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.