Happy Equinox, SAD sufferers!

Today is the first day of Spring, and one of the two days of the year when day and night are of equal length.  From here on out -- until the Summer Solstice at least --  there will be more daylight than darkness.

Spring is always a time when I have a lot of energy to get things done.  As it is, I've felt dramatically better since Daylight Savings time.  There's something about that extra hour of daylight in the evening that improves my mood and productivity.  I love DST and I wish they'd do away with standard time altogether.

Happy Equinox, and Happy Spring!

Lamictal 300 mgs: Travel, Light Therapy, and Delayed Sleep Phase

If you follow my blog, you know that lamictal messes with my sleep.  If left to myself, I would sleep from three a.m. to 11.  I'd be completely out of sync with the world.

And indeed I was out of sync for months.  This changed when I started using a blue light in the mornings.  Pretty soon I was getting up around 9:15 all by myself.  No alarm, no struggle.

Then, I went out east to visit family.  And getting up became a struggle again.  I could usually make it out of bed by 9:30 or 10, but this required an alarm at 9:15 which I would then ignore for as long as I could.

Then, I stayed up all night for my Solstice vigil, and watched the sun rise.  Suddenly, I was getting up at 8:30 ... again, without an alarm.  For a confirmed night person this was a bizarre experience.

Fast forward to last week.  I was in the Midwest, visiting family.  I dutifully did my light therapy every morning, but didn't adjust my body to the time zone.  My family are all night people, and Pacific Standard Time is two hours behind Central Standard Time, so instead of sleeping from midnight to 8:30 I slept from 2 until 10.  I should have had no problem getting back into my groove at home, right?  I hadn't changed my schedule at all.  I would go home, and my body would still be on PST.  I'd go to sleep at midnight and wake up at 8:30.

But no.  Now I'm once again struggling to get up at 9:30 or 10.

I guess the position of the sun really matters (as if I hadn't figured that out by this point).  I may have thought I was keeping my body on PST, but I was getting up when the sun was in it's 10 o'clock position.  And that was enough to hose me.

I guess I need to stay up and watch a sunrise again.  Sigh.

Lamictal 300 mgs: Down and Depressed

OK, partly it's because it's been gray and cloudy and gloomy.  But mostly, I've been slipping back into feelings of helplessness and hopelessness.  I feel like there's no part of my day that I enjoy.  I feel like I'll never get out of the hole I'm in career-wise.  I'll turn 37 this year, and in spite of all the hard work I've done -- and I mean really hard work, I'm still cripped by mental illness by learning disability.

And RSI.  Did I mention I have RSI?  Yeah.

Happy Solstice, Seasonal Depressives! We made it.

Today I wanted to wish all of you a happy shortest day and longest night.  The sun us is as far as it's going to get from the Northern Hemisphere.  It's all uphill from here.

Of course, for many people there are blizzards and snowstorms to come, and cabin fever, and the grey-brown misery that is February.  You know, I think the only thing I like about California's non-seasons is that February, though often gray at least part of the time, is always green.

We'll still need our sunlamps.  We'll still need to be gentle with ourselves and vigilant about self-care.  But the sun is returning, and bringing with it mood and sanity.

I wish you all the happiest of Solstices.  Remember -- axial tilt is the reason for the season!

Choosing an SAD Therapy Lamp: New Article on Squidoo

Yesterday I finished an review of light therapy devices I wrote on Squidoo.  I really enjoy the Squidoo community and I don't write there enough.  I figured that since I've been learning so very much about different therapy lamps for seasonal depression, I should share my experiences, and my frustrations, with the world.  The article goes into more depth than I have in this blog.

Please check it out!

How to Celebrate a Psychoversary

A glass of red wine, and the Hallelujah Chorus played nice and loud.  Then played again, only singing along this time.  In a pretty half-assed way, to be sure, because I was sight-reading and not all of it is easy.

Nonetheless, singing Hallelujah.

Happy First Psychoversary to Me!

I've made it past the one-year mark of my first (and worst) psychotic episode!

I know that I've been doing better this year -- no delusions in October that get progressively worse through November -- but I've nonetheless been very apprehensive about early December.  That's when it all hit the fan last year.  That's when I had to start covering things in foil.  That's when I went on Abilify for the first time.  And it wasn't as an "add-on treatment for depression", and it wasn't as a mood stabilizer like this year.  It was an antipsychotic.  I was taking it to control my psychotic delusions.

I've still been moody as hell.  The lamictal has helped a lot, though clearly not enough; As I've titrated up, my mood has risen and stabilized, only to fall and destabilize as the sunlight decreases.  But I haven't had a single delusion.

I received my diagnosis of psychotic depression one year ago today.  Passing this milestone feels huge to me, like I can begin hoping for a full recovery.  I feel like I deserve to celebrate!  Any ideas how one celebrates a psychoversary?  Please, please share in the comments.

Phillips GoLite BLU, and How to Use It.

A few weeks ago, when I was particularly frustrated my life revolving around my sun lamp (oh I do crack myself up sometimes), my partner got me a Phillips GoLite BLU Plus.  It's battery rechargeable, has a clock and a timer ... generally more portable and convenient than my sunlamp.

The point: Follow the directions.  If you have trouble falling asleep at night, use it in the morning.  If you have trouble staying up at night, use it in the afternoon.
 
I decided to ignore the directions.  I figured that since my mood slumps between 4 and 8 pm, that's the time I should use the blue light.  It helped, insofar as it freed me up from my desk long enough to lift weights, do my SPCA shift, make dinner, that sort of thing. 

I now think that  using it in the afternoon was perhaps ... unwise.

Blue light is a tricky thing.  It can help with seasonal depression, but it's not necessarily a good thing for bipolar disorder (and whatever my disorder "really" is, it acts a lot like bipolar in some ways).  Folks with bipolar can be tipped into hypomania or mania if they get too much blue light.  For that matter, anyone using too much light therapy can experience headaches, nausea, and irritability.

And if you use it too late in the afternoon, you'll have trouble falling asleep.  Remember my delayed sleep phase?  Course you do.  I emphatically do not need help staying awake at night.

The upshot is that yesterday I used the damn thing for an hour in the morning.  This morning I woke up on my own at eight frakking thirty  Yeah.  8:30.  Me.

I had a bit of trouble falling asleep last night, but when I slept I slept well.  The sleep issue could well be due to the Adderall I took in the morning to alleviate my crazy mood.  I'm writing in front of it right now, so we'll see how it goes in the coming days.

I wrote yesterday about my mood lability over the past few weeks.  My pdoc and I had tried to address it with an Adderall booster in the afternoon -- it made my afternoon depression go away, but it also messed with my sleep.  Then I tried taking the Adderall booster in the morning.  It still helped, but not as much, and it still messed with my sleep.

Lamictal 300 mgs: Plus 2 mgs Abilify, minus 5 mgs Adderall

The short version: my mood has been all over the place for the last week and a half.  My pdoc had two options.  Number 1: Go back on 12.5 mgs of Zoloft, which would numb me out a bit, and shouldn't give me SSRI problems because they'd be tempered by the lamictal.  Or, number 2: go back on Abilify for the short term at a very low dose; I'd still feel my feelings, but I won't be reduced to tears over stupid shit.

In other words, the lamictal is helping a lot with the depression, but it's not stabilizing my mood as much as it needs to, and it needs help.

We decided to try Abilify first. We know from past experience that it will work immediately.  I also think it's important to feel my feelings; I just need not to be completely overwhelmed by them.  I feel pretty good about this.  I can start it tomorrow and stop crying like an emo kid.

We're also removing the Adderall from my cocktail.  After two weeks it's clear that while it does help my mood, it doesn't help enough.  It also wreaks havoc with my sleep.   Unless I can be sure to squeeze in some seriously vigorous exercise, and I can't always do that, and messed up sleep equals messed up mood.

A few words about my mood lately.  At some times I'm feeling really good, almost too good, and for no particular reason.  Then if I'm triggered (or sometimes when I'm not), I crash and crash hard.  I start sobbing and simply can't talk myself down, let alone stop, for several hours.  When I finally do, I last about ten minutes before I start sobbing again.

What do I mean when I say "stupid shit"?  Well, let me tell you about the day after Thanksgiving.  We like to cook our own small turkey, because we like to do things with the leftovers.  But, unbeknownst to us, the turkey was partially frozen.  It probably was up against the side of the refrigerator case or something.  Anyway, it took all afternoon to cook (way too long for a 12 lb turkey, so I was already crying about that).  Then we cut into it, half of it was raw.

The rational side of my brain, and my husband, told me that this wasn't my fault, and that we could just use the turkey for stock, so it wouldn't be a total loss.

The crazy part of my brain was in tears because I'd wasted all day and my husband was sick so he couldn't help me cook so we hadn't spent time together and he was leaving the country the next day AND I RUINED THE HOLIDAY!

Don't even ask what happened when he returned from his trip and didn't immediately give me a hug.

I can't be crying so much that it interferes with my life.  And with my husband probably also being depressed, I can't be triggering that feedback loop where does something without knowing it will upset me, and then I start crying, and then he feels bad for upsetting me ... and gets stressed ... and I feel bad for stressing him out, so I cry more ... and he withdraws from me emotionally ... so I get more upset ... and the cycle begins anew.

To wrap up: Abilify.

Oh Yeah, My Mood Action Plan

My experience the other night made me remember that I'd created a Mood Action Plan back in the day.  I've printed it up and posted it above my desk/studio table.  I've already acted on some of them -- namely those that deal with my daily mood crashes:

• Troughs or crashes in mood between the times of 4 and 8 pm become more frequent
• Troughs or crashes in mood between the times of 4 and 8 pm become worse (tearfulness, paranoia about relationships, pessimism running to despair)
• Troughs or crashes in mood lengthen beyond the 4 to 8 pm range

All three of these symptoms are occurring, a fact to which I have alerted my pdoc (which was action number 1 on my Plan). We're trying an Adderall booster in the early afternoon, but it's proving to be problematic for my sleep if I don't get in some vigorous exercise during the day.  And I do mean "vigorous". It has to be weight training -- going for a run don't cut it.

Lamictal 300mgs: Nearing My Psychoversary

It was last year at this time that things started to get really bad.  I felt OK during the sunny days, had low energy during the cloudy days.  Once it hit 4 pm though ... then The Thoughts started coming.  They went something like this:

There's not enough light in the house.  There's not enough light in the universe! But if I turn on all the lights in the house, I can keep it from tipping into the darkness.  

So ... darkness somehow "weighs more" than light?  That doesn't make any sense; how can darkness "weigh" anything?  It doesn't; it just doesn't.  

On the other hand ... I the dark, cavernous maw in the other room is sort of bugging me. All right, I'll humor myself, I'll turn on every damn light in the house.

And then, as the weeks wore on:

Lamictal 300 mgs: Dark Thoughts

Several months ago, I wrote about why I didn't realize my depression was worsening: because I was nowhere near The Pit.  Like a lot of depressives, when I get depressed I feel like I'm falling, as if I'm circling a dark pit, as if I'm falling into it.  Or at least I used to.  Before my psychotic episode I had no such feeling, and it didn't occur to me that I was headed for trouble.

I've been at a loss to describe what did happen to me last year.  But last night I had just a brief glimpse of it.  This horrible feeling welled up for a few minutes, kind of like what happened last year but nowhere near as serious ... it felt like ... like ...

It felt like I was being engulfed by a wave of devouring darkness.  It's not falling into The Pit.  Trust me, they're totally different.  Believe me, the devouring darkness is worse.  But this being me and all, I felt better immediately when I could assign a dramatic metaphor to what I was feeling.

And yes.  If it happens again, or lasts more than five minutes, I'll be calling my shrink.

My Pharmacoepia

Just for fun the other day, I decided to compile a list of all the medications I take.  Here they are in all their scary, scary glory.

Morning cocktail:

• Lamictal, 300 mgs (mood stabilizer)
• Vyvanse, 70 mgs (long-release amphetamine to treat ADD)
• Claritin, 10 mgs (anti-histamine)
• Nasacort, 2 puffs each nostril (corticosteroid to keep my sinuses and ears from inflaming)
• Singulair (leukotriene inhibitor to prevent asthma symptoms

Midday:

• Adderall, 5 mgs  (used as an amphetamine "booster" to treat late-afternoon mood slump)

Bedtime: 

• Ativan, 1.25 mgs.  

Monthly:

• My good and dear friend, the Nuvaring (birth control)

As Needed:

• Q-var (corticosteroid for wheezy asthma -- I pretty much have this for emergencies)
  
• Abuterol (corticosteroid for acute asthma attack -- I need this even less often than the Q-var)
• Phenlyephrine (decongestant that is MY BEST FRIEND, because I can't tolerate Sudafed; for the longest time there were no other decongestant options out there, but phenylephrine was released because you can't cook meth from it.  Thanks, crystal meth epidemic!)
• Advil (If you don't know what this is, you live under a rock and probably don't have internet anyway)
• Booze (for fun.)

My poor liver.  My poor, poor liver.

 

Lamictal! Adderall! Ativan! The Musical!

In yesterdays post I wrote about feeling tied to my sunlamp for most of the day.  This is particularly bad during the late afternoon during my usual 4pm to 8 pm slump.  It's seriously cramping my style.

I saw my pdoc recently, and he was concerned about the slump.  He wants to try other things before raising the dose of lamictal.  It which seems fair enough. 300 mgs of lamictal is as high as they usually go to treat mood disorders; 400 mgs and upwards puts you into anti-convulsant territory.

So his suggestion is to take 5 mgs of Adderall XR in the afternoon.  Great.  Another drug.  I wasn't already feeling like my pee could be sold as a street drug that "will really make you trip, man!  This stuff is primo!"

Hmmm.  Maybe there's a profit to be had there ...

Yesterday was the first time I tried the Adderall booster.  It definitely helped my mood, but I slept like crap last night.  I was exhausted, and hope to sleep like a baby.  As I sometimes (OK, all too frequently) do these days, I had two drinks to make damn sure I would sleep well.

Your Recommended Dose of Irony: My Sunlamp is Depressing Me

In case you haven't read any other post on this blog, I have severe seasonal affective disorder.  Now, you're asking yourself, how "severe" can seasonal affective disorder really be?

It can be SO SEVERE, that's right folks, SO SEVERE that one can become actually psychotic due to lack of sunlight.  (I've written about it here, here, here, and here.  Also, on a lighter note, here.

Since I don't want to wind up psychotically depressed again, I sit in front of a sunlamp.  A lot.  My sunlamp is in my brightly-lit art studio, which also has full-spectrum lighting.  It's very bright in here.  Which is good.  It helps me.  But it's also getting kind of old.

I need to sit by the sunlamp in the morning, so I do that while checking my email and blogging.  Then I get distracted by checking my email and blogging ... and besides, I just feel so much better when I'm by the lamp.  So I'm here at 9:30 or 10 every morning, eating breakfast and messing around on my computer.  I do that for a couple of hours.

Then, I have to be back in front of the sunlamp when it starts to get dark.  My mood slumps, sometimes severely, between the hours of 4 and 7 pm.  Now that it's getting noticeably dim by 3:30, I have to be here by that point, or the dreaded slump begins.  On days when it's rainy and dark I just park myself here and stay all day.

The problem is that it gives me no flexibility in my afternoon schedule.  Having lunch with a friend from 1 to 3?  Can't stay an extra hour.  Can't run errands afterward.  Can't come home and exercise -- nope, need to sit in front of the damn lamp.  And it's not like I can move the lamp; I need to be in my studio, where it's generally bright, or I start to slump.  Anyway, having a light that emits 10,000 lux seriously strains your eyes if it's all up in your face in an otherwise not-brightly-lit room.

Lamictal 300 mgs: My First Really Bad Day

Yesterday sucked.

It began with a bad dream.  If you don't want to read my whole long post about it, suffice it to say that the dream involved betrayal, abandonment, rejection, and a package tour.  Horrible.  It affected me more than my dreams usually do, probably because it was so obviously about my deepest fears vis a vis my current situation, and I began my day slightly depressed.

When I hit my usual trough of 4 pm, I felt much, much worse.  Lately my troughs have been pretty mild.  I'll feel a little down, or a little less energetic, or both; however, yesterday was the first day in a long time that I've landed in the depths of despair.

I don't know what could account for it.  I'd been up late the night before, and therefore up early the next day, but I've done that before without suffering such consequences.  I'd skipped my sunlamp the night before -- this seems like a pretty likely factor.

Lamictal 300: Depressed Mood and a Really Bad Dream

This morning I'm fighting sadness and a depressed mood.  I've taken my meds, I'm eating breakfast, I'm sitting in front of my therapy lamps like a good mental patient.  But still depressed.

My mood trouble was brought on my a bad dream, which is unusual for me.  I have plenty of dreams that are weird or scary; lately I've had a long string of them in which, despite the varied content of the rest of the dream, I am escaping a city on fire.  Rarely do they continue to bother me after I wake up.

I think this one is a problem because it hit a little close to home.  My biggest fear is that I will be rejected for my mental health problems.  Maybe my friends will be scared or uncomfortable and stop talking to me (they haven't).  Maybe my partner will leave me because I'm just too crazy (he hasn't).  Or maybe word will get out somehow, and I'll be judged by strangers -- people will look askance, mothers will pull their kids close to them as I walk down the street, and I'll never find work again!

Yes, I have a dramatic imagination.

In my dream, I was in some sort of group (in jail?  On a package tour?  Both? I couldn't tell) and a good friend of mine was there.  The guard/tour guide (who was armed) announced that since I had been psychotic he would have to bound hand and foot to a metal bar.  I was tied up in dead lift position, bent forward with my ankles and wrists shackled to a bar in front of me, as if I were about to do a dead lift with a barbell (this at least makes sense since my dead lift form has been kicking my ass lately).

But how had the guard known anything about my mental health history?  I didn't know any of the other people in the group ... I looked around and realized my friend Kris was there.  She avoided my gaze, as if guilty and frightened.  She had ratted me out.  She thought I was dangerous.Then the group was led onto a passenger train.  I was still ted up, but thanks to Dream Logic could nonetheless move around comfortably, so I found my friend and asked he why she had told the guard something so private.  She looked away and told me that she thought I was unpredictable, possibly violent, and that he needed to know about me.  It was for the safety of everyone else in the group, she said.

In keeping with more Dream Logic, our friend Janet suddenly showed up out of the blue.  Janet is a doctor, and had also been told of my condition; she asked me a bunch of patronizing questions and responded to everything I said with patronizing half-answers.  I tried to explain that I'd only had one episode; it was almost a year ago; I had posed no threat to myself or anyone else.  She smiled condescendingly, as one would to a child, and told me it was for my own good.

The passenger train passed by a number of beautiful old stone buildings with the windows bricked in.  The tour guide explained that they were abandoned.  Nonetheless, someone had taken the time to make lovely, intricate Celtic knots with the brickwork.  And belying his statement that the structures were abandoned, we passed a building where one floor had people living on it -- and they were being evicted so the windows could be bricked in.

At the end of the journey we came to a swimming pool that reminded me of some of the beautiful public baths from the late 19th century.  This image of the Sutro Baths in San Francisco show the slides, the diving boards, and some of the seven different pools -- one fresh water, six salt water -- that were kept at different temperatures.

Image courtesy of efliv's Flickr stream, shared under CC license

 

Despite my protests that I had spent years on the swim team, that I had worked for years as a life guard, that I had in fact taught aquatic safety to numerous Girl Scouts, my friends wouldn't let me swim.  The proprietor told me it was "for my own good".

300 mgs of Lamictal, Week 1: From Delayed Sleep Phase into Somnolence

I am now up to 300 mgs of lamictal, what I hope will be a therapeutic dose.  I know that higher doses are used to treat epilepsy -- lamictal was first developed as a anti-convulsant -- but I have no idea whether there are problems if they're used to treat mood disorders.

Fortunately, my mood seems to be pretty good so far.  On the other hand, my mood has improved every time I've titrated up, only to sink again as the days continue to get shorter.  On the other other hand, my daily dip has seemed to even out somewhat, which I figure I can take as a good sign.

My first week at 300 has also changed my side effects dramatically.  My delayed sleep phase is simply gone -- I get sleepy at 11:30, fall asleep around midnight, and usually wake up around 9.  On the other hand, sometimes I sleep too much, until 10 or 10:30.  Nine hours of sleep is what I need to function well.  Ten hours is unusual.

The GI effects that I bitched about so much have also vanished completely.  They came on suddenly at 150 mgs, and continued through 200 and 250.  At 300 they just disappeared.  Yay!

"Falling Back": SAD, The Return to Standard Time, and How I Survived It

On Sunday, the clocks officially got turned back by an hour.  On the plus side, an extra hour of sleep.  On the minus side, the sun sets an hour earlier.  And on the double-plus minus side (ha! see what I did there?), at this time last year is when I really began to lose it.

I was at home in Minnesota for a family wedding a year ago.  My visit had been great.  We'd had a lovely, late Indian Summer*.  The days were balmy -- I didn't even need a coat most of the time -- but the nights were cold enough that frost was forming on the ponds.  Since we've all grown up, the younger family members and friends have scattered all over the country, and all over the world.  Most of us (not me) have demanding careers.  We hadn't all been in one place since my brother graduated from high school ten years before.

After the wedding reception we set our clocks back (which, I'm just now realizing, means the happy couple added an hour to their wedding night ... clever!).  The next day we had a nice post-wedding brunch at one of the bride's parents homes.  And when we started home at around 4:30, and it was already dusk, I thought, bleahhh ...".

Lamictal 200 mgs: Two Weeks, and Still Not Stable

I realized today that it's been awhile since this, my mood diary, has included writings about my actual mood.  Mostly I've been bitching about side effects.  Because they've really sucked.

It's been two weeks since I've titrated up to 200 mgs of lamictal.  My mood was higher, and more even, for the first few days ... and then it rained for a few days.  The days got shorter.  My mood started slipping, and my late-afternoon troughs returned.  I'm still at a point where waking up to a cloudy day, or hearing something that's only a little sad, can leave me depressed for the rest of the day.  I'm seeing my shrink today, and planning to ask him if we can raise my dose.

But.  The last two days have been pretty good.  I think.  Maybe.  Too good?  Maybe.

A few nights ago, I stayed up until 4 am reading Tina Fey's book, Bossypants, after staying up until 2 am watching Voltron.  It was hilarious.  So was Bossypants.