Medication and addiction

I don’t remember a lot of the details of this story.

I remember that the doctor prescribed the medication in the fall of 1986, when I was in graduate school in Ohio.

I first saw the doctor who took me off the medication during the winter of 1989. I know this only because I dated a book that he recommended to me Feb. 20, 1989.

In between, the details aren’t so clear.

I started having bouts of diarrhea in 1986. I could not predict when they would hit me. It seemed not to matter what I ate or didn’t eat. The bouts hit hard and suddenly.

When I decided to take a trip with classmates to New England that would involve about a 14-hour drive, I panicked. What if I got diarrhea on the van and couldn’t make it to a bathroom? I would have to use public bathrooms. What if they weren’t clean?

My obsessive-compulsive disorder had me obsessing over the possibilities.

Finally, I went to student health on campus and a doctor prescribed a drug for me. It worked.

During the trip, I wanted to insure that I wouldn’t have any diarrhea. So I took extra pills. I figured if one would help, more would help more. And I didn’t have any stomach problems on the trip.

I continued to take the medication, and if I was facing a situation where I wanted to be sure not to have to worry about having diarrhea, I took extras.

The pills made me sleepy and dopey, but the side effects were worth it to me not to have to face a potentially embarrassing episode and not to have to worry about it.

At some point, I discovered when I tried to get the medication refilled at student health that I was making the request too soon. In other words, I finished up a prescription before I should have.

The pharmacist expressed concern, I remember, but I revealed nothing to her.

I didn’t reveal that I took more of the medication than I needed. I didn’t reveal to her that I panicked inside when she told me I couldn’t get the medication refilled.

I didn’t want to be without the drug.

I don’t remember how I ended up in the office of the medical director. Isn’t that something, that I don’t remember those details?

I suspect I can’t remember because the medication was blurring my thinking. And I wanted to put the whole episode out of my mind when it was over.

I was in talk therapy at the time with a psychologist on campus. It would be another year before she referred me to a psychiatrist, but perhaps she referred me to the medical doctor for my depression.

Regardless of how I ended up there, I found myself telling the medical director about my depression without sharing any details about it.

I also didn’t share with him my dependence on the medication.

I didn’t even admit to myself that I was addicted to the medication. I told myself I needed it to keep from having diarrhea, and that if I stopped taking it, all my problems would start again.

The medical director told me that he didn’t want to prescribe anything for depression until he knew whether or not I was depressed. The medication could be depressing me, he said. And there was another medication that would help my stomach problems without presenting the same dangers.

He worked out a plan for me to wean myself off the medication and start the new one.

He also talked to me about the importance of exercise and introduced the idea of meditation to me.

And he told me to come back in six weeks.

I didn’t wean myself off the medication. I took it in extra doses until it was all gone. I had no refills left, just the new medication for my stomach.

I didn’t sleep well or much at all in the weeks leading up to my next appointment with the medical director. When I remember that time, I picture myself figuratively “walking on the ceiling.” I couldn’t relax. I never felt sleepy. I felt like I was on high alert all the time.

My body was reacting to the removal of a depressive medication that I had taken for over two years.

My depression didn’t lift. The doping of my physical system and my mind lifted, but the clinical depression remained.

When I went back to see the medical director, we didn’t talk about addiction, and he didn’t prescribe anything for my depression.

But with his encouragement, I did begin to think about starting a running routine, which I eventually did later that year. And I tried meditation for the first time, based on the book The Relaxation Response, by Herbert Benson, MD, with Miriam Z. Clipper.

  I have a different relationship with and a respect for medication today. I don’t want to have another story in my life missing so many details.

Top 5 things that have helped my OCD

I have put together a list of things that have helped me most with my obsessive-compulsive disorder.

Other things have been of help to me, including meditation. But the following list includes what has been most important.

Not all of these things are for everyone. For example, I realize that medication is not the right choice for everyone. But these are the things that worked for me.

Once I made the list, I couldn’t rank them. I couldn’t say for sure that one was more important than another in helping me control and live with the obsessions and compulsions. So here’s my list, in no particular order.

Medication

Medication changed my OCD from being debilitating. With medication, I was able to consider that there might be ways to live with this disorder.

I have had to try different medications through the years, mostly because of my co-morbid diagnosis of depression. It’s not an easy thing, to change medications, to wait for them to work, or not work.

But it has been worth it to be able to gain some distance from an all-consuming OCD to an OCD that I can work with.

I’ve written more about my medication journey here.

Therapy

I’ve had talk therapy through the years, but the therapy that has helped me the most has been the practical cognitive behavioral therapy that I’ve had this year.

While it’s not been the formal exposure and response prevention therapy, it included exposures and the whole philosophy of learning to tolerate the anxiety and moving beyond it. The exposures my therapist led me in were helpful and instructive.

While the CBT got waylaid because of other therapy needed for my depression, I look forward to getting back to it. In the meantime, I’ve been doing some of my own exposures.

Brain Lock

I first read Brain Lock: Free Yourself from Obsessive-Compulsive Behavior-A Four-Step Self-Treatment Method to Change Your Brain Chemistry, by Dr. Jeffrey Schwartz with Beverly Beyette, in the 1990s, and I worked on its principles on my own with some success.

The book taught me to walk away from compulsions even though I was feeling intense anxiety, and I learned that the anxiety eventually died down.

I wrote in detail about how I use “Brain Lock” in this post.

Adopting a cat

Adopting Waddles in 2000 changed my life in many ways. One of the ways was to give me almost constant exposures for my contamination OCD and my hyper-responsibility OCD, though I would not have known to call them exposures.

I learned to live with an animal and clean up messes without freaking out. I learned the joy of responsibility, which began to outweigh my fears of responsibility.

Learning that I wasn’t alone

From finding out a person I really respected and liked had OCD to starting a blog and connecting online with others who have OCD, finding out I wasn’t alone in my suffering has been a big component of my OCD improvement.

What has helped you the most in your battles with OCD and other anxiety?

They do go together: Depression and gratitude

What do I have to be thankful for when it comes to depression? Quite a bit, I discovered, when I sat down to make a list.

*I am thankful that I am being treated for depression. Before I was diagnosed with depression, before I was treated, I lived in a gray and brown world. That’s the way things seemed: no color, little light, dull and lifeless. Hopeless. Though I’ve had periods of depression even after I started treatment, even though I have bad times, I’ve never fully returned to that gray and brown world.

*I am thankful for the treatments that are available. I’m thankful for the medications and therapies that have been developed for use with depression. I’m thankful for the intelligent minds and compassionate hearts that have tried to find ways to combat this disease.

*I’m thankful for doctors and therapists that have helped me in the past and today. I’ve had some bad luck with providers, but overall, I’ve had some good ones, and a few excellent ones. Right now, I have a couple of excellent providers who help me weather the depression.

*I’m thankful that I can afford to pay for medication and therapy. I’m thankful I have health insurance to help me do that.

*I’m thankful for close friends who have listened to me through the years and offered support and encouragement without judgment. I’m thankful for the blogging community and the friends I’ve made through blogging. I have received so much inspiration and hope.

*I’m thankful for my cats. Their presence is always a comfort, and they teach me about love and life every day.

*I’m thankful for my husband. My world is beautiful for knowing him and having him in my life. He loves me, depression and all. I love him.

*I’m thankful for the hope in my heart. I hold on to that hope when the darkness comes around.

What is one thing you are thankful for today?

Anxiety on the bike trail

Part of the road in English Park.

On Saturday morning, my husband and I decided to bike in English Park, the park that runs along the river that I wrote about last week.

Last summer was the first time we rode our bikes in the park, and we biked on the road that circles the playing fields. It was good exercise, but we were literally going in circles. And we had to watch out for cars and walkers and slow down periodically for the speed bumps.

This spring, there’s a new road leading from the old part of the park to the new, still largely undeveloped part of the park. That’s the road we took Saturday.

The new road is gravel set in asphalt, a little rough, but smooth enough. It winds under a train trestle, but there’s a shelter built underneath to protect walkers, runners and bikers as they pass under.

Me before the coughing started.

Further back, the road narrows and is made up of dirt and gravels. It winds along beside the Staunton River, and soon all we could hear were the sounds of the water, birds singing, the wind in the trees and our own voices.

The road is fairly level, so we made good time, slowing down periodically to enjoy the sights. We were surrounded by green: trees, bushes and weeds. Sometimes rocks rose to our right, part of the river bluffs.

Then I started coughing.

I have asthma. My doctor calls it of medium severity, but I think I do pretty well most of the time. I use a maintenance inhaler, Advair, and I have a rescue inhaler.

That morning before we left for the park, I used my rescue inhaler because I was feeling a little wheezy and exercise sometimes brings on an asthma attack.

I didn’t use the Advair, and I’m sorry to say I had not used it the night before either.

I am usually a compliant patient in that once I’m on a medication, I take it as directed unless I have a problem with it, at which time I call the doctor.

But I’m different with Advair. It’s silly, really. I am supposed to take one puff twice a day. Easy enough. But I have to rinse my mouth after I use it, and sometimes I don’t think I have time to do that. So I skip a dose. Yes, that’s pretty silly.

Back on the trail in the park, we had biked through a section where something—blooms, pollen, something—was heavy in the air, and I started coughing.

We stopped and I drank some water. Still coughing. I was out of breath, and I just couldn’t bike any further. I took out my inhaler and told Larry I’d stay where we were and he could go on.

He rode further down the road.

You might wonder why I would have him go ahead of me when I was starting with an asthma attack. It’s because we’re used to them. I cough, get short of breath, use my inhaler, and get back to normal, and everything’s fine.

He rode out of sight, and I shook my inhaler and squeezed. Nothing came out. It was a dead inhaler.

By then, tears were running down my cheeks from the exertion of coughing, and my hands were shaking. I was coughing so hard that I thought I would surely throw up.

We were at least a mile from the truck, and even if I could get there, I didn’t have another inhaler. My extra was at home.

With no option of an inhaler, I decided I’d try to calm down the attack on my own. I let the coughs come out, and then I pushed my bike slowly back up the trail, towards the truck and towards some shade.

I drank some more water.

A photo I took while I was trying to calm down: rocks and trees.

And I tried to concentrate on the sounds around me. I don’t often get to a place where I can hear no human sounds, only nature’s sounds. I decided to savor them.

By the time Larry got back, I was calm and could breathe better. I was grateful that it had been a mild attack.
We rode on back to the truck, and I made it fine, though I was still coughing a little.

And when I got home? Yes, I used the Advair. It’s not a quick fix, but it’s time I started using as directed to help stave off these attacks.

Will I check my inhaler before the next bike ride? You know I will.

What’s the hardest thing you have to be willing to do to maintain good health?

Depression: I will not be empty



From http://en.wikipedia.org/wiki/The_Starry_Night



 

February 6, 2007

  I went to see my family doctor today. I told the nurse that I was there for three reasons: blood pressure recheck, antidepressant discussion and my right ear. But I was really there for one main reason—the antidepressants and the fact that they didn’t seem to be working anymore.

The doctor listened to me tell him how I felt empty (I didn’t tell him that my heart felt empty, something that had come to my mind yesterday and seemed to really describe how I felt.)

He talked about upping one medication and keeping the other at the same dose and coming back in three weeks to re-evaluate.

I was tearful and said that I didn’t even know what I was like normal. I guess I was getting that idea from some of the essays that I’ve been reading in that book about depression, writers on depression. The doctor said, probably when you are really low—and he meant the low without any meds—that is your normal.

That struck me. That was my normal? But that wasn’t normal!

But the doctor said that a bright side to it was that there were so many meds that could lift me up from the bottom and things were getting better in the treatments for depression. He said that I would probably always—the rest of my life—have the low times and have to have the meds tweaked and changed. But like people who were born with something physically wrong with them, I could learn to adapt.

So I up the one medication, keep taking the other, try to get more light (because he said that it could be partly the time of year and the darkness that was affecting my mood), and try to have a more positive outlook.

And that I needed to go to work. I asked him if it would be a good idea to miss a few days of work. He didn’t think so, because he said being at home might make my depression worse. He thought I needed to be out there.

That didn’t please me much, because I was hoping for at least a short reprieve from work. He said that he could write a note for work, but that he thought the best thing for me was to work. So I didn’t push it.

He also brought up the possibility of seeing a counselor, preferably a psychiatrist, if things didn’t get better within the next two or three months.

Is my normal depressed and OCD? Or just depression? Is the OCD keeping me from being normal? So many questions. I wish I was a happy spirit. I wish that I had faith and belief in God that would sustain me. I don’t have enough faith or belief though—it’s so fleeting and so nebulous, I don’t think that I can build a life on it. And I don’t like that feeling of not being able to.

I wrote the above in my journal more than five years ago. It’s a picture of one of the many times I’ve found myself sinking into hopelessness. One of the many times I’ve had to admit to myself, I’m depressed again.

I think differently now about those words “depressed again.” I’ve haven’t been “not depressed” for many years, if my therapist is right about my having chronic depression.

Has my life been all bad, all sad? No. I’ve had many good times and happy times. And I believe that there’s a firm base within me that is content and hopeful.

But depression comes calling with more subtlety than the obsessive-compulsive disorder. I feel exhausted even when I’m not busy. I complain more. I sleep a lot. I have a hard time concentrating. I have a hard time caring about my life. I feel like I’m heavy and have a hard time moving. I don’t want to do things that I enjoy other times. My heart feels empty.

And I don’t even realize it until I’ve been experiencing those symptoms for weeks.

I am doing more now to fight the depression, though. My psychiatrist tweaked my meds, and I’m already feeling better. And I am doing the Cognitive Behavioral Analysis System of Psychotherapy. We start the real work on Friday.

I told my therapist that my family doctor had told me that I would have to adapt to life because of the depression. My therapist told me, “Oh, you’ll do better than that.”

I believe I will.

OCD is hard

I’ve been thinking about what it’s like to have obsessive-compulsive disorder.

How I experience OCD now is different from how I experienced it when I was child, teenager and young adult.

If I compare my life now to how it was when I was in my 20s, I can say with no doubt that things are better now. I cope better. I am able to turn away from the compulsive urges much more easily. I have tools in my toolbox to fight it.

On this blog, I write mostly about what it’s like for me now to have OCD. I continue to have problems with obsessions and compulsions. I am still discovering ways that OCD works itself into my life. My general anxiety and depression can still throw me to the floor and make me think I’ve never moved forward.

But I have moved forward. With medication, cognitive behavioral therapy and personal lifestyle changes, all ongoing, I am moving forward. I am grateful for that.

I know many others are suffering in the depths of OCD, where they are exhausted and in despair. I wish I could wave a wand and take away all their pain.

Because I know how hard it is. That is something I will never forget, no matter how much my own OCD and depression improve.

I’ve had the chapped and discolored hands and wrists from having them in water and strong cleaners much of the day.

  I have stood in front of my stove for hours, looking at the knobs from every angle, touching the top over and over, checking for heat, while I tried to reassure myself that the stove was off.

  I have cleaned the bathroom using bottles of disinfect at a time, then made up excuses—lied—to try to keep others from using it.

  I have driven in circles, back and forth on the street, looking for bodies that I may have run over.

  I have picked up sticks and rocks and anything that looked dangerous as I tried to walk from one place to another, backtracking and bending over to examine something that looked like a weed but might be a wire that could stick someone in the foot.

  I have written research papers that said nothing because I was so afraid of plagiarizing.

  I have failed to finish so many books because I couldn’t turn a page until I’d read it multiple times, making sure I’d really read it.

  I have prayed and chanted continuously, thinking I was somehow responsible for keeping everyone safe by doing so.

  I have confessed my sins, or what might possibly be sins, to anyone who would listen.

I’ve prayed for God to just let me die because I didn’t think I could take one more minute of the pain.

Somewhere inside me was a little hope. It must have been there, even though I couldn’t feel it, because somehow I didn’t give up.

It has taken years for me to reach a point where obsessions and compulsions don’t occupy every waking moment. I am getting better faster now, I believe, because I am doing cognitive behavioral therapy, something I didn’t think I needed before.

OCD will always be with me. It will always be with you, too, if you have it.

Hope will get us through, though. No matter how tiny that hope is, even if it’s just a small thought that there must be something better than this. Even if all the hope you have is the knowledge that someone else got better.

I got better. I’m getting better. And you can too.

OCD: Picking up sticks

It seems like a stick looking straight down, but at an angle, it looks like a nail. When I nudge it with my foot, it rolls a little, but I still can’t tell.

People are coming. I turn and walk in the direction of my original destination, the student services building.

But it might be a nail. Somebody might step on it and get hurt. It would be my fault.

I turn around again, and I walk back the 10 feet. People are passing by.

I lean forward, put my head down and move it around, like I’m looking over the ground below. Maybe they’ll think I’m just looking for something I dropped.

After they pass, I touch the stick/nail again with my shoe. I can’t tell.

I pick it up. It’s a stick. But it’s a hard stick. I can’t break it. Maybe it’s not a stick.

I place it at the edge of the sidewalk, right where the concrete meets the grass, out of the way of walkers.

I take up my journey again.

But someone could still step on it. And it might not be a stick.

I go back and pick up the stick. Maybe if people see me do it, they’ll think it’s something I dropped.

I carry it with me into student services, into the bathroom. I throw it into the trashcan. Then I wash my hands.

That’s a small illustration of one of my harm obsessions. It was strongest when I was in graduate school.

When I walked on the street or on campus or through a parking lot, I checked for things on the ground that could harm someone.



At one point in my life, a walk along here could cause me a lot of anxiety.



I don’t remember ever finding any nails. But I found lots of sticks and rocks that could potentially be harmful. Or so I thought.

Walking somewhere was never a quick trip or a straight journey from A to B when this OCD symptom was at its peak.

I had to check every stick I saw, every little rock and anything that looked like it could be harmful.

I had to stop and examine it. I had to pick up a lot of things to figure out what they were. And sometimes that wasn’t enough.

This harm obsession was sometimes at odds with my contamination obsession. If I picked up a stick or an unknown object, I was contaminating my hands. But I had to pick it up in order to keep other people safe.

That was what it was all about. Keeping other people safe. It was my responsibility.

So harm trumped contamination long enough for me to get to a sink to wash my hands.

When I started taking medication for my OCD and depression, some of my symptoms got a lot better. The picking-up-sticks was one of those.

My eyes are still drawn to potentially harmful objects on the ground, in the driveway, in the parking lot. But now I have a new tool. I can call the obsession for what it is—OCD—and walk on, refocus.

Have you experienced a checking or harm obsession like this?

Sleep

Sleep lingers all our lifetime about our eyes, as night hovers all day in the boughs of the fir-tree. Ralph Waldo Emerson

I have a love-hate relationship with sleep.

I love to sleep. Taking naps is a favorite activity. Some days, I come home from work in the early evening, take a nap for two or three hours, get up for a few hours, and go right back to bed for more sleep.

On Saturdays, I like to sleep late and then take a long afternoon-into-evening nap. On Sundays, I look forward to another afternoon nap.

I love the chance to sleep.

But I hate that I want to sleep so much. I would be accomplishing more in my life if I didn’t sleep so much.

Sleep, that deplorable curtailment of the joy of life. Virginia Woolf

I hate that I can even think that napping is a favorite activity.

My husband doesn’t like me to sleep so much. He says he’d like for us to do more together, but I nap away every weekend, every day off from work.

I wasn’t always like this. I didn’t take naps even when I was in graduate school and was exhausted all the time. I didn’t have time for them.

But sometime in my early 30s, I started to love sleep.

It’s frustrating. I make plans to do so many things, but I find myself tired and sleepy, and I give in to it.

I don’t know how much of my craving for sleep comes from the medication I take and how much from habit.

My psychiatrist and I have tried to find a balance with two medications. It’s difficult to take an amount that enables me to have the motivation to not sleep and an amount that wires me.

Am I just lazy?

A life of leisure and a life of laziness are two things. There will be sleeping enough in the grave. Benjamin Franklin

I don’t feel lazy. I have either been in school full time or worked full time my entire adult life, except for periods when I was unemployed and looking for work. I’m a hard worker on the job.

It’s when I’m off the job that I want to sleep. And I want to stop it.

I believe that it’s a combination of things that is causing my problem. Antidepressants are probably contributing, as are the medications for anxiety.

There are lifestyle changes that I need to make. I need to exercise regularly, get up at the same time every morning and have more of a routine of sleep.

But I think my problem is also connected to the OCD-related procrastination I have. If I am sleeping, I don’t have to deal with issues regarding cleaning, reading, writing, checking, etc. I don’t have to face things that I know will cause me anxiety.

I am not saying that I’m not responsible for my behavior. I am. I am just considering contributing factors.

I am hoping that I will be adding more tools to my toolbox to fight the OCD. I’ll be starting cognitive behavioral therapy a week from today. I have to get serious about making lifestyle changes. And I have to push myself more than I am now to break through the procrastination.

I’m the only one that can do it. I need to make this change in my life.

Do you have problems with too much sleep? How do you combat it?

I start ERP on Thursday

I will start exposure therapy for my OCD on Thursday.

I wrote a post when I decided to make the plunge, but I didn’t think I would start so soon.

I had an appointment with my doctor, a psychiatrist, on Monday and told him I wanted to start. Another doctor in the practice does the therapy, so we thought I’d have to wait a month or so to get an appointment.

Turns out he had an opening this Thursday, so I’m all set up.

My psychiatrist will continue to monitor my medication. He said medication could take me a certain distance, and therapy like the ERP could take me further. That made me feel better. I like the idea of the medication and the therapy complementing each other.

I’m nervous about the challenges, but I’m excited about the possibilities. I like the idea of setting priorities and goals as part of the therapy.

Do you have any suggestions on preparing for my first appointment?

Why not tell?

Why is it so hard to reveal to anyone else—medical professionals, family, friends—that we have OCD?

In writing, in very broad strokes, about my own early journey to treatment, I realized how many times I missed the chance to share my struggles with doctors.

Part of the reason I kept my symptoms to myself was the embarrassment I felt. Think about it. How strange does this sound?

“I stood in my kitchen for five hours the other night checking my stove to make sure it was off,” I tell my doctor. “My hands are so red because I used a bottle and a half of Lysol to clean my small bathroom. Oh, and I was late for my appointment today because I had to drive up and down the street outside to make sure I hadn’t hit someone with my car.”

How would the doctor react? I was afraid to find out.

I think another reason I didn’t tell my doctors was because I didn’t want anyone thinking I was crazy, weak, someone to be pitied, not to be trusted.

Knowing what I know now, and with the experience I have, the only kind of doctor I would have is one who would treat me with understanding and respect.

What I have gained in getting help from medical professionals far out ways any embarrassment I felt as I revealed my problems.

I have had the benefit of understanding doctors and therapists who encouraged me and told me I would feel better even when I didn’t believe it.

I have had the benefit of medications that have helped me deal with OCD, depression and anxiety.

I have learned ways to think about myself less negatively and more realistically.

I can live a good life with my various disorders, and knowing that is a gift.

It’s not my fault I have OCD. It’s not my fault that I have depression. It’s not my fault that I have anxiety.

And it’s not your fault either.