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.

SSDD

Same shit, different day.

My mood is still shit. I'm still depressed, still having suicidal ideation, and have been cutting. That is most certainly not a good combo. I have had 2 days in the last 3 weeks where going to the hospital might have been a good idea - except I don't think it would help much (I have been able to keep myself safe . . . well, except for the cutting).

I had a talk with hubby about everything a couple of nights ago to let him know what goes on in my fucked up brain. Maybe I scared him a little, I don't know. He thinks I need to add something else to my cocktail again. Maybe I do. But I don't know what. I don't have a good track record with antidepressants. He gave me homework though - to look back through my mood journal and see if there was something that I was on in the past that helped, even if I had to stop it for some reason.

Here's what I found:

I've always been on lithium and lamictal  - l&l - (both are mood stabilizers). For awhile I was on those with an antidepressant (most of the time, wellbutrin). This combo had me in a constant mixed state. I had mostly irritable hypomania mixed with depression, with a few short stints of euphoria. Reading through my journal, seeing how much irritability, distorted thinking, and depression was there makes it obvious that this is not a good combo.

I've also been on l&l with cymbalta. This combo lifted the depression a little but still kept me in a mixed state. L&l by itself renders me with deep depression.

I was on l&l with wellbutrin when I was hospitalized last November - wellbutrin was stopped while I was in the hospital and I was started on zyprexa. That knocked out the mania, but depression was still there and I was hospitalized in December after Latuda pushed me over the edge.

While on l&l and geodon, I had depression, sometimes a little more mild, often times more moderate and I lost my creativity. Mania/mixed symptoms are gone. Then, geodon was stopped and I started on seroquel. Still no mania/mixed symptoms. Well, irritability, but I'm not sure if that's mixed or more the depression. And I've been on wellbutrin and brintellix with these combos with no real benefit.

So, l&l with antidepressant alone = mixed episodes. L&l with antipsychotic = no mania/mixed, but depression. L&l with antipsychotic and antidepressant = no mania/mixed, but depression.

I'm not sure what to do. I'm sure my pdoc, whom I see next Wednesday, will suggest maybe upping the seroquel again. But I don't know what else would be helpful. I need something. Something has to change because I can't keep feeling like this.

And how, exactly, am I feeling?

Let's take a "good" day (good being a relative term). Today is a "good" day. I start the day not wanting to be awake because being awake is pointless and stupid. I spend the day going through the motions, feeling empty, and vacant, and detached. I don't really feel anything. I'm flat, apathetic. Why should I bother cleaning/drawing/etc when everything is so pointless and hopeless? It doesn't make sense. Sleeping to escape makes sense. Cutting makes sense. If I cut at least I can feel something physically - pain. That's almost like a feeling. My urge to cut is strong, sometimes overwhelming. I float along, feeling nothing, doing nothing. Well, that's not entirely true - I feel irritability. Easily. It's the only thing I do feel. I get snippy and bitchy. And in trying not to be snippy and bitchy, I tend to withdraw more.

Now, a bad day. Again, I awake not wanting to be awake because everything is pointless and stupid. Only now, I feel despair. Overwhelming despair and depression and darkness. Not only is being awake pointless, living is pointless. I want to die. I don't know how I can possibly make it through the day. The emotional pain is so great that all I want to do is curl in a ball. Curl in a ball and not exist anymore. Sometimes I do this - even at work - because I don't know what else to do. I get overwhelmed easily, I feel like giving up, and my irritability can get out of control. I tear up easily and often break down sobbing. I want to cut - this time not to feel physical pain, but rather to numb the emotional pain. I want to cut deep enough that I need stitches. My mind fixates on death - my death. Suicidal ideation. I hurt so bad that I don't know how I can go on living. I can't live like this - this is torture, not life. I know that if it does continue to go on like this, I'll kill myself. It's a certainty I'm terrified of.

I struggle whether it's a good day or a bad day, just in different ways. Neither of these days are really okay with me. I have to feel something other than this. I'm so fucking tired of dealing with this. No one should have to - especially for as long as I've had to. I'd really love to throw in the towel.

But I can't.

So there's where I am. Stuck between shit days and shit days. We'll see what my therapist says this week and what my pdoc says next week. What else can I do . . .

Some Thoughts on Suicide

Suicide is a touchy subject. It is, isn't it? The proverbial elephant in the room. Mental illness is bad enough, but bring suicide into the mix . . .

There are two things that that really get my goat about talking about suicide. Two stereotypes that people seem to hold onto.

1. People who talk about suicide are looking for attention

2. Suicide is selfish

Going into a talk about suicide with this mindset is a recipe for disaster.

Let me start by saying this: unless you've been at the point where suicide seems like the only answer, you don't get to tell me how I feel. You don't get to tell me to "buck up and look at the bright side."

There are a few things I want to address and I don't think I will do this as eloquently or as straight forward as I would like. My brain is scattered right now.

We all know what suicide is - taking one's life. We all know there is attempted suicide, completed suicide, and suicidal ideation (thinking about suicide). And there are warning signs, which often go unnoticed. I will be addressing the warning signs, don't worry.

Here's a point I want to drive home to y'all: most people who contemplate suicide truly don't want to die. They simply want the pain to stop and they see ending their life as the only way to accomplish this. Let me sat this again: WE DON'T WANT TO DIE.

Have you ever been in that much pain? That much emotional pain that you want to die? I have. Several times. Sobbing, rocking myself, knowing that things can't possibly better, that I'm a burden on my family and friends because of my constant mood swings and neediness. Knowing that my illness, bipolar disorder, will be with me my entire life and that I'll face more episodes like this, worsening depression, mania, and shorter periods of remission. I can't face the truth that I don't feel - that I often don't feel love for my husband or son - I can only fake it. That I don't feel joy or happiness and everything that once has meaning is now dead to me. That sometimes I'm so apathetic I can't even move. It's a physical pain too - exhaustion beyond belief, headaches, nausea. I'd give anything to make it stop. I'd do any thing to make it stop. And in those moments, in those moments of weakness . . . suicide seems plausible. Suicide seems like the only answer.

But I'm lucky. I'm still able to rationalize things. I think of my son and husband and I don't want to hurt them. I mainly don't want to scar my son with losing his mother. He's the reason I haven't taken pills. He's the reason I've had my husband lock up all of my pills in our safe, to which I don't know the combination.

Why am I telling you this? Why am I getting so personal with this? Because it's real. Because it happens. Because an educated, rational, once happy person has recently considered taking a whole bottle of propanolol to end her life - even though she has a wonderful family and group of friends and support system.

I've been talking about suicide lately, about not wanting to exist. I always say that I don't want to die, but that I don't want to exist. If I could just not exist until I felt better. Or that I want to sleep and just not wake up . . . those are words to pay attention to. Those are words of someone looking for help - not someone looking for attention. Do I get attention from saying things like that? You bet your sweet ass I do. I get attention from my hubby and my therapist mainly. My manager. But I need that attention. I need for someone to say, "you matter. You're important. I'm here for you." And that's all. I need to hear that. I have all the reasons I need to kill myself - give me a reason not to. And not by chastising me and telling me that I'll be hurting my family - do you think I don't know that? Trust me - I know that. But part of me thinks they'd be better off without me. Gently remind me that you'd rather have me around, even if I'm depressed and moody and sullen. That you love me no matter what. Don't make it about you. Don't tell me how it would affect you.

So is suicide selfish? In a way, yes. But when you're in that frame of mind, when you see it as your only out, it doesn't seem selfish. It seems like your only saving grace. It seems like you're doing everyone else a favor. When you go on about how my suicide will affect you, about how it will affect your family, my family, my friends, this person and that person, you diminish my feelings. You're telling me that everyone matters more than me and what I'm feeling and what I'm going through. What I'm feeling is real. Even though it may be twisted, illogical thinking, it's real. And to stomp on that, well, it does more harm than good. Acknowledge my feelings, try to understand them - even you you may not. Tell me you care and you want to help. Validate me. Hear me. Let me vent. Don't make my feelings about you.

Let's look at some warning signs for suicide:

1. Talking about suicide
2. Preoccupation with death
3. Feelings of hopelessness/despair
4. No hope for future
5. Self loathing
6. Withdrawing from others
7. "Getting affairs in order"
8. Self destructive behavior
9. Sleep problems
10. Sudden changes in mood or appearance
11. Sudden calmness

If you notice these signs in someone, talk to them. Let them know you care. Ask them about suicide - asking them isn't suddenly going to make them suicidal if they weren't before. On the contrary - it lets them know that you're open to talking to them about it and helping.

I have many things on this list tucked under my belt right now, which is why I'm worrisome to my hubby, therapist and psychiatrist. But we've taken precautions. We've talked openly about it. And I feel safe. Help someone else feel safe. Please.

If you're feeling suicidal, call the National Suicide Prevention Hotline at: 1-800-273-8255

Want to more things NOT to say to someone who is suicidal? Read this blog post.

In Remembrance

No, this isn't about Paul Walker. That shit is annoying.

This post is for my dad. Thirteen years ago today he passed away at the young age of 43 from lung cancer. December 1, 2000. He was at MD Anderson in Houston, Texas, undergoing experimental chemotherapy. He had the most aggressive form of lung cancer and it had already metastasized to his vocal cords and brain when he was diagnosed. His battle with it lasted 6 short months.

I want to tell the story of my dad, my last memories of him. I don't know the proper timeline of events - I don't remember all of the details. And I want to do the story justice.

So I'll be writing about it off and on, and when I get a full story done, one that I'm happy with, I'll post it. My dad was an amazing man. He was my confidant and my champion. I was very much a daddy's girl and we put each other on a pedestal.

Dad, I love you and miss you. Thank you for watching over me, you're the best guardian angel a girl could have.