I'm Not Sure What to Think

I'm really not.

I'm sitting down to write because I've felt like I've needed to all day (I've been out at the therapeutic riding center all day working with both the kids and horses).But now that I'm sitting to write, I find I'm at a loss of words.

I've been struggling again, I think that's a given. I had ECT yesterday and I thought "oh good. I can talk to Dr. M and figure out something to do about these recurring depressive symptoms." I told the nurses as they did my intake and started my IV and they urged me to talk to Dr. M.

So I did.

And he really didn't tell me what I wanted to hear.

One, it can take up to 6 months to get the full benefits of ECT. Two, I need to go easy on myself, be gentle, and give myself time - it took awhile for me to get this sick, it's going to take awhile for me to get better. Three, I need to learn how to better manage/regulate my moods - it appears I'm getting triggered, having an exaggerated, bipolar mood reaction, and that I'm mismanaging that reaction (hence the episodes of despair or sobbing or cutting or intense anger).

I told him I was going back to a DBT group and he got a huge smile on his face. "Good. That will be good for you." The lead nurse, J, agreed that DBT would be wonderful for me.

So the plan stays: my current meds, ECT every other week, and therapy - both my regular and the DBT group.

Here's what's frustrating though: I'd had a couple of fairly good days and I had ECT and group yesterday. And today, today I'm at the riding center all day. Mucked stalls in the morning, work with the kids in the afternoon, spend time with my fave horse and barn buddy there, Thor (who, strangely, happens to be Dr. M's horse). All day I had to keep fighting off despair. It kept washing over me. Random times, no rhyme or reason. I'd be petting Thor and suddenly all I could think about was how nothing really mattered, everything was pointless, and that I'd eventually end up killing myself because nothing gets better. Ever.

I'd throw everything I could into fighting those thoughts and feelings. I do what I'm supposed to do: remain present, acknowledge the feelings, allow them to pass, replace negative thoughts with positive ones. Everything that I practice, that I've been taught to do . . . I do it. Then I finally resort to distraction. I go find something to do or someone to talk to or I immerse myself in grooming. Whatever I can to stay on top.

Today I had that despair wash over me at least 10 times. Even though I would count this a "pretty good" day, I still had to fight so much to stay on top.

Is this how it's always going to be? Always fighting, always struggling, every day? This is what I worry about. Because I don't want to do this every day. I don't want to fight my own mind every day. I'm worried that at some point I'll be too tired. Because what's the point? Why struggle?

I shouldn't think like that. That's not productive, right? I'm just so frustrated.

Well, I have therapy on Thursday, so we'll see what M has to say about all this.

Update

On Tuesday I saw my new pdoc, Dr. M. First impression: nice, personable, and no nonsense. He read through all of the info I brought him (my med history, illness history, hospitalizations, etc) and asked him why I had come to him.

Well, because the NP I was seeing told me she wasn't going to prescribe anything new, that meds won't help me, and that I'll be depressed and suicidal for the rest of my life and that I need to get used to it. Oh - and have you considered ECT?

His response? "Looking at your med history I can see why she would say that. She could have done so a little more tactfully . . . I think she's stumped. Have you considered ECT?"

"Um, no. It's probably not a good idea because of the short term memory loss, with me being a nurse and all."

He then went on to discuss ECT with me a little more in depth. He's been doing it for 20 years and has seen remarkable results with it. The vast majority of his patients have little to no issues with memory. The talk put me a little more at ease.

But I still really don't want ECT.

One thing he was willing to try was to start me on Lexapro (an antidepressant). Before I was diagnosed with bipolar disorder I had been on Lexapro for depression. Any time we increased the dose, I would get hypomanic for a couple of weeks. The hypomania would slowly wear off and then I would be okay for awhile. But then the depression would creep back in. Dr. M is hoping that since the Lexapro made me hypomanic in the past, that it will lift the depression now.

And that's it. That's all he's willing to try. If the Lexapro doesn't help and I'm still having issues with depression, my next step is ECT. Because I'm doing all the other stuff (CBT, trauma work, DBT, Al-Anon . . .). There's not much left.

Fingers crossed that the Lexapro helps.

New pdoc?

I'm planning on switching pdocs. I was a bit displeased with mine at my last appointment.

(To refresh your memory, she told me that meds won't work on me and that sometimes people have a black cloud over them and are suicidal all the time and you just have to get used to it)

That rubbed me the wrong way. And by "rubbed me the wrong way", I mean pissed me off, had me sobbing, and stole away any hope I still had left of managing my depression. I couldn't believe she told me that. I mean, even if she was thinking that she shouldn't have told me that. Not when I'm depressed, suicidal, and losing hope on my own.

Not the best thing to say.

Hubby and a couple of my friends have told me to find another pdoc. That what she said was unacceptable. That it seems she's throwing in the towel. Meds won't work on you.

I am torn though. I keep thinking, what if this is all me? What if meds won't work for the depression and that I do just need to do more trauma work? What if this is a situational type of depression, that I have to buckle down and plow through and it's all on me?

What if?

What if I'm changing pdocs because I basically didn't like what she had to say? Maybe changing pdocs won't help anything. Maybe the new one will say the same thing. Maybe I'm just chasing meds, looking for the easy way out.

I look back at myself over the last 3 years, trying to see patterns, trying to see what I'm doing right and what I could improve on. I'm trying to be open and bluntly honest with myself. I need to be if I'm going to get stable.

One thing Ive noticed (and I picked up on this about a year and a half ago) is that once I start to get better I'll be better for a couple of months and then relapse. I get depressed again. And a year and a half ago M (therapist) and I discussed this. We talked at length my "not wanting" to get better. We worked through it, we found and worked through a few triggers, and having me identify this flaw within myself had curbed that tendency to self sabotage.

And I look back and I see no self sabotage for my mania (and hospitalization) last November, no self sabotage for my suicidal depression (and hospitalization), last December, and no self sabotage for my suicidal depression (and hospitalization), last May. I find no trigger, no form of self sabotage - it just happened.

July and August this year I was starting to become more stable. In October I started to slide, by November I was down and getting worse, and December has been horrid. I know I had one trigger: a piece of Al-Anon literature I read on forgiveness. It gave me icky feels. I worked through these feels in Al-Anon, in therapy, and with my hubby. I worked through them. I laid them to rest.

Now, knowing that was a trigger, I was doing all the proper things to counter the emotional response. I talked about it, I journaled my feelings and thoughts, I countered my negative thoughts, I didn't catastrophize, I did everything right.

I worked through it. I felt better about it, and felt that I had nothing more to say on the matter.

Several weeks later is when I really started to spiral. I did all of my CBT stuff that I've learned about, I talked to hubby and in therapy. I didn't let myself isolate - I forced interaction. Again, doing everything right.

So what the hell is going on?? Did I have a PTSD trigger that threw me into a bipolar mood episode? Is this just PTSD? Is this just a bipolar shift with no real trigger? Does it really matter?

Because here in lies the rub: I'm doing all my CBT things, I'm trying to stay present, stay in the moment, take it day by day (sometimes moment by moment), counter my errors of thinking, not isolate, trying to "fake it till I make it" . . . all the things I should be doing.

But they're not helping.

They should be helping. If this was all me, all PTSD, all a trigger, then this shit should be working. And it's not. M pointed out that that one Sunday at work where I was crap and laid on the floor for 2 hours because I was suicidal and didn't know what else to do was most definitely not a trauma issue - it was most definitely a chemical imbalance issue.

If all my behavioral therapies are not working that would lead to a chemical problem, right? So meds, right?

But my pdoc won't prescribe me anything else because she believes this depression is all trauma, all in my head. That if I do more trauma work I'll be fine.

I don't even know what to talk about trauma wise anymore. I really don't. We've gone over my abusive relationship and rape. We've gone over my dad's death. We've gone over stuff with my (alcoholic) mom several times. I don't what else to say on these matters. I have no idea. I don't even know what to say in Al-Anon anymore (I've been silent the last three sessions cause I have nothing to add).

So what more trauma work do I need to do??

There's only one area I see where I need more work: fake it till I make it. I've been faltering in this area. Why? Because it's hard to pretend to be positive, to be okay, to be well, to be not depressed. It takes so much energy and it's so much easier to give into the depression. It's better for me to fake it, it is. But I've been so tired lately, the past few weeks, that it's gotten harder. It's easier to give in. To not fight. See, part of me wants to give up. I'm tired of fighting my moods everyday. I'm tired of the knowledge that I'll do this for the rest of my life. It's too much to handle and so I'm slacking on forcing myself to seem okay (even when - especially when) I'm completely broken on the inside.

What the fuck do I do? Change pdocs I guess, see what the new one has to offer. I don't know. I don't even know. This is all very frustrating as fuck.

Also? I've noticed that since I've been on 600mg of seroquel my cognition is suffering. I forget letters in words or add extra letters, it's taking longer for me to think things through, to respond. Joy.

And Then My Hope Went *poof*

That's exactly what my hope did.

*poof*

Gone. Lost somewhere in the stratosphere, floating around, uncatchable.

Or it's in the trash. I'm not sure at this point. (Floating around in the stratosphere sounds sexier though).

Why did my hope go *poof*? Well, I saw my psychiatrist, Mary, on Wednesday. And . . .

Wait. Let's back up a minute.

I want to recap what's been going on, in case you haven't read any previous posts. I'm depressed again. It's bad again. I have suicidal ideation on most days. I want to cut and I have. I alternate between wanting to die or wanting to not exist. It feels as though everything is being ripped from me again - I was starting to get stable over the summer and now everything is crashing down around me, hundreds of thousands of tiny shards and there's no way I can possibly pick them all up again. And every time I shatter like this, I miss a few pieces. Or a hundred pieces. Each time I break it's harder to collect those pieces, those shards, and this time they seem to be scattered further.

Okay. Back to Mary.

I sat in the waiting room doing a word search on my phone, feeling irritable and depressed. Surprisingly, I didn't have to wait long to be called back. Mary has a psychiatric nurse working with her who starts the intake - she gets my weight, blood pressure, and starts asking me questions. How are you doing? Bad. I'll go with that - the opposite of good. What's been going on? My depression is continuing to get worse. Five weeks ago Mary increased my seroquel and I haven't noticed any difference. I have suicidal thoughts more days than not. Do you have a plan? Yes. But I have no intent. Can you contract for safety? Sure. When was the last time you cut? This morning (I proceed to roll up my left sleeve). What's been going on the last few weeks? How's home? Work? Nothing has changed. Work is busy, home is fine. No triggers that neither I nor my therapist can identify.  Any hallucinations? No.

She typed everything I was saying, went over my meds, and brought me back to Mary's office. I liked Mary when I saw her 5 weeks ago. I liked her more than Chika (she works with Mary and is who I've been seeing since June).

Mary is reading everything her nurse wrote about me. I sit down. She looks up at me over the rim of her glasses. Cami, right? Yes. Seems like you're not doing to well. Tell me about the suicidal thoughts.  Um, well, I have ideation more days than not. I think mostly right now of slitting my wrists. Before it was always an overdose, but not now. I've had 3 days in the past 5 weeks that I probably should have gone to the hospital. But I'm stubborn and I didn't want to go - I wanted to try and manage it on my own. My therapist was a little mad at me because 1. I didn't go in, 2. I didn't call or email him (but he was in Italy on vacation and I didn't want to bother him), and 3. I didn't call you to let you know.

Before she asks another question I pull a piece of paper from my purse - the results of my genetic testing - and hand it to her. As far as my current meds go, my dosing is fine (the genetic testing was for medication metabolism - so, for example, if you're a high metabolizer for such and such a class, you'd need a lower dose of that drug).

Mary is looking at the results and to her computer screen. Results. Computer screen. Then she looks at me. You've been on a lot of meds. I know. She sighs. I don't think meds are going to help your depression. Look - you've been on so many and none of them has really helped, at least not more than a few weeks. Meds aren't going to help. I stare at her. The force of what she just said hits me hard and I'm speechless.

Wait. No.

Meds aren't going to work? You're telling me meds aren't going to work? (I think this, rather than say it).

She continues. Have you ever considered ECT? (I'm staring again). It can be very successful in treating depression. I haven't really thought about it for myself. Seriously, at least. It's just . . . the memory loss associated with it. Not such a good thing when you're a nurse. I'd have to be on leave for the entire duration of treatment (3-6 months). That's true. Have you heard about EMDR? Yes. You have a lot of trauma in your past, EMDR would be beneficial. I already do trauma work with my therapist. His specialty happens to be trauma. We're just moving at a snail's pace because it can be so triggering. My session last week was crisis intervention because of my depression. But we've been working on trauma. Okay, good. Have you heard of DBT? Dialectal behavioral therapy? There are group DBT sessions that you may want to look into. You learn coping skills and ways to manage your emotions. Okay . . . You could also look into neurofeedback. What's neurofeedback? You have electrodes placed on your head to measure your brain waves and then you learn how to change your brain wave pattern.  Oh. Okay. Do you give me referral? How does that work?

I'm almost in a trance at this point. My head is reeling. I'm going into shutdown mode. Meds aren't going to help your depression. You don't understand Mary. I need meds to work for me. They have to work for me. I've been doing everything right. I'm trying my hardest. I'm fucking trying and I need a little help here!

She continues. You'll need to research groups nearby and contact your insurance company to see if they cover these treatments. Some companies do, most don't. You do need to work through your trauma. I think that will help. It complicates things. Okay. (I nod. I'm on the verge of tears. I'm trying desperately not to cry). She looks sternly at me. You know, sometimes people have this black cloud around them their whole lives and it never gets better. Maybe they have suicidal thoughts all the time and they're just there. It doesn't go away. 

I'm staring again. I wouldn't doubt that my mouth dropped open a little bit. You're sitting here telling me that this won't get better. Meds won't work. Here are a few therapies you could try that may or may not help and that insurance probably won't cover but I'm trying to give you something to grasp for because let's face - nothing has worked before so probably nothing will work now, either. The same person telling me this told me 5 weeks ago that I didn't have to feel depressed - that we would find something that works and we can manage the depression better and don't give up because I'm hopeful that you'll get better soon.

This is not okay.

She must have read my face, my thoughts, my posture. Look, you should be proud of yourself! Look how far you've come! You're doing every possible thing you can do to get better. You're doing everything right. Okay. How about we try increasing the seroquel to 600mg? Maybe you just need more. Maybe your body needs a higher dose for the antidepressant effects. (I nod. I'm not hopeful. You told me meds won't work, yet we're going to increase a med that you don't think will work. Are you trying to placate me?) Okay. We'll try that for 4 weeks and I can even increase it to 800mg in 4 weeks if we want to try that. But we'll try 600mg for now. Look into DBT group and neurofeedback. And have a Merry Christmas! Okay.

I nod. I'm in disbelief. I make my way to the front desk and make my follow up appointment. The tears are threatening. I make it to my truck before I completely break down. I sat for 10-15 minutes sobbing. Uncontrollable sobbing full of pain and despair and frustration.

That was not what I was expecting from that appointment. Well, increasing the seroquel I expected. But not to be told that meds probably aren't going to work, aren't going to help, and we're kinda at the end of the line so maybe you should look into ECT because there really isn't much more out there for you. I was looking for hope, and I didn't get that. The thin strand of hope I'm desperately holding on to is unraveling.

And it fucking sucks.

I'm looking into DBT and neurofeedback. I'm going to discuss them with my therapist (I don't see a huge difference between DBT and what I've learned doing CBT with my therapist).

All I want is for something to work. I don't think that's too much to ask.

I've two docs tell me I need to sort through my trauma stuff and I have been. And even though I have been, I still can't identify triggers (I know some, and I can counter them so I don't have such a large emotional response, but I don't know most).

So I went up to 600mg of seroquel Wednesday night. Yesterday morning and this morning were hard to wake up to - for many weeks now I've been having a progressively harder time waking up simply because I don't want to be awake - but jumping from 400mg to 600mg seems to have made me more drowsy in the morning (hopefully that will go away).

The only thing I can do is to keep trying. At least my stubbornness comes in handy with this. My therapist had told me that as long as I'm breathing, there's hope.

I'd like to believe him.