Easy Peasy Japanesey

Back in July, I’d signed up for a Japanese class. Mainly because I was bored and suffering from cabin fever; it provided a great opportunity to get out of the house and gain a new skill.
A month-long intensive course for a small group, we were taught the hiragana syllabary and basic grammar/ vocabulary. Even though it makes my usual problems (performance anxiety, social phobias) rear their heads again, I’m enjoying the learning process so much that I went back for round 2 earlier this month.

I’ve had a fascination with Japan since primary school, and as an added benefit you gain fresh perspectives from learning a new language, especially when it doesn’t belong to the same language family as your mother tongue. Different languages come with radically different views of the world around them, which I find very exciting to discover.
The first time I strayed out of the Indo-European branch was 20 years ago, when I started learning Biblical Hebrew at school. Shame that I haven’t had a chance to use it after I got my high school certificate, because even though I can still read it, I forgot 90% of the grammar and vocabulary.

Also, I like the challenge. I spent so many years at uni with the sword of doom dangling over my head that I forgot what it is like to pursue a skill just for the sake of it. As mentioned before, I am not completely anxiety-free in class, but there’s no big test in the end or target I have to meet: just attending and learning is the goal. And nothing or nobody forces me to go there, so I have the freedom to quit whenever I want to. Which is not anytime soon.

Learning Japanese is difficult. Not sure how much of that is the inherent nature of the language (from an Indo-European perspective, at least) and how much of it is my rusty brain creaking into gear… I usually grasp the concepts explained to us immediately, but the reading/writing and numerical systems are very complex, and it is intimidating to start off from a place of complete illiteracy. We stammered our way through the textbook like first graders, even though now, after eight weeks’ worth of lessons, the prospect of reading the lines out loud is not as daunting anymore. I did practice between sessions, though, because it’s a lot to take in at once. Come to think of it, I wonder how long it will be until it doesn’t hit me like a wall of cryptic text anymore – even if I know all the words, nothing jumps out at first glance.

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Cola Addiction Revisited

Long-time readers of this blog may remember the post about Cola-addiction I wrote over three years ago. Even though I was fully aware of how unhealthy it is, I couldn’t go a day without it. When I noticed recently that my cola consumption had been comparatively low for several days in a row, I decided to attempt kicking the habit. It’s been over 48 hours since my last glass now and, to my surprise, easier than expected. The cravings are manageable, and the headaches I’ve had over the past two days may or may not be related to withdrawals. They are nuisance rather than a huge problem anyway.

Why now? The biggest factor in this is the valdoxan: since I’m sleeping better, I don’t feel as groggy anymore and thus don’t need the coke to “wake up” my brain. Plus I was ready for it – right now, I feel like I can handle making lifestyle changes and sticking with them. I am motivated by my weight loss; my depression index and anxiety are low, and I have a moderate amount of energy. Why not seize the chance?

Thoughts On Psychotherapy

Last autumn, the clinic contacted me regarding a follow-up evaluation for the medical study. Actually, they had first contacted me in summer, but my family and the paperwork for the renewal of my husband’s residency permit kept me so busy that it got pushed out of my mind. After their last reminder, I offered to drop off the questionnaires in person – I had an appointment with the psychiatrist anyway, and it’s less than five minutes driving distance between the two locations. That way, the clinic would have them faster than via traditional mail, and I’d feel a little less guilty for making them wait so long.

The evaluation mostly consisted of self-report questionnaires like I had filled out so many times before in therapy. The most difficult was a section where I was supposed to rate the difference between summer 2011, when the clinical trial ended, and autumn 2015. On paper, my situation sometimes didn’t look all that different, but on the inside it sure felt like a world apart.

So one dark December afternoon, I was knocking at my therapist’s office door again. I felt a lot more nervous than I had anticipated: I hadn’t seen him in three years, and still didn’t know what medical problems had caused him to terminate back in 2013, whether he’d be visibly altered.

When he stepped out of the door, he looked maybe a few pounds heavier than I’d remembered, but definitely healthy. There was an emergency meeting going on in his office, so I couldn’t go inside, and he had only a minute, but “didn’t want me to leave without saying hello”. He showered me with questions, of which I managed to answer less than half, and we agreed to meet again in January after my next psychiatric appointment.

I wasn’t any less nervous about the January meeting than I had been about the December one. It was scheduled as a follow-up, because strictly speaking he was not allowed to see me outside the medical study – the clinic has stopped outpatient treatment completely, with the exception of clinical trials. Which buried my hopes for ever going back to therapy with him for good. Since he had already received my questionnaire, he was somewhat in the loop of what had happened in my life over the past three years.

“What would you say is the biggest difference between now and then?”
I had to think about this one for a moment, then replied that I felt like I had grown up. That I didn’t let people trample all over me anymore, that the person I used to be just a few years ago seemed like a stranger now.

It’s true in many respects. I don’t have that crippling feeling of worthlessness anymore. Not that I think about how awesome I am all day long – I just don’t bother with that topic at all, neither in the positive nor in the negative sense. It’s just become irrelevant for my life as it is now.

Both the therapist and I agreed that I had responded extremely well to psychotherapy. I am convinced that a lot of the positive developments that were planted in therapy only came to full fruition two or three years later, when I was not having sessions anymore. I don’t even know how to describe it properly, other than that my brain got rewired.
He used that phrase a lot when I first started, but I only came to understand its true meaning now: in situations where everything happens too quickly to think about the best strategies, my brain defaults to different reactions than it did in the past. I stand my ground, I defend myself when attacked. All those hours of roleplaying these scenarios during the sessions are paying off.

I also have the situational analyses internalized, so when I find my mood tanking, I ask myself where I did not behave the way I wanted to, and what I could do better next time. I may sound like an infomercial that tries really hard to sell its product, but psychotherapy was the best thing that might possibly have happened to me.

Here’s the catch: it takes a long time to become fully effective. It only happens when you master a situation you would have failed previously – even when you don’t consciously register it, your brain notices that the new strategy was successful and is more likely to try a similar approach next time. So it takes a row of successfully averted crises for the new behaviour to grow roots. If you are like me and try to avoid adversity, it might take a while until you had enough exposure to such “opportunities”.

Of course, CBASP does not change your personality. I am still introverted and shy. But it gave me the tools to fix the holes in the hull that would have made my ship sink in the past.

The meeting with my therapist was over too quickly. I miss him – or maybe not him as much as what he had to offer (that sounds horribly selfish, but essentially what a therapist-patient relationship boils down to): a safe environment to try out new behaviour. Somebody who asked questions that opened up fresh perspectives. Especially the latter.

Of course, I could just start looking for a new therapist, but regardless of who I’d see, that person would never know the “old me”. The Layara who showed up on the clinic’s doorstep in 2010 was so afraid of everything that I’d never be able to properly communicate this to any other psychotherapist.

Then, there’s the question of familiarity. He is “tried and tested”, I know what to expect from him. With any new caregiver, a lot of time and effort would go into reaching that same degree of comfort.

Time is the third problem. Health insurance pays for 26 sessions every two years, and I always wanted to keep that option as my safety net. I don’t want to use them up and then be left with nothing to fall back on if disaster strikes!

And even if I decided to do that, there’s only one CBASP therapist left in my area, with long waiting lists.

When discussing this with the psychiatrist, she basically said she thinks my development over the last six months was promising enough to not necessitate any further psychotherapy right now – that I should see where the new medication and new circumstances (my husband’s new job) take me, and then make a decision. I agree with her – I certainly feel too well to use up my 26 “emergency sessions”. And for paying out of my own pocket we are too poor.

Maybe it is for the best. It took me more than a year to come to terms with the sudden end of therapy, but it also forced me to stand on my own feet. Ultimately, I was ready to do so. And in January, we parted on the promise to keep in loose contact, so unlike 2013, I did not feel like I had to say goodbye for good.

Depression Symptoms & Antidepressant Side-Effects Assessed

It’s becoming very clear that despite taking twice as high a dosage of venlafaxine / effexor now, the timed-release capsules work much better for me. The nausea and vertigo vanished completely, and in the mornings I don’t go through withdrawals anymore either. I do feel quite drained from the experiences of the last three weeks, though, very tired and listless. I lost 6 kg (13.2 lbs) – 4 kg over the first weekend and another 2 kg since – and even though I would welcome further weight loss very much, it goes without saying that vomiting, diarrhea and skipping meals due to nausea is not exactly a healthy way to drop the kilos and at least partially responsible for the feelings of weakness. On top of that, venlafaxine also suppresses my appetite for a good part of the day, until it returns in the evening and I suddenly start scouring the kitchen for all the stuff I did not buy when shopping…
There has been no improvements of the symptoms I primarily started taking venlafaxine for yet, the cognitive impairments and lack of energy, but I do feel more emotionally stable recently. Next Friday I have a follow-up with the psychiatrist, when I’ll find out whether I’ll increase the dosage further or stay on it for the time being.

As for the welfare process and related paperwork, the main appointment at the job centre had been cancelled on Tuesday already because the lady had become sick, and the one who works on our case at the employment agency was replaced with a colleague due to illness as well. While being very friendly as well, this colleague could do little more than collect the forms we had filled out at home and the documentation we had brought. Other than that, we will have to wait for them to get back to us. I handed in the questionnaire on my medical complaints today; the question was: “Do you have medical conditions which influence your current job or have done so in the past? Please give a short description of your illness respectively your symptoms and tell us which kinds of occupation would be influenced by these.” The space left blank was less than a quarter or a page, so I could not go into much detail:

“Diagnosis: chronic recurrent depression with comorbid panic disorder.
– permanent / daily symptoms: muscle pain in legs and arms; social anxiety; slowed-down thinking; word finding problems; problems falling asleep (at least 2 hours / night); severe lack of energy; hypersomnia; decreased libido
– frequent symptoms (at least 3 days per week): stomach pains; digestive problems (diarrhea); back pain; memory problems; concentration problems; depressive emotions (sadness, emotional emptiness, hopelessness); headaches
– periodically appearing symptoms: insomnia
– under stress also anxiety attacks
– currently (since mid-March 2013) additionally vertigo, nausea and vomiting due to starting an antidepressant regime (venlafaxine)

Because of the diverse symptoms, I am physically, intellectually and emotionally affected with any kind of occupation.”

That is as accurate an assessment as I could give of my daily problems in such a small space, and each of my healthcare providers should be able to confirm them. I learned today that the medical service will first contact my general physician for information, which is a bit of a problem since at least 80% of my depression treatment has been done by my therapist; the general physician does get reports from my psychiatrist, but except for the fact that I have participated in the medical study he does not know anything about the psychotherapeutic treatment. I do hope they’ll get in contact with him as well – if our regular case worker had been present today, I would have asked her, but her colleague was not familiar with the protocol in such cases.

The End Of An Era

Yesterday, I exmatriculated from university. Thirteen and a half years of fighting, and then it took all of 58 seconds to leave – there is a form you print out, fill in your name, address and student-ID number, give the reason for exmatriculation (I checked “illness”), and hand it over to the student secretary. She double-checked with my student-ID, stamped the form, gave me a formal statement that I had left uni, said goodbye, and that was it. My niece, who had accompanied me, timed the procedure.

That was in the afternoon, however. The morning my husband and I spent at the job centre, where we had an official appointment to start the welfare process, and saw someone from the employment agency afterwards. She might help my husband find a job, and I had to see her to work out the procedure regarding the “impaired working-ability” label. We got a total of about 50 form sheets we have to fill out: the actual application, and different questionnaires on just about every aspect of our existence, from the flat we live in (size, number of bedrooms / bathrooms / kitchens, how much rent we pay, what kind of heating it has, how much we pay for water and electricity, etc.) over our respective job résumés and occupational histories to a questionnaire on my depression history. We have to bring bank account activity statements for the last three months, and attestations of my health insurance, my husband’s integration class, the exmatriculation from university, a copy of my rental contract, yadda yadda yadda. And all of that has to be ready by Friday next week, because then we have the next appointment.
The procedure regarding my medical status will be that I formally release my general physician, therapist and psychiatrist from their obligation to secrecy, so that the job centre’s medical experts can inquire about my depression history, the treatments and my current status. They will then write a formal assessment, based on these facts, and I will get an invitation for discussing the results. If the results are clear and nobody objects, I will not have to undergo any further examinations through a medical officer.
The lady from the employment agency was very nice and sympathetic; she even inferred that she had personal experience with it – I just could not tell whether she meant depression, panic attacks or both. Regardless of what was the case, I felt treated with respect and in a non-judgemental way, which certainly is a first in my dealings with bureaucracy outside of the mental health sector. She’ll also remain our contact person for the rest of the process, so I’m doubly glad about this.

We were at the job centre for over two and a half hours, with over an hour of waiting in chairs in between. I had not taken the venlafaxine that morning, because I didn’t want to go into a side-effects frenzy during the appointment, but halfway through the withdrawal set in and my brain started buzzing like a mobile phone. I hope that for our appointment next week the timed-release capsules will prevent that scenario.

Venlafaxine: Doubling The Dosage

It was time to go from 37.5 mg to 70 mg of venlafaxine per day, and also to switch from the regular tablets to timed-release capsules. Today is a public holiday in Germany, and with the long Easter weekend ahead, I would have a few days in a row for adjusting to the new dosage. I was prepared for the worst – more nausea, maybe even vomiting, but in the end it turned out relatively harmless. There was a bit of vertigo and some tingling in my limbs, but generally the transition was rather smooth. I can definitely tell a difference between timed and regular release, because as a capsule, the side-effects do not (sometimes violently) spike within the first 120 minutes after consumption, but create a gentler wave rather that carries you into the afternoon.

Arranging Appointments Around An Antidepressant

The good news of the day: after my therapist’s statement arrived in the mail, I was able to start the application process for welfare today and it got dated back to March 1st, meaning that once the application gets approved, I’ll get the full sum for this month already.
The bad news of the day: it’s a damn complicated process. As a university student, I am not covered by welfare – except when the student is not able to work at least 18 hours per week, which I’m currently not. But to earn the “impaired ability to work” label, I first have to meet the job agency’s doctor; until then, I count as a non-impaired person seeking state support – and as such, I cannot apply for the kind of welfare I would qualify for, because I am a student. Are you still following me? So the idea the people at the job centre came up with was that my husband needs to start the process, and put my name on the list of other people in the household who’d belong to the “community in need” (a rough approximation of the German construct “Bedarfsgemeinschaft”) instead of the other way around, and once I saw their doctor, we would switch the application over to me as the main applicant… We have another appointment on Thursday morning, which will hopefully bring more clarity about the proceedings.

Which brings me to the next problem: the new appointment is at 9 AM. Right now, I’m toying with the idea of taking the venlafaxine afterwards, because the withdrawals in the morning are generally less severe than the side-effects after taking the pill. That also means that I am going to stay on the current dose until then, because I am sure increasing it will also increase the side-effects again for a while.
Generally I am doing better; the nausea / sickness is finally gone and my appetite usually returns around 4 PM, which allows me to have a normal dinner. The only persistent symptom I currently have is vertigo or dizziness, so that I still have to lie down again after breakfast, but it feels very normal, no paraesthesias or “funny feelings”.
I am not sure if I have any positive effects from the venlafaxine yet. My husband claims I handled our financial crisis last week much better than he expected and credits the antidepressant for it. It might very well be the case; I have not had any severe anxiety recently, but on the other hand I have been so consumed with just managing every single day that there was literally no time for me to worry about anything else.

More Financial Woes

The last two days, we had a financial crisis to weather: I had exceeded the credit limit of my bank account and was two months behind with the payments of the electricity & gas bill, and had two letters in the mail which threatened me with termination of the bank account and gas supply respectively if I didn’t pay off the debts immediately. The bank account wasn’t a major obstacle since a smaller sum only was required to bump it back into the credit range, but the electricity & gas bill posed a huge problem – no matter how we juggled the figures, we did not have enough money to pay it off. I tried to arrange a payment in rates, but while the idea got green-lighted by the company representative I spoke to on the phone, the finances department never called me back to discuss the details. So in the end I had to ask a friend to help us out – which she graciously did, and actually had offered to do first.
I don’t like mixing friendships and finances, but when forced to choose between having the heating turned off and asking for help, I will swallow my scruples and pride. As bad as it is that I have to ask for help and as much as I have cursed my situation and the depression which led me into it, one positive aspect of it is that I can be certain that my friends are not fair-weather-friends only, but genuinely care.
It also reminded me of something my therapist once told me – that one cannot be successful in this world without a support net of other people, and that you cannot recover without asking others for help.

The good news are that my therapist’s statement is in the mail and should arrive within the next two days, which means that on Monday I can officially start the application process for welfare. So hopefully the financial problems will be alleviated a little soon.

One huge problem on top of the monetary hassle was that I had to manage the organisation of all the “negotiations” while suffering through the venlafaxine side-effects: yesterday I made my phone calls in the morning, before taking the antidepressant, with the result that I was well past my usual breakfast time when finally being done with them, and already had withdrawal symptoms. Today I had to wait for a company representative to come over, which was scheduled for 11 AM. So I was up and dressed the entire time when during the past week I would tide over the most intense side-effects in bed, meaning that I completely spaced out on the sofa because of the brain zaps. I was so dizzy that I could hardly see straight. Eventually my husband persuaded me to take a nap, which was just as well, because the guy showed up at 2.30 PM only.

Generally I am doing better, though: my appetite is getting up and while meat still is a no-go, I actually had a proper dinner tonight (spaghetti with tomato sauce), the first in a week!

Day 4: Trippin’ On Venlafaxine

That’s the only way I can describe it. The nausea has shrunk to a 15-minute-period which sets in about an hour after taking the venlafaxine, but in the afternoon I experienced paraesthesias wandering from my brain over the back into arms and legs – a tingling sensation, not unlike the feeling when the hair stands up on your arms. It was, and here I start sounding as if being high, as if I was floating in water, or as if my body was filled with water and jellyfish were drifting through it, pulsating. My brain was the biggest jellyfish of them all, from where all activity radiated over my body.
I did not hallucinate – at all times I knew who I am, where I was and why I felt that strange. But when you go see a 3D-movie, you know that what you see is not real, yet the illusion still works, and that was how it felt for me.

The Third Day On Venlafaxine

I lost 4 kg (8.8 pounds) since Friday. Even though it is getting easier on my digestive system and the nausea usually starts dissolving 90 minutes after taking the venlafaxine, I still can eat only selective groups of food, and only in small portions –  apples, bananas, pineapples, potatoes, rice, bread. Oh, and my soy drink works too. But meat, fish, eggs or vegetables make me instantly sick. While I actually welcome the weight loss, I hope that does not lead to a rebound further down the road…
The brain zaps are increasing, and sometimes it feels like thousands of ants are crawling over the surface of my brain.