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  Certain anti-depressants can cause issues as serious as brain damage if withdrawn from improperly.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.