Sunday, May 8, 2011

It's been a profoundly difficult week.

I keep wondering if I am going out of my mind.  What is real and what isn't?  I've started seeing my therapist, the one who's moving away, two times a week now.  I asked him if wanted to see me twice as often because he was "worried I was going to off myself."

He said "no."  Knock on wood.

I can't help but wonder if all this talking is making things worse; if it is only drawing more attention to my suffering; if it is better to swallow and bury it, to laugh instead.  He argues ironicalness is a coping mechanism, but not an ideal one, that it is better to feel.

I am not so sure.

I find myself driving into college town, pulling over less than a block away from that bridge.  We've become so familiar to each other.  I sit in my front seat writing goodbye notes on the backs of old pay stubs.

After long gazes, after considering the 9 foot fencing, I reevaluated my plan.  To really simplify things, I would need a ladder, and I would need to do it when there wasn't nearly so much traffic.  I would need to come back during the night or early, early morning.

Although I was tired and really just wanted to get it over with, I was okay with taking the time to do more planning.  It wasn't worth dying if I wasn't going to do it right.

I drove home.

I went to bed early.  I was exhausted; there was nothing I wanted to do.  I couldn't sleep.  I felt compelled to open the window, take of the screen and jump, but surely this wouldn't be nearly enough of a fall to guarantee death.  I started planning: what about the fifth floor of the hospital?  Is the entrance locked?  I'd have to be careful, there was so much grass in some areas.

I didn't want to think this way, but it's difficult to turn thoughts around.  I had reached a new level of desperation.  Maybe I should stop taking drugs all together.  I always used to be able to get back on track when I was at Oberlin, and I didn't take any drugs as a student.  Something had to change.

I saw my PCP a few days ago.  I sat there, flatly explaining that everything seemed pretty pointless.  After a while she started suggesting alternatives, including ECT.  I was disturbed and appalled.  I know ECT has become comparatively less...barbaric, that the delivery is less prolonged and less intense, that they sedate people.  Still, I had a friend who underwent ECT.  I knew her before and after.  It was like someone had replaced her head with a yellow balloon, bobbing happily in the breeze (but empty).  She had a lot of retrograde (and probably anterograde) amnesia, too.

I started to wonder, what would it be like to forget all these memories, to forget memories of my son, his birthdays, my marriage.  How is this living?  After all this bullshit, you want to steal my memories, too?  From what I'm read, I'm just not convinced of the efficacy of ECT and that the benefits outweigh the risks.  From what I've read, it's not uncommon for people to have reduced IQs of 30-40 points (although many state they do not feel less intelligent).  I might as well just get ECT, and go back to my job as an automaton.  That's the kind of promise that I envision.  Maybe I'm being overly protective of what memory and intelligence I do have.  Still, getting robbed of all this is - calling it frightening seems like an understatement.

We talked about trying some of the old (and now comparatively more obsolete) tricyclic antidepressants.  My husband took my script to the pharmacy (which apparently doesn't routinely stock it).  I told him to just get it filled - that I didn't want to read about the side effects, that I was worried if I did I wouldn't bother taking it, that I was desperate.

I don't know.  I just keep going through the motions.  I keep trying to put on a brave face, but in this job, where I am grossly underutilized every day, I just have too much time to think.  This thinking, it's not pretty: counting down the minutes, plotting my demise.

Everyone once in a while something real slips out.  A narrow beam of light through a cracked doorway: excitement about xanthomas, about knowing something, about actually being useful in some capacity that is above that of a trained monkey.  Every once in a while, something very real and very sad slips out, too.  I find myself reduced to a puddle of goo, trying to hold back sobs as I sit in my car, driving down the road, listening to the radio.  Sometimes I feel as though I am carrying around the entire weight of the world, that I just need to lay down and cry, that I am not capable of much beyond that.

I don't know what's happening.  Things are changing, but I can't seem to discern if it's for better or for worse.


  1. I hope therapy is helping- I think talking things out can be helpful, but at the same time it forces you to think about unpleasant things- it's hard.
    We didn't learn a ton about ECT in psych, but the amnesia thing is common. From your writing, and the fact that you're pre-med, it's clear that you're very intelligent, and that intelligence is part of who you are- I don't know if that's worth risking to do ECT- until you exhaust every other option. But again, I'm not your doctor. I hope you have a nice mother's day!

  2. Hmm...yeah, I don't know what to say about the ECT. I did have a friend who did it, but I wasn't living in the same city and I don't know how it went. I would just say to do what you need to do right now. If taking the tricyclics is going to help, find somewhere that has them and start there. Thinking good things for you!

  3. ECT works really well for some patients. But still, like Cate said, I don't know if it's right for you given how much you value your intelligence and memory. Try the TCAs, see how they go. If those fail, you still have the MAOIs. Keep doing what you're doing.

    Do you have something you're looking forward to? Can you force yourself to think of that instead when you start thinking about the bridge?

  4. Can you take this memory and intelligence into your own protective custody? I am not the sharpest quill on the porcupine, but it seems that part of yourself is self-protective. Can you focus on that and develop it? As a chronic under achiever I gave up on being useful decades ago, but have only recently come to terms with it. You still have it and it seems to want to live. Work on that.

  5. I was kind of going to echo what Jon said. Since you obviously value your intelligence (and we all commenting and reading your blog do, too) then cultivate that to show you that your intelligence is worth saving for and that bridge will not only take your life but your intelligence, your memories, your good wishes as well... Is it possible to hate that bridge for doing just that?

  6. Have you explored TMS (transcranial magnetic stimulation) with your doctor? Not sure what the latest studies are showing, but I remember it seemed to have promise, without the level of risk as ECT.

    At one point I asked my doctor about trying to get into a study for deep brain stimulation. I'm sure that has a pile of risks as well, but if you don't respond to some of the older medications, it might be worth looking into.

    Depression is so hard. I hope you have some better days ahead of you soon.

  7. When I worked in psyche I saw *tons* of patients show amazing improvements from ECT, often from as few as 4 or 5 treatments.

    The retrograde amnesia is typically only associated with events immediately prior to the therapy (and I mean, immediately prior, like 30 mins before the treatment).

    It is not often associated at all with anterograde amnesia.

    I do not know the latest literature on IQ levels but honestly, I think the neuroplastic changes that occur from depression and anti-depressant drugs are more damaging.

    I was actually so amazed by its efficacy/results I told my PCP that if I was ever in a severe depression to sign me up for ECT before anything else.

    There is a lot of misinformation out there about ECT. I would talk to your psychiatrist about it and get his/her views on it. It might just be the thing that works for you.

  8. i also get excited about xanthomas...:)

  9. ABB's post reminded me of a patient of mine. It's actually really interesting. She had severe depression whom we were really concerned about because her memory seemed really badly affected by the ECT. She was really lethargic and was having trouble verbalizing. It turned out that it was just that her electrolytes were out of whack because we had over diuresed her with her thiazide diuretic. Oopsie. After we fixed that, her depression actually had improved a lot.

    There is something to be said for no side effects from the medications.... I don't know. Hopefully you won't have to make these choices.