Grief and Dysthymia

My mother recently passed away due to a massive stroke and I’ve noticed an increase in download (1)my depression and anxiety symptoms. Around the time of her death my symptoms increased to the point where I considered going to a doctor for something to help sleep and for anxiety. Now, almost two months later my sleep has improved but I still experience waves of sadness and panic whenever I think about her loss. I can’t believe she is really gone. It just seems so bizarre since we were inseparable for so many years.

Grief vs major depression. I believe at one time therapists used to think that major depression was due to a major loss such as a job, relationship and or parent. Now with that idea somewhat out of favor it is hard to distinguish grief from clinical depression. Apparently they have similar symptoms and therapists are discouraged from diagnosing people with major depression while grieving a loss of a loved one. What complicates this further is the fact that people’s length and form of grief can vary to quite a degree. Some take a few months while some take a few years. Interestingly, some people who have taken antidepressants for grief have ended up stopping them due to a flattening of affect. Personally, a flattening affect is all I ever experienced from antidepressants and I think it might interfere with recovering from depression. I noticed that if I did experience depression with more sadness a period of improved mood soon followed. A flat affect seemed harder to recover from. This is an excerpt from an article on when grief becomes clinical depression.

Dr. Miller points out that for some people who have previously struggled with acknowledged or unacknowledged depression, the death of a significant other can be the catalyst that brings depression to the foreground. In such cases, professional treatment such as therapy and/or medication can be helpful. In the interviews we conducted while writing and researching Saying Goodbye, we learned that some people found antidepressant medication to be helpful for restoring sleep and appetite and “taking the edge off.” Other people who tried medication stopped taking it because they felt as though their feelings were “flattened,” and that the medication interfered with their ability to grieve.

As someone who has been diagnosed with Dysthymia at age twenty and also with Psychotic Depression eight years ago, this is even more complicated. I have experienced depression at a moderate to severe level for most of my life which didn’t seem consistent with the definition of Dysthymia. During my psychotic episode, eight years ago, I experienced a depression that was much more severe and bizarre. My experience of grief now seems more like my psychotic episode in that my sleep is more impaired and my stress level is much greater.

My relatives response was different than mine. My sister seemed to bounce back rather quickly. She initially expressed grief by crying but seemed to recover much faster and focused on the will and the process of probate which was necessary due to an error on the part of my parents. This could be partly due to her not be as close to our mother as me during the last eight years. I, on the other hand, was initially in a state of shock, disbelief and anger and have stayed there pretty much. I don’t anticipate that my experience will change much because that was how I responded to my father’s death seven years ago. Thoughts of my father aren’t as painful now but I think that is due partly to not obsessing about his death anymore. At least when he passed I still had my mother, now I feel like I have no one I can trust or who cares unconditionally about me. I think that might be why a death of a parent is so traumatic for most. To be loved unconditionally is unique to a parent child bond and it is something that most people try to find in a friend or a mate as they go through life.

My mother experienced her first stroke in 2009 and I took care of her from 2010 until 2018. When I initially came to stay my father was diagnosed with heart failure and was quite ill. I was still experiencing a psychotic episode at the time and had been hospitalized briefly unbeknownst to my family. This was all extremely challenging to say the least. My father then passed away in May 2011 after an operation to fix an aneurism. My mother was extremely distressed since her whole life was devoted to taking care of her family and also due to the fact that they were quite close. After about 2016 when she fell and hit her head she didn’t seem to recognize me any more but still remembered my sister. That was upsetting since I was taking care of her for all those years. In a way her personality died long before she physically did and I should be able to cope with this death better but for some reason that was not he case. When I sit in the living room now and think about her not sitting in the chair I experience extreme panic, almost like I did when a child and separated from my mother.

From 2010 to 2018 I didn’t work much apart from taking care of my mother. I initially applied numerous places but had no luck and gave up. Then around 2013 or so I attempted to volunteer at a library in hopes of obtaining a MLS. At one point my mother became so distressed by my leaving her alone and the people where I volunteered seemed so disinterested in me that I ended giving up. In the last couple of years when my mother became extremely disoriented it became impossible to work outside the home. I would have to sit with her in a room most of the day and if I left to go to another room she became incredibly stressed out. Even taking a shower became a major problem. If I left the house within the last couple of years she would be terribly confused what happened to me when I returned. This meant that I had to take her every where I went. In the last two years simply taking a walk became a problem since she was terribly fatigued. The fatigue toward the end was probably due to a heart problem. During the last six months she was first diagnosed with atrial fibrillation and then towards the last months she had a heart attack and was diagnosed with heart failure. I became as much of a prisoner of dementia and various health problems as she was.

To some people my response probably seems odd and excessive since most people are married when an adult and they form bonds with others. This has not been my experience. I have always felt the closest to my parents, had few close friends and never married. At this point in my life I don’t really care that much what people think of me. That is one good thing about getting older. I know I’m quite different from others and they will just have to deal with it.

 

Advertisements

A case for mixed depression with Bourdain

Mixed depression according to some researchers is rather common but for some reason 0AMZgedO_400x400people don’t think of it when someone like Bourdain commits suicide. Perhaps the depression goes unrecognized since the person’s behavior isn’t consistent with depression and the hypomanic symptoms are not meeting some arbitrary threshold. According to Targum:

“Mixed” depression is a clinical presentation in which a patient meets the full criteria for MDD and, at the same time, has a mixture of other features that are consistent with hypomania or mania. However, when only two or three of these manic symptoms are present, the duration fails to meet current criteria for hypomania (4 days) or mania (7 days), and therefore the diagnosis does reach the full criteria for a hypomanic or manic episode.2  

One hypomanic symptom would be Bourdain’s restlessness and consistent traveling in search of the perfect meal in Parts Unknown. This is at odds with depression but his affect while doing so often seemed depressed to me. His commentary for the most part rather acerbic/cynical but punctuated with periods of levity.

A second sign of hypomanic symptoms was his suicide. It is fairly well known that suicide increases with mixed states. A mixed state is often a high energy state combined with a depressed mood. What constitutes high energy though is somewhat debatable. Most see it as an increase in physical activity which is productive but I contend from personal experience that one can have an extremely restless mind and be quite fatigued at the same time. In addition to the high energy there is often insomnia which might be attributed to stress or depression and not a symptom of hypomania.

A third sign of bipolar disorder was that Bourdain also seemed irritable which is another symptom of hypomania but most would probably see it as consistent with agitated depression. Depressed people can be irritable but it is usually not combined with excess goal orientated energy.

A fourth indication of bipolar was he was an ex addict. Addiction is more common among people with bipolar and could be due to a need to medicate or control an agitated and unhappy mind. What is unknown is had he relapsed or was he taking any antidepressants which might have precipitated the suicide. Antidepressants are known to aggravate bipolar depression and it is not a stretch to think they might have been involved.

A fifth sign was that he was married twice and in a relationship with a third woman. Multiple marriages are more consistent with bipolar tendencies. Irritability, grandiosity and restlessness is obviously going to cause more conflict.

And finally, his success as author, journalist and chef supports someone with a tendency towards hypomania. On average individuals with bipolar tend to be more productive and creative people which he certainly was. He wrote numerous books and was a famous TV personality.

Symptoms can fluctuate to quite a degree in bipolar disorder/unipolar depression and if that happens within a day this is often just attributed to what is know as diurnal variation. Personally, I experienced a very pronounced variation when younger. Somewhat of a mixed state early in morning, around 3am- 6am and then an improvement as the day went on. At night I often felt much better and was considerably more productive. This was considered as still consistent with Dysthymia according to my doctor.

What really seems to confound a diagnosis of “mixed depression” or bipolar disorder is how one evaluates what is “high energy”. Is it always productive or can it be nonproductive as in anxiety? Dr. Phelps is one doctor who challenges how excessive energy is evaluated. How can one measure a racing mind which can occur in mania or depression with mixed features. It sounds like it often depends on self report and a rather subjective evaluation of a patient’s symptoms.

 

 

 

 

Interesting At one point in past I took…

Status

Interesting. At one point in past I took an antihistamine and felt significantly better. I was convinced that it must have been due to an added stimulant(such as with Zyrtec- D) but it wasn’t. This also agrees with my experience with Ayurveda. I found the Pitta diet to be the most helpful overall with regard to anxiety and irritability. The Pitta diet overlaps considerably with this theory. What is puzzling though is how yogurt (high histamine) was helpful in regard to motivation but not so much anxiety. #depression #antihistamine #inflammation
https://healinghistamine.com/researcher-finds-depression-is-caused-by-histamine-inflammation/

Interesting that so many commenters want to be…

Status

Interesting that so many commenters want to be spared the details of Kate Spade’s suicide. I think to a degree necessary because it shocks people out of complacency. Depression and suicide are still thought to be moral failings and always due to some external factor. This individual apparently was well off and respected. This story supports depression as more of a disease with unknown and perhaps uncontrollable factors. This scares people, as it probably should. https://www.npr.org/sections/thetwo-way/2018/06/05/617145848/fashion-designer-kate-spade-found-dead-in-apparent-suicide

Managing stress while using social media

I find social media to be somewhat of a double-edged sword in regards to mental health. It helps one to feel more connected to others but it also brings one into contact with numerous trolls who obviously make stress worse. What is the solution? Well, I think for one thing anything that gives one more control online is helpful. Here are a few ideas that will create boundaries:

1.Limiting the time spent online in any form of social media. Instead of staying on Facebook/Twitter all day perhaps limit to a couple of hours.

2. Using lists on FB or Twitter is also helpful. Lists on Twitter reduce the amount of material to peruse. Lists on FB do the same.

3.Carefully select one’s audience on FB . There are always a few people who are predictably annoying so I tend to limit who I share with

4. I never comment on public pages on FB. The pages that discuss politics are full of opinionated people who will never change their minds, so why bother.

5. I generally don’t engage with trolls. I see many people who however possibly because they can’t tell if the person is serious or not

6. I limit the amount of information to the greatest extent when it comes to the general public and also to so called “friends”. Why help out the all the scammers/ data miners/stalkers.

7. Find groups with like minded individuals who help reduce stress. I joined a few mbti groups for introverts which help me feel less strange and isolated.

8. I tend to not follow posts after commenting due to numerous notices. Lately though FB will give a notice on threads that I deliberately unfollowed. Facebook’s strategy according to one article on Ideapod is to make people spend all day on the site and they do this partly through excessive notifications.

“I think we have created tools that are ripping apart the social fabric of how society works. The short term, dopamine driven feedback loop we’ve created have destroyed how society works,” former Facebook Vice president of user growth Chamath Palihapitiya, told students at Stanford Graduate Business school, last November.

People with depression have more difficulties than the average person although. Depression is associated with problems with excessive stress and rumination. One negative comment can cause me to waste many hours obsessing over an anonymous and often ignorant person. Years ago one had only to deal with real life people, now one has to deal with people who have an artificial and anonymous identity.

Of course, the down side of increasing control is that one reduces the fun of debate and spontaneity so one doesn’t want to over do it.

 

 

Job application discrimination and mental illness

Recently I’ve applied for a number of library government positions in southern Oregon where I’m fairly sure I met the minimum requirements but was never even asked for an interview. The basic requirements were the following: a high school degree and some experience working in a library.I wonder if there is some way to report discrimination at the level of a job application if it was due to age, mental illness(I admitted a disability) or gaps in employment? I have a recent seven-year gap in employment due to illness of parents and self. My father had heart problems and died in 2011 and my mother has dementia since 2009 due to a stroke. I additionally experienced a psychotic episode in 2010. During that period( 2010 – 2017) I volunteered for two years in a college library, assisted a person with research on a book and have taken care of my mother who has a moderate level of dementia.

Since I have a bachelor’s degree in Biochemistry/Psychology, five years experience working in a library(OHSU/ Lewis and Clark) and two years experience supporting systematic type health reviews in the Portland VA, I feel more than qualified for a position that could be filled by some one with lower qualifications. I have also applied for some office assistant positions at a university which I’m sure I met the minimum qualifications but was never even asked for an interview. I think my gaps in employment in addition to age ( which can easily be looked up) prevented an interview. I think when employers see large gaps they sense something is wrong health and or personality wise. I love how people are angry at the unemployed/disabled while at the same time discriminating unjustly against them. An excerpt from a medscape article  and a second article summarizes it best.

Work is a major determinant of mental health and a socially integrating force that is highly valued. No single social activity conveys more of a sense of self-worth and social identity than work. To be excluded from the workforce not only creates material deprivation but also erodes self-confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability.

“Once they heard that word that’s it. Sometimes I think it’s worse than telling them you’ve been in jail. Once you mention that their face changes and their body language changes and you know you won’t get the job”.

“I applied for a government job and they said the mental state wasn’t quite what they were looking for.”

I believe that discrimination due to mental illness was at play also when I lost my last position with the VA. I overheard conversations toward the end about me which strongly hinted that my health was problematic and that they needed to be cautious about getting rid of me. This came from a medical doctor who should be more enlightened on the topic. In the end, they gave much of my work to an intern who was doing it for free and when I protested my position was eliminated.

Is there any recourse here? Obviously if one reports discrimination he/she will probably not get the position or even if he/she did probably wouldn’t want to work there because of potential retaliation. This issue bothers me on principle and also obviously for financial reasons. Reporting employers like this would feel like time well spent but in the long-term might be bad strategy. I think employers know this and this is why this crap persists.

Is it possible to be chronically depressed and optimistic at the same time?

Is it possible to be chronically depressed and optimistic at the same time?

A couple of months ago I came across an article in Elite Daily about people who tend to run late and one common feature was that they were optimists. I am one of those people and I tend to run around 5 minutes late for most of my appointments. I can remember being late for school in fifth grade and having to sprint to school most days. A positive byproduct of this was I won a number of awards in track and field. Despite the lack of awards for most of my life this pattern continues and for some reason it is hard to break.

What struck me as odd when I read the article was that it seemed inconsistent/at odds with being Dsythymic. Aren’t depressed people negative about everything or at least most things? From my perspective I am negative about most things however when it comes to multitasking and estimating time I am curiously rather optimistic.

According to the article one common feature of the chronically late is that they tend to be optimistic. Somewhat unexpected. I have usually thought of people who run late as possibly unmotivated/ self absorbed /undisciplined /unorganized /disagreeable but never as optimistic. More specifically, people who are late are apparently bad at estimating how much time it takes to do something and tend to be more big picture types of people.

A second article in the NYT said that the chronically late tend to either be addicted to the adrenaline rush of a deadline or feel good about accomplishing so many tasks in a short period of time. Many late people tend to optimistic and unrealistic, she said, and that affects their perception of time.

They really believe that they can go for a run, pick up the clothes at the dry cleaners, buy groceries and drop off the kids at school in an hour. They remember that single shinning day 10 years ago when they really did all those things in 10 minutes flat, and forget all those other times when everything took much, much longer. (NYT 2007)

In a third article on the topic, by the same researcher as the one in the NYT, mentioned some more characteristics.

DeLonzor identified links between chronic lateness and certain personality characteristics, including anxiety, low self-control and a tendency toward thrill-seeking( Huffington Post 2013)

The researcher mentioned two additional reasons for chronic lateness. A third group consists of absent minded professors who might have ADD. The fourth group consists of the rebel who likes to annoy people with their lateness and this could be due to feelings of inferiority. Making others wait makes them feel more important. The fourth group is the least common.

When thinking about myself the adrenaline rush makes some sense in regard to depression since my depression is the low energy variety where anything that causes an adrenaline rush would conceivably correct for the defect. I remember writing most of my papers for English literature the night before. I simply could not be creative without the threat of a deadline. I can also identify with the type who tries to accomplish many things with in a short period of time. I t makes me feel very efficient and productive. Either explanation could give a depressive a nice dopamine rush. The rebel explanation is also somewhat relatable too however in my case it has more to do with rebelling against societies values. In my opinion being five minutes late isn’t that terrible and there are more important things to focus on in life such as solving problems and being creative. What is also interesting here is the fact that being on time is of more importance with people who have lower rank in society. Medical doctors are notoriously late but are not chastised like others with lower status.

The idea that late people hold onto or focus on a time in their life when they were the most productive is rather interesting and I can definitely relate. Even though I have chronic depression, I still do focus to a great extent on my euthymic periods when I was very productive. I don’t hear this from most Dsythymics who seem to embrace their depression to a greater degree. This makes me wonder in turn if my real personality is quite different than my Dsythymic one.

It also occurred to me also that arriving too early for an appointment causes me anxiety and one article supported the idea of mental illness playing a role. Sitting somewhere and waiting without anything to do tends to heighten my anxiety. If one is running late one is occupied with doing something on the way to an appointment. Additionally, it annoys me to a degree that my life revolves around other people that I often don’t like. I guess the remedy for this would be to take along a book so that I am doing something I enjoy while waiting for an appointment.