Thursday, October 25, 2012

Medication and Drug Interactions!

Grapefruit is actually a problem pretty often
Let’s keep it light today because my moods have been swinging all over the place and I can’t handle anything more stressful than the mountain I already have. 

I made a quick post about this last night via my other social media, but it’s never a bad idea to highlight a good tool.

So if you’re like me (or not like me at all but still taking medication for mental health issues) you may in fact be taking more than one medication. Or you may be taking some medications that you think work but haven’t been specifically prescribed for you. Or you may be getting medications from different doctors…. Which can be a problem b/c not all medications interact well together.

Hopefully your Psychiatrist (or whatever) is aware of the interactions between the specific drugs they’re prescribing you. If you’re like me, however, you may be a little paranoid and like to check for yourself. Also, they can’t be aware of any you haven’t mentioned to them.

On top of that alcohol, tobacco, and even various types of foods and beverages can interact with certain medications creating unwanted side effects. Side effects that can reduce the effectiveness of your medicine or possibly increase the action of one causing an accidental overdose.

Side effects and interactions occur differently for different people based on their body chemistry, which is why medications may be prescribed together, and monitored. However, prescribing clinicians are human too and sometimes an oversight can be made.

Which leads me to the point of today’s post.

Medication Interaction Checkers! Drug Interactions Checker   

Medscape Reference Multi-Drug Interactions 

** my favorite

Even if you find an interaction that looks like a major problem, discuss it with your prescribing medical clinician before making any changes to your medication. They’ll know a lot better what is right for you than I do. Not to mention that stopping certain medications abruptly without proper weaning can be even more detrimental than taking it in the first place.

Stay informed! And discuss any and all concerns with your personal medical professional. 

Wednesday, October 24, 2012

Dysthymia or Dysthymic Disorder

So far we’ve talked about Depression and Major Depressive Disorder. So today I want to talk about Dysthymia.

Yanno how sometimes it feels like everything has a veil of gloom permanently settled on top of it? It can be sunny outside, but inside it’s always dim. You can’t remember what it’s like to get excited or happy about anything?  Everything, no matter what it is, has the exact same impact… practically none. Nothing really seems dire, but nothing really seems important either. It’s a constant slow trudging through the muck and drone of daily life. Then one day you realize that those “sometimes” have actually turned into years.

Dysthymia is a chronic type of depression in which a person's moods are regularly low. However, symptoms are not as severe as with major depression. It presents as having a low or depressed moods for most days, for more days than not, and for at least 2 years. For it to be Dysthymic Disorder, no Major Depressive Episodes should have been present during the first two years and there should not have been any Manic Episodes ( Bipolar), a Mixed Episode, or a Hypomanic Episode. In short, Dysthymic Disorder is characterized by an uncomplicated, long-term, low-grade depression for two or more years.[1] And like all disorders, it has to cause a significant distress or impairment in social, occupational, educational or other important areas of function. Significant and lasting, not just occasional.

That doesn’t mean there can’t be contributing factors or periods of MDD though. Many people with dysthymia have a long-term medical problem or another mental health disorder, such as anxiety, alcohol abuse, or drug addiction. About half of people with dysthymia will also have an episode of major depression at some point in their lives.

In fact, they call this Double-depression. Double-depression occurs when a person experiences a major depressive episode on top of the already-existing condition of dysthymia.

"It is difficult to treat as people accept these major depressive symptoms to be a natural part of their personality or as a part of their life that is outside of their control. Because people with dysthymia may accept these worsening symptoms as inevitable, it can delay treatment. If treatment is sought out, it is commonly treatment-resistant due to the fact that the major depressive symptoms are addressed, but often not the dysthymic symptoms."[8]

So far the exact causes of dysthymia are unknown though it does tend to run in families. It also occurs more often in women than in men and affects up to 5% of the general population.[2]

Unlike most disorders I’ve talked about that say you need to have something for at least a certain amount of time, with Dysthymic Disorder you shouldn’t have gone without experiencing two or more symptoms for 2 months.

Typical symptoms include:
·         Poor appetite or overeating
·         Insomnia or hypersomnia, meaning, too little or too much sleep.
·         Low energy or fatigue
·         Low self-esteem
·         Poor concentration or difficulty making decisions
·         Feelings of hopelessness

Not much different than any of the other types of depression. It’s strictly a matter of degree. On a scale of 1 to 10. With 1 being happy/content and 10 being the darkest grip of gothic suicide… here you’re living at a pretty consistent 3 to 5 where everything is just kind of crappy all the time. It especially translates to self-image and how a person views themselves, which is tyipically negative and discouraging. Since this is chronic…. Very, very persistent, a person will have actually lived with this for years, making it almost impossible to view the future as anything different than what the past has already been. The future is as bleak and hopeless as the past has proven to be.

Finding that hope, where there just hasn’t been any, seems like an impossible feat. And because it also doesn’t present with that urgent direness that Major Depressive Disorder does it can often go overlooked, or be passed off as not as big of an issue.

In my country we like to judge things, and say something isn’t as bad because someone, somewhere is suffering with worse. This is an awful perception, b/c you, as an individual, or not someone else, somewhere else. Your circumstances are your own. When it comes right down to it, you are the center of your world, and your perspective is all you have to view the world with. You can’t view it through someone else. So while your circumstances may not be the same as what anyone else is going through, that doesn’t mean that what you’re going through isn’t important, and isn’t worth taking care of.

It may not be life threatening, but it is life diminishing. No one wants, or deserves, to live a diminished life, so you owe it to yourself to do what you can to live the fullest life you can.

I wonder if this is where I’m heading towards now. Or more of a dysthymic-like depression instead of the type of depression I’m used to dealing with. Too soon to tell, and I’m not actually sure this is how mental health progression works, but at least I feel like I’m changing in a better direction. I honestly don’t feel the crushing depression that I used to. I do attribute this to a combination of my medication and the major changes I’ve made in my life. I’ve worked really hard to kick out the negative and disruptive influences in my life, and I can honestly say I’ve been more at peace with myself and my life than I’ve ever been.

But. There’s always a but isn’t there? I still don’t feel “happy”. I still feel baseline kind of low.

Maybe it’s dysthymia (but probably not since I had major depressive episodes during my first 2 years suffering with depression, and I have occasional hypomania). Maybe I’ve just had a shitty life so it’s a natural response. Maybe it’s just that my life is in a transitional phase. I still have things to work on. Less than I did before, but life doesn’t stop, and hopefully growth and personal evolution won’t either. I’m not at an end point, so maybe I’m just not there yet, but still getting there. That’s the most frustrating thing… the not knowing. The amorphous blob of potential that is the future.  Because it can be potentially bad, or potentially good. It’s important to gain self-awareness so we can gain more control over ourselves. When we have greater control over ourselves, we have more control over where our future can go as well. 

Monday, October 22, 2012

Major Depressive Disorder

Depression. It’s not fun. Not even a bit. Fortunately for most people that suffer with depression it’s a temporary state. For those of us that are less fortunate, it can be chronic. Just think of everything I talked about on Thursday, and extend that over a period of time that lasts for weeks, months, and often years, and years, and years. 

Major depressive disorder (MDD) (also known as recurrent depressive disorder, clinical depression, major depression, unipolar depression, orunipolar disorder) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities.

It’s a disabling condition that affects millions of people in the U.S. and magnitudes more around the world. In the U.S. alone nearly 3.4% of people with major depression commit suicide, and up to 60% of people who have committed suicide had depression or another mood disorder.

The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status examination. 

The causes of depression, as we understand, are still incomplete. Like many mental health issues and disorders though the causes may include psychological trauma, psycho-social, hereditary, evolutionary, and biological factors. Not to mention certain types of long-term drug or alcohol use can both cause and worsen depressive symptoms.


How do you know if it’s MDD and not just depression?

First for it to be a Major Depressive Disorder there needs to be a depressed mood or loss of pleasure or interest in daily activities consistently for at least a 2 week period. This change of mood should also represent a change from the person’s normal mood. It must also be accompanied by the negative impairment of social, occupation, educations, or other important functioning.  < --- Causing a significant impact on the person’s life is what makes all of these issues a disorder, and not just “like the disorder”.

Clinical depression is characterized by the presence of the majority of these symptoms:

·         Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.) - Check
·         Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day - Check
·         Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. – My eating disorders would get more severe when I was more depressed.
·         Insomnia or hypersomnia nearly every day - Check
·         Psychomotor agitation or retardation nearly every day

o   Psychomotor agitation is a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one's hands, pulling off clothing and putting it back on and other similar actions. In more severe cases, the motions may become harmful to the individual, such as ripping, tearing or chewing at the skin around one's fingernails or lips to the point of bleeding. - Check √especially as of late I’ve been doing this more and more as I’ve recently written about.

·         Fatigue or loss of energy nearly every day - Check
·         Feelings of worthlessness or excessive or inappropriate guilt nearly every day - Check
·         Diminished ability to think or concentrate, or indecisiveness, nearly every day
·         Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide – Check

Other Symptoms may include:

·         Preoccupation with, or ruminating over, thoughts and feelings of worthlessness – Check
·         Inappropriate guilt or regret – Check
·         Helplessness, hopelessness, and self-hatred – Check

 In severe cases, depressed people may have symptoms of psychosis. These symptoms include 

·         Delusions or, less commonly, hallucinations, usually unpleasant. 

Other symptoms of depression include:

·         Poor concentration and memory (especially in those with melancholic or psychotic features) - Check
·         Withdrawal from social situations and activities - Check
·         Reduced sex drive – Check √ especially during periods of high stress.
·         Insomnia is common among the depressed. In the typical pattern, a person wakes very early and cannot get back to sleep. Insomnia affects at least 80% of depressed people. Check < ---- I suffered with insomnia at my most depressed, solidly from around the 8th grade up until college. I had periods of adjustment where I slept better, especially now, but I still have bouts of insomnia.
·         Hypersomnia, or oversleeping, can also happen. – For me this was less of an issue. But I had periods of this for sure.

There is also a distinction that is made between MDD and grief or bereavement. Grief and bereavement can certainly cause or contribute to depression and may eventually lead to MDD, but that’s a different kind of depression. No less significant in any way, just different than MDD.

Depression is debilitating. And when it’s chronic, it’s no wonder thoughts of suicide can be such an issue. After a while depression feels like the only way you remember ever being. When it seems like you’ve always been this way, and you are literally incapable of envisioning yourself or your life feeling any other way… what is the point of having a bleak, dark, meaningless existence for a countless number of years and no hope of it ever getting better? One of the worst things about depression is it steals your hope.  There’s no end because you don’t know any other way.

The times when you’re flat out miserable are debilitating. It’s almost worse when it’s not debilitating; those times when there’s no all-consuming sadness, when it’s just… bleak. There’s not even sadness to look forward to. Just an endless expanse of nothing.

It’s insidious because it doesn’t go away, it doesn’t seem like there’s anything causing it, or any reason for it. Which can also make you feel guilty, especially when the people around you just want you to be happy. Which leads to pretending to be happy. Which leads to resenting the people that make you pretend to be happy for their sake.

Depression leads to guilt. Guilt leads to Pretend Happiness. Pretend Happiness leads to Resentment. Resentment leads to being pissed off at everyone, and becoming a hermit so you can mope and brood by yourself, in bed, in the dark, where no one can bother you at all. And it never gets better ever.

Fortunately there are plenty of things you can do to fight depression. I’m just not going to talk about them today. Hah!
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