Cognitive Deficits Revisited: Coca Cola Addiction

Chances are, at some point during the last few days you came across the headlines claiming a link between the consumption of soda, especially diet soda, and an increased risk of depression. The idea itself is not new and has been circulating the media before, but surfaced again this week – even though at a closer inspection there is room for scepticism.
Most of the following text I had written almost a week ago already, but not quite finished the post yet when it suddenly became a hot topic.

Some of the most persistent symptoms of the chronic major depression I suffer from fall into the category of cognitive deficits: word finding problems, temporary inability to access memories, concentration and learning difficulties, generally slowed-down thinking and speaking. There is no doubt that I have improved in all those areas over the past two years, but the progress has not always been linear. The subjectively best I felt in September 2011, when according to the BDI-II my overall depressive symptoms were in the range of 10 points and lower, a score equal of euthymia (non-depressed, reasonably positive moods). That was also the time when I experienced the least cognitive impairment, in all aforementioned categories.
The biggest differences between now and then are that in September 2011, I was not yet back at university, and I had been on a number of short trips that year, providing both recreation and intellectual stimulation. Over the course of just a few short months, my cognitive capacities had improved greatly. In 2012, it was mostly classes, homework, written exams and office appointments instead. As a result, most of the cognitive deficits made a comeback or got worse again. The only exception is access to memories, at least concerning personal history. I remember a lot more now than I did back in May 2011.
It’s a vicious circle: the depression causes cognitive deficits, and I get depressed over those cognitive deficits…

Most days, it is as if I have a cloud in my head; every brain activity appears somewhat hazy. The closest approximation I can give is that feeling when you are just about to fall asleep and your thoughts start drifting, and then you are being forced to rouse yourself and do some task. Except that for me, this sensation can last for hours and is present at any time of the day, without being tied to sleepiness. Brain fog. Mental cotton-balls. A muddy pond in your head.
The only remedy I have for this is drinking Coca Cola – there’s something about the sugar-&-caffeine-rush that clears out the clouds and suddenly makes me more alert, more concentrated, more “intelligent”. Strangely enough, coffee does not nearly have the same effect. Nor do fresh air or anything else I tried. Only cola gets me out of the sedation.

I don’t want to drink coke on a regular base. I am worried about all kinds of negative effects this might have on my health, from diabetes to cavities in my teeth to osteoporosis (the sweeteners in diet coke severely upset my digestion, so that is no option). But more and more, I do crave cola due to the effect it has on my brain and thinking abilities. Nothing else lifts the psychomotor retardation as effectively. None of the blog posts of the last months was written without either a glass of cola standing next to me or having been consumed prior to typing.
I try limiting myself to two glasses a day, one in the early and one in the late afternoon, sometimes coupled with a cup of coffee. The results are about six hours of clarity. But there is no denying that occasionally, I drink more, and that on some days, I already crave cola before breakfast.

As I was going to wrap up this post and googled “cola depression”, I came across another fascinating blog post at Evolutionary Psychiatry, discussing the case study of a woman addicted to coca cola. Until very recently, I was much more worried about the physical consequences of my cola-consumption, and while my own intake is far lower than the quantities mentioned, it does make me wonder about possible influences on my mental health.
There is something of a dilemma: Either I give up Coca Cola and experience even more psychomotor retardation, accepting that the lowered intellectual capacities will depress me even more, and deal with the coke cravings on top of it. Or I will continue drinking soda, but risk possible negative effects for my physical and mental health, in the latter case even increasing the damage my brain has already taken in twenty years of major depression.
Maybe I’m fooling myself into a false sense of security by thinking that two glasses per day are permissible. Maybe I’m fooling myself by thinking that eventually I will get rid of the fatigue and brain fog for good, consequently not needing the cola-boost anymore. Maybe I’m a fool for thinking I will be able to quit the soda eventually. All I know is, right now I will take uncertain and abstract health risks over the certainty of daily psychomotor retardation.

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Looking Back At 2011

The year is coming to an end and it’s time to take inventory. Over the last twelve months, I have time and again observed anniversaries and compared my life to what it used to be, but it’s because of New Year’s Eve that I feel like I’ve truly come full circle.
A year ago, I was just experiencing the very first days together with my boyfriend, I had just started therapy (but was still in the anamnesis phase, not yet learning coping / healing techniques), was still in the last throes of quitting citalopram. I had an incredibly bad year behind me, full of anxiety and panic attacks, physical and emotional pain, cognitive deficits and side-effects. 2010 was left behind tired and exhausted, but with a tiny spark of hope.

There’s so much I have to be grateful for in 2011:
– My boyfriend. We only lived together until the end of March and certainly didn’t think we’d still be on different continents on Christmas and New Year’s Eve, but even if most of the year was spent geographically apart, we’ve remained emotionally closer than ever. If anything, this forced separation has galvanized our desire for being together, and the bureaucratic process – which took far longer and was far more costly than anticipated – proved that we are serious about our commitment to each other.
He’s made me laugh (despite myself, sometimes), held me when I cried (both literally and figuratively), endured my endless therapy talk without complaining or becoming jealous of my therapist once, cared for me when I was bedridden with influenza for weeks on end. Through him, I learned to enjoy life again, learned to want something more out of life again than just the mere absence of pain. Through him, I lost the fear of giving myself to another person.
– My friends. All of them have been incredibly supportive, encouraging and generous with their feedback as well as very patient listeners. I owe lots of laughter to them and many a good idea. After having been largely unable to maintain social contacts, I am grateful that nobody held this against me and that I actually did have a social life again this year.
– My therapist and the team behind him. Everybody at the hospital I ever had contact to has been nothing but friendly and highly professional. A special mention must go to the psychologist who was my very first contact person ever there; who did the phone interviews and various formal clinical interviews with me as well as the two MRi scans, and who coordinated most of the appointments with other specialists for me. Her kindness ensured that I even made it past the initial phone interview stage without getting scared away.
Towards my therapist I have to be thankful not only because of his skilfulness and expertise, but also for his constant support beyond the requirements. In addition to the therapy sessions, we must have exchanged about a hundred emails over the course of the year. He’s helped me getting a sabbatical at uni and wrote to my health insurance. In crisis situations, his response was quick and most helpful. Most importantly, he treated me humanly when I felt most inhumanly.
– My family. That might come as a surprise, but despite all our problems and dysfunctional ways, I want to be grateful for the good times we shared.
– The progress I made. I learned to verbalize my problems, ask for help, selectively trust people, maintaining social contacts better, take care of my needs, find solutions for my problems. I can read books again and am attending university again. I found out what “normal” feels like and was euthymic for the first time since childhood. Over the course of the last year, I gave my life a completely new direction. I learned to have hope. Last but not least, I started a blog which I’ve managed to maintain for seven months already and which brought me much joy.

To my readers, all the best wishes for the new year – may it bring you much happiness and joy!

The End Of The Chain

Originally I had planned writing about my therapy session this weekend, but my sister had a borderline-related meltdown again last night. She called at 1.30 AM from some place about two hours away she’d gone to with some friends, crying. I gave her the phone number of “my” hospital’s psychiatric ambulance, because quite frankly I was at a total loss: I still don’t know what exactly happened that made her cry, and I have only limited insight into the ways a borderline personality brain works and she doesn’t tell me everything either.
If she had not been that far away, I would have gone to pick her up, but was entirely too tired for spending four hours on the autobahn, and if fatigue isn’t dangerous enough already, the emotional distraction does the rest. So I didn’t offer to bring her home and only hoped she would actually call the psychiatric ambulance. I’ve consulted them twice myself – once in December, when I was weaning myself off citalopram and had a question on medication, once in May when I was freaking out over the first experience of euthymia – and they were really helpful both times. What’s more, you speak with professionally trained experts there who know how to handle this and who know what’s going on, while I can offer sympathies at best and otherwise clutch at straws.

Ever since her last episode in July, I have been repeating at least once per week that my sister should get professional help while she is doing relatively ok, not wait for the next emergency to happen. Obviously, she did not, so that now we have exactly the situation I warned her about. Additionally, I go back to university in a week and that means I do not have the time anymore to help or accompany her the way I could have done it during the summer months.

The consensus on Borderline Personality Disorder / Emotionally Unstable Personality Disorder is that for the majority of concerned people it is caused by sexual abuse, with a small minority of cases reporting no abuse, but disturbed communication in the family. For chronic depression, there too is a high prevalence of emotional / physical or sexual abuse. Before starting therapy, I had to fill out a couple of surveys and did interviews asking me about my childhood: my sister and me did not grow up in the classic neglectant family. We were clothed and fed properly, taken to the doctor and generally cared for materially and emotionally. I can with certainty claim that neither my sister nor me were abused.
However, since July I’ve been thinking a lot about how we grew up, and been quietly observing the behaviour of all people involved and comparing it to memory, with the result that I believe that in our family, there are some serious flaws in the way we communicate and share – or don’t share, rather – emotions.

My father is basically unable to talk about his emotions at all when sober. It’s not that he’s cold or distanced, but very impersonal, and since he doesn’t seem able to handle his own emotions, we children couldn’t learn anything about this from him.
My mother is rather different, but only when it comes to venting negative emotions. She’ll leave no doubt about how it makes her feel when you disappoint or annoy her, but she too has problems voicing positive emotions.
I don’t blame my parents, because they both are only the products of their own upbringing through my grandparents, and those again were damaged by their parents and WWII… My sister and I merely are the ends of a long chain.

We also don’t touch each other in my family. We got hugged and cuddled with when we were children, but around the age of 10, this kind of affectionate behaviour started to fade out and by early adolescence, it was completely gone. I have been wondering if this wasn’t one of the triggers that caused my first depressive episode at the age of 12. I haven’t hugged either of my parents in 20 years and the rare moments of physical contact are exclusively left to casual brushes of dirt off a shirt, or similarly meaningless gestures. The one exception are birthdays, when we shake hands, but on all other occasions we remain physically distant.
Over the years, this kind of distance crept into all my relationships safe for that with my niece – but she’s only 10 years old now, so she’s still in the “zone” anyway (she’s more outgoing than I was and comes to get her hugs if she doesn’t get them, though). It’s not easy to admit, but there were times when she was the only person in my life I would get in physical contact with, and when my boyfriend came to Germany, I had to literally learn touching him. During the first few days, I would even direct myself when talking, “Touch his arm. He needs to feel that you like him physically, too.”

Of course, we don’t say the German equivalent of “I love you” to each other either. Loving one another is something you do in my family, but you don’t express it – neither physically nor verbally.

When I was doing the examinations which evaluated my family background, I had not been aware of any of these patterns. In fact, I was too pre-occupied with the pain my daily existence caused to pay any attention to them, but now that I’m recovering, I can take a look at them and observe…
I do believe that both my parents and my sister need psychotherapy too, but doubt that my father or my mother will ever undergo it. For my sister, however, I hope that she gets a chance at it soon.

Cognitive Deficits

Looks like I came down again for good – no further euthymic phases during the last 48 hours. Which does not mean that I’m doing poorly; quite the opposite. My legs hurt earlier, but I managed to relax them and went for a long walk outside.

Yesterday, I borrowed a text-book for students of psychology from the library, because I want to understand what’s going on better. My therapist always explains everything to me, but if I asked every question which pops up in my mind in between, we’d never actually get to work on my problems.
I’ve always collected as much information as possible about topics that are on my mind a lot, but only now I find myself actually able to do it. Just a few weeks ago, I still lacked the ability to concentrate sufficiently, not to mention the energy. If there is a drop of regret, it is that I was not able to chronicle the whole therapy properly due to those reasons; I’ll have to depend on my unreliable memory for that.

Cognitive deficits are among the most scary symptoms of depression. It is one thing to lie on the sofa without moving for hours on end, and an entirely matter if suddenly you cannot remember facts you usually knew, if your memory gets clouded and you cannot carry on the most simple conversation without frantically searching for words. My brain always had been the one part of my body that I could count on, and suddenly that started to fall apart. More and more often, I would feel like having a wall of opaque glass in my head – I could still tell there was something behind it, but there was no way to access it.
There were days when I was scared about this, especially in the beginning – if your grandmother has Alzheimer’s, that can make you worry quite a bit. Later I had started to accept this state as a given, but still mourned the lost capacities. I could hardly believe it when not too long ago the first cracks appeared in the glass wall, and ever since the impairment has slowly started to crumble away.
Before starting therapy, I had tests done at the hospital where I did not perform too badly, but sitting through exam-like tasks is different from losing personal retention, because on the former you get concrete feedback immediately, but the latter you do not notice immediately. You only know that the recollection of an event, for example, is gone if someone else mentions it and you cannot recall it at all, or if you are asked to name certain situations and draw a blank when searching through your memory for it.
In the very first therapy session, we did an anamnesis of my depression history and I actually had to look through old diaries to get this right, because in my head it was a huge jumble at best. Five months later, this has become a lot easier; I have access to a lot of memories again that were temporarily lost.

Chatterbrain

While yesterday I had a good night’s sleep, the last one turned out almost as disturbed as the first. My brain just wouldn’t shut up, going into a frenzy of activity that only subsided in the morning hours. I tossed and turned, but it is like having a blaring radio in your head that won’t let you rest. Naturally, I am very tired once again.
And yet, I also had what after yesterday’s session I recognize as a depression-free phase: it lasted about 90 minutes today and occurred in the early evening, coupled with an increased desire to walk. The urge to move had been back this morning already, but without the elevated mood then.
This morning it proved somewhat difficult to live it out since I was grocery shopping with my mother and maternal grandmother (not the one suffering from Alzheimer’s) and my grandmother uses a walking aid, making her rather slow, but in the evening I just got my sports shoes on and walked out of the house, even running for a short distance. It felt so incredibly good – hard to believe that less than a week ago I still had to push myself, that I had no surplus energy whatsoever.
I walked as fast as I could, making long strides, lifting up my head and taking in the beautiful evening sun, feeling the wind in my hair. I was just at complete peace with myself and the world – no worries, no negative thoughts. About an hour and a half later, I started to “come down” again, but since I’m not in such a terrible place anymore as I used to be, that is alright as well – the decline was smooth, no sudden crash. I had a taste of the things to come now, and am more motivated than ever to fight the depression down completely.

***

My therapist explained that the brain works with thresholds, and that I must have reached a certain threshold which triggered a non-depressed reaction, but because my brain is still re-building the cerebral structure, there is a delay in its reaction. Over time, the gap between stimulus and reaction will become smaller, and eventually there won’t be any delay anymore.

This development proved a bit of a surprise to both of us; my BDI-II score was back to 10 in only 6 days, so we compared last week’s assessment to this week’s: I lost a point in the categories “sadness”, “irritability”, “loss of energy” and “tiredness or fatigue” each, everything else had remained unchanged. Irritability was down because I had my privacy back after the trip south and because I could command better over my own time again, which in turn affected all the other categories: being irritated costs energy and makes you tired and sad, the latter also being the case if you cannot do what you want to do.
We also took a look at “things I did right” over that time, specifically over the weekend and on Monday, since that is the time when the threshold was reached. We had started to formulate rules a while ago which, if I abide them, make my depression go away. Those rules are different for every person, so you first have to find them out; mine are rather basic: “Keep in touch with people, so you don’t fall back into social isolation” – “Get active to make things happen, take control over your life” – “Express your wishes openly” and, new since yesterday, “Spend time alone to unwind” as a direct result of the trip to my grandmother. The latter is the only rule I have regularly followed before starting therapy, but as a result usually violated the first rule by not keeping in touch with people…

In addition to following my own rules during the days we were looking at, there also was a new behaviour that had never come up nor been discussed in our therapy sessions before: avoiding to let my own mood get dragged down by those of others. It actually took me by surprise since I had handled the corresponding situation with gut feeling rather than careful thought, but apparently my intuition had led me on the right path here.
In the past, I would often succumb to the “vibes” sent off by other people around me – just had to spend some time in the same room, and my mood would drop inevitably, even if they had not been directed at me. This time around, I managed to stay focused on my well-being without avoiding the social situation or acting inappropriately; a huge step forward for me.

In retrospect, yesterday’s session felt a little like taking inventory: I brought up how I couldn’t possibly imagine making this kind of progress when I first showed up on the hospital’s doorstep back in October, and we spent some time talking about the differences between now and then as well as tracing the steps that led so far. My therapist also confirmed what I had already suspected after last week’s therapy session: that there’s a lot more liveliness to my body language. Rated on a scale from 1 to 10, with 10 being the range displayed by the average healthy person, I would have scored 2-3 in October and 8-9 now. Not quite there yet, but considering my many inhibitions, it is a tremendous change.

For the first time ever, I also spoke about some memories I had only recently unearthed again, after being “lost” in my brain for years – but I prefer keeping that for another time, since the thought process on this story is not finished yet; I remembered more since talking about it in therapy, and believe I also discovered some parallel to an event which took place years later that strongly hints at some underlying pattern for some of my earlier episodes of major depression – I want to talk about it to the therapist first, though.

It was very apparent that my therapist was happy for me, and he even walked me outside the hospital and continued talking to me outside for a few minutes. I rather enjoyed that, and took it as a compliment and encouragement for the path still before me.