There are black dogs and black dogs: October 2007

Tuesday, October 30, 2007

An excellent lecture about ECT

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

Monday, October 29, 2007

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.

Thursday, October 25, 2007

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.

Monday, October 22, 2007

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.

Thursday, October 18, 2007

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?

Tuesday, October 9, 2007

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

Wednesday, October 3, 2007

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:

Tuesday, October 2, 2007

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

The Royal College of Psychiatrists - Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy (ECT)

Monday, October 1, 2007

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.

There are black dogs and black dogs