Musings on my mental illness

Okay, so the current bout of depression has me facing some facts I would rather not face.

1. I will probably struggle with depression my whole life.
I don't want this to be true and I know that there is always a chance that the perfect pill, learning to live with myself better and a miracle are all possible and that a future without depression could happen. But the present situation provides a great deal of evidence to the contrary. And I hate that this could be true. It sucks for me and my family, especially my husband. It is knowing you will live with a person who has a chronic illness which impacts on their ability to be themselves and function and be the partner that are supposed to be. I can't speak for him. But I hate that our future could be punctuated with me disappearing under a black cloud and him having to cope with it.

2. My meds aren't working anymore.
I have increased the dose and the anxiety is gone, mostly. But the dispair has really moved in to stay, as it were. This means I will probably have to change meds. This is terrifying as the process can make you feel even worse, before you feel better, and there is no guarantee that I will only have to switch once.

3. There is no magic fix for this.
I have been through this enough times now to know that no one thing will make enough difference.

Here are the basic models of treatment and recovery from my very amateur observations and reading:

• The JK way (John Kirwan) - he credits his recovery and wellness with active relaxation and exercise. 
• The "Live More Awesome" way - this is the guy who set a goal to float down the Waikato river on a lilo to raise money for the Mental Health Foundation. He also recently created the longest water slide ever. He doesn't believe in therapy so much as setting big goals, the achievement of which make life exciting and worth living for.
• The talk therapy way - there is a lot of evidence for the efficacy of various forms of therapy to help work through issues or experiences which may contribute to mental illness. However, it is quite dependent on the relationship with the therapist. I personally have found psychotherapy really helpful. The principles behind it is that the actual relationship you have with the therapist can be used to face things in a safe and empathetic way and also learn how healthy relationships can function.
• Cognitive behavioural therapy - this focusses on how the thoughts we have can help or hinder our mental health. What stories do we tell ourselves about the world around us, the people we interact with and daily events? What assumptions do we make? Is their really evidence for that? It encourages changes in thinking patterns to move away from thinking that isn't useful or helpful. 
• Natural therapies - this may include supplements, diet changes, acupuncture etc. There is a lot of evidence to support some approaches and diddly squat for others. You also have to be very careful because often medications for mental illness have contraindications with natural medicines and herbs. There are also people making bucket loads of money off vulnerable and desperate people.
• Healthy lifestyle - good diet and exercise all help to increase the good feelings in the body. Eating like crap and living on the couch would make anyone feel a bit gloomy. That said, if you in the throws of depression the energy required to do anything seems to require superhuman effort. I am not a great example of using this approach ;)
• The skills approach - this aims to increase a person's resilience to the ups and downs of life by introducing skills which give a person greater control and mastery over their mental state. Psychologists often focus on this and CBT is part of this approach. This may include mindfulness techniques, meditation, strategies to use in a crisis or when a mood or action is triggered. 
• A spiritual approach - this has overlaps with other approaches and can be as vague or as structured as the spiritual beliefs which the approach is based on. There is the very unhelpful "mental illness is demonic possession" approach. Now I am a Christian and I do believe in evil as an actual thing in the world, but it is not wise to tell someone with a mental illness that they have a demon in them. The people I know who are wise and discerning in the church understand that one prayer session may not bring the instant healing which we all would love to occur. But I do believe that a Christian faith built on the knowledge of being unconditionally loved by God, that we are all messed in some way, that we can be forgiven and healed and live a purposeful and significant life, can be a truth that helps to heal and provide the comfort in despair that  makes a difference. I personally have had times when my anxiety was crippling and prayer, with no words, just my spirit groaning, was all that brought relief. But depression is not a sign of a person's spiritual failings or lack of faith. We live in a broken world with broken people who hurt each other. And all of us suffer in some way for that. For other people Buddhism, and other spiritual practises create meaning and peace in a way that can make a significant impact on their mental well being. We are all spiritual and it is an aspect of our existence which is often the part most in pain and most seeking of hope and significance.

Probably a mixture of all of the above will work or help most people. I have done the therapy, some cbt, some mindfulness. I am definitely not an "active relaxer" like John Kirwan but it is really good for me to get engrossed in an activity such as gardening or scrapbooking( I feel no shame). Exercise and diet definitely make a difference too. But my perfectionist tendencies mean I have to be very careful about how to approach it. I am also not one for 'out there' goals. Worship in church and the singing that is part of it really can help me. But sometimes it seems that God has hit the mute button and all I have is doubt and confusion.

This time around I am not going to use therapy - as I read recently on the Live More Awesome facebook page "shit in a food processor still comes out as shit". For me I think I need to let go of all the stuff I could use to explain my depression. I just don't want to be depressed anymore. I have talked a lot. Now I just want to get on with life.
Meds will continue to be part of my life and actually I really need this to work so that I can do anything else that could help.
Healthy living is definitely a priority - sleep being the major one and some regular exercise. I reserve the right to eat junk cause at 3pm in the afternoon with two preschoolers it can be the life raft.
I think I want to focus more on how my faith could counteract some of the intrusive and negative thinking that plagues me. Maybe I will find someone who I can talk to who has expertise in that.

If you get a chance to listen you should check out the interview with Mike King on Radio NZ. He runs the Nutters Club on ZB which encourages people to phone in a talk about their struggles with mental illness. He is making it not taboo and speaking to groups about how we can all support those with mental illness. He is honest about his own journey and I found what he said really refreshing.

The thing I guess that I wish people realised is that depression is deadly. It kills so many people each year in NZ. It makes people feel there is no hope, no escape and that taking your own life is a reasonable choice to make. A lot of people express anger if someone chooses to end their life. Their actions appear selfish and self indulgent, leaving so much pain and grief, questions and guilt. But if you can just imagine how awful someone would have to feel to make that choice, then hopefully you can remember that when someone says they are stuggling with depression. Because no matter how much they tell you about how hard life is for them, they will never tell you how truly torturous it is.

So tomorrow I will have my appointment with the adult mental health team. I will become an official mental health "consumer" again. And I really hope that somehow, someone whose mind is working well for them, can help me through this time. I am fresh out of brilliant ideas.

Fake it till you make it

My current mental state is driving me crazy. Haha...
 I wake up in the morning with the feeling of lead in my feet and cotton wool for brains. I get up and get started on feeding kids, getting dressed, showered and pop my three magic pills. After about an hour I feel overcome with the deep desire to go back to bed and hide under the covers. At the weekend, with hubby around, I could have actually done that. On Saturday I did. The sleep was awesome. But when I woke I just wanted more. With the bedroom door closed and my mind switched off in slumber, things felt safe.

But on Sunday morning I made a different choice. I could feel the panic and lethargy coming on. But I knew that it would totally suck for hubby to be left on his own with the kids again and that when I emerged from hiding later in the day, everything would be the same. So I did the opposite. I stayed up. And I took Ella out. We had breakfast at a cafe, played at the park and did the supermarket shopping. And it was better. I did what I would have wanted to do if I were well. Faking it till I make it.

This has been one of the most useful strategies I have learned in the journey with depression. I did a course through Auckland Adult Mental Health service for people struggling with acute depression. Basically it looked at dealing with the acute mental distress which people can suffer. That horrible feeling that has me wanting to run and hide and never get out of bed again. Or the anxiety which feels like I am about to sit my School Certificate exams or have just been attacked. That level of distress means you can't think and often the strategies you use to cope, actually make the distress worse. It is that state of either total terror or complete despair where you brain just won't work to help you and your body is paralysed by it.

The key to coming out of that state is to do the opposite or something completely different from what you would naturally do. So instead of going to bed and hiding, I went out. By doing that it is possible to short circuit the usual pattern of spiralling into deeper distress. And it worked enough to keep me going throughout Sunday.

But now on Friday, after a busy and long week where I still can't get to sleep until at least midnight, and things are still grey, I wish for some reprieve. Just a little while with my mind at peace and my body relaxed. I think that is why when feeling distressed it really is so easy to eat the chocolate, play the mindless game on my cell phone or any number of things which don't help in the long run but just give you a little break.

Irony is evil

So about two days after my last post where I so happily posted my intention to wean down my dose of antidepressants, I started feeling the gloom. I guess I had been ignoring the signs. I didn't want it to be true and I was doing my best to believe the story that with my last child born and this year just ticking over, that my hope would be fulfilled and that I could pretend that I could just get on with living.

But no. The gloom has not lifted. My anxiety is back. I am feeling under an overwhelming, thick blanket of self loathing and sadness. I am trying, I really am. To kick that damn blanket off. But it keeps creeping back. I hear myself speaking negatively, I have those unbidden, horrible thoughts about myself and that I just can't do it. That it is all too much and that I am the broken bit of the puzzle which is stopping the picture being beautiful.

Today I cried with my hubby. It felt good to cry and be angry that we are back here again. And to talk about "living with depression" in a very long term sense. No magic wand.

So the blanket has lifted a little. I feel okay tonight. I hope for deep and refreshing sleep. And on Monday I will go to the doctor and say "You know that plan to cut back..." And I will choose more consciously to do what I know I need to do to head once again towards wellness. But I am angry and sad and angry, that as a few things have happened, and I have had some stress, and I have eaten crap food, and not exercised enough, and not been more mindful, that my mind has once again slipped down the rabbit hole. And I will have to scrabble back out again.

There is so much shame in that. Cause unlike a broken leg, where I could point to a cast and show you the xray and point and say "See, here. It's broken"... instead it is me who is broken and faulty.

Depression is shit.

Great Expectations

As I drove home from work on Thursday I was really aware of all the traffic heading away on holiday and I started thinking about the fact that it really hadn't dawned on me that it was the beginning of a holiday weekend. I guess it's cause we hadn't planned to go away. We were planning an at home weekend with the sole goal being to get the vege garden ready for winter. I was excited about hubby being around for four days in a row, the first time since Christmas. But I had to do a bit of positive self talk as I drovem towards the beginning of the Easter weekend, to make sure I had realistic expectations.

It has taken the last three years for me to fully understand and accept that once you have kids a holiday weekend or any holiday for that matter, is not a holiday. At least not by traditional definitions. It has taken a while to change from thinking that I will be able to sleep in, read books, have some me time, go out when I like, go away camping/road tripping just cause it is a long weekend. I mean there are some very practical reasons why holidays are different now, but I have had quite a few where I have had this sense of frustration and disappointment since becoming parents.

I get crabby and short tempered. I try to give myself a break from housework but then end up feeling depressed by the mess. Ella gets bored and we all start getting at each other cause somehow we are trying to still have a DINKY (double income no kids) holiday when there is nothing DINKY about our lives. All because my expectations don't match my reality.

But not this time. As I drove home I told myself that this weekend would be great. But it would still involve the housework, cooking, caring for both kids and all the other normal, hum drum stuff. But it would be different cause hubby would be home and we could do some different things, and I could have some naps, and we might catch up with some friends, or cook some yummy meals. But I would not spend four days doing whatever I felt like. Cause holidays are different now.

I was talking to a friend who has gone away with her extended family to a bach. I think there will be three generations and a total of about 5 kids of various ages. I made a hesitant "oh" as she told me. She assured me that it would be fun, but it wasn't going to be a rest and she would be busy. She inspired me by showing me that by having realistic expectations I wouldn't be feeling a tension between my hopes and my reality. Instead I could enjoy it for what it is.

And I am. What a quiet but lovely time I am having. I have had a nap, done about 5 loads of washing, been out for icecream with Ella and now will go tidy up and do the dishes. A lovely long weekend where my expectations are met and I am satisfied. How unusual!

Weaning Mummy

For the first time in three and a half years, I am considering weaning myself off antidepressants. It is a pretty remarkable place to be in, to be actually feeling well enough that I would see a future where popping my two miracle pills each morning wouldn't be the pillar on which my life is held together.

I have been on paroxitine since about 3 weeks after Ella was born. It was like suddenly a light went on and I could see why other people seemed so excited about life and enjoyed things. Up until that point I honestly hadn't been able to see what the fuss was all about, most of the time, even before Ella. I tried citalapram before we tried to conceive another baby but my anxiety wasn't managed well on that so I switched back. Switching back triggered a relapse and I had to increase my dose to the maximum for a while. That is why the idea of weaning is a bit scary. But the confidence, self awareness and skills I have learned through therapy, pregnancy with George and since George's birth has shown me that I am strong and that I know how to look after myself. I don't need to fear a stressful day or event and feel that antidepressants are essential to my wellbeing. Well, I am hoping that is what I am going to discover through the weaning process.

Weaning off antidepressants is not something to do without a very well thought out plan and a bit of reading so you know what to expect. Most SSRIs have quite a long half life, which means they stick around in your system for a while so withdrawal doesn't kick in for a few days if you suddenly drop your dose. But paroxitine (aropax, paxil) has a very short half life and you have to take it within the same couple of hours each day or you start to feel funny. It also has some side effects that aren't too pleasant. It makes me feel really tired about an hour after taking it, you can get what feels like electric shocks in your brain that are painless but very wierd. It also limits (over sharing warning!) sexual satisfaction. After three and a half years, I am ready to see what it feels like to be me without the chemical assistance.

Often people try to reduce their dosage during holidays or at a time when they have lots of support. I have learnt the hard way that I need to be living my normal routine and not do it when I have lots of important events or possibly stressful situations, such as Christmas, or major changes in my life. So now is actually a great time. Life is in a pretty straight forward pattern right now and I am feeling no sense of pressure to do this in a certain time frame.

So I have done some reading and am planning a very slow withdrawal process by only reducing my dose by a quarter tablet, two weeks at a time. Hopefully that way I can avoid some of the awful side effects paroxitine withdrawal can have. And I will be able to keep a close eye on my state of mind so if things start to slip I can stop and let things stabilise. If I find myself feeling down or anxious I will just stop. In the big picture, needing to take a pill or two each day is a small price to pay for wellness and joy in my life.

It is pretty confronting to think about the fact that I am physically dependent on medication to avoid going potty. It can feel very shameful and I have moments where I feel like I am flawed and pathetic. But then I remember that choosing to be well and live well is actually empowering, and if that means taking antidepressants, then that is a positive choice. Everyone has their battles and health issues. Some people take blood pressure meds, others need insulin for diabetes. It is better than using other substances such as alcohol or illegal drugs to self medicate. I still reserve the right to use food sometimes!

So after Easter the process begins. Wish me luck and hopefully there will be no going down the rabbit hole.

Awhi Mama

I am really excited about a new blog I have started. . I have wanted to do something more to support teen mums, like those I teach. So the blog Awhi Mama is one way to do that. Please check it out if you want to know more about teen mums in New Zealand and the challenges they face. I hope the blog informs and gets more people passionate about the "issue" of teenage parents. We have the highest rate of birth to teenagers of anywhere in the developed world so we ignore it at our peril.

Be where you are

This year i have been enjoying being where i am. Or at least learning to. We moved to our own home in a new suburb about 18 months ago now. We are quite far from where i have lived most of my life. We love it. It feels like a small town.
This year i am aiming to live local. So we go to a local mainly music class, ella starts dance classes this week and we have started going to a local church which is walking distance from home. Each week we walk up to the village shops to go to the library and have a picnic in the park. It is really helping me to feel settled here.
Another way of "being where i am" is surrendering to the season of my life and the circumstances i am in and not fighting them. Life feels very busy and it seems there is no end to laundry and housework. I have been wrestling with this. But this week something clicked.
Suddenly i could feel myself surrendering to it and pressing into it. No Facebook has helped cause i am no longer distracted by what other people are doing. Also, because daycare is more expensive this year, i can't do extra days at work. This is hard to accept cause i love helping out when things are pressured (the extra time was voluntary), and need to fit work into the evenings after kids are in bed and housework done. I have also dropped all the groups i was involved with last year and before George was born. That has been hard and there has been some grieving, but life is more simple and i am enjoying more time at home. Now with two littlies, pottering at home is so lovely and as long as we get out once a day, i avoid cabin fever.
Since becoming a mum i have also struggled with how to do my Christian faith in a way which isn't just desperate prayers when i am losing it. I think i have read my bible a total of less than 10 times in the last 3 and a half years. It is pretty hard to stay in church for the sermon with managing kids who don't like going to Sunday school on their own. Oh that's if we ever get to church. I have felt guilty and lost. All the advice seemed to be "try harder" or set up a conflict between my kids and time for spirituality.  But yesterday i suddenly realised that this is where god has put me right now. This is where i am. He knows my circumstances and it has to be possible to have an authentic and rich relationship with managing Jesus while being in this season and without escaping it. So listening to worship music in the car and at home, praying and praising while i hang out the washing and delighting in ella and George are how it is right now. And i am even managing to give up tv time at nights to spend some time reading the bible.
By being where i am and accepting both the limitations but also the joys i feel so much more at peace and can really get into the moment.
I don't know what the future holds for all the ideas and dreams i have but right now i am being right here and it is good.