Depression and its nasty little secrets

First of all, I am back after a long absence, I had lost myself in many ways. And as I typed that sentence, I wondered what it meant, and to be completely honest, I don’t know, but it seems like the correct and right thing to put.

Second, I hate the original name of this blog. It makes me sound desperate, but when I created the blog, it was the most original thing I could come up with, so however many years after I created this, I am stuck with it. Dear lord, I just looked and May 16, 2011, is the date that I first posted. I was looking for an outlet, and this seemed like a reasonable one. There are some decent posts, but why in the heck did my Fitbit stats post every day in 2013. I promise not to do that again.

Also, I have not been on this site in so long, I have no idea about this formatting crap that is going on. Why can’t I just pick a color, and size and type. Why is it changing with each time I hit the enter button? I guess I could hit help and settings and learn more, to learn more, but I probably won’t.

Anyway, to get back to the title and what I was really wanting to talk about, DEPRESSION. It is all over in society, and I would guess, 1/4 to 1/2 of my patients meet the criteria for clinical depression. Most don’t want to admit it to themselves, much less me. And no, internet trolls, it is not that they just feel sad. And it is not just standard grief, though the second has a lot of similar symptoms to it and can turn into it if they don’t grieve properly. And I am not saying there is a standard textbook way to grieve, it is individual, but if you don’t take care of yourself properly through this time, you will develop depression and may or may not be able to exit this state.

What I want to talk about is the overwhelming fatigue and inability to do even the most basic tasks to take care of yourself. I am talking about showering and brushing your teeth. Seriously, brushing your hair, even with a short haircut is exhausting. How do I know, because I have been there. I have been battling it for months. And even knowing what I know, it is a struggle, and sometimes that struggle is to do the very things you need to do, to pull yourself out of this deep hole.

How does one avoid these struggles? Fuck if I know. I overall have a pretty good life. I mean it isn’t all puppies and rainbows, but I have a good job, and make more money than I ever have. I actually turned down a sizeable raise because the anxiety that went along with thinking about it, put me into a panic. In hindsight, I should have taken a lesser raise which was offered, but in my mind at that moment it was all or nothing. And so, I chose nothing, or the baseline at where I was sitting. It is just for a year, and I will still be getting bonuses here and there.

So, is the issue my marriage? I don’t think so. I am married to a good, supportive husband, who does most of the cleaning. And he is supportive of my running adventures. He has put me on a budget in the past, because I was online shopping in the middle of the night, when I was not sleeping, and bought $500 of fairy garden gnomes and other such nonsense. I don’t even like gnomes or fairy gardens. And so somehow, I have myself trained that I can put whatever I want in my Amazon cart, but after 10 pm, I cannot hit buy. It is a good compromise. Because, while it has been a while, there have been some interesting things in my cart the next morning.

He is very supportive in other ways. When I threaten to quit my job, he lets me know that it is fine, but I will have to either stop spending so much or get another source of income to replace it. As of right now, I don’t have a plan. Additionally, I am actually good at my job, well the patient care part, the documentation not so much. And yes, I know the documentation part corresponds to patient care, but I do miss the paper chart of residency. Yes, I said it. Also, he wants me to have something to get up for, because he knows me well enough to realize, without a purpose I would not get out of bed. So yes, I do have a long-term underlying depression. I am on medications, I am getting better at taking, but I have a problem with my medication planner. IT DOESN’T FILL ITSELF!!! And while I almost always feel better after I run or other work out, it is a struggle to get myself motivated to start. Sorry Scientologists, vitamins and sunlight are not going to do it for me. Though I do have a happy light that I use during the wintertime, because Seasonal Affective Disorder will almost always make an appearance. I seriously don’t know how people live in Seattle. Great town to visit, but pretty sure I would become suicidal living there due to the weather.

So other things in my life, my kids. One is in college and living at home. The other is in high school. Both are typical boys. And while they will make appearances at mealtime, hanging out with me, or watching movies, not really what they want to do. And it is normal, and it makes me sad and proud at the same time

My parents are both reasonably healthy and recently retired. They live in another state but visiting is always an option. I don’t do it as much as I should, however. I last saw them in August when I did a run in New Mexico, and they are coming here for Christmas. My husband has 1 living parent, as his father died of cancer shortly after Easter. But his sister is taking the primary responsibility for his mom, so I am good there.

So why am I depressed? Health? Well, maybe a bit there. Caught Covid after a trip to Yellowstone. How did I do that? Well, I am guessing it is due to the lack of food places, due to staffing issues. Came back with COVID. But it started raining the day we left, so I will take credit for flooding the park. As if I have that kind of power.

All joking aside, I got fairly ill with COVID. Could only struggle to breath and sleep. Husband put alarms on his phone to make me use the nebulizer, I literally couldn’t function well enough to do that. And yes, I was boosted, made it 2.5 years without catching it. Primarily due to the vaccine. But Omnicron was enough different. Husband also had it, but only had an annoying cough. Fairly certain my oldest had a mild case, and the youngest, if he had it, was asymptomatic. All of us were boosted with the original vaccine. But back to me. I could not breath, I could not think. Husband contacted my boss to get a prescription of Paxlovid, which worked within 12 hours. Still had a brain fog, and fatigue, and mild shortness of breath, but hospitalization was not imminent. But after recovery, it took a month before I could even run a block. And since I was training for the London marathon, I was in a panic.

And the brain fog was even worse. For about 6 weeks, it was plain awful. Not sure how I took care of patients, but even after the 6 weeks it was still there. And to be honest, this is the first morning since June that I woke up fully rested with a mind that was awake and functioning, no fog. So, my medications are back at a good level, because there was an issue with that also, most of it being my fault, some the DEA, some the insurance company and a small bit the doctor’s office. But mostly mine.

Additionally, I didn’t want to pay for my eczema medication at $1000 a month. I can afford it, but it seems ridiculous, and I am also confused about how the co-pay card only helped for 2 or 3 fills when it has an upper limit of $11K. Makes me think that my specialty pharmacy that I have to use, for this medication per my insurance, decided to not pay for it at all during that time, and then just decided to use the copay assistance 3 times, since the cash pay price is $3500 for 2 doses. Yes, I said that correctly, 2 doses, or a one-month supply. I tried to deal with them during my brain fog and lack of ADD medications, and maybe or maybe not, my Cymbalta, but I just ended up hanging up on them. And then went 3 months without medication. I could go on about this, and the ridiculous cost of medications, especially since the FDA has an orphan drug pipeline, which helps to pay for these niche drugs, but that is an entire pile of worms that I don’t want to get into.

But back to the depression, so you could say I have been in a slump, more days than not for the past few months. I was actually honest on the PHQ 9 form given to me by my doctor. I also stopped sleeping. Terribly tired, couldn’t sleep. I blame the lack of Adderall, because when I take it regularly, I sleep like a baby at night. Basically, when it wears off, my brain turns off. Maybe not completely, because my watch, which is a Garmin and my OURA ring, seem to think I sleep terribly. The ring thinks I am doing slightly better than Garmin does. But both like to lecture me in the morning.

But this morning, I was wide awake at 6 am. I have only minor aches and pains, and my brain felt clear. IT was odd. So, my hypochondriac part of my brain started trying to figure out what was wrong. And nada. So next I tried to figure out what I did yesterday to cause this. A good 5-mile run, a decent diet, drinking water, took my medications, all of them, and a good night’s sleep. I have done some of that the past 6 months here and there, but maybe the fog is lifting. I had energy to take a shower, brush my teeth, and use the water pic and floss. Don’t get me wrong, I was still brushing my teeth, before I left the house, and most nights, but the flossing and water pick did not happen. I am not ashamed or afraid my dentist will read this, because at my last cleaning, I told them that I didn’t floss.

Another change, I am planning to go to a friend’s house at 2 pm. And I am not currently trying to figure out how to get out of it. That is my norm. Last week, I made dinner reservations for my husband and I, and Sunday, I cancelled them, after asking if he really wanted to go, because I did not want to leave the house. I know I have an issue that if I am supposed to do something, I have to do it before getting to my house, or I will not do it. An exception would be like going to vote this past week, I ran to the house to pick up my oldest, so he could vote for the first time. But I was in and out in under 5 minutes, my car was still running in the parking lot, and I had not taken off my shoes. That is the only way I can leave my house once there, is it has to be super brief, and I cannot sit down, and I must leave my car running.

I am not sure what else to say here, but to tell others, I see you. I know it is hard somedays to get out of bed, shower, brush your teeth and hair, and make yourself presentable just to function. I see those of you who go through the motions, and I understand. And I know how hard it is to get yourself outside for a walk, to the gym, or even to the exercise bike in your own living room. My treadmill is at the end of my bed, I literally don’t even have to leave my bedroom to get on it. And yet, somedays it is the biggest most difficult journey of all.

Is there anybody out there?

There is an ever increasing number of patients that I see, that are feeling all alone.  A little crazy, sad, depressed, etc.  And I wonder if it is a recent phenomenon or if I have just been unobservant, and it has been there all along.  Or if it might be due to more patients being comfortable enough to open up about it.

Or if it might be our ever increasing need to broadcast every part of our lives.  The need to post countless pictures and status updates on Facebook, tweets on Twitter, checking in on FourSquare, is it a need to be seen or is it maybe a sign of a need to know that someone cares.  Maybe it is a way to connect, and yet the connection can often feel empty in itself.

There is no one who needs to know what you ate for lunch, and yet I would venture most of us have posted pictures of a meal or two.  (I am just as guilty.)  And not all thoughts are gems.  And something posted carelessly can come back at you in the end.  But maybe the problem isn’t social media, maybe it is merely allowing us to see what many of us keep hidden just beneath the surface.

The danger in this is that we become immune to posts that appear to be attention seeking.  The person who posts “I just want it all to end.” may not be taken seriously when they are at their lowest.  And yet, I am sure many of us have seen these posts.  But if that is your way to connect with others, it is probably not going to save your life, because if someone were to decide that you were serious, there is the potential delay between the time posted and the time they try to find the appropriate authority for help.

And then there is the thought that many are posting just for attention.  Of course you want attention, but is that the healthiest way to get it.  From strangers and acquaintances?  Does it mean something if they don’t really have a personal connection with you?

There is something to be said about true human contact.  I know telemedicine is supposed to be the wave of the future, a way to get specialists into communities that would not otherwise happen.  And maybe it will work eventually, but living in a community where the psychiatrist is a “Doc in a Box” does not appear to be overly satisfactory to patients.  There is something to be said about human contact to help with healing patients.  I cannot tell you how many patients ask me to take over their psychiatric needs because they don’t care for their “Doc in a box.”  They don’t like talking to the box.  Something always seems to be missing in those relationships.

Human contact is under-rated in this rapidly changing environment of social media and electronic medical records.  While I think EHRs are a good thing, the biggest complaint patients have when their physicians change is that “they are no longer talking to me, but they are looking at their computers.”

As humans there is a need to know that someone cares, that someone is out there.  Unfortunately we are teaching the next generation not to go outside and play, but to make connections online.  And how much can you truly know about someone that you cannot see, and have never met.  There is much to be learned from facial expressions, from posture, from touch.  These cannot be duplicated from a machine, and a “there, there” on a computer screen is a poor substitute for a pat on the shoulder.

The Power of Positive Thinking

I know it is cliche, but there really is something to thinking positively.  That point hit me in the face yesterday- though in reality I notice it most days.  People who dwell on the bad, tend to appear to have more chronic problems, while those that say life is good, seem to be healthier.  Or at least they seem to deal with even chronic illness better.  That is not to say that everyone is not entitled to having bad days, but if every day is “the worst day of your life”  well people are not going to want to be around you.  And that will include those that have to, family, physicians, etc.

 

I have patients, that literally spend their entire visits complaining about every aspect of their lives.  That is fine, it is my job to at least listen.  But those visits are exhausting, and if it is an every visit event, after a while, I will start to dread their visits.  Sorry but I am human.  This is not just someone who complains about their aches and pains, but their sons and daughters, who have moved away, and everything in life is against them.  That is how they view the world.  That it is against them, and that they don’t have this or that.  They focus on the don’t haves.  How exhausting it must be to go through life focusing on what you don’t have.

 

The other side at least attempts to find some good.  It may not always be easy- trust me once you tell a patient about their cancer, nothing else that visit matters.  But usually if they are a generally positive person they will undergo treatment a little easier.

 

Looking through the internet, trying to find out what is wrong with you, while their may be some legitimate cause to do so, focusing on diagnosis that you may or may not have, not only hurts your emotional well being, but it also will eventually hurt you physically.  Not to sound like a pharmaceutical commercial but depression does hurt.  Usually leads people to the doctor for pain, not depression.  Rarely does anyone come in and say “I’m depressed.”  Sometimes a spouse will drag them in saying that they are depressed, but usually the presenting complaint is “I’m tired.” “I hurt” “I have no interest in anything, anymore.”  It is true that pain can lead to depression, but it is also true that depression can lead to pain.

 

Life needs to be something to savior, to experience, not something to dread.  If you aren’t happy where you are in life, figure out what you should do to fix it.  No one will do it for you.  While I hesitate to tell anyone to leave their job today, remember that if you are looking for a new path in life, it is you who must sell yourself.  Anyone hiring for jobs that require customer service, don’t want to hire the negative person with all the qualifications.  Though if you do hate your job, find something outside of it that is your calling that gives you joy.  There is not a pill for happiness, it has to come from within.  Find out what it takes to be the best you that you can be.  It doesn’t have to take much, baby steps will go a long way.  And see if with time you start feeling better, start having better health.  While it will not take care of everything, having a positive outlook will go a long way towards better health and prosperity.