Kid gloves and some science

I feel like people sometimes handle me with kid gloves.  I really do not want anyone to walk on eggshells or to treat me differently than they used to or would treat anyone else.  Would you treat someone with high blood pressure or migraines differently than someone who didn't have a dissese or illness?  It is pretty much the same thing with depression.  I'm not an outcast, I'm not broken, I'm not something you need to avoid.  You want catch what I have from me.  It is not contagious.  It's depression not the plague.  

The other day at the pharmacy getting my prescriptions refilled the tech or whoever was checking me out looked at each bottle then up at me.  For all three.  She had this look on her face like "Are you a psycho or something?"  It was really awkward, but that is the price you pay when you get three antidepressants at the same time. 

So, as I said above I am on three medications right now.  Zoloft, Remeron, and Wellbutrin XL is my cocktail at the present time.  All three are antidepressants.  None are anti-psychotics.  So why treat me like I am psychotic?  Maybe it stems from a lack of knowledge.  Maybe people just need more information to understand.  That's why I am here.

So I am sure there are some of you out there that are familiar with antidepressant medications and some of you that are not.  Here is a brief rundown of the different medications used in treating depression and anxiety.

The most common class of medications used in the treatment of depression are known as SSRIs or Selective Serotonin Reuptake Inhibitors.  Basically you have neurons that put out serotonin, a monoamine neurotransmitter attributed to feelings of well-being and happiness, into the gap between that neuron and another neuron, known as the synaptic gap or cleft.  SSRIs come in and block the serotonin from going back into the neuron that released them, known as the presynaptic terminal or axon terminal.  The reabsorbing of neurotransmitters by the axon terminal is also known as reuptake.  When reuptake is blocked, it allows for the serotonin to stay in the synaptic gap longer, thus allowing more to be transmitted to the receptors on the second neuron or dendrite.

Here is a picture of a neuron.  Neurons are the building blocks of the nervous system.  Note the dendrites on one end and the axon terminal on the other. 

When lined up in a row these neurons create a pathways for signals to travel within the brain and spinal column as well as transmit from the rest of the body to the brain.  Even though it sounds like it may be a long process, the neurons communicate very quickly.  Think about how when you get a paper cut or a pin prick and how quickly you feel pain.  Sensory neurons carried that pain signal from the site to your brain in a fraction of a second.

They do that in much the same way as described above with serotonin, just with a different neurotransmitter.  Here is a picture of the area between an axon terminal of one neuron and the dendrite of another.

So SSRIs block the reuptake allowing more time for serotonin to sit in the synaptic gap so more can be taken in by the receptor cell.  Common SSRIs include: Zoloft, Paxil, Prozac, Lexapro, and Celexa.  Some of the side effects you see with these most commonly are dry mouth, extremely vivid or strange dreams, weight loss/gain, sexual side effects, and suicidal thoughts, especially in patients in their teens and early 20's.  SSRIs are very popular as it is difficult to overdose on most of them.  However, large amounts can cause serotonin syndrome which can be fatal or leave the person with permanent damage.  Serotonin syndrome is rare, but is known to happen when large amounts are taken or SSRIs are combined with other Serotonin acting medicines.  Funny story, when I was first put on an SSRI (Celexa) I had what was thought to be a mild serotonin syndrome reaction: fast heart rate, tremors, sweating, and color hallucinations.  Fun right?  Well severe serotonin syndrome is no fun.  High temperature (106 F), severe increase in heart rate and blood pressure, uncontrolled muscle movements and spasms (can be permanent), seizures, and mental status changes.  A common over-the-counter herbal medication called St. John's Wort if taken with an SSRI can lead to serotonin syndrome.  So make sure, if you are on medications or thinking about going on them, to let your doctor know all things you take.  This includes vitamin/mineral supplements, homeopathic/holistic medications, pain relievers, or antacids to name a few.  Also, some foods can trigger bad reactions as well, the main one being grapefruit and grapefruit juice.  You wouldn't believe all the medications affected by grapefruit juice.  If you get bored and want some knowledge you can google it sometime.

Another class of medications are SNRIs or Serotonin-Norepinephrine Reuptake Inhibitors.  They work in similar ways as the SSRIs, but they also block the reabsorbtion of norepinephrine, also known as noradrenaline.  One of the main functions in the body is acting as part of the fight or flight syndrome, but it is also increases energy and elevates mood.  SNRIs that are commonly prescribed are: Effexor, Pristiq, and Cymbalta.  Cymbalta also works to reduce neurologic pain such as fibromyalgia.  Many of the side effects of SNRIs are the same as SSRIs.

Next you have tricyclic antidepressants or TCAs.  They work on similar levels blocking the reuptake of neurotransmitters.  However, with the rise of SSRIs and SNRIs, which have fewer and less severe side effects, TCAs are not prescribed as much anymore.  The most popular one still prescribed is Elavil.  TCAs interact with many other medications and can cause fatal implications if paired with medications like Calcium Channel Blockers and antipsychotic medications.  It was also possible to overdose on TCAs, which isn't always the greatest thing to give a depressed person something they can overdose on.

Tetracyclic antidepressants or TeCAs are very similar to TCAs, but are not as prone to overdose.  TeCAs such as Remeron and Asendin compare to SSRIs in that toxicity is improbable with overdose.  Side effects are much the same as the rest, but also cause drowsiness due to histamine effect, and weight gain. 

The next category has fallen primarily towards the wayside because of their side effects and drug interactions.  Monoamine oxidase inhibitors or MAOIs are typically the last line of medications tried to treat depression.  Next time you see a commercial for a medication and towards the end typically you will hear something like "Tell your doctor if you are on MAOIs."  MAOIs take a different approach than the reuptake inhibitors.  Monoamine oxidase is responsible for the removal of neurotransmitters from the synapse.  So in effect, MAOIs keep PacMan from chomping up all the serotonin, melatonin, epinephrine, norepinephrine, and dopamine dots.  People taking MAOIs need to watch their medications, supplements, and diet very carefully.  Some cheeses, chocolate, and alcohol can cause a spike in blood pressure which can lead to stroke or heart attack.

The final category are atypical antidepressants.  These don't really fit into the other groups, but are still antidepressants.  Wellbutrin and trazodone are popular atypicals.  Wellbutrin is a dopamine and norepinephrine reuptake inhibitor.  It also has a mild stimulant effect and is used in smoking cessation.  The major side effect different from the other antidepressants is a risk for seizures.  If you have had seizures in the past you should not take Wellbutrin.  Doses over 600mg cause a tenfold increase in seizures.

There is your science lesson for the day.  I figured I would have an educational post and subject you all to the basic pharmacology of antidepressants.

Ok, so back to me.  I had my faculty meeting with the instructors this morning and it went well.  Most of them were surprised by the news, but were very supportive.  I knew they would be, how couldn't a group of nurses be empathetic right?  There is a certain comfort that comes with having people know.  Like before, it was almost like living a lie.  I had to keep straight who knew what and which story they knew.  No more though.  Everyone gets the same story and it is nice to know how much people care.

I am pretty sure I was always meant to help people.  I guess that is why I was drawn to nursing.  That, and the science of it all.  So if you are reading this, and you appreciate what I have to say, and think someone could benefit from it I urge you to share this blog.  Even though you may not know of anyone who is depressed, they are out there.  The silent ones.  The ones like me a few months ago.  I am happy and more than willing to talk to anyone who needs someone to talk to.  So please, help your friends who do not know how to get help, or feel like they are not worth getting help.  Friday and Saturday nights can be some of the roughest days for someone with depression.  For most people it means the weekend and time to party, hang out with friends, go do something.  For someone who is clinically depressed weekends are lonely.  Weekends are scary.  Weekends mean, to put it bluntly, more people end up in psychiatric facilities.  It is no secret why I was released on a Thursday.  Friday and Saturday were the busiest intake days at the hospital I was at, and I assume it is like that elsewhere.  So please, take the time to share this site with your friends on Facebook, your followers on Twitter, anyone you can, so maybe, just maybe they won't feel so alone. Thank you.

Now begins the long road to sanity

You come out of the hospital feeling pretty good. You know you aren't alone in your struggles and you have learned some healthy coping skills to use when you are feeling depressed. You truly hope to be treated the same as always, but that isn't reality. Everyone who knows treats you a little differently whether they know it or not.

The first few weeks to months the people closest to you walk on eggshells around you out of fear of sending you back off the cliff. You know why they do it, you just wish they would see you aren't the same person you were just two weeks ago. You are empowered and feel as though you are so much better, but once again, that isn't truly reality. You aren't better, you are doing better, but you are not cured. You still need help, a lot of help. You are pushed in a good way to pursue the avenues for help you vowed to do. Relying not just on medication, but also going to therapy. Getting help with all aspects of your life.

It becomes more and more apparent just how much you have neglected the relationships in your life. I found myself taking an inventory of my relationships and saw for the first time the devastation I had on them. I begin to realize that I have no true friends, I have no one to confide in, the relationship with my wife is strained because of the things I have done and the things I haven't said. The thoughts begin to scratch through again. But this time you know what to do, you talk to your therapist, you use some the coping skills you learned in the hospital, and you tell yourself you are a good man, you just have some things to work through.

You successfully get rid of the thoughts. You won a battle. The war is far from over, but you are gaining ground. For the first time in a long time you feel like there is hope, there is a light at the end of the tunnel that isn't just the headlight jog a freight train coming at you.

The day after I got out of the hospital I had a faculty meeting at school that I had to go to. I knew they were going to ask where I was and what happened. I couldn't call my clinical instructor while I was in the hospital, so my wife had to do it. I missed lectures, I missed a day of clinically, and I missed an important presentation. They wanted an explanation. These instructors are all nurses, all very smart, well educated medical professionals. How am I supposed to lie to them about what happened? I am not ready to tell people the truth about what really happened.

The best I can come up with is telling everyone it was a medication reaction. I had a bad reaction to a medication. It is kind of the truth right? I mean isn't overdosing just having a reaction to the medication? Ok so it isn't the whole truth, but there is a shade of truth in it, sort of. I tell them it was a benzo for anxiety and they wee afraid I would withdrawal from stopping it, thus the weeklong absence from school. They bought it. I feel bad for lying, but at the same time good for not having to open up about my mental illness.

This week at the faculty meeting I will be apologizing for the lie, explaining what really happened, and asking forgiveness. Friday morning I will address the nursing faculty and open up to them about what has been going on and is still going on. If I keep telling myself this maybe, just maybe I won't freak out about it. Maybe I will actually tell them and be articulate in telling them. Maybe I will not stumble or stammer through my little speech. Maybe they will accept me for me.

I have come a long way in the past few months. But, I still have a long ways to go. I hope you all stick with me on this journey. I am sure there will be exciting times, as well as boring times. Some times the boring times will be a welcome relief. Boring is normal. Boring means you are ok in your own thoughts and in your own company. I never thought boring would be a great thing. Before when I was bored I got stuck in my own head. Now, boredom is a welcomed emotion. It has been so long since emotions were allowed.

Well here I am

So now I have made it through admission at the psychiatric hospital and am on unit.  I gave you the description of orientation, which certainly did not orient me to anything.  Not much goes on that first night.  All I know is that once the others got back from dinner, they were back for about two minutes while they passed out cigarettes for smoke break.  I learned very quickly that people here smoke, a lot.  Although they only get 3 smoke breaks a day, if it comes one minute late there is hell to pay.


After smoking they all file back in and head to various areas of the unit.  Some go to their rooms, some color on the lovely copied coloring book sheets spread out on the tables, some file in to the conference/group therapy/individual therapy/TV room.  I was in the TV room, I knew no where else to be.

The unit I was on was for non-psychotic patients.  So depression, anxiety, bipolar, anger, and any other mood issue were represented here.  We shared a wing with the chemical dependence unit.  My first impression of the people?  We have quite a mix.  I would say the oldest is about 60, the youngest was 20.  One guy said he was 19, but we doubted it.  He looked about 30, and acted 12.  Loud, gangster wanna-be from Arkansas.   Most of the people were very laid back.  Calm and quiet.  Either medications were working or they were plotting.  I could think no differently.  These people were in here for some serious things right?  I mean they weren't all just here for reasons like me, were they?

That night I got my first taste of "Group."  Some knucklehead with a clipboard starts yelling "Group!" over and over as he heads to the catch all room we were in.  This was evening goals group.  Basically you say how you are feeling and if you met the goal you set in the first goals group of the day.  I have no goal to share as I have just arrived.  My mood?  Freaking the fuck out inside.  "I'm ok, little anxious, but other than that ok I guess."  'Why are you anxious?'  "Well... this is my first time in a place like this."  'Ahh so just nervous about being here?'  "I guess so."  And we move on.  Most people lie in group I come to find out.  Responses of great, fantastic, outstanding, spectacular, and even stupendous flow out of people's mouths.  There are two common goals.  These apply to I would say 80% of the folks in there.  The first is to attend groups.  The second is to get out of here.  They both sound like fine goals to me.  I will probably use the first one tomorrow morning.

After group was over it was pushing 10 o'clock.  Seems like a good time to go lay down.  Luckily I had no roommate yet.  They said I would likely get one though.  Doors have to remain open, and the light in the hall is very bright.  A lot of thoughts got through your mind that first night.  Mostly "What am I doing here?  I need to be here.  Does this mean I am crazy?  God, what will tomorrow be like?"  I begin to think about my kids and my wife.  What they just had to witness and go through.  The tears begin again.  Remorse, shame, and regret are now my roommates.

When I got here and throughout the evening I never payed much attention to the staff floating around.  They were here, they were there.  At night though, you are acutely aware of the staff.  The reason?  Q15 status.  Every 10 to 15 minutes the staff has to note where you are, what you are doing, and mood if you are showing one.  This is 24 hours a day.  The night guy, he does his rounds with a floodlight.  You know those big flashlights with the brick of a battery?  One of those.  Every 12 minutes like clockwork he is there shining that beam on your face.  If you have the blanket pulled over your head in an attempt to be shielded from the spotlight inquisition you are asked to pull it down so he can see you.  Because, I could have wadded up things to make it look like someone was there when really I was tunneling out using a rock hammer I fashioned out of crayons and markers.  With sleep interruptions like these you never know what time it is.  You have windows, the blinds are between the panes of glass and are closed.  There is an orange streetlight right outside, so the window is perpetually glowing that color regardless of the time.  The only clock is all the way down the hall at the nurses station.  So if you really want to know, you can stroll down there and check.  Let's just leave it at, you never need an alarm clock in the psychiatric hospital.

That night I am up at 2:00am.  The reason?  Someone comes into my room, takes a crap in my bathroom, flushes and comes around the corner, realizes it isn't their room and heads out.  I figured it was a good time to get upi and venture out to the lobby.  No TV after a certain time and the room gets locked anyway.  I discover that the refrigerator on the unit is stocked with chocolate milk.  Salvation.  Chocolate milk in hand I sit down on the plastic couch and begin looking through a magazine.  "Who will be our next president?"  Ok, we are a little over a month from the election.  I begin to read the story.  Quickly it becomes painfully obvious.  It begins talking about if Bush would be back, or if John Kerry, Hilary Clinton, or some other characters would take his place after one term.  Flip to the cover.  The date February 2004 .  Well then.  It is 2:30am and I can either read this time warp of a magazine that I already know the endings to, or stare at the wall.  Hello wall.

Time goes very slow when you have no where to go and no one to talk to.  Being committed, if you want to call it that, gives you a lot of time in your own head.  Good, bad, or ugly, it is just you and your thoughts.  And for most of us in there, that is a dangerous place.

My first full day in the looney bin.  The loud Arkansas native was sent packing.  They pretty much discharged him and sent him out on the street.  He couldn't find anyone willing to pick him up, so off he went.  We all figured he would be back, but alas he must have found his way somewhere.  I began to meet the other patients.  Most of whom were very good, nice people.  They just had problems, like me.  A fairly good percentage were either former military or current military.  Some there for help, some there to get medically discharged.

I begin to get fairly close to two of the other guys.  One just a couple years older than me, the other is only 20.  They both have similar stories as mine.  Both in there because they did something they shouldn't have.  The 20-year-old had already been there for 11 days.  That was after the military had to send someone to Florida to get him, as he had done his stupid act while on leave.  He hadn't been home for the entire month.  We shall refer to him as "A" from here on out.  He may have only been 20, but his eyes revealed someone much older.  I'm not sure if it was the meds or just him.

Medications are a whole other story in there.  The doctors... they like to tinker.  Let's change this, let's add that.  I wouldn't allow them to add anything.  I made them stop giving me benzodiazipines.  They put me in a fog, and had made things worse to that point, so I wanted to go without.  My inpatient psychiatrist doesn't think it is a good idea, but I don't care.

Later that day I meet with the medical doctor.  Things are going great until he looks at me and says "It's time to stop lying.  We know you use drugs."  Ummm I do?  News to me skippy.  "You tested positive for high amounts of opiates.  So we know you abuse drugs, and since you didn't tell us upfront about it we can't believe anything you say."  I am dumbfounded.  The last "opiate" I took was a Lortab when I had a kidney stone over a month ago.  He will hear none of it.  I tell him to contact the hospital I was just at and see if I tested positive there, or to check the one I did for school 2 weeks ago.  He just scoffs and looks through my chart.  Whaddaya know, negative yesterday.  So ummm, where during nearly constant observation between then and now would I have scored myself large amounts of opiates?  I later find out from one of the nurses that they get false positives from their tests all the time.

That first day you have a lot of meetings.  Medical doctor, psychiatrist, psychologist, social worker, nurse, another social worker, and an expressive therapist.  They all pretty much ask you the same things.  I assume to see if you change your story, or become irate.  I do neither.

All the days are pretty much the same.  Schedule is pretty well set, although on the weekend, things don't always take place.  Some group sessions are absent.  The groups over the weekend were primarily art therapy and music therapy.  Plastic scissors, glue sticks, crayons.  Kindergarten all over again.  Except the art you are making is something you would have expected to come from Marilyn Manson or a young Ozzy Osbourne.  And music therapy?  A woman with a keyboard sings you songs that are supposed to be uplifting and inspirational.  The only uplifting that occurred were the lifting of people's asses out of chairs and out the door.

There are a handful of things very popular in the psych ward.  I already mentioned smoking.  The others include various card games, football, Criminal Minds, and chocolate milk.  I swear to you we went through probably 3-4 gallons of chocolate milk a day.  Trash cans filled with those little 8 ounce cartons.

I would be remiss if I didn't mention one of the employees there.  He is the epitome of what you don't want to have as an employee, especially with the clientele.  He is the guy who works at a place like this solely so he could exert his "power" over the patients.  On Sunday coming back from lunch, he was bragging about carrying a gun in his pants.  I ask to see it, he tells me it is there, and if he shows it to me it would be to shoot and kill me.  I press again, "Where are you hiding it?  You have no bulge on the small of your back, hips, or front of your pants, pockets have noting in them, and it isn't by your ankle because you just lifted your pant leg to scratch your leg.  So where is this gun in your pants?"  If you can't tell I have had it with him at this point.   He had been talking down to me and others all day.  He responds with, "It's a small gun."  Regrettably I could not keep myself from responding "Man, your girlfriend must hate that small gun in your pants."  This guy during my stay will make 4 other patient's cry, after I hurt my knee (I will explain in a bit) he told me he was going to kick my white ass up and down the hall, told me to stand up so he could kick me in my knee and watch me fall, and asked when I was being discharged so he could wait for me in the parking lot so he could show me his gun.  Not the most therapeutic person. 

So the knee story.  While at "gym time" we were playing volleyball.  Mind you the court is carpet over concrete.  At one point I jump, land, and pop with pain.  Sharp behind my knee right at the top of my calf.  I think maybe it is just a bad cramp or pulled muscle.  The rest of gym time I spend hobbling around.  It hurts so bad by dinner I decide to stay on unit and not go to the cafeteria to eat.  It took over 24 hours to be seen by anyone for my knee, the medical doctor who finally sees me tells me after the exam it appears I tore my ACL.  So if being here could get worse, it just did.

The other guy I become close with, we shall call him "D", is having some troubles.  They tell him he is to be discharged in the morning.  He confides in me that he doesn't think he is ready and that if he is released he will kill himself.  The fact that they are willing to release someone in that mindset is a testament to just how messed up our system is.  They send people out who are not ready, don't have the tools to deal.  I go to my social worker and my psychiatrist and tell them what he told me.  I had to right?  Even though he told me in confidence, I couldn't live with myself if he was discharged and followed through.  He later thanks me for telling them.  He ends up staying.

A lot of talk is made of keeping in contact with people.  I think when you are in there, and you go through some of the experiences with these people and you come out feeling very close to them.  Then out in the real world you just don't want to relive the time in the hospital by seeing them.  I should call them though, if for nothing more than to know they are still fighting.

Being released is an odd feeling.  You don't quite know how to react.  You are happy to be out, but scared to death at the same time.  You are treated differently than before.  At least it seems that way.  A long shower and a shave are a welcome perk of being free.  Inside you don't really get to shave.  Someone has to watch you while you do it and you have to use a single blade bic using just soap, but the biggest hurdle is getting a male staff member to watch you. 

I'm out.  Now begins the journey of truly seeking help.

I wasn't trying to kill myself

As the title of this post states, I wasn't trying to kill myself.  I just wanted the incessant thoughts to go away.  If you or someone you know is having thoughts of harming themselves or someone else call 911, call a suicide hotline (1-800-273-8255), get help some how.  Having been at this point, the person isn't thinking straight.  The person with these thoughts that are so consuming does not know where to turn.  Make the call before it is too late. 

The day started like just about any other.  Went to school for a bit.  No big issues anywhere.  Until I was driving home.  The thoughts flooded in.  The dam had broken.  Crying, bawling, sobbing all the way home.  It was uncontrollable.  The thoughts of suicide were coming fast and were unrelenting.  Nothing I tried got them out of the forefront of my mind.  Cuts to my arms, chest, thighs, legs.  Nothing.  They kept pouring in.  'People would be better off without you.'  'Your wife could be happy again if you were gone.'  'Your kids would be better having no dad, then the pathetic excuse for one you are.'  These are just thoughts.  You should be able to control your own thoughts.  You no longer can.  The thoughts have won, you have lost.  Severe depression has won, hope is lost. 

God, I just want these thoughts to end.  So you do the only rational thing you can think of at the time.  I could drown out the thoughts.  I know how to make them go away.  To the medicine cabinet I went.  Self-medication is a poor coping skill I have come to learn.  But, at the time, it was all I could think of.  Take some pills.  Doesn't work.  More pills, still nothing.  The thoughts are still there, running wild.  More pills.  The thoughts ease some.  More pills.  The thoughts have subsided for the most part.  You beat them.

Wow, it is getting hot in here.  Now it is cold.  Why am I breathing so heavy?  I am having to work to breathe.  Getting up and standing is out of the question.  What was once thoughts of suicide are becoming thoughts of "What have I done?"  The thoughts begin to jumble around making no sense.  Breathing fast and shallow, I can't catch my breath.  The next bit is a blur.  Up until the point where my wife and kids got home.  She knows something is wrong.  There is no hiding that something is very, very wrong.  I tell her.

I will pause here to tell you all this.  I can never take back the things I did.  I can not take back the pain I caused to the people who care for me.  This day was the scariest in my life, and the scariest for many others, especially my wife.  I can't apologize enough for the things I did that day, but I can make damn sure they never happen again.  Hopefully, with time, like the scars from the knife, these scars will fade and be replaced with great memories.

A call to my psychiatrist from my wife leads to him telling her to call 911 and have an ambulance come to take me to the hospital.  I stumble my way to the stairs as the sirens approach.  First to arrive, the police.  I have to be searched and patted down, then questioned.  The ambulance and fire crew are allowed in after the police finish.  I have to try and explain everything.  Things are still kind of a blur, I have no idea that my 5-year-old daughter is watching and hearing all of this from the top of the stairs.  This information is told to me by the paramedics in the ambulance, again in the ER, and by the nurse in the ER.  I needed to hear that.  It broke my heart to think of her seeing me like this.  I thought I had wanted help before.  Now I know I needed help.  I had to get better, not just for me, but for my wife and my kids who truly adore me.  It was that night in the ER and then ICU that I know I want to live and I never want to feel the way I have been feeling ever again.

All I remember of the ambulance ride to the emergency room is being yelled at to wake up and to stay awake.  Punches from the paramedic make my eyes open, but they close again.  Another hit and booming words "Breathe, stay with me, stay awake!"

Once I begin to come around later that evening I am told by the ER nurse that I had two choices.  Choice one: Go to a psychiatric hospital voluntarily, or choice two: involuntary admission in handcuffs and police escort.  I already know I need the help, I vow to go voluntarily, and I mean it.  Tomorrow morning a representative of the psychiatric hospital would be in to evaluate me and arrange for my transport to the facility.

The night is long in the ICU.  You can watch your vital signs as they are constantly monitored.  The alarms go off quite often in my room.  Blood pressure dips to 86/50 at times.  Pulse down into the 40's then up to the 120's.  Respirations slip to 4 per minute while I briefly drift to sleep.  I am getting replacement potassium through my IV which causes my arm to throb and feel like it is going to fall off.  Not much care is made in making someone who came in overdosed comfortable I guess.

The next day a visit from my general practice doctor, who mind you had no idea of anything going on, he reviews the chart and asks me some questions and talks about me going home.  Home?  In my mind I am thinking "What is he talking about home?  I thought I only had two options.  I want help, not home.  Not the same four walls that closed in on me less than 24 hours ago."  He decides to leave it up to the person from the psychiatric hospital on whether I should go or not.  Apparently to him I was well enough to go home... makes me question his doctoring abilities.

The lady comes in to talk with my wife and I, we discuss options, and once again I am back to the two options.  Voluntary or involuntary.  Once again, I stick to the voluntary path.  Although, I state I want to be released no later than Monday at 10:00 am (this was Friday at about noon) because of lecture.  In my mind this is all but agreed upon.  I will be taken by ambulance on the 30 mile trek from medical hospital to psychiatric hospital.  I had never ridden in an ambulance before and here I was, getting my second ride in 24 hours.   I don't recommend doing it this way though.

You truly do not know what to expect when you are admitted to a psychiatric hospital.  One flew over the cuckoo's nest is the extent of my understanding of them.  There are many rules about what you can and can not bring in.  No electronics at all, ok I get that.  No drawstrings, shoe laces, or hoodies, as you might hang yourself with the string, or attack someone else.  No outside books because, and I quote, "You could have soaked the pages in drugs."  You are only allowed two sets of clothes at a time.  No outside toiletries, which includes deodorant or toothpaste.  And believe me when I say it, their toiletries... not of good quality.  You get  a bottle of "body wash/shampoo" in one, some toothpaste that leaves your mouth feeling like you hadn't brushed in months, and a roller ball deodorant which should just drop the "de" because it was pointless.

When you are admitted you have to go through a question session, then you strip down naked so they can make sure you aren't hiding something and to see any bruises or cuts you may have.  After that you get to put on some drawstring-less shorts and a t-shirt and some spiffy socks with non-slip squiggles on the bottom and are escorted down a locked elevator, through a few locked doors until you reach your unit.  You are then given the brief tour of "Here is your room, here is where you have group sessions, here is the nurses station, and the schedule is by the door."  You scan the room not knowing why the other 14 or so people are here.  Then they all go to dinner, but you can't.  You are on suicide watch.  You can't leave the unit at all.  You and the guy talking to himself in the corner get to eat right here.  Humility, if you hadn't already found it yet, is the only thing left. 

I will stop here and wait for another post to go through my stay at the psychiatric hospital.  I am sure your eyeballs are hurting from reading so much by now.  I will say though, I did not meet my Monday release date that I had asked for.  I was there for 7 days.

The Darkness

I put on a very good show at times for people who don't really know me.  The people that know me best, however, have seen my pain first hand.  They had to watch as I spiraled, unable to help me until I wanted to help myself.  They are my heroes.  The ones who have stuck by me through this.  I owe them my life and so much more.  My wife has been very patient and supportive.  She has pushed me when I needed to be pushed and given me space when I needed it.  She has been instrumental in my getting help, pushing me to not back down from seeking the help I desperately needed.  Depression doesn't just effect the person with it, but it takes a heavy toll on those who care about that person. 

My recent bout with depression began with fleeting thoughts.  How worthless I was.  How nothing I did was right.  How I was undeserving of the people around me who loved me and cared about me.  These thoughts over time can take you to a very dark place, a place where in your mind there is no way out.

Compounding with those thoughts were the other contributing factors, also known as symptoms.  Not only do you have these thoughts, but you begin seeing things, as if those thoughts were reality.  I'm not talking about hallucinations, but skewed perspective on how things actually happen.  Everyday interactions, even the best of them, become in your mind, worse.  Everything around you hates you.  Everything you encounter, you just know, is looking down on you.  Because after all, in your mind, you aren't worth it.  Not worthy of love, of friends, of family, and at times, of using air to breathe.  You pull away from everyone.  What used to be conversation, is now one word answers.  What used to be socialization, is now isolation.  What used to be happy, is now maddening sadness.

It is hard to explain how your brain becomes so mad at you.  You try to think positive thoughts, but it comes back full force.  For years, on top of years, you took everything and pushed it down to a place no one could see, even you for the most part weren't allowed to open it up.  Then all of a sudden it reaches capacity.  Every hurtful comment from a classmate as a kid, every snide remark about your appearance, every jab anyone ever took at you comes flooding out.  All that pent up rage and frustration pours out of your brain like an erupting volcano sending rivers of burning hot memories flowing over the inside of your closed eyelids.

Closing your eyes is no solace from depression.  For a while I was sleeping maybe 2 hours a night.  My brain wouldn't shut off in it's rage of self-loathing.  Time would tick by.  You find yourself becoming sleep deprived, which only makes you more angry, and more irritable.  You begin to fear what you might do or say to someone you care about.  So you pull away even more.  If I do not talk to them, if I do not get too close, I can't get upset.  I won't explode on them in a misplaced and misguided fit.  So who do you take it out on?  Bingo.  Yourself.

There are symptoms of depression I never really knew about.  Like the pain.  Back pain, leg pain, headaches, stomach pain.  So now, you have self-hatred, can't sleep, in pain, and a ticking time bomb of irritability and anger.  The thoughts begin.  You are a terrible person, you are a drain on everyone who knows you, you are inconsequential.  You are quickly becomes you aren't.  As in, you aren't worth it.  People would be better off if you weren't there anymore.  Lives would be better, if you ceased to live.

Then it began, and it wouldn't leave.  Thoughts of harming myself.  Thoughts of ending myself.  Numbers rolled through my head.  Five of them to be exact.  To most it would just be a odd string of numbers.  To me, it was the combination to the safe that contained a way out of life.  I battled these thoughts, and this is about the time I knew I needed help.  This is when I reached out.  When I had a plan.  I didn't want this for my life.  I wanted to be me again, not a broken down shell of what I once was.

I went to the psychiatrist, and he gave me pills.  Pills to help, or so I thought.  The pills made me foggy.  I was slow, couldn't concentrate on things and was left to my own thoughts, which were still in a bad place.  How do you escape from yourself?  Normal distractions didn't work.  I no longer enjoyed anything.  If I smiled or laughed it was because it was expected at that time, but I didn't feel levity, just pain.  So I remembered what worked one time.  I was in class, Human Development to be exact, and we were talking about death and suicide.  The only thing I really learned from that entire class was that I wasn't normal.  I was devolved.  But, during this class I couldn't take it, but couldn't leave either.  I dug my ring into my cheekbone.  Pain.  I could feel that, and it took my mind off of things.  I went home with a dent in my cheek and a bruise from digging the metal in.

Pain could take some of the thoughts away.  So I cut myself.  Over and over again.  Places hidden from the world as to not let others see.  Some of the scars still remain, and are a reminder of where I have been, and the journey I am on.  I am sure they will fade with time as most things do. 

This was my life.  My life before treatment began to work.  Treatment took quite some time to really take hold.  It took months.  Months of medications and pitfalls.  Victories and defeats.  It all came to a tipping point on a sunny, warm September day...

Hello New World

I have a problem.  I realize this.  Most of you do not know about this problem.  But lately I have been thinking about opening up this problem to the outside world.  It is a scary proposition, but after thoughtful consideration, I believe I am ready.

I suffer from depression.  Actually, my clinical diagnosis is Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD).  I have kept this a secret from most people, and by most I mean the vast majority of the people in my life.  I have had to act, and lie at times, to keep this a secret, but no more.

Our nation has a mental health problem.  It is not that everyone is crazy, it is just having a disorder like mine is almost taboo.  The only way to get around this is to shine some light on the subject.  Although my flashlight is very small, it may light the way for one person, and that is enough for me.

My depression started long ago.  I am not sure when or why.  I guess that is often the case.  I remember being very sad even back to elementary school.  Definitely I had what I now know is depression by about age 13 or 14.  I had my ups and downs.  Some periods were fine, others were very dark.  I went quite awhile without a major episode.  Probably eight years or so.  But a few years ago I began sliding back downhill.  Further and further down, until I hit bottom.

Like many others with depression or any number of other mental illnesses, I did not seek treatment for my problem for a very long time.  When I did decide to get help I was amazed at just how hard it was to find the help I wanted and needed.  I spent a few days calling different psychiatry and psychology offices.  Every time they either didn't take my insurance, or even more often were not accepting new patients.  I finally found one that was taking new patients and my insurance.  The catch?  The next available appointment was over three months away.  I almost lost it.  So, I asked if there was any hope of something sooner, and the disengaged receptionist told me that I could be put on the waiting list for a cancellation, but that wasn't very likely.  Even more frustrated I said "So short of checking in to a hospital or killing myself, what are my options?"  The woman had the gall to tell me "Well, unfortunately even hospitals are turning away some patients."  This was...  Shocking.  I could barely mutter any words.  When given two options she just told me that the only sure fire way was to kill myself.  Nice.

I called one last place, a place I had tried before but was closed when I called.  Last ditch effort to get help.  They actually took me.  First appointment was a couple weeks away, much better than a season away.  They put me on the waiting list for cancellations, and they actually had one within a couple days and I got in sooner.

The psychiatrist I saw was surprised I never sought treatment before.  He said most people who go as long as I did don't make it.  I guess it is the little victories.  I was put on some medications, had to be switched because the one was causing some odd reactions.  I won't go too far into the medication merry-go-round that ensues to try and find the right combination with this post.  I have to save something right?

So I guess this just about does it for my introductory post.  My next one I will talk about some of the symptoms I had leading up to seeking treatment.