New Data

So a new study has come out from England suggesting that the modern anti-depressants are not clinically more effective than placebo. I don't really know how I feel about that. Half the time I'm not sure if my depression is real or if I'm engaging in some sort of cowardly escapist self-deception, so why should I be any more confident in the treatment. I know it does something. The dreams and the sex don't seem to me to be placebo effects. Something is going on in my brain and it's something I can feel. I don't know if Prozac is better at causing side effects than it is at treating depression and anxiety. That would certainly be irony.
I know the stuff isn't perfect, I believe if it were I would feel better. The motor wouldn't run all the time, the anxiety wouldn't consume me the way it does. The waves of self-hatred, the unseen, unheard, breakdowns in the shower or at work, the self-destructive thoughts triggered by frustration, all these would ease. It seems that Prozac is a lifeboat with a leak, and I don't know if it will float, swamp, or sink. I just know that jumping out of it is more than I can face.

Fluoxetine Dreams

There is an apparent blood-level of medication that I tend to pass on the way up and on the way down where my dream-life becomes very active. Usually it happens when I change levels of medication, run out and skip a few more days than I should, or when I start to get attenuating effect from my current dosage. In fact it seems to be a decent barometer of when things are about to go south with my condition. Right now I'm getting used to my new higher dose and I'm still in the vivid dream stage. As a matter of fact I've been there longer than the normal couple three days, and I wonder about this. I guess we'll have to wait and see.
In the meantime, I just need to deal with the night-time strangeness. The other night I dreamt a party at my parents' house and late in the evening all the parents of these adult people at the party came to pick them up and they were all of a really advanced age. One of the people at the party was a coworker, only for some reason her name was Mavis.
Another time I had a dream about being chased through my best friend's backyard by a couple of hippopotamus'. Then there was the strange carnival where I had to play home-run derby using a tightly rolled towel as a bat, and the one where I wandered through a labyrinthine parking garage, mad at my wife because she let the car get stolen.
It's entertaining, anyway.

Sex and Prozac

Guys on Prozac probably know where this is going.

I may be making an assumption here, but I feel safe in generalizing that the great majority of those suffering from depression have associated image and esteem issues. That being the case, it's terribly ironic that the popular treatments for depression cause difficulty in sexual performance. Obviously there's a disconnect (heh) here. Even when everything works it still becomes much more like work and less like fun. Which sucks. So you get depressed, take medication, impact your sex life, feel worse about yourself, take more medicine... you can see where this is heading.

I can often tell how effective the level of medication I'm on is by how easy sex is. A bit of a catch 22, really, once sex starts getting easier and more enjoyable then I know my depression is about to get worse. And in reverse fashion, once I start feeling better, there goes the sex. Of course, one could always respond by more medication, but the insurance companies are awfully stingy with Viagra, seems they want to try and tell you how often to have sex.

Sore Throat

I spent fifteen minutes screaming at God the other day.



Actually it was my therapist who suggested it. I'm angry, and the one I'm most angry at is God, if you want to put a face on it. I'm not going to go into the details of my reasons, even a blogger gets a little privacy, but my life has felt like the target of a bored cat, something to be played with. So right or wrong, that's how I feel and the anger and frustration I harbor fills me more and more. So she says I won't heal until I deal with the anger.

So I shouted at God, told the deity(if any) what I thought of someone who would play around with someone's life as it feels mine has been played with. Said things that two-thirds of the christian community would no doubt declare put my down payment on lake-front property in Hell. If so at the moment being damned feels neither better nor worse than I was before.


All it really seemed to get me was a sore throat.

WhenTheMotorWon'tStop

The motor won't stop. When I get hit by something, the motor starts, and becomes the energizer bunny.
My mother's car broke one day on the highway, years ago. A piece inside the engine somewhere broke off and rattled around in the guts of her minivan until it stuck in the mechanism that controls the accelerator. The car behaved like the pedal was floored no matter what she did. She started flying down the highway faster and faster, the engine roaring louder and louder. It took her a while, but she finally got it out of gear and coasted it to a stop.
This is my nervous system. When life takes one of its normal innumerable little shots at me it knocks something loose and the heart pounds, the hands shake, fight or flight cuts loose, rattling around inside a small box. I can't find the way to get it out of gear. A thousand unhelpful visions flash across the screen inside my head and like Alex amidst the Ludovico technique, I can't stop it. Last night it took an hour of computer trivia at 2am to make it stop.

My brain doc was outraged, in his mild idiom, when I told him the HMO wouldn't pay for enough pills for 60 mgs daily. "Let me know if I can help..." he said.

Charlie Brown

This is how I often feel. A hot thrumming guitar string across the middle of my stomach lets me know my dread has crystallized into a fear of something concrete. Stupid things. What ifs. Conflict with people who's reactions to me shouldn't cause me to bat an eye. Charlie Brown always said his stomach hurt. I understand what he meant.
Charlie Brown wasn't nearly the comic figure that his creator intended him to be. He was the poster child of depression and anxiety disorder and if he had ever been allowed to progress to adolescence he would without doubt have been a teen suicide or a serial killer.

From A Charlie Brown Christmas.
Lucy: "Are you afraid of responsibility? If you are, then you have hypengyophobia." Charlie Brown: "I don't think that's quite it." Lucy: "How about cats? If you're afraid of cats, you have ailurophasia." Charlie Brown: "Well, sort of, but I'm not sure." Lucy: " Are you afraid of staircases? If you are, then youhave climacaphobia. Maybe you have thalassophobia. This is fearof the ocean, or gephyrobia, which is the fear of crossing bridges. Or maybe you have pantophobia. Do you think you have pantophobia?" Charlie Brown: "What's pantophobia?" Lucy: "The fear of everything." Charlie Brown: "THAT'S IT!"

I grok this. Pantophobes of the world unite, you have nothing to lose... since you're afraid of everything already.

Stuck in the Mud

So that's what I am. The euphoria passed and things are not a whole lot better than they were before I started, at least at this moment. I can tell you about symptoms and serotonin uptake etc, etc, but I still don't understand my condition. I feel dangerously close to the edge of self-pity talking about this, I don't want to descend to the level of "poor me". But one of my greatest dilemmas is figuring out where my flaw ends and my fault begins. It is so easy for anxiety and depression to put a person in a place where even trying to improve seems an insurmountable obstacle. When is that legitimate and when is it 'sitting in the shit and complaining about the smell'? I don't know, I really don't. It's been ten years or so since my diagnosis, and aside from being able to keep a job I'm not sure I really want I don't know that I am any healthier.

My psychiatrist just increased my dosage. I am now at 60 mg once daily. I started this process at 10 mg. The curve is alarming. 5mg/year or thereabouts. Hmmm... there goes my sex life. Those riding the Prozac bus know of what I speak. Combine that with incipient middle age and I am lucky when I get my rocks off at all. Where is it headed? Am I looking at climbing up the dosage ladder step by plodding step until I reach the maximum dosage, then, when I still have problems, switch to Wellbutrin or Paxil or the flavor of the month and start at the bottom again? Will I ever really reach a place where I consistently feel better? Am I expecting too much? If I am supposed to haul myself out of the hole on my own, then (not to mix metaphors or anything) I feel like I brought a knife to a gunfight. Again, I return to the question of whether or not these thoughts are condition or behavior. If the latter then anyone reading this is entitled to point and laugh and throw rocks. I can't stand self-pity. Which makes me suspect that often I can't stand myself.

Crises at home lie behind the increased dosage. I found myself alone in a room at work unable to function for the better part of an hour, thinking I was having a nervous breakdown. I kept wondering if I should go to a hospital and then wondering how much doing that would cost me (not financially but overall). I ultimately rode it out but the effects linger and upon telling my brain-doc he suggested upping my dosage. My therapist's advice is Winston Churchill's; "When you're going through Hell just keep going."

So that's what I'll do.