Monday, October 4, 2010

Billy Returns Is Now billy45.wordpress.com

I've moved Billy Returns to:

http://billy45.wordpress.com

See you there!

It's OK to Be Angry - The Story of My Depression

I have this recurring dream where I am back in my old house, the house I grew up in, and I'm feeling very anxious. Although the dream is never the same, there are certain elements that keep reappearing:
  • I am alone in the house or I am with an ex-girlfriend or friend.
  • I am trying to find something or get something done before my father and the rest of the family comes home. I'm searching through my desk or a bookshelf, but I can't find what it is I'm looking for. This makes me feel frustrated and nervous.
  • If my family does return, they make me feel very uncomfortable by ignoring me or by laughing at me.
The latest incarnation of this dream, which occurred last night, ended with my folks laughing at me and not taking me seriously, despite the feeling that I had something very important to communicate. I don't even remember what I was trying to say or if I was even able to utter any words, but I woke up feeling extremely tense, sweating so much that the bedclothes were damp. I often wake up feeling anxious even if I can't remember my dreams.

After relieving some of the tension with abdominal breathing, I realized that I finally understood what this dream is all about, and, why I keep having it. It has to do with the history of my depression and the difficulty I faced for many years battling it.

Despite starting my university studies as a gifted 17 year old, I had to drop out after my first year due to a deteriorating ability to sleep, eat or concentrate. I was deeply depressed and miserable. My father eventually kicked me out of the house and I lived on the street for a period of time. This experience ruined my health both physically and mentally. As far as I and most people I knew were concerned, I was garbage. Worthless.

I was very, very angry at my father for many years. It started in high school after my mother passed away, due to his constant criticism and angry "lectures" that could go on for hours. I stayed angry for a long time. I finally recognized this anger as something that I was holding on to with my subconscious mind after starting to meditate nine years ago. I tried my best to let it go for the sake of my health. I think I did not recognize that I had been emotionally abused for a long time.

I say I was emotionally abused because I grew up in a household where I was not able to express my feelings. I am not talking about being ignored from time to time or experiencing the "normal" emotional ups and downs of a healthy teenager. Every aspect of my life was strictly controlled. I had to have perfect grades. I had to do well on college entrance exams and go to one of the best universities. I was verbally abused, much more so after my mother passed away and there was no one to defend me. When she died, by the way, my father offered little comfort. I was supposed to get back to business as usual: studying. If I asked for money to buy clothes or something else I needed, I would get a two-hour lecture on how selfish I was and how hard my father was working to eventually pay for my college education.

Growing up in a strict household with parents who immigrated from Asia, as a child I basically viewed my parents as gods and never felt that I had a say in anything. If you don't know what this is like, don't pretend that you know. You don't. In fact, the first time I raised my voice to my father was when he kept insisting that I stop being depressed. I was so frustrated by the insinuation that I was somehow to blame for being ill that I finally just snapped and screamed at the top of my lungs that I was not doing this on purpose. Of course, being an abuser and not allowing me free expression of my emotions, my father immediately kicked ome ut of the house. He had already threatened to abandon me or withdraw support many times in the past when he was unhappy with me in some way. I had already been severely ill and unable to sustain study or employment for over three years, despite numerous attempts to take classes and hold down any sort of job.

When my father kicked me out, all my hopes were dashed. I felt as if the last person in my family no longer cared about me. I no longer cared about myself and was completely distraught. I was allowed to return home a few times after being homeless for months. The last time I was allowed to live at home I spent more than a year with severe anxiety and depression, sleeping anywhere from 14 to 18 hours a day, barely eating and only able to skim books or watch TV to distract myself from a growing sense of dread. I felt so seriously broken during this time. Although I was allowed to see a psychiatrist and a psychologist for a time, my father made it clear that he didn't think that I had a problem that necessitated medical care. When I was kicked out of the house, I was unable to afford to continue seeing the doctors.

After getting kicked out again for raising my voice to my father for the second time in my life--for the same reason as the first time--namely, objecting vehemently to his claims that I was making myself depressed on purpose,  I was determined to not undergo the experience of being homeless again. I worked a series of menial jobs at minimum wage until I caught a break and got a better job with a local company that paid a decent salary. I even thought that I was better, thinking that the ability to work and survive equated to not being depressed. Never mind the fact that I had very few healthy relationships with people and that I used alcohol to numb the growing restlessness and hopeless in my heart.

I eventually went back to school (with some help from my father) to finish my degree. He has always been consistent about stressing the importance of education. That much I admit. I earned near perfect grades, but I was still depressed and only functioning at about 50% of my full capacity. After graduating, I hadn't a clue as to what I wanted to do with my life and I was in debt. Nothing seemed interesting to me. Everything had become tedious and boring. I was most afraid of the boredom that seemed to dominate my life.

With no greater hopes than receiving little more than minimum wage and scanty benefits, I eventually pulled up all my roots, left my girlfriend and a large number of good friends and moved abroad in the hopes of finding a new life and a new direction. I remain an ex-pat living abroad, but thankfully I have been receiving treatment for my depression and I am finally realizing why I felt so numb, why I felt like I had no future, but more importantly, why I always felt so tired, so lonely, so wrong.

With the recovery of my physical and psychological health to levels I had never experienced before, I also realized that I had been treated very badly by my family. They never once showed any compassion for me when I was bedridden with severe depression or when I nearly lost my mind on the streets. They continuously judged me and blamed me for being depressed. And when I needed their help in more recent years, when I developed severe anxiety and crippling depression a few months after moving abroad (the stress of moving amplified my depression from dysthymia to full blown major depressive disorder). I begged my folks to let me come home to seek treatment and recover. I was told I could never come home to live in my parents' house. How dare I even ask such a thing of them?

At the same time, I can't blame my folks for my depression. That's not fair or realistic. I could have sought treatment when I eventually made decent money working for a salary before I returned to school full-time. I could have taken medication and sought the help of a counselor. As an adult, it is my responsibility to take care of my own health. I know I developed some bad habits over time. I drank heavily in my late teens and early twenties. I also smoked pot heavily during my last year of high school and on and off for more than a decade. I also smoked cigarettes for many years. All of these things damaged my body and my brain. No doubt about that. And then I look at my willingness to get well many years ago, my willingness to see doctors, to take medication, and how that was poo-pooed and how I was told I was weak, I was lazy, I was bad. After my experience living on the streets, all I knew how to do was survive. And that's all I did for many years after that experience.

But what I need to do now, in order to move on with my recovery, is to address the fact that my family, and particularly my father, did wrong by me in a major way. As a gifted child and a high-achieving student, the pressure was always there to be the best. Ninety-five percent was never good enough. All the emphasis was on academic achievement, never health, happiness, or the value of relationships. I was never encouraged or supported in any other activity besides martial arts and music, the former my passion, the latter my mother's obsession. However, by the second year of high school none of these activities could be sustained due to the rigorous academic load I was faced with. By my junior year, I was already suffering from extreme fatigue, irritability and insomnia. By my senior year, although I manged a perfect GPA before applying to and eventually being accepted by one of the best universities in the country, I was a complete wreck. I was lost.

And things only got worse the longer I remained depressed. I was treated as a complete failure for dropping out of school. I was judged for not being able to hold down a job. I tried my best, but things got so bad that some mornings I just couldn't get out of bed in the morning. I lost two jobs and did miserably in several courses as a result. I was treated like a pariah and was never once asked if I felt OK or if I thought I might need some help. There was absolutely no benefit of the doubt, no trust in the fact that I was trying very hard, but I still could not get things together. Believe me, I was trying. I sought answers in philosophy, music, mysticism, drugs, and later meditation, sex, and food. In fact, the search for answers, for the truth, dominated my thoughts since the age of 17.

My entire 20s were spent searching for something, but I wasn't really sure what it really was.  I would occasionally have a fleeting vision of happiness, and it didn't involve being rich or famous. It was a simple vision of living life and enjoying it. I'd visualize a scene of shaving in the bathroom of my own apartment, relaxed and content, not feeling the chronic anxiety and emptiness that had long since become my constant state of being. A vision of being able to feel normal, not tired and unable to carry out a plan beyond the initial stage of inspiration. I had desires deep inside of me, to become a musician, to become a chef, to become something, but I could never sustain these dreams. I had the talent to start off quickly at almost anything I chose to do, but I didn't have the energy or the clarity that comes from calmness and stillness within.

What really made me feel absolutely powerless and ashamed of myself was the fact that I was completely aware of the disconnect between my abilities and what I was actually able to do. This was a very painful and frustrating realization. Only now do I recognize that my inability to actualize was a distinct symptom of depression. How do I know this? Because the first time I allowed myself to receive proper treatment that was not interrupted, the first time I was prescribed antidepressants, benzodiazapines and a Z-drug to sleep just two years ago, I felt like a completely different person. It was suddenly very easy to have an idea and to follow through on it, a subtle sequence of events that probably goes unnoticed in most people. I was able to exercise, cook, garden, and meet girls. I felt great. I was able to make myself happy, not by buying things or comparing myself to others, but by being myself. That's all. Just being myself. For the first time in almost two decades, I liked myself for who I was. There was nothing wrong with me as a person, there never had been. I had lived with that burden for so long, and suddenly I saw the lie for what it was. And I was angry.

Less than a year after achieving an albeit tenuous state of remission, I made the mistake of thinking that I was "fixed", that I didn't need to continue taking medication. I was scared of the stigma surrounding the use of benzos and Z-drugs, despite the fact that I didn't abuse them, nor did I have trouble getting off them, at least at first. I scheduled myself from morning to evening with school, work and martial arts training. I even kicked Effexor in a pre-planned 3-month timeframe by gradually removing more and more of the little time-release pellets inside the capsules that had brought me back to life.

What followed was a year and a half of sheer misery. And again, I thought that there must be something wrong with me, that I was a bad person. Thank goodness I finally relented and sought psychiatric help. It took almost six months, but I finally found a combination of medications and lifestyle choices that slowly but steadily restored my health.

Now I have absolutely no doubt that I suffer from depression, that I have suffered for a very long time, and that there is nothing wrong with me. I take my medications religiously and I have learned a great deal about using herbs and supplements to enhance recovery. I studied and trained various forms of meditation and martial arts in order to learn how to master my body and mind. I had been doing this for years in the hope of relieving my suffering, but without medication it was futile.

And now I know why I keep having these nightmares, why I keep reliving the frustration and anger of being written off by my family. I realize that it is OK to be angry, that it doesn't make me a bad person. I need to feel this anger. I was starting to feel like I was becoming emotionally numb again. Not depressed or anxious, but not alive. I know that I had my emotions suppressed for a long time, first by my family, then later through self-denial. In fact, my family still treats me like I am wrong in some way, their opinion no doubt bolstered by my most recent relapse. It doesn't seem to matter that I responded to medication in such a robust fashion. That fact is conveniently ignored by my parents. My father sends me emails asking me to accept God and to turn my life around. But God is with me and has always been with me. I never would have survived some of the situations I was in if that weren't the case. In His mysterious way, God used my depression to temper my willpower, my faith, and to instill in me an unabashedly positive attitude. Those who suffer are comforted, that's for sure.

I no longer respond to my father's emails. I have made repeated attempts to explain my understanding of exactly how things fell apart and how his neglect and abuse helped create the isolation and stressful conditions that provided the fertile ground for my genetic predisposition to depression to bud and flower into a terrible nightmare that still haunts my dreams.

It is known that depression and other affective disorders--or whatever you choose to label them as--get worse with time. The best strategy is to treat them as soon as possible, and to provide the emotional support needed by those suffering in order for them to deal with the tremendous psychological impact that these illnesses can afflict on the psyche and the soul. The absolute worst thing to do is to judge and to reject someone who already feels worthless and hopeless.

I can no longer ignore this fact. My subconscious won't let me, even though I'd like to think that I'm 95% recovered. The deepest parts of my psyche are trying to tell me that it is OK to be angry, that I need to be angry in order to save myself from being lost to denial, to a tapestry of lies woven over many years by myself and my family. It's time I started listening.

Sunday, September 26, 2010

Chinese Herbs for PMS/PMDD: Ba Zhen Tang

It has become clear that my girlfriend, B, suffers from a form of depressive disorder linked to her menstrual cycle. The week before her period begins, her mood and energy levels take a nose dive and she crashes hard. Her symptoms include severe fatigue, muscle weakness, constipation, nausea, edema, headache, anger, poor memory, clouded thinking, poor judgement, anxiety, paranoia, and obsessive negative thinking.

The stress of being in a relationship with someone suffering from depression used to be the main reason why she said she felt depressed. Even after I found a working psyche med combination and started to recover, she was unable to feel good about this and refused to see the positive transformation occurring right before her eyes. When her period finally began she would feel much better after about 2-3 days.

As I learned more about using Chinese herbs to treat depression, I wondered whether the formula called Ba Zhen Tang - Eight Treasures Decoction - would be good for B. This formula strongly tonifies the Spleen (capitalized because it represents functions, not the anatomical spleen) and builds blood. Women are at particular risk for blood deficiency. The week or two before her period, a woman must produce extra blood to support the growing uterine lining. A lot of B's symptoms are pretty consistent with the Chinese medical diagnosis of blood deficiency: forgetfulness, poor memory, poor sleep, dizziness, fatigue, and constipation. Her periods were often very short with light flow.

Now that B and I live in a normal apartment with a kitchen (a long, horrible story for later), and since we have a good source for fresh herbs at the local market, I decided to try making Ba Zhen Tang from dried herbs. I knew B wouldn't take herbal extract pills with any consistency. She can be really stubborn about not doing something that could make her feel better. I think this is a symptom of depression and anxiety, to be honest. It's like there is a fundamental inability to accept your limitations and feel compassion for yourself.

I went to the market and tried to explain the situation to the herb lady. I used my limited Mandarin and got my point across. The herb lady has pre-mixed packets of the most common formulas. I bought two packs of Ba Zhen Tang that I could use to make six servings. At two servings a day, $6 worth of herbs would make a three day supply.


A packet of Ba Zhen Tang.
Here is a standard formula for Ba Zhen Tang:
  • Dang Shen/Radix Codonopsis
  • Bai Zhu/Rhizoma Atractylodis Macrocephalae
  • Fu Ling/Poria
  • Gan Cao/Radix Glycyrrihizae
  • Dang Gui/Radix Angelica Sinensis
  • Bai Zhao/Radix Paeoniae Alba
  • Chuan Xiong/Rhizoma Chuanxiong
  • Shu Di Huang/Radix Rehmannia Preparata

Here's a photo of the herbs inside the packet:

1...2...3...4....9? Nine?
It took me a moment to realize that there were nine different herbs in the packet I'd bought. It turns out that what's missing is Shu Di Huang a.k.a. prepared Rehmannia. Prepared rehmannia is a sticky, glutinous black colored herb that is the result of processing rehmannia root. It nourishes kidney and liver Yin. It is good for blood deficiency and helps with dizziness, insomnia, irregular periods, and heart palpitations. If you are Yin and/or blood deficient, it's like you lack coolant and tend to overheat and dry out.

Yum...Shu Di Huang/prepared Rehmannia
Image Source

In its place, we have Shan Yao/Rhizoma Dioscoreae and Da Zao/Fructus Jujubae a.k.a. Chinese red dates. These two herbs have more to do with tonifying the Spleen, Kidneys and Lung. They do not appear to be a substitute for rehmannia. I need to ask the herb lady why she made this substitution.

The replacements

I used the following traditional method to make an herbal decoction from the raw herbs:
  1. After rinsing out the herbs in a colander, I put the herbs in a stainless steel pot and added 4 cups of water. Metal is not really the best material for your cooking vessel, as it can react with certain herbs. Stainless steel is OK and it's all I have right now. I plan to buy a traditional ceramic herb cooker in the near future. You should be able to find one at your local Asian grocery.
  2. I heated the water to a boil, lowered the flame, and let the herbs simmer partially covered for about 45 minutes while stirring occasionally to keep the herbs submerged. 
  3. When the water had decreased to 2 cups (my pot has handy markings inside), I poured the tea through a strainer into a bowl. That left me with 2 cups of pungent medicine. I had B drink 1 cup immediately. 
  4. I put the herbs back in the pot, added 3 cups of water, and repeated the simmering process until I had 1 cup of liquid left. I added that to the remaining tea from the first brew. That made two more servings for the next day, one for before breakfast and one before bed. Herbal medicine is best taken on an empty stomach, say 30 minutes before a meal or 1-2 hours after. Unlike pharmaceuticals, which often upset the stomach, herbs are pretty mild - we're trying to strengthen the digestive system after all.
The results? B seemed to feel better after two days. A few days after finishing her last cup of Ba Zhen Tang she started getting antsy and negative. When her period finally came today (right on schedule, now that I monitor these things), she spent most of the day in bed. We're talking about someone who does not have a diagnosis of depression and is more or less fully functional for 75% of any given month.

I'll be honest, I'm really glad I am writing this blog, if only because it gives me a way to express my frustration. As much as I feel that I don't really have much to complain about, I was in denial about my own frustration with B's situation and how she handles it. It affects me a lot. I guess it's only fair that I get a taste of what it is like to live with a depressed person. It just drains the energy out of the room. At least B is finally starting to admit that she has a problem. That's a start. Next month I'm going to suggest she take the herbs for six days. I think it's definitely worth the small amount of trouble it takes to cook them up.

Saturday, September 25, 2010

Pre-Remission Journal: SSRIs Make Me Feel Worse

Friday, October 30, 2009
3:25am

 
I remember being in love with things, the earth, God's creatures when I was young. Nothing inspired me more than learning about animals, nature, and technology. If something was awesome in some way, I was attracted to it. I miss that sheer wonder and respect for nature and things thoughtfully designed and created. There is only a hint of that left right now, but one by one it seems like my interest in things is fading fast. I don't think this is normal anymore. At first I thought it was more of an Ecclesiastes-inspired letting go of childish things, and perhaps it was to some degree, but it has become something more, something subtle but sinister, sucking the joy out of life.


*note* Switched to fluoxetine 20mg, but by the third week experienced multiple bouts of diarrhea for several days until discontinuing fluoxetine (Sat, Nov 21). I wasn't feeling too hot until then either. I had no appetite and felt even more anxious about going out in public. I felt like there was a heavy weight pressing down on my chest.


After telling the doc that I could not tolerate fluoxetine, he switched me to 15mg Remeron/mirtazapine. He seemed pretty confident that it would make me feel better. Confident enough that instead of scheduling the usual 2 week follow-up, he prescribed 5 weeks! I thought that was odd, and asked if he was on holiday (we wouldn't meet again until the end of December. He said he was. I asked what I should do if there was a problem. He sort of shrugged off my concern and mumbled that I could call in and meet with one of his colleagues.

Thursday, September 23, 2010

Rhodiola rosea and Depression: Update I

Herbalgram report on Rhodiola rosea: read and download from Scribd.com

I've been taking Rhodiola rosea extract for the past few days and I have definitely noticed a positive effect in terms of mood and energy. I actually noticed an effect after the first dose, but couldn't be sure if it was solely due to the rhodiola. I took one day off, then decided to that I should take it every day in order to form a fair opinion of its effects. The second time I took it I again noticed greater energy and a brightening effect in my visual field. I made sure to take it apart from my usual morning cocktail of vitamins and herbs. There was no mistaking the effects this time.

I purchased bulk Rhodiola rosea extract powder and made my own capsules. Pictured above is 500mg of extract in a "OO" sized capsule.

I had ordered Rhodiola rosea extract powder from Beyond a Century a few months ago, but was hesitant to try it because I knew it could affect neurotransmitters. My experiences with niacin and folic acid have taught me that supplements and herbs that affect neurotransmitter production and reuptake could potentially interact with my meds in a negative way. In the case of niacin and folic acid, I tend to feel tired and sluggish. I attribute this to an overproduction or lessening of the reuptake of serotonin. I do not get this effect with rhodiola. In fact, I feel more alert and my mind moves faster.

The Rhodiola rosea I purchased is standardized to 3% Rosavins. I do not know the concentration of Salidrosides. I have heard that the ideal ratio of Rosavins to Salidrosides is 3:1. The extract powder is very resinous and is quite bitter. It also seems to be somewhat hydrophobic and coats your tongue and the inside of your mouth. I have a pretty good tolerance for the taste of bitter herbs, but rhodiola is a bit too much for my liking. I decided it'd be easier to make my own capsules using OO-sized gelatin capsules and my Cap-M-Quik capsule machine that I purchased from the guys at Purebulk.com. If you do decide to take the powder raw, have a sweet drink or candy ready as a chaser.

My curiosity piqued, I went to the library and read through a copy of The Rhodiola Revolution by Richard P. Brown M.D., Patricia L. Gerbarg M.D. and Barbara Graham. Both Brown and Gerbarg are practicing psychiatrists and take rhodiola for certain health conditions and as an energy booster. They also recommend rhodiola to some of their psychiatric patients and report little to no adverse reactions with any medications including antidepressants and mood stabilizers (see Important below). The book also contains a good summary of the physiology of stress and how rhodiola might help to build a tolerance to its deleterious effects.

As doctors with a healthy dose of scientific skepticism, Brown and Gerbarg went straight to the source, literally, by contacting Dr. Zakir Ramazanov, a Russian plant biochemist and molecular biologist that participated in formerly classified research on adaptogens. He discovered the power of Rhodiola rosea after taking it while serving in the military and later used the herb to cure his Post Traumatic Stress Disorder (PTSD). Dr. Ramazanov shared his extensive findings with the authors and even took them to one of remote mountainous regions in Siberia where Rhodiola rosea grows naturally. It is believed that the difficult conditions in which the plant grows may be the stimulus for the plant to produce its adaptogenic substances.

I plan to continue taking Rhodiola rosea for the time being as part of my daily blend of herbs and supplements. I have heard that rhodiola can lose its effect over time and is best cycled. If I find this to be the case, I will report back with my experience. If anything, my positive results from taking rhodiola remind me to keep an open mind and to be continually humbled by the healing nature of herbs. I urge you to cultivate your belief in the possibility of healing from depression and anxiety and to remain steadfast for as long as it takes to find relief. I know what it's like to suffer deeply and I also know that there is always hope.

For more information on Rhodiola rosea, the author's of the book The Rhodiola Revolution along with Dr. Zakir Ramazanov have published a nice report in the publication Herbalgram. Click here to read and download from Scribd.com.


Important: The authors are clear to highlight a slight risk when taking rhodiola for activating mania in bipolar individuals who are not currently on mood stabilizers or in a stable condition. If you are prone to manic or hypomanic states, take a small dose of rhodiola to see if it affects you in a negative way. Do not mix rhodiola with other stimulants and take your dose in the morning if you are prone to insomnia.



*As you should know, the purpose of this blog is not to make recommendations for treatment. I am not a doctor nor do I pretend to be. You are responsible for your own health and you should always consult with your doctor before trying any medications, supplements or herbs. I tell my doctor about any supplements that I take and I have her approval as long as they are helping and not hurting my recovery.*

Tuesday, September 21, 2010

Depression and Addiction: Negative and Positive Spirals

In my experience with depression and addictive behaviors, I am either caught in a negative or positive spiral. It takes discipline to maintain a positive spiral. It is all too easy to get knocked out of a positive spiral and to end up in a negative spiral. A negative spiral is chaotic, passive, and builds momentum much quicker than a positive spiral.

Let me try to describe some of the behaviors and thought patterns associated with each type of spiral:


Negative Spiral
  •  I stay up too late surfing the web or reading. This is not a productive form of reading. My mind is usually unsettled and  I end up flipping back and forth from topic to topic or just skimming the words on the page. Even if I've taken my meds on time, I pass the point where I could have easily fallen asleep and push on towards a very agitated, unsatisfied state.
  • As a result, I wake up late feeling very tired. I make breakfast, but I still feel fatigued after eating. Due to state of my nervous system during the night, my metabolism is already screwed up.
  • I drink a strong cup of coffee or tea in order to "jump start" the day. This usually backfires due to the aforementioned unbalanced state of my metabolism/homeostasis. I end up feeling burned out but unable to rest even if I try.
  • I'll tend to eat starchy or sweet foods that are easily prepared e.g. toast with jam, cookies, candy, juice and other sweet drinks. I can't concentrate enough to plan out and prepare a wholesome meal.
  • I feel too tired to exercise. I feel to jittery to nap. I'm stuck in this horrible in-between zone where I'm not getting anything productive done. I can't even concentrate enough to watch a quality TV program or movie. I can't read more than a page or two of a book without feeling bored.
  • I don't wash up promptly in the morning. I feel dirty all day.
  • I smoke compulsively without even enjoying it. I feel guilty as a result.
  • There is no rhythm to the day. A positive rhythm would be: eat, rest, work, rest, exercise, rest, read, rest, etc. Momentum is allowed to accumulate, like pumping a playground swing higher and higher. You swing your legs forward, using the resulting momentum to swing back in a relaxed state. You ride the momentum forward and pump a little higher. This is a great analogy for the oscillation between work and rest that powers the positive spiral.

Positive Spiral
  • Again, it all starts the night before. I take my meds at the correct time and give myself plenty of time to settle down in bed. I don't read or surf the web within a half hour of my prescribed bedtime.
  • I wake up early enough and prepare a good breakfast that includes protein and complex carbs.
  • I wash up promptly and take care of my personal hygiene.
  • Within an hour or so of eating I have a light workout. 
  • I shower up, have a relaxing shave, put on some clean clothes.
  • I get online and spend quality time at news sites, forums, or other pages of interest. I don't get sidetracked and start opening up tab after tab after tab...
  • I think about what I want for lunch and go to the market to get necessary ingredients. Even better, I thought about this the day before.
  • I take a little siesta after lunch.
  • I do some quality reading/studying and/or go to the library. These days, the mission is to look for jobs and to send in my resume.
  • If I smoke, I only do so after accomplishing a small task. Delaying the act of smoking demonstrates that I am choosing to be active rather than passive. Smoking is passive in a sense; if you don't do anything, you will smoke. That is the insidious danger of smoking--it has a life of its own. All behaviors attached to smoking become automatic rituals. They act at the subconscious level and can circumvent conscious thought. In a positive spiral, there is awareness (some call it mindfulness). I am in conscious control of my actions and am not a slave to my compulsions.

The toughest aspect of the negative spiral is the guilt and shame that it inevitably produces. The longer a negative spiral is allowed to go on, the harder it is to halt its momentum and shift into a positive spiral. The good news is that it is always possible to break out of a negative spiral. And the longer you can stay in a positive spiral, the more positive habits you'll have ingrained into your being that will help you to get back on track. These positive habits need constant nourishment and practice. A negative spiral will quickly act to destroy these habits by not only removing the constant reinforcement that supports positive activity, but also by actively breaking down the "good" connections you've made in your nervous system and replacing them with chaotic, purposeless connections.

Breaking out of a negative spiral is a field of study in and of itself. You don't have to be depressed or addicted to some behavior to reap the benefits of training yourself to initiate and maintain a positive spiral. In fact, this blog is dedicated to the art and science of the positive spiral. Hmmm. That's catchy. I call dibs on any trademarks! But seriously, I want to be open and honest about my negative behaviors because it helps me to understand and accept myself. Without understanding, acceptance, and compassion for myself in my weakest of states, I cannot continue to recover from the black dog of depression.

Monday, September 20, 2010

Pre-Remission Journal: Starting Medication - SSRIs

When I started medication to treat my depression and anxiety, I started a journal in order to keep track of what medications I was taking and whether or not they seemed to be working. I wanted to be as systematic as I could, which was limited to what I could handle at the time, but I still felt that it might help me if I had to switch medications. Looking back on my journal, I see that I can still learn from it by finding healthy patterns and identifying bad combination of medications and herbs. I won't edit the entries too much. My writing patterns may also indicate what state of mind I was in when I wrote a particular entry.


Monday, October 26, 2009
1:08am

It's been about 6 days since upping the dose of Faverin (fluvoxamine, an early SSRI) to 50mg/day. I've been in a stupor since then, but having trouble sleeping as well. Average bedtime: 3-4am, waking up around noon or later. This sucks. I still feel completely apathetic towards everything and the only thing that makes it better is that I've stopped pressuring myself over finding a job for the time being. My appetite is non-existent and I feel I have no coordination or strength in my body.

I have a sloshy, bloated stomach from too much spicy food at B's sister's (not really sister) house. I have no idea how they can eat like that (more likely twice as hot) every day. I popped 8 Strong Wakamoto and will hope for the best. I started developing the strange rash on my left arm this time. I applied 1% hydrocortisone. It should be gone in the morning, but why did it occur in the first place? Milk? Greasy food? Who knows anymore what the hell is going on.


Notes:
Insomnia has been a problem since I was 15 years old. When I first entered treatment, I would have to read or surf the web until I was completely exhausted. I have always had trouble getting up early as a result.

These days I can fall asleep by 10:30 - 11:30pm and wake up as early as 6:30 - 7:30am.

The bloated stomach is a symptom of Spleen deficiency in Chinese medicine. This is probably a symptom I've had for a long time, but never really addressed. I am currently taking herbs to tonify the Spleen and rarely experience bloating or indigestion. As a result of good digestion and absorption of nutrients, I have a lot more energy. Spleen deficiency can also cause obsessive thinking and worrying. It sounds weird, but in a sense obsessive worrying is like never feeling satisfied. You feel like you need more and more...never getting enough. In this sense, treating Spleen deficiency can lead to more calmness and lessening of these symptoms.

I guess I've really come a long way just in terms of my sleep schedule. The ability to get enough quality sleep is not to be underestimated. Chronic sleep deprivation can bring on depression, while problems sleeping through the night are a common symptom of depression. It's a negative spiral that can lead to a daily cycle of dreading both sleep and daytime activities.

Sunday, September 19, 2010

If The Meds Are Working, Don't Rock The Boat

A recent experiment with herbs (not Rhodiola) has led back to a lesson that I've had to learn several times over: if the meds are working and you are feeling good, don't change them.

It should simple enough, right? But for several reasons that I'll touch upon, once we start to get out of the deep pit of depression and anxiety we think we 'd like to reduce our medications or get off them completely.

Here are the reasons why I've gotten off meds that were working or thought about trying to reduce their dosage:

  • I don't like the idea of needing to be on medication in order to be "normal".
  • Medications are expensive, and it's always better to save money. Right?
  • Taking medications is a hassle. Every morning and every evening I have to take a large amount of pills and capsules. Most of them are vitamins, minerals and herb extracts. Three of them are psyche meds.

I'd say those are probably the main reasons why I've gotten off meds or thought about getting off of them. Here's why I think these reasons are not in my best interest:

I don't like the idea of needing to be on medication in order to be "normal".

This is simply pride and vanity. I know that I need to take certain medications right now in order to minimize or eliminate the symptoms of depression, anxiety, insomnia, obsessive worrying, fatigue, and an overall negative world view. But there is a still a part of me that thinks I should be perfect. I shouldn't have to take medications in order to function like most other people can without taking drugs, right? Well...no. This is not congruent with reality. The reality is that, for reasons that are still unclear to science and to mankind in general, some people develop mood disorders or mental illness and cannot function without pharmacological intervention.

The good news is that there are a lot of different medications out there and new medications are being developed as we speak. Without going into the debate about whether or not meds work or whether Big Pharma is only interested in profits, the fact is that there is probably a medication or combination of medications out there that can help a person suffering from mental illness to function better and to regain a sense of purpose for being alive.

I am well aware that there is a small percentage of people that are resistant to most treatments and require some pretty creative combinations of medications in order to control their symptoms. My official diagnosis is probably considered to be treatment-resistant depression because I tried several different medications before I found a combination that turned things around. It took a deep faith that I would find a successful treatment in order for me to hang on for so long after initiating treatment. Nothing is more disheartening than getting your hopes up about a new medication only to have your hopes dashed because you are not improving or your symptoms seem to be getting worse.

Ask someone who has been through this hell if they'd be content living the rest of their lives taking medication if it meant they could get back to the business of living. I think you'd get a pretty unanimous, "hell yes!". We need to remember that humble attitude once we start to feel better.

Medications are expensive, and it's always better to save money. Right?

It's hard to argue against the money argument. But here's why it is another false argument in my opinion: you won't be able to make much money if you are crippled by depression and anxiety. You won't have the clarity of mind to spend your money wisely and you won't have the capacity to enjoy your money in the first place. 

The cost of medication has threatened my very survival and nearly broke up my relationship with B. She has been a real saint as my savings slowly disappeared towards the cost of doctor's visits and medications bought at the pharmacy. It was only when my medication regime was stable that I was able to start ordering them (legally) from Canada with my doctor's blessing (well, I would have ordered them from Canada anyway).

Now that I am able to order generic versions of all of my medications, I am paying less than a quarter of the full retail price I was paying at the hospital pharmacy. The total cost comes to about $70 a month. That's a little over $2 a day. That's less than the price of a creamy espresso drink. I think most people could afford to pay that. There are other ways to save money on medication, such as prescription assistance programs and of course insurance, but we'll talk about that another time. The point is that the cost of medication can be reasonable for most of us, and the fear of money is not a reason to avoid a treatment that could breathe new life into the battered and bruised heart of someone suffering from depression.

Taking medications is a hassle; every morning and every evening I have to take a large amount of pills and capsules...

In the end, I only have to take three psychiatric medications a day. However, I choose to take several supplements and herbal extracts because I know they also help in the fight for sanity. I can go a few days without the vitamins and the herbs, but I end up feeling it in the form of lower energy and a flat mood. Again, I am thankful that I have found a working solution to my problems and for the most part I have no trouble obtaining and taking all the pills.

Going back to my response to reason #1, it's only some form of fear that would make this into a real problem. Fear of what others think. Fear of not being perfect. Fear of feeling like I am dependent on something outside myself in order to be happy. But that's bullshit. My medication doesn't make me happy nor do I think it will. They only put me in a position where my daily efforts and attitude may lead to happiness, just like it is for everyone else.

And that's all we really want, isn't it? Instead of spending every waking moment fighting for our sanity and dignity amid a torrent of negative thoughts and the slow suffocation of fatigue and anxiety, we want our effort to go towards building our lives and our relationships with those we love. So Amen! meds, I say. Amen! 

Friday, September 17, 2010

Rhodiola Rosea and Depression

September 18, 2010

I'm taking a number of herbs for depression, energy and anxiety. But I won't go into those right now. I going to try taking Rhodiola rosea extract for a few days to see if it affects my mood and energy.

[Rhodiola appears to have noticeable effect! See Update I on Rhodiola Rosea and Depression]

I am going through a difficult time right now in my recovery. I am in a new living space, I'm able to cook, and overall the environment is much better than it was before. Nonetheless, my relationship with B is not doing so well. I know I have to find positive strategies to deal with this frustration. Until now, my go-to stress relief has been smoking. This is pretty much the worst thing I could be doing since it steals my energy and brings my mood down. I also tend to procrastinate horribly when smoking. I'd rather smoke than take positive action.

I won't say I've been perfect in terms of quitting smoking*, but I have made some changes:
  • I'm making nutritious food and making sure to eat enough
  • I'm going to the library in the afternoon and reading/taking notes
  • I've polished a basic version of my resume and I am ready to send it out to some jobs that I think I am more than qualified for
  • I'm trying to remember the importance of meditation and calming in the overall picture of regulating my mind and energy
  • I'm trying to invest in my own future outside of the relationship; what I mean is that I am trying to not let my relationship problems make me feel like my future is hopeless. It is not.
I just took about ~500ml of Beyond a Century's Rhodiola extract. It tasted a little bitter and sweet and coated my tongue with an astringent powder. It is not unpalatable like, say, eurycoma longifolia.

We'll see how it goes.

Addendum: I felt frustrated last night when B came home. She had an extremely long day, and her habit is to pretty much ignore me and act pretty ungracious. Earlier in the day, I'd made a large quantity of Indian food (dahl, potatoes) so we'd have some good food to eat. When she came home, I asked B is she was hungry. She said she didn't want to eat. Without any further conversation she changed clothes and went straight to bed. After half an hour, I wrapped up what I was doing and got ready for bed. After about ten minutes she got up and said she was hungry. I was going to warm up the food, but she didn't show any signs of getting up, like she wanted me to bring the food to her in bed. I wasn't in the mood to do that, and plus I don't think we want to eat food in the bedroom and have it smell like oil and curry. She finally got up and I heard her heating up some food. I thought I'd go out and hang out with her while she ate. I heard the TV come on and knew that she didn't want to interact with me at all. I peeked out and saw a bowl of lentils sitting untouched on the dining room table. She was eating a bowl of rice and some preserved mushrooms we received from her relatives. 


This morning was more of the same. Today (Saturday) was unusual in that B needed to go to work for the morning. Before we got up, I asked B if she wanted to eat breakfast. She said yes, but rolled over in bed. I got up and made scrambled eggs, toast and coffee. When it was ready, I told her it was time to eat. I hate it when I make food for her and she waits a long time to sit down to eat - when the food is already cold. After a few minutes she came over to me and said in her fake-cheerful voice, "Thank you, Billy!". I was feeling a bit pissed off because she hadn't said anything else to me otherwise. No 'good morning', nothing about her previous day. Nothing. I also asked her, "Did you even try the beans last night or did you just throw them away?" She said she tried them and put them back in with the rest of the leftovers. I wasn't really feeling too cheerful by this point and she finally noticed after eating a few bites of egg and toast. She asked me why I was upset, but I didn't say anything. "Try the cinnamon-sugar--it's good," was all I could say. She got up, took out a Ziploc bag and put the rest of her breakfast inside to take to work. Now she was going to punish me for being upset, and rightly so in my opinion, by not talking to me. As she locked the gate to leave for work I asked her what time she'd be coming back. That's something I'd like to know, especially since she expected me to make her lunch or dinner. "After lunch," she said with some contempt and just left.


I finished off that smoke and had one more. I walked back to the apartment wondering what I was going to do. I don't want to go back to sitting around the apartment not doing anything. I will still go to the library this afternoon. I do feel very depressed, however, not only because I broke my self-imposed smoking ban, but because I felt weak, ineffectual, hopeless, and above all else, sad. Sad about my condition, sad about my relationship, and sad that there seems to be very little joy these days no matter what I do or how hard I try to maintain a positive attitude.

Quitting Smoking (Again) and Herbal Chicken Soup

September 13, 2010

It's day three of not smoking. As usual, I reached well beyond the point where smoking was enjoyable and had to face the fact that I was chasing something that wasn't real. The more I smoked, the more I smoked. There was no end in sight. As usual, I had to chuck an unfinished pack in the trash. The act of voluntarily getting rid of perfectly good smokes is the symbolic gesture that begins the ritual transformation of kicking the habit. Finishing a pack just won't go it; that's just a natural pause in the game of smoking. But throwing away smokes is sacrilege; only a non-smoker can do that. In order to quit smoking I must become a non-smoker. There is no other way.

I had a very hard time waking up this morning. Still tired even after eight hours in bed. I guess I didn't eat enough last night. This is becoming an issue. I am not used to having to eat more food just to be able to feel normal. I am very wary of not overeating, but I think my metabolism is speeding up from the weight training. Other than that, I've been getting very little exercise as of late. That was because of the smoking. As a smoker, I didn't exercise that much. As a non-smoker, I can exercise all I want. I might as well, since that's one of the best reason's not to smoke, to embrace health. I don't feel too healthy today, however, despite going to the gym yesterday. That's why I went to the market to get myself some herbs.


I bought this pre-mixed package of herbs for less than $3
I went to check on the chicken soup and it is looking good. Absolutely no scum, just some yellow fat/oil that I skimmed off. I bought a free-range chicken and a packet of herbs from the herb lady. I told her I was making chicken soup and I wanted some herbs to "boost qi". She reached up and pulled a packet out of one of the bags hanging from the frame of her stall. I asked her what it was called, but she just told me how many herbs were in the packet. Thanks. I guess I understand that most people don't know anything about Chinese herbs, so it's pointless to try to explain what the individual herbs are much less what they do. I hope I can slowly show her that I know a thing or two and that I'm interested in learning whatever she has to share.

There were nine different herbs in the packet, all very fresh. 

Based on some experience and several online resources, I think I've identified the herbs. Following a counterclockwise spiral from the top left their Chinese Pin Yin and Latin pharmaceutical names are:
 
  • Shan Yao/Rhizoma Dioscoreae
  • Huang Qi/Radix Astragali
  • Dang Shen/Radix Codonopsis pilosulae
  • Yu Zhu/Rhizoma Polygonati Odorati
  • Da Zao/Fructus Jujubae
  • Gou Qi Zi/Fructus Lycii
  • Gai Ben.Rhizoma Ligustic
  • Bai Zhu/Rhizoma Atractylodis macrocephalae
  • Gan Cao/Radix Glycyrrhizae

Most of these herbs tonify the Spleen and Qi and remove dampness. This means that they make your digestion stronger and prevent bloating and undigested food sitting in your gut. They also enhance your metabolism and boost energy production. The Gou Qi Zi a.k.a. Goji Berries or Chinese Wolfberries add some Yin to the mix, to balance out all the dry, warm herbs. The Yu Zhu a.k.a. Solomon's Seal also helps to moisten and nourish Yin. Gan Cao a.k.a. Licorice Root is added to many formulas to harmonize the actions of the other herbs and to shore up digestion as well.

The aroma of the herbs and chicken is so good. Note the yellow fat. The leftovers turned to a thick, collagen-rich gelatin in the fridge.

The soup is a bit tart and sweet. I added some salt and I think it'll be ready to eat in about 10 minutes. Oops, I forgot to make rice. Stupid.

Why am I so absent-minded these days? Is it because of the smoking? Is it the depression coming back? Is it "normal"? Will I ever be able to know if the way I feel is normal, is justified and I don't have to worry about it?

Well, when my mind starts going a little too fast or in a negative direction, it's usually time to eat. I guess adults can be like cranky babies before they get their bottle. I sure hope babies don't have existential crises every time they get hungry.

The soup is delicious and nourishing. I'm very fortunate that I can walk 10 minutes to the market to buy fresh meat and herbs. Food truly is the first medicine.