I've been snoring the last few nights and my ears are tender when I put in and take out my earplugs. I think I'm trying to get a cold, which I'm going to use as my excuse for why I slept so much today.
I didn't go to sleep until well after 2am, then was awake at around seven. I had treatment at ten, and got back to the apartment shortly after eleven. I napped briefly, then read a little, then slept for about four or five more hours. Not ideal, especially for any hope of good sleep tonight, but I do at least feel well-rested.
Sleep has been my biggest struggle here. Partly, my day is just too unstructured. Also, I hate the mattress here. My sleep patterns have changed to include a long period of wakefulness in what I consider the middle of the night (often 5am-7am). I have nightmares nearly every night, but that has been a long standing side effect of antidepressants. I'm just remembering them more than usual.
I'm so excited about the New Year. As my friend reminded me, 2012 is when the world is supposed to end. At least my last year will be happy! :) I have big plans for 2012, though, and look forward to sharing them with you soon.
Friday, December 30, 2011
Treatment Day Twenty-Four 12/29/11
After treatment and a little play time at the beach, my friends went home today. I cried as soon as they pulled out of their parking spot. This seemed a little odd, since I hadn't cried after any of my other visitors left. I realized, though, that they are the last visitors I plan to receive during my time here in Charleston. I'm alone and homesick, but in the last stretch. By this blog's calendar, treatment 31 will be my last day here. It would have been thirty, but the one day with the equipment down has to be tacked onto the end.
I had another catering gig tonight. Dr. Ruth was there! She is incredibly short and pretty old, but still quite spry. I didn't speak to her personally, but I overheard her talking to other people and her accent and smile are adorable. This was my first seated event (versus banquet style), and I didn't care much for it. There was a lot of standing around waiting for people to leave while their guest speakers gave their speeches. We weren't allowed to be in the banquet room while the speeches were going on, which was unfortunate. The event was a recognition of top performers in their fields, and I'm sure some of it would have been inspiring.
After the event, I called my boyfriend. It started with a normal conversation, but soon my tears were flowing again. This time, I didn't just cry, I wept. We're talking snot-dripping, tears in my hair and mouth, red-faced, wailing kind of sobs. I'm not a crying kind of chick, so twice in one day seemed ridiculous.
I can't really explain all my tears today. It was like all my emotions were balled into one snot flavored wad. There were happy tears. My one friend, who is generally about as warm and fuzzy as I am (which is not at all publicly, but we're softer at heart), told me how proud she was of me for finding this treatment and following through with it. My other friend shared the excitement of her new pregnancy with me. Her daughter called me Aunt Stephanie, even though I'm not biologically related to her at all. I felt so loved.
There were also sad tears and anxious tears and lonely tears. I miss home. I'm worried that treatment won't "stick". I want to be held by my boyfriend and licked by my dogs.
Talking to my boyfriend was good. He is my biggest fan. I know that depression has made me hard to live with for everyone in my life. Friends and family are able to miss out on the darkest moments, but my boyfriend is close enough that he can't avoid it all. What makes him amazing is that he wouldn't choose to avoid the dark moments; he really wants to be with me through good and bad. I know he'll stick with me on this journey no matter how it turns out, and he'll do his part to see that everything turns out happily ever after.
Enough of that warm and fuzzy... the point of all this is that I still have emotion. That, of course, is good. I don't want to be blunted. Some days are still going to be hard. Nothing about this hard day made me want to die, which is my little victory. I just want to go home, happy and healthy. It looks like I'm headed that way.
I had another catering gig tonight. Dr. Ruth was there! She is incredibly short and pretty old, but still quite spry. I didn't speak to her personally, but I overheard her talking to other people and her accent and smile are adorable. This was my first seated event (versus banquet style), and I didn't care much for it. There was a lot of standing around waiting for people to leave while their guest speakers gave their speeches. We weren't allowed to be in the banquet room while the speeches were going on, which was unfortunate. The event was a recognition of top performers in their fields, and I'm sure some of it would have been inspiring.
After the event, I called my boyfriend. It started with a normal conversation, but soon my tears were flowing again. This time, I didn't just cry, I wept. We're talking snot-dripping, tears in my hair and mouth, red-faced, wailing kind of sobs. I'm not a crying kind of chick, so twice in one day seemed ridiculous.
I can't really explain all my tears today. It was like all my emotions were balled into one snot flavored wad. There were happy tears. My one friend, who is generally about as warm and fuzzy as I am (which is not at all publicly, but we're softer at heart), told me how proud she was of me for finding this treatment and following through with it. My other friend shared the excitement of her new pregnancy with me. Her daughter called me Aunt Stephanie, even though I'm not biologically related to her at all. I felt so loved.
There were also sad tears and anxious tears and lonely tears. I miss home. I'm worried that treatment won't "stick". I want to be held by my boyfriend and licked by my dogs.
Talking to my boyfriend was good. He is my biggest fan. I know that depression has made me hard to live with for everyone in my life. Friends and family are able to miss out on the darkest moments, but my boyfriend is close enough that he can't avoid it all. What makes him amazing is that he wouldn't choose to avoid the dark moments; he really wants to be with me through good and bad. I know he'll stick with me on this journey no matter how it turns out, and he'll do his part to see that everything turns out happily ever after.
Enough of that warm and fuzzy... the point of all this is that I still have emotion. That, of course, is good. I don't want to be blunted. Some days are still going to be hard. Nothing about this hard day made me want to die, which is my little victory. I just want to go home, happy and healthy. It looks like I'm headed that way.
Wednesday, December 28, 2011
Treatment Day Twenty-Three 12/28/11
I have friends visiting again. Though I can't go home, home is doing a nice job of coming to me. One of my friends went to treatment with me today. Dr. Li told her that they are working on studies to see if rTMS might be effective in helping people to stop smoking. From what I could hear with my earplugs in, it sounded like they've already tried it for treating overeating without success. I guess it can't cure everything.
My friend took a picture during treatment. It's the first time I've been able to see what the device looks like actually on my head. It was in the tapping phase when she took this shot.
She also took a brief video which I will try to upload when I am at a better computer with a faster connection. There's not a lot to see, really. My friend said that the left side of my face twitches a little when it's tapping and the right side doesn't really move at all. The device shows no movement at all (you can't see the tapping, you just hear it).
As we were walking out, I saw on Dr. Li's laptop that someone new is starting the clinical trial next week. I think that I'm the fourth person to enroll in this study at MUSC, so new person should be number five. To the new person, I wish you luck and hope you have the success I've had so far.
Today makes one week since I officially declared myself in remission, and I still think that's where I'm at. I feel happy. I feel patient. I feel calm.
My friend took a picture during treatment. It's the first time I've been able to see what the device looks like actually on my head. It was in the tapping phase when she took this shot.
She also took a brief video which I will try to upload when I am at a better computer with a faster connection. There's not a lot to see, really. My friend said that the left side of my face twitches a little when it's tapping and the right side doesn't really move at all. The device shows no movement at all (you can't see the tapping, you just hear it).
As we were walking out, I saw on Dr. Li's laptop that someone new is starting the clinical trial next week. I think that I'm the fourth person to enroll in this study at MUSC, so new person should be number five. To the new person, I wish you luck and hope you have the success I've had so far.
Today makes one week since I officially declared myself in remission, and I still think that's where I'm at. I feel happy. I feel patient. I feel calm.
Tuesday, December 27, 2011
Treatment Day Twenty-Two 12/27/11
Another depression screening day. We're off track a little because of the holidays. I asked Dr. George last week if I could know my scores. He explained that they don't share scores with patients because scores too high (indicating more severe depression) may make the subject more depressed. Competitive people (like I sometimes can be) may give inaccurate answers at an attempt to "improve" their scores. It all makes sense. I guess that's just another area where lip gloss girl messed up by tallying my score in front of me that one time.
Dr. Li seemed more concerned today about my hand shaking during treatment. It always does some, but it did seem a little more pronounced today. He checked a few times to make sure I wasn't having a seizure (definitely wasn't). We discussed afterwards that my arm doesn't shake hardly at all when it is down by my side. Today, I was nearing the end of my book, which meant the heavier weight was in my left hand (the shaky one) and turning the pages is always when the shakes hit. After we discussed all that, he seemed at ease. The shaking (more of a jerking?) only happens during the tapping, and I think that's the key thing. We had tested my threshold again today and I was still at 77, so there should be no change in physical response. Interestingly, testing my threshold makes my right hand twitch, but it's my left hand that twitches during treatment. Any way, it didn't bother me, other than needing to pause if the tapping occurred while I needed to turn a page.
It's a rainy day in Charleston. I've got more friends coming to visit today, which is especially good since the catering gigs seem to have dried up. It's always trickier for me to entertain when the weather is bad, as my mind always goes to outdoor activities when thinking of things to do. I feel confident we'll have a grand time regardless.
I figured out how to see my blog stats today. I was pleased to see that most of my posts receive between twenty and eighty views each. I had no idea so many people were interested in my progress. I have a few folks who regularly comment or "like" on facebook (who really keep me encouraged and going), but I didn't know I had other secret followers. I hope this blog is entertaining and maybe even helpful to my readers. Thank you to everyone who reads it. Whether you comment or not, it helps a lot to feel like my words matter enough for people to bother reading them. This is a rough journey, and I love knowing that I'm not alone in it.
Dr. Li seemed more concerned today about my hand shaking during treatment. It always does some, but it did seem a little more pronounced today. He checked a few times to make sure I wasn't having a seizure (definitely wasn't). We discussed afterwards that my arm doesn't shake hardly at all when it is down by my side. Today, I was nearing the end of my book, which meant the heavier weight was in my left hand (the shaky one) and turning the pages is always when the shakes hit. After we discussed all that, he seemed at ease. The shaking (more of a jerking?) only happens during the tapping, and I think that's the key thing. We had tested my threshold again today and I was still at 77, so there should be no change in physical response. Interestingly, testing my threshold makes my right hand twitch, but it's my left hand that twitches during treatment. Any way, it didn't bother me, other than needing to pause if the tapping occurred while I needed to turn a page.
It's a rainy day in Charleston. I've got more friends coming to visit today, which is especially good since the catering gigs seem to have dried up. It's always trickier for me to entertain when the weather is bad, as my mind always goes to outdoor activities when thinking of things to do. I feel confident we'll have a grand time regardless.
I figured out how to see my blog stats today. I was pleased to see that most of my posts receive between twenty and eighty views each. I had no idea so many people were interested in my progress. I have a few folks who regularly comment or "like" on facebook (who really keep me encouraged and going), but I didn't know I had other secret followers. I hope this blog is entertaining and maybe even helpful to my readers. Thank you to everyone who reads it. Whether you comment or not, it helps a lot to feel like my words matter enough for people to bother reading them. This is a rough journey, and I love knowing that I'm not alone in it.
Treatment Day Twenty-One 12/26/11
I got to see my dogs this weekend!!!! And also some other family and friends :) My spirits are high, but there's lots to attribute that to besides treatment.
My boyfriend went with me to treatment today. It was the first time I'd had someone watching who could tell me everything about what I look like from the outside. Only this wasn't the kind of thing that interests him much. If I were observing, I would study the machine intently and ask lots of questions about the display (I know there is one because the doctor can always tell me how much time I have left, but I can't see it when I'm in the chair and it isn't on when I'm out of it). Instead, he sat quietly with his ear plugs in. His only comment afterwards was, "I'm glad I brought a book. It was loud and boring." Oh, well.
Even after the boyfriend left and I was back to my lonelier alternate reality, I still felt good. I didn't feel especially tempted to hop into the car with him and just head home because I now know this is working. It's working big time, and I don't want to miss a dose. If anything, I'm getting scared to go home because I don't trust yet that I will continue to do well after the treatment ends. What if I need it everyday to feel this way? Perhaps Wal-Mart will have a home version on their shelves soon.
My boyfriend went with me to treatment today. It was the first time I'd had someone watching who could tell me everything about what I look like from the outside. Only this wasn't the kind of thing that interests him much. If I were observing, I would study the machine intently and ask lots of questions about the display (I know there is one because the doctor can always tell me how much time I have left, but I can't see it when I'm in the chair and it isn't on when I'm out of it). Instead, he sat quietly with his ear plugs in. His only comment afterwards was, "I'm glad I brought a book. It was loud and boring." Oh, well.
Even after the boyfriend left and I was back to my lonelier alternate reality, I still felt good. I didn't feel especially tempted to hop into the car with him and just head home because I now know this is working. It's working big time, and I don't want to miss a dose. If anything, I'm getting scared to go home because I don't trust yet that I will continue to do well after the treatment ends. What if I need it everyday to feel this way? Perhaps Wal-Mart will have a home version on their shelves soon.
Monday, December 26, 2011
Treatment Day Twenty 12/23/11
I had an interesting conversation with Dr. George today. I was asking his opinion on polyphasic sleeping (essentially, sleeping 2 hours awake 6 hours, three times per day). Our conversation shifted slightly to various sleep studies he'd been involved in during his career.
One study was especially interesting to me. Basically, study participants had to live in an clock-free and artificial light-free environment (including electronic devices that emit light, like computers). With their functioning hours limited largely to daylight time only, the study hoped to determine what our natural sleep needs were when we weren't fighting them.
Two conclusions Dr. George shared with me from the study struck me as particularly interesting:
1. Most study volunteers naturally settled into an 8-10 hour sleep time that became part of a 25 hour day. Though our sun's orbit gives us a 24 hour day, our body clocks seem to want to add an hour to each day. For example, if a study participant went to sleep at 9pm on one night, s/he would want to go to sleep at 10pm the next night, 11pm the night after, etc.
2. People with bipolar disorder (not me, my depression is unipolar) were the only group that did not develop any pattern for their sleep. They may be awake for 36 hours straight, sleep for 4 hours, be awake for 2 hours, then sleep for 2 days, or any random sleep/wake pattern. Dr. George indicated that there was some thought that the gene for bipolar disorder may be on the same gene as the one for sleep patterns. He said that he felt that one of the most important things a person with bipolar disorder can do is to self-regulate their sleep patterns, using sleep aids if needed to insure that 8-10 hours of sleep are achieved each night.
I enjoyed my week with Dr. George. I suspect I could pick his brain for hours and continue to be both amused and educated.
One study was especially interesting to me. Basically, study participants had to live in an clock-free and artificial light-free environment (including electronic devices that emit light, like computers). With their functioning hours limited largely to daylight time only, the study hoped to determine what our natural sleep needs were when we weren't fighting them.
Two conclusions Dr. George shared with me from the study struck me as particularly interesting:
1. Most study volunteers naturally settled into an 8-10 hour sleep time that became part of a 25 hour day. Though our sun's orbit gives us a 24 hour day, our body clocks seem to want to add an hour to each day. For example, if a study participant went to sleep at 9pm on one night, s/he would want to go to sleep at 10pm the next night, 11pm the night after, etc.
2. People with bipolar disorder (not me, my depression is unipolar) were the only group that did not develop any pattern for their sleep. They may be awake for 36 hours straight, sleep for 4 hours, be awake for 2 hours, then sleep for 2 days, or any random sleep/wake pattern. Dr. George indicated that there was some thought that the gene for bipolar disorder may be on the same gene as the one for sleep patterns. He said that he felt that one of the most important things a person with bipolar disorder can do is to self-regulate their sleep patterns, using sleep aids if needed to insure that 8-10 hours of sleep are achieved each night.
I enjoyed my week with Dr. George. I suspect I could pick his brain for hours and continue to be both amused and educated.
Treatment Day Ninteen, 12/22/11
I strive to be open in this blog. Occasionally, there are things too personal for even me to share. The thing that is most on my mind today falls into that category. What I will share is that it falls into that general self-esteem category.
The treatment hasn't magically made me love everything about myself. What is has done, though, is helped me to move forward. I know that a month or two ago, my experience and feelings from today would have easily left me lying in bed for three days straight at least. Instead, I was down for a few hours. I didn't even go to bed, just kind of moped while I worked on cleaning my apartment. Then I talked to my boyfriend a little about it (something I wouldn't have done before) and I moved on. I truly moved on, I didn't just pretend to be better when I wasn't. Maybe not a big deal to most, but a small miracle to me.
The treatment hasn't magically made me love everything about myself. What is has done, though, is helped me to move forward. I know that a month or two ago, my experience and feelings from today would have easily left me lying in bed for three days straight at least. Instead, I was down for a few hours. I didn't even go to bed, just kind of moped while I worked on cleaning my apartment. Then I talked to my boyfriend a little about it (something I wouldn't have done before) and I moved on. I truly moved on, I didn't just pretend to be better when I wasn't. Maybe not a big deal to most, but a small miracle to me.
Wednesday, December 21, 2011
Treatment Day Eighteen 12/21/11
I feel Tony the Tiger (Grrrrrreat!) today. So much so that I want to mark today as the day my remission began (I hope).
I slept in today, later than I should have, but I didn't have treatment til 1:00 and nothing else to do. Since it was rainy, I drove to treatment. Dr. George had another visiting professor in, this one from Korea. While Dr. Korea spoke broken English, it was obvious they wouldn't get too deep into info that was new to me because of some degree of language barrier.
I did learn that Dr. George thinks the Cervel device (the one used on me) is trickier to place than other models. Most are more like helmets that slip onto the head and into place. The Cervel has arms that are placed on the individual contact points on the head. While the disadvantage is the trickier placement, the advantage is that rTMS is expected to be used for a number of additional brain related conditions which would require different spots on the brain to be stimulated. The helmet-style goes right into place for tapping those depression points, but wouldn't be useful for treating perhaps Parkinson's. I'm fairly convinced that if researchers can find the right spots on the brain and the right way to stimulate them, rTMS will be used in nearly every brain-related condition that exists within the next decades.
I also learned that some insurance companies are starting to come around and cover the treatment, but with steep deductibles. Dr. George referred to one insurance company that was covering rTMS with a $100 deductible per treatment ($100/treatment x 5 treatments/week x 6 weeks = $3,000). Compared with the full price of roughly $15,000, it's a big step, but still not pocket change for most people. As I understand it, current rTMS treatment involves some sort of cartridge or something that has to be replaced at each session, at a cost of about $100 to the doctor (again, about $3,000 for the entire course of treatment). Newer rTMS devices seem to not need that cartridge (or whatever it is), so they should help bring down the cost when they reach FDA approval and are on the market. As with everything, competition brings the price down too. For now, it's a one man show. Dr. George anticipates another model receiving FDA approval within 1-2 years, and the Cervel model receiving approval in 2-3 years, based on where they currently are in the clinical trials process (and assuming good results).
Back to my amazing mood... I found myself thinking "I am me" several times today. What I mean by that is that I am who I feel like I'm supposed to be. I've known there is a happy, at peace person within me. I once was lost, but now am found. I keep smiling like I've got a secret. In the same sense that I don't think anyone could really understand how depression felt to me, I don't think anyone can understand how good it feels to have its shadow lifted. I hope it stays gone for good. And that's how great I feel today - not just a good mood, but a feeling of lasting change. I hope. I hope. I hope.
I slept in today, later than I should have, but I didn't have treatment til 1:00 and nothing else to do. Since it was rainy, I drove to treatment. Dr. George had another visiting professor in, this one from Korea. While Dr. Korea spoke broken English, it was obvious they wouldn't get too deep into info that was new to me because of some degree of language barrier.
I did learn that Dr. George thinks the Cervel device (the one used on me) is trickier to place than other models. Most are more like helmets that slip onto the head and into place. The Cervel has arms that are placed on the individual contact points on the head. While the disadvantage is the trickier placement, the advantage is that rTMS is expected to be used for a number of additional brain related conditions which would require different spots on the brain to be stimulated. The helmet-style goes right into place for tapping those depression points, but wouldn't be useful for treating perhaps Parkinson's. I'm fairly convinced that if researchers can find the right spots on the brain and the right way to stimulate them, rTMS will be used in nearly every brain-related condition that exists within the next decades.
I also learned that some insurance companies are starting to come around and cover the treatment, but with steep deductibles. Dr. George referred to one insurance company that was covering rTMS with a $100 deductible per treatment ($100/treatment x 5 treatments/week x 6 weeks = $3,000). Compared with the full price of roughly $15,000, it's a big step, but still not pocket change for most people. As I understand it, current rTMS treatment involves some sort of cartridge or something that has to be replaced at each session, at a cost of about $100 to the doctor (again, about $3,000 for the entire course of treatment). Newer rTMS devices seem to not need that cartridge (or whatever it is), so they should help bring down the cost when they reach FDA approval and are on the market. As with everything, competition brings the price down too. For now, it's a one man show. Dr. George anticipates another model receiving FDA approval within 1-2 years, and the Cervel model receiving approval in 2-3 years, based on where they currently are in the clinical trials process (and assuming good results).
Back to my amazing mood... I found myself thinking "I am me" several times today. What I mean by that is that I am who I feel like I'm supposed to be. I've known there is a happy, at peace person within me. I once was lost, but now am found. I keep smiling like I've got a secret. In the same sense that I don't think anyone could really understand how depression felt to me, I don't think anyone can understand how good it feels to have its shadow lifted. I hope it stays gone for good. And that's how great I feel today - not just a good mood, but a feeling of lasting change. I hope. I hope. I hope.
Treatment Day Seventeen 12/20/11
Today I had another guest observer. This guy was visiting from a university in Texas, and was both a neurologist AND a psychiatrist. Lots of free time or ambition or both.
Visitors provide a good opportunity for me to learn more about the treatment, as the treating doctor always tells them about stuff I wouldn't even think to ask. I learned today some of the ways the Cervel device (the one being used on me) differs from other rTMS devices. A big difference, apparently, is that the Cervel is water-cooled, while others are air-cooled. I'm not sure yet what benefit that provides, but it was a big talking point. Cooling is a big issue because the high current would make it crazy hot without a good system in place (my layman interpretation). While talk was muffled with my earplugs in, I think I heard that the device operates at 3,000 volts. Considering 120V is standard in US households, that sounds high enough to sautee my brains.
I took out my earplugs for a few seconds to try to better eavesdrop. All I heard really was the tapping, which was my first time hearing it without earplugs. It was louder than I realized, similar to the sound those annoying wooden clackers make that small kids sometimes play with.
Dr. George pointed out my twitching face to the Texas doctor. Apparently it's as visible on the outside as it feels on the inside. Dr. George asked me about any discomfort, and I told him that it didn't bother me except when I tried to talk during active tapping, because then I was trying to talk with chattering teeth.
Dr. George is very personable, and chatted with me about my progress in a way that included Dr. Texas. I told him that I was feeling on average a six or seven on a scale of 1-10, a nice improvement. We discussed that I had still not reached remission. Dr. George bragged to Dr. Texas about my having gotten a job in Charleston and that I walked to treatment, symptoms that indicated improvement to him. Indication that he doesn't know me well, to me.
When Dr. George conducted my intake interview, he seemed surprised at my accomplishments. He even asked how I had managed to graduate high school on time. I didn't even mention to him that it was with honors or that I had received multiple scholarship offers. Graduating high school on time, finishing college, walking to treatment, finding a job... these to me were minimal accomplishments, but Dr. George's response helped put them in perspective.
If you've never experienced true depression, it's hard to explain. Small accomplishments do feel impossible. There have been many days in my life where thinking about getting out of bed felt overwhelming. Taking a shower has sometimes taken a monumental effort. But I've never really quit trying, not for any length of time, anyway. This is what I most wish I could have other people understand. I don't expect anyone to understand that taking my medicine every day or responding to phone calls is hard. It doesn't make sense, even to me. I just wish that everyone who knew of my struggles also knew that I am almost constantly fighting to win. It looks like I'm lazy or hopeless or helpless, but simple things like showering or answering the phone are often challenges for me - challenges that I usually accept.
When a person has lost a limb, we are often amazed at all they accomplish despite that lost leg or arm. We marvel when they learn to accommodate their situations and can still drive or run. My depression isn't as obvious as a missing limb, so no one notices how much accommodating I do in a day, despite my condition. Dr. George is one of the first people in my life to really understand what an accomplishment I have achieved by choosing to walk to treatment or get a part-time gig. He just doesn't realize that it isn't from treatment, but from my own stubborn will to make it. I chose to walk to treatment from day one, knowing that I wouldn't want to but that it would be better for me. I looked for the catering gig because I learned that idle hands are incredibly dangerous for me a long time ago.
This is the first entry I've written that has made me cry. I cry because this is the first time I've put into words the weight I carry every day. As I've said, I'm good at putting on a pretend face and seeming like all is well. It seems so pathetic to try to tell someone that brushing my teeth felt impossible today. There are no automatic habits in my life other than lying in bed. Everything I do requires a conscious decision. My only instinct has been to wait for death to come and, at times, to try to force that action.
I don't want to end this on that sad note, though. What I'm really most trying to express is that it feels like a load lifted to have someone really understand the million challenges I face in a day. Even writing this, I feel like I sound like a whiny wretch, trying to get credit for showering and other things most people do everyday. But I know that everyone can't understand, any more than I can understand what life is really like for those missing a limb.
One of my biggest issues is absurdly low self-esteem. I'm always trying to be a super achiever so someone will pat me on the back and make me feel worthwhile for a moment. Dr. George has helped me see how many little things I should be patting my own back for. I know that the treatment alone won't "fix" me, but I hope that I pay attention to all the little lessons like these I learn on the journey. Before, I was too unwell to hear the messages, but I think my mind is clearing in multiple ways.
Visitors provide a good opportunity for me to learn more about the treatment, as the treating doctor always tells them about stuff I wouldn't even think to ask. I learned today some of the ways the Cervel device (the one being used on me) differs from other rTMS devices. A big difference, apparently, is that the Cervel is water-cooled, while others are air-cooled. I'm not sure yet what benefit that provides, but it was a big talking point. Cooling is a big issue because the high current would make it crazy hot without a good system in place (my layman interpretation). While talk was muffled with my earplugs in, I think I heard that the device operates at 3,000 volts. Considering 120V is standard in US households, that sounds high enough to sautee my brains.
I took out my earplugs for a few seconds to try to better eavesdrop. All I heard really was the tapping, which was my first time hearing it without earplugs. It was louder than I realized, similar to the sound those annoying wooden clackers make that small kids sometimes play with.
Dr. George pointed out my twitching face to the Texas doctor. Apparently it's as visible on the outside as it feels on the inside. Dr. George asked me about any discomfort, and I told him that it didn't bother me except when I tried to talk during active tapping, because then I was trying to talk with chattering teeth.
Dr. George is very personable, and chatted with me about my progress in a way that included Dr. Texas. I told him that I was feeling on average a six or seven on a scale of 1-10, a nice improvement. We discussed that I had still not reached remission. Dr. George bragged to Dr. Texas about my having gotten a job in Charleston and that I walked to treatment, symptoms that indicated improvement to him. Indication that he doesn't know me well, to me.
When Dr. George conducted my intake interview, he seemed surprised at my accomplishments. He even asked how I had managed to graduate high school on time. I didn't even mention to him that it was with honors or that I had received multiple scholarship offers. Graduating high school on time, finishing college, walking to treatment, finding a job... these to me were minimal accomplishments, but Dr. George's response helped put them in perspective.
If you've never experienced true depression, it's hard to explain. Small accomplishments do feel impossible. There have been many days in my life where thinking about getting out of bed felt overwhelming. Taking a shower has sometimes taken a monumental effort. But I've never really quit trying, not for any length of time, anyway. This is what I most wish I could have other people understand. I don't expect anyone to understand that taking my medicine every day or responding to phone calls is hard. It doesn't make sense, even to me. I just wish that everyone who knew of my struggles also knew that I am almost constantly fighting to win. It looks like I'm lazy or hopeless or helpless, but simple things like showering or answering the phone are often challenges for me - challenges that I usually accept.
When a person has lost a limb, we are often amazed at all they accomplish despite that lost leg or arm. We marvel when they learn to accommodate their situations and can still drive or run. My depression isn't as obvious as a missing limb, so no one notices how much accommodating I do in a day, despite my condition. Dr. George is one of the first people in my life to really understand what an accomplishment I have achieved by choosing to walk to treatment or get a part-time gig. He just doesn't realize that it isn't from treatment, but from my own stubborn will to make it. I chose to walk to treatment from day one, knowing that I wouldn't want to but that it would be better for me. I looked for the catering gig because I learned that idle hands are incredibly dangerous for me a long time ago.
This is the first entry I've written that has made me cry. I cry because this is the first time I've put into words the weight I carry every day. As I've said, I'm good at putting on a pretend face and seeming like all is well. It seems so pathetic to try to tell someone that brushing my teeth felt impossible today. There are no automatic habits in my life other than lying in bed. Everything I do requires a conscious decision. My only instinct has been to wait for death to come and, at times, to try to force that action.
I don't want to end this on that sad note, though. What I'm really most trying to express is that it feels like a load lifted to have someone really understand the million challenges I face in a day. Even writing this, I feel like I sound like a whiny wretch, trying to get credit for showering and other things most people do everyday. But I know that everyone can't understand, any more than I can understand what life is really like for those missing a limb.
One of my biggest issues is absurdly low self-esteem. I'm always trying to be a super achiever so someone will pat me on the back and make me feel worthwhile for a moment. Dr. George has helped me see how many little things I should be patting my own back for. I know that the treatment alone won't "fix" me, but I hope that I pay attention to all the little lessons like these I learn on the journey. Before, I was too unwell to hear the messages, but I think my mind is clearing in multiple ways.
Monday, December 19, 2011
Treatment Day Sixteen 12/19/11
Dr. Li is on vacation this week, so Dr. George is handling my treatment all week. Dr. George heads the program and handled my input exam. He was an early advocate for rTMS and has been a pioneer in the field. When he first started his research, people thought he was crazy. Now he's highly respected and recognized as an expert on magnetic brain stimulation.
Dr. George doesn't do as much of the hands-on work these days, so he was a little awkward in setting up the device for me. Still, he got everything going and I received the same treatment I always have, with the "hammer" hitting the same spots at the same intensity for the same length of time.
During treatment, Dr. George asked me how I felt the treatment was coming along. I told him that I felt improved but not cured. I explained that my morning melancholy was still with me, and that I sometimes still dipped at various times through the day. Overall, I'm improved, but I'm greedy and want more. I don't want to just be better, I want to be cured.
Dr. George quickly reminded me that "cured" isn't really a word we use in mental health. Rather, we strive for remission. Essentially, remission means that I will feel and act "cured", but the symptoms of depression can return at any time. If they do, rTMS will likely be helpful again. Hopefully, remission will last at least several years.
Based on my responses, Dr. George indicated that I was right on track with the progress that most people experience who go on to remission. A few more weeks and I could be there too.
After treatment, it was my day for a depression screening. I had the good nurse again, which meant a better experience but no indication of my score. I think next week I'll just ask her to tally it while I'm there.
When she asked me if I had thoughts of wanting to die this week, I was able to tell her no for the first time. My qualifying statement, though, was that I had seen a dead dog on the side of the road and had actually felt jealous of it for being able to escape life. I don't know if it's more pathetic that I was jealous of the dog or that that is considered an improvement.
I am improved, though. Enough so that I know it. That's the important thing to remind myself.
Dr. George doesn't do as much of the hands-on work these days, so he was a little awkward in setting up the device for me. Still, he got everything going and I received the same treatment I always have, with the "hammer" hitting the same spots at the same intensity for the same length of time.
During treatment, Dr. George asked me how I felt the treatment was coming along. I told him that I felt improved but not cured. I explained that my morning melancholy was still with me, and that I sometimes still dipped at various times through the day. Overall, I'm improved, but I'm greedy and want more. I don't want to just be better, I want to be cured.
Dr. George quickly reminded me that "cured" isn't really a word we use in mental health. Rather, we strive for remission. Essentially, remission means that I will feel and act "cured", but the symptoms of depression can return at any time. If they do, rTMS will likely be helpful again. Hopefully, remission will last at least several years.
Based on my responses, Dr. George indicated that I was right on track with the progress that most people experience who go on to remission. A few more weeks and I could be there too.
After treatment, it was my day for a depression screening. I had the good nurse again, which meant a better experience but no indication of my score. I think next week I'll just ask her to tally it while I'm there.
When she asked me if I had thoughts of wanting to die this week, I was able to tell her no for the first time. My qualifying statement, though, was that I had seen a dead dog on the side of the road and had actually felt jealous of it for being able to escape life. I don't know if it's more pathetic that I was jealous of the dog or that that is considered an improvement.
I am improved, though. Enough so that I know it. That's the important thing to remind myself.
Sunday, December 18, 2011
Treatment Day Fifteen 12/16/11
It's been an adventure-packed few days.
Thursday evening, I had another catering gig. This one was at the South Carolina Aquarium. In addition to get paid for the work, I got delicious food and a free (self-guided) tour of the aquarium. I've seen better aquariums, but it was worth seeing for free. I tried to be considerate of the fish and not eat my shrimp and crab in front of them. It seemed rather cruel.
In my now vast catering experience of three events, I have learned the following:
Fridays treatment was quite early, as I had to leave town immediately afterwards for a funeral. Having been up late the night before working my catering event, I was especially tired, and Dr. Li kept making small talk with me to keep me from dozing. I've gotten so used to the brain tapping and teeth chattering now, that I definitely could have slept the whole time.
The funeral was in the small town of Waynesboro, Georgia, bird dog capital of the world. It was about a three hour drive for me because the route was small highways through tiny speed-trap towns. I pulled over in my rental car twice to stand up and move around, just to stay awake. I really need to get better at this morning thing.
At the service and afterwards, I saw family I hadn't seen in as long as twenty years or more. I met two cousins I'd never met before and caught up on a lot of family gossip. While death is always sad, it was nice for me to escape Charleston for a little while and see loving familiar faces. Mom, Dad, Sis and Bro were all there, as well as in-laws, nieces, a nephew and my fave aunt and cousin. I had to remind myself that they weren't there for me so I wouldn't monopolize all their time, but it brought me as much comfort as I hopefully provided for them.
It was weird seeing a lot of these people, though. The time and distance didn't matter so much, as facebook had kept many of us at least a little connected. That was the problem, though. While I know that not everyone reads everything I post on fb, I knew that probably some of them had been reading my blog. They didn't really know me, per se, but they knew all this oddly personal stuff about me. I really want to talk about it, to be open to questions, but I understand the awkwardness of it. So instead I got mostly generic questions (or no mention at all of The Uncomfortable Topic of Stephanie Having Depression) like "How's the weather in Charleston?" or "When do you get to go home?" I was finally around people and wanted to talk about it, but I think that it was awkward to most people in that way that it might be if you knew a cousin had undergone a sex-change operation. You might wonder, but probably wouldn't feel comfortable asking "So, what's it like having your penis chopped off?" So, I retreated inside myself a little, trying to be invisible in a crowded room.
Saturday, I was still in Waynesboro, and we went to the local Christmas parade. Their high school football team had made it to state championship, so the whole town showed up as the players led the parade. I didn't really want to go, not feeling especially cheery, but mom wanted me to and I wanted to be wherever mom wanted me. I love her and she was hurting from the death. It ended up being a nice day and a fun little parade.
Later, we went to Lights of the South. The event boasts more than four million lights on over 100 acres. I can tell you that, even with mom's need to take a picture of everything and of every person standing at every display, we walked through the entire thing in under an hour, so I'm doubtful of the 100 acre part. There's quite a lot of burned out bulbs in that four million count, too. I will let my pictures speak for themselves as to the quality of the "holiday" lights.
The drive home brought us to Peach Orchard Road in Augusta. That is the exit my "bad" grandpa lived off of, and it gave me a relatively brief sweep of emotion to be there. When I get near there, I have an urge to go to their house, as if seeing it again will bring some sort of closure or answers as to why it all happened. I refrained from asking for the detour, but really wished I could bury my head on mom's chest and be comforted. I had to remind myself that it was my job right now to provide comfort, not to ask for it.
I had noted during the weekend that each family seemed to have its one child that brought the most concern. In each sibling group, there was always one who was financially irresponsible, on drugs, or in some way living on a destructive path. I asked mom when we returned which of her kids she worried about the most. Her answer was me.
My siblings and I are all reasonably responsible at this stage in life. We've all faltered along the way, but none of us have fallen into a pit. I guess I shouldn't have been surprised that mom would be most worried about me, but I kind of pride myself on my independence and the fact that she's never had to bail me out of any trouble. Still, I guess it is kind of worrisome when you never know if you're going to get a call that your daughter is dead because she took her own life. That's been a real possibility with me.
Mom didn't really get into any of that, though. She just said that she worried because I travel so much and have an adventurous life, and she doesn't always know where I am and if I'm okay. I suspect she probably worries about me more when I'm in Oak Ridge and she hasn't heard from me in two weeks than when she knows I'm in Guatemala and she hasn't heard from me.
Mom said that she worried less about me when I'm in a relationship. The feminist in me wanted to be offended, but I understood what she meant. Me being in a relationship means me having someone involved in my day-to-day life, so at least someone knows when I'm slipping down the slope. Otherwise, it's just everyone assuming I'm fine until they learn differently in a bad, bad way. I've mentioned before that I'm very good at pretending and hiding my moods, and I think my family knows by now that my saying that I'm fine to them on the phone doesn't necessarily mean that I really am.
Anyway, it was good. It was good to see family. It was good to feel like a part of the family. Sometimes I disconnect myself from that too much. I don't know how to ask for what I need from them, and I don't feel like I contribute anything to them, so I just... leave it alone.
So, it always goes back to the magical question: "Is treatment working?" I wish that it was working so well that I didn't still have to ask the question. It isn't. But it is working well enough that it feels like it's worth hanging in there. No machine can rebuild my self-esteem, it can only help me feel well enough to be able to finally work on that myself. I hope I'm getting there.
Thursday evening, I had another catering gig. This one was at the South Carolina Aquarium. In addition to get paid for the work, I got delicious food and a free (self-guided) tour of the aquarium. I've seen better aquariums, but it was worth seeing for free. I tried to be considerate of the fish and not eat my shrimp and crab in front of them. It seemed rather cruel.
In my now vast catering experience of three events, I have learned the following:
- If you want to get women on the dance floor, you have to play a line dance type of song. "Cha Cha Slide" is popular, but "Macarena" or "Chicken Dance" will work. Once they've followed a step-by-step dance, they'll stay out there, but it's a ghost town 'til then so you might as well start with it.
- Men will only dance to slow songs, with two exceptions. (1.) They're gay or (2.) They're trying to hook up with a much younger woman and think their dancing makes them seem younger. (It doesn't).
- If you are curious as to the sexual orientation of a date or coworker, play Lady Gaga. Your question will be answered within three seconds.
- If you ever find yourself holding up the thumb, index finger and pinky finger sign for "I love you" while yelling, "Yeah, this is my jam!" when a song from your high school years comes on, you're too drunk to drive.
Fridays treatment was quite early, as I had to leave town immediately afterwards for a funeral. Having been up late the night before working my catering event, I was especially tired, and Dr. Li kept making small talk with me to keep me from dozing. I've gotten so used to the brain tapping and teeth chattering now, that I definitely could have slept the whole time.
The funeral was in the small town of Waynesboro, Georgia, bird dog capital of the world. It was about a three hour drive for me because the route was small highways through tiny speed-trap towns. I pulled over in my rental car twice to stand up and move around, just to stay awake. I really need to get better at this morning thing.
At the service and afterwards, I saw family I hadn't seen in as long as twenty years or more. I met two cousins I'd never met before and caught up on a lot of family gossip. While death is always sad, it was nice for me to escape Charleston for a little while and see loving familiar faces. Mom, Dad, Sis and Bro were all there, as well as in-laws, nieces, a nephew and my fave aunt and cousin. I had to remind myself that they weren't there for me so I wouldn't monopolize all their time, but it brought me as much comfort as I hopefully provided for them.
It was weird seeing a lot of these people, though. The time and distance didn't matter so much, as facebook had kept many of us at least a little connected. That was the problem, though. While I know that not everyone reads everything I post on fb, I knew that probably some of them had been reading my blog. They didn't really know me, per se, but they knew all this oddly personal stuff about me. I really want to talk about it, to be open to questions, but I understand the awkwardness of it. So instead I got mostly generic questions (or no mention at all of The Uncomfortable Topic of Stephanie Having Depression) like "How's the weather in Charleston?" or "When do you get to go home?" I was finally around people and wanted to talk about it, but I think that it was awkward to most people in that way that it might be if you knew a cousin had undergone a sex-change operation. You might wonder, but probably wouldn't feel comfortable asking "So, what's it like having your penis chopped off?" So, I retreated inside myself a little, trying to be invisible in a crowded room.
Saturday, I was still in Waynesboro, and we went to the local Christmas parade. Their high school football team had made it to state championship, so the whole town showed up as the players led the parade. I didn't really want to go, not feeling especially cheery, but mom wanted me to and I wanted to be wherever mom wanted me. I love her and she was hurting from the death. It ended up being a nice day and a fun little parade.
Later, we went to Lights of the South. The event boasts more than four million lights on over 100 acres. I can tell you that, even with mom's need to take a picture of everything and of every person standing at every display, we walked through the entire thing in under an hour, so I'm doubtful of the 100 acre part. There's quite a lot of burned out bulbs in that four million count, too. I will let my pictures speak for themselves as to the quality of the "holiday" lights.
The drive home brought us to Peach Orchard Road in Augusta. That is the exit my "bad" grandpa lived off of, and it gave me a relatively brief sweep of emotion to be there. When I get near there, I have an urge to go to their house, as if seeing it again will bring some sort of closure or answers as to why it all happened. I refrained from asking for the detour, but really wished I could bury my head on mom's chest and be comforted. I had to remind myself that it was my job right now to provide comfort, not to ask for it.
I had noted during the weekend that each family seemed to have its one child that brought the most concern. In each sibling group, there was always one who was financially irresponsible, on drugs, or in some way living on a destructive path. I asked mom when we returned which of her kids she worried about the most. Her answer was me.
My siblings and I are all reasonably responsible at this stage in life. We've all faltered along the way, but none of us have fallen into a pit. I guess I shouldn't have been surprised that mom would be most worried about me, but I kind of pride myself on my independence and the fact that she's never had to bail me out of any trouble. Still, I guess it is kind of worrisome when you never know if you're going to get a call that your daughter is dead because she took her own life. That's been a real possibility with me.
Mom didn't really get into any of that, though. She just said that she worried because I travel so much and have an adventurous life, and she doesn't always know where I am and if I'm okay. I suspect she probably worries about me more when I'm in Oak Ridge and she hasn't heard from me in two weeks than when she knows I'm in Guatemala and she hasn't heard from me.
Mom said that she worried less about me when I'm in a relationship. The feminist in me wanted to be offended, but I understood what she meant. Me being in a relationship means me having someone involved in my day-to-day life, so at least someone knows when I'm slipping down the slope. Otherwise, it's just everyone assuming I'm fine until they learn differently in a bad, bad way. I've mentioned before that I'm very good at pretending and hiding my moods, and I think my family knows by now that my saying that I'm fine to them on the phone doesn't necessarily mean that I really am.
Anyway, it was good. It was good to see family. It was good to feel like a part of the family. Sometimes I disconnect myself from that too much. I don't know how to ask for what I need from them, and I don't feel like I contribute anything to them, so I just... leave it alone.
So, it always goes back to the magical question: "Is treatment working?" I wish that it was working so well that I didn't still have to ask the question. It isn't. But it is working well enough that it feels like it's worth hanging in there. No machine can rebuild my self-esteem, it can only help me feel well enough to be able to finally work on that myself. I hope I'm getting there.
Thursday, December 15, 2011
Treatment Day Fourteen 12/15/11
I have a theory about depression. It is completely non-scientific, and the study sample of one (me) is too small to be valid.
Sometimes bad things happen. They can be one traumatic event, or a series of bad events over a period of time. Either way, the brain's response is to numb you to get through it. Endorphins, seratonin, norepenephrine, whatever... they don't kick into high gear because the mind knows that your body will never be tricked into being happy when things are that bad. Many people become addicted to various substances seeking that fake happiness, but it never seems to work out. Since your body can't fake happy, it just becomes numb. Numb is better than hurt.
My theory is this: the neurons that the rTMS are stimulating are responsible for the numbness. Mine shut down a long time ago, perhaps in early childhood, and I've been numb since then. They had to stop firing to make certain parts of life bearable, but like a car that hasn't been started in months, the battery goes dead and needs a jump to get going again. rTMS is my jumper cable. Right now, my car needs a jumpstart every time I try to turn the engine over, but hopefully it will eventually build enough of a charge to maintain it. I'm almost halfway done with treatment; I hope my charge will fire on its own by the time it's done.
Sometimes bad things happen. They can be one traumatic event, or a series of bad events over a period of time. Either way, the brain's response is to numb you to get through it. Endorphins, seratonin, norepenephrine, whatever... they don't kick into high gear because the mind knows that your body will never be tricked into being happy when things are that bad. Many people become addicted to various substances seeking that fake happiness, but it never seems to work out. Since your body can't fake happy, it just becomes numb. Numb is better than hurt.
My theory is this: the neurons that the rTMS are stimulating are responsible for the numbness. Mine shut down a long time ago, perhaps in early childhood, and I've been numb since then. They had to stop firing to make certain parts of life bearable, but like a car that hasn't been started in months, the battery goes dead and needs a jump to get going again. rTMS is my jumper cable. Right now, my car needs a jumpstart every time I try to turn the engine over, but hopefully it will eventually build enough of a charge to maintain it. I'm almost halfway done with treatment; I hope my charge will fire on its own by the time it's done.
Wednesday, December 14, 2011
Treatment Day Thirteen 12/14/11
Today I miss home. I'm not talking about my boyfriend, my dogs, my housemate, my friends and my job. I've missed most of those since day one. Today I miss all the other little conveniences and luxuries that make up home.
I miss having a kitchen equipped with an oven, a collander, butter, sugar and more than one pot. I miss having my washer and dryer in the same building where I reside. I would kill for a shower with any kind of water pressure and decent temperature control. I want my bed. I need to tinker in my basement and kill unwanted greenery in my yard.
Though it may not read like it, treatment still goes well. I think that I would be in a very bad place right now if I were here going through this without that added help. I'm still very optimistic that this is the big game changer for me.
As far as side effects go, they are minimal. Despite my more active lifestyle here (walking and biking daily), I'm pretty sure I've put on a few more pounds. I suppose that is explained by the microwave meals and convenience snacks, but it's not like I've ever been queen of healthy meals. I've had a few minor headaches. My tooth fillings still hurt a little during treatment. If I don't grip the chair arm, my left arm wants to twitter about when the device is actively tapping. It's no big deal except when I try to turn the page in my book.
I still have nightmares almost every night, but that's been around since I started taking antidepressants more than fifteen years ago. Lately, they seem to cause more sleep disturbance than usual, but that may be in part due to the unfamiliar, uncomfortable bed. Most nights, I'm waking up between four and five, and staying awake for about two hours before drifting off again. This is definitely a new development since beginning treatment. Interestingly, that kind of sleep pattern is associated with depression. I didn't have it before but do now.
My official diagnosis at the start of this was Major Depressive Disorder with Melancholic Features. One of the distinguishing features of this type of depression is that symptoms are worse in the morning. That is definitely still the case for me. It's about more than just not being a 'morning person'. I wake up most mornings filled with dread and immediately berating myself for things I've failed at or anticipate failing at.
Another feature is a strong sense of guilt. I still feel guilty for very minor mistakes I made twenty years ago. For example, I was the bailiff in mock trials once in ninth or tenth grade. The teacher had told me that, because these 'hearings' were just for fun, the judge would sometimes forget to swear in witnesses at the start of testimony. She told me that if that happened, I should just politely remind the judge.
Because this instruction was so burned into my head, I didn't notice when the judge did swear everyone in. Thinking I was doing a great job, I said, "Excuse me, your Honor. Are you going to swear the witnesses in?"
He replied, "I thought that's what we just did."
I understand that this is minor, and that probably no one besides me ever gave it a second thought. But here I am, twenty years later, and I still feel my face flush with embarrassment when I think of it. And I have a million other stories like that which add to my feelings of guilt. I could talk all night about mistakes I've made, but be hard pressed to name ten -- nay, five -- things I've accomplished that I'm proud of. So far, I think treatment is working well on my depression, but the 'melancholic features' are still shining through.
I miss having a kitchen equipped with an oven, a collander, butter, sugar and more than one pot. I miss having my washer and dryer in the same building where I reside. I would kill for a shower with any kind of water pressure and decent temperature control. I want my bed. I need to tinker in my basement and kill unwanted greenery in my yard.
Though it may not read like it, treatment still goes well. I think that I would be in a very bad place right now if I were here going through this without that added help. I'm still very optimistic that this is the big game changer for me.
As far as side effects go, they are minimal. Despite my more active lifestyle here (walking and biking daily), I'm pretty sure I've put on a few more pounds. I suppose that is explained by the microwave meals and convenience snacks, but it's not like I've ever been queen of healthy meals. I've had a few minor headaches. My tooth fillings still hurt a little during treatment. If I don't grip the chair arm, my left arm wants to twitter about when the device is actively tapping. It's no big deal except when I try to turn the page in my book.
I still have nightmares almost every night, but that's been around since I started taking antidepressants more than fifteen years ago. Lately, they seem to cause more sleep disturbance than usual, but that may be in part due to the unfamiliar, uncomfortable bed. Most nights, I'm waking up between four and five, and staying awake for about two hours before drifting off again. This is definitely a new development since beginning treatment. Interestingly, that kind of sleep pattern is associated with depression. I didn't have it before but do now.
My official diagnosis at the start of this was Major Depressive Disorder with Melancholic Features. One of the distinguishing features of this type of depression is that symptoms are worse in the morning. That is definitely still the case for me. It's about more than just not being a 'morning person'. I wake up most mornings filled with dread and immediately berating myself for things I've failed at or anticipate failing at.
Another feature is a strong sense of guilt. I still feel guilty for very minor mistakes I made twenty years ago. For example, I was the bailiff in mock trials once in ninth or tenth grade. The teacher had told me that, because these 'hearings' were just for fun, the judge would sometimes forget to swear in witnesses at the start of testimony. She told me that if that happened, I should just politely remind the judge.
Because this instruction was so burned into my head, I didn't notice when the judge did swear everyone in. Thinking I was doing a great job, I said, "Excuse me, your Honor. Are you going to swear the witnesses in?"
He replied, "I thought that's what we just did."
I understand that this is minor, and that probably no one besides me ever gave it a second thought. But here I am, twenty years later, and I still feel my face flush with embarrassment when I think of it. And I have a million other stories like that which add to my feelings of guilt. I could talk all night about mistakes I've made, but be hard pressed to name ten -- nay, five -- things I've accomplished that I'm proud of. So far, I think treatment is working well on my depression, but the 'melancholic features' are still shining through.
Treatment Day Twelve 12/13/11
I effin' hate parking garages. They give me the creeps and the willies and they smell bad and people seem to lose their patience and manners in them.
I'm irritable and I hate everything about my appearance. How did I become so disgusting?
It's a bad day.
I'm irritable and I hate everything about my appearance. How did I become so disgusting?
It's a bad day.
Treatment Day Eleven 12/12/11
As expected, I had a depression screening today. I had the nurse whom I prefer (not the lip gloss applying one), but she doesn't tell me my score. Still, I can assume my score improved, as my attitude is certainly better. It's not nearly as stressful to answer questions about wanting to kill yourself when you don't want to kill yourself.
Treatment was standard. Dr. Li has to stay in the room with me throughout my thirty-seven minutes to make sure nothing goes wrong and to make sure the device stays in place (he usually adjusts it once or twice mid-treatment). He always looks like he's busy doing official business, but today I noticed as I was leaving that he was reading an article on Newt Gingrich. More productive than surfing craigslist, I guess.
I feel really good today. I have for several days in a row now. Feeling better is impacting me in more ways than I would have guessed. It's not just about wanting to live or feeling more alive. I have more appreciation for the people in my life. When my depression is at its lowest, other people are just a necessary evil in the world that I avoid as much as possible. I don't want to explain to them why I'm down, or pretend that I'm not. I just want to escape. I don't think people are bad, nor do I suddenly dislike my friends, I just am too deep in my own mess to want to be bothered.
I don't know how to explain how I'm feeling now, except that I'm starting to soften in places that had long ago hardened. I don't really remember a significant period in my life that wasn't affected by depression, but I'm hopeful that I'm heading into my first major remission and possibly a cure.
Treatment was standard. Dr. Li has to stay in the room with me throughout my thirty-seven minutes to make sure nothing goes wrong and to make sure the device stays in place (he usually adjusts it once or twice mid-treatment). He always looks like he's busy doing official business, but today I noticed as I was leaving that he was reading an article on Newt Gingrich. More productive than surfing craigslist, I guess.
I feel really good today. I have for several days in a row now. Feeling better is impacting me in more ways than I would have guessed. It's not just about wanting to live or feeling more alive. I have more appreciation for the people in my life. When my depression is at its lowest, other people are just a necessary evil in the world that I avoid as much as possible. I don't want to explain to them why I'm down, or pretend that I'm not. I just want to escape. I don't think people are bad, nor do I suddenly dislike my friends, I just am too deep in my own mess to want to be bothered.
I don't know how to explain how I'm feeling now, except that I'm starting to soften in places that had long ago hardened. I don't really remember a significant period in my life that wasn't affected by depression, but I'm hopeful that I'm heading into my first major remission and possibly a cure.
Monday, December 12, 2011
Treatment Day Ten 12/9/11
The melatonin worked wonders. I slept like a babe and awoke refreshed and ready for adventure.
I had found an ad on craigslist looking for seasonal banquet servers. I thought I'd swing by before treatment and fill out an application. They needed help for events on both Friday and Saturday; could I start right away? My sister and I had planned to meet at our halfway spot for dinner, but it sounded like she had a crammed weekend anyway, so I figured she wouldn't mind me cancelling our dinner for the sake of my more long-term sanity in finding something to do with my time on a regular basis.
I had a few hours til treatment, but had to round up a white button-down shirt and black tie, pants, socks and shoes. I hit a few thrift stores and Kmart, and had my supplies just in time to grab lunch and head to my brain tapping.
My happy news at treatment was that, since the device had been down Thursday and I never received that treatment, I didn't have to undergo a depression screening today. Apparently, those are only given after every five treatments, not just always on Friday. So now I'll have my screening on Monday, which suits me better. I hated ending my week on a sour note and have a natural acceptance for Mondays being a little rough.
After treatment (nothing interesting to report there), I headed to my first gig. It was a swanky corporate Christmas party at a country club. I hadn't done work that was that physically demanding in a long time. When I was helping one of the (much younger) staff put away tables at the end of the night, she stopped and said, "I think there's something wrong with this table. I keep hearing a clicking sound." The clicking sound was my old arthritic knee. Ugh.
Though I was exhausted at the end of the night, I was also happy. It felt good to use my body for physical labor as it was intended. It started my gears grinding about ways to incorporate more activity into my current job and reminded me of my dream of working as an FBI profiler.
Saturday night was a completely different experience than the first, but still felt good. The first night had an open bar with top shelf drinks; the second night featured Gatorade with tequila mixed in. Friday night had delicious handmade chocolates; Saturday night had a wedding cake that was on the verge of toppling over at any moment. The staff at the Christmas party was professional and polished; the smell of weed was heavy in the air of the break area at the wedding. Regardless, they were both enjoyable, exhausting, and made me some decent extra cash.
I spent most of Sunday recovering, either sleeping or reading, but definitely not moving a whole lot. Still, I felt good. Physically, I was tired but felt useful. Emotionally and mentally, I felt content. I've got to assume the treatment has a lot to do with that, because without it, I think I would have been fine with just sleeping my time away here. The restlessness that has stirred within me feels like the fire of Stephanie being rekindled.
I had found an ad on craigslist looking for seasonal banquet servers. I thought I'd swing by before treatment and fill out an application. They needed help for events on both Friday and Saturday; could I start right away? My sister and I had planned to meet at our halfway spot for dinner, but it sounded like she had a crammed weekend anyway, so I figured she wouldn't mind me cancelling our dinner for the sake of my more long-term sanity in finding something to do with my time on a regular basis.
I had a few hours til treatment, but had to round up a white button-down shirt and black tie, pants, socks and shoes. I hit a few thrift stores and Kmart, and had my supplies just in time to grab lunch and head to my brain tapping.
My happy news at treatment was that, since the device had been down Thursday and I never received that treatment, I didn't have to undergo a depression screening today. Apparently, those are only given after every five treatments, not just always on Friday. So now I'll have my screening on Monday, which suits me better. I hated ending my week on a sour note and have a natural acceptance for Mondays being a little rough.
After treatment (nothing interesting to report there), I headed to my first gig. It was a swanky corporate Christmas party at a country club. I hadn't done work that was that physically demanding in a long time. When I was helping one of the (much younger) staff put away tables at the end of the night, she stopped and said, "I think there's something wrong with this table. I keep hearing a clicking sound." The clicking sound was my old arthritic knee. Ugh.
Though I was exhausted at the end of the night, I was also happy. It felt good to use my body for physical labor as it was intended. It started my gears grinding about ways to incorporate more activity into my current job and reminded me of my dream of working as an FBI profiler.
Saturday night was a completely different experience than the first, but still felt good. The first night had an open bar with top shelf drinks; the second night featured Gatorade with tequila mixed in. Friday night had delicious handmade chocolates; Saturday night had a wedding cake that was on the verge of toppling over at any moment. The staff at the Christmas party was professional and polished; the smell of weed was heavy in the air of the break area at the wedding. Regardless, they were both enjoyable, exhausting, and made me some decent extra cash.
I spent most of Sunday recovering, either sleeping or reading, but definitely not moving a whole lot. Still, I felt good. Physically, I was tired but felt useful. Emotionally and mentally, I felt content. I've got to assume the treatment has a lot to do with that, because without it, I think I would have been fine with just sleeping my time away here. The restlessness that has stirred within me feels like the fire of Stephanie being rekindled.
Friday, December 9, 2011
Treatment Day Nine 12/8/11
My sleep patterns have become insane. I'm sleeping for 3-4 hours then staying awake for 3-4 hours, around the clock. I don't know if it's from the treatment, boredom, or the stiff mattress. I'm usually someone who can sleep nearly anywhere, though, so I'm inclined to think it's from treatment.
Treatment today was at 9am, which means a 7:30 wake up time to allow for my pedestrian commute. Unfortunately, that doesn't seem to ever fall in my natural sleep/wake cycle, so it feels brutal getting out of bed. Today was the coldest temperature I've experienced since being here, too.
I drug myself out of bed and into the cold for another day of head tapping. When I arrived, Dr. Li had trouble with the device again. He futzed around with it for 45 minutes or so before admitting defeat and sending me on my way. He asked if he could call me when it was repaired and have me return within an hour. I told him that would be no problem.
I waited all day, unable to get involved in any major activity because I needed to be able to leave as soon as I got the call. I had thought today would be a Habitat day, but I didn't want to show up only to have to leave soon after. The call never came.
When 5:00 hit and I knew the call wouldn't come, I decided to get out of the apartment for a while. I went to Vitamin World to get some Melatonin, hopeful that it would provide a solid night's sleep. Since it was cold out, I decided some soup would be nice. Normally I prefer to avoid chains and eat local when travelling, but O'Charley's potato soup was calling me.
I googled the closest location and put the address in my GPS. Modern technology is wonderful. I went through the heaviest traffic I've seen since arriving in Charleston, taking a half hour to go six miles. When I got to the designated address, there was no O'Charley's to be seen. Knowing that the navi is sometimes off on addresses, I went a mile in either direction with no success.
The familiar refrain "I wish I was dead" returned. I felt like such a failure. My only job here is to get better, and I seem to be failing at that. Mom talked to me when I was feeling great, and now I feel like I'm supposed to be that way all the time. I'm so used to hiding my emotions, it's second nature. I do it partly to protect those who care about me, so they don't worry about me. I also do it so I won't be hated. I don't want to be the Debbie Downer that no one wants to be around because I'm always so blue, but the truth is that I can feel that way for months at a time. I pretend to be okay because the repercussions to being honest are serious. I could hurt my family (I've done that before); I could lose my friends (I've done that before); I could lose my job (I've done that before); I could lose everything (I seem to tempt fate with that one often enough). All because I hate myself.
It was dark and I was again frustrated. A lot of my trip seems to be filled with that emotion. I was obviously on the posh side of town, and I went to the fanciest Wal-Mart I've ever seen. It actually had a huge window display, and the area's ordinances kept its sign short enough that I almost didn't see it.
I went in to get some Febreeze, as my nephew now has me paranoid about my vehicle smelling bad. While I was there, I decided to get some wine to aid the Melatonin in getting me to sleep. I also picked up a can of tomato soup to help satiate my soup craving.
By the time I got back to the apartment, I no longer had the desire to make soup, so dinner was skipped. I Skyped the boyfriend, took the Melatonin, and prepared for a (hopefully) restful sleep.
Treatment today was at 9am, which means a 7:30 wake up time to allow for my pedestrian commute. Unfortunately, that doesn't seem to ever fall in my natural sleep/wake cycle, so it feels brutal getting out of bed. Today was the coldest temperature I've experienced since being here, too.
I drug myself out of bed and into the cold for another day of head tapping. When I arrived, Dr. Li had trouble with the device again. He futzed around with it for 45 minutes or so before admitting defeat and sending me on my way. He asked if he could call me when it was repaired and have me return within an hour. I told him that would be no problem.
I waited all day, unable to get involved in any major activity because I needed to be able to leave as soon as I got the call. I had thought today would be a Habitat day, but I didn't want to show up only to have to leave soon after. The call never came.
When 5:00 hit and I knew the call wouldn't come, I decided to get out of the apartment for a while. I went to Vitamin World to get some Melatonin, hopeful that it would provide a solid night's sleep. Since it was cold out, I decided some soup would be nice. Normally I prefer to avoid chains and eat local when travelling, but O'Charley's potato soup was calling me.
I googled the closest location and put the address in my GPS. Modern technology is wonderful. I went through the heaviest traffic I've seen since arriving in Charleston, taking a half hour to go six miles. When I got to the designated address, there was no O'Charley's to be seen. Knowing that the navi is sometimes off on addresses, I went a mile in either direction with no success.
The familiar refrain "I wish I was dead" returned. I felt like such a failure. My only job here is to get better, and I seem to be failing at that. Mom talked to me when I was feeling great, and now I feel like I'm supposed to be that way all the time. I'm so used to hiding my emotions, it's second nature. I do it partly to protect those who care about me, so they don't worry about me. I also do it so I won't be hated. I don't want to be the Debbie Downer that no one wants to be around because I'm always so blue, but the truth is that I can feel that way for months at a time. I pretend to be okay because the repercussions to being honest are serious. I could hurt my family (I've done that before); I could lose my friends (I've done that before); I could lose my job (I've done that before); I could lose everything (I seem to tempt fate with that one often enough). All because I hate myself.
It was dark and I was again frustrated. A lot of my trip seems to be filled with that emotion. I was obviously on the posh side of town, and I went to the fanciest Wal-Mart I've ever seen. It actually had a huge window display, and the area's ordinances kept its sign short enough that I almost didn't see it.
I went in to get some Febreeze, as my nephew now has me paranoid about my vehicle smelling bad. While I was there, I decided to get some wine to aid the Melatonin in getting me to sleep. I also picked up a can of tomato soup to help satiate my soup craving.
By the time I got back to the apartment, I no longer had the desire to make soup, so dinner was skipped. I Skyped the boyfriend, took the Melatonin, and prepared for a (hopefully) restful sleep.
Wednesday, December 7, 2011
Treatment Day Eight 12/7/11
I woke up feeling grumpy this morning. Grumpy, not depressed. I don't think that any type of treatment could ever turn me into a morning person.
Treatment was at 9:30 today. I put in my earplugs and leaned back in my chair as usual, and Dr. Li put the device on my head. However, it wouldn't start. He played with several settings, and did the famous turn-it-off-then-turn-it-back-on that is supposed to fix everything. Still nothing. He tried to call the Cervel folks, but they're on the west coast, so it was too early to reach anyone. I offered to leave and come back in the afternoon, but he was certain he could get it working.
After a few more attempts, the machine finally came on. I didn't love the idea of something working on my brain that hadn't been working at all a few minutes ago, but I've come to trust Dr. Li's knowledge and since he was okay with it, I was okay with it.
Today, I had the brilliant idea of bringing a book to read during treatment. I don't know why it took me so long to think of, except that I'm slow to start any new book. I had to hold the book at an odd angle that was slightly tiresome to the arms, but it was so worth it. Anyone doing this treatment, bring a book! The time went by much more quickly. I'm now reading 37 minutes of Tommyknockers per day, which I think will fill my remaining 4 1/2 weeks nicely.
After treatment, my grumpiness was increased, probably by the extra time spent waiting to start treatment. I got in the car to go volunteer at Habitat, but I just didn't feel nice enough to deal with people. Instead, I headed to Michael's to look for some craft items.
During the drive, I had a strange sensation. I'm used to thinking of suicide. I go through phases where I'm attracted to different methods. For a long time, I obsessed with overdose, until I tried it with horrible results. Hanging has been my preferred fantasy for a year or more, sprinkled with occasional thoughts of gunshot. But today, I imagined being strangled by someone else. The thought came so quickly and clearly that I grabbed my neck in startled response. It passed just as quickly, but left behind an uneasy feeling.
I returned to the apartment, suddenly exhausted. I took more than a nap, it was a deep and nightmare filled sleep. I awoke feeling disconcerted. Needing something to do, I went to the Habitat store, but it was late enough in the day that they didn't need any volunteers. I then went to give plasma, as I often harp on that as being a way to earn money when all else fails and you're desparate enough. I try to practice what I preach (I'm not desparate, but a little extra money never hurts), but the plasma place would only accept donors with proof on in-state residence. So, back to the apartment.
The hard part of this treatment isn't sitting in the chair for 37 minutes everyday. The hard part is figuring out its successes and failures. Are my nightmares and exhaustion from the treatment, or just random experiences? Are my good moods the result of a sunny day at the beach, or from a tapping on my neurons? I know that it will take time to see any real, lasting changes in my depression. This artificial environment that I'm living in now - away from home, responsibility, work, dog licks, friends, and everything else that makes my world - makes it even harder to judge my progress.
Treatment was at 9:30 today. I put in my earplugs and leaned back in my chair as usual, and Dr. Li put the device on my head. However, it wouldn't start. He played with several settings, and did the famous turn-it-off-then-turn-it-back-on that is supposed to fix everything. Still nothing. He tried to call the Cervel folks, but they're on the west coast, so it was too early to reach anyone. I offered to leave and come back in the afternoon, but he was certain he could get it working.
After a few more attempts, the machine finally came on. I didn't love the idea of something working on my brain that hadn't been working at all a few minutes ago, but I've come to trust Dr. Li's knowledge and since he was okay with it, I was okay with it.
Today, I had the brilliant idea of bringing a book to read during treatment. I don't know why it took me so long to think of, except that I'm slow to start any new book. I had to hold the book at an odd angle that was slightly tiresome to the arms, but it was so worth it. Anyone doing this treatment, bring a book! The time went by much more quickly. I'm now reading 37 minutes of Tommyknockers per day, which I think will fill my remaining 4 1/2 weeks nicely.
After treatment, my grumpiness was increased, probably by the extra time spent waiting to start treatment. I got in the car to go volunteer at Habitat, but I just didn't feel nice enough to deal with people. Instead, I headed to Michael's to look for some craft items.
During the drive, I had a strange sensation. I'm used to thinking of suicide. I go through phases where I'm attracted to different methods. For a long time, I obsessed with overdose, until I tried it with horrible results. Hanging has been my preferred fantasy for a year or more, sprinkled with occasional thoughts of gunshot. But today, I imagined being strangled by someone else. The thought came so quickly and clearly that I grabbed my neck in startled response. It passed just as quickly, but left behind an uneasy feeling.
I returned to the apartment, suddenly exhausted. I took more than a nap, it was a deep and nightmare filled sleep. I awoke feeling disconcerted. Needing something to do, I went to the Habitat store, but it was late enough in the day that they didn't need any volunteers. I then went to give plasma, as I often harp on that as being a way to earn money when all else fails and you're desparate enough. I try to practice what I preach (I'm not desparate, but a little extra money never hurts), but the plasma place would only accept donors with proof on in-state residence. So, back to the apartment.
The hard part of this treatment isn't sitting in the chair for 37 minutes everyday. The hard part is figuring out its successes and failures. Are my nightmares and exhaustion from the treatment, or just random experiences? Are my good moods the result of a sunny day at the beach, or from a tapping on my neurons? I know that it will take time to see any real, lasting changes in my depression. This artificial environment that I'm living in now - away from home, responsibility, work, dog licks, friends, and everything else that makes my world - makes it even harder to judge my progress.
Treatment Day Seven 12/6/11
I woke up feeling like a new me. Treatment was scheduled late today, 1:30, so I hadn't set an alarm. I woke up around 10am. Old Stephanie would have just stayed in bed until I had just enough time to shower and get out the door. New Stephanie was excited to begin my day.
I cleaned up and was out the door by eleven. I had decided to visit the local Habitat for Humanity Restore, both to shop and to discuss volunteering. My great find was a little Charlie Brownesque Christmas tree to brighten up my apartment.
I headed towards treatment, but was running early so I wandered a little down King Street to kill time. I went into a consignment shop called Butterfly, but left quickly after seeing a $380 price tag on a used dress. I decided then to walk to treatment from where I was (I had driven because of my Habitat adventure), so I took a scenic route to MUSC.
Treatment was unspectacular. The 37 minutes felt incredibly long, but I didn't even really have any discomfort today, just boredom. I learned that chewing gum during treatment helped with the teeth chattering problem, and left me with minty fresh breath.
After treatment, I headed to the beach. The temperature was in the mid 70s and fabulous. I pondered on the insanity of my not living closer to beach, as I feel most at peace there. I spent some time hunting for seashells for my boyfriend. He grew up closer to the Pacific coast, so he only discovered snorkeling and finding great shells this year with me, on his first trip to the Gulf. His childlike excitement made me want to find some amazing shell for him, but the cold temperature of the water kept me from wandering in far enough to find anything great. I compromised by incorporating smaller shells into a message in the sand for him, a gesture far mushier than is typical for me, and perhaps another indication of my improved well-being. I call him Slim.
I cleaned up and was out the door by eleven. I had decided to visit the local Habitat for Humanity Restore, both to shop and to discuss volunteering. My great find was a little Charlie Brownesque Christmas tree to brighten up my apartment.
Habitat also told me they would be happy to have me volunteer. Conveniently, I didn't have to schedule my volunteer time, just show up and be ready to work and they'd put me where needed. I headed towards treatment, but was running early so I wandered a little down King Street to kill time. I went into a consignment shop called Butterfly, but left quickly after seeing a $380 price tag on a used dress. I decided then to walk to treatment from where I was (I had driven because of my Habitat adventure), so I took a scenic route to MUSC.
Treatment was unspectacular. The 37 minutes felt incredibly long, but I didn't even really have any discomfort today, just boredom. I learned that chewing gum during treatment helped with the teeth chattering problem, and left me with minty fresh breath.
After treatment, I headed to the beach. The temperature was in the mid 70s and fabulous. I pondered on the insanity of my not living closer to beach, as I feel most at peace there. I spent some time hunting for seashells for my boyfriend. He grew up closer to the Pacific coast, so he only discovered snorkeling and finding great shells this year with me, on his first trip to the Gulf. His childlike excitement made me want to find some amazing shell for him, but the cold temperature of the water kept me from wandering in far enough to find anything great. I compromised by incorporating smaller shells into a message in the sand for him, a gesture far mushier than is typical for me, and perhaps another indication of my improved well-being. I call him Slim.
Showing affection is unusual for me, but making it this public is unheard of for me. I know this separation is hard, though, so this is me letting him know how much I miss him.
After beach time, I returned to the apartment, planning to help teach a class for work via Skype. Unfortunately, we had technical difficulties, so my evening was open. I watched Limitless, a movie with an interesting concept about unlocking the full potential of the brain. It seemed relevant to my situation, as I think of my treatment as unlocking some forgotten areas of my own brain. The movie was mediocre. My treatment, however, seems to be going so well that everyone I have spoken to who knew Old Stephanie has noted the beginning emergence of New Stephanie. That makes me happy.
Monday, December 5, 2011
Treatment Day Six 12/5/11
I listened to the weather forecast as I got ready for treatment today. I saw the rain falling outside my window as the weatherman called for a 10% chance for rain today. Doesn’t the fact that it is already raining automatically mean 100% chance of rain today?
I drove to treatment feeling disappointed that I wouldn’t get the beach day I had planned, but still feeling overall good. Since Friday afternoon, I’ve felt like treatment is starting to work. Oh, happy day!
On Mondays, I have to have my motor threshold retested. It determines the intensity of my treatment. Too low and the treatment isn’t fully effective; too high and I run the risk of seizures. It may change slightly during treatment so we check it weekly. It’s still at 77, so no change.
I felt the normal mild discomfort. At the beginning, I also experienced what felt like a surge of pressure against the fillings in my upper left teeth, but it passed within a minute or so.
My friend Angie came to visit this weekend, and I was so happy to have her company! We had a nice time, and there were lots of little ways that I saw my own improvement. I felt genuinely happy, not just putting on a friendly face to keep others from feeling uncomfortable.
Now that I’m starting to feel better, I’m bored. I used to be content to lie around in bed all day. I tried to force myself to stay busy to stay out of my darkest places. Now I want to do stuff, but the weather is rainy and the budget is tight. Still, bored is much better than depressed.
I hope that tomorrow’s forecast is more accurate and it becomes a beach day for me. My sleep patterns are getting weird, so I’m also rooting for a good night’s sleep tonight.
I miss home, but at least it’s starting to feel like it will all be worth it.
Friday, December 2, 2011
Treatment Day Five 12/2/11
I’m going to hate Fridays. Fridays are evaluation days.
I had my treatment as usual. I’m getting so used to it, I could almost nap during it, except that I have to remain alert during treatment. I snagged a picture of the device, shown below. The "arms" coming out either side are what send the pulses through my head. They rest firmly on top of my head, but are in no way attached (no straps, etc).
Afterwards treatment, I met with a nurse for her to conduct a Hamilton Depression Scale on me. The nurse was different from the nurse I had seen previously. This one seemed less compassionate. She actually applied lip gloss in the middle of asking me about suicidal thoughts. It felt like she was saying, “I know you feel bad, but it can’t be as bad as my dry lips.” Maybe next week, she’ll trim her toenails during our session.
Changing nurses made me feel like the results might get skewed. They each put their own emphasis and examples in different areas. Today’s nurse asked: “Do you ever feel overwhelmed by seemingly simple tasks, like washing the dishes?” I don’t enjoy washing dishes, but I don’t get overwhelmed by them, so no.
The previous nurse had asked, “Do you feel overwhelmed by everyday tasks, like checking your voicemail?” Bingo! Yes! Same essential question, different responses. Keeping the same nurse might give a more accurate insight into my level of depression.
Based on the questions asked, one might assume that people with depression are gassy hypochondriacs with no libido. The first psychiatrist who interviewed me seemed surprised that I had graduated high school on time. Apparently, we’re lazy and/or stupid, too. No wonder it’s so hard to find anyone willing to openly discuss depression.
I scored a 55 on today’s test, but I don’t know any of my scores from previous tests to know how that compares. Apparently there are several versions of the test, so I can’t interpret the results with my Google Fu either.
After getting to discuss all my feelings of self-hatred and my lack of interest in living, I was free to go. As I had walked to treatment, I had to walk back to my abode. Unlike my last walking adventure, this time I was hit on several times. Good for the ego, but I look forward to being able to find my own self-worth someday, rather than depending on anyone and everyone around me.
The big success of the day is NO NAP! I got up at a good time and remained active. I didn’t try to escape today. J I felt good most of the day, except during my test. And my friend Angie is coming to visit for the weekend, so I look forward to having someone to share the sights of Charleston with.
Have a great weekend!
Treatment Day Four 12/1/11
I rode a borrowed bicycle to treatment today. I felt like I was living a live version of the ‘80s video game Paperboy. I had potholes and dogs to avoid. I caught my handlebars on a gate that I thought I was narrowly missing but was going slowly enough that I didn’t go splat. I caught my coat in the spokes and came to a sudden stop. In short, I was my normal uncoordinated self, and it was kind of fun.
When I got to treatment, Dr. Li had me wipe the sweat off my head before he placed the device. It was kind of embarrassing, but he saw my bicycle helmet and knew why I was sweaty. As an aside, there are no helmet laws in South Carolina (bicycle or motorcycle), and I’m surprised at how many people choose to not protect their heads.
Treatment was treatment. No headaches or more than mild discomfort. The vibration of the device causes my teeth to chatter and my left eye to twitch (just rapid movement with the vibration, not any kind of spasm), which gets annoying but doesn’t hurt.
I rode my bicycle back to the apartment and immediately commenced napping. The amount of sleep I get is directly proportionate to how bad I’m feeling. The more I sleep, the worse I feel. As I’ve mentioned before, I sleep mostly to feel like I’ve escaped life for a while.
During bouts of depression (which typically last months), my first thought upon waking in the morning is “Ugh, I’m still here.” I put off getting out of bed until I absolutely must. Fortunately, I have a huge sense of responsibility and sense of guilt when I’ve fallen short, so I usually am able to make my obligations. My very worst days are those that get neglected altogether and are spent in bed. I wake up long enough to eat something sweet, knowing that the sugar crash will soon put me back to sleep. I can literally spend days in bed if there is no one around to see it.
Assuming I make it out the door, I have an amazing talent at hiding my depression. People that I’ve worked with or even lived with have had no idea of my struggles. They have no idea that, as I laugh at their water cooler banter, I’m repeating what has become my mantra in my head: I wish I was dead. A simple sentence, but one which I repeat dozens of times per day. At this point, my sense of responsibility and guilt keep me from killing myself, but it doesn’t keep me from my passive hope for death.
It’s not that I never have moments of happiness. It truly brings me joy to be held by my boyfriend or licked by my dog. I love having family visit as much as I love seeing them go home. J The defining characteristic of depression for me is that the happy feelings are always fleeting, and the sadness always lingers.
I’m not very close to many people. It’s harder to keep my secrets, to hide my sleeping, to contain my anger with people who are around too much. Friends and family have expressed a willingness to help, but what is anyone supposed to say or do when someone they care about is talking about wanting to die? My boyfriend wants to bring me enough joy that it takes the depression away, but it’s not something that anyone can fix. When the depression cloud is around, no amount of love or money or anything else can bring me mental sunshine.
With each tap of the rTMS device, I pretend it’s breaking up my depression clouds. I hope it really is. So far, I’m still in dark places, but I remind myself that I’m only on day four.
Wednesday, November 30, 2011
Treatment Day Three 11/30/11
Today was not off to a banner start. I awoke with that old feeling of wanting to escape. Perhaps I could call Dr. Li and cancel my appointment, just for today? But I resisted temptation, and drug my butt into the shower and out the door, late enough that I had to drive rather than walk or bike.
I had a little bit of a headache after yesterday’s treatment, which is the most common side effect. Dr. Li said I could take pain relievers, but it hadn’t been bad enough to warrant that. After years on anti-depressants, I try to avoid adding any other pill to the mix even occasionally, out of resentment towards medicine in general. I should appreciate how much it has helped me, but instead I view it as a reminder of how defective I am.
When I start a new exercise program, the first day is usually great, the second day and has some soreness, and the third day is miserable. My rTMS seems to be following the same pattern. Today, the gentle tapping I felt two days ago now felt like a hammer tapping. It still didn’t hurt, per se, but it wasn’t exactly pleasant either.
After another thirty-seven minute treatment (37 is my favorite number, btw), I went on my way, feeling neither better nor worse. I checked out some local thrift stores to avoid going back to the lonely apartment (with no cable, I might add).
When I did return to my dwelling, I felt pretty good. I took only a small nap, mostly out of boredom. I looked at jobs some more, but realized that most of the seasonal stuff is already filled, and there isn’t much out there for someone from out-of-state looking for occasional work (Hello, I’m from Tennessee and don’t know anyone here. Would you like me to babysit your kid?) . Tomorrow I’m going to go to a temp agency that is looking for holiday banquet servers, which could be a nice fit. I decided against the jewelry store, mostly because they want lots of weekend work. That makes sense, of course, and I wouldn’t mind, except that I have friends and family coming to visit me during some of my weekends here and I need that more than I need $8/hour.
I went to the Laundromat later in the evening to wash my new thrift store finds, and to escape my four walls that started off as being so cute and have quickly become suffocating. I haven’t been to a Laundromat in years. They’re not any more fun than I remember (though they are a good place to blog, as I write this while my dryer spins), and I think they’re a lot more expensive than they used to be.
I sooo want to report amazing things, to say that I feel cured already. Alas, that is not the case. The doctors are very evasive when I ask how long it takes typically to see results, but they have said they’ll send me home at four weeks if I’m not seeing at least some improvement or earlier if I start doing any worse.
Treatment Day Two 11/29/11
Today had an amazing start. I was just awakening when my phone rang. I contemplated not answering, especially when I saw it was a number I didn’t recognize. Fortunately, my hatred of voicemail (and not wanting to have to check it later) compelled me to answer.
The person on the other end of the call was someone who I rarely hear from, but come away delighted every time I do. This call was no exception. She had read a previous blog post, and was calling to encourage and cheer me on.
During the call, she made me feel like I was being brave, not just for doing the treatment, but for sharing my story. She reminded me that all of us have some kind of issues we struggle with, but we keep them to ourselves. But knowing that others have it rough somehow makes the journey a little easier, so maybe we should all share a little more. She said it all in such an awesome way that I started feeling like a hero as I mulled the conversation over in the shower.
After I was clean, I checked facebook and my email, only to find more inspiring words. Some shared words of encouragement for my journey, others told me of their own battles with depression. If nothing else, I know that this treatment is already helping me by giving me an outlet to discuss what I’ve kept bottled up for so many years. I hope that helps others, too.
I decided to walk to treatment today. From my apartment, it is about two miles, and I always enjoy the quiet reflection I experience during a walk. I thought it would be most beneficial for my walk back, to process any icky feelings that treatment may dredge up.
When I arrived, Dr. Li informed me that some of the people from Cervel, the device manufacturer, were visiting. He asked if I minded them watching as I received my treatment. How could I say no, when I obviously was now a superhero and owed it to the world to share my journey?
Despite my earplugs, I was able to hear some of the conversation going on around me during my treatment. The Cervel folks had some questions about the placement of the device on my head. It went quickly and smoothly today, but Dr. Li explained that that was because we had spent time yesterday on determining my perfect placement. From now on, he just placed it based on the work he did on that first day.
At some point, Dr. Li showed them a hair cap, the kind used for home hair highlights. I couldn’t quite hear well enough to know what it was used for, but it sounded like perhaps some people have to wear it during treatment. All I can say is that I’m glad I no longer have the big hair I had in the 80’s, because it seemed like it would be used to minimize giant hair.
Dr. Li also told them that the device is set at 77% motor threshold for me, a percentage that varies with each person and is directly related to how much juice he had to put through the machine to make my hand twitch. Being the competitive person I can be, I wanted to know if 77 was high or low compared to most, but it seemed inappropriate to ask.
The Cervel people studied the device. They asked Dr. Li more questions. Interestingly, they had no questions for me. It seemed like, since they designed and built the device, they’d be more interested in my response to it than in its technical specs. I guess they assume that will all come out in the study results. Or perhaps they didn’t quite know how to say, “I’m sorry you want to kill yourself. I hope our device works. Mind if we ask a few questions?” Perhaps they were just being professional and I’m being overly-sensitive, something I’m prone to. Still, it made me appreciate Dr. Li’s small talk from yesterday, ear plugs and all.
On the walk home, I wasn’t giggly, but I wasn’t too down either. I was reflecting on just how aware I was that I am now a test subject, an object to be studied. I didn’t feel like such a hero now.
A man approached me, obviously mentally ill and probably homeless. He wanted to tell me about the birthday party he had had two years ago, and which took ten months to plan. He showed me a picture of his girlfriend of two years, nine months, and four days. We prepared to part, and he asked me, “Why are you walking? Are you exercising to lose weight?”
I knew the question was harmless, just as I knew that the Cervel folks weren’t intending to dehumanize me down to a test subject. He didn’t mean that I’m a fat, disgusting cow and they didn’t mean that I’m a freak to be studied. I knew that, but I didn’t feel that.
I went back to my apartment with familiar feelings rising within me. I wanted to escape how I was feeling, something that has led to dramatic actions in the past. I’ve learned a lot through the years, though, and just escaped through a long nap. Sure, I could have done better, like going for a run or giving myself a pep talk about how awesome and gorgeous I am. But I also could have done worse, and some days choosing to live is a victory.
After my nap, I knew I had to find something to occupy my time. When I’m busy, I don’t dwell as much about the bad thoughts. Staying occupied has been my primary coping mechanism for a number of years now. So, I went looking for a job. It’s always better to make money than to spend it, and that was the kind of productivity I needed: something that I was obligated to, not just wanting to do. I can decide to blow off an art class or a movie, but I have too strong a sense of responsibility to blow off a job.
I picked up an application at a jewelry store that was looking for holiday help. I don’t even know if it’s the kind of job I want, but it gave me an excuse to get cleaned up and out of the apartment. That’s really all I needed right then, just that reminder that I look decent when cleaned up and feel like a normal, competent human being out in the real world.
When I first started researching rTMS, I found a reasonable amount of scientific/medical information, but almost no firsthand accounts from patients. I hope that this blog helps soothe and reassure someone else. My experience probably will not be the same as anyone else’s, but at least they will know that “normal” people go through this kind of stuff, too.
To my morning caller who made my day, I’d love it if you’d send me the name and author of that book we discussed. I suspect it might be great reading during my time here.
Tuesday, November 29, 2011
rTMS Treatment Day One
Over the last week, I became increasingly tense about my impending treatment. Thanksgiving was an odd combination of family, anger, tears, and turkey. Did I mention I had to stop taking medications for the study? :) But, finally, the day has arrived.
I was on time for my 9am appointment at MUSC. As I am receiving rTMS as part of a study, I had to undergo more preliminary tests to build their research data. This included yet another drug screen (aced it), depression screening (which indicated that I’ve become even more depressed since my last screening two weeks ago), and a new test that was slightly evil. It tested my response times and cognitive ability. A few example questions:
Look at the following words and tell me the color of their print (try it, trickier than it looks):
Red
Green
Blue
Green
Red
Blue
Blue
Red
Repeat back these letters and numbers, saying the numbers first in numerical order and then the letters in alphabetical order (I didn’t get to see these on paper, they were just given orally):
DK4L8T (ANSWER: 48DKLT)
J97M2QX (ANSWER: 279JMQX)
Between tests, I had to wait in the lobby. There was an older man there waiting for his wife, who was undergoing a different treatment for a different condition. When I explained that I was there for magnetic therapy, he told me he knew someone who had had it done. I asked if it was successful, and he told me this story:
“This man was in his sixties, and had struggled with depression for most of his life. He had tried several medications and had even undergone a few rounds of electroshock therapy. Nothing worked. His mother, who was in her eighties, said her one wish was for her son to know happiness before she died. Because of magnetic therapy, her wish came true.”
Hope. That’s what it’s all about. Thank you, kind stranger. And thank you to all those who did trials before me that enabled me to be on this path now.
Finally, it was time for the treatment to begin. At least I could definitely say I was starting at a very low point, so any change should be noticeable. The screenings and tests had left me at my lowest.
First, the doctor had to determine placement of the device on my head by testing for a reflex response. When the device hit the right spot (on the front left side of my head), it caused an involuntary twitch in my right hand. This meant we hit jackpot. While looking for it, he apparently hit the wrong spot too, which caused my left hand to twitch so hard I could have knocked myself out with it. The body is creepy amazing.
I had to wear ear plugs for the procedure, though it wasn’t exceptionally loud. I would describe it as being about as loud as a washing machine is when it’s spinning off-balance. I couldn’t have any earrings or facial jewelry on. Otherwise, there was no prep required on my part.
I sat in a chair similar to those in dentists’ offices, leaned back to a reclining position. The device had two arms that came down from either side to form a teepee on my head (specific to the Cervel device, not all rTMS machines). They were padded and not uncomfortable.
Once the process begins, the device cycles between approximately five seconds of tapping and thirty seconds of inactivity, alternating between the two for thirty-seven minutes total. The tapping had two contact points on my head, with the stronger one at the spot on the left front of my head that caused my hand to twitch, and the second near the top center of my head, slightly to the back and right (again, specific to Cervel). They had warned me that the tapping may cause a headache, but I had no troubles. The pressure from the device was comparable to what I would experience from tapping on my head with my own finger, only much faster.
The doctor tried to make small talk with me as I went through the procedure, which was frustrating since I had in earplugs, had a mildly noisy device tapping on my head, and couldn’t move my head to try to at least read his lips or see his gestures. Still, the time went by reasonably quickly. He pushed the device arms aside, validated my parking, and sent me on my merry way. And “merry” it was…
I don’t know yet if it was the excitement of having finally started the procedure, at being done with the evil questions for the day, or if the procedure was already working. I just know that I felt giddy. Not just happy, I was actually on the verge of giggling. I’m not a giggling kind of girl, so this was exciting. The feeling lasted for an hour or so, and gradually faded, though I didn’t get as down as I had been before the procedure. It’s fairly typical for me to feel worse in the morning than the afternoon, though, so this left me with my usual afternoon feeling of not bad but not good.
rTMS works by activating neurons that aren’t firing. During the procedure, it gets them going, so it is actually possible that my great mood was from the neurons firing and, thus, the procedure working. Eventually, they went back to sleep until tomorrow's treatment. Ideally, the neurons will over time get used to being active and will start firing on their own, helping me to be more happy and less depressed.
I’m very excited about today’s events, but will remain skeptical until I see a more lasting effect. Stay tuned and follow the journey with me!
Monday, November 28, 2011
Adventures in rTMS
I have lived with chronic depression most of my life. Some of my other posts delve into the “why” of my condition, but this one chronicles some of my quest for healing. It has been a long journey, filled with a number of antidepressants in a number of dosages and combinations with little success. The meds kept me from killing myself, but not from feeling miserable about being alive. I’ve explored alternative treatments including meditation, acupuncture and herbs, all with no results. Then I heard about rTMS.
My journey to rTMS began a few years ago, when I first heard about it from my friend Angie. She had a friend who had completed the procedure through a clinical trial and had amazing results. I was intrigued, but learned quickly that it wasn’t offered anywhere in my area. It had also already received FDA approval, which meant that psychiatrists were now able to charge about $15,000 for the full treatment, a cost that generally was not covered by insurance.
Still, I learned all I could about the procedure. Repetitive Transcranial Magnetic Stimulation (rTMS) uses magnets similar to those used in MRI’s to stimulate neurons in the brain. In fact, it was the recurring mention of good moods reported by patients receiving multiple MRI’s that led to the theory behind rTMS.
I should mention that I have no expertise or formal training on this subject. The information I provide is based on my own experiences and interpretations, so be sure to research further on your own.
A company called NeuroStar is the only company currently (Nov ’11) FDA approved to manufacture the device for rTMS. I visited a psychiatrist in nearby Chattanooga and was able to see the device and learn more about it. It looked like a really high-tech hairdryer like those you would see at the salon. The participant sits down and the device is lowered onto his head. Treatment takes less than 45 minutes per day, but must be continued for five days per week, for four to eight weeks. It is outpatient, requires no anesthesia of any type, and can be done before work or on your lunch hour (no driving restrictions after treatment). Pretty convenient if you have $15,000 and live near one of the few cities where treatment is offered. I don’t meet either of those qualifiers.
I heard more about rTMS this fall at a NAMI convention. There was a representative from NeuroStar there to answer questions, but I already knew all the info he had to share. What caught my ear was when a PhD from Vanderbilt spoke about rTMS as the direction that mental health was heading. He had no financial gain for the treatment, but was still endorsing it. He also mentioned that other companies besides NeuroStar were conducting clinical trials to test the procedures efficacy on other conditions such as bipolar disorder, post-traumatic stress disorder, Parkinson’s disease and more.
Ah! More companies! More clinical trials! Clinical trials mean free treatment in exchange for being their guinea pig. I returned to research mode, and was met with success.
I visited www.clinicaltrials.gov, a comprehensive website of all clinical trials seeking FDA approval currently being conducted. Through its handy search features, I was able to identify all clinical trials investigating rTMS to treat depression. Though NeuroStar had received FDA approval, any other company wanting to manufacture a similar device had to go through the same process.
I emailed every university doing the study. I realized that taking six weeks of medical leave from work and paying for travel and housing would still be considerably less expensive than paying $15,000 out of pocket for the treatment, so I was willing to go anywhere that would take me. Fortunately, the Medical University of South Carolina (MUSC) responded, and they were one of the few locations within driving distance to me.
MUSC started with a phone screen. They asked me uncomfortable questions about my history, medications, suicide attempts and any other awkward topic they could think of. I had mixed emotions when I learned I was screwed up enough to make it to the next phase of screening.
MUSC had me come to Charleston for my next screening. They had to see me in person, and probably wanted confirmation that I was serious about my willingness to travel for the study. Apparently, they had a lot of interest in the study, but few who actually followed up with screening and commitment to the study.
At the initial screening, I was provided with lots of information about what it meant to participate in a medical trial. All my treatment would be provided at no cost. All my results would be confidential. I had a 50/50 shot of receiving a “sham” (placebo) treatment. Zoiks. Did I want to give up six weeks of my life for a sham?
Since I was in Charleston, I figured I’d see if I qualified before I decided if it was worth the gamble. I completed three hours of interviews, asking more details about the most intimate details of my life. I had drug tests and pregnancy tests and blood tests. I felt more alone than I had in a long time, and definitely could tell I was a part of an experiment in a science project.
I left, feeling depressed but hopeful about the study. The multiple researchers who had interviewed me had to convene to discuss my viability for the study, and would let me know the next day if I was in. The drive back to Oak Ridge was long and reflective. I was filled again with self-loathing, hating that my life had gotten so out of control that I was willing to be a test subject to try to get help. It felt like selling plasma to pay the bills (which I’ve done before, too). You do what you have to do but it doesn’t always fill you with pride.
The next day, I got the call. I didn’t qualify for the study. That really left me feeling low, believing I was too messed up to qualify for a study about messed up people. My disqualifier was that my last suicide attempt had been within the last five years, which put me in a high risk group that wasn’t allowed to participate.
The guy at MUSC told me that there was another study that I might qualify for that also involved rTMS. This one didn’t have the suicide disqualifier and, better, it didn’t have a sham treatment. I was guaranteed to receive real rTMS. The distinction in this study was that it was testing having two contact points on the device versus four contact points. Essentially, it was testing whether the magnets worked better when directed at two spots on the brain or four.
I was intrigued but afraid. My previous screening had hit me hard, and I didn’t know if I had the strength to go through it again, especially with the chance to be rejected again.
I had a work meeting later that day. I work in mental health, so topics relevant to my own struggles are often discussed. That day’s meeting was about hope and recovery and resiliency, themes that run strong in my work but are sometimes forgotten on a personal level. Though I was there professionally, everything that was said hit me personally. I knew I had to continue to have hope, and for me that meant doing the study.
I had to take another trip to Charleston (14 hours roundtrip) for another screening. I had to answer more questions, dredge up more horrible memories, pee in a few more cups, and wait another nerve wracking 24 hours to find out if I was in.
It paid off. I made it into the study. I would start in two weeks, right after Thanksgiving. All I had to do was rearrange my entire life for six weeks, find a place to live in Charleston, and explain to everyone that I was disappearing for a while to try to stop wanting to die. No sweat. Let the adventure begin.
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