Feel fragile

[Jan]

Most people would describe me as strong, capable, resourceful--even brave.

But when I consider crises that I most likely will face as I get older (and in a society that I think is headed for trouble), I'm not sure I won't completely break down.

For one thing, there is no one depending on me. I live alone, I support only myself, and I'm not in a romantic relationship. I have a cat who is my main source of affection and love. I do have friends, but most of them have lives very different from mine in terms of work, family, demographics. My family lives far away, and I've never relied on family in a crisis. There is no one in my life who is there for me alone, whom I can call on through the bonds of blood or committed love.

I've never had a major life crisis, but I think that if I do (e.g., I hit someone with my car, I get arrested for having a joint, my house is burglarized, etc.), I am not at all sure I can handle it. I don't make much money, just enough to live on, and I don't have health insurance or a pension or an inheritance waiting. I'm terrified that a simple slip-and-fall could render me unable to work, and I don't have a safety net. Who would see to my welfare? No one.

Forget major life crises: I'm concerned about how I'll respond to any raising of my stress level. For the record, I generally handle stress badly: hyperventilation, insomnia, racing thoughts, crying, inability to function, isolation, rage, compulsive behavior. I don't want to subject people in my life to my breakdown.

I feel like I can't keep the various plates spinning in my life to keep from having everything break at once. I feel like SOMETHING's going to break, and that will bring my whole life down around me.

I know that my cat will die someday. (I'm crying now.) The grief I will feel may completely incapacitate me. If he dies by accident or through a condition I could have treated and didn't, I will add guilt to grief.

I'm not able now to simply "stop, smell the roses, take each day as it comes and let tomorrow take care of itself." There are termites eating away at my life: age, health concerns, financial insecurity, American society becoming fractious and hateful. I can't ignore them, and there isn't a lot of power I have to do anything about getting older and frailer.

I have been treated for depression, but reject the idea of antidepressants or anti-anxiety drugs. I don't believe in SSRIs (I did take them and they made me hypomanic--I still can't believe some of the odd things I did while on Prozac/Zoloft/Wellbutrin/Paxil) or in benzodiazepines. Plus, they cost money, and you are instructed to take them virtually forever. Stopping Paxil cold turkey five years ago was not fun at all. One writer said, "the only thing drugs lead to is taking more drugs." If I'd listened to the doctors, I'd be taking lithium, additional Prozac, Ativan, Clonapin (for the restless legs caused by Prozac) and would probably be institutionalized by now.

I suppose the thing is to find a sympathetic therapist who won't recommend drug therapy. That's another chunk of money to come up with (government subsidized mental health programs are few and far between in BushAmerica).

Maybe I'm not looking for advice. I just feel on a trembling edge all the time. There's a voice in me sobbing hysterically (I hear it). I have a nihilistic urge to destroy my life just so I can "finish the job." There are not many scenarios of my future that don't point to a quick and efficient suicide as the best way out.

If I come home one day and find my cat dead, I will break down. I don't know how or when I'll be able to recover and go out and be an entertainer again.

I just feel like I'm already broken in pieces, just waiting for a shake to completely fall apart.

 

[Daniel E.]

As you can imagine, I agree with you that therapy would be helpful, especially since you feel hopelessness:

There are not many scenarios of my future that don't point to a quick and efficient suicide as the best way out.

Also, therapy can pay for itself many times over in the long-term by increasing your productivity, reducing the potential need for psych hospitalizations, improving your physical health by lowering your stress/cortisol level, etc.

I suppose the thing is to find a sympathetic therapist who won't recommend drug therapy.

Well, they may recommend drug therapy, but it's not like most therapists just stop therapy and start lecturing endlessly on the value of medications as if the therapists were drug reps. Therapists know that meds are limited in what they can do.

That's another chunk of money to come up with (government subsidized mental health programs are few and far between in Bush America).

You may find some good news when calling mental health facilities/offices for sliding scale fees. If you live near a university, they often have low cost counseling centers for the public. Another way to find the cheapest rates may be to call the local office of the Department of Children & Families or other agencies that may have some relationship with low cost mental health facilities/offices.

In larger towns, there's also free, local support groups for people with depression and anxiety, but I have never tried those.

I know that my cat will die someday. (I'm crying now.) The grief I will feel may completely incapacitate me. If he dies by accident or through a condition I could have treated and didn't, I will add guilt to grief.

One of the best lessons I get from pets is to live in the present. My cat is mostly concerned about eating when it is hungry, sleeping when it is tired, etc. So she's basically a Zen monk. Only humans are concerned about maintaining a permanent state of affairs, which is impossible and would be boring, anyway. Also, as Bill Maher says, we live in a death-scared society, and death isn't the worse thing that can happen to someone, especially with animals since they don't anticipate or know of death.

If I come home one day and find my cat dead, I will break down. I don't know how or when I'll be able to recover and go out and be an entertainer again.

My impression is that, with time and treatment, you will be more able to deal with sad and stressful circumstances. Even when we "break down" for a while, we can come back up fighting ( going to pieces without falling apart).

You may also feel better by doing proactive things like reading a book on dealing with cat/feline emergencies and, if you haven't already, finding out in advance which vet clinic(s) or university vet clinic handles emergencies well at night. The only practical advice I have about indoor cat safety is that some cats can get trapped by jumping vertically down into small spaces, especially with a water heater in a corner wall. This happened to my cat, but the cat was freed within minutes with the help of neighbors. My understanding is that being stuck like this would have only been fatal, however, if the cat was left like this for days or weeks.

 

[Jan]

Menopause is a factor: I have cascading hot flashes, insomnia, night sweats, nausea, anorexia. I just learned that my sister didn't cease menstruating until she was 60, and I don't relish nine more years of interrupted nights. I'm considering, much as I don't like it, going on hormones, which aren't too expensive and you aren't expected to build your life around them.

I've made an appointment with a therapist at a sliding-scale place. I've made an appointment with a sliding-scale health clinic (not until September) to see if my physical symptoms are really physical. Frankly I'm not optimistic about the therapist I'm going to see; she has an exotic name that makes me think she's not American, that she has a cultural background that will make her unable to identify and empathize. Or that she'll be barely into her twenties, with a chirpy little voice and a script straight out of her last class and almost no experience of living in the world. (Been there, done both.)

Out of all the therapists I have seen in my life (about 8), nearly all of them wanted me to do drugs. They REALLY wanted me to do drugs. "It's a chemical imbalance." "These drugs are a miracle." "Don't you think you should just try them?" "You'll thank me." When the depression returned, three wanted me to take more drugs, or take another drug. What's next: electroshock?

Should I let myself be talked into drugs that I already know from experience that I don't want to take, just because most therapists are well meaning and the samples and visits by the drug reps have absolutely zero effect on their practice? Am I supposed to keep the therapist happy? I think these drugs are bad things. SSRIs are not much different than amphetamines. Benzodiazepines are addictive. (I used to work for a research pharmacologist who worked on exactly these drugs.)

I know the standard riposte is, "but many people have GOTTEN THEIR LIVES BACK through these drugs. These drugs are A MIRACLE for THOUSANDS of depressed people." I'm completely unconvinced. And depression hasn't gone away, has it? More depressed people than ever before. We're creating depressed people faster than we can drug them out of it.

Is there any way to be happy and serene in this world that doesn't involve drugging yourself or praying out loud 24/7 while cruising the mall?

Perhaps I'm asking for too much, like someone who can tell me how to live in this world where the gaps in the safety net get wider every day. Maybe I should give up the work I love and get a mind-deadening office job, so I can get health care to deal with the depression linked to a mind-deadening office job in a society fracturing at the seams.

Maybe I should go to school and get training in a job I might like better, then; maybe I should take a class at a community college on relaxation techniques, or yoga. Maybe I just need a hobby; or maybe I need to be a volunteer at a shelter. Maybe I should just paste a smile on my face--they say that helps too. I'm being sarcastic because I feel a little patronized, as if I don't already know the litany of standard remedies. I'm not a child, I'm fifty-one.

I know how to take care of a cat. I've read plenty of cat books (I've read a shopping bag full of psych books and self-help books too, for that matter). I can handle a feline emergency. My cat is kept indoors and I'm very vigilant about his safety. I'm afraid of stumbling onto him, causing an accident that injures or kills him, or just coming home one day and finding him dead.

If my cat knew what I know, he might be depressed too. If I were a cat I would probably be happier. But I'm not a cat who lives only in the present, from bowl to nap to yarn to nap to bowl. The situation won't be remedied if I manage to not worry about my cat--it's more than that.

I'm sorry if I come across as irritable and sniping. Irritability and bitterness is part of my problem. I don't feel like a very nice person these days; I feel like I hide a sniping, sarcastic self behind a pleasant facade. I feel like I'm not the person anymore that I thought I was: that I'm really not very nice at all, and it's only a matter of time before all my friends draw away from me. Sometimes I think that as you age the waters recede and all the spikes and peaks and mucky bottoms of your personality are revealed. Not a happy thought in my case.

Something has changed in me over the past few months, and instead of happy and grateful as I've been ever since I went back to the arts three years ago, I'm anxious, sorrowful, and thinking that it's just a matter of time before I'm either arrested, institutionalized, or out on the street. Suicide to follow shortly thereafter.

And y'know, some of the stuff I'm worried and depressed about is worrisome and depressing in the objective extreme: Bush, war, the falling dollar, the rising debt, the crash that we know is coming, the oil that's running out, the raging weather. The boarded-up businesses in my city, the cardboard signs that say Hungry Vet--Please Help, the road rage, the hate radio that seems to run 'round the dial, and the bland stupid faces who think Iraq is something you put your guns on, praise Jesus. It's not just about me and my psyche. Some people in this society will be plowed under, and I have a strong suspicion that I'm one of them. How can one be serene under a tsunami? What is the job of therapy in this age of insanity?

I hope you won't just write me off with "well, good luck to you, then."

 

[Daniel E.]

I think HRT (hormone replacement therapy) would be a good idea, but as a 28-year-old male, my opinion shouldn't count for much. I've also been reading that soy is good for menopause, too, as you probably know.

Should I let myself be talked into drugs that I already know from experience that I don't want to take, just because most therapists are well meaning and the samples and visits by the drug reps have absolutely zero effect on their practice

Your point is legitimate, and it is a point I have made to my own therapist. My current therapist wasn't concerned when I stopped taking meds because I already tried everything including all of the newer antidepressants as well as ECT with no known benefit. Exercise, therapy, socialization, music, and working are my main sources of treatment.

Regarding depression and American society, you may like this article:

In every way, depression is a growing problem. Rates of depression have steadily climbed over the last 50 years and are significantly higher in those born after 1945 than in those born before. In addition, the average age of onset of a first depressive episode is steadily decreasing--it is now mid-20s whereas it once was mid-30s. Cross-cultural data show that the United States has a higher rate of depression than almost any other country, and that as Asian countries Westernize their rates of depression increase correspondingly.

The Art of Avoiding Depression

 

[Jan]

The suddenness of this depression makes me think there are more than a few contributing factors. Haven't had a really good night's sleep for at least two months. Can't eat, so I don't get a balanced diet and am probably undergoing some blood-sugar-related mood swings. My appetite is really picky, and sometimes I make food and then can't force it down (I'm not a good dinner party guest, obviously). I don't mind on the one hand because I don't gain weight, but I don't feel too good most of the time. I have "green attacks" almost every day.

My father had an ulcer, and in the fifties the treatment was to remove part of his stomach--essentially he had a sort of gastric bypass like obese people get these days. He never had a healthy day in his life after that, got really thin, anorexic, even bulimic: he'd eat the food he wasn't supposed to and then vomit it up. That ruined his teeth and deteriorated his health even further. He was always irritable, but I realize now that he probably never felt really well, ever.

I thought of asking a psychiatrist I know to prescribe a week's worth of sleep medication, but it's not so much insomnia as hot flashes and sweats that wake me a dozen times a night. I get a few hours of sleep between 3 and 7 a.m., but then a hot flash wakes me again and then I have to get up. Then I get very weary and spacy in the mid-afternoon. I used to go out at night but can't work up the energy anymore. Several months of this and maybe it's all snowballing into this internal near-hysteria I feel.

I took Premarin for six months and it didn't seem to make a big difference, but I was sleeping better, at least. I have a history of stroke in our family (my mother just had one at age 87) and I'm terrified at that possibility, too. I don't smoke, or drink more than lightly, but then again, neither did my mom.

Thank you: I kinda needed to vent all that stuff in the last two messages. Until I get with a therapist, this is my pour-it-out place.

 

[David Baxter PhD]

Jan, the starting point for me would be to find a way to stabilize your sleep. I don't doubt that there are other contributing factors, as you suggest, but I'm not sure you'll feel a whole lot better until you're getting decent sleep.

Your idea of asking your doctor for something to help you sleep is a good one, I think. One possibility might be trazodone, which in addition to helping with sleep might also help with the menopausal symptoms.

 

[ThatLady]

It really does sound like you're suffering from hormonal fluxes right now, hon. Something to help you sleep might help a lot. Trazodone, as Dr. Baxter suggested, might be a very good medication to try. Another thing that helps some people is to drink a cup of warm milk before bed. It's not just an old wive's tale. For many, it is helpful.

I hope you can find something that will help. Living in the dregs of depressive thoughts is no way to live, and not getting any sleep surely isn't helping.

 

[Daniel E.]

From www.medscape.com/viewarticle/484767+Insomnia+and+Menopause&hl=en]Insomnia and Menopause - Medscape[/url]:

Pharmacologic agents used in clinical practice to induce sleep or maintain sleep include hypnotics and sedating antidepressants. Sedating antidepressants, such as the tricylics and trazodone, produce drowsiness and may help sleep, but residual sedation and interactions with other medications need to be considered in postmenopausal older women. The controversy concerning hormone replacement therapy (HRT) has increased the use of antidepressant medications, such as the selective serotonin reuptake inhibitors (SSRIs), for managing hot flashes as well as treating anxiety and depression. Of interest, 1 potential side effect of this class of antidepressants is sleeplessness.

The mechanism of action of the available hypnotics is via modulation of the gamma-aminobutyric acid type A (GABAA) receptor complex. Hypnotic medications fall into 2 major categories: the benzodiazepines (temazepam, flurazepam, and triazolam) and the newer nonbenzodiazepines (zaleplon and zolpidem). Good efficacy, together with improved safety and tolerability of these newer agents, have made them the first-line choices when a hypnotic medication is indicated.

The use of HRT for treating insomnia in postmenopausal women, particularly with regard to objective measures, is controversial, and results may depend on the specific type of hormone or hormone combination used.[2] Similarly, because of conflicting objective and subjective results, there is no consensus regarding the role of HRT for treating hot flashes and related sleep disruption.[16,17]

A 2004 copy of the PDR Monthly Prescribing Guide lists the following antidepressants as most sedating:

Remeron (made me sleep 13+ hours a day), Desyrel/trazodone, and the following tricyclics: Elavil, Anafranil, Sinequan, Surmontil

 

[David Baxter PhD]

Other than the side-effect of drowsiness, which is desirable if used to treat insomnia, I've never encountered anyone who experienced any other side effects from trazodone. Because it makes one sleepy, it really isn't prescribed as a stand-alone antidepressant any more.

 

[Daniel E.]

I never knew trazodone was so popular for treating insomnia:

Trazodone, a triazolopyridine antidepressant, is currently the second most commonly prescribed agent for the treatment of insomnia due to its sedating qualities.

A review of the evidence for the efficacy and safety of trazodone in insomnia. (2005)

The last few years have seen a remarkable rise in the off-label use of trazodone for inducing sleep in nondepressed patients, to a degree that it is prescribed for this purpose as commonly as the leading hypnotic.

The use of trazodone as a hypnotic: a critical review. (2004)

 

[David Baxter PhD]

Yes. I have several clients who take it for that purpose.