Panic Attack

Last night I suffered an anxiety/panic attack over the upcoming exam. I saw it coming in the afternoon already, but tried to ignore it – not that ignoring the early signs did much good. Around 1 o’ clock in the morning I started crying and woke up my boyfriend, who tried calming me down and get me to sleep. When I finally drifted off, I had very unpleasant dreams and woke rather early, being completely cramped – my left hand was so tightly clenched that I had to open my fingers with the other hand.
I’ve also had increasing cognitive problems over the last days, with the ability to memorize going downhill really fast, word-finding problems and slowed speech. All very familiar symptoms, but it is scary how fast they can come back once I am really stressed out. So I emailed my therapist about this and he wrote back that the panic attack is enough for him to give me a doctor’s note which will allow me to not participate in tomorrow’s exam, so that unlike on Tuesday I won’t lose one of the precious three attempts. I see him briefly tomorrow morning, and for Monday I had a regular appointment scheduled anyway.

I think I probably overestimated my mental capacities and, trying to cram as many facts into my head as possible, eventually buckled under the pressure. I guess I should only have registered for two exams in the first place…

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Semester Exams

The next two weeks are entirely dominated by exams, plus a palaeontology / micropalaeontology test which got announced on short notice, because too many people want to get into the zoology class. Tomorrow I’m taking the test, Tuesday the chemistry exam, Friday crystallography, the following week physics and mathematics.
Even though I’m rather good at palaeontology, I had to learn for this test because here the absolute grade isn’t as important as the relative placement – in other words, one wants to leave as many people behind as possible, to ensure getting into the class. However, studying for palaeontology is taking away time I meant to invest into chemistry, which is the exam I have the least chances for passing to begin with. At the beginning of the semester, I would have thought that role fell firmly to mathematics, but chemistry is twice the workload and just more than my brain appears capable of handling. I somewhat regret registering for the chemistry exam now as it will use up one of three attempts for taking I have – guess I will just give it a fool’s try on Tuesday and if I fail, I’ll spare the other two attempts for next year…

I’ve written before about the effects depression has on the brain: it alters and destroys synaptic connections in the brain which then have to get re-connected again (through therapy). I really feel the difference between now and ten years ago – I tire much more quickly of learning and have a harder time remembering facts. When working on long-term projects, like writing a paper, it doesn’t create too many problems because I can take breaks as I want and the result depends on continuous effort rather than a moment’s “genius”, but I struggle with preparing and sitting exams. After about 90 minutes, I need a break for several hours, and even though I still have two weeks to go, “learning fatigue” has already set in.
The sad part is knowing that ten years ago, I easily would have excelled in classes where now it takes an effort to be “merely” good. And I know that it could be worse, that after all I still manage to keep pace – but there is a lot of frustration still, and I am constantly afraid that from the outside it looks like I am procrastinating, and I am afraid that I will be judged by the professors and other students, because they are not aware of my background story.

Almost There…

One more day, and it’s Christmas break. I am really running on reserve fuel now… and apparently it shows. One of the students I spend some of my classes with asked me today, “Are you doing ok?” I replied that I was being tired and needed a break, but this was quite the understatement. I was touched by the sentiment of him asking, though – how easy it appears to be for some people.

We got back two physics homework sheets today, one I had done when I was only halfway on the decline, the other I had submitted last week. The old one came back with a result of 31.5/32 points, the other with 8.5/34 points. Both were of comparable difficulty and length and I put equal effort and time into them. The difference is that the first one I did while not suffering from cognitive deficits, the second clearly shows that I could hardly think logically.
Once I go past a certain point, it’s not only fatigue and stiff muscles, but an increasing inability to articulate myself or recall memories. With each point my BDI-II score rises, learning becomes harder. My therapist, who has a background in neurology, actually understands this kind of symptom and takes it seriously. When we were talking last week, I couldn’t remember a word I was looking for and gave him a few others until I finally found the one I had meant to say. He replied, “Good that you remembered!” and nothing more, but from the way he looked at me (and from former conversations), I knew that he was aware of the struggle behind it.
This kind of problem usually starts out very unspectacular, you merely have to concentrate a little harder. But as time goes by, the concentration you have to bring up for understanding the text grows increasingly out of reach. Eventually, the level of your reading skills just isn’t up to it anymore – as if you gave a young child of 6 or 7 years a text written for adults. At the worst stage, sentences just stop making sense. You look at them and it is as if every word is written in a different language, and if you try to read one of them, they start moving over the page and never hold still long enough to actually see them properly.

I know that getting rest and sleep and doing recreational activities will “fix” this again, just as those symptoms disappeared during spring and summer before. I will not touch any of my uni stuff before January 2 – classes start again on the 9th.

Last Session Of The Year

Last therapy session of the year; the next one is on Friday the 13th (January 2012), to which my mum will accompany me. Apparently, my regular therapy is also coming to a close – I’ve had 31 sessions so far and if I recall correctly, that means only 4 more in the normal rhythm before drawing them out. Not sure about the time periods between them, but I do know that session 40 is definitely my last one. I’ll part with a laughing and a crying eye: laughing because my life improved so vastly, crying because I will be sorry to say goodbye to my therapist for good. The whole purpose of our relationship was that it would end again eventually, but I’ve grown fond of him… but, I guess that’s a bridge I’ll cross when I get to it.

We took a look at my uni schedule today, trying to find out what I can eliminate – all contact hours, homework and commuting time added up, I had a 50-hour-week and a BDI-II score of 20, with a tendency for the worse. Friday was crossed off the list completely and I’m supposed to figure out what I can do without until I reach a point where the work load does not push me into a depression anymore.
“We are pulling the emergency brake now,” my therapist said. “And if it gets too much,” he smiled, “just scratch another class off the list and go to the cinema instead.”
Eliminating classes wasn’t the problem, I didn’t need help for that. The huge difference is that if my therapist “allows” me to take it easier, I feel like I’m actually doing something pro-active and taking care of myself, whereas without discussing it in therapy, I’d have suffered from a bad conscience and felt like I was only procrastinating. That’s clearly something I still need to learn during our remaining time together: that I have a right to take care of myself and that I’m allowed to set limits.
A job is only possible in summer, because I’m going to have exams and an “en bloc” course and an excursion (probably followed by another protocol) during the upcoming semester break, and during the second semester my situation will hardly be any different…

Our roleplaying exercises were a little different today: not the usual dialogues acted out, but instead my therapist challenged me to defend my position. After I told him that I preferred learning at home over learning at the library, for example, he said: “Convince me! Why should I believe you are learning more effectively at home?” So I listed my reasons – that I felt more relaxed at home and could concentrate better because I wasn’t constantly aware of the people around me, that I didn’t have to watch my stuff if I walked out of sight of the desk, that I had more freedom on when I wanted to learn…
Later he made me stand up while he remained seated (a position I hate, because it causes me to feel vastly overweight – even though he doesn’t get that impression and it exists in my head only) and voice the effects the depression has on me as if talking to my mother: “I have troubles falling asleep and wake up in the night; the muscles in my arms and legs hurt, my joints too. I have headaches and backaches and stomachaches. My eyes are inflamed and hurt and I can’t always see properly because of that. I can’t concentrate very well either and doing my homework gets really difficult because of that. There are cognitive problems which make me forget words and sometimes I don’t even understand my homework anymore because of this.”
Only when looking back I realize I listed exclusively physical symptoms, but didn’t mention the sadness, crying and despair descending upon me. Had I spoken to my therapist directly instead of him acting as a proxy for my mother, I would probably have mentioned this, but since we hardly ever discuss intimate feelings in my family, I didn’t speak about this in therapy either.

One aspect I forgot about and which my therapist highlighted today was exercise. There is no room in my current schedule for any kind of physical activity. He described a scientific experiment to me, in which hamsters had been exposed to stress over a long time, leading to the hamsters becoming depressed. The source of stress was removed then and the hamsters got divided in three groups: group A had a nice cage, plenty of food and social contacts; group B a nice cage and plenty of food; group C a nice cage, plenty of food and an ergometer. Everyone suspected group A to show the fastest recovery rates, but in fact it was group C which was the most successful within the given time frame…
Exercise is supposed to be light and fun – no pressure to achieve any results, but regular periods of physical movement. I certainly remember how beneficial my Tae Bo classes were, even though I have nowhere near the energy for that now. But I’ll try to reserve a fixed time for swimming or cycling or something like that.

Depression Revisited

Those last few days my situation has been really bad; as mentioned before, I depend on financial support from my parents, and my mother has been urging me to get a job, even though I hardly have the time and capacities for taking a job on top of my studies. I tried handling the situation on my own, but when she threatened I had to move out of my flat (which would equal moving in with my parents again), I panicked and wrote to my therapist about the situation. He replied:
“My medical opinion is that a place of your own is very important. Moving out or getting a job at this time would put your health in extreme danger and further increase the risk of chronification. That’s a specialist’s opinion. Please stay calm and tell your mother that you are in close contact with me and asked for my medical opinion. I’d be happy explaining it to her personally in the new year.”
I am going to take him up on this, because I believe that he’ll be able to speak with much more authority to my mother than I could ever have. If I say anything, it might look like I’m unwilling to get a job, when in reality, that’s not the case at all. I wish I had the energy to handle both…

I don’t actually think my mother was going to kick me out – it’s more like a really inappropriate kind of hyperbole to steer me in the direction she wants me to take. But at that time, the idea really freaked me out: I do love my parents, but living with them permanently would drive me over the edge quickly.

I’ve had so much stress lately that the muscles in my limbs turned stiff and hurt so much that I can’t fall asleep until 4 in the morning. My eyes are inflamed again too. Those are symptoms I can handle, though. What unnerves me is how much my cognitive abilities are influenced by this: it’s harder to concentrate and doing my homework becomes more difficult. It started about two weeks ago already, but has increased since.

Another Cancellation

Today’s session had to be moved to next Thursday, so that will be a full six weeks since the last one. I’m not angry or disappointed, just getting really… impatient. I just want to discuss certain points so that I can finally move on from them – the mental list of stuff I have to tell in the session isn’t getting any shorter.

But, as I said, I harbour no negative feelings; my therapist sounded regretful in the message he left on my mailbox and said there had been a problem – that’s the trade-off for being treated at a hospital: there’s always something that can happen unexpectedly.

Usually, I get both a phone call and an email when something important happens, and in the email my therapist asked me for a short update. Here’s what I wrote:

I’m pretty well so far and managed to stabilize at a niveau just under ten points. I am enrolled for GeoSciences now and start lectures on October 10 – the administrative business still makes me nervous, but in the end I got everything done without burying my head in the sand.
With my family I was in southern Germany for a week, which was partly wonderful and partly very emotionally exhausting, and a week ago I spent four very nice days with my aunt and sister in Weimar.
Generally I found that I could internalize what I learned in therapy even more and utilize it almost instinctively; further I feel like my cognitive abilities improved significantly over the last couple of weeks and that I will be able to handle university intellectually now.

Once Again, Back Home

Sunday evening I returned from a short trip to Weimar, a small German town with a rich cultural heritage: (in some cases temporary) home to Goethe, Schiller, Bach, Nietzsche, Liszt and many more, founding place of the short-lived first democratic German republic and the Bauhaus movement… Those four days have been filled with a lot of programme – too close or already beyond overkill for many other people, but I really enjoy this kind of intense involvement with topics I am interested in. Beyond the pure joy, I got out of it with a lot more confidence into my cognitive abilities. My sleeping brain is waking up – there was no problem handling the wealth of information.

Apart from all the pleasant things, a visit to the former concentration camp of Buchenwald was scheduled for the last day too. I visited Auschwitz in 1998, so I had a good idea of what to expect and the kind of effect such a day can have on the overall mood. Back then, I experienced a major backlash over a week after the actual visit, becoming furious at all the people around me, in my head silently screaming at them because they dared going about their comfortable everyday life when such acts of inhumanity were reality.

Admittedly, I didn’t really feel like paying Buchenwald a visit, not because I want to close out what has happened – on the contrary, I find it extremely important to educate people about this – but because I don’t want to jeopardize my new and relatively stable mental health. Since the rest of the group wanted to go, though, I joined them and assumed a somewhat distanced perspective, not unlike watching the news: intellectually, I took it all in, but tried to keep my emotions out of the experience. It seems that this approach worked, because even though I find my thoughts wandering back to what I read, saw and heard there, they don’t take over my imagination.

Overall, however, it was a great trip with very little room for depressive thoughts and worrying – just what I need(ed). And next week I will finally have a therapy session again: even though I’m getting by quite well without, I miss them and talking to my therapist. It seems longer than just a month since I last saw him and I do believe that he’ll find me different from the last “version” he met; at least I feel like I have changed during the last few weeks and shed even more depressive behaviour and thoughts. I feel more self-confident and more secure.

Physical Side-Effects of Depression

In the therapy sessions, we usually concentrate on the emotional and behavioural aspects of depression, since this is the area where we can work on change. The physical side-effects of depression, which used to even eclipse the emotional pain quite often, will go away too when the depression vanishes.
For a long time, however, I wasn’t aware that these two aspects – mental/emotional well-being and physical pain – were so closely related. I blamed my thyroid and the Hashimoto’s disease for feeling fatigued and for the memory problems I was experiencing, even if the lab results showed that my medication was perfectly adjusted. For all the other complaints, I saw three doctors in total who all diagnosed me with a variety of conditions which usually matched the most recent physical manifestations, but always ignored the full picture. Nobody suspected depression before I started having panic attacks, and even though I personally suspected a mental health problem earlier, all the symptom lists for depression I checked mentioned weight loss and sleeplessness, while I was (am) clearly overweight and slept much more than the average person: I always dismissed the self-diagnosis again on these grounds. Only at the hospital I learned that in chronic depression, weight gain and hypersomnia can occur too, as well as many other symptoms.

Today, I wanted to take inventory of the physical side-effects which one would not necessarily relate to depression and which I experienced over the course of the years.

Permanent or frequent complaints:

• Muscle pain in the limbs: I’m not entirely sure when this started, but by spring 2009, I very often had severe pains in the muscles and nerves of my arms and legs. Sometimes it would feel like a “tennis arm”, sometimes like the kind of muscle cramps you get when over-exercising. I combatted the pain with ibuprofen, paracetamol or aspirin, which brought relief for a few hours.
  My second general physician diagnosed me with multiple sclerosis because of it.
  When I was put on an antidepressant in summer 2011, the pain went away after only four days. It returned after I discontinued citalopram; my therapist was the first person who told me that it was stress-related and caused by an inability to relax. Ever since, I lie down and try to consciously relax all of my body whenever I feel the pain. With the progress in therapy, the days when my limbs hurt become fewer and fewer.

• Inflammation of the eyeballs: This symptom first occurred in spring 2009 too, when my eyes became red, dry and sensitive to light. In the beginning, the intensity would be sometimes less, sometimes worse, but last year, it was permanent.
  My first general practitioner diagnosed it as hay fever – never mind that weather or seasonal changes had no influence on it at all. My sister and niece both have hay fever, so I am rather familiar with its symptoms, and I was very certain that the inflammation of my eyes was not allergy-related. The next doctor saw it as a symptom of MS, together with the muscle pain.
  As with the muscle pain, the inflammation vanished when I started to take citalopram and returned afterwards. Recently, the inflammation had come back, but as I try to counteract the stress, it gets a little better every day.

• Headaches: I used to have headaches very frequently; up to four or five times a week during the most intense periods. The most common form was a consistent, one-sided pain directly behind the eye, as if someone was relentlessly poking me into the eyeball from behind. In 70% of all cases, the left side was concerned. Rarely (once every couple of years), I will also have a case of migraines, when I can’t tolerate light and sound and have to lie down in a dark, quiet room with a wet cloth on my face.
  The headaches started very early, during my teenage years already, and currently occur on about two or three days per month.

• Digestive problems: Another group of symptoms that I had since adolescence – stomach aches / cramps, diarrhoea, a couple of episodes when I couldn’t eat anything but apples and plain rice, one episode of histamine intolerance that vanished after two weeks. Now I experience those problems about 2 – 3 times per month, but during the worst of it, that would be 4 – 5 times per week, for months on end.

• Backaches: For about twenty years, I used to have “typical” complaints like tense muscles around the shoulder and back of my neck, but in recent years, there have also been intense phases of lower back pain. The latter first occured early in 2008, about two weeks after I had started a new job that pushed me to the limit in regards to social anxiety. I didn’t make the connection back then, but in retrospect, it seems very clear that the job and the new type of backaches were related.

Infrequent or singular complaints:

• Vertigo: One morning in 2007, I woke up with such a heavy case of vertigo that I literally couldn’t get out of bed. Lifting my head alone brought such waves of nausea that I had to vomit. It took three days until I could leave the house and see a doctor for it, who was clueless and referred me to a specialist. I had my ears and head checked, especially the sense of equilibrium, but everything was fine. They sent me home, “If it happens again, come back.” So far, there has been no second episode of unexplainable vertigo.

• Chest cramps: This is a strange one. The first experience was the night after I celebrated my 18^th birthday with a party; I woke up in the wee hours of the morning with a feeling as if my stomach was starting to petrify. Since then, I have spells when it happens a couple of days in a row, just to stop again just as suddenly for about half a year.
  Very often, the cramps come at night and I wake up from the pain, but sometimes they can also occur during the day: the muscles around my stomach become hard and cramp; a very intense ache that I feel under the sternum and in the middle of my back. Sometimes, I can sense the muscles there going tense a few hours before the actual cramping, but usually it happens within minutes only.
  Heat helps as it relaxes the muscles. At my most desperate, I had hot water bottles on both chest and back and was drinking hot water to relax the muscles from inside as well, because the pain can get so intense that I can hardly stand upright anymore and feel like opening my chest with a knife just so I can reach under the sternum and massage the muscle.
  Some people have suggested that it might be heartburn, but it feels completely different and is not inside the oesophagus or stomach, but very clearly outside of it.
  It appears that the chest cramps have become less intense and more infrequent, but is too early for making a definite call still: I had episodes of up to nine months without them and experienced some chest cramps this spring, so it will need at the very least a year without them before I consider them gone.

Intelligence & Intellect

Thursday night I informed my parents that I wanted to make a new start at university, which went better than expected. My mother stressed that I had to get my act together this time around, but the conversation wasn’t unpleasant.
It was one of the few times when my therapist had actually told me what to do: “You need to talk to your parents, soon.” I had been afraid of doing so, mainly because I’m prone to worst-case-fantasies and after a while I can’t tell anymore what’s a realistic expectation and what’s just exaggerating imagination. The biggest problems (by far) in the equation are money or related to money: how everything’s going to be financed and whether I’ll be able to still get a job after all those years. I am going to try applying for a student loan; I don’t like the idea of accumulating debts, but on the other hand it would mean a stable “income” and I could concentrate on the actual classes.

The anxiety is finally gone. I still feel nervous about my cognitive deficits, but try to tell myself that at a time when the depression was not quite as pronounced, I had no problem handling the intellectual part of university.
The irony of it is that I grew up being told how intelligent or smart I am, but instead of becoming convinced that this is true, I live in constant fear that some day people will find out that in fact I am not nearly as intelligent at all and it was just a huge misunderstanding… It might just be a manifestation of chronically low self-esteem, coupled with what I experienced when I was at the absolutely lowest and my concentration was so poor that I could hardly read two lines from a text. The letters would start dancing before my eyes, flowing into unintelligible gibberish.
The topic came up in session and my therapist told me that he had gotten to know me as an intelligent person. “Did anybody ever tell you?” – “Quite a lot of people told me, actually,” I replied, “But… well….” He asked me to guess how many out of his CBASP patients had been able to do a situational analysis alone on the flip chart after a comparable number of therapy sessions, with hardly any help or correction from him, as I had the week before. I was clueless. “None,” he said; then, after a second’s reflection, “No, you are the only one.” He explained that even though a considerable number of his patients with chronic depression were highly intelligent people, I was the first to take the knowledge and transfer it that quickly.

Rationally I know that my intellectual capacities used to be above average, and I also know that I am not the smartest person alive – not even the smartest person I know.
There are three aspects I worry about: first, depression changes the cerebral structure and I worry that the last years, when I had more symptoms over a longer time than before, “damaged” my brain so much that it will never fully recover.
One problem lies on the side of perfectionism, because less than excellent results would feel like a failure in the past. So, I don’t wonder if I’ll manage to pass exams, but I worry if I’ll be able to get good enough grades to not make me feel disappointed in myself.
The last aspect is whether I’ll be able to control my nerves in exam situations, because it has happened that I got so nervous that there was nothing but “white noise” in my brain, like a temporary amnesia – I literally couldn’t remember anything, even though I knew it was somewhere in my brain. My therapist explained to me that this happens when your brain is too busy with too many different things at once: if you are sitting an exam and suffer an anxiety attack at the same time, the brain will eventually tend to the anxiety only and neglect everything else, because the anxiety starts a lot of instinctive reactions in the body. Instincts, however, always have priority.

Yet, a part of me is also looking forward to studying again; happy that I get a second chance at higher education and doing what I used to love so much when I was younger. There is a little glitter of hope on the horizon.

Can I Make Good Decisions?

At the age of 31, I am still a university student, even though that word only described me sporadically over the last six years. I spent more time hiding from professors and fellow students than in class.
Now that the depression is lifting, I can understand again what once made me want to study – for the first time in years. My brain and my talents were very suitable for entering the academic world: I used to have the ability to concentrate for hours, I needed to read something only once and could remember it afterwards, and – most importantly – I had a fervent passion for my subjects (prehistoric archaeology, geography and palaeontology). All of this died a miserable death between 2003 and 2005. I still tried to soldier on, during the short phases when my depressive symptoms weren’t quite as pronounced, but no matter how hard I tried, the crash followed only a few months later.

I am living off my parents’ support right now, which I hate, and my father is going to retire in three years, so until then I need to stand on my own feet anyway. Due to a major reformation process of the German university structure, it is not possible anymore that I finish my original degree, but I would have to transfer my credits to a new degree.
So one of the biggest questions in my life is right now: what am I going to do? If I kickstart the transfer of my credits, I need to be certain that I can last as long as it takes to finish, which I am not yet, especially since I’d need to work a part-time job additionally. (Finding such a part-time job proves really hard, as I am experiencing right now. They want students aged 21, not 31.) If I bid university adieu for good, all the time and money that went into it will have been wasted – and I don’t have a real idea what to do then either….

If the financial side were not a problem, I’d give myself another six months off (with the help of my therapist, I have been granted a sabbatical until October) and start university next spring; until then I should have fully recovered. I’d get a different degree (most likely in palaeontology) and hopefully a decent job at a library or something similar afterwards.
But since the financial side is a problem, I do not know if it weren’t better to admit defeat and start a vocational training for a job.

One of the problems is that I am not certain if I can really make a good decision yet. Depression messes with your perception of the future and your circumstances, and only one year ago, I was absolutely certain that I’d never want to go back to university again, but as I recover, this conviction crumbles away. I know now that I’d be very sad to not have a degree, so I’d need to be absolutely certain about a decision against it.