Wednesday, November 18, 2015

My Cymbalta Story (or, "How I Learned to Give a Duck About Life Again")

This weekend was rough for two reasons.  The first is depressing and the second is anti-depressing.

See, Andrew’s mother visited, and as usual, it was not a very pleasant time.  I can’t say that it was “bad” per se, since his mother pointedly avoided any eye contact or direct exchange of words with me.  In fact, on both Friday and Saturday night, she only said two things to me: first, that it was bad manners to eat pomegranate seeds with my hands and that I should use a fork, and second, a suggestion that I have adopted too many animals. (“When will it be enough?”)  I guess no one told her that it’s bad manners to comment on other people’s eating habits.  As for when I have enough animals, well, gee, I don’t know.  I guess I keep adopting animals because they don’t judge me and they’re the only real support network I have.  It sure is shitty of me to take in strays off the street.  Next thing you know I’ll be trying to help the homeless and the mentally disabled like some sort of chump. 

One day you're donating to the ASPCA, and next thing you know you're volunteering at soup kitchens and organizing AIDS benefits.  It's a slippery slope.


Anywho, she broke the ice on Sunday and finally talked to me (to tell me to shut up).  We went to a restaurant Jack had picked out that had no vegetarian options, forcing us to go to another restaurant.  This prompted complaints that we’d eaten what we wanted to on Saturday.  (Andrew made a big, homecooked meal that was “lacking in protein” because it didn’t have any meat.) She also complained that it hadn’t been filling.  (Note: there were leftovers.)  

When we sat down at dinner, she snapped at Andrew and I to stop talking because he was asking me how work was going, and according to her, we “spend all of our time together anyway,” and could talk to each other after dinner.  It’s actually a good thing she shut us up because she had some very important things to say, like how windy it was.  Riveting conversation, really.


Both Andrew and I were disappointed because this trip was supposed to be something of a sounding board for our trip to Pittsburgh for the holidays and, in between his sister’s catty judgmentalism (Hi, Lily) and his mother’s coldness, I can’t say I’m at all looking forward to it.  The truth is, the only reason I’m going is because it means a lot to Andy to have the family together, but “the family” is a bunch of people who actively make a point of judging and excluding me, so there you are.

Allow me to lighten the mood by representing the situation using these fluffy little ducklings.


As for the anti-depressing part of the weekend, well, that would be my shiny new antidepressants!  I finally went to a psychiatrist because my depression had become unmanageable and unsustainable.


Much like Andrew’s family dislike for me, my struggle with depression has not been much of a secret.  Depression gets a lot of attention in the news nowadays and it is probably over-diagnosed.  Much like ADD or OCD, there’s a lot of grey areas.  If a person is sad, there’s not an easy way to tell whether they are sad due to a chemical imbalance or an environmental problem or some combination of the two.  


Depression, for me, is best described as treading water in molasses.  It’s exhausting to keep your head up and you don’t go anywhere.  You feel disinterested, emotionally, in things you know you should logically care about.  You feel tired, like giving up, and then you feel guilty for not being able to get it together.  In fact, Hyperbole and a Half had a rather incredible post that summarizes it much better than I ever could, so go read that.


I’ve fought with depression most of my adult life, with three distinctive major depressive “episodes.”  During these episodes, I self-medicated with alcohol and I burned a lot of bridges with my friends.  I lashed out and was self-destructive and generally a very unpleasant person to be around.  Sort of like Andrew’s mother, but more drunk.

"Self-medicated" is a kind way to say "openly addicted."


My most recent depressive episode probably began in May or June.  Like depression itself, “major depressive episodes” are very difficult to define.  They creep up on you and are often only identified in hindsight.  This one was pretty obvious, though.  I felt tired and unmotivated and just generally sad, and forcing myself to do anything was an incredible effort, like climbing a mountain or dealing with Andrew’s mother.  About a month ago (or maybe even more), I told Andrew, “I can’t do this anymore.”  And I really meant it.  The depression had gotten to a point that was just unbearable.  I was on the verge of a true meltdown and I didn’t know how to fix it.

People were like, "You need to get your shit together."  
Allow me to lighten the mood by representing the situation using another fluffy little duckling.


The search for medical intervention began!  During this miserable, four-week process, Andrew began cold-calling psychologists, therapists, and psychiatrists, with little to no success.  One of the issues we faced was that since I had recently moved jobs, I did not yet have my new insurance card, nor was I aware of what my benefits covered.  Another issue was that many of the psychiatrists proved to be almost impossible to get ahold of; you would get an answering machine or secretary if you were lucky, and rarely any call backs.  Most doctors Andrew spoke with told him they weren’t accepting new patients and referred him to other doctors, most of whom were also either unreachable or not accepting new patients.  Some of the ones who were “accepting new patients” were doing so in two or three months, much longer than I felt I could wait.


One of the perhaps most ironic elements of this process was that no truly depressed person in the world would have been able to run the gauntlet necessary to get a doctor.  Andrew did most of the searching and calling and listing names and then scratching them out.  I laid on the couch and cried a lot.  That’s just how it was.

 As usual, my dog was there for me.  And that's why I keep adopting animals, Andrew's Mom.


Finally, after four weeks, we had some success.  I was able to schedule a visit to both a psychologist (i.e. a therapist) and a psychiatrist.


I talked to the psychologist and then filled out a bunch of forms in triplicate detailing my symptoms. (Feelings of despair: yes.  Feelings of hopelessness: yes.  Exhaustion: yes.  Anxiety in social situations: yes.  Bed-wetting: no.  Left-handedness: no.  Mental retardation: no.  Magical thinking: no.)  (These were all actual items on a list of symptoms.)  

Magical thinking doesn't actually sound so bad.


Next I talked to the psychiatrist, who went over all the symptoms again.  (Excessive worrying: yes.  Feelings of guilt: yes.  Marked lack of interest in daily activities: yes.  Frequent crying spells: yes.  Frequent traffic violations: no.  Compulsive hand washing: no.  Tinnitus: no.)  I was prescribed Cymbalta for depression and clonazepam for anxiety.  Both look like a stock image of medication: one is a cheery yellow tablet and the other is a soothing blue-and-white pill.


My biggest fear was that the drugs would do nothing.  I had really gotten my hopes up at this point.  My depression was so unbearable that the only real solace I had was waiting to get prescribed some medication in the desperate hope it might alleviate my symptoms.  But psychiatric medication is an inexact science, so there was no telling what would happen.


I needn’t have worried.  Upon the very first dose, I felt like a completely different person.  Specifically, a person who had overdosed on Benadryl, because they immediately knocked me out.

 Cured!


Upon waking the next morning, I went to work.  It was sometime in the mid-afternoon that I discovered a rather interesting symptom: short-term memory loss.  I had no memory whatsoever of waking up, doing my morning routine, or getting to work.  I was plating bacteria that day and had to ask my PI three times for instructions because I just couldn’t retain anything.  We had a presentation on qPCR that afternoon, which I fell asleep at.  I woke to discover that the qPCR reps had bought everyone lunch.  I sat hunched over my sandwich, feeling very disoriented and having a lot of strange, paranoid, unsettling thoughts that everyone was watching me, that I was disgusting, and that my sandwich was making loud, squishy, revolting noises.  It was a very strange experience.


Going over my notes later, I discovered that I had developed some sort of weird dyslexia; many of the words were simply missing letters.  My handwriting looked completely different.  Here’s an actual excerpt:  

“Dissocition [dissociation] of melt cure [curve] checks specifty [specificity] of amplicons and quantity of of [sic] CYBR.  As dable-straned [double-stranded] DNA molcules [molecules] breud [break] down and dye breaks off.”


This was moderately frightening, but my psychiatrist had warned me that the first week would be pretty bad and I should stick it out unless I felt like I was in genuine danger.  So I stuck it out.


A week later I am happy to report that most of the drowsiness and loopiness has leveled off, and although I’m generally a bit sleepy, I am also no longer feeling depressed.  My memory has gotten moderately better, although it’s definitely not what it once was, and I have to write everything down.  My writing is back to normal.  Most of the typical symptoms of Cymbalta, like nausea and insomnia, never affected me at all.  In fact, I’ve slept better than ever before.  It’s probably due in a very large part to the drugs that I was able to handle Andrew’s mother’s visit so effectively.  My interest in work and my hobbies has returned, although mustering the energy to pursue them is a little difficult due to the medication’s sedative effect.  But generally I feel much better and very hopeful for the future.

 Sometimes, you have to stand strong even when the odds are against you. 
Credit to this guy for the amazing comic.


To summarize, I put off getting antidepressants because I thought I could shrug off my depression and that I didn’t need them.  I was worried about the cost, and worried about the stigma, and also just didn’t have the energy to go get them.  But now that I’ve tried them, I cannot recommend them enough.  Even with the side effects, the improvement is so beneficial, and I wish I’d pursued this sooner.  I’m aware not everyone will have as positive an experience as I did, but if you’re reading this and you’re experiencing depression and you are actively avoiding medication, do yourself and favor and give it a go.

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