Suicidal ideation

With some full disclosure to my doctor, I got a new label of something I have: Suicidal ideation.

Sounds scary or kind of cool or maybe like an awesome name for a band, huh?

Well, if you look up the definition, it can definitely slip over into Scary Land:

Suicidal ideation is a medical term for thoughts about or an unusual preoccupation with suicide. The range of suicidal ideation varies greatly from fleeting to detailed planning, role playing, and unsuccessful attempts, which may be deliberately constructed to fail or be discovered, or may be fully intended to result in death. Although most people who undergo suicidal ideation do not go on to make suicide attempts, a significant proportion do. Suicidal ideation is generally associated with depression; however, it seems to have associations with many other psychiatric disorders, life events, and family events, all of which may increase the risk of suicidal ideation. Currently, there are a number of different treatment options for those experiencing suicidal ideation.

That one comes from Wikipedia.

From About.com we get:

Strictly speaking, suicidal ideation means wanting to take one's own life or thinking about suicide without actually making plans to commit suicide. However, the term suicidal ideation is often used more generally to refer to having the intent to commit suicide, including planning how it will be done. Suicidal ideation is one of the symptoms of both major depression and bipolar depression.

Ah ha!  That's me if you just reference the strictly speaking part...especially the area I set in bold and underlined for extra impact. 

There are days I wish I was dead.  There are moments when I cannot help but think that it is the only way to be done with this.  I sometimes think that my family would be better off without me and my issues.

But...

I do not have a plan.  I have no intention of harming myself or others.  I am not going to kill myself.

Why?

Because I don't really want to die.  I love my life.  I love my family and my friends.  I love the activities I do and the things I accomplish.

My husband knows and understands this.  Often when I tell him that I wish I was dead he will calmly ask me if I have a plan.  When I tell him no, he just gives me a hug.  I also have friends who know and understand.  They know the right questions to ask just to check that I haven't slipped over into the Scary Land version of suicidal ideation. 

So, I have suicidal ideation.  For me, it's not necessarily bad or scary or something that requires intervention.  It's a thought and nothing more.

So...

I haven't done a personal post in a while.  It's mostly because there is nothing to say about me or my life...at least nothing that relates to my mental illness issues.  Since this blog is dedicated to that, I don't want to ramble on and on about my friends or pets or family.

I had a checkup with my doctor on September 20.  It was one of those med review things.  I'm at a difficult point in my "recovery/fight/struggle".  My meds work.  I don't feel bad and have more good days than bad days.  Life in my head is starting to even out some and is less chaotic and I generally know what to expect.  But, I still have bad days.  And I still struggle.  And there are still times that my depression stops me from doing things.

This is a difficult point because I am topped out dosage-wise on my Zoloft.  It cannot be increased anymore.  According to the dr. the med he would usually add on would be Wellbutrin but that doesn't work for me, in fact, it makes things worse.  With Zoloft he doesn't really like the other combos.  So, we would be looking into trying a new med and dropping the Zoloft.

That scares me.  In a way, my Zoloft is a security blanket.  I know what it does for me and how it affects me.  I know which side effects I usually see.  We know each other and are friends.  A new med is starting over.  A new med is potential success or failure.

Because I have been dealing with this for 17 years and have been treating it with medication for 14 years, there are several drugs I have tried that didn't work for me.  Most of those are now offered in generic form.  I still do not have health insurance or a job so we have to budget.  And generic drugs are generally affordable.  If we bump up into the non-generic drugs, things get pricey.  Yes, there are programs available that can offer some help.  And, yes, there is the potential that I can get free samples from the doctor.  But...

I do know that I'm going to do what is best for me.  Even if that means the expensive meds.  Me getting better and leading the best life I can, despite my depression and anxiety, is the priority.

So the dr. and I talked.  He asked me what I wanted to do.  I told him I would like to stay on my current meds.  I want to do this because I feel like I'm finally even and predictable/stable and want to see if that is the kind of existence that I can enjoy.  I need to figure out how to "do me" in my current situation and see if it enough. 

I go back in 6 months and we go from there. 

The price of happiness has gone up

Today was my one month med check with Dr. S.  It went really good.  As I've said in a few past posts, I'm feeling mostly good but still just a bit blah and unmotivated.  I'm also still having some brain issues in that my thoughts are jumbled at times and I'm increasingly forgetful.  Dr. S said there were three options to remedy this:

1. Get on a routine that includes at least eight hours of sleep a night.  Exercise daily and live a healthy lifestyle that includes eating properly.  
2. To increase my Zoloft dosage.  Zoloft tops out at 200 mg and I am currently taking 100 mg.
3. Add an additional medication to give me a boost without the side effects of increasing my serotonin like Zoloft would do.  He would put me on 150 mg of Wellbutrin XL. 

The first option is already something I'm working on and it is slowly falling into place.  The sleep schedule is still not right or perfect but that is because of my husband and his current work schedule.  I am trying to eat better and take care of myself physically and spiritually.  It's a process and one that I'm slowly incorporating into my life again.

Option two and three were the ones we discussed.  He wanted to go with option three and I agreed with him.  I'm worried that more Zoloft will make me into a zombie who cannot feel emotions.  It is already messing my my sexual pleasure but that is something I can deal with for now.  Wellbutrin (generic is Bupropion HCL 150 mg XL) will help with the sexual stuff and should give me the boost I need to get motivated and get past the blah feelings.  It will also, hopefully, help with the concentration issues.

Although I have the pills now, I'm not going to take them until Friday.  My Zoloft is almost gone so I might as well start them both at the same time with thirty pills each.  By doing this I also won't be running out of one two days before the other.  It's a little bit OCD of me but that is how I roll.  

So the cost of my happiness has gone up, at least for now, and will if the Wellbutrin works.  Here is my new breakdown for costs of my medications:

• Bupropion HCL (generic form of Wellbutrin) 150 mg XL tablet -- $38.08 for thirty tablets
• Sertraline (generic form of Zoloft) 100 mg tablet --$19.72 for thirty tablets
• Lorazepam (generic form of Ativan) 0.5 mg tablet -- $16.84 for sixty tablets

The Lorazepam is not something I need to refill monthly and, if history is any indication, the sixty tablets should last me around six months.  This makes my monthly medication bill to be just under $60.00.  Not bad, really.  I did find a discount prescription site and my card should arrive in a few weeks.  I'm going to give it a try since it is free.  Heck, it cannot hurt and if I can get my meds for half price or less, it is definitely worth it.  

Dr. S has also pretty much dismissed the thought that I might be bi-polar.  He still wants me to self-monitor for any signs or symptoms.  But he is feeling rather confident that I'm not.  He did mention that it can turn at any time so I'm to report any problems immediately.

Also, I'm to take the Wellbutrin in the morning.  If I find it messes with me being able to sleep, I'm to switch it to something I take before bed.  It's really just a game of chance and figuring out what works best for me.

My next med check will be in three months on Tuesday, January 8, 2013 at 9:30 am. 

Back in the saddle again

Yesterday, I returned to the doctor after being off my anti-depressant and anti-anxiety meds for at least a year.  Overall, it went as I expected but there were some moments that surprised me, in both good and bad ways.

I waited for a long time for my appointment.  I get so frustrated when I have an appointment and it is not kept.  I realize that things happen and that appointments cannot always be kept but I would feel much better, and be much less likely to have the panic attack I had, if someone would at least communicate with me.  Let me know my doctor is swamped or was called away with an emergency.  Just reassure me that I haven't been forgotten.

What do I mean by a long time to wait for my appointment?  My appointment was for 2:30 pm.  I arrived 15-20 minutes early to check in.  At 3:30 pm, I was finally called back from the waiting room.  I was then put in an examination room while a nurse took my information.  To be fair, the clinic is going to a new computerized system so the intake was a bit slower than normal.  After the intake, I sat there for at least 10 minutes before getting moved to a different examination room.  I finally saw my doctor at 4:10 pm.  This means that I waiting for my doctor for an hour and 40 minutes beyond my appointment time.  I call bullshit.

In this post, I wrote about my apprehension for the appointment and what would probably happen.  It is slightly accurate.  One thing I can say for sure is that I now know that my doctor DOES LISTEN to me.  Huge sigh of relief on that.

We talked and we both listened to each other.  He told me that besides my meds, I need to also be leading a healthier lifestyle that includes getting eight hours of sleep each night, incorporating regular exercise and eating healthy and regular meals.  I know that and agree and will do my best to make those healthy habits stick.

One of his new concerns, and one that I've heard before, is that I might be bi-polar.  His thoughts are based on how my moods sometimes cycle rather rapidly.  I do not experience intense mania, but may be quite "okay/normal" one moment and an hour later I can be impatient and in tears.  Dr. S's concern is that if I'm bi-polar, treating me with only anti-depressants will be a bad thing that can actually escalate the mania moments.  Not cool.

If I am bi-polar, I'm okay with that.  Different diagnosis do not scare me any more.  I feel the more I can be labeled with as far as my mental illness(es) go, the better because knowing what I have to battle against allows me to best prepare for that battle (e.g. medication, research, support groups).  If I can name the problem, I can address it.

The fear I do have if I am bi-polar is affording the medication.  It is much more costly than regular/typical anti-depressants.  Dr. S did reassure me that there are a number of programs available to help offset the cost.  There's a lot of paperwork involved and the application/referral process will take upwards of twelve weeks.  I will need to rely on my parents even more should this be the case.

Because Dr. S isn't fully convinced I am bi-polar, we are going to continue to treat my depression and my anxiety.  I'm back on Zoloft, 100 mg once daily and have Ativan, 0.5 mg that I can take up to three times a day as needed.  I am to be hyper-vigilant for any expressions of mania or high moods.  My anti-depressants should start to show in my moods in about two weeks with them reaching their maximum helpfulness in six-eight weeks.  I am going back for a recheck in four weeks on October 16.

I'm back in the saddle again.

HISTORY: Post-traumatic Stress Disorder (PTSD)

*I first mention PTSD in a post I intended to devote only to medications.  This post is a continuation/clarification of that original post, which you can read here.

When Dr. S mentioned PTSD, I wasn't entirely surprised.  It made sense and after I had shared a lot of my history with him, I knew he might go that route and tack a PTSD diagnosis on with everything else.  He strongly recommended counseling to work through those issues.  That wasn't going to happen and it's not going to be happening any time soon.

I think the PTSD label is semi-accurate.  I don't overly identify with it but know that it is part of who I am and will be something that I will struggle with, perhaps forever.  I'm okay with that.  As much as my past is painful, it has made me who I am and I really like that person.

HISTORY: Agoraphobia

*I first mention Agoraphobia in a post I intended to devote only to medications.  This post is a continuation/clarification of that original post, which you can read here. 

Agoraphobia is more than just the fear of leaving your home.  It is more of a fear of being unable to get out of a situation or location.  This fear may be of being embarrassed or just not seeing a way out.  It is because of the perceived fear that some become unable to leave their own homes or safe areas.

I was able to leave my home but there were moments that I simply could not handle the thought.  This makes life very difficult when you have obligations outside of your home.  And I did.  Often I would work myself up into such a panic that I couldn't leave.  Sadly, this also created some permanent memories of bad experiences that I was unable to get past and prevented me from being present in some aspects of my life as well as the lives of my family members and close friends.

I still have issues from time to time but the anti-anxiety medications have helped immensely.  There have been very few incidents in the past three years that have actually forced me to stay home.  I feel like I've mostly conquered my agoraphobia, so much so that I no longer consider it to be part of my diagnosis.

HISTORY: The panic attacks

*I first mention panic attacks/anxiety disorder in a post I intended to devote only to medications.  This post is a continuation/clarification of that original post, which you can read here.  

I cannot remember when I had my first major panic attack but I do recall that it kicked my ass - mentally, physically and emotionally.  It must have been in late 2004.

When they first started, they were small.  I'd get worked up and have problems calming down and catching my breath.  Generally they were short and about the time they started, I would be able to work myself out of them.

But something changed.  That first major panic attack left me gasping for breath.  The tightness in my chest was nearly unbearable and I honestly wondered if I was having a heart attack.  My throat was raw, my muscles were sore from getting so tense.  I was crying and panicked.  This sucks!

I would have panic attacks while at home.  I would have them in public.  I would have them in my sleep and wake up in the throes of a full-blown panic attack.

Getting back on my Zoloft helped and the Ativan really made a difference.

I still have panic attacks from time to time.  They occur much less than they did in the beginning and it is rare that I have the big, full-blown panic attacks.  I have begun to recognize situations and environments that are more apt to cause me to have a panic attack and I have been building up my arsenal of coping mechanisms.

HISTORY: The bi-polar diagnosis

*I first mention the bi-polar diagnosis in a post I intended to devote only to medications.  This post is a continuation/clarification of that original post, which you can read here. 

In my post on anti-depressants, I talk about Dr. R giving me the diagnosis of bi-polar instead of just depression.   When I first heard the term, I was terrified but in some ways, it made sense.  The cycling, the highs and lows...these were hallmarks of bi-polar disorder.  But was I?

I'd been wearing my depression diagnosis for seven years at that point and we were getting pretty comfortable with each other.  This was something different.  This was something new.  This was something I knew very little about and couldn't wrap my brain around it.

I freaked out.

Upon arriving at the pharmacy with my new prescriptions, this time to include Lithium for my bi-polar disorder, I called my mom.  I was in tears and scared.  I don't know why I was scared but this was new and different and I needed to talk to someone.  Since my husband was at work, mom won the lottery.

When I told her about this new diagnosis, her comment made me angry.  She told me that I wasn't bi-polar.  When I asked her how she knew, she said "I know you and know that you aren't bi-polar."  She doesn't know me.  She knows what I choose to let her see.  She knows what I let her know, nothing more.  She is not in my head and she doesn't walk in my shoes.  It wasn't for her to decide.  I know she was probably reacting as a mother and not wanting this for her daughter.  I understand that now but, in that moment, I was pissed off that she made the statement. 

I was on the Lithium for a while but it made me a bit of a zombie and I was someone that was unrecognizable.  My husband was especially concerned.  After discussion, I was weaned off the Lithium and Dr. R changed my diagnosis back to depression.  I don't remember what reasons he gave for the change in diagnosis.

After this (mis?)diagnosis, I did further research into bi-polar disorder.  I am much better informed.  Do I think I'm bi-polar?  I'm not sure.  If I am bi-polar, I would have bi-polar disorder II, which is where the mania episodes are less intense.  I would also often be in the mixed state where the mania and depressive states overlap.  I'm not a doctor so until one tells me otherwise, I will keep my depression diagnosis and work towards maintaining my mental health.