Bipolar disorder: Let's take this deadly disease seriously

Sometimes the memory of my hospitalization comes back to me in cinematic flash backs.

“Give me paper. I need paper,” I screamed at the triage nurse in the ER.

This was the second time I’d been to the ER in as many weeks. I apparently had my shit together too much during my first visit to the ER to be admitted. I was put on a waiting list to receive outpatient treatment.

But, by my second trip to the ER, my mania had tailspinned into psychosis. Bipolar disorder with psychotic features  is common in type 1 bipolar disorder.

I grabbed the paper and pen from the nurse’s hand and scribbled “Jesus loves Karl Rove.”  I underlined the phrase and then shoved the paper back at the nurse.

In my demented mind, I firmly believed that the campaign tactics used by Karl Rove in the 2004 presidential election were an elaborate scheme to shove me out of the religious community in which I had grown up. I had lost everything after those elections, or so it seemed. I became severely depressed and once my depression lifted these manic thoughts took over.

I don’t remember anything else about the triage room after that point. I woke up to my grandparents beside me in my hospital bed.

A doctor soon came in to tell me that I was coming down from a manic episode and that I had a textbook case of bipolar type 1.

That episode occurred 10 years ago. I’ve been on 900 to 1200 mg of lithium daily since. I’ve had great success with my treatment with little side effects, but not everyone is as fortunate.

The death of 28-year-old Natalie Fuller should remind us all how serious this disease really is. Natalie lost her battle with mental illness on March 14.

Natalie experienced her first psychotic break at 22 — the same age that I was when I experienced mine. 

Natalie’s mother wrote an account of Natalie’s battle with mental illness in the Washington Post. In the story she said Natalie would go through phases were she would quit taking her medicine. She said Natalie didn't think they worked for her.

When I first received my diagnosis, the psychiatrists at KU Med put me on a cocktail of lithium, Depakote and Risperdal. My hands trembled, I gained 20 pounds and I felt no emotions. I wanted to get off it all, but the doctors convinced me to tapper down to just the lithium and give it a try. They explained that every time you relapse the episodes get worse and the shorter the period between episodes the more intense subsiquent episodes will be.

Getting off medication is not an option, they said. You will end up back in the hospital; you might end up in jail; you could end up dead.

I've been on my medication for 10 years because the thought of the hospital, jail and death scare me.

15 to 17 percent of people who have bipolar disorder die by suicide.  Put inperspective, approximately  .0101 percentof the general population in the United States dies by suicide. The survival rate of stage 2 breast cancer  is higher than that of bipolar disorder.

This, my friends, is a serious, deadly illness. Let’s start treating it that way.

Live your best life now in three steps

About fifteen months ago I slipped into a catatonic-like depression. Sure, I could move, but barely. I had recently given birth to my daughter and the Zoloft my doctor had prescribed hadn’t kicked in. I have bipolar disorder so we knew the chances of postpartum depression would be high.                 

With my baby less than two weeks old I found myself unable to get out bed. I was able to press through with the help of some sayings I learned in Al-Anon. These mantras helped me be my best self and I’m convinced that they can work for you too.

Do the next best thing. 

Life can be overwhelming, especially when you have a mental illness. It’s hard to project into the future, but you can always do the next best thing in the present. When I felt crippled by depression, early in my post-partum experience, at one point the next best thing for me was simply setting up and holding my baby. So, I sat up. I held my baby. My depression didn’t automatically go away, but that step led me closer to the light. That step enabled me to live my best life at the moment.

Stop Worrying. 

Worry takes us out of the here and now and holds us hostage in past regrets or future concerns. Don’t get trapped in worry. Acknowledge the concern, address the aspects that are in your control, and let go of the rest. I recently learned to let go of my need to control and “fix” problems that I never had control of to begin with. As a result I no longer experience the anxiety and panic attacks that used to plague my days.

Pause for poise. 

Whatever you are doing, pause. Take a deep breath. Think of something that makes you smile. Take time to focus on the things that make you smile. This exercise will help you relax, focus and remember why you want to be your best self in the first place.

I still have days that are difficult. Depression and anxiety will always be part of my life. But day by day, I’m doing my best. Some days aren’t as great as others, but I chose not to worry about that. There’s no time to worry about yesterday when you are living your best life now.

Managing my plate full of stress

I’ve had a lot on my plate lately. Like, I have more on my plate right now than an over-eater at Golden Coral.

I decided, just for the heck of it, to rate my stressful life events on the Stressful Life Events ListSocial Adjustment Rating Scale. Anything more than 300 means you are under high stress. I scored 334, which is a pretty conservative rating of my stress. In that past 15 months I have given birth, filed for divorce, moved, switched careers, moved to another state, and had a 75 percent reduction in my household income.

So that stuff happened. I understand that life happens. But when you have bipolar disorder life happens so fucking hard. Seriously. I often have to remind myself that this illness is real, and valid, and hard. So hard.

When I was hospitalized in 2005 I made friends with another woman who had bipolar type 1. I had just graduated from college. She had just bought her first home. Big events trigger episodes, both mania and depression.

I remember thinking when I left the hospital that I never wanted to have another big life event again. I couldn’t imagine myself with a husband and child and mortgage. I just wanted to play it safe.

But there’s nothing safe about life. It’s full of risks. Clearly I’ve taken my fair share. Some of the risks had a great return. Others taught me lessons that I take with me to this day.

I used to think that taking risks would land me back in the psych ward. You can’t go through stressful life events without becoming symptomatic. Over the past 12 months I’ve experienced two significant bouts of hypomania. One was uncomfortably close to mania. In both instances depression symptoms shortly followed after I scaled back on my antidepressant.

These ups and downs are part of being bipolar. It’s easy shrug them off as just “these ups and downs.” But truthfully, I felt so overwhelmed and worthless tonight that I had to phone a friend to remind myself that me living is a good thing.

It’s hard to understand how someone who has so much going for her can feel so worthless. It’s hard for me to understand, even as I experience it. How can I go from a flood of creative thoughts, from seeing everything as beautiful to feeling like my very existence is nothing more than burden on the unfortunate souls who happen to be my family? How do I go from feeling so wonderful to feeling so absolutely despicable? How do I go from loving myself to loathing myself faster that Kim Kardashian can change her hair back to brunette?

I don’t know the answers to these questions. I probably never will. What I do know, is that I’m not in the hospital. My friend reminded that things suck, but I don’t. And my feelings, valid as they are, will pass. I ended the conversation and was able to read my daughter her bedtime stories, tuck her in, say her prayers, and see the beauty in her smile.

I’m not in the hospital. I have managed to get through some of my most trying times without any full-blown episodes. I’ve been symptomatic, for sure, but I haven’t had any full-blown episodes. That’s not just something. That’s everything.

Bit by bit, my plate’s gonna clear. These stresses will pass. And quite frankly as long as they are on a plate and not a hospital tray I’m going to call it a success.

This damn bipolar weather

People often refer to Kansas weather as bipolar. And that description is 100 percent true this week. (By Kansas I also mean Kansas City, just to clarify.)

This seriously was this weeks weather forecast. WTF!?

Yesterday the high was 72. I’ve been going for runs after work. I’ve had enough energy to cook when I get home AND play with my daughter. Life has been great during this January spring.

Doing my nails is a sure 

sign that I'm hypomanic. 

Perhaps I’ve been a little hypomanic, too. I sold a lot of things online and in return did a little shopping, organized my closet, did my nails, and of course thought of tons and tons of stories that I can turn into to blogs and/or chapters. I thought of story ideas to pitch for freelance assignments. My mind was flowing like the soda fountain at Sonic during happy hour.

Alas today’s high is 48 with clouds, which, to be fair, isn’t bad for January in Kansas. But the clouds have messed with my mojo. (I also may have forgotten to take my anit-depressant last night.) My mojo has been messed with. This morning I closed and locked the door to my office so no clients would walk in on me crying. (I manage a supportive living apartment for clients who have mental illnesses and while I strive to "keep it real," there are limits on just how vulnerable I want to be.)

But if I am going to keep in real, this is what bipolar weather looks like for a bipolar person disorder.

This is what depression looks like. 

It's the most genuine selfie I've ever

taken.

It looks like tears in black and white. That’s what it looks like. That’s what if feels like. But just like the weather in Kansas, the depressive darkness that I feel right now will pass. And I have been giving the chance to live, an opportunity that seemed completely out of reach 10 years ago.

I have been given the chance to live AND a little life to care for and steward. 

It's hard to believe that this precious little one belongs to me.

I have been given the chance to live AND a career where I get to help people and live out my passion. 

I feel honored to be part of the team at 

Mental Health America of the Heartland,

providing hope for other consumers of mental

health care.

I have been given the chance to live AND amazing friends and family to share that life with. 

My daughter and sister, two of the kindest, 

most beautiful people you will ever meet.

The bottom line is I have been given the chance to live. Sure, I’m living with bipolar disorder and it’s hard. How hard? Harder than you’ll ever know if you aren’t experiencing it. It’s hard, but that’s life and thank God I’ve been given the chance to live. 

The facade of having it all together

I wanted to write a blog to kick of Mental Illness Awareness Week, but I couldn’t decide what to write about. I’ve been thinking a lot about the ways mental illness is simultaneously stigmatized and trivialized, but that’s not what I decided to write about tonight.

As I was getting ready to write, a blog that Erin Brown posted depicting what she “really” looks like popped into my head.

In the age of blogs and social media, we posts our best self. The us where our tummies are tucked in, our blemishes are hidden with concealer, and the coffee stains on our teeth are photoshopped out. We present our best self, our tidiest houses, and well polished ideas.

Even when I share a vulnerability or weakness, I package it in a nice tidy blog with a motivational take away for the reader.

But the truth is life isn’t always nice and tidy. And neither is my apartment.

This is what motherhood really looks like.

That is what my sink looked like when I got home from work. And there is no excuse for the situation going on in my bedroom corner.

I likely need an intervention, but it doesn't fit into my schedule.

Hoarding is a new diagnosis in the DSM-V. I take solace in the fact that best friend, who is a licensed therapist, assured me that I am not in fact a hoarder by the clinical definition.

What I am is a new mom, who happens to have bipolar disorder, and has a lot on her plate. I’m juggling a lot of balls these days and if something is going to drop you can bet your ass it won’t be my daughter’s bedtime story.

I share these pictures of my messy home not because I’m proud of them. (I was actually serious when I asked my friend if she thought I may be a hoarder.) I’m sharing these photos because the truth is no one has it together all of the time, including me.

When you have a mental illness it’s important that you prioritize your health. Sometimes that means letting the dishes go and that’s okay.

I did end up doing the dishes tonight.

Ahh, serenity.

I actually wrote this blog in my head while I washed the dishes. And the take away is this: Sometimes life is messy. You do what you gotta do. Apparently posting a photo of my dirty dishes is what it takes to motivate me to clean the kitchen. Whatever it takes.

A Whole New World

As I read through all the posts about Robin Williams today I couldn't help but think of my favorite films that featured him.

Aladdin immediately came to mind. I went to see Aladdin in the theaters with my sister Tempest and our Uncle Rob when I was 10 years old.

Rob was technically our step uncle, but he was the only one of my step dad’s family that I actually claimed as my own.  I liked Rod. He had cool books at his apartment, like the Lord of the Rings trilogy and a slew of Choose Your Own Adventure Books.

Rob always said interesting things. On the way back home from the Aladdin he did this cool trick where he predicted which cars would stop and turn with 100 percent accuracy. (When I learned what a turn signal was that trick didn’t seem quite as magical.)

I talk about Rob in past tense because like Robin Williams, Rob Morrison also lost his battle to depression. Rob took his own life in a way similar to how Robin Williams reportedly did.

Depression and suicide are so hard to comprehend. As someone who has bipolar disorder and suffers from depression the countless number of “there’s hope, let’s fight the stigma” posts that I see on Facebook in light of Williams’ death don’t encourage me. Maybe because I know that a week from now I’ll see another insensitive comment making light of mental illness and be reminded that we don’t see these diseases as the clinical brain disorders that they are.

Mental illness and addiction are clinical illnesses and they need to be treated as such.

When it comes to depression, I often hear people say you can’t understand this beast until you’ve had to slay it yourself. I think there’s truth in that. But I also think it’s important for people to have an awareness of what it’s like to suffer from depression. So I started thinking about what it was like for me.

My darkest bout with depression occurred in 2005. By the time my depression reached a stage that I would call full blown, I found it difficult to connect my thoughts. It felt as if the electrical cord that connected my brain to reality had been cut.  I couldn’t piece together information to write stories. I had trouble following my sources during interviews. I remember staring at computer monitor for hours, hours, trying to come up with a lead about a high school senior I had been assigned to write a feature about.

I felt fatigued. Not tired, fatigued. I once heard someone describe fatigue as carrying around wet afghan on your shoulders. This is how I felt, how I constantly felt. My limbs felt like noodles. Similar to how I had experienced after a bad case of the flu. Only this didn’t go away.

I had no motivation. No motivation to eat. No motivation to go to class. (I was in my last semester of undergrad.) No motivation to go to work. (I had a part-time job at the local newspaper.) No motivation to shower. (I reached a point where to the thought of water actually terrified me.) No motivation to even get out of bed. (Eventually the thought of simply getting out of bed also terrified me.) I had no motivation.

I slept a lot when I was depressed. As much as possible. I cut back on my hours at work, skipped class, and isolated myself from friends. I did anything I could to get more sleep. And I thought maybe if I got enough sleep I wouldn’t feel as fatigued my motivation would come back.

I tried to drink more water, and go for walks and pray. But none of these things work. I tried to watch college basketball, but even the Kansas Jayhawks couldn’t bring me out of this funk.

Eventually my prayers changed to pleas for God to put me out of my misery. I wanted my life to end. There came a time where I had no other desire than that to end my life, to escape the sorrow, and fear and darkness that consumed me. I had no suicide plan. I didn’t want to end my life myself, but rather I wanted

God to end it, if for no other reason than as an act of mercy.

You see, I believed in God. I still do. And I believed that if there was a Hell then surely I had already entered it.

Well, God didn’t end my life. My depression lasted for almost five months. It took a couple months of being on Paxil for the depression to lift and it took several more months for a doctor to accurately diagnose me as bipolar.

It’s been almost 10 years since that depression and I am alive. My life has trials, but I am a live. I have a life. And I love it.

When I hear stories of those who have lost their battle to depression I say a prayer of thanks that by God’s grace I overcame mine; I say a prayer of help that I may overcome the episodes of depression to come; And I say a prayer of wow at the beautiful thing we call life.

Robin Williams had a beautiful life. May he rest in peace.

Reboot your mind, recharge your soul

This summer my husband and I have done a lot of traveling. From the plains of Nebraska, to the Rocky Mountains, to the Caribbean, we've been just about everywhere this summer, except home in Kansas.

I love to travel, because it has an almost magical way of putting things into perspective. I always come back with a greater appreciation for the things I love most about home and insights into any challenges I face. For me traveling is the equivalent of shutting down and restarting your PC at work. That reboot seems to fix all that ails you.

I wrote this blog on the plane headed home to Kansas, feeling fresh and rebooted. These past two months I have gotten behind on my blogging and have lacked the motivation to pursue freelance. But I think a little time hiking in the mountains and swimming in the ocean has given me the motivation to get back on track.

A couple weeks ago, we went to a concert at Red Rocks in Colorado. Looking at the beautiful rock formations reminded me of my rock climbing days in college. (Side note: while you can climb rocks that are red in Colorado, you cannot climb at Red Rocks. Doing so will get you a huge-ass fine.)

I love rock climbing. The thrill of getting the top of a rock will give a rush comparable to that of Colorado's finest dispensaries. The exercise is more mental than physical. When you are stuck in a spot with no where to move your brain must think of all of the possibilities. Could turning your hip up and to the left enable you to get the foothold that you need? If you grab on to that tiny indentation will that give you enough leverage to pull yourself to the next foothold? When your on the ledge of a rock and you feel stuck you can't dwell on that feeling. You are forced to think of your next move. You are forced to envision how you will get to the top.

Living with bipolar disorder is much like rock climbing. Depression can leave you feeling stuck, as though you are on the middle of a rock, while mania can give you the sensation that you are free falling out of control without a rope and harness.

The secret to successful bipolar treatment is to always, always envision you next move. See yourself at the top of that rock. Name that rock. Because the stability you'll experience at the top is yours and you should own it.

I go to Colorado at least once a year. I love the mountains. They remind me that the journey is not over and that the rock/mountain/depression that I'm currently climbing will be conquered.

March is over but the mania has yet to begin

I like to think of myself like Wichita State with the possibility to shock the nation.

The thing everyone loves about March Madness and the NCAA Final Four tournament is that you never know what will happen. Every game is anybody's game. Upsets happen. Second half come backs abound.

The fast paced, unpredictability of college basketball make it the best sport ever. Seriously.

Teams recruit, prepare and practice, but come game time anything can happen. There is no rhyme or reason.

This lack of predictability reminds me so much of my journey with bipolar disorder, particularly depression. I try so hard, perhaps too hard, to avoid depression. I workout regularly, and even signed up for a half marathon to give myself that extra jolt of motivation. I cut preservatives (or almost cut preservatives) from my diet. I pray. I shop. I get my hair done.  I spend time with friends and family. I take my meds and eat plenty of fruits and vegetables. I do all of the things that one should do to stay healthy and depression free.

I often feel like depression shouldn't happen to me. I am Kansas against Michigan. I have this game in the bag late in the second half. I should win this.

But just like Kansas, I don't always win the game. Depression over powers me, despite my best attempts, despite all that life has blessed me with.

And who am I kidding. I can't really compare myself to Kansas basketball.

I'd love to have the humor and wit of Anne Lamott and Tina Fey or the character development of Joyce Carol Oates. Those three writers are the caliber of Kansas basketball. I'm more like Wichita State, someone most people have never heard of but who has the potential to shock the nation in the big dance.

Of course, in my case the big dance isn't basketball it's simply life. And we already know that Wichita State didn't beat Louisville. They won't be national champions this year, but they did shock the nation and make it to the Final Four.

The Shockers success gives me hope in my own ventures. I think I do have what it takes to overcome these bouts of depression- the support, the proper medication, the will power. I think I'll get through these ups and downs.

And who knows, I might pull a Wichita State along the way, and write something spectacular that will shock the nation. I believe it's possible and it's not mania talking. 

5 things I learned from depression

I don’t like to write about depression. I don’t like to talk about depression. I don’t like think about depression. I don’t like to acknowledge that depression even exists. I would rather steal the words of The Bloggess Jenny Lawson and say “Let’s pretend this never happened,” when it comes to depression.

I’ve lost too many days to depression as is and the reality of bipolar disorder is that the possibility of another episode of depression is always on the horizon.

Sometimes you can do all the things you are supposed to do- stay hydrated, exercise, eat healthy- and you can’t escape the slip into darkness. This weekend I felt a numbness in the place where joy usually resides. It was husband’s birthday, KU was killing it on the court in the Big 12 Tournament, yet I felt nothing but pain. It hurts to think about depression because I know I’ll never get those days back. Those opportunities for celebration are gone. And I’ve already lost too many days to this disorder as is.

I don’t want to think about, or talk about, or write about depression, but I am because if the lessons I’ve learned can help even one person then maybe, just maybe, my lost days will have some redemption.

So here’s what I’ve learned about depression:

1. Get help sooner rather than later. I know, you think you can do it on your own. Or maybe you think you don’t deserve help. Or maybe you think you can’t afford help. Or maybe you think you can pray this demon away. There a million reasons not to get professional help. IGNORE ALL OF THEM. I lost a lot of days listing reasons why I shouldn’t get help. And I will never get those days back. You can start with your primary care doctor but I always recommend follow up with a psychiatrist. If you have bipolar disorder SSRI’s, which are often used to treat depression, could trigger a manic or hypomanic episode.
2. If you EVER, EVER, have thoughts of hurting yourself or fixations of death call your doctor immediately. If you don’t have a doctor call the National Suicide and Crisis Hotline at 1 (800) 784-2433. I know this can be the hardest thing to talk about. Trust me, I’ve been there. There is so much judgement surrounding suicide and you may think that no one will understand what you are going through. The truth is, you may be right about no one understanding, but there are people who can help even if they don’t understand your condition completely.
3. Let your friends/family/significant other be there for you. This too can be hard. You may think of yourself as charity case, but I can assure you that your loved ones don’t. They care about you. Let them take you to lunch and stay by your side as you ride this out. If you are lucky enough to have loved ones that are there for you, for God’s sake let them be there for you.
4. Stick to your routine as much as possible while you ride out this storm. Continue to exercise, meditate and go to work if possible. Go through the motions. Even if you are only going through the motions while you wait for your medications to adjust it will make the transition back to health easier than if you cave into the urge and stay in bed all day.
5. Know your support team. My husband, best friend and therapist are the three people I know I can be completely honest with, even if my darkest moments. I know these people will never give up on me and they are who I turn to when I start to feel the darkness rising. Identify your support team and don’t be afraid to cling to them.

Life is tough and messy and depression can make life unmanageable. But there is hope. There is life after depression. That is what I always tell myself. And to be honest I’ve had days where I don’t even believe those words even as I tell them to myself. But on the other side of depression I’m so glad that I hung on even when I couldn’t see the light at the end of the tunnel.

Power of a pill

When you have a chronic illness you understand the importance of taking your medications as prescribed.

The trouble with some illnesses, such as bipolar disorder, is that the medications and dosages required to keep you well can change over time.

Finding the correct dosage can be tricky and when you do find that magic prescription you certainly don’t want to mess with it.

From my experience with bipolar disorder every psychiatrist has his or her own opinion about what medications work best and how you need to tapper off of, or alter, medications as needed.

I have been seeing a resident psychiatrist. Every visit I would see the resident and the he would tell me his thoughts on my medication and then an attending physician would come in and tell me what he or she thought. Most visits I would have the same resident, but the attending, who had the final say on my treatment plan, always changed. And so did my treatment plan. This became worrisome when I decided that I wanted to get off of my medications to try and conceive.

Some docs prefer a more conservative approach while others shrug off the idea of getting off my meds for pregnancy as no biggie. Typically the doctors I saw who were more easy going about getting off my meds were new male residents.

I knew I needed to find an experienced psychiatrists who was female. I thought I female doctor would take my concerns about pregnancy more serious than a male doctor. I realize just how sexists that sounds. And I acknowledge it is in fact sexists.

I’m okay with my sexism because I know that a female doctor works best for me. Trying to have a baby is a complex, emotional issue. Particularly if you have health problems that stand in the way. I admire people who can just get pregnant on a whim without thought to how it will play out. I am not one of those women. Even if I didn’t have bipolar disorder I would not be one of those women. It’s just not my personality.

For over seven years I relied solely on lithium to manage my moods. It worked great, but a several months ago my anxiety and depression seemed to need more than lithium. I got on 50 mg of Zoloft, which seemed to do the trick for a while.

After a few months on the 50 mg, my depression started to creep back and seemed to be even worse than before. I felt on edge at work and drained when I came home, crying at the drop of a hat.

The resident I saw during this bout increased my dose of Zoloft to 100 mg. This complemented the 900 mg of lithium I took daily.

The extra Zoloft made me feel happy, really happy. Soon I felt elated and decided that I should get off the antidepressant. After all, it would be one less thing to worry about when I decided to get off all of my medications to conceive.

I tapered off of the Zoloft in about week. A day after my last dosage, I felt amazing. My therapist classified me as hypomanic but warned me that coming off of the Zoloft could have side effects.

Two days later my mental state completely collapsed. Nothing could motivate me and I couldn’t stop crying. It seemed as though I had dove head first into a deep depression.

After only three days of this depressive state I found myself in a dry heave style of crying. I had put out calls to my doctor, but they weren’t returned. I decided to go back on the Zolft at 50 mg (and get another doctor).

Within a day I felt like myself again, not depressed or elated, just myself.

I never realized what dramatic impacts such subtle shifts in my medications can cause. Now that I am back to myself I’m hesitant to change my medications again. I know I will have to before I can conceive, but I will never again take for granted the power of these pills.

Erring on the side of happiness

I generally try to put on a good face wherever I go, but especially when I have to go to my psychiatrists office.

I say “my psychiatrists office” as if I have I psychiatrists I see regularly. For now I go to KU Med and see which ever resident fits with my schedule.

In reality, I haven’t been able to find an attending psychiatrist who sees outpatients who is not a complete quack, but I’ll save my adventures in doctor hunting for another post.

This blog, is about saving face, a skill that I have mastered over the years. During my quarterly psychiatry visits my goal is to be the ideal patients. I have had doctors hug me at the end of my appointments before. Why? You might ask. Because I’m an extremely compliant patient. I take my lithium as directed (minus my the little experiment I had earlier this year), I get my labs checked, I exercise, eat healthy, and stay connected to my support systems.

I strive to be the perfect patient. If there is ever a hint of hypo-mania in my head, I call in. That’s what good patients do.

I’m like a teacher’s pet, only with my doctors. I don’t want to let them down, so much so that when I’m feeling depressed I don’t like to mention it. I mean really, an ideal patient shouldn’t get depressed, right?

This obsessive people pleasing may sound strange to you. Unless you are related to me or a part my inner-inner circle, in which case you already know this is the neurosis we call Arley.

A few weeks ago I had an appointment with a new resident. I scheduled the appointment with a female resident who came highly recommended from my therapist.

That morning I put on a super cute dress I just bought from White House Black Market, scrunched my curls in place and prepared for what I thought would be an awesome doctor’s visit. I planned to discuss the possibility of tapering off my medication so I can maybe, possibly, fingers-crossed, try to get pregnant next year. I was ready for the appointment. I was ready.

Before my doctor’s appointment I had a slightly stressful meeting at work, but I didn’t let that get me down. I listed to Fresh Air on KCUR on the way to KU Med and thought about all the questions I wanted to ask the doctor about bipolar pregnancy.

But when I arrived at the sixth-floor outpatient psych unit, the receptionists put glitch in my plans.

“Your appointment isn’t until tomorrow Miss Arkenberg,” she said politely.

“What?” I’m sure my voice was obnoxiously high. “My appointment is today. It says so on my phone.”

I held up my iPhone as proof.

She just gave me a look that said, “Seriously?”

Clearly I had typed the appointment into my phone wrong, but I knew there was no way I could take off two afternoons of work in a row. And I couldn’t let anyone at the office know that I had written down my doctor’s appointment wrong. I mean really, getting confused about when your psychiatry appointment is, how embarrassing is that?

“Well, what if Dr. Smith’s 2 o’clock doesn’t show up?” I asked. “Could you squeeze me in then?”

It was already 2 p.m . so I thought their might be a good chance that she wouldn’t show up.

I was wrong. Two minutes after I asked the questions the woman showed up, prompting me to call her swear words in her head. It wasn’t this woman’s fault that I entered the wrong day in my calendar but I needed someone who I could project my anger towards.

I sat down in the waiting area to collect my thoughts. As I did so tears began to fall down my cheeks.

“Come on Arley,” I thought to myself. “Be strong. Think of a plan. What’s your next move going to be?”

I decided to reschedule my appointment with Dr. Smith. I couldn’t come back tomorrow, but I would be able to come back in a couple of weeks. That seemed like the reasonable, responsible thing to do. That seemed like the thing a “good patient” would do.

But when I went up the receptionists desk to reschedule my appointment she wasn’t there.

I sat back down in the waiting room and succumbed to my tears.

Ten minutes later the receptionist came up to me to let me know that there was another doctor available to see me.

I wiped the tears from my eyes and followed the doctor into his office. Instead of giving him my pre-scripted overview about how well I was doing and how my husband and I would like to start having children, I broke down and told him how I really felt.

I felt overwhelmed.

I felt tired.

I felt paranoid.

I felt anxious.

I felt embarrassed.

I felt isolated.

I felt confused.

I felt depressed.

I realized that I hadn’t planned to tell the doctor and of these things when I left the house this morning. I’m always hesitant to tell anyone when I feel depressed. In some ways I’m still ashamed of my depression. As if I should know better. As if the chemicals in my brain should cooperate better.

The doctor asked me if their was a reason that I kept my SSRI (anti-depressant) at such a low dose.

“I’m scared of getting manic,” I confessed.

“It’s okay to err on the side of hypo-mania,” he said. “We can catch that and make adjustments. We want you to be happy. We want you to err on the side of being happy.”

His words, “err on the side of being happy,” struck me. I had never thought of it that way.

Part of me has always viewed happiness as frivolous or even reckless if there was any risk involved at all.

This doctor was telling me to go ahead and take the risk. My happiness was worth it. I was worth it.

When I left the doctor’s office that day, I didn’t feel like the ideal patient. But I did leave with a new outlook on life and a script for a higher dosage of Zoloft.

Dissecting my depression

Sitting in the parking lot of Dillion’s while my husband purchased groceries for our camping trip, I felt a hot steady stream of tears roll down my face.

Depression. When it occurs it causes me to write ridiculously long sentences like the one above and I don’t know how to stop it. 

I typically try to pinpoint the trigger of my depression.

Is the dose of Zoloft I’m taking causing me to rapid cycle? Some studies show anti-depressants can cause rapid cycling (i.e. frequent shifts from depression to hypomania).

Is it my always evolving job description at work? I tend to get anxiety when I don’t have a clearly defined role.

Is it the changes in the weather? A cloudy, rainy forecast can get me down in the dumps.

Or is the routine stresses of my life? I mean stress would be what would cause a normal person to be depressed, right?

Sometimes I think it’s the reality of constant change, rather than the change itself, that causes my depression.

But no doubt levels of my serotonin and other hormones that cause my depression once the triggers go off.

During these times of depression, I just want to break free. Break free from the reprimands for all the ways I’m falling short. Break free from my mind that’s trapped in this foggy haze. Break free from this moment where I can’t see things clear.

I mustered the strength to get out of the car to go inside to inside Dillion’s to get a drink from Starbuck’s.

I don’t know how to break free. But at Starbuck’s I have control to chose my own destiny, at least as far as beverages are concerned. That morning I ordered a chilled lime refresher instead of my normal latte. And just maybe breaking free from my morning routine was enough to get me through the morning.