Sorry for the break, there.  I took a writing hiatus, and then life got really busy.  I am going to try getting at least one of these written a month, more if I have topics that come to mind.

Today I want to talk a little bit about choosing to go off of a med, or meds.

Recently, after two and a half years of looking, I've landed a job, a good job, one that really fits me and my skills well.  For obvious reasons, this has helped my self-esteem, sense of self-worth, and general mood enormously.

For all of these reasons and more, after consideration, I chose to go off Abilify, which is the third drug in the cocktail I take.

The first point I want to make is that there are good reasons to try going off a med.  A major change in circumstance, as outlined above, is one of them.  Another is the inability to handle the side effects, or because it is causing other medical issues.

The main reason people seem to try going off their meds, though, is because they "feel better."  This is not a good reason to go off a med.  Chances are the reason you "feel better" is because the med is doing what it is supposed to be doing.  If feeling better does not come as part of an outside change or a breakthrough in therapy and world-view, the last thing you want to do is to try going off a med.

Let's say, though, that you have a good reason for trying to go off.  The first thing that needs to happen is a discussion with your prescribing doctor.  None of these medications are ones you want to stop cold turkey.  You need to create a plan for going off the medication, and your doctor needs to be a part of helping create that plan.  Certain anti-depressants can cause issues as serious as brain damage if withdrawn from improperly.

Additionally, you need to give your doctor the chance to say whether s/he feels it's a good idea that you go off the med.  You can agree to disagree, and insist, but you should at least hear your doctor out first, especially if s/he explains why s/he feels that way.

Finally, you need to monitor yourself very carefully when going off the med.  The minute you start to notice signs of depression, you need to be talking to your doctor again.  The solution might NOT be that you have to get back on the med, but then again, it might be.  And you have to be willing to acknowledge that possibility.

Taking myself off the Abilify has gone very successfully, but a) I'm in a stressful, but good place in my life right now, b) I talked with my doctor about it, and c) I was on 5 milligrams of it, as opposed to the thirty of Lexapro I take and the two hundred of Welbutrin, both of which I have no illusions that I can wean myself off.

I wouldn't want to discourage anyone from getting of a med if it's possible for him or her, but I would urge everyone who's on them to be incredibly careful in making that decision.

Dare You To Run: Self-Care and the Art of Saying No

I said no to myself last week.  I've been having writer's block.  For me, writer's block isn't so much that I can't write--I can always force words, one way or another--but that nothing I write speaks to me.  Last week, I had time to write this blog, but I said, "Self, you need to take a week, see if it helps."

It didn't, but the point is that I tried.

I'm terrible at saying no.  Saying no to myself when I have set goals, yes, but also saying no to other people.  Going back to the post of two weeks ago, saying no feels like admitting that there's something wrong with me, that I am something less than completely functional.  If I don't say no, in other words, I am fine, I am on top of things, I am more functional than Joe Shmoe standing next to me.

The problem is, saying yes to maintain that facade means that I get even less functional in reality.  It means that I over commit.  I am not saying this is something that happens only to depressives.  Quite the opposite, I suspect this happens to plenty of people with perfectly normal brain chemistry who don't like letting others down or have a plethora of reasons for the inability to refuse a request.

That said, I think it wears on depressives more than the average person.  In essence this is "spoon theory."  Spoon theory works like this: imagine a collection of spoons.  Now imagine that for each activity you do in a day, a spoon gets taken away.  The spoons represent energy, the energy available to do something, to create something, to carry out a plan.  Depressives (along with other populations that are not the focus of this blog) start with fewer spoons than people not suffering from chronic disorders.  (I do not actually buy into the theory that persons without disorders have an unlimited number of spoons, we all have limits, it's just a matter of how far they stretch.)

So, essentially, because we have less spoons, we have to be careful in apportioning our spoons.  This does NOT mean that you should never ask someone you know to have depression to do something.  It does mean that a) you should probably consider how much you really need that person's help, and b) you need to not take it personally if the person says no.  Honestly, if it's someone you love and care about, and they normally don't say no, but they get up the nerve to say it?  Positive feedback is a really good idea.  Something like, "Well, I'm sad you're not going to help, but I'm glad to hear you putting yourself first."

How does someone who has trouble saying no start to do it?  Well, first of all, start small.  Start by realizing you have to tell yourself no some of the time.  Had plans to clean your house this weekend but really, really don't have the spoons to do it?  Tell yourself no.  Tell yourself you need to ask for help, or it needs to wait.  Tell yourself you can do ten minutes, but that's it and no more.

The next step is to start verbalizing self-care to the people you know support and love you.  A friend asks you out for dinner and you need a night at home?  Say, "I'm sorry, but I need to go home and take care of myself tonight.  Can I take a raincheck?"  Half-measures, or putting things off, is a great way to start.

Another half-measure is if someone asks you to help with something and you limit the amount of time you're willing to give.  In other words, someone asks you to volunteer, let's say, and you respond, "I'd love to, but I can only give one hour every other week."  It doesn't matter if time-wise, you can give more.  Spoons-wise, if that's what you have, that's what you give.  If you have less spoons, but you aren't yet able to just say no, then this is a way of at least limiting the deficit you feel at the end of the day.

The important thing is to remind yourself that you're not doing this to be mean, or because you don't care about helping others, or for any reason other than if you're not taking care of yourself, you cannot be a helpful, productive member of society.  You might be able to fake it really well for a while, but sooner or later, it is going to crash in on you in one way or another.  Maybe you get physically ill to the point where you can't do anything, or maybe the depression drives you to self-harm or complete inactivity.  However it happens, it's inevitable if you're not able to put yourself first at times.

Of course, all of this is a lot harder than just waking up and deciding you're important.  The depression actively tells us we're not.  I know some people who leave themselves notes around the house reminding themselves.  I know other people who have mantras they say when they wake up and go to sleep.  I, personally, have to essentially fake it until I make it.  I set saying no as a goal, as something I should do, and that reframes it for me in terms of something to achieve.  Everyone has a different way of getting there, but taking those first steps are crucial, because everything else will follow.

Depression and Identity Politics

I was talking with a friend the other night about self-identification, and the way diagnoses can become a huge part of how we view ourselves.  I got to thinking about how I define myself in relationship to my depression, which is an illness.

I do define myself by a number of identity traits that are or are not inherent.

So, for examples, I consider myself a Jewish person.  Jewish first, person second, not because my personhood is necessarily subordinate to my Judaism, but because my Judaism informs such a huge part of my life that it's only reasonable the adjective should come before the noun.

I am a woman, or, following on the prior paragraph, a female person.  For that matter, I'm a cisgendered female person.  Again, the vast majority of my outlook on life, the decisions I make, are based from a cisgendered female perspective.

To make certain I'm not leaving those parts of myself that are privileged unmarked, I am a white person.  At the same time, I am a person of Russian and Polish descent.  And here we see where the "person" comes first.  My whiteness defines me because it inherently defines my experience in relation to others.  My heritage does not.  It is a part of me, it does not encompass me.

I am a writer, because I am driven to write, because I write in my head, because writing is something I could not live without.  I am a person who plays bridge, a person who swing dances, because I do those things, but the world would go on turning for me were they to disappear from my life.

Which begs the question: am I a depressive, or am I person with depression?  I like to think it's the latter.  I like to think that the illness does not control so much of me that it comes before my rational, even normative--to a degree--thought process.

People with cancer are not cancerous, or "cancer people."  People with asthma generally do not define themselves as asthmatic in terms of personality, in terms of what drives them as people.  Obviously, these are not direct parallels, since, outside of brain cancer, neither of these illnesses affects the mind, and how our mind works is so often how we define ourselves as human beings.  Still, the fact remains, it is not considered healthy to define ourselves by our physical maladies, and yet it seems to be no surprise to people when persons with mental illnesses see that as a driving force for our personalities.

I argue that they are certainly part of us.  Perhaps even a significant part.  But I also argue that we, like people with MS or Lupus or Crohns, are doing our best to get along despite the presence of the disease.  It informs our personalities, it should not define them.

To wit: we are not mentally ill persons; we are people suffering from mental illnesses.

Busy as a Busy Bee: Coping v. Hiding

If I had a penny for every time I've had this conversation, I might be able to penny tile my kitchen floor.

Someone: How've you been?

Me:  Good, y'know, busy.

Someone:  That's good, it keeps your mind off things.

Rationally, I am aware that non-depressed persons probably do use this coping technique.  In fact, I've spoken with a number of people who find it useful to keep themselves busy when upset about something, because it gives them less time to be upset.  That's logical and a seemingly healthy way to handle a problem so long as it doesn't go to the point of complete avoidance.

That said, depression is not a problem, it's a condition.  It doesn't go away because my days are packed with things to do, it just makes those things a billion times harder to get accomplished.

I am a busy person.  I work two, sometimes three, part time jobs.  I'm on the board at my synagogue, I regularly volunteer for a battered women's shelter, I have a standing bridge game, a weekly swing dance, and I work out at least five, usually six days a week.  I also make it a point to write every day that I possibly can, even if only three hundred to five hundred words.

I, for the most part--the part of me that is not terrible at saying no to people--choose to be this way.  I strive to keep myself occupied and feel productive as hard as I possibly can.  That said, no single part of me believes that if I am just busy enough, the blanket of depression will disappear for a few hours, and I will feel better.

Productivity, at least for me, is a learned hiding mechanism.  I figured out very young that the more I do, the more accomplished and useful I am as a person, the less I seem depressed in the eyes of the world.  And with the stigma of depression, as a kid, unable to verbalize why I was allowed to be depressed, to act on feelings that are caused by a chemical imbalance in my brain, that was the safest path.

At this point, it is hard for me to undo a lot of that, even as it's become actively harmful behavior on my part at times.  I am an introvert.  I need more down time and time to myself than the average person probably does.  But I rob myself of that due to the deep-rooted need to appear fine, appear together.

High productivity in depressed persons, although rare, can be a sign of hiding, it can be a sign of frantically trying to keep things together, it can be a sign of habits so ingrained even the depression cannot touch them, or all three.  What it is probably not a sign of is someone trying to run from the depression for periods of time.  Or, if it is, that person is likely doomed to disappointment.

If someone you know is a depressive who keeps busy, the kindest thing is to not assume at his/her/hir reasons for it.  If you're actually concerned, it's something you can discuss with them.  Otherwise, if when asked how they are they say, "busy," a great response is, "Yeah?  How is that for you?" and the intent to actually listen.

Over the Rainbow: Expectation Management for Depression

My therapist once told me that a study done showed that for most people, the best parts of a vacation were the anticipation of it, and the memories of it.  I found this fascinating, since I have a rule about anticipation of anything.  It's a pretty simple rule: I don't do it.

My sister was recently pregnant with the first kid between me and my two siblings.  People kept asking me if I was excited, and I kept lying and saying yes.  The truth is, excitement is part of anticipation, so if I can help it, I don't do it.

Here's the problem with anticipation and excitement: both are forms of expectations.  And expectations, more often than not, at least for a depressive, are a really good way to get yourself disappointed.  And disappointment is a stronger trigger than almost anything I've run into over the years.

So why do I lie about this?  Do you know how it sounds if someone asks you if you're excited about your soon-to-be-born nephew and you say, "Not really," and shrug?  All of sudden, you're somehow that psycho.  You can try to explain that expectations are a thing you don't do, but people just look at you and nod, and you can tell they're thinking there's definitely something wrong with you.

I could be wrong, but I don't think depressives have any more unrealistic expectations of life than anyone else.  I think it's that we don't handle the disappointment of life not conforming to our expectations as well as someone with "normal" brain chemistry.

I suspect this is also related to why depressives have a reputation as being pessimists.  Honestly, science itself is kind of all over the place on this issue.  One theory suggests depressives hold a negative bias on the world, the next suggests that depressives are realists and non-depressives hold a positive bias.  It really just depends on what you're reading.  But science aside, popular views of depressives are as pessimists, or persons with a negative bias.

I'm not coming down either way in this post.  But I definitely do not believe that striving simply not to have expectations of a situation--positive or negative--makes me a pessimist.

The reason I'm writing about this is that lately my ability to suppress expectation has been, at best, fluctuating.  And in fairness to the popular view of depressives as pessimists, it is easier when, if I'm going to have expectations, they're low, or even negative.  That means anything greater than what I was expecting is a pleasant surprise.

Positive expectations, however, are a real problem.  A couple of months ago, for reasons that are too long to go into, it looked like I might get a full-time job.  And for the two to three weeks where this seemed like a real possibility, I was incredibly happy, which might be an argument for positive expectations.  The problem is, when it didn't happen, I spent the next month so low that my therapist consistently kept me late and was worried that I was a danger to myself.  I probably was.

I like to think I'm getting back on track of being even keel and without expectations.  A lot of times to do that, I have to hold to negative expectations until I can wipe the slate completely.  Again, this probably leads people to believe I'm a full-time pessimist.  Instead, what I strive for, and what I suspect a lot of depressives strive for, is a completely neutral slate.

All this is to say, next time you ask a person if they're excited about something, be it a new job, a trip, a new baby, whatever, if they hesitate, or don't give you the exact answer you're expecting, consider for a moment that excitement might be a dangerous state for that person.  Better yet?  Ask the person how they're feeling about the subject, rather than asking them if they're feeling the "normal" emotion, or what they're "supposed" to be feeling.

Everyone, depressives or otherwise, deals with life's events differently.  Not making assumption goes a long way toward making those who don't function within what we've codified a "normal" emotional sphere less like outsiders.

Not-So-Happy Holidays

It is common wisdom that the holidays can be a hard time for people.  However, when people say this, what often follows, to describe whom holidays are hard for is, "people without family."

Let's be honest: holidays are hard for people WITH family, too.  Family, for all its good, and sometimes not so good intentions, is stressful.

If you think it's stressful for non-mentally ill persons, multiply that by infinity-squared, and you'll have roughly how it feels for the mentally ill.

Depressives, since that is who this blog is about, in particular, accumulate certain labels within  families.

"She's so lazy, she spends days in bed."

"He's so undependable, every time we have plans, he has to cancel."

"She's such a debby-downer."

"What a glass half-empty guy."

The thing is, as depressives, we aren't generally super fond of our own brains.  Our brains tell us we are worthless, that nobody cares, that if we were to kill ourselves, everyone would be better off.  Our brains, put simply, are not our friends.  If anything, they function as the enemy a good half or more of the time.

This means that anything a family member says?  Even if we know that person is generally bitter or cruel or otherwise not someone we should listen to?  Echoes three to four times as hard in our brains as they will in a non-depressive's.  We already believe all those things about ourselves; being told them just solidifies the belief.

In turn, this means that a person who's depressed is likely to stress for a month if not more about a big family gathering, such as one during the holidays.  The stress turns itself into depression and frustration with ourselves about not being able to handle a "little family affair," which also then spins out into more depression.

Don't get me wrong: I don't believe in letting depressives off the hook for doing things we shouldn't just because we're depressed.  But gossiping about us, or saying mean things to our faces isn't going to make us do the right thing.  It's just going to further convince us of our worthlessness.  If you hear someone talking about the depressive in your family in a way that's not going to be helpful, it's probably a good idea to gently remind the person speaking that the depressive doesn't want to be that way, and likely needs help.

Additional to this, even with the kindest family, depression is isolating.  And isolation at the holidays drives even non-mentally ill persons to self-medicate and engage in other dangerous behaviors.  Depressives, however, are more likely to isolate themselves out of a sense of being unwanted, and then spiral from that sense of being alone.

Honestly, there may be nothing you can do about this.  If the isolation aspect of the illness is bad enough, there might just not be a way to reach the person.  On the other hand, if it's not, a little bit of reaching out goes a long way.  Maybe sitting next to that person at dinner and asking her how she's doing, then really listening.  Or, if you play games where teams are needed, including her in your team.

The happiness of depressives in your family is NOT your responsibility.  But if you love that person, or simply have compassion for them as a person, single instances of kindness and understanding can have considerable impacts when a person is in a bad place, and the holidays are often a time of bad places.  Think on it, on what you want the spirit of your holiday, and the meaning of your family gathering to be.  From there it's up to you.

Level-Headed Pills: Prescribing Doctors and Medication

For those of us who need meds, getting on them is almost as difficult--sometimes more--than finding a good therapist.  For one thing, medication culture has made it harder to find a good prescribing doc.  For another, meds take time to work and are fraught with possible side effects.

Let's start with finding a prescribing doc, since, obviously, meds can't happen without one of those.  The safest way, I've found, to find a psychiatrist, is to ask your therapist for recommendations.  She will usually know of someone safe and good.

What makes a prescribing doc safe and good?

1.  One who listens to you.  Appointments are generally fifteen minutes long.  About five to ten of those should be spent talking about how you're feeling.

And--this--is a really important note: you HAVE to be honest with your prescribing doc.  If you're just feeling "not suicidal" but you tell her you're "fine," she doesn't know any better.  She can't read your mind.

But if you DO say "fine" and she doesn't press, doesn't ask questions about, say, sleep patterns and enjoyment of regular activities?  Find another doc.  Depressives are taught by society not to express themselves.  Any doctor should know that's a self-protective measure.

2.  One who explains things.  You're NOT a doctor.  You don't know what one drug does as opposed to the next.  It's your doctor's responsibility to explain that to you, and to make sure your questions are answered.

3.  One who gives you choices.  You're the person who has to go on these meds.  If you're doc is telling you something is imperative, i.e., "this is the only med that will work for you," something is hinky.  Instead you're doctor should say, "there are a couple of routes we can go, here are the pros and cons of each," and leave the final decision up to you.  It's rare that there's only one treatment option, this is not an exact science.

Let's assume you've found a doctor who fulfills all those prerequisites, now what?

Well, first of all, it's going to take about six weeks for the meds to kick in if this is your first go around.  Do not freak out if nothing happens--that just means you need to try something else.  Alternatively, also do  not freak out if what happens is you stop sleeping and/or start gaining crazy amounts of weight, or some other serious side effect.  Again, this probably just means you need to try something else.

TALK to your doctor about all these things.  Tell her what's bothering you about it, what's working about it.  Meds can be tweaked time and again--and need to be.  I've had to change meds seven to eight times in the last seven years due either to them ceasing to be effective, or having counter-indications, or just side-effects that I couldn't stand.  For instance, when I first when on Prozac, I stopped sleeping.  Like, at all.

Sometimes, it takes a combo.  I'm currently on a cocktail of Welbutrin, Lexapro, AND Abilify.  There are side effects.  There are going to be side effects with almost any of these drugs.  It's a matter of whether you can handle them, or if they are worth the trade-off of not being suicidal and never wanting to get out of bed. For me, Lexapro and Abilify cause weight gain, something that is hard, because I have body dysmorphia.  It's another reason why I exercise so much.  But I make myself handle it in order to enjoy daily things like writing and spending time with my pets.

Medication is NOT for everyone, but if you've spent significant chunks of your life feeling hopeless and wanting to just close your eyes and sleep forever?  It's definitely worth a shot.

I was amazed to find, when I first got on meds that worked for me, that there was someone underneath all that pressing, obliterating hopelessness, someone I actually found pretty interesting and diverse.  There might be someone inside of you who you want to meet.  It really is worth a shot.