes, it upset me.

But today, I could hear encouragement when it was offered by someone supportive.

Today Mindfulness skills allowed me to feel and experience the emotions of the moment and yet use the CBT strategies that I have learned to right my perspective and reorient my day so that I could finish it feeling like I had accomplished something useful.

Today, the dog has finished his day at heel.

 

Depression? … No, it’s not just … (sigh) … Forget it … 12/10/2011

Filed under: Experiencing Depression,Explaining Depression,Managing Depression,Medication,My Black Dog,self-management strategies,Social Supports & Networks,Talking About Depression,Therapies,Work — jillnottelten @ 5:30 pm
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If there are around 7 billion people in the world, then I reckon that there are about 7 billion ways to explain depression.   Seriously.  Everyone is so different.  Just when you think you’ve nailed a way to explain what it is and how it affects you, you come across someone for whom that explanation just doesn’t cut it.  Now, I know that it’s not necessary to tell everyone what is going on.  It is not everyone’s business and not everyone even wants to know.  But sometimes it’s necessary – and necessary that they have an understanding of what depression actually is rather than just what they assume it to be.  If someone is going to support you, live with you, take your sickness certificates seriously when they start piling up or you relapse in the work place – they need to understand more than just what they see at surface level.

So how do you get there?

How do you explain that you have this black dog that is constantly with you, even when under your command and at heel?

How do you help someone get past the idea that you could just put mind over matter if you wanted to?

How do you convince your boss that you’re not being lazy? Or taking sickies?

How do you convince your grandfather who is not very aware of mental health issues that you are not a hypochondriac?

Do you find yourself getting into arguments over these things?  Being left feeling guilty and doubting yourself because of the things that people say?  Feeling frustrated and defeated because they just don’t understand? Or just feeling out of your depth explaining the nature of depression, it’s causes, what perpetuates it and what helps to treat it and to support your recovery? You are not alone. Do you struggle to understand these things yourself?

The first step in becoming more confident explaining what is happening to you to someone else is to become more confident in your own understanding. Write down what you know.  Organise your ideas under headings like

My Diagnosis (there are different types of depression):

Definition of diagnosis and Symptoms:

Body chemistry:

Thoughts (ie what it does to them, not necessarily yours although you may include a couple of less risky examples):

Behaviour (ie what people do because of depression):

Effects on function and everyday life:

Treatments that people use (ie medication and therapies):

Treatments I use: How well my treatments are working (and if you are thinking of trying any others some time):

Things recommended to help recovery:

Things that I do/am doing:

Things that are recommended for carers/supporters/workplaces who are supporting people who have depression:

Resources that I have found that might be handy to give people:

How did you go?  Where are the gaps?

The next step is to dig around and fill in some of the gaps in your own mind.  Make a list of the questions that you still have.  You don’t necessarily need to have them all answered before you talk to someone about your depression – but they are there for you to follow up on for your own benefit.  Sometimes you can also make a joint venture out of finding the missing information with the person you plan to talk to if they are someone who you trust.  If anyone would like me to work through a series on these or to post any heading in particular I’d be happy to include something like this in future entries.  Please put any suggestions or requests in the comments section for this post.

When you have thought through these things for yourself and written them down – if you come to a time when you need to pull your thoughts together for an explanation it is so much easier to do. The next thing to think about is this.  What type of person or question are you dealing with?

People like your grandparents and some parents have been brought up in a generation where sickness is seen in form of a disease or medical issue – so with them, I would start by explaining to them the aspect of depression caused by biological factors and that it’s an episodic illness.  Perhaps I would give them some information to read, or would talk to them and describe what happens – maybe draw a diagram of a synapse and show them how my neurotransmitters are out of balance.  Then I would tell them the symptoms that causes and how they affect everything else.  Then I would go back to my drawing and show them how my medication works and talk to them about why I need to keep on taking it.  If they were interested and wanted to know more about my treatment, I might also explain that I go to a psychologist to learn techniques to overcome other symptoms too because they have become fairly stubborn and I get lost in them at times – but that I don’t expect that this will be like the medication, and it’s not like lying on a couch talking.  It’s about learning specific skills and having time limited therapy that has been show in the research to be very effective in strengthening recovery and preventing relapse.  I might then tell them about my goals and what I’ve been working on and how things are going.  Lastly I would talk to them about what kinds of things experts say that family and friends do that help.  If they wanted something to look at for more information, I would try for something from a doctor or official health site, in large print if I could find it.

Your boss might need a medical kind of approach too.  With them I would also look for information for employers on one of the mental health support websites.  BeyondBlue has a good one (http://beyondblue.org.au/index.aspx?link_id=7.980&tmp=FileDownload&fid=1176 ).  It has another one about whether or not to disclose if you are considering the decision (http://beyondblue.org.au/index.aspx?link_id=7.980&http://www.beyondblue.org.au/index.aspx?link_id=6.1068&tmp=FileDownload&fid=356 ).  I would stick to workplace issues only and be clear about how your efforts are going in relation to getting or staying on top of your work.  Make sure that you are clear of your work place rights.  If you are in Australia, BeyondBlue spell them out more specifically or direct you to a source.  I’m not sure where international readers would need to go.  Mr Google would, I’m sure.

For siblings and friends – it probably depends upon how they relate.  Some will understand best if you describe it by its symptoms and numerous courses, some will need a scientific approach, others will need an explanation of the treatments that they see you taking and using as an entry point.  Usually family and close friends want to know what they can do and feel frustrated when they feel helpless.  It’s important to make sure to give them information about your symptoms, your treatment, what your doctor thinks is causing it and what they can do to support you.  Sit down with them and talk about what helps if they are involved in your life.  If they are not talkative people, gradually feed them things to read.

I’m not going to talk about young to school-aged children here because I want to talk to a friend who is a specialist in this area and do a special post specifically on this topic at another time.  However, for adult children my advice is similar to that which I have written for siblings.  Generally they want to feel that Mum or Dad is okay.  Yes, it’s strange and they start hovering as though they were the parents and can get overbearing at times.  Other times they may be so caught up in their own lives that they don’t even seem to notice.  In both cases, it’s important that you are ready to educate.  If you don’t have the energy for the conversation, young adults will respond to websites.  Sending them to http://www.beyondblue.org.au , http://www.blackdoginstitute.org.au and http://www.scottishrecoverynetwork.net will get them well oriented to Depression, treatments and some people’s experiences stories if they look around.  There are also great resources there for family and friends.  Then they can come back and talk to you about what they have learned.

Then of course there are your parents.  All the strategies in the world will not stop their concern at times.  This is part of their world.  For most people, when things are hard – all a parent wants to be able to do is make it better, easier somehow.  It’s the nature of the role and love that they have had no matter how old we get.  I am aware that there are people who are not lucky enough to have families who have cared for them like this – but on the whole, a parent’s response to any perception of threat to your wellbeing is a desire to protect you (remember, that one that’s been driving you nuts since you were at least as young as 14).  When talking to your parents about your depression remember this.  Once a parent – who has considered themselves a carer or a protector throughout your life when you have been unwell or threatened – accepts that you have depression and understands the nature of the illness, they will find it difficult to respond to as well.  It is good to have information designed for families and carers for them if they find watching you struggle hard.  Make sure that you spend time talking with them about what helps and what doesn’t.  Calmly.  Write it down first if you need to.  I share things to read with my family.  They don’t say much, but their education shows in the things that come up when we are talking about my health or my plans for the future.

My observation from working with people who find their parents “too interfering” is that often in by not telling them anything about what they are doing for their depression – is that a lot of the parent’s interference is related to ignorance; and that more, rather than less information about what is going on, better education for the parent and some help to reassure the parent that their son or daughter is making healthy choices goes a long way toward defusing the situation.  I know that this is not true in every case, but frequently it is.  And while some of the parents need to learn better adult boundaries, others are just desperate for the wellbeing of their son or daughter.  It may not be possible to put all of your parent’s concerns to rest.  This is not your job.  Nor is it your job to protect them from ‘finding out’ – because ten to one odds say that they have already noticed that you haven’t been yourself for a while and are already worrying in secret if bothering to hide it.  Explaining the true shape of the issue that you are dealing with and telling them how they can help rather than leaving them to shadow box with the ghosts they imagine is all that you can do.

Sometimes, unfortunately, like we might have been to start with – the people we care about or people we need to know may also remain in denial of depression in someone they know.  This is very hard.  Sometimes a family member might respond if they come to the doctor with you.  Other times it may be a case of letting your treatment and the efforts that you are putting in prove themselves over time.  It is hard to be motivated to do this with someone saying that you are being lazy or playing sick.  It doesn’t help the thoughts.  It can increase anxiety.  It is humiliating even to one’s self.  If the person won’t respond to your attempts to talk to them or to give them information, unfortunately it is difficult to make their choices for them.  However, the best way to deal with them is to prove them wrong.  The best way to prove them wrong is to prove that the treatment that you are undertaking and the effort that you are putting in is having an impact.  Even if it’s a partial impact that goes in fits and starts – change can be a catalyst for more change.  Perhaps seeing a change in you as you progress will convince them that there was something to that information that you tried to give them a few months ago…

 

Medication: Weight or Baggage? 09/10/2011

Filed under: Clinical Depression,Depression,Managing Depression,Medication,self-management strategies,Therapies — jillnottelten @ 10:18 pm
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Ever want to hear a room full of doctors or mental  health workers stop talking?

Introduce debates that have been raised in recent years questioning the effectiveness or the place of medications in the treatment of mental illness.  Suggest that there might be evidence of options that would be more appropriate starting points for treatment.  Ask them whether they would be ready to choose to live with the side effects that may result from some of the anti-depressants that are out there.

Have I surprised you?

I am not anti-medication by any means.  I use medication.  Unfortunately, at present, a lot of it although I hope in time to be in a position to reduce this.  There are some people who are.  They say that Depression can and should be managed by using strategies such as those that I discuss in “Beyond Medicine” with use of lifestyle strategies with regularity and discipline as well as well evidenced ‘talk therapies’ that build skills and resilience like CBT and Mindfulness.  Some even think that medication makes depression worse.

There are now groups who go over research that comes out about treatments to see what standards people are using to measure ‘success’ of treatments against and how it really measures up with other treatments if judged by the same criteria (eg http://www.power2u.org/medication-optimization.html ).

My depression falls within the ‘major depression’ and severe spheres.  That is within the spectrum of severity where it is clear from research that anti-depressants have a measurable effect.  It can be proven that they make a difference.  Research is finding not much evidence to prove that medication makes a measurable difference as opposed to placebo or other forms of therapy for mild depression and little more so for moderate depression.  Now, that’s not saying that there are no cases where it doesn’t work and all cases where it won’t be worth a shot – or that you won’t underestimate how severe your own depression is.  I certainly did at first.  What it does say is that it is worth asking some serious questions and exploring a range of other treatments either before or instead of medications.

Consider the some of the side effects of antidepressants.

Short term side effects of SSRIs can include nervousness, anxiety, muscle tics, suppression of REM sleep (and then drowsiness), nausea, dizziness, diarrhea, gastrointestinal problems, different types of sexual dysfunction, emotional blunting and apathy.  With long-term use come risks of cognitive changes.  Now most short-term effects will pass as the body gets used to the medication, but still …

Tricyclic antidepressants have potential side effects that include blurred vision, dry mouth, constipation, bladder problems, sexual dysfunction, dizziness, drowsiness and increased heart rate among others – again some settling after a short time and others continuing.  Not everyone gets any or all side effects, but most experience some.

If you take MAOI anti-depressants, then you can’t eat certain types of food.  Potential side effects here include low blood pressure, constipation, vomiting,  headache, altered sleep, dry mouth, drowsiness, fainting, sexual dysfunction, weight gain and lower alcohol tolerance.

And people wonder why people stop taking medications!!?!  Do you want to take them?  How will they help you?  Sometimes trying the non-medication based therapies first does make a lot of sense.  While it seems easier to just take a tablet, how confident can you be that the tablet will make you feel better?  Mine do.  But remember, firstly, my Depression is severe and secondly, I also need to bolster it with management strategies that aren’t medication-based.  I need both.

Here’s the thing though.  What ever you do decide to do – make sure that you are fully informed.  Do your research.  Also – ask your doctor the hard questions like:

“Why this medication?”

“What are the side effects?  How long would I expect them to last?”

“Are there any risks associated with this medication?”

“Will I be able to keep working while I start taking it (if you are working) or will it affect my performance?  Should I take a few days off?”

“How will I know if the medication is starting to work?  How long should it take?”

“Are there any precautions that I should follow over the next few days/weeks?”

“What happens if this medication doesn’t work?”

If you do agree to try a medication, stick with it as advised.  The time frame your doctor gives you for how long it should take to work will be only an estimate.  Also, some medications are dangerous to stop unsupervised.  If you are trying a medication, consider it a joint experiment by yourself and your doctor.  You bring your expertise of your experience and the effect that the medication has upon you.  Your doctor brings medical training and independent observations.  Both are needed to make an informed decision about where to go with your medications.

If you are on long-term medication, you doctor and yourself share a partnership.  Again, you are the expert on yourself, your symptoms, experience and how the medication is (or isn’t) impacting your life.  Your doctor is the expert on the medical facts, observations and assessments as well as the medication itself.  In any partnership for decisions to work to their best advantage both people should be involved in the decision-making event – even if the right of decision is mostly with one person.  This means that both people’s expertise can be used.  Sure, ultimately, it’s your life and your right to agree or disagree with your doctor’s medical opinion – but when there’s medication involved and you want to change it or come off it, at least informing them is a smart thing to do.  They can then tell you if you need to know about any risks and you can ask them what you need to know to make sure that you are safe.  You can also make a judgement call about how much you think you can manage with your own strategies with a lower dose of medication in place and work to negotiate this with your doctor.

Ultimately, I think it comes down to the type of depression that you have.  Some don’t need medication.  For some the decision could go either way.  And there will always be some that need it.  However, the question about whether we do or don’t use medication is weightier than deciding whether we can tolerate side-effects or would rather carry a load of self management strategies that may seem burdensome when we feel so amotivated.

We all need the self-management strategies.  These have been proven to be effective in reduction of depression regardless of the level of severity.  Our decisions about medications need to be weighed carefully.  How much of the work are we expecting them to do?  They are a tool, not a workshop and not a finished project.  They are designed to equip us to work at life.  If they’re working, you’ll be able to take up the management strategies that are more lifestyle driven and see your mental health improve to wellness.  Sometimes with meds still in the background.  Yet for others, in time a mutual farewell to the partnerships with doctors and health workers gives way to a continuing lifestyle-driven means of managing wellness.

 

B-B-B-Budget: The Cost of Medication. Is It Worth It? 02/10/2011

Filed under: Clinical Depression,Depression,Function,Managing Depression,Medication,Treatment Resistant Depression — jillnottelten @ 4:47 pm
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Budget.

Now there’s a scary word.

Why is it there?

It goes through my mind on a regular basis.  Like – every time I run out of a few medications at once.  And especially on those really special occasions when they all run out at the same time.  You know the ones?  Or perhaps you don’t.

Me – I have what is known as Treatment Resistant Depression.  It means what it says.  It’s a bastard to treat.  It doesn’t respond to the basics and I go to a psychiatrist who is a specialist.  Yay me!  It also means that what works is an interesting combination of meds.  This is complicated by the fact that my depression is the result of surgery that I had in my early 20’s that also left me with a tendency to partial seizures (now controlled – by medication…).  I also have a history of really nasty and persistent migraine that I resisted medication for until the summer when I had them for 4-5 days a week every week for about 5 months and found myself at risk of losing my job over the number of sick days that I was accumulating.  I also have low levels of vitamin D and a back injury that has resulted in the growth of osteophytes (essentially arthritis).

I figure that I am lucky to live in Australia where a large proportion of the cost of most medications is subsidised by Medicare – the government scheme to ensure that health care is affordable for everyone.  It says something that I generally reach the threshold of what people are expected to pay without further subsidy (Medicare’s safety net) by about October or November each calendar year.

My meds for Depression include Lexapro (also known as escitalopram) an SSRI, Edronax – a SNRI, Lamictal (lamotrigin) which works as a mood stabiliser but is also an anti-seizure medication and Valdoxan – which is only new.  I’m taking Valdoxan at a low dose as an augment to my other anti-depressant medication.  I’ve tried to go without an augment several times, but it just isn’t enough to hold me – I relapse with the slightest of triggers.

Valdoxan is expensive however because it is not PBS listed (ie not on the Medicare Pharmaceutical Benefits Scheme list) but is sooo much better than Lithium which is what was what was used as an augment before.  Valdoxan wouldn’t replace Lithium for someone whose primary medication need was for Lithium – but as an augment it has been great.  It helps me sleep at night, doesn’t leave me drowsy through the day, doesn’t put on weight or make my hair dry and frizzy – just costs a lot of money.  But it allows me to function so much better than the Lithium did that I don’t begrudge a cent.  I also take a very small dose of Abilify which has helped with some other weird symptoms that used to come when I was low on sleep.

Next, I take Topamax to prevent migraine.  Much as I hate to admit it – this has proven very worthwhile.  While I still get an occasional breakthrough migraine a few times a year – they are nowhere near as severe, don’t last more than a day and don’t leave behind the ghost migraines for days afterward.  In short – I can function.  On top of this I take Vitamin D supplements and Glucosamine with Chondriatin (and I notice the difference with my back stiffening if I stop taking it).

Finally, one of the fall out effects of my depression has been the decrease in concentration and attention span that has come with it.  This year to see if we can improve that my doctor has been prescribing me a low dose of dexamphetamine – and I think it’s working.  The catch has been that it gave me tremors in my hands and, in the beginning, headaches – I had finally managed to get rid of all antidepressants that caused this – so it was back to the Propanolol for me to get rid of the tremors.  Propanolol also helps with prevention of migraine too, so it adds a bit of reinforcement to the Topamax (not that I would take it if it wasn’t for the tremor!).

That, ladies and gentlemen, totals at eight prescription medications and two over the counter alternative medications.  Not what I would call ideal – but they all serve a specific purpose and thinning them out would leave me very vulnerable to relapse – trust me, I’ve tried – under the supervision of my doctor whom I’ve told point-blank that I won’t take something or other … several times.  One day I hope to successfully reduce them, but I think that it will take a lot more skill in managing my depression on my part, more research time, planning and preparation.

I buy the Vitamin D and Glucosamine at discount pharmacies.

The rest I go to the same pharmacy for all the time.  This helps if I run into any trouble with any scripts or if I’m physically ill – they’ll run it around to my place for me.  Also if I get prescribed something else or go to buy something over the counter – the pharmacists there know what else I take and can tell me if it will cause me any problems.

Recently I had to get all my scripts filled at once.  It cost a lot of money.  At first I cringed.  But really, I’ve done this before and its nothing new.  It’s about four weeks medication that I’m paying for.  I know how much my medication costs.  In the end I just shrugged my shoulders and paid.  I said to the lady who served me the same as I’ll say to you.

“A day’s wages is not a lot to pay in exchange for the ability to function for a month.”
 

The Wall with a Hole in it … 30/09/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,Routine,self-management strategies,Work — jillnottelten @ 5:23 pm
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And I’m not talking ATM.
Have you ever felt yourself to be up against that dragon that you were never destined to slay?  That worm you’ll never be early enough to get? The one that leaves you feeling like the Emperor in all his glory when he set out in grand style to show off his ‘new clothes’ just when you think you’ve gotten a hold on it.

My nemesis is time.  Not just any time – although we have a slippery time keeping pace with each other continually.  No, the ultimate battle is drawn around the time of sleep and waking.  Here I am repeatedly mauled by my dragon, eaten by the worm and left with nothing but the Emperor’s new clothes to show for all the effort that I have made to conquer the struggle.  I feel as though I am beating my head against a brick wall.

What happens you ask?

I set an alarm clock.  Actually I set two alarm clocks ten minutes apart.  I do not trust myself with one.  I have been known to turn one off in my sleep!  I set one to raise my level of consciousness and the other to wake me.  For most of the year this is adequate.  But then comes the changing of the guard – it starts to get light earlier or later in the spring or autumn and for several weeks my dog hides the alarm clocks.  He must.  Some nights anyway – because they sure as hell don’t wake me.  But then I also have trouble in getting to sleep – so maybe it’s not all the dog’s fault.  At times I sleep no more than an hour or two a night.  Others I may get to sleep and then wake up at two in the afternoon – ON A WORK DAY!  This year I thought that I was winning at work until the seasonal sleep monster set in.

Right now I feel like I am beating my head against a brick clock.  In getting to sleep.  In waking up.  In getting to work.  My psychiatrist has given me something to try for the short-term (ie 4-6 weeks) as it’s a regular pattern and struggle and part of a bigger picture of short-term seasonal change in my mood.  It’s not a relapse – just a dip.  But oh so disappointing because its been so stable for so long.  In lots of ways I think I could handle it if the sleep didn’t go out the window.  It’s started to affect my work though, so I’m taking the medical option this time.  Maybe next time I’ll be able to have the personal strategies down strongly enough to manage it without boosting my meds for a few weeks – but I need to prioritise keeping my job over my pride for this time.  I may have to wake up and phone in to work in the Emperor’s new clothes.  I do not have to parade through the streets in them.

Bloody Dog.

Damn Clock.

So for now I get my sleep under control.  I keep my mood stable with a little extra help than usual until the season settles.  At least I will be able to keep the dog in his place.  At least I will stop messing things up so badly in getting to work.  It will only be for a few weeks and then its back to the normal cocktail that I’ve accepted will be a part of everyday.  Back to using my ‘personal medicine’ or lifestyle strategies to manage life and its stressors.  Then I get summer to strengthen my other skills and to be ready for autumn when it comes.  Perhaps I will plan a short increase in meds again.  Perhaps I will plan time off work.  Perhaps I will be enough on top of my sleep to manage it with flying colours.

My Dog loves the twilight of the seasons.  He thinks its play time.  He loves the dawn.  He dances while I wake.

Oh to be able to open one eye and say in my firmest voice.

“Sit. Dog.  Sit!”

And have confidence that he’d obey.

One day.  One day he will.  One day I am determined to slay that dragon.

One day.

 

Seasons Come & Seasons Go 29/09/2011

Filed under: Depression,Experiencing Depression,Function,Leisure,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,self-management strategies,Treatment Resistant Depression,Work — jillnottelten @ 10:24 pm
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Some people are Summer people.  Some people, spring people.  Some are winter people.  Some love autumn.

No, I’m not talking about people’s colouring or the things that they like to wear (that is something that I, in fact know very little about).  I am simply talking about peoples’ favourite times of year.  Some people like to soak up the sunshine in summery garb out in the garden, down at the beach or over at the local pool.  Others love to curl up by the fire in their favourite jumper under a rug with a good book and a cup of hot chocolate – or put a movie on.  Some love the colours of autumn and the beginnings of that lick of ice in the early evening.  And some the radiant brightness of spring, its scents, the new life, the slow steady warmth, the magpies diving at you from overhead…

I never settled to a favourite time of year.  I really do enjoy almost all of all seasons – and by the time one ends I am ready for the next.  I am not fond of the days that exceed 40 degrees celsius with no cool breeze for long stretches at a time.  Hot winds are their own breed of evil in Australia for reasons far beyond temperature tolerance.  I’m not a great fan of temperatures at the other end of the spectrum either – especially if they come with a wind.  Actually – wind bugs me more than temperature.  But seasons – apart from the odd bits like getting up in the dark to go to work in winter – seasons are a delight.  Full of life.  At least, I always used to think so.

My dog pays attention to the seasons too.

Unlike me, the dog has clear preferences for different times of the year.  It took me a while to work this out, but its consistent.  The dog is stubborn in winter.  He moves slow.  He needs more time.  He takes more time and holds me up whether I plan it or not and he wears me out more easily than he does during the warmer months.  I think he’s arthritic.  He gives me no trouble if I allow for the arthritis though.  A bit more sleep – 1/2 hr or so more than I need in summer and I’m fine.  I just need to be patient.

Summer is usually the dog’s best time of year.  He still needs discipline, but he’s more content to walk at heel and doesn’t drag and tug away at the lead.  Spring and Autumn are strange.  Most of the seasons fall in with the winter and summer behaviour for Dog according to temperature and what the light is doing.  In each of these season there comes a point where the light changes – and over these few weeks the dog goes nuts.  He is unpredictable.  I can not afford to let my guard down for more than a few moments at a time.  My sleep gets poor – this starts the ball rolling.  My energy levels become low, my motivation to maintain routine relapse prevention strategies gets sloppy and I soooo don’t feel like doing anything about it.  It at these times that I have frequently relapsed (almost without exception).  I made it through autumn this year.  So far I have struggled this far through the last few weeks.  Another 3 – 4 should see me through the worst of it.

Until then, its keep on keeping on and stick to the programme.  Watch for warning signs – the very time of year in and of itself is a trigger – even without the presence of other factors.  Light does funny things to my health in other areas too.  It’s like the dog becomes delirious.  Here is a time when I need my friends and family – my supports more than any other time of the year.  I’m struggling to get to work on time at the moment, but so far my boss has let me cover with time in lieu.  Still, I’m determined to conquer that one too.  I get there on time more often than not – just not as often as I should.  Just now – when I least feel like it – discipline becomes oh so important.

I had my last review with my Psychiatrist this week.  We agreed that it would also be possibly a beneficial thing to increase one of my medications for 1-2 months during the peak risk zone while I’m wrestling risk factors and wavering – just for that short-term – and then go back to my current dose afterwards as the weather and season stabilises a bit more.

Hopefully the combination of ‘personal medicine’ or monitoring of triggers and early warning signs with the kind of action plans that are outlined in my post “Better Medicine”  with the temporary medication adjustment will prove to be a good protective measure.  I’ve had a good year.  I’d hate to mess it up now.  I’m hoping to get to at least a whole year without a relapse this year!

So roll on to the latter end of Spring.  Because despite all of this, I really do love spring.  There’s a certain level of hope and promise in the air in Spring that’s unique to this time of year.

Come Dog.  Heel.  Walk.  Heel.  Walk.  Heel …

 

Food Glorious Food 25/09/2011

Filed under: Clinical Depression,Depression,Managing Depression,Physical health & wellbeing,self-management strategies — jillnottelten @ 5:54 pm
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Fruit.  Vegetables.  Meat.  Protein.  Dairy. Iron.  Carbohydrates.  Breads.  Cereals. Rice. Pasta.  Vitamin E.  Vitamin C.  Vitamin D. Vitamin B.  Fats.  Sugar.  Cholesterol.
Hormones.  Blood Sugar levels.  Chocolate.  Shortbread…

How we eat makes a big difference to how we feel.  It affects how much energy we have.  It affects how efficiently our system processes what we do eat and how easily it will break down and prevent or minimise constipation.  For some it can affect them at a more vital level – for those with diabetes it is even more important to monitor food intake, as for those with particular allergies.

Recent studies indicated that people with depression have a high (anything up to a one in two) risk of developing diabetes.  That is an enormously scarily high statistic.  You might ask, “Why?  Why this on top of everything else?”

A large part of the answer is thought to be tied up in lifestyle issues.  They actually think that for most people this is preventable!  Risk factors for development of type 2 diabetes include lack of exercise and sedentary lifestyle (ie sitting around a lot and inactive), obesity especially if your weight distribution is more around your stomach than your hips and thighs, eating unhealthily is a major cause of type 2 diabetes – too much fat, too many simple carbohydrates and not enough fibre in particular; also high blood pressure, high cholesterol levels, high cortisol (stress hormone) levels,  smoking, family history, gestational diabetes and aging (over age 45 becomes higher risk).

A lot of these risk factors overlap with issues that occur regularly in people with depression.  It is common for people with depression to have little physical exercise and very sedentary lifestyles, poor diet and become overweight due to a combination of this and at times side effects of medications – and the lovely little belly that the medication leaves is usually a tummy rather than hips and thighs.  Stress level hormone levels may be high due to anxiety levels; depression, like diabetes often has genetic links, many of the high levels can be secondary to diet and lack of exercise and statistics indicate that a high proportion of people with depression also smoke.  Oh – and yes, we might say that we’re 39 for a while, but everybody ages.

The good news is that the majority of the factors identified as risks are preventable.  They are also helpful ways to improve the prognosis of the course of our mental health.

Look for ways to become more active.  Start small and build up a little at a time.  Sooner or later you will feel like you are exercising.  In the meantime, you will be stretching out those muscles and getting them ready for a challenge.  One of the biggest weight loss programmes in the world was started by a woman who started out by walking around her clothesline.

Research what needs to go into a balanced diet.  Plan what you will eat ahead of time and stick to it.  I find this really hard, but it really is worth it.  I have more energy when I do and it helps keep a lot of other things more balanced.  Try cutting up your veggies when you get them and storing them ready to use – that way you don’t have as much to do to prepare food when you have to cook.  Same with your meat and everything else.  It takes longer to store – but half the time (at least for me) a large part of the battle in getting the energy together to get something healthy and wholesome to eat is in overcoming that ‘I don’t feel like all the preparation’ feeling.  At worst keep a couple of pre-cooked healthy meals stored in the freezer for when you don’t feel like cooking.

Talk to your doctor about a Quit smoking programme.  It is possible.  People do it all the time.

See someone about some anxiety management strategies.  If you already see a case worker, therapist or doctor ask them for advice about what to do or where to go.  Look around for local programmes through community health resources.  If you get stuck and are not sure where to start, check out the mindfulness and CBT pages on this site or post me a comment and let me know.  If you’re in Australia, ask your GP to write you a referral under “Better Health” to see a psychologist or clinical psychologist.

Just to start off, this week I had a really simple meal of a piece of steak about the size of the palm of my hand.  I had a couple of mushrooms that I chopped up and cooked with it in the pan.  I then steamed in the microwave generous serves of broccoli, cauliflower, both green beans and yellow ones and some snow peas that I grew in my garden.  It was filling, plain and simple.

Why not share something healthy that you cook/prepare or plan to cook/prepare after reading this in the comments.  Maybe we can collect some recipes and ideas?

 

I wanna be a … 18/09/2011

Filed under: Clinical Depression,Depression,Function,Managing Depression,Routine,self-management strategies,Work — jillnottelten @ 8:29 pm
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Jetson!

Are you old enough to know The Jetsons, I wonder?  Most are, surely.

I’m not after the groovy little space-sedan.

I’m not even in it so much for the robot house keeper – although I would certainly NOT turn her away …

I want the bed that tips you out when you need to get up, stands you up and puts you on a conveyor belt to the shower and gets you started for the day.

I swear, that has got to be the hardest part of the day!  I’m okay once I’m showered and dressed for the day – but until that point it is all up hill.

On work days I don’t trust myself with less than two alarm clocks.  I’ve been known to turn alarm clocks off in my sleep.  I figure that one will at least bring me out of deep sleep and the second can wake me if the first doesn’t.  I don’t keep at least one near my bed.  I make sure that I need to touch floor to turn it off.  I also make sure it’s a really noxious sound so that I don’t just let it keep going.

One thing that I don’t do that a lot of people say works well for them is put out my clothes the night before.  I have tried it a few times, but tend to finish up thinking that I don’t feel like wearing what I put out and finish up dithering over what I do want to wear.  That said – it would probably work fine on work days if I kept it up – so I should try it again.

I also tend to waste a lot of time putting off getting to the shower (especially in winter) puttering around the house.  Alas! This just makes me late.

Oh for an alarm clock that tipped the mattress 45 degrees and dumped me on the floor with a bang if I reached for a snooze button!

Drat the need for motivation, will power, decent routine & bedtimes, discipline in lights out and organisation in the morning.

But then again, if I have been eating well, doing exercise, working, and going to bed at a decent hour I am likely to have been refreshed by sleep and find it easier (note that the word here is “easier” and NOT necessarily “easy”) to wake and rise.  Perhaps key to my struggle with rising in the mornings is my lack of discipline in other areas – most obviously in getting to bed at a decent hour reliably, but also exercising regularly.  I would also have more energy if my diet included more fruit and vegetables.

So many things to fine tune.

I still envy George Jetson.

 

Attishoo! Attishoo! We All Fall Down 31/08/2011

Filed under: Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,Physical health & wellbeing,Routine,self-management strategies,Work — jillnottelten @ 9:42 pm
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What’s going on?

I’ve got a headache that I’ve had on and off for a few days now.  I’m so tired so much of the time.  I’m disorganised.  My house is a mess and getting less clean than I’d like it to be – it’s not grotty, but without action it could get there without a lot of effort … I’ve spent the last couple of days off loafing in my ever comfy PJs and while I’ve gotten up and done stuff, I’m sure I said ages ago that I was going to stop doing that…

Hang on.  These things are all among my early warning signs.  I’m off my game.  Nothing serious yet – but now is the time to act.  I’ve been going really well for ages.  It’s not even my Depression that’s knocked me off my game – it’s the damn cold that I’ve been fighting.  Yet this I do know.  In the past relapse has often followed physical illness.  The dog acts when he knows I’m not at my best.  He takes advantage of weakness.

So what do I do now?  Give in? Panic?  Book an extra doctor’s appointment?  Nope.  Now is the time to reach for my WRAP – my Wellness Recovery Action Plan – something that I should probably be going over more regularly to remind myself of the daily and weekly/regular things that keep me well.  In my WRAP I found that I’ve been neglecting a lot of these over the last couple of weeks and that I have gotten sloppy with a couple of my routine maintenance markers over the past couple of months.  My work WRAP (my own experiment) shows me that I’ve not been sticking to my wellness goals about leaving on time and planning my day either – no wonder I’ve been feeling like I’ve been run over by a truck.

Now is the time to restart the action plans.  I need to tell someone that I’ve noticed that I’m off my game and that I’m acting on it – that way they can ask me how I am going with my action plan in a couple of days to see if I need some help to get things moving again or if I’ve been able to self-start again solo (often harder than I think it’s going to be).  I’ll wait to see how things progress and talk it over with my friend before I rush into moving any appointments forward.  I think I’m okay if I get reorganised at this point.

So its back to setting alarms and keeping them for going to bed and lights out at night.  I’ve been letting the sleep run thin.

I need to plan my meals rather than look in the fridge and hope that there’s something I feel like eating in there.  And I probably need to start putting more attention towards the balance of what I eat because I don’t think I’m eating enough fresh fruit and vegetables (that’s a new strand to the plan for me).

I need to put away the things that are lying around and creating clutter.

I need to clean the house.  When that goes to my list though it will read room by room and the floors will be separate.  That way I can do it in parts and feel like I’m making headway when I cross things off on my list.

I need to set up a routine for maintaining my housework.

I need to set aside time for doing things that I like to do.

I need to work out how I want to prioritise a couple of things that I have going at the moment so that I can put away what I am not going to finish in the immediate future and finish off what I am doing in my ‘projects’ department.

I need to set aside time for some meditation and prayer.

I need to make sure I leave work on time.

I need to make better use of my diary and go back to keeping a list of things that I need to do to mark off and prioritise – this works well for me

I also really need to put some effort into starting to exercise and to spending more time outdoors.

If I need help with anything, I can and will ask.

I’ve been good with most of my other stuff but things involving routine, and doing things that I’m not instinctively motivated by (like exercise and cooking for anything other than guests) are difficult.  It may get easier.  Who knows?  My goal is to find something that I enjoy in the things that I find difficult to do at some point – but not now.  Now the need is to just do it.

We all fall down.  We all need to know the best way to get up again too.  Take the time to be prepared.  I use the WRAP (http://www.mentalhealthrecovery.com/wrap/ .  You can now download an old edition of this from “Recovery X-Change” http://www.recoveryxchange.org/downloads/RxChange%20WRAP%20WorkBook.pdf  if you want to check it out a bit more closely).  There are a number of different systems people have.  The most important thing is to be ready to be ready.

All I have is a cold.  It does not have to become a relapse.

Right now though it’s approaching bed time.  So rather than editing anything else.  I’m going to post this and head for the sack.  Good night.

 

 
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