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Monday, July 19, 2010

The Reds and the Blues

I feel as though I have been under a cloud for the last month or two. I work very hard to keep things in perspective, to keep on trucking. Still, sometimes things happen, and when they do, you have every right to be upset, you know?

It's just that I don't want to indulge in that right too much, because I suppose I am always afraid of stepping over the edge into depression. I wouldn't call what I'm feeling depression, simply because many times I have felt so much worse than this, but I am making a conscious effort to pay attention and keep my head above water.

I'm going back to therapy. I thought with everything that would help. Actually, it was before a lot of things happened that I asked my doctor to recommend someone. I went to see her about a month-and-a-half ago to follow up for my PMDD. Right before the wedding, we decided to raise the estrogen dose in my pills, because on the minimum I was having complications and was still in pain. Emotionally, though, the minimal dose proved to be very helpful. I'd never felt so balanced, so myself. The higher dose improved the physical symptoms but seriously made me feel crazy.

My doctor and I came up with two solutions. The first was that I begin taking Wellbutrin, and that maybe it would balance out the crazies caused by the Seasonique. She also went ahead and prescribed me a different brand birth control pill, to see if my body would do better on a monthly cycle rather than a three-month cycle. She said if I wanted I could take the Wellbutrin and see if it balanced the Seasonique, and if not, I can change to the other pills. I filled both prescriptions, and decided to take the Wellbutrin with the Seasonique first like she suggested.

I felt a difference for the better within a couple days, and then within two weeks for sure, when the medicine was supposed to begin taking full effect. I thought everything was going pretty well. The problem is that over the last month or so I've been experiencing depression and anxiety, but there are so many things going on in my life I honestly can't tell if it is external events or the effects, or lack of effects, of my medicines that is contributing to it.

When my father died and since, I have been feeling and thinking about a lot of things, so many that I couldn't really begin. I don't know if you'd call it the typical stages of grief, but I certainly have felt denial, anger, and sadness. I have felt and relived things I have been shutting out for a long time.

I have also been thinking about my Mom a lot. I looked back on my life and looked at things through another lens -- through what actually happened, what I remember, why certain things happened. When my mother was diagnosed with cancer, from that moment, she became a saint in my mind. Really, she already was before that. When I would think about the years she spent working nights at the Chicago Tribune. When I would think about how courageous it was of her to finally leave my father. She really thought she would die if she didn't. When I thought about her taking typing classes and stuff just to get some secretarial skills so she could get a halfway decent job, and that somehow that led to her progressing and eventually editing proposals for NASA. When I would think about her not having any credit, and somehow providing for us with clothes, and everything we could want for Christmas and birthdays. When I would think about moving from welfare and foodstamps to one day owning a house in the suburbs. How I went from sharing a tiny room with both my sisters in Chicago, to eventually having my own.

But there are other things, things that everything else doesn't always cancel out, even when I want them to. Some memories still make me very angry, even some things my Mom has continued to apologize for well into adulthood.

I have memories that haunt me nearly every single day. Sometimes things don't go through my head for awhile, and then they hit me all at once, and I can't sleep for days. Generally, when that happens the most though, is during spikes in PMDD symptoms. I need to let go of a lot of things. But at times lately I am feeling angry and having realizations about things in ways I had not thought about them before. It is frustrating because I just want things to make sense. I just want to feel one way I guess.

In spite of the old things that I suppose have become especially raw in light of my father's death for some reason, there are still pleasant things in my life. I try not to sweat the small stuff. I love Toby and I love my dog, and our life together. I love my family, and my sister is in town, and my nephews -- seeing them has been wonderful.

I know that on days when my anxiety is high, I sometimes overreact. My husband could certainly attest to that. But there are other things that are in the back of my mind nearly every day: my mother's treatment and progress (they have extended her chemo treatments again, and she is very weak and is losing a lot of weight); my grandmother's health (she had her first treatment for the cancer yesterday, and says she has recovered nicely from the surgery she had); nervousness and anxiety over my plans for the next year (my graduate school application and the move we are going to make); dealing with my father's death ....

I think with all this stuff, it would be best to talk to a professional at this point. My number one confidante is my husband, but I can't put everything on him just like I can't put everything on my friends.

The thing about my life, and my friendships, and even writing these things for the few of you who read them, is that I don't know how much is too much or how little. I have held so many things in for so long that I'm afraid of saying too much.

This stuff's heavy, and everybody has their stuff. I'll be the first person to understand that. It is hard, though, when you have so many superficial surface level-friendships, and you have heavy things on your mind. For example, Joe's death. It's not like I'm going to go around telling people my father died. Most people don't even know the situation or history to begin with? How would anyone possibly understand if they don't know? And even if they did know, how would they understand because they did not live it?

I really don't want to come across as a pity party. That's not what I am feeling right now. Just evaluating. Trying to handle things. Trying to figure out whom to share them with, or even if it's worth it.

But like I said, is it this stuff or it it the PMDD or is it the changes in medication, or side effects in medication or all of it? Is it caffeine? I gave up caffeine again, but I'm tired all the time. I want a cup of coffee, but not if it's going to make me crazy and anxious and irritable. Am I working out enough? I'm trying to. I have realized that exercising is key to my mental health, so even if I'm physically not wanting to, I'm trying to get my exercise in at least a few times a week. Am I eating healthy enough? Probably should do a little better. I've gotten to be a little more relaxed about my eating habits lately.

When my doctor gave me the Wellbutrin, I said that these were things I noticed that I needed to do. I was feeling the crazies but I also hadn't been taking care of myself as well as I could. I really think I'm doing better at that, and not feeling nearly the level of craziness I was more than six weeks ago. The Wellbutrin really is helping. But with all these changes coming up and the few things that have been upsetting me, I hope and think seeing a therapist again will help. My first session is tomorrow. Thanks for listening.

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Wednesday, February 10, 2010

Treatment

I started the pills around November. My doctor and I decided to go with LoSeasonique. Part of understanding PMDD is understanding the relationship between levels of estrogen and progestin in the body and serotonin levels in the brain. It seems that for a "normal" woman, the levels of serotonin actually get higher before a period. For women with PMDD, the serotonin levels plummet. It's the body's reaction to the changing hormone levels that does it.

Since my treatment options were to try birth control pills or SSRI's, I decided to try the Pill first, since we're getting married but aren't interested in kids just yet. My neurologist gave me the OK to take estrogen. Since I'm no longer a smoker, we are not worried about the risk of stroke. Also, according to my doctors, my Mom's stroke years ago was caused by a very rare condition that is not necessarily hereditary and I'm not at risk for it.

Of course, on top of this stuff, I am doing what I can to "naturally" help myself. With the wedding diet, I've been working out regularly and counting calories for months. I quit caffeine months ago, although I still do have decaf once in awhile. I know that decaf does have caffeine a little; however, it doesn't effect me in nearly the same way as it did before I went on the Pill. It used to definitely make a difference in increasing my lack of concentration, anxiety, and irritability. The effects now are only slight. But I rarely have chocolate and only drink an occasional caffeine free soda. Mostly, I drink water. I take women's vitamins to help also with Vitamin D and Calcium deficiencies, which are also supposed to make PMDD worse. I workout about three times a week, and usually run and bike miles when I do. It definitely helps with managing my thoughts and mood, as well as stress.

On the whole, the Pill is what has helped the most. The first two months were like a dream. Even my fiance would tell you how changed, how more like myself, I am. The first two weeks I noticed my fuse was a little short, but that was only from adjusting to the meds. After that, it was smooth sailing. No craziness at all.

The third month I had a lot of cramps and spotting, though. I went back to my doctor not knowing if this is a good thing. I certainly don't like it, but still mentally, everything is fine. She suggested I try another three-month pill cycle and see if it improves, because this is common for a lot of women, and sometimes the body gets used to it and it stops. If it doesn't improve, though, with the blessing of my neurologist she will raise the estrogen level.

So, I'm about to start my fourth month. I'm having my first period in three months. Today is the first time I have missed work because of my period in more than three months. I'm home today because of the cramps. I have been in a bit of a low mood, and have had a little insomnia, so that's probably partly the period, but who knows, because I've also been upset here and there about my sister and my mom. I used to have to stay home because of the PMDD, just because I was that afraid I would yell at someone, so missing one day because of cramps isn't a big deal to me.

I'm very grateful for LoSeasonique for now. Even my migraines are predictable. They last a little longer, two-to-three days instead of one or two, but I have been able to predict them. During the 13-week set of pills I only got them the first, fifth, and ninth weeks. When they come I just take my Naproxen my neurologist prescribed me, and it helps. I used to get them twice a month, during ovulation and again before my period.

We know it is a short-term solution. I do worry about if I have to try another pill, and I worry about post-partum depression if we later decide to have children, but for now, this is the best thing. I have been able to handle my life, get my work done, maintain my relationships. I do not miss that level of rage I would feel, or how I would get so nervous and anxious for no reason my voice would shake.

I just read that although doctors treat PMDD, the FDA has still not recognized it as a medical condition. I hope more people can learn about this disorder so that one day more women can get help with it. It definitely made the difference in the quality of my life when I finally decided to do something about it. I'm glad I did, and I'm glad I've had the support from my friends and future husband to do so.

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Saturday, October 24, 2009

Red Kryptonite

This blog hasn't been public for some time now. Yet, I still have not gone out on the limb I used to so far as my personal life. I suppose a few things have been on the brain lately. Besides thinking about grad school and planning a wedding, and going out for sushi on Fridays, there are at least three things I've been dealing with that sometimes infringe on my happiness.

One is that I have recently been diagnosed with PMDD. This is something I've been working on for the past year. I did some reading and research, finally tracked my symptoms for a few months, then went to get help. PMDD has no clear-cut solutions. When looking at treatments, most women and doctors seem to use trial and error. I am just glad to be getting help. The symptoms are completely awful. I believe I have actually been going through this for about 15 years, but through all of my 20s, particularly after 24/25, it's been getting worse, and the disorder is actually known to get worse, as you get older, as you have children, until it stops with menopause. Yay! - not.

I can't even begin to comprehend how much of an impact this has had on my life. I can remember times where my world was going completely crazy, where I had breakups or other awful things, and I'd remember getting my period, and thinking great, now this! But I never imagined that feeling of my life being upside down and then turning it upside down could have been tied to this, too.

I self-medicated with caffeine and alcohol all the time, which inevitably made it worse. Women with PMDD tend to overuse caffeine because of the fatigue it causes; caffeine increases nervousness, anxiety, and irritability. Alcohol makes the mood swings even worse, which has its own dangerous effects. I have given up caffeine recently. I wouldn't say completely, but I am still working on it. I don't have caffeine every day. I drink only caffeine-free soda. I don't really do decaf coffee anymore, either -- I found after quitting caffeinated, that even with decaf I can definitely feel the effects, and it feels awful. I rarely drink anymore, sometimes not for weeks in a stretch, but when I do I definitely pay attention to where I am in the month, and steer away from alcohol during PMDD time.

It is a blessing, though, that my life is in order enough that I was able to map out my migraines, headaches, cramps, irritability, bouts of insomnia, anxiety, nervousness, forgetfulness, difficulty concentrating, low moods, manic behaviors, and other pains in my body. It gives me hope that I can possibly have this one thing that has upset my stability for so long under control. And for now, although all these things take me over close to half of every month, between ovulation and the week before my period, at least now when the symptoms come I know what foods and drinks to stay away from, I know to exercise for sure to keep my mood elevated, and I know that the intense anger or sadness for no reason is internal and biological, rather than something external or horribly wrong with my life or myself. I can recognize my symptoms for what they are, try to be patient, lean on my future husband who has been amazing and strong in helping me deal with this, and handle things as logically as I can.

It is incredibly tiring, though, to have this thing hanging over your head, this thing that you have to plan around every month. I read this book that was recommended to me by a friend of a friend I was introduced to, who also has PMDD, and devotes her blog to it. The book helped me understand what I'm going through, and she helped me by letting me know I do not have to suffer, and never alone.

I went to see a neurologist earlier this week for the migraines. Migraines are separate from PMDD, but can in some cases, cluster around PMDD symptoms. Mine definitely do, so I'm getting help treating those. I also was approved to experiment with estrogen and progestin, or progesterone treatments; I wanted to make sure they were safe with me, because of my mom's history of stroke. He gave me medicine for my migraines, and approved my taking estrogen, since I quit smoking four months ago. But in the event estrogen makes my migraines worse, which is a possibility, I will have to opt for a birth control pill without estrogen to prevent pregnancy. In that case an antidepressant would also treat the PMDD. My gynecologist already prescribed me Zoloft, which PMDD patients can take 15 days out of the month or so. I know it has been proven to help women with this, but I wanted to explore all my treatment options before making a decision. I'm hanging onto the Zoloft prescription, but for now I am going to get an opinion from one more gynecologist, and then discuss what all these doctors have said with my primary physician, and we'll decide where to go from there.

I have a lot of hope now. Hope that I won't have to take another sick day because I'm afraid that if anyone talks to me on a certain day at a certain time in the month I might lash out and lose my job. There's also hope that I won't very much look forward to plans like hanging out with one of my best girlfriends, or attending another's engagement party, only have to cancel because I feel horrible inside and out and need to lie down on a couch and not be out in public doing anything. Hope that I won't say anything horrible that I won't mean one second later and hurt the people I love the most when I'm like Clark Kent meets red kryptonite. I can't wait to feel better 365 days a year. I can't wait to feel like myself all month, instead of one or two weeks of it.

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