Why I Need Antidepressants

Poems that are #relatable

A few weeks ago, one of my two medications ran out.

I take two anti-depressants. One is the 'primary' medication; it's double the dosage of the other, and I take it every night. That one is an SSRI, which regulates serotonin. The second medication regulates dopamine and norepinephrine, which I can't even pronounce but which apparently my brain can't regulate on its own. I take that one every morning before 11am; if I forget to take it before 11am, I'm not supposed to take it at all that day because it will keep me up too late. It's happened enough that I have more of the morning med than the night med. So, the med that I ran out of is the most important one for me to take every day.

At the start of this year, my insurance plan changed slightly so that the company would only cover my medications if they were through their home delivery program. A prescription sent to a regular pharmacy had three covered refills, and then it was pay out of pocket or switch to the home delivery program.

If you haven't noticed before, insurance companies really suck. Despite submitting my prescriptions well in advance, calling my doctor's office, and double-checking with the office manager, I never received my refill. I took my last dose of my night med on a Saturday, and proceeded to have the worst week in a long time.

It started out okay. I was stressed about school, and it didn't seem worse than regular school stress. I got to Wednesday before feeling very anxious. Thursday, the weight of my depression slowed me down. Thinking felt like trying to walk through a thick bog. The medication seemed to be totally out of my system by then.

My therapist has described the way that I experience depression as 'somatic', a word I hadn't heard before she said it. I'm not just sad when my depression is acting up. In fact, it rarely feels like sadness. Depression feels like the biggest weight on my chest, like my blood has thickened and my heart is struggling to push it throughout my body, like my mind was given a mild anesthetic and is starting to wake up to pain. When I'm depressed I feel like the parts of my body are disconnected. My fingertips feel different from my hands, and my hands are on another planet from my shoulders. Trying to mentally work out how to move is exhausting, like my brain is trying to find each individual body part on the way to my legs and feet. The fog in my brain makes it so hard to keep up a conversation.

That day, I went to my three classes and then went to the office as usual. I went to my boss's office and explained that my insurance/home delivery company messed up so I was off of my medication for my "chronic illness". Chronic illness, that's what I tell people instead of explaining that I have MDD (major depression disorder) and GAD (generalized anxiety disorder). The idea of telling professors and employers about my mental illnesses makes me feel panicked and defensive. Besides, "chronic illness" isn't inaccurate when you've been diagnosed with MDD for over four years.

Anyway, I only worked for an hour to get something finished up, and then I went home. I was so hungry when I left the office, but by the time I got home I had used up every bit of energy and I fell asleep almost immediately. I slept for four or five hours and woke up disoriented and starving. I had dinner and did nothing productive for the rest of the night.

That night on the phone, Preet (my boyfriend) asked, "Has it always been this bad? Was your depression this bad before you went on medication, or has being on medication for a while made being off medication worse?" He went on to say that he didn't remember me being so miserable in high school, before I went on medication.

It's always been this bad, I told him. The next morning when I took my morning medication, I texted him a quick correction: it actually used to be worse, because I was not entirely off medication, just off the main one. The secondary med was still doing its job.

That day, Friday, I started trying to get the medication situation figured out early in the morning. I found the home delivery program's forms for the doctor to fax to them, and filled out my portion of it. I wrote up a little fax cover letter, which I ended up using as a script for the phone call to the doctor's office instead. I talked with the office manager no less than five times that morning and tried three different fax machines, trying to get the form faxed over so that she could get the prescriptions attached to it and sent over to the company for processing. By two or three in the afternoon, I received an email from the company saying the prescriptions were processed and approved and would be delivered by December 14th. I decided to call them after work to ask if they could do expedited shipping; I was on hold for 45 minutes while the customer service rep tried to get the shipment expedited and then, when that failed, get me an override and a 30-day prescription to be picked up at my regular pharmacy. After those 45 minutes, the gentleman got back on the line to ask for my phone number so that he could call me back once he got it figured out.

That's when I had my breakdown. I texted a friend who lives on campus to ask if he was home, intending to go over and break down in private if he was (he wasn't). I texted a friend who works at GU to ask where he was, and he met me at the front gates. He got off his bike and took one look at me and I started sobbing. (Crying in public is the worst and I hate it, but I have done it so many times in my life.) He sat with me as I bawled, and that's when I got the call from the customer service guy who said he sent my prescriptions to my pharmacy and they should be ready for me. My friend walked with me to the pharmacy, where they said they had no prescriptions ready for me and nothing they could fill. I called the company back, talked to the gal behind the counter a bunch, and left with no medication and a promise that the lady would call me as soon as they got the prescriptions together.

I didn't get my medication until the following morning. For one full week, I was off my meds, and I couldn't sleep for longer than two or three hours at a time, and the sleep I did get was restless. I couldn't think clearly. I cried more easily and apologized for things I didn't need to be sorry for. I had a constant headache.

Fun fact: the headaches were the reason I finally got help for my anxiety & depression. At the end of my junior year of high school, the headaches had gotten so bad and so constant that I went to my pediatrician, who referred me to a neurologist, who was the best doctor I've ever had. She helped the headaches and never forgot that I mentioned anxiety that first time I met her. I came in for a follow-up after summer break had started, and she asked about the anxiety. When I said that it hadn't gotten any better, she frowned and said, "But school's out! You shouldn't be anxious!" She prescribed my first antidepressant, which I think was the smallest possible dose it could be. The next follow-up appointment, I told her how my symptoms had improved, how I was so grateful it was better, and she said, "Some of that still sounds like anxious behavior. We can do better." That sentence impacted me so much. We can do better. I can feel better. I don't have to settle for feeling okay or not totally awful. I started weekly therapy and worked with my neurologist to find a medication and dosage that worked well for me. My senior fall, I got my best grades of all of high school, because the anxiety and depression wasn't keeping me from functioning properly.

There are a lot of things I have to do to stay healthy. I can't have caffeine, and I was once advised to avoid MSG and chocolate. My neurologist stressed that I drink at least 64 ounces of water every day, more in the summer. Sleep is absolutely crucial, and sleeping at the same time each night is best. I can't drink alcohol much or often because it interacts poorly with my medication. I need to get a certain amount of sunlight every day, and I use a sun-light in the wintertime. I'm supposed to prioritize exercise. I have to make sure to get multivitamins that contain certain combinations. A healthy diet is also highly recommended (but I am a college student, after all, so that one doesn't always pan out). I go to therapy every week (a different therapist from the one in high school) and see my psychiatrist every 3-6 months. I talk to my boyfriend at least once a day and call my parents every 1-2 days. I have to intentionally plan out social time. I got a cat, lovely Robin, so that I would get up every day, feed him, play with him, and clean his litter box. Having Robin is another form of therapy for me; when my depression gets bad, I don't want to take care of myself, but I always take care of Robin.

And I also take psychiatric medication. It took years to find the right cocktail to stabilize me, but last December I started my current medications. I take two antidepressants daily and one anxiety medication up to three times a day as needed. Last month I told my psychiatrist that my depression gets much worse for a few days before my period starts, and apparently that's a diagnosable condition too, so now I take a small extra dose of my main medication for a few days each month.

Before I started taking medication, all of the extra stuff I do now didn't help that much. Everything was so bad and hard that lifestyle changes could only improve it a little. Medication addresses the problem I can't, which is my brain chemistry.

Even doing all of this, some days I'm still really down. Sometimes my mood plummets, hard, suddenly, for no discernible reason. Last night was one of those times. I have to work hard to recognize when my mood changes and to communicate what's going on with me. I have to work hard to be kind and patient, because my mental illnesses do not give me a free pass to be a jerk. I still have to push myself to be open and honest, even with my therapist.

I hope that my being open with you, dear reader, contributes to a world which is more accepting of mental illness. Emotional vulnerability is hard, but I think seeing other people be emotionally vulnerable helps us to deal with our own emotions. At least, that's what I hope I can do for other people.

Thanks for reading.

Time Flies

(Note: This entry was written on March 3, 2018, while flying from DC to Omaha. Apologies for the delay in posting.)

It’s odd, how when you’re in a plane, you notice when the landscape below turns into farmland. I don’t know where in the country I am right now, but I’m over farmland. The land becomes more sectioned in the Midwest; the intersections are all neat and planned-looking, and probably a mile apart each. The squares are sectioned off into smaller shapes, differentiating the land used for different purposes. In the growing seasons, it’s even more apparent, but right now in early March, practically still winter, it’s all just varying shades of brown. Darker brown for the fields that will probably hold crops later in the year, lighter brown for grazing land, the occasional thicket that I know has a house in the middle but is too far below for me to really see.

I’m in a plane, probably somewhere past Illinois at this point, on my way to Omaha for spring break. It’s been a very long time since I last wrote. I regret not writing – here or anywhere, really. In the past year, I’ve avoided reflecting on life, and that’s all blogging or journaling is. Writing a blog post describing the happenings of my life makes it almost impossible not to reflect on those happenings, and I didn’t want to do that.

In the past year, my life has changed. I’ve become more reclusive, and my priorities have changed. I don’t know how they changed, but I can feel that they’ve changed. Since my last post, I’ve been on psychiatric medication; it’s been extremely helpful for me, and I’ve attended therapy most weeks. I’ve learned how to parse through my moods and how to determine what I need and what will be most helpful. I’ve strayed from the Church, and started to come back.

It’s been a hard eleven-ish months. I lost my grandfather in June; I think about the time before and after his death often. It’s gotten easier with time to acknowledge that he’s gone, but most times I still feel my eyes start to sting with held-back tears and a lump in my throat. I’ve learned how to breathe through it whenever I don’t feel up to crying. Last summer, I cried so often, and I never felt up to it. It took a while to learn how to control the tears. I cried at least once a week, but usually more than that. I always cried at least once on the way to or from my grandmother’s house each week; I cried whenever I said “my grandparents’ house” and had to correct myself. When I went back to school in the fall, every time something went particularly well for me, I started to cry when I realized I couldn’t tell my grandpa about it. Whenever I started to feel discouraged by all of the work I had to do, I reminded myself that my hard work was admirable, and I’d be struck with sorrow that I couldn’t tell my grandpa about how hard it was to balance three jobs on top of classes and that I would never hear him tell me he was proud of me again. I know he was proud of me; recently I looked back through my old journal entries, and at the bottom of the very first one in this journal, I wrote, “My grandfather is proud of me.” I cried when I saw that. I know he was proud, and at least I have that. I don’t even necessarily wish he was still alive; I’m not that selfish. My grandpa Rich had been sick for a long time, and he was tired and ready to go. I just miss him, is all. I’m glad that he’s not hurting anymore, and I can deal with the missing. The missing has made me more sensitive to a lot of subjects; I can’t watch anything in which a parent dies, because the whole time my grandfather was dying, I kept thinking about how that was my mom’s dad, and how one day I am going to lose my parents. (I’m quietly crying on this plane now and I’m really hoping nobody tries to ask me if I’m okay. I’m okay. I’m just sad, and that’s okay.)

It honestly kind of sucks that people die. It sucks that this is part of life. I think this more than anything else shows me how young I still am. I may live on my own, work, and care for another life (albeit a cat’s), but I’m still angry about facts of life. Or maybe that’s normal. I’d like to think that one day I’ll learn to accept the facts of life, but today I think it’s unfair and scary and I want to scream and cry that I never want my parents to die, or Preet, or my cat, or anyone I love. I just hope and pray that I have a long time until I have to deal with any of those things. (My nose is runny and gross, and I feel like the Weird Girl on this plane.)

Other than dealing with the facts of life, things have been okay enough for me. Last semester was challenging, and there were days that I wasn’t really sure I’d make it to Christmas break in one piece. I ended with decent grades, and I applied to Georgetown’s grad school at the end of December. Yesterday I received an email saying that I’m officially admitted into the Georgetown Graduate School of Arts and Sciences. I applied for an accelerated program, so some of my undergraduate coursework will count toward my Master’s degree. I’ll be earning an MS in theoretical linguistics; that umbrella includes syntax, phonology, semantics & pragmatics, and language acquisition. It should take me about one extra year to finish the degree.

Update: I’m over northeast Missouri, about to enter Iowa. We’ll be landing in less than an hour. I stopped crying somewhere in the last paragraph, and now I’m exhausted. For all the crying I’ve done in the last year, you’d think it wouldn’t exhaust me so much. It should be like running: the more you run, the less tired you are at the end of a medium-paced mile.

This semester is going fine so far. It’s just about halfway through. I’m not working as much, just a few hours here and there doing odd jobs. My classes this semester require more regular work than last semester or the semester before that; I have to write a lot, and I can’t get away with not doing my readings like I sometimes could before. I’m actually writing this to procrastinate writing a paper; my head felt full of thoughts, none of which were related to my paper, so I decided to put them down.

This semester I’m taking four classes: Cross-Cultural Communication (taught by Deborah Tannen), Justice and Consumer Culture (a theology class about consumerism), Research Methods in JUPS (a required course, as much about research ethics as methods), and Peace Education. The paper I’m avoiding is for Peace Education. I don’t know why I’m avoiding it. I know from some sixteen years of education that everything seems hard until I start, and then only sometimes is it actually hard. For me, it’s the getting started that’s the biggest obstacle, really getting started. I’ve put some stuff down for this paper, but I haven’t gotten to the point where my ideas are flowing easily and the work is just putting them into words in an order that makes sense.

Right now, everything is pretty much okay. There are some snags – like the fact that I haven’t found an apartment to move into in May – but my classes are going along alright, and they’re interesting enough. I’m okay, and the people that I care about are mostly okay, and nobody is worryingly sick. Maybe now that everything feels a little less intense, I’ll be willing to update this blog more often. I suppose we’ll just have to see.

Thanks for reading, and I hope you find a moment of peace today.

P.S.: This is roughly how long my paper has to be; if only I’d started writing that instead, I’d be done with it instead of still avoiding it.
P.P.S.: At time of publication, the paper was finished and submitted. Also, I apologize for the pun in the title, but only a little bit.