To Hell And Back Again

After the last post, I fell into a really dark hole. For every problem solved there appeared to arise two new ones, and between a lack of energy (which was bordering on apathy) and near-despair, I had some really horrible weeks. None of the bills due June had yet been paid, and I’d really had more than enough of those troubles over the last months: we got threatened with having the gas / electricity switched off twice and had to borrow money from a friend to pay those bills. I had my bank account terminated because I accidentally went over the credit limit and (thanks to being preoccupied with the side-effects of venlafaxine) didn’t notice immediately, so I ended up being blacklisted as a “financial offender” for the next three years – it will be as good as impossible to get any kind of loan, and I had to go begging at the bank to be granted another bank account, and on top of everything else I will have to pay off almost 1250.- Euros for the old account and in penalty fees. I tried explaining my situation on the phone, but first I had to wait three weeks for a call-back since the people holding the decision power were always busy, and when they finally did get back at me, the lady berated me for it “being all my fault”.
We just about managed to pay for my husband’s German classes and get some food on the table, even though the latter was perilously close to uncertainty at two times at least. There was one day when we had all but € 9.- between the two of us, and all that was left to eat was a bit of frozen vegetables, half a jar of jam, pasta and potatoes. No bread, fruit, rice, cheese, meat, fish, butter, milk or soy drink or whatever we usually eat. Our options were plain potatoes or plain pasta, with a bit of spinach or peas. Nothing you’d traditionally serve for breakfast – and having just asked a friend to help us out with money so we wouldn’t have the gas / electricity cut off, I didn’t want to go begging again. My mother-in-law unwittingly saved us from this by sending some money, and my friend scolded me for not telling her earlier when I related the story to her… All I can say is that there’s a difference between having to ask for help once, because you got into a tight spot, and having to do it again and again, week after week or month after month. It wears you out mentally.
I believe my husband became more worried about me and my state of mind than about the money, because even though I was not entertaining thoughts of suicide, he made me promise I wouldn’t do anything to myself. Nevertheless, even getting dressed became an almost insurmountable obstacle, and I oscillated between apathy and fits of crying. I felt like I had nothing left in me: no energy, no fight, no will. And even though I had successfully fought off the denial of the application in April, nothing appeared to move forward in that regard ever since – until the beginning of June.

The money came in about three weeks ago, and despite the fact that we didn’t get approved for March (when I was still officially a university student and not available for welfare), we got monthly allowances retroactively from April 1st on. We could pay our bills, and get rid of the debts with the health insurance and the energy provider. I made a payment plan with the collection agency to pay off my old bank account in rates, paid off my sister since she had covered the contents insurance of our worldly possessions earlier this year, and gave two months’ worth of rent to my mother, as a thank you for supporting us when my parents were on a budget themselves.
Having this existential problem lifted off our shoulders has done more for my mental health than any other measure taken during the last months. For the first time in years, I go to bed without being afraid of what the next day is going to bring: even though I still get a fright when one of those “official-looking” letters comes in, I can immediately remind myself that we have the money to take care of whatever is heading our way.
The German welfare system is far from perfect and much criticized, but compared to our situation during the last year – and especially the last couple of months – we are doing peachy right now. Of course, we are not eating steak and lobster, but I can buy everything we need and some more, whereas before I would have to prioritize and calculate whether I had enough money to buy some yoghurt, for example, or whether it had to wait until the next time since it was not strictly necessary.
There was one day when I went to the neighbouring town for shopping, since the local supermarket had some offers which justified spending money on a tram ticket as we would still save compared to buying the same products in our hometown – and I made a mistake when calculating the expense. It was just a minor figure I was off, about 50 cents, but I ended up those 50 cents short for buying the tram ticket back home. I did not dare taking the tram without a valid ticket because of the € 60.- fine if I got caught, so I had no choice but walking home. It was a relatively warm day and I was dragging / carrying about 30 kg (roughly 65 pounds) of bottles and groceries in my shopping trolley and two bags. I had called my husband to meet me halfway, but by the time we got home, I was completely exhausted.
That is only one story out of many about how destitute we were. I walked around in jeans ripped from wear and tear for over a month, because I could not find a pair cheap enough in my size. When I finally found one, it had a bad, unflattering cut and I didn’t like the colour, but at least the prize was very low and the fabric not torn, so I bought it anyway. After just a few short weeks, the pull tab of the zipper broke – cheap material, I guess – so I had to put a safety-pin through the eye of the slider for using the zipper: the result was that every time I went to the toilet or got (un-)dressed, the safety-pin popped open and stung me in the finger. At that point, I made such a pitiful figure that my mother and sister gave me a part of my birthday present, two pairs of jeans, about ten days early.

Maybe that gives a little insight into why I have not been blogging. At some point, I just got too exhausted – all my mental energy went into making sure we would get on state support. And I wanted to escape from the daily struggles, not reflect on them.

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Sleeping Problems & Depression

As someone who had no experience at all with sleeping medication, I did not really know what to expect when taking zopiclone. My sister said it had knocked her out within two minutes, but that she woke up only six hours later. With this in mind, I took my little pill at 10.30 PM, after I already was in bed. I read for half an hour without noticing anything, but after switching the lights off it really was a matter of minutes only until I was asleep. I shortly woke up in the middle of the night and when my husband left for class, but it was not before 9.30 AM this morning that I became fully conscious.
Obviously, I am quite happy about this and hope that my cycle is corrected now so that I will be able to sleep tonight as well, without the help of a hypnotic agent. However, it also was a good demonstration on the limitations of sleeping medication: it was not a refreshing rest, and I have been tired all day long. It felt more like I had been knocked out instead of sleeping, and I did not dream either – which I usually do every night.
The best thing about it was that when my husband came home from class, I was not only awake, but had also showered, dressed, eaten breakfast and opened the shutters. Instead of a zombie-like “…. heyyyyy…” from the bedroom, he got a “Hi!” from the kitchen – and I got a hug in return, because he was so happy to see the zopiclone had helped.

Sleeping problems are a very common symptom of depression, but a lot of publications only focus on insomnia and /or early waking, entirely leaving out hypersomnia. In fact, back when my doctors were still throwing diagnoses like MS into the ring, I myself already suspected it could be depression, but the insistence on insomnia and early waking made me doubt my own feelings: if depression was tied to decreased hours of sleep, I surely could not have that, since as a rule I was sleeping too much.
Early waking is defined as waking up significantly (an hour or more) earlier than one intended to and not being able to go back to sleep, coupled with excessive worrying while lying awake. This happens very rarely to me only, about once or twice per year.
I do have massive problems falling asleep, though,even on my best days. I read that the average healthy adult needs seven minutes to drift off, and while no source for that claim was given, it matches what I see in my husband: once the lights are off, it takes only a few minutes until he’s gone, whereas I stare into the darkness for at least an hour, often longer. About once a year, I will have a period where the problems with falling asleep grow into a full-blown insomnia, even though I have never had it for as long as now.
However, once I am asleep, I usually do not wake up until I had my full share – unless being interrupted by external signals like the alarm clock, of course. According to the IRS-SR, my nine hours of sleep within a 24-hour-period count as slightly elevated; when I first started therapy, I would need twelve. Under the influence of citalopram (at least in the beginning) and before receiving thyroid medication, it would be even more.

I just hope I can get a handle on this now and will have plenty of restful sleep tonight!

Help Me, Zopiclone

I did not think it was possible, but the last night was almost worse than the one before. It started promising: Got tired and went to bed at 10.20 PM, read for half an hour and switched the lights off at 10.50 PM. Fifteen minutes later, I was asleep – until 1 AM, when I woke up and was so alert that I could not force myself back into the realm of dreams. Got out of bed for a couple of hours, then back into bed, where I read until 6 AM. Lay awake for another hour and finally dozed off just after 7 AM again.

At least I did not cry this time, but it was even more confusing than simply staying awake. So for tonight, I asked my sister for one of the zopiclone pills she got prescribed for her insomnia last autumn. A definite first, as I never took any kind of hypnotic agent before, but I just cannot go on like this. I have tried everything to rectify my sleeping cycle and it only got worse, and even though I am generally not keen on using pills, I feel like I am going to lose my mind if I don’t get back to normal hours soon.

In other news, I have an appointment with the psychiatrist in four weeks. As the psychotherapy is covered by the fundings of the clinical trial, he has pretty much free reign to do with me whatever he deems fit, because with the exception of the citalopram two years ago, the health insurance did not have to pay for anything yet.
I’m not quite sure how I feel about all of this yet. I would have prefered to see my therapist as the psychiatrist as well, because nobody else knows my mental health history as well as he does, and quite frankly it would save me the hassle of having to get to used to another “stranger”. However, I have hardly any right to complain, and maybe it will even be good for something to keep the two treatment fields separated.

Staying Up All Night

Last night I broke my personal record for insomnia by falling asleep at 7.15 AM only, after my husband had left for class. Needless to say that aside from being immensely tired, I was also extremely distraught emotionally. Fortunately, I did not post the blog entry I had started writing, because it connected only marginally with the reality of my everyday life and was otherwise observed through the lense of nighttime pessimism.
Unfortunately, that means I also missed the time-window for calling the psychiatrist. The practice had been closed over the last few days because of carnival, and today they were only open in the morning… Will have to try tomorrow again, when they also open in the afternoon.
After I had finally drifted off, I dreamt that my therapist had done a new assessment questionnaire with me, and my results exceeded 100% in some categories. “That’s great,” he exclaimed, “now we finally know which parts of your brain we can cut out!”

A Bad Day

And I do mean bad: not-sleeping-until-5-AM-and-crying-after-waking-up-bad. I have been talking to my therapist about starting antidepressants again; even though he is also a psychiatrist, he must not treat me as such because legally therapy is “aftercare” for the clinical trial I was part of, and he is only allowed to see me as a CBASP therapist. With the kind of health insurance I have, I cannot see him as a regular patient, and I don’t have the money to cross over to his regular patient pool.
He said the antidepressants will not be able to replace the psychotherapeutic work (which I did not mean to do anyway), but might be able to aid it. He also recommended a psychiatrist to me, which makes things a lot easier as I do not have to do research and worry about whether I made a good choice or not.

Going Back On Antidepressants?

(For the past couple of days, I have been under the spell of a virus infection which is currently on a rampage in my neck of the woods – sneezing, coughing, sinus pains, yadda yadda yadda. Not that I really dare complaining; having suffered through a real influenza two years ago, I know how bad it can get and how far away I am from that still.)

For a little while now I have considered going back on antidepressants. Taking citalopram was a mixed blessing, which I have written about in one of my first blog posts and in the Pre-Treatment Diary, and for a long time I was adamant to not go back on medication. However, my perspective on it has changed since: To begin with, I believe I was too depressed in 2010 that antidepressants alone could have “cured” me – even on medication, I still was severely depressed. After two years of psychotherapy, I can feel and tell apart varying degrees of depression, even within the same category of “severe”, “moderate” or “light” depression, but was not attuned enough for doing so two years ago. I can also tell where citalopram worked for me and where it did not, and it undeniably helped with the panic attacks, even if it could not eradicate the depression enough to make a difference.
Maybe a different brand or class of antidepressants will work better than the citalopram did.

The reason why I am even considering going back on antidepressants is that I feel myself slipping – very slowly, but it is happening – into another episode of depression. My energy levels are getting lower; concentration lapses; the cognitive deficits are becoming worse; insomnia. I just want to curl up on the sofa, hide from the world. (And none of that has anything to do with the cold; it has been going on for a much longer time than this.)
What worries me is an unpredictable sadness flooding me out of nowhere, making me tear up from one minute to the next. It is so difficult to explain to other people… sometimes, it is as if I am in a bubble, and inside it time goes by much slower than for everyone else. I am too slow, too lethargic to keep up with the rest of the world….

Due to my husband’s integration class finally starting and me being unable to fall asleep, he has gone to bed earlier than me all week long: I would just stay in the living room and join him a couple of hours later, so that I would lie awake only one or two hours in bed instead of four of five. Sitting around at night all by myself has somehow emotionally transported me back to the times of my deepest depression, and I always had a pattern where my mood would tank over the course of the evening. The sadness increases with every hour, and I feel more and more lonely until I fall asleep. It is like being the only person in a vast, empty land, with nothing to distract or occupy the mind, where only bitterness and desolation thrive. Everyone around me is asleep.
I went to bed at two o’ clock in the morning, hoping I would be able to sleep. Instead, I found myself falling into sadness again – so badly that it cost all my self-control and restraint to not wake up my husband. I knew it was silly; after all, I was lying right next to the person I had married, no reason to feel lonely. And yet, there was this strange sensation of being completely isolated from everyone else in the world.

Forcing Myself To Post

This is not the first time that I’m trying to write a blog post, even though a couple of weeks have passed since the last attempt. The biggest hindrance being my continued inability to express myself – if talking about it poses great difficulty, writig appears an almost Herculean task. So I’ll just try to give a very fragmentary overview in the hope that eventually I’ll be able to express myself more eloquently.

I don’t know how I made it through the semester, in hindsight maybe even less than at the time of living it. In the end, I was so burned out that I pushed all but one of the exams to October, because I wasn’t mentally fit for studying any more, but at least that one exam I passed with an “A minus”.

My husband’s appeal for a residency permit got granted for three years (after that, it’ll be a permanent one). We jumped through all the bureaucratic hoops and in December he can finally start the mandatory German classes, the way there being paved with many frustrations that will require a post of their own.

My old computer broke after five and a half years of faithful service. The power supply unit literally blew up (knocked out the living room’s fuse, smoke curling out of the computer’s back) and damaged not only the PSU, but also the mainboard and processors. It was only because of a financial donation from my mother-in-law that I could buy a laptop as replacement… All my personal data – photos, all my uni files, the templates for the blog charts etc. – still are on the old harddrive, but I hope I can get them back soon.

The last regular therapy session was in April. I had one “on the side” in late June, which my therapist had crammed in between hospital duties one morning, but following up on this, all scheduled appointments got cancelled due to the persisting staff shortage at the hospital, and then August rolled around, which my therapist takes off every year.  I was told to get in touch via email at the beginning of September, so I guess by Wednesday (when the first dust of back-to-work-stress has settled) I will contact him.

For about three months, I have argued back and forth with German Telecom over the cancellation of my landline phone back in February: because I couldn’t pay my phone bill all at once, I had cancelled my phone and arranged for payment of the remaining bill in four rates, due in March, April, June and July.  In May, I received a letter reminding me of outstanding payments on my landline and when I called customer service to clarify the mistake, the ladies I spoke to insisted that my phone had been turned off because I didn’t pay – never mind the fact that if one calls my old number, an automated message announces that the phone number is not available at the moment. It wasn’t turned off, it was properly cancelled. On top of that, they spoke of the fee due in May, when the payment plan I’d received in the mail clearly stated that no rate was due that month, and claimed that a sum equivalent of three rates was still due when I had already paid two rates out of four.
In the end, I got so worried that I even discussed it with my therapist the one time I saw him, even though his suggestion to take a lawyer to sort this out was rather unsatisfying to me – how would I pay the lawyer? I don’t have any insurance which would cover such a case either, and so I could only hope that one of my emails or phone calls would finally sort out the matter.

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These are, in a nutshell, the most important events of the past months. This is the third day I’m “working” on this post, just to give some kind of perspective regarding the difficulty of writing. By the end of June, I was at a score of a whopping 33 points in the BDI-II, which signifies heavy depression, and right now I’m still lingering at around 15 points on good days, or higher on bad days.
The most persistent symptoms are a lack of energy and “emptiness” inside. Not only am I  devoid of any kind of esprit or verve, but sometimes it’s even hard to tell what I’m feeling. There’s… just nothing I could put into words. Which is upsetting when my husband asks me what’s wrong, because I don’t want him thinking it’s something he did. It’s just our circumstances, I guess. We’re on a very tight budget and can’t really afford to go out, much less to go on a trip for a while. So I guess part of that emptiness inside is just boredom, being stifled by the ever-same routine. And part of it is pure dread in the face of having to go back to uni in a couple of weeks. Even though I know that I should take it as a challege and one day at a time, the memory of the last semester is too fresh to actually see it this way.
Around this time last year, I thought if I went back to uni, it would take a couple of weeks and then I would get used to it. I thought that if I did not manage 100% productivity, I would reach at least 70%. Right now, it feels that anything beyond 30% is beyond my capacity, and I wonder if I will ever become “normal”, ever be able to finish uni, get a job – and hold it down. How do “normal” people manage?

Writer’s Block

Words don’t come easily these days. I’m suffering from some kind of writer’s block, which ultimately is only a symptom of problems in other parts of my life. And the blog isn’t the only way it manifests: my last therapy session was the one I posted about in April and I haven’t written to my therapist either in the meantime. We talked on the phone briefly when he had to cancel my appointment in May due to staff shortage at the hospital, so he has a vague idea that I am not too peachy, but despite a few attempts I could never finish an email even though trying really hard – I can’t put into words what exactly the problem is or what he could do to help me. Same goes for my husband. He asks me to talk to him about it, but I just don’t know what to say. I don’t know where the root of the problem is and I don’t know what to do to make things better – all I can tell him is that I am increasingly suffering from university-related anxiety, but that’s something he can tell without me pointing it out to him.
Yesterday, I woke up two hours prior to the time the alarm clock was set for, and the thought of going to class filled me with such dread that I burst into tears and ended up staying at home. Today was hardly better, just less teary, and even though I left for class, I just ended up counting down the minutes until I could go home again. On the outside, all I have to do is sit there and take notes, nothing more, but inside me there is so much anxiety that even that leaves me completely exhausted after two hours.

Finances, Fear, Family, Frustration

I’ve been in financial trouble lately, culminating in a letter threatening to turn off my gas and electricity if I didn’t pay within the next few days. It came as a really unpleasant surprise, because I was under the impression that I had already paid all I owed last month, but apparently had been mistaken. My boyfriend was able to cover for that and so we’ll continue having warm water and heating, but it still weighs down on me. My mother barks at me that I have to quit university and get a job, my therapist tells me it’s of utmost importance that I finish university, as does my boyfriend… I’m tired of being stuck in the hamster wheel, tired of the perpetual financial strains.

And I feel guilty because I do not have the stamina for handling both a job and uni. I can’t even hold up university alone…

Last week I saw my therapist for a few minutes because he had to give me a doctor’s note so I’d get out of the second attempt of the chemistry exam. He puts a lot of emphasis on the fact that I learn to put up boundaries towards other people and learn to defend myself so I can actually do what I need to make myself feel good. Which is a lot easier said than done, especially since my brain just “empties” under stress and I become completely speechless, in the very sense of the word. It is a reaction to the cortisol surge one experiences under stress: long-term exposure to this stress hormone damages the brain cells in the hippocampus, which results in memory problems, and it also impairs retrieval of already stored information.
This morning, I was crying after receiving the letter from the energy supplier, and despite my boyfriend asking me to talk to him and say something, I just was not able to. I could not form a coherent sentence, neither in English nor in German. Even now, it is difficult to describe what is going on in me in these situations – one should assume that once the problem is taken care of, everything is alright. And my boyfriend echoed what my therapist tells me as well, that I have to stay in the present and not make this about everything that went wrong in my life, but I am not always able to do that immediately. The fear and despair can be faster than any rational thought.

Money is not the only source of stress – there also are the uni exams, of course, family situations, and the fact that the bureaucratic process for our marriage is very frustrating. I had to hand in a statement from my parents that they supported me financially, which got “lost” – even though I handed it in, it never arrived at its destination. Then I brought a second copy of the statement, only to be told that I had to re-write it. It is almost ridiculous that my boyfriend’s American documents are all fine, but my German documents create all kinds of problems…

Disclosing Depression, Part 3

The appointment with my therapist lasted no more than five minutes; we didn’t even go into his office but talked standing in the door frame. He had my note already prepared, which stated that I was incapable to work or sit exams from Thursday until Tuesday – tomorrow we’ll figure out a long-term strategy in our regular session. I was grateful that he filled in a few more days than just Friday, because it doesn’t look like I only wanted to get out of the exam this way.
I got a little glimpse of my therapist in his role as a psychiatrist, too. Usually, when I come to see him, his business as a psychiatrist is done and he takes his white coat off and sheds the whole “clinician persona” for the duration of the meeting, so the whole scene had a faint hint of strangeness to it. The psychiatrist-character appears a lot busier and, even though still being very friendly, more authoritative.

There’s no diagnosis on the note, but a huge stamp stating “[…] Clinic […] for psychiatry and psychotherapy” above my therapist’s signature, so when I hand it in on Monday, it will be known at the institute that I am being treated for mental health problems. So far, the university administration knew because I had taken a sabbatical a year ago, but none of my professors or other people at the geosciences department are clued in currently.
I am not sure how I feel about the fact that this is going to change: I like to keep some things private. It’s none of their business what I’m struggling with, but I also understand that it is better to be open about it and admit the problems I have – especially since my depression is chronic, not a singular episode. Recovery takes a long time, and I will have many more moments when depressive symptoms temporarily return, so it would probably be better to make it public and then deal with whatever consequences this has. Legally, I am on the safe side: my therapist told me more than once that they must not discriminate against me and have to treat me like anyone else. It is not open discrimination I fear anyway, but the hidden prejudices which are not expressed openly.