Conquering the day. (On chronic depression.)

My next shrink appointment is in August, and I have a feeling it’s going to be a long two months.

There’s no cure for clinical depression. Coping mechanisms are the currency we need to survive. We look within and gather what we can, learning from ourselves. We learn from others, too… mental health professionals, counselors, clergy, friends, family. We look to individuals we admire, gaining inspiration from them. And, of course, there’s the internet, always ready with advice and “life hacks.”

Certainly, coping mechanisms and strategies and inspiration can be found online. That stuff abounds in books and videos, too. We have popular culture contributors, historians, philosophers, teachers, poets and writers, celebrities of all sorts, and spiritual sages and practitioners and self-help gurus whose words of wisdom are posted as adages meant to uplift or even save us.

I’ve written about a few adages I find to be helpful. I haven’t mentioned those that I find to be detrimental, though. There are a few out there that I think are really just not good. Some adages or tidbits of “wisdom” (often displayed as memes) only serve to show you that you are to blame for your own depression. I saw one on Instagram recently – the one that spawned this post:

“If you are depressed, you are living in the past. If you are anxious, you are living in the future. If you are at peace, you are living in the present.” (attributed to Lao Tzu)

We’re constantly looking for those coping mechanisms, for ways to survive depression. When we see these kinds of adages, we think, well… maybe that person isn’t aware that they’re trivializing the struggle by placing pithy quotes before our eyes, suggesting that if we wanted to, we could change our outlook or perspective and just “get over it.”

We’re happy for those who are well, and we know that many of them mean well, but those who are well aren’t helping when they (inadvertently or otherwise) wellsplain our lives to us. The last thing we need to be told is that we’re doing life wrong.

Unfortunately, there’s no “how to” when it comes to being happy. There’s only a how to cope. How to get by. Clinical depression presents like any other chronic illness: we go through spans of time that feel “normal” and fine. We can feel good and at peace. Then there are the dark spells. The dark spells are tough to work through. I lean on gratitude and love, purpose and intent, anticipation and music, working out, reading and writing, “little things” and those adages that do help. But general happiness is a unicorn in the forest of the depressed.

Each trial through mental illness is individual, because the people living with those illnesses are individuals. There is no panacea for mental illness, and if there is, it’s just not going to arrive in a meme. I know it’s easy to misunderstand depression and think that the depressed can just “get over it.” I wish that it worked that way. It just doesn’t.

Depression can be managed, though. I’m doing a pretty good job at managing it, a fact that I can recognize even though I’m in a dark spell.

 

Conquering the day.

 

Speaking of life hack memes, is there one for how to not eat a whole box of Medjool dates in one sitting?

 

Friday mental health meditation.

It’s been a hard week.

With chronic, clinical depression, you live with a continuous mental health ebb and flow. It’s usually unpredictable. When I feel the ebb, it’s easy to dwell on factors that might be feeding my mental state into the darkness.

Because while the low points usually come from nothing in particular (such are the vagaries of compromised brain chemistry), there are also times of stress responses to factors I can identify.

I recognize the counterproductive nature of dwelling on those factors, but still, it’s hard to avoid gnawing at them sometimes. This is why I constantly enumerate the things for which I’m grateful. When I catch myself going over the negative stuff, I can fall back on my long-standing practice of counting my blessings throughout the day, every day.

When I’m down, I try to dwell even more on the positive.

In other words, actively practicing gratitude amounts to depression damage control. I have other forms of therapy. Working out consistently is therapy, literally: exercise frees the body’s endorphins to help the brain make you feel better. Creative endeavors such as writing are therapy. Loving on (and being loved by) my cat is therapy. Eating well to avoid poisoning my body is therapy. I try to laugh a lot. I try to maintain a lifestyle that can help others, rather than hurt them. Now, minimizing my life is even a form of therapy. I see a shrink and take psych meds, as well, but in the daily course of living, it’s these other actions I choose to take that help the most.

I’m grateful to have the unwavering support of Callaghan and my parents, but I try to manage my mental health without leaning on them too much. I’d never take them for granted, but I don’t want to be needy, either. It’s helpful just knowing that they’re there. I have to take responsibility for myself, because what if they’re not there one day? I can’t allow myself to become dependent on others for my mental well-being. This is a survival instinct more than anything.

Apropos of nothing, here’s a selfie I thought would be amusing to take (the other day):

 

Yet another awkward mirror-selfie attempt, but hey. Hi.

 

There’s always another day, and next week will be a new week.

 

How I manage my mental illness.

I’ve touched on some of this in various posts in the past, but I’ve been asked to share an actual list of tactics I use to maintain my mental health.

First of all, I accept that PTSD and clinical depression are a part of who I am. Mental illness and the management of it are “my normal,” and this acceptance helps a lot.

It also helps to accept the fact that just as there are great days, there are horrible days, and days ranging between the two. Sometimes, all the meds and talk therapy and things on the list below just aren’t enough. When this happens, I try to recognize that “this, too, shall pass,” keeping it all in perspective. (I know that this is so much easier said than done. I can say it easily now, when I’m not at the bottom of the abyss of hopelessness and despair. All we can do is try.)

That being said, here’s my list… things I do to manage my mental illness:

1). I avoid alcohol (with few exceptions).

Alcohol is a depressant. It also counters or otherwise negatively interacts with medications taken for mental illness. Consuming alcohol on a regular basis is never advisable for the mentally ill.

2). I take medication and talk to my therapist on a regular basis.

Meds and talk therapy are basic, first-line tactics of controlling mental illness. It’s critically important to adhere to such a routine and to have my external resources at hand. I regularly visit my doctor at the V.A. hospital, and I know that I always have access to emergency help at a national veterans’ crisis line.

3). I work out and try to eat well (within reason, making sure to maintain a healthy balance).

Exercise heightens our mood by way of its effect on our brain chemistry. It leads to improved physical fitness, which improves our physical health. (For this reason, more and more companies are including gym membership coverage fees in their employees’ benefits packages.) Improved physical health reduces stress and makes us feel more energetic and better about ourselves, in general. Choosing healthier food options most of the time comprises the other half of this picture.

4). I have routines, and I stick to them.

Routines are underestimated and even sneered upon. We like to say that spontaneity is critical to quality of life, and there is certainly something to that, but the fact is that routine can provide us with mental health benefits, too. Routines are valuable. They can be soothing when everything else is chaos. Routines can give us a sense of control and accomplishment.

5). I eliminate toxic factors in my life (to the best of my ability).

The word “toxic” is overused in our current vocabulary (instigated, I suspect, by self-help gurus, but that’s beside the point) – and yet, it captures this point well. In a nutshell, a toxic factor is that which makes us feel badly about ourselves. It’s a negative and destructive force and presence in our lives.

Toxic factors can include situations, places, and/or people and relationships. It’s not always possible to eliminate such factors; when we can’t, we can seek out ways to lessen their negative impact. I recently liberated myself from an utterly demoralizing situation, and that leap hugely improved my mental health and quality of life.

6). I engage my creative energy to the fullest extent possible.

If you have creative juices, let them flow. If you have hobbies, indulge in them. If you don’t have a hobby, get one. Losing ourselves in the physical act of doing something we enjoy goes beyond mere escapism. It often involves honing talents with which we’ve been blessed. The act of doing something physical that requires the creative part of our brains is beneficial to our mental health. There’s a reason why occupational therapy is a part of an in-patient mental illness patient’s prescribed agenda.

7). I have cats.

Connecting with animals on an emotional level and caring for them has proven to be a powerful stress reducer, improving our mental and physical health. Our relationships with our pets can actually extend our lives, improve the quality of our lives, and even save our lives. I can’t think of anything that can compare to cultivating the love and trust of an animal. (I say “animal,” but this applies to birds and fish, too.)

 

Nounours: Please to not underestimate the healing powers of my purrs.

Nounours: Please to not underestimate the healing powers of my purrs.

 

8). I actively express my compassion for others in one way or another, however small.

Example: I don’t have time to physically go and volunteer at homeless shelters, so I choose to do my part by providing with water. I make sure to have one or two small bottles of cold water with me when I leave the house, especially in the hot months.

We buy generic water in bulk, keep the bottles in the refrigerator, and give them to the homeless when we see them on the street or at a red light. (Admittedly, I try to identify those homeless who are vets, though I’ll give water to any homeless person, of course.) Every time, without fail, the person takes the bottle of cold water with visible – sometimes overwhelming – gratitude and joy, which they express in such an open and heartfelt manner that I’m instantly put in empathetic touch with their plight. Water is never an unwelcome thing. The person usually opens it and chugs it immediately.

Kindness is invaluable for the human spirit.

Giving water to drink means and accomplishes much more than giving change or a dollar. Giving water with a smile is an act that says, “I recognize that you’re a human being and deserving of this basic, life-saving thing. Someone cares about you and your well-being.” I don’t think it’s necessary to explain how showing compassion to the needy can be anything but beneficial to all involved.

9). I set goals for myself and plan things to anticipate.

I believe I devoted an entire blog post to this. Having agenda items to look forward to is a pleasurable thing. It can also, in the worst of times, give us a reason to keep on keeping on.

10). I try to get 7-8 hours of sleep every night. (Still trying. Still mostly failing. But still trying).

This can’t be stressed enough: Adequate sleep and quality sleep are important for optimal physical and mental health and well-being.

11). I count my blessings and nurture my relationships with loved ones.

One word: Gratitude.

Being grateful for what we have – and who we have – is an incredibly powerful reminder that things could always be worse.

 

Keeping it real.

Keeping it real.

 

That sums it up: In addition to acceptance, meds, and professional talk therapy, I manage my mental illness by working on physical health, stress reduction, and gratitude. I try.

“Do not go gentle into that good night” (Thoughts on trolls, suicide, Robin Williams)

In any given human interaction scenario, there’s that proverbial line. Once you cross the line, you’ve entered the land of excess. You’re beyond. I think that as humans, for the sake of decency, we make efforts to not go there. We don’t want to offend.

Conversely, there’s a sub-species of human who regularly and deliberately crosses the line, a sub-species that evolved out of the masses somewhere in the mid-90’s when the World Wide Web opened for business and ushered us into a new dimension of existence. Suddenly, we could hang out in the ether. No one could see us, but we were there. And we had keyboards. They had keyboards… they of the sub-species whose raison d’être is to go there, into the beyond. Those with a propensity to offend could now do it in the most cowardly fashion: Invisibly. At some point, someone started calling them “trolls.” The name stuck, and the verb form quickly followed. Trolling is now a behavior that’s as common-place online as annoying ad pop-ups you have to “click to close” before you can read what’s on the page.

Trolls are everywhere. It’s just a fact of the internet that nothing is sacred to them. I know this, but still, I was aghast at their comments on articles about Robin Williams’ death (if I may use that event as an example). As a reader, I saw that as crossing the line of all lines. When trolls unleash their misdirected anger in the comments section of an article about someone’s death, they’re so far beyond that I can’t begin to comprehend it.

Maybe it’s naïve of me to expect nothing less from trolls who spend their days seething under the bridges of the interwebs, but really? Robin Williams committed suicide in an apparent state of confusion and despair. He was a fellow human being, an artist who devoted his career to making us laugh and using his acting gifts to enrich our collective human experience with the depth of his dramatic performances.

We now know that Robin Williams suffered with Lewy Body Dementia and a couple of other, related neurological diseases. His depression was likely a by-product of LBD, but what if he didn’t have LBT? What if he was simply, clinically depressed, as everyone assumed at the time of his suicide?

Disdain for those who commit suicide* confounds me.

Within our legal system, we have a mechanism by which murderers are shuttled away from incarceration. We informally call it the “insanity plea,” and those who use it can take up residence in a medical facility instead of in prison… because to be determined to be too mentally unfit to stand trial is to be recognized as suffering with a medical condition.

Given this, I often wonder why the murderer of one’s self doesn’t deserve that same consideration. Why do we judge the deceased who took their own lives? Why does the church refuse to bless a soul that died deliberately? The act of suicide comes from a place of inner chaos, whether from clinical depression or from neurological disorders such as those that Williams experienced. Regardless, to be in this state of despair is to be mentally unfit. If a criminal can escape prison due to being mentally unfit, why can’t a person who committed suicide also be spared? Why can’t we acknowledge the fact of mental illness and let the dead rest in peace?

 

Works of two of my favorite poets (of the many who've committed suicide).

Works of two of my favorite poets (of the many who’ve committed suicide).

 

You can’t explain such concepts to trolls. They can’t be reasoned with, but you can reason with others. You can explain how it’s offensive to speak of the deceased as being selfish, pathetic, immature, “a loser,” etc. Many of us say such things. “Suicide is cowardly and selfish. It’s the easy way out that only hurts those left behind.” In my opinion, if we’re into Political Correctness, we should deem it un-P.C. to speak unkindly of those who commit suicide.

Suicide is only tragic. 22 veterans commit suicide every day, and do we speak of them with disdain? No. For the most part, we understand that P.T.S.D. (whether from military experience or from other traumatic events) and depression go together. We reserve our disdain for civilians… but suicide is suicide. No one who commits suicide is mentally fit at the time of the act.

Trolls who emerge to spew their vitriol in the comments section of article about people who committed suicide – such as Robin Williams – are the worst, as far as I’m concerned. They’re gleeful to have this excuse to rant about politics, religion, etc. They want their hatred to be heard, and they’ll use any occasion to achieve that.

The fact is that trolls are the cowardly ones… not the victims of suicide. (This is not at all to say that those who judge suicide victims are trolls.)

People who commit suicide can no longer avoid “going gently into that good night.” Let’s honor their bravery in fighting it, rather than looking down on them for dying.

 

*****

*Please note that I don’t include extremists in my definition of suicides.

Accidental O.D. (or, I am an airhead). Let’s learn from it.

One day about two weeks ago, I accidentally took too much of my antidepressant. It was a very mild overdose, and nothing horrible happened. I didn’t go to the E.R. or anything like that. I just felt messed up, a little shaken, and maybe just a tad embarrassed when the incident passed.

Everything was fine the next day, but the experience was enough to startle me into the realization of how stupidly easy it is to take an overdose of a prescription medication by accident.

I’ve been thinking about this a lot since then. Often, when it’s reported that someone died from an “accidental overdose of prescription medication,” or “toxicology reports show the presence of prescription drugs in his/her system,” the jaded public’s reaction is largely, “‘Accidental’… right.” There’s a tendency to immediately categorize the death as either a substance abuse-related accident, or as a suicide. We aren’t so inclined to accept “accidental” without any negative connotation attached. We’re cynical. We assume an underlying moral abberation on the part of the deceased, or, at least, questionable character. We sum up the death as “just another senseless tragedy.”

After my experience, I totally understand how someone can simply, accidentally take too much of a prescription drug. What happened was I screwed up my dosage. I made a mistake.

There was some confusion that led to an oversight that led to the mistake, all on my part. My shrink increased my daily antidepressant dosage to 400 mg. Talking about how he’d send in a new prescription, he explained that I’d take two pills in the morning, and two in the afternoon. Either I mixed up parts of the information, or I just altogether missed the part about the prescription strength being different. I went home and took another pill, adding to the one I’d taken a few hours earlier.

Later that day, I took two more for my newly increased afternoon dose, instead of the one pill I’d normally take in the afternoon.

Two to three hours after that, I wasn’t feeling too well. The discomfort was vague and nondescript at first, so I figured, just ignore it… but once it started, I felt increasingly worse, and pretty rapidly. I remember trying to work and being unable to focus. I remember the inside of my head feeling like pins and needles, the same physical sensation you get when your foot falls asleep. There was nothing I could do to alleviate it, and the sensation didn’t dissipate the way it does when it happens to your foot. At the same time, my head felt like it was being constricted from the outside, like there was a band around my skull being pulled tight.

Then it was evening, and the pins and needles sensation inside my head worsened. My heart raced, which was further disconcerting. I felt strangely out of control under my skin. I couldn’t think. Still, I tried to ignore it all. I called Mom at the usual time, but I had trouble focusing on what she was saying, and when I tried to talk, I felt like I was underwater. Everything was a struggle. My head was a maddening ball of tingling, stinging little points, and I felt like I was lost in the middle of it. My mouth was dry. I did have the mental wherewithal to suppose that I was having a reaction to the increased dosage of my antidepressant. But I only took four pills, I thought. That’s what he prescribed, and it’s not enough to kill me.

I remember trying to pay attention to my breathing, and I remember taking my anti-anxiety medication with a big glass of water. Then I was waking up. I woke up to my alarm, which I’d apparently set. I felt fine! I had no recollection of going to sleep, but I remembered how I’d felt before that. I went to get my medication, and that was when I checked the label and saw that the pills in my current prescription were 150 mg, not 100 mg. It was the new prescription that would be 100 mg! Those were the ones I’d take two of twice a day.

 

This was me when Armageddon was happening inside my head, only it's not, because that happened a couple of weeks ago, and this picture was taken in the middle of the night last night. So this is a reenactment of the inside of my head from a couple of weeks before. But at least there's candlelight.

This was me when Armageddon was happening inside my head, only it’s not, because that happened a couple of weeks ago, and this picture was taken in the middle of the night last night. So this is a reenactment of the inside of my head from a couple of weeks before. But at least there’s candlelight.

 

In this most inopportune moment of airheadedness, I jumped from 300 mg to 600 mg when I was told to increase to 400 mg. I took four 150 mg pills in a 12-hour period because I neglected to read the label to verify the prescription strength (the irony of this being that I diligently read the labels on everything else I consider for consumption), and I did it suddenly, which I now know you’re not supposed to do… any changes made to psych drug dosages should be made gradually. In the case of my particular drug, making abrupt increases can cause seizures, so I’m lucky that this didn’t happen. I’m lucky that the overdose was mild, and I only felt like my brain was scrambled until I fell asleep. I was able to wake up in a normal state, go to work, and function well, as if nothing had happened.

Somehow, Callaghan didn’t notice anything unusual about me or my behavior that evening. He only knew something was wrong because I told him that I wasn’t feeling well. Apparently, I talked about calling my shrink the next day to tell him that the new dosage wasn’t working out for me, which I never did… because, of course, once I realized my mistake, I fixed it. I went back down to 300 mg, then increased in increments over the next two weeks. I’ve been taking the prescribed 400 mg per day for a few days now, and all has been well. I haven’t had any further issues.

My point is that anyone can make this kind of mistake.

To translate my experience into something that might be useful to someone, I just want to throw out a reminder that prescription drugs are a serious matter, no matter what they are. It’s always better to err on the side of caution. It’s always better to double-check the details of our medications, to educate ourselves about what we’re taking and how we’re taking it, and to be aware of any drug interaction risks, including mixing medication(s) with alcohol. Depending on the drug, the individual, and external factors, human error plus one glass of wine could be deadly; it’s safest to avoid alcohol entirely when taking psych meds or pain meds (especially the opioids – the narcotics).

Just one oversight could result in a terrible, potentially irreparable circumstance. In some cases, it doesn’t take much. It would be horrible to accidentally die and leave people shaking their heads, wondering where you went wrong, or where they went wrong, or where your parents went wrong… right? Prescription drug-related tragedies can be avoided. It never hurts to be over-cautious.