Friday, October 22, 2010

Of suppositions & sugar pills. Friday, Oct. 22, 2010.

“My recovery has been an evolution, not a sudden miracle.” – Patty Duke

Like a nasty rash, it keeps spreading again and again – provoking confusion, hopelessness and even fear for people taking antidepressants.

A meta-analysis of meds’ effectiveness, published last winter in the Journal of the American Medical Association, seemed discouraging to say the least. The presses were rolling, and a three-word summary of the study – “ANTIDEPRESSANTS DON’T WORK!” – flooded the traditional media as well as the blogosphere.

Perhaps most visible was Newsweek’s cover story, “The Depressing News about Antidepressants,” with the subhead, Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.

But that’s not what the results of the analysis actually said – and as a 25-year veteran journalist who also suffers from depression and bipolar, I’m going to call this journalism what it is: bullshit.

Don’t get me wrong. I’m no friend of Big Pharma. I resent the hell out of the pharmaceutical companies that charge outrageous amounts of money for these medications even as they spend billions to persuade TV-watchers to ask their doctors for Happy Pills that will solve all their problems. Not only that, but I’ve suffered extreme side-effects from taking the wrong meds. (Come to think of it, I’m not thrilled about the side effects of the right ones, either.)

But the meta-analysis didn’t say that meds don’t work. It said, “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial (emphasis mine).”

Allow me to put this into English: “If you’ve got a case of the blues, antidepressants probably won’t help you. But if you are very severely depressed, antidepressants can be very effective.” I’d like to add, “And they can save your life.”

That’s what frustrates me every time I read a reference to the AMA report. I fear it can lead people to stop taking their meds. For someone who is mildly, or situationally, depressed, this will save them a few bucks. But for someone with severe, unrelenting, clinical depression, the result could be deadly.

What we really have here is not the wrong meds, but the wrong people being studied. No one would study a group of people without cancer, give them chemotherapy, and then announce that chemo doesn’t cure cancer. But that seems to be what happened with this meta-study.

Further, the abbreviated report simply increases the stigma people with the most severe depression already face. If meds can’t treat it, then your depression must not be a medical illness. If it’s not an illness, then it’s caused by your thoughts. If you try to change your thoughts and your depression doesn’t lift, you’re just not trying hard enough.

When I was experiencing what I would learn later was a mixed episode, I was determined to get better – without meds, and with Dr. David Burns’ Cognitive Behavioral Therapy. This therapy is ideal for situational or moderate depression – it works amazingly well. But – based on my own experience only – Dr. Burns’ assertion that CBT works as well as medication even for severe, clinical depression is overly optimistic. I filled up seven notebooks with my “cognitive distortions.” I’ve never tried so hard at anything in my entire life. And I wound up attempting to kill myself.

It wasn’t until I had been on several medications for a period of time that my mood began to even out. Believe me, I experienced no placebo effect. In the beginning, I felt hopeless that any medication would work for me; later, there were meds I had faith in that did nothing. In fact, the placebo effect is least likely to be a factor for those who are the most severely depressed.

You see, until we found the right “cocktail,” I was truly too sick to help myself. I respect those for whom therapy was an adequate cure, but please don’t judge me for needing meds as an adjunct. Perhaps now I’m ready for that next step – stable enough to try CBT again. But – for me – it’s medication that has brought me here.

Thursday, October 21, 2010

Just because you’re paranoid. Thursday, Oct. 21, 2010.

“Just because you’re paranoid doesn’t mean they aren’t after you.” –Joseph Heller

Does anybody else struggle with a credibility gap? Or maybe it’s just me.

In the cinematic masterpiece “12 Monkeys,” James Cole (Bruce Willis) finds himself in a mental institution, displaying all the symptoms of paranoid schizophrenia. He claims to be from the future, and is afraid of the people that are after him. He can be traced via a device implanted in one of his molars. Against his will, he’s drugged to incapacitation.

The problem is, Cole is entirely sane. He really IS from the future – he’s been sent back in time to locate a virus that will wipe out most of the population of earth. He’s also a prisoner, so a tacking device has been placed in his teeth. But when he tries to explain his situation to hospital staff, they don’t buy his story. Who can blame them? Eventually, Cole comes to distrust himself. After all, he’s a textbook case!

Two things happen when you are diagnosed with a mental illness. First, the symptoms you have suffered are put into a context, and finally make sense. That’s the good thing. The bad thing is that from that day on, you lose credibility. You continue to live your life, as everyone does, but suddenly it seems like everything is about your illness and not about your outer environment.

It can be a frustrating thing to have a “reason” for your distress. You might have a bad teacher or an inept boss. Your spouse or parents might be cold and uncaring. You might have a physical illness, like irritable bowel syndrome or myalgic encephalomyelitis. But now that you have depression, anxiety, borderline personality disorder or bipolar, the problem is suddenly inside your head.

It can be difficult to talk about your problems with a physician, counselor, or family member, once your diagnosis is out of the bag. After all, diarrhea can be a manifestation of your anxiety (even though you might have food poisoning). You know you’ve always been too sensitive (even though your work environment is toxic). Your credibility is shot. It’s all about you.

And the person with the most doubt isn’t necessarily your father, wife or co-worker. The person with the most doubt is you. That’s why it’s so important, when you are anxious or depressed, to try to be as objective as you possibly can. Really listen to yourself. Journal. Keep track of your moods and how they may be affected by various factors.

Does anybody else struggle with a credibility gap? Or maybe it’s just me.

Wednesday, October 20, 2010

Not OK to feel. Wednesday, Oct. 20, 2010.

“They may forget what you said, but they will never forget how you made them feel.” –Carl W. Buechner

Do you remember two months ago when I wrote about a co-worker who was angry at me? Well, I learned today that she is still mad.

The nature of the problem doesn’t really matter; it’s my emotional reaction to it. And my reaction is fear, shame, and depression. This individual actually believes I’m being provocative, when actually the reverse is true. I’ve been walking on eggshells because I don’t want this person angry with me. Or anyone, for that matter.

One of my very earliest memories is of my parents telling me it was OK to be mad. I think I was about 4 or 5. I can only guess that in order for such a comment to come up, they must have seen me refusing to vent emotions in a healthy way.

Still, despite that memory, I believe I grew up in a household where it wasn’t OK to show emotions – particularly anger. Whenever I got angry at my mom or my dad, I was afraid to express it – out of fear that they would be angry back, or that my anger would somehow result in their death. (I’m 46 and I still have that “magical” belief that my anger, particularly in the case of my mom, will cause her to die.)

My first “real” job at a newspaper was on a staff where everyone yelled at each other like members of a big Italian family. At the time, I thought the environment was stressful, but looking back, I actually think it was healthy for me. I started to develop a thicker skin, and I had several opportunities to be angry without experiencing dire consequences.

Now I’m in a much quieter environment, working directly with only a couple of people. There is no way I can “speak my mind.” A single comment I made has taken on a life of its own and my teammate is holding a grudge. Several years of holding my tongue has been for naught.

It doesn’t seem OK to feel angry here. It doesn’t seem OK to feel angry at home, either. I think the only place I can feel angry is inside my car, if it’s parked. And that’s where I went over my lunch hour to cry. I don’t know what else to do.

Tuesday, October 19, 2010

Factor X. Tuesday, Oct. 19, 2010.

"Suicide is a particularly awful way to die: the mental suffering leading up to it is usually prolonged, intense, and unpalliated. There is no morphine equivalent to ease the acute pain, and death not uncommonly is violent and grisly." – Kay Redfield Jamison

Lately I’ve been wondering what makes us unique. And by “us,” I’m referring to those of us who have attempted to end our lives.

The American Society of Suicidology exists to study people like “us.” They are able to name risk factors for suicide: mental illness, especially bipolar disorder and schizophrenia; low self-esteem; perfectionism; history of loss (unemployment, foreclosure, divorce); gender (women make more attempts, men complete the act more often); recent exposure to another’s suicide; old age or terminal illness.

But what they can’t seem to explain – what no one can – is what I call Factor X: that one quality that gives us the ability to ignore, and override, the brain’s overwhelming desire for self-preservation. You see, MOST people that have a mental illness, MOST people with low self-esteem, MOST perfectionists, and MOST people who have suffered a loss don’t take that action. There is something different about us. What is it?

As I continue on this road to recovery, this Factor X bothers me more and more, and I’ve been trying to find the answer. One researcher believes it is the willingness to undergo physical pain and detach from it, and had found a connection between people who self-injure or otherwise abuse their bodies and people who attempt suicide. People who are suicidal have a high pain threshold, he says.

This doesn’t ring true for me. Other than my battle with dermatillomania, there is nothing in my background or personality to suggest that I like pain, nor that I can handle it better than other people. In fact, I would suggest that the opposite is true. I’m a wuss.

Right now I’m reading “How I Stayed Alive When My Brain Was Trying to Kill Me” by Susan Rose Blauner, who made a number of suicide attempts before she decided she wanted to live after all. Blauner developed a system to overcome what had become an addiction to suicidal ideation.

This does sound like the way my brain thinks. I experience certain “triggers,” and my brain’s automatic response is, “I want to be dead.” Blauner says it’s actually OK to have suicidal thoughts – the task to learn not to act on them, and to substitute those thoughts with more realistic and nurturing ones.

But I’m halfway through the book and I still can’t find out why some of us have actually converted our thoughts into actions, when the vast majority of people who have suicidal thoughts have not.

I’ve heard many people say, “I don’t have the GUTS to commit suicide.” Is Factor X really some kind of courage? If so, why didn’t I go mountain-climbing instead?

Understanding leads to control. I want to understand what makes me different, because it’s frightening that Factor X is a part of me.

Monday, October 18, 2010

The Electronic Friendship Generator. Monday, Oct. 18, 2010.

“There's a certain detachment involved when you're surfing the Web, sitting alone at the computer, facing an inanimate screen. But there are real people to be found on the other end of the ‘intertubes.’”-Anne Hammock CNN

“Your account has been blocked,” the message said. A virus, Koobface, had been detected in it. In order to run the program that would remove the virus, I had to choose which of five wall photos belonged to five FB Friends – and I could only attempt this once an hour. Uh-oh!

The first thing I did was check SNOPES, and sure enough, the problem was legit. (Damn.) Because I have a firewall at work, I had to choose the photos from my home computer – and the photos displayed weren’t of my FB Friends’ faces. They were of poems and puppies and kittens and sunsets. Ack! It took five long days for me to unblock my account.

Recently I was offline for over a week during a trip with my husband. But this time, the choice wasn’t mine, and I felt like I was grounded on the night of the Senior Prom! What was going on in Facebook land? What was I missing? I felt lonely, disconnected, and strangely sad. The lyrics of “FACEBOOK UNBLOCK ME” seemed to be written with me in mind.

So here’s the part where some people would say that I should “get a life.” I should get friends and activities “IRL” (In Real Life”) and not “waste time” on the “Electronic Friendship Generator.” My mom is one of those people who says she “can’t figure out why someone would want to sit at a computer when there is a whole world out there.”

Well, I have a real life, thank you very much. I have a full-time job that’s fulfilling and interesting. I have a husband and son who I love very much. I’m very involved in our church, and I participate in peace activities. I have, by most measures, a very full life. And part of that full life happens to include Facebook and the Friends I meet there.

For a host of reasons both professional and personal, I’ve chosen to limit the number of people who know about my bipolar disorder, and even fewer know of my suicide attempt. Perhaps I should be “fighting the stigma” by coming out of the closet – but I fear the ramifications to my job and family would be too great.

So there is a part of me – a big part of me – that’s known mostly in cyber-space. And that means some of my relationships with Facebook Friends are as intimate – or even more intimate – than many of my relationships “IRL.”

Right now, Facebook meets a need in my life. It provides the support group that I couldn’t find when I checked Google and the Yellow Pages. And I won’t be ashamed of it. I need all the support I can get.