Mental Health Post #21: Sleep

Few things screw me up more than not getting good sleep.  Ironically, not getting good sleep is part of the game with almost all mental health disorders.  Whether it's insomnia, or sleeping too much, or bedtime procrastination, there's always something in the grab bag for those who struggle with poor mental health.  I've struggled with all of these (and more!) in my fight to have good mental health.

One of the most severe times I experienced insomnia was when I was going through post-partum depression (PPD) after my first child was born.  I struggled to sleep every night.  It felt like I never slept at all, but after weeks of "not sleeping", I'm pretty sure I was experience micro-sleep or I would've been dead, literally.  Still, the feeling of laying there awake in bed, alone, for hours at a time haunted me.  I got up each day more tired than the previous one and I became fixated on my need for sleep.  I was just.so.tired.  Because I was bottle-feeding this baby, my husband and mother- and father-in-law stepped in to help withe night feedings so I could, ostensibly, "sleep."  We moved in temporarily for a few weeks with my MIL and she gave up her giant, super comfy bed for Derek and I.  It was exactly what I needed for healing and finding a new daily schedule as I was starting antidepressants and seeing a therapist.  But I still struggled to sleep.  Over a period of months, especially once I had started the antidepressant, I finally started getting a healthy amount of sleep and over the next few years, things eased.  I now know that what prevented me from sleeping was extreme anxiety (as well as the depression).  Not knowing when my baby would awaken and need me and all the fears of being a new mom, along with the lifestyle changes and the physiological changes of giving birth, realllllly made it hard for me to relax.  I still struggle with this because anxiety is omnipresent and never goes all the way away for me.  (It's just well managed.)  At night, I practice deep, even breathing (remember how I talked about breath-holding being a symptom of anxiety?), and I focus on relaxing the muscles of my jaw and neck.  I do this every single night.  The only times I don't have to do this are after extreme exertion (like hiking) or if I have to take something like a Benadryl that night.

I have to admit I have rarely had trouble with sleeping too much, though I know this is a common problem for those with depression.  But I have really struggled with having an uncooperative body clock.  I'm a night owl.  Like a SUPER night owl.  I find going to bed between 1-3am to be comfortable for me.  I've been able to sleep in late for the past few years because of arrangements Derek & I have made, but before that, I was a consummate napper.  Frustratingly, this body clock issue seems to have gotten worse as my hormones have been changing during perimenopause.  Just a few years ago, I found midnight a good time to go to bed.  I'm really hoping things will adjust better once I hit full-on menopause and the hormones get sorted.  In the mean time, I make due by napping when needed, and sleeping in when I can.  I often wonder how others are able to cope when they have wonky circadian rhythms like me, though I assume they are able to help control their sleep through the use of caffeine and alcohol.  (I tried caffeine and it's a good short-term solution for me when driving or vacationing, but I super-ultra-mega rapidly metabolize it so it just doesn't last for me.  Not to mention the fact that it messes with my mental health, and physical health, as well as my sleeeeeeep.)

But let's talk about bedtime procrastination.  I think this is something many, many of us struggle with, even those who may not have a mental health issue.  I think you can figure out what bedtime procrastination is from it's title, tho teasing out the why is a little harder.  It differs from day to day or situation to situation for me.  I know that when I had young infants, especially when I was breastfeeding and no one could take night feedings for me, I sometimes had to cut into my sleep time because I was dying from the lack of Me Time.  Derek would sometimes gently chastise me and ask me why I wasn't going instantly to bed, and I would explain to him that sometimes recharging the emotional reserves is more important than sleep.  This is still true sometimes today though I have a lot more time and flexibility in my schedule than I did with young children.  Today my biggest problem is the computer in my pocket.  Sometimes I find myself on social media or YouTube or reading the news and look up and it's been an hour.  This seems to me a common issue for all of us in the digital age, and especially bad for those who are working on better self-regulation.  I've used alarms, or screen time limits, or even going off of social media each time I feel like I am doing a poor job of moderating my usage.  Even then, I find that I sometimes struggle to go to bed, sort of like a toddler who needs a drink and a snack, and to pee again, etc, etc as soon as bedtime rolls around.  I attribute this to some residual sleep anxiety--after enough years of struggling to sleep, one can dread laying down and hoping that they will fall asleep without laying awake for too long listening to the clock tick.

What do I look like when I am consistently not getting enough sleep?  I become super fragile, emotionally, and don't deal well with distress of any kind.  I become less able to function socially, and I have less control over how I speak and react to those around me.  Basically I turn into a big ole toddler who's naptime is overdue.  My family has learned that it's best for everyone if I make sure I get enough sleep.

I recognize that not every is like me and puts sleep down as one of their hobbies.  (I literally was flabbergasted when I realized that not everyone else put sleep down as a hobby when Derek and I moved into our first young married congregation and we were filling out get-to-know-you papers.  What is wrong with you monsters? ;))  Not everyone needs as much sleep as I do to be fully functional.  But it's also crystal clear that for those that struggle with emotional health, finding a way to tame  sleep by having a consistent schedule, and clean bedtime hygiene, is as important as any other tool used to improve mood and behavior.  It's also super tricky and can take a lot of time and effort to find solutions, and just when you find a good solution, bam, you are pregnant or you hit perimenopause and you find you need to reevaluate your approach and possibly your methods for getting enough sleep.  Being patient and flexible, as hard as it is, can again be one of the most important things to bring to the table when working to have better sleep.

Photo note: if only we could all sleep as easily as dogs do...

Mental Health Post #20: Addiction

I've been thinking a lot about addiction lately since the show Dopesick came out on Hulu (haven't had a chance to start it yet).  Like many other people, I've often used the phrase "addictive personality" in relation to myself mostly.  Recently, I've really come to hate that phrase because it is so pathological and makes me sound like this forever broken person.  It has a connotation that it's hopeless for a person to even try to overcome this "personality defect".  I do believe it is so helpful to know if you have a family medical history of addiction because there is a genetic link to addiction.  Often in looking back on one's family, one can see issues of mental health in their predecessors as well.  I generally believe that anyone who has struggled with addiction has generally struggled with some sort of mental health problem as well.  (Just a reminder that I'm not at all a health professional and you are always welcome to disagree.)  But to just say I have an addictive personality is one dimension of mental health in a world of complexity.  

We know that poor mental health is usually a combination of many, many factors: genetics, personality, past trauma (especially during developmental years), exposure to substances, parenting, cultural messages, etc etc.  Some of my ancestors struggled with substance abuse disorders, and because of that my parents were always very careful about how we approached using even over the counter medication.  I appreciate that perspective because it forced me to take note of my relationship to any kind of drug, but especially the pyschoactive ones.  I didn't always agree with my parents' opinions on how I was using those drugs, especially ones that were prescribed to me by legitimate physicians, but hey, we all have disagreements with our parents about various things as we grow and change.  

I think the point I want to make here is that instead of focusing on whether we have an addictive personality, it might be useful to look deeper and ask if maybe we are dealing with a mental health disorder?  This might seem tricky at first because there are a lot of different kinds of addictions.  I think many white people think of male people of color dealing in an alley, which is not only racist, but also deeply hurtful to both white people and people of color.  Instead, it might be helpful to look at all the different ways that addiction can be expressed.  For some people it can be gaming, for others it can be through substance abuse (with legal/illegal drugs and/or prescription medication from legitimate medical providers), and for still others it could be excessive exercise or masturbation or porn use or eating.  However you slice it, the issue is escapism pure and simple.  And when I say escapism, I am not talking about watching a little TV, hanging with friends, reading or scrolling through social media to relax after a hard day of work.  We all know that we require downtime almost every day to recharge emotionally.  

I've often been asked how you know when you are doing too much.  I think there are a couple questions that you can ask yourself that will help you know if you are addicted to something.  First, can you live without the thing you believe you may be addicted to?   As in, can you go a few days without it or do you completely fall apart?  If you are not functional without 4 hours of gaming every day, you may have a problem.  Second, do you find yourself increasingly procrastinating deadlines to participate more in the issue you struggle with?  As a teacher, Derek often talks about how some of his students who do not know how to self-regulate come to college and get stuck in this rut of being stressed about classes and homework and self-medicate with some gaming.  Then they get even more stressed about how behind they are and retreat into more gaming because they are so anxious and eventually all they are doing is gaming and they end up failing a class or three.  For me personally, I feel like if I wondering if I am too addicted to something, then I probably am.  Hence my constant social media fasts.  ;)

I don't want to leave people on a downer note because I believe there is help for those struggling with addiction.  It almost never is overnight, and even when addressing the root problem of poor mental health, healing never happens immediately.  We have bumps in the road and we have to continually pick ourselves back up.  Many will struggle with addictions their whole lives.  Like many people, I have found hope in my relationship with God.  I have found strength in knowing that He cares about me and that I have worth in His sight.  I also couldn't do what I do without all of the mental health professionals that have been in my life for two decades now.  I'm especially fond of my therapist with benefits, Derek.  Truly this road is best traveled in groups.

Mental Health Post #19: Intrusive Thoughts

When my kids were much younger, we used to have a conversation every Sunday as we drove to church.  It was not about anything religious, nor was it about anything prosaic like dinner plans.  It was, in fact, about Frozen Girl.  You don't know this title, so let me explain to you exactly who Frozen Girl is.  Frozen Girl is an Incan mummy found in the Andes mountains in the late 1990s, and featured in a children's non-fiction book that my kids had checked out from the library months before.  Frozen Girl both repulsed and deeply fascinated my kids, to the point that she featured in daily conversations.  Now, months later, one of my daughters began bringing her up habitually, like clockwork, when we passed a certain road driving to church.  I would hear this little voice in the back say, "I wanna talk about Frozen Girl."  Said daughter was only 5'ish years old and at first it was kind of funny.  We would talk about Frozen Girl for a few minutes and then we would move on.  Every time, I wrestled with how much I should say in describing how she had died, especially when I was asked if it had hurt and if she had been scared.  After thinking about it long enough, I realized that it was her (and her sisters') way of contemplating death and the fear of going away.  After enough time, we stopped talking about it, and now that my kids are old, we sometimes bring up Frozen Girl again in reminiscence of how cute and silly they used to be as littles.

This story illustrates to me the repetitive nature of our thoughts when we are worried about something.  When you have chronic anxiety, you can find yourself ruminating about things all the day long as you replay what you should've done and what you should do in the future.  You can have compulsions like needing to go over and over procedural lists in your heads of how to behave or what you need to do.  It takes up a gross amount of bandwidth and drains energy away from other important aspects of living.  Many people with mental health diseases complain of brain fog, and the inability to think clearly and consistently.  I personally find it almost impossible to hold thoughts in my head and my memory goes to the dogs.  

Besides having repetitive thoughts, someone with anxiety/depression may have strange intrusive thoughts that are deeply unsettling.  I'm not talking about the normal weirdness that is inherent in the human condition.  Everyone wonders what it would be like to kiss some random person, or curiously thinks what it would feel like to jump off a cliff.  We have the weird thought and we throw it away because it's such nonsense.  When you have intrusive thoughts, the same distressing thoughts can keep coming back, sometimes worse each time.  I remember after I had one of my babies when we lived in family housing, I became almost obsessed with worry that my kids would get a hold of the kitchen knives and somehow fall on one.  It was just specific enough and often enough that it started to cause me real anxiety.  Thankfully it started getting bad around the same time I was finessing my antidepressant dosage, as well as seeing a truly wonderful therapist.  She talked to me about not letting my mind focus on those weird thoughts and how to recenter myself so that I didn't get so hung up on unlikely scenarios.  I like knowing that when we think about things over and over again, we are creating roads in our minds.  The more often we walk those roads, the more formed they get.  They may start out as just a deer trail, and with enough time and rumination, they can become 8 lane highways.  The goal is to not allow that kind of development to happen with the toxic thoughts.  We all have Frozen Girls in our lives and while we don't want to repress them in an unhealthy way, we also don't want to be thinking about them all the time and ruin all the good living to be had.

Photo note: we planted a tulip poplar last fall and it has the BIGGEST leaves.  They are so glorious and I hope that tree gives some family so much joy in 40 years when I no longer live here...

 

Mental Health Post #18: Some Random Causes of Poor Mental Health

I'm sure many of you have heard a few things by now about serotonin and other neurotransmitters and their probable involvement in mental health.  But mental health is so much more complex than changing how much neurotransmitter is hanging out in the brain.  We have these awesome antidepressants that help us to help ourselves, but we still don't know fully why or how different physiological changes can affect our psychology.  Plus, there are many other factors, both internal and external, that can affect how a person is feeling from day to day or year to year.  Here are a few that I've experienced or witnessed throughout my life:

1. Infectious/chronic disease: This is not black and white but also can have an intricacy of effects.  On the one hand, just feeling crummy from chronic pain or fever literally makes you not feel good.  I had the misfortune to suffer from mastitis (breast infections) after most of my pregnancies which would cause me to run very high fevers for days at a time.  Twice I was hospitalized and given IV antibiotics to get it under control.  Those fevers sapped me of my ability to think clearly, to make decisions and to feel whole.  Anyone who has been really sick can understand how something as innocuous as a fever can cause your mental health to diminish.  There is another aspect to this too, especially for those who have chronic or long-last conditions: being sick and unable to do the things you love is draining and often causes feelings of loss.  Even the most emotionally robust person is going to have times where it can be hard to have a good mood because they need so much more care from others, and spend so much more money on their medical interventions, and can have restricted activities.  These things can lead to poor mental health in the short- and the long-term.

2. Prescription drugs/OTC/supplements: I've had more lightbulb moments than I would've liked over the past few years regarding the medications and supplements I've taken for various things and their affect on my mental health.  For instance, I learned long ago that antihistamines affect my mood in a negative way.  The higher the dose or the stronger the medication, the bigger the effect.  Not too long ago I was prescribed a cheap, common prescription antihistamine called hydroxizine to help with the eczema in my basement (sorry, I just learned this euphemism so you're going to hear it non-stop because it's hilarious!).  It's also supposed to help with anxiety and has the added benefit of causing sleepiness which can be a godsend for someone who is unwittingly digging furrows in their own skin at night from the itchiness.  What my dermatologist didn't know is that hydroxizine may be great for anxiety, but it's a real bummer if you have major depression.  Two days after I started taking a baby dose, I was a complete wreck and I could not figure out why.  I had been sleeping tons, eating enough, and it wasn't almost my period.  But I was crying non-stop (okay, that's not abnormal since I'm a crier, but this was over the top) over my own parking job or ridiculous things like that.  Thankfully Google helped me find some good academic information that said hydroxizine can be contraindicated in persons with major depressive disorders.  To a lesser effect, I've noticed that even OTC allergy meds like Claritin and Allegra do this too, as well as Benadryl.  Because I have to take these drugs daily/weekly, I've learned to be ready if I am going to have to increase a dose and know to give myself extra time and self-care.  Benadryl, a cheap, super helpful rescue allergy medicine, will leave me a little moody the next day, and knowing that helps me to be able to be kinder to myself and lessen expectations for a couple days, as well as let the people around me know so they don't take my moodiness personally.  Other drugs that I'm aware of that can affect mood include all steroids (especially when coming off of a steroid), many herbal supplements for mood, and some cancer medicines.  Here's the take-away: if you just started a new medication and your mood has precipitously dropped, look it up and consider if maybe it is either that medicine you are taking, or maybe an interaction between two or more medications.  Or you are eating grapefruit.  (Am I the only one that thinks it's super weird how you cannot have grapefruit with like every single medication ever?!?)

3. Temporary medical conditions: I want to specifically zero on vitamin and mineral deficiencies here.  I've had a long-standing war with my body and it's ability to hang on to ferritin (iron) in my red blood cells.  Thus, I've had chronic iron-deficiency anemia for literally decades now.  About every year, I go in for iron infusions which tops me off for a few months before I need more gas in the tank.  Anemia makes me not only fatigued and craving corn (I have no idea why, but I'm just grateful I'm not eating detergent or dirt like other people with pica), but also incredibly fragile mentally.  I know many different deficiencies in essential nutrients can cause this symptom in people.  One of the first things my new psychiatrists from every move have ever done was order a full CBC (complete blood count) and a workup on my nutrient levels.  For some people, getting more folate or vitamin B in their diet can be enough to help them sustain a positive mood.  For others it can be a big piece of the puzzle with other interventions to figuring out better mental health.

 

4. Trauma: I've mentioned this before because I have experienced trauma in my life.  Examples can include physical, sexual and emotional abuse, living through war, moving frequently, medical trauma, experiencing the death of a loved one, and many, many other things, particularly as they happen to a young child.  Childhood trauma literally changes the way the brain develops and grows.  It can cause certain parts of the brain to shrink, or neurotransmitters to release too much or too often, or not enough or not often enough.  It literally changes the scaffolding of the nervous system and can have long-term impacts on a person's mood as well as their approach to life.  How to address this?  Through boat-loads of trauma counseling and usually medications.  And then of course patience and time.

I think the hardest thing about mental illness for me has been the amount of patience I've had to learn to deal with the time it takes to address any of these things.  Even when you have something as small as a fever that is making your feel rotten, time seems to slow down and it can be hard to get to the next day.  Dealing with poor mental health in a loved one is also just so difficult.  You want them (and yourself) to stop suffering immediately and for everyone to be happy and contented.  Please don't give up, on yourself or your loved one.  Hard times usually do end and joy and happiness come back.  Sometimes the hard things don't go away, but your capacity to live with them and still be joyful is increased.  I know truth this and depend on it myself.

 

Photo note: am the only one that thinks the little antennas of slugs and snails are SOOOOO cute??  Ya they are covered in a mucusy slime, and they eat holes in my tomatoes, but those antennas!!

Mental Health Post #17: Medications

Ah, medications for mental illness.  I thought there was nothing more controversial to talk about in health care until Covid came to town.  ;) Now we get to fight about masks, vaxxing and people spit-talking at us.  But this post isn't about Covid.  Today I want to talk about my (limited) experience with antidepressants and what kinds I've taken and what I know about them.  Which isn't a lot, but that's okay--we have Google and all sorts of reputable websites (see my previous posts about good medical websites) for the in-depth stuff.

The first time I wandered in to the arena of antidepressants was after I bore my first child and had severe PPD (post-partum depression).  I was prescribed the generic of Prozac (fluoxetine) which I took for about 8-10 months if memory serves me correctly.  I took a medium dose during that time and then eventually weaned off of it.  I don't actually remember how that wean went, but that tells me it probably wasn't a huge deal and I didn't have severe side effects from going off of it.

The second time I started antidepressants was when I had PPD after the birth of my second child, AND realized that I had never felt truly good since I had weaned off the Prozac a couple years before.  This time, I was committed to stay on the anti-depressant until I was sure that I could function well without it.  (Joke's on me since that will be my death probably!  ;)  I tested out the generic for Zoloft (sertraline), which was newish at the time.  I started on a medium dose, but after months of consultation with my amazing psychiatrist (Sheila Marcus at UofMich, she's famous!), I moved to the highest dosage.  At this dosage, I found my anxiety was better managed than at the lower doses.  The depression was kept at bay by all but the very lowest starting doses, but anxiety is a little trickier beast.  

I took the Zoloft for about 2 years before I "pooped out" of it (this, I kid you not, is a technical term!).  See I kept getting pregnant and when you are pregnant, your blood volume increases drastically, and you need higher and higher doses to maintain healthy mood.  During this time I found that some drugs did absolutely nothing for me (looking at you Celexa (citalopram) & Nexapro (escitalopram)), and I ended up back on Prozac when all was said and done.  Unfortunately, I pooped out out of Prozac (as well just pooped a lot in general) during my last pregnancy.  I went back to Zoloft which was fine for a few years before it began to lose it's efficacy.  Not because I was pregnant anymore but because after a period of time, the body seems to habituate to the drug and they no longer do as good of a job at keeping those neurotransmitters hanging out.  This is absolutely not the same thing as becoming dependent on a drug (like an addiction)--the mechanics are totally different.  You can Google it if you want the complete run down since I don't want to go too in-depth here.

Eventually, I started taking a new class of antidepressants, called SNRIs (serotonin and norephinephrine uptake inhibitor).  All of the previous anti-depressants I mentioned are in the SSRI drug class (selective serotonin reuptake inhibitors).  These newer type of antidepressants affect more than one neurotransmitter and seemed to be more effective in general.  I started with a drug called Cymbalta (duloxetine) which worked well for about a year before it seemed to abruptly stop working at all.  Though pharmacogenetic testing (tests that see what drugs you don't respond to because of your genetics), I found out that I was an ultra-rapid metabolizer of Cymbalta.  Bummer, that.  I moved to a newer drug called Pristiq (desvenlafaxine) and I loved it.  Unfortunately, I started getting baboon syndrome a couple years later (go look that one up, it's a real party) and as part of my efforts to see what was causing it over a period of a year, I moved off of Pristiq and back onto good old Prozac.  (It probably wasn't caused by the Pristiq, since it seems to be nickel and formaldehyde among other things that are my primary allergenic issues.  But some drugs can contain more of both of these trace allergens, so it's hard to know.)

Here's the thing about antidepressants.  Individuals have totally different responses to medications.  There may be observed averages in populations on many things like side-effects, half-life of drugs, etc, but people all have slightly different chemistries that means everyone can have slightly different affects to any medication.  You noticed that I said Celexa & Lexapro did absolutely nothing for me at all.  But I knew others who LOVED those drugs and found them super helpful.  A related note is that honestly we are still learning a lot about these medications.  When I first took Prozac, the pharmacists told me to take it at night because it would make me tired.  That was never the case for me.  It woke me up and I routinely took it in the morning.  (They also told me that I needed to talk to my doctor about taking it during pregnancy and that I was harming my baby when I was literally being prescribed to by one of the foremost depression-in-women experts in the world.  Note to everyone: gather lots of facts and remember that information that comes from someone in another industry may or may not be accurate.)  Now that I am taking it again, my current psychiatrist tells me all the time that Prozac is "activating".  I can back that up personally.  ;)  

Another medication that I have taken for probably over 20 years is called Buspar (busperone).  Buspar is an interesting drug, the only one in it's class.  It is specifically a serotonin agonist meaning it increases serotonin activity in the brain, but it also seems to have a mild impact on dopamine as well.  It's especially helpful for anxiety, and works well in conjunction with other antidepressants like the SSRIs and the SNRIs.  I also came off of this drug about a year ago in the search for what I was allergic to and found that while it REALLY SUCKED to wean off of it entirely, it also didn't improve my dermatitis.  So I'm happily back on it for life if I have any say about it.  

Here's a fun one I took: amitryptaline.  Before I knew I had POTS (a cardiac syndrome that can cause fainting, vertigo, etc), I was diagnosed with an inner ear disorder and was given amitryptaline to see if it helped.  It did nothing for the "inner ear disorder" but man did I sleep soooooo good every night.  Amitryptaline is part of a kind of older antidepressants called tricyclics.  They increase serotonin and seem to block some pain signals in nerves.  Some people take them for neuropathies and other nerve problems with varying degrees of success.  A big problem with the tricyclics is they are fatigue-inducing. So while I didn't keep taking amitryptaline, it did help me to find that moving to the SNRIs would be a good thing for me.  (I believe they have related affects on anxiety.)

Last, but certainly not least, I have taken a benzodiazepene for about 12 years, first only a couple times a year, and now still not daily, but more often than before.  I initially took Ativan or Xanax (depended on my prescribing doctor and since we moved a few times, they sometimes changed my medication).  They both worked fine, but later I discovered that Klonopin has a longer half-life and moved to it and found it to be highly effective for controlling the anxiety (which is much hard for me to control than the depression).  I've also had to use Valium for a couple of medical procedures, but baby, that stuff is strong and I hope I never have to take it again.  You feel "comfortably numb" to quote Pink Floyd, but not in a good way.  Here's the thing about benzos: they ARE addictive, deeply so.  I don't recommend them for just everyone because you need to know how addictive they are and use extreme caution so as not to fall into drug abuse.  I personally feel like I have the potential to have an addictive personality and exert extreme caution with how I use them.  But even more scary to me is the thought of not having that lifeline when things spiral out of control.  I don't know if anything is quite as motivating as the thought of losing a helpful tool in your mental health kit.  So I have certain nights of the week that I take it before bed to assure that I get a good night's sleep that night (yes I totally need to do a post just about sleep because people SLEEP IS EVERYTHING!!).  For all of these reasons, I think these are a drug class that are perhaps not always suitable for teens and young adults and anyone else that thinks they may struggle with abusing the prescription, much in the same way that opioids can be abused.

A note about the half-life of a drug: you know how you learned about Carbon-14 dating in school?  How the radioactive isotopes decay and when they are halfway decayed, that is their half-life?  The concept is similar with the drug's half-life.  The half-life of fluoxetine (Prozac) is 4-6 days.  That means around day 4-6, you have half the amount of the drug circulating in your body.  (BTW 4-6 days in a very long time for an antidepressants.  Part of the reason I do love Prozac.)  However, if you are an ultra-rapid metabolizer, as I am with Cymbalta, which already has a very short half-life, you may literally be experiencing withdrawal every day because your body is breaking the drug down and excreting it the way the Kardashians spend money.  I am also an ultra-rapid metabolizer of ibuprofen which means it basically doesn't work for me.  Knowing this stuff can be so helpful, and if you have the funds and the opportunity, I highly recommend getting the pharmacogenetic testing done for yourself and loved ones.

I would be remiss if I didn't also briefly talk about withdrawal feels like.  A couple of Christmas's ago, I ran out of my antidepressant and forgot to order more.  So when I took my pills out of my pill packs, I wasn't taking the Pristiq.  I got super sick, like I had the flu.  I literally thought I was going to die by day 5.  Thankfully, I realized what was going on by day 6, but it really showed me the value of putting reminders in my calendar so that hopefully NEVER happens again.  When I had to go cold-turkey off of Buspar, I had similar symptoms of nausea, dizziness, extreme fatigue and moodiness, but not at quite the same severity.  Going cold turkey off of Cymbalta was actually not super difficult since, as I mentioned, since I was basically withdrawing every single day as my body speed-walked the Cymbalta to the exit.  <<insert eyeroll at my body having to be a special snowflake in this way>>

A couple important things I've learned over the past two decades: one I already mentioned, that everyone can have small or big differences in effect of the same drug because everyone has different chemistries in their bodies.  Two, that sometimes a medication may not work, and that it takes time to move from one drug to another (when you taper off of one antidepressant and taper on to another one at the same time, it is called cross-tapering).  It can be a difficult time for anyone experiencing it, but I know it helped me so much to know that the next few weeks or months would be difficult and adjust my expectations.  A couple of times I have been asked by my doctor or have had to go cold turkey off of an antidepressant and I highly do not recommend it.  One of those was Buspar, and at the time, I was desperate to figure out why I was having extreme eczema in my basement.  If I have to change drugs, I try to do it when the day is lengthening (late winter, spring/summer) and never in the autumn.  But I had no choice with the Buspar and that fall was a difficult one for months even once I had completed my taper off.  

One final observation: the medications I have mentioned are the tip of the iceberg.  There are other classes of medications and even therapies that do not involve a pill, like ECT (electroconvulsive therapy), or TMS (transmagnetic stimulation) or VNS (vagus nerve stimulation).  I feel like the world is truly starting to blossom with better knowledge about the multitude of causes of poor mental health, and treatments are slowly catching up with that knowledge.  I truly pray that my children and grandchildren will find it so much easier and cheaper to get the relief they may need, especially as we see the world erupting into vast numbers of mental health crises over the past few years (particularly since the pandemic began).

Photo note: I found my first silver leg hair.  I had no idea that all of your body hair eventually turns silver until a few years ago.  And when I say all, I mean everything, including the stuff in the basement.  You can thank me later for this educational moment...  (And just in case someone is really freaking out about why I don't shave, there is nickel and/or lubricating strips on all the razers in the whole world.  I'm very happy to have hairy legs year round, honestly.  Have you ever felt your leg hair flutter in a breeze?  Or sway around in the water?  I'm telling you, ladies, you are missing out on some cool sensory experiences.)

 Mental Health Post #16: Suicide

This next post has really been weighing on me because it's a hard topic.  I've been putting off writing it (see my last post about procrastination and anxiety!) because I am scared I won't do a good job of addressing it.  I am, of course, talking about suicide and suicidal ideation.  I have been suicidal in my life, though not for many years.  The first time I contemplated killing myself was when I had expatriate depression (see previous post about this).  I was so low and in so much pain for so long that I wanted only to escape that pain.  And since I could not escape my situation, I started thinking of ending my life.  The very thought of doing so shocked and terrified me so much that I immediately told my dad and thankfully, that's when the ball got rolling and I was able to return home.  

The second time that I considered suicide was a couple years after we moved to our current location.  I had been trending downwards mood-wise for a couple of years, but didn't want the hassle of addressing a medication change (which in the back of my mind I knew was necessary).  I also didn't feel like I had a deep relationship with my psychiatrist and was worried about how to even address the issue with him.  The trend continued until on New Year's Eve, I threw a packet of glitter at Derek in front of a bunch of family members when he didn't listen to me about something, a move so childish and embarrassing that it shames me to even bring it up now.  I was excruciatingly humiliated and ran upstairs and locked myself in the bathroom for several hours where I wept and ignored pleas from my family to come out.  It was not good and I wondered how I could ever leave the room again, or even show my face to my husband and children, much less the other family members.  So my mind started to go down that dark path again.  Unlike the first time, I started thinking about plans and wondered if it really was the only option for me.  Thank God for Derek who must have known how bad it was and talked to me through the door and convinced me that he was worried about me and couldn't live without me.  My children all came by too and pushed homemade cards and beloved treasures for me under the door.  I made an appointment immediately with my psychiatrist and after a few months of medication adjustments, I was on the road to stability that I have thankfully been on for many years now.  

What I realized that second time was that even if I didn't value my life, and felt like I couldn't go on with the pain in my soul, there were people who did and who would be devastated if I did something drastic like take my own life.  I mentioned in my last post the LIE of depression/anxiety: that things have always been bad, and always will be bad.  Do not believe this LIE.  It is wrong and it is not reality.  Reality is that you have been happy before and you will be happy again.  You feel true and valid horrible pain right now, but it will not last forever.  I think many people that contemplate suicide do so because of the intense emotional pain they are experiencing and the need to escape it because they feel trapped.  That was the case for me for sure.  

The second experience was a real wake-up call for me to stay on top of my mental health, to be consistently self-evaluating my trends while taking into account my normal cycles like seasons and menstruation.  I realized that caring for mental health can take the same kind of hard work as any other chronic disease, but that it is possible to remit and to have times of beauty and contentment in life.

Please, if you are having thoughts of killing yourself, reach out to someone.  If you don't feel like you can talk to anyone around you, please call the National Suicide Prevention Hotline:

800-273-8255

Please please believe me as someone who has been so low that I would rather die than continue to bear the burden of extreme pain, please know that you are loved, your life is worth continuing and there is help.  You are needed.

For those who know someone who is struggling with severe depression and anxiety, please take any talk about suicide with absolute seriousness.  Do not disregard talk about death or wanting to get away from such extreme pain.  Many times, people talk about suicide as a way to bring attention to the soul-sucking pain they are experiencing because they are at the end of their rope.  You can also call the National Suicide Prevention Hotline for help as a concerned friend.

Photo note: such a heavy topic, so we'll lighten it up a little with a picture of my zombie dog.  He's all ready for Halloween...  ;)

Mental Health Post #15: How to Help

Sorry for the delay, I was on vacay!  This next post comes by way of request, as well as being something that's been on my mind.  One of the most insidious manifestations of poor mental health for me is procrastination.  You can call it many things, such as shutting down, escapism, dissociation, hypoarousal, but the end result is the same: you are stuck.  I hate when I get stuck.  For me it happens over a period of days and weeks as my mental health declines, but for some people it can seem more suddenly, perhaps in the form of a panic attack that paralyzes them in the moment or several days.  No matter how it expresses itself, I believe it is usually because of declining mental health that happens over a period of time, whether the person is aware of it or not.  Here are a few tips I try to keep in mind when I become stuck.

What TO do:

1. Nip it in the bud: Many people with chronic pain know that you don't wait to take pain medication; you take it as soon as you know the pain is ramping up.  I know people do this for migraines; I used to do it for my severe menstrual cramps.  The longer you wait, the less effective the pain relief and the more you suffer.  I've talked a lot about being proactive with mental health, and here it is again.  When you see that you are spiraling down, get help ASAP.  Sometimes this just means talking with your support network, sometimes it can mean changing medications or dosing, sometimes it can mean in- or out-patient psychiatric care.  The point is to nip it in the bud.  But don't fret over not having addressed something earlier.  Whenever you start is the start of something better.

2. Start with something small: You know how overwhelming it is to see an item from the to-do list in front of you that is large and complex?  I read something awhile ago talking about procrastination in general, and the best thing they said is to break it down into smaller, more manageable tasks.  For me, it means making lists, sometimes on paper, digitally, or just in my head. I do so love my lists.  In the past, that often meant making a rough sketch of my day.  For example, when I had that severe episode of PPD, I started small and (finally) got the help I needed from my OB (aka medication and therapy).  Then since I knew the Prozac was going to take time to kick in (4-6 weeks), I made a plan for my days.  They revolved around the feeding/napping schedule for my baby and taking time for myself.  I remember one of the things I had loved to do before giving birth was the daily crossword in the newspaper.  So in the mornings, I took my baby for a walk to the local gas station and bought a paper.  Then I would do the crossword while she napped, along with other chores.  This small amount of structure helped me move on to bigger things that allowed me to relax into the days, even the ones where things didn't go the way I planned.  Of course, this has taken years of work to achieve and I still get flustered and stuck at times.  Then I do the same thing again where I take something small to get myself moving and make a plan for how I will accomplish what I need to do.

 

3. There are better days ahead: One of the biggest fallacies my mind likes to trap me in is that it has been and always will always be this awful.  It has always hurt like this, and I will always feel trapped by the insatiable emotional pain that I am experiencing.  This is a LIE!  I cannot reinforce this enough.  It is not in any way true.  I have been so down that I have been suicidal and started planning my suicide (in the distant past thankfully), and since that time, I have been so happy I've laughed till I've cried, I've had fulfilling relationships, and I've slept beautifully for many, many nights in a row.  I've also had disappointments and downturns, and challenges that force me to reconsider how I am doing things, but truly the positive has outweighed the negative, despite my many health challenges.  My sister has a little sign on her fridge that says something like "Life isn't all sunshine and rainbows, but most of it is."  (Sorry, Julie, you should post a pic because I'm sure I'm misquoting.)  Know that there are better days ahead even if right now it is almost impossible to slog through a day/night.

 

4. Take time to ponder: when things are rotten is not the time to revamp your life and habits. I feel like we learned this lesson with raising kids: when a kid is having a tantrum, that's not the time to give them a lecture on how they should've eaten lunch at lunch time so they won't have a meltdown now.  Take time when things are good to make plans for what to do when they aren’t good. I like to think through possible scenarios and imagine positive outcomes. 

 

5. Get help from your support network: Of course, no one can imagine every possible scenario, and you can never be truly prepared for when life punches you in the face.  This is when you stop being so damned independent and you ask others for help.  (Can you tell this is something I really struggle with?)  People love you and they want so badly to do things to help you.  Let them.  Let them be needed like we all want.  Accept the person picking up carpool for you, let someone come help tidy your house, and take the hugs that are offered. 

What NOT to do:

 

1.  Don’t continue putting the thing you are struggling off indefinitely because it will only get worse. I guarantee this.  I can count on one hand the number of times that putting something off had zero negative effect on my life.  Give yourself grace and allow yourself time to grieve for what you need to do, but in the end, you must accept that you need help and then go forth and do...

2. Don’t run away from it through escapism (gaming, entertainment, substance abuse, doing anything but the thing you are dreading).  As a teacher (Derek), and as human beings, we have seen people use gaming, TV, substance abuse, and other addictions to put off doing what needs to be done.  It doesn't matter if it's a mountain of homework, or social anxiety and the inability to leave the house: getting stuck and not addressing the problem can lead to addictions and worsening mental health.  This is probably a good time to say that everyone needs downtime: all work and no play right?  But set limits for yourself, be they time limits, chapter limits, minutes watching a show, etc.  (I love using my phone timer functions for this!)

3. Don’t make huge life decisions while having a mental crisis or under a huge amount of stress. Your decision making is deeply impaired and you may well regret what you decide tomorrow.  Kind of like rebound dating right?  It's also so great to have people to bounce ideas off of.  Many times, just making a decision slowly, over a period of days can be super helpful in knowing the right path forward.

*I just want to address one big thing after so many posts.  I hope you don't feel judged by these posts.  I'm not perfect, no one is perfect, and we're all groping our way in the dark.  I hope these posts come off as informative and helpful, and not judgemental.  Believe me, I am the last person to judge someone because of their ability or inability to care for their own mental health.*

Photo note: I voted.  With duck lips of course. ;)

 Mental Health Post #14: Expatriate Depression

When I was between my sophomore and junior year in college, I did a French-speaking study abroad in Belgium as an au pair (nanny).  I was SO excited to travel and to experience language-immersion.  I am pretty decent at languages, probably one of my only intellectual gifts.  I had started learning French in college and just loved the feel of it in my mouth as I spoke.  (Can a language have a mouth-feel like a drink?...)  Unfortunately, things did not go as planned right from the beginning.  To start with, I had started dating a guy immediately before I left (like in the couple weeks before!).  Then my planes were all delayed until I was like a half a day late to the Brussels airport.  Remember, this was back in the stone age when we didn't have cell phones, and I was totally clueless on how to make a phone call from a foreign payphone.  (Or how to pay for it, AND I didn't bring the host family's phone number.)  My host father was understandably upset at going to and from the airport looking for me and worrying.  Finally I got to the home I would be staying at for three months, absolutely exhausted and numb from the stress of the past couple of days of travel.  And I found out that the host mom was in the hospital with pre-term labor, and the toddler I was supposed to care for was with family in another country.  Kudos to my host father for working to get me set up with French classes in Brussels and teaching me how to shop at the local supermarket, how to take public transit to get to my French classes and church, and how to drive an actual VW Bug from the medieval times...  

Almost immediately after arriving, my host father made plans to go pick up his little one in the other country.  Road trip!  It was so cool to drive through the other Western European countries.  We also made a couple stops to see some beautiful sites.  We visited my host father's family and I made a crucial mistake: I brushed my teeth with the local water (they warned me not to drink it, but I guess I was too naive and dumb to think about brushing with it?).  And I got traveler's diarrhea.  Like so bad that I pooped my pants trying to get to a bathroom in a foreign country while my host father was visiting a loved one in hospital.  (Please pardon how vague this is, but I am taking out details to protect privacy.)  I was so sick the entire time we visited with his family and at the hotel on the way back.  Not an ideal way to make acquaintance with the child you are going to care for.  Finally I got back to normal and we settled into a routine at home where I would care for the little one while both parents were gone.  Somewhere in there, the host mother gave birth prematurely and things got even more stressful.  At some point, I realized that I was really struggling.  I had extremely long periods where I was alone and anxious all the time about navigating the foreign landscape and new routine.  I could never get the Bug to start (and I grew up driving a manual transmission), I was so isolated from any other adults, and I dreaded the times I had to myself more than the times I spent caring for the little one and with other family members.  I found myself pulling in, and weeping for hours at a stretch, while I wandered around the house aimlessly.  I became so numb that I tried to make myself feel by eating vast quantities of delicious Belgian Waffles (gaufres), and gained 20lbs in 2 months.  I tried to soothe myself by taking care of errands like shopping, going to my French class, playing piano, and hanging out with fellow au pairs from BYU.  Unfortunately, I fell deeper and deeper into depression and started getting darker and darker thoughts.  One of my lifelines at this time was my dad.  He listened to me and paid for what I'm sure was extraordinarily expensive transatlantic phone calls.  At some point, I confessed that I wasn't sure what what I was going to do next (aka I was suicidal), and things changed rapidly.  Plans were made for me to fly out of Heathrow, and the next things I knew was that I was on the Chunnel and running around London (literally, I walked everywhere in one day because I didn't even know what the Tube was at that point) to see the sites before heading home.

When I look back, I realize that the depression I felt was a combination of factors: obviously leaving my comfort zone, and having so many (what I now know is normal) snafus in traveling and circumstance, plus my own tendency toward mood disorder.  Plus the isolation and the realities of life in a foreign country which I was definitely not prepared for in anyway.  (I am laying no blame here to my host family or BYU--who could've known what was to come or how I had a predisposition to struggle?  There were some issues with oversight that I won't go into which I believe is why my group was the last group to do foreign language study abroad in the same manner at BYU.)  This was my first major depressive episode, and still my longest by far.  Even my first experience with post-partum depression was not as long or as severe (by this I meant, I never truly got to suicidal ideation with the PPD).  Here's the craziest part of it: almost by magic, it was immediately lessened by my arrival in San Fransisco (I literally kissed the ground in the terminal when I disembarked).  I was still cautious and broken inside, but returning to the familiarity of America and my normal routine (I enrolled in summer school at university immediately) dispelled the deep gloom and desire for self-harm within a couple of weeks.  I never needed to go on medication and I actually had a renewed purpose in life and motivation.  I made a couple of big religious decisions (for my LDS friends: I took out my endowments and began weekly time in the temple) and was a star pupil who really attacked my studies with more determination than before.  

The thing about it was that I never truly "got over it".  While I found myself functional and moving forward in life afterwards, I felt deep guilt for my shortcomings as an au pair and a person for decades afterwards.  Even now I have tears welling up as I think about the incredible burden of psychiatric pain that I went through at that time.  I'm pretty sure this qualifies as true PTSD (as more than one psychiatrist has told me), and it's ramifications still affect me today.  This experience is why we did a sabbatical in England: I wanted to start preparing my kids now for culture shock and situational anxiety/depression.  I asked that it be England because then there would at least be a shared language (I mean, at least we share the same root language, right?...).  And it was still hard for me because those feelings from over twenty years ago flared up the minute we set foot on English soil.  Some of my kids struggled too, but overall I feel like we all made progress because we had each other, and we had our support group (including my beloved mother in law who came and stayed with us in a brutal heat wave of July).

Coming back to the purpose of me posting about this experience: I believe it is waaaay more common than is talked about.  I've seen it referred to as expatriate depression on the internet, tho I believe it is commonly referred to as situational anxiety/depression or just plain old anxiety/depression among mental health professionals.  I have felt pangs of it as I've traveled this ginormous country of ours, or the brief trip I took to Toronto with Derek, or Hawaii.  Just pangs, but still echoes of what scarred me so deeply  can be difficult to deal with.  (The irony of this is how much I adore traveling.  Just so much.)  And I don't believe I'm the only one by half.  As a member of the Church of Jesus Christ of Latter-day Saints (aka the Mormons), I have seen many people who go to serve missions, even domestically who struggle greatly with what seems to be this same phenomenon.  

What can be done?  For me, there was no choice but to leave the situation and seek healing over time.  For some people it can mean extra support until they become adjusted to their new situation.  Some people will discover that it is the tip of the iceberg and that they need medication and/or therapy perhaps lifelong to maintain good emotional health.  Either way, it requires patience and compassion from a support group as the person attempts to deal with both internal and external stressors.

 One last thing: I found this blog online that has some really thoughtful write-ups on this very topic.  I encourage you to look through it if it's something you want to know more about.  Like me, the writer is not a mental health provider, but someone who has dealt with expatriate depression.

https://lifeinmerida.com/what-is-expat-depression/

Photo note: A close up of the creepiest part of my Halloween displays, the baby dolls.  Please also note the skeleton on the door that is supposed to be putting her hands on her hips, but instead has a rather unsavory position.  Don't worry, I changed it...  :\

Mental Health Post #13: Seasonal Affective Disorder

Lucky number thirteen!  Seems appropriate since I'm going to talk about something that often comes around the same time as spooky season...Seasonal Affective Disorder (aka SAD).  This kind of depression is one that comes about when there is less sunlight (as in the northern and southern-most latitudes) for a part of the year.  I start to notice about the beginning of September since I live in Northern Utah.  It can also occur in places that are frequently cloudy.  (I definitely had trouble in the Pacific Northwest and in Michigan for the 8 months of winter!)  I know that I have struggled with this for as long as I can remember.  Which is strange because autumn is by far my favorite time of year, and I adore the big holiday season.  Is there anything cozier than sitting in your house sipping a hot drink with a book while the snow falls softly down outside (and a heat-producing chonk snoring next to you)?  For a long time I brushed it off and attempted to not deal with it.  That worked to a certain extent, but I always struggled when I got to January.  It probably should've been a red flag that my birthday month was also the worst month ever.  Or maybe February was...  Either way, I could almost not stand how the end of winter dragged on, especially after the effervescence of the holidays.  I felt so droopy and endlessly listless.  I wanted to sleep all day, but not the escapism of depression sleeping.  I had little ambition to accomplish things I was earlier excited about and I really had to push myself to exercise.  I was emotionally fragile and had a lot more trouble coping with disappointment and challenges.

At some point, I decided to address this issue for me.  I couldn't change the weather, or speed up time, but I could change some of my personal habits and thought patterns.  I was already taking antidepressants by then, so I wondered if I should be taking a different kind of medication.  What turned out to be important for me was to make sure I was doing well in managing my medications: making sure to take them regularly, and watching for signs that I needed to up my dose or switch to different kind of antidepressant.  I also found that if I burned the candle at both ends through the holidays, I would have a sort of emotional hangover in January that would be hard to overcome.  The very most important thing though, was knowing that how I felt wasn't forever.  That in a few months time I would be drowning in hot sun on my skin and even putting aloe on burns.  In fact, this very concept of impermanence is so crucial for all of my mental health ideation.  Knowing that the future will be different and that change will come is part of how I am able to get through harder times.  It doesn't make it easy, but it can make it bearable.  I mentioned before how I love the scriptural verse, "Sufficient unto the day is the evil thereof."  I hadn't thought too much of this verse until one day many years ago, I was talking to my sister and she mentioned that she and her husband had talked about that verse and how important it was to take things one day at a time.  When I have been at my lowest (like my first experience with PPD), there were days where I was taking it every 10 minutes or half hour at a time.  Derek likes to say you can do anything for 10 minutes (this was in relation to doing plank at one point and I don't think I'm the only one who thinks doing plank for 10 minutes is bananas!).  There are days when I think, I can get through this day.  And then we'll see how tomorrow goes, but I bet I will be able to get through tomorrow.  And eventually time is speeding up and I 'm not counting the seconds, minutes, hours.

One other thing that some people really like is to have a "happy light" to bask in each morning.  You can finds all kinds of full-spectrum lamps on the market for every situation, even doing your hair in the bathroom.  I do pull out our little happy light every fall, especially for my kiddos that have to get up so very early for high school.  But what I find a lot more effective is getting outside midday for a run or a walk.  I see people walking on their lunches too which makes me think that they have also discovered the secret of sunlight in eyeballs (albeit weak sunlight).  The combination of exercise with sunlight is magic and tends to rev me up for the rest of the day.

I know many people have winter blues/depression.  I'm curious what things y'all have found to be helpful?

Mental Health Post #12: 10 Things You Shouldn't Say to Someone With Poor Mental Health

This post is for Derek, who has been writing top 10 lists for far longer than I've known him... ;)  Here are the top 10 things you shouldn't say to someone struggling with poor mental health.  (Not in any particular order.)  Many of these are things I have heard or are even things I have said.  I've seen them expressed both explicitly and implicitly.  May we all be better at approaching those who are suffering.

1. "You need to read your scriptures and pray more", for those who are religious, or "Think positive thoughts!"  for those that may or may not be.  Not only does this invalidate what someone is actually experiencing, it also has connotations of shame (as in, you are clearly not being a good enough person).

2. "You need to eat better, take this supplement, or exercise more."  I don't want to step on when people are sharing advice, but I do want to make it very clear that passive-aggressively blaming someone for their mental illness due to their lifestyle does not make mental illness go away.  It makes it worse, and can damage your relationship deeply.  Context is also important: if a friend is trying to help by sharing things that have helped them, then that is a win.  If someone is trying says this to make themselves look better, not so good. 

3. "The antidepressants you are taking are making you this way/the antidepressants you are taking are addictive and dangerous."  Let's just stop with the anti- anti-depressant stuff.  We have plenty of clinical data now that proves in most cases that antidepressants can be a crucial help for those that cannot find relief through other means.  Standard antidepressants (like SSRIs or SNRIs, you can Google these) are not addictive, are not dangerous when taken as prescribed, and do not make people depressed when properly prescribed.  (My only caveat here is that in some cases, teens and young adults who start an antidepressant can initially worsen in the first couple of weeks.  Physicians are aware of this and will hopefully guide parents to keep extra watch during this time.)

4. "You need to suck it up/pull up your bootstraps/stiff upper lip, etc."  This does not work in almost all circumstances for any kind of suffering.  I recognize that this is usually a response borne of frustration, but it is counter-productive and again, invalidates the pain a person is experiencing.

5. " Depression/anxiety are just something you have to live with. Everyone has it and we all just get by. That is how it always has been and how it always will be."  First of all why should anyone accept living half a life?  We have these wonderful tools, medications & therapy, and there is no reason not to do things that improve your mental health.  Also, saying that someone should just accept their pain and live with it seems to me like a form of gaslighting.  Along these same lines I would group things like, "Other people have harder lives than you and look at how they are doing," or "It could be so much worse."  One of the most frustrating parts about these statements is that I find myself saying them to myself.  It's not okay to say to yourself or anyone else.

 

6. "I am frustrated and angry that you aren’t acting how I want you to act." I am guilty of this one, especially in my younger years when I wasn't aware of how pervasive poor mental health is in the life of a child, family member, or friend (or myself!).  A load of patience is required when dealing with someone with poor mental health because they cannot make changes overnight.  Having realistic expectations for yourself or someone else is truly key here.  I love the line from Matthew 6:34: "Sufficient unto the day is the evil thereof."  To me this line says that every day has its ups and downs, and we can save ourselves a lot of suffering by having healthy expectations and not worrying too much about the future.  Another way of saying this would be to "take it one day at a time."  I also love these phrases in the context of managing anxiety. 

7. "<<crickets>>"  I can't think of too many worse things than just ignoring someone who needs help, and yet we all do it because we are scared, or shy, or unsure of ourselves.  Let's all recommit to having the courage to reach out to those who need help, even when it's inconvenient or puts us outside of our comfort zone.

8. "I know exactly what you are going through because I was super sad when my favorite sports team didn't make it into the finals."  I wanna be careful here because I don't want to de-legitimize other people's pain.  But I want to make it very clear that sadness and depression are not the same thing.  Occasional nervousness about a high-stakes experience is not the same as chronic anxiety.  If you do not have experience with mental health, do not say you understand.  There are ways to show compassion without showing false empathy or being derogatory.

 

9. "I’m sure it will go away soon and then everything will be fine."  Brushing off someone's suffering is painful and again can be damaging to your relationship.  It also causes a breach of trust.  When someone doesn't feel safe talking to you, then you are no longer a part of their support system and they will cease coming to you for help.

10. "Just don’t think about it and it will go away."  I hate this one.  Like so many of these other statements, it strips legitimacy from a person's suffering and isolates them.  It also can generate unrealistic expectations.  I like to think often of power imbalances in relationships, and in a relationship where one person exerts a great deal more authority than another (for instance in a parent/child or teacher/child relationship), this can cause a wealth of damage.  Please don't ever say this to someone about any pain they are experiencing.  

If I could sum up this up, then I would say please show compassion and listen when you are needed.  Legitimize their feelings and tell them you love them, frequently.  It's always okay to say that you don't have experience with how they are feeling, and to ask them to explain it to you.  Then tell them that you are here for them and make sure you actually are.

 

Photo note: beautiful autumn mountains highlighted by stormy clouds.

 

 

Mental Health Tiny Post: Breath Holding

Did you know that people with chronic anxiety often hold their breath? It’s not intentional, it just sort of happens. I did not realize until my early 40s that I do that routinely. In fact, when I was pregnant with my youngest, I would be sitting on the couch reading (my most favoritist relaxing activity), and would suddenly gasp. I had been holding my breath and my poor fetus needed me to breathe! . Since I realized I do that, I’ve tried to practice mindfulness in deep, even breathing, especially in a stressful situation. Not only does it take my mind off what is happening, but it gives my brain some much needed oxygen. Once again I am reminded that anxiety affects more than one dimension of life.

 

 

 Mental Health Post #11: Book List

Today will be short and sweet.  Here is a list of books I love and have read that deal directly and peripherally with mental health, trauma and accompanying issues, in no particular order.  I'd love to hear any others you recommend.  I prefer the book copy, but I'm sure you can get any of these on Kindle or Audible if you prefer--none are obscure titles.

 1.     The Body Keeps the Score by Bessel van der Kolk, MD: deals with childhood and intergenerational trauma and how they impact physical health

2.     Childhood Disrupted by Donna Nacazawa: also topical on trauma and physical health.  This book is sort of a spiritual successor to The Body Keeps the Score and builds on many of it’s ideas.  This is one of the main reasons the ACE score was popularized by the media.

3.     How to Hug a Porcupine by John L. Lund: talks about having relationships with difficult personalities.

4.     The Highly Sensitive Person by Elaine Aron: this is one of my very most favoritest of all because of instead of pathologizing a sensitive personality, it exalts it.  I highly recommend it to everyone because even if you aren’t sensitive, I guarantee that you will have interactions with someone who is!

5.     Securely Attached by Kristin & Mike Berry: full disclosure, I read this as someone preparing to adopt.  But it has so many great ideas about dealing with childhood trauma and mental health that I got a lot out of it for myself!

6.     The Out of Sync Child by Carol Kranowitz: I think of this one as a nice companion to the Highly Sensitive Person.  It talks about sensory processing disorders, and while I skipped some of the heavy science parts of it, it had some really great info for coping with constant overstimulation for anyone whether diagnosed or no. 

7.     The Boy Who Was Raised As a Dog by Bruce Perry: I should warn you that if you struggle to read about real people who were abused, this may not be a book for you.  I found it an important read as a future adoptive parent, and also very informative on how trauma affects the emotional growth process.

8.     Boys Adrift, Girls On the Edge & The Collapse of Parenting by Leonard Sax: these are really great books that take a look at how parenting and child raising has changed and some ideas on how to ameliorate some of the mental health issue kids have today.  I don’t necessarily agree with everything, but there are definitely some good ideas.

9.     The Anxiety Survival Guide for Teens by Jennifer Shannon, LMFT: this is a favorite hands down.  We paid our kids $10 each to read it years ago.  It is simple and explains how the monkey mind works and how to make better habits to overcome anxiety.  It also lays out some common anxiety issues.  I can’t recommend it highly enough.

This is literally just the tiniest tip of the iceberg.  There are sooooo many great CBT (cognitive behavioral therapy) workbooks, and zillions of books about any mental health issue you can think of.  There are some great videos online (I like Prager U for one) that have science-based information that is really accessible.  When you are looking for stuff online, remember to turn on your BS radar and if something seems off about what is being said, fact-check the crap out of it!  Don’t worry if what you found turns out to be garbage—in an age where there is endless information (and endless trolls) you are bound to run in to stuff that isn’t good.  Or something that isn’t helpful to you.  The beauty is that you know you and can hopefully find the information that will help YOU to grow and be healthier. 

 Photo note: Emperor Sol relaxing in his Royal Corner...

 

Mental Health Post #10: Panic Attacks

Take two—thanks Facebook for deleting my almost finished post…  ☹  Today’s topic is panic attacks.  If you had asked me even a couple years ago if I had ever had a panic attack, I would’ve said yes, I’ve had 2.  But in the short intervening time, I’ve learned that there is so much more depth to the presentation of panic attacks.  The experience is as individual as personal perception.  To this end, here are some of the symptoms I have had when I’ve had a panic attack:

·       intense trembling

·       racing heart

·       sweating

·       nausea

·       hyperventilating-

·       fight/flight/freeze response (Google this if you aren’t already familiar with it)

·       catastrophizing (imaging the worst outcome for many scenarios)

·       zoning out and/or dissociating

The beauty of the panic attack is you can have all of these symptoms or just one.  And rarely has one of my panic attacks looked like what I’ve seen in the theater.  (See meme below just for fun—remember none of this is medical information and should only be taken as anecdotal experience.)  To illustrate, here are three different panic attacks I’ve had in my life time.

1.     Over 20 years ago, someone called me out in front of a bunch of family members.  It was humiliating, and I felt unjustly accused.  It was a sore spot in my life (still is difficult today) and haunted me.  About a year later, it came to my thoughts again and I found myself becoming more and more upset.  I sought out my support human (aka Derek) and I talked while he just listened.  During that time, I was shaking uncontrollably to the point where my teeth were chattering and I could barely articulate words.  I was sweating and felt sick to my stomach.  I did not cry, I did not hyperventilate and I did not curl into the fetal position.  After about an hour, I was calmed down enough that I was able to get ready for bed.

2.     About 6 years ago, for absolutely no reason that I could understand, I was sitting in church and suddenly felt the need to flee.  I felt emotionally claustrophobic and could not sit through the service for one minute longer.  I immediately got up and walked home (thank goodness I live close!).  I took a nap (I did not feel the need to take a rescue medication, aka a benzodiazepine) and felt right as rain when I woke up.  I still do not know what triggered this response, so I blame hormones.  So easy to blame because they are so often the problem <<eye roll>>.  I did not cry, I did not have any physical symptom except perhaps a little faster heart rate. 

3.     I have had one stereotypical panic attack.  I contract influenza about 4 years ago (despite getting a flu shot) and found myself struggling to breathe.  Derek took me to the ER (because of course it was the weekend) where there about 300 million other people with influenza in the waiting room.  So we waited and waited and waited and then we waited a little more.  My throat started to close up and I felt like I was suffocating.  I started crying hard, hyperventilating, shaking and my heart was pounding out of my chest.  The nurses came over and took my O2 sats and they were well above 90 (I blame the hyperventilating).  So I was sent back to my chair and told to wait.  I was afraid so I told Derek we needed to leave (here’s the “flight” part).  The staff told me I should not leave but I would not change my mind.  We went instead to my family doctor and they diagnosed me with bronchitis bordering on pneumonia (no Xray to confirm that one of course) and gave me tons of medications.  This one was especially difficult for me because I felt I had been shamed at the ER for my “melodramatic” display—it was especially powerful since the people who had done the shaming were medical professionals.  (Please don’t judge them too harshly—people don’t understand the power dynamics they wield in their various positions and they were full well beyond capacity.)  In this situation, I displayed many of the stereotypical actions of someone having a panic attack.

When a person has a panic attack, they are in an extremely vulnerable position.  The way you act toward them at that moment and afterwards can affect your relationship for a long time.  When someone has been kind to me when I was experiencing severe mental illness, it has changed how I’ve seen them probably forever.  When someone has been short with me and shamed me, it has made me feel unsafe with them.

Here are some things that I do to prevent panic attacks from fully blooming when I feel them coming on.  You will notice that many of them are similar or the same as to what I do to manage my chronic anxiety.  The key for me is to not put off addressing it—taking action immediately is crucial to keep it from becoming consuming.

·       Make sure my physical needs have been met, particularly eating/blood sugar issues.

·       Go for a walk or get some kind of exercise, preferably alone at first.

·       Use the 5,4,3,2,1 rule (I’ll append a link at the end of this)

·       Talk to a trusted loved one about the cause of my stress, if I know what it is.

·       Sometimes I find journaling soothing.

·       Meditation/prayer is of course helpful.

·       The very few times when it was not otherwise controlled, I took my emergency medication, a benzodiazepine.  Thankfully I have only had to do this a handful of times.

 Later, I like to look back over the recent past and see if I can identify what might have been trigger so if possible it can be avoided, mitigated, or at least emotionally prepared for.

Like any other disease, panic disorders take patience and work.  Having a good support system is crucial to my success.  I have had to limit things that are difficult for me like toxic people, reading too much current news, and not overloading on depressing information.  For example I have had to limit how much exposure I have to WW2 media (yes, I am the one white person in America who has still not watched Schindler’s List) because it is so damaging to my mental health—don’t worry, I think I’ve learned the lessons I need to learn from what I have consumed.  I still have times when I get stressed (as laid out in a earlier post) but I don’t feel like I come as close to panicking as I used to.  Again I blame hormones (or maybe I thank them for diminishing?...) and time spent practicing good mental hygiene. 

54321 rule:

https://www.urmc.rochester.edu/behavioral-health-partners/bhp-blog/april-2018/5-4-3-2-1-coping-technique-for-anxiety.aspx