Saturday, January 24, 2015

Every Treatment Has a Price Tag

My journey with depression began at 14. At least, that's what I've always told therapists on the first day. I have what's called "major depressive episode disorder" which means that my life is a roller-coaster ride of ups (which means "basically functioning") and downs that go way down, sometimes down to suicidal ideation. My first depressive episode was at 14, which was also the year I started my period. Completely coincidental, I'm sure.

The second diagnosis on my chart is PTSD, which is a fairly new addition. It's been called Bipolar II and Generalized Anxiety Disorder before we figured out when it started. Finally, we were able to trace the crazy panic attacks and psychosis and fear of men to the year and a half that I volunteered at a rape crisis center in college. It took us forever to figure out because I was never personally raped, but during and after that time I exhibited the signs of someone who has been assaulted. Apparently, some people empathize so strongly with those they help that they suffer PTSD themselves; it's a common problem with those who work in hospitals, prisons, etc. It's why detachment is so vital for first-responders, therapists, ER doctors, and anyone else who works with trauma survivors.

To make things even more complicated, I experienced a semi-constant level of anxiety and fear - mini-traumas if you will - during my childhood. When I think back on my childhood, I remember feeling afraid, a lot: of our crime-ridden neighborhood, of burning in eternal hellfire, of emotional abuse at home, of being too poor to eat. Experiencing this high level of stress and fear as a child wore down my defenses, so that when I spent over a year listening to women who had just been raped and watching rape kit exams and sitting with survivors while they were interrogated by police, something in my brain went snap. 

Due to my not-so-happy childhood -  and the fact that my mom is severely depressed all the time - I have a hard time knowing what "normal functioning" looks like. Maybe that's why it took me so long to get help, and why my husband was the one pushing me to get it.

Over the last three years, I've experienced multiple kinds of mental health therapies: marital counseling, Cognitive Behavioral Therapy (CBT), EMDR, in-patient emergency care at a mental health ward, and group therapy, not to mention the cornucopia of drugs. Let's see, I've tried Zoloft, Welbutrin, Lamictal, Ambien, Prozac, Effexor XR, Lunesta, Klonapin, Xanex, and probably other things that I've forgotten. Out of the entire above list, the things that have helped the most are Effexor and EMDR. Thus far I've only done one session of EMDR, and it's done more good than hundreds (not exaggerating) hours of regular talk or CBT counseling. Which makes sense, since PTSD isn't something you can talk yourself out of.

These years have taught me things about the illness through trial and error, mostly error. For instance, Effexor is more "effective" (heh) because it targets norepinephrine as well as serotonin, and most medications only target serotonin. (Wellbutrin is also different because it targets dopamine). Apparently my brain needed more norepinephrine, and all the Zoloft in the world wasn't going to help it. This also ties into PTSD because norepinephrine is regulated by the amygdala, the part of the brain effected the most by PTSD. This is what controls the fight-or-flight response, along with other kinds of vigilance, concentration, and response. All of which go hay-wire when you have PTSD. 

Some of the treatments were effective, in their way, but had unacceptable side effects. For instance, Wellbutrin did wonders for my energy and depression, but it also upped my anxiety, which was already at ridiculously high levels. Maybe with the right drug combo I could take Wellbutrin again, but I'm not willing to try it until I've done more EMDR. 

Twice now I've tried Lunesta for insomnia. Oh, it does wonders for my sleep, without the horrible headaches that some medications give. However, I recently stopped taking it again because I remembered why I stopped last time: it makes my poor memory even worse and decreases my (already poor) concentration. But without it I can't seem to sleep until 2, 3, or even 4 a.m. I haven't figured out how to help this situation yet. 

There's not really an end to this post, because I could go on all day about medications and therapies and treatments. At a certain point I get depressed just thinking about it, which doesn't help. I want to write about it though, in the hope that someone who sees it will feel... not so alone. Solidarity. 


  1. I will follow this up with an actually informative post that isn't just a brain dump :) For now though, EMDR is a fairly recent (as in post 1970s) therapy developed for PTSD, though it's been used for phobias and other things too. Originally it involved moving your eyes back and forth (it stands for Eye Movement Desensitization and Reprogramming), but nowadays most people wear headphones with musical tones that sound on the left and right side like a metranome. Basically, you start by thinking about the trauma, and then let your mind wander. After about a minute (it feels a lot longer) the therapist shuts off the music and you talk about where your thoughts went, any emotions you had, and where you ended up. You start again with where you left off, and you do this for awhile. It sounded so kooky to me that I didn't do it until I was desperate - and also, the therapist I had was so down-to-earth and not kooky that it reassured me. The idea is to process your traumatic memories. I'll do another post soon that goes into the research behind it.

    1. Very interesting. I'm really glad you've found something helpful.

  2. Thanks for writing about this, Caroline. Not only for those who will feel less alone from having read it, but also for those of us who live with or love people who struggle with such issues. It's good to gain some small measure of understanding.

  3. Solidarity indeed! I totally get it. We have run the gamut of the treatment cycle in my house between us all. One of mine even considered ECT. But she was too young and no hospital would do it. I am glad now, but at that time, nothing was helping. I am fascinated with EMDR as another one has crippling PTSD, sometimes resulting in seizures. Exposure therapy proved to be overwhelming for her. I wonder if it is hard to find someone who practices this?

    1. You live in an urban area, right Kelly? You likely have multiple providers to choose from then. If you have insurance that covers mental health, call them and ask for a list of covered providers who are certified in EMDR. They should be able to provide you with this. You can also look on psychology today online and search specifically for someone. Be careful though, because some people will say that they provide EMDR but aren't certified, so do your homework. It's a pain but well worth it, in my opinion.

    2. Oh, thank you so much! I will have to see if my daughter is open to trying it, but I think she will be,
      Sorry I have kind of disappeared! Some tough times...

  4. Thank you for being willing to share this, Caroline. Depression is a bitch. I have my bouts with it too. Good to know we're not alone.