Thursday, July 30, 2009

Insomnia

Midnight is the first minute of a new day - Gil Scott-Heron.
My night-time sleeplessness is back. On a good night, I'll get three hours of sleep before I'm awake; some nights it's an hour-and-a-half. (I've got a pretty reliable 90-minute sleep cycle.)
It's not good. I know it. I read the stuff in the journals about the effects of lack of sleep. During the night, I might get another sleep stint on the couch and, depending on the day, I may need and get one more more. Rarely does it add up to more than six hours in a 24-hour period.
I'm in my head often enough to know some of the things that I'm thinking and feeling that accompany the insomnia. I can't say that those things cause my lack of sleep, only that they're there at the same time.
The coaching that I've received suggests exercise, quiet time before bedtime, no caffeinated products after noon or so, no heavy meals late in the evening. There are also positive things to do, such as variations on meditations, relaxation responses, listening to the radio, not listening to the radio.
I'm also taking a prescribed sleep medication that's supposed to have a long half-life and so should help me stay asleep longer. (I rarely have trouble falling asleep at the prescribed time, between 10 and 10:30.)
I don't say that noting works for me. I just haven't a reliable combination of practices. Yesterday, for example, I walked five miles, half in the morning, half in the afternoon. I did have one diet Coke with supper, about three hours before bed. I also had a stimulating conversation during dinner out with a couple of friends. Lights out at 10:30, awake at 1:30.
For the past couple of years, I've kept detailed notes about the amount of sleep that I'd get each day, exercise, meals, snacks, and items of note. That data hasn't yielded anything meaningful and only adds work. So, I'm taking a break. I do keep track of my activities each day and ensure that I average 30-60 minutes of exercise each day.
Acceptance doesn't mean that I'm giving up or giving on, only that I accept that this is what's happening now and, while it's happening, I will try to make the best of it. If there are other ideas, I'll consider them and, most likely, give them a try. In the meantime, my day starts when I wake up, be it 1:30AM or some other time. Some days, my day starts several times. That's not a wholly bad thing.

Thursday, July 9, 2009

ECT on the front page of our hometown paper

From the 9 July 2009 Worcester Telegram and Gazette: ECT debate: A danger, or effective therapy?
My experience with ECT (Electro-convulsive theraphy, colloquially known as shock treatments) has been positive. I believe that it broke the cycle of depression in a way that other treatments - medications or various forms of psychotherapy - could not. It's been more than a year and half ago since my last treatment. Since then, I've had some bad days, but nothing as severe as I'd experienced in the time before ECT.
Dr. Serge Botsaris, cited in this article, has been my doctor for several years. He and his staff have treated me with ECT.
I'm not going to get into the argument about the safety or efficacy of ECT for anyone else. Each person, in close consultation with doctors, family, and friends, needs to make that decision individually. In my experience, I believe that I received a great benefit and, if needed, I would have the procedure again.
Two notes on side effects:

  • The major risk, in my opinion, comes not from ECT itself, but from general anesthesia. All but one of my ECT treatments took place at St. Vincent Hospital. The other one was at UMass. There they used a different anesthetic. My O2Sat levels fell into the 30s. (Anything below 90 is usually cause for alarm.) I recovered without any apparent long-term effects. Subsequent treatments were uneventful.
  • I did experience one curious type of memory loss, what I call geographic memory. After the ECT treatments, places I'd known well before were unfamiliar on first visits. Downtown Worcester, for example, might have been downtown Biloxi. That condition has improved as I build up new memories of these places.
    There may be other memory problems that I can't identify, but many of those could also be attributed to the depression itself or increased mileage on the brain.
I should also make clear that ECT, as with any of the other therapies available, is not a cure for depression. It's a treatment that relieves symptoms and allows the patient to get on with life. There is, to my knowledge, no cure for depression, only relief from symptoms and periods of remission.

[In the case that the link to the original is unavailable, I've saved a PDF version of the story here.]

Friday, July 3, 2009

Dept. of liver

There are several reasons why I am glad to be taking Emsam®, an MAOI antidepressant:

  • It works.
  • It's easy to use. It's a patch that I change daily. 
  • The dietary restrictions related to MAOIs, although challenging at times, give me an even better excuse not to eat liver.
    There are some folks who have discovered that liver is, to quote, "Energy-boosting, mood-lifting, and frugal."
    Back in the day, my mother believed that liver was good for us and served at least once a week. When she wasn't looking, I gave the liver to the cat or, in one case, hid it in the cupboard. (I forgot to remove it later, which is how she found out.)