Anxiety. Depression. Suicidal Thoughts.

Anxiety. Depression. Suicidal thoughts. They are all rolled up in one.

I am anxious about a lot of things these days. From something as mundane as sitting here typing on the computer to driving to cold calling a prospective client (which may never pan out because I’m too anxious to call right now). My anxiety has been debilitating in the past where I didn’t want to leave my home, and I fear it’s getting to the point of debilitation again on some days.

My anxiety depresses me. It keeps me from doing things that no one would think twice about. But here I sit, a prisoner in my own body, freaking out about nearly everything. To escape this, combined with my severe lethargy, I crawl into bed and sleep, hoping that when I wake up, things will be better. But they usually are not.

Please don’t get me wrong. I have a life many people would envy: a loving husband, a supportive family, and a steady job. I am thankful for the good things in my life. But this attitude of thankfulness and gratefulness doesn’t take away the depression inside of me.

I do not want to go back to the hospital. If I fear anything worse than death, it may be going back to a psych hospital. I have passing suicidal thoughts about hanging myself, but I haven’t been able to act upon it. I can’t determine whether I am a harm to myself in which case I would need to go to the hospital. The point of the hospital (for me) is to get me away from things that would cause immediate harm to myself. But I can’t be locked up in a hospital forever. (I guess I could in a state institution but that would be a nightmare.)

Somehow, existing in this jumbled mix is me. Somewhere inside, I am bubbly, wonderfully wacky, and beautifully strange. The depression and anxiety fuzz all of that. I am only some of what I used to be. I go to sleep, hoping for some kind of reprieve from this dark cloud that hangs over me.

My Dark Passenger: The Suicide Side

Image from zazzle.com

Although I’m not a fan of the Dexter books or TV series, I’ve been introduced to both by way of my husband who enjoys both forms of Dexter media.

The other day I flipped through Jeff Lindsay’s latest, Dexter Is Delicious, and read a little bit about the part of Dexter that he calls his “Dark Passenger,” the voice inside of him that compels him to kill. (But he justifies this by killing murderers. An interesting twist on the anti-hero.)

I ruminated on this as I’ve been dealing with a lot of suicidal thoughts lately. And really, there’s nothing wrong in my life that would cause these suicidal thoughts to arise. It’s just something in me gone haywire. It’s like a part of me that’s not really a part of me that I can kind of talk back to. It sounds otherworldly and crazy.

It is.

So I’ve taken to calling the suicidal voice (unlike Dexter’s homicidal one) in my head the “Dark Passenger.” My husband kind of likes this too as it identifies something that’s not really me although it’s a part of me.

The Dark Passenger is pretty random these days. Even if I have a slight mood crash, he’ll—because my sinister voice is clearly not a seductive she, maybe androgynous—tell me that life is not worth living and to go kill myself.

Me: What?
Dark Passenger: Go kill yourself. Life isn’t worth living anyway. You’re a total failure and you know you can’t do anything right.
Me: Um, why are you bugging me? I’m not even depressed right now.
Dark Passenger: [silence]

Yeah, that’s pretty much how our conversations go. It probably sounds a bit schizophrenic or something but that’s basically my stupid battle to stay alive. You can probably imagine how terrible our conversations are when I am depressed.

My Dark Passenger’s a bit starved, you see, because I haven’t tried to kill myself in a while and he’s getting antsy. I was last hospitalized for a suicide attempt in 2006 and even though I’ve had a few half-hearted attempts since or serious thoughts about an attempt, I haven’t had a serious attempt that has required me to be locked away for a good bit of time. I still get freaked out about my near-sexual assault encounter and that’s done a good job of keeping me in check for now.

So the Dark Passenger tries to get me whenever he thinks he’s got an opening:

No one signed up for your class. You’re a loser. Go kill yourself.

She never called you back. See? No one likes you. Go kill yourself.

You can’t get pregnant or do anything right. You’re not cut out to be a mother. In fact, you weren’t meant to be one because you need to go kill yourself.

And on and on and on. It’s easy to tell him to shut up when I’m not deeply depressed. Not so much otherwise.

Maybe there’s something to that “Get behind me, Satan” stuff after all. D. Martyn Lloyd-Jones, a famous British preacher, once suggested in his book Spiritual Depression to “talk back” to one’s negative voices. While it doesn’t work in the most severe of cases for me, it works. . . for the most part.

Should psych drugs be avoided at ALL costs?

My brain isn’t functioning today quite honestly so my apologies if the following makes no sense whatsoever. It’s long and I ended up rambling.


Lately, I’ve been thinking about whether there are any benefits to using pharmaceutical drugs. I have blogger friends who are very much anti-pharmaceuticals anything, try to avoid drugs as much as possible but take them if necessary, or think pharmaceutical drugs are a Godsend.

I’m still trying to figure out where I stand.

Pharmaceutical companies are in the business of making money. It is not to their advantage to put out completely shoddy products that do not work. I’m sure many of them bury negative data and findings that do not shed a positive light on their drugs but if something works overall, they’ll put it out there. I don’t believe the doctors who are involved in these trials are all dirty, rotten sell-outs. Some of them are very well-meaning and honest who work to make these drugs as effective as possible. Call me naïve if you like but I just can’t bring myself to believe there are more greedy docs who skew results than there are those who are concerned with advancement.

I don’t think twice about popping Excedrin Migraine when I’ve got a painful, debilitating migraine; I have no problem taking naproxen (aka Aleve) when I’ve got menstrual cramps, and taking ibuprofen isn’t an issue if I have severe muscle pain. I don’t question the safety of these drugs. I’ve used them for so long, they’ve proven to be relatively safe for me (not everyone can tolerate those drugs) and efficacious. The safety risk of taking Excedrin Migraine sometimes outweighs the benefits of not taking it. (Note: I only speak of adults in terms of ingesting this kind of medication.I don’t believe developing bodies, such as youngsters, are able to handle medication that can significantly affect mood.)

When it comes to psych meds, I am not anti-medication. Psych meds should be taken on a case-by-case basis. There are some people who consider these meds to be a life-saver while others complain that it has made them miserable and worsened their lives. This is the gamble people take when choosing to ingest a psych med—most people don’t know that. Trouble is, most people don’t know when the stakes are high enough to take that risk.

I shouldn’t be in a position to judge anyone but when I hear people taking antidepressants based on circumstances—a job loss, failed relationship, loss of a life—I worry that it’s unnecessary. We are becoming a nation that is more reliant on “quick fixes” rather than developing coping mechanisms. It’s easier to pop a pill and dull your emotions than it is to face problems, tackle issues head on, and learn to work your way through it. Case in point: rising unemployment hasn’t slowed sales of antidepressants or sleeping pills.

  • I have an aunt who was a violent paranoid-schizophrenic. She was placed in a mental institution and drugged up the wazoo. Now, she’s basically existing; the lights are on but no one’s home. The drugs have killed her. She’s alive but not really.
  • My father was a non-violent paranoid-schizophrenic. It got to the point where we needed to medicate him to get him on track. The medication helped him to function “normally” but his thought processes and physical ability was significantly slowed. He once told me that he felt useless because my mother was busting her butt at work to pay for my college and he was basically an invalid because his mental illness had prevented him from being able to work. He died 4 months later. A few days after the funeral, my mom began to find his psych meds hidden all around the house. I often wonder if the drugs killed him.
  • Another aunt (this is all on the paternal side of the family) also became a paranoid-schizophrenic. She was a brilliant woman who was basically reduced to moving from place to place to the point where she eventually became homeless and could not hold down a job. She disappeared for a while but during one cold winter, was found and brought into a homeless shelter. She was placed on meds and her cognitive functions returned despite the fact that her speech was sometimes garbled. She traveled the world, went on cruises and various excursions. The change was remarkable. Psych meds improved her life and saved her—the benefits of the drugs outweighed the side effects.

As I withdraw from Lamictal, I am curious to see who I am without this drug. Will my creative juices flow freely once again or are they now somewhat hindered? Will my cognitive functioning correct itself or will I forever suffer from problems? Will my short-term memory loss issues smooth out or will I still suffer from intermittent forgetfulness? I have some side effects that may remain with me for a while or perhaps forever (though I hope not) but seeing others fully recover after taking drugs for 10 times longer than I have gives me hope.

I feel the majority of my progress has come from intensive counseling and being infused with the truths as laid out in the Bible. I’d say 90% of my progress has been due to counseling. I give the meds 10%. You can tell I don’t place much stock in them. But they’ve helped to cut down on the mixed episodes.

So far, I haven’t had any suicidal thoughts are behaviors that are out of the ordinary. (Thank GOD.) I’ve been dealing with a mild depression but that stems from basing my worth based off of my career rather than any biological imbalances. The last time I suffered a severe depression, I was on Lexapro (if that tells you anything).

I’ve gotten a lot of resistance and concern from family members who question my decision to come off of the medication. They’ve seen a miraculous change in me and attribute it to being on meds. Meds aren’t a cure-all. They don’t see the counseling and shifting of thought processes going on that has helped me to develop coping mechanisms. Meds may help people “cope” but they don’t develop the tools needed to cope.

I’ve decided that I’ll probably give that Christian psychiatrist a call. My counselor recommended him and she said that he’s very neutral on meds and doesn’t shove them on anyone. I mentioned that I wasn’t sure if anyone would accept me as a patient only to lose me in the end—she insisted he wouldn’t mind. The intake cost is hefty but since I was able to temp a few days for my job this week—I’m not permanently returning, I can swing it.

Which brings me back to my position on psych meds: I said it earlier but I think it’s a case-by-case basis. In my personal life, I’ve seen the benefits outweigh the side effects and I’ve seen the side effects outweigh the benefits. And I’ve seen benefits (not necessarily beneficial) as a result of side effects. Psychiatry is the biggest medical guessing game of all medical specialties. There are no certainties, and there’s no one medication that works best for everyone. Pharmaceutical companies make it a point to put the disclaimer on the patient information sheet that they’re not exactly sure HOW these drugs work. All that stuff about serotonin, dopamine, and neurotransmitters is pure speculation when it comes to depression. You’ll have me convinced about chemical imbalances once I can get a MRI and blood test done. Until then, it’s all trial-and-error.

So if I do suffer from relapses while withdrawing from this medication and it gets to the point where I may need to be hospitalized, I’m not averse to remaining on the drug. Better to be alive and on a psych drug than dead because I was determined not to use it at risk to my safety. If I end up having to stay on the drug, the future of giving birth to children will seem a bit more uncertain.

Loose Screws Mental Health News: Suicide slide

congregationA new study from the University of Manitoba shows people who regularly attend some kind of religious service are less likely to attempt suicide. The study, published in the Journal of Affective Disorders, surveyed 37,000 Canadians and their connection with spirituality, religious worship, and suicidal behavior. Those who simply said they were spiritual but didn’t attend religious services did not show a reduced risk of suicide attempts. However, I was dismayed to read that researchers didn’t investigate why regular church attendance decreases the risk of suicide attempts. (Note to self: Go to church each Sunday!) (pic via www.assumpta.fr)

Alison Go of U.S. News & World Report cites a study from Academic Medicine (originally reported by Inside Higher Ed) which suggests depression affects 21.2 percent of medical students. The rates is 11.2 percent higher than that of the general population. And unfortunately, 13 percent of black medical student reported suicidal ideation in the survey, suggesting that the demographic is more likely to suffer from suicidal thoughts.

And yet another study about suicide… The University of Gothenberg in Sweden performed a study on people who had nightmares following a suicide attempt and found out that they were five times more likely to try committing suicide again. The conclusion is based on a meager sample size of 165 patients but I suppose it’s a start.

While it appears that other sleeping obstacles do not raise the risk of multiple suicide attempts, patients who have attempted suicide seem to battle sleeping problems on a regular basis.

It is normal for patients that have attempted suicide to suffer from sleeping difficulties. Some 89 percent of the patients examined reported some kind of sleep disturbance. The most common problems were difficulty initiating sleep, followed by difficulty maintaining sleep, nightmares and early morning awakening.

Interesting observation considering that I have pretty much all of the common problems with the exception of early morning awakening.

Finally in a semi-cool story, a 22-year-old New Jersey guy who was friends with an 18-year-old Californian over the Internet called California police when he found out the 18-year-old said he would attempt suicide. Although it sounds like the teen (his name was not disclosed) is pretty upset about being saved (I know the feeling), it’s a (somewhat) happy ending compared to what happened in November when a Florida teenager streamed a webcast of him committing suicide by dying of a drug overdose. The Florida teen died before police arrived.

FDA: No link between Singulair and suicidal behavior

On Tuesday, the FDA announced that an investigation into Merck’s clinical trial data did not discover a link between Singulair (montelukast) and suicidal behavior. The investigation, which began 9 months ago, was prompted by a number of reported suicides, especially that of 15-year-old Cody Miller who took the drug and appeared to have no history of mood or behavioral problems. (It is worth noting here that Singulair “is the top-selling drug for people under 17 years old” and Merck’s biggest seller with annual sales of close to $4.5 billion.)

In attempt to assess Merck’s data better, the FDA also investigated AstraZeneca’s Accolate (zafirlukast) and Cornerstone Therapeutics’s Zyflo (zileuton). Although the FDA did imply that “the data were inadequate to draw a firm conclusion” and said that the clinical trials were not set up to observe any psychiatric behavior. Here are the data the FDA discovered during their review of these trials:

SingulairSingulair: 41 placebo-controlled trials that included 9,929 patients

  • Reports of suicidal thoughts: 1 (treated with Singulair)
  • Attempted suicides: None reported
  • Completed suicides: None reported

AccolateAccolate: 45 placebo-controlled trials that included 7,540 patients

  • Reports of suicidal thoughts: 1 (placebo group)
  • Attempted suicides: 1 (placebo group)
  • Completed suicides: None reported

ZyfloZyflo: 11 placebo-controlled trials (number of patients unknown)

  • Reports of suicidal thoughts: None reported
  • Attempted suicides: None reported
  • Completed suicides: None reported

Forgive me for being cynical but the data sounds fishy. I can’t pinpoint why but it does. The suicide numbers and patient involvement data seem to deviate some from the numbers listed in Merck’s PR issued last March. (I’m seeing 11,000+ patients vs. 9,929 patients.) Regardless of the clinical trial data, it appears that the FDA as of yet have not reviewed post-marketing data.

Scott Korn, a senior safety surveillance executive for Merck said in an article for Reuters:

“‘At the time we did not believe, and we still don’t think a link has been established’ between Singulair and the suicides.”

In the same article, Sanford Berstein analyst Tim Anderson had this to say about the possibility of the FDA finding a link:

“If the… safety review leads to a stern warning about behavioral changes in the Singulair label, this could frighten users of the drug or their parents and give Merck’s competitors ammunition to attack the brand.”

The Washington Post has Dr. David Weldon, director of the Allergy and Pulmonary Lab Services at Scott & White in College Station, Texas, on record saying that he had not “seen any increase in psychiatric problems with the drug but that some patients had complained of nightmares after starting on Singulair.” (Note: It appears that the closest conflict of interest Weldon would have here is that he served as a consultant and is honoraria for AstraZeneca.)

Dr. Rauno Joks, head of the SUNY Downstate division of allergy and immunology, made an interesting point in the Washington Post article:

“The physician really needs to review whether there are symptoms that have developed since patients started taking the medication, if there’s an underlying depression that was there before medication started.

Also, seasonal allergies in and of themselves can cause fatigue and lethargy, which makes it harder to assess, because those are some of the symptoms you have with depression.”

The FDA says they’ve completed analyses of submitted clinical trial data but their “safety review will continue” for several more months before they come to a concrete conclusion. For customer testimonials, check out medications.com that has over 2,300 people reporting side effects and askapatient.com that has an average 2.3 rating from 524 reviewers. The most commonly reported mood-related side effect on both of the sites is irritability.

December

I have since learned that December is also a hard month for me. December has certain markers, so to speak, that jump out at me throughout the month.

December 9 — The day my father died
December 14 — The day I found out
December 17 — The funeral
December 18 — The burial

Makes for quite a depressing Christmas. Even though he passed away only 7 years ago, it still hangs a dark cloud over my head. It takes me so long to get into the “Christmas spirit.” I now settle into the Christmas mood a week before the holiday, which is somewhat frustrating because it took me almost a month to finally enjoy hearing Nat King Cole’s smooth voice crooning through the ceiling speakers at Barnes and Noble.

I think celebrating Advent next year might help, however, I never know much about the season anymore since I no longer attend Catholic church and the Presbyterian church I attend doesn’t seem to acknowledge it. I need to remember that Christ is “the reason for the season” (yes, I know it’s trite) but the materialism surrounding Christmas really does a good job of distracting me from focusing on that. Materialism is tangible; Christ is not. But materials are temporal; Christ is eternal. Something to keep in mind.

I’ve been incredibly busy lately and have gotten pretty sidetracked from blogging. I’m traveling a good bit this (and the coming) year, trying to get a personal website up and running, running errands and accomplishing chores, trying to fit in exercise, spend time with friends and family, attend (usually) church-related activities, and make time for myself at night. My life in the past 2 years has moved faster than I could even imagine or fathom. The introduction of children could only make it crazier.

How’s my mental health in spite of all this? Well, I was doing pretty well most of the year with the exception of my “normal” dive in August. Lately, I’ve been dealing with some suicidal thoughts again. Mostly passing and no serious urges but the idea of trying has been tempting. I mentioned recently that I’ve felt a “need to prove” that I am serious about committing suicide. It’s a serious pride issue. Why should I care whether people think I’m suicidal for attention or not? That doesn’t matter. I shouldn’t be more concerned about what people think of me. Rather, I should be more focused on living my life to please God and for His glory.

I’m currently reading a book by J.I. Packer titled “God’s Plans for You.” (You can read a preview of this book through Google Books.) Lately, I’ve been struggling with what I should do with my life. I’m experiencing what has been deemed a “quarter-life crisis.” It’s like a mid-life crisis but with different challenges. Usually those challenges are related to career and vocational decisions. The mid- to late-twenties is the time when college grads are hit with the reality that full-time work isn’t as idealistic as they hoped and they are faced with the grim realization that some—or many—of their dreams may never come true.

This is becoming the case with me.

I obtained a degree in print journalism and a minor in English, hoping that I could enjoy working as a reporter or copy editor in the newspaper or magazine industry. It started out that way but then a move to Pennsylvania and a switch to daytime hours and a lack of clips set me back and now I am a freelance proofreader. Granted, I’m fortunate to even be a freelancer at 26 but proofreading at an ad agency was NOT what I had in mind when I took on my student loan debt.

While I enjoy the people I work with and have become more comfortable with the materials that come across my desk, I again have fallen into the perfectionism trap. I had a week where I caught a string of my own mistakes that I’d missed (other people—non-proofreaders—had caught them) and it was extremely discouraging. This has led me to wonder whether I’m even in the appropriate field. Now, I have a desire to pick up writing again (as opposed to sole editing) and am frustrated at my lack of internal motivation. I’m even beginning to wonder whether I should go back to a full-time job because it’s tough not knowing when a check will drop in my lap during any given day of a month and the fact that I am a terrible boss and employee when it comes to meeting my own deadlines. I’m even afraid of getting audited come tax time.

All in all, I’m currently facing a slew of decisions. Where to take my career and the prospect of motherhood, which may be hindered by my Lamictal (lamotrigine) treatment. I don’t want to be taking Lamictal during a pregnancy unless absolutely necessary and right now, I don’t feel that it’s absolutely necessary. I would like to take the risk and come off of it to see what happens but so far, it sounds like Lamictal withdrawal can be hellish. Lamictal during pregnancy raises the risk of a baby being born with a cleft palate. The likelihood of that happening to me is low and even if it does happen, it’s fixable but why take the chance? I’m also the super-psycho freak that will halt topical steroid medication of my eczema and zealously check all toys “Made in China” for lead.

Gianna at Beyond Meds and CLPsych over at Clinical Psychology and Psychiatry have written pieces on how Lamictal’s efficacy has been shown to be no better than placebo. This is something I intend on writing about soon considering that I’m one of the patients who could probably (currently, anyway) sing the wonders of the drug.

So there’s the update. That’s what’s going on in my life. I hope that you are all well. I likely won’t post again before 2009 so I’d like to wish you all a Happy New Year!

Mood rating: 5

Goal for 2009: Staying Alive

I’m being hit by suicidal thoughts again. Hard.

I’m not going to the hospital but if these thoughts keep pummeling me, it’ll become a consideration again. I’m walking a fine line here because my husband’s family has had a suicide hit close to home earlier this year and they don’t need to experience another loss. I try to keep in mind how important I am to many people that I know: my husband, my in-laws, my mom (I’m her only child). I try to visualize the grief my mother would experience losing her only kid. It’s worked so far. I can only pray that it lasts.

In the meantime, I’ve had my husband hide my belts. I ended up in the hospital in October 2006 after my husband woke up just in time to find me kicking a chair away in an attempt to hang myself from an air vent.

After what now seems like a short reprieve, I constantly glance up at the ceiling air vent in our bedroom thinking about trying the hanging thing again. I’m sure I could find something else to use if I really wanted to but I’m trying not to dwell on the idea too much.

The lies that used to convince me to try killing myself, oh say, three years ago, don’t work as well anymore. I can fight off most of them:

Lie #1: Nobody cares about you.
Answer: I have a husband, a big family, and wonderful friends who love and care for me. I’d be missed.

Lie #2: You don’t make a difference in this world.
Answer: I have a 98-year-old grandmother who loves me to pieces, I have a mother who I bring so much joy to, I have a husband who tells me I’m the best thing that’s happened to him, and I have a mother-in-law who thinks that I’m so cool, she wants to spend time with me. I do make a difference.

Lie #3: You’re worthless.
Answer: My husband tells me all the time that I’m worth something to him and that he’d be lost without me. If only for him, I’m worthwhile.

So the “lies,” or challenges if you will, have changed. Here’s the new one:

“You’re such a liar. You’re just looking for attention. You want people to pity and feel bad for you while you sit there and cry wolf. So, if you’re so serious about committing suicide, why don’t you show them that you’re not kidding and prove ’em all wrong?”

Hmm. Good question.

Mood rating: 3

Generic Lamictal (lamotrigine)

I'm on "Day I-don't-know" of lamotrigine (generic Lamictal). It's been at least 2 weeks. I haven't had any significant side effects except for extreme fatigue. I am often tired. Some days, I can give myself a boost of energy by playing the Wii Fit (which I snagged Saturday afternoon) and other days, exercising just wears me to out to the point where I head to the shower and then to bed. I can have 3 cups of coffee, never become fully awake, and still go to sleep at a decent time.

I'm still not sleeping well. Haven't slept well since before I went into the hospital in October 2006. I can't remember the last time I had truly restful sleep.

My symptoms remain at bay. I haven't had many suicidal thoughts or impulses. In fact, some days, I can go without thinking about suicide at all. I can't say it's all the medicine — my counseling and faith play a much bigger role — but I'm sure the medicine helps.

I've recently noticed that I'm not suffering from as much social anxiety. Again, I don't know if this is due so much to the medication as it is to the resurgence of my spiritual life. I ventured out on Sunday to a meetup writers workshop group that I'd never been to before. It was extremely weird. Not the situation, but the fact that I walked into a room full of strangers, made myself comfortable on the couch at the coffeehouse and offered input quite freely without worrying about what the others thought of me. I even had the audacity to network with a woman who works at a trade magazine in the area. How strange. I don't have balls. This is not me.

What the heck has happened to me?