Archive for December, 2012


Drugs

I talked with my therapist yesterday about my meltdown last weekend and the social anxiety thing the week before. She’s convinced me to bump my meds back up to 150mg.

Honestly I had forgotten that I’d gotten my MD to decrease the prescription for me however many months back. I’m sure I deliberately blocked it, not wanting to even consider the possibility that undermedication might be the cause of my 6+ month slump. But she convinced me, so now I’m back up to the ol’ 150 until further notice.

That’s all for now.

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First big depressive breakdown I’ve had in… quite a while, I think.  I’m sure I didn’t think to chronicle them all here or I’d go back and check.  But I can’t remember the last time I cried so hard or gnashed my teeth so much, straining to burst out of myself because being myself felt so unbearable.

I know I’ve been in kind of a dip lately, the last month or so I’d say.  But this is something of a troubling development.  It makes me afraid to trust myself, afraid to trust any progress I might have made or might make down the road.  Because what if it all culminates in another degrading fit of wailing, simultaneous self-pity and self-loathing.

I should have trusted my judgement and just gone home when I initially thought of it.  But this frame of mind isn’t really conducive to good choices.  I guess I was already too far gone, I don’t know.

But in the interest of getting back on the horse, so to speak, I am going to start making myself meditate again.  As with most things, my meditation has kind of petered out, and so any chance I might have had for real awareness of what was going on in my mind was probably minimized to the point of impossibility.

I do feel sorry for myself.

But as I awoke this day feeling at least moderately refreshed I find myself believing that I can probably survive another day, another week, another year.  I just have to take it at my own pace, pay attention to what my mind and body are saying and Do. Not. Overdo it.

Must not be disheartened.  Must have hope.  Must move forward.

Sexuality

Wasting time on Wikipedia one day not too long ago I came across the concept “hyposexual.” More specifically it is “Hypoactive Sexual Desire Disorder,” a bona fide sexual dysfunction (as per the DSM-IV) “characterized as a lack or absence of sexual fantasies and desire for sexual activity.”

I made a note to myself to bring it up with my therapist when I see her next week.

I have sometimes wondered if my sex drive is defective in some way. Clearly I’m capable of having sex and even marginally enjoying it, but I don’t fantasize, don’t enjoy masturbating, don’t really get horny unless I’m actually physically engaged with someone or the odd occasion where I find myself reading smut online.

I have speculated that my sexual development might somehow have been stunted due to the antidepressants I was taking all through puberty. After all, if they are known to decrease libido, isn’t it possible that taking them as the libido is first emerging could be harmful?

Being on antidepressants now doesn’t help matters I’m sure. And it’s more likely that if I am hyposexual it’s due to psychological issues about fear, shame, body image, etc. Hopefully I will remember to mention it to therapist, because I am curious to hear her opinions on it. Plus it will enable me to segue into another topic I’ve had questions about for some time…

Bit o’ frustration

I’m signed up to go to a Meetup thing and I don’t know anybody else who’s going.  Have to leave the house in about 1-1/2 hours in order to get there in time, and already starting to feel anxious about it.  I wish I had somebody to go with!!  But it would be nice if I at least had somebody I could text and be like “damn, I’m really getting anxious” and have them tell me “hey it’s ok, you’ll be fine and you’ll have fun once you get there.”  Previously I might have sent something like that to L, but I’m sort of distancing myself from her these days.  Too much pot and recreational use of prescription drugs for my comfort. And besides, she never actually hangs out with me anymore.  And she was kind of the only person I had who I felt familiar enough with to express this sort of anxiety.  I don’t want to talk myself out of going.  I know it will probably be lots of fun.  But I’m afraid!!  Afraid of new people, of unfamiliar settings and activities.  Sigh.  I have a movie.  I could easily stay home and watch that instead.  But I also really could use the exercise and the adrenalin from physical activity should be good for my brain chemistry, too.  So you see there’s no good reason not to go.  But goddamn I’m scared.

Stumbled upon this article from the BBC News website, which shares the results of this study in The Lancet.

I was somewhat surprised to read that there hadn’t already been a definitive study (if this could be called definitive?) about the efficacy of CBT (cognitive-behavioral therapy).  It’s been around for a while now.

“Before this study, no evidence from large-scale randomised controlled trials was available for the effectiveness of augmentation of antidepressant medication with CBT as a next-step for patients whose depression has not responded to pharmacotherapy. Our study has provided robust evidence that CBT as an adjunct to usual care that includes antidepressants is an effective treatment, reducing depressive symptoms in this population.”

I’ve been in and out of “talk therapy” for well over a decade, though I’m not sure how much of it was CBT.  I honestly don’t know enough about the history and development of psychotherapy, or even what different forms of therapy are commonly in use these days.  All my therapists have been more or less the same, so I’m guessing it has all been CBT.  No Freudian psychoanalysis, anyway.

Details aside, I can honestly say it has been extremely helpful for me.  Obviously it hasn’t “cured me” — I don’t think what I’ve got can really be “cured” — but having someone to talk to about whatever’s going on in my life has helped me make important decisions, take myself more seriously (in a good way) and, most importantly, kept me working on myself.

The thing about medication, great a boon as it has been to me through the years, is that it doesn’t encourage active participation in the growth process.  For someone like me, who probably has something of a chemical imbalance but also a fair amount of non-genetic emotional/psychological dysfunction, staying actively involved in my own treatment is crucial.

That’s not to say that I think I would achieve the same results if I were to sit and talk to myself or journal or something for an hour once every few weeks.  That certainly helps too, but having an appointment, having to go, having someone with notes who looks back and says “last time you expressed such-and-such a feeling,” keeping far better track of things than I could even if I cared to, makes it feel more substantive, somehow.  I don’t want to say I spend my $60 copay JUST so I can feel my treatment is more “real,” but there is something to that.  Plus, if I’m financially liable I’m much more likely to keep with it (tell that to the running shoes I bought last month… but that’s a different story).  It’s far too easy to “not feel like” meditating or reading another chapter or just practicing a little awareness.  Which is why I haven’t really done much meditating the last few months… so maintaining contact with a therapist is important.  It keeps me present, keeps me from being able to ignore or pretend.

I guess that makes me one of the 46% of people (as reported in the study) who respond positively to CBT.  I wonder, with no small amount of sympathy, what the remaining 54% do?

…….all you can think about is going home and eating cookies.

 

:/

Enrichment

I’ve reached that frame of mind again where I think I need to focus on doing things I enjoy.  Enriching my life.  I think I’m going to be alone for quite some time.  I’m not swearing off the idea of good friends entirely, but I think when it’s something I want so bad trying to artificially manifest it is ultimately counterproductive.

I do start to despair a little, periodically, because it’s been so long since I’ve had a good friend that I don’t have things to talk about.  Like I want to have something I wouldn’t even be able to deliver on if it came along.  I don’t know what people talk about. Or I just don’t think about them. Or they’re so internalized, I’m so accustomed to not sharing my thoughts with anyone that it will be very difficult for me to get in the habit of doing so when the opportunity presents itself. And maybe since I’ve spent so much of my time by myself, with myself, thinking about myself, maybe I don’t have much skill at actually relating to others.  I don’t know.  That’s not the point here anyway.

My point is, I turned outward again.  I think it started when I sent that drunken e-mail to NM.  I don’t regret doing that, I think it was a good experience.  But what followed was that old panicked need to Not Be Alone.  And as nice as it would be to Not Be Alone, I can’t count on that happening anytime soon.  I have to focus on enriching my life as it is, not as I wish it might be.  I have to take care of myself now, do the things I want to do now, because Now is all there is.

I feel a bit better just typing this.  Honesty.  Works wonders.