Update; switched medicines

I haven't written here for a while, and I probably should have. But then again, I should stop feeling so guilty all the time. :-P

I got picked up by the Huddinge Hospital unit for affective disorders -- they do a sort of an outreach programme to help other medical personal deal with affective-spectrum patients. So I now see a psychiatrist at the university hospital expert unit for Bipolar 2. So far, I have been really impressed with that contact.

December has been exceptionally crappy. My new psychiatrist switched me from fluoxetin+wellbutrin to lamotrigin (anti-epilepticum with recognized use for mood stabilization with bipolars). Stepping off of the SSRI/NDRI cocktail was painful, with almost a week lost in back-to-back anxiety pangs. Then I stepped straight from there to a round with the flu that had me floored for a week. I'm slowly getting back to sensible speeds again, but it is slow running, and not particularly comfortable en route.

As for mood, I feel like a wad of cotton has been removed. I feel clearer, brighter, and more ... interested in things. I also have re-acquired my sudden, unexplainable and deep anxiety/sadness blips where I crash out over a time period of a few minutes, and then after spending up to maybe 30-45 minutes as a tearful wreck suddenly return to normal about as quickly. It's disorienting, and a bit of a strain for the people around me, but I hope that as we ramp up lamotrigin these blips will reduce in frequency.

That's it at the end of 2014. Happy holidays all y'all.

Evaluating differences

I can tell that I behave differently now from a year ago, or a couple of years ago. Different in several ways — some obviously good, some possibly bad.

Unnerving, though, are the differences that I find myself unable to evaluate.

I've been fretting a little bit lately over my own work productivity and focus. Nobody is complaining, far from it — but I notice how my roles in my collaborative projects are shifting around. I am doing far less of the project leadership I used to do: run far ahead and pull everyone else along by persistence, constant communication, and waves of work. I am being less focused, less productive, when I'm actually in the office, and doing less work when not in the office.

And here's the thing: I can't tell if this is good or not.

It's a difference, which unsettles me a bit.
It could be bad, could be a part of my depression, could be something I should work at breaking out of. Breaking out of the lethargy, act as if I don't feel it so that eventually my actions pull my mood with them.
It could also, just as validly from my own viewpoint, be a good thing. It could be that I finally manage to pull down my own self-expectations to something manageable, something that won't exhaust me utterly, something more on the size of what I can sustain happily and healthily.

But right now? I don't know, I really don't.

Accepting and Not Accepting Professional Advice

A sheep in a grove. Not a metaphor for the groves of academe, honest.

I'm taking Prozac. I had no idea. I'm not one of those types who obsesses about the drugs the doctors give me. I went to the doctor and she gave me fluoxetine.  Never heard of it, started taking it. Turns out it's Prozac (well to be precise it turns out that Prozac tm is fluoxetine.) Just now I am seeming quite anxious.  I hope this is a side effect that the doctor warned about, that sometimes you feel more anxious for the first couple of weeks. Because I'm not enjoying it but if it means the drug is working and will kick in to reduce anxiety soon, that would be nice. 

That was just some stuff to tell you before I get on with the post.

I had my appointment with Occupational Health at St Andrews the other day. 

I am really glad I found out about them because it was very useful to have somebody to talk to and get advice on things like when to go back to work.  I'm actually surprised - maybe disappointed - that I didn't know about them before. It was only when a friend with depression told me that it had been useful did I think of going to them. I have been doing well since then so didn't feel the need, but when I had my recent crash I definitely knew that I wanted to talk to them.  I can't comment of course on whether Occupational Health or equivalent at your university or workplace is good and beneficial. Indeed I can't tell you that at St Andrews they will be useful to you. But it's certainly worth investigating.

Some of the advice I got I am taking but some I'm not.

And the main piece of advice I'm not taking is that I am writing this blog post.  I was advised that it might not be in my interests to blog about my illness here (or on facebook or twitter), because things I write here might come back to hurt me.   However, the advice was further that if I had to blog then be sure to let me wife read it or let it sit for a day or an hour before posting it. 

Now I have mixed feelings about this advice. Because the whole point of Depressed Academics is a place for me or anyone else to talk about this issue in our lives. And to be a vehicle for other people to see that it is there in our lives.  I've mentioned before I find it dispiriting that this little blog is one of the first hits when you search for depression in academia, because it shows how little there is out there. 

So therefore my gut reaction is that I want to blog here about my depression and current mental health issues.  So here I am.  

But it's really important to say that I don't think that anyone should talk in public about their mental health - or any other kind of health issue - unless they are completely comfortable doing so.  That is incredibly important to me.  I mean that being open about my issues is my choice and I don't want anyone to think that they should do the same.  I don't want anybody to see this blog or my posts and think: wow, well there is depression in academia but you have to talk about it.  No, absolutely not! There is depression in academia and you don't have to talk about it. But if you do want to talk about it, like some of us here at D.A., then this is one place you can do so if you wish.

So that advice on not blogging? Well, I think I'm going to not accept it. Which you can obviously tell because you are reading this. 

But does that mean it's bad advice? No, I think it's probably good advice. Mainly because of the point I made about nobody being under pressure to be open. Also because - and this is a very good point I hadn't thought of - when you are in the midst of mental health issues, your judgement about what to say and what not to say may not be quite right. And also maybe it could hurt your career.  Either because somebody treats you wrongly, either consciously or subconsciously (and in either case very likely illegally), or because you say something which is held against you which you wouldn't normally say.  The latter is a worry because in the heat of stress and upset one might well say something, maybe about a colleague or the university or the department, and which may be true but would have been better left unsaid.  

I can say that being open here on Depressed Academics on the off chance it helps others is just simply is more important to me than my career. I am incredibly lucky to be a full professor at a great university. So actually I really don't have to worry about my career much, as long as I'm able to do my job. I'm also firmly convinced that I don't want to move into more senior university management, not least because I'm not sure my mental health could cope with it. If a statement like that comes back to bite me later, well so be it.

So I conclude I suppose that this was good advice that I am choosing not to take.

But I will take the advice of not posting this until I let my wife read it.  Just in case. 

Other advice was good and I am taking it. 

One was to try and do things with my time off. Not just slump in bed (which is where I am writing this, sorry!) So to get out for a walk for example. That was great advice and I took it the next day. The lovely bucolic pictures on this post are from that walk, up the hill that overlooks Cupar where I live. Obviously these are selected, and I didn't take a photo of the cellphone mast with the unofficial dump next to it. But that aside, these pictures are actually representative of the walk. 

Another was to take the whole time off which the doctor signed when I went to her last week. Which is five weeks.  I don't really want to be off for five weeks, but my brain just doesn't seem to be there. Plus of course judging when to go back is tricky when the whole problem is anxiety and your brain not quite working well. 

Another piece of advice was not to feel guilty about taking that time off. I'll try to work on that one, but I am quite good at feeling guilty. 

I'll close with a random observation which might one day be another post. While I was in the throes of my referendum obsessions, I wrote many thousands of words on facebook and in blog posts etc, and it seemed very easy. I mean I wasn't sitting there thinking "oh I must write, oh no..." And I also seemed to find my voice. I don't mean that my voice is talking endlessly about the referendum, but that I mean the "voice" in the sense of an authorial voice. If you don't like the word voice, I suppose it's just a writing style.  But I'm going with voice. 

So I found my voice over the weeks before I crashed, and I found that I quite like it. It's long winded, has asides and longer diversions, doesn't start where it ends. So I don't see any reason why you should like it, but I find it easy to write and some people do like it.  

So I wrote this post in that voice and here it is.  If my wife says it's ok.

Appointment and Shopping

I've got an appointment at Occupational Health Service at St Andrews University, which I've heard good things about.  So that is a good thing. 

I wish I'd known about this organisation earlier. I'm a bit embarrassed I didn't, but also I suppose it needs better publicity.

I went shopping today to get some beer and crisps.  But making tiny choices seemed very hard: should I look for meringues to make Eton mess??   It's well known that decisions become hard when you are anxious, but I really saw this - and felt it - today.

I'm microblogging this because ... I don't know, but I am.

Feeling normal from time to time

Last night I had a bath and afterwards realised that during the bath I more or less felt normal.  I mean, normal being however I usually feel, which may not be normal at all.

Also this morning woke up with the same feeling.  Got up and got breakfast like I normally do instead of slumping and waiting for my wife to do it.

Later on started to think about the referendum again and was winding myself up.  But managed to catch it, and have a nap.  Not feeling normal right now but not too bad.

For me the not normal feeling is a slight clench in my stomach telling me that something is going to go wrong: maybe not my stomach but just on the bottom of my ribcage on the left.

Apropos nothing I'm pleased that my sense of humour never went away. I don't mean it's particularly helped me, but it's nice that I'm not completely broken.

And here are two news stories on the referendum that have cheered me up a bit in the preceding days:

Random donations to a food bank, showing that many Scots want to get over the referendum and get on with helping other Scots.

Tam Dalyell on the West Lothian Question (partly because I honestly thought he had died so was pleased he's still her).

And finally here's an amazing story that I hadn't heard about until now

India got an orbiter round Mars for $71 million.  !!!

Vignette

1. On Friday, I had to sign for medicine. I couldn't remember the day of the month, the date, or the year!

2. Today I had to park to get medicine. I forgot and drove past, but pulled over with a slightly longer walk. Then I got the medicine and walked home. So I walked back to get the car.  (It was about a 5 min walk away)

3. I'm very glad i started Depressed Academics 21 months ago because I couldn't have started it now and it's nice to have a friendly place to chat.

It's Anxiety

Should have realised.

Went to the doctor for symptoms of anxiety and she changed my medication to be more anxiety focussed.

Don't know if that will help.  I'm not obsessive about meds so haven't even looked at the name yet.  Apparently it can make me more anxious for the first couple of weeks.

I think the anxiety is an issue.  I am a worrier definitely, and then join that together with an obsession, I dunno but it could be not too healthy. In this case - the referendum - obviously it can cause anxiety.

But now I have whatever you have when you anxiety. I think it's called anxiety.  The tiniest things set my heart racing and I notice it.

Anyway, it's anxiety.

Vignettes

I feel like my brain is a million pieces of jelly, shaken apart and now hoping to settle back together again in the right order.

Yesterday I wanted to listen to an audiobook or podcast and I simply couldn't decide which. This has never happened before.

Lots of nice mails and comments as I expected.

Successfully got off facebook and twitter but it's harder than you think.  Now can only get in with entry code that goes to my wife's phone.

I don't know which side of breaking point I'm on

I met an old friend today, and I mentioned I was having trouble.  He said an interesting thing, along the lines of "As long as I've known you, you've always been on the edge, but you've always been able to hold it together."  This is a very good description and I have recognised what it describes in myself before as what you might call "high-functioning depression". But I'm not holding it together now.

Straight away I'll tell you I don't feel suicidal in any way.  Don't want you to worry.

But otherwise I'm not coping at all.

Last night I stood in my bedroom in floods of tears.  My wife held me tight.  My children came in and also held me.  My daughter stroked my left cheek,  to my wife's disgust (not really) since she had previously stroked it to no effect.

Earlier in the day I had a wonderful experience that made me really happy. I wanted to come straight home (about 6pm) have supper and write about it.  But it was now 9 or 10 and I hadn't started. I was upset with myself, and also wound up.

What was I wound up about?  The Scottish Independence referendum, as I've blogged about here. Not only was the referendum over 2 days ago, but my side won. I thought it would get calmer then, but somehow it didn't.  I guess the problem is that my obsession didn't know it was meant to be over: why should it?  I mean normally it's something timeless (like chess problems) so it can just go on as long as it wants.

In fact it's got a lot worse.  I think there are various reasons for that. The election night (the night before last) had me going to bed at 4.30 or 5 and up again at 7.30, so obviously mild sleep deprivation doesn't help. Annoying because I hadn't meant to do that.  With bad timing my pills ran out a few days ago and I only just got them back again. My fault for not refreshing the prescription because I was doing so well!    What's been happening after the result has been very different to a normal election, where one side celebrates and the other side is miserable.  So I've still been winding up, plus of course there is a lot of postmortem stuff my mind can obsess over.

Anyway, what happened over the last couple of days is that the obsession took over from something that happened to me when I wasn't doing something else, and on a good day I could beat with website blockers, to something which was full on all the time.

I still file like I'm just on the right side of the breaking point. But I don't think I can stay there much longer if things go on as they are.

Ok, don't be stupid Ian. What the bleep are you thinking?  You know you are way past the breaking point.  But I did write those sentences in all seriousness.  Same with the post title. Kind of interesting the way your mind plays tricks on you, huh.

It's obvious I can't do my job at the minute.  Not to anything like a sensible standard.  I could probably hold it together enough to go into work and to come home, but to nobody's benefit.

So what I'm going to try to do is this.

By a lucky coincidence my sister and brother in law are visiting this week, so I think that time with them will be a great help and take my mind off things.

1.  Tell my head of department and school welfare officer this fact
2.  Turn off twitter and facebook completely for a week
3.  Greatly reduce and possibly stop email completely ditto.
4.  This all has some problems because of "forgot your password" and the like.  I'm sure I can sort something out with my wife.
5.  Do things I enjoy like cooking, reading.
6.  Do more running because I have found it really hard to get enough done over the last year or so and I enjoy it - though I wouldn't say for sure it helps my depression.
7.  Keep taking the tablets
8.  Go to see a doctor
9.  Have naps
10. Hug my family
11. Drink a bit more.  Sounds crazy but I've been cutting down for a few weeks and I feel that has worked well, but it just seems like something extra to worry about. Obviously take this back on doctor's orders but that's the plan right now. My drinking is not out of control, because fortunately I don't like to get drunk.  But I do like to drink a moderate amount all evening which takes me over the advised weekly allowance.
12. Ditto eating. Comfort food.
13. Avoid coverage of the referendum, but that's a bit tricky... but certainly I can't let the
14.  Talk to the university occupational health officer - probably via school welfare officer.
15. You know, whatever, I'm not really very functional right now so I think I'm going to stop worrying about this list.
16. Ask my sister to read this post. I've never been very open face to face, while very open online as you can probably see from Depressed Academics.

This seems like quite a long list to me.... but ... umm... well ok I guess we just see what happens. In my family we tend to make long lists and then get upset that they are not done.

It might be that a week turning off and on again will get me back to normal.  That would be cute.  Because there's important work I want to do and was getting into the flow of when my brain wasn't stopping me. But I have no idea how long this could be.

I suspect that I've been this bad or nearly so before. But certainly those other times I didn't decide I couldn't do my job. Now I look back from here I probably should have done.

Honestly, since I started Depressed Academics 21 months ago I have always had imposter syndrome here because my depression has been under control.  I don't feel like an imposter at the minute.

There's one last thing I'm going to do, which is to tell everybody. I mean, I think that is pretty clear by now.  But also I'm going to mail the staff in the department to tell them. I don't think people should do that in general, because their health is for themselves alone, unless it affects their work. If it does, there is a VERY limited group of people who need to know.  Other people might just need to know that somebody is away or not available, or signed off for unspecified reasons.

Obsessive, moi?

Ok, I get it.

I completely get that my current obsession with the Scottish Independence Referendum isn't healthy and isn't helping anyone.

Background

Three days from now (as I write) the Scottish electorate will go to the polls to decide if Scotland should be independent from the UK, or remain - as it is now - a constituent nation in the United Kingdom. The decision will be on 50% + 1 vote and will be definitive. The referendum has been in the schedule for several years, but of course it is now reaching fever pitch. There has been regular polling throughout, which for a long time was roughly 42-45% Yes, 55-58% No.  Recently the polls have tightened to very close to 50:50.  For sure, nobody knows which way the result is going to go.

What do I think?

If you want to know what I think, you can find out on my personal blog, where a number of posts discuss various aspects of the referendum. Or if you want less considered thoughts, look at my twitter timeline. Well if you want to know even more, and you know me in person, friend me on facebook.

Obsessive, moi?

I'm completely obsessed. I have wasted days online refreshing twitter and facebook, surfing the links that come up, looking at arguments. I find myself just absent mindedly clicking on facebook and twitter to see what's new a minute into trying to do something important. I installed an app to block  these sites, and would find myself going to my phone to get the info, though it did work a bit. And then I wasted half a day because the app wasn't working.

I've posted many many many comments on facebook.  And many tweets on twitter.  And I have also written and deleted posts before sending them. And many more I have mentally composed without writing them. And many many more thoughts have entered my head about the referendum.

Not helping me or anyone

I don't honestly think I've been helping others very much. Maybe a bit, highlighting things they hadn't seen previously. I have had some good arguments where both parties have left thinking differently, not on the main question, but on some of the issues. But equally not helping them by bombarding their timeline with what are often ranty posts.  Ranty because I can't hold myself back in the middle of whatever thing infuriates me this minute. And as I say, my friends should see many of the posts I don't send!  Oddly, today I did get a mail from somebody saying he was enjoying my posts: I think he must just be the politest person on the planet!

The point of this essay is not whether I am helping my friends or not. It's that this obsession is obviously not healthy for me, and I know that because my brain gets so scrambled.  It just gets to a place I hate, where almost every thought is about this issue, I can't fix any of it,  it matters very deeply to me, and it causes me pain.

Simply put, I'm a worrier, and when I get into a certain loop it just takes over my brain somehow.  I know this because it's happened to me a few times before in my life. All have been extremely unpleasant to me. Usually about some failed relationship in some sense (and I'm not going to go into details about those.)  When it gets like this I feel in danger. Not so much that I am not functioning - just now I'm doing functioning well and I'm not even depressed.  But I feel like some stick could hit the fast spinning wheel of my brain and throw me off it, with unpleasant effects.

Obsessive, moi?

Obsessive is what I do. I get into some computer game, and just play it to death. Eventually move to the next one and never pick up the old one again. My daughter noticed this years ago: it's not subtle. I archive binged on books decades before it was possible on films and tv. It was Asterix, or it was Asimov, or it was Peanuts.  And I would read them over and over again, not going on to the next obsession.  Now I get into a movie or tv series and watch it over and ... well I think you are getting the idea.

If I find something fascinating I just obsess about it and think about it all the time. Growing up it was cricket. I would get out my reference books and compile all time great teams composed of players with the same initial letter. (If I remember right the H's and B's were particularly good: Holding and Headley against Bradman and Botham amongst many others.)  For a few happy years it was chess puzzles. I particularly enjoyed helpmates. I would have long baths and do several puzzles in them with a portable chess set (a wonderful one found by my wife.) I would wake up and think about a chess puzzle in my head, have an insight, and go to the chess set to find out if I was right.

You might see where this is going. This obsessive brain that doesn't stop thinking about stuff is one of the reasons I am good at my academic job. I think and think and think and something comes to me.  Often the result is garbage. Sometimes they are really good ideas.
 
I wouldn't change it

I would love not to obsess about a broken relationship or the independence referendum.

But if I had a choice of a button that changed my brain to be non obsessive like it is, I couldn't hit it. The risk would be too great that I would change myself so I wouldn't recognise myself and I would be no good at my job.

Emotional selfawareness — the rare success

So this is something I struggle with. Noticing how I'm feeling early enough that I could possibly do something about it. It was the main focus of my first therapy, back a decade ago: mapping my swings so that I could pick up on warning signs and figure out ways to disrupt them before they started a resonating, self-amplifying feedback mood spiral.

It is really hard to do though. Especially since many of my mood swings sort of self-reinforce. It's only natural that I feel crappy, because I should be feeling crappy, because I don't deserve to not feel crappy, so I shouldn't even try to knock myself out of it… things like that…

But today, a measure of success:

I traveled all day today. Got out of bed at 4.30am to fly from Vienna to Stockholm. Couldn't sleep yesterday night. Have been resigned all day to how sooner or later this sleep debt will kick off a mood swing. Just waiting for it.

It came now. Just as I was gearing up towards maybe packing myself into bed, I felt pressure behind my eyeballs, and my breathing got strained and sorta staccato-like, and an overwhelming need to cry.
Came and went in waves. There a minute, gone a minute

I realized that this wasn't how I should be feeling.
And then I remembered: I actually have something for this. I got oxazepam against the rare case where I want to knock out a feedback spiral before it starts. Together with a lecture about drug-seeking behavior, and cutting down the dose for each pill, but that's good enough for me.

Took one.

Knocked out the spiral.

I now no longer feel like a crash is impending. Nor like it necessarily needs to show up at all.

If only I could remember these the times I crash so bad my face goes weird or my movements just slow down…

Running uphill to get any help

I am frustrated with how my clinic is handling me this summer.
Frustrated and annoyed.

I have a significant threshold before I even get around to asking for help in the first place. I don't think I am all that ill, I don't remember the things that do happen, and I minimize my issues, procrastinating anything even vaguely like contacting health professionals.

This past spring, I finally got around to asking for help from the University clinic in Minneapolis. I got 5 therapy sessions out of the approximate month I still had left before my travels, and immediately was convinced that I do need therapy in addition to the medication I am on. So I did what I thought was the most responsible thing, and got myself an appointment to see my psychiatrist immediately upon returning to Sweden.

Booking the meeting over 2 months in advance meant that I had an easy time of getting a time slot that worked well for me.

The appointment arrived, and I show up on time to the clinic. My psychiatrist, on the other hand, was delayed. Quite a bit. She took the patients preceding me, and in order to get back on track with the schedule of the day I was shunted over to the on-call psych team.

The on-call psych team
1. could not order talk therapy
2. did not understand that I was not in the middle of a crisis
3. ended up requesting a new appointment for me

Now the new appointment has arrived. It's in September. On the same day that I am scheduled to have a work luncheon in Berkeley in the middle of my upcoming US trip.

So now I have to start all over again seeking the talk therapy it is increasingly clear I could use. The entire lead time I had is for naught. And there is that huge threshold again, getting around to even booking any sort of appointment when I keep convincing myself that they don't have time to deal with me, I'm not that ill anyway, and all these things that just delay and delay and delay my requests for help.

I thought I did everything by the book, so why didn't I get help?

[Vignette] Alone in a crowd

It struck again. It's been a while, but I guess that with my moving, the stress of all the conferences ahead of me and the long-ish absence from Susanne all contribute.

All of a sudden I was lonely. Apathetic. Felt abandoned. Felt excluded. Felt worthless.
Only: I was with many many friends. In a bar. For the vastly popular regular bar hangout that I have been organizing all year. And still, I just fade away. My attention drops off. My feelings of engagement, of presence, just drop away. Fade away until nothing exists but me and the pattern in the veins of the wood floor.

My friends being friends, of course, notice after a little while and want to know what they can do. What I need. What I want. How they can help.
I have nothing. I don't know. I'm already … gone. If I knew something that worked, I could have asked for it, want to think I would have asked for it earlier. But I have no idea.

Eventually I packed myself up. Bid everyone a good night. Assured them over and again that I would be fine walking home on my own. That nothing would happen to me. And walked off.

Halfway home, there was a pretty view out from campus. Rolling hills in the distance, fading into the clouds. I stopped. Pulled out my drawing kit (I have a new hobby, a new obsession…) and made a colored sketch. Meditative. Stopped the ugliness, the spiraling, the hopelessness.

A Depressing Reminder That I'm Doing Well

I seem to have had an energy transplant lately.   I don't know who's got mine but I hope they are enjoying it.

That's a slightly longer term thing: doing more teaching than I am used to this semester (entirely reasonable amount by anybody's standards but first year back as full time from being half time for a decade.)   It seems that it's been hard to get the energy to contribute fully and get things done in the key areas I want to outside of teaching.

More recently I had a cold a couple of weeks ago and it seems to be taking me a while to recover.

Today there was a specific thing.

I have been miserable today.  I don't know why.   But I was miserable, was highly unenthusiastic at work.  Came home early and had a nap.   Had a box of Maltesers I had been saving for a moment such as this.   Did have the sense to go for a run as it might cheer me up.   But the run had to be bailed on 4/10 of the way out and walked home.   Had a comfort food supper.  Had a bath.

I try hard to use a word like "dispiriting" when I'm not talking about the medical type of depression.  But this was literally a depressing day.  

But the reminder that I'm doing well is that this is news.   I don't feel happy all the time but I've had months, maybe the odd year, where every day has been like this.  For the last year or two a day like this has been news, so that is nice.

I still regularly say to myself I want to kill myself, but I don't really as I've covered before.  But I guess I can't stop myself saying even here that everything is not perfect even though I've been doing well.  But yes I am doing well.

Remembering I have medication

Over a year ago, when I started my current treatment plan, I got a scrip for oxazepam to help with the anxiety attacks that come with ramping up fluoxetin. Turns out that the anti-anxiety med work incredibly well for whacking me out of an anxiety spiral, so I kept them, and asked my psychiatrist to give me a new (small!) scrip to keep this as an emergency break option.

Today, for the first time in the 17 months I've had these pills, I remembered them while entering the spiral and took one.
Previously I've always either ridden the anxiety out (painful) or only gotten around to the pills when Susanne suggested them to me mid-crash.
Today I actually remembered myself.

I have no clue what was going on though. I was hanging out, lazily surfing the web when I got some sort of discomfort feelings. Either hunger or nausea, but can't quite tell which… And then it went off: within a few minutes I was starting large wracking heaving sobs. Somewhere along the ride I realized something was happening and first googled for anxiety self help techniques before I realized I have those damn pills right here.

Took a few minutes for them to kick in; I went for a (long overdue) shower and halfway through I went from deep sobs to … nothing … in the space of a single breath.

It is a tough ladder to climb:

1. recognize the emotions I experience
2. recognize the emotions when they happen
3. realize I have tools to deal with them
4. realize I have tools to deal with when they happen

I'm sure later stages are on the horizon, but now I'm still struggling somewhere around 3. Sometimes between 2/3 and sometimes between 3/4.

Medication adjustment kicks in

Today, two biggish things happened with respect to my depression.

For one thing, my therapy session seemed to penetrate … something. I shed a large load of anxiety there — we spent the session examining sources of my anxiety and discussing the need for me to recognize my own intrinsic worth instead of expecting and depending on external valuation and validation.
Something in all of that clicked (my cynical side wants to say that it was when the therapist told me I have worth: producing an external valuation to use) a little bit, and the rest of the day has been low on anxiety.

For another thing: the grass was pretty. I was walking along the nicely wooded walkway home, and the low sun was streaking across the malls at a very low angle, so that the individual leaves and leafs in the lawn gleamed with a seemingly inner glow. It was so beautiful I just walked along with a soft smile playing on my lips the entire way home.

I cannot remember the last time I just smiled away on my own because I was content and happy in the moment.

Adjusting meds, taking therapy

I have now, on advice from a psychiatrist here, and after checking with the Stockholm internet based psychiatric advice service that taking advice from other psychiatrists is not some sort of horrendous faux pas, increased my dose of fluoxetine: from 20mg to 40mg. Hopefully, this deals with the anxiety and depression issues that have gradually returned since I started medicating about 16 months ago.

Right now, I'm 3-4 days into the switchover: I have started noticing effects, but not stabilized yet.

I also have started seeing a psychologist for therapy. It's painful, but aspects of it are helpful as well. My worldview is intrinsically pretty horrifying, and once the basic assumptions my emotional circuits work with show up, the size of my emotional responses no longer are quite as outlandish as I am used to considering them to be.

My worldview, on the other hand, is pretty unreasonable. But this is hard to change, and won't happen in an instance.

I have an appointment with my main psychiatrist in Stockholm already scheduled. My plan for that is to

1. validate the medication adjustments, possibly talk about further adjustments - depending on how much the fluoxetine increase dulls me off
2. ask if we can add psychotherapy to my treatment plans. I've done only medication for over a year now, and it helped a lot in the beginning, a little in the middle, and not so much towards the end of the year. It would be ... very nice if I could get to use therapy to help me reshape my worldview so that it is not quite as terrifying.
   Even if it turns out to be difficult to add psychotherapy in my health care plan, I think we will do it. If we have to pay for the therapy sessions ourselves, we can afford to do so, and I'm likely to get some support from my employer's healthcare plans as well.

But right now? Kinda difficult. 

I feel useless. I cannot concentrate. I beat myself up for not doing anything enough. I feel ugly.

Then again, I got rejections on a journal submission and a job application today. So maybe feeling a little bit shitty is not ... entirely unreasonable.

I really should write here more.

My new skill

If anyone read my posts last May or whenever I began writing for Depressed Academics, you would know I was having a really hard time emotionally. Here I am a year later and I have to congratulate myself on something in particular: my new skill of sitting with uncomfortable feelings without being destructive or resorting to some form of escapism.

Truth be told, I am having a pretty hard day today. I've been experiencing mixed states-- a combination of an elevated/anxious mood and symptoms of depression: crying, isolation, etc. Mixed states are probably my least favorite mood state(s) because they can be so unpredictable. The last several days, I was in a hypomanic state-- which was pleasant initially. However, underlying the pleasantness was the knowledge that at any time, I could tip into a more severe manic form. I had been monitoring my moods carefully, ensuring not to get too overstimulated either by drinking too much caffeine or being around too many people as these things can definitely heighten my mood. Making sure I got my sleep, doing my deep breathing. The basics.

I noticed my mood shifting earlier today, however, due to family stuff, I had to keep myself composed. Be strong. Be the rock. After all, some members of my family are having their own issues-- whether its financial or emotional. So I was there for them as they had been for me when I was going through my breakdown last spring and summer. The problem with "being strong" when you feel like crumbling is that at some point, you have to release those feelings. Alternately, you can avoid them or overeat or oversleep or drink a beer or a lot of beer and forget. These things are what constitute escapism.

I released my mania last spring when I went crazy in the city of 2. I was in a similar situation I as I am now. Living at home with family and in a hypomanic state. I have a tendency to "let loose" emotionally in environments and people I'm most familiar with. So when I was invited to visit my friends in the city of 2-- a place I had lived for several years before moving in with family -- I decided to go even though I had a feeling it might disrupt my moods. In fact, I went because it would disrupt my mood. Let me explain. Physically, I felt I had to release all the built up energy and neglected emotions. This wasn't my cognitive process- but rather something like muscle memory. In other words, I knew (somewhere inside of me) I was about to go crazy and I needed a safe space to do so. So I chose my safe space to be with my two closest friends at the time. However, since this wasn't a cognitive process, I didn't think that they might not be equipped to handle my emotional state. And that's when things got complicated.

Back to my new skill. I am feeling really shaky in the sense that at any moment I could teeter on over to mania's side or worse, a severe mixed episode. But instead of indulging in that drink or another destructive behavior, I've been sitting with my feelings. Figuratively and literally. For instance, I've been communicating with my family and being assertive about my needs. Earlier I told them I needed to stay home to unwind, relax. When I was back at the house, I ended up calling a friend and talking out what's been bothering me. But instead of completely "letting loose" with my friend, I kept the conversation to a specified length and told her that if she had to go at any time, to let me know. By establishing those boundaries, I didn't overwhelm my friend. Additionally, I have been invited to visit the city of 2 recently--invitations I've rejected for the simple reason that I actually do not want to disrupt my moods this time, intentionally or not.

The good news in all of this is that I see my psych doctor later today. The other day I wrote out a list of all my questions relating to my my anxiety, irritability and elevated mood. I do have some speculation as to what triggered this emotional state so I'll be bringing up those concerns and issues as well. Just knowing I see my psych doc is comforting and reassuring. Because I've gone through this before, I know the drill and I'm prepared. Despite this difficult and painful state to deal with, at least I know that I do have resources here to help.

Before signing off, there's an adage that just seems too fitting not to reiterate. I feel like people with a mood disorder know this one best: this too shall pass. If I had a penny for every time I heard someone say that in response to a difficult situation! But what I'm trying to say is that if I could sum up all my lessons into one remark about the malleable nature of moods, that adage would be it.

I'll keep you updated.

You know, the usual: mood swings, self-improvement and questions

I feel like March has been one big self improvement month yet when I look back at my emoods app with the record of my highs and lows, this month has seen the most mood fluctuation. The emoods app I use is pretty basic. It tracks my hours of sleep, whether I've taken my medications and what degree I've experienced depression, irritability, mania or anxiety. I like mood tracking because it can lead to seeing patterns I normally wouldn't if I just went day by day. The pattern that recurs most frequently is the correlation of higher hours of sleep with either depression or irritability. In the beginning of March, I was sleeping on average 10 hours a night or more. I've been trying to get my sleep down with some success. But I feel like I really have to make an effort to manage less hours.

The last couple of weeks I've been exercising more. I've even started jogging about a mile a day. I also made a schedule for listening to my mindfulness/relaxation exercises, which I've been following semi-regularly. This past week I've done acupuncture twice- though not so much for my mood but to aid with smoking cessation. Finally, I bought a lovely little lavender eye pillow to chill in the freezer and put over my eyes when I meditate. I guess my goal for all these things is to get in to relaxing and self-soothing habits for when I eventually begin to experience higher levels of stress. Right now, my stress levels are pretty low with not being enrolled in a university and all.

I am pretty sure I posted this link in another one of my posts, but here it is again:

http://www.dartmouth.edu/~healthed/relax/downloads.html

(Those are some of the guided relaxation exercises I've been using.)

Anyways, I'm not really sure of what to make with my moods fluctuating as they are. I do seem to "bounce back" easier than before. They aren't severe mood swings, definitely more mild than I've seen. Probably due to experiencing less stress. I see my psych doc in May, and I've been toying with the idea of proposing we begin to lower the Abilify. Of course, being mindful of my (mild) mood swings, I wonder if I should postpone my proposal. My reason for wanting to taper off the Abilify is related to the weight gain/maintenance issue. I'm off the Depakote. I saw a dip in my weight and now it's creeping up again. I dislike feeling so vain about the weight issue, but it is very important to me. My BMI is 29, which falls in the overweight category. GRR!!

In regards to returning to my PhD, I still become very anxious and worried when I think about it. There is some lingering uncertainty. Nevertheless, I am happy I've been returning to my skills in order to help ease the present emotions as well as prepare me for whatever happens next.

Now to some questions to my fellow contributors of Depressed Academics and/or readers of this blog:

1. Are you currently therapy and what type? Does you feel it helps? I ask because I've kind of dismissed the whole therapy thing this year. I feel like I've learned what I can learn from therapy and now it's up to me to be my own therapist...

2. Do you use mood tracking? If so, what kind? Maybe we can get a running list in the comments. I did once do the paper mood tracking but I much prefer apps with the ability to see a graph from my input. I do, however, feel like my mood tracker doesn't account for other variables that would affect mood.

3. Finally, for those on meds, how do you determine whether it's a "good" time to change medications? Of course, I understand this is deeply personal and to be discussed thoroughly with a healthcare provider. I'm just curious to see what intuitions and approaches other people use.

As a concluding tangent, I want to acknowledge all those out there who are currently in a degree program- whether it's a BA, MA or higher and who are currently dealing with emotional issues. I look back at my academic performance and career and I wonder how the heck I did it. But even more so, I wonder how I am going to continue doing it. Right now, I feel scared and uncertain. My fear is deeply rooted in my health concerns. It's also weird because so rarely people in one's program acknowledges mental health concerns. So thanks again, Depressed Academics, for reminding that depressed people do exist in the university sitting. Moreover, that they are rocking at it too.

Til next time!

[LINK] Academia Is Killing My Friends

http://academiaiskillingmyfriends.tumblr.com/

Gathering anonymous stories of issues in academia — including harassment and mental health.

Decisions, decisions, decisions

It's been almost two months since my last post. I did make the switch to Tegretol and am now completely off the Depakote. I would say the transition has been successful. No strange side effects. No major setbacks. Moreover, my mood has been fairly consistent.

Since taking a medical withdrawal, I kept in touch with my advisor from the University. In mid March, I will be coordinating with faculty and my doctors to get my documentation together for the readmission process. A couple months ago, the thought to return was scary and brought much stress. In order to sort my thoughts out on returning I took up a suggestion of a previous therapist to create a CBT grid listing the disadvantages and advantages of going back to my PhD versus not returning. I won't reproduce the whole list but this was kind of the gist:

Advantages of returning to my PhD:

• Tuition covered plus stipend 
• Support from doctor, therapist and program
• Many opportunities I wouldn't otherwise have
• Passionate about the field of study
• Job opportunities
• The possibility to travel and do research
• Strong program and responsive and dedicated faculty

Disadvantages of returning:

• PhD programs are high stress and have high expectations, which could be a strain on my health
• Worry that I'm unprepared and/or made a bad first impression
• Might have to go back on a higher dose of medications or even make a medication change
• My current support won't be there

After writing up the list, I didn't look at it for sometime. Lately though, I've been reading and rereading it daily. Whereas there is a variety of advantages to going back, the core of the disadvantages centers around my health. I have never ever felt like my emotional dysregulation disabled me. It never felt like a crutch. Or something which held me back. But it's pretty obvious from looking at my list that my health concerns are a factor in whether or not I return to my PhD. 

It's crazy to think what this list might look like had I not had these health issues. But then again, I wouldn't have taken a medical withdrawal if it wasn't for my health. I could wonder what life would be like if it were only a little different but I don't think that kind of thinking would help my current situation much. For now, I'm clinging to my list. And taking it day by day.

The three difficulties; and self-esteem

I went out with friends tonight, mid-conference, to a pub I like here.

About three beers down, the conversation turned to mental health, and coping strategies, and related subjects. I started talking about my issues in the past, and present, and how I am now in the habit of consciously reminding myself that whatever my internal commentary track is telling me might not be the ground truth.

At this point, a (buddhist) good friend of mine interrupted me and told me about the Slogans of Lojong, and specifically about this one:

Train in the three difficulties

The first difficulty is to even see a neurosis for what it is. The second is to be able to deal with the neurosis, and the third is to deal permanently with the neurosis

(paraphrased from my friend's explanation)

He pointed out that my even being able to recognize my mood spirals for what they were, and able to try to tell myself to temper my trust in my intuitions based on my impression of my depression talking over my more sensible thoughts was already achieving the first of the Three Difficulties, and for him an ability well worth respect.

It is very helpful, at times, to be reminded that as far as I may feel I have yet to travel to some sort of sensible, workable, harmonious end-state in my relationship to my depression; where I am now is significantly further along than where I started.

 

Link: On Depression, and the Toll Academia Exacts

Jacqui Shine writes on depression in academia

Here's the thing, though: Graduate school doesn't make me depressed. Depression makes me depressed. 

Researcher Development assistance

http://www.theguardian.com/higher-education-network/blog/2014/mar/01/mental-health-issue-phd-research-university

The Guardian writes about mental health support system in universities for PhD students and academics; and the culture they need to overcome just to even reach the academics they could help.

On being the happiest person in the room.

I'm delighted to welcome a new contributor, Patch: I'm posting this but everything after this is written by Patch.

[Greetings. I'm Patch, a new contributor to this blog. Hope you enjoy my meaningless drivel. :)]

Often I am told that I appear incredibly happy, positive and optimistic. By often, I genuinely mean at least once a week. When I tell people that I am actually a clinically-diagnosed depressive with aspergers, anxiety and an eating disorder, the response is usually befuddlement.  “But you don't act depressed / anxious / socially awkward / etc! Surely it can't be that bad?” they exclaim, “You act happier than I do and there is nothing wrong with me!” they continue, shocked that someone with mental illness can appear to be as happy as a small child who has just discovered how to blow a raspberry. According to many of the people I converse with, having a psychiatric disorder makes me unable to feel joy, express delight or giggle with glee. They wonder what exactly my secret is. Weed? Copious amounts of alcohol? Mountains of prozac? Nope. I'm just good at finding things to be happy about.

Currently it's the fact that my Lush products arrived and they are making my flat smell absolutely delicious. It's the fact that the person who packed the products in the box wrote their name on the invoice with a love heart. It's a letter sent to me from a friend in the states. It's another friend promising to start a rock collection in my honour. It's my self stirring mug. It's the box of tissues I bought with a boat on the front. It's an email from my Geography tutor telling me not to worry that I couldn't get out of bed due to the flu because he also has it. It's my spotty duvet cover, my wind-up lego torch, my Thor figure, my replica of the ring of power, my mother sending me a picture of my dog, my hair defying gravity. It's the thought that someone has just read Harry Potter for the first time, that someone just laughed so hard they cried, that someone slipped on a banana skin and landed on their arse. The amusement of mishearing song lyrics, the fun of playing a videogame in a way that you don't normally do.  It's the little things, and finding humour in everything. I'm currently giggling because of the number of pills I have to take at the minute makes me sound like a maraca, and that is hilarious. It sucks that I need the pills, but there is a bright side.

It's a cliché for a reason, and it's not easy. Life does suck, and often I can't think of things that make me happy, but surrounding myself with things that did at one point can often be a helpful solution.

My flat is full of junk. Little knick-knacks that at one point made me smile and therefore might do it again. I have a small plastic figurine of Gandalf I bought on a whim. I have a lightsaber that doesn't light up but makes a great noise when opened to its full length. I have a box of teabags with googly eyes stuck to it – no reason, I just love googly eyes. On my worst days I will look at that box of tea, and no matter how bad I feel, how many new cuts I have on my arms, how much I want to jump into the north sea, I somehow manage to smile.

Preparing for the bad days on the good days is one of the best things you can do, and certainly one of the most useful things I have discovered in my 7 year long battle with mental illness. By planning for the worst and ensuring you have safe ways of improving your condition can save your life – it's definitely saved mine.

It's all the Neanderthal's fault...

"It's tempting to think that Neanderthals were already adapted to the non-African environment and provided this genetic benefit to (modern) humans," said Prof David Reich, from Harvard Medical School, co-author of the paper in Nature.

But other gene variants influenced human illnesses, such as type 2 diabetes, long-term depression, lupus, billiary cirrhosis - an autoimmune disease of the liver - and Crohn's disease. In the case of Crohn's, Neanderthals passed on different markers that increase and decrease the risk of disease.

Asked whether our ancient relatives actually suffered from these diseases too, or whether the mutations in question only affected the risk of illness when transplanted to a modern human genetic background, Mr Sankararaman said: "We don't have the fine knowledge of the genetics of Neanderthals to answer this," but added that further study of their genomes might shed light on this question.

Joshua Akey, from the University of Washington, an author of the Science publication, added: "Admixture happened relatively recently in evolutionary terms, so you wouldn't expect all the Neanderthal DNA to have been washed away by this point.

"I think what we're seeing to a large extent is the dying remains of this extinct genome as it is slowly purged from the human population."

http://www.bbc.co.uk/news/science-environment-25944817

Good early fall, bad winter

My writing here dropped off late summer, early fall. I was feeling good, and I didn't have much to say on the blog.

My writing here has been low if not completely absent during the winter. But for completely opposite reasons to earlier on.

From about a week before I went back to Stockholm over christmas & new year's and through the entire trip back home I've been crashing out a lot. We're talking daily emotional crashes. I don't know why, and I didn't end up having quite enough time to go see my psychiatrist about my medication levels.

I have an ambition of getting in touch with the student's mental health clinic when I get back to Minneapolis. I should be doing more about my health than I am doing right now. But logistics seems to dictate I wait until this summer to see if tweaking my medication is needed.

Now (today) things are well; I'm jetlagged and headed into the largest conference I regularly attend at all for the entire rest of the week. But I'm keeping stable.

A less crazy New Year?

Happy New Year Depressed Academics,

I know it's only January, but I can feel in my bones that this year is going to be different. Maybe that's just optimism speaking, but really, I'm actually excited to see what this year brings.

A little update since my last post: My doc is swapping one of my old time mood stabilizers for a different one with less side effects and specifically, it has no weight gain side effects. Anytime I have a medication change, I feel uneasy. What if this medication isn't as effective? What if I feel worse? Would if I have to go back on the Depakote and my efforts amount to nothing? I had a week to think about whether I wanted to try this different medication, and I figured I might as well try it. I mean after all, a medication with less side effects is always going to appeal to me more than one with more.

The thing is the Depakote has always been a staple in my (most) stable med combo. Also, I have been on this medication before. It's called Tegretol and for me, it was a little less potent than the Depakote but I was also on it with a couple different meds than I am on now. So who knows! All I know is I am willing to try and if it doesn't work it out, so be it. I figure if I remain the same as I am now on the Tegretol and without the Depakote, I'll be content. If I crash, I know I am resilient and can always go back on the Depakote. My mum pointed out one outcome I didn't think of: Would if I actually feel even better than I do now? All I can do is marvel at that idea. We will see.

Now, onto this New Year business... I don't like the notion of New Year resolutions. It seems like a set up for failure or a trap to only plan your self-improvement projects for a once a year time frame. And that's silly to me. I am just telling myself to do what makes me feel good: restful sleep, exercise, healthy foods, routine. With those aspects in line, the rest will fall in place.

So maybe it will be a less crazy year. Maybe not. I still have to figure a lot of things out. I am aiming to complete my Masters thesis by March. Around that same time, I plan to notify of my potential return to my studies. It's really not a lot of time before March, and just thinking of these two things brings me stress! And then I simply remind myself to breathe and do only one thing at a time.