Better living through chemistry

Bupropion and trazodone pills

Walgreen’s is my dealer.

These are the pills that keep me sane, or at least keep me in the world of the emotionally-vibrant. They consist of 300mg of bupropion (brand name: Wellbutrin) taken in two pills daily and 50mg of trazodone (brand name: Oleptro) taken at night about an hour before bed. Bupropion treats the symptoms of my dysthymia, the emotional dullness and tendency to lapse into major depression. The trazodone, while technically a very weak antidepressant, helps me sleep.

I was diagnosed with dysthymia by my primary care physician in 2012. It seems like people who receive disease diagnoses fall into one of two categories: glass half empty or half full. The former see the diagnosis as a tragedy, yet another misfortune they must tackle. You’d think, as someone with a depressive disorder, that I would fit squarely into that category. Strangely, I did not, nor do I now. Despite my condition, I’m relatively optimistic. Thus, my reaction was a half full one: now I know what the hell’s been wrong with me all of these years and can take steps to fix it. The diagnosis explained why felt like an emotionless golem. It explained why I often felt intensely sad for no apparent reason. It explained why my mood could be completely divorced from the wonderful things happening in my life. It explained that my emotional distance from the world was not a personality trait, but rather a disease.

Bupropion was the first antidepressant the doctor wanted me to try. There are various reasons for this. Most common depression drugs fit into one of two categories: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). SSRIs include drugs such as Lexapro, Zoloft, Paxil, and Prozac, and SNRIs include drugs such as Cymbalta, Effexor, and Pristiq. The Mayo Clinic pages to which I link explain them far better, but briefly, these drugs work by adjusting the levels of neurotransmitters in the brain. Both SSRIs and SNRIs have many common side effects: nausea, decreased libido, insomnia, and more.

My antidepressant of choice fits into neither category. In fact, to make things more fun, researchers don’t really fully understand exactly how bupropion works, though they have a general idea. But before I get into bupropion and how it helped me, I should probably explain how I got to the point of getting the prescription in the first place. My doctor’s visit was precipitated by a terrible bout of major depression, one where I got the closest I ever had before to committing suicide. My friend encouraged me to go, and I am so glad that she did. The doctor said that my symptoms are consistent with dysthymia, a word I’d never heard before. She also said, because of the disconnect between my mood and what was happening in my life, that I was a good candidate for medication. She prescribed bupropion.

Before I started the bupropion, I had hardly any energy. After work, I’d come home, collapse, and just read random things on my phone until I gave in and decided to attempt to fall asleep, usually unsuccessfully. When I first started taking bupropion, I felt amazing. It was like I’d been seeing the world in greyscale and suddenly could see in color. These emotions that I’d experienced in full only periodically in my life came flooding in. I don’t think that I really understood the stunning beauty of the Columbia River Gorge, where I live, until I started taking medication. The vibrant green forests, sheer sculpture-like rock faces, and shining river hit me with a wave of emotion. I never really thought of beauty as an emotional attribute before, but that experience changed my view of it.

Most importantly, I had my energy back. Within three days of starting the drug, I not only had enough energy to mow the lawn of the house of was renting, but also the one of the house I was buying and my neighbor’s lawn. In one day. This was unheard of for me. I cleaned the house. Work tasks were dispensed with efficiently and effectively. I felt like a person again, with emotions, motivations, and energy. My initial experience with bupropion made me realize that so much of who I thought I was – that person I hated and criticized – was not actually a part of my personality, but rather an illness.

The honeymoon lasted a few months with bupropion. The first couple of weeks, it ran me through a cycle of side effects. Initially it was the nausea. Then it was the insomnia. Last it was the irritability. Little things would annoy me, things I’d brush off before. Once those few weeks past, it was pretty smooth sailing. Weirdly, though, after a few months, I started getting panic attacks. I would lie on the couch, shaking. They had no apparent cause, and it scared the shit out of me.

Given that strange side effect, my doctor thought it best to try me on other antidepressants. Initially it was escitalopram, an SSRI. Honestly, it didn’t really do much for me. I went back to my emotional dullness within weeks of starting it. Next up was venlafaxine, an SNRI. It seemed to do a reasonable job at elevating my mood, but I was tired constantly. I slept long stretches in an almost coma-like state, nine to ten hours a night, and woke up feeling like I hadn’t slept at all. I took three hour naps on my days off. So despite that my mood was decent, it was hard to notice due to constant exhaustion.

That’s when I decided to go back to the bupropion. This might seem like an odd decision, given the panic attacks, but I thought that 1) now that I knew they were coming, maybe I could predict and control the attacks better and 2) the bupropion’s side effects overall seemed better than the other two drugs. And the bupropion did work better when I began taking it again. The panic attacks never came back; I still don’t know ultimately why they happened. Eventually, the bupropion settled into giving me mild insomnia, for which the doctor prescribed trazodone. However, I didn’t pair my medications with other self-treatment measures. That lack of self-care, and my increasing forgetfulness at taking my medications, led me into major depression, the effects of which were brutal.

After I broke, I got more serious about my treatment. My doctor gave me the option to double my bupropion intake, to 300mg/day, which I decided to try. It made an amazing difference. This time, though, I took on other measures. I started eating better. I bought a rowing machine to exercise indoors during the cold, wet winter months. I improved my sleep habits. After doing some research and consulting with my doctor, I limited myself to one drink per day (bupropion interacts with alcohol even more poorly than other antidepressants), although I was never really a heavy drinker.

Probably my most interesting self-imposed treatment, though, is I require myself to have at least one in-person social interaction per day. Sometimes that interaction involves going out to listen to music or hanging out at the brewery. Sometimes it might just involve interacting with a clerk in a store. As an introvert, I can easily go through an entire day without interacting with anyone, thus further isolating me and exacerbating my issues. My social interaction rule, however, helps keep me connected. Already, that rule has brought some amazing new people into my life

Now that I’m on a positive path of treatment, it’s like I’m discovering the real me. I’m not sure that I’ve ever met him in his entirety, only glances. He’s optimistic. His mind is agile. He loves to hike. He enjoys musicals. He’s a devoted Whovian. Now, all of these things – and more – are coming to the fore. It’s pretty exciting to get a chance to revisit who you really are in adulthood. Chemistry is helping make that happen for me.

Precision of language

I recently reread The Giver by Lois Lowry, a young adult dystopian sci-fi novel written long before such things were cool. For those of you who haven’t read it, and without giving too much away, it’s the story of a boy growing up in an extremely controlled environment, so controlled that people’s families and professions are chosen for them and their emotions suppressed. I cannot recommend this book enough, and I cannot recommend avoiding the movie version enough. Seriously, it’s awful. Just take my word for it.

One of the themes of the book deals with how this society governs the way its citizens communicate. There’s this concept of “precision of language”, the idea that you should use the words that you actually mean, without embellishment (e.g. use “hungry” instead of “starving”). Hyperbole does not exist in this society. As the main character, Jonas, discovers the hidden costs this society imposes, he also begins to see how restrictive this centrally-imposed “precision” is.

“Do you love me?”

There was an awkward silence for a moment. Then Father gave a little chuckle. “Jonas. You, of all people. Precision of language, please!”

“What do you mean?” Jonas asked. Amusement was not at all what he had anticipated.

“Your father means that you used a very generalized word, so meaningless that it has become almost obsolete,” his mother explained carefully.

Jonas stared at them. Meaningless? He had never before felt anything as meaningful as the memory. (Chapter 16, pp.59-60)

Passages like this got me thinking. Dystopias aside, sometimes I think that the language we use to discuss mental illness could use some precision. The terms we use can be interpreted in so many ways, as I noted in my first post; they’re what I like to call squishy.

Probably the obvious terms that fall into this category are things like “crazy”, “losing your mind”, “psycho”, and “insane”. This 2012 article from The Guardian discusses use of these terms quite well. It seems like, while these terms may have started as descriptions of mental states, they’ve gained much more informal use to denote that something’s ill-advised, random, or strange (see the entry for “crazy”). You can see this common use of these terms all over the music world.

I’m guilty of using these terms myself, in the informal sense. I refer to things as being “crazy” or that I’m “losing my mind” in the flippant senses of the terms. The issue, as The Guardian article discusses, is using these terms to refer to people. When used in reference to people, these terms often are pejorative (e.g. “That guy is psycho”.). Mildly pejorative, sure, but pejorative nonetheless.

These terms can be particularly hurtful if used against someone with an actual mental illness, as there’s a good chance one may not even know that the person they just called “insane” has such an illness. Perhaps as a vestige of my undergraduate degree in philosophy, and despite my dark passenger, I have a fairly thick skin in regards to taking offense. However, a lot of my fellow dysthymics have highly sensitive personalities, and I’d imagine that’s the case with people who have other mental illnesses as well. You could unknowingly hurt someone in a particularly painful way by calling them “insane” or “crazy” pejoratively; those people likely already feel deep shame for having a mental illness, and, in a sick cycle, the mental illness itself encourages that shame.

I admit that I’m still pretty bad about using these terms frequently, and occasionally even pejoratively. I’m weak, and it takes time to retrain myself. There is one word, however, that I only use in very specific circumstances: “depressed”. When I was diagnosed with dysthymia, it made me hyper-aware of how people use the term “depressed”. It occasionally gets used flippantly (e.g. “I got really depressed when the University of Oregon lost that game”.), but more often I hear it used by “normal” people to mean that they’re feeling really sad or experienced something sad. “Man, I’m feeling really depressed today”. “The events in Nigeria are really depressing”. “I’m in such a funk; I’m feeling so depressed”. Anyway, you get the point. These statements can be brought on by truly terrible circumstances: grievous injuries, deaths, and other atrocities, to name a few.

Not to belittle other people’s sadness (and keeping in mind that I’m emotionally stunted), there is nothing quite like the intense sadness that you feel when in the throes of major depression. It’s a existential crisis, a crippling weight that your mind cannot unload. This truly terrible and terrifying state has many awful aspects, but it’s made worse by the fact that you don’t understand. You don’t understand why it’s happening to you. You don’t understand what you did to deserve it. You don’t understand how you can rid yourself of it. You don’t even understand how you’re going to make it through another minute, let alone another hour, day, or week. You cannot envision a future for yourself. All hope is lost.

So I don’t use the term “depressed” lightly. If I say I’m depressed, my state of mind is an incredibly awful one. This does not mean that I begrudge others use of the term. Instead, I think that being within the depths of psychiatric depression deserves a new term. I looked through a thesaurus to see if there was any word that comes even close to describing the feeling. “Despair”, “dejection”, and “despondence” get somewhat close, but even they’re insufficient. Perhaps there is a word in another language that truly captures the depths of despair and hopelessness endemic of depression, but I suspect not. Coining new names or words is not a skill I posses, so I won’t punish you by trying. But, alas, until such a word enters the lexicon, I’m afraid that the language of depression will continue to lack the precision it needs.

My harshest critic

I’ve always really identified with the song “Call and Answer” by the Barenaked Ladies.

I realize that the song is about a romantic relationship, but I’ve always thought of the song as somewhat of a metaphor for the warring parts of myself. These lyrics particularly speak to me.

But I’m warning you, don’t ever do
Those crazy, messed up things that you do
If you ever do, I promise you
I’ll be the first to crucify you

Source: MetroLyrics

Before I mentioned I am my harshest critic, and that that critic is a real shithead. As the song says, I’m the first person that will crucify myself if I do something wrong or, as is more often the case, if I perceived that I did something wrong. Many people with depressive conditions like mine judge themselves very harshly, often cripplingly so. Allie Brosh of Hyperbole and a Half depicts this self-destructive tendency brilliantly in her post “Adventures in Depression“. I’m no psychologist, but I think my harsh criticism of myself is amplified in my weaker moments by a warped form of projection bias, namely in that I project my own harsh judgments of myself into other people’s heads; they’re judging me as harshly as I judge myself. My perceived slights against humanity are then amplified, as I fear not only the assholish observer’s judgment, but also the criticism from all of those other people who feel the same way he does.

This feedback effect comes through in my work. When my dysthymia is largely under control, I would say that the criticism is more “tough love”; it makes me work harder, better, faster, stronger, driving me to shut that asshole up and do work about which I can be proud . When I’m not in a good place, though, nothing that I do is right. Case in point from this week: I recently re-designed the website of a local organization with which I’m involved as part of my job. I emailed the membership about the changes and requested suggestions. Someone responded back with a good suggestion. So what do I do? Rather than seeing the suggestion as it was – a good idea that I didn’t happen to think of – I started mentally kicking myself about it. That was so obvious, I said to myself, how could you have missed it? What an idiot.

I’m not an idiot, of course. Or at least I wasn’t in this specific instance; I make no claims on my idiocy in other contexts. I’m human. Sometimes I miss things, and that’s okay. What I am is recovering from a bout of major depression from last month, and hints of it still rear their ugly little heads. Fortunately, since I’m recovering, the better angels of my nature prevailed. That’s what happens when I’m a good state: self-criticism still arises, but the more logical part of myself quickly determines that most of those self-criticisms are crap.

If I give credence to all of those self-criticisms, though, my productivity plummets. Those criticisms suddenly don’t just originate from me; they originate from everybody. All of the membership thinks I’m an idiot for missing that obvious suggestion for the website (a suggestion, I’ll add, that was only sent to me and one other person, but far be it from my addled brain to bring in that fact). Everything I write is awful. I handle every staff interaction horribly, and the staff know it. I don’t do things quickly enough, and everyone notices. I don’t get enough done, and everyone again notices. The self-replicating cycle of criticism gets to the point where I’m only really comfortable doing the things I’m pretty sure that I can’t screw up: getting rid of unneeded items from the collection, going through donations, and getting the bills paid. I’m good at those things. Even I can’t screw them up too much. I hope I never, ever have to go through my rather involved evaluation process when I’m in this state; I’d be suggesting a demotion for myself.

These judgments aren’t based in reality. Everyone is not judging me as harshly as I am. My work isn’t as terrible as I think it is. If my work is suffering, it’s because of the negative feedback loop being created by my diseased mind that makes me scared to even try. As I further learn to recognize when I have valid criticisms of myself and when it’s the dysthymia talking, I’m coming to a better state of mind and a better approach to my work life. It’s proven much more challenging in my social life, but I’m working on that, too. Partly why I enjoy “Call and Answer” so much is it encapsulates many of my experiences into a mere four minutes. It encapsulates not only my tendency to crucify myself, but also my tendency to pick myself back up and keep going. And it’s that tendency that allows me to continue to succeed despite my illness.

I think it’s getting to the point
Where I can be myself again
I think it’s getting to the point
Where we have almost made amends
I think it’s the getting to the point
That is the hardest part

If you call, I will answer
And if you fall, I’ll pick you up
And if you court this disaster
I’ll point you home, I’ll point you home

The S word

I haven’t really talked about the S word other than in passing in my first post. And by “S word”, I do not mean the expletive but rather suicide. Many people are uncomfortable discussing mental illness, but bringing up suicide can bring entire conversations to a halt. Almost everyone to some degree can identify with aspects of depression; we’ve pretty much all had experiences in our lives that sent us to the depths of despair. However, few other than the mentally ill can identify with the idea wanting to kill yourself. To the degree that we are beholden to our genetics, it is a biological imperative to desire to live, which is why it takes pretty severe circumstances or a very high degree of mental perversion to even consider it. Most people have not met those conditions.

Dysthymia is often termed a “mild” depression, an adjective for which I don’t particularly care for a few reasons.

  1. “Mild” doesn’t really take dysthymia’s persistence into account. If you think of major depression and dysthymia like you’re carrying weights, major depression is like trying to carry an extremely heavy weight; it taxes your strength almost immediately. Dysthymia is more like carrying a pretty heavy weight, but carrying it for a prolonged period of time. In other words, both major depression and dysthymia can make you collapse, it’s just a matter of how long it takes.
  2. As my best friend likes to say, having an illness is not a fucking competition. The term “mild” implies something being not as serious, not as important, not as worthy of attention. Mental illnesses certainly have a degree of urgency; major depression is a much more urgent condition, as there is a more immediate risk for suicide. However, all mental illnesses are dangerous if left untreated. To my knowledge, we don’t have antibodies to fight off mental demons.
  3. Dysthymia can easily become major depression, a state known as double depression. As noted in point 1, if you’ve been carrying a heavy weight for a long time, you’re bound to collapse sometime if you don’t shed some of it. There’s a strong link between dysthymia and major depression, as noted by Harvard Medical School:

“More than half of people with dysthymia eventually have an episode of major depression, and about half of patients treated for major depression are suffering from this double depression. Many patients who recover partially from major depression also have milder symptoms that persist for years. This type of chronic depression is difficult to distinguish from dysthymia.”

This is a long-winded way of saying that, despite its generally low level of depression, dysthymia poses a suicide risk, too. This conclusion for the most part seems borne out by research.

I am not without suicide experience. I have never actually tried to commit suicide, but I ponder it often in my darker moments. Like many other depressed individuals, I know exactly how I would do it (slitting my wrists or, excepting that, drug overdose). Plans exist in my head for dealing with my affairs post-suicide: who would receive my meager assets, how would I make sure that my animals were taken care of, what things at work would I need to ensure someone else knew, where would I commit the act to ensure that my friends and loved ones wouldn’t be who found my body. I’d imagine this all sounds grisly and terrible to many people, but such thoughts are not uncommon among the depressed.

In my brighter times, the thought of suicide mystifies me. How could I ever consider suicide when I have such a great life and so many people who depend on me? Those specific plans I made while in the pits fade from my immediate memory. Even as I write this, though I’m having somewhat of a down day, I have no desire whatsoever to go to my grave. The brighter times also are when I protect myself against such thoughts. I do not keep razor blades in the house, nor do I sharpen my kitchen knives very finely. I do not keep large quantities of painkillers in the house, the lethal dosage amounts of which I am fully aware. Firearms are forbidden from my house. (The strong link between guns and suicide is yet another excellent reason to advocate for gun control with your legislators.) I make sure that I have social interactions at least once per day. The numbers for some particularly close friends are in my speed dial. Recently, I put the number for the National Suicide Prevention Lifeline on speed dial as well. The number is 800-273-8255. Please share it with anyone you think might be at risk.

There are a lot of reasons why I have never carried through with suicide. Recently, the most obvious reason is treatment. However, there are many others: the anguish that my friends and family would feel, the mess they’d need to clean up (despite my plans to get my affairs in order), the idea of saddling my mortgage onto my not-at-all-wealthy family.

However, in keeping with the overall theme of this blog, the major thing throughout my life that has prevented me from committing suicide is my work. The reasons above are good ones, but I guess somewhere in the back of my mind I always figured that friends and family would bounce back from my death. (I should mention that having a mortgage and significant other affairs to deal with are a relatively recent occurrence for me.) But my work was always an exception. I’ve always been deeply embedded in the places where I work. I wasn’t really indispensable; I don’t think anyone truly is. However, both others and I perceived me as such. There are always things that only I know, future plans that are only in my head, tasks at which I particularly excel. I don’t think I consciously withhold information from others; it just happens, as I imagine it does in any workplace. The thought of leaving my workplace in shambles, together with my aforementioned reasons, somehow kept me from really going through with it.

Notice that none of the reasons I mentioned have much to do with me or a sincere desire on my part to live for my own sake. That is why, to those who say that suicide is a selfish act, I say only this: fuck you. Fuck you and your ignorant judgment made with no attempt at understanding. While I can’t say they don’t exist, I have never met a depressed person who did not think of others constantly and who was not fully aware of the damage they’d leave in the wake of their suicide. The warped depressive mind is such that you truly think that both you and the rest of the world would be better off if you weren’t in it. You understand that you’ll likely hurt people, but you also think that they’ll get over it and lead better lives in your absence. Yes, this is completely illogical, but depression defies logic.

Since getting diagnosed and learning more about myself, I’ve become much better about succession planning at work and, to some degree, at home. I know this sounds strange, as it seems like I’m removing one of the reasons preventing me from committing suicide. However, I really think this is a sign that I’m in a better place. I now worry about dying in a car accident or falling off a cliff on a hike, leaving my coworkers, family, and friends high and dry. When in the depths of depression, I couldn’t care less if I die in an accident; I might actually welcome it, as it seems easier than killing myself. However, for me, with an actual desire to live came a respect for death. I realize that it could happen at any time without warning, and I want to make sure that the people I love and respect are left in the best possible position should that happen to me.

If you’ve read this far, I heartily thank you. I know that reading about suicide can be grueling and awful, particularly if you’ve lost loved ones to it. And if you’re inclined to worry about me due to the contents of this post, I greatly appreciate your concern but also assure you that you have little reason to fret. That I’m able to write about it so openly and (relatively) objectively shows that I am in a positive state of mind. Suicide is a specter that haunts the depressed constantly, but that doesn’t mean that the specter has to possess you. Its continual presence gives you even more incentive to seek treatment and to better your life.

The assholish observer

The holidays are stressful for everyone, but they can be particularly brutal for people with mental illness. I’m fortunate that the holidays have never been a particular trigger for me. However, as stresses mount and social situations become more frequent, I am provided an opportunity afterwards to reflect on the continuing ways mental illness affects my life. This holiday season, I was reminded of one of the more unpleasant effects.

I noted in a previous post that I’m a introvert, i.e. I refresh myself by being alone or with small groups of friends and loved ones. New Year’s is always an interesting time for me because it often involves going to some party with a whole lot of people I don’t know. I wouldn’t say that I get anxious necessarily – it’s highly unlikely that I have an anxiety disorder – but I nonetheless need to make sure that my batteries are charged properly before the heading out, something I did this year

This New Year’s, some friends and I went to some houses with lots of people I don’t know. Yes, houses plural. It was a “house pub crawl”, which I did not realize was a thing. Anyway, we ended the night at a very cramped house with a dance party going on and 25-30 people shoved into two not-terribly-large rooms, people of whom I knew exactly 3 (one whom I met that day). In other words, it was an introvert battery leech.

I was designated driver, a role I often serve because 1) I don’t particularly enjoy the sensation of being drunk and 2) I really shouldn’t be mixing all that much alcohol with my meds anyway. Being sober and starting to get overwhelmed, I ended up where I often do in such situations: standing somewhere out of the way as inconspicuously as possible. Despite my efforts, people nonetheless would interact with me, including my lovely friends checking up on me.

Meanwhile, back at the point, mental illness, this situation brought up one of the most long-lasting parts of my disorder. My mind since the onset of my dysthymia has always been able to split itself in two. One of those parts is just me in the moment, doing whatever. The other is the supposedly-rational observer me, the part of me that some depression researchers might think of as my brain engaging in “analytical rumination“. I don’t want to give the impression that I hear voices or anything, as that is definitely not the case (and, if true, would mean that I have even more problems). It’s more that my mind is operating on two tracks simultaneously, with thoughts from both tracks occasionally coming to the fore. That observer me is the part that judges, that criticizes, that tells me I’m not good enough and that I could be doing better. That other part of me is kind of an asshole, hence I christen him “assholish observer”.

When I was at the party, the assholish observer was telling me I was lame for not approaching people and talking with them, that I should have been dancing like other people, that I should have tried to talk more to the new friend I met that day, that I looked like an idiot standing alone, that my year had been unproductive and wasted, and that my new year would be similarly so. He berated me when I left a bit early, alone, to go on the long, cold trek back to pick up our vehicle, even though that was probably the best thing that I could have done to get some energy back.

I mentioned that my dysthymia primarily manifests as itself as an emotional dullness. Let me correct that. There are two emotions I feel quite acutely when in the throes of depression: shame and guilt. The assholish observer shames me. He tells me I’m a social moron, and, as if from a self-fulfilling prophecy, I often am. I become less confident in the social skills in which I’m already pretty damn unconfident. In addition to the emotional greyness, the assholish observer is another aspect of my illness that, taken by itself in limited quantities, isn’t too terrible. Taken as a continual life companion, he becomes toxic.

On my good days, my medication and other treatment keeps the assholish observer at bay. Somehow, even before I started getting treatment, I managed to keep him at bay; I wouldn’t be where I am today if I hadn’t. But when I’m weak or stressed or my batteries are running low, as on New Year’s, he comes back, more critical than ever. He’s my (non-violent) dark passenger, and he’s kind of an asshole.

Moments of lucidity

Oftentimes, I have moments. These moments arise because, I don’t know, I’m taking my medications regularly, I’m taking care of myself, the stars are properly aligned, whatever. These are my moments of lucidity, the times when I feel happy and “normal” and like I’m the “true” me. I know that I’ve used a few fuzzy terms there, but I really don’t know how better to describe these times. Sometimes these moments last hours, sometimes days, and sometimes, just sometimes, even months. Last week has been such a moment. Of course it had to happen during a short work week <sigh>.

Not surprisingly, these moments of lucidity are my most productive both at work and at home. So a question arises: how do I best use these productive moments, especially considering that I have no idea how long they might last? I can really use these moments to get a lot of great things done. They’re when I write grants to get cool things for the library. They’re when I plan and arrange neat projects. They’re when I catch up on my backlog of employee evaluations.

Screenshot of my inbox

I may find your views intriguing, but I really don’t need to be subscribed to any more newsletters.

On the other hand, my office and home are littered with half-completed projects begun during my good moments. Cases in point: the rooms in my house with only half of the wallpaper removed, the nearly 5,000 unread messages in my work inbox, the detritus of my plans for a big restoration project of the historic Hood River Library (now happily moving forward once more!), my poorly-maintained heirloom rose garden with plants older than my mother, the general state of my office (that just means that I “break free from tradition” and “produce fresh insights”, right?). I could go on, but I’ll spare you, and maybe spare myself any further guilt.

I don’t have a specific plan to harness these moments, admittedly, but I wish I could figure out a good way to do so. Even if my dysthymia is acting up, I have a decent sense for what I should prioritize at work. Make sure you get people paid. Ensure that the finances are on the up & up. Fix safety hazards immediately. Maintain the work face, even if it isn’t at full strength. Put the library on a positive path to achieve its strategic goals. I think I’m lucky in this respect, as I know that prioritization can be an issue for others with depression.

So basically what I end up doing in my moments of lucidity is jump into things with gusto, as much as I can healthfully muster, to take advantage of them. That’s when my inbox count drops precipitously and I get all those grant applications I’ve been thinking about out the door. Am I burning myself out more quickly by doing things this way? Probably. That habit could even make my worse dysthymic episodes arrive faster. But what else can I do? I know it’s trite to say, but I am truly my harshest critic; I’m pretty brutal on myself in my self-evaluations at work. I come pretty close to saying I suck on some matters where an objective observer might just say I need some work. Thus, when I’m at my best, I want to get my best work out. Along with my personal relationships – and because I’m childless by choice – my work is the legacy I leave. My moments of lucidity are what allow me to leave a decent one.

A need to know basis

One of the things about which I thought deeply after I was diagnosed was whom to tell. On the personal side, the choices were fairly easy; I told a few trusted friends and family members. On the library side, it was more challenging. I wasn’t actually worried about losing my job, although it’s definitely still a valid concern for many with mental illness. My performance evaluations were good, I received positive comments from my bosses and the public, and I’d just helped bring our library district out of a difficult time. Even so, there’s still a lot of stigma attached to mental illness. As noted in the articles linked above, people could look at you more skeptically and judge you more harshly if they’re made aware of your condition.

As a librarian, I know that information – the good, the bad, and the ugly – has a tendency to spread whether you want it to or not. Wrong information has a particularly bad habit of ferreting its way around. (See: fictional connection between autism and vaccines) By telling people about my dysthymia, I lose control of that information. With my friends and family, I could choose to tell only those I trusted. With the workplace, I wouldn’t get to be so discerning. Would those I told tell other people without my permission?

There was another odd quirk I had to consider: I’m the boss. We’re a small independent library district, with fewer than twenty employees. As library director, I’m responsible for human resources and nominally in charge of the district. I do have a supervisor, five of them, to be exact. Special library districts in Oregon are independent governmental entities overseen by elected five-person governing boards. They’re kind of like a city council, but they just focus on the library. (Or whatever the focus of the particular district. Did you know that vector control districts are a thing? I didn’t until I got this job.) That board also supervises the executive director, i.e. me. However, the Board only serves policymaking, fiscal, and strategic planning functions; they’re not responsible for day-to-day library operations.

So, to get back to the question at hand, whom do I tell at work? My illness could adversely affect the library’s operations pretty dramatically. I didn’t feel like I needed ADA accommodations for my mental illness (that link applies to men, too, by the way), but there could be times when my work suffered. Do I tell the whole board? Just the board president? And whom among the staff should I tell? If I’m falling down on the job, they’re the ones that will have to pick up the slack. Will they question my motives for telling them, like I’m trying to cover up for poor job performance? Will they think I’m just looking for pity? Will they believe me in the first place?

Ultimately, I chose to tell the two people whom would be impacted the most: the board president and the assistant director. I trusted both individuals, and my trust has proven well-placed. The decision was made easier when I started thinking about it as like telling them I had a physical or neurological disorder. It’s common courtesy to tell those most affected at work about times your work performance might be impacted. Since telling those two individuals, I’ve become much more open about my dysthymia. Several other staff know now. I mean, it’s not like I sent out a library-wide email or anything; I really, really don’t recommend sending out a company-wide email. Sometimes the issue would arise in personal conversations, though, and people have been very accepting.

I look forward to the day when choosing whom to tell about your mental illness is as unremarkable as telling people you have epilepsy or a peanut allergy. Until that day comes, though, speaker discretion is advised.

The work face

Back in October, I read a Slate article about an amazing photography series called Dualities by Portland-based artist and instructor Liz Obert. The series explores how people with mental illness mask what they’re thinking and feeling from the outside world. To do this, she took two photos of each participant, one of how they present themselves to the world and the other as they are alone when in the throes of their illness. The images depict people in their homes, showing a concept likely very familiar to those with mental illness: our very different private and public personas, or “faces”, as I like to call them. The results are poignant and stunning.

Images of Jason from Liz Obert's series Dualities

Funny, my feline roommates are filthy and unemployed, too.

Obert’s project presents incredible visuals showing the different faces we show the world. In my experience, I have far more than just two faces. Like Obert’s subjects, I have a private face. I also have a social face, a work face, and the face I show only my dearest friends (which is probably the closest anyone will ever see to my private face). If I think about it longer, I could probably come up with even more. I’ve got a whole kabuki drama worth of faces.

My work face is probably the one I wear more than any other than my private face. It is wholly unlike any of the other faces that I wear. The work face is confident, even arrogant. It’s talkative, eager, and full of initiative. With my work face on, I present at conferences, I participate in tongue twister tournaments, and I even get interviewed for local television programs. These are things there’s not a ghost chance in hell you’d catch me doing in any other context. In social situations, I don’t even particularly enjoy being in photographs or hearing the sound of my own voice, let alone getting up in front of other people and doing things.

I’m a classic introvert. My batteries only recharge when I’m alone or with a small group of friends. The work face therefore requires a lot of energy for me to wear, kind of like Ryu’s dragon form in Breath of Fire. (Why yes, I am a nerd. Why do you ask?) This isn’t so much a function of my dysthymia as it my personality.

Everyone, not just those of us with mental illness, has multiple faces they present to the world. If you’ve ever worked a customer service job, you’ll know what I’m talking about. Still, the work face makes me wonder: how can I have exude such confidence and competence in one setting and completely lack them in another? In my worse moments, the very existence of the work face makes me question whether I have a mental illness at all. Part of the perniciousness of mental illness for many is that the illness, combined with the still-present social stigma about mental health, sometimes makes you question whether you’re truly sick. “You’re trying to pass off your deep character flaws as mental illness”, I sometimes think to myself. After all, the very existence of the work face shows that I’m clearly capable of being the things my mind tells me that I’m not. With the work face on, it seems like I can do anything.

To borrow from Dr. Seuss, though, except when I don’t, because sometimes I won’t. When I fall into a major depressive episode as I did recently, even the almighty work face loses its strength. It takes incidents like that to remind me that my different faces are just roles that I play, consuming my stockpiles of introvert energy as I wear them. One of dysthymia’s common symptoms is lack of energy. If I’ve been managing my dysthymia poorly, I lack the energy to do much of anything. When I have limited energy, I end up putting a lot of it into my work because my identity is so tied up in it. But that’s a discussion for another time.

The challenge I’ve set for my treatment is how do I get those faces to converge a bit? How can I get some of that initiative and eagerness when I’m not at work? As an introvert, I realize that my different faces will never completely converge, nor, quite frankly, should they. But some equalization surely would help me both privately and publicly.

Why blog?

Now that I’ve introduced myself, however verbosely, I suppose I should discuss why I’m writing this blog. The honest answer is, I’m not really sure. I don’t know if I’ll ever make this blog public beyond a few friends, although it might be nice. But then, I also have to consider if that would be detrimental to my social and professional lives. It also depends on if I have the steam to keep it going. In the meanwhile, I’m going to write it as if it was a public blog. Sorry, dear hypothetical reader, I won’t be giving you too many of the grisly details.

I’m mostly hoping that the act of writing might be a part of my treatment process. I am seeking treatment beyond just writing this blog, of course. I take the antidepressant bupropion. Sometimes I use trazodone to help me sleep (Insomnia is a common side effect of antidepressants. Trazodone is also an antidepressant, although that’s not why I use it.). I take vitamin D3 supplements (despite being a ginger). I see a therapist. Not always successfully, I try to  watch my diet, exercise, and sleep habits.

Sometimes it seems like treating my dysthymia is like playing whack-a-mole. You feel really good about yourself for all that animal abuse you’ve just inflicted because damnit, you knocked them down! Then, in a moment of weakness or inattention, you let one slip. This gets you down. Then, all those other moles you thought you’d shoved sufficiently back into their holes come rushing back out. Anyway, my analogy is wearing thin. Just think of this blog as one of my mallets.

The inspiration to start this blog actually came from a post from the great Coping with Depression blog by Erin Schulthies and Jennifer Tazzi. The post discusses coping with depression while you’re unemployed. I’m fortunate to have never been unemployed, but the post got me thinking how much I’ve relied on my employment to distract me from my underlying mental illness. I’ll go into that further in a future post, but I thought it might be interesting to start a blog exploring the interaction between dysthymia and employment. My identity is almost inextricably linked to my job in a not terribly healthy way. I’m not sure I fully know who I am independent of the job I’m doing at any particular time. There’s an interplay between my job and my mental illness that I think is worth exploring, and I’d imagine I’m not the only person for whom that’s true.

There are so many good depression blogs out there. The aforementioned Coping with Depression. Erin Schulthies’ other blog Daises and Bruises. Douglas Cootey’s A Splintered Mind about overcoming depression and ADHD. The sadly silent-of-late Hyperbole and a Half by Allie Brosh. Many more that I’m failing to mention. Hopefully, I can contribute a few new ideas to the mix, or at least think through some ideas for my own treatment process. In future posts, I hope to explore a lot of things: the work versus home persona, jobs and identity, who and how to tell about your illness, the dangers of “natural” remedies, the interplay of depression and atheism, how workplace leave and health insurance policies affect mental health treatment, and more. We’ll see how far I get.

Who is the dysthymic librarian?

There are a lot of things I could say to describe myself. As you might surmise from this blog title, I’m a librarian. There are many other superficial descriptions I could give you (not necessarily in order of importance): male, thirtysomething, white, Oregonian, childless, atheist, cynic, ginger. The list goes on. But I’ll try to get on to the more interesting stuff. I work for a small public library district in northern Oregon in the lovely Columbia River Gorge. My photography skills are seriously lacking, so I can’t really do justice to the Gorge or the main library at which I work. Fortunately, Blaine Franger of Beautiful Hood River has done it far better than I ever could.

Hood River Library at night, copyright Blaine Franger

The cool kids sometimes call it Hogwarts.

Being a librarian is a pretty great job. I actually direct the library, which is kind of like combining a stressful customer service job with a Kafkaesque government bureaucrat position. Really, it’s more fun than I make it sound. Trust me. I’m sure I’ll write about my job more in the future.

In addition to being a librarian, I also have dysthymia. No, it’s not an STI, even though it kind of sounds like one. Dysthymia is actually a somewhat common but not particularly well-known mental disorder. You can read more about it on the Mayo Clinic‘s great dysthymia page. And, since I’m a librarian, you can bet that I’ve vetted my sources! Need the TL;DR version? Dysthymia is a low-level but chronic depression that lasts for at least two years. For many people, dysthymia can last the entirety of their adult lives. While I was only diagnosed in 2012, I’ve had it for over two decades.

I find “depression” to be a frustrating word; it’s just so … squishy. Some might just think of “depression” as a simple emotion that’s just a worse type of sadness. Some might think of it as a severe mental illness associated with suicide and an inability to feel joy. Still others might just think of “depression” as a concoction of the modern medical and pharmaceutical industries to make money. I have a lot to say on that, as a dedicated (if not card-carrying) woo fighter, but that’s perhaps for another time. And oh yeah, my public policy peeps would probably be annoyed if I didn’t note that “depression” is an economic term, too.

These definitions are all to say that a dysthymia-like condition is not necessarily the first thing that people think when they hear “depression”. Someone you know might even have dysthymia and you don’t know it. Dysthymic people can be outwardly quite gregarious, or they could just be a bit laconic and dark. They could also be somewhere in between.

Every dysthymic person is different. For me, dysthymia manifests as a general dullness. It’s like I feel the world in greyscale. I’m usually not actually really sad, as “depression” would imply. But I’m also almost never really happy. Or really mad. Or really excited. Or really much of anything. I’m just … meh. Emotions are like the colors through which we experience the world, and my color receptors are broken.

This probably doesn’t sound that terrible. I mean, it’s not like bipolar, schizophrenia, or other “serious” mental disorders. But imagine not really feeling any strong emotion for years on end. You aren’t ecstatic when you get a fantastic new job. You can’t feel empathetic sadness when your friend tells you she was raped. You don’t get excited to watch your nephews unwrap their Christmas presents. You don’t get angry when you find out that someone directly lied to you at work. I’ve experienced all of these things. Or, more accurately, I didn’t experience them, because my emotional world is in shades of grey, and not the fun Fifty Shades variety.

Such lack of feeling can get even the strongest person down, of which I do not rank myself as one. Not surprisingly, dysthymia can have deep impacts on your life and work. I’ve lost romantic relationships due to my illness, dropped the ball at work innumerable times, and neglected my home and family. It can also easily develop into major depression and suicidal tendencies because the weight of not feeling is so brutal. I’m (hopefully) recovering from an acute suicidal episode as I write this post. I’ve had several throughout my life.

Dysthymia is challenging. It’s challenging to have, obviously, but I’d also imagine quite difficult to diagnose and treat (disclosure: not a doctor here). As noted, I wasn’t actually diagnosed for nearly two decades after the disease’s initial onset for me. I would like to think that I’ve been remarkably good at hiding my illness. Others would have to be the judges on that point, I suppose. But I’m tired of hiding how dysthymia affects my life, especially of hiding it from myself. I’m tired of thinking of it as a personality trait, even though it’s been with me so long that it effectively is. Maybe starting this blog is the first step to admitting the extent of my problem.