Pre-Treatment Diary

This is a collection of updates written for a group of friends, chronicling the process from the first admittance to depression over trying out an antidepressant for a couple of months to getting into the treatment programme I attended until December 2012. The entries have been slightly edited to remove any clues for real life names or locations, and my friends’ responses have been taken out as well. Occasionally the phrasing might sound a little strange, this being the result of a direct reply to something which didn’t make it into this diary.

June 1, 2010

Things have gotten worse rather than better, on the whole. I have muscle pain in my thighs and upper arms and neuralgic pain in the arms and wrists since Christmas. If I take Ibuprofen, the pain goes away for the rest of the day, but usually is back after 24 hours; on some days it’s worse than on others. At first I thought it came from spending too much time in front of computer when I had this insane work load for uni papers, but it didn’t go away even when I was less in front of the computer.

The inflammation of the eyeball is still persistent, too, but every time I take Ibuprofen a few days in a row, it goes away for a while.

I don’t want to bore you with all the minutiae of it, but I have also been on the decline mentally, with increasing episodes of panic attacks, hypersomnia alternating with insomnia, fatigue and “heavy limbs”, plus I notice how I’m withdrawing further and further from social contacts – not because I don’t care, but because everything tends to overwhelm me to a degree where I can’t cope with it anymore, and how I’ve been slowly but surely giving up most of my hobbies.

After some online research and thinking about it, I’m pretty sure that my problems stem from a clinical depression rather than a physical illness, especially since depression can also manifest in physical complaints like pain, and I’m also sure that I’m at a point where I won’t manage without either therapy or antidepressants (or both) anymore. Everyday life… is a lot more exhausting than it seems to be for everyone else and while there are good days, on others I only wish I could stay in bed and never get up again, not because I’m necessarily sad all the time (which I’m occasionally, but not constantly, and I’m also not suicidal), but because I’m so tired and everything seems so demanding that I just want to shut down then.

I kind of downplayed it because I didn’t want to come across like a pity-seeker, and as written above, not all days are bad.

Guess I always thought I’d manage to still make some kind of u-turn eventually, but it increasingly looks as if I won’t work this out on my own anymore. I feel exhausted rather than anything else and I’m somewhat afraid that if I don’t seek help, the day will come when I will indeed just stay in bed.

So, yeah, gotta bring this up with my doctor somehow, even if I have no fucking clue how to do that, because I need the insurance to pay for whatever they decide will be most helpful. I’m not good at discussing feelings with “strangers”.

June 2, 2010

I came home yesterday to a notification that my student health insurance ran out on my birthday and already had another panic attack last night over it, because without health insurance, there would not only be no treatment, but health insurance is also mandatory for students and I already saw myself being expelled from university and losing my job. Thank goodness I managed to postpone that on the phone this morning…

June 7, 2010

Going to see the doctor tomorrow (didn’t work out earlier), so I should know more soon.

June 8, 2010

Well, looks like I have a depression.

I got offered therapy sessions, which I’ll definitely do, even though they said that waiting lists are long and it’s most likely going to be weeks or even months before I can start, but I can already select two or three therapists and put my name on their lists. There will be a “trial period” consisting of 5 – 7 sessions and then it will be decided if we – the therapist and me – think we have a productive enough relationship to continue for the prescribed period of time.

Therapy is only for “sorting out the mess” caused by the depression, though, and to prevent future relapses.

As for the source of the depression, there could be a physical cause behind it. Hypothyroidism is the most important reason and, at the same time, differential diagnose, so my thyroid levels are getting checked again, and also whether I have iron deficiency. If all that turns out normal, it’s most likely a chemical imbalance of neurotransmitters in the brain and I can give antidepressants a try, which I’ll do, because the current state is simply not tolerable anymore.

That was a new doctor I saw, because I felt that the relationship with my usual one was not going anywhere anymore after all those years and that she was biased against me or not taking me serious anymore and I started feeling more and more like a complete nutcase with her (even though I’ll consider the option that this kind of feeling is on my end only and part of the depression), and I simply didn’t have the time and energy to journey all the way to the other doctor I saw last year. I think the new one is good, though, or at least what I need right now, because he’s very calm and soft-spoken – one of those energetic “get off your ass and do something!”-types would have driven me bonkers for good now, because I’m more or less like the proverbial rabbit in front of the snake at the slightest sign of adversity. If not for the leaden paralysis (because that’s what causes the “heavy limbs”), I’d probably have tried to arrange my life “around” the depression, but this is so… overwhelming and exhausting that I’m willing to give whatever looks promising a try.

June 9, 2010

No news today, the blood sample hasn’t been back from the laboratory yet – hope it will be tomorrow.

Can’t say I’m a huge fan of antidepressants, but then, I prefer giving them a try rather than sitting around waiting if and when things get better. That is, if they don’t find any physical reason; my iron levels have never been tested even though I had discussed that with the doctor in the past.

If they are too weird or have too many side-effects, I can still stop taking them.

Finding a therapist is complicated, because the larger part of them only takes patients with a so-called “private health insurance” or those who pay for the sessions directly, neither of which is the case with me (which is why there are waiting lists with those who do).

Also, I am not certain yet what kind of treatment style I want, if I prefer a male or female therapist or if I am truly indifferent on the topic, yadda yadda yadda…

Last but not least, it needs to be someone who’s not overly complicated to travel to, because I will be going there every week for at least half a year, maybe even longer.

All I know so far is that I want someone who is not biased towards non-heterosexual patients, but they hardly mention that in their profiles.

June 10, 2010

I just got off the phone with the doctor and the result of my blood sample is that I’m so clearly hypothyroid that he increased the hormone dosage by 50%, starting tomorrow. Which is really curious because all those times before when I asked to have my thyroid checked, the TSH-levels always were in the normal range, and now they are so clearly elevated that there is no doubt at all.

So antidepressants are off the schedule for the near future, because we’ll have to see if the depressions (and physical symptoms) lift again with proper hormonal dosage.

June 13, 2010

It’s not that I am against the existence of antidepressants, but they also scare me a little, to be honest. Especially since in the beginning, they can make symptoms worse before they get better, and I don’t really want to go there.

I’ve been taking the higher dose of levothyroxine for two days now, but no effect yet: none of the unpleasant side-effects (sweating, nervousness, tachycardia) that usually occur during the first days, but my brain is still as mushy as it used to be lately.

June 15, 2010

It kicked in today, and boy, this is almost as bad as back when I started treatment for the first time. I feel like I’m about to suffer a heart attack…

The evenings are actually ok, only a slight nervousness, but the mornings are really bad – shortly after taking the pills my heart is pounding as if I’m simultaneously sitting a maths exam, performing brain surgery and robbing a bank. I tell myself all day, “It’s ok, don’t freak, it only feels this way but there isn’t an actual threat.”

June 24, 2010

After another massive bout of anxiety attacks this morning I caved in and got a prescription for antidepressants. Just can’t and don’t want to wait anymore whether it’s going to get better or not; the more I try to pull myself together, the worse it gets.

I think the antidepressant I get is none of the really potent stuff, and even if it should be, I am getting a low dosage only to begin with. Pill poppers might get disappointed if breaking into my home. 😉

Right now, I just hope the side-effects won’t be too bad and that it works quickly, because this morning was fucking scary. I had to ask my mother to take me to the doctor because I thought I was going to collapse, and I am somewhat scared that it might repeat before the SSRI gets to work properly (which might take up to several weeks).

June 25, 2010

So far all’s quiet – I started on a really low dosage today and will work my way up over the next two weeks. As previously said, it might take 2 – 4 weeks to kick in and even longer to show the full potential, while side-effects can appear immediately, but so far I’m not feeling anything, neither in the positive nor in the negative sense.

June 27, 2010

Well, today the side-effects are there. Periodic nausea which comes and goes all day long, a slight headache and a dizzy feeling like having carbonated water inside my brain, really curious. But bearable; if it doesn’t get worse, I shall not complain.

June 28, 2010

The side-effects should be gone about a week after I reach the full therapeutic dosage, so another week and a half, maybe less. You need to start with a low dose and increase slowly, so the body has time to adjust, and you also need to decrease the dose slowly when you stop taking the antidepressant again, or you might suffer from SSRI discontinuation syndrome, which is only another word for withdrawal symptoms.

Even though the side effects increased today, they are still ok – mostly curious rather than bad. When I move my eyes too quickly from one side to the other, it feels like my brain is “trembling”: there is really no other word to describe it. It doesn’t hurt or anything, just feels very strange, like a rush of gas trying to escape a bottle you just opened. It starts just behind the eyes and seems to rise up to the top of my skull.

So, yeah, that much concerning my latest “drug trips”.

July 1, 2010

I don’t know if it’s the antidepressants or the weather or the combination of both, but I’m so sleepy these days… I have to take a nap or even two in the late afternoon and still sleep like a stone. And I have the most vivid dreams, which actually is kinda cool.

Last night I dreamt Emma Thompson came for a visit and we both were trying to do my niece’s maths homework. I was supposed to explain the homework to her, but didn’t understand them.

July 19, 2010

Three weeks after starting on the antidepressant, I had a follow-up examination this morning.

The worst of the side-effects had eventually faded away, no more brain zaps and vertigo and hardly any nausea, just the fatigue was rather persistent, even though it seemed to get a little bit better over the last days – the vivid dreams had returned to “normal” too.

Mentally, the antidepressant didn’t have a huge effect yet. I haven’t had a panic attack since, but that’s about all I can say.

Physically, however, it is already working: the pain in the arms is erased and also the chronic inflammation of the eyeballs is gone. So it should be clear that those were somatic symptoms of the depression and not multiple sclerosis (or hay-fever), as my previous doctors claimed.

Over the next two weeks, I need to work my way up to double the dose of what I am taking right now and then stay on it for three months. After that, there will be a re-evaluation of the general situation, because it can take two months until the antidepressant shows full effect and we won’t know for certain whether it’s really helping any earlier.

I found a therapy programme which sounds good, at the [insert name of the hospital where I’d get treated eventually]. They take outpatients also and have a really diverse offer of state-of-the-art treatments and innovative programmes, so the only question is whether they allow patients with my kind of health insurance…

July 20, 2010

Well, crap, I just learned that they take outpatients only if you have been an inpatient previously, and I’m not going to have me committed just for that.

July 21, 2010

Right now, I’m pretty sick – the nausea made a glorious comeback. Oh well, two more weeks and then it’s done…

July 27, 2010

Tomorrow I am going to reach the full dosage which I am going to take for the next three months, and I gotta say that the last week has made a huge difference. I don’t know if that’s because the higher dosage works better for me or because I’ve been taking it for over a month now and the antidepressant is slowly reaching its full potential, but the last few days were the first where I’d not only attribute the absence of something to the drug (no physical pain, no panic attacks), but where I started to feel a bit more… relaxed.

Not that I’m totally “zen” or high even, but before, I needed a reason to feel good. Now, it feels rather like I need a reason to be upset (and there are reasons, but it still makes a difference).

Also, now that I already have a certain level of the antidepressant in me, the side-effects don’t last quite as long (except for the sleepiness, that is) – this time next week I should be over them.

July 29, 2010

Day 2 on 40µg of citalopram, which previously was the worst day when increasing the dosage, and I’m doing quite well. Only a little bit of nausea and dizziness, but it’s nothing compared to when I first started with 10µg.

Really happy that it’s working, because I heard that some people have to switch a couple of times before they find something that helps them, and that must be rather discouraging.

August 4, 2010

It appears I spoke too soon, the last 36 hours brought vertigo, so that I had to feel along the wall for getting into my bed without bumping into anything, only to have bad nightmares.

It’s still an improvement over the mental state before the antidepressant, so I’m not discouraged, even though I have to say that “drug-enhanced” dreaming makes for especially nasty nightmares: getting beaten up, nearly raped and almost poisoned in the same dream is a bit much even for me. I usually tend to concentrate on one form of torture.

They were very courteous about it at work, even though I didn’t tell them I was taking antidepressants, but blamed it on thyroid medication. However, most of the student team, including me, is on temporary leave since Monday (until October 1) due to insufficient financial funding.

Life would be so easy if I had an impotent*, childless, 98-years-old millionaire husband. (*Just to make sure… spoon-feeding him is ok, spooning not.)

All joking aside, daydreaming about becoming rich is trying to cheat my way out of my problems – of course, if I didn’t have to have a job anymore and could live off my fortune, I wouldn’t have work- and university-related anxieties anymore. But not because I conquered them. So the goal has to be learning to get over my fears and try to work my way out of this mess…

August 25, 2010

I have been feeling rather shitty these last days because of neuralgic pain in my lower back and right leg – it got so bad that I could only sit for a few minutes and hardly walk. It is better now and will probably be gone in a couple of days, but until then, my computer time is still limited.

Still have not found a therapist – my aunt, a pharmacist, said what they told me on the phone about the treatment programme at the hospital is not true, that they do indeed have facilities for out-patients and that the women I spoke to probably just did not feel like doing her job properly. So I’ll try again.

September 2, 2010

Warning, tearful drama ahead…

I am completely crushed: we had a little arrangement this morning that I would bring my niece to school at 8.30 so my sister could leave for work and catch the 8.39 train. I was there at 8.27, ready to go, but nobody was there anymore – so I called my mother to ask if she had taken my niece to school, which she had not but my sister instead, and I got a full load of “one can NEVER rely on you; everybody is bending over backwards to do things for you and nothing comes back EVER.”

So it went from how my sister had missed her train because of me (which she would not have had she not left too early with Mia) to how I had ruined the family finances to the lowest level and that my sister would have to get a loan at the bank so we had something to eat at the end of the month because my parents were too old to get one (I think the part about my sister getting a loan was made up) to how everyone was scolding her because she was letting this happen. Even my father’s 80-year-old aunt, whose views on everything are usually discounted as outdated or reactionary, was brought up as an example: “Layara is 30 years old, she has to look after herself. What does she need a place of her own if she can’t pay it?” Which also introduced the topic of how I was living in a filthy pigsty…

I am trying so hard get my shit together and every time I start to feel slightly optimistic and as if I can actually attempt to correct everything that is going wrong in my life, I get verbally beaten over and the foundation on which I am trying to base everything crumbles away again. It’s true, I am taking their money every month, but it is also true that I moved out ten years ago because my father was drinking too much at that time and I just could not bear it anymore; actually it was my parents’ doing that I ended up in the flat where I live now, because I had already arranged moving into a flat in [name of city where I attend university] with a girl I had befriended then (the contact didn’t last) and they convinced me to move in with my sister instead.

Sometimes, I feel like selling all my stuff and going away, and the only reason I never really tried it is my niece, because she’d take it very hard. I know I’m not exactly living in the tidiest place, but it is me who has to get along with that, and if I had my own money, I would tell them to go mind their own business. And I also know that the last ten years don’t amount to much, but it’s not as if I didn’t care about that – I just don’t know how to tell them that I’m fucking dying inside when I have to go to university or apply for a new job and that even half a year later I still feel stressed out about every single exam I sit.

It has come to the point where I sometimes wish that I actually had MS just so I would have a socially acceptable excuse for failing, and there are days when I just want to go out and buy a bottle of vodka to block reality out, and the only reason I do not do this is that I know it would just get me into deeper trouble in the end.

Later:

I’m still completely messed up and my eyes hurt from crying so much. It’s just unfair, especially since I try very hard to be “useful” to make up for my other shortcomings. On Monday, I was helping my niece with school stuff until 9.30 PM while the rest was watching TV, and yesterday I drove my grandmother to the hairdresser, fetched my father from work and drove my mother and sister to the supermarket afterwards – and I really don’t mind doing that or do it only because I “have to”. I just do it to help out and would never complain about it, but you can’t say that nothing comes back from me, nor that you cannot rely on me.

I had all of that shit last week already, and the week before as well… I’m on the verge of just admitting myself to a mental hospital just to get a break from all this, because I can’t take it anymore.

I promise to not do anything stupid, but I never felt so much urge for it as now… Spent most of today in bed so far.

September 3, 2010

I wrote a letter to my mother this morning, two pages long (typed), explaining how I was feeling and that what she did was rather counterproductive when it comes to sorting my life out. I tried to describe how my problems are not born from laziness, but from petrifying fear, and that I only had a chance to successfully sort everything out if I did not have to battle with criticism from the outside permanently in addition to all the negative feelings that already are inside myself all the time. For other people the verbal “kick in the arse” might work and motivate them to prove themselves, but in my case it causes the exact opposite of the intended reaction.

I handed her the letter just a moment before I left for picking up my niece from school, and she has not commented on it yet, but I know she read it.

We will see if anything changes.

September 6, 2010

The letter has served its purpose, because the situation at home has gotten a lot better since. My mother didn’t comment on it, but there was no more yelling and no negative comments afterwards. I’m still licking my wounds, but feeling better already.

I’m currently doing “anxiety management” tasks that are supposed to help me over the waiting time until the therapy sessions start – to raise self-awareness and awareness of triggering factors etc.

October 18, 2010

Day 85 on the full dose of citalopram – day 100-something of being on antidepressants.

The physical side-effects I previously described here have been completely gone for a while now. No vertigo, no nausea, no funny feelings in the brain. I have a hunch that the extreme fatigue I occasionally succumb to are manifestations of my depressions rather than side-effects of the medication, because during the days in Bavaria I felt no fatigue at all, and on the second day after returning home, it was back.

I guess it is time to make it official that the plan of [changing my career] did not work out. I have known it for about 2 weeks, but was too disappointed to really talk about it.

I try my best to better my situation, but am standing on shaky feet. The waiting lists for therapists that my insurance will pay for are long and I need help now, not in a year, but I do not count as an emergency case because I am not suicidal.

The situation at home has become better on the whole, but occasionally (like today) I still get a good deal of stuff told that I cannot really cope with, and as a result everything inside me implodes and I wish they would just leave me alone to rot away like the spewn-out piece of gristly flesh I feel like then.

I just have no plans for the future – everyone wants to know what I am going to do, and I don’t fucking know it at all. There are no plans.

So, needless to say that I do see me staying on antidepressants for quite a while.

October 19, 2010

I fainted on my way to work today. We have 2-story-trains here and while climbing up the steps to the upper story, my vision suddenly blackened and I only felt my knees buckling under me, then I was gone. As luck would have it, a 6’4″ bodybuilder police officer was directly behind and caught me, otherwise I would either have fallen down the stairs backwards or crushed anyone with a more normal stature who would have followed me.

I wasn’t unconscious for long, maybe two seconds. It really was only a blip, but I had been feeling unwell all morning already, so I called in sick at work and went back to [my hometown]. From the train home, I called my mother and asked if she’d pick me up at the train station because I was afraid of fainting again, but this turned out being a very bad move: as I came up the escalator leading outside, she was already waiting, glaring at me furiously. I had not even stepped off the escalator yet when she started berating me (in public, with lots of commuters around to witness this): how it all was my fault, a direct result of my unhealthy lifestyle, and a lot of other venom-drenched accusations I’d rather not list here. It got so bad that I decided to try without her help and risk fainting again on the pavement, because if I’d listened to this a minute longer, I’d lost my composure for good.

So I went straight to my doctor, where I could not help but break into tears in the practice. Which in itself made me feel even worse – I don’t cry in front of other people… We had a long talk about how hopeless I feel and the situation that I am in. Don’t know if I feel better, but at least I stopped crying.

Later:

You are right, I should not lose sight of the way already behind me. The problem is that for all the bureaucratic facilities out there, I am simply a faceless “unproductive” number who enjoyed society’s benefits long enough and now is supposed to get off her lazy arse. For example, I have had an endless back and forth with my health insurance and finally managed to avoid getting kicked out of the student fare for another year, but by September 2011 I will have to pay more for my insurance regardless of whether I am finished or not. All I managed is to push back the catastrophe, but not to find a solution to avoid it.

I spoke to the doctor about the situation in the family and he agreed that it is not an easy constellation, but ultimately insists that my only way out lies in geographic separation. It’s not like this thought has never occurred to me, but where should I go without money? To earn money, I would need to get a job, but I’m such a mess currently that I wouldn’t last a week in any ordinary job, so I’d have to get better first. But to get better, I’d need more peace at home or to move away… that’s where the cat bites its own tail.

He also insists that it is not my task to help raise my niece, but that’s easier said than done. She needs me, and… she was there when I went through hell before getting my thyroid diagnose. She was a baby and small toddler only, but there is something to be said for the unconditional love of a small child. They don’t judge you by status or financial situation or success in the world. Back then I always thought that she is something like the child I’d never have, but nowadays I feel more like she’s my little sister.

Anyway, formulating a solution is easier than living it. Fucking shit, I’m crying again.

October 27, 2010

Life is still difficult here, but I manage to keep the head over water. Something that helps is making detailed to-do lists and crossing stuff off as I complete chores: you are not supposed to write down “clean the flat”, but list every single task separately, for example:

  • throw old magazines in paper bin
  • empty paper bin
  • clean the dishes
  • put books back into living room shelves
  • put books back into bedroom shelves
  • vacuum living room
  • vacuum hallway

That way, you break everything into tiny bits and even though the list gets rather long, the tasks are so small that they are much less overwhelming and intimidating, and even if you do not manage all of them, there still is a sense of accomplishment as you cross at least a couple of them off. And the next day, you continue to get another few of them done…

The “drug dreams” are back, even though I did not change medication in the past three months. Last night I dreamt Sarah Palin was asking me directions to the local hospital and I ended up inviting her to a garden party. She attended and was really charming, all my family and me liked her tremendously. She also had written a book that I found very engaging. Not sure yet if I should count that as a nightmare.

October 28, 2010

So, not only the dreams are back, but also the vertigo. I don’t understand it since I have not missed a single dose, but I will wait out a couple of days for them to vanish again.

Latest dream: all of my family moved in together and both my grandmother and my mother were constantly re-arranging the cutlery drawer according to their own system, arguing about it.

November 3, 2010

The latest episode from the realm of drug-fuelled dreams:

My mother, father, aunt and me were on vacation at the North Sea shore, on the island where we often spend our vacations. I had a rented bike and went on my usual tour over the island, riding the bike in a rather aggressive fashion, passing time and again parking lots where numerous white-painted vehicles stood – small transporters and SUVs, scooter-like rides and motor cycles.

We had a quick meal at a fast food joint that looked like a place I sometimes visited as a kid, where I ate fries, and suddenly my sister was there. We went to a parking space and climbed into a transporter, but my sister ended up behind the steering wheel (she does not have a driving licence). I told her to chance seats, but she insisted in trying first, which did not work, so finally she gave up. I got out of the transporter to walk over to the other side and my sister climbed to my former seat. For some reason, I ended up just in front of my sister’s door again, and I saw that three of my former class mates sat in the back of the transporter. One of them quickly climbed behind the steering wheel, started the car and slowly drove off, leaving me standing there. I was pissed off and tried to show them my middle finger, but did not manage to bend the ring finger, so I had to press it down with the other hand.

I got on a scooter and started driving around, and suddenly my sister sat next to me again and we got followed by a herd of big rats which chased us through a maze of front yards with bumpy flagstone ways half hidden under large blue flowers. We seemed to get smaller and smaller the longer it took and the rats came closer and closer, so finally we jumped over a fence-gate into a garden, running to another parking lot on the other side. But even though there was the usual selection of cars available, we ended up on a scooter again, being chased down a long cobblestone street.

At a crossroads, the rats would have caught us if not suddenly a large group of reddish Persian cats had appeared, chasing the rats away and bringing us to a “safe zone” where the king of the cats resided. He had a daughter who, curiously, was a blonde, blue-eyed human girl about to marry a rat (even though I did not see her, I knew that the rat king had a human princess as daughter, too) and who pleaded with her father to let the rat’s family move into the safe zone, too, to prevent their imminent destruction in a huge rat-slaughter.

November 8, 2010

I’m having a phone interview for admittance to a clinical programme for treatment of chronic depression by the [hospital] in 15 minutes. I’m nervous because this would be my preferred choice of location and institution and I hope I can be added to the pool. Not to mention that the programme includes 48 therapy sessions instead of the standard 26.

Later:

The interview went well and the woman I spoke to was very nice. She said my chances are good that I’ll be included; I’ll hear about this during the next couple of days.

If I don’t get into the programme, I have a first appointment with a psychologist in January.

Even later:

Already got an invitation to the psychiatric hospital for Wednesday afternoon, where I’ll meet the attending physician who runs the department of psychotherapy and specializes in uni- and bipolar mood disorders.

I am not 100% certain if that means I have already been approved and included in the programme, but since the email said I should bring a referral from my doctor, I assume that I am in.

I’d be very glad if it worked out indeed; maybe it is just a prejudice, but I just feel better going somewhere with a big apparatus of staff rather than a single therapist running his/her practice, where there is no kind of supervision through others. And the woman I spoke to was really friendly and unthreatening. Not to mention that I’d get almost twice as many sessions.

Another couple of minutes later:

Need to correct myself; I’m not yet in, because I first need to go through two more diagnostic sessions before, but unless they find something organic which causes the depression that all other doctors previously overlooked, there is no reason why I should not advance. And if there really should be an organic cause and treating it makes the depressions go away, I do not need therapy anyway and nothing’s lost.

Also, the programme runs 48 weeks, not 48 sessions: twice a week for the first month, then one session weekly for the next four months, afterwards “aftercare” starting with one session every two weeks and finally tapering out with one session per month.

Oh, and I would need to get off the antidepressant again for inclusion, but considering the periodically recurring side-effects, I would not be too sorry to bid them goodbye. They prevent me from sliding even further down the spiral, but clearly do nothing to help me solve my problems.

And again later:

Thanks to Google, I found a summary listing all inclusion/exclusion criteria.

I’m so in now. Only need to do just as badly as before for the next two weeks and repeat the HSRD test in two weeks. All other exclusion criteria have already been checked.

November 9, 2010

Shit, I am nervous about meeting the doctor tomorrow. Which is actually stupid, because unlike “normal” people, they get very excited if you tell them about all the weird stuff you feel.

You should have heard the voice of the woman who interviewed me – her voice got noticeably higher when I told her about my sleeping problems (excessive sleeping alternating with insomnia), not to mention the neuralgic pain in my limbs. She sounded like someone who just caught a very big fish.

But I still am nervous, simply because it is an intimidating scenario to me.

November 10, 2011

Back from the psychiatry.

Bad news first: I’m too depressed for inclusion in the programme I originally wanted to participate in. The doctor said he could not recommend going 48 weeks without antidepressant considering the degree of my depression.

Good news: they have another programme where I could be included, and I am already in its patient pool now. This other programme is about CBASP therapy, possibly in combination with escitalopram, an “updated” version of my current antidepressant.

The team is super-friendly and I feel quite comfortable working with them. Everybody takes a lot of time and care, and they are super-quick: already had a call after arriving home, doing the introduction interview for the other programme.

My schedule for the next few days is discussing with my usual doctor how far I can reduce the current medication, because I need to be medication free when I start with the programme, so that no after-effects of the citalopram play into it when I start.

Monday I call the therapist’s assistant, tell her what the doc and me figured out, and we make an appointment for the first diagnostic meeting, where there will be more interviews and a first “test drive” of the MRi scanner, just to check whether I really can stand entering the tube at all without actually running it yet, because before starting the actual treatment programme, I will have to spend an hour inside the MRi, getting my brain scanned while completing tasks via head-mounted video display, to collect data.

I get randomly added to one of two groups, one starts with medication and brief clinical checks, the other starts with CBASP therapy. After 9 weeks, there is another MRi scan and evaluation interviews, and if the degree of your depression has not gotten better by at least 20%, the other method is added, so that you are on antidepressant and therapy then. If it has bettered by 20% or more, you stay on whatever you are as a monotherapy for the entire time. This second phase runs 20 weeks, then the programme is completed.

I am quite happy with the way it turned out, and by chance I also found out that the one therapist I picked as an alternative, the one in [big city], has been trained by the therapist I saw today. He said he’s a “very good man” and laughed, because obviously he cannot say anything negative about him in this case, but then added that he knows him very well and that I made a very good choice, especially considering the type of depression I suffer from.

So even if for some reason I cannot be part of the programme, I still have that alternative to fall back upon, even though right now they say I am something like an ideal candidate.

To be perfectly frank, curiosity currently overrides nervousness concerning the MRi scans – always wanted to know what my brain looks like.

Anyway, the whole operation is looking promising and just the fact that *something* happens now makes feel a bit better already. And I couldn’t want nicer people or more modern methods for treatment.

One side note, I saw some of the inpatients of the psychiatric hospital and boy, did they ever look like personifications of hopelessness and despair. There was this older, gaunt woman standing in a door with a very emaciated face, grey-ish skin and almost white, unkempt hair and frumpy clothes, and when I left the office again 90 minutes later, she had not moved an inch! She looked like an ancient mummy come to life.

November 15, 2010

Tomorrow I start reducing the dosage of my antidepressant, Thursday is the next diagnostic meeting at the psychiatric hospital.

The last week was rather bad; I have had some conflicts with my mother (again), who changed her strategy and claims I am hiding behind my illness and use it as an excuse for underperforming, which makes me both sad and angry. According to her, I should pull myself together – I was on the edge of telling her that I already am pulling myself together and that if I did not do that, I would not even get up anymore in the morning, but I do not even have the energy for arguing, so I try to ignore most of those comments.

My mum needs an anger management class, but if I told her that, she’d jump right into my face.

November 16, 2010

Spoke with my sister this morning, and even though we are not any closer to a solution, at least we know that we are making similar experiences…

On the bright side, no additional side-effects through reduced dosage yet as I wean myself off of the citalopram. That means, not any more than I have experienced over the last two weeks, even though my compliance was at 100% with no missed dosage in over 100 days. I haven’t changed the brand either, so there is just no explanation for that. *scratches head*

November 18, 2010

Today’s session at the psychiatric hospital was good and exhausting. I did an one-hour-long interview that was filmed for the sake of group analysis through the team later, which made me rather nervous, and additionally had to work on a “childhood trauma questionnaire” and one with 130 questions that you had to answer with either yes or no.

The childhood trauma questionnaire consisted of the following statements:

  • Got hit so hard that I had to see a doctor or go to the hospital.
  • Family hit me so hard that it left me with bruises or marks.
  • I was punished with a belt/board/cord/other hard object.
  • I believe that I was physically abused.
  • Beaten so badly it was noticed by a teacher/neighbour/doctor.
  • Someone in my family helped me feel important or special.
  • I felt loved.
  • People in my family looked out for each other.
  • People in my family felt close to each other.
  • My family was a source of strength and support.
  • People in my family called me “stupid,” “lazy,” or “ugly.”
  • I thought that my parents wished I had never been born.
  • People in my family said hurtful or insulting things to me.
  • I felt that someone in my family hated me.
  • I believe that I was emotionally abused.
  • I didn’t have enough to eat.
  • I knew there was someone to take care of me and protect me.
  • My parents were too drunk or high to take care of the family.
  • I had to wear dirty clothes.
  • There was someone to take me to the doctor if I needed it.
  • Someone tried to touch me in a sexual way/made me touch them.
  • Someone threatened me unless I did something sexual.
  • Someone tried to make me do/watch sexual things.
  • Someone molested me.
  • I believe that I was sexually abused.

You had to rate them with 1=never, 2=seldom, 3=sometimes, 4=often, 5=almost always. That one was relatively easy, because I sure as hell don’t have a childhood trauma, so I could get over with this one quickly.

The “yes or no” questionnaire was a lot more difficult, because there was no “sometimes” or “maybe” category, and because the questions were covering about any common mental disorder in existence. Some were “I avoid social gatherings or work that involves many people”, “I often fail to finish tasks because I get lost in organisational details”, “I am very moody and quickly lose my temper” – but also stuff like “I can see an aura around other people”, “I often feel another physical presence in the room” or “I sometimes feel like my plans and personality alter completely from one day to the next”. I had to brood quite a lot over some of them…

The interview was easy in so far that the person doing it (the one who also did the phone interviews) is really nice and tried to make me feel comfortable, but difficult because you are asked to differentiate between motives and reasons that sometimes are extremely hard to tell apart. For example, did I stop doing something because I lost interest in it, because I lack the drive/motivation to get started, because I am scared of it or because I am simply not able to do it anymore? And all of that for a very wide array of topics: hobbies, family, friends, strangers, work, sleeping habits, eating habits, personal hygiene, household chores, sexual feelings and so on… Do I feel guilty, worthless or inadequate? Is something the result of physical, emotional or mental fatigue? Is the range of emotions one feels narrowed? Can you still feel joy? Do you still enjoy social contacts? If not, why?

An hour of that is about as much intellectual effort as sitting an exam.

I have a headache now.

November 19, 2010

I wouldn’t say cathartic, because “katharsis” implies a crisis and subsequent emotional cleansing, a change. For that, I will have to start the actual therapy first. This is still the diagnostic phase – the interview will be repeated nine weeks into treatment. The interviewer fills out a kind of chart each time which results in a score: the higher, the more depressed you are. Each interview is only about the last seven days and if the second interview after nine weeks of either medication or therapy only shows no improvement of at least 20% compared to the first one, the other method is added and you receive a so-called “combination therapy”.

I already had such an interview last week, when the doctor did the BDI-II with me, a revised version of the Beck Depression Inventory, which is a diagnostic tool. I scored 49 out of 63: 0-9 means minimal depressive symptoms that require no treatment, 10-16 mild depression, 17-29 moderate depression, 30 and above severe depression.

I don’t and won’t know today’s result, but it probably is in the same range. Last week’s interview was informal only, to get a rough idea of what they are dealing with, but today’s interview was already done as part of the programme, even though I’m not officially in until the diagnostic phase is over. I also think they might do an analysis of my body language with the video; the interviewer did ask if I minded being filmed and said that if it was an absolute no-go, I did not have to do it, but it would be very helpful, and since I do want into the programme, I agreed. She assured me it would no be shown to students or end up online or in publications, and I had to bite my tongue to prevent saying, “Gee, thanks for giving me paranoid ideas!”

What is currently happening is that for the first time I am gaining some kind of holistic perspective on my depression, instead of just seeing it as a bunch of loosely connected (or even unconnected) symptoms and episodes. Some aspects that I was hardly aware of before are suddenly gaining contour. And I surprise myself. For example, I found that talking about personal hygiene was more embarrassing to me than talking about sexual feelings…

Those interviews are very demanding and exhausting, because you are looking at all the things wrong in your life through a magnifying glass and classify them, tear your dirty little secrets out of the corner and expose all your ugly sides and the stuff you usually hide from other people, but you do not yet work on this. So, yes, sometimes I feel even more like shit than before. But it is part of the process, and they have a 24/7 psychiatric ambulance, so if I hit rock bottom and cannot endure it any longer, I can go there. I have been close to this twice during the last week, but not quite there yet.

November 22, 2010

I got the schedule for the next proceedings: Friday I have another test/interview with a different woman, in the second week of December I have the last diagnostic meeting with the doctor. Until then I must be completely off the citalopram, so I reduced the dosage further today and am now on 50% of the original dosage. I experience lots of vertigo in the morning from weaning myself off, but everything else is ok so far.

After the second meeting with the doctor I start the actual therapy – whichever method that is: either by taking cipralex or by meeting the therapist.

November 26, 2010

Today’s session was an independent diagnosis for the sake of meeting scientific standards and achieving comparability, and to explore personality traits to exclude other mental illnesses like paranoia, schizophrenia, bipolar disorder and so on. While last time focused very much on my current state and the symptoms of the last two weeks, this was more about the history of my depression and social anxiety.

Next thing is an ECG and a blood analysis of enzymes (liver, pancreas, thyroid), electrolytes, iron, triglycerides, so-called inflammatory indicators and a pregnancy test.

I’m really feeling the withdrawal symptoms from reducing the citalopram now: in the morning I have to feel along the wall if I don’t want to stagger like drunk, same in the shower. By early afternoon it’s usually gone. And I’m getting pimples everywhere because it messed up my hormones.

The treatment programme starts about a week or two before Christmas, while the earliest date a conventional therapist could tell me was March, so I am trying to hang in there.

November 30, 2010

I’m feeling real shit, and not because of reducing the antidepressant, but because my life is just shit at the moment. (And that moment is like chewing gum, going on and on and on…)

I am not tired of life, but tired of my own life.

December 3, 2010

At the moment things are changing very fast… every day the somatoform symptoms of the depression get worse again: muscle pain in the legs, in the arms, pain in the lower back… The doctor told me that’s because you cannot relax anymore physically and your muscles cramp. This has been going on for 48 hours without a break now and today I caved in and called the psychotherapeutic ambulance because I had to ask if and which painkillers are permitted.

They said Ibuprofen is fine, if not taken too frequently and in too large doses (didn’t have anything else in the house). I read somewhere that the risk of intestinal bleeding is increased by about 1,000% if you take a combination of citalopram and ibuprofen, so I wanted to make really sure I could do that.

The results of the blood test and the ECG came back today, everything is fine. TSH is 0.97 (lab parameters 0.27 – 4.2), healthy heart beat frequency (81, even though I was nervous as fuck, my “normal” pulse is around 65), oxygen saturation of the blood at 98%.

I just picked the sheet up and did not see the doc for discussion (that is supposed to happen next Thursday), but according to the stuff I can find online my heart works perfectly normal, and they would have called me if not anyway.

I always had a rather low heartbeat rate – back in school we were supposed to achieve a pulse of 120 beats/minute in sports and I had problems even getting mine in the three-digit-area. So, for me, 81 is already quite high if you keep in mind that all I did was lying on my back. Before I got thyroid medication, I had a pulse of 48.

So with that the last two exclusion criteria for the programme are off the table. Healthy as a horse apart from the depression.

December 8, 2010

Today is the first day completely off the citalopram and there is a carousel in my head from the vertigo. Tomorrow I have a monster day at the hospital, with one appointment at 10 AM for which I have to show up without breakfast, and one at 4.30 PM. Then another appointment on Monday and next Wednesday I will be at the MRi screening all afternoon long, and then I am finally done with the diagnostic phase.

It’s snowing quite badly outside, so I’ll probably take the bus there since they are going to draw quite a bit of blood tomorrow for several examinations. No breakfast + blood loss + slippery roads + vertigo = too many risk factors. I just need to pay better attention than the last time I took the bus there, because on the way home I took the wrong one by accident and ended up on a 75 minutes long tour of the city’s outskirts.

December 9, 2010

Both private and public transport pretty much crashed here due to snow. The doc said he was working at this hospital for 13 years now and it has never been so difficult to get home…

I’m between two appointments right now; they took six big phials of blood this morning, which adds up to about the same amount as a blood donation. I was so glad when at 11 AM I was finally allowed to eat something, because I started to go rather light-headed, but now I am fine.

So far everything looks good – the last results are due later today (or at least we hope the lab will manage to have them ready). They are testing for autoimmune diseases among other stuff, but nobody is expecting anything irregular anymore.

Later:

This was a looooong day, but with good results as I have absolutely NO deficiencies, all my inner organs work very well, all the different blood cell quantities are as they should be, cholesterol is good, hormones are good… the doc said he wishes he had results as good as mine, and (what made me really happy) that despite being overweight, it does not show on the paper. My weight is only a cosmetic problem, but not a health risk.

On Monday I sign the contract that makes me part of the programme – the doc said he’d have let me sign it today, but the rules demand that I get enough time to read all the info material and think it through again – and by the end of next week I will already know whether I start with medication or with therapy.

December 13, 2010

Today I had two nurses crouching over one of my arms respectively, trying to draw the required quantity of blood until after 35 minutes (!) they were finally done. First the veins would not show at all, then they vanished again before they could put the needle in, and then none of the target areas gave enough blood. So after trying the elbows and hands on both sides, they had to draw it from the inside of my wrists, which now both fucking hurt and look like I have gone through an unsuccessful suicide attempt but was too stupid to slit my wrists properly. Both my arms are covered with haematoma and needle pricks.

The nurses do nothing but taking blood samples for the lab every day, so they have lots of experience and are very skilled, but that was a challenge even for them. “Who on earth allowed you to participate in this programme?” But they took it with humour.

Before that, I had my “test ride” into the MRi scanner, which is very close to my personal limit when it comes to claustrophobia. The fact that you cannot move much is not the problem, but the “roof” of the tube is literally one inch only from the tip of your nose – it feels like lying in a closed coffin. And I have to spend 60 – 90 minutes inside that thing on Wednesday…

The contract is signed and treatment starts next Monday – cannot wait to learn what I start with.

December 16, 2010

It will probably take more MRi scans than I’ll hopefully ever go through in my life to get used to the procedure, but while it was physically stressful (loud, warm and very narrow), I did not freak out.

I had to lie on a table, with a plastic cage around my head on which the video glasses got fastened, and additionally to the ohropax I had a foam cushion on either side of my head, both for protection from the noise (which sounds like a cross of jackhammer and microwave) and for fixation of the head. The actual time inside the scanner was about 60 minutes, with another 90 minutes of questionnaires and training before.

First, I simply had to watch pictures, with an arrow pointing up-, side- or downwards indicating whether a positive, neutral or negative picture was to follow. The positive pictures were babies, playing children, puppies, kittens, dolphins or smiling people; the neutral pictures furniture, trees or adults with neutral expressions; the negative pictures were a dirty rat, waste/litter, a turd, nasty dermatological diseases, flesh wounds, people mutilating themselves, a boxer punched in the face with blood squirting from his head, a shot person lying in her blood and, my two “favourites”, a disembodied arm that obviously got ripped off a body lying on a surgical table, with shreds of flesh everywhere, and a hand stuck in some kind of electrical saw.

Then I had to play a “game” where I was shown pictures of one of three men in random order and had to choose a conversation topic, predicting how they would react on the topic (positive or negative) based on their previous reactions in the game. Only one of them would actually be 100% reliable, the other two had differing chances of unpredictable reactions.

The third round was an interpretation of stick figures in comic strips according standard questions I was shown before each comic strip: “Does the figure feel better, worse or the same as in the previous picture?”, “Does the figure see more, fewer or the same number of living individuals than in the previous picture?”, “Do you feel better, worse or the same as in the previous picture?”, “Do you see more, fewer or the same number of living individuals than in the previous picture?”

Finally, a reaction test where you had to press a button whenever a flashlight went off. Before the flash, there was a picture of an arrow: if it pointed upwards, a fast enough reaction earned you 2€, if it pointed downwards, a fast enough reaction prevented the deduction of 2€ from your money, a vertical arrow pointing both directions was simply a reaction test without money being added or subtracted, and a horizontal arrow pointing both directions simply meant a break with no flashlight following.

I won 8€ out of possible 20€, which is ok, but obviously not great. In the beginning I was doing really well, but then I missed the flashlight once and that completely interrupted my flow. But considering that some of my predecessors actually scored negative amounts, I shouldn’t complain.

The last ten minutes I simply had to lie inside the tube doing nothing while they did a complete scan of my brain in “idle mode”.

In 8 weeks I have to repeat the whole thing – they can actually track how the brain gets “re-wired” through the following therapy and which methods change the brain in which way. The geek inside me is endlessly fascinated by the whole procedure, but it still is very stressful – I was so tense after that one hour that not only I had a headache, but stiff limbs and back pain.

December 17, 2010

The lot was drawn and I start with the CBASP psychotherapy on Monday, which makes me really happy. It is exactly what I wanted – I might get back on antidepressants by mid-February in addition to therapy sessions, but until then, I’ll stay free of medication.

They took blood again. But I think I’ll be spared the next weeks as there are no medication levels they need to check anymore – got quite enough needle tracks, haematoma and scabs already.

December 20, 2010

I had a long and partially difficult neuropsychological testing session today where they evaluated my concentration ability and whether my judgement of emotions is right when seen or heard.

And I had the first 90 minutes of therapy sessions, which went really well. It gives me hope even though my day started really bad: already had a fight with my mother on the phone before I had even gotten up.

It’s only the start of a months-long process, but I like my therapist and the psychologist who made the diagnostic preparation and whom I’ll continue to see for certain tests in between, and from the little I experienced today, the therapy has good chances of being successful.

January 7, 2011

I am doing quite well at the moment – for my own standards, that is. Before each therapy session, I fill out a BDI-II questionnaire to assess my current depression index, and I made progress already. It still lingers in the “severe depression” area, but not nearly as deep down as I was only a few weeks ago.

Those sessions are some of the hardest intellectual work I have ever done, because they require careful thinking and judgement, but it is so worth it… I don’t know how he does it, but when I start the session, it feels like I have 100,000 chaotic thoughts in my head, and when I’m done with the session, the therapist boiled everything down to one or two sentences that miraculously describe the way I enter or maintain interpersonal relationships in a most accurate way. He makes me aware of patterns that I have lived my whole life but never been aware of.

January 25, 2011

[My boyfriend] is really sweet and gentlemanly towards me: he cleans up the mess I leave in the kitchen when cooking, does the dishes, takes care I don’t get up late for work… today he made me breakfast while I was in the shower and when I came home from work, he had cleaned up my living room.

(He does not know I am typing this, even though he sits only about a metre behind me.)

My depression index has dropped from 36 points at therapy start (49 back in October) to 18 last week, which means I am lingering around the boundaries between mild and moderate depression now.

I feel A LOT better than just a couple of weeks ago. Of course, part of the success is simply due to better living circumstances right now, but the “tools” given by the therapist prove very helpful. I never knew how to handle aggressive/hurtful behaviour by others, for example, and now I am learning just that (among other things) and it is so easy that I wonder why I never thought of it myself…

And simply knowing that I have a place to turn to for professional support or help in (so far hypothetical) crisis situations is extremely helpful, too.

January 27, 2011

I was back to 22 points this week, but actually I was starting to freak out a bit because I got better so fast… as if I was doing something wrong.

The standard scenario for each therapy session is an analysis of a difficult everyday situation that occurred during the last week. You give a description and then pick it apart: how did it make me feel, what was the result, did the actual result match the result I wanted to achieve…? And then the therapist and me figure out what I could have done to make myself feel better and what I can do next time in a similar situation to prevent it from “going wrong”.

The most difficult for me is roleplaying the scenarios for the sake of making the proper response more “automated”, so that it will just pop out in confrontations eventually, and so you find the right tone: neither too aggressive nor too timid. Even though it is very effective, it makes me rather self-conscious and I need a couple of tries until it sounds right.

February 1, 2011

Back to 18 points yesterday; that’s an improvement of 51.4% in six weeks. Anything better than a 20%-improvement means I don’t have to take antidepressants again, the decision date being in two weeks.

February 23, 2011

So the switch decision date is over and as coincidence wants it, the influenza messed up my scores. They decided to push the decision back to next week because of it, because medically it doesn’t make sense if I get on antidepressants just because of that.

Today was the second MRi-scan; it went pretty well. Still glad I’m done with those, though.

3 thoughts on “Pre-Treatment Diary

  1. Pingback: Pre-Treatment Diary « Lugubrious Layara

  2. Pingback: Change Of Plans « Lugubrious Layara

  3. Pingback: Going Back On Antidepressants? | Lugubrious Layara

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