Pretty much the same cocktail of meds I’m on now used to work well, and got me into full remission (i.e. no symptoms at all between episodes). I’m not sure what got me thinking about this recently, but while my depression has become increasingly treatment-resistant overall, my medications are still doing a pretty good job in certain areas. This post will explore where they’re still working and where they’ve flown the coop.
For me, depressed mood was never about sadness. The best description I’ve come up with is experiencing the mental equivalent of physical pain. The meds definitely take the edge off of this. My mood is still low, and I haven’t experienced good mood for several years now, but it’s not usually front and centre shouting for attention.
The meds used to control this fully, but since my illness has become treatment-resistant, this is a symptom they just can’t budge. Anhedonia means I don’t enjoy anything, and am not interested in any of the things I used to be interested in. Even when there are things I like, such as blogging, it’s on a cognitive level rather than having any positive emotional element that goes along with that.
Before I got on my current cocktail of meds, I struggled a lot with insomnia during depressive episodes, both in terms of getting to sleep and waking up early. Now, other than the occasional hiccup, my meds take care of the sleep pretty well.
In the past, I lost significant amounts of weight while depressed because I had no appetite. Now, my appetite will drop off if I’m feeling particularly low, but for the most part, that isn’t much of an issue any more.
This is where the wheels have really fallen off. Psychomotor retardation is a physical slowing of movement, accompanied by slowed thoughts. When I tried coming off my antipsychotic about six years ago, this was the symptom that came rushing back in a relapse. I went back on the antipsychotic, was in remission for another couple of years, and then relapsed again. Since then, the psychomotor slowing has progressively gotten worse. I’m taking a stimulant, dextroamphetamine (Dexedrine), and it helps somewhat, because when I run out of it, I get slower. But this is by far the most stubborn symptom that’s caused the most disruption. The associated speech impairment, in particular,, has really done a number on my level of functioning.
This is hard to judge. I have considerable cognitive symptoms (concentration, memory, etc.), and those have probably worsened over the last few years, but It’s hard to say where I am in relation to my old baseline when in full remission, because so much time has passed since then. But overall, I’d say this is an area where my meds aren’t doing a heck of a lot anymore.
It’s hard to get a clear picture on this, because the psychomotor slowing drowns it out. I can say that lack of energy is never the rate-limiting step these days; my limitations physically are from the psychomotor symptoms, not from low energy.
I don’t think feelings of worthlessness were ever an issue for me. Apparently I had delusional guilt during my first hospitalization, but I don’t have any memory of that. Since then, though, guilt hasn’t been a problem. I’m not sure how much of that is meds and how much is that it’s not really personality-congruent. I don’t tend to be self-critical, and never have. My guess is that the guilt during my first episode was influenced by having a hard time with the identity shift from nurse to patient.
I think the fact that it’s been 8 years since my last attempt is a testament to the fact that the meds are working in this area. Treatment-resistance has brought a new baseline lack of desire to continue living, but that feels quite different from suicidal ideation. I do still get some flare-ups of suicidality, but I’ve never been impulsive in that sense and I know I can get through flare-ups, so they don’t concern me all that much when they do pop up.
I’m definitely grateful for what the meds have continued to give me, especially in terms of sleep. Sleep makes a huge difference. Maybe something new and wonderful will come along for the rest of it, maybe it won’t, but in the meantime, I’m just here.
If you take meds, are there certain things that they do and do not help with?