Depression and assertiveness

Recently I have had some problems with my car. It feels like it is slower than usual almost to the point where it seemed like the brakes might be engaged when not needed. Initially I took it to have the brakes examined. Nothing appeared wrong with the brakes. Then I went to a mechanic where I mentioned that the car seemed slower than usual and also that the accelerator seemed more rigid than usual. The mechanic agreed that the accelerator seemed less responsive and reported “fixing” it. To my dismay after the repair, I noticed that the pedal felt about the same as before the repair.

For a week I drove the car and thought perhaps it was just my imagination that it felt the same. The reason for this is that at the time I was experiencing headaches, dizziness and a feeling of being slowed down when not even in the car. After a week though, I decided the problem still lay with the car. I complained about the car still seeming slow and the pedal stiff and not as responsive. The shop said that they would look at the car again. They reported finding nothing wrong a second time. A mechanic and I then drove the car around in order to further investigate. He explained that there was nothing wrong with the pedal. At that point, I thought there was not much that could be done. This came down to a subjective disagreement about my car. This is exactly what I anticipated prior to complaining.

The issue with the car is rather similar to my experience with medical doctors. I complain of a problem and they often find nothing. I often wonder if the problem lies in my communication skills.

I’ve noticed also that “depression”, if that is indeed what I have, can cause me to be unassertive and indecisive. When my energy increases though my assertiveness, decisiveness and persistence often improves. I tend to not have a problem complaining when over charged in a store or asking a hairdresser to cut more off. Why not complain about the car repair which is much more expensive?

In the end, I think I probably will pursue the problem with another mechanic and will not go back to this one. He probably thinks I’m too stupid to notice the difference. He may have won a minor battle here but not the war in my mind. I tend to lack assertiveness but not persistence or flexibility when solving a problem.

Since fall began I’ve had difficulty waking up…

Since fall began I’ve had difficulty waking up early and consequently tried to use some light therapy. After four days I’ve noticed a stimulating effect which has included an increase in my anxiety level and or panic attacks. I’ve experience claustraphobia for around twenty years and noticed it is specifically worse with the light therapy. A quick Google search suggested that people with panic disorder should avoid light therapy. At this point I think I will stop it completely and see if my anxiety improves.

I suffer from panic disorder. I used a light box for four days for 30 minutes starting at 6:30 a.m. On the fourth day I experienced a severe panic attack which lasted from about 8:00 P.M. thru 5:00 A.M. I did not continue using the light. …

Recently I’ve experienced symptoms that seem more in…

Recently I’ve experienced symptoms that seem more in the direction of hypomania than depression. I think this could be possibly due to drinking more caffeine in the afternoon, deliberately phase advancing my sleep schedule because of job, changing my diet and increasing my stress by working more hours. Some of my symptoms included racing/crowded thoughts, a decrease in the amount of sleep, and periods of extreme irritability. Today I had a bad case of rage over something minor and I realized that I had consumed junk food(Cheetos) and more caffeine than usual and at a later time.Rage in connection to junk food( MSG?) and caffeine is something that has consistently been a problem ever since a teenager. I noticed in the news that there recently has also been a connection with sodium nitrate and mania. It occurred to me that both sodium nitrate and junk food can induce severe thirst. Thirst/water balance is in turn intimately connected with the HPA axis. Perhaps an increase in cortisol here? The increase in excitability seems fairly close to when the food is eaten and the excitabilty is reduced by consuming water. Ayurveda would concur that food items which cause thirst would be the ones who would also increase irritability. Ayurveda would also say that an increase in thirst inducing foods would change one’s perception of temperature. This seemed to be the case since I felt much warmer than usual.

Grief and Dysthymia

My mother recently passed away due to a massive stroke and I’ve noticed an increase in 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.

 

A case for mixed depression with Bourdain

Mixed depression according to some researchers is rather common but for some reason people 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…

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…

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