The Danger Zone

"'Cause it’s another overcast day, Like it’s been for weeks, And I would blame feeling down on the weather If I had no other reason to be." (In Perfect Time ~ Jill Barber)

Ever wondered why so many patients stop their own meds? I used to wonder. Actually it used to p*$$ me off...

"What was the point of that? You came to us for help, we provided you with a medication which should only be adjusted with physician input, and you just stopped it?? You know better than a doc how to taper a med and when it truly isn't needed anymore??? Geez!!"

Of course I wouldn't say that to my patient, but that was what I was thinking. Instead I would try to delve more into the reasons behind their decision, to help me when formulating my teaching plan about how this should be handled better in the future.

So that was me, perfect nurse. Then along came February. (Actually, it was January on, but why quibble with details...) I'm faithfully taking my meds, and then I catch myself, every once in a while taking an extra one...

"maybe I just need a little more serotonin, maybe I just have gotten used to this level of med - I know the dosing range and I'm on the low end..."

I smarten up and go back to taking the prescribed dose. I work on other things to try to kick the funk - walking, exercising, eating better, going to bed before 1 am, avoiding alcohol even more than I usually do. Then I realize that I've missed a couple doses. Four, to be exact. In a row. And I'm feeling OK. Better than OK - actually kind of good. For the first time in months. So I start to think...

"Maybe I'm over this - I know the research says that a minimum of 9-10 months of treatment is required for remission and minimizing chance of recurrence - that's how long I've been taking this! maybe I'm ok. Maybe I can stop the meds..."

One would think that with my background I would recognize the red flags waving, but I don't. I do, however, know enough about antidepressants to recognize that they shouldn't be stopped cold turkey, but weaned off over a period of time so I take one, wait two days and take another. Then....

WHAM

I get hit by a 2x4 (or maybe it was an 8x16), and it knocks me off my feet. There are indeed social factors contributing (a close family member is diagnosed with invasive cancer, a trusted child is caught being very untrustworthy, some really awful events at work), but amid the fog, the fatigue and the despair, the truth hits me.

I've just done what so many of my patients before me have done. I'm just like them. No better, no worse. Just a patient.

So every day I learn something new. And some new things are more humbling than others.

Red is Blue

"Everything is changing. You're looking for the cure.
And you feel like you're the loneliest girl in the world.
Trouble in your head now, don't know what to do.
Seems like up is down and red is blue"

(Red is Blue ~ Ben Folds)

What is the deal with health care workers and depression?

Shrinkette quotes a Washington Post article that states "One in 10 American women takes an antidepressant drug."

Well here in Canada far more than 1/10th of my health care colleagues take medications for depression, and a significant number of my patients (especially women of childbearing age and the elderly) are taking mood stabilizers and antidepressants.

I was vaguely aware of this trend, and then as I read more in the blogosphere I've noticed lots of posts about my on-line colleagues (nurses, doctors and paramedics) and their ongoing struggles with depression. Most upsetting to me was Dr Dork who completely disappeared from the blogosphere after admitting that he was dealing with a depression crisis. As I read the comments to his post Dr Dork: Lazarus, arise ! I was struck by how many bloggers echoed his sentiments, including and Kim, whose writings I read every day, and whose writing never gives away the fact that she, too, sometimes needs help.

Why do so many of find ourselves frequently deep in the doldrums? Is it what we do? Are we so sad because we deal with heartbreak and sorrow on a daily basis? Or is it who we are - we are sad so we join others who feel the same well. Hell, misery loves company, right? Or is it that those of us who experience depression are more likely to end up in helping fields, allowing us some small feeling of making things better for someone else, since we can't do the same for ourselves. Is it a chicken and egg story with each of the parts chasing the other?

And why does it matter to me?

Because I think, after years and years of self diagnosed dysthymia, I'm finally ready to ask for help. I am finding it harder and harder to just press on, to put on a good face. At home it is easier and easier to retreat away from my real life into the computer, or instead of being home, to pick up even more shifts and work at a pace that prevents me from thinking about anything other than the patients in my care.

The asking for help is hard. Really hard.

Despite my knowledge that mental illness is just that, an illness, I continue in my reluctance to admit that I am sick. I want to believe that I'm stronger than that. I don't want to think that this could be hereditary. I've worked my butt off for years to prove that I'm not like my other family members whose life challenges have been a frequent and ongoing source of stress and concern. I'm afraid that if it is hereditary, I've passed it on to my kids, like some malignant gene that makes life miserable. I am mortified to have to ask my doctor for meds. My doctor is wonderful, caring, and a friend. Our children used to play together. I don't want her to know that I can't do it. There is no adult emerg doc that I work with who I trust enough to keep my need confidential. My pedi doc friends cannot prescribe an adult drug to an adult without opening them selves up to concerns about improper prescribing practices. It would be easier to ask a stranger, but there is no walk-in clinic doc that will prescribe, since they cannot do follow up. I can't go to a new family doctor as none in my area are accepting new patients. I can't think of any single person I could talk to without feeling embarrased at my weakness. I don't even want my husband to know, although he'd have to be blind not to recognize the problems after all these years. I also have difficulty accepting that I have these feelings despite having such an excellent husband, amazing kids, wonderful family, an terrific group of close friends and fabulous coworkers. There is nothing wrong in my life, so why am I so down?

Update. That was June, this is October. What a difference a couple months can make.

I did it. I worked up the courage (truly one of the hardest things I have ever done in my life!) and asked my Doctor to put me on an antidepressant. She was kind, supportive and prescriptive.

Swallowing the first pill was a real challenge - I wasted six before I managed to choke one down, but now they go down easily and they are working. I feel normal for the first time in more than five years, and probably closer to ten years.

Now my challenge is not to run though the streets with a placard proclaiming the benefits of my new medication. Truly though, this feeling is wonderful and I wish more people could feel it.

"I think I can make it now, the pain is gone. All of the bad feelings have disappeared. Here is the rainbow I've been prayin' for. It's gonna be a bright (bright), bright (bright) sun shiny day."

(I Can See Clearly Now ~ Johnny Nash)