Monday, August 1, 2011

Still More About Psychotic Depression: Why I Didn't See It Coming

My psychotic depressive episode happened after several fairly stressful months.  When it happened, and in the months since, I've been blaming myself -- I knew I was getting stressed!  Why didn't I take better care of myself!

The stress involved money and employment.  Early in the year, my husband had taken a job at a startup that entailed a significant pay cut.  To make a long story short, I had believed that I would be able to make up at least some of the lost income, and it turned out that I couldn't.  My husband's job is far from where we live, and he was trying to make a go on public transit, but the time this took was truly ridiculous.  He was getting stressed and snappish.

I was also getting stressed.  I could see my thoughts heading into depressive territory: I'm just unemployable.  I'll never find work.  How did I think I could find work, with my spotty work record and 10% local unemployment?  Who in their right minds would hire me? Et cetera.

But I did some CBT on myself.  Thoughts are not facts.  It's normal to feel frustrated.  Job hunting is hard work.  You're getting a good response rate on your resumes and cover letters, and it's only a matter of time before one of these interviews turns into a job.

And indeed, one of the interviews turned into a job.  A job that vanished after two weeks, because the company was banking on a deal with a major client that fell through.  Yeah, my hard work and persistence sure paid off.

What could I have done to minimize this stress?  What could I have done to avoid my psychotic break?

Last week, I suddenly realized: there was nothing I could have done.  Why?  Because I was nowhere near The Pit.

Dealing with my mental illness has been all about navigating The Pit.  Medications were about giving me a ledge from which I could climb out of The Pit.  Therapy was about learning how close I was to The Pit, what I could do when I was in danger of sliding into The Pit, and eventually, how to avoid sliding into The Pit in the first place.  Once I'd figured out how to do this, I was more or less in recovery from depression.

In the weeks leading up to my psychotic episode, The Pit was nowhere in evidence.  It is true that I asked my doctor to raise my Zoloft dose after my job dissolved.  I remember closing my eyes and thinking, This isn't bad, yet.  But it will be.  Nonetheless, I wasn't close to circling The Pit.  I just knew I needed to keep it that way.

I went from 12.5 mgs of Zoloft to 50.  At this dosage, it sapped my energy and motivation, so I dropped down to 25 mgs.  External stresses eased somewhat.  There were several weeks of warm, sunny days.  I felt good.

I felt good as I started to have mild delusions about photons tipping the house over and letting the darkness wash over everything.  When a helicopter hovered very low over my parents house late at night while I was visiting, and I had the odd sensation it was hovering over my parents' house specifically, and then that it followed me down the street when I went outside to check it out, I wrote it off.  Because I felt good.

The Pit didn't appear until a several days before my psychotic episode.  Then, it opened up and swallowed me on a pretty much daily basis around 5 pm, and spat me out again by 8, after a few hellishly bad hours.  Then, I'd feel OK again, as I would during the day.  A few days before the 'sode, I tried bumping my Zoloft back up to 50 mgs.  It seemed to have no effect whatsoever.  But I'd be seeing my pdoc the following week anyway.  I could live with it until then.

The psychotic episode, when it came, was not exactly "mood congruent".  With depression, psychotic episodes tend to take the form of irrational guilt, such as feeling responsible for events that can't possibly be their fault, or having unreasonable fears of terrible physical illness.  Me, I was deeply and personally worried about entropy.

All of this raises some serious questions going forward.  Is my diagnosis correct?  Right now, it's major depressive disorder with psychotic features.  In the past, it's been major depressive disorder or dysthymia.  However, the fact that my depression clearly cycles may indicate that I have a bipolar illness.  The second question is related to the first one.  What are the symptoms I need to watch for in order to avoid this in the future?  Clearly, it's not all about avoiding The Pit anymore.

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