Coffee

I think that coffee is an effective antidepressant. More than that, I think it’s at least as effective as the prescribed antidepressants.

So far the information is anecdotal  - I’m not entirely confident about this. On the other hand, both my housemate and my office manager also think that coffee works as an antidepressant for me.

I’ll need to do a 4-8 week test to see if coffee does work. But here at least are some of the initial feelings.

• The coffee intake needs to be fairly high. My current ‘dosage’ is two double espressos a day.  Since a single espresso has around 75-100 mg of caffeine, I’m taking in about 300-400 mg of caffeine a day (in comparison, a Starbucks Grande Cappuchino has about 150 mg of caffeine). And that doesn’t include the odd cup of regular coffee by my parents, etc.
• It has to be spread through the day, including evenings. So I’m sipping coffee all day, everywhere. Including cold coffee. Mind you, I’m fine with cold coffee but the coffee taste in my mouth all day can be a bit much. Sometimes too much…there are moments where I really don’t want to smell coffee for a while.
• About the drinking of coffee on evenings – yeah, it can keep you awake at nights. Do it a few nights in a row and you can look haggard and sleep deprived.
• The problem with coffee, and unlike medication, is that I tend to take it for granted. As a result I might miss my ‘dose’, particularly on afternoons and evenings when I am busy doing chores and odd tasks. And especially if I think “If I take some coffee now, I won’t sleep”. So I skip the coffee – and by the next morning I’m depressed.
• Caffeine makes me hyper / manic. It turns out that my mania / hypomania is very well controlled so I can risk this. I wouldn’t suggest this to someone who becomes manic easily.

So. What do you think?

 

Disclaimer: Do NOT replace your meds with coffee. Coffee acts as a real drug – talk to your psych before make any substantial changes in your intake of coffee.

 

 

Off Seroquel

Well, for now. Six days ago, I got depressed enough that I didn’t have the ability to take my meds. Yes, this really does happen and no, I have no control over it. Don’t bug me about being irresponsible.

Of course, I promptly went hypomanic (and had a great time). Then crashed after 4 days. All of this is predictable and expected. So nothing new here.

Noteworthy is that for the days after I came off the Seroquel, I complained a lot about being cold. Six days later, the grumbles are only now fading. It’s hard to untangle all the variables, particularly since I’ve been getting very little sleep, but (a) it only started after I came of the Seroquel, (b) I’ve handled sleepless nights before with fairly mild aftereffects, and (c) the temperature here has been 24-30 degrees Celsius (75-85 F).

I’m tentatively putting this as a side effect of coming off Seroquel, pending further confirmation. Any feedback would be appreciated.

 

I’d like to start back Seroquel and finish my experimenting, but I can’t yet. I’ll be traveling soon, and if I’m on Seroquel I have visions of falling asleep in the airport and missing my flight. Or having flight attendants being unable to wake me at the end of the flight. Or staggering up to an Immigration official as if I was drunk or drugged. I’ll start back after the trip ends.

And I do like being able to go out at nights again. It’s temporary, but hey, grab the opportunities while I can.

Cause and Effect, Depression and Stress

The traditional and common model has it that there must be some event or stress in your life that causes depression.

I think that’s just wrong.

And my experiences over the years generally have borne me out. Stress does not cause depression. Getting depressed creates stress in your life.

For example…

One thing that correlates with the onset of my depression periods has been staying up late reading science fiction. Now, there are two possibilities of cause and effect.

One is that when I find a good book and stay up until 2 or 3 am, I screw up my sleep cycles, become sleep deprived, have low productivity the following day, possibly create stress and thereby trigger a depression episode. Sounds logical, yes? Especially if I do it two days in a row. So this theory is “Staying up late to read triggers a depression episode.”

The second one possibility is that when the depression episode starts, one of the symptoms is that I try to hide myself from the real world by escaping into a fictional one. And as for staying up late, well, 2 am feels safe, because no one else is awake. So this theory is “Depression causes me to stay up late reading”.

The first possibility sounds more logical, doesn’t it? There’s a clear reason why I should have gotten depressed. See, stupid me had to stay up reading. What an idiot, especially if he knows it from past experience!

The second possibility sounds airy fairy, even to me. I mean, how could depression cause something like that. And what caused the depression to start with? This isn’t even worth mentioning.

Except…the second possibility seems to be the correct one. Here’s why.

I’ve been tracking my moods daily since I started taking Seroquel at the beginning of June. And around the same time my brother gave me a new science fiction trilogy to read. Now it turns out that I couldn’t read anything for the first week because I was sleeping. Interestingly though, I didn’t read much in the second or third weeks either. I did start the trilogy, and it was not great fiction, but it wasn’t bad either – so I’d read a few pages here and there over the days. There was no burning enthusiasm to find out what happened next, and overall, given a choice of doing something or reading, I chose doing something.  And since the Seroquel tended to put me to sleep, I didn’t read much at night.

Until the Seroquel stopped working at the dose I was taking and I started into a depression episode.

Usually, my depression episodes have a swift onset – usually over a day or so. However, the Seroquel interfered with this, so I have a few days of records of complaining of the onset of depression and days of low productivity. And then I have the nights where I stay up until midnight or 2:30 am, reading some books which I didn’t think were particularly fascinating a week earlier.

The late night readings follow the onset of the depression.

So in this case, the logical sounding cause/effect of possibility one is not correct. The more subtle scenario – in which the depression episode started and then external symptoms of it, like staying up late, became visible – is the correct one.

I’d actually like to extend that. Given my years of experience, I’ve generally found that there are very few external triggers for depression episodes – and daily stress is not one of them. My explanation has been that the depression episodes are probably triggered due to some biochemical process / failure within the body. The depression episodes then change our behaviours which are visible to other people.

However, since the biochemical changes are invisible to other people, the first they see of the depression episode are the changes in our behaviour. And then as the depression episode becomes worse, they then see the more radical changes in our behaviour, and assume these were caused by the first visible changes in our behaviour.

So while the general idea is that
incidents / behaviours in my life  —cause—> depression episode

my experience has been
internal biochemical changes start a depression episode —which shows up as—> incidents / behaviours in my life  —which then become—> more severe incidents / behaviours in my life

Notice that cause and effect are reversed. Depression is not caused by incidents. The incidents are a symptom of a depression episode that has already started.

 

Media and Crazy

Have you noticed that for the past few years it’s been sexy for television shows to have people who are mentally strange.

Think Monk and Bones. House kind of fits due to failed social skills, as does Sheldon (Big Bang Theory).

And these people aren’t amusing sidekicks that play off to the star  - they are the star of the show. And they are shown fairly sympathetically, even Sheldon.

Being sorta crazy is being accepted into the mainstream by the media.

Doggie Treats

Pepperidge Farm Goldfish make the best doggie treats.

However, one must be resist the temptation to also feed oneself. The goldfish in the bag have been touched by the same hand that was in your doggie’s mouth.

Seroquel – Effects and Side Effects

Here’s my recommendations on what to expect if you are going to take Seroquel.

First off, if you are planning to take this, you are going to sleep a lot. So much so, that you should assume that you won’t be able to do anything for the first 5-7 days after you start taking it. No work, no social activities, no anything. The only thing I did in the first 5 days is sleep, stagger groggily around the house, sleep more, feed the dogs, eat, and then take meds and go back to sleep.

Really. For 5 days. It started improving somewhat after the 5th day, but slowly.

If you decide to take Seroquel, I recommend that you (a) take vacation for at least 2 weeks, (b) tell people that you will not be able to attend any social activities for two weeks, and (c) hand over all tasks that you do at home to someone else. If you have responsibilities elsewhere, hand them over temporarily to someone else for 2-3 weeks. If you have children or pets, you will not be able to supervise or take care of them for at least a week, so make sure someone else is able to do so.

I am not kidding. You’ll be so groggy that you’ll be non-functional for the first week or so.

I’d also recommend that you discuss with your psychiatrist about slowly ramping up in 50 mg steps every 2 days until you reach the desired dosage. That way you body has some time to get used to the meds. If you start off by taking a 200 mg or more dosage at the beginning, there’s a good chance you’ll sleep for upwards of 20 hours the first night (I slept for 32 hours).  Sleeping for so long is both scary and traumatic and is likely to cause you to stop taking the Seroquel.

Unfortunately, if your dosages is 300 mg or higher, slowly increasing your dose extends the amount of time you’ll need to be on vacation. Assume 1-2 days extra for each increase in medication step that you do.

Once things sorta settle down and you aren’t sleeping or groggy all day, what’s next?

Well, you’ll still be sleeping a lot.  Here’s my typical 24 hours.

I take my dosage of Seroquel XR (200 mg) on an afternoon around 6:00 – 6:30 pm. Once I  take it, the Seroquel will knock me out within 2-3 hours, so that I am usually in bed between 8:00 pm and 9:30 pm.  But it’s not quite so simple.  I usually do have some time between when I take the medication and when I pass out – the 2-3 hours I mention above. However, the time is pretty variable and the Seroquel has taken effect in as little as 1 hour or as long as 4 1/2 hours.

Critically, there is very little time between when I realise the Seroquel is going to knock me out and when it actually does – it’s about 15 minutes between I start feeling groggy and when I completely pass out. What this means is that after I take medication I can’t drive at all – I may pass out at the wheel. It also means that if I want to do any social activities after 6:00 pm, someone has to provide transport and I may very well pass out at a restaurant or in the cinema or at a cocktail party. And since the time to passing out is so variable, I can’t accurately predict how much “safe time” I have. I’ve found it easier to simply stay at home.

Yes, I could take the medications later. But there’s a catch. With the meds, I consistently sleep for about 9-10 hours every night. If I take meds at 6:00 pm as I do now, and pass out at around 8:30 pm, then I will get up at about 5:30 – 6:00 am. Which is good for me. If I take them at 8:00 pm and pass out  at 10:30 pm, I’ll wake up 7:30 – 8:00 am.

But notice something – if I take the meds at 6:00 pm, I have no night life. But if I take them at 8:00 pm, I still have no night life because I have to be home by 8:00 pm – and very few social activities on evenings finish by 8:00 pm. Hell, I can’t even go to the cinema at 6:00 pm. If I want to stay out reasonably late, to go to dinner with friends and reach home at 10:0o pm, then I have to take my meds at 10:00 pm, pass out at 11:30 pm and wake up at 8:30 am – which starts getting late on a morning to be getting up. If dinner runs late because we are having a good time chatting, and I don’t fall asleep until midnight, then I’ll wake up somewhere between 9:o0 and 10:00 am.

And it’s actually a bit worse than that.  After I get up, I’m still somewhat groggy and I usually need about 1-2 hours to get myself moving and ready for the day. This happens every day, by the way. So, really, if I went to bed at midnight, I’m not actually ready to face the world until somewhere between 10:00 and 11:00 am the following day. See the problem?

I take my meds at 6:00 pm because the combination of the amount of sleep that I do plus the time it takes to get focused on a morning leaves me ready to face the world at around 8:00 or so. Which is an acceptable time for me. With Seroquel, there’s a trade off between having more awake time on an evening vs. on a morning.

So, once I’m moving, what do I do with the time between 8:oo am and 6:00 pm. So far, I’ve been fairly productive (though the final decision isn’t in on that yet). However, for the first week or so after I stopped sleeping all day, I still felt groggy during the day. In fact I felt like falling asleep every time I sat down, though it didn’t interfere with the stuff I wanted to get done.

For me, Seroquel acts a lot like a more powerful version of Tegretol. In both cases, taking medication allows me to decide on tasks and make them happen. Seroquel doesn’t feel like an antidepressant so much as something to increase my productivity, a focusing and doing aide, if you will. Seroquel also noticeably makes me less fearful of people – so I’m more likely to call someone, answer my phone, send or reply to an e-mail, write a business letter, call a friend, or feel comfortable talking to people generally.

One of the odd side effects of Seroquel during the day is that I have to have sugar every one and a half to two hours – if I don’t get the sugar, I get wan, light headed, and groggy enough to pass out. This means that when I wake up, I have a cup of sweet hot chocolate (2 heaping teaspoons of sugar), and then throughout the day I drink hot chocolate every two hours or so. Or have biscuits (Pepperidge Farm Brussels cookies, yum!). Or Coke.

It’s a pretty high sugar intake daily and it seems to be necessary. Oddly enough, coffee doesn’t seem to have a noticeable effect in stopping the grogginess. Nor does a regular meal like lunch, unless I have a Coke or juice with it.

Even so, I’ve found getting out of chairs to be an effort all day – it requires two hands on the arm rests and a deliberate effort to stand up. I also tend to lean against things rather than just stand up.

The other noticeable side effect has been if I don’t drink enough fluids, I get chapped lips and dry hands. Given that I drink so much hot chocolate, this hasn’t been a big deal, but I’d still recommend that you keep a lip balm close by because the chapped lips can be painful.

I also can’t exercise on mornings. The grogginess on mornings affects my coordination and leaves me staggering about, very much like a drunken man. The effect wears off during the day, so the best time to exercise is the 3-4 hours before I take my medications. These days though, that time is spent walking the dogs and doing odd and ends.

So  my day is wake up in the morning, have a hot chocolate and stagger around the house doing small tasks for an hour or so, change and go to work, finish work, walk doggies, take medication, feed dogs and watch television or read until I go to bed at around 8:00 or 9:00 pm. It’s not an exciting life and it currently has no social activities or exercise, but during the day my productivity is such that it’s still worthwhile in catching up on things not done in the last 6 months. In the next month or so, I will have to change it to include exercise and going out with people or I will really become a recluse.

Panic Attacks

Since my major meltdown in 1997, I haven’t gotten panic attacks. Or at least nothing compared to what other people write about. I’ve often wondered why, because I get depressed as much and as intensely, as other people.

On the other hand, I do tend to retreat into my house when I’m depressed and read trashy science fiction and not think of anything at all. Most people don’t seem to do that.

I’m wondering if there is a relationship between the two effects – panic attacks vs retreating and doing nothing.

I do know that when I am depressed and I try to force myself to do something, I get the following effects:

• First I get a feeling of not wanting to do whatever I am trying to do. It’s as if my mind says  ’Let’s get dressed to go out’ and then my mind immediately replies to itself – ‘No, I don’t want to do that’.
• If I continue to force myself to get dressed, I get distracted and do pretty random things, like pick up a book to read, or wander into the kitchen looking for food. Random things.
• If I really force myself to continue, I start triggering panic attack symptoms – the feeling as if a hand is clenched around my heart, an extreme desire to run away or hide from people, a feeling of terror.

I don’t get the panic attack symptoms anymore mostly because if I start feeling that way, I back off and stop doing whatever I was forcing myself to do.

There’s a good reason why I start backing off when panic attack symptoms start to show up. Once upon a time many years ago when I was a teacher, I tried to make it to school while depressed. I really didn’t want to leave the house, but I forced myself because it was my job. As I drove closer and closer to school, the feeling of “I don’t want to do this” and the associated terror got so bad that about two blocks from school, I turned around and fled. Course, I then crashed into another car at an intersection because I was in such terror that I couldn’t concentrate on the traffic. I just wanted to escape now!

Since then, I back off from those symptoms.

So. When I’m depressed, I don’t get panic attacks. But, I don’t do much either.

Seroquel, Sleepiness, and Psychiatrists

I’m taking Seroquel at the moment, and all the information says it will make you sleepy. That’s ok. What they don’t tell you is just how sleepy it makes you.

This the first time I took Seroquel, I took 100 mg at 11:00 pm one night, and then slept through the following day and night to get up at about 7:oo am, about 32 hours later.

Well, that’s not entirely true. I got up for 2 minutes at around 6:30 am the first morning to let the dogs out and then collapsed on the living room floor where my housekeeper found me three hours later. The front door was wide open for the entire period.  She roused roused me enough to get onto the living room couch where I then spent the next 22 or so hours.

During that period I did not go to work, visit my parents, brush my teeth, or answer any phone calls. I just slept. The dogs did not get fed that day either, poor critters.

What annoys me most about this is that the psychiatrist could have been way more forthcoming about what would happen.  Just telling me that I would be sleepy and to avoid driving doesn’t even come close to saying I would sleep for 32 hours.

My reaction might have been a bit extreme side, but I’m sure many people taking Seroquel had bouts of intense sleepiness which completely disrupted their following day.

Psychiatrists should be more more explicit about what the drugs they are prescribing will do and offer suggestions on how to prepare for the side effects.  Leaving us in the dark to find out the side effects ourselves can be scary at best and can be thoroughly disruptive to our day. And I really don’t appreciate that my dogs weren’t  fed simply because a psych was careless about talking to me and preparing  me for meds he prescribed.

Clinical Drug Trial Lengths and Effectiveness

I’ve always been a skeptical of the clinical drug trials since so many medications have provided me with little or no long term benefit. Now I have a bit more than skepticism to go on.

I’ve been trying Seroquel since the beginning of June and keeping daily notes and mood chart scores. The results have thrown up a peculiar issue which does relate to drug trials.

If I were part of a clinical drug trial that lasted 3 weeks, Seroquel would have scored perfectly. Once I got over the week long bout of mostly sleeping, Seroquel worked to keep me productive and stable for the next two weeks. On a scale of 1-5, five being the best, Seroquel would have gotten a 5.

However, I’ve been on Seroquel for nearly 5 weeks. If I had to score Seroquel at the end of 5 weeks, the result would be drastically different from the score at the end of 3 weeks. As it currently stands, Seroquel doesn’t seem to be able to keep me from getting depressed. If I had to rate it now, it would get a rating of 1 1/2 or so.

So the length of a clinical drug trial matters. People like me, whose moods cycle rapidly, would score a drug to be more effective if we were in a short clinical drug trial than in a longer one.  I’m assuming that people whose moods don’t cycle rapidly would rate a drug more effective if they took part in a long clinical drug trial than in a short one.

If the trial was double blind and the people in the sample were completely randomised, this would theoretically help dampen the length effect. But not completely – if the number of rapid cyclers in the entire sample was higher than the number of slow cyclers, then the drug would be favoured in a short clinical trial and penalised in a long clinical trial. Vice versa, if the number of slow cyclers was higher than rapid cyclers in the entire sample, the drug would be favoured in a long clinical trial and penalised in a short clinical trial.

For people like myself who have to make decisions on which drugs to take, knowing the length of the clinical trials which supported a drug’s effectiveness matters.  This should be part of the information that is provided to us by psychiatrists when they are recommending drugs.

Just Try It…. Hah!

I am beginning to hate the phrase “Just try it and see what happens” as much as I hate the phrase “Think positive”.

This phrase is usually uttered by people who are trying to help me by suggesting  something that is (a) usually wacky and ridiculous, for example “Have you tried massages to help you with depression?”, or (b) something I have tried in the past, often a few times, but which is now supposed to magically work because someone suggested that I try it again.

I’ve been actively dealing with my mood swings since I was diagnosed fifteen years ago. I bet you that I’ve tried pretty much everything you have suggested. Except the patently stupid ones, like nooni juice.

More to the point, I have far far far more experience on what may happen than you do, because I’ve lived through what you are about to suggest at least a few times.

I don’t need to try something to see what will happen, I can draw upon 15 years of experience to predict what will happen. And guess what? When I try it, my predictions are usually right, because I am an expert on being bipolar and on attempting to stop or alleviate the mood swings. A professional, if you wish.

If you don’t believe I have the experience, here’s what – I want you to touch the hot stove every morning to see if it won’t burn you. I want you to just try it every day and see what happens. Because it doesn’t matter what past experience says – you have to try it each day to see what happens. Because you never know, one day it might not burn you.

Won’t take me up on my suggestion, will you? Then why the hell are you trying to inflict the same crazy nonsense on me by telling me to try something and see what happens?

So, please please please stop insisting that I try something if I say it isn’t likely to work or didn’t work before. What you mostly are to me is irritating, and if I go along with you, I am wasting my time and resources just to please you, when I could be attempting something that I really haven’t tried before.