Resolve

It sure took a while, but I'm finally coming around to some stability. There is still plenty of confusion, but it's no longer the sharp, bewildering threat to my existence that it was last month. Once again I am larger than it is. Phew!

Yesterday I confirmed my appointment with Dr. S------ and put my acupuncture treatment on hold until next month to avoid blowing out my budget. This was in contradiction to advice from both Sunny and Mike, my opposite extremes, and I think it indicates the return of my own opinion.

The weird element is that I'm now doing a self-indulgent teenager routine, staying up late watching Firefly and then sleeping in until 10am on a weekday. At work I'm unmotivated (although I'm never motivated after 4 hours of front desk duty.) What does it mean? Maybe it's my MO to spread my energy around when I feel it returning; an MO I need to change. I need to focus. I need to make an outline of what I want to talk about with Dr. S------ on Thursday, and by extension, the goals for my treatment this year.

The broad goals are to treat depression and inattention. But in treating them, side effects become issues of their own accord: the jittery inattention, impeded memory and sexual side effects from Effexor make it only a so-so trade off. The question now is whether 5-HTP and other nutritionally based interventions, along with exercise, CBT and therapy can create an approach where these side effects don't figure. Because it crosses specialities and disciplines it's a longshot, but I'm prepared to be diligent and thorough like never before in the interest of moving my life forward in a real and lasting way.

Reality check

I did end up getting my mood dip, two days after the missed dose. It wasn't as severe or as long-lasting as the one before I added Effexor and 5-HTP so serotonin is a factor. The other major dysfunction is attention, which has been going very poorly since Effexor re-entered the equation. It could be because of Effexor, or it could be the last thing to correct itself after the depression of early February. I was laying in bed this morning, scanning my outlook and am now almost certain that at least half of the problem is that I'm incapable of finishing anything. It's very demoralizing to be living such a thoroughly unfulfilling, and hence depressing, life.

Is going off meds really the best use of my energy at this particular time? It is a complete life-suck! I have fewer mental faculties to analyze an increasingly subtle and more complex situation, while trying to gain some traction in other areas of my life. Am I just self-sabotaging by biting this off at this point?

I've now engaged two additional health/mental health providers, one of which (acupuncture) is going to cost me a pretty penny; and in the meantime have to decide whether to drop Dr. W---- as my psych, and how therapy with Charles is to go forward. That's a lot of variables to be managing in a state of confusion and exhaustion and subject to lapses of depression. Additionally, there is the hard limitation that my professional situation also needs focused attention; attention I simply cannot muster!

Grr! This is so not what I wanted to be doing this year! I was going to shape my future and build more fun into my life. Instead, I feel more stuck than ever in the remnants of my former life with Jason.

I have come to one conclusion from reading online resources for adults with ADHD: I start too many projects. My house has become a de facto unfinished project graveyard, and every carcass is a reproach. I'm surrounded! I need to get organized, and start by culling some projects.

I've already rearranged the living space to reflect this intention: Where before I had a conversation area (albeit one infringed upon by the moped - yet another unfinished project) I am setting up a study area for computer and desk work. Whatever clothing or fabric items I can't put away I'll get rid of, and no more can be acquired until the reserves dwindle by at least two projects.

The kitchen needs a complete head to toe, and I need to make a firm commitment to doing the dishes within a day of their use. It ocurred to me the other day that I always tip without fail, and that when eating at home there should be a similar inalienability between eating and washing the dishes.

(I can feel the coffee kicking in. I've started drinking it now and again, and so far my stomach has not reacted too adversely. It does make it harder to tell what the medications and acupuncture are doing, but it's nice to at least have the opportunity, occasional as it may be, to be able to think through a full thought.

In addition to a personal organizing system, I think I need a mood log to record my shifting states. Coming up with metrics that I'll actually be able to assess regularly and that'll be useful is the challenge. And actually logging them, but that almost goes without saying. I've been wanting to get an iPhone, but maybe and iPod Touch that I can use as a PDA is more realistic.

I also need to establish a budget. Acupuncture twice a week at $70 a pop is a significant cost, and I'm not sure I can actually afford it. I might have to re-evaluate this schedule, and make cuts in other areas of expenditure if I decide to go forward with it.

Basically I need to realign my priorities and shave off the extraneous. That's really hard since I excel at said extraneous activities while the essentials tend to be areas of deficit, but it's what I need to conquer if my life is to change in any significant way.

I have half an hour before I have to leave for acupuncture, so I'm going to get started designing the affect log.

Progress report

Yesterday I forgot to take my meds (and supplements) until late at night. Toward the middle of the afternoon my attention started to fray significantly and I could no longer do any complex work. I had some coffee hoping the energy boost would help but it didn't and only made me jittery as well as distracted. As soon as I realized that I had missed the dose I took it, cringing at the withdrawal I would suffer today. Only it didn't come! I love 5-HTP! I have buoyancy!

Saying yes to more

Last night I went to an acupuncturist for the first time. The woman who worked on me also did cupping, which consists of applying glass cups to your back and then creating a vacuum in them to suck toxins out of your body. She did this at least 30 times, all over my spine and different spots around my back. I can say this with conficence because my back is very sore and covered in purple circular bruises, but I did feel better afterwards and still do today.

I had also just increased Effexor to 75mg the day before so I can't conclusively say it was the acupuncture/cupping, but I'm keeping an open mind. Maybe I'll lower the Effexor to 50mg next week as a control since I have two acupuncture sessions scheduled for each of the next two weeks. That should be enough time to establish causality.

The stuff's not cheap either, and only 30% of it is covered by my health insurance, but if western medicine isn't resolving my problem it makes sense to look at alternatives. And I'd rather spend my money on my health than on clothes or stuff for the house.

Adjustments

So last night I stayed up too late and caught a sore throat. Does that mean I deserve to be bedridden today? And what's more, feel horribly about myself? This is unacceptable and it's clearly medication/depression-driven.

In the meantime, my psychiatrist is still on vacation and his possible replacement won't have an appointment for me for almost another month. So I have to work out on my own what I'm going to do here.

I started the year saying yes to things, but this strategy clearly has to be attenuated to realistically reflect my resources. What's happened is I've said yes to everything indiscriminately while at the same time my mood is contracting at a rate alarmingly similar to that of the economy. So I have to cull some of the stuff I said yes to and set up tiers of priorities for my fluctuating energy level.

First the list of current projects and commitments:

- knit Thomás' blanket
- Skype with Max and Karina
- learn Flash and Actionscript 3
- read Catfish and Mandala by March 15
- cull and organize fabric pile
- finish plaid shirt
- plan Cambodia trip with Andy
- make clothes for Cambodia trip
- fix moped
- do taxes with Matt
- file for divorce
- pay off debt
- meet/date guys
- clean/organize kitchen
- stop getting sick!!!! Get a hat!
- sort out medication
- establish an exercise regime
- establish a monthly budget
- start saving

There's more, but these are the bulk of the stuff that circles my consciousness on a regular basis so it's what I have to sort through to free up mental space.

What's missing

Okay, it's resuming, this downward slide toward depression. I've been listening to "The How of Happiness" on CD and am reminded of everything I've forgotten about the mechanics of depression: the triggers, the self-reinforcing patterns; and I feel an urgency to formulate a strategy to counteract it.

So what's missing in my life? What am I not doing that I need to start doing? For one thing, I don't have enough (1) relationships that matter. In fact, relationships stress me out, which makes me avoid them, which reinforces the isolation. So I have to figure out how to negotiate relationships. All of the ones that I've sidelined because I don't have the bandwidth. Especially if I'm not going back to the Samaritans I need to be answerable to the people in my life.

Also, (2) continuity. Whether it's depression, Asperger's or ADHD that's responsible I can't just keep going from field to field, never acquiring expertise, never finishing anything. I need to build upward and forward. I don't need a fresh start; I need progress. I need to learn how to synthesize and develop.

(3) Exercise. I just got out of yoga and feel so much better than I've been in the past two days. I've been mopey and deflated, and it shows! People have remarked that I don't look happy. I have to make time and emotional space for exercise. Maybe add another activity in addition to yoga. But what?

(4) Visualize my future. I'm coming to the conclusion that I just have no idea what I want my life to be like, and it kind of makes sense: for six years Jason had set the beat for our lives. Now that he's gone I don't know what that beat should be. I was so much younger six years ago that that doesn't inform my situation now. Am I going to be a producer of culture? Am I going to be a consumer? Would I be content to settle down with a hard-working suburban husband? Do I need to move to San Francisco? If I want to shape the outcome of my life I can't just wait for these questions to answer themselves.

Finally, the glue that holds it all together is (5) discipline. I need to intentionally cultivate optimism; cut short the negative overthinking; live in the moment; and enjoy it. These are things I have practiced and benefited from before, but which have eluded me of late. And only I can make these into my priorities. I have to handle stress better since it's the trigger that brings the whole thing down. I need to devise and stick to better life systems. I can no longer just fly by the seat of my pants. It's time to set some order and stick to it.

This last part is going to be the most difficult. I have never developed a habit I didn't break; or started something I didn't get sick of. Staying engaged turns out to be the most crucial part of life, and it's the single lesson I've flunked the most times. In school I'd get in juust under the wire because I was smart and tested well, but in life it's about stamina and dedication. I may need to get a coach to keep me on track; or CBT; or both. This is the long haul.

Coming up for air

I don't know what happened to my mental state in the last couple of weeks. I don't know if it was a delayed Effexor crash or some crazy combination of sickness, exhaustion, stress and PMS. Or maybe it was an aggregate of all of those things plus the Effexor crash. It started out as many depressions before it had: slow, heavy, and murky. But I was also feeling so much older and less healthy than I had ever been during previous depressions. I had just received news of my last living grandmother's passing, which did nothing to remove sickness and mortality from my thoughts.

By Thursday of that week my mood had devolved to complete despair and confusion and I considered suicide as an option for the first time ever. That was indeed very scary and finally prompted me to reach out to Jessie, Mike, Sunny, Martha, and on Jessie's urging, Charles. Acknowledging the acuteness of the pain was helpful in getting it under control, and then accepting that restarting Effexor might be the only good choice was the beginning of the recovery trajectory. In the end -- and I'm not sure that it is in fact over -- a small dose of Effexor seemed to help to stabilize me, although I started taking it last Monday, and my mood didn't really right itself until Thursday night when I went out drinking with people from work.

That night deciding to go out in itself was of some controversy with Sunny, who warned that alcohol would only aggravate my depression. But I knew from previous experiences that alcohol is uniquely useful for breaking a thought logjam and figured it might do the same for a mood rut. It worked. I was so glad of it in fact, that I wasn't even upset after I passed out and hit a metal door with my cheek, giving myself a shiner I'm still nursing. If I've learned -- or rather, been reminded of -- anything it's that where depression is concerned you have to take the good moments wherever you can get them. Hunkering down is a total fallacy of depressed thinking. You don't get used to depression; it imprisons you.

Friday saw my mood much improved, but it was also when I got my period, hence the causal tossup between Effexor, alcohol and hormones. It wasn't an aggressive or manic correction, but the needle had definitely made it onto the positive side of the dial despite occasional wobbles. Over the long weekend I made an effort to keep busy even when it meant ignoring the feelings of confusion and tiredness, and maintaining that momentum may be another key to staving off depression.

So I still don't know what happened to me in early February. I was like a teenager swinging from suicidal ideation to passing out drunk to ho-hum totally fine -- which would support the PMS hypothesis, except I can't recall ever having PMS so severe in my life.

Now if I can just get rid of this confusion I'll be satisfied that I'm out of it completely. But again, it could be akathisia from being back on Effexor. My knee's shaking again...