Tag: treatment

A white bottle of white pills spilled out on a black background

Feeling Shame about Psychiatric Medication

Genevieve2 Comments

The first time I experienced shame related to mental illness, I was 11 years old and caught in the torturous intrusive thoughts and compulsive behaviors of OCD. Therapy did not go well because I found it nearly impossible to overcome my shame and embarrassment enough to participate. There were times when I was so appalled at myself for having intrusive thoughts that I genuinely feared my parents might stop loving me if they knew what I was struggling with.

The shame about mental illness started early, and the shame about taking psychiatric medication soon followed. Therapy was not going to work, so when I was 13, I agreed to start taking Zoloft. I remember leaving my psychiatrist’s office with my mom after that appointment and just sobbing in the middle of the parking lot. I felt so broken in such horrifying ways, and I thought that taking the medicine meant I was failing to fix myself.

Where My Pill Shame About Psych Meds Started

It felt like a very adult thing, taking medication. I’d carefully dole the pills out into their respective days in my weekly organizer. When I took them, I’d count them over and over and over – One, two. One, two. One, two. Sometimes, I would ask my mom, “Is this two?” and point to the pills in my palm. The root of that counting compulsion was the fear that I might accidentally take more than I was supposed to and overdose. OCD had such a hold on me that I doubted my ability to count to two.

Zoloft completely changed my life. Once I reached 200 mg, it was like my brain had been rebooted and all the bugs were gone. It was amazing. I took it for a few years and then came off it. Although I slip into old patterns sometimes, the OCD never returned in anywhere near full force.

Self-Criticism about Depression Medication in Adulthood

As an adult with treatment-resistant depression, I have mixed feelings about psychiatric medication. The Zoloft helped when I was a kid, but it was still something I considered to be shameful – something to be hidden. Whether that pill shame stems more from my own insecurities, my family’s attitudes, or societal messages, who’s to say? All I know is that I’ve never been able to shake that feeling, despite years of therapy and much contemplation on the irrationality of my beliefs.

I’m always hesitant to write about this. I want to emphasize that I know the way I think about psychiatric medication is unhealthy, and I don’t think anyone else should feel the way I do. It’s odd that being aware of that doesn’t seem to change my thoughts about myself. So, I guess this is a “don’t do what I do, but if you do, you’re not the only one” kind of a post.

A hand holding several pills of different sizes and colors in its palm.

Sometimes, I accept that taking psychiatric medication for my depression is the right choice for me. It keeps me safe-ish and mostly functioning, so I try to appreciate the benefits and set aside my gripes on the subject. When my depression worsens, though, all of that goes out the window. I start thinking that I’m lazy and selfish and a horrible burden on my loved ones. Much like when I was younger, I tend to view my psych meds as daily reminders of my inability to fix myself through force of will.

Psych meds help me attain the activation energy needed to use healthy coping skills, but I also know that making behavioral changes can improve depression on its own. In my brain, if I’m not “better” yet, I must be doing therapy wrong or not trying hard enough to implement new practices.

But, Do I Need Psychiatric Medication?

I’m so tied to ideas of independence and self-sufficiency that benefiting from my depression medication feels wrong. It almost feels like cheating. I tend to think that if I make progress while taking meds, I didn’t really earn it.

Whenever I try to change the medications I take and my depression gets worse, it seems like proof that the work I was doing to help myself wasn’t enough to even make an impact. If a change in my medication sends me tumbling back down the mountain, was I supporting myself at all with other strategies? It’s a discouraging thought that leaves me teetering between believing that I need to try harder and nothing I do will make a difference.

You would think that the solution to that would just be to stay on my meds, but my mind is a convoluted mess, so it’s not that simple.

Is the Improvement from Psychiatric Medication Real?

I try to remember that during the times when my depression has been much better, I don’t feel so strongly about how medication helped me get there. That suggests that I’m not seeing things clearly when I’m depressed.

Photo by Anna Shvets: https://www.pexels.com/photo/pills-fixed-as-question-mark-sign-3683053/

Then again, maybe I don’t care about it when I’m better because the medication is influencing me in such a way that I forget about the beliefs I held before. Maybe I’m seeing the truth about myself and the pointlessness of life more clearly when I’m depressed, and that perspective is covered up by my medication when I’m feeling better. I know that sounds wild, but sometimes I’m moderately convinced by this weird logic.

Self-Compassion and Treatment-Resistant Depression

I’ve spent years trying to learn how to be kind to myself and accept that my mental illness is not my fault. I know that I’ve made progress, but sometimes, it just falls apart. It’s like I’m climbing a flimsy ladder, and every once in a while, I slip and go crashing through the rungs below me. And then I’m in an undignified heap on the ground, berating myself for not accomplishing my goals and using medication when I shouldn’t need to.

I don’t give myself any space to accept that there’s something not right in my brain, and it’s okay if I can’t fix it by myself. I know this cognitively, and yet I can never seem to fully convince myself of its validity.

Do you relate to any of what I wrote in this post? Do you see your medication differently? I’d love to know.

An abstract blue and red painting with wide brush strokes and vertical red lines

What Noise Sounds Like in IV Ketamine Treatment: The Ketamine Chronicles (Part 14)

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Yesterday, I had another ketamine infusion for my treatment-resistant depression. It had been almost five weeks since my previous infusion, and while three weeks was our best guess for my interval, it seems like now I can actually go something like four weeks before really noticing it wearing off. I’m hoping that if I keep doing the behavioral things that help my depression (running, volunteering, therapy, etc.), I can at least maintain this amount of time between IV ketamine treatment appointments.

Linguistic Confusion During IV Ketamine Treatment for Depression

Most of my ketamine infusions have been visually focused, and usually what stands out to me are snapshots of images and colors. However, some of my ketamine infusions are much more auditory-heavy. Throughout it, conversations in the hallway and the other room sounded loud and close, and I felt as if I were being crowded around in the room I was in. Strangely, conversations outside the room sounded loud but were completely unintelligible. The boundaries of words and sentences disappeared and I was washed in streams of unending verbal noise. Nothing made sense, but I still strained to understand. The sounds of English words were familiar, but I just couldn’t parse them enough to grasp their meaning.

A messy spread of wooden typography letters in dark and light wood.
Photo by Raphael Schaller on Unsplash

This theme of linguistic confusion stretched throughout the infusion. I remember a filing cabinet stuffed with folders that I couldn’t read. The letters were there; I could pick them out, but putting them together and reading them as words eluded me. Later, messy papers with gibberish words filled my internal vision. I felt confused, I was upsidedown, my arm with the IV ached. The room seemed loud, and I saw stampedes of paper animals painted with pastel watercolors. They piled up and tumbled around me, threatening to knock me over and crush me. The fan in the room added noise that pushed it all to an intolerable volume, so I asked Erin to turn it off. I got ready to speak, opened my mouth, and seemed to just think the words out loud.

Did I Say That?

I notice this feeling often during my IV ketamine treatments, and it’s interesting to note how little deliberate control over our mouths’ movements we need in order to make coherent sounds. All I do is form an intention to say something, and it just…happens. It feels a little like I’m inhabiting my body separately from its direct controls.

A distorted glass with yellow and blue fractals approximating the experience of ketamine for depression
Photo by Jakob Owens on Unsplash

Ketamine is a dissociative anesthetic, meaning it creates a state of perceived separation from the self. Altered senses and seemingly “out-of-body” experiences are common when receiving treatments of ketamine for mental health conditions like depression and PTSD. In my experience, I can still talk during a ketamine infusion, but it feels like someone else is doing the talking.

In any case, my request apparently worked, as Erin then got up and switched the fan off. That lowered the ambient volume enough that I could focus again on my music.

I remember there being more visual scenes after that, but I don’t recall them very well. The only one I have much memory of is a scene set in a grocery store with a broken jam jar, shards of glass glinting under the fluorescent lights, and wine-red jam splattered on the linoleum.

IV Ketamine Treatment for Depression in Combination with Other Strategies

The rest of the day is a blur. I slept off and on, interrupted by Stella periodically. It wasn’t until about 6 P.M. that I started to feel more like a person, but I was still glad to crawl into bed at night and sink into sleep. This morning, I’m tired. I’d like nothing more than to go back to bed for the rest of the day, but I know it’s important to get myself up and moving. I do best with routine, so in the interest of helping my brain repair itself through the effects of ketamine therapy, I’ve already had coffee and been to the dog park. So far, so good.

If you’d like to read more about my experience with ketamine for depression, start from the beginning of The Ketamine Chronicles or visit the archives. Click here for mobile-optimized archives of The Ketamine Chronicles.

What to Consider When Switching Therapists

Genevieve2 Comments

There are lots of reasons you might go from one therapist to another. You might be moving, looking for another perspective, or simply feel ready for a change. Or, it could be that your therapist is leaving; career change, maternity leave, any number of scenarios in which you must decide what to do with your treatment. And, pretty much no matter what, switching therapists is hard.

I’m in this boat right now, and I’m finding it more tricky than I expected. For one thing, I’ve had the same therapist for almost two years. We’ve gotten to know each other (in a heavily one-sided way), and when I’m not completely shut down with depression, I really enjoy her company. It takes me a minute to be comfortable with someone, so the thought of switching therapists and beginning that process again is daunting.

Online Research

When I began my search for a new therapist, I started with Psychology Today’s therapist directory. You can filter it by issue, insurance, gender, and other factors that might help you narrow it down. I also tried googling a combination of “therapist” with “depression” and my area.

Contact Method

Some therapists provide an email address with their contact information. Text, be it emails or SMS, is BY FAR my favorite way to communicate. Making phone calls is an arduous process, what with the scripting and practicing and heavy sweating. But, leaving a message on an answering machine is, in my experience, more likely to get you a speedy reply. [Pro tip: if you approach phone calls the same way I do, keep a list of potential therapists and the status of your contact. I can just imagine leaving the exact same scripted message for the same person twice and being mortified enough to cut contact entirely.]

Make Appointments with Multiple Therapists

I highly, highly, highly recommend that you make appointments or consultations with multiple people. It’s way more time-consuming, and I’m finding it difficult to tell my story again at each new appointment, but it’s the best way to find a therapist that you like. Your current therapist might give you a list of people to call, you can search the web, and if you meet with someone and it doesn’t work out, ask them if they have any colleagues they can recommend.

Therapists Understand that Switching Therapists is Hard

Switching therapists is an interesting process to go through after being in therapy for a while and having done the search a few times before because I feel much more sure of myself. I know what kinds of approaches I’m looking for and I know roughly what to expect at an initial appointment. But, I also have more of a history within the mental health treatment sphere to explain in a coherent manner. The sequence of events is too long to describe in detail at a first meeting, so I have to decide how to summarize in a way that gets everything across. I don’t always succeed, and then we’re left filling in important gaps that I forgot about. Fortunately, therapists understand that the transition can be a difficult process.

It can be hard to leave a therapist who has helped you through really tough times. They’ve supported you and listened to you, and it’s natural to be sad that your time with them is over. But, it’s not meant to be a relationship that lasts forever. I’m going to miss my current therapist, but I’m also looking forward to getting a new perspective. It might be just what I need to put all the pieces of my recovery together.

grey cat in sunlight yawning

My Depression Naps are Unnecessary (Shocker)

Genevieve1 Comment

Over the last week, I have taken a grand total of one nap. ONE. This is grossly reduced from my usual minimum of six depression naps per week, each spanning roughly three hours. I cut back on naps this week because I was spending time with my family, instead. Between running errands, cooking, cleaning up, and catching up, there wasn’t much time to sleep during the day, and if there was, I prioritized family time.

The week is over, and I’m learning that I’m capable of being more active than I feel I am. My depression and the medication I take to treat it make me tired, and I might need a whole ‘nother week to recoup from this napless week, but I can function without naps. I think I should take this to mean that doing more is more sustainable than I thought.

I’ve been nervous that adding activities outside the house would be a disaster, because how could I go out and do stuff when I sleep for three hours every afternoon? This is probably a cart and horse problem; I’m worried that I won’t be able to fulfill my commitments if I still feel the need for excessive sleep. But perhaps adding more commitments to my schedule will make me less depressed, and therefore, I would sleep less. There’s bound to be an unhappy medium in the middle, but it would probably settle out eventually. In (wildly simplified) essence, be tired and have nothing to do, do more and briefly be more tired, then be a normal amount of tired and have fun doing whatever you want. This is something that everyone in my life has been saying forever, but sometimes it takes a while for you to come to the same conclusion, right?

A large part of my robust depression nap schedule is due to the lithium I take in the morning. However, I’m sure that another part of it is, at this point, a habit. My brain has learned that every day at the same time, we go to sleep for a few hours. It’s come to expect it. Breaking out of that habit is tough, but if I eliminate that and reduce my depression as much as possible, I’ll be left with just the lithium tiredness. That’s manageable, and as I’ve learned this week, very possible to function with.

Before I was even taking any medication, I slept as an escape. I went to bed before dinner because I didn’t want to be awake anymore, and I took long naps because I couldn’t stand the feeling of experiencing an entire day. Maybe this was what I needed, for a time. It helped me face my existence in more manageable chunks, but then it spiraled into something more damaging. I’m not going to stop taking naps entirely. I feel best when I give in and curl up on my bed for a few hours, sleep it off, and wake up partially refreshed. But I’m also going to remember that I don’t have to do that.

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Considering My Next Mental Health Treatment

GenevieveLeave a comment

I have an appointment coming up with my psychiatric nurse practitioner, and that means my thoughts frequently settle on the effectiveness of my mental health treatment. By now, I’m familiar with the questions she’ll likely ask me, but somehow the answers never come easily. Determining how I feel is not something I’m very good at, although I’ve gotten better at it. This time, I’ll attempt to describe the seemingly endless plateau of “meh” on which my mood currently resides. I have occasional dips into the dark chasm of “really bad,” but for the most part, things are ok. But as I decided after I was released from the hospital, I’m not settling for “ok” this time. I want to feel great, exuberant, joyful, even- happy. Happy would be good.

At this point, it seems like I’m running out of viable mental health treatment options that come in pill form. I was told I was a candidate for and encouraged to try Electroconvulsive Therapy (ECT) while in the hospital (a treatment that has changed immensely since it first began). My mother’s worried googling turned up IV ketamine as a promising treatment that my psych NP also encouraged. I knew people in my partial hospitalization program that moved on to do Transcranial Magnetic Stimulation (TMS). These are all safe treatments that, if they work, can change your life for the better. So, why am I so resistant to the idea?

I think it comes down to acceptance. When I first became depressed, it took me a long time to get to a place where I felt comfortable taking antidepressants. I clung to (and sometimes still do) the idea that if I just tried harder, all my problems would be solved. This is because, like many of us, I’m way too hard on myself. But it’s also because it was scary to fully accept that I have an illness that can’t be overcome through sheer force of will; a fact that my biochemical imbalance predetermines. On one hand, taking responsibility for your mental health is an important part of managing it. On the other, there’s an element of frightening imposition that comes with accepting that the very fact of your diagnosis is out of your control. I carry my depression around with me- not by choice or through lack of effort, but because its complex tangle of symptoms, neurological effects, and genetic alterations are not things I can leave behind.

Despite coming to terms with the apparent chronic nature of my depressive episodes and the fact that right now, I need antidepressants, I see this next step in mental health treatment options as Phase Two of my personal acceptance hurdle. It was tough to accept that I needed antidepressants, and now it’s tough to accept that I may benefit from another level of psychiatric treatment. I like to mull things over for a very long time, so until or if I decide to make that leap, I’m just considering it.