The Walrus >> New Treatment for Depression >> Mapping the Blues >> science

This is one of most interesting articles about depression that I've read. It covers the history of depression treatment, some very interesting research into brain patterns shown in depressed patients, and a preliminary review of deep-brain stimulation (DBS) treatment.

Here is the transcript of an interview with Dr. Helen Mayberg, the doctor profiled in the earlier article.

We have a ways to go before DBS or any similar treatment is going to be generally available and, more importantly, proved to be effective. Nevertheless, the idea of evidence-based treatments - where we can see the effect of treatment as it happens, rather than waiting the days, weeks, and months that are now a part of the current treatments - is exciting and hopeful.

The benefits of mindfulness may only be in the mind

I've read a lot about mindfulness over the years. It's the basis of stress reduction course that I took last summer. Well, it appears, at least in the case of a recent article by Ellen Langer, that mindful exercise may not be any better for you than plain, old drudge work.

In Exercise Study, Occam's Razor Shelved in Favor of Buddha's Magic Wand - 60 Second Science

Fifty-minute walks, three times weekly for Treatment Resistant Depression

In addition to the cardio workouts resulting from a recent string of snowstorms, Marley and I have been taking longer walks, three miles or more. We're only a couple of weeks into the new regimen (along with an increased dosage of Emsam) and we haven't seen a lot of improvement yet. Nevertheless, it can't hurt (except for the falling-down part that often comes with walking on icy roads).

Ref: Dr Shock MD PhD: 3 Times Walking 50 minutes a Week for Treatment Resistant Depression

When Big Pharma fails, there's Toyota.

We're learning that depression is can foreshadow intellectual decline in older people, possibly by diminishing the executive functions of the brain. This may have a longer-term impact that lasts into our older years. Fortunately, Toyota is developing cars that may be able to compensate for our shortcomings.

Get Healthier and Happier - US News and World Report

Get Healthier and Happier - US News and World Report: "Gradually, many mental-health practitioners are coming to believe that adjusting brain chemistry with medication isn't enough—that depression is a complex chronic disease, akin to diabetes, requiring lifestyle changes and ongoing monitoring to address underlying causes."

If we have so many answers, why does depression still exist?

Lots of people have lots of ideas about origin and treatment of depression. It can get very confusing and disheartening. If we refer to depression as an illness, for example, we're taking sides, implying that the symptoms of depression are caused by malfunctions in the brain and body. Treatment, then, typically comes in the form of something from the outside - medicine, magnetic stimulation, electroshock, or, in the rarest of cases, surgery.

Another camp says that depression is largely a result of societal behaviors that isolate us from one another. Throw in bad exercise and diet habits and you have a deteriorating body and brain that naturally leads to depression and anxiety. Meds demonstrate the marketing prowess of Big Pharma more than good medicine. (Right on cue, The Onion explains it all.) The treatment plan (or, even, the cure) for depression winds up being, "Don't do that." If you're thinking that you're depressed, think about something else. Call upon your higher power. Load up on Omega-3 fatty acids, run a 5K, and you'll be fine.

All of which can leave people with depression feeling as though they're powerless over an unseen medical condition or that they're failures because they can't apply a few simple principles to get and stay well. Conversely, when one or more of these techniques leads to a time without symptoms of depression, one's tempted to say, "I'm a good patient. I know what to do."

And all that, sounding like hiking boots in the washing machine, is how I'm feeling. We're expecting a lot of snow today, so I plan to talk with my psychiatrist on the phone, rather than in person. We'll probably increase the dosage of Emsam. Marley and I will go for a long walk. There's plenty to be grateful for. Whatever works is good for today. Whatever doesn't work, well, we'll try something different tomorrow.

Aqua's ECT treatments

A well-told tale about Aqua's experiences with ECT and the depression and meds that frame it: Vicarious Therapy: Me and ECT.

(via Dr. Shock)

The Neurobiology of Treatment-Resistant Depression

It's easy to get discouraged with the news that "Treatment-resistant unipolar major depression appears to be the rule rather than the exception." The Neurobiology of Treatment-Resistant Depression

Nevertheless, we keep going. The Emsam is showing good results so far. I haven't more good than tough days, even though I haven't slept well the last two nights. I have an appointment with my psychiatrist on Thursday; we'll discuss the option of increasing the dosage. My biggest concern with the increased dosage is that the dietary restrictions come into play at the next level. It's an odd world when bananas and raisins are proscribed, but Cheez Whiz is permitted. I'm probably going to have to stay away from Chinese food because anything worth eating is made with soy sauce. Of course, we might conclude that I should stay at this dosage for a while longer, making dinner safe for hot and sour soup.

ECT Videos

I've mentioned a couple of these before, but it's good to have the links in one spot: Dr Shock MD PhD: 9 Videos on ECT, electroconvulsive therapy.

Something to keep you awake at night

So, if the amount that you sleep either increases or decreases, you'll face an increased mortality risk. And then they tell you that it's not a good idea to use medications for sleep, that fixing sleep hygiene is the key.

NYT - Self-Nonmedication

Having recently come off of Effexor, I can confirm that this writer's withdrawal experiences are consistent with mine. I can also confirm that it's my opinion that it's dumb to wean oneself off of such a medication by using reduced-dosage samples squirreled away from whatever source.

Bruce E. Levine: Why I Don't "Disease" Depression - Living on The Huffington Post

Bruce E. Levine: Why I Don't "Disease" Depression - Living on The Huffington Post: "Instead of labeling depression as weakness or illness, we might better decrease depression by understanding it as a normal, albeit painful, human reaction."

I think I'll just present this as is. The article contains stuff worth pondering and can lead to some healthy feistiness, but the disease model for depression still make sense to me.

Continuation of the med adventure

When I presented the prescription slip to the pharmacy technician, she studied it for a few minutes and then handed me a pad of paper. "Could you," she asked discretely, "write down what you think the prescription is?"

A traveler around the world of work: What does a change change?

A traveler around the world of work: What does a change change?

How to be depressed

How to be depressed

How do you spend your days?

Yesterday, a friend asked me how I spent my days. I did have a good answer because a) I couldn't remember some of the things that I've been doing and b) my days and weeks don't have a lot of consistency.

For example, I have attended an outpatient support group on Mondays, Wednesdays, and Fridays. I couldn't, however, remember why I hadn't attended this past Monday's session. (Sandra reminded me that I met my psychiatrist at the hospital to pick up samples of my new medication.) I didn't attend today because I went back to bed after breakfast and didn't get up until nearly 10.

Some days, such as today, have appointments and errands. I'm writing this from a cube at the car dealer's where my car is having its 15,000-mile service. (I've had this car for less than a year and it's already at 15K miles, even though I no longer have a job.) I've done some grocery shopping, skimmed a lot of junk on the web, and brought in a load of firewood. Later this afternoon, Sandra and I will go for walk along the rail trail. I get some form of exercise almost every day.

I watch TV, although not much, and listen to news shows on the radio. I read some - newspapers and magazines, mostly; I have had a library book for a couple of weeks and just renewed it for a couple weeks more.

There are a lot of computer-related tasks that I attempt, but just a few that I can complete. For example, yesterday, I wanted to set up a backup scheme for our laptop so that we could mirror the system disk on one of our USB drives. In order to do so, I needed to create a new partition on one of the large drives. I stared at the problem for about 20 minutes before realizing that I didn't know how to begin. Our important stuff is backed up safely, but not in the way that I would like to have it.

For most folks, I'm sure that my days seem to be crushingly dull. Getting through a day may not seem like fun or much of an accomplishment, but, for many days, it's all I've got. What do I do for fun? What are my hobbies? Would I like to have sweet potato salad at the Thanksgiving dinner? I can't believe that a simple answer is so much work.

New life inside the depressed brain - The Boston Globe

New life inside the depressed brain - The Boston Globe

These tiny halls

It was, by any measure, a rough stretch. After Wednesday's ECT treatment, my body was very sore, particular around my neck and shoulders. This is typically occurs when either I don't receive enough muscle relaxant or when my body, for reasons uncertain, metabolizes the muscle relaxant differently.

In addition, my.mood sank. I had a pair of 6s. We reached my psychiatrist on Friday evening and settled on a plan (increasing my Seroquel) that we hoped would keep me stable until I could see him on Monday (today).

It worked. Sandra and I went to a Thanksgiving farm fest on Saturday. Yesterday, we went to a famer's market, out for brunch, and for a hike in one of our favorite nature preserves.

So, now I'm waiting to see the doctor at his other office in the psych ward of an old hospital. I'm starting the MAO inhibitors. More on this as it goes along.
---
Sent from my Verizon Wireless BlackBerry

Post-zap

It was good to be in a familiar hospital with people I know and who were kind. I was also somewhat scary, based on my experience with my last ECT. (The last one took place at another hospital with another set of doctors and other staff.)

I arrived at 7:30, was wheeled into the surgery suite shortly after nine, and went into the ECT room about 9:30. I think it was a bit after 10 when I awakened, although it's tough to tell when I don't have my glasses. Today, it was more difficult that usual to remember the day or time of year (spring vs. summer). I don't think that I really got it until Sandra brought me home.

For the rest of the day, I've had a few sore muscles and an ache on the right side of my head (where the doctor placed one of the electrodes). Before the procedure, I asked about unipolar (electrode on just one temple, with other other on top of the head) vs. bipolor (electrodes on both sides). Doctors prefer unipolar because the risk for memory loss is lower. I'm ready to try the other in the hope of finding more relief.

Sandra and I talked about an upcoming vacation, but I was able to provide much enthusiasm or input. We did enjoy a walk on a nice mid-autumn day.

They're giving out awards for depression

To dream, perchance to sleep

Since making the change to my meds (discontinuing Imipramine and starting Lamictal), I've had nights of odd dreams and little, deep sleep. The first night, I dreamed about not sleeping. Since then I've had lengthy dreams about work, business travel, and, then, last night, working in California. In a previous job, I was in California a lot and this dream set, even though located in a warehouse-type office building, reminded me a lot of that job. The dreams stretched out for what seemed like hours, but I'd also awaken often between segments.

This sleep pattern, I think, had made my mornings difficult. Today, however, has been difficult all the way through. Marley and I went for a walk this morning and I've done a bit of laundry, but, otherwise, I've not been able to do much today.

Shaking the medicine bottle

Sandra and I met with my psychiatrist yesterday afternoon and reviewed the effect of the increased Imipramine for the last 30 days. The results weren't impressive. I've been drifting along between kinda-ok and not-so-good, which is disappointing, given the clear progress that I was making after my hospitalization.

So, we decided to take some new steps:

• I will start Lamictal today. Lamictal is a mood stabilizer that, the doctor believes, works well on the depressive cycles.
• I will also stop taking Imipramine to clear my system in preparation for starting Monoamine oxidase inhibitor (MAOIs). In a couple of weeks, we'll try Emsam, an MAOI that's delivered via a transdermal patch and so doesn't have the same stringent dietary restrictions as the meds that are taken orally.

Because of the slow increases of both Lamictal and Emsam, it may be a couple of months before I can feel the full benefit, if any, from these meds.

In the meantime, I will also resume ECT. I'll have a treatment next Wednesday.

Kitty Dukakis at UMass Medical School

This morning, I attended a lecture by Kitty Dukakis on the topic of ECT, covering both her personal experience as a patient and her observations as a writer and lecturer.

Her talk reinforced what she'd written in her latest book, Shock: ECT is effective and safe as treatment for depression and other mental illnesses.

What I found most compelling and admirable is that she gave this lecture during a time when she is receiving ECT treatments. As she noted several times, her depressive periods run on a nine to 10-month cycle. When she notices (or those around her notice) that the symptoms of depression are returning, she arranges for a series of six ECT treatments. She'd scheduled this lecture earlier in the year, not knowing that it would be time for ECT. She has chosen to receive her treatments as the need arises, rather than having a monthly maintenance treatment.

She spoke from notes and often read whole paragraphs. She paused for an extra few seconds as she tried to remember a name. Her good humor was clear, even if the pace of her speaking was measured. She talked candidly about the memory loss associated with ECT. Some of the loss is temporary, some not. She regarded the loss as a trade-off that she was more than willing to accept.

It was good to hear her in the context of a medical school. Several of the questions from the faculty and students sought to know how they could do better: what kinds of service delivery, research, and legislation could help? Ms. Dukakis highlighted the Avera Behavioral Health Center in Souix Falls SD as an example of a comprehensive treatment facility.

So, lest we forget, ECT is not a cure, but it is an effective and safe treatment.

---

This lecture was part of the Grand Rounds series sponsored by the medical school. I learned about it yesterday in our support group. I saw no signs in the building regarding the lecture nor have I been able to find any mention on the school's web site. I wonder how many people who wanted to attend the lecture who are still wandering those corridors.

Depression: Recognizing the Physical Symptoms

The Internet can be a great source of helpful information about depression and other topics. Let's not forget, however, that even web servers can have bad days.






From Depression News.

An excellent lecture about ECT

A video of a fascinating lecture that turns personal. (Some PG-13 language)

Some days don't have much of a chance

It probably would have been ok if I'd slept just a few hours because I had stayed up to watch the Red Sox win the series last night. Not so, however. I went to sleep around 10, when they were up 2-0. I woke around 2:30 and listened to the radio for a while before getting up. The BBC bemusedly reported that the Red Sox had won the "World Series" when the teams in Major League Baseball are all from North America.

Anyway, I woke after just a few hours of sleep, felt alright until about 8, and then, well, tried to get the day started. I did some grocery shopping mid-day, did some laundry, took care of a few small chores, but stumbled around with little energy, enthusiasm, or focus. It was a beautiful day - sunny and fresh after a hard frost overnight. We'd had a wonderful weekend. So, it was pretty much just about the sleep.

Oh, and I missed an appointment with my therapist. I had the appointment in my calendar at 4PM, but it was really at 3. All the way there, I thought that it would be a short visit because I was too tired to engage in anything of substance. Dunno if I sabotaged myself or not.

I have an 8AM dentist appointment tomorrow. I'd like to think that the day can't help but be better after that, but I know it ain't necessarily so.

Boston trip

I wandered into the 'bcn studio some time in the fall of 1968. the Big Mattress: The Golden Years • WBCN • 312 Stuart Street. The station had changed from classical music to underground rock, etc. in the spring of that year. The music and the attitude were so different, so important, that visiting the station became something of a pilgrimage.

The visit was brief. Jim Parry was on the air. There was a massive Ampeg tape machine, maybe two, and there were LPs on every surface. "What are you doing here?" Parry asked.

"Just looking."

On the same trip to Boston, I visited A Nubian Notion, which IIRC, was located on Cambridge Street. It was quite the place for a white kid from the exurbs.

Watchful waiting

I had an appointment with my psychiatrist today. I learned some stuff from him and he learned stuff from me.

• My QT interval is somewhat high (44o and later 421), so we're pretty much at our limit for the Imipramine.
• I've had close to an equal number of tough days and OK days. The tough days, however, aren't as bad as the ones that I had in August.
  
• If the tough days become more frequent or more difficult (a score of 5 or so), we can resume the ECT treatments at short notice.
• We'll give the current Imipramine level a couple more weeks. If there's no improvement, we might try MAOIs. The medications are now available in a patch that doesn't impose the same rigid dietary restrictions. ("MAOIs can cause death if they are combined with certain foods or taken with certain other medications.")

All of the doctors' reports have been submitted for my disability claim. It will probably be another month or so before I hear anything further on that front.

Big topics - what can I do with the time I have left?

When I started this journal, I explicitly tried to stay away from big, philosophical topics because a) I wanted to chronicle my activities during my time out of and in work and b) it was much more important that wrote about what I did, not what I thought.

Well, as it has turned, one of the big topics is having a direct impact on my daily activities. Quite often, I have bad days - hours when I'm exhausted, unable to focus, or, worse, unable to care. On such days, I will often catch a second wind in mid-late afternoon, around 3:30 or 4:00. I then have to decide what I will work on for the rest of the day.

A bunch of years ago, I was watching a Red Sox game on TV. The announcer mentioned that open tryouts were scheduled for the following Saturday. "All players," the announcer said, "must be between the ages of 16 and 25 years old and must bring their own gloves, shoes and uniform." I was going to be 26 in a few months. I was saddened because a totally unrealistic fantasy, that of being a professional baseball player, was beyond my reach. Truth be told, that idea entered the realm of fantasy when I was 11 or so and unable to see the inside fastball.

How, then, do we judge our days? Some times, our judgments have good, empirical evidence - Did I hit the inside fastball or not? Other times, they're relative - How well did I do today compared with yesterday or days last week? How well did I do relative to my abilities for that particular day?

For the last six-plus months, I've assigned each day a number on a 1-7 scale, with 1 being great and 7 being somewhere around a bag of wet donuts. I'd been assessing the days for even longer, but didn't start recording the numbers until April. I found that I needed to average below a 3 to do my job. There have been two brief periods, in mid-July and late last month, where I've averaged better than a 3 for a week. (A sample of the chart is available here, in PDF.)

On days with a rating around a 3, I think that I ought to be doing ok, even to the point of being able to handle tasks that are something like the kind of things that I had done at work. So, today's been a 3, I think, and what have I done? I babysat Cassie for a couple of hours, did a couple of errands in town, and a few other miscellaneous chores. It's a 3 because I felt/feel pretty good, but I don't have a lot to show for it. Oh, I also talked with our neighbor who'd been in the hospital for a couple of days as the result of a severe arthritis flare-up. Yeah, that's the stuff that will generate a fresh grant of stock options.

See? This is the kind of thinking that drove Martin Luther bonkers. Anything that he could do, he should do, and why wasn't he doing more? This is a good reason to stay away from big topics and concentrate on the next right thing to do. In the meantime, maybe my granddaughter will remember that she and I had fun playing in the back yard on a nice autumn day.

Will I be able to play the piano?

It's usually not a lot of fun to be around people who have depression. Not that they (I) will dominate the conversation by moaning about how bad things are, although that can happen. More often, though, the person with depression is like this little dark star in the room, inhaling all of the light, energy, and oxygen in the room. So, it's no wonder that, after a while, people back away.

I'm certainly blessed to have family and friends who are not like that, who stay close and who keep bringing buckets of joy. I'm deeply grateful. I'm also aware, however, of who's not around. For example, I've not heard from anyone from the company I left in the spring. I've tried to keep people posted, but, after three or four tries, I've let it go. (Well, sort of. I wouldn't be writing if I'd let it go completely.)

So, is this a chance to feel sorry for myself? Probably. But, it's also a recognition of some facts:

• Being out of work changes things. I see fewer people and have even fewer chance or casual contacts.
  
• I get lonely.
  
• Some people don't know how to react to someone who has an illness. The old nemesis, perfectionism, steps in and freezes people. ("I don't know what the best thing to do is, so I'll do nothing until I figure it out.")
• Even in good times, I'm not always a social person.
  

The medical treatments that I receive aren't likely to change much of that which is the core me. Some of the talk therapy, notably CBT, might. In any case, people change, but not much.

This thread started when I read a couple articles:

• Shrink Rap: Let Me Tell You About My Illness


• Patients with more chronic lifetime depression histories, and those with multiple depressive episodes, may be particularly vulnerable to reduced support via a gradual erosion of emotionally fulfilling relationships with family and others.
  

I can haz brain?

Hope is not always our friend

This article in the Wall Street Journal provides some interesting ideas about hope and how hope can sometimes keep us from accepting and adapting to our current condition. We keep expecting that the hoped-for thing will come soon, so why bother investing time and energy into what's happening now?

[Update: 12/15/07]

Last Sunday's New York Times included an article on this topic:

It might seem strange that patients who are better off objectively were less satisfied with their lives, yet the finding makes sense: “If your condition is temporary,” Ubel explains, “you’re thinking, I can’t wait until I get rid of this.” Ubel says thoughts like these keep you from moving on with your life and focusing on the many good things that remain.

A walk around the block

Marley and I went for a walk this morning. We'd had a rain shower just before dawn, so there were a few small puddles to avoid. The wet roads also made the car tires sound louder. Why, I muttered often, are people in such a hurry. From stop sign to stop light, they'd accelerate hard and then hit the brakes. This is what I've been missing each morning.

I heard some geese overhead, but I couldn't see them. A couple of visits ago, my therapist asked me if I became sad as the days become shorter. No. When I hear or see geese, I remember a line from Joni Mitchell's Urge for Going - "See the geese in chevron flight." It's a sad song and I associate it with autumn, but that's a close as I get to feeling sad in the fall. (I first heard the Tom Rush version and still think of his recording when I think of the song. The BBC has broadcast a three-part series with K. D. Lang talking about music from the cold, hard midlands of Canada. Last night's segment was about Saskatchewan. Lang talks about Joni Mitchell and Urge for Going plays under much of the report.)

We went out early for the walk because I'm waiting for a call back from my new doctor. This past Sunday's Boston Globe had an article about how patients will fire doctors and vice versa. I called my doctor yesterday morning and haven't heard back. This is getting old.

National Depression Screening Day 2007 - World of Psychology

National Depression Screening Day 2007 - World of Psychology

I'm not Jack

Interesting and thorough article about diagnosing and treating depression in the elderly.

Behavior: Depression in the Elderly

The doctor, however, might consider a name change:

C. E. Chaffin's Blog: Dr. Chaffin's Tips for Enduring Depression

C. E. Chaffin's Blog: Dr. Chaffin's Tips for Enduring Depression

The Royal College of Psychiatrists - Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT)

Mental disorders cause 1.3 billion annual days of lost role performance

Mental disorders cause 1.3 billion annual days of lost role performance

$ curl --silent "$url" | grep -E '(title>|description>)'

They talk a lot about reframing in cognitive behavioral therapy (CBT). With reframing, you're taught to look at problem situations in a different way. This is most useful when you know that you're heading into a spiral or when you're having racing thoughts. If you can do so, it's helpful to avoid extremes of language: I can never.... I/they always.... Instead, you might be able to say: I can't yet .... or This time, they ....

One of the challenges, however, is that you don't always see the connection between a problem and the spiral. For example, I've been trying to find an easy way to fetch some web pages using RSS and Perl. I've looked at this problem before and may have even solved, but I can't remember if I did or not. So, I was trying a number of different approaches, each of which sent me off on an unhelpful path of configuring and compiling and debugging and such. I stopped for a while, took a lunch break, and noticed that my mood was slipping. Marley and I went for a walk around the block (about a mile). It was during that walk that I made the connection between my frustration this morning and my slipping mood.

[Between paragraphs, my mechanical pencil and I got into a tussle. I wanted to make some notes about something else, but I couldn't get the lead refill to behave properly. I know that it's not Darfur or Rangoon or that island off the coast of Yemen that just blew up. I found another pencil and will save the refill for another time.]

This is a reminder why I'm not ready to go back to work. I'm not yet able to solve problems that require that I learn something new. I can also get sand-bagged emotionally when I encounter frustration. I'm a lot better than I was, but still not ready for prime time.

Black dogs and purple elephants

The Purple Elephant in the Room: Talking to Someone With Depression

» Blog Archive » Month of the Black Dog

» Blog Archive » Month of the Black Dog: "It’s October now and that means it’s National Depression Awareness Month and October 4 is Depression Screening Day."

Depression - OrganizedWisdom

This is a good starting place to learn about depression: Depression - OrganizedWisdom

(via Dr. Shock)

If you can't reach your doctor, the Internet is always there to help you

via

Depression, ECT, and memory

Dr Shock MD PhD: How does short-term memory work in relation to long-term memory?

Shrink Rap: The Co$t of Being Depressed

This article shows the costs for various anti-depressant medications. Of course, the cost to you will vary widely, depending on your insurance coverage: Shrink Rap: The Co$t of Being Depressed

Lest there be doubts

I met with my new psychiatrist this afternoon (new, as in he'll be my primary psychiatrist). I earned my nerd badge by presenting him with a graph that's tracked my daily mood for the past six months. I reported that I'm doing much better, the result of the hospital stay and the change in medication. I also mentioned that I'm still having trouble with directions and recognizing places. (I needed to get and use directions to find his office, even though I've been there before.) I attributed it to the ECT treatments. He thought that was unusual, that the treatments would affect such a specific area of memory. When the appointment was over and it was time to leave, I opened the door and walked into a closet.

Uh, oh

Brain atrophy in elderly leads to unintended racism, depression and problem gambling

Psychiatric Times - series of articles regarding depression

These articles provide a good overview of the current state of the art in the treatment of depression. They are well-written with just a taste of jargon.

• Clinical Depression: Complexities of Diagnosis and Management
• Adherence to Treatment Regimens in Major Depression: Perspectives, Problems, and Progress
  
• Never-Ending Winter: Chronic Depression
• Cognitive Therapy: What Is Its Role in Depression Treatment?
• Placebo Effects on Pharmacotherapy Outcomes in Major Depression
• Treatment-Resistant Depression: The Role of Gene Factors
  

Huh?

I think that this means that they can predict the effectiveness of an antidepressant by seeing how you react to loud noises. Or, maybe, how you react to research articles with ridiculously long titles.

Differential prediction of first clinical response to serotonergic and noradrenergic antidepressants using the loudness dependence of auditory evoked potentials in patients with major depressive disorder

Who hid my roads?

One of the truly odd side effects from ECT surfaced when we were going to a family function last weekend. We were going to a part of Worcester that I know quite well. It might have been a year or two since we'd gone to that area, but we used to go there almost weekly for dinner, shopping, visiting, and such. This time, however, from the first road out of our town, nothing was familiar. I was driving and Sandra had to provide turn-by-turn directions, even when we were on Main Street, Park Avenue, or other major roads.

This has happened a few times in other cities or towns, but not consistently. That's the scary part, that it happens unexpectedly, that I get lost on roads that I think that I'll know.

A friend believes that is due to aging, not the ECT. Dunno. I don't think that I got that old that fast.

Changing of the stethoscopes

I have a new psychiatrist whom I'll see next week. Well, he's not really new. He and another doctor in his office have been providing me with ECT since last November. He's new in the sense that he'll be my primary psychiatrist, the go-to guy for meds and other issues, as well as ECT.

My previous psychiatrist and I got along well and he provided good care, except for the problem that I when I would try to reach him on the phone. Going several days without receiving a return phone call twice put me at too much risk. I canceled an appointment that I'd had scheduled for this week. I don't know yet how I'll let him know that I've fired him. I need to do that soon, but not necessarily today.

There is also some risk for me as I change doctors while my application for disability insurance is making its way through the review process. There are so many twists and shuffles in that process that another probably won't be noticeable.

Blue is nice in the sky. In the lips, not so much.

While I was in the hospital, I had an ECT treatment. I'd been scheduled for one at another hospital with another doctor, so the in-patient team thought that it would be good for me to have a treatment as planned. If things had gone as planned.

Three of us left 8East (accompanied, of course) shortly before seven in the morning. I think that my stuff started around eight.

When I awoke after the procedure, all of the muscles in my torso, arms, and neck were very, very sore, so sore that it was difficult for me to take a deep breath. That's just what the staff around me was trying to get me to do, take deep breaths from an oxygen mask. My oxygen saturation level, O2 Sat, the level of oxygen in my blood, had fallen into the 30s. (Anything below 90 is a cause for concern.) Apparently, I'd been 'combative' when I came out of the general anesthesia. No one had or has a good explanation of why that happened. Later that morning, I went back to my room and had supplemental oxygen for several more hours. By evening, my O2 Sat levels were fine. My muscles were sore for a couple more days.

» Top 5 Blogs on Depression

» Top 5 Blogs on Depression

Memories like a freight train

The hospital let me preserve my nerd status by permitting me to have pens and a small notebook in my shirt pocket. Other patients couldn't use a Q-tip unless a staff member was present, but I had a blue and a red pen. I didn't write a lot of notes - I was in the hospital as a patient, not as a reporter. The notes that I did write were mostly reminders of things that I could do if/when I ran into hard times again. For example, you know those Atomic Fireball candies? They can help you break out of a spiral of downward thoughts by moving your attention away from the thoughts in your head and toward the fiery sensation in your mouth.

There's no question that I'm feeling better. We've gone back to an antidepressant, Imipramine, that I first used years ago, when I was in high school. I had to phase out one of the other meds while increasing the Imipramine dosage, so it's taken a couple of weeks to get everything in place. Each of the medications has its own set of side effects, peculiar not only to itself, but also for each patient.

So, I'm feeling better. Now what? There's plenty to do, but it's still difficult to pick something and get started with it. Dunno if this has happened to you, but, the other night, I was lying in bed, thinking to myself, "I've forgotten how to go to sleep." That thought tumbled around for quite a while. Eventually, of course, I did fall asleep, although I don't remember how. The same kind of thing happens during the daytime. I didn't used to need to think about what I was going to do; I just knew and then I went ahead and did it. Now, I have to think about what I'm going to do, but I've forgotten how.

What's that got to do with a freight train, the title of this note? I've got boxcars full of ideas, memories, and stuff, but they're on different tracks in the railyard, waiting to be connected to something, waiting to go somewhere.

Machine treatment of depression

The unhappier you are, the more ice cream you get

And, then, ...

I just returned from a seven-day, six night stay at UMass Memorial's mental health unit, known to the locals as 8East. I went there voluntarily because I'd run out of ideas. I met lots of good people on both sides of the stethoscope and return home with a renewed sense of hope. I also picked up a dandy of a cold. I have a number of good stories that I'll add shortly. Anyway, that's where I've been.

There's no mistaking it when the hard times come

[Note: this is a note that I started back in August, a few days before I went into the hospital. The note has been kicking around in my Drafts folder since then. It's a reminder of how bleak things were at that time.]

---

We're all so eager for me to get better that there's double the disappointment when the hard days return. Not only is it difficult in and of itself when I have a bad day, but it's made worse by the fear, real or otherwise, that it's never going to get better.

Now, I know that words such as never or forever or always are little head clamps that keep me focused on a past that I wish I could change or a future that I dream of or fear. Mumble, mumble, mumble.

The more that I think about the words that I'm using to try to describe how I'm feeling and what it means, the more I'm reminded of a quote from Jimi Hendrix. "Blah-blah, woof-woof."

Staying in the present (living one day at a time, as some would say), I can say that I'm near tears most of the time.

Lest there be any doubt that I was in the right place

At our last meeting, my therapist recommended that I join a support group for people living with depression and other related conditions. The group is led by a nurse practitioner/social worker with decades of experience in cognitive behavioral therapy (CBT). The group meets on Monday, Wednesday, and Friday mornings. My therapist thought that it would be good for me to be with people more regularly. I don't have a lot of direct personal contact, mostly because it's been very difficult for me to do so, but also because it's easy for me to drift away. I do get lonely, but the times when I need contact the most are also the times when I'm least able to make contact.

So, yesterday morning, I went to my first group session. When I got to the parking lot of the building where the session would be held, I looked around my car and discovered that I didn't have shoes. Typically, I leave my shoes in the car for those times when I might need them - stores, restaurants, and the like. The previous night, I wore my shoes into the house and left them there. In the parking lot, I pondered for several minutes before deciding that it was better to go the session without shoes than not go at all. A few people asked me, "Where are your shoes?" "At home," I replied.

Notes on language and usage:

It's common to refer to these sessions as "group." "I went to group this morning," said as though group might even be a proper noun (Group). It seems as though there is a grammar rule that lets us know when we should use the article "the," but I can't find or figure it out. For example:

• I went to school.
• I went to the store.
• I went to hospital. (British English)
• I went to heaven.
• I went to the woods.
  
• I went to camp.
  

Dept. of Similies

It's been like standing waist-deep in a rip current, requiring nearly all of my strength just to stand still.

I had an ECT on Monday, three weeks after my previous one instead of the planned four weeks. Today is better than yesterday, which was better than Tuesday. This morning, I stacked the last of the firewood from my father's house, moving it to the rack just outside our back door. A cool night is forecast, so we might need a fire in the stove by morning.

So, I've almost completed my three tasks for today. I wrote some checks for expenses regarding my father's house, took care of the aforementioned wood, and made a call to Social Security. (I'm waiting for a call-back on the last one.) Even if this is all I get done today, it's a more productive day than many that I've had lately.

Damn Interesting » The Total Perspective Vortex

Damn Interesting » The Total Perspective Vortex

Studies into clinical depression have yielded similar findings, leading to the development of an intriguing, but still controversial, concept known as depressive realism. This theory puts forward the notion that depressed individuals actually have more realistic perceptions of their own image, importance, and abilities than the average person. While it’s still generally accepted that depressed people can be negatively biased in their interpretation of events and information, depressive realism suggests that they are often merely responding rationally to realities that the average person cheerfully denies.

WSJ - Bibliotherapy: Reading Your Way To Mental Health

This morning's Wall Street Journal has an article about bibliotherapy, using books to help a patient to get and stay healthier. My mother was a great believer in bibliotherapy, believing that the right book at the right time had great healing powers.

Note: the article may not be available to all readers. If you have problems getting to the article, please let me know.

From PostSecret.com

Nice kitty

My Way News - Oscar the Cat Predicts Patients' Deaths

Waiting for the phone to ring

I like my primary psychiatrist. He's personable, savvy, and smart. He's also busy, often too busy. Unless I come to my appointments well prepared, we can spend most of the 15-minute session setting our context from the last meeting. (Nearly all of my appointments are 15 minutes long and focus on medication management.) Usually, he's very good at getting back to me on the phone, within a couple of hours. On occasion, however, I can wait a day and sometimes two before he calls. (If there was a real crisis, I could go to Emergency Mental Health.) Nevertheless, it's a long time to wait.

It's also difficult to wait by the phone. When I called on Monday, I provided my home phone number because I was going to be at home for the rest of the day. Today, however, I have errands to run. So, I have forwarded our home phone to my cell phone. We have this nifty software service from Verizon called iobi. With iobi, we can manage our incoming calls - forward, block certain numbers or people who have masked their caller ID information, review voice mail online, and a bunch of other stuff. There's no problem that can't be made more complicated by a piece of software.

More on Fox News

Fox News security hole exposes 1.5 million users' personal information - Wikinews, the free news source

When last I wrote ...

I noted that I was having a tough time after my ECT last Monday. Well, the tough time stretched out for pretty much the whole week. I've been able to do physical work, such as filling my car with wood from my father's house, bringing it home, and stacking it in our back yard. That's been good work. I try to remember to put the wood bark-side up so that the rain will run off.

The rest of the time I try to work on tasks that are similarly focused. I'm making my way through the paperwork needed to apply for Social Security disability. I have most of the information that I need. I'm waiting for reports from my doctors and I'll need to get a copy of my birth certificate. With some good luck, I might be able to file my claim this week.

I made a promise to my doctor that I wouldn't become a viewer of the Jerry Springer Show because my doctor said that he's seen other patients deteriorate after even a few episodes. I did watch the Fox News Channel while I was having my lunch today. Mr Springer is going to have to step it up a notch if he's going to keep pace with these folks. I turned off the TV and tried to read the rest of the Sunday papers.

Overall, the toughest part is trying to deal with multiple activities that require decisions, what's call multitasking by some workers and context-shifting by nerds. If I can schedule one thing at time, I can usually keep my feet under me. Additional things to do, however, don't always have the courtesy of stepping nicely into the queue. And then, well, here I am again.

A Simple Cure For Anxiety And Depression - Depression

A Simple Cure For Anxiety And Depression - Depression: "Ultimately, anxiety and depression are culturally-induced patterns of thinking that can be overcome through a deliberate cultivation of awareness."

This is at the core of the mindfulness practices that we learn in the stress reduction classes. While this article, IMHO, overstates the ease with which these practices can be applied. ("...,the cure is simple, quick, and free."), it's good to remember that we can, to some extent, take charge of our own recovery. Depression, like many other diseases, can rob us of the ability to do the things the things that we need to do to get better.

Take it easy on ECT - World of Psychology

A good summary of some of the issues around ECTs.

Take it easy on ECT - World of Psychology

A hard day follows

It's not uncommon for me to have a tough day or two after an ECT. I don't know why it happens, but it does. I woke at 12:30AM, snoozed for a bit on the couch between 2 and 4, and snoozed again a couple of times between 6 and 9. I can't tell if I'm sleeping badly because I'm low or low because I've been sleeping badly. At any rate, today is not a day to work with sharp objects.

This was the first time that I missed one of my stress reduction classes, but I'll be able to attend the evening class on Thursday. The classes have been quite a bit of help, giving me a firewall that helps prevent me from spiraling too far down. One of the techniques, a three-minute breathing meditation, is particularly helpful because I can use it almost anywhere at any time.

So, what does a hard day look like. Well, I've described depression as being wrapped in a wet, wool blanket. The effect is both frustrating and wearying on body, mind, and spirit. What I get done happens slowly, often with missteps that consume time and energy. On such days, it's important to dial back the expectations for the day, invoking the three-thing rule: try to do three, and only three, things for the day.

My three things:

• Pick up and stack another load of wood.
• Schedule a service appointment for my car.
• Think of the third thing to do.
  

All goes well.

The only noteworthy part about this morning's ECT is that I was very tired afterwards. We arrived home at 11:15. I had my breakfast, read a bit of the Sunday Times, and went up for a nap. I woke 2½ hours later. I feel good, but won't try to do anything too demanding physically or mentally.

In a couple of weeks, I'll call the hospital to schedule an appointment for mid-August.

Short, sharp shock

I have an ECT scheduled for this morning. We're on a monthly schedule now, quite a change from the twice-weekly regimen that I was following when I started in November. The only hard part about the preparation is that I can't have my morning coffee. (Nothing to eat or drink after midnight.) They'll bring me coffee and toast afterwards.

The overall process has become routine, which is a good thing. Sandra drops me off at the hospital at the appointed time. The woman at the reception desk greets me by name, verifies the information on the form, asks me to sign a consent form, gives me a yellow paper ID bracelet, and walks me to my room. I turn on the TV (CNN), get changed into the johnny, and lie down on the bed. A nurse's aide, who also greets me by name, takes the vitals. In a few minutes, the nurse will come in to review my chart, ask me who will be picking me up, and gets an IV in place. When it's time, the nurse gives me a shot of Robinul to clear my sinuses. The nurse's aide then wheels me to the same-day surgery unit where the fun happens. Usually, they're finishing up with the previous patient, so I might have to wait a few minutes before it's my turn.

A 12'x8' room fills up quickly when you add a hospital bed with yours truly, two anesthesiologists, the psychiatrist who flips the switch, and all that gear. They double-check to make sure that I am indeed the right patient and that I know why I'm here. (Not in the metaphysical sense, but do I know that I'm receiving an ECT today.) With a blood-pressure cuff on one arm, cardio monitors stuck to my chest, I'm ready for action. I receive an IV shot of caffeine (to help with the seizure), followed by a muscle relaxant and the anesthetic. The doctor puts an oxygen mask on my face and tells me to take deep breaths. In a few seconds, it's lights out, Lucy.

Twenty minutes or so later, I wake up in the recovery room. They'll ask if I have a headache., which I don't. The most discomfort that I've had was some muscle soreness, feeling as though I've been bounced around. I mention that at the next procedure and they will give me a bit more muscle relaxant. They monitor me for about 10 minutes and, then, call for the nurse's aide to bring me back to my room. More vitals, the aforementioned coffee and toast, more CNN. The nurse tells me I can get dressed and then calls Sandra. While waiting, we review my post-procedure instructions - no driving or operating machinery, no heavy lifting, resume regular diet, etc. I'm to call the hospital to schedule my next ECT. When Sandra arrives, I get into a wheelchair and the nurse's aide brings me to Sandra's car.

If you're a nerd and depressed, ...

For the last six months or so, I've used a numeric scale to track my mood, energy level, and mental sharpness. I started out using a modified version of the pain scale that medical professionals often use to assess pain. I gave each day a number on a scale from 0-10, with 0 meaning no problems and 10 being fully incapacitated. Initially, Sandra and I used that daily number as a part of our evening discussion about my day. I also used it with the various doctors to give a concise answer to the troubling question, "How are you?"

Later, I found that 0-10 was too wide of a range, so I started using 0-7. I keep these numbers on the family calendar and in an Excel spreadsheet, also noting any other events such as a change of medications or an ECT.

My worst number has been a 6, my best a 2. The running average has been trending in the right direction, from an average of 4 in April to 3.5 recently.

A few observations on this method of tracking:

• The number is a highly-subjective composite number. Ideally, I would have separate numbers for mood, energy, and cognition. This method, however, was easy and allowed me to answer a simple question, "What's your number?" with a simple answer, "3.5."
• When I was going to work, I found that that a 3 was the minimally acceptable number for me to function. If I tried to work on a 4 day, I'd find that I'd make a lot of mistakes or just stare off into space, unable to make decisions or complete tasks.
• I found that I would typically have a couple of tough days after an ECT, but would then get better than I had been before the treatment.
• I will probably start tracking my sleep hours as well. Early-waking has been a chronic problem for me for quite some time. A couple of days of waking at two or three in the morning will eventually translate into troubled days.
  

The spreadsheet is easy to maintain and the resulting chart updates itself. I can make a copy available if you're interested.

You wanted to sleep?

You wanted to sleep? This getting hit on the head lessons.

Last night's medication night was too string. Half-dose tonight.

There's always an answer that's simple, quick, and wrong.

My doctor and I had a good conversation this morning. I was prepared, with notes about how things have been and questions about what's ahead. We agreed on one slight change to the meds in the hope that it might help me sleep through the night. (I've been waking at two or three in the morning quite often.) He aslo suggested a couple of other changes, but left it open for a bit more research and reflection. With one medication (Wellbutrin), doubling the dose raises the risk of one particularly nasty side effect, seizures, tenfold.

"This," the doctor said, "is never going to be uncomplicated."

For the past month, I've had more good days than bad. The tough times usually barge in with little warning, but they haven't lasted as long nor have they been as severe. We're encouraged that things are moving very nicely in the right direction.

Of course, if we keep reading, we'll find articles such as this one from the July 3^rd edition of the Wall Street Journal.

First!

Welcome.

A bit of explanation. For more than three years, I've maintained a journal called A traveler around the world of work. (I've changed the title a couple of times to reflect changes in my work status.) After mingling topics related to work, my two cents on various topics, the camp, and depression, I think that it's time to reorganize my posts into three general categories, each with their own blog location:

• The original RoasterBoy blog includes topics related to work and other items of interest.
  
• This blog includes topics and links primarily focused on depression. See the sidebar for an explanation of the title of this collection.
• The View from the Cove blog will include topics related to our camp and life on the lake.

All of this will no doubt require more tinkering as we move along, so I ask for your patience. Please let me know, via comments in the blog or by email, how well you think that this is working.

Again, thanks for reading.