Sunday, July 24, 2011

More About Psychotic Depression

There doesn't seem to be a ton of information out there regarding psychotic depression.  What there is doesn't seem to be too helpful.  I'd really like to find out what the course of the illness is (or usually is) so I can understand what happened to me and intervene before it happens again.

The tricky thing about what happened to me last winter is that my mood had not been getting seriously worse.  At least, not most of the time; it was much worse than usual, but only in the late afternoon and early evening.  This is usually a low point for me in terms of energy, if not mood, so it wasn't too surprising.  I also have seasonal issues, so it wasn't surprising that my mood was worse in general.

When I presented my psychotic symptoms to my doctor, he said that I was surprisingly functional (possibly one of the reasons I avoided the hospital?), because most psychotic depressive symptoms happen in patients who are so depressed that they're having trouble getting out of bed and caring for themselves.  And indeed, during the morning, early afternoon, and late evening -- and for that matter even during my crashes -- I could move around and do things.  In fact, I felt like doing things.  I needed to move around; I wanted to distract myself.

In the few days before my psychotic symptoms appeared, my evening mood was noticeably worse.  I cried nearly every night.  I was sure that my life was falling apart.  I was sure that my marriage was falling apart -- after all, I hadn't talked with my husband in a week.  Why hadn't we talked in a week?  Well, he was travelling all over Europe, and staying in a different country every night!  There were times I'd get emails from him letting me know that he'd just arrived at his latest hotel room, and the time stamp would be 3 am where he was.

When I came out of my crash, of course, I would be able to accept this as the explanation, and feel silly for getting myself worked up.

I certainly noticed that I was getting paranoid about my marriage, and planned to tell my psychiatrist at my upcoming appointment.  Maybe I should get a light box for my seasonal problems.  Maybe there was something else we could do short of raising my dose of Zoloft, which would only cause that weird combination of anxiety and sedation that it does for me.

In hindsight, there were clues that my thoughts were becoming irrational, but they didn't bother me because at the time my mood was fine ... even in the evenings.  Throughout October, as the days got shorter, I noticed that I wanted to have all the lights in the house on.  We have a main room and a kitchen downstairs, and I had the persistent thought that if the lights in both areas were not on, that the house would become overbalanced.  The light part of the house would start to tip, and all of the darkness from the other room would come rushing toward me.  Turning the lights on in both rooms kept the photons in balance.


In spite of my arts background, I am more or less scientifically literate.  I know that photons, being light particles, are made of energy, not matter, and they do not have mass at all.  They cannot therefore "weigh less" than darkness.    But the thought was persistent, and caused enough distraction and anxiety that I just turned the damn lights on so I could go about my business.

I'm an artist with a rich spiritual life, so I do "irrational" things all the time: this piece "doesn't like" that color, so I'll change it.  Having that piece of furniture there "blocks the energy" in the room, so I'll move it.  My ancestral spirits "want" an offering of bread and salt.  I recognize that these things are all true on an emotional level, not a rational one, but that's OK because the rational level isn't the only one that counts.  I put my worries about photons into this category of events, and went on with my life.

My explanation for what was happening went like this: I was well aware that the crappy weather in 2010 was having an impact on my cognition and my mood.  I hadn't gotten my dose of sunlight in the Spring, so I hadn't shored up my mood and energy, and I knew winter would suck as a result.  I decided that my thoughts were a "natural" response to these facts.

In retrospect, since my psychotic break involved a terror of photons being devoured by the universe, this persistent thought pattern was almost certainly prodromal (a fancy Greek word denoting the time before an illness becomes symptomatic).  But how do I tell the difference between an irrational creative or spiritual thought, and an irrational precursor to psychosis?

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