Patterns in Depression and Dysthymia

Once, a few years back while in a therapy session, my doctor mentioned to me that although she didn’t like to label, she had diagnosed me with dysthymia. At the time I didn’t think much of it, figuring it was just a particular diagnostic class of depression and that I didn’t need to know the details. But for a number of reasons recently, I decided to look into what it meant. In short, dysthymia (sometimes called chronic depression) is a form of mood disorder which has similar symptoms to depression, but they are often milder and last longer, for years. For me, the symptoms could be described as varying levels of hypersomnia, hopelessness, anxiety, guilt, loss of interest, sadness, and excessive crying, although many people experience it differently.

I’ve always felt that I was particularly sensitive to environment, in that in certain surroundings and social groups, the effort it would take to pull myself out of my self-critical thought patterns and incessant negative thoughts was more than I could manage. So I carefully considered the location of my university choice so as to put me in the place I felt most comfortable. For me, that place is a big city: a place so abundant with people that although I am surrounded by them, very few of us have the time to observe our neighbors closely, care about their choices, or actually express to them that we are uncomfortable with their differences. To me, this is the place where I can be me, find others like me, and find the inner strength to not worry about whether or not I fit in and am liked by the people I encounter each day. Living in this city filled with life and energy quells my anxious thoughts and helps me to be both carefree and driven. I feel at home here, and I love to show my acceptance of all the varied people who are my neighbors. And I can find any service that I need quickly, while not having to return to the car culture that my youth was so entrenched in. I firmly believe that this is both a great place to be and a great place for me.

Dysthymic people can also suffer from major depressive episodes, in this case termed “double depression.” I think I’m beginning to see some patterns to when my stronger depressive episodes develop. This last few months, there have been similarities to the depressed period which had originally brought me to my therapist in the first place. It seems that I am very sensitive to my social environment. When I was skating, it meant my home club and coaches. In school this meant my classmates and professors. At work it’s my coworkers and bosses. While some uneasiness may kick in right after a switch (new semester, new job, etc.), I’m often buoyed for the initial period by my love of new things. To me something new is something to learn from, and I love learning. But after the newness wears off, generally 3 to 6 months in, things get bumpier. I often start to really notice the people around me, and in many cases I start to fixate on the feeling that I don’t belong.

As I write this, I can remember so many times when this has happened. The first instance when I felt this way to the degree that I was not in control of my thoughts was when I was 17, and my training routine at the rink had changed. I was skating full-time at a club that I had rarely felt quite right at, and I was not able to spend much time at my favorite club, the place where I really felt at home. Many of my closest friends, skaters at that club, had moved on to other things. My coaches had decided to teach exclusively at this place that never felt as homey, and I found myself surrounded by ambitious young skaters. I was unable to value the maturity and strength that my skating had, and I only saw myself as a giant among little girls in a sport where smallness is an advantage. The bulimia that had began less than a year earlier spiraled out of control, and by the end of the summer I decided to quit, thinking that taking myself out of this environment, this competitive skating world, would help me heal. At the time, I didn’t realize how long that process would take.

Years later, when I was a junior in college, it was the beginning of classes with other driven students from my major field of study that led to this place. At first I did well enough, enjoying the challenge and the new things to learn. But as the semester wore on, the attitude of my professors and classmates wore me thin. By Christmas I couldn’t bear to attend the Holiday Party for fear that my professors would secretly be laughing at me for thinking I had a place in the department. By spring, I was missing classes and homework assignments because I couldn’t bear to turn in what I thought was such poor work or even to get out of bed and face the day. At some point I got low enough to feel that I was out of control and that my school success was in danger, and I wrote an emotional, pleading e-mail to my Dean. And so began that road to recovery.

Having been acutely aware of my environment, when I found myself struggling not long after having entered my first office job, I figured it was pretty normal. I was in a new environment, a foreign environment to me, and it would take me time to learn the ropes and find my place. But now I think it’s more than that, and I’m beginning to see the similarities to other situations that have led me to this emotional place.

This time, I was nervous about the new setting and lifestyle. But for the first 3 months, I was happily engrossed in a high priority, fast-paced project. I drew energy from this and didn’t concern myself much with the coworkers who weren’t on the project. There were many instances of a coworker’s statement or behavior being an unpleasant surprise to me, but the good parts outweighed the bad, and I could almost say that I was loving my job.

Then, in July, that project’s major deadline passed and I didn’t have much to do for it anymore. My work day slowed down, and I took on more varied tasks requiring interaction with more of my coworkers. And the feeling that I didn’t belong grew stronger.

Now, It’s been 6 months since I started this job, and I’ve been feeling somewhat out of control of my thoughts and emotions for the past couple of months. By the end of August it was pretty clear to me that I was having more difficulty than normal, healthy people do. This was compounded by my period of no health insurance (I had to wait 3 months after my job began to get health benefits) and the difficulty I had in obtaining my antidepressant prescription, which I’d been on for over 5 years. I managed to get the Rx, but not without significant stress, cost, frustration, and two hospital visits.

It was at the second of those emergency visits (I had tried but been unable to find a psychiatrist that would see me, a new patient, on short notice, and my therapist was out of town) that I realized that my struggle to adjust was outside the bounds of healthy behavior. I confided in the doctor that I had cried at work almost every day the prior week, and she said that sounded like the meds weren’t working. She let me go home with a prescription and the promise that I would go to my new psychiatrist appointment the next week  and come back in if I couldn’t make it until then. To top things off, this particular visit marked the first day of our “staycation,” and I spent the whole day in the hospital (the wait was over 7 hours!). I resolved to shake the feeling that I couldn’t even properly enjoy a vacation from work, and Husband and I made the best of the rest of our time off.

Since then it’s been a struggle, but I see the light at the end of the tunnel. My insurance has kicked in and I’ve found a psychiatrist that I feel comfortable with. We increased my dosage in September, and things have gotten only slightly more manageable. He said if things were still rough by this week, I should go back in and we’ll try a combination instead. So I will do that this week, and try it out for a while. Between him, my therapist, and the support of my husband and friends, I will get out of this rough patch too.

*Edited slightly from original posting

The Love Song of Flicka Mawa

or…a brief story about my experience with bulimia and how much healthier I am now

The very first Cat Wisdom I featured on the sidebar of my page was this quotation from The Love Song of J. Alfred Prufrock, by T.S. Eliot:

And the afternoon, the evening, sleeps so peacefully! Smoothed by long fingers, Asleep … tired … or it malingers, Stretched on the floor, here beside you and me.

So I just went back and reread the poem, and it had such a calming effect on me. I was thinking about how I’ve loved this poem since I was 18, when I read it in English class in high school. My freshman year of college, I actually posted it (in it’s entirety in 12 pt font – around 4 feet long) to one of my walls. It’s interesting to think back on this, because it is also a reminder of how far I’ve come as far as mental health goes since those days. To continue the poem excerpt will give you an example of the urgency and indecision of my thoughts at 18:

Should I, after tea and cakes and ices,
Have the strength to force the moment to its crisis?
But though I have wept and fasted, wept and prayed,

Though I have seen my head (grown slightly bald) brought in upon a platter,
I am no prophet — and here’s no great matter;
I have seen the moment of my greatness flicker,
And I have seen the eternal Footman hold my coat, and snicker,

And in short, I was afraid.

And would it have been worth it, after all,
After the cups, the marmalade, the tea,
Among the porcelain, among some talk of you and me,
Would it have been worth while,
To have bitten off the matter with a smile,
To have squeezed the universe into a ball
To roll it towards some overwhelming question,
To say: “I am Lazarus, come from the dead,
Come back to tell you all, I shall tell you all” —
If one, settling a pillow by her head
Should say: “That is not what I meant at all;
That is not it, at all.”
At 18, I was bulimic and depressed (which I channeled into the bulimia). Every decision I made felt fraught with tension – to eat the food, or not to eat the food? Or perhaps to go buy lots of good food, only to later find the nearest public one-stall bathroom in order to purge it back out. I was often far from home, taking myself to school or figure skating training or my boyfriend’s house, all of which were over a half hour from my home. When people ask me where I grew up, I hesitate to name the town my house was in, because I feel more connected to some other towns, the towns where I skated or the town, 40 minutes from home, where I went to public high school through the state’s school choice program just so that school would fit better with my training. It was definitely pretty intense, and I often felt kind of locked inside my own head. I was also completely overworked. In addition to this intense sports regimen I worked a part-time job at the local mall or coffee shop or beginner programs for the sport, and I was in many AP classes. I was an exceptional student and stayed up late at night finishing my homework. Most of my friends were also figure skaters. People at school whom I was friendly with had stopped asking me to hang out long ago, having learned that I was always busy. I, of course, had made friends at the rinks where I trained, but by my junior year many of them had quit. I was soon training in a new location, where nearly everyone was younger than me (and much richer and, for lack of a better word, cattier than me). So I was also pretty lonely. Or perhaps you’d say insanely lonely, at least compared to now…compared to living here with Husband, in this loving happy marriage.

I met Husband immediately after my sophomore year of college, which makes it nearly 4 years ago. I think I have made a lot of progress in that time. Although I had seen a counselor as soon as I got to college, I had still been struggling with the bulimia on and off up until the day I met Husband. I remember it very well, because I had been having a really bad day as far as the bulimia was concerned. But then I got a call from the exciting man I had met on match.com, and we made plans to meet up. And when I met him, I was so overjoyed at having found this wonderful, amazing, funny, intelligent, creative and adorable human being with whom to share my time, my thoughts. In whom I found understanding, which gave me the ability to be completely frank about the crazy thoughts inside my head. And he was as crazy for me as I was for him! This amazing catch thought I was amazing too, and genuinely found me to be sexy, which helped allow me to be sexy without being ashamed or overly concerned about whether I looked ok. He awakened in me the confidence I had been building but struggling with, and I didn’t need the clutch of the bulimia anymore. I moved on, and over time the thoughts faded, and now I no longer remember with accuracy the calorie content of most of the foods I encounter, nor the location of the nearest prime locations for a bulimic episode.

So as far as mental distress over eating, I have improved vastly. Physically, however, some manifestations remain. While I did successfully rid myself of the purging aspect of bulimia, I still occasionally binge eat. I don’t think I do it as often as I used to, but Husband and I both will sometimes spend time chilling out and eat so many sweets that our tummies ache after. We haven’t done this in a while though – we have both been succeeding at eating a bit healthier and losing some weight. For me, it’s been very slow and gradual, but there is a significant downward trend over the last few months, and that’s good. I get a fair amount of activity running, crawling, jumping, and playing with the kids a few days a week and now I can play DDR at home too, but I need to get to the gym more.

Additionally, I still suffer mental distress over other things. After giving up the bulimia (I say “giving up” because it was an addiction and a crutch), I plunged into a depression, which I have written about more extensively and still deal with. For that too, though, I can report improvement. I think 2008 has been relatively depression-free so far. Sure, there have been some sad and stressful times, and a minor quals freakout, but for the most part I’ve been functioning well – getting good work done, spending time with friends and of course with Husband, and spending time at my part-time nanny job. (Where two small children love me so much that last night, the older one kept something small from my bag that I had let him play with and brought it everywhere, even to bed with him. I feel loved, and warmed to think that the thought of me is so comforting to him.)

So, that’s where I am now, and a bit about how I got here.

Aiming for healthy

Well, I’ve officially lost 3 lbs on the “We’re f*cking broke” diet. You might think that doesn’t sound so great, but I’m pretty happy about it – it’s helping me to get used to only eating until full, or sometimes being a bit hungry, and I think helping me to get back on to a healthier schedule. We’ll have some money again this Friday, and then the broke part will go away (we’ll switch broke out for poor), and then I’ll get to eat healthier, more balanced foods. But hopefully I can stay on track as far as overeating and exercise – sometimes losing just a few pounds is enough to get me more motivated again.

Overall, I just want to be healthier. Right now, I’m overweight – at a BMI of 30.4, I’m technically considered obese, but I don’t think you’d call me obese by my appearance – I have really strong leg muscles from my days as an athlete, and I wear a size 14 largely because of my chest (a large chest runs in my family). I have high cholesterol, but much more good cholesterol (HDL – high density lipids) than bad (LDL – low density lipids), and my blood pressure is always in the completely normal range. Here’s a picture of what I look like today:

Me, today

As far as exercise, on a weekly basis I walk everywhere (to get around the city) and I run around with the kids. I go to the gym to bike, use the elliptical, or take a yoga class, but that varies a lot more. I also continue to practice a sport I was competitive in as a kid – but usually only once every few weeks (it’s been even less frequent lately) – as it’s tough to get to the training center for that.

Why do I want to be healthier? Well, it has little to do with my appearance. Unlike when I suffered from bulimia, I now am much more ok with my body. My husband finds me sexy and I’ve learned to buy clothes that fit my body type. As many of my readers know, however, I hope to have children in the future, and we’re not really talking that far off. Right now we’re thinking we might start trying to get pregnant in the Spring of 2009, which is about a year and a half away. And I want to be healthier for my future pregnancy, and for my future children, and yes, for myself. There are a lot of pregnancy complications that are more likely when one is overweight, and I think since I have lots of time to plan, I should do whatever I can to put myself in the healthiest place I can be before I decide to rent out my womb to a tiny little being. One of the largest factors of that will be losing weight. Another will be to exercise regularly, some of which should be in activities that can continue throughout pregnancy, so that I can exercise during pregnancy as well.

Getting healthy, for me, is part of pre-conception planning, a practice that has become more common in the past few years. I really found the book, Before Your Pregnancy: A 90 Day Guide for Couples on How to Prepare for a Healthy Conception, to be helpful. It includes a section on diet and exercise, with recommendations for a diet and activities that focus on the nutrients and muscles that are needed for a healthy pregnancy.

I was tagged

So Rebecca over at Adventures in Applied Math tagged me for this meme. I’m finally getting around to doing it.

Here are the rules:

  • I have to post these rules before I give you the facts.
  • Each player writes eight random facts/habits about themselves.
  • People who are tagged need to write their own blog about their eight things and post these rules.
  • At the end of your blog, you need to choose eight people to get tagged and list their names.
  • Don’t forget to leave them a comment telling them they’re tagged, and to read your blog.

Okay, so eight random facts/habits about myself. What to share? I feel like it should be something I haven’t shared yet…but maybe I’ll allow myself a little detail on things I’ve only mentioned in passing. I tend to be a pretty open person, so expect some of these to be pretty personal!

  1. Last summer I was diagnosed with skin cancer. It was on my face, so I had to get a special surgery called Mohs surgery. Actually, I could really write a lot about this, so I think maybe I’ll write a separate post on it.
  2. As a kid and teenager I was a very competitive athlete. I trained over 20 hours per week from when I was about 10 until I was 17, when I decided to stop competing in the sport.
  3. Perhaps the largest reason I stopped competing at 17 was because I had been bulimic for many months, and I thought that if I stopped competing and removed myself from the pressure of the sport, I might be able to get better more easily. It took me another three years to finally rid myself of the bulimia, so sometimes I wondered about whether stopping competing was really the right thing. But I think, these days, that it was helpful for me to start learning how to be much easier on myself. I think about the way the thoughts in my mind went back then, and I seem like a stranger to myself.
  4. I have gained weight steadily since I stopped being bulimic, at about 20 pounds a year. Or maybe it was 30 for the first two and then not much this last year. Anyhow, I’ve been bulimia-free for 3 years and I weigh 60 pounds more than I did when I was a competitive, eating-disordered athlete. I am definitely overweight now, but I try to work out and exercise. I am scared of becoming too concerned about my physical appearance again, because I still have those feelings sometimes. At the same time I want to lose at least 20 lbs before I try to get pregnant, because I know that being overweight leads to more complications in pregnancy.
  5. My parents are getting a divorce, right now. They just sold their house last week. I am really happy for my mom, for whom the relationship hadn’t been working for over a decade. I am sad for my dad, who may have been a bit clueless about how my mom was feeling, and is now kind of surprised, and definitely lonely.
  6. Husband and I have a lot of credit card debt. This was really hard for me to accept when we first got into it, because I had grown up in a very comfortable upper middle class family, and we had always paid all our balances in full each month. I had been raised to respect money and savings and not to spend money I didn’t have, and I felt ashamed that we had gotten into this debt. Over time, I’ve learned to deal with it and accept it as a function of the stage of our lives we were in at the time – we are both trying to follow our dreams for what we will do with our lives, but neither of our dream pursuits make much money at this early stage of the career.
  7. I adopted Fluffy when I lived in the dorms. At the time I had a walk-through double, and my roommate said it was ok. Cats are most definitely not allowed in the dorms, but I had met someone else who kept a cat, and I longed for a cat quite strongly. So I went to the ASPCA and adopted Fluffy, who was three years old at the time. I had been deciding between her and another cat, and when I picked her up again, she put her paws on either side of my neck and cuddled her head against me, and I was won over. To this day she sometimes gives me these “cat hugs.” I adore her!
  8. I am a very picky eater. When I was a kid, my mom told me that she had been a picky eater too, and that her family told her having me was her punishment for being so hard to feed (jokingly). I live in the very multicultural NYC, but I won’t eat Indian, Ethiopian, Thai, or sushi. Or nuts. Or any seafood. And the list could go on…

Now I am supposed to tag people, but I don’t really want to. If you are reading my blog and you want to do this meme too, consider yourself tagged!

University and depression: Part I, the undergrad years

Well, here it is, that post I’ve been promising to write, that post that I’ve been thinking about writing for the past few weeks, ever since I found out I failed my doctoral qualifying examination. Wow. There, I said it. I really did, I failed it. And this is not an experience I am used to, not really, no. But it’s been a long journey, these past 3 or 4 years of which that I’ve really been initiated into the specific discipline that I am in. And that whole journey led me to here, led me to this place where I am in grad school, in a PhD program, but I failed the quals, as we call them. So, what happened?

Depression. Anxiety. Self-doubt. When I really entered the field I am in, I experienced the beginnings of school being really, really challenging. In high school, school was easy. It began to get challenging when I started AP’s, but after I got the knack of that it was fine again. Then I started college, at a very prestigious university. I had come from a mid-grade public school system, and I wasn’t sure if I would be up to snuff with the other students, if I would be playing catch up, or what would happen. But during freshman year I learned that I was even an excellent science and math student at my prestigious undergrad institution. I put a lot of work into my classes, but overall it wasn’t that hard; I put in the time and I didn’t doubt myself. I didn’t doubt that the outcome of this effort would be learning the material well, acing the exams, and being at the top of the curve. And the outcome was just that, so in that first year I learned that even at a top school in the country, I could be a top student.

By sophomore year I had gotten used to the idea, and my perfectionism allowed me to accept nothing less. At the same time, though, I was dealing with an eating disorder, one that I’d had for years, since I had been a competitive athlete in high school. It continued in the beginning of college but I began therapy as a freshman, and by sophomore year I was really doing better, not using my disordered eating as a crutch for my emotions. I still had bad days and I wouldn’t say I was healthy yet, but I began to alter my thoughts and to free them from focusing on my eating, my weight, my body, and most of all, how I deserved to be punished for all of my mistakes. In my head I was just a horrible, failure of a person, and I had let everyone down. As I began to free myself from my eating disorder, I dealt more and more with a general depression, one that made me sad and listless…made the days stretch out and the future seem unbearably long and normal. But I soldiered on, and classes were still proving to be pretty easy for me. I had not yet really entered the core classes of my major, with the exception of a sophomore year intro class. I was just laying the foundations, and my foundations were strong, at least academically speaking.

Then, that spring, I met the man who is now my husband. The day that I met him in person was the last time I purged; I consider it the day I left bulimia behind forever. I continued to struggle for a while with altering my thought patterns to be less self-destructive, but having the support of Husband was so helpful, and I managed to keep up enough strength to refrain from going back to binging and purging. That summer, I began researching with a professor in the department in which I was majoring. I would say that was really the beginning of my initiation into the field. I loved research, even the mundane parts that the undergrad in the lab is forced to do, and the summer passed, full of joy and love at having found Husband.

Then the fall came. It was time to enter the core classes of my field. They are the sorts of classes that without having taken them, you can barely understand what the title is about. And they were hard. But it wasn’t just that, it was barely even that, maybe. My peer group changed. Now, the classes were completely full of the other students who had been on the top half of the curve in the foundational classes. And my new professors, they were not the hand-holding types. They didn’t welcome us to the field we were entering with understanding. No, they laughed about how low the means were on the test. The first test in one of these core courses, a “midterm” that was one of a few midterms for this course, had a mean in the 30s. As in, students knew about 30% of the material on the test. And this wasn’t unusual for this professor. I, as it happened, got a high grade on this first one, and the professor paid me what he thought was a compliment, something about how I wasn’t so dumb. Yes, thanks, let’s put that in the negative, like he really thought we were all dumb but hey, maybe I’m not.

As the semester went on, things got worse and worse. There was an overwhelming amount of work to do; I no longer had my bulimia as a crutch; and I had a playmate, Husband, who lived with me and had a normal job that didn’t require homework, just begging to distract me from studying. On the next test in that class, I panicked, and ended up with a below the mean grade. As the semester went on, I sunk deeper into depression. It made me feel like crap that I got such low marks on tests, even when the mean was somewhere around there. A grade in the 30% or 40% range was just so disheartening to me, being the perfectionist that I am; it made me feel stupid, like I didn’t have any understanding of the subject we were supposed to be learning. I couldn’t put myself in perspective; I couldn’t realize that being in the bottom half at a top school doesn’t make you a complete and useless idiot. All I could do was feel little and ashamed.

The whole semester was very rough on me, and by the end of it, I had completely retreated inside myself. I was worried to even be seen in the department office, worried that the professors would judge me as that stupid or incompetent girl, the one who doesn’t belong in this field, the one who can’t cut it. I stayed home from the department holiday party because I was too embarrassed to show my face. My grades came in, and I saw grades I had never seen before, even a C+, which was shocking to the perfectionist academic scientist girl who had made the dean’s list every semester previously.

To make matters worse, Husband and I were very very low on money, and this was a pretty new thing to me too at the time. I had not, before, had to worry about how much the groceries cost, or whether or not I could get a new pair of pants after the ones I had ripped a hole. And my peers, at this prestigious institution, so many of them were rich, with mommy and daddy buying them the newest Tiffany’s fashion or a brand new pair of Uggs. So I had other stressors in addition to school and classes, and I worried as well that I was a failure because I hadn’t managed my money well enough to stay out of debt and still eat full meals and do a few normal college student things like buy drinks and go to movies.

In the spring semester, things didn’t really get any better. In fact, they probably got worse, although I found the teachers to be more adept at teaching the subjects, so that kept me afloat a bit. But by mid semester I just felt like I was in such a hole. I would sleep ALL THE TIME. I mean, all day. I’d sleep through classes. A lot. And finally I wrote a letter to my dean of academic advising, asking her if she could help me. I met up with her, got myself a regular therapist (I hadn’t been to regular therapy since spring of freshman year when the eating disorders program was complete), and began to talk to my professors. I still slept a lot and got sad and cried and felt stupid, but at least I had finally reached out a little bit. With my dean’s help, we told my professors that I was having issues. I was so afraid that they thought I just didn’t care, that they thought I missed classes or homeworks because I wasn’t trying hard enough. That was really what led to my embarrassment: the idea that they might think I didn’t care. The thing was, I cared so much but I got so anxious. Thinking about this class, this subject, studying for this or that exam, doing a homework set, these types of things were things that sent me to bed, to curl up with my blanket and pillow and sometimes with Husband and just cry about how inadequate I was, how I couldn’t handle it at all. So just letting my professors know that I really did care but was having other problems, that really helped me. In order to get the help I needed, I knew I had to step up, and be able to show up in the department and meet with a professor or TA, so reaching out to my dean was a helpful step.

All of this leads to my discussion of failing the doctoral qualifying exam, and how it is that even though I did, I’m proud of all the progress I’ve made and I’ve really come to terms with my having failed. I’ll talk about that in the next post, in Part II. For now, let’s just say that the undergrad years were hard for me, and I dealt with a real depression. (Oh, and by the way, I’d been on prozac this whole time, but in the spring semester I saw a doc and had the dosage upped to the dose I’m still on now. I think it really helped). So, this was all about my junior year. I’m not going to go into senior year, but just know that it had similar themes of anxiety, depression, and worrying about not measuring up, plus some of its own ups and downs. Next post, I will talk about grad school and preparing for the qualifying exam, which in my program is normally taken in the spring of your first year of graduate school, and covers….dun dun dun….everything you learned in undergrad, yes the undergrad years: that time when I was a depressed and anxious wreck. Fun!