Category Archives: Treatment

The Not So Daily Grind

misc 064Can’t believe I have been away so long. Thankfully, I have moved on to a non-management position in my work. I am thinking that the unrealistic expectations of my last position convinced me to step away from nursing management. I now am working again as a hospice case manager. Some may think, “Hospice? Isn’t that depressing?” But actually I find it quite fulfilling. Death and dying is just another part of the circle of life. I have the opportunity to accompany individuals and their families on their end of life journey. I work with a committed team of professionals that help our patients and families at this challenging time. Even though it is challenging, it is also rewarding. It is a privilege to help others with their journey.  So it really doesn’t feel like a grind at all.

Intensive group therapy helped me get my head together and know that I needed to change my career direction. Met some amazing people coping with some difficult circumstances. The biggest take away was for me to be in touch with my feelings and to push myself to live and not just exist. What I mean, and what continues to be a challenge for me is motivation. It is so easy to just let time slip by and not be accomplishing anything. I still struggle with this day-to-day. Hopefully  writing about my struggle will help. I have always found that blogging has been therapeutic. And goodness knows I need it.

Our prime purpose in this life is to help others. And if you can’t help them, at least don’t hurt them. —Dalai Lama

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Dramatic Increase in Antidepressant Use

From Medscape Online:

October 20, 2011 — Antidepressant use by Americans has risen dramatically in the last 5 years, with almost 1 in 10 individuals older than 12 years now taking these agents, according to data released from the latest National Health and Nutrition Examination Survey (NHANES).

However, the survey, which was conducted by the Centers for Disease Control and Prevention (CDC), also showed that less than one third of those taking a single antidepressant between 2005 and 2008, and less than half of those taking multiple antidepressants, visited a mental health professional in the past year. Those who did make such visits were significantly more likely to be men than women.

“Females are more likely than males to take antidepressant medication at every level of depression severity,” writes lead author Laura A. Pratt, PhD, from the Office of Analysis and Epidemiology at the CDC’s National Center for Health Statistics (NCHS) in Hyattsville, Maryland.

The study was published online October 19 as an NCHS Data Brief.

400% Increase

According to a 2010 report released by the CDC, antidepressants were the most frequently prescribed prescription drug between 2005 and 2008 for adults aged 18 to 44 years, and the third most commonly used drug for all ages.

That report also showed that use of antidepressants increased by almost 400% for all ages from between 1988 and 1994 to the period between 2005 and 2008.

The NHANES is a continuous survey conducted by the CDC’s NCHS. It focuses on the health of the US population and consists of a household interview and a visit to a mobile examination center for a physical examination.

For this analysis, data were examined for 12,637 participants aged 12 years and older between 2005 and 2008.

Questions from the Patient Health Questionnaire were included in the NHANES to assess depression symptom severity.

Results showed that almost one third of people with severe depressive symptoms took antidepressants during the study. Although more than 60% of these individuals took this class of medication for longer than 2 years, 14% had taken it for more than 10 years.

“In general, there was no significant difference between males and females in length of use,” report the researchers.

Other findings included that:

  • 10.8% of all Americans older than 12 years take antidepressants;
  • 15.4% of women older than 12 years take antidepressants vs 6.0% of men;
  • those numbers increase to 22.8% vs 8.5%, respectively, for those aged 40 to 59 years;
  • for all ages with severe depressive symptoms, 39.9% of women and 21.0% of men take antidepressants; and
  • whites are more likely to take antidepressants (13.6%) than are blacks (3.9%) or Mexican-Americans (2.7%).

No variation in use was found between different income groups.

“According to the American Psychiatric Association guidelines, medications are the preferred treatment for moderate to severe depressive symptomatology,” write the investigators.

“The public health importance of increasing treatment rates for depression is reflected in Healthy People 2020, which includes national objectives to increase treatment for depression in adults and treatment for mental health problems in children,” they add.

2005-2008 NCHS Data Brief. Published online October 19, 2011

Ch-ch-ch-changes

This past week has been ch-ch-challenging. I just took my son to college and that was a bit stressful. I’m doing my best to cope with that colossal change in my life. Then I go to work on Monday to find out from the CEO himself that they let my boss go. Wow. That was a shock. I liked working with him (see previous post, New Environments). He was always positive and motivating with me, but apparently not with everyone else, which was the rationale we were given for his departure.

Of course this would be the week that I also run out of meds and I’m waiting for the new insurance card to arrive so I can get the prescriptions refilled. Not a good week to be off my meds! So my mood took a nose dive and I was dragging through the week. It was everything I could do to make it through the day, and I couldn’t wait to get home and crawl into bed. Too much loss for one week. I admit I shed a few tears as well, I was feeling lonely coming home to an empty house with my son gone.

I am so glad my son is attending a nearby college, he decided to come home for the night on Friday and we spent breakfast together on Saturday. That cheered me tremendously. Knowing I can see him regularly has eased the transition. Now I just need to figure out how to handle the new situation at work.

The Price of Health

I just need to rant a bit about the cost of health insurance. Having been between jobs, I have had the misfortune of paying for my health insurance through COBRA. To maintain health insurance for myself and my son is costing me approximately $1200 per month. That’s just obscene. And yes, I have tried to apply for an individual policy and have been rejected twice due to having “too many medical problems.” I’m guessing having any problem is too many for an insurer. They only want to insure the perfectly healthy of course. I didn’t choose chronic illness. I didn’t choose to have to take three different and expensive medications to manage my Depression. It’s not like I have cancer or something really expensive to treat. Of course they probably look at the possibility of needing medication, therapy and the potential for hospitalization as just too much risk.

So, needless to say, I am a bit depressed about the enormous amount of money I am spending on insurance. And I still have copays for medications (ranging from $15-60) and for doctor visits ($30). So I am probably spending more like $1400-1500 a month on health care. I truly can’t understand why we can’t have universal health care.

I’ll be using up almost all of my pitiful retirement account to pay for the insurance for the next three months…until I can get on my new employer’s plan. I just hope I don’t have any really serious health problems in the meantime. They say that’s how most people lose their homes, etc. is due to catastrophic illness/injury. I’ll just have to say my prayers.

The Pills That Quell Despair

Everyday part of my routine is to ingest a handful of pills morning and evening. Part of that handful are three specific medications to treat my Depression. One a pretty bicolor capsule, one a small blue pill and one a medium-sized white tablet. Without these, my world would be full of gray, melancholy thoughts, escaping into sleep, and thoughts of suicide. Not a pretty picture for sure. Meds make me feel at least baseline functional. They aren’t “happy pills” by any means. Believe me, I wish there was a pill for happiness, I would be queuing up for that one.

How did I get to be on so much medication? Well, I’ve been on lots of other medications along the way. Started out on the miracle drug Prozac when I was initially diagnosed in 1995. Boy was that a life saver. At the time, I was suicidal and homicidal. Scary even to talk about those really dark days. The thoughts were obsessive, and I felt terrorized day and night. Had the most horrible nightmares too. Plane crashes, fires, murders, any kind of violent mayhem you can think of…it’s any wonder I could cope at all. Prozac took all of this away, so I could participate in therapy and work on things I needed to change. It was such a relief not to have those intrusive thoughts, the kind that make you feel really unglued.

But sometimes the drugs stop working for no apparent reason. So I’ve been through a number of antidepressants to manage my symptoms. I’ve been on four or five different medications between Prozac and my current mix. I’m not one of the lucky ones that can be weaned off medication, but I can say I’ve never been hospitalized. I’ve always kept trudging on, maintaining the status quo the best I can. That is part of my disease, I put other’s needs before my own, so that was one of the main reasons for never checking out…people were counting on me!!!

I understand not everyone benefits or even approves of the use of medication. And I’ve certainly done my share to contribute to the wealth of Big Pharma by taking the newest meds on the market. But medication works for my symptoms, and I need to use them in  combination with therapy to get and or stay well.

Wellness is the ultimate goal, right?

But I Don’t Like to Exercise (whine)!

No kidding, and yes, I’ll take some cheese with my whine. I’ve felt more down and fatigued lately, so of course my therapist suggested I should get more exercise. Eeek. Exercise has been found to be extremely helpful in alleviating depression symptoms and it’s something you can do for yourself.

So why doesn’t walking the dog when the weather is decent count? Not my fault the weather has been crappy. Needless to say that hasn’t helped my mood either (see previous post regarding Melancholy Weather). I’m not the kind of person who enjoys exercise for exercise’s sake. I do like to do things that are purposeful and are outdoors, like biking, walking in the park, etc. I just don’t seem to find the time to do these things consistently and incorporate them as a routine part of my life. I know it should be a “priority” but there just doesn’t seem enough hours in the day.

I do enjoy gardening and when the weather finally breaks will spend many hours out in the yard. That can be an upper and lower body workout! But the key is that I am accomplishing something and I am preoccupied, so I don’t realize I am exercising. I would find walking on a treadmill just excruciating, even with music or tv to occupy my thoughts. Somehow I better find some way to tolerate more exercise (I’m not a group or class type person either) or bad weather. Would love to hear others ideas for making exercise tolerable.

 

Being Comfortable

Maybe I just had to learn to be comfortable with being uncomfortable, with being scared out of my mind, and to let go of the past like it wasn’t about me. — Mark Vonnegut, MD (from his book,  Just Like Someone Without Mental Illness Only More So)

That just about sums up what it’s like to have low self-esteem and to be uncomfortable in your own skin with having a history of Depression. It takes a lot of time and therapy to feel a sense of being ok with oneself, and sometimes it isn’t a consistent feeling. Having mental illness like Depression undermines everything you think you believe about yourself. It turns your world upside down. Sometimes in the midst of certain circumstances, it completely alters relationships, and can even destroy those that are too weak to withstand the emotional pain and upheaval.

So much of dealing with this illness is regaining an equilibrium. You never really go back to the way you were…it changes you too much. You have been to a dark and hollow place. It’s like being cut or burned, it leaves a scar. So the goal is to get back on your feet and be functional in a new way, not necessarily like before. Sometimes the old way of doing things wasn’t the best for you anyway.

After 15 years of dealing with this chronic illness and three major episodes, I finally feel like I am making progress on the equilibrium part. What it was I accomplished in psychotherapy the last two times I’m not sure now. I was in different points in my life, with different situational crises, so I had different things that I had to handle. Now that I’ve reached the “midlife” point, I guess I have more time to focus on myself and what I need. Boy, I sound like the typical codependent!

I know I won’t be comfortable everyday, but I’m working on it. Hope you can too.

Merry Christmas!