Archive for June, 2009

June 29, 2009

The Booster Shock (the sixteenth treatment)

Today I had my first maintence ECT treatment. My sister accompanies me to the hospital. This whole process really doesn’t take long. You get to the hospital around 8am, have ECT around 9am, then you’re out of there around 10am. Still, I owe her a debt of gratitude for having to take her older sister, of all places, to a psychiatric hospital.

Because it’s been about three months since the last treatment, I first sign some papers and then am escorted to the ECT prep room. The preparation is very simple. They check my vitals and I am asked to put on a gown over the clothing I have on. I guess the gown’s for formality. I wait in the room for a little bit. They’re playing R&B love songs in the room. I guess they want us to ‘get in the mood for  this procedure. Soon, a nurse takes me to the ECT treatment room, which is set up kind of like a gasoline station, with curtains between each patient bed-all of us hoping for fuel that’ll keep us going. Dr. H, the anesthesiologist, and some of the nurses all remember me. It’s comforting to have familiar faces around me, though it really means that I was there a long enough last time for them to still remember who I was.  The nurse puts some monitoring patches on my body, then inserts the port for the anesthesia and muscle relaxant into my right arm. Dr. F, my soft-spoken new ECT psychiatrist, enters the room and speaks with me.

A couple students are ushered into the ECT room right before my turn for the little spark. Dr. H tells them, “We’re about to do the procedure on her right now.” The students, who are probably younger than I am, surround my bed. Before I could say hello, Dr. H injects me with Brevital, the anesthesia, as he tells me I’m going for a little nap. I am out within a second; I’m always so amazed how quickly anesthesia works on the human body.

I wake up maybe 40 minutes later. I realize I have no clue what day or month I’m in. As a nurse comes to check on me, I ask him. He tells me that it’s June 29. I am later wheeled back into the prep room for a final vitals check. Before I am wheeld out to the car, they hand me an envelope with some directions, and most importantly to me, the date for my next ECT: Monday, July 6.

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June 28, 2009

In the Words of Carrie Bradshaw

Last time I was about to have the very first ECT in January, I called upon the wisdom of Carrie Bradshaw to give me some sound advice from those “Sex and the City” episodes. Here I am, the night before a new chapter in my ECT adventure, and I think I’ll summon Carrie’s great words again.

“Sometimes we need to stop analyzing the past, stop planning the future, stop figuring out precisely how we feel, stop deciding exactly what we want, and just see what happens.”

All I can do now is to just see what happens.

June 28, 2009

Weekend Update

It’s the day before my first maintenance ECT, or the sixteenth little spark. “Meet the Press” is on the television, but I can’t seem to pay attention even though the two Davids, Axelrod and Gregory, are having a lively conversation. Instead I’m looking at my hands.

I’ve completely chewed up my nails. They now look like the fingernails of a five-year-old, short and stubby. With the rough edges, they probably accurately display the level of anxiety I feel but I don’t readily admit to having. It’s quite embarrassing. As much as I try to never show publicly any semblance of that tension, the condition of my now-nonexistent nails along with my rough hands reveal the truth.

I guess I’m more scared than I say I am. Just how much more, I don’t know. I wonder how I’ll feel about it tonight.

Anyway, what did I do this weekend to distract myself from thinking about Monday’s treatment? Go on date night, with myself. Hours before the show started, I drove to the nearest Ticketmaster outlet to purchase a single ticket for the show, and last night I went to see Bill Maher at the Ryman Auditorium by myself. It was the break that I needed, to just be transported into that world of political humor, profanity and sex jokes. You won’t be thinking about ECT while you watch Maher pretend to hump numerous objects. He was quite generous with the time; the show was nearly two hours long.

The high from getting to see live one of the comedians whom I watch weekly has mostly worn off (at least it’s not the haze of alcohol), and my mind is clearly zoning back into thinking about tomorrow.

June 28, 2009

ABC News: Alcohol Use Associated With Suicide, Especially in Minorities

Alcohol Use Associated With Suicide, Especially in Minorities – ABC News
Nearly One-Quarter of Suicides in New Study Linked to Alcohol Intoxication

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June 25, 2009

News Item: International sessions to focus on latest research on bipolar disorder

I didn’t know that the eighth annual International Conference on Bipolar Disorder was held this week in Pittsburgh. Here’s an article that appeared in the Pittsburgh Tribune-Review on Tuesday.

International sessions to focus on latest research on bipolar disorder – Pittsburgh Tribune-Review

For more info on the conference: http://www.8thbipolar.org

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June 23, 2009

The Assessment (part 2)

…continued from “The Assessment (Part 1)….

I wait some more in the bare room, painted with some odd, hospital green color up to the chair rail (or some sort of padded rail), and then cream for the rest. I don’t know why they bothered with the wallpaper border that was placed near the ceiling.

Dr. F finally walks in. I stand up, and we politely introduce ourselves to each other. I had been told by Dr. A that he was in his 70s, but his age is not apparent at all from his looks. I don’t know what I expected – perhaps nothing at all – but he’s only somewhat taller than I am, and he has on a tie and a jacket, no white coat.

It starts on an awkward note. “So, you had ECT three years ago,” says Dr. F. “No, it ended in late February,” I tell him. Instead of the dates of my outpatient ECT, he had been given a chart that had my last hospitalization date, which had been three years ago. I guess he hadn’t read my file. He asks me a little more about how long I had been out of ECT, if I thought it helped, and when the depression came back. I think the depression came back about two months ago, I reply, and to that, he notes to me, “so the effects only lasted for two months.” I hadn’t really done the math until then. I put my hands over my month to say to myself, “That was it? Two months?”  Fifteen treatments to have only two months of ceasefire of some sort? It is at this point when my mind begins to wonder if I am really making the right call.

The evaluation goes on. Dr. F mostly asks me questions that were similar to the ones asked by the assessment person. At one point, he does say to me that I don’t look depressed. I end up having to explain that I never come across as a depressed person. This is one of those comments I probably should’ve expected. The thing is, if I’m outside of my home, I try to look fine. And most will agree that they’d never know I have some mental disorder just from looking at me. But I become almost uncomfortable with that comment because I’m generally afraid people are skeptical to the nature of the illness or can’t really see beyond my exterior. Now I’m afraid that Dr. F’s initial perception of me from the exterior has skewed this assessment. I now question to myself if the indifference I feel is just part of being human or if it’s even depression. I lose confidence in the answers that I have about my own self, because I can’t tell if I am right about how I’ve viewed and felt the last month or so. Have I painted an inaccurate picture of my very self? Am I labeling certain behaviors as “symptoms” when they’re just me being me?

I get through the questions somehow, and Dr. F begins to talk about the treatment itself. As he talked, it dawns on me that he is expecting for me to have ECT once-a-week for at least the next few weeks, and then tapered very gradually to twice-a-month, etc. Though Dr. A and I’ve discussed the idea of maintenance ECT, as in having it once-a-month or so, we’ve been focused on just this single treatment. One Treatment only. He explains to me that this is how a tapering schedule works and that this is probably what Dr. A had in mind. I am not sure what to say. All I could do is nod while looking shocked and confused. I do manage to get across to Dr. F that I hadn’t expected to hear what he had just said.

By the end, I am caught totally off-guard. He wraps up the evaluation with some remaining questions. He tells me those are all the questions he had for me, gets up, shakes my hand and leaves.

I tug on my hair hard as I walk out the hospital door and to my car. Later in the afternoon I am home, and I google about this ‘tapering schedule’ that Dr. F had talked about. In all my readings that I had done, I must have missed reading more carefully about maintenance ECT, because the procedure he talked about is so clearly written out in the clinician books and ECT program web sites. How could I have totally missed reading all this info?

I now am not sure about a thing.

June 23, 2009

The Assessment (part 1)

I am at the psychiatric hospital’s waiting/intake area. I walk up to the receptionist desk and ask to see Dr. F, my new ECT psychiatrist. She nearly assumes that I’m a visitor. I tell her, “I’m the patient.” Oh, she says. She takes down some information.

I guess they are redoing the bathroom by the waiting area. The sound of the drill is almost unbearable but that noise also masks all my anxieties about being here though I know what to expect. The receptionists have bouncy voices that resonate in the space. It’s probably a good thing. Their chatter kind of suspends me from sinking into my nervous thoughts.

There are several people sitting in the room, most of them holding a red ‘visitor’ badge in their hands, indicating that they don’t have any personal business being here. But maybe this is routine for them, too; people seem pretty calm for having to sit here. An older lady is fashioning herself a peanut butter-and-banana sandwich by slicing a banana and placing the slices into a sandwich she pulled out of her tupperware. A guy is messing around with his BlackBerry. Some are watching Rachael Ray on the television that’s in the room. Maybe they are also looking to have distractions from thinking about being at the hospital. I breathe in deeply and I apply more lip gloss, as if I hadn’t smeared enough of it on already.

An intake person calls my name to come into the corridors of the hospital. The receptionist buzzes the button that opens the doors. I’m led to a bare room with two sofas and a trash can. The chairs feel like they’re covered in plastic. There are no magazines, tables or lamps. Just a dull, square room with linoleum floors. Now, this feels like a psych hospital. It’s a barren room, but it doesn’t feel sterile. Instead, it feels almost worn out, though there is no visible sign of that on the furniture. Maybe this is the perception I have because I know what happens in here.

An assessment person comes into the room and starts to ask me a series of questions: how’s my appetite, what medications do I take, when did I last harm myself – those types of questions. As she asks me about my recent condition, I realize that I don’t really have an answer. I begin wishing I had a clue what happened in the past few months. I clearly didn’t mean to get back into this mess again. After the questioning, a nurse stops by with the vitals machine, making sure that I’m alive. Apparently, I’m still alive.

June 21, 2009

News Item: Bipolar disorder costly to treat

Albert Lea Tribune | Bipolar disorder costly to treat

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June 19, 2009

Why I’m choosing maintenance ECT

It’s been a bit unclear, even to me, how I reached the decision to have maintenance ECT for this one time. For my own sake, I just needed to jot this out so that I know I’m doing the right thing.

  • The ECT treatment the first time around was very helpful, but I knew it going in that it wasn’t a lifetime cure (the relapse rate within a year is something like 90 percent). The purpose of maintenance ECT is what it says it is: to maintain. I want to maintain the life I’ve regained.
  • When ECT treatment works the first time, the likelihood of it working the next time around is very high. Side effects for me were negligible, even after the 15 times within a five-week period.
  • In the recent months, it’s taking a stimulant for me to be able to stay awake during the day and get things done. It’s starting to feel like any motivation I have right now has been artificially induced. I don’t have a problem with having to take the medication, but this wasn’t something I required right after the ECT treatment.
  • By trying a single treatment, my doctors (and I ) will be able to determine if periodical ECT would be an effective treatment for the long run.
  • Some old thoughts are starting to creep back into my system. The apathy that had disappeared seems to slowly make its way back. As much as I’m not in a mood to fight it off, I know logically that I’ve got to fight it off now or the floodwaters will surely find its way back.
  • I have nothing to lose from doing this.

I feel like my head’s been stuck in a vat of molasses when my doctor and I began to plan on this treatment. When Dr. A asked me at my session yesterday if I felt ready, I realized I had not sat down and really thought about what all of this stuff meant. This may not be the greatest time for me to be pondering all of this (the GRE does come first on the calendar), but it needed to be done. This may not be my complete reasoning for getting maintenance ECT, but at least I’ve put something down. “Clarity is not a bad thing,” says Dr. Melfi to Tony in an episode of the Sopranos. Yeah, I could use some clarity, and making a list like this one helps me just a little bit.

June 17, 2009

“Scared Shitless”

That’s what Juno’s stepmom (Allison Janney) tells the mom-to-be Vanessa (Jennifer Garner) at the end of the movie “Juno.” I’m not sure if “scared shitless” is really how I feel, but I have to admit, I’m nervous.

Rebecca from Parthenon Pavilion, the psych hospital, called Monday to let me know that everything’s been set up for me to have my first maintenance ECT, and all right after the GRE (yay). I will meet my new ECT psychiatrist and be evaluated by him next Tuesday. On the same day, there are also the evaluation by the hospital staff and a physical done by the internist, the two appointments that need to be done within a week before the actual treatment.  And the main event will take place in two weeks, on Monday, June 29.

There’s not a need to be so anxious. It’s really not a scary procedure. I should know; I’ve gone to it fifteen other times. And for this one, you get the treatment, you don’t drive for 24 hours, and then you go back to your life. It’s so simple.

It’s an awkward and a bad time to be filled with this energy. I need to be studying, but instead I just watch the time pass by. One of the channels has some sort of a “Six Feet Under” marathon going on. But mostly I’m just sitting under the ceiling fan, watching it spin around and around. (Well, I finally finished taking a practice test, so I guess I’m making some progress.)

It’s the process to the actual happening that causes those nerves to turn my stomach or make me pop some alprazolam (xanax). I know I am overthinking everything right now, but isn’t the process leading up to these events (ECT and the GRE) the only part I can really control? Actually now that I think about it, there’s practically nothing I can do to change the outcome of the ECT, but that’s not the case with the GRE scores. Really, learning more vocabulary will only help me on the exam. Besides, alprazolam only hinders you from having a good seizure.

June 16, 2009

New Study: Depression Gene? Maybe Not

From WebMD.com
Depression Gene? Maybe Not

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June 14, 2009

I miss Tim Russert.

Every Sunday I watched ‘Meet the Press’ to be marveled by Tim Russert. I admired him. He’d pose questions in a way that would make even the most experienced politicians stammer.  While I was working for a publication a few years ago, an opportunity came when I got to interview a gubernatorial candidate. I remember telling my editor in preparing for that interview, “I want to be like Tim Russert.”

But his interview skills weren’t the only part that drew me to the program. It was the essence, the spirit, of Mr. Russert himself that made the show more special than just those incisive questions. I always loved it when he’d insert a little shout-out to his favorite sports teams right at the end of the show. “If It’s Sunday, It’s Meet the Press,” he’d say, and many believed it. And if you couldn’t catch him on Sunday, then there was “The Tim Russert Show” that ran on CNBC on Saturdays. I watched that, too.

It’s been a year since Tim Russert passed away.

I wonder what he would have said on election day last year. Oh, if we could have heard his commentary when Barack Obama became our president. Amidst the flood of political opinion today, there’s still a void in the political journalism front. I still want to hear what Tim Russert would’ve said.

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June 12, 2009

Why study for the GRE? So I can understand Bill Maher (no joke!)

Instead of going through some more of the GRE stuff tonight, I watched “Real Time with Bill Maher” on HBO. It turned out to be a good call. During the show, Bill Maher commented on how garrulous Larry King (his first guest) is when he’s not on his own show, and then jokes to Chris Matthews, one of tonight’s panelists, that Matthews is always garrulous.

Garrulous? It means loquacious, or talkative, even talking a little too much. How did I know what Bill Maher meant by ‘garrulous’ in the first place? It’s all thanks to having been going over my GRE vocabulary. (I think I actually had to learn that word in high school, but I didn’t remember what it meant until I saw it again in the last two weeks.) I honestly wouldn’t have known what he meant had I not been semi-studying for the exam.

Thanks, Bill. It was confirmation that learning these words for the GRE actually will pay off, even in understanding late night comedians. I guess I should get back to my vocabulary flash cards….or maybe I’ll watch some Dave and Craig. You never know if they’ll toss out a word that I might need to know.

June 11, 2009

In need of a little spark

I woke to a day with a sky that had a eerily gray tint to it. It’s Thursday, so it starts out with my session with Dr. A, as it does every Thursday. I got to her office building a few minutes early, so I sat in my car for those moments almost dreading what was to come. I hadn’t been able to write any for days, because it’s as if my mind’s ‘hamster on the wheel’ just collapsed and died. I physically felt okay, but I lacked any emotional content. Maybe people don’t usually have intense feelings every day, but a dearth of even a base to build any intensity just isn’t me. I just didn’t have anything to say.  My capacity to use language as my one means of communicating any emotion just vanished, and if one’s going to spend time with a psychiatrist, you better bring that part of you. I couldn’t. During the hour in her office, I wrung my hands as the tension in my body just crept in more and more as the clock tick-tocked away. So many awkward pauses, it was really horrible.

Even after it was over, I pretty much felt this session may have been a waste of time, not on my part, but for my “Dr. Melfi.” By the time I got back in my car, those ominous morning clouds had turned into an obvious sign that a thunderstorm was coming. I went home for a bit before work.  The rain began to pour hard right as I left for work, just as I realized I had left both umbrellas in my car. I ran to my car through all that water.

It was probably a good thing my job today mostly involved just cutting open boxes and placing the merchandise in the stockroom. A mindless task for a mindless, or a lifeless, person. After my shift I spent a good few hours at Panera Bread and studied for the GRE. I still don’t get these basic Algebra problems. Frankly, I just haven’t done enough studying and reviewing for something that’s coming up in about ten days.

As I drone on and on about today, it sounds like absolutely nothing happened that should have provoked strong emotion from any other person (and therefore should not be worried about why I am feeling this way). But the thing is, that’s not entirely true. At the very least, I know that I would have had strong opinions about what was actually placed in motion today. Dr. A and I discussed maintenance ECT again, and she called the admissions people at the hospital during my session so that I may be able to have treatment as soon as two weeks from now. Dr. A handed the phone over to me so that I could speak with the person on the phone. The intake person  informed me that I had be re-evaluated by a different ECT psychiatrist ( since my ECT doc is working full-time somewhere else) and also go through the whole intake procedure-including the physical- all over again. The lady on the phone talked to me as if I had never had the procedure before. When she asked me if I had any questions about ECT, I almost wanted to say, “I think the other 15 times gave me a pretty good idea about how this whole thing goes.” Before Dr. A put me on the phone with the intake person, I did hear Dr. A tell that lady that I might have maintenance ECT every month to six weeks.

Apparently, the waterworks ended about as quickly as it came. The weather had made an amazing turnaround by late afternoon, with a nice breeze and a beautiful pale-blue sky.  I’m now sitting on the porch with my cat, wishing I could just have a good cry, like that short and sudden downpour. But I can’t figure out how to do that today. Simon seems to feel more passion for gnawing on my chives than I do about anything right now. I’d be jealous of him, except I don’t even feel that.

I still feel like the sky saw this morning. Ridiculously dull.

June 9, 2009

Forbes: Early Bedtime May Help Stave Off Teen Depression

Early Bedtime May Help Stave Off Teen Depression

from Forbes.com 06.09.09, 12:00 PM EDT
Extra sleep quells suicidal thoughts as well, study finds

TUESDAY, June 9 (HealthDay News) — Teens whose parents pack them off to bed at 10 p.m. are less apt to become depressed or have suicidal thoughts than their peers who stay up much later, recent research shows.

“This study bolsters the argument that a lack of sleep can cause depression,” said study author James Gangwisch, an assistant professor of psychiatry at Columbia University Medical Center in New York City. “Teens with earlier parental-mandated bedtimes were less likely to suffer from depression and suicidal thoughts.”

Gangwisch was to present the findings Tuesday at the Associated Professional Sleep Societies annual meeting, in Seattle.

The study stemmed from data on more than 15,000 adolescents who participated in the National Longitudinal Study of Adolescent Health.

The researchers found that 1,143 of the teens were depressed and 2,038 had suicidal ideation, the term clinicians use to describe suicidal thinking. Dr. Jonathan Pletcher, an adolescent medicine specialist from Children’s Hospital of Pittsburgh, pointed out that suicidal thoughts are common in teenagers, which is why the study included more teens with suicidal thoughts than depressed adolescents.

“A lot of teens have suicidal thoughts, but there’s a big difference between suicidal ideation and being suicidal,” Pletcher said.

When Gangwisch and his research team looked at the relationship of depression and suicidal thoughts to parental-mandated bedtimes, they found a clear correlation.

Teens whose parents insist on 10 p.m. or sooner for lights out were 25 percent less likely to be depressed and 20 percent less likely to have suicidal thoughts, compared with kids who hit the sack at midnight or later.

Gangwisch said he adjusted the data to account for numerous factors, including parental connectedness and the age of the teens, because older teens probably would have later bedtimes. After controlling for these factors, he said, it was clear that a lack of sleep was to blame for the increased risk of depression and suicidal thoughts.

“Kids that have to go to bed earlier are getting more sleep,” he said.

Pletcher said it’s likely that a combination of factors accounted for the increased risk. “There’s a bi-directional relationship between depression and sleep,” he said. “Teens who get less sleep may be more anxious and more likely to feel badly. But, I think this study’s findings also speak to a connection between the teen and their parents and their ability to work together.”

Both Gangwisch and Pletcher agreed that most teens need at least eight to nine hours of sleep a night, and said that parents might underestimate their teen’s need for sleep.

“Getting adequate sleep is a huge priority,” said Pletcher. Besides increasing the risk for depression and suicidal thoughts, a lack of sleep can affect a child’s focus and learning, he said. And Gangwisch said that a dearth of sleep is also associated with obesity and type 2 diabetes.

Pletcher said that teens who don’t get enough sleep may also be more impulsive.

“Don’t underestimate how a lack of adequate sleep can affect everything from mood to behavior,” he advised.

More information

The National Sleep Foundation has more on teens and sleep.

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