Depression vs Unhappiness

I've been pretty shitty the past several days. Very shitty. Depressed, sobbing, struggling. I've been trying to figure things out. I like having shit figured out.

My first two weeks of ECT I went 3 times a week - Monday, Wednesday, and Friday. I started feeling better quickly. I was the poster child for how ECT should work. Then we switched to weekly. I had ECT on Monday. By Friday my mood was starting to slip, starting to drop. So I saw Dr. M the next Monday and told him about that. He doesn't want to increase the frequency of ECT treatments (the goal, after all, is to eventually space them out to monthly). He told me to call his office and make an appointment so we could adjust my meds.

That appointment was last Wednesday. We're increasing my lithium from 600mg to 900mg. I'm not optimistic that this will help at all - I've been as high as 1200mg without any added benefit. But we'll see I guess. He also told me that he doesn't believe I'll ever not need ECT. Meds historically haven't worked well for me and he thinks I'll always need to have ECT. Again, the goal is to get me to monthly treatments but he sees me staying weekly for the foreseeable future.

Then last Thursday night, as I was getting ready for bed, I realized I couldn't remember if I had taken my meds. See, I normally take my night meds around 8:30, and here it was 9:30 and I couldn't remember if I had taken them. Well, I couldn't take a dose at that time because I can't double up on my Seroquel. That's a bad idea for me.

Thursday night I didn't sleep. Maybe 3 hours? Which means I probably hadn't taken my meds (Seroquel knocks me out). So now here I am, having missed meds and not slept. And Friday was horrible. I spent the majority of it sobbing uncontrollably. I cut. And I cut deep. Deep enough it needed stitches (which I did not go get).

Saturday I worked and my mood was equally as bad. I hid. I didn't want to interact. I tried though. I forced myself to. My coworkers knew I was struggling and they rallied around me. Gave me hugs, words of encouragement, and checked on my patients for me when I was unable to do so (I spent a good hour hiding in the break room sobbing). I wanted to cut so bad, but I didn't. I folded paper cranes instead. On of the labor nurses cleaned my cut and put steri strips over it for me (kind of like stitches but it's really sticky tape).

Sunday I was still crap. J and I went to the gym (I really didn't want to, but I really fucking need to). His brother wanted to go bowling with us. I didn't go. I couldn't. I desperately didn't want to. It didn't sound fun and I didn't want to interact.

Today I had ECT and I talked about all of this with Dr. M. Asked him what more I could do. His response was classic: "Well you could stop cutting yourself for starters!" He said the cutting is probably related to trauma or unhappiness. I asked him, "So I have to be like Billy Crystal in City Slickers and find my happiness?" (I've mentioned that to M as well).

It got me thinking: how am I unhappy? What's making me unhappy? I did an inventory of symptoms:

- difficulty waking in the mornings
- increased appetite
- consistent weight gain
- no motivation to workout
- no motivation to clean the house
- not wanting to do things
- not caring about my appearance (I've been wearing hardly any makeup, haven't been doing my hair, wearing gym clothes)
- not wanting to interact with people
- feeling worthless
- feeling like things are pointless (why should I bother? nothing matters)
- feeling like life is too difficult, people would be better off without me (suicidal thoughts, can't do this anymore)
- not finding joy in things (doing things, my artwork, working with the kids at the riding center - I like spending time with the horses, but working with the kids isn't feeling rewarding like it used to)

All of that stuff right there? That's depression. Those are symptoms of depression. Now, last few days aside, overall my depressive symptoms have been better. Overall I feel a hell of a lot better than I have (because, to be perfectly honest, had I not started ECT when I did, I would have killed myself - I was planning it). So I'm better. I am.

I've been trying to figure out the last few days. Did I become exponentially worse because I missed a dose of Seroquel and didn't sleep? Can that really fuck me up that much?? Am I that sensitive?

And so then the cutting. And the uncontrollable sobbing. Is that unhappiness? Trauma? Depression? All of it?

Like, if I had taken my meds Thursday night like normal and slept, would I have been fine this past weekend?

And how fucking frustrating is that?? I don't sleep one night and I completely lose my shit.

The past few weeks have made me realize how much I truly need to take things a day at a time. How much I truly need to stay in the moment. I'm not going to have the answers for everything and I have to be okay with that.  I also do have to remember that I have bipolar disorder - a chronic, progressive illness - and that I will have days that are worse than others. That I will have times where I will lose my shit for seemingly no reason. And that sucks. But that's reality. I think another problem is I was secretly under the impression that I would have ECT, start feeling better, and then miraculously not need it anymore and be essentially "cured" of my symptoms. Bitch, you're bipolar. For life. Fucking accept and deal with it.

It also doesn't help that I think personality wise I tend to lean towards more melancholy. Always have. I need to focus on little joys. Keep forcing myself to interact and be upbeat - even when I don't feel it.

And I need to not cut.

Bit of a conundrum

Yes. I'm facing a conundrum.

Remember how my hope went *poof*? Well. I decided to try something. See, I'm not all that hopeful that increasing my seroquel is going to do anything for the depression. I'm not hopeful at all, actually.

So I did something.

Last night I skipped taking my seroquel.

Yep. I didn't take it. And I didn't sleep. Maybe 3 hours? Maybe? And this morning I was wide awake and felt deliciously hypomanic. Well, not too high actually - just good. Awake, good, even.

And then I got tremors - like, bad. And some anxiety.

We went to my mom's house this morning to do Christmas there as I work tomorrow (xmas). My brother and his family was there, hubby's mom and brother, and it was okay.

We were there for 2 hours and towards the end my mood was starting to plummet. Probably a combo of lack of sleep and extended family time. Right?

I've been working on my book this afternoon, actually accomplishing something, getting a little more direction with it.

My mood right now is weird. I'm a little anxious and feel . . . weird. Just, weird. I feel a little down, empty, tired, dizzy almost, lightheaded at times, and there's some irritability creeping in. The depression isn't as pressing as it normally is, which is nice, but it's certainly not gone. But I have some of the underlying hypomania.

My conundrum: do I skip the seroquel again and see what happens? See if I get more hypo? Or do I take it as prescribed, like a good girl, and hope that 600mg lifts my depression?

I work tomorrow, so if I skip the seroquel again, and get more hypo . . . well, it could be decidedly not good. But I have klonopin in my purse to knock me down.

I keep thinking that I should be good, I should be compliant and take my meds as prescribed. I mean, Mary told me not to stop the seroquel (or any med on my own). And I know better. I know better than to just to stop taking a med. Especially cold turkey. When I skipped doses of geodon I had rebound depression - bad. Would that happen with missing another dose or 2 of seroquel? Or hypomania? Or mixed?

I want to miss another dose, but I'll admit - I'm scared to.

I was originally put on an antipsychotic for mania - I was hospitalized a year ago November for that. And, I really haven't had mania since then (well, I've had some of the irritable hypomania sporadically, or an hour or two of slightly euphoric mania). But for the most part? Nothing. Depression.

I had a brief 2 month span this past summer where I felt pretty stable. Then boom - horrid depression again.

So what do I do? Stop seroquel on my own against the advice of my psych doc (and therapist)? Or keep taking it and hope against hope that the increased dose helps?

Gaaaaaaahhhhh!!! I hate this! Why can't shit just work?

Fuck me.

3 weeks later . . .

It's been around 3 weeks since my last post. Why so long? Because I don't want to post negative post after negative post. I've written some, I've just never published them.

I saw my pdoc, oh, I don't know, 2.5 - 3 weeks ago? Something like that. She said that we should be able to manage my depression better. So she upped my seroquel from 300mg to 400mg. She said that on doses up to 300mg seroquel works on mania and as a sleep aid. At doses over 300mg, it works on mania and as an antidepressant. She's confidant that this will work. I see her again on the 17th.

Long story short, it's not helping much. My depression is still bad. Most days I battle with suicidal ideation. This past Saturday was particularly bad as I was actively suicidal and wanted to slit my wrists. Luckily hubby was with me all day. I didn't quite let on how bad I was though (I don't want to go back to the hospital).

I want to spend all my time sleeping. That way I don't have to deal with how I'm feeling. I've been reading a lot to escape too. And art. I've been drawing.

I'm really getting tired of this. This stupid depression. I'm trying so hard to stay positive and yet it beats me down. I tell myself over and over that life is worth living, but the majority of the time I don't feel that way. I do have good moments, sometimes even a pretty good day, but they're few and far between. It's mostly me trudging through, faking it, forcing myself to talk and interact. I had started pulling away from hubby and son and I talked to him about it - I can't let myself pull away.

I still feel distant though. I feel like a lie.

I'm trying not to talk about this much, to anyone really, because 1. I don't want to be a burden, 2. I don't want to seem selfish and self absorbed, 3. I don't want people to think I've brought this on myself, and 4. I'm hoping minimizing/ignoring/denying how I feel will help (I'm aware that this is not the best tactic and usually doesn't work - and yet I try it anyway).

I'm done for now. Maybe I'll write more later, maybe not. I'm trying not to go to in depth as I don't want to break down right now.

Ugh.

It's been a bit . . .

So it's been almost 2 weeks since my last post. I haven't much felt like writing.

But I do today.

I've been on the Brintellix for around 3 weeks now. My anxiety had started to get bad 2 weeks ago and I was worried that it would get as bad as it was the last time I was on it. I've noticed, however, that over the last week the anxiety has lessened. It's there every once in awhile, but it's manageable and not terribly bothersome.

And that's good news, right?

Sad thing? The Brintellix isn't really helping my mood. Not like it did the last time I was on it. I've had one good day (last Sunday) - a day where I felt "normal", happy, and content with life. I was at work, it was busy, and I had fun. But every other day? Just like before going back on Brintellix.

What do those days look like?

An overall feeling of being "down". I'm withdrawn. I don't want to participate in life. I'd rather nap the day away so I don't have to feel what I'm feeling. And what I'm feeling is all muted - except for my anger. I'm quick to anger. Everything seems to irritate or annoy me. I want to be by myself - I don't want to interact with anyone - family included.

I'm doing what I can to counter these feelings - don't think I'm giving up, or giving in. I'm not. I'm forcing myself to be more positive and upbeat (I don't know how well that's working - I should ask friends and family about that). I'm not doing the negative things I used to do (catastrophizing, all or nothing thinking, shit like that). I'm trying my best to be mindful - to stay in the moment. I'm forcing myself to interact.

Here's the thing - I'm stable. I'm the most stable I've been in 3 years. I'm not having big swings. I'm not hypomanic, I'm not horribly depressed. Nope. Stable. And that's good. The last thing I need is to have a major swing and be hospitalized again. But this low level depression? I think that's my baseline. I think that I'm stuck here and that's just how it's going to be. I'll have a good day here and there and all the others I'm going to have to fight for. I really don't want to accept this, but I don't think I have any other choice.

But wait - there's more!

I've been trying hard to be more "present" at home, around hubby and son. I had been getting bad about ignoring them, taking them for granted, lashing out at them. And I've been trying to be better about it. I don't know how well I'm doing in that regard. Sadly, I've felt myself starting to slip again. Feeling myself starting to withdraw more. Wanting to be alone and to be left alone. I'm trying to ignore/counter this as it's not good for anyone. I feel my anger sneaking back in. Ugh.

And also? Seroquel. FUCK Seroquel. I've had issues with drowsiness/grogginess/somnolence since I started it. I've had issues with my appetite since starting it (I've gained 17 pounds in around 13 weeks). And those two issues are getting progressively worse. It takes me around an hour to wake up in the morning and by midday I'm groggy and a little zombie like. The other thing, which has cropped up recently, is doing things in the middle of the night and not remembering them. The other night I kinda "woke up" standing in the closet with the light on - I have absolutely no recollection of getting up and walking into the closet. I don't remember waking up to go to the bathroom. If I tell hubby something after I've gone to sleep, I don't remember it. Now, maybe that part is only mildly annoying, but I would prefer for it not to get worse.

I see my psychiatrist in 2 weeks and I'm going to request that I go off of Seroquel. I'll start back up on the Geodon, whatever, I don't care. I didn't like the side effects of Geodon but they are preferable to the side effects of Seroquel. I have samples of 150mg Seroquel (I'm currently taking 300mg), so in a few days I'm going to drop my dose down - start to wean myself off. It's not like I felt a difference from when I was on 50mg vs 300mg.

So yeah. That's it. I'm frustrated. But what else is new, right?

Just a quick update . . .

This is just a real quick update and I'll write a real post soon. I'm back on the Brintellix (you may remember that I was on it before around 3 months ago - it worked, my mood was getting so much better, but it gave me crippling anxiety). Well, the seroquel isn't doing much for my depression which is starting to get bad again (not suicidal bad, but I-don't-want-to-participate-in-life bad). It's taking a toll on hubby and son and so the decision was made to try Brintellix again. My pdoc is hopeful that the seroquel will help control the anxiety better than the geodon did. We'll see. I'm anxious as I type this so . . .

So I'm probably stable . . .

I truly do believe I'm stable. I've made it through the worst of the recent med changes, made it through the rebound depression, and I'm what you would call "stable". I'm not having any major mood swings. Rather than the swings hitting like a tsunami, they're 4-5 foot waves that lap more gently at the shore.

This should be good, right?

In a word: yes.

But also no.

Why? Because the moods I'm feeling now are very stunted. They're subdued. At times, they're almost not there. And this, for me, is bad. I'm used to feeling the extremes of moods. I'm used to the highs (though relatively rare), the hyper irritability, the deep sorrow and depression. I feel that. It's guttural. It's intense. But now my moods are meh. Blah. Whatever. Flat. Apathetic.

Or anger.

Here's my problem: I'm stable, but I'm not happy. I feel more like I'm on the outside of everything, viewing, but not taking part in life. I'm bobbing right along the surface, able to keep my head above water, but still drowning - albeit slowly.

I'm stable, but I feel no real joy in things. My job, that I love, is an annoyance. It's an inconvenience. Everything about it makes me irritable and resentful. Dealing with patients can make my blood boil. I don't enjoy it anymore.

My hubby and son . . . I try feeling joy, happiness, and love with them and I mostly come up short. I don't want to do anything with my son. I don't enjoy him. Him wanting to play a game with me irritates me and makes me snippy and angry and sad. I would prefer not to interact with him. With my hubby I do a little better. But I'm not really happy around him. I try. I try.

I'm stable, but I'm still depressed. Maybe I'm not at the sobbing-constantly-suicidal-depressed phase, but I'm depressed none the less. It's more mild. It's this black cloud that never fucking leaves. It's always there. Always hovering over me, always making everything more difficult. I'm more withdrawn. I avoid people and conversations. I'm almost constantly irritable. I'm down, melancholy. Whatever you want to call it.

I'm stable, but I'm not really alive. Does that make sense? I'm existing. I'm going through the routine of everyday life. I get up merely to make it to bedtime to escape again. During the day at home all I want to do is sleep to escape how I'm feeling - or, rather, what I'm not feeling.

I don't want to exist. I want to live. I felt how it feels to live while on the Brintellix - but I was taken off of that due to side effects. If I can't live, what's the purpose of being alive? Seriously. I want to wink out of existence.

That's not really an option though. So I'm trudging along, going through those motions, praying for a spark. Trying to keep hope alive while I'd truly like to throw in the towel.

Because this shit is hard. Pretending to be okay is fucking hard. Especially when there's no end in sight. Maybe this is as good as it will get for me. That's depressing in and of itself.

My pdoc is happy with my progress. She thinks the seroquel is working wonders. After all, I'm stable, right? That's the whole point. Stability. Who the fuck cares if I enjoy life . . . as long as I'm stable.

And before you go thinking I'm all doom and gloom and dwelling on everything bad - I'm actually not. I'm doing everything I can to stay in the moment. I'm picking out my errors of thinking and countering them. I'm taking it one day at a time. I'm trying to do things that I used to enjoy (though most of the time I have to force myself). I'm doing my best not to catastrophize. I'm eating healthier again, exercising regularly. Listening to good music, keeping busy, not allowing myself to nap too much.

And yet I mostly feel like crap. I'm still depressed. I'm still not happy. The unrelenting black cloud won't break up for anything. I'm stuck.

Increasing my Seroquel

I saw my pdoc yesterday and we're increasing my seroquel. I'll have 4 days at 150mg, 4 days at 200mg, and then be up to the target dose of 300mg (I've only been taking 50mg over the past 2 weeks). I'm hoping it works. We'll see.

When she first gave me the seroquel 2 weeks ago, she said there would be no difference in the level of sedation between 50mg and the higher doses. Yesterday she told me I might notice increased sedation. WTF? I've already noticed that I'm more sleepy throughout the day and have a harder time getting up in the morning and now you're telling me that this will get worse. Thanks. It's also increased my appetite 10 fold and I'm already gaining weight. If this doesn't slow down it'll be a deal breaker for me. (To counter this I'm getting my butt back to the gym and using Sensa - though it's hard to work out when you're sleepy and have no motivation thanks to worsening depression).

I had decided that I would give this med change 8 weeks to fully take effect. I think that's more than reasonable. Which means I still have 6 weeks to go. I'll be honest - I'm not optimistic. One might argue that I wasn't optimistic with the Brintellix and that worked. And that would be true. I'm hoping that seroquel will prove me wrong. I don't know if I'll wait the full 8 weeks. I might decide at 6 weeks whether or not it's working for me. If not, I want back on the Brintellix. If the anxiety comes back then we treat it. I'm tired of feeling like crap.

The last 2 weeks have been rough. I've cried almost every day and I'm back to not wanting to exist. I'm back to thinking that everything is hopeless and pointless and why should I bother trying. Sadly, what comes next is not wanting to live. And that quickly spirals into suicidal ideation. I don't want to go there. I don't want to be there. I want to feel good. I want to feel happy. I want to be stable. I'm tired of this fucking unrelenting depression.

It's frustrating to have felt so good and to now feel so bad. And no, it's not fair. It's like I'm not supposed to be happy. I'm not supposed to be well. And that's a bunch of bullshit.