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Help: Depression, Motherhood & Upside-Down-Me

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When I saw the exoression on my face and dark circles under my eyes in this self-portrait of us, I was totally shocked.

When I saw the expression on my face and dark circles under my eyes in this self-portrait of us, I was totally shocked.

I am writing this well after my bedtime, because I don’t want to go to bed. I don’t want to go to bed, because if I go to bed, then tomorrow will get here faster. I know that this is untrue, and that being exhausted tomorrow will not make the day any better. But I have been staying awake to put off Tomorrow since I was a little girl.

What happens tomorrow? I meet with my psychiatrist. I am terrified. Not of her–she’s such a lovely person and so good at her job that my midwife started handing out the doctor’s card to local moms/moms-to-be who need help after speaking to her just once or twice. I am terrified of what she might say, and of what she might not say. It’s been a month since I saw her last, but it feels like six. Two weeks ago (again, feels like six) I told you about my anxiety attack after locking myself and my son out of our apartment. That blog entry is proof that I recognized what was happening and opened up my Anxiety Tool Kit to start dealing with those feelings right away. But they multiplied. I talked through it, but I kept crying. I felt foggy. I didn’t realize how terrified I felt about leaving the house until my therapist challenged me to leave with my son, walk out the front door of the apartment building, turn right around and open the two doors between us and home. I still haven’t done it. I can’t even do it with Nathan inside the apartment, ready to buzz us in. Since the point of the whole exercise is to prove to myself, to that doubting voice, that I can remember my keys, it’s unlikely that I would forget them. I can’t imagine it going wrong. I can imagine doing it. But I haven’t done it.

It took me awhile to realize how terrified I felt of going outside in general, because we were snowed in. As you may have heard, the East Coast, from New York to Boston (and us in between) got a lot of snow. I grew up in Minnesota, so a blizzard is not a scary event, and I can deal with snow. I know better than to drive during a blizzard, but I was not exactly panicked about the weather. In fact, I was thrilled. Thirty inches of snow fell in as many hours. It took days and days for a plow to get to our driveway. There are still major streets here that become one lane due to massive mountains of snow left behind by the plows. My husband, Nathan, couldn’t leave the house to do his grad school work; he usually leaves for a few hours every morning to work at Starbucks or the library.

Here’s the chronology: on Wednesday night, I locked us out. On Thursday, I had a therapy session about that over the phone because I felt too panicked to leave the house to go to therapy. On Friday, a blizzard dropped nearly three feet of snow on our heads. On Saturday, Sunday and Monday, the streets were too blocked to drived anywhere. But on Tuesday, he didn’t go in to school. He probably stayed home in part because of the snow; he had no idea how things looked up north on campus, and our car is notoriously bad in even a few inches of snow. He also stayed home because the thought of him leaving brought me to tears.

In under a week, I spiraled from Thriving all the way down to Crying At Random and shrieking “Take him!” whenever our baby fussed. I suddenly felt like a complete and utter failure whenever he wouldn’t be soothed by nursing or bouncing. I stopped sleeping at reasonable hours. I’d be awake at 3:00, 4:00, 5:30, hours after Walt had fallen asleep, playing games on my phone (and often crying). But this is where it gets weird, for me, because I didn’t feel my heart racing or recognize any anxious thoughts on a loop. I just felt… numb. Or sad. Once, I woke him up so that he could talk me out of self-harm; my urge that night was minor, in the scheme of such things and compared to what I felt in the past. But I have only ever felt those urges when I have also felt trapped and hopeless.

I felt depressed, obviously. But was this depression? Was this postpartum depression?

Obviously, the snow made going to therapy impossible, so I talked to my therapist over the phone. I told her about the crying (mine and my reaction to the baby’s), the fog, the feeling numb. I told her how surprised I was that the change had happened so quickly. I told her about my sleep and losing track of time.

I actually saw her today. Things are a little better, because I’ve been taking Benadryl to get to sleep. Yes, we co-sleep, and taking “something” to sleep isn’t safe for bed-sharing. But Walter is sleeping in his co-sleeper, now, if he must, so it’s safe for me to take something like Benadryl that makes me extra sleepy for a few hours. The sun is out, and I’ve gone outside to appointments (chiropractic! fun!) and even twice just to prove that I could (just not with Walter in tow). I’ve gone out for lunch and shopping with my mother-in-law. But I still feel all wrong.

There was a lovely moment today, with our gorgeous little family all snuggled up for a nap, when my husband told me that he was blissfully happy. The three of us, cuddling, was the best thing he could possibly wish for. He had never been happy like this before Us. I started to cry, because I saw but did not feel that joy. I knew that I should. I knew that I loved my family. I knew that a month ago, I would have felt the same rush of joy he was describing. But I cried today, because I could not feel the joy I had earned.

I’m crying now, as I type this. I’m doing everything I’m supposed to do, and I am not in any danger. I thank God that I have no intrusive thoughts about my son. Most of my smiles have been because of my Walt. He loves to smile up at me during breaks from nursing, and I get a special smile he saves just for me. I have fantasized about being far away, alone in a quiet hotel, because he is fussy almost every night around sunset, sometimes for over an hour, and hearing his cry hurts my heart. It hurt my heart a month ago, too, but I had perspective, then. Now, if I can’t comfort him, I can easily loose all perspective and start picturing a teenager who will hate me for every mistake I have made and will make. I have even wondered, at my lowest, how long it would take before my family realized that I was just weighing them down and left.

Part of me wants to hear my psychiatrist respond to this information with the words “Postpartum Depression.” I want those words as proof that it’s not my fault; a voice in my head has always told me that I am “faking it.” If I just tried a little harder… But do I need the diagnosis? Is it even possible to tell, yet? This could be a relapse of depression–Major Depressive Disorder is already in my history. My major depressive episode had prolonged and extreme triggers, and this just feels chemical. I feel like I got hit by a truck, or by a magic spell that erased my mental-illness-fighting powers. My therapist agreed today that, had I locked us out a month ago, I would have bounced back by now. She has a social work degree and does not diagnose things like PPD.

Something unfamiliar is happening. Suddenly, there’s a kind of distance between me and my own life. Underneath all the chatter in my head about diagnoses and justifications is one desire: find help. I just want to know that it’s going to be ok. I want to know that there is a path back. I want the mood swings to stop–I am scaring myself by feeling so full of rage and sadness that my face actually flushes hot and red. I don’t want to dissolve into tears every time my son cries. A month ago, I was pitching ideas to other blogs and excited about attending a conference, BlissDom, after winning a ticket in a contest. Tonight, I can hardly remember where this post started or where I wanted it to go. Hours go by without my noticing, or I feel like hours have passed after just one. My world is upside-down. I will do anything to make it right again.

Psychiatry + Pregnancy = Flexibility

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After I posted yesterday’s update about the return of my Generalized Anxiety Disorder symptoms during my second trimester, I went to visit my psychiatrist. I love my new psychiatrist (in a completely appropriate way), because she has this power to immediately impart calm and reassurance whether it’s over the phone in five minutes or during a half-hour session in her office. Her demeanor and her voice just seem to say, “Don’t worry too much. Everything will be just fine, and this is all perfectly normal.” You can imagine that visiting her office last night helped me come to terms with this change.

I want to explain the changes she/we made to my medication regimen in detail, because psych meds are just so often misunderstood. I’m going to go over what each is of my medication is for and why I need two.

First, I take an SNRI, or Serotonin and Norepinephrine Reuptake Inhibitor called Effexor. Norepinephrine is a chemical that seems to help with anxiety, so having more of it in my brain is, apparently, a helpful thing. Serotonin, as you have probably heard, is a chemical that helps make us happy. If there is too little in your brain, you are more likely to become depressed. I started on Zoloft, the most commonly prescribed SNRI, but switched a few years ago to Effexor. (I am a big advocate for No Drugs Without Therapy, because eventually, every drug will stop working. Therapy teaches you coping skills that don’t stop working.) I was supposed to eventually only take an SNRI, but that didn’t work out. Anyway, here are the thoughts on Effexor, me and the second trimester of this pregnancy:

I am feeling more anxious all of the time, not at any one particular time, so that tells me that my “baseline” jumped up. Effexor (especially in the extended release capsules I take) is intended to do its work ’round the clock. To help me feel a little calmer all of the time, my doctor suggested increasing my dose by the smallest increment. She also suggested that I take 150 mg when I wake up and the other 75 mg in the afternoon, to help for all of the day.

Second, I take Klonopin, aka clonazepam, the benzodiazepine that has been such an important and yet difficult part of my treatment. We’re working with a fairly high dose already–3 mg a day (1 mg morning, afternoon and evening) is already half-way to the maximum recommended dose of 6 mg total per day. That’s my ceiling. At one point in my life, I needed that. If we end up going there by the end of this pregnancy, that’s fine with me. But my psychiatrist wants to move slowly, so we don’t hit that ceiling too quickly.

The new regimen (and it feels good so far!) is that I take a 1 mg in the morning, 1/2 mg mid-morning, 1 mg in the afternoon, 1/2 mg early evening, 1 mg before bed. If I didn’t already take pills 80 times a day because of all the vitamins for the baby and me that have to be taken with food or not taken together or taken with a meal that has saturated fat in it if possible (Vitamin D–that stuff does not want to be absorbed by me… what’s your deal, D?)… but I digress. The point is, I remember to take the half-pills, and so far, so good. Sometimes, I worry that I love Klonopin too much, but I have never been tempted to take more than the prescribed dose, so I’m not actually worried about addiction.

And I’m taking it one day at time, so that’s all for now, folks. Ask questions, if you like! I’ll be more generous than Lucy from The Peanuts and not charge you a nickel as I open up my psychiatry booth. ;)

This is No Honeymoon: My Second Trimester & the Return of Anxiety

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I have been avoiding writing this post, because it means admitting to the world what I have only admitted to a few loved ones.

My anxiety is back. I stay up late worrying about things like whether I need to send a gift to the anniversary party we’re not going to or if a card will suffice. I am convinced, daily, that when I show up to work, I will be promptly fired, for no particular reason. Worst of all, I am not hungry the way I was in the first trimester of this pregnancy. I have to remind myself to eat, and it is hard to work up the energy to eat well enough to take good care of Bug. (I have eaten three pastries today, and it is barely 5 pm.)

I will see my psychiatrist tonight, and we will increase the dosage of one medication or the other. There are two factors working against me, here. First, the hormones that raged during my first 12-13 weeks seem to have helped my anxiety. Those slow down during trimester two. The second is that, in pregnancy, the amount of blood in my body will end up increasing by 50%. That dilutes the medication, according to my psychiatrist.

Then, there’s the sleep. I was so exhausted during those first months, that I passed out each night before 10 pm and slept like the dead. Now, worries can keep me awake.

I have read that the second trimester is the “honeymoon period” – no more morning sickness, more energy, better hair, better skin, better nails, whatever. Yeah, my hair looks pretty fabulous lately. But I never had morning sickness, and my job includes taking naps with the baby I take care of. For whatever reason, the hormones I got with my pregnancy did me a world of good. Isn’t there some way to inject those, now that they are less intense? Oh, well. It would probably be bad for the baby.

I had a lovely vacation. Now, back to reality. So much for that honeymoon.

Addiction and Benzodiazepines: Xanax DID NOT Kill Whitney Houston

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Shame on you, Dr. Holland. You give psychiatry a bad name. And I mean that from the bottom of my heart, where there is lots of love for GOOD psychiatrists.

I am not an authority on addiction, benzodiazepines or Whitney Houston. But the media coverage surrounding the Xanax (a benzodiazepine) found in Whitney Houston’s hotel room has made me see red. I’m enraged and deeply, truly sad. So I’m weighing in.

I almost threw something at someone else’s television twice while watching The Today Show on Monday (the baby was napping). There was so much wrong with the segment I was watching, but because the Today Show is probably not bound by any real ethical boundaries, I point my finger squarely at you, Dr. Julie Holland.

Dr. Holland, a psychiatrist, played a nasty trick wherein she listed facts that, by themselves, are (mostly) true (millions of prescriptions for benzos are issued in the US, women do make up the majority of those patients, Whitney Houston was one of those women with a benzo prescription). The context combined with her disdainful tone, however, screamed this untrue idea: “Xanax causes addiction and benzodiazepines are Dangerous with a capital D. Women, especially, beware.”

So here’s the segment. Unfortunately, I couldn’t find a clip shorter than five minutes. Please, wait through the commercial (sorry!) and then skip ahead to 3 minutes, 10 seconds. Watch for about sixty seconds until they start talking music cliches again, and you should get all of the offensive part.

[The video has “expired” and is no longer available. Sigh.]

I’m really, genuinely sorry that you had to see a 30 second commercial for only one minute of relevant footage. But I felt the need to give this Dr. Holland plenty of her chance to get out several statements that she is, in my opinion, ethically bound to make. She did not make them. Did you spot what was missing? There was this fact, which I found confirmation for at the American Association of Anxiety Disorders:

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older (18% of U.S. population). [emphasis not mine]

And here’s something I didn’t even know but doesn’t surprise me:

Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.

And this? This is repeated verbatim under the headings Generalized Anxiety Disorder, Panic Disorder  and Specific Phobias:

Women are twice as likely to be affected as men.

I also learned from the AAAD that women are more likely (but not twice as likely) than men to suffer from PTSD. So, there’s the context that she completely missed as she complained about the “millions of prescriptions” and about all these poor women on benzos and carelessly implied that taking benzos and being addicted to prescription drugs are the same thing. That last bit? That was the most unethical part of all of this, in my opinion. Because she didn’t say anything even remotely resembling this:

Benzodiazepines often create a physical dependency, but do not necessarily cause addiction, and are used by many as part of an effective treatment plan. Viewers: consult your doctor before making any changes to your medications.

I would have forgiven her if she had just fit in something like that, somewhere, even as a throw-away. She is, in fact, incorrect in a number of places (Xanax is the least habit-forming benzo and stays in the body for so little time that one of my two psychiatrists won’t even prescribe it because she prefers Ativan), but I want to focus on her dangerous confluence of addiction and dependence.

I am angry about that clip and coverage of Xanax in the media in general because taking a potentially habit-forming drug does not give me a drug habit, and I don’t appreciate the implication that I must have one if I take Xanax (which I have taken, but don’t at the moment). Taking a prescription drug that is habit-forming does not give you an addiction. Addiction is a disease. A person drinking a glass of wine might be an alcoholic and might not be. Alcohol is, nevertheless, a habit-forming substance.

Addiction is a disease that is not the same thing as experiencing a physical dependency on a prescription drug taken for the treatment of an illness. I’m not writing this to prove that I’m not an addict. I know that I’m not addicted to anything. That’s good enough for me. All the same, I do not appreciate a psychiatrist going on a popular television show and implying that I am an addict. I don’t like that even a few of the millions of patients with prescriptions for Xanax or any benzo might hesitate after her harsh characterization of the drug.

I am physically dependent on benzos. Klonopin, in my case. I feel like electric shocks are charging through my body at random if I haven’t taken Klonopin in over ten hours. I experience “textbook” withdrawal symptoms. In fact, I can’t even take a low dose without experiencing withdrawal, that’s how sensitive I am to the absence of this drug. The American Journal of Psychiatry published an article about “addiction” vs “dependence” in 2006. Here’s a neat definition of the term “dependence,” from that article:

The term “dependence” has traditionally been used to describe “physical dependence,” which refers to the adaptations that result in withdrawal symptoms when drugs, such as alcohol and heroin, are discontinued. Physical dependence is also observed with certain psychoactive medications, such as antidepressants and beta-blockers.

With me so far? Anything that causes your body to change when a substance is used, anything from caffeine to antidepressants to heroin, can cause dependence, and all that means is that your body experiences withdrawal when you take away the chemical. “Withdrawal” means that your body adapted to functioning with that substance (coffee, anyone?) and if that chemical (caffeine) goes away, your body has to adapt again. This adaptation is very different from the kinds of changes that happen with addiction. In fact, the very next sentence in the article I just quoted? It’s this:

However, the adaptations associated with drug withdrawal are distinct from the adaptations that result in addiction, which refers to the loss of control over the intense urges to take the drug even at the expense of adverse consequences.

I am physically dependent on Klonopin. I do not and have not experienced anything resembling and intense urge to take the drug. I know the difference: I was hooked on nicotine for about five years, and I know what it means to lose control over an intense urge, even at the expense of adverse consequences. Dead of winter? I was outside shivering with a damn cigarette in my hand. Sick? It seemed perfectly reasonable to me to smoke four cigarettes a day instead of eight. That was helping, right? No, that was denial, a huge problem when you’re addicted to something and don’t want to admit it! Quitting smoking was hard. Not taking my benzos? All kinds of uncomfortable, but not hard to do. I once (against the advice of my doctors) tried to function on less than my prescribed dose of Ativan (yes, I’ve tried a number of benzos, only to find that Klonopin is the only thing that really truly works, but I don’t them in combination unless directed to do so by a doctor). It felt gross and my anxiety spiked. I had some sort of idea that I’d be a better mother if I took a smaller dose. It was stupid. It cost me a job. I won’t do it again. But are you getting the difference between taking benzos and experiencing a physical dependency versus being addicted to the drug?

The following statement (same article) really helped me understand why this Dr. Holland failed to make the distinction between dependence and addiction:

…clinicians who see evidence of tolerance and withdrawal symptoms assume that this means addiction… [there is] tremendous harm that is now being done to the patients who have had needed medication withheld because their doctors believe that they are addicted simply because they are dependent.

And that’s not the only harm that a lack of understanding regarding this distinction has caused. I can only pray that the Today Show’s irresponsible reporting didn’t cause anyone to stop taking needed medication without consulting a doctor. It’s not even necessary to publicize any dangers posed by benzos–they don’t kill. They just don’t, not by themselves, not if you’re not trying to kill yourself. For more information on that, I will send you elsewhere: send you here and give gold-stars plus high-fives to the Huffington Post’s Walter Armstrong for writing The Truth about Whitney Houston and Xanax. It’s a good, informative read. And filled with less rage than this post.

Finally, I do agree with Dr. Irresponsible on one thing: combining alcohol with benzos is really bad. It says so on the label, but take it from me: however low your dose of any benzo might be, it will amplify the effects of the alcohol exponentially. I have actually injured myself (by randomly falling over in public on a date with my now-husband) by thinking that a few drinks would be fine. Nope. One glass of wine puts me to sleep. A whole bottle of wine and an overdose of Klonopin, combined with a hot bath? I am pretty sure that I would drown. Not that we know that that is what happened to Whitney Houston because we don’t know anything because the toxicology report isn’t back yet. That’s my public service announcement, but it’s also a reminder to get the whole story before making sweeping judgments.

The Treatment Plan: Finally Approved By All

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I got on a train before dawn this morning in order to make it to my appointment with Dr. P at 8:30 am. It was worth it. We had an awesome chat (we always do) and made each other laugh (we always do). We talked about why I am against the idea of tapering my Effexor dose or trying to switch to a better-researched, more-often-prescribed SSRI:

“I have accidentally lied to everyone every time we have made changes to my meds. I will say ‘I’m fine! I’m fine!’ And then ‘OOPS I lost my job because I was so anxious I couldn’t leave the house. Maybe I’m not fine.’ I am terrified that if we do it again, that will happen again. I don’t want to do it again. I can’t afford to lose this new job.”

She completely agreed with my reasoning. She told me that she had just finished a frustrating and unsuccessful attempt to switch another patient to Zoloft. This was a huge relief, because honestly, I would have doubted myself if she had questioned my decision. In fact, while I was talking, I was thinking “Maybe I’m just not being tough enough?” That’s not a thought I need. It’s also not an accurate thought. I am one tough lady.

At the end of our session, I heard the most wonderful words I have heard ever during this entire process:

“I wouldn’t change a thing.”

Phew!

I have officially done everything I could possibly do. Including all of this:

I hope not to add any prescriptions to my daily regimen of pills, but I have acquired quite a collection of vitamins and supplements. I’ve replaced prescriptions meant to help with migraines and insomnia. Recent blood work revealed that I have almost no Vitamin D in my body; without Vitamin D, I’m not going to even get pregnant, let alone give a fetus enough Vitamin D to grow bones and other important things. The weird thing is that I’ve been taking quite a bit of D since I first learned I was deficient last summer. And yet… nothing! So I added some more of that. There are other vitamins and supplements to prepare my body for pregnancy, too.

It’s starting to make me laugh, because there so many bottles. I had a drawer for them. They don’t fit anymore. I tried to take a picture for you, but they didn’t all fit in the frame. I have a very large pill organizer like the ones old people use. Seriously. I made these collages so you could see all the bottles, though:

 

Clockwise: Calcium, Prenatal, Fish Oil, Vitamin D

Clockwise: Effexor XR 150 mg, Effexor XR 37.5 mg, Klonopin, CoQ10, Vitamin B2, Passion Flower tincture, Magnesium Citrate

What are they all for? Well, here’s a list, excluding the prescriptions:

  • New Chapter Bone Strength Take Care Supplement (calcium) & New Chapter Organics Perfect Prenatal: These two are for the pregnancy. Most people take one prenatal vitamin per day after they find out about a pregnancy. The problem with this is that most prenatals have lots of iron and lots of calcium, but our bodies can’t absorb both at the same time. “Calcium inhibits iron absorption from non-meat sources. Wait at least 2 hours before taking an iron supplement following a calcium supplement or vice versa” (MIT). The coolest thing about the New Chapter prenatal is that it’s made from food and includes probiotics; you take three small pills a day instead of one huge pill, and it’s so easy on the stomach that you can take it on an empty stomach. [New Chapter has not asked me to praise their products, nor have they paid me. For the record.]
  • Nordic Naturals Arctic D: Cod Liver Oil (liquid): Fish oil contains Omega-3 fatty acids, including DHA, key elements for, well, life in general, but especially for pregnancy. “DHA is an essential fatty acid—we must get it from diet or supplements, because our bodies don’t make it—and consuming enough DHA is critical for normal and healthy development of infant brain, eyes, and nervous system.” And… “Omega-3 fatty acids are highly concentrated in the brain and appear to be important for cognitive (brain memory and performance) and behavioral function. In fact, infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are at risk for developing vision and nerve problems.” My nutritionist recommends this brand for several reasons, but it comes down to this: “…fresh and pure raw material: fish low on the food chain, which naturally contain low levels of impurities (and are also ideal for long-term sustainability, given their short reproductive cycles). All of our products are made exclusively from four types of fish, none of which is endangered: wild-caught Arctic cod (Skrei)…” Do you know what’s in the fish oil pill in on the drug store shelf? Mean neither. Also, it really does taste like lemon, and there’s no burping. Watch the expiration date, if you use this: three months after you open it, it’s done. And I mean done. I learned this the hard way. (The Arctic D has extra Vitamin D in it–to help with my deficiency.)
  • Vitamin Code RAW D3 is made from food and other stuff found in nature, like the New Chapter products, but it’s got 5,000 mg of D3 in each pill. I’m hoping that between the sheer amount of D in the supplement and the “RAW” part, my body will start absorbing and retaining some of the stuff.
  • CoQ10 and B2 are supposed to help prevent migraines. My neurologist recommended this. The suggested dosage varies, but I take 400 mg. The migraine treatment with B2 is 400 mg as well. I’m not taking that much for now, at least until I can find out if it’s safe during pregnancy. Note: I took another brand of CoQ10 (I think it was NatureMade) and it had all sorts of artificial colors in it, so I threw it out. Read the labels! Why put artificial colors in a nutritional supplement? I don’t understand it at all. Apparently because it’s good for the heart and blood it should be colored bright red? So strange.
  • Passion Flower is the extract of said flower, and I put some of this tincture in a glass of water before bed. I’m really hoping that traditional medicine is right, and passion flower helps with sleep and anxiety.
  • Magnesium Citrate is helping my body handle all the iron in the prenatal, aid digestion in general and is also good for anxiety. Ever seen that Natural Calm powder stuff? It’s mostly magnesium oil in pill form. It’s just easier for me to remember pills than powders (because of the old lady pill organizer…)

Both the magnesium and the passion flower were given to me by the latest addition to my team, a naturopath, acupuncturist and Chinese medicine practitioner. We’re mostly going to use acupuncture to help with my sleep issues, since we don’t want to add a bunch of herbal stuff that might not be so safe for pregnancy (natural is not the same as safe!). The passion flower has been approved by an herbalist she trusts, and that’s good enough for me–the dose is tiny.

If you haven’t tried acupuncture, no matter who you are or whether you are perfectly healthy, DO IT. It feels so good. I rarely ever feel any of the needles themselves, if I do it’s like a tiny pinch, and after a session, I feel like five pounds have just evaporated out of my muscles.

So that makes nine kinds of pills and two liquids, but it’s actually a total of 15 pills I swallow every day. And two liquids. I guess that’s why I’m so careful about what’s in each one of them.

Learning to Fail: A Life Skill

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My greatest fear used to be a fear of Failure. I remember sitting in session with my first serious twice-a-week therapist (the Great and Amazing Kate) and discussing this fear.

“Failure is insidious,” she said. “You don’t have time to fear it, because it happens in tiny ways, small bad decisions, and it’s over before you even notice it’s coming. If you are worried about failing a class from the beginning, you probably won’t fail the class.”

I’m paraphrasing most of that, but she definitely said that failure is insidious. I remember that language, because I had to look it up. Google says it like this:

in·sid·i·ous/inˈsidēəs/

Adjective:
  1. Proceeding in a gradual, subtle way, but with harmful effects: “the insidious effects of stress”.
  2. Treacherous; crafty: “an insidious alliance”.
Synonyms:
sly – treacherous – guileful – crafty – perfidious
Perfidious is a great word, too. But back when I was talking to Kate, we were talking about how I was not actually failing at anything in my life. I don’t know that I ever had. I was 21. I had an amazing school record. I had prepared my resume for life after college, but that life wasn’t starting for another year. I had whole year ahead of me of this thing that I was so good at–being an undergraduate.This past year, I have learned to fail. I failed at my last attempt to take a graduate course in exactly the same way that I failed to keep this job I so desperately wanted. I loved that course; in many ways it healed me, being there. I was a class on mental illness and memoir, for heaven’s sake! We talked about talented people who struggled with mental illness all the time! That’s all we did! Seeing myself in that context was totally awesome. But after a series of absences, I promised my professors that I would not miss another class. One day, I didn’t feel well, the train still scared me half to death, and I didn’t go. As soon as the clock ticked past the last train that would have gotten me to New York on time, I knew it was over.

Yesterday, as soon as the clock passed 1:00 pm, the time I was supposed to be at work, as soon as I knew I wouldn’t go, I knew it was over. I had failed to keep my job. It happened just the same way.

Here’s what was gradual, subtle, and harmful: I did not admit to anyone, not even myself (especially not myself!) that I was not taking enough anti-anxiety medication. We had agreed, Dr. P and I that 4 mg, stretched out over the course of a whole day, might be enough. I had held myself to that number even as my sleep disappeared and my thoughts scattered. Even while I looked over my shoulder, convinced that someone must be noticing all the mistakes I must be making, even if I couldn’t quite name the “someone” or point to specific mistakes.

I refused to admit that there was a pattern emerging in my absences from both babysitting and school jobs. That I couldn’t go a whole week without missing a day. That the mom I babysit for had a real point when she called me on it. That I was crying too often. That, on the weekends, I couldn’t so much as walk the dog without freaking out.

I have not learned to fail gracefully; I don’t think it’s possible. But I have learned to fail with humility and with a sense that I will learn something.

I have learned that even when I fail, I am not a failure. I do not feel that I, as a person, am a failure. I can examine my mistakes to learn from them, to learn about where I am. I take that knowledge to my husband, my therapist, my psychiatrist(s). And I move forward. In fact, I am blessed. So much help. So much support. So much love. With all this love, all this family and these friends around me, how can I be a failure? It’s not possible!

And so, I accept that I lost something I should have held onto. That I also did the best I could. That I also sabotaged my own efforts. That all any of this means is that I must accept the fact that I need more medicine.

Another therapist, Monica, once told me that I draw “lines in the sand.” 4 mg/day? A line in the sand. I must learn again and again that these are not real boundaries. That I must cross the boundaries I create if that’s what it takes to keep me healthy. That my health matters more than the stubborn attachment to The Best Way to do anything, especially if that Best Way is something I made up and didn’t tell anyone about.

The quickest, most insidious way to failure is to embrace denial. To pretend that everything is ok, even as it spins out of my control.

Speak UP! You are HERE!

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I’ve been writing a little bit about internet forums for women who are TTC (trying to conceive) lately, and I will definitely continue to do so, as they just keep becoming more fascinating. In fact, I would very much like to go get a Master’s in Women’s Studies and write a thesis on this topic. Anyway, for now, I have this to share:

I got a “PM” (private message) this week from a woman who lives in Australia; like me, she and her husband are waiting to start trying for a baby until she sorts out her psych meds–what does she need to stay on, what can she do without, etc. We’ve been having a lovely conversation all week about doctors, medications and cultural differences. Australia’s health care system is, I hear, a lot less judgmental than ours. Which makes sense to me, because the public health care system in the UK was a lot less judgmental. Ahem, free birth control. Need I say more? (I have issues with handing out hormonal birth control like candy, but if it’s going to prevent an unwanted pregnancy at a university, which is the community my UK doctor served, I am reluctant to criticize. What’s more likely to interrupt a woman’s education than an unwanted pregnancy? Not much. So, free birth control gets my stamp of approval, even if I do wish they’d do a better job educating women *everywhere* about how the stuff works.)

I digress.

Despite the lovely nature of this conversation between two women with quite a bit in common, one thing keeps nagging me, something I can’t quite shove away: the conversation is happening not in the already anonymous “public” forum, but in “private” via fertilityfriend.com’s messaging system. Why does this bug me? Because even when there is no chance that anyone will find out who we are, our real names, anything we don’t want them to know about our private lives, we still are not willing to openly discuss psych issues and pregnancy!

I hear from a lot of men and women who relate to the things I write, here and elsewhere on the web. I appreciate it, I do. I love the support, the encouragement and the “e-hugs” I have gotten from each and every letter-writer. I also invite you all to share your stories publicly.

You do not need to provide any personal details. You do not need to tell me or anyone who you are. You just need to speak up. Because we are not crazy. We are not freaks. We are human beings. We do a really good job, most of the time, coping with some pretty difficult circumstances. Some of us are severely ill. Some of us appear to most people we meet to be 100% healthy. But the thing about stigma is that it doesn’t go away if we all agree to hide. When we hide, when we are quiet, we give the stigma power.

I would like to see a Horton Hears a Who movement grow and grow. You see, at the end of this Dr. Seuss classic, it takes every Who in Whoville shouting the same phrase at the tops of their voices in order to make themselves heard. Do you know what they shout?

“We are here! We are here! We are here!”

If you are brave enough to share your story, if you think it is at all related to anything I have written about, please email me at amtonyan [at] gmail.com. I would love to include a guest post from you. If you have a blog, send me a link. I’m off to post a new thread in that forum for women dealing with psych issues pre-pregnancy/pre-TTC. I hope to hear from you soon, you brave, beautiful people!

The Worst Day… and a Half? It’s OVER.

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At 4:00 am this morning, I had been awake for a couple of hours. I was watching TV, waiting for my brain to slow down. I decided to give bed a try. I curled up next to my Nathan. And promptly burst into tears.

I cried and hyperventilated and cried and the hyperventilated some more for a really long time. I lost track. Nathan had no idea what to do. I had no idea what to do. We contemplated the emergency room. Eventually, daylight happened and therapist and psychiatrist called me back. (Very speedily, I might add.) Here’s what we all think is at the bottom of the 36 Hours of Gut-Wrenching Anxiety Attacks:

I made up a special goal all by myself, for myself, regarding this bridge from Klonopin to Ativan. I decided, somewhere along the line, that when I switched to Ativan, I would be taking the lowest possible dose. That would make me a better person, because I would be saving the fetus that doesn’t exist yet from exposure to more chemicals. Nathan says that I did, in fact, talk often about my hope that because I had never tried Ativan, it would be more potent, allowing it to be a more effective medication at a lower dose.

My psychiatrist very politely pointed out that this is not the goal that the medical professionals have in mind. The only goal of the people who actually have degrees in stuff like how medication seems to help deal with anxiety is to get me switched, as comfortably as possible, from Klonopin to Ativan. That other goal? The one where I am awesome because I don’t need more than a tiny dose of the new meds? That’s the one I made up. And when I realized that it wasn’t going to happen, a very strong voice screamed in my head, over and over, “You have failed.” Of course, if I can’t manage to do this, this tiny, simple thing (that is really not small or simple at all), then I obviously cannot be a mother. That’s obvious to you, too, right?

Well, if not, then it’s not four in the morning and you are not tired or crazy enough. So there are two issues, it turns out. First, I was indeed under medicated. But that should have been resolved the minute I took my afternoon dose of Klonopin (well, the minute that dose kicked in, about an hour after I take it). Because the last two doses of Klonopin did not “fix it,” then underlying anxiety caused by my feelings about switching medications must be causing these attacks.

I felt better as soon as I got off the phone. I get it. It makes sense. And I’m exhausted. But not scared, anymore. I let it go, the stupid “take only a tiny amount of the medication” idea, and am working on accepting that taking these meds does not automatically make me a terrible (future) mother.

The Worst Day

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Despite the fact that I spent most of today asleep and plan on going back to sleep quite soon, I can say without a doubt that today was the worst day I have had in a long time. Over the long holiday weekend, we began the process of “bridging” my medication from Klonopin to Ativan. Since I take Klonopin three times a day, and Ativan is usually prescribed three times a day because it enters and leaves the body pretty quickly, the procedure is fairly straightforward. Replace one Klonopin dose with one Ativan dose. Wait. See how I feel. Adjust if necessary. Repeat.

Good psychiatrists always start a patient on a new drug at the lowest therapeutic dose. This is good for many reasons. If the patient experiences unbearable side effects, a low dose will leave her system more quickly and the side effects will stop more quickly. If it works and the side effects are just the run-of-the-mill, I can handle this until they go away type of side effects, then you get lots of room to increase your dose if necessary.

Right now, I hate this rule. Give me a high dose and give it to me now.

I hate mornings if I am not properly medicated. I don’t want to move. I don’t want to shower. I don’t want to get dressed. I hate any alarm clock or human attempt to wake me. So after the holiday weekend, I was stuck in a rut of what my therapist and I call “Pajama Days.” I wore pajamas every day for almost a week. No, I have not left my house since last week. Why? At first, I was sick. Then, I just didn’t feel like it. Then, I really felt like I would die trying.

This morning, I woke up just before noon with only a few hours of sleep because I was up all night worrying about whether or not I would be able to get up and go to work today. I took one look at the clock and a rush of thoughts about why I was not going to be able to do this–namely, get up, shower, get dressed, go to work–triggered a full-blown anxiety attack. I called Nathan, just to hear his voice, took my medicine with him coaching on the phone and waited.

Nothing happened.

We tried the lowest therapeutic dose, ok! Ativan at 1 mg isn’t working for me! I hyperventilated and cried for over an hour. I made Nathan call in sick to work for me. I passed out and slept until 5:00 pm! I woke up and took my Klonopin “afternoon” dose and cried some more. I cried even more during a phone session with my therapist, because I still couldn’t make it out of the house.

This person who is afraid that danger lies in wait just outside her front door–a danger she won’t be able to predict, anticipate or control for and should just avoid by staying inside–this person is NOT ME. Anxiety is part of my life, and I am learning all kinds of things as I learn to deal with it. Good lessons, like patience and forgiveness (mostly trying to forgive myself) and, a big one, don’t judge because you never know what’s really going on. But I can’t learn any of those things if I am curled up into a tight little ball refusing to breath. Give me the drugs.

Tomorrow has to be better. Because I’ll be taking a little bit more Ativan. And today had nothing to do with anything except the glitch in my brain that fills me with a primal fear I can’t reason away. The only way I know to push that back down is to take medicine. So more medicine will mean less fear. And less terror has got to be a good thing. So no matter what tomorrow is like, it will be better than today.

Can I Be a Bottle-Feeding Lactivist? Please?

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I have no idea who to credit for this, which is sad, even though I tried to find you, Dear Artist! I had to post it, though, because it is too awesome to skip.

There was a comment on the blog, and there was a tweet. Both suggested that I find out more about Klonopin and breastfeeding. Immediately, I felt defensive. Why weren’t they trusting my doctor? Why did they think that I would just give up breastfeeding without a fight?

I don’t know these women, but I am guessing that they do not think ill of either myself or my doctor. They don’t know me. Or my doctor. I am guessing that they are trying to help me make the most educated decision I can make. On twitter, I could express that. Take a look at our conversation.

[hr] 

DoNotFaint Anne-Marie Lindsey: @HygeiaKate I’m sure you’re lovely. But it can feel like competency of my doctors and my level of education are being questioned, you know?

HygeiaKate Hygeia Kate: @DoNotFaint Unfortunately the level of education of most MDs in the US in regards to bfing and medications is next to zero.

Anne-Marie Lindsey: @HygeiaKate That’s so true. I travel two hours to see someone who is truly an expert.

Hygeia Kate: @DoNotFaint And I hear from SO many moms that their doctors tell them they have to stop bfing bc of totally benign medications.

Hygeia Kate: @DoNotFaint Given healthcare climate it’s understandable…never going to get malpractice suit by saying that no med is bfing compatible. :(

Anne-Marie Lindsey: @HygeiaKate So true. We have to ignore it and find dr. who knows better. I’ve gotten the smile and nod down already & I’m not even pregnant.

Anne-Marie Lindsey: @HygeiaKate … the LactMed link [providing very sciency information on Klonopin and breastfeeding] says pretty much what my dr said. Small # of examples + my dose = more danger than we want to risk.

Hygeia Kate: @DoNotFaint Well I wish you well with your MDs…sounds like you’re doing a great job surrounding yourself with knowledgeable ones. :) [hr]

See? A very helpful person! I’m really glad that I told her that I was afraid of assumptions about me being uninformed or choosing an uninformed doctor. Because there’s a group of women that I need to confess that I fear: lactivists. I didn’t misspell that. Lactation activists. I believe in everything they stand for. I believe that breastfeeding is awesome and to be encouraged and supported and laws should be passed to protect the right to do it in public. I am all about breastfeeding. I once shouted down a group of high school classmates who were offended when an audience member of the play we were in started breastfeeding during act two. I basically said they should improve their concentration because the only thing that actually happened was a slight distraction. You know what else is distracting when you’re acting on a stage? Someone leaving the auditorium. A crying baby. Offended? Absurd. I would shout and hold signs in support of better lactation education in US hospitals. I would occupy something. So why am I afraid? I don’t want to defend this “decision” over and over again, and I don’t want to be written off as a mis-informed, un-educated, well, BAD mother. But I have a feeling that this is not the first controversy I will encounter in the whole pregnancy/parenting project. So I’ll join in the conversation. And, as usual, I’ll avoid people who shout or refuse to listen or judge or hate. Because who likes that? Nobody!

But there’s one more reason I feel sad about not being able to breastfeed while taking the drug that has saved my life. I want to participate in the culture surrounding breastfeeding. I want to go to La Leche support groups. I want to talk about latching. Heck, I even want to talk about blocked ducts at this point. I want to connect with other new moms over something we share. I want to tweet HygeiaKate with questions. And I’m sad, because it looks like that’s not going to happen.

How sad am I? I’m really, really sad. I have been crying a lot. I share this, because my BFF, E, told me today that she had no idea, even after reading yesterday’s post, that this was so hard. Apparently, I seem like I have “it” together. How that happened is a total mystery to me, because it usually feels like chaos over here! So, for the record: the prospect of missing out on this experience makes me extremely sad. And a little angry.

I’m not depressed. I’m not even anxious. The baby is going to have two parents who could not possibly have more love to give. Nathan loves the idea of being included in the feeding right from the very first one and very logically pointed out that an exclusively breast-fed baby is not fed by Dad. Donor milk, milk sharing, formula and all of our options are healthy and will make sure Baby gets all the right nutrition. We will all bond. We will be the cutest family! But I wanted to breastfeed. And I don’t get to do it. I am disappointed, darn it!

Also, I hate washing dishes. And there will be lots of bottles to wash. Bother. You know what else is a bother? Toting around bottles and formula (or donor milk) and filtered water. Making a bottle in the middle of the night. Making a bottle for a screaming baby who does not want to wait another second. It’s all more bother than I wanted. [Yes, breastfeeding has a learning curve, but it comes with so much less equipment to carry/wash!] So much for that part of Avi’s awesome Lazy Parenting philosophy.