What Does Your Brain Tell You When You're Depressed?

One of the fun parts of hypomania for me (I use the word "fun" sarcastically) is that not only do I get depressed, anxious, and revved up at the same time, usually my depression and anxiety are the things that get revved up.  So my brain goes a mile a minute, but it's going a mile a minute about how horrible I am, what a bad person I am, and how I'm going to hell.  See?  Fun.

The hell thing is a recurring thought; every time I get hypomanic, that's what I tell myself, over and over again.  I'm  lousy person, a lousy parent, ugly, fat, and worthless, and my ultimate punishment (as if having these thoughts isn't punishment enough) is an eternity in hell -- whatever that is.  I know a lot of this can be chalked up to Catholic guilt, but I think it's more than that, too.

I think when you're depressed or anxious, your brain seizes on the most convenient negative thought possible and replays it and replays it like Elf on TBS at Christmas. I'm still working on how to get it to stop the replay; as far as I can tell, it's not as easy as pushing a button.

Does your brain tell you something over and over again when you're depressed?  Is there a thought on replay in your head?  Have you figured out how to turn it off?  If you have, more power to you.  If not, join the club.

Owning Our Antidepressants

On Saturday, I happened to read this guest blog post at OwningPink.com, about how the author believes that, contrary to what most modern medicine tells us, depression and anxiety are not physical ailments.  Instead, they really are "in the head," and, unlike a physical ailment like diabetes, medication is not the answer.  In her words, "attributing anxiety and depression to a chemical imbalance is horribly disempowering," and by prescribing antidepressants we're "throwing in the towel" and abdicating responsibility for our mental health.

The author, who is a Ph.D. in Psychology, cites some interesting statistics from a few "anti-antidepressant" books.  She says one doctor believes that as many as 75% of the people taking antidepressants could "significantly reduce" or eliminate their meds with the help of a doctor and lifestyle changes.  She also mentions one doctor who believes the whole "serotonin deficiency" approach to depression is a sham, and is based on some questionable, at best, science.

When I first read the article, I was irritated and a little mad.  I though her attitude was a little too simple, and a little too self-serving.  I also took some issue with her "research," as all her information seemed to come from the same two sources, and she goes on to contradict some of the research she presents.

Okay, so let's talk about the author (it's all about ethos, people).  Her name is Bethany Butzer and she has written a book called The Antidepressant Antidote, is a speaker on the topic, and is also a yoga instructor.  On her website, she classifies herself as a "Mental Health and Wellness Advisor."  The topic of getting off of antidepressants is obviously her passion and her platform.  She does say that she thinks antidepressants are good in some circumstances, and if they've helped someone get through a bad patch then fine, so she's not exactly "anti-antidepressants," she's more "uncomfortable" with antidepressants.

The more I thought about the post, the less irritated I got and the more reflective.  There were a few things she said that kind of made sense, that I think I agree with.

One point she made that I do, more or less, agree with:  she says, "I think our acceptance of this [idea that depression/anxiety are a result of a physical problem] reflects our longing and desire for a simple solution." I think most people who are depressed enough to consider going on antidepressants would love a "quick fix" -- who wouldn't?  And I think that in our society we tend to demand fast, easy solutions.  The irony here, I think, is that antidepressants usually take 3-6 weeks to work, and that's if they do work.  They really aren't that quick-acting.  

I think my biggest issue is with her general hypothesis, the idea that antidepressants are "disempowering."  I can see where the idea comes from; that if we have a medical problem, there's nothing we can do about it other than take medicine and wait for it to work.  But that's not entirely true.  If we think about diabetes, the go-to comparison illness for depression, there are lots of lifestyle changes a person can make that can improve their medical condition; the same goes for illnesses like heart disease and arthritis.  You may never be able to cure these problems, and these lifestyle changes usually have to work in tandem with medication.  But a person who manages their diet and exercise and takes insulin is going to be a much healthier diabetic than someone who takes insulin alone (something I'm trying to make my diabetic cat understand, but he's not buying).

My other thought is, what if we view antidepressants as empowering, instead of disempowering?  Rather than looking at medication as something that strips us of responsibility, it is something that enables us to be responsible. When someone is at the point where depression or anxiety has gotten so bad that they are visiting their doctor or a psychiatrist, the last thing they want to hear is, "It's all in your head.  It's up to you to fix yourself.  Start going to yoga and get on the treadmill."  Hell, I'd wager that 9 times out of 10, that's going to make someone more depressed.  But if the doctor says, "Okay.  I can give you this medication, but it's going to take a while for it to work.   It'll help you, but it will help more -- and quicker -- if you start going to yoga and get on the treadmill."  If you feel like you have a little bit of help, that you're throwing fixes at the problem from more than one direction, you are going to feel better faster -- regardless of if the antidepressant is really working on a serotonin deficiency or not.

In general, I kind of waffle about antidepressants.  I do think they are over prescribed, but I think they also help a lot of people.  I also think you'd have to be living under a rock to not know that exercise, a healthy diet, and other lifestyle choices help fight depression (that doesn't mean that people always make those healthy choices, but hey -- free will's a bitch, right?). 

Parenting is Hard, Bipolar or Not

Yesterday was a horrible day.

I had pushed myself too hard on the treadmill the night before (I'm in that awkward stage where I'm really too fat to run, but too impatient to walk), so I woke up with with bad abdominal pain from aggravating some existing hernia issues.  So, right there, things were bad.  Then my three year old woke up acting as if she had been possessed by a demon sometime during the night, which was bad enough, but she also decided she was going to take the five year old down with her by baiting her into her own screaming tantrums. Throw in the normal morning crap -- the baby not wanting to eat, bright blue yogurt on the beige carpet, not wanting to brush hair, etc. etc., and I was a crying, hysterical mess by 9:45 a.m.

My morning dose of Xanax helped a little, and my mother coming over helped a LOT, but all day long I had overwhelming guilt issues.  I should be able to handle this crap myself, shouldn't I?  I mean, all moms have bad mornings, but they don't go crawling to the Xanax bottle or Grandma to get through.  I hate that I can't grit my teeth and do my job (seeing as how being a full-time mom is my current job).  I just could not pull myself together; I was crying, cursing, angry, and irritable.  I hate my kids seeing me like that.  Not to mention I'm much more likely to snap or yell at them, which I really hate.  My five year old, especially, is very sensitive and gets very upset when she's yelled at.

And all day long, I kept thinking about this blog post I recently read from the website BlogHer (it's a blog directory that I can't exactly figure out the point of, but anyway) entitled No Excuses:  Parenting Isn't Hard, which made me roll my eyes so hard I thought I sprained them.  The author's point was that it's not "hard" to avoid yelling at your kids, grabbing them, getting in their faces when they do something wrong, and that people use the excuse that "parenting is hard" to explain yelling at and treating your kids poorly. 

The analogy she bases her argument on is that if you were in a fast food restaurant and saw a man yell at a woman for spilling her drink, grab her by the arm, and drag her out the door, you would be appalled and maybe even say something.  But if you see a mother do that to a kid, it's just "life as usual."  And while I agree with her that it's never okay to abuse a kid (if you consider that kind of behavior abuse, which I kind of think is up for debate), her point that it shouldn't be "hard" to not yell at your kids, to always treat them lovingly, not not lose your temper -- all because they are "small, dependant people" and we love them so much that (in her words) we should want to "snatch [them] up and squeeze [them] to bits in a fit of overly-emotional love-smush."

Uh.  What?

I won't even get into why the analogy is faulty to begin with, or how ridiculous the phrase "love-smush" is.   I'll just deal with the general argument.  Now, I probably have more irritability issues than a normal person, but I think the idea that it's "easy" to not lose your temper with your kid just because you love them so much is a tad...freaking insane. 

Of course I love my kids.  Even on mornings like yesterday, I love them.  But I admit, I don't always like to be around them.  And yeah, I lose my temper and yell -- but it's not because I don't love them, it's because I can only take so much.  When I tell three year old to take her yogurt to the kitchen because the baby was going to get and spill it, leave the room, and two minutes later hear the five year old yelling that the baby spilled the yogurt because the three year old didn't move it, these children that I love are incredibly, unavoidably frustrating.  And, oh my God, parenting is the HARDEST job I have ever done.  No, it's not complicated;  no, it's not intellectually taxing (usually).  But it's intense, and it's exhausting, and it never ends. 

Am I crazy (well, crazier than I thought)?  Am I in the minority?  Do most people think that parenting isn't hard?  Is there something wrong with me that I'm not constantly overcome with the desire to "love-smush" my children?  Is this attitude another side effect of my bipolar disorder, and should I just crawl back to my mind-numbing meds?

Somehow, I suspect if you took an informal poll of moms, most of them would say that, at least at different times, being a parent is hard.  But maybe I'm wrong.  Maybe I'm the one who is flawed.  If so, I guess I'd better call and get my psychiatrist to up my Xanax dosage, because hard or not, parenting is one job you don't have the choice to resign from.

Postpartum Post-Traumatic Stress Disorder

When I was pregnant with my first daughter, I dutifully read my baby and pregnancy books.  Anyone who has read any of these books knows that they totally freak you out -- in the "potential complications" chapter (or whatever the chapter is called) the book always details horrible problems that could occur during and after delivery for both mom and baby, like "your uterus will rupture and then attack the nurse" or "your baby will be born with a full set of teeth you'll need to diligently floss."  And, even though these complications were rare, like most first-time mothers, I visualized all these scenarios with horror.  I began to think maybe the old-fashioned method of just knocking the mother out during delivery was not a bad idea.

One potential problem that I remember reading about, though, was postpartum post-traumatic stress disorder (PTSD).  I remember thinking, "How the hell could having a baby be so traumatic?  People have been doing it for a long time."

Oh, how very innocent I was.

I had a traumatic birth, but I'll omit the gory details.  And I didn't realize till maybe a year later that I did have PTSD as a result.  Every time I'd drive by the hospital where my daughter was born, or come anywhere near the office where my (I-can't-stress-enough former) OB-GYN was, I'd have panic attacks.  I also had serious postpartum depression, and I do, in retrospect, attribute at least some of the cause to PTSD. 

It turns out that an estimated 1-6% of women have postpartum PTSD, according to Postpartum Support International.   Some of the causes could be unplanned c-sections, forceps or vacuum extraction (both of which I had), and/or problems with the baby.  (See the NIMH page on PTSD here.)

Most people associate PTSD with people who have been in war zones, or victims of violent attacks.  That's what I thought.  I honestly never thought, when I was looking through all those "potential complications" in the baby books, that I would end up with PTSD from childbirth.  (Neither did this woman, whose story on Salon.com is engrossing).

Recently, a psychiatrist suggested I had medically-induced PTSD, as a result not only of my birth experience, but other hospitalizations since then.  In my last pregnancy, I was hospitalized a whopping four times, once in the psychiatric unit and three times in the perinatal unit.  And if you were wondering, the perinatal unit had WAY better food -- and, surprisingly, a lot less moaning. 

A google search for "medically-induced PTSD" doesn't really turn anything up, so I'm not really sure if this is a legitimately recognized condition, or if it's more like saying "you have chicken-induced PTSD," if you were attacked by a chicken.

Regardless if it's a real condition or not, though, I've seen a lot of doctors lately -- body ones, not brain ones -- and my anxiety level is definitely starting to go up.  And, frankly, I'm annoyed.  I have a lot of other sh*t to deal with, but medical PTSD isn't one I need.  I'm starting to wonder if it's too late to go back and sue the doctor that delivered my oldest daughter.

But then I'd probably end up with "legal PTSD," and I really couldn't handle that.

Routine, Interrupted

I'm not OCD; far from it.  I'm not particularly clean or organized or particular.  That being said, we are in the process of  remodeling our kitchen, and oh my, it is driving me nuts.

I should state upfront that I am really excited for the new kitchen.  It's going to be great.  I've worked hard putting it all together, and it's not going to take that long to do -- just a couple of weeks or so, then I'll have a beautiful new kitchen to enjoy.

However...there's something about my routine being disrupted that causes me to totally crash.  I've gone through two bathroom remodels and various other smaller projects, and it's always the same -- it get irritable, depressed, and anxious.  I can't cook anything, I can't really wash dishes, it's hard to get to my refrigerator (at least I still have one, though), and all the contents of my kitchen are strewn around my living room and dining room.  I found my two-year-old trying to eat a beef bullion cube she found yesterday because she assumed if it was in a shiny wrapper, it was candy.  She was disabused of that notion pretty quickly.

Out of curiosity, I did a little web searching on bipolar disorder and routine, and found quite a few articles that talk about how people with bipolar disorder may be helped by regular routines.  I'm not surprised, because a disruption to my routine certainly wreaks havoc with my mood, so it would stand to reason that the opposite is true.  Here are the articles:

From webmd.com:  Daily Routine May Help Bipolar Disorder
From the American Journal of Psychiatry:  The Importance of Routine for Preventing Recurrence in Bipolar Disorder
From healthyplace.com:  Stability in Bipolar Disorder Requires Routine

At least I feel a little justified that I'm not just making up an excuse for my bad mood.  Here's hoping the reno goes quickly.