What is… psychomotor retardation

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: psychomotor retardation

Psychomotor retardation is one of the less common but more outwardly observable symptoms of depression, and is listed as one of the possible diagnostic criteria for a major depressive episode (in major depressive disorder, bipolar disorder, or schizoaffective disorder).  It involves a slowing of both thinking and physical movement, and often includes slowed speech with delayed responses and quiet volume.  Gaze tends to be fixed and eye contact is avoided.  Affect is often flat, meaning there is little to no facial expression of emotions.

These symptoms have been described as far back as ancient Greek times.

There is a standardized test to measure psychomotor retardation called the Salpêtrière Retardation Rating Scale.  It contains 14 items that measure walking, speed of movements in the limbs/trunk and head/neck, flow of speech, speech volume, shortness of verbal responses, limited spontaneous speech, easily fatigued, rumination, loss of interest, time perceived as painfully slow, and problems with memory and concentration.

The Motor Agitation and Retardation Scale is another test used to evaluate the extent of psychomotor retardation.  It considers abnormal gait, immobility of trunk and proximal limbs, postural collapse, slowing of movement, flat affect, downcast gaze, and speech that is soft and monotone, with delayed onset.

It’s not known exactly what causes this symptom, but it’s been suggested that changes in neural circuits in the prefrontal cortex may affect the basal ganglia, an area of the brain involved in regulating movement.  The neurotransmitter dopamine may play a role.  The hypothalamic-pituitary-adrenal axis, which connects the brain and the adrenal glands, has also been implicated.  There may also be reduced regional cerebral blood flow.

Psychomotor retardation is more common in the melancholic subtype of depression, and  also in depression with psychotic features.  One study found that a higher number of previous depressive episodes was associated with more severe psychomotor symptoms, particularly the cognitive aspects.  Electroconvulsive therapy (ECT) seems to be particularly helpful for this aspect of depression.

Slowed psychomotor activity has appeared off and on throughout the course of my illness.  It was particularly bad during my second hospitalization, which lasted two months.  As time has passed, though, there’s been a pattern of abrupt onset psychomotor retardation in response to major environmental stressors.  It generally starts when I wake up the day following the stressor, and tends to last a few weeks.  It’s always been something I’ve been quite aware of but have no control over.  I’ve come to conceptualize it as my brain’s way of trying to protect me from the world, because my thinking gets slowed down and my emotions are shoved off into a corner somewhere.

This was triggered again for me this past weekend after the stigmatized cluster-f*ck I experienced when I went into ER (twice) for physical reasons but they decided I was just a psych patient.  When I woke up the next morning, even walking to the bathroom was a challenge.  For me at least it’s not the same feeling as lack of energy; it’s more like my body is trying to resist the movement.  The rating scale described above mentions slowing of time; I don’t always experience that, but this time around it was pretty painful for a few days.  I didn’t feel like doing anything, even watching tv, and of course that made the time go by even slower.  Putting words together to speak out loud can be challenging.

Is psychomotor retardation a symptom you’ve experienced with your illness?  Have you noticed any patterns with it?

 

You can find the rest of my What Is series on my blog index.

Sources:

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

Positives and negatives

Last week I was reading a post on Revenge of Eve about her weekly happy list challenge.  The challenge for the week was to identify routines that bring you joy.  I adore Candace and normally participate in her challenges and such things, but this one just wasn’t doing it for me, and that got me thinking.

When was the last time I felt joy or happiness?  Honestly, it’s been around 3 years – before this current episode (although who can really call it an episode anymore) of depression got started.

Psychopharmacology guru Dr. Stephen Stahl divides mood-related depressive symptoms into two broad categories: decreased positive affect and increased negative affect.  Decreased positive affect involves impaired ability to experience positive  emotions, and includes anhedonia (inability to experience pleasure), apathy, and amotivation.  Increased negative affect involves the presence of negative emotions like guilt, irritability, and loneliness.  Decreased positive affect seems to involve the neurotransmitter dopamine to a greater extent, while increased negative affect seems to have more involvement with the neurotransmitter serotonin.  Norepinephrine seems to play a role in both.

While I certainly have increased negative affect thrown into the mix some of the time, overall my mood symptoms have been much more in the decreased positive affect category.  Other than thinking the guinea pigs are cute, I just don’t seem to have the capacity to feel much of anything positive.  When I’m being mindful of things in nature I’m able to feel interest and curiosity, but that’s about it.  Perhaps in a way it’s a good thing that there’s not a ton of negative stuff kicking around in my head most of the time, and probably on a day to day basis decreased positive affect is easier to cope with than increased negative affect.

When it comes to treatment, though, I wonder if with decreased positive affect there’s less to sink  your teeth into in terms of creating change.  It makes me wonder if perhaps that’s why counselling has never really gotten off the ground for me.  With decreased positive affect it seems like there would be less to grab onto from a CBT perspective than increased negative affect.  Sure, CBT would suggest behavioural activation and all that crap, but I’ve done that before and it doesn’t make a difference.  It’s not that I’m biased against behavioural activation in its various forms, and I think it’s the kind of thing that can be quite effective for some people some of the time, but personally I’ve tried activation with the hope of motivation following along later, and it just hasn’t happened.

That’s part of why my trip to Italy a few months back was important to me.  When I’m well, travelling is my passion; it’s what matters most to me, and I find it exciting and fulfilling and all that jazz.  The fact that I felt “meh” throughout the trip wasn’t necessarily all that emotionally distressing in and of itself, but I think it really reinforced in my head that the lack of happiness truly is a capacity issue rather than a circumstances issue.

So if lack of happiness is in fact a capacity issue, is there any point in doing “try to be happier” activities/challenges/etc.?  I’m not saying I shouldn’t look for positives.  I keep a daily gratitude log, and I make a point of writing down accomplishments and other positive things in my journal.  I try to be very attentive when it comes to practicing self-care.  I think all of these things are important to help keep negativity at bay, and I certainly intend to continue doing them.

But trying to find happiness or joy where there is none available seems kind of like an exercise in futility.  It’s not that I haven’t felt those things before; I used to experience them quite regularly.  But I’ve come to accept that illness has taken that away from me, at least for the time being.  It’s not a conclusion that has much emotion attached to it, and it’s not something that I’m invested in, in the sense that I wouldn’t be willing to let it go.  But for now, at least, it just is.

Do you struggle more with lack of positives or excess negatives?  Do you think it makes a difference in how we experience our illnesses?

How do I compare thee…

“Don’t compare yourself to others. You have no idea what their journey is all about.” –  Regina Brett

The internet makes it very difficult to avoid comparing ourselves to other people.  There they are, in their Instagram-perfect photos and their seemingly amazing lives.  Perhaps the “nice” thing to do would be to feel good for them, and maybe the reasonable thing to do would be to recognize that things probably aren’t as perfect as they seem.  But how many of us in our worst moments are nice or reasonable?

In some ways I’m a bit of a dinosaur, cruising along on the tail end of generation X.  I didn’t grow up in an ultra-connected world.  I had a Facebook account at one point, but I ended up  deleting it, partly because I was playing way too much Farmville (does that even still exist?) but mostly because seeing other people’s supposedly happy lives was making me feel utterly alone and bitter in my depressed state.

Quitting Facebook wasn’t that hard, but what I continue to struggle with to this day is Google stalking.  Not of the hardcore creepy variety, but finding out what former classmates and colleagues were up to, and using that information to conclude that my life was even more pathetic than I thought it was.  A lot of it was career-oriented, and it was particularly bad in situations where I felt like I was at least as capable as the other person.  Jealousy is never particularly pretty.

It’s interesting, when I’m well I’m not prone to fall into that trap of comparing myself to others.  I always had pretty good self-esteem, and I was very independent, preferring to do my own thing than to follow the crowds.  I was pretty content with where I was in life.  I had goals and ambitions, but they were more focused on what I wanted rather than being relative to what other people were doing.

Depression totally changes things.  The biggest trap I fall into is comparing myself when ill to myself when well, because it’s been a big drop.  The friendships, close family ties, full-time work in a career I loved… that’s all gone.  Sometimes I will then turn to Google stalking to reinforce these views.  I’ll see how much career success a former classmate or coworker is having, and compare that to myself being hardly able to work.

Sometimes I’ll start should-ing on myself.  I should have done this, and then I’d have that.  If I hadn’t done this, I should have been able to have that.  There is a reasonable part of me that knows hindsight is 20/20.  That reasonable part, though, also recognizes that there is a germ of truth underlying all of this; I have had substantial losses.  I just need to re-orient where I’m focusing my comparisons.

I’ve tried really hard over the past year to stop with the Google stalking, and I’ve gotten a lot better with it.  It’s been a long time since I’ve logged into Linked In, and when I get an email with a Linked In connection request I just delete it.  My Twitter and Pinterest accounts are only for blogging-related things.

The online mental health community has been really helpful in shifting my focus to the reality that we’re all facing a lot of challenges and trying to fumble along as best we can.  The respect and admiration I feel for others in the community reminds me that I deserve to get those same things from myself.

It would be so easy to let myself get sucked up in the social media whirlwind and go back to my Google stalking habits.  It would be easy, but I choose not to go down that road; or, when I head in that direction, I will reorientate myself to where I need to be.

 

Is comparison something that you struggle with?

What is… melancholia

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Melancholia

Melancholia comes from the Greek for black bile, part of the ancient four humours medical belief system.  In the 5th century B.C.E., Hippocrates first identified melancholia as a disease with various mental and physical symptoms.  In the 16th and 17th, the idea of a melancholy temperament became fashionable in English art and literature.

In the present day, melancholia is used to to specify a type of major depressive episode.  Some researchers have argued that it warrants its own diagnosis, but the committee formulating the DSM-5 was not convinced that it was a distinct disorder.

In the DSM-5, melancholic features specifies a subtype of major depressive episode.  Melancholic symptoms include anhedonia (inability to feel pleasure), lack of positive reaction to normally pleasurable things, a quality of mood that is distinct from grief/loss, early morning awakening, psychomotor retardation (slowed movement and thinking), significant loss of appetite, and symptoms that are worse in the morning.

People with melancholic depression tend to have normal levels of developmental stressors, and no significant problems with relationships or work when they are not depressed.  Melancholic depressive episodes are more likely to happen with no identifiable triggers, and people are more likely to identify their depression as an imposed disease rather than a logical reaction to life stressors.

Melancholic depression is thought to caused mostly by biological factors.  It is associated with an increased likelihood of family history of mood disorder.  It is also associated with higher severity depressive episodes, including psychotic depression and suicidality.

Individuals with melancholic depression tend to respond less well to SSRIs, and respond better to antidepressants that target the neurotransmitter norepinephrine.  MAOIs (monoamine oxidase inhibitors) tend to be the most effective antidepressant in this population.  The addition of a psychostimulant like an amphetamine may be helpful.

My most recent psychiatrist thought I had melancholic depression.  I don’t have all the symptoms now, but the prominent anhedonia definitely matches.  The types of meds I’ve responded best to also matches.  I suppose it really doesn’t make that much of a difference; everyone’s illness is unique, regardless of subtype.

Does melancholic depression sound like something you may have experienced?

 

Sources:

https://en.wikipedia.org/wiki/Melancholia

https://en.wikipedia.org/wiki/Melancholic_depression

You can find the rest of the What Is series on my blog index.

 

Brokenness

I’ve been thinking lately about my inability to maintain relationships with people.  Depression has caused me to shut a lot of people out of my life.  Mostly I haven’t given it much thought, but it dawned on me that it has to do with a sense of brokenness.

My illness makes it hard to be around people, and it seems like things ending up getting to the point that the relationship itself is broken, and no more fixable than trying to glue broken glass back together.  And the brokenness is always my fault.  Not my fault in terms of blame, guilt, or shame, but my fault in that the sense of brokenness wholly (or at least mostly) exists in my head, and may or may not have a strong basis in reality.

Probably what gets me into the most trouble is that once I feel that brokenness, it seems irreparable.  It feels final.  And I don’t know how to overcome that barrier. It’s not that I feel that I am broken myself; the brokenness applies only to the link between me and the other person.  There’s a very detached quality to it; there really isn’t much of anything in terms of thoughts or feelings attached.

One of my oldest friends tried to stick by me the longest with this current episode of depression (although is it even an episode any more at this point?).  While her efforts to reach out on a fairly regular basis struck me as kind, it didn’t change the brokenness.  Did she do anything wrong?  Not really; I felt invalidated by some things she said at one point, but I knew full well that was not her intention.  And that wasn’t what triggered the brokenness.  What really cemented it was when I went over to visit her and her kids while they were putting up their Christmas tree.  I’m sure my friend thought the visit went not too bad, aside from me not saying much.  In my head, though, that afternoon was inexplicably the death knell of the friendship.

It’s also a problem with my parents.  I had my reasons for initially pulling away from them when depression came into my life again a couple of years ago, but that’s not really an issue now.  What persists, though, is the sense that the close connection I used to have with them is permanently broken.  I’m not sure how I would even go about trying to change that thought pattern.  It’s almost like key pieces are missing that makes it impossible to reassemble the relationship as it was.

This has all come to mind as a result of an altercation I had with a friend recently.  It was over something that’s not really that important, but I’m getting that done and broken feeling.  It’s not a conscious choice that I’ve made; it’s just there.  Yet another casualty in depression’s destructive march through my life.

 

 

 

Book review: The Inflamed Mind

book cover: The Inflamed Mind

The Inflamed Mind: A Radical New Approach to Depression is written by psychiatrist Edward Bullmore, and presents inflammation as a new frontier in tackling depression.  The author’s bio at the beginning of the book reveals that he works at pharmaceutical giant GlaxoSmithKline.  He doesn’t try to be subtle about disclosing this, and I didn’t pick up any sense of bias.  He explains that in 2010 GSK shut down its mental health research and development (R&D) programs, and this was what prompted him to start thinking seriously about neuro-immunology and the role of inflammation.

The author refers multiple times to an anecdote of his experience of social withdrawal and morbid rumination immediately following root canal surgery.  It was gone by the next day, but he wrote “you could say I had been a bit depressed”, and attributed this to inflammation related to the surgery.  While I understand the point he was trying to make, as a person living with depression myself I couldn’t help but roll my eyes.

Cartoon drawings are used effectively to capture neuro-immunology concepts.  Explanations are given in simple terms, without making the mistake of sacrificing accuracy for metaphor.  Scientific terms are used, such as the immune cells known as macrophages, and the signalling molecules they release, called cytokines.  While it’s somewhat difficult for me to judge, as I was familiar with many of these concepts before reading the book, I think it was pitched to a level that a reasonably intelligent person could understand without having a science background.

A patient referred to as Mrs. P. makes frequent appearances throughout the book.  The author encountered Mrs. P. during his medical training.  She had rheumatoid arthritis as well as depressive symptoms, but her treating physician insisted that the depression was a normal psychological reaction to her physical disease.  It was a relevant example, but it struck me as a bit over-used.

There was what initially felt like a bit of a detour to philosopher René Descartes to explain the persistent idea of separation between mind and body.  However, Descartes ended up appearing even more often than Mrs. P. did, to the point that it got to be a bit much.  The author writes “I can fondly imagine that Descartes himself might have agreed with me, but I can’t be sure.”  Oh my.  He did make the interesting point, though, that the mind/body divide is a sort of “medical apartheid”, and I very much agree that a more holistic approach will better serve patients.

Bullmore argues that placing depression solely within the mental domain actually serves to increase shame and the likelihood that people will think the illness is their fault, which is in many ways what the idea of a “chemical imbalance” tries to counteract.  He goes on to explain the shortcomings of the serotonin hypothesis, which was used as the  basis for the development of selective serotonin reuptake inhibitor (SSRI) antidepressants.  He also explained that approaching depression with a focus on serotonin and related neurotransmitters has stalled out, and there have been no major advances in the treatment of depression since around 1990.  He writes: “To this day, in 2018, I could still safely and acceptably treat most patients with mental health disorders based solely on what was written in those those textbooks” that he used when he started his specialty training in 1989.  While I understand the underlying point that there haven’t been any revolutionary advances in psychiatry, the notion of seeing a psychiatrist whose knowledge base is rooted in 1989 is unpalatable, to say the least.

The book explains that according to the DSM: “According to the official diagnostic criteria of the American Psychiatric Association, depressed patients can only have a diagnosis of [major depressive disorder] if they do not also have a bodily disease.”  Based on this, he concluded that Mrs. P. who had rheumatoid arthritis couldn’t have a depression diagnosis.  To me this interpretation seemed a bit odd.  The exact wording in the DSM-5 is: “The episode is not attributable to the physiological effects of a substance or another medical condition.”

The possible relationship between depression and evolution is discussed.  The author explained that back in the caveman days social withdrawal could have been a form of quarantine to prevent infectious disease, adding that: “One might even wonder if the stigmatization of depression in 2018 is somehow related to the isolation of ancestral tribe members who were behaving as if they were inflamed.”  That seems like a bit of a leap, and is followed by yet another leap: “Could the common feeling that ‘we don’t know what to say’ to our depressed friend conceal an ancient inherited instinct to recoil from close contact with people who are behaving as if they are inflamed and infectious?”  By that argument, though, why is there not such a social recoil from people with type I diabetes or Crohn’s disease?  Or the oft-referred-to Mrs. P. with rheumatoid arthritis?

While there is a strong argument that inflammation is a factor in depression and an important target for research, there isn’t much yet in practical terms.  The book describes the “Remicade high” that some clinicians have seen in patients who rapidly cheered up while getting an infusion of that anti-inflammatory medication.  There have been some small studies with anti-inflammatories that have had positive results, but there isn’t a clear indicator of something particularly effective that’s available right now.

Vagal nerve stimulation is also mentioned as a possible intervention  to target inflammation.  Cytokine receptors on the vagus nerve respond to high levels of inflammation by signalling to the spleen to deactivate macrophages in order to maintain homeostasis.

I started this book quite prepared to buy what the author was selling, given my prior knowledge of some of the research in this area.  I was a bit surprised by the book’s presentation of the idea as though it’s something that everyone is denying, because it’s sufficiently accepted to have made its way into the mainstream continuing medical education activities that I’ve viewed.  Bullmore writes that “we could be on the cusp of a revolution”, and I know personally I’m hoping that advances in anti-inflammatory treatment approaches will end up being able to help with my own depression.

The book makes a strong argument that further research into inflammation is going to open new doors in depression treatment.  However, the fact that we don’t have keys to those doors yet limits its practical usefulness.  Still, this book is worth reading if you’re interested in finding out more about a new way of looking at the biology of depression.

 

I received a reviewer copy of this book from the publisher via www.netgalley.com.

 

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Why I hate the 1-10 mood rating scale

happy face rating

mohamed_hassan on Pixabay

I became a nurse 14 years ago, before I became mentally ill.  Even then, I wasn’t a fan of asking people to rate their [mood, etc.] on a scale of 1-10.  It struck me as such a cop-out, a poor substitute for actually exploring with the person how they were feeling.

And then depression hit, and I ended up in hospital myself.  Almost every day someone was asking me to rate my mood, and I hated it.  That feeling I’d had before about it being a cop-out?  Quadruple that – at least.  It felt like none of them actually cared how I was doing; they just wanted to get in and get out.

There is a huge array of different emotions that we can experience.  While we may label some as good and others as bad, they all have their time and place.  No one wants to be excited when something bad is happening just like we don’t want to feel angry when we’re getting a relaxing massage.

Reducing mood to a scale ranging from sad to happy seems totally arbitrary.  What if I feel anxious?  That’s neither sad nor happy, but somehow it has to be slotted in on the scale.  What if I’m angry because the professional asking me the question is being a prick?  That’s not happy, but telling them to go f*** themselves might be rather satisfying.

The idea of imposing a 0-10 rating is also arbitrary, because the frame of reference is subject to so many different influences.  What’s “normal”?  If I was bipolar, maybe 5 would be expected to be my normal.  But since I have depression, people may expect me to cruise along at an 8 most of the time.  What’s a zero?  If I’d experienced childhood sexual assault would that be my zero and anything else is pretty much automatically an 8 or above?  My zero before I got depressed was a whole lot different from the zero when I was trying to kill myself, so how’s that supposed to work?  And does my zero if I’m suicidal today necessarily correspond to the zero I was at if I felt suicidal six months ago?

I get that it’s helpful to track mood.  I track my mood in my bullet journal with a numerical ranking from -3 to +3, with zero being neutral.  I also use coloured coded letters to record specific emotions.  Different days may have the same ranking but a very different mix of emotions, but a numerical rating alone wouldn’t capture that.

What’s really important here is that mental health professionals should take the time and effort to dig a little deeper.  A number that I pull out of my ass has very little meaning on its own if someone doesn’t try to understand the complexity of what’s actually behind that number.  If the person asking is just looking for something to write in my chart so that it looks like they’re doing their job… well, chances are, I’m going to sense that, and whatever I tell them is going to be a load of BS.

The reason this has come to mind recently is something a friend of mine said.  He’s in psychiatric nursing school right now.  He tries to be understanding of my illness,  but in many ways he’s clueless.  I’ve tried to explain to him what it’s like, and he just doesn’t get it, although not for lack of trying.  I was talking on the phone with him on Boxing Day, and he hadn’t asked how I felt about Christmas.  He can’t seem to wrap his head around the concept of anhedonia, and I think he just figured I chose not to do anything for Christmas.  He was babbling on about some stupid work-related anecdote, and then finally he asked how I was doing.

I told him I wasn’t doing very good.  There was a pause, and then he asked me how I was feeling on a scale of 1 to 10.  Oh for crying out loud.  I told him he could f*** off with his stupid 1-10, and I hung up on him.

He wasn’t trying to be a jerk, but the last thing I need is a friend making a lame-ass attempt to assess me using a crappy assessment tool that pisses me off to begin with.  I’m not sure what to do about this whole thing.  I’ve tried explaining, and he just seems to be a bit thick when it comes to this issue.  So maybe I need to either just put up with it, or back off on the friendship (except he’s my only in-person friend).

I don’t know, but what I do know is that people can take that 1-10 and stick it where the sun don’t shine.

What is… seasonal affective disorder

Seasonal affective disorder (SAD) is a subtype of depression with symptoms that occur based on a seasonal pattern.  Typically depressive symptoms occur during the winter, but other patterns are possible.  For example, depressive symptoms may appear in the spring, or anxiety symptoms may show up in the summer.  The potential symptoms of SAD are the same set of symptoms that can occur with other types of depression, although winter depression tends to be more likely to be associated with oversleeping and increased appetite.

People with bipolar disorder who have a seasonal element to their illness may be diagnosed as bipolar I or II with seasonal pattern.  Seasonal fluctuations are more common with bipolar II than bipolar I.  Spring and summer may trigger the onset of mania or hypomania.

Approximately 6% of Americans experience SAD, while around 14% experience seasonal dips in mood that don’t meet the full diagnostic criteria for a depressive episode.  One survey found that 20% or Irish people experience SAD.  The exact cause of SAD isn’t clear. Rates of SAD are elevated at higher latitudes that have less light in the winter, which may effect melatonin production by the pineal gland in the brain.  This can affect serotonin production, as melatonin is a precursor to serotonin.

Light therapy one option that can be effective for treating SAD.  It involves sitting in front of a 10,000 lux light box for 30 minutes or a 5000 lux box for an hour.  Times may need to be lower for those with bipolar disorder.  It’s recommended to sit 30-60 cm (about 1-2 feet) away from the box, at an angle that allows the light to shine in your eyes without staring directly at it.  Light therapy and treatment with SSRIs have been shown to have approximately equal effectiveness.

Getting regular exposure to outdoor light (even on cloudy days) and physical activity may also be helpful.

I live on the wet west coast of Canada, just north of the 49th parallel.  The biggest issue in the winter here is that it rains a ton, so the sun doesn’t make an appearance very often.  While I find cloudy vs sunny days make a transient difference in my mood, winter doesn’t seem to affect my symptom patterns overall.  However, since early on in the course of my illness I’ve had a consistent seasonal pattern of a major drop in mood starting in late August and lasting through September.

I have a light box that I sometimes use in the winter, but I don’t notice much of an effect from it.  I actually prefer the warm glow of my Himalayan salt lamp, even though it’s not the right kind of light to be effective for SAD.

Do you have a seasonal component to your illness?

 

Sources: 

https://en.wikipedia.org/wiki/Seasonal_affective_disorder

https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651

You can find the rest of the What Is series on my blog index.

2018 year in review: Health

2018 in gold numerals

BiljaST on Pixabay

Depression does a number on my recall ability, so I turn to my bullet journal to help me look back on 2018 from a health perspective.  The chances of my illness ever going back into full remission seem very slim at this point, so I think it’s probably better if I set aside hopes of that and consider it more in terms of managing a chronic illness.

Mood

September was my hardest month of the year, and it was the time when I had the most sustained suicidal thinking.  There have been a few days scattered through the year when I rated my mood as neutral, but nothing above that.

Cognitive symptoms

I get overwhelmed very easily, and have a hard time with concentration.  My memory isn’t too bad, but my recall tends to be slow.  These symptoms have fluctuated in intensity, but over the last year they’ve always been there to some extent.  I’ve worked hard at having a system to be organized to compensate for that, and I give myself credit for that.

Anhedonia

This has been steadily present throughout the year.  It doesn’t necessarily affect my level of functioning, but I feel like my quality of life takes a considerable hit because of it.  Going on a couple of vacations reminded me that this aspect of my illness doesn’t take a holiday break.

Physical symptoms of anxiety

I haven’t had a lot of emotional/cognitive anxiety, but I do sometimes get the heart pounding and chest tightness kind of physical anxiety.  Sometimes it seems to be attributable to situational factors, but sometimes it feels totally random.  I also struggle sometimes with feeling like I’ve been overloaded by environmental stimulation and I’ll start to have mild panic symptoms.  That hasn’t been as much of an issue this year as it was the year before.

I’ve had vertigo on and off throughout the year.  Some of the time it coincided with tension headaches, and my massage therapist thought this might be related to me carrying a lot of tension in the sternocleidomastoid muscles in my neck.  Other times, the vertigo seemed related to anxiety or feeling overstimulated.  When I was travelling in Italy I had what is apparently called “rocking vertigo”, and I felt like all of the time I was on a boat bobbing up and down on the waves.

My tremor  is primarily related to taking lithium, but it gets worse if I’m anxious or overstimulated.  That’s fluctuated a lot during the year and there doesn’t seem to be a clear pattern.  Sometimes it gets bad enough that it’s quite noticeable to other people, and I hate that.

Gastrointestinal

My GI system tends to act up related to what’s going on in my head, and I can see that it tends to be most problematic in the days following stressful events.  Overall, though, it hasn’t been too bad this year.

Alcohol

I used alcohol for numbing more than I should have, although it was a sporadic thing rather than something I did regularly.  I seldom drank large amounts, but it’s still not the greatest choice of coping (or non-coping) mechanism.

 

Well, that’s me for the year.  Having a bullet journal that I’ve made regular entries in definitely makes it easier to see what’s been going on with my mind and body throughout the year.  As for patterns, I see some, but there also seems to be a lot of randomness.

Do you keep track of things related to your health?  What have you noticed from 2018?

Why can’t you search Pinterest for “depression”?

Pinterest logo

I discovered this quite a while back, but it just popped into my mind again recently.  Pinterest won’t let you search for the word “depression”.  If you try, it gives no results, just this message: “If you’re in emotional distress or thinking about suicide, help is available.”  If you search for “depressed” or “major depression”, though, that’s totally okay.

Okay, so time to try a few more search terms.  Searching for “suicide” gives you the safety message, but you still get your search results.  If you type in “suicidal”, it’s the same situation as with depression; you get the safety message and no search results.

Curious to see what Pinterest would do with far more problematic and disturbing terms, I did some more searching.  Psychotic, PTSD, trauma, homicide, homicidal, violence, abuse, killing, murder, stalking, and rape are all okay, with no safety messages. “Nigger” gets no results and a message about hate speech.  “Whore” gives no results, with a message that “Some nudity is okay for Pinterest, some isn’t.”  “Incest” and “slut” generate search results, but the same caution about nudity.

It seems just plain bizarre that the word depression is an issue but homicidal isn’t.  Well, time to explore this a little more.  So I clicked on Pinterest’s “help is available” link.  It takes you to a questionnaire.  The first question asks whether you’re having thoughts of suicide right now.  It then provides a crisis line number and says to call them if it’s an emergency.  Following this, multiple choice answers are given: no and maybe.

If you click no, it takes you to the next question, which is a multiple choice asking what you’re struggling with.  It suggests that you could try a crisis line, the Live Better app, or the Calm meditation app.

If you click maybe, it then provides crisis line resources and asks if you’re likely to use them, and why you might be reluctant to.

To me this whole thing just seems downright strange.  Who are they helping by showing search results for depressed/suicide but not depression/suicidal?  Suicidal I can at least kind of get it, but to treat depression as a scary word is complete nonsense.  What is wrong with this world when homicidal is just fine but depression is unacceptable?

I get the sense that someone in the Pinterest powers that be has decided this is a way for them to cover their ass.  Perhaps a little less ignorance would serve them much better.

Book review: How to Stop Feeling so Damn Depressed

Book cover: How to stop feeling so damn depressed

How to Stop Feeling so Damn Deporessed: The No BS Guide for Men by psychologist Jonas A. Horwitz is a how-to guide that aims to tell men how to take on depression and win.

The author explains that this book is for men with severe depression.  I found the use of the term “severe” a bit unclear as it did not seem to be used to specify a severe major depressive episode; rather, it was used to refer to a major depressive episode of any severity.  It may well be that much of the audience of this book isn’t going to be aware of this distinction, but to me it still felt a bit sloppy.

The central metaphor used throughout the book is of depression as a “Beast”, an entity that is separate from you as a person and lies to you in order to feed itself.  It can be starved by not engaging in the behaviours that it pushes you to do.  This metaphor is leaned on heavily.  Some of the ideas incorporated into it are not exactly true in a literal sense, but the book does not make this clear, which could potentially result in readers making some inaccurate assumptions.

In some parts of the book information seems to be either oversimplified or exaggerated to the point that it pushes the boundaries of accuracy.  The author writes: “One of the most basic ways your Beast gets more energy is to trick you into flooding your brain with chemicals that directly cause depression.  Let’s start with the most common: alcohol.”  Yes, alcohol can have a negative impact on depression, but it is a central nervous system depressant, which is not the same thing as a direct mood depressant as the book implies.  The author also warns that every time you drink it will make you feel “much, much worse”.  While the aim here is a good one, realistically a single drink is not going to have that significant an effect, and presenting the message in this way may actually serve to weaken what is a very valid underlying argument.

There were a few things in the book that struck me as a bit gimmicky.  I can be fussy about the written word, and arbitrary capitalization (e.g. Beast) is a pet peeve of mine.  When talking about sleep hygiene, he referred not to one’s bedroom but one’s “cave”.  In the section on alcohol, the author cautions that alcohol can decrease testosterone levels and lead to “man boobs”, i.e. gynecomastia.  It seems a bit like offering up decreased breast size to warn about the dangers of anorexia nervosa.

The author focuses heavily on the importance of physical activity.  He recommends that for severe depression, the most important treatment strategy is exercise, ideally 30-60 minutes per day 4-5 times per week.  While exercise matters, it’s also important to be realistic and recognize the substantial limitations that depression can create.  Those experiencing severe depressive episodes may feel exhausted by previously easy tasks like getting out of bed and showering.  Having been in that place myself where taking a shower feels like climbing Mt. Everest, this blanket suggestion about exercise seems woefully out of touch.

While I do have a number of concerns about this book, there were certainly positives as well.  The book gives a useful explanation of cognitive behavioural therapy, and gives good examples of some of the common cognitive distortions.  Various other treatment options are covered, and there is a helpful section explaining what to expect from psychotherapy.  The author touches on the important point that we need to address social expectations that men shouldn’t talk about their feelings.

In terms of organization, there are concise point-form summaries provided at the end of sections.  My preference would have been to see the book broken down into smaller chapters, particularly given the adverse effects depression so commonly has on concentration.

Clearly I’m not the intended audience of this book.  While the book states it’s for men with severe depression, I actually think it would be much more appropriate for people experiencing mild depressive episodes.  Even though the beast metaphor didn’t work for me, it may resonate with some people and make it easier for them to conceptualize their depressive illness.  But if you’ve ever been so weighed down by depression that dragging yourself into the shower felt like an insurmountable obstacle, this book is not for you.

 

I received a reviewer copy of this book from the publisher via www.netgalley.com.

 

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Master of my domain? A look at depression and masturbation

While this may seem like a bit of an odd topic, it’s something I’ve vaguely wondered about for a while.  My line of thinking goes, if orgasms get the feel-good chemicals flowing, might that have any sort of benefit for depression?  And especially for single folks like myself – could masturbation have any positive effect when it comes to depression?  It’s well known that both depression itself and antidepressant medication can dampen sex drive, but is it like any other kind of behavioural activation where you try to fake it until we make it?

I was curious to see what science had to say about this, and was actually a bit surprised to see how little research has been done on the topic.  What I did find was a mix of interesting information and rather dubious scholarship.

In the Victorian era, masturbation was seen as a potential cause for an array of different medical conditions, including epilepsy, insanity, neurosis, and neurasthenia (a condition characterized by weakness and fatigue).  Thinking began to change in the 20th century, as some sex researchers argued that masturbation was healthy and normal.  This became a topic of interest in the field of psychoanalysis, and while Sigmund Freud argued that masturbation caused neurasthenia, he later concluded that it may help to prevent neurosis.

Negative views of masturbation still exist, both socially and in academic circles.  In the academic journal articles I looked at for this post, these negative views seemed to be most associated with studies that had considerable flaws.

In a 2010 paper, researcher Stuart Brody expresses his opinion that: “It is likely that only unfettered, real [penile-vaginal intercourse] has important mood-enhancing benefits.”  In describing the findings of another research study, he confuses correlation with causation in his attempt to argue that semen-vagina contact is important, and he does a rather odd connect-the-dots with the statement that “more condom use means more depression and more suicide attempts.”

A 2013 paper coauthored by Brody claims in its title that “immature psychological defense mechanisms are associated with women’s greater desire for and actual engaging in masturbation”.  The authors erroneously interpreted the findings of two research studies, incorrectly stating that masturbation was associated with an increased risk of depression.  They also suggested, with no clear basis for their claim, that there are multiple links “between masturbation, character, and risk of depression”.

A paper by Das reported that self-rated happiness is inversely correlated with masturbation, i.e. there is greater happiness with less masturbation.  He stated that in a subsection of depressed men, negative mood has been linked to increased masturbation.  However, the  paper he cites to support this claim actually says no such thing.

Cyranowski and colleagues found that women with a history of depression, particularly those with recurrent depression, had a higher frequency of masturbation than women who had never been depressed.  This correlation remained constant even when they controlled for a number of other factors, including current depressive symptoms and the use of psychiatric medications.  The researchers wondered if this might be related to decreased sexual pleasure from intercourse with a partner, but found that the data didn’t support this conclusion.

Frohlich and Meston learned that women with higher depression scale scores reported an increased desire for masturbation and were more likely to have masturbated within the past month.  These women also reported a decreased desire for partnered sex, and difficulties with arousal and pain.  The researchers speculated that masturbation may provide a reliable form of pleasure or self-soothing even when depression has decreased interest in other activities.

In contrast to these results, in a study by Kennedy and colleagues, 40% of men and 30.4% of women with depression reported a reduction in masturbation.  This finding seems consistent with what one might tend to expect given the nature of depressive illness.

None of the literature that I came across definitively answers my question about whether masturbation could be helpful in some way in depression, although Frohlich and Meston gave some supposition in that direction.  It’s interesting how our society is in many ways hyper-sexualized, yet we don’t talk much about real-world sex, much less masturbation.  It would be nice to see more research and dialogue to address both sexual dysfunction and healthy sexual function in people experiencing mental illness.  In the meantime, to borrow a classic saying from Seinfeld I, for one, will not be master of my domain.

 

Sources:

  • Brody, S. (2010). The relative health benefits of different sexual activities. The Journal of Sexual Medicine, 7(4.1), 1336-1361.
  • Brody, S., & Nicholson, S. (2013). Immature psychological defense mechanisms are associated with women’s greater desire for and actual engaging in masturbation. Sexual and Relationship Therapy, 28(4), 419-430.
  • Cyranowski, J.M., Bromberger, J., Youk, A., Matthews, K., Kravitz, H.M., & Powell, L.H. (2004). Lifetime depression history and sexual function in women at midlife. Archives of Sexual Behavior, 33(6), 539-548.
  • Das, A. (2007). Masturbation in the United States. Journal of Sex and Marital Therapy, 33(4), 301-317.
  • Frohlich, P., and Meston, M. (2002). Sexual functioning and self-reported depressive symptoms among college women. The Journal of Sex Research, 39(4), 321-325.
  • Kennedy, S.H., Dickens, S.E., Eisfeld, B.S., & Bagby, R.M. (1999). Sexual dysfunction before antidepressant therapy in major depression. Journal of Affective Disorders, 56(1999), 201-208.
  • Patton, M.S. (1996). Twentieth century attitudes toward masturbation. Journal of Religion and Health, 25(4), 291-302.

Decision time – Christmas and depression

Recently my grandma was asking me what I was planning on doing for Christmas, and it made me shudder inwardly.  Of course it didn’t help that her short-term memory is awful and she kept asking the same question over and over.  It’s not something I have any desire to think about, but I suppose I have to.

I used to love Christmas.  I loved putting up a Christmas tree, eating yummy Christmas goodies, listening to Christmas carols, watching Christmas movies, and spending time with my family.  It was never something stressful; rather, it was always one of the happiest parts of the year.  Depression has stolen that away, and this will be my third Christmas in a row just not giving a crap.

Last year I stayed at my Grandma’s over Christmas, and had Christmas dinner at my parents’ place.  My brother and his now-wife were there too, and it was just way too much.  Not that there was any real drama; it was just over-stimulating and a difficult reminder of how much depression has taken away from me.  It was really, really hard.

This year Grandma is in a care home.  My brother and his wife will be spending Christmas with her family.  So if I were to go home, it would be me and my parents, with me not even able to pretend to care, and my parents pretending not to notice me not caring.  Grandma would probably spend Christmas with my uncle, but my parents wouldn’t be involved in that because my mom never had much contact with her brother but even less since me dad threw a random shit-fit at him a couple years ago and has refused to see him since.

Probably I will end up staying put and doing nothing for Christmas.  Putting up the tree seems like more effort than I have any interest in spending, but maybe I’ll string up some Christmas lights in my bedroom.  And maybe I’ll making some of my favourite Christmas baking classics, like shortbread cookies and butter tarts (which apparently is a Canadian thing – I don’t know why the rest of the world hasn’t caught on).  Maybe I’ll gain 10 pounds from drowning my sorrows in rum and eggnog.  ‘Tis the season, after all.

I admit it – I’m a ghoster

Yes, that’s right, I’m guilty of ghosting.  Ghosting is not a nice thing to do to someone, but are some forms of ghosting worse than others?

I would like to propose two different types of ghosting: offensive ghosting, which serves to actively reject another person, and defensive ghosting, which is done for the purpose of self-protection.  I say this because depression has made me a ghoster.  If I am feeling uncomfortable or invalidated in an interpersonal relationship while I’m depressed, I get really overwhelmed, and my first instinct is to retreat into my hermit cave.  I’m not wanting to hurt the other person, I’m just trying to feel safe. Depression means that some of my more mature coping mechanisms just aren’t available to me, and when I’m feeling really low, avoidance is about all I’ve got to draw on.

I used to have friends, although now that seems like a whole lifetime ago.  When I became depressed a couple of years ago after experiencing workplace bullying, my depressive urge was to isolate.  I tried the opposite action direction to push through and try to socialize anyway.  But these friends, though I know they were trying to be helpful, were being really invalidating.  The pressure of trying to stay connected with these people eventually became too much, and I snapped.  I blocked numbers on my phone.  I didn’t respond to emails.  I tried to hide from the world.  It’s not that I was trying to reject these people, I was just trying to hold onto a shred of sanity.

I also ghost my family.  I find it very hard to feel connected to them when I’m unwell, so it feels quite uncomfortable when I have contact with them.  That means that when I’m feeling really low, I just fall off the grid completely.  Unsurprisingly this is very stressful for them, and they worry that the next thing they’re going to hear about me is a call from the police.  I know that, yet when I get the phone call and see the number on my call display the thought of answering makes me feel ill.

I suppose ghosting can be appealing because it feels safer than any alternatives.  It’s very hard for me to feel safe with people, and especially hard for me to feel safe in any sort of conflict with people.  I wish that I didn’t frequently feel under attack when interacting with others, but that’s a sense of safety that I just haven’t been able to rebuild.  And until I do, I’m sorry to the people that I run away from, but I’m the only one that can look after me.

Do you ever ghost people?  Do you think your illness plays a role?

Bedtime stories from the big bad wolf

Most nights, just before bedtime, I get hit with a rush of anxiety about the future.  How will I take care of myself?  How will I support myself financially?  What if I can never resurrect the tatters of my career?  Then I climb into bed, the meds take over, and off to sleep I go.

While this nightly wave might be exaggerated, it’s a reflection of some very real concerns that I have.  I deliberately choose not to think about the future if I can avoid it, and focus on the present and whatever I’m able to do now.  Except trying not to look at the big bad wolf of the future doesn’t make it go away, and it pops up in the evening to remind me that it’s still there.

I’ve gotten used to it sufficiently that I can shift my mind back away and not give it too much pre-bed airtime.  I wish it would stop, but I don’t think it will.  I have no certainty.  I have no safety net.  I have no resilience to handle setbacks.  All I can do is just exist each day.  Perhaps that would be a good thing if it was about mindfulness and that kind of thing, and maybe there is an element of that, but when it comes down to it, it’s really just one more form of avoidance.

A few years ago I never would’ve imagined that I’d be having this kind of fear stop by to pay me a visit each night.  I felt stable and certain looking towards the future.  I didn’t consider that my illness might shift from episodic to constant.  So many things I could never have guessed.

And yet here I am, with the big bad wolf hiding in the closet, peeking out at me with his menacing stare.  He is a companion on this journey through invisible illness.  Perhaps someday he’ll devour me, ripping me to shreds to match my little red riding hood.