WillSpirit

Where Will meets Spirit
∞ A Blog Devoted to Balance, Peace, and Clarity ∞

A formerly depressed physician tells stories of trauma, grief and recovery, and offers suggestions for emerging from darkness, living with mood swings, and awakening to life.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.




Where next?

WhereNext

Recent posts have, hopefully, demonstrated big changes in my mindset and emotional stability. A profound awakening has lifted me out of my rut and set me on a new path. But where is this new road headed?

For the past thirty years I’ve worked to overcome chronic depression, and other emotional challenges. There have been some successes, and some excited moments, but low moods have remained stubbornly clamped over my heart. Twenty years ago, attendance at Alcoholics Anonymous meetings convinced me to look for a ’spiritual’ solution. I toyed with Buddhism, but ended up in the Religious Society of Friends, or Quakers, which had been the spiritual heritage of my maternal ancestors. Since it demands few doctrinal beliefs, it fit me well. But although I attended countless Meetings for Worship, and many weekend retreats, my so-called spirituality remained an intellectual exercise. I liked the idea of deeper forces in the cosmos, but I never felt connected with anything more than curiosity.

Ten years ago I enjoyed my first set of spiritual breakthroughs, during a diagnosed ‘psychotic episode’. Some of them had a Christian theme, which prompted my conversion to Roman Catholicism. After five years or so, my glowing convictions about Christ faded back into the atheism of my upbringing. Once again, I found myself in need of a spiritual home, only now it seemed clear that lasting belief in supernatural concepts was beyond me. Even with another try, Buddhism remained a poor fit for my personality and philosophy. Tenets about reincarnation would have been easy to sidestep as a Western Buddhist, but the emphasis on reason, although laudable, reminded me too much of science. Rigid scientific thinking seemed to be part of my problem.

Two weeks ago I had my second series of spiritual breakthroughs. During them, ideas that had been building in my mind for many years coalesced into an empirically based worldview, but one that did not rely on scientific reasoning. It came to me by wordlessly, without resistance, embracing known facts about what it means to be a human. After the epiphany blossomed, I pulled out the book, 365 Tao by Deng Ming-Dao and read a few random pages. To my amazement, the texts articulated a worldview nearly identical to the one that had flooded me after years of struggle. The book had been buried in my little home library the entire time, but I had never opened it before. (Although I had often meditated on the shorter and more cryptic Tao Tse Tung.) There were minor differences in perspective, but in essence the end result of all my grappling had been on my bookshelf the entire time. Taoism seems to have roots deep in a receptive awareness of nature. I reached my similar frame of mind through opening myself, without resistance and with as little ‘thought’ as possible, to the awesome sweep of proven biology and physics (it’s no coincidence that I have a Master’s degree in biophysics).

Taoism is based on an abstract idea (The Tao) that stands for an all-encompassing, endlessly mysterious, and deeply consistent animating principle. There is little if anything blatantly supernatural, at least not in the little Taoism I’ve read so far. My experience remains hard to articulate, but it came from taking all my knowledge of our physical and biological nature, and allowing it to sweep through my heart. Doing so prompted a soul-saturating awareness of the ‘rightness’ and ‘interconnectedness’ of creation.

It needs to be emphasized that I don’t rule out the possibility of overtly supernatural phenomena such as ‘God’ or reincarnation. However, I learned that such beliefs are not needed to support a spiritual awakening every bit as profound as my one of ten years earlier, at which time the idea of God had been central.

When I began my spiritual journey, it would have been impossible to predict that it would end like this. All I could do was stumble blindly until the pieces fell in place. Possibly, I could have picked up 365 Tao a decade ago, and been spared the struggle. But it is more likely that the words would have remained veiled until a designated and unpredictable moment when my eyes were opened.

It is hard to overstate the value of the awareness that has come to me. It has melted away my petty, egoistic concerns. It has given me faith that the universe is benign, and that despite the inevitable traumas of life, I will be safe. It has prompted me heart to literally ache with the desire to help others find peace. It has swept away decades of depression and cynicism. And it only invokes truths that most rational and educated people would accept.

So what is my next obligation? Where do I go from here?

Where next? was published on January 28th, 2010, with the tags , , , . There are currently 10 comments on this article so far.

‘Through a glass, darkly’

rose tinted glasses on a dog

Sometime back I promised a post about how one’s attitude changes with drugs. When I quit Cymbalta almost a month ago, I quickly lost my confidence, started to feel tired and discouraged, and decided life did not have much value. I fear that without my strong connection, devotion, and commitment to Mandy I would have succumbed at last to the suicidal tendencies that have dogged me since my first major depression at age twenty. Yet not long before things had looked pretty rosy to me.

At present I am coping with some medication-induced injuries that will never leave me, even though I’ve quit the drugs that caused the damage. I find the destruction visited upon my body demoralizing and infuriating. But before stopping the Cymbalta, it seemed like my grip on the situation had improved, and I had hope that with a little time and meditation my distress would abate and I would settle into a more-or-less calm acceptance. Not long after my final dose of that drug (I continue to take several others), the problem started looming large again. I felt, once more, like my life had been destroyed. Given that my passion for breathing (and all the other essential components of human life) has always been lukewarm, suicide started to look like a logical and acceptable solution. How much grief, defeat, and loss can one person take?

As I’ve implied, my agreement with myself and Mandy is that I will stay around for our relationship. So although I had a well-worked out plan for my demise, I never set a time frame, and just sat out the foul emotional weather. In just the past day or so, I have started to feel more like I can continue to live without merely gritting my teeth and waiting for natural death. Life has begun to look worthwhile again. Mandy and I have more frequent affectionate moments, I smile more often, and I feel like my energy has returned. Today we happen to be enveloped in smoke, due to a supposed ‘controlled burn’ that escaped its lines and is now raging in Yosemite. Every few hours the wind shifts to carry a thick cloud of particulate haze into our region. If we did not have so much air pollution, I’d be outside catching up on all the chores I neglected as I fought my way through this withdrawal. It feels good to recover the desire to be productive. I hypothesize that my brain is building more serotonin and norepinephrine receptors to compensatefor the reduced levels of those transmitters that followed stopping Cymbalta. (See this discussion about what is probably going on.)

My optimism would be greater if this had not already happened once. About two weeks after cessation there came a previous time of relief from the whirlwind, but it only lasted five or six days. So I will not be surprised if the curtain descends again. But right now I am feeling better, and I won’t spoil it by predicting another setback. This is how I ended my post back at the time of the last break from despair: “What I’ve written so far is the introduction to my real topic: the relationship between the chemicals that traverse my brain and the ‘person’ that the organ produces.”

For a number of reason I never got back on-subject. Today I am going to try to tackle, in a small way, the relation between chemical changes in our brains and the people we think we are.

In my opinion, it comes down to something like different vantage points. I wrote during the last storm break about how my little house in the hills would be invisible to a passenger in one of the airliners that regularly stretch contrails above me. I live my drama down here in the trees, yet those in the aluminum tubes soaring overhead have no clue about my problems and discouragement. They just don’t see my world of concerns. When I am medicated, it is like I am flying in the stratosphere. I observe my anxieties glide beneath me, but they look tiny and far away. Sometimes they get obscured by the pretty scenery, and I can almost forget they exist. But when I stop the drugs, I land flat on my belly on the August-baked earth, and gasp for full breaths in the smoky air. The pharmaceutical agents become the proverbial ‘rose-colored glasses’, that make a dim world look bright.

If they worked as well as I describe, I’d have to ask why one should fight the way I do to end my dependence on the medications. But if you look through pink-tinted lenses long enough, you no longer see the pink. Your mind adjusts and everything starts looking the way it did before. So then you are no longer jetting through the upper atmosphere close to the speed of sound, and instead end up bouncing along at ground level in a dilapidated truck. What’s more, even though the chemicals no longer help as much, the side effects continue. That is why I stopped Cymbalta. It helped my mood a bit, but the benefit diminished until it no longer seemed worth the heavy cost in adverse reactions (primarily anorgasmia). So I stopped taking my daily green pills, and have been fighting to regain my footing ever since.

If my entire opinion about whether to live or die hinges on a chemical called duloxetine marinating my brain, the question becomes, who am I? The suicidal man who feels life has dealt so many injuries it no longer warrants engagement? That is to say, am I ‘really’ this troubled person who emerges upon cessation of the drugs? Or am I instead the (kind of) bubbly soul that can discover benefits even in raw wounds and festering infections? Am I ‘in fact’ the wry middle-aged guy who emerges when the drugs (occasionally) work perfectly well?

Or am I both? Or neither?

At least I now recognize that my feelings change. It used to be hard for me to see that my attitudes shift. If the world felt awful, I believed in an unshakeable way that my feelings at that moment accurately summed up the nature of life as it had always been. On the flip side, if things looked cheery, I had a hard time remembering how it felt to be depressed. After years of gyrating feelings and world-views, I now recognize that tectonic shifts have repeatedly rocked my inner environment. My ability to predict eventual good feelings even when I am mired in deep depression has improved. I have recollection when I feel rotten that life once seemed fun, and vice versa.

As that sort of memory consolidates, I start to appreciate that my feelings are transient little things that have no direct relationship to outside reality. They are my internal filters, and not firmly connected to either the external scenery or my actual ’self’. The same person (me) and the same life (mine) can look ashen through one set of spectacles, and sunny-yellow through another. I am the person behind the glasses, or even further back: behind the eyes. Possibly the real me looks through yet another screen: the brain. Some believe that our true selves have no material biology, but exist as ethereal spirits. I don’t go quite that far, but there is no question that somewhere separate from all the opinions, all the filters, all the moods and feelings, sits a person who is protected from the storms, and watches with a wise and tolerant eye as all the hurricanes and earthquakes and volcanoes thunder over the landscape. I’ve mentioned Acceptance and Commitment Therapy (ACT) before, and I am touching here on ACT’s core assumption.

I am not the earth’s tremors, or the volcano’s blast. I am not the wind or the sun or the rain. I am the ’self’ that observes all the changes, all the weather, all the thoughts and feelings. But this is so easy to forget. It is as if, while watching a movie, I confused the events on the screen for things in real life. If I think that somehow my identity is that of a scared and lonely man, hemorrhaging and forlorn, I am overlooking the fact that at other times, with different chemicals in my blood, I feel like ’someone’ entirely different.

It could be that I am nothing more than a memory stream. A dynamic album of photographs that keeps adding page after page after page. My identity cannot be pinned down to any particular image, not even the most recent ones. Instead, to get any sense at all of ‘me’ as a stable and defined entity, you have to look at the entire book as a unit.

By changing my drug regimen I am not creating a different person. I am just turning the page, putting in new pictures taken through different lenses. What I think and feel today is just an addition to my identity, not the summation of it.

Does this make any sense at all to others? I know these ideas are not mine alone, and no doubt writers more eloquent than I have stated something like the same point of view with greater clarity and logical support. But this is what I meant to bring up two weeks ago, during my previous respite from the Cymbalta-withdrawal nightmare that has been my ‘reality’ since August first. I am aware of some texts I need to read that touch on similar streams of thought. When I get more information, a wider perspective, and time to digest, I will return to this subject of self and how it relates to the turbulent currents of mood, opinion, biochemistry, and experience.

mothdrawing
For now, I am glad of the break from the pain. It feels good to expand again, and fill my wings with blood the way a newly metamorphosed moth pumps itself up before taking flight into the moonlit sky. For now, at least, I can nourish myself again, and savor the nectar of daily life.

(Click here to link to a nice video showing a moth feeding on nectar.)

‘Through a glass, darkly’ was published on August 28th, 2009, with the tags , , , , . There are currently 2 comments on this article so far.

The whole story.

shipwreck

I am almost sorry about yesterday. What a discouraging post! I say ‘almost’ sorry, because my goal here is to be honest about what goes on in my world, inside and out. I don’t want to hide my moods; certainly not the positive ones, but not the depressed ones, either. If I don’t watch it, my text drifts into the arid desert of analysis and logic, and away from the messy emotional compost that nourishes my more heartfelt writing. Personally, I find too much issue-dissection boring. Life is as much about what the heart feels as what the brain thinks. States such as passion, affection, sorrow, euphoria, fury, and desperation often look disorganized and senseless. If I am to be authentic, and open about my inner experience, sometimes I will sound wretched. (Another reason I’m not too regretful is that I received such nice, supportive comments!)

My feeling life gets tossed about by frequent typhoons of sadness and despair. Although the cloudiness alternates with brighter moods, including pressured winds of optimism and plans that soar high above firm ground, I never venture far from the shade. Until recently I called my storminess ‘bipolar disorder’, and my bleakness ‘depression’. At this stage in my life I find it more helpful to consider myself a bit temperamental, mournful, and sensitive, but to pitch the illness concept overboard. Whatever you name what I’ve ‘got’, however, I am never long on an even keel, and I spend a lot of time in the stagnant duldrum of hopelessness.

So if I am going to write with feeling, which makes more interesting reading than pure logic, there will be times when things sound a bit unhealthy. Self centered. Whining. Self pitying and immature. I hope the less uplifting posts will alternate with essays that climb toward ecstatic observations on the spiritual underpinnings of biology, or pieces that animate the possibility of utter contentment in the face of chaos and loss.

I could make the decision to censor ‘ugly’ material out; I could make myself always sound spiritually fit and possessed of wisdom. But I have given this thought, and my goal in this blog is to tell a story of life. Not just my own history, though that forms the basis of most of my ideas, but the larger story of life as a damaged human being. An injured person may have days when everything ‘falls into place’. On such days every insult, each wound, and the countless pangs of grief, are recognized as openings rather than cuts. The awareness blossoms that such fenestration widens the eyes so they can see more beauty, and expands the heart so it can offer more love. But most of us with hellish memories also suffer times when the vision clouds over, and the heart cramps into a lonely knot of muscle, unable to accommodate more than the thinnest stream of blood.

Even Jesus, we are told, had moments of doubt in the garden of Gethsemane. My spiritual development is as close to that of Jesus (or the Buddha’s, or Gandhi’s, or Mohammed’s) as a flea’s heart is to an elephant’s. So for me, at least, perfect and perpetual equanimity remain out of reach. I suspect this to be true of all but the most determined and fortunate of those who are raised deprived, assaulted and hated instead of nurtured, protected and loved. When children suffer overwhelming losses, they grow up with infinite feelings of want. When they are attacked, they learn to expect the worst. And when despised, they learn to hate themselves. Such lessons take a lifetime to unlearn. On the best days, one gets blessed with a radiant comprehension of life and its full panoply of emotions. One understands that joy, love, anger, and grief are just different directions that the same wind blows. One feels the uneven but never-ending currents of time, space and fate flow like God’s blood through the mind, body, and soul.

But there will also be days when it all looks like a lump. At those times the injuries seem too great, the loneliness too imminent, the joy too sparse, for life to be worth living.

I have my saintly moments. But they are not as common as my darker days. I am not offering a cure in this blog. I am not presenting my path to recovery as a method others can follow and find salvation. That would be a lie. My path has not proven to be direct and unerring in leading me to peace. My commitment to well-being wavers, and sometimes I just break down and cry.

That is the story I want to tell. The entire canvas, including the splattered and shredded edges that often get hidden when one uses an elegant frame. This is my life nailed to a tree. It is not hanging in the Met, or bound in the rare books section of a major library. It is a mess. But it is sometimes beautiful, often interesting, and it is all I have to offer.

My aim is not to lead people to think I always view life as a precious jewel, which I certainly don’t. Or that I am living the perfect story of recovery, which will never be the case. I choose instead to present the days as they strike me, the ideas as they arise, and the emotions as they crash over my bow.

Yesterday I was a shipwreck. Today I feel more like the transom of an ancient wooden fishing boat I once found on the beach in San Francisco. The varnish had at one time been shiny, and the wood had formed part of a stout and working vessel. What I found had turned into a labyrinth of splinters and warps and cracks. The paint that once proudly announced the boat’s name could barely be deciphered. But that piece of wood had an elegance it had never known when it was still functioning as a beam across the stern of a trawling watercraft. Time and catastrophe had etched it with a fineness that it seemed to want to share with me. So I took it home and put it in my garden.

This is my transom. It is wrecked, and not all of it will be beautiful. But I want to share it with you. Feel free to place it in some corner of your garden. Let the moss grow over it, and let the ants move in. Or burn it and toast marshmallows. It is my gift to you and to the world, if you want it. It will not always be attractive, or even inspirational, but I will try to keep it authentic.

So I don’t apologize for whining, even though I’m embarrassed. Yesterday, I was a lonely and discouraged child. Today I am an inept but enthusiastic poet. I am sometimes enlightened. I am often discouraged. But most of all, I am alive. And good or bad, upbeat or down, this blog is helping me stay that way. I pray that it helps you, too.

(I modified this post on 2009 August 28, c. 07:30 PDT, primarily in the first paragraph, but I changed a few other spots also.)

The whole story. was published on August 27th, 2009, with the tags , , , , , . There are currently 13 comments on this article so far.

Letter to a Friend

rippleReflection

The post I planned to write today will come later.

For the past several months a counselor practicing Acceptance and Commitment Therapy (ACT) has been teaching me to expand my philosophy, and quit struggling against my hardships. My insurance granted pre-payment for twenty sessions, and I have completed 12 or 13 so far. My relationship with this clinician started at a propitious time, and dovetailed with my involvement in Bipolar Advantage, which teaches one to take a more positive attitude toward mood fluctuations. These two influences spoke to my gathering awareness that being frustrated and unhappy with ‘the way things are’ serves me poorly. They also bolstered my resolution to wean myself off as much medication as possible, a step made more essential when I awoke to the horrific damage psychiatric drugs have wreaked on my body.

This therapist’s work underlies much of what I write about accepting life’s deprivations, acquiescing to grief, and appreciating the sublime qualities of emotional distress. Knowing that outside of the sessions this person has kept up with my blog posts, and sends me insightful comments on how they relate to my individual story, adds to my feelings of gratitude. I wrote a letter (actually an email) of thanks this morning, and ended up sketching part of my core emotional landscape. Posting a slightly revised version of my message on this site offers my audience a view of my inner milieu, while at the same time publicly expresses my appreciation. Knowing that others share your experience can be very healing. I hope that one or more of my readers will resonate with my longstanding ambivalence about life, and also my growing desire for more engagement. ACT teaches, among other things, that while we all undergo times of distress and cataclysms of sorrow, we can remain open to common joy. Even more, during those shaded times when our days feel bleak and fortune has violated all its promises, it remains possible to enjoy being alive. Perhaps it is akin to loving one’s child even as he spits hostile words at you. He may not be pleasant, but he is still an infinite gift.

A large segment of the population staggers under a burden of emotional agony. If that were not so, investors in pharmaceutical stock would not be so well rewarded. No doubt people have always been afflicted by almost unbearable feelings, but in this era of education, abundance, sanitation, and comfort, I believe we can do better. Not that the pain will go away, but perhaps our appreciation of day-to-day reality can increase. Imagine a world where even in the midst of wage-slavery and fears of violence people relished being alive. Where they accepted their pain to the point that they had energy to fight against injustice. Where financial and material trappings became less important than human relationships and creative expression. The way to achieve this vision lies in opening up, ’sharing experience, strength, and hope’ (as they say in Alcoholics Anonymous), and collectively learning how to thrive in the midst of a challenging world. I try to do my little part by deconstructing my rusted and creaking mental mechanisms to a behavioral health audience, and handing on the tools and lubricants others have provided to help me get things running more smoothly.

This therapist gives me much in this regard. I publish this letter as a public statement of gratitude, with the prayer that programs and messages such as ACT will propagate outward into our culture, like the rings stretching away from a pebble pitched into a pond. Where the surface of my depression once looked as solid and impenetrable as a pane of glass, ACT shows that all pain has depth and rhythms, and that I can learn, grow, and even enjoy myself while exploring these textured realms. Of course, the ideal often lies beyond my grasp. My ability to take such a philosophical stance, and savor the warm sensation of blood pumping from my wounds, depends on practice and motivation. But I have been fortunate to meet someone who has had the patience to sit with me as I bleed, until I understand that unlike the blood that flows through my body, the blood of the soul is infinite. No matter how much I hemorrhage, I will always have the vital spirit to go on, if I choose. So much better than my previous experience in the mental health world, where the philosophy has always been to apply pressure and tourniquets. Sure, drugs can slow the rivers of emotion, but once you tighten the tourniquet the limb goes dead.

I place the letter here because it is more personal and less intellectual than much of what I write. I want to allow people to get to know what I’m really going through, rather than always hiding behind a facade of philosophy, analysis, and weak attempts at lyricism. Fact is, I am making progress, but slowly. I see the path ahead, but have yet to walk most of it. This message shows one footprint along the trail.

Dear [M],

I’m glad that my last blog post provided, at last, some good news in regard to my mental state.

Contemplating death as a solution has always seemed reasonable to me, given how my mother checked herself out of life as I watched. In the suicide hotline we always ask about prior suicidal behavior; I’ve only made a few weak attempts, none of which had a high likelihood of lethality. But suicidality has become a part of who I am. Even twenty years ago I was pretty sure I would some day kill myself. Obviously I have not, and may never, but I no longer feel alarm about thoughts of destroying myself. I think that attitude helps me support people who call the hotline in crisis.

On the other hand, I respect that such talk upsets others. I wish when in my worst moods I could censor my statements better. In particular, it is hard on Mandy to know how often thoughts of death go through my mind (not that I talk about it all the time, but it only takes occasional mention to make the problem apparent). Accepting that life brings pain, and that pain can be endured or even seen as a kind of beauty does not automatically translate into a desire to keep experiencing it. I am OK with that disconnect, but I am not so pleased that my ambivalence about life pollutes the happiness of those around me.

Back to today. Bottom line is I feel better, and happy to keep going. I truly do have a commitment to stay around for Mandy, and I would never leave my dogs unprotected. I even look forward to the future, no matter what it brings.

Thank you for paying attention, and supporting me as I work out a philosophy and mind-set that will carry me through the last several decades of my life. I need to have some kind of framework to both endure and see positive aspects to further declines in health, increased physical pain, and the probable loneliness that await me. Having a deteriorating neck that hurts all the time, and threatens the integrity of my spinal cord, plus knowing how few close relationships I have other than my marriage, does not give me a rosy picture for the future. I appreciate that ACT is not about convincing myself that my fears are unfounded (they aren’t), but rather gives me at least a glimmer of hope that I can survive the struggle. There is even that astounding suggestion that no matter what happens, my future can be enriching and full of adventure.

I look back at what I’ve written here and almost laugh at myself: this is how I think when my mood is more or less good (although I’m realizing my spirits are not as upbeat as yesterday). I don’t know how you feel about getting saddled with me for twenty sessions, but it has helped me that you have been so understanding. And I am thrilled that there is at least one person reading my blog who really ‘gets’ what I’m writing about. Of course, it’s not surprising that you do get it, since you taught me much of what I’m saying. What’s nice is that you’ve taken the time to read how I’ve been thinking about the acceptance philosophy. (You’ll note that I don’t do much with commitment, at this point. I need to more fully commit to staying alive before I can talk with any authenticity about fidelity to values, etc.)

To try to end on a positive note, I am highly motivated to search for reasons to stay alive, and to be glad I am. I want to build something more than a stoic fortitude to not abandon Mandy. Writing helps me feel good about breathing and thinking. Knowing that you (and hopefully a few others) find what I produce interesting makes it even better. In the end, creating something attractive and worthwhile out of tragedy and sorrow has been the task of artists throughout the ages. After decades thinking of myself as primarily a scientist, I now see that creative expression will be my salvation. That requires the knack of appreciating the heavenliness of heartache, which you and ACT have taught me.

Thank you.

(I modified this post on 2009 August 15, c. 17:45 PDT.)

Letter to a Friend was published on August 15th, 2009, with the tags , , , , , , , . There are currently 2 comments on this article so far.

Disappointment and other Treasures.

TreasureChest300

Time to turn over a new blog leaf. Watching the growth in readership stall, and then the numbers start to dwindle, has happened twice since I began this blog (effectively July 1). Both times occurred after I went nuts and wrote really long posts that had only a little to do with mental health. My tag-line is ‘Just another Mental Health and Spirituality Blog’, but the sites I visit are almost all mental health oriented. So far I’ve not found a spiritual blog community that would be receptive to my biologically-based views on ‘God’. Given that the conversation I’m entering revolves around psychiatric issues of one kind or another, I will try to keep my blog in line with that topic. You all are teaching me what interests you or, more to the point, what doesn’t. In the future I will put the long posts about memoir-related or spiritual topics on webpages separate from the main blog, and then just provide the links for those (few) who are intrigued. I also plan to (once again) try to keep the posts shorter. I’m not sure what my cut-off should be. Maybe under 600 words?

With this new resolve, and the fact that I am typing better today, my mood has improved. My left ring finger, wrapped in gauze, has the sensitivity and accuracy of an elbow. But it’s only real job is typing ’s’ (’w’ comes up rarely, and ‘x’ almost never); with practice, I am learning to get it right. As usual, my spirits bounce back when I accept things as they are. I need to be OK with my minor injury, and not hate myself for all it seems to imply about my loss of dexterity, trouble coming off Cymbalta, etc. (The things I whined about in my last post.) I need to recognize that blog stats are just numbers, and not the same as people. I need to be satisfied with having one or two commenters say they enjoyed a post. After all, that rewards me far more than when AwStats shows a large number of ‘visitors’ who may just be web-bots for all I know. I need to get used to the fact that my blog project will not take off immediately, may never take off, and that ‘taking off’ is not the goal anyway.

Like all of us, I have concerns about finding financial security. But the joy I get out of writing, and out of communicating with others who share my concerns, has nothing to do with money. I need to hold on to that truth, and not get distracted by my anxiety about paying the bills. As is so often the case, the rewards this task has brought me are different from the ones I hoped for. The large number of fine blogs, the difficulty in attracting attention, and the frustration of realizing people don’t want to hear my ‘loftiest’ ideas have made it obvious that notoriety and financial success are unlikely. On the other hand, I’ve made contact with special and sensitive people of like attitudes, and I am now writing far more than ever before. Even to someone with chronic desires for high-achievement (tempered only a little by a decade of failure), who was raised to value status and ‘winning’ over relationships and helping, those seem like pretty good results. Thank you to all of you who have helped me find this treasure.

Disappointment and other Treasures. was published on August 10th, 2009, with the tags , , . There are currently 3 comments on this article so far.

Wouldn’t it be great if long-term antidepressant treatment worked?

Before antidepressants.

Before antidepressants.

After 1 year on antidepressants.

After 1 year on antidepressants.

This is a response to a post on the Hopeworks Community blog.

Dear Hopeworks Community,

Personally, I believe you overstate the value of medications, especially in bipolar II/depression. (They are indeed quite effective against manic escalation. It is not impossible for someone with Bipolar I to go without meds, but it is difficult and takes discipline.) However, the efficacy of antidepressants is regularly exaggerated by psychiatrists and pharmaceutical representatives. Are you aware of a single long term placebo-controlled study that demonstrates sustained benefit of any antidepressant over time frames longer than a few months? I’m not. Approval trials typically last six weeks. And even in that short time period, usually not much more than half the population benefits (compared to 30% that respond just to placebo). Yes, when people first start antidepressants, they often feel better. But if they are someone with longterm problems with low moods, and many recurrences, (which is the story for most bipolar II patients) when you look a year later they are usually back to fighting depression. Only now they are stuck on medication that causes even worse moods and other symptoms if they try to halt drug treatment. Realistically, don’t you notice that mental health clinics are filled with clients in awful depression who also happen to be taking 3 or 4 or 5 medications? If pharmaceutical therapy works so well, why are there so many people like this? For acute depressions, especially prolonged situational depression, psychoactive agents can really help. They may also give those with more chronic problems a bit of relief while they learn better ways of dealing with their moods. But as a sustained strategy: medication just does not work. If long term antidepressants were often effective, I would be in favor of them; I am not reflexively anti-medication. But they are not.

The psychiatrist who claims he has “seen a few BP2 people who do not have deep depression make it [without medications], but they are the rare exception” is a psychiatrist who loses his patients after they realize they can find ways to deal with recurrent depression and hypomania without drugs. The only ones he sees are those who come back asking to be restarted on pharmaceuticals. Not only that, but once established on long-term drug treatment, it is all-too-true that patients find it exceedingly difficult to stop. But to say that bipolar II patients can’t come off drugs is very different from saying they are better off than if they had never been established on longterm treatment in the first place. And how hard does he work to very slowly taper his patients while providing behavioral means to manage their moods? A close family member required a 2-year taper off prozac, and she was just on the one drug. Imagine how much patience it would take for a psychiatrist to help patients get off 4 or 5 medications. Does he work that hard to achieve something he obviously does not believe in?

Therapy and counselling are indeed helpful. Not always those based on opening up (though for clients coming from traumatic backgrounds, as many with bipolar II diagnoses have, it may be vital), but especially those that provide behavioral advice (including promoting exercise) and cognitive training, along with something like meditation or spiritual support. And peer interaction can be lifesaving. But meds? They are not a rock opposing a hard place. They are just an ineffective pebble (with crushing, boulder-like side effects and dependence potential) opposing a condition that can often be ameliorated without longterm drugs. Unfortunately, those who have difficulty succeeding with behavioral/cognitive changes are unlikely to be helped by ongoing medications. Instead, they will just have drug dependence, with attendant adverse effects, added to their list of woes.

(I modified this post in several places on 2009 August 3, c. 12:00 PDT. I did not introduce any changes in the opinion expressed, or examples cited.)

Wouldn’t it be great if long-term antidepressant treatment worked? was published on August 3rd, 2009, with the tags , , . There are currently 3 comments on this article so far.

Atypical Antipsychotics

The so-called atypical antipsychotics are the pharmaceutical industry’s new SSRIs. In the 1990’s the Selective Serotonin Reuptake Inhibitors came on the scene like an explosion. The hype was enough to convince almost anyone with depression to give the drugs a try. Prozac looked like the answer to all sadness: just take the pill and feel better. No need for therapy. No need to work on your attitude or lifestyle. No need to increase your tolerance for adverse moods. Just pop a pill and go on with your life.

Years later, we now know that the SSRIs do not exceed the older drugs in effectiveness. Compared with ‘tricyclics’ (the older antidepressants), drugs like Prozac have different side effects, but not fewer. Perhaps the only real advantage of SSRIs in treating depression is that they don’t kill you if you take too many. Tricyclics are notoriously lethal in overdose.

So the dust has settled, and SSRIs no longer look like wonder drugs. Worse (from the standpoint of the drug companies) most of the patents of the native SSRIs have expired (long acting preparations and other alterations may still be available only in branded forms). So the pharmaceutical industry needed to move on to something new.

Enter the ‘atypical antipsychotics’. They are ‘atypical’ because they work differently from the old antipsychotics. The old drugs were essentially dopamine blockers. The class had been discovered because of an herbal folk remedy for insanity, from which a very effective anti psychosis drug was isolated. It turned out that it worked by blocking the effects of dopamine in the body. This led to the ‘dopamine hypothesis’, where schizophrenia was postulated to be the result of excess dopamine. That idea turned out to be far too simplistic, but there is little doubt that dopamine is one of the neurotransmitters that goes awry in psychotic illnesses.

Atypicals, however, have less effect on dopamine than the older drugs, and more effect on serotonin and other neurotransmitters. (They also may be more discriminating in which of the body’s several types of dopamine receptors they target.) The prototype was clozapine (Clozaril), which had tremendous antipsychotic activity, but life-threatening side effects. Working from the structure of clozapine, researchers created the other atypical agents. These include: olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and risperidone (Risperdal).

Unfortunately, I have taken all of them at one time or another. Oddly, although I have had one episode of psychosis, my psychiatrist at the time prescribed atypical antipsychotics long after the psychosis had resolved. That’s because the drug companies started promoting these agents for mood disorders. First they were proposed for manic symptoms, but eventually some of them were touted as effective agents for severe depression. They are being used more and more for such reasons.

When I took them, they mainly felt like strong sedatives. Sure, they helped with agitation. They made me feel like I’d been hit with a hammer.

Problem was, they had terrible side effects. Well-known problems include incredible weight gain, increased cholesterol, and diabetes. I got the first two, and was well on my way to the third by the time I finally quit the drugs. There are other side effects, it turns out, when these drugs are used in combination with different classes of psychiatric medications. I won’t go into detail right now, because I am still getting up the nerve to talk about how these drugs have harmed me: it is a very sensitive subject for me.

My point right now, however, is that these are toxic drugs. Their side effects are far more dangerous than, say, those of the SSRIs. Given the epidemic of obesity and ‘metabolic syndrome’ in this country, we really should question whether these drugs are being overused. Especially since the evidence for their effectiveness in many conditions is not all that convincing.

Addendum:
Here is a link to a good site to check out if you want to know more about the controversies surrounding atypical antipsychotics. I also just came across an article about the problems with big Pharma and atypicals (with reference to a recent major legal settlement involving Zyprexa) on HuffPost by Dr. LLoyd I. Sederer. My thanks to Liz Spikol for her The Trouble With Spikol blog post summarizing the article.

Atypical Antipsychotics was published on July 2nd, 2009, with the tags , , , , , , , , . There are currently 1 comment on this article so far.