One of the best decisions I made in 2012: antidepressants

I wish that eating well, running, and staying busy were enough to keep depression and anxiety at bay for me, but they aren't. Those are all things I've been doing for years, and still - for years - I had this constant, nagging feeling of Something is wrong with me. I planned my own funeral for fun. I wrote depressing entries in my diary. I made friends and lost them, over and over again. Something is wrong with me. I got angry and threw things. I cried while lying on the floor of the bathroom, light off, door locked. I quit things, changed jobs, viewed moving once every year or two as a perfectly logical approach to dealing with social discomfort. Something is wrong with me.

And yet throughout that time, I looked totally functional to most people. I went to school or work. I excelled in classes and in my jobs. I smiled, bantered, was personable. I maintained my relationship with my husband. I had a kid.

Few people outside my immediate family knew how much I was struggling. I didn't know how much I was struggling. Periodic bouts of exhaustion, near-constant irritability, and daily anxiety attacks were, from my perspective, just part of the fabric of my personality. And to a certain degree, one gets used to feeling bad when one has felt that way since her early teens. I had enough coping strategies in place (like working really hard, eating well, running, sleeping, zoning out, distancing myself from others if I might go all Jekyll-and-Hyde on them, etc.) that I got by, for the most part. As the years went on I also became adept at hiding what was really going on.

That's a common theme in mental health: hiding. Which is partly why so many of us who struggle with difficult mental experiences feel so isolated and alone. We don't want to embarrass ourselves, so we compensate by striving to look normal (or better yet, GREAT!); when we do furtively glance over the wall to see if there's anyone else out there, the place looks empty. In reality the mental health landscape is full of people struggling with similar things, all hiding from one another, afraid (often understandably so) to stand up and put it all out there. I think that's slowly changing. Finally.

I started therapy long before I started taking an antidepressant, a strategy that now seems somewhat backwards. Don't get me wrong: therapy has been invaluable in that it's offered a place where I can dig through my life and identify where, how, and why ineffective habits developed. It's given me tools: I've learned how to set boundaries, be nice to myself, combat negative thoughts, handle conflict, and be more assertive. I needed the therapy; it was one of the best decisions I have ever made. The problem was, implementing these strategies while dealing with full-on depression and anxiety was like trying to build a life raft while in the active process of drowning. 

Only after I got in touch with a psychiatrist, received a diagnosis (major depression and PTSD), and started on Zoloft (a relatively reliable, long-studied antidepressant used specifically to treat PTSD, among other conditions) did I realize just how long I'd been on the verge of being pulled under permanently. I'd gotten so used to treading water that I didn't know life's not supposed to be a constant day-to-day, year-to-year struggle. I did recognize that the bad times were growing progressively worse. By last January I was having the conversation with my therapist of, "I won't end my life. But I think about it. But I won't do it. But sometimes I want to just not exist," and him saying, "What you're holding onto is an emergency exit option. As long as that door is open, even just a little, you are in danger."

It's hard to describe how different my life is now that I am taking that little white pill every morning. Maybe it looks the same from the outside. I'm still doing what I've always done: working hard, running, putting time and effort into my relationships, challenging myself. But from the inside, it's like Extreme Makeover: Headspace Edition. My anxiety is still there, but I'm mostly able to manage it. I still get depressed, but I recognize the warning signs and know to take action before things get really bad. And all the techniques from therapy? Now I can actually put them into practice on a consistent basis. (Turns out, positive self-talk really works, if you can make yourself do it!)

Sometimes it's hard to remember what it used to be like. I do find myself wondering why I couldn't pull it together, why I made things so hard for myself. But then I'll read an old journal entry or think back to one of my earlier sessions in therapy, and I'll remember that I didn't do this to myself, that I was working as hard as I possibly could to fix my brain. I couldn't save myself no matter how much CBT, EMDR, or western meditation I did. A person with two broken arms might know everything about what it takes to construct a house; she might have all the tools, all the blueprints. But unless her broken arms are set and have a chance to heal, there's no way she's going to be able to actively use her arms to build it.

That's what medicine has done for me: it's put me in a place where my brain can rest long enough to (hopefully) get better. Sometimes I do wonder whether I will ever be able to stop taking Zoloft. Part of me believes it's just a temporary support beam, and that if I can just use this time to reconstruct and galvanize my way of thinking, I'll eventually be able to remove that support. Another part of me worries that if I ever stop, the whole thing will collapse. At any rate, I'm not ready to quit medication just yet. It's working for me; if it's working, why stop? The statistics also give me pause. Depression is one of those things where if you experience it a couple of times, you're likely to experience it again in the future, and it might be worse the next time.

Of course, every person's experiences are unique, and that's certainly true when it comes to antidepressants. I've read that for some people, they don't work; some people have side effects that negate the positive outcomes; other people do well on them for awhile, and then the medication loses its effectiveness. For all I know, Zoloft might lose its oomph for me, too. But for now, I'm just grateful that it's working. It's one of the best - perhaps the best - decision I made this year.

Saturday Six; Vegan Days 3-5

1. My family came into town today. One thing that I've noticed since being in therapy, taking antidepressants, and learning how to set boundaries is that I can now handle having my relatives in my home for extended periods of time (and by "extended," I mean six hours or so, tops). This has not always been the case. Used to be that having them here for even half an hour sent me into a tailspin of anxiety, depression, and dissociation. The most important thing for me is not letting them infiltrate my own space: whereas we used to have them stay in our house, we now ask them to stay in a hotel. Although somewhat inconvenient, it works out so much better for everyone.

Confession: as healthy as that all sounds, I was kind of a mess yesterday. When it comes to my family, panic attacks are my autopilot measure.

2. Another confession: while they are in town, we have plenty of libation on hand. Alcohol does serve its purpose at the holidays. I did not learn this in therapy. 

This is one of my favorite inexpensive wines - mostly because it tastes good, but I also do love the label. :-)

3. One of my students from this past semester sent me a hand-written thank you card. My grades have been in for two weeks and she's already received her updated transcript, so it's not like she was doing this to win favors. I have to give her props. Maybe one day I'll make writing personalized thank-you messages a goal; as it is, I'm happy if we manage to get the water bill in the mail.

4. Paper snowflakes: I love them.

5. Today was Day 5 of the 30 Day Vegan Challenge. So far, so good! 

Breakfast: GF granola cereal with almond milk

Snack: Almond milk (!) latte at the new cafe in town... This is the first time I've been to a local place that offers almond milk

Lunch: GF pasta (Trader Joe's brand, which is pretty good) and sauce with an apple on the side

Snack: Orange and a Larabar

Dinner: Sauerkraut with potatoes, green beans, and mushrooms. Sauerkraut: smells stinky, tastes delish, yay for fermented food.

I'm reminded that this whole vegan thing isn't an issue for me as long as I have access to the food I like/need and a way to cook it. I'm not craving meat or dairy so far. In the long run, I think cheese will be the toughest thing: I do love a good stinky cheese.

6. To offset the calorie count: mat Pilates last night (first time doing a bona-fide Pilates class) and an Xtend Barre class today. After two weeks of being away, I'm sore.

Depression, etc.: How important is a diagnosis?

At my second therapy session three-ish years ago - right after Therapy Guy finished my intake questionnaire - I asked him what was wrong with me. I wanted a diagnosis. I'd already done my research and had narrowed down the possibilities, so I was quite prepared to handle whatever answer he gave.

"There is nothing wrong with you," he responded. 

Except that answer.

It pissed me off. A lot. How did he know? Had he lived inside my head for the past two decades? Nope. I knew something was not right. He simply didn't know me well enough. Because if he did, he would surely see that there was something very, very, very wrong.

Now that I am familiar with him and his compassionate, kind nature, I know that what he didn't mean was, You're making all this up. You're just some thirtysomething suburbanite with too much time on her hands, and you don't need to be here. Instead, what he meant was, You are perfectly fine and worthy just as you are - you just don't believe it yet. You may be struggling but you can make your life better. 

For a long time, he would give some version of the "There's nothing wrong with you" statement every time I asked him what my problem was. Even when I brought in journal entries that made me sound insane. Even when I cut myself. Even when I called him really late at night from two time zones away, crying into his voicemail. He always insisted that I was an acceptable person, deserving of concern and care, and that there was nothing innately wrong or bad about me.

Therapy Guy is not a big fan of the psychiatric diagnostic manual. He views it as a collection of symptoms ("experiences," he calls them) packaged in a variety of convenient ways. Patients in the mental health system are typically labeled with one of these "experience packages," even though everyone's set of experiences is unique, and even though the labels are often given for the primary purpose of appeasing insurance providers. That is why Therapy Guy doesn't deal with insurance companies, and why he treats the individual, not a diagnosis. I see what he means: looking at the diagnostic manual, I could probably give myself a whole slew of labels, and yet none of them would really fit exactly what I deal with.

On the other hand, his reluctance to offer a diagnosis has always bothered me a little, and when I finally did receive one from my psychiatrist early this year, it was kind of a relief. I deal with symptoms of depression. I deal with symptoms of PTSD. And while that doesn't mean I equate them with who I am or the change I am capable of, yes, it's really nice to have a framework of reference from which to work. (I now realize that Therapy Guy was already working within that general framework, so it's not as if I was totally off track in terms of trying to get better.) My psychiatrist's choice of antidepressant - Zoloft - was based on research indicating that it is effective for PTSD. That's why she picked it as a starting point for me. Pharmaceutically, it gave us a place to begin.

Moreover, it's nice to feel that I am not alone. When I hear someone say that they struggle with depression or PTSD, I know that even though our experiences aren't exactly the same, we share some common ground. I can relate to the challenge. It's comforting. The label - while limiting in some ways, and inadequate - creates a sense of community, and for people like me who often feel isolated and different, that sense of community is meaningful to me.

The important thing to realize about mental health diagnoses (as with many physical health diagnoses) is that they aren't necessarily permanent. Mental health is a fluid thing, and our personal choices play a big role in it. Most psychiatric conditions are treatable. Doesn't mean treatment is easy, but it's possible. So even though I was diagnosed with PTSD in February, I may not always have PTSD (there are many, many excellent treatments for PTSD; with enough time and support, people do recover). And even though I may have a genetic predisposition to depression, I may be able - with help and vigilance - to avoid the worst relapses. 

As Therapy Guy likes to say, People have an immense capacity for change.

So I kiss goodbye to every little ounce of pain

Today I saw my therapist for the first time in several weeks. His wife just had a baby, so he's been taking a paternity leave.

Two years ago, a year ago, even six months ago, his absence would have been very difficult for me to cope with. The inability to reach him by phone, to set up an emergency appointment, would have made me feel panicked and abandoned.

(I know that might sound weird to some of you. All I can tell you is that when you have grown up feeling like you can't really depend on or trust anyone because they will eventually screw you over, and when you have so many relational hangups that are so ingrained in you that for the longest time you don't even realize they are there, when someone trustworthy and parental finally does come along and sticks with you, the bond is very strong. And age does not matter.)

But this time, I just felt happy for him. I was so busy with running, working, traveling, parenting, having fun with friends and my husband, and - dare I say it? - thoroughly enjoying my life that when my therapist finally did call me back to set up a new appointment, I didn't get around to calling him back for nearly a week. I was just in my zone, and I wasn't in a hurry to see him again. As it was, I felt like I had little to discuss.

Fast forward to my session with him today. We talked about recent goings-on, how being nice to myself by "talking" to myself in a positive way is actually working, about how even though circumstances haven't really changed (including the common presence of difficult emotions), my way of handling them has. I have worked very hard to change the way I treat myself, to be more self-aware, and to give myself space and encouragement. What I've recently realized is that little by little, I have established an internal "new normal." 

These are all very good things, but I ended up crying quite a bit during the session . I don't quite understand why, but I think part of it is the sense that this very difficult part of my journey is coming to an end. And although this journey to deal with the past and rewire old behavioral patterns has been hard, it has also been intensely profound. One amazing thing about it is the bond I have developed with my therapist. It is a deep and meaningful relationship, as is any relationship in which individuals overcome an exceptionally difficult challenge together. 

But I don't need my therapist the way I used to. Even if I do feel depressed again, even if difficult situations arise (as they surely will), I am simply less dependent on him now, and that likely won't change even if circumstances should nosedive. It's a good thing, but it makes me feel sad, too, because it means that our paths are starting to diverge.

It's not just about him. It's also about the hard things I have realized, the difficult memories I've had to look full in the face, the struggle to take responsibility for my own life now. I'm not the same as I used to be. And even though I like my life now, I guess there is some sadness in realizing that there are certain things I am moving on from.

This post sounds sappier than I intended it to be. I heard this song on the way home and was struck by how it mirrors the mood in my head right now:

Two Fingers - Jake Bugg

"So I kiss goodbye to every little ounce of pain

Light a cigarette and wish the world away
I got out, I got out, I'm alive and I'm here to stay
So I hold two fingers up to yesterday
Light a cigarette and smoke it all away
I got out, I got out, I'm alive and I'm here to stay

There's a story for every corner of this place
Running so hard you got out but your knees got grazed
I'm an old dog but I learned some new tricks yeah"

Running as a way to mitigate depression and anxiety?

I've been away - not at the loony bin (though sometimes it's certainly a distinct possibility), but at a professional conference. Actually, wait. This professional conference IS like a loony bin, except that few of the people there actually recognize they have issues and the majority of them don't see psychiatrists. Same issues, less recognition. Always interesting.

Anyway, so first I was preparing for this conference (in the form of putting together a talk, which took a ridiculous amount of time and which put a spotlight on my poor graphic design/PowerPoint skills), and then I was at the conference, and then I was drinking and eating and giving my talk and reuiniting with people I hadn't seen in a while. And drinking more. 

Very little running was involved, unfortunately. I mean, I DID run, but they were relatively short workouts on the hotel treadmill. I should have run 18 miles on Sunday and it just didn't happen. Good thing I am in taper mode, since the marathon is in only 2.5 weeks away. I'm thinking of doing 18 miles this Sunday even though I suppose Hal Higdon would not approve. But would it really pose that much of a problem? I have two weeks after that to rest.

Speaking of running...

The last conference I went to was last June, and for whatever reason, it left me reeling and depressed. I don't know whether it was the stress of traveling, dealing with huge crowds of people, being away from my family, or what, but all of a sudden I went from feeling really stable (for the previous 4-5 months) to hitting bottom again. The situation was not good. At one point I wondered whether I might need to check myself into a hospital. The trigger seemed to be this academic conference experience. Thus, I was concerned that this very recent conference - which involved just as many people, almost as much traveling, and a strong dose of stress - might send me reeling down the same path.

Thankfully, it did not. I've been trying to figure out what the difference was between now and last June.

Things that are the same: I'm still taking an antidepressant, same dose. I'm still seeing my therapist every other week or so (actually less these days). Actually, if anything, the summer conference should have been less stressful: I wasn't teaching any classes at that point. I had to present at both meetings.

So what is different? The only major difference is that I'm now training for a marathon and attending butt-kicking barre classes on a regular basis. So could the extra exercise be at the root of this newfound stability (relatively speaking)? In a way, it seems counterintuitive. Marathon training itself takes a lot of dedication and a certain amount of sacrifice. It cuts into work time, family time, and rest time. Then add to that the barre workouts - if I do them 4 times a week, that's another 6 hours where I'm not really attending to my responsibilities. And yes, on a day-to-day basis, it does feel like a lot. I do feel the strain.

On the other hand, my immersion in these activities means that:

(1) I have more energy during the day and I sleep better at night.

(2) I have less time to worry/stress, because when I'm working out I'm very focused on the task at hand.

(3) I'm forced to make transitions more quickly. For instance, even if my mind WANTS to stay in work mode all evening, when I get to barre class, it simply can't. There's not enough energy for that.

(4) I have a better social life. I'm opening up more to RF, getting to know her friends, and starting to get to know the people at Xtend Barre.

Ultimately, I keep myself so occupied that I do not leave as much room for ruminating, worrying, planning, obsessing. I think that's a big part of it. Maybe I've been underestimating the positive long-term effects of exercise on my mental state. Maybe it's kind of like the antidepressants themselves: one pill here and there won't make much long-term difference; you have to take them every day if you want them to work, and they don't work right away. If you miss a day, it won't hurt you much so long as you get back on track the following day. Perhaps the influence of exercise on the brain is similar: the long-term consistency is key.

Difficult long runs and depression: How to keep going

What I have learned through marathon training so far is that running long distances is a true mind/body experience. As in, at a certain point both your mind and body (especially the legs) are screaming at you to STOP THIS NONSENSE IT IS INSANE. Then you have to somehow find the one small part of you (the David to your Goliath) that is willing to ignore both of them and carry on in the hope that at some point it will get better.

That's the other thing I've learned: you can be feeling completely trashed at mile 16, yet by mile 18 you'll feel like you're flitting weightlessly along on puffy clouds and rainbows. It doesn't seem possible, and yet it happens sometimes - that complete, rapid shift to feeling 100 times better than you did just a few minutes prior. Of course, sometimes it doesn't happen, but with the help of gels, water, mini goals (run to the mailbox... now run to the telephone pole...), and your running buddy, you get through it anyway.

Basically it's taken me approximately two months of marathon training to learn with respect to physical endurance what it's taken 2.5 years of therapy to learn with respect to dealing with depression/mental endurance: you keep moving forward knowing that it is going to get better. You don't know when - be it a mile down the road or 24 miles down the road - but at some point it won't be so hard. You just keep going. It sucks, you keep going. You puke, you keep going. You think bitter, evil thoughts about the drivers who don't understand crosswalk signals, but you keep going.

A difficult long run and depression are obviously not the same thing. If I had to choose between horrible, painful, 20-mile daily runs and daily depression, I would choose the running. No question. And while I *might* wish those horrible running workouts on my worst enemy under the right circumstances, I wouldn't wish depression on anyone. Ever. Because depression is like being in the solitary confinement ward of hell.

But. Sometimes now when I get depressed - and it does happen, frustratingly enough, even with the antidepressants and the running and the decent diet and 6-8 hours of sleep every night and the therapy - I try to treat my mind the way I treat it when I am struggling during a run. Which is basically to ignore the protests while giving it as much meager encouragement and positivity as I can muster, and by trying to distract it.*

It's not that simple, really, or at least it doesn't feel simple when things get bad. But I think this approach - ignoring the negative, saying nice things to myself (even when I protest), clinging to the belief that it won't always be so hard - is helping. I'm not saying it makes me feel good. Honestly, it doesn't. Depression is a deep pit. It's not like you can just launch into a standing jump and hop out of it. But treating depression like a difficult yet surmountable obstacle - as opposed to an insurmountable and permanent fate over which I have absolutely no control or any way to deal with - helps get me through, which at certain points is all I can ask of myself.

“Listen to the people who love you. Believe that they are worth living for even when you don't believe it. Seek out the memories depression takes away and project them into the future. Be brave; be strong; take your pills. Exercise because it's good for you even if every step weighs a thousand pounds. Eat when food itself disgusts you. Reason with yourself when you have lost your reason.” - Andrew Solomon, The Noonday Demon

Change

I grew up in an environment that touted change - or important, life-altering change at any rate - as something that happens in an instant. You are given a choice, you make the right choice, that moment stands as The Moment When It All Changed Forever, and that was that. Change involves a single epiphany that then stands as sort of a North Star for life.

So I guess I've always had it in my head that I should be able to change immediately. It should be something I can will to happen right away, if I just try and believe hard enough. Mind over matter.

What I have come to understand is that change can be painfully, glacially slow, so slow that you can't see it happening in the moment. Rather, you can most easily see it when you reflect how you handle multiple instances of a particular situation or problem over many months or years or maybe decades. I spent a lot of time doing that last week while traveling: for instance, considering how I handled meeting new people three years ago (panic, self-consciousness, dissociation) versus how I handle meeting new people now (still shy and self-conscious, but I try to look people in the eye, smile, and hope that they will give me time to be myself, and I try very very hard to avoid spacing out). How I dealt with travel delays/cancellations three years ago (panic panic RED ALERT OMG I AM NOT IN CONTROL) versus how I handle them now (this sucks, but hey, did you say I get an upgrade to first class???) How I handled self doubt then (wow, you're such a moron, how can you even show your face) versus now (you're doubting yourself, and that's normal, but you have a lot to offer... Hang in there, you can do this).

I'm not saying I'm a whole new me or that my reactions to problems/dilemmas are always ideal, but... yeah, I see a change, and that change seems largely permanent. I have modified my habits and way of thinking to the point where I feel like I can live with myself. I even like myself a lot of the time. But again, it took a lot of time. And talking. And ugly emotional crises. And depressions. And cutting. And digging through unpleasant memories. And learning to trust certain people. And stepping back from the ledge (figuratively, but kind of literally, too) when I needed to.

I realize that life and experience are fluid, and that things won't always go as well as they are going now. But just knowing that change happens - albeit slowly - helps.

"Thanks to impermanence, everything is possible." - Thich Nhat Hanh

*  *  *

In other news, marathon training continues. Yesterday I ran 5 miles on my own, and today I ran 8 miles with my training buddies. Tomorrow it's another five miles, followed by several miles on Saturday and (GULP) 18 miles on Sunday. Wow.

Friday Five: Prepping for Italy edition!

1. I'm going to Italy tomorrow! I'll be there for a week, participating in a conference/workshop a couple hours north of Rome. I'm nervous about traveling, not knowing the language (though I can count from zero to twenty in Italian!), and the potential for coming across as a total dunce at this workshop, but mostly I'm just excited. September in Italy is supposed to be beautiful, and made all the more beautiful by Italian wine and Italian coffee.

2. This week's mileage:

Sunday: 15 miles (see previous post)

Tuesday: 5 miles

Wednesday: Xtend Barre class

Thursday: 4 miles

Friday (today!): 13 miles! I stayed home, packed, and went on the 13-miler with my husband. The weather was sunny and cool, and my legs felt good for most of it. I'm bringing my running attire to Italy and will go out for a jog if I have time. But if not, at least I completed this week's long run, and hopefully I can get right back into the swing of my marathon-prep schedule when I return.

I'm not sure I've ever run 37 miles in less than 6 days before!

3. I went shopping today for travel snacks, and I found THESE. At TARGET! 

Nutritionally-complete (well, mostly), gluten-free, vegan travel snacks. I never thought I'd see the day. True, I don't like the amount of packaging these require, but there's some measure of comfort in knowing that even though I'll be spending a total of >15 hours in flying metal sardine cans, at least I'll have snacks that I can eat and that taste good.

4. I hate packing. I do it a lot and it never gets any easier. I'm trying to stuff everything into a backpack and a small suitcase. Should be totally doable, but somehow I'm struggling.

5. I am grateful for:

-awesome family

-awesome friends

-awesome therapy guy

-awesome advisor

-health - especially that I am healthy enough to run

-pharmaceuticals that work, and that I have been feeling like a normal, relatively happy person lately (knock on wood)

-the ability to grow and to gain new insights, even from familiar experiences

-wine

-hummus

-travel opportunities

-blogs (I love reading blogs! My guilty pleasure.)

-Blue jeans

-New episodes of Guiliana and Bill on Netflix

Five things (cherries, Kindergarten, television shows about drugs, etc.)

• I am in love with fresh summer cherries. Rainier cherries are my favorite but really, any decently-priced ones will do.
• Also I am in love with the show Breaking Bad (four or five complete seasons on streaming Netflix). It's about two guys who make crystal meth, and it's a lot funnier and more riveting than it sounds.
• I'm going back for more Xtend Barre tomorrow. I'm not as sore as I thought I'd be, and I feel really good about myself even though I can't actually see any results yet, of course. My goal is to do that followed by a 45-minute run. I was supposed to do the run today but lack of self-discipline kicked in. So I'll double up tomorrow.
• My son has his half-day Kindergarten orientation tomorrow! AAAAAAAHHHH! I feel like we (me, husband, son) are all very unprepared, and none of us seems to believe it's actually happening, but here goes...
• I sound more upbeat here than I actually feel. 

Eggplant and potato pizza-ish

Four things about my life today:

• First thing: My son starts Kindergarten in a couple of weeks. I'm feeling all "OMG, my baby is growing up so fast!" My husband - the stay-at-home parent - is feeling all "OMG, I will have free time again!!!" Tomorrow begins the easing-in process for the school year. He'll have a screening session to establish a baseline of his current knowledge/skills, and the following week he'll go to school for a half day with his new teacher and classmates. After that, it's 8 hours a day, 5 days a week. The other day he asked me, "How many years will I have to go to school?" And I said, "Well, at least 13, but probably 17. Maybe more, if you want to." He stared at me and told me I must be kidding. I decided to leave it at that. We're going shopping for school supplies after his screening tomorrow. He doesn't care, but I am so excited. Lists like this make me feel gleeful:

• Second: I had a great therapy session yesterday. I was able to articulate my thoughts and be honest (doesn't always happen), and I left feeling comforted and cared for. Those are the sessions that make the more frustrating/confusing ones worthwhile.

• Third: This morning I did 35 minutes of running/walking. 10 minutes of walking, then ~25 minutes of alternating between fast walking and 9-10 minute pace. As far as interval training goes, it was pretty easy, but even easy, short interval workouts seem to help me maintain my level of fitness when I don't feel like putting in longer runs (especially in this insane summer heat).

• Fourth thing: I made gluten-free, vegan pizza tonight. Actually, it's not really pizza. Not technically speaking, anyway. It's more of a pizza-ish concoction consisting of GF bread topped with veggies - in this case, caramelized onions (yes, they make another appearance!), eggplant, mushrooms, potatoes, and tomatoes. I cooked the eggplant, potatoes, and mushrooms with the onions for a while before topping the pizza-ish.

This is my favorite GF vegan pizza crust mix:

The recipe calls for two eggs, but I sub in ground flaxseed. 1 egg = 1 tbsp ground flaxseed + 3 tbsp water. It works really nicely and gives the crust a subtly nutty flavor. I also added freshly-ground pepper and some dried dill.

The finished product:

I realize it doesn't look all that exciting, but it was quite tasty.

Caramelizing

This morning I felt perfectly fine. I felt normal. I felt composed, calm, and focused. Now I feel awful: spaced out, tired, sad. Depressed. Unsure of myself, of my identity. The shift happened sometime during therapy today. I could feel it happening, but I still don't know why. It was basically 50 minutes of silence and staring at the carpet punctuated by the occasional attempt to say something and making no sense whatsoever. It's frustrating to be drowning in these incredible, breathtaking waves of deep emotion and have no idea where they're coming from.

There is absolutely nothing in my life right now to feel sad about. I feel guilty for letting myself get this way; other people have far more reasons than I do to feel down. But trying to badger myself into pulling it together never works.

I have learned that the healthiest way for me to deal with this - because it happens a lot - is to just hang on tight and ride it out, and try to find some sort of non-self-destructive distraction.

Right now my distraction is fennel and onions. I'm caramelizing them. For some reason, that's always comforting. I watch them slowly, slowly, slowly turn brown and sticky and sweet. I occasionally stir them around, but not too often. Caramelizing is about patience and walking away for a while and trusting that if you simply keep going, what's supposed to happen will eventually happen.

Habits

Lately I've been thinking a lot about habits - good ones, not-so-good ones, ones I have that work for me, ones I'd like to have, ones I'd like to get rid of. "Habits" has been a topic of conversation at home, in therapy, and on some of the blogs I read. One is the blog No Meat Athlete, where Matt has talked about some of the habits he's recently picked up and the potential power inherent in adopting new, beneficial habits - things like making your bed every day, doing a baseline amount of exercise daily, etc.

I can think of a few habits that at this point seem pretty ingrained in my daily routine and that I don't want to drop, ever, because they have made a big difference:

• Flossing my teeth. It sounds silly, but one time - in my pre-flossing days - I paid $7000 in dental bills and wiped out our entire savings account. My teeth seem prone to developing cavities no matter what I do, but a few minutes of flossing every night has definitely helped counteract that. My teeth were relatively problem-free at my last two cleanings.

• Bringing my lunch from home. I used to go out for lunch a lot more often, back in the days when I still ate things like sandwiches on wheat bread, pizza, and other inexpensive, gluten-y favorites. Getting rid of gluten from my diet drastically limited my restaurant options at that time and forced me to get cooking. And although it's gotten easier over the past few years to find GF items on most menus, those offerings often seem pretty halfhearted and thoughtless. I've gotten in the habit of eating leftovers for lunch the next day, plus an apple, an energy bar, some nuts and dried fruit, etc. Knowing what is in my food gives me peace of mind... and honestly, I think it tastes pretty decent, too. 

• Running at least five times a week. This doesn't even feel like a habit anymore. It feels more like a compulsion. When I don't run, I get antsy and worry about declining fitness. I do force myself to take rest weeks every now and then, but that's usually when I'm really busy/distracted and can't worry as much about exercising anyway.

Two habits I am currently trying to cultivate:

• Drinking 64 ounces of water every day. I've never been a big water drinker, even when I exercise. I think I get a lot of the fluids I need through the food I eat (fruits, veggies, etc.) However, my doctor recently pointed out that because colon cancer runs in my family, I need to do my best to... keep everything moving along. And drinking water is a very good way to do that.

• Avoiding one-use items. I try to take my Nalgene and my insulated coffee mug to school every day. Sometimes I forget, and then I end up buying coffee in a styrofoam cup from the cafe in my building. Coffee with a side of guilt just isn't that good. Same with grocery shopping: I feel bad when I forget my cloth bags and end up with a trunk full of plastic bags. (For a really great guilt trip about one-use items, see the documentary Trashed. You will look at plastic bags and bottles in a whole new way.)

Habits that I would like to have but don't, and probably won't anytime in the near future:

• Making my bed in the morning. If I can eat breakfast, get showered and dressed, put together my lunch, get my stuff together, and be in the car by 8 a.m., I feel highly accomplished. Adding bed-making to the list would be like purposely seeking out failure.

• Cleaning stuff on a regular basis, a la Flylady. I mean, we clean, but not on any regular schedule. I do my best cleaning when I am anxious and/or procrastinating or when I find myself tripping over Legos/cars/random crap that comes in birthday party goodie bags. Or when I can't see out the window because there are too many handprints on the glass.

• Meditating. I think this will happen at some point, but right now I seem to have a massive mental block when it comes to meditation. Yes, I believe that it can work wonders, but sitting still for five minutes makes me feel like punching a wall. And isn't that kind of NOT the point? I use running, walks outside, and cooking as time for meditation-like brain activity.

A habit I would like to get rid of: Negative thinking. Of course everyone thinks in a negative way sometimes, and perhaps it's occasionally necessary. But I am a glass-half-empty kind of person in pretty much every situation, even situations that are supposed to be fun, happy, lighthearted, etc. Doesn't do much for anxiety or depression. I'm working on replacing negative/useless thoughts with more positive/useful/pragmatic ones. This is such an ingrained habit, though, that I really have to be on top of it, especially on days that are tiring or stressful.

In some ways, nothing has changed since I last posted in January:

• I'm still in grad school and I still love it.
• I'm still running. In fact, in the past few months I have ramped up my mileage and my pace significantly. That's because I started running with a group of people who are faster than me. Every workout is hard, but I definitely see the results. And that makes me happy.
• I'm still cooking a lot - because I enjoy the smells and tastes and sounds associated with food, and because that comforts me.
• I still have my awesomely amazing little family around me. I love them.

Some things, however, have changed:

• I passed my comprehensive exams, wrote my dissertation proposal, passed my qualifying exams, and am now a full-fledged Ph.D. candidate. This all happened within a span of ~5 months, which is a little hard to believe. But I did it.
• I went vegan. So now I'm a gluten-free vegan. It's actually been really easy. The only tricky moments are when I am traveling, particularly within the US. We are still a country highly dependent on processed foods. I hope that will change.
• I started taking medication. The psychiatrist at the student counseling center diagnosed me with PTSD and major depression and then put me on Zoloft. It worked fabulously for about three months. I felt like a new person. I felt like I had come back to myself. I wasn't overly happy, I still got overwhelmed and irritated, but I felt like ME and I was able to let go of things more easily. I couldn't remember the last time I'd felt that way. 
• I re-started regular therapy sessions with my old therapist. He is charging me an abominably low fee for each session, which I appreciate so much. Now I know why good therapy is so expensive; I wish I could pay him more.

Last week, I had another episode of depression/detachment that lasted for days. I spent the majority of time in bed. I'm not sure what's worse: feeling really, really low, like you are the scum of the universe; or feeling like you are watching life from a distance and can't get yourself integrated into it. For me, I think I struggle more with the latter. Depression is so awful, but I can kind of muddle through it knowing that it will get better. I can usually make myself do things like run, make dinner, and communicate with my son. The detachment, however, is scary because it affects my ability to think rationally, feel secure, or communicate with pretty much anyone. When I am detached, I struggle to put words together. I have a hard time remembering stuff. And I feel like I have little control over anything. Honestly, I feel really stupid when I am that detached. I WANT to get back to myself, but it's not something that I can do just by sheer will.

This episode occurred after I'd attended a pretty big conference in another city. It was weird because from the outside - and even somewhat from the inside - I looked I was doing well. I talked to people, gave a presentation I was proud of, socialized, went for runs with my friend, ate healthy and delicious food... But all the while I could feel the mental seams straining and then suddenly pulling apart. And then I had to rely on the thing I do where part of me is getting things done and looking normal, while another part of me is just trying to survive. It is a weird contrast. It seems like that sort of thing shouldn't be possible, but because I have been doing it for the majority of my life, I'm pretty good at it. Sometimes I hate myself for it. People think I'm fine, and I'm not, and I resent them for not knowing, but I don't WANT them to know, but I want help, but I don't want to appear weak, so I continue on in robot mode... The crazy thing is that I manage to get things done in robot mode, and often I do them well. I don't quite understand how that happens.

I feel like I'm slowly coming out of it now (finally). I've had a lot of support from my family, therapist, and psychiatrist. We increased the antidepressant dosage a bit, which may help (though I guess now I know that medication alone isn't going to fix everything). I told my advisor about the PTSD, which at the time seemed like a good idea but which I am now kind of regretting. (Why is it that when you have pneumonia, or cancer, or some other physical illness/condition, no-one blames you for it, but when you have a mental illness, they think you just aren't trying hard enough to get better? I don't want to be treated any differently, and I don't want him to assume that I can't handle things... I just want him to know that sometimes I might need to take a day off, the way people do when they have chronic migraines or something else along those lines.)

I want to change. I want to believe that I CAN change, that I don't have to live my life feeling like I am in a bubble, separated from everyone else. I've been working on that for more than 2 years now, and sometimes I feel so discouraged that I haven't managed to "fix" myself.

Cracking

Last week, two days before my paper critique presentation (the last step in the comprehensive exam process), I lost it.

I could feel it coming on - the exhaustion, the muddled thinking, the panic, the inability to get to sleep or stay asleep, the obsessive studying and note-taking (did I really need to write and re-write and re-write the four characteristics of a geographic information system?) - and I knew there would be consequences, but I kept thinking that I just needed to shove all that aside, pull myself together, and get through the presentation. And I almost made it. I almost managed to plow through before I lost my mental cookies.

And then Tuesday came along, and someone said just the wrong thing, and I came to a screeching halt. I felt so low, so depressed, so anxious, and so very out of it. I can't really explain it - I felt utterly detached from reality and unable to ground myself. Everything seemed so loud and looked so dim. I came home from school that day and went straight to bed, where I cried for three hours. Then I wrote to my advisor and said that I was struggling. Then I proceeded to not fall asleep for a while, and then I woke up at 3 a.m. and couldn't get back to sleep. All the while knowing that I needed to have a polished written critique submitted to my committee by 5 p.m. Wednesday, and a polished 20-minute presentation ready to deliver by 1 p.m. on Thursday.

On Wednesday morning, I dragged myself to my old therapist's office. I had bags under my eyes and I wasn't thinking clearly. I was dizzy. I kept spacing out; he kept asking me how present I was and reminding me to stay with him. I told him that I felt like I was really, truly on the verge of a breakdown and that the thought of continuing to live with these mood swings - as I have for most of my life so far - was unbearable. I told him that sometimes the thought of death was so nice. Not that I would ever do anything to myself - I wouldn't, because I wouldn't do that to my son; I wouldn't ruin his life - but for as long as I can remember, when things get bad it's comforting to think of not being here. I remember being 13 years old and obsessively planning my funeral, just because it helped calm me down. But this time I was scared, because I was so very out of it and I had such a tenuous handle on... everything.

When the hour was up he did the typical "Well, it looks like we're out of time" therapist thing, but when I stood up to leave and fumbled through my wallet for the check, he hesitated and said we had a couple more minutes. I sat down again, and he gave me some suggestions - one of which was to go to the student counseling center and talk to them about medication. I have tried hard to avoid medication for reasons I don't totally understand. Perhaps it's a control thing. Perhaps it's a fear that the medicine won't work, and then what will I do? What will my options be? Perhaps it's the worry that the medicine will work for a while, and then it will stop.

But this time I think I'm ready to try it. What happened last week truly terrified me. It's not like comprehensive exams were the scariest thing in the world, nor should they have been as stressful as I managed to make them. I think they were just the straw that broke the camel's back... Between that, and my mom getting sick, and traveling last month, and having this cold that won't go away, plus all of the other things that are always running obsessively through my head anyway, plus what just may be chemical issues in my brain that I can't control, I shut down. I broke.

So in two weeks I have an appointment with a psychiatrist. I know that by then I may be feeling fine. I may have forgotten what I felt like a few days ago (and what I still feel like, a little - these episodes leave an emotional residue). But regardless, I'm doing it anyway, and I'm going to make sure the doctor understands that despite my placid and friendly-looking exterior, I need some help.

One of my friends sent me a link to a blog entry about a guy who was afraid to go on medication but found that it made a real difference for him. It's a Christian blog, and I'm not a Christian, but it was moving and helpful and comforting anyway:

http://www.air1.com/blog/brant/post/2012/01/10/Is-Jesus-Enough.aspx

I especially relate to this - this feeling that I can't rest, I can't make my mind stop, I'm a failure, life is rushing by and I can never quite catch it: "My life had been wasted. I'd accomplished nothing, and the sorrow of it all was descending on me. The vanished years! I've done nothing! Where did the time go? Life is too fast, rushing by like a freight train, and I couldn't get on it... I'd previously lie there and think about how I blew it on the air this morning; how I never should have quit talk radio; how I shouldn't have said that one awkward thing five, 10, or 25 years ago;  how I'd wasted whatever I'd been given; how I'd failed to provide a yard for my kids to play in; how the years were slipping by, and, though my wife said differently, I just knew I wasn't doing enough as a dad or a husband or a child of God."

In the two years that I have known my therapist, he has never recommended medication. I'm not sure that's really his thing. He has recommended talking, meditation, yoga, tai chi, and rest. He has recommended opening up to other people and taking some risks in order to develop friendships. He has recommended relying on my family when things get tough. He has recommended that I call him if I need to, even if it is 11 p.m. on a Saturday night (he doesn't mind and he will call me back, he says). But the other day, I think he could see that I have kind of hit my limit. I think he could see how scared I was and how tired I was - of myself.

I did get through the critique, by the way. After my therapy session I came home and slept for two hours. Then I hauled myself out of bed, somehow wrote something that my advisor said was thoughtful and comprehensive, and put together a presentation that, while not an oratory masterpiece, served its purpose. In all honesty, I have no idea how I did it. I really don't. I'm just glad it's over.

Drained

I am drained. Finding out that someone you care about has cancer totally flips your world upside down. Everything looks and feels different.

If I were to give myself grades for my current performance at school, in helping keep the house in order, and with parenting, I'd award myself a solid C in every category. I'm not really failing, but by no means am I excelling. I'm just sort of floating along. Getting up every day, getting dressed, making lunch, going to school, and giving my kid as many hugs as he wants is pretty much all I can muster. Whatever I manage to accomplish outside of that is just a bonus. What I really want to do is stay in bed for a week. And I'm not even the one who's sick.

Maybe I don't look particularly sad, angry, or worried, but I feel all of those things, and they're manifesting themselves emotionally as well as physically.

I went to see my old therapist today because I needed to talk to someone who really knows me and my history. He told me my feelings are normal and that it isn't selfish to feel the way I do. We talked about my mom, my family, and the potential repercussions for the future. He reminded me that in a week or two, I will have adjusted to this "new normal" - kind of the way your body adjusts when you increase running mileage. After a while, it won't feel as taxing as it does now.

It was so good to talk to him. He listened. He pointed out the healthy, positive choices I've made and am making. He showed that he cares. But the session made me feel sad, too. I wish I had good friends - or just one good friend - to share these things with whenever I need to. I wish someone would call me up or email me and be like, "This sucks, and it's hard. How are you doing? Do you want to talk about it?" But for whatever reason, I haven't made good friends in my adult life, and I feel alone a lot (which definitely doesn't do much for depression or anxiety).

Mostly I'm sad and worried.

I've been doing well with running, though: 3 miles on Monday, six sets of 400 meters on Tuesday, and another 3 miles today. Tomorrow is a rest day, and then I'll run four miles on Friday.

That's better: 1 hour run/walk

One hour workout tonight, and I felt pretty good. I alternated between running and walking:

-10 minutes walking
-5 minutes running
-5 minutes walking
-10 minutes running
-5 minutes walking
-20 minutes running
-5 minutes walking

Nothing wrong with walking!

The best part was that when I was running, I was in the happy zone, just gliding along and enjoying the exercise.

*
It's been 4 1/2 weeks since I quit therapy. After 1 1/2 years of seeing my awesome, thoughtful, caring therapist once a week or once every other week, this is a huge adjustment for me. I didn't necessarily want to end treatment, nor did I necessarily feel "done" with it. But I did it for two reasons: 1) it was getting expensive (he'd given me a massively reduced rate, but still, therapy is not cheap), and 2) I was starting to feel a little too dependent on it.

Is therapy addictive? I would argue YES. It's hard not to get addicted to having a whole hour every week to talk about whatever it is you want to talk about and have someone listen as if you are the most fascinating person on Earth (which clearly I am not nor ever could be, but my therapist did an awfully good job of making me feel worthwhile and interesting and cared for).

Don't get me wrong - therapy is also hard work. At times I felt worse after sessions than I did before. I guess it's kind of like running: if you want to improve, if you want to make progress, you have to push yourself. Sometimes it's going to hurt. But then you see yourself changing and feeling better about yourself, and you're inclined to keep forging ahead.

I miss my therapist. The whole concept of psychotherapy is kind of weird in that in order for it to work, you need to find a counselor that you're compatible with, someone you can fully trust. Then once you do, you spill your guts, your biggest and most painful secrets, to someone whom you're ultimately going to have to say goodbye to. And it's not like you can end treatment and suddenly become friends with that person. It's not like you can feel free to just call up every now and then for a chat. Goodbye is goodbye, unless you go back to paying them to listen to you.

I guess part of figuring out how effective therapy actually was is seeing how I handle life without it.

It's been a while...

My last blog post was in January. I stopped writing when things got too busy... and when things got too busy, I also stopped running on a regular basis. I hit the road or the treadmill maybe once or twice a week - that was it.

It was a rough spring. I've always had sporadic issues with depression and anxiety, but earlier this year they ramped up to a whole new level. I felt like I was drowning, like I couldn't breathe. I was tired all the time. I was lonely. At times, I felt nearly suicidal. The only thing that seemed to mitigate the symptoms was school, so I'd go in early in the morning, work nonstop until 5 or 6, and then drive home. My symptoms seemed to worsen in the evenings, on weekends, and whenever I had a break. Not ideal for the mother of a preschooler (and definitely not ideal for the preschooler). I did my best, but it was like trudging through taffy.

I saw a therapist every week. Therapy helped me work through some painful experiences and negative self-perceptions, but it was hard work. Sometimes I'd leave feeling much worse than when I walked in. Still, I slowly improved. I gained some valuable tools for coping with tough emotions. I learned to remind myself that "I won't always feel this bad. It will get better." A few weeks ago I decided I was ready to venture out again sans therapist. At my last session, I asked him to identify one thing that he thought would really, truly help me manage my moods. I thought he might recommend yoga, or meditation, or medication.

Instead, "Run. Run often. When you talk about running, it's clear that it's a positive thing for you. And enter races - compete. It'll give you something to shoot for and something other than school to focus on."

And so for the past 3 weeks I have been running nearly every day. I've tracked my feelings and my moods, and while the anxiety and sadness still crop up, they've lost their oomph and their edge. I feel better about myself and more confident around others. Challenges, obstacles, and criticism seem less daunting somehow. When I received some (what I felt were) unfair comments on a recent homework assignment, I didn't go home and cry the whole evening as I would have in the past. I felt disgruntled, and I thought, "That sucks. That's uncalled for," but then I went on with my day. It was just a blip. It was a small drop in the huge ocean of experience, a drop that became increasingly diluted until I forgot about it entirely.

In the past, I've always run for fitness or to work off extra calories. But now I want to run for my mental health. Like I said, I've always struggled with roller coaster moods and emotions, and I'm tired of it. I'm tired of feeling lousy. And I don't want to go through what I went through this past spring. It was just too scary. If running 5-6 days a week will give me a brighter outlook on life, then that's what I'm going to do.

So I'm going to start writing here again and logging my miles (still mostly on the treadmill), but I'm going to change my focus a bit. It's less about the distance and exercise now, and more about managing my emotional well-being. I want to see if I can tame my moods simply through exercise and healthy living.

I'm also planning to enter more races, as my therapist suggested. I recently ran a 6K, and this Saturday I'll be running in a 5K. I like short races. They don't require a ton of training, but with some effort I'm pretty sure I can improve my times. And I do enjoy being around other runners, feeling their energy, and moving together towards a common goal.