Excerpts Published in The Commons

The editors of our local, independent, alternative weekly recently asked if they could use excerpts from this blog for an article. I, of course, couldn't help myself and did a little editing, but they did a great job of extracting pieces that are particularly appropriate for this time of year. You can see it at http://www.commonsnews.org/site/site04/story.php?articleno=4371&page=1

Note: The typographic eccentricities in their online headlines are troublesome to their tech folk but wonderfully appropriate for my content…

www.davidblistein.com

You can now follow up on the progress of David's Inferno and my other work by logging onto www.davidblistein.com. I still plan to turn this blog into a book. In fact, it's next in line. It's just that you never know who's going to cut in front next. Will update my progress on that book on this blog until I get everything combined on the new one. Thanks for reading! (P.S. The meds are still working…that's the most important thing, right?)

Submissions Wanted.
One of my goals in writing this blog is to talk about how complementary medicine has played an important role in my continuum of care. Or, to put it in more human terms: how other stuff got me through it and continue to help me today.
      As I begin to write a book based, in part, on this blog, I would love to hear from acupuncturists, homeopaths, cranial sacral workers, massage therapists, nutritionists, herbalists, etc.—even astrologers and psychics—any practitioner willing to share their own perspectives on and approaches to treating depression.
     One of the premises of these disciplines is, of course, that it is important to treat the whole person, not just a symptom.
     Still, I think it would be helpful for people to have a general idea of how different "modalities" approach depression. I'm looking for brief essays (±250 words). Naturally, you'd have final approval of content and attribution, if I include your essay in the book.
     My address—for submissions and/or questions—is davidblistein@gmail.com.
     Please feel free to forward this to practitioners you think might be interested in contributing.

"The Truth Wears Off.”
The New Yorker (December 10, 2010) addresses four questions that every self-respecting gobbler of anti-depressants, anti-psychotics, and anti-all-kinds-of-other things has wondered about:
     1) Why are clinical studies such unreliable predictors of which treatment(s) will help me?
     2) Why can a drug/remedy that was perfectly effective for many years suddenly stop working?
     3) Why can that same medication have an entirely different effect when I start taking it again after stopping for a while?
     4) Why should I worry about having an erection for four hours when I can barely get up in the morning? [sic]
     While the New Yorker headline is intriguing, the question it addresses in the subhead: “Is there something wrong with the scientific method?” isn’t all that provocative. Most people know that scientists occasionally fiddle with results based on who’s paying for the research, their own assumptions, and current conventional wisdom. In fact, the author (Jonah Lehrer) does a really good job of proving that very fact—albeit anecdotally—by telling stories about experiments that follow all the rules of scientific protocol, but yield significantly different results over time.
     But the article doesn’t really address the more practical question implied by the headline: “Why does the truth ‘wear off.’”
     A while ago, I wrote about “entertaining ideas that are intriguingly unconventional.” This article reminded me of two ideas that are extremely conventional, but often seem to be overlooked when we try to answer the questions above:
     1) Humans evolve. All the time.
     2) Each one of us evolves. All the time. In fact, we're a swirling mass of energies in constant flux.
     These facts might not provide much relief for people who are currently struggling to find a drug(s) or other therapy that works, but, I hope, they might inspire some confidence that there’s something out there…or in you…or in humanity at large…that will.

Powerful Positive Thinkers Getting You Down?
It’s time for me to stop writing this blog. Indefinitely, if not longer. There are a few reasons:

1. My goal was to collect my thoughts about clinical depression so I could eventually write my poor-man’s version of William Styron’s Darkness Visible. Clearly, I have more than enough material to get started.
2. I also wanted to track my major depressive episode from a perspective four years later. Which means I’ve arrived at Fall/Winter ‘06/’07—the period when it got way darker before the dawn. I don’t particularly feel like looking at that material right now. And there’s no need to subject anyone else to it either. I’ll get to it eventually.
3. I’ve been focusing more on my other blog (www.davidblistein.tumbler.com), in which I write about all kinds of other, way-less-depressing topics. 
4. I want to begin gathering information on how holistic/complementary/alternative practitioners view and treat depression. 

But the other day I stumbled upon several web pages with quotes about happiness…and I kept stumbling…until I realized there was at least one more post I had to write:

* * * * * * * *

People have been writing about happiness for a long time:

When a man has lost all happiness, he's not alive.  Call him a breathing corpse.  - Sophocles

Some of the quotes are just good one-liners:

What a wonderful life I've had! I only wish I'd realized it sooner.  - Colette

Others have a kind of crazy contrarian wisdom…

Sanity and happiness are an impossible combination.  - Mark Twain

I found some elegant metaphors:

The most singular difference between happiness and joy is that happiness is a solid and joy a liquid.  - J.D. Salinger

Quite a few argue it is futile it is to look for happiness outside oneself…

A man should so live that his happiness shall depend as little as possible on external things. 
- Epictetus

Many talk about how happiness can come from making other people happy:

Happiness never decreases by being shared. - Buddha

Others offer simple but profound truisms:

We all live with the objective of being happy; our lives are all different and yet the same.  - Anne Frank

* * * * * 

All these insights make sense to me; both the "me" who’s known manic depression and the one who’s known enthusiastic joy.
     But I kept coming across other quotes—mostly from the literature of classic spirituality and/or modern self-help—that suggest our happiness depends only on our ability to manage our own hearts and minds.

What we call the secret of happiness is no more a secret than our willingness to choose life.  - Leo Buscaglia

Learn to be calm and you will always be happy.  - Paramhansa Yogananda

The happiest and most vital people are those who have goals. - Dr. Joyce Brothers

If you are not happy here and now, you never will be.  - Taisen Deshimaru

It's impossible to be unhappy and feel fully present in the moment.  - Eckhart Tolle

If your own mental attitude is correct, even if you remain in a hostile atmosphere, you feel happy. - Tenzin Gyatso, 14th Dalai Lama

When every single thing you do aligns with your values, you will be among the happiest people on this earth.  - Peter Thomas 

I’ve spent a lot of time in spiritual and even New Age circles, and I have a lot of respect for these people and what they say. But, frankly, these claims simply were not true when I was clinically depressed.
     I understand that many, if not most, of these writers would add the caveat that they are not talking to or about people who are clinically depressed. But, caveat or no, they can make a depressive want to cover his/her head in shame. Because these quotes illustrate how, despite the ongoing efforts by professionals and just plain folk to explain why depression deserves the “status” of an illness, the seriously mentally ill are still often given the overt or subliminal message that they should be able to pull themselves up by their synaptic bootstraps.
    The fact is that the clinically depressed often do not even have the capacity to think positively or be calm or even choose life. As for the ability to feel fully in the moment, believe me, they've been there and it ain't a real happy place.
     The very best I could do during that time was to repeat positive affirmations as a kind of prayer. One that, you could say eventually came true, although certainly thanks to "treatments" besides prayer. But, at the time, they made me feel only the more helpless.
     So if you suggest a depressive think positively, please do it gently. Because, from my perspective, to say things like this to someone in real mental pain can feel more cruel than helpful.

Asking a depressive to look on the bright side is like asking someone who’s color blind to see red.  - Me

The quotes above came from various websites:
http://www.about-personal-growth.com/quotes-on-happiness.html
http://www.quotegarden.com/happiness.html
http://thinkexist.com/quotations/happiness/
http://www.wisdomquotes.com/topics/happiness/
http://www.goodreads.com/author/quotes/4493.Eckhart_Tolle
http://www.happiness-project.com/happiness_project/about.html

Seasonal Affective Disorder.
No self-respecting book about depression would be complete without a discussion of Seasonal Affective Disorder.
     Like all things diagnostic in the world of mental illness, the phrase is a vague stab in the dark at a disorder that manifests in all kinds of ways, and for which there are many not-too-reliable treatments.
     If you suspect you have this disorder, you definitely shouldn't start taking 20 mg of Celexa and call your psychiatrist next spring—although that might help. Nor can you simply start working under bright full-spectrum lights—although that does seem to help a lot of people, if Nor can you simply spend all winter in Costa Rica…although, that does sound like kind of a good idea.
     While the disorder can kind of sneak up on you, I had one specific experience each year (long before I was taking meds) that assured me it was going to be a long sad winter. I'd be on my daily commute—a beautiful 20-mile ride. One October morning, I’d round the corner at the top of the highest hill and be overwhelmed by the sight of breathtaking fall foliage, a crystal-clear view of Mount Monadnock, and a sinking feeling in my stomach.
     While I’ve always believed that my major agitated depressive episode in October 2006 was a non-accident just waiting to happen, the change of seasons probably helped get it off to a flying start.

* * * * * * * *
The fact that Seasonal Affective Disorder has come out of the closet illness-wise is a double-edged sword. On the one hand, more people feel comfortable asking for help, instead of listening to people who say they'll “just snap out of it.” (Although, they may.) On the other hand, a few down days might cause someone with a mild case to become anxious…which can be depressing…which can cause anxiety…
     With the notable exception of a friend who keeps telling me how much he loves November, a lot of people seem less perky during the winter. Some acknowledge it. Some suffer quietly. For some, it is a pattern that they have learned to recognize and deal with by getting outside more, working out more, taking more vitamins, and/or intentionally thinking positive thoughts. For others, it’s something new; maybe based on changing hormones or life circumstances. In which case it can be kind of scary.
     For those of us who are already medicating, the first line of defense may be simply upping the dose. I did that a year ago with one of my meds, on the recommendation of my doctor, figuring I’d be able to go back down in the spring. Around May, I stared slowly trying to do just that. But at the first shadow, I quickly scurried back to my full dose. It just wasn't worth the risk.
     Don't take my advice—seriously—but I'd try a lot of other things before medications if I "just" had seasonal depression. I know that some people are able to take antidepressants for short periods to get through a difficult time and then go off. But from my perspective, once you start, you have to be at least prepared for a possibly long ride. For the simple reason that going on and off is so dicey.
* * * * * * * *
While I subscribe, at least in part, to the chemical theory of depression, I like the idea that our real seasonal disorder is the fact that we try trying to be as productive through the winter months as we are during the spring and summer. Bears are smarter than the average human. As are Eskimos who definitely scale back their fishing and hunting in winter. To my eye, they do look kind of grumpy, but I’m pretty sure that’s just racial prejudice and projection.

NOTES:
1. I don’t like the acronym SAD because if you got it, you feel a whole lot worse than sad.
2. There are also people who get depressed in Spring, although their symptoms tend more towards the manic. (BTW: Others have already made the March Madness jokes.)
3. For more about Inuit and Pskov peasant winter habits, check out my favorite citation of all time… http://chestofbooks.com/health/natural-cure/The-Hygienic-System-Fasting-and-Sun-Bathing/Hibernation-In-Man.html.
4. Speaking of which, I know Inuit is a more appropriate term, but are also Yupik peoples in various far northern regions who sleep a lot in winter and don’t like being called Inuits. Because they’re not.

Oy vey...The Hangman. My therapeutic calendar for May-Sept 2006 demonstrates an unwavering commitment to restoring my mental health and/or indiscriminate flailing. I’ve interspersed notes from the time—primarily from e-mails. It's not exactly pleasant reading but, in retrospect, the swings between despair and hopefulness is kind of poignant. I always felt that real relief was just around the corner.

 Summer 2006

May 3: Cranial Sacral; Homeopath

May 4: Horrible early morning. Surprisingly hopeful mid-morning. The rain, which has been going on for two weeks continues. After a while, you develop a great facility to function in the world while in the throes of a depressive episode. But it’s a strain.

May 6th: We've had a wonderful spring and I'm coming around.

May 11: Acupuncturist

May 19: We're coming to the end of 2 weeks of rain here…not the best kind of weather for a guy who needs bright sunlight…but just took a new homeopathic constitutional and have seen some positive signs (in between the "wailing moaning and gnashing of teeth")

May 31: I'm a few more homeopathic remedies from throwing myself back at the mercy of western meds!

June 1: Whenever I emerge…and I write this having just returned from a walk during which I caught a few brief glimpses of my full self, engaged, and enthusiastic again…the first thing I want to do is reach out…call people…interact.

June 2: Massage (Rolfing)

June 2: A couple of days ago I took a bunch of magnesium and it really calmed the flutter in my throat chakra, and for the next 24 hours I thought the homeopathic remedy was really coming up and working. I had my energy and enthusiasm back for all kinds of different projects and ideas. But the next day and now…after 2 days of rain here, my head/heart balance is all jumbled again.

June 7: Homeopath

June 9: I sort of think I bottomed out a couple of days ago. It's not so much that I really felt any different, it's just that I realized in my bones I was going to be start moving in the right direction. Maybe slowly. But the right direction.

June 10: Energy Treatment (Scoff if you will, it made me feel better…)

June 15: Cranial Sacral (I also did a therapeutic 55-mile bike ride to celebrate my 54th birthday.)

June 20th: Totally crashed the day after the cranial sacral treatment but have been improving slowly—two steps forward, and only 1 back ever since.

June 22: Cranial Sacral

July 6: Channeler

July 10: Some agitation is still there particularly in the morning, but my spirits are definitely lifted…general direction is positive.

July 14: Cranial Sacral

July 19: Homeopath

July 23: Astrologer

July 24th: Had a fabulous deep restful sleep the afternoon I took the homeopathic remedy. The next morning, however, things were the same and I moved back into the "have to exercise right away w/ drive heaves at the end" phase.

July 28: Cranial Sacral

July 31: Cranial Sacral (at 5 a.m.—we were trying to catch the demons in the act!)

August 3: Psychiatrist

August 4: Homeopath

August 5th: My stability, or lack thereof, has continued to be…uh…challenging. Both my psychiatrist and homeopath have said that this doesn’t fit the standard “pictures.” Still, I have Valium for when things get really bad.

August 18th: Well it’s been a bit of a wild ride but things have settled down. Bottom line I’m starting to have some good periods…measured sometimes in hours; once a whole day. And the bad periods seem not quite so bad.

August 27: Chaneller

September 1: Massage

September 1: I still spend most days just trying to keep on keeping one…I was thinking the other day that I’ll refer to this as my “Lost Year” and then I decided I should be positive and think of it as my “Found Year.” Or maybe just my “Lost & Found Year.”

September 6: Homeopath; Psychiatrist

September 7: I don’t want to jinx anything but today wasn’t a bad day. And that’s GOOD.

September 11: Shiatsu-Energy-Worker-Kabbalah-influenced Tarot Reader. (Really.)

September 19: [Same]

September 20: As of today, I seem to be fracturing again and will probably try to lie still and lay low (instead of doing a workshop I'd signed up for].)

September 25: This time the Shiatsu Energy Worker did a Tarot Reading which began:

"The first position is your connection to the Divine; manifestation of the Crown Chakra area. The head centers. Pituitary, pineal glands. And it’ll give us a picture of what that looks like at the moment…Oh boy…the Hangman."

September 30: Channeler

September 30: For the last 3-4 days, I've caused quite a ruckus, fortunately, for the most part, in the privacy of my own cabin. Finally, well, who knows what triggers what, but Sunday afternoon, Wendy came upon me in total extremis and took me outside, put me in my sleeping bag on the ground, and just watched over me for a couple of hours. I've been slowly, very slowly, walking back to balance ever since.

"Stop Making Sense.” (Homeopathy Part I.)
In the midst of all my personal chazerai, a homeopath was trying to determine the right “constitutional” for me: a kind of magic bullet that I hoped would heal all my ills.
     Homeopathic constitutionals are not the same as the symptom-specific remedies in little bottles and tubes that we buy to deal with aching muscles, insect bites, and this year’s version of the plague, a.k.a. flu.
     The right constitutional gets so deep into the fundamental energetic causes of what ails you, that it can bring about a pretty radical transformation in your physical, mental, and/or emotional well-being.
     This isn’t as strange as it seems. In spite of all the relatively modern focus on observable and/or measurable phenomena—such as germs, cellular aberrations, heredity, and environmental factors—there’s a certain undefinable something that seems to determine how, why, and when each of us gets sick in our own individual way. An undefinable something that underlies not only those germs, etc., but even our positive or negative thoughts, our ability to love and be loved, or what we eat.

Dr. Samuel Hahnemann
Founder of Homeopathy

     Homeopaths look for that certain something.
     A lot of people walk into their offices saying that have a chronic headache, back problem, a cough that won’t stop, or manic-depression so bad they don’t know if they’re coming, going, or both. But from the homeopath’s perspective, each of these symptoms is just one of a myriad of ways that you are “presenting” what really ails you.
     He wants to know what time you wake up in the morning; if you have a history of knee problems; where you itch; if, how, and when your private parts have been working lately; and way more than you’d like to tell anybody about your sweat, snot, and bathroom habits. In fact, during the first appointment—which can last a couple of hours—you may wonder whether the guy is more psychopath than physician.
     Again, however, this isn’t as strange as it sounds. After all, a psychiatrist evaluates each individual’s symptoms to try to intuit which anti-depressive, psychotic, or anxiety medication will work. Often it takes several tries. A homeopath is, essentially, trying to do the same thing. It’s just that he's looking at a way wider set of conditions, and trying to intuit a remedy whose effect, if any, is more all-pervasive and can’t be explained by any current scientific model.
     In any event, based on one or more of these in-depth examinations, a homeopath gives you a few tiny sugar-based pills that contain an essence of some animal, vegetable, or mineral substance that’s been diluted so much that scientists often can’t find a single trace of it left in the remedy.
     And that’s when the fun begins. Or not.

“I want a new drug, one that won't make me sick...one that won't make me nervous, wondering what to do."

Buspirone

I had mixed feelings about the trade name BuSpar when my psychiatrist prescribed it on August 3, 2006.
     Drug companies put a lot of effort into coming up with names. They need something with an obtuseness only a doctor could love (and prescribe). At they same time they want to give patients at least a subliminal message of encouragement.
     In retrospect, neither the name Valium nor Prozac seems to fit that bill. But they have become so much a part of the lexicon that we don’t question them anymore. The names Zoloft and Paxil are a little more calming and uplifting. Wellbutrin suggests it may actually tame the beast. And, for some reason, Cymbalta has a relaxing ring, even though the image of crashing cymbals isn’t exactly soothing.
     The name BuSpar sounded unpleasantly Germanic to me, but did imply it’d put up a good fight in what was increasingly appearing to be a losing battle.

Benzodiazepam

     Its generic name is Buspirone Hydrocholoride. It’s really an anti-anxiety drug as opposed to an antidepressant, and distinguishes itself by being an Azapirone instead of a Benzodiazepines like Valium or Lorazepam. The advantages, they say, is that Azapirones have fewer side effects, aren’t addictive, and don’t cause cognitive/memory impairment. Which is obvious from looking at the chemical drawings. Just kidding.
     From what I read, Azapirones are most effective when used in conjunction with an SSRI. In some studies, thy seemed no more effective than placebos. But I think that happens a lot with antidepressants—unless the side effects are really outrageous, the hope that “this is it,” often helps even a placebo to raise your spirits for a while.
    The half-life of Buspirone is pretty short, so I ended up taking 3x5mg/day and then 3x10mg, with brief contrarian and nerve-wracking trial of 3x15mg. I suspect my psychiatrist was trying to find  a less addictive way of dealing with my anxiety than the Valium I was continuing to gobble. But by November we were slowly weaning me off it so we could try a new drug.
     I always considered myself to be a well-informed patient but, reading the literature now, I’m amazed at how little research I did back then. Although, in the midst of this kind of experience, it’s hard to know whether a little knowledge is a good or dangerous thing.

August 4, 2006…four years ago today.
From an e-mail to a friend...

A Homeopathic

"My stability, or lack thereof, continues to be…uh…challenging. But I actually feel like all the pieces are coming together. In one way or another, my psychiatrist, astrologer, psychic, homeopath, and inner self are all now saying the same thing.
     "Both the psychiatrist and homeopath have admitted that this doesn't fit the 'standard pictures,'—which, although that clearly complicates the cure, gives me a perverse pleasure. In any event, I have a homeopathic remedy that seems to work, although it doesn't 'hold' very long; Valium for early in the morning and other times things get really bad; and a prescription for a new anti-anxiety/anti-depressant to take if the days start getting shorter before I start getting better. *

Buspirone 5mg

     "All the non-physical types say it's coming to an end. Not too much longer…a few more months of ups and downs to go. From the astrologer's point of view, December is the end of a ±two-year Pluto opposition over my Venus then Rising then Sun. (You know me, I'll believe anything, as long as it makes for a good story.)
     "So I write a little, bike a lot, work in the woods, and start other little projects. Rest when I can. I think of it as being on 'sabbatical' or 'temporary disability.' Too bad I'm not working, they'd probably pay me big bucks to be this screwed up. But just learning how to try not to accomplish something every minute is a lesson, no? As a friend said, 'When this is over, you'll probably say you hope you never have to go through that again, but if that's what it took to get you where you are now, you'll think it was all worth it.'" **

Valium 5 mg

* I had finally gone back to the psychiatrist the day before, and he gave me a prescription for a drug called Buspirone and (90 more Valium (Diazepam)—a treasure drove of soporific bliss. I have his notes, but am still working on my doctor-scrawl translation. But the days must have gotten shorter real fast that year because I started the Buspirone right away.
** Remarkably, he was right.

http://news.health.com/2010/04/13/

If antidepressants cause suicide does that mean chemotherapy causes cancer deaths?
Extensive studies have been done on whether antidepressants increase the risk of suicidal thoughts and behaviors. And the subsequent headlines, like those based on many such studies, have generated a whole lot more fear than hope.
      The fact is that, just as chemotherapy can make some patients feel worse and, ultimately, even shorten their lives, so antidepressants can make some patients feel worse and, sadly, trigger suicidal thoughts.
      These are strong drugs. But the underlying diseases are pretty virulent to begin with—which makes the attempt to draw direct causes-and-effects seem a bit simplistic. Still, the same people who see trying chemotherapy as brave (which it is!), even while accepting that it may 'hasten' death, may consider taking antidepressants indulgent or foolhardy because it can "cause" death.
      Suicide is such a taboo topic, I always hesitate to bring it up. Which is probably the reason this post took me much longer to write than any to date.
      I accept that psychiatric medications are over-prescribed in the sense that less aggressive treatments might help many patients, especially children and adolescents, feel and function better. I also accept that it’s important for patients to understand statistical risks.
     Still, while the link between taking antidepressants and suicidal thoughts is somewhat tenuous, the link between hopelessness and suicide isn’t. 
     So to imply that medications “cause” suicide or simply do not work, seems like a disservice to all of those who are or might be helped by them. And even a disservice to the unique individuality of those who, having tried everything, ultimately feel there’s simply no more hope.

Pluto oppositions.

By July 23, 2006, “How long is this going to last, oh Lord?” had tied, “What’s should I try next, oh Lord?” and was threatening to overtake, “If you got something to say, why don’t you say it, oh Lord?" in my list of top 10 existential questions. Which, from a theological point of view, represented at least some kind of progress for a lapsed Jew. So, when someone suggested I visit her favorite astrologer, I was more than happy to do so.
     I like serious astrologers. As much for their descriptive as predictive powers—both of which have little relation to the mass-produced newspaper, magazine, and short-form web variety.
     In other words, I’m not talking about the, “your partner has different ideas how to spend money,” kind of description. (Even I know that.) I’m talking: “Pluto coming opposite your ascendant moving into your descendant…it’s kind of like a death and rebirth. And all you can do is surrender and align with the meaning.”
    In terms of therapeutic rephrasing, I’ll take that kind of talk any day over: “What I hear you saying…” I know what you heard me saying. I just heard me saying it. But I never heard me saying that my problems were caused by Pluto. I thought the fault, dear Brutus, probably lay in myself, not the stars.
     Besides, it did feel like a death and rebirth. And, since I was constantly wavering between surrendering to the thing and all-out warfare, her perspective was valuable. She then explained that the purposes of this time in my life wouldn't, "always be clear at the moment. So," she continued ominously, "all your knowing is not useful here.”
     That’s tough love for someone who prides himself on being able to scale tall conundrums in a single leap of logic. Still, in some small way, it put my mind at ease. At least it wasn't going to have to take all the heat for this thing.
     But, at the time, what mattered most to me was [in short form]:

 “So the thing you’re absolutely experiencing now is this Pluto transit. There it is, opposing your Venus back in September ‘05, then your rising sign and sun between October and December. It’s influencing them all last fall…this is long…and going all through December of this year. Looks like it’s moving off there…even when it comes back, it doesn’t come all the way back. So, as of the end of December, it’s moving away. Through this year, it’s going to be at its most intense. Meanwhile, Saturn is coming up to conjunct this natal Pluto from the end of August through early October, and it’s going to come back in March '07 through June '07. Then it’s gone."

     While I was pretty devastated that I didn’t feel it “moving away” in December '06, by March '07 I had found the right meds. And, by June '07, it was, indeed, virtually gone.

Valium.
Among my more vivid memories is the look on my (new) psychiatrist's face when I told him I was taking 30mg of Valium on my worst mornings—i.e., between ±4 a.m. and 8 a.m.—as I desperately tried to avoid facing the day.
     He managed to retain his calm, clinical tone as explained that he didn’t mind prescribing that much for someone who arrived at the hospital just one un-restrainable thrash short of a straitjacket. In that case, they usually gave an injection. Fortunately, the idea of self-injection never appealed to me, or else he would have been giving the wrong person the wrong idea at the wrong time.
    I mean it’s not like I was overdosing per se: 30mg - 40mg is, as far as I can tell, the maximum daily prescribed dose. It was probably the 4-hour dosage period of time that troubled him. And the fact that I wasn’t eating much. The Jameson or two the evening before may have also helped visions of rehab dance in his head.
      It wasn’t even like I was doing the max every night, I reassured him. Often it was as little as 5mg - 10mg. (Isn’t it interesting how we closely we read the look on our doctors’ faces when we’re trying to convince them to give us more or less of the drug he/she wants to prescribe and we do or don't want to take?)*
    But I’m getting ahead of myself—about nine months ahead of myself. Because, while reviewing my records (as doctors like to say), I see that on this very day in history, four years ago, I was prescribed 30 (5mg) Valium.
     I had somehow managed to live, if you can call it that, the previous three months on a grand total of just 40 (5mg); and the previous seven months on the same amount. Over the next four months, however, I would be prescribed 30, 90, 90, and finally 120, as if my poor psychiatrist was just throwing the stuff at me in a wild attempt to stop the madness.
    Over the same period, as I, in turn, began to throw myself back on the mercy of western medicine, I was prescribed 5mg and then 10mg of an anti-anxiety drug called Buspirone (BuSpar) and 30 of the sleeping pill Lunesta for good measure. Clearly, I was determined to lick this thing once and for all...

--------------------------
 NOTES: All the italics are mine:

1. From Crazy Meds: “Unlike most anticonvulsants, benzodiazepines are mostly useless as mood stabilizers. Their addictive nature, potential for abuse just don't make their case for them.  Especially when the bipolar often have an attitude of too much is not enough. That, and long-term use aggravates depression."

2. I can decipher some of the prescription but translations are welcome: "Phone _____ for renewal of diazepam [C3??] 5mg —rarely needs it but wishes to have it available. He _____ has used it sparingly. [emphasis mine]...diazepam 5mg PRNBID[???] #30 ORF [?]  [??]" 

3. In the interests of fairness, although I did end up eventually switching to a doctor with equally bad handwriting, the one who wrote the script above had been able to help me for years prior to this episode.

FYI: I'm experimenting with a different kind of blogging on Tumblr. It's neither manic nor depressive; but, I hope, still interesting.

Janis Joplin, Jimi Hendrix, Phil Ochs, Jim Morrison, Brian Jones, Sid Vicious, Rory Storm, Del Shannon, Richard Farina, Keith Moon, Richard Manuel, Kurt Cobain...
I had a really good time at the Rock & Roll Hall of Fame when I visited there with my brother and nephew on July 7th, 2006—even though it was a rather odd choice of venues for a mentally-tentative relative...

Tentative though I may have been when I walked in the door, I was soon overwhelmed by the shameless outpouring of creativity that drew me into each acoustically-shielded exhibit. I walked out after about an hour, still gasping at the synesthetic connections that had taken me back 35 years, faster than a speeding bullet (poor choice of metaphor there.)
     A childhood drawing of a flock of sheep by Jimi Hendrix—with one black lamb off to the side; a letter home to mom from Joan Baez about this guy named Bobby; Jim Morrison’s Cub Scout shirt; John Lennon’s Sgt. Pepper jacket; Grace Slick’s vest from Woodstock (be still my heart…); Neil Young’s fringe jacket (be still my brain…).
     I have surprisingly few regrets from the 1960s. But, if instead of being mildly manic on that day several decades later, I’d been pleasantly stoned, any one of those holographic images would have taken me on a long, pleasant journey into some of the most intense years of my life—a time when depression was, even at its worst, a rather attractive pose…and, for a price, there was always temporary relief close at hand.

There's more to the picture

Than meets the eye.

Hey hey, my my.

  
Pretty good 17th b-day Jonathan, wasn't it?

Post #100.
This blog was inspired by William Styron's Darkness Visible. I read that book just as I was emerging from my ±2 year period of dysphoric mania in 2007.
     One night back then, Wendy asked why I was reading that, of all books. I said: "Because I feel like I'm listening to a kindred spirit."
     It was such a relief to read someone who took a clear-eyed, literary, and—of all things—sane look at the experience. Styron captured the desperation without sounding desperate. He captured the anxiety without sounding manic. While he may have occasionally lost his sense of humor, he didn't lose his sense of irony. Bottom line: he got right inside the disease and ripped it open, so the allegedly sane could see the guts of the thing.
    Even in the midst of my experience, I wanted to write about it; I wanted to understand it; I wanted it to have meaning. Because, as bad as I got, I knew that I was still a writer (husband, father, son, brother, friend) first and a depressive a distant second.
    This blog is not a cry for help. Nor is it a daily chronicle of wild emotional swings—although I do include writings from back when I had them. Nor is it an attempt to provide a comprehensive overview of the disease, although I do occasionally indulge in some plain-English versions of medical jargon. It's my attempt to, like Styron, help the allegedly sane see the guts of the thing—and the clinically ill to know there is intelligent life on the other side.
     As I've said before, I'm a successfully treated depressive. Every day, I take 200 mg of a mood stabilizer called Lamotrigene and 60 mg of a basic anti-depressant called Cymbalta. Occasionally I nibble on a benzodiazepine called Klonipin (think "Valium Light"). Not only am I not currently depressed, I'm probably happier than most people reading this. If I missed a dose, it'd be OK. If I missed a couple, things would get dicey. If I went cold-turkey, I would probably break into cold sweats and my emotions would go haywire.
     Someday this will be a book, or the basis for a novel, or some kind of wild interactive web thing that hasn't been invented yet. For now, it doesn't matter. For now, I just have to write it.

A footbridge. A stone walkway. A multiflora rose. A septic tank.
A labyrinth. #5 in a series of  projects from 2006.

Every year, I cut a cord or so of wood to heat my cabin. Although not much wood, it still leaves behind a lot of slash, which, like any self-respecting guy with a chainsaw, I throw into half-hearted piles, hoping they'll decompose before anyone notices.

     In 2005, however, a weird thing started happening: The brush began intertwining itself into orderly circles around trees. Soon—as if the elves or aliens were getting increasingly bold—the branches started wending their way around several trees and even around curves in the paths.
     Clearly, as quickly as I was creating chaos out of order, Wendy was doing the opposite. At the time, the game was tied…and I was definitely rooting for her.

The first labyrinth I ever saw is one of the most famous—at Chartres Cathedral. It was the summer of '76 and I was with a group of people who were searching for enlightenment or some reasonable facsimile. We were there on the summer solstice because that's one of the few days the labyrinth isn’t covered with chairs. It’s also the day that a fairly perfect circle of sunlight falls in a certain way on a certain flagstone that’s set somewhat askew on the floor in the transept.
     The labyrinth didn’t make much of an impression on me. Neither did the circle of light which, as I remember, my friends were crowded around in the hopes of seeing the face of God. Thanks to too little sleep and too much cognac, I was in a fit of manic transcendence and saw God just about everywhere. In fact, I was beginning to wish he’d leave me alone, so I could find some inconspicuous corner and take a nap.  But, I digress.
     In subsequent years, Wendy and I walked our share of labyrinths. Although I respected the spiritual intentions of these labyrinths, and am always up for a radical  transformation, I never really got what the big deal was. Walking them just seemed like going in circles, albeit meditatively. If the rhythmic clockwise and counter-clockwise turning was doing any inner re-balancing, it was way below my coarse conscious mind.

    But even I could tell that Wendy was on to something with the intertwining-branches thing. I liked the challenge of using the same low-tech approach to building a labyrinth in our woods. And, I secretly thought it might buy me enough karmic credits to help me find a way out of my Dantéan dark wood.

NOTES: 
1) As you may know, a maze is designed to get people lost. A labyrinth is designed to guide people in and then out...
2) I was hoping to pass along some of the fascinating facts I've learned about Chartres over the years but, unfortunately, while surfing around to refresh my memory, I ran across http://www.labyrinthos.net/chartresfaq.html which does a pretty believable job of debunking most of them. BTW: The picture above of Chartres also comes from that site.
        


A footbridge. A stone walkway. A multiflora rose. A septic tank. A labyrinth. #4 in a series of  projects from 2006.

Building a footbridge from house to cabin—connecting a narrow stream but wide psychological divide—gave me hope that one day I would get to the other side.
     Setting a series of heavy stones in place, to make a walkway that didn’t quite lead where I wanted it to go, gave me pause.
     Digging down deep to get out all the roots of an allegedly invasive and definitely thorny bush, reminded me it wasn’t easy to get free—but that it was possible.
     The symbolism of having our septic tank pumped, however, simply made me smile. Still makes me smile.
     Every old house has its rituals. You learn them one by one. When to get the chimney cleaned. How to install the idiosyncratic storm windows on the screened-in porch. Which pipes lead where and—most importantly—where the shutoff valves are.
     If you have a septic tank, where it is and how often to get it pumped out: typically every 2-3 years.
     I knew where our septic tank was—at least I had found a treasure-type map with obscure symbols and bad spelling. But, six years in, I still hadn’t had it pumped. And this was a good time. Because, since I wasn’t doing a helluva lot of productive things out in the world, I thought a few small victories at home might prove that there was a bright side to having a bipolar husband. Wash some windows. Clean up the basement. Match all the socks and throw the orphans away (what a nightmare…) Although I wasn’t sure that having the septic tank pumped would necessarily endear me to Wendy, I knew, by then, she appreciated any gesture at normalcy.
     This is how to get your septic pump dug: 1) Call septic tank guy. 2) Make appointment. 3) Find septic tank. 4) Dig gently until the top is exposed. Four steps that anyone old enough to pick up a phone and a shovel should be able to do easily.
     It wasn’t easy. Not for me. #1 & #2 were the hardest. Primarily, because I had to commit to being home and functional on a specific day, at a specific time, and ready to deal in a grownup way with a total stranger who was holding a rather large hose with a rather large diameter that was sucking up everything within reach.
     Having dodged the appointment bullets, I had to bite the next two: find it and dig. Frankly, I didn’t know what to expect. I went online (seriously!) I wanted to get an idea of how deep it might be…what diameter…how you actually got the top off…questions that, really, you don’t need to know to dig up a septic tank. In any event, imagine the euphoria when I finally hit pay dirt…actually pay cement. Imagine the the pride when the guy with the big hose came and I was able to show him the top, exposed for all to see. Imagine the relief when I confessed I couldn’t get the top off, and he said no problem—that was his job!—upon which he materialized a special long, hooked, iron rod that was designed specifically for this purpose. Imagine the thrill of standing there shooting the breeze, and then some, with this consummate professional; calmly asking obsessively detailed questions about sewage:
     So, how often…? What’s the deal…? What’s that for…? And, “What’s the worst…’ I’m going to spare you the answers…OK, fine, the answers are:
1) depends how many teenagers live in the house, 2) whether you’re grandfathered, 3) gray water, and 4) dental floss.
     Finally, imagine the charmingly twisted symbolic logic of watching his truck drive away, and being convinced that I was, in some way, cleansed; relieved of a huge burden.
     We look for hope wherever we can find it. And leave no stone unturned.

A footbridge. A stone walkway. A multiflora rose. A septic tank. A labyrinth.
#3 in a series of  projects from 2006. The symbolism borders on the banal, but reminds me, in an oddly fond way, what it was like.




From my perspective, humans are the only truly invasive species. After all, an “invasive” is described as a "non-native species whose introduction causes or is likely to cause economic harm, environmental harm, or harm to human health. These species grow and reproduce rapidly, causing major disturbance to the areas in which they are present." ‘Nuff said.
     One of the more common invasives around here is the Multiflora Rose—a beautiful, fragrant vine, full with tiny rose flowers. It can overwhelm just about any tree or bush it gets its prickery vines around. I didn’t really get what the big deal was about until one day I biked past a neglected orchard which had Multiflora growing in one mass all the way up its hillside. Still, it’s not quarantined in Vermont. Just on the watch list. Which I wasn't very surprised to learn since Dwight Miller, the late great patriarch of the orchards that surround us, used to watch it all the time. And, in his ADHD way, try to control it using a combination of his beloved “Brush Hog,” Yankee wit, and, if all else failed, benign neglect.
     We had one major Multiflora Rose on our property. It enveloped a tree that, at the time, I thought was a young multi-trunked black birch. I felt kinda guilty about letting the vine keep growing where it could provide berries for birds who were more than happy to plant the seeds in the neighboring orchard. In 2006, “kinda guilty” meant "kinda tragic obsession."
     After consulting with Dwight, I learned that the vine propogated through its roots as well as seeds. So I couldn’t just cut the thing down, I had to dig up the roots—which were busy underground doing the same thing as the vines were doing up above.
     I started by pulling away all the vines I could without ripping my arms to shreds. Then, I went at the thing with a shovel and pick axe, following the distinctive roots—inside they’re a bright mustardy color—until I was confident I had removed every single trace of this “unwanted” plant that had invaded our personal piece of paradise. I don’t remember how long it took. In my memory, it was days, weeks, months. So it must have at least been a few hours.
     Eventually, I was done. Having spent all that time sweating mentally and figuratively over a project that really could have been ignored—or taken care of with a chain saw (and a brief yearly follow-up) in less than a minute.
I’ve always been good—some might say too good—at identifying with plants, animals, and inanimate objects. In any event, looking at that multi-trunked tree, freed at last from its crown of thorns, gave me a feeling bordering on freedom…release. I hadn't felt that way in a long time.
     Turns out that the tree I liberated is a Japanese Bayberry, which is also considered an invasive. But, I don’t worry so much things like that anymore…even though it sure seems like there are a lot of berries on the thing. Every year, a few small seedlings appear in the middle of a cluster of ferns 100 yards away. I just dig them up before they get out of hand.

A footbridge. A stone walkway. A multiflora rose. A septic tank. A labyrinth.
The stepping stones from the house to my cabin don’t lead directly to the cabin. And they're more than a step across—unless you take giant steps.
     For many years, I didn’t understand why Wendy told me to put them like that. Particularly in the Spring when I often had to hop-step to avoid the saturated ground. Many muddy shoes and vaguely annoyed thoughts later, I finally saw what she saw: that while nature doesn’t really abhor a vacuum, it is slightly baffled by straight lines. And, although it's bemused by human dreams of creating order out of chaos, it can't help but follow its own mysterious, but decidedly non-linear, logic.
     The symbolism did not, and does not, escape me.
     The stones came from various places on our property. I even copped a few from a tumble-down stonewall out back. Which they're considering making a crime around here. But I figured a few from our own land would be forgiven by the Gods and, hopefully, the neighbor whose border we share.

     Unlike the borderline-boulder that became my front step, these stones were all in my weight class. As long as I kept my knees bent and back straight, I could lift them high enough to rest on my thighs and then leverage-pivot them onto the cart.
     Compared to most hole-digging, going down 6” to plant a paving stone is pretty easy:
     Put stone in place. Outline the ground with spade. Set aside rock. Remove sod. Dig/scrape soil until hole vaguely mirrors contour of the rock. Place rock in hole. Rotate back and forth a little. Try to convince yourself it’s perfect. Realize it’s a little high or low, here or there. Remove rock. Repeat. Repeat. After 15-30 minutes, surrender and move on.
     It sounds simple. And it was, physically. But to my mind it was high drama:
     Decide exactly where to put the stone. Eyeball the depth exactly on the first try. Debate with self whether it looks exactly right—i.e., like it had risen gently out of the ground after the last glacier and is getting ready to settle comfortably back in place until the next one. And, most importantly, worry about what Wendy, friends, neighbors, and casual walkers-by would think. Would I be exposed for the incompetent hole-digger and stone-paver that, clearly, I was? Would I spend the rest of my life in a Sisyphian struggle to get them just right?
     One of the (many) reasons I politely declined when my psychiatrist suggested I check myself into a hospital, is that I couldn’t imagine being confined to corridors. Since it's a very enlightened place, my therapeutic captors would undoubtedly have let me go for walks outside—maybe even do some cardio- or weight-work in a wing dedicated to a different kind of therapy. But I doubt they would have sent me out with a shovel to bake my psychosis in my own sweat.

A footbridge. A stone walkway. A multiflora rose. A septic tank. A labyrinth.
What did I actually do all day during that time? Looking back, I wonder the same thing. Because, even when you feel almost human. you can’t walk away from a “major episode” of agitated depression. Wherever you go, there it is.
     Still, even though I lost 25 pounds, I did eat. Even though I feared waking up in the morning, I did sleep. Even though I lost most of my interest in sports, I did watch some. Even though I wasn't all that functional, I did work a couple of days a week. And, even though they were primarily monosyllabic, words did come out of my mouth.
     I even did some writing. Some of which wasn’t all that bad, although clearly lacking in life, like a plant that only thrives in full sun.
     I also started projects I was unable to finish: washing every window in sight; cleaning up the basement; going through boxes of memorabilia. All remained half done. (Most still are!)
     There were, however, a few projects that I did finish. Projects so rife with symbolism that it borders on the banal. But projects that remind me, in an oddly fond way, what it was like.

A footbridge. We have a seasonal stream—about 8’ across, that runs between the house and my cabin. Shortly after we moved in, I built a platform bridge to cross it—just 2 x 4's nailed onto 6 x 6’s. Sometimes, during the spring thaw, it rained so hard I’d have to clear the leaves and gravel that were damming the upstream side. The rest of the year, it did just fine on its own.
     One day in Spring 2006, however, the rains were so strong, the waters actually lifted up the bridge and deposited it 10’ away on the lawn. So I decided I needed to build a small arched bridge.
     I thought about this bridge a lot. Actually, I obsessed about this bridge. As I drove around or went on bike rides, I’d look at other small arched footbridges. I studied pictures in books. I measured the span several times a week, and kept forgetting the number and/or where I’d written it down. I settled on a width and then realized it wouldn’t be wide enough for my lawn tractor. I decided to put in railings and then realized that the lawn tractor cart might occasionally be loaded with sprawling saplings and brush, and the railing would get in the way.
     Occasionally, I’d try to reason with myself: “Dave, calm down, it’s just a little footbridge.” But the other voices in my head refused to listen. Eventually, through some extraordinary engineering insight (i.e., I found some graph paper), I realized that if I bought three rough-cut 2 x 12's that were 8’ long—no, better do 10’; no 8’ will be fine; 10’ to be safe—I could cut arcs in the tops and bottom, nail down some planking, and be done with it.
     But where should I get the 2 x 12's? And, if I went up to 10’ how would I transport them? Would I need to dunk them in a high-powered preservative? Was there something less toxic to use? What about the arc?—it looked good on graph paper, but what would it be like to walk across? Most, importantly, how the hell was I going to layout and then cut arcs in 2 x 12's?
     I could go on and on, of course. But I’ll put us both out of my misery. Eventually:
     1. A friend not only knew where to get the 2 x 12's, but convinced me my bridge would last a long time even if I didn’t use preservative. Of course, it took two weeks before we found a time that worked for both of us and the guy with the little sawmill. But, eventually I drove the boards to my house—sticking out of the passenger-side window with red flags on the ends, like hostages trying to get the attention of passing cars.
     2. I figured out how to mark the curve. I laid the 2 x 12's against one wall in the basement, put a nail in the floor on the opposite side, tied a long string to the nail, and attached a pencil at the other end. After fiddling with the length of the string a bit, I was able to draw roughly similar arcs on all three boards.
     3. I found someone who believed that someone as unstable as me could still be trusted with his Sawzall.
     4. I bought brand new ripping blades.
     5. I cut the arcs—which, while not easy, was enhanced by my demonic mood.
     6. I got the first friend over to help me prop up the three 2 x 12’s, as I laid a few 2 x 4's on top to hold them steady.
     7. Then I nailed the rest of the 2 x 4's down. And only bent a few nails in the process. Although, I did end up a couple of 2 x 4's short, of course…
     8. As you can almost tell by the picture, the new location meant I'd have to move the large stones I'd put in the ground leading up to and away from the bridge. But that's another story.

I walk across that bridge almost every day. From where I live to where I write. And back. Over the last few years, the water, as is its nature, has started eroding the banks below the ends of the bridge. So, a few weeks ago, I reinforced that area with heavy rocks. I still need to put some flat rocks under the ends of the bridge. Then, at last, it should be stable.

Friends.
These excerpts are all from e-mails written in May, 2006:

From a friend who had driven by and seen me on a street corner:

So amazing…through the rain I see…that’s david....from the distance of the road you seemed somehow one step removed from this world…here yes…but…stay here, david...there are more adventures!!!!

From my idiosyncratically shamanistic friend in New Mexico.

No more "breakdowns".... for either of us—or energy that wraps around one's heart and fucks you up. I've died for the cause before and no more.... no need. I find a lot of it comes down to loving myself. Hope your wailing and moaning is swept away with the rain.

From a friend living in Europe :

I have a favor to ask. I am in Sicily and don't plan to come back until August. I need a shrink in the States who will write me a prescription. The last doctor I had in NY was impossible.
     Your psychiatrist was the first person to prescribe medication for me, but I don't know if he'll remember me—it was almost ten years ago. Do you think you might be able to call him to see if he is willing to talk to me? It is impossible to get anything for ADD in Italy because they don't believe in it…

From one of the funniest people on the planet whom my wife and I have known for a long time. Maybe too long:

And as for nervous breakdowns...dude, you’ve been living with her for umpteen years. There’s no mystery here. You’re in line for the frickin’ Distinguished Service Cross. If I was you I would have downed a quart of Liquid Plumber years ago and been done with it.

From my anything-but-depressed friend in California.

My daughter is bouncing back and forth with the same thing. She was doing well on her homeopathic supplements, but then went into the deep, dark, well that she sinks into now and then. She cries, she can't do anything, be anything, etc. She snaps out of it eventually, but it's hard to watch her be so despondent and lacking hope. And I'm sure it's hard for her to have Pollyanna for a mother, too.
     I hope this doesn't sound cruel, but I often think she needs other people's energy to get by. Do you ever find that to be true? She won't do western meds AT ALL.

From me, responding to the above….

When you're deep into depression, the very idea of having to "socialize" can be excruciating…and yet, at times, it can be particularly soothing, particularly if it's with people who understand and are sympathetic to your condition. Otherwise, you spend the day maintaining two personas…an external one who relates more or less functionally with others. and an internal one who feels like it wants to scream, curl up in a ball, break down and cry, whatever.
     I know that when I emerge…and I write this having just returned from a walk during which I caught a few brief glimpses of my full self, engaged and enthusiastic again…the first thing I want to do is reach out…call people…interact.
     All of which is my way of saying that I feel deeply what your daughter is going through and can only wish her all the best.

One morning, I realized I was running out of Lamotrigine...

I called for a refill, but, having no other excuse to go downtown, I decided to split my two doses that day (i.e., 50 mg morning and night instead of 100 mg).
     The next morning, I took 100 mg because I was sure I'd get downtown. But I didn't. So, I took 50 mg that night and 50 mg the next morning. That day—I can't remember why I didn't go to the pharmacy—maybe it was snowing? In any event, I took my last 50 mg that night.

The writers of those tiny-type prescription inserts whip themselves into a frenzy about how you can break into weird rashes, send your blood pressure soaring, and/or die if you lose at medication roulette. But, at least with the antidepressants I’ve taken, they are rather la-di-da about missing one dose: don't double up, just take your next regular dose and get on with your life.
     But they don’t tell you why. As I understand it, the why has a lot to do with the half-life of your medication—basically, how long it takes for half of it to leave your bloodstream.
     Unlike the Strontium 90 they just found in the soil near my friendly neighborhood nuclear plant—which has a half-life of about 30 years—the half lives of most medications can be measured in minutes, hours, or days. Obviously, the longer the half life, the less problematic it is to miss one dose.

In other words, over three days, I had taken 350 of the prescribed 600 mg. If the half-life of Lamotrigine (a.k.a. Lamictal) was 30 years, it wouldn't have been a big deal. Unfortunately, it's more like a day.

While, in general, doctors encourage patients to be well-informed, I guess they think a little bit of half-life knowledge could be a dangerous thing—especially in the delusional, anxiety-ridden minds of the mentally ill. They may be right. After all, the half-life depends on a lot of factors, e.g., how much you weigh, other drugs you’re taking, and whether your kidneys and/or liver are operating at full power.

When I woke up the fourth morning, I was seriously agitated. But the pharmacy wouldn't open for a couple of hours. I took a Clonazepam, which calmed my mind a little but didn't do much for the shakes.

To my ever-curious, albeit chemically untrained mind, half-lives explain a lot. For example:

• why you might be told to take one drug, say, 3x/day and another 1x/day; 
• why it takes a while to get up to a therapeutic dose…i.e., for all those overlapping half-lives to stabilize into a fairly steady amount in your bloodstream;
• why they tell you not to double-up after missing a dose;
• and why you should tell your psychiatrist everything you can about your health history and daily habits. Hey, he/she might not be pleased that you smoke, drink, and never exercise, but it's better to fess up, rather than be given the wrong amount of the wrong drug.

By the time I was in the car, my heart was racing, I was beginning to cold-sweat, and it took all my powers of persuasion to convince myself I wasn’t having a heart attack. At one point, I almost pulled over and called 911.
    I got downtown and managed to feign some measure of calmness while picking up my prescription.
    I started sucking on one before I was even out the door.

The half-life of Lamotrigine is particularly variable—although a day, actually ±25 hours, seems to be the accepted average for someone taking it on a regular basis. Ergo, on the day after a given dose, you have 50% of it left in your system; 25% the next; 12.5% the next, and so on. Which means that, by the time I drove to the pharmacy, I was at ___% of my regular sustained dose. (You do the math…I get really confused when I try). In any event, it wasn't a whole lot compared to what I'm used to.

I felt better almost immediately—maybe a placebo effect, although Lamotrigine is absorbed pretty quickly (reaching peak concentration in 1.4 - 4.8 hours). Most of my symptoms were gone within an hour, leaving me with that feeling of shaky relief you have after narrowly escaping a car crash.   

Not only am I not a chemist or biologist or biochemist, I have never even taken a biology or chemistry class. Below you'll find some layperson’s explanations of facts I found by simply download the “Prescribing Information” on the Lamictal website. Similar information is undoubtedly available for your medication(s).
     By the way, you also might want to check out the highly idiosyncratic and borderline x-rated, but very amusing, Crazy Meds. It's kind of like Hunter Thompson meets drug-blogging—which is essentially what the guy actually did in his own gonzo way. It does have a forum, and med-forums are always risky because you might hear stories about reactions, etc. related to a drug that you're using without any problem. Nevertheless, the site moderators work hard to collect a lot of good information about different meds, and put it out there in plain, irreverent English.
     For more of my questionable (and irreverent) chemistry about Lamotrigine, click "Read More". It gives you an idea of what you can learn with a little research.

“You have to navigate your own personal catastrophe.”*
One day, I decided to dig up a rock that had been harassing my lawn tractor for years. I approached this borderline-boulder with a long iron pry bar, pickaxe, two boards, two shovels, two hands, and equal parts determination and trepidation. Slowly, methodically, I began to work my way around it, stopping every few minutes to re-evaluate its emerging size, contour, and depth. Each time, it returned my gaze rather sheepishly. As if it would like to help but, having been stuck there for the last 10,000 years, didn’t have the slightest idea how to begin.

During May - June 2006: I saw a cranial-sacral therapist, acupuncturist, homeopath, rolfer, and one of my favorite psychics. (I also saw a dentist but he doesn’t count since, by then, my whole life was one long root canal.) This undoubtedly sounds like a study in hopeless flailing. But there was a method to this particular aspect of my madness.

Naturally, the rock was bigger and heavier than I’d imagined. A lot bigger and a lot heavier. But I kept at it, slowly working the edges, finding a ray of hope every time I was able to release one of the many smaller rocks that were wedged up against it; rocks that I could then use as fulcrums to release others. Eventually, I began to get a little wiggle room. Something the rock seemed to kind of enjoy.

People like to say there are no “magic bullets.” But we depressives—like most people with chronic illnesses—always hold out hope that some singular therapy or medication will put us out of our misery.
     By that point, I was more than happy with the minor victories that these appointments offered: the hopeful anticipation; the sense of release that came from lying on a table while one of my friends—as I considered all these practitioners—surrounded me with their own particular brand of kindness; the lightness I’d feel afterwards for a few minutes, maybe hours.

Once I got some serious purchase on that rock, I started sliding boards underneath. More purchase. More leverage. More boards. Slowly—to our mutual surprise—the rock began to rise from the earth. And kept rising. Except that, every once in a while, no matter how carefully I levered and pried, it would shift slightly off one of my precarious supports and fall back into place with, seemingly, more determination than before.

Each of my therapies was helpful. The question was always how long it would "hold." Frankly, if I'd had a cranial-sacral treatments several times a day, my depression could have probably been kept at bay indefinitely. Taking pills just turned out to be a little more convenient eventually. And I knew/know full well that even they can drop out from underneath you. 

It took a while—and the help of a neighbor who saw me struggling with it—but that rock is now the front step of my cabin. It does shift a little…I’ve never been able to get it perfectly steady.

* One of the more interesting pieces of advice that the psychic gave me.  

Western = Eastern = Alternative = Traditional = Complementary = Conventional = Holistic = Integrative.
About twenty years ago, practitioners of “alternative” medicine started referring to their practices as “complementary” because, in many cases, they saw the benefit of offering their treatments as complements rather than alternatives to traditional western medicine. But the original name is still used frequently, which leads many patients to avoid "alternatives" or, perhaps, believe in them too blindly.
     More recently, the phrases “holistic” and “integrative” have become popular—honorable attempts to acknowledge that practitioners should do everything they can to learn all about their patients and find the best combination of all possible treatments. This concept, of course, is not new. Well before Dr. Andrew Weil (who, I must admit, never seems to age), it was recommended by healers from Hippocrates to Paracelsus. And, to their credit, they didn’t complicate things further by using fancy words like “modalities,” when something far less intimidating like “mode” or even “approach” would do just fine.
     There’s a certain conceit in the claim that any practitioner could treat the whole person. We’re talking 11 systems, 22 internal organs, 206 bones, 600 muscles, 60,000 miles of arteries/veins/capillaries, 100,000 hairs (on a good day), 100 trillion cells*; plus individual combinations of genetics, lifestyles, environment, and astrological influences; plus individual mental, emotional, physical, sexual, and spiritual capacities and/or experiences. Even healers who say they can see auras or energetic bodies—which presumably present a bigger picture—have to deal with an organism that’s in constant flux (e.g., 1 billion of those 100 trillion cells are replaced every hour). As I’ve said before, under the circumstances, it’s amazing that individuals can ever be cured with similar medications or “modalities.”
     Interestingly, for many years, the so-called medical establishment treated proponents of complementary medicine as second-class citizens of the healing nation. Now, the tables are frequently turned.
     Fortunately, the medical/modality fiefdoms are crumbling. Still, the generally accepted wisdom is that western medicines focus primarily on symptoms while complementary medicines are more concerned with underlying causes.
     This, too, may be an artificial distinction. If there is a mind-body connection that goes both ways, wouldn’t the same be true for the cause-symptom connection? Isn’t it possible that a pharmaceutical can get to the causes of an illness while a complementary medicine could be masking it?
      I’m not trying to disparage any form of healing. On the contrary, I'm trying to address the underlying assumptions that lead some people to have feelings of failures they have when they "resort" to western medicine; as well as the dismissiveness or even scorn other patients face when they try an "unproven" complementary treatment.
     Patients, especially depressives, find enough causes for concern without worrying about whether they're doing the right thing. Rest assured that, in some way—no matter how inscrutably personal or even karmic—we all are.


* There are various estimates of these things, but I always put the most trust in children's books and websites: in this case http://www.kidskonnect.com/subject-index/31-health/337-human-body.html

Mental illness & medication as a spiritual path.
Six years under a fig (bodhi) tree…forty days and nights in a desert…seven-day sesshins at a Zen Center…three-day vision quests in the middle of nowhere…weekend retreats at a monastery. These are just some of the more popular, albeit not-guaranteed, ways to attain what’s considered the pinnacle of human consciousness—whether you call it enlightenment, religious ecstasy, cosmic consciousness, or some other word that “just can’t describe it.”
     In my experience, a major episode of manic dysphoria also works pretty well. As I emerged in mid-2007, I would sit on our porch staring out at the trees, overwhelmed by the delicious sensation of just sitting on our porch staring out at the trees.
     That’s why I suggest, only partly in jest, that some kind of emotional breakdown may be a more direct path to the experience of enlightenment than beating yourself up trying to intentionally put your attention on the NOW. De gustibus.
     Many, if not most, people experience at least one helluva long dark night of the soul (as St. John of the Cross put it in the 16th Century). Whether you awaken to greater wisdom, acceptance, and/or compassion—or just go back to your ordinary life with a big sigh of relief—you'll probably agree that you've been changed, often profoundly, by the experience.
     The potential of deep depression for spiritual/personal transformation has led many people to suggest that we shouldn’t medicate away the pain…that these dark nights are part of being human—in fact among the most meaningful parts of being human.
     Whenever I read words to this effect, I wonder if the writer knows (or remembers) what major depression really feels like. It hurts. OK? It hurts.
     Nobody suggests withholding medication from people with headaches, broken legs, heart disease, or cancer, arguing that if they’d just suck it up and endure the pain, they might reach some kind of transcendent omniscience. But, for some reason, we’re worried about over-medicating depression?*
    During my 20s and 30s I spent countless hours sitting with my legs crossed, watching my breath, and trying to still my mind. I can assure you that meditation also hurts. It hurts your knees. It hurts your back. It can make you kind of crazy. But I chose to do it. And I could stop anytime. If you want to lie on a bed of nails or do 10,000 prostrations, more power to you. But if you ask me to help you up, I’m happy to do so.
     I wouldn’t be where I am today—I wouldn’t even be able to sit still long enough to write these words—unless my depression had been treated. More importantly, I had transcendent moments and profound insights before, during, and after my episode—in good times and bad, even during long existential but-not-depressed dark nights.
     Psychosis isn’t a one-way ticket to transcendent truths. In fact, all too often, it’s a one-way ticket to something far different.
     For some of us, maybe medication is the only sane response to an insane (inner or outer) world.
* I’d like to give credit where credit is due, but I can’t remember where I first read this idea.

“Mental Illness Is the Only Sane Response to an Insane World.”
The British Psychologist R.D. Laing popularized this theory back in the 1960s, a time when hallucinogens made the experience of mental illness available even to those who weren’t naturally inclined.
     Like many radical insights of that time, it was a gust of fresh air that blew away a lot of old, stale perspectives. Unfortunately, it dislodged an equal amount of common sense in the process. And, like many theories that glorify mental illness, there are so many exceptions they demolish the rule.
     “Only” Laing says? As far as I’m concerned, living happily and healthily in a small Vermont town is a reasonable response. "Crazy" as it might seem, other people are quite contented working for a high-pressure, high-paying, high-tech firm. And for many, including John Burdett’s character (quoted in the previous post), you can always retreat into the safety of your friendly neighborhood monastery.
     An “insane world” he says, implying that our time is particularly bizarre. Has he forgotten the holocaust (or fall of the Roman Empire, for that matter) so soon? Besides, madness was around back during days many would consider paradisal by comparison to ours.
    “Sane response?” Are we talking suicide? Terrifying visions? Paralyzing anxiety? Excruciating depression? Incapacitating bipolar? That’s ‘nuff said, unless you’re more contrarian than even I can imagine.
    Not to get overly academic, but “sane” isn’t really the right word anyway these days. The Romans used it to mean whole, healthy or sound; i.e., sound mind in sound body. But we’ve bastardized it to serve our obsession with cleanliness: sanitize, sanitary engineers, sanitary napkins, and even the rather troubling phrase: a “sanitary” military operation (that is performed with surgical precision). Even the word sanitarium evokes images of a place where you have to wear white and get sprayed with Lysol on a regular basis.
    Still, I don’t mean to make Laing wrong. While you clearly don’t want to scratch too far below the surface of his insight, he’s right that everything we do—from one perspective—is an attempt to stay in some kind of balance with the world inside and outside of us. From that same perspective, it’s interesting to look at mental illness as a chronic inability to find that balance.
    Even ordinarily well-balanced people can be thrown off by death and disaster. And a little anxiety seems to be a reasonable response to losing your job, home, life savings—or simply hearing something strange go bump in the night. (Picking up a weapon is an attempt to bring yourself back in balance with whatever's out there.)
    Mental illness, however, while it can be triggered or exaggerated by all of the above, is rooted, fundamentally, in some imbalance in oneself—like there’s an internal gyroscope that’s spinning out of control.
    Maybe that’s why people have such a hard time recognizing depression in others. When you sit on your bed all day, head in hands, (like those sanitized images from the TV commercials), the diagnosis is pretty easy. It’s even easier when you walk down the street ranting and raving about how you just saw Jesus drinking coffee at Dunkin’ Donuts. (Although that’s a vision that frankly, seems pretty reasonable to me. Didn't I hear something about how he could turn bread into wine?)
     But when you manage, at least to all appearances, walk the walk and talk the talk while keeping that whirling out-of-control gyroscope out of sight, can you blame many people from being fooled much of the time?