I always found it senseless and cruel that most antidepressants, at least the SSRIs, take 4 – 6 weeks to fully be functional.  Is this a colossal joke?!  What depressed person wants to hear, “Hey, you’ll be feeling much better, just wait another month or two!”  Having already suffered badly, sinking into further depths of not recognizing your brain, further days of losing sanity, you now have to wait.  Tick tock.

Slowly weeks one and two pass and your anxiety increases… “Why isn’t this damn drug working?!”

Week three shows up and you question if anything is different… “Wait, was that smile for real, or was it still my masked cover-up?”

Week four comes and one day you wake up and you can tell you are different… “Hallelujah!!!”

Six times and I am still not quite used to this adjustment. 

What the doctors don’t tell you is what you may experience when you come off of a drug.  For a few months now, I have been weaning off of Seroquel, an antipsychotic I was prescribed while hospitalized in January 2015 for both its help with psychosis and that it works mighty well as a sleep aid.  This drug has had so many “lovely” side effects… weight gain, bloat, constipation… that I couldn’t wait until I could go off this stuff.  Several months after starting this drug, I was no longer in need of it for its antipsychotic-ness but still relied heavily on it for sleep.  Then, it stopped working for that and I had to add Lunesta in the mix.  So why, why was I still taking it?!  I started out on 100mg and after a few weeks went down to 50mg all under the supervision of my psychiatrist.  About a month later (over 2 weeks ago), I went down to 25mg, the lowest dosage.  Then, starting with this Sunday night, I stopped taking it.

And then I started to not sleep!

For the last two nights I have had what is called Rebound Insomnia – “Rebound insomnia is when you can’t sleep after coming off sleeping pills. Your brain and body have adjusted to the sleep medication and almost anticipate it. The feedback mechanisms have had their set points adjusted, to some extent. The set points change back of course, but in the short run your body experiences insomnia in response to the lack of drug… (courtesy of sleepdex.org).  Seriously?!  This is jut cruel now!  Even with my .5mg of Ativan and 2mg of Lunesta I am still experiencing rebound insomnia.  It is now taking me more than an hour to fall asleep and I am waking up at 4:30 in the morning.

What to do, what to do.  Do I cave, give in, and take the Seroquel?  Do I continue hoping there is only a day or two more of this?  There is already a panic brewing inside of me.  I know how bad not sleeping is for me.  It is a huge trigger for my Depression and Anxiety.

Searching on the web, because the internet doesn’t lie and is only there to scare you, I have found several people who complain because their rebound insomnia is going on for three weeks… three weeks?!  Okay internet, you’ve officially scared me.  I can’t go three weeks with my current sleep pattern.  I’ll wind up back in the hospital with them pumping me with large quantities of Seroquel to get me to sleep and back to square one.  I refuse to give in.  I logically know this drug is doing nothing for me right now.  Without it, my digestive system will start to function normally again and maybe this extra 10lbs I’ve been holding onto since the birth of Seroquel into my system will disappear.

So, ladies and gentlemen, because I do not fully trust the psychiatric system, I want to let you know that there is such a thing as “rebound insomnia” and it is as cruel as finding out in the beginning that you will have to suffer another one to two months before you will feel better from your Depression (if the correct drug is picked).  I implore you to ask your doctors about the drugs you are on, their interactions and their rebound effects.  It is your body, you should know what you may be in for.

Rebound insomnia… really?!

I seem to be a star pupil when it comes to EMDR therapy, so much so that we have taken a break from it and returned to CBT (Cognitive Behavioral Therapy).  In other words, I am back to what I would like to call normal therapy.  My therapist, after months of reprocessing certain devastating memories… Tyler, losing Tyler, losing myself, my Postpartum fiasco… decided I needed to learn how to cope.

To cope… according to Dictionary.com, the word “cope” is defined as “to face and deal with responsibilities, problems, ordifficulties, especially successfully or in a calm oradequate manner“.

Key word: successfully.  Okay, Dr. B., I agree with  you completely.  After being on this earth for over 36 years, I should learn how to “cope” with my tragedies, both big and small.  Instead of stuffing them to some corner of my brain and locking them away, I need to face them head on.  I need to embrace them.  After years of CBT, you would think I would know by now how to “cope”.  I don’t.  It seems that with every episode of Depression and Anxiety, I start out as an infant and need to relearn everything once again.  It is rather annoying and downright tedious.

So after dealing with the typical “replace negative thoughts with positive thoughts” exercise, my therapist who is big on Mindfulness and Meditation, suggested we try exercises employing this.  Why not?  I am game for anything therapy wise.  We decided to focus on a guided meditation dealing with sound.  Why sound you ask?

One example… this Saturday night, as my husband and I were in the basement watching TV, our neighbors decided to celebrate July 4th a bit early.  I mean, it isn’t even June 4th yet.  Even though we were in a basement which deafens the sound a bit with its concrete and insulated walls, I sat scrunched up in a fetal position with my hands on my head scratching at my scalp.  I started rocking back and forth, curses flying out of my mouth.  It was not a pretty sight.  This sound, like my neighbors’ annoying diesel truck and dirt bike is something I can’t control.  I dislike things I can’t control.  I am an Alpha after all.

I sat comfortably in the soft cushioned chair upholstered in a floral pattern.  My arms draped over the arms of the chair, my feet were flat on the floor.  My therapist proceeded to get up telling me that for this Sound Meditation we would in fact need sound so he opened two of his office windows and returned to his seat.  He began to read from a book which directed me to close my eyes.  Simple task, done.  Then it got more difficult.

“Focus on the sounds around you.  Those near and those far.  Those that are long, those that are short.  Those that are loud, those that are quiet.  Notice how they fade in and then fade out…”

As he spoke these words all I could think was these damn cars.  They are so loud.  How am I supposed to learn how to tune them out?!  Okay, Steph, focus on the birds.  You like nature sounds.  Ah, birds, tweet, tweet, tweet.  Damn cars! Shit, a motorcycle!

I was then supposed to imagine the sounds passing by like clouds.  They roll in, they roll out.  Instead my breaths got short and rapid, my lank hands were now gripping the ends of the arms of the chairs, my head felt like it was being squeezed.  I was nauseous, dizzy, tense and about a few seconds away from getting up and shutting the windows myself.  The sound was too much for me.  I was having a full blown Anxiety Attack.

When my therapist finished reading, he looked up at me and asked me how it was.  Being a great faker of feelings he didn’t notice any of the affects my Anxiety was having on me.  Between rapid breaths I asked, “Does it get better?”

“Does what get better?” he replied.

“Meditation?  I am having a freaking Anxiety Attack.”

“Hmmmm… this exercise is supposed to have a calming effect,” he responded.

“So was the Container Exercise.  I seem to be in this 1% where Meditation has the opposite affect,”  I joked, “My head feels like it is being squeezed in a vice.”

At this point my hands were now in tense fists.  I felt as if I would vomit soon.  I just wanted to leave.  I needed fresh air.  I needed space.  I needed….

“Would you like to try this again?” he asked.

My eyes widened in horror, “Like now?!  I am still coming down from my attack!”

“No, not now.  I can see how distressed you are right now.  But could we try it again with the windows closed focusing on smaller sounds at another session?  I think you should give it a try a few more times before ruling it out.”

I pondered this.  Obviously, this first time did not yield the response he or I wanted.  Neither did EMDR for at least the first month of doing it but eventually it worked wonders.  I knew I needed to get over this sound annoyance thing or I would forever be enveloped in my Anxiety.  I trust my therapist and agreed to try it again.  The battle continues.

At first when I read this article, “Is Depression an Illness? Or Part of the Human Condition?”, yesterday it was kind of ironic.  I had just posed the question to my therapist on Monday of can Depression be cured since it is labeled a disorder?  His summation of the question led to the theory that professionals now believe Mental Illnesses such as Anxiety, Depression, Panic Disorder, etc are not necessarily Illnesses but rather spectrums.  These spectrums have levels with low being the ordinary human being, to a point somewhat in the middle that points to those like me who have issues typically coping and fall under the title of “Disorder”.

When I read this article (see above) by Chantal Marie Gagnon, PhD, LMHC, at first I was rather shocked to hear a psychiatrist admit that she does not believe these illnesses are real.  She, along with my therapist, agree that to some level, all human beings will experience depression and anxiety.  Because of this, Ms. Gagnon states, “Are we all disordered? Do we all need medication?”  She then goes on to admit that her and her fellow constituents “fail to give people the knowledge, support, and tools they need to move past those difficult period.” 

This got me thinking, am I really ill?  I suppose those who have a lower degree of depression and/or anxiety have formed coping techniques that aid them through their time of hardship.  This is something I greatly lack.  I still haven’t fully developed coping techniques and I do believe it is because of this that I quickly become so far gone that medications and therapy are needed to bring me back.

She goes on to state that “the medical model of labeling feelings as “illnesses” limits recovery options”.  She continues to say that as Americans we have been bred to believe that if we have an illness, we need medication to recover.  Other countries believe in looking at diet, exercise and forms of meditation first before handing over a prescription for a controlled substance.  She blames the psychiatrists, including herself, of doing this to sustain their income.  I agree to some extent.  All the times I ever walked into a psychiatrist’s office, they have been more than happy to send me off after the 10 minutes of getting to know me with a script for Ativan.  This only continues to build my annoyance with the Mental Health Care system here in America.

But do I believe that I could have overcome my Postpartum Depression and Anxiety and this 6th episode of Depression and Anxiety without medication?  Do I think I could have survived them with diet, exercise, psychotherapy, yoga and meditation alone?  NO!  I was to the point of Anorexia this last time because I couldn’t eat.  I couldn’t eat because my Anxiety was so severe.  Telling me to eat better and exercise would have been a sarcastically mean retort.  I definitely had a Disorder.

But at what point does my Major Depressive Disorder change into just a past episode of Depression? I always imagined that Depression and Anxiety remained with me and just had periods of dormancy.  Could I be wrong?  If I am, what does that mean?  Where does that put me now, not quite suffering but not quite cured…

My therapist joked, “You are in partial remission with Major Depressive Disorder.”  Hmm… sounds a bit too complex.

The part of the article that struck me was when Ms. Gagnon’s colleague, Dr. Barry Duncan states, “As crazy as it sounds, problems, like depression, also provide possibilities for living our lives differently, for reaching new conclusions. Depression is obviously painful, and it brings attention to the fact we are not happy with some aspect of our lives. The depression, therefore, can be a life-transformation vehicle.”

Yes!  Right on!  All my episodes have always had me digging deeper into my soul.  I questioned my happiness with my career, my family, my friends and my hobbies.  Therapy helped me comprehend what wasn’t going right and in turn gave me the tools to alter my perspectives.  Like the article states, I constantly battled with my identity each time.  Who was I?  Did Depression and Anxiety define me? Coming out of each bout has made me wiser and more aware at what triggers me and what my feelings are when these illnesses are returning.  I have grown from them.

Her final debate is the argument about labeling Depression an illness due to biochemical properties.  I have read countless articles that to some point explain Depression as not producing enough Serotonin.  According to the study in this article, those patients given a placebo over an actual antidepressant did about the same.  The study continues to state “that a psychiatrist with a positive therapeutic alliance with his patients was more effective in improving depression symptoms with a placebo than was a psychiatrist with a poor therapeutic alliance administering a real antidepressant drug” (Krupnick, J., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P.A., 1996).

Hmmm…. the above again supporting the need for Mental Health reform in the US.  That being said, it is true to fact and I totally agree that psychotherapy has done more for me than my medications.  Of course, I am thankful to my medications for what they have done for my psyche.  In my opinion (again, I have no medical background, just experience), I tend to think that for some, Depression and Anxiety are Disorders and this may be because of genetics, because of biochemical factors and because of environmental factors.  I know many aside from myself who will agree that if it wasn’t for their meds, they wouldn’t be here.  That in itself says it all.

I never had a Psychiatrist I loved.  Heck, I never had one I liked.  Honestly, my relationships with my Psychiatrists these last 20+ years don’t even measure up to an “acquaintance” standard.  They are short, sometimes snippy, and barely lift their eyes off their laptop to make eye contact.  These doctors that control what medications I take… and I am only in their office for a whopping ten minutes… at most.

It bugged me yesterday as I sat in the waiting room for my appointment.  I wasn’t even meeting with my normal Psychiatrist.  I had a sub-psychiatrist for this visit as my normal doc was out on maternity leave.  No big deal, it wasn’t as if I were close with her even after seeing her for over a year.  I entered my sub’s office where he asked me the typical psychiatrist questions:

“How are you feeling?”
“How are the medications working?”

Yada, yada, yada.

I thought maybe he at least read my file before meeting with him, but nope, he didn’t.  I had to tell my story of the last year to him as quick as possible as I only had about 2 minutes left on the clock of my appointment.  And like that, my ten minutes were up.  I am not sure what was accomplished as this man knows nothing about me and just handed me prescriptions for controlled substances.  Upon leaving, I made my next appointment.  I asked the receptionist who I should make it with and she responded, “It doesn’t matter.  Your regular doctor will be back then if you would like to see her.”  Then was three months away.  Then was almost at the end of summer.  Then was August.

On my drive home, I really thought about the Mental Healthcare system in the United States.  I even crowdsourced to see if my revelations about the system had merit and wasn’t shocked with the answers, but I should have been.  Most of the people that responded to me agreed that they had appointments with their Psychiatrists that lasted up to 30 minutes at most, but it was more like 10 minutes where only drugs were discussed.  These people then revealed that like myself, they saw a Therapist weekly or biweekly for an hour or more at a time.  And the kicker, these 2 team members never conversed with each other about care!

This is what angers me.  I’ve signed waivers to no end that enables my Psychiatrist to contact my Therapist (and vice-versa) concerning my care and they never have.  There are waivers signed for them to contact my Primary Care Physician… never have.  This situation was even more complicated when I was hospitalized.  I had additional doctors, several hospital Psychiatrists, along with my Therapist and regular Psychiatrist and there was still no contact.  Amazingly, the hospital Psychiatrists didn’t even converse with each other.

I thought some more.  How can I receive the best care possible when my “Team” chose to be independent workers?!  I became the go-between, the third party mediator.  This was all fine and dandy for now because I am doing well but a couple of months ago when I had a breakdown… wouldn’t it have made sense for this “Team” to talk?  It’s bad enough as the patient your medications are a trial and error affair taking weeks sometimes months to get correct, now you, mentally impaired with Depression and Anxiety, need to be able to handle the negotiating between your “Team”?!  I understand from a work perspective, as I hold a full-time job myself, that it is hard to fit things in.  Asking these Psychiatrists to talk with their patients Therapists is another step to make in a busy job they already do.  Think about it… if they work 8 hour days and see 4 patients an hour (although 15 minute appointments are a stretch), that’s 32 patients a day.

32 patients a day… that’s 160 patients a week!  I’d be shocked if they knew my name without looking at their laptop when I came in!  But they should.  They are dispensing medications that can be harmful.  These medications carry some serious side effects, some even include suicidal thinking. With this knowledge, wouldn’t it be a wise decision to discuss the patient’s condition with both their PCP and their Therapist?  Get an idea of who their patient really is aside from there in depth 15 minutes?! (note sarcasm)  See if they have any medicinal allergies they are lying about?  See if they are known to hide their suffering to an extreme?

How do we accomplish this?  Among my crowdsourcing was a Therapist and she even agreed she would rather be doing the Team method but that it was hard to enforce.  By not having our Teams discuss our care we are really at a disadvantage here in the United States with Mental Healthcare.  We need this system to be audited, to be dissected, and to be resurrected in a way that really has the patient’s care at the core of the system.  After all, this is May, it is Mental Health Awareness Month!

I woke up this morning with snippets of Canadian singer Bryan Adams’ song How Do Ya Feel Tonight? in my head (I’m a child of the 80s and yes, I like Bryan Adams)…

“is there anybody out there?
anyone that’s loved in vain
anyone that feels the same…”