medication | livingwithablackdog

What do you do with the Shockers? 25/11/2011

Yes, I am still here. Still living, breathing and blogging. Just fell victim to a couple of very shocking weeks (interspersed with some lovely moments, but very few and far between).

This week I’ve barely been able to tolerate daylight, let alone the computer screen – migraine like I have not had in a long time since my medication includes migraine voodoo concoctions … but … amidst my Barry Crocker of a week the week before and the ensuing weekend I became a bit disoriented and missed a couple of doses of my meds, hence the hole in the firewall (just to mix some more metaphors). Yesterday I went to the GP to get a medical certificate for work and stopped at the shopping centre on the way home. Talk about sensory overload! My world had not yet totally stopped spinning so I had this strange spacey kind of sensation as I was walking, the noises were louder and more jarring, lights and colours still bright, smells still sharp. I couldn’t get out of there fast enough!

Work has been crazy and exhausting trying to manage the politics and dynamics within the office. Don’t get me wrong – I like my job. If only work could just be about going and doing your job and coming home again, what a relief it would be! But there are systems and other people that one has to navigate to do one’s job. Equipment that one and space one has to somehow get adequate access to do it. Preferably in a way that lets you stay well without creating more stress than is necessary – which is where the battle lies at present for me. At present it seems that I am destined to bang my head against a brick wall and progress nowhere and to endure life in the office that gets claimed by miscellaneous team members to serve as their staff room – while my office buddy and I are trying to work in it!!!

But alas! These are not healthy things to dwell upon. The goal is to work out how to attack and push through. I had thought that we had had a strategy for the work one, but it is back to the drawing board on that one next week as it looks like this is rapidly fading into embers.

At present I am struggling not to dwell on the difficulties of the last few weeks. I grew frustrated that my usual seasonal dip in mood was dragging on longer than usual, but didn’t really look beyond it for other triggers until much too late. Sitting down with a friend a couple of weeks ago to go over what had been happening clarified things a lot more for me. One of the reasons that I am so focussed on work issues over the past couple of weeks has come about because through sitting down and working through my usual triggers and warning signs with my friend revealed that my workplace is simply loaded with triggers. There is little wonder that I have been struggling to emerge from my usual brief decline and regathering of mood.

It’s so easy to forget to go back to the basics when one gets busy. I can sort of see why Mary Ellen Copeland, the woman who designed the WRAP suggested that going over triggers and warning signs should be something that someone should do daily to prevent relapse. I’m not sure that I would ever go to daily, but I do know that I need to be going over my WRAP a lot more frequently than I do. The whole point of knowing one’s triggers and warning signs is so that you can be alert to them. It’s one thing to know them – but so easy to miss them unless you’re really watching.

So – What do you do with the shockers? Do you beat yourself up over them? There’s no point in that. To me, it seems you need to do is stand back and detach a little. Stand in the moment. Not the future. Not the past. Just the moment. Examine – and for me, it helps if I can find someone to help me stay in perspective … at least to get me going – and learn. This helps me to see cause and effect relationships; it helps me to learn and relearn trip hazards; it helps me see things specifically rather than looming ghouls and it leaves room to remember that there were a couple of good moments in the last fortnight too.

From there I can start with a plan. If the plan needs adjusting, then so-be-it, but perhaps – just, perhaps … next week can be a bit better …

Please.

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Do You Tell Your Boss? 13/11/2011

If you have a mental illness do you tell your boss?

Are you obliged to tell your boss? Why or why not?

With discrimination rife in society and difficulty getting friends and family to understand what you are going through, what are your greatest fears in the workplace? Or the study environment? Or wherever it is you spend most of your productive time?

Does your illness affect your ability to do your job at times? In what ways?

Does your boss know? Do any of your colleagues? What led to them finding out?

Whether you are studying or working always consider ahead of time whether you are prepared to disclose your illness. If your current position is non-disclosure, consider carefully any occasions which might arise which might make it more necessary and under what circumstances you may disclose if at all.

Disclosure is always best done in a planned manner. You should have some idea what you are going to say, how you want to say it and how you are going to explain its relevance to your work. If you need some adjustments to your work conditions or some time off, it is best for you to come to your boss with some options that you have considered and reasons for your request. You need your boss to understand that you wish to be healthy and productive as possible and are trusting them so that they are able to best support you to reach a goal that is in both of your best interests. A large proportion of ‘Western’ countries, including Australia, provide legislation to support your right to this.

When you plan what to disclose think in terms of how you are affected by your mental illness more than your diagnosis. You may, in fact decide to disclose only the effects of your illness and not your diagnosis, stating that you have “a condition that affects …”. You may identify symptoms or you may simply describe what it does to you and how that affects your work eg my condition means that I have less energy than I used to have. This means that I have to be careful how I plan my time and that I have to take holidays at regular intervals throughout the year to maintain stable health. I need to be careful to use my meal breaks and leave on time so that I don’t become over-tired. Or my condition means that I need to take medication. When I change medications, sometimes I am more sleepy than usual and over-sleep or become very drowsy in the afternoons. Sometimes my speech even gets slurred and I sound a little intoxicated. So if I’m changing medications I need to take a week off, otherwise I find that I’m coming to work late all week and I sound as though I’m tipsy for half the afternoon and I don’t get much done and am at risk of making faulty decisions or overlooking things because my head is all foggy – especially in the first few days. After that I will be fine at work again, but might over-sleep a couple of times in the 2-3 weeks afterwards while my body gets used to the new meds. It doesn’t happen very often. I’ve only needed to do it 2 or 3 times, but each time I’ve been glad that I did.

You do not need to disclose specify personal or medical information if you tell them about anything at all.

You should also think about when to disclose. That is – when you are applying for a job, before a job interview, during the interview, after you have been offered the job and before starting, during the time you are employed after you have worked there for a while, if you become unwell and need to or never. There are pros and cons of disclosing at each point of the way. Sometimes your circumstances will have presented you with little choice to prevent awkwardness – you may have become unwell at work and have it become obvious that something was wrong or you may have symptoms that you are aware will soon become obvious if arrangements aren’t made to cater for your needs. Again, despite prejudice and stigma in some places you have legal rights to have your needs and confidentiality met and protected within your workplace in most western countries. Further, in Australia at least, if you become unwell because the employer failed to attend to your needs having been made aware of them, you are entitled to compensation under work cover. It is however, worth serious consideration whether or not you are going to disclose because unfortunately discrimination does still happen and there are people who do fail to respect privacy and you never know where they are until you find them.

Some helpful things to consider at each stage of the employment continuum.

Prior to interview

Why you might …

You are able to to discuss the organisations policies and support resources when exploring the prospective position
You are able to get an idea about your employer’s predisposition to your needs from the word go.
If you have restrictions on any key job criteria due to temporary limitations because of recent relapse/graded hours return to work plans.

Examples of Why you might not …

Risk of discrimination influencing whether or not you get an interview.
No work related needs arising from your mental illness.
You don’t believe that they need to know/believe it irrelevant to job.

At the job interview

Why you might …

You are able to address people after creating a positive impression of yourself and demonstrating your capability.
You can gauge their understanding of your meaning and clarify appropriate questions about your needs.
You are able to discuss with the employer positive traits that you bring to the team that you have learned through your journey of recovery.
You are able to discuss your needs and what your potential employer would be able to accommodate or explore during the interview process.
You can brief them as to whether your referees are aware of your condition and how it affects your work and offer consent to discuss previous workplace arrangements with other employers if they have gone well.

Why you might not …

Risk of discrimination in job selection.
You don’t feel that you have needs that require accommodating or can manage them without support from your employer.
You might worry about where information gathered by panel members will go and whether people are trustworthy to maintain your privacy.
Concern that even if you get this job, opportunities for advancement could be limited by poor understanding of your illness.
You might be well and consider it unnecessary at this point in time.
You might not want to distract the panel from thinking about your abilities by talking about areas of need.

When contacted with an offer of employment

Why you might …

You are able to discuss your needs without risk of missing out on the job due to discrimination.
You can arrange to enter the work place with a plan in place that accommodates your employment needs and commence as you mean to continue.
If required and with your consent, the employer can arrange appropriate mental health sensitivity workshops for managers or staff by organisations such as Beyond Blue or circulate general anti-stigma/population health information among routine organisation circulars, yet not make it obvious that it was for your benefit.
Allow development of appropriate support and mentoring systems.

Why you might not …

Fear of stigma, gossip and/or discrimination.
Currently well and don’t feel that you are affected at work.
Work does not need to know.
Protection of positive image and opportunity for advancement.

During the course of your employment

Why you might …

You decide that your employer is trustworthy.
You become unwell.
You encounter difficulties or are not performing to standard because of symptoms or medication side effects and need to offer reasonable explanation or require support, alternate work arrangements or time off for medication reviews etc.
You are being harassed or bullied.

Why you might not …

It might not be necessary.
Protection of positive image and opportunities for advancement.
It might result in harassment and discrimination.
You are able to manage your needs without workplace support.

Never disclosing

Why you might …

Protection from gossip and discrimination.
Protection of positive image and opportunity
Privacy
Stable health
Lack of necessity

Why you might not …

Difficult to prove entitlement to compensation in case of illness, relapse or deterioration due to failure of workplace to meet needs for psychological health if they were not disclosed.
Relapse or need for hospitalisation might put your job at risk.
Might discover a positive attitude to mental health issues within workplace.
Legal obligations under occupational health and safety act where specific work related tasks are affected resulting in serious risk issues.

What did I do about disclosure to my employer with my job?

For me it was simple. I told mine. I disclosed at interview. I felt that this was necessary because I had taken my previous job without learning to manage my mental health well and my references would have reflected that in the answers to some of the standard questions that interviewers ask referees no matter how careful the referees were. I chose to take control of this situation at the time of my interview because having reached interview I could present myself as a competent individual in person, demonstrate that I was healthy and create a positive impression before and whilst disclosing. I also needed to disclose because I wanted to work less hours than the position entailed and needed to offer a good explanation. I told them that I had depression, how it affected me in terms of energy levels, concentration, seasonal patterns, medication changes and how I managed these things to be able to work. I spoke of arrangements that I had previously made with my former employer that had been helpful and asked if they would be amenable to such strategies. I also used the opportunity to tell them things that I had learned and accomplished through the experience of working, the determination and dedication that it entailed and the commitment to my job that resulted so that I could achieve personal satisfaction through working. In my case this had a positive effect and outcome, although it doesn’t always. I don’t disclose before I have the chance at interview to sit down and talk with the employer so that I can get a gauge on how they are reading what I am telling them and to avoid preconceived assumptions about what I will be like that are difficult to shift. There are always risks associated with disclosure, but my reasoning is that if they are going to discriminate when I am well, I would rather not have to deal with them if I were to relapse.

When I am in the workplace I lay low for a while and watch what goes on around me. As long as they are not untrustworthy, I tell someone if they are closely and directly affected by my health so that they are not left in the dark if I have to take leave at short notice. That’s usually only one or two people. Often they are among the first to notice that I am off my game, so it can work in my favour because when someone who I work closely with starts asking if I’m okay and comments that I’m not myself before I notice anything, it gives me a cue to step back and check my early warning signs and triggers. Over the course of years there have been a couple of people who have learned how to pick my good and bad days at least as well as I do myself and also to support and accommodate me through the bad ones and to lean on me in return when I’m good. I’m pretty limited in what I disclose to start with, but with proof of worthiness comes more trust.

My current situation in my new workplace is new to me. I have always had employers who were fiercely protective of my privacy before. I have little in the way of evidence about my current manager, only the report of one other worker about two specific occasions of breached privacy. I have, however worked in a place where it has been possible to work with my information kept private and so I am prepared to stand for my rights in both privacy and in workplace accommodation now. If I expect the respect of others, there may be times that I need to stand up and remind them what it entails. This is however new to me and the workplace is one with strange dynamics.

I have included in the Fact Sheets menu this week a document called “Choosing Your Path. Disclosure: It’s a Personal Decision“. It’s about disclosure of ‘disability’ (or illness) in education and training after High School and employment and the processes of application, entry and engaging in the roles. The booklet discusses legal issues, reasons why one may or may not disclose at various stages of training or employment, responsibilities and some of the considerations to ponder in making your decision. Also have a look around the Beyond Blue website as they have a number of resources for work sites and managers as well as fact sheets about telling your employer about your illness and maintaining good mental health for tertiary education students. Lastly, I have listed a book called “Tackling Depression at Work” in the Books menu. I’ve not yet read this one, but it was written by reliable people and has been well reviewed so should be worth a read. I have listed the book at the publisher’s site, you may or may not be able to find it cheaper elsewhere if it interests you greatly.

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Black Thumb 06/11/2011

Filed under: Depression,Function,Goals & Purpose,Managing Depression,Medication,self-management strategies — jillnottelten @ 1:38 pm
Tags: awareness, Depression, early warning signs, exhaustion, Habits, medication, Mental Health, Mindfulness, planning, purposeful activity, Relapse prevention plan, routine, self-management

Habits. My life is full of them. Good ones. Bad ones. Helpful ones. Ones that I have resolved to end a hundred times over, yet continue with. I have things that I do because I like to. Things that I do because I have to. Things that I do because that’s just what I’ve always done. Some I maintain consciously, some unconsciously; and some are maintained by failing to maintain others. Habits.

I spent yesterday afternoon pottering in the garden. Among my many little chores I spent lifted bulbs from some pots.

Now, I am very new to gardening. My once black thumbs are currently oscillating between a brown and occasionally get a very slight hint of green (until I forget to water the garden for a few days in a row). There is no science going on – it’s all experimentation … almost. I do occasionally look things up on the net. After I write this post I will be looking up what you do with bulbs after you lift them.

Which brings me to the some of the reflections that I had yesterday as I waxed poetical in my head and got very grotty at the same time.

I have never grown plants that were bulbs before. So this year was certainly an experiment. Some grew and some did not. I believe that I probably planted some upside down, but can’t confirm that. I probably over-watered some … they rotted in the soil. Others grew and didn’t bloom. I am not keeping bulbs of plants that did not bloom. Some grew and missed a few days water and got hot wind and died while others did quite well. Some even made it to bouquets for friends.

Yesterday came to the beginning of stage two of my experiment with bulbs. I went to the pots that held the plants that had bloomed that I had liked and decided to lift the bulbs. Not quite sure of the correct procedure I began to burrow. Now the first pot was not so difficult. They were tulips. The second pot I did just to get rid of the bulbs because I still wanted to keep the pot, but needed to get the bulbs out. They too, were easy to find. The daffodils gave me no trouble. And then I came to these other plants – whose name I do not recall – but the bulbs were in little nests that were distributed unevenly around the planter box and while the upper couple of bulbs in the nest were of reasonable size there were also bundles of little balls – I assume new bulbs – that would often fall free and needed fishing for. It took a lot of work to sift through this pot to lift the bulbs.

While I was doing this it struck me that If I were this thorough with everything, much of my life would be a lot simpler. I would not have forgotten to take my medication yesterday morning had I refilled my dosette box when I emptied it. I would not get weary looking at the mess in the kitchen as often if I were in the habit of cleaning up after myself as I went more regularly. I would be exercising regularly by now instead of simply planning to start within the next month. I would not grow weary from lack of sleep. In short, I would be more scrupulous about my habits. Certainly it’s laborious. Yet, there is a purpose to these habits the same as there is a purpose to my clearing the pot. I am seeking to be in the best of health so that I can get on with living and doing other things. Just as I was clearing the pot so that I could plant something new in it that would grow over the summer months. There is a purpose to maintaining habits that are mundane that is anything but.

The second reflection came to me while I was battling one-handed with my bush rose whilst watering it. I was attempting to remove the spent blooms – I’ve been taught to do that, but don’t do it regularly enough so there are lots at present. They’re all over the bush. Some of them were impossible to get to without doing battle with thorns while working one-handed. Others, within reach while able to be grasped and eventually detached, were not easy to remove. I also managed to get spiked by the tree regardless. Ouch. How different the bush rose was from the geraniums which simply slip off the plant with the slightest pull.

I am much more like the bush rose than the geranium when it comes to surrendering my bad habits. How much simpler life would be if when I noticed that I needed to change I were able to simply let go of the old ways like my geraniums. But, no. For me it is work. It requires effort and often shakes up the petals of some of the other flowers during the process. Occasionally, not just the dead rose came off with the pulling, but some of the good ones beside as well. I think my roses are very much like my habits. They grow without effort and bloom. Often they serve a good purpose, but then are no longer needed. Other times they just are. But when they are past their usefulness and deadweight, burdensome – they do need removing. Sometimes it can be done while I’m doing other maintenance like the watering, but I think that I am going to have to go out soon and pull them off myself deliberately. One at a time. Not a job that I see as stimulating, but to encourage the bush to be productive and to keep it looking healthy it needs to be done. Now I just need to take the same path with my troublesome habits and learn to tackle them one at a time and replace them with helpful ones.

Will I be as meticulous in dealing with my dead habits that are no longer blooming as I work at being with my flowers? Will I dig and sift as thoroughly as I looked for my bulbs when it comes to removing them?

Again I set my resolve to commit to tackle my environment and not let it get out of control (The kitchen, living area and study are cluttered again and the floors are past cleaning time). My dosette box should never be left empty – I used to be good with that. There are a number of other things that I need to sit down and map out.

Which plant holds the flowers that are hardest to remove in your garden? Just how carefully are you prepared to dig out your bulbs?

I think I still have black thumbs in the habit garden and it’s time to green up. What colour are your thumbs?

It's loaded now!

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Forgetfulness

Filed under: Depression,Experiencing Depression,Managing Depression,Medication,Poetry — jillnottelten @ 12:11 am
Tags: awareness, Chewing gum, Clinical Depression, Depression, early warning signs, medication, Mental Health, recovery, self-management, sensory modulation

This morning I forgot to take my pills

which wouldn’t be so bad –

Except that I forgot yesterday as well.

And so today I’m spacey cos I don’t

forget to take them as a rule

And my senses feel estranged – they ebb and swell.

My mind is hard to focus

I need to find some gum

When I chew I can organise my thoughts

I could crunch to concentrate

or just sleep to rejuvenate

And tomorrow take my meds just as I ought.

ps I usually use a Dosette box, but got slack about refilling it this week. Bad move.

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Watching Wellth 16/10/2011

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

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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
Tags: Abilify, Chondriatin, Clinical Depression, Depression, Dexamphetamine, Edronax, escitalopram, function, Glucosamine, Health, Inderal, Lamictal, Lamotrigine, Lexapro, Lithium, medicare, medication, Mental Health, Ostelin, PBS, Propanolol, safetynet, self-management, Topamax, Treatment Resistant Depression, Valdoxan, Vitamin D

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.”

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The Dog in The Fog 27/07/2011

Filed under: Clinical Depression,Cognitive,Depression,Function,Managing Depression,Medication,My Black Dog — jillnottelten @ 7:43 pm
Tags: black dog, Clinical Depression, cognition, cognitive, Depression, Edronax, Lexapro, Lithium, medication, memory, Mental Health, Mood, processing, recovery, thinking, thought, Valdoxan

There are a lot of things I hate about Depression. Take your pick – the effect it has on your self-worth, your energy levels, your mood, how sociable you feel and act, your self-image and presentation, that non-expression on your face … or the medication – weight gain, constipation, tremors, medication for the tremors … the constant need to micromanage your life to prevent relapse routine, exercise, diet, sleep, early warning signs, triggers, medications, appointments and to cap it all off there’s the increased incidence of things like diabetes and heart disease in people with depression. Some of these are direct results of depression. Some are spin-off effects from symptoms played out in the lifestyle. Some are medication related. But by far the effect that I loathe the most is the ‘fog’.

Thinking in ‘The Fog’ is like those movies where a character moves across a misty set barely able to see what is in front of them, working to make out the shadowy forms in the haze before them until the mist folds away just before they meet it to reveal what is there – yet the objective never quite within sight. When I am not well my mind is in stupor. Gears creak. Cogs struggle to turn. I forget things constantly. I lose my place in what I am trying to communicate to someone. These are things I was once very good at. As I get better I can do all of the things that I used to do – but many of them I do more slowly than I once did. It now takes me longer to process things in my head – arithmetic, deciding how to express something carefully, making a decision, figuring something out. Some of this is because of medication – but not all of it. Some is the Depression itself. It has slowed my once quick mind. Recent changes to medications have freed it up a little, but it is still not what it once was.

It is not obvious to everyone. Mostly only to people who have known me for a long time before and after the Depression left its mark. When talking with a friend and therapist with whom I once worked once told me that the difference had made her cry. It was such a relief to know that another person was grieving too.

I had an ongoing dilemma with medications until recently that centred around a Lithium fog. After years on a tricyclic that kept me well in tandem with Lithium, I eventually had to stop the Lithium so that I could use anti-inflammatory meds for chronic back pain that wasn’t responding to any other form of treatment. The result was that the back pain settled reasonably quickly, but it was difficult to keep my mood stable on the tricyclic alone. In the end, my Doctor suggested that a medication change was the way to go and I finished up on a combination of Lexapro and Edronax. Beautiful. I could think. However, like the tricyclic (which I’d been on because SSRIs on their own didn’t work), in reality my mental state was still not really robust. Finally, after much resistance on my part, I restarted Lithium as an augmenting medication to bolster the main ones – and, for stability I did need it. But it really stank. The fog was back. Lithium, I find does slow me down – preferable to relapse and job loss – but still unpleasant. My best news has come with the release of Valdoxan. Given how much I hate and object to the use of Lithium, my doctor has trialled me on this in place of the Lithium as my augmenting drug and it is working beautifully and without fog. So what is now left that is attributable to medication is as low as we can get it.

What has been affected is what I will call my ‘working memory’. The part of the brain that is operating and pulling everything together at any moment so that I can think, move, find information that I know, solve problems, come up with ideas and take action of any kind. It is where what is needed from my short & long-term memory, senses, visual-spatial understanding, communication and organisational understanding and my level and focus of attention are is pulled together and used to observe or interact with the cues, instructions or things in the environment around me to guide my actions in a certain way. It is where, to a large extent I can regulate the speed of my actions also. BUT here’s the thing. When I’m not well my level of attention is affected so I miss information from the environment and not all of the information that my mind needs makes it in. The speed of the working memory slows down, my memory is fuzzier and less accessible, I lose the flow of operations I am doing. It’s like if there is a little man inside my memory coordinating all the information, he ages 100 years and can’t manage all of the information when I’m depressed. When I’m well he returns to almost his original age and moves reasonably well; but he’s been left now with some injuries – back strains and a touch of arthritis that slow him down just a little on the fine and detailed work or when handling really heavy stuff. He can handle it, but he’s not as fast as he was before the injuries that the sudden aging episode left on him. And nor am I.

At times I think walking with a black dog is like walking through the high mountains where there is rarely a day unaffected by mist – not necessarily always pea-soup fog; yet always just a light haze. Not enough to hamper most of the time, but enough to dampen the spirits and frustrate – especially one who is unaccustomed to fog. But the moments when the fog lifts and the sun shines through – Oh my! They are glorious.

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I have a Dog 23/06/2011

Filed under: Depression,Managing Depression,My Black Dog,self-management strategies — jillnottelten @ 11:13 pm
Tags: black dog, Clinical Depression, Clinical Psychologist, family, GP, medication, Mental Health, mental health workers, planning, Psychiatrist, recovery, responsibility, Social supports

I have a dog.

Lots of people have dogs. Most of them are called things like Spot, or King or “Here, Boy”. They’re spotty Dalmatians, flat-faced Rotties, alert Alsatians, perky Jack Russells, yappy little floor mops, podgy Pig dogs, loyal Labradors and trusty Heelers. Or so we say. Most of them are bitzers. But the average household dog is loved.

My dog is a black dog. He is with me everywhere I go. I have what is known as treatment resistant Depression.

My journey has been a strange one. I find myself standing amidst two different worlds on a regular basis. In one world I stand with my black dog, visiting a doctor. In the other I stand with the doctors and other health workers trying to keep my dog out of the way while I see others who come to me, some trailing their own black dogs. I am also a Mental Health worker. In fact, I was a mental health worker before my black dog came to join me. While I had been an empathic one before this, the shift in perspective gave a lot of insight to the way that I worked.

I will always be glad not to have been in the workforce at the point in my journey when my symptoms of depression became so severe that I couldn’t function. It was a spectacular crash. I was – it seemed – irretrievably tangled in this black dog’s unsecured lead to a point where I had tripped and was unable to get up again. Mongrel dog. As it was with a lot of time, hard work, patience and medication I was able to get untangled – but I’m stuck with the dog and the lead.

More time, more and more review and adjustments to medications by my Psychiatrist, a lot of work with a Clinical Psychologist, an excellent GP, a supportive supervisor and manager at work, a couple of great friends and a magnificently supportive family behind me and eight years later I have my black dog much better trained.

With a lot of time, effort, meds, bucks, sweat and tears I have trained my dog to walk at heel. He does not run riot anymore. He is not a puppy. He is still a challenge and will always need a close eye. There will always be times when he moves unexpectedly and I stumble on his lead or get pulled in a different direction. There will always be places that are not as dog-friendly as others, even if it’s not deliberate. When making plans I must plan not only for my needs, but for those of my dog. They can be costly in all senses of the word. They can be inconvenient. They can seem impossible.

But if I plan for him, I can plan for me. And I can do all manner of things.

He is not my pet. He is my responsibility. I am never without him.

He is my black dog.

livingwithablackdog