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treatment resistant depression

Bad Day

by Heather Loeb
written by Heather Loeb

For the past few weeks I have (mostly) been rocking the quarantine by staying on top of school work, baking, cooking more, sewing and I even learned to make bread. Good bread. I kept repeating myself, “When is this period of productivity going to crash down on me?” Because it always does, and today was that day. This whole week, actually. I stopped home schooling the kids, my sleep schedule is messed up, I haven’t done anything but lie on the couch and have a migraine.

I know everyone has bad days but why does something so good get taken away from me, just like that? Why can’t I go a long time being productive and happy?

I don’t mean to whine because there are people out there who have it so much worse and I want to remember that. I’m just sad. I’m in mourning of the me that got so much done, the me I was so proud of myself. It hurts to say this but I don’t know which one is the real me, the baseline Heather. I’d like to say the productive, happy one is but I’m better acquainted with this Heather – the one who feels buried beneath judgment, worthlessness, hopelessness and inadequacy.

I want to tell myself that it’s just hormones and/or only anxiety, and if I know anything, it’s that anxiety is a big, fat liar. It can take over your brain, meld your thoughts with those of the devil. And it feels so real. So, so real.

I know I’ll pull out of this little funk in time but I’m so afraid I won’t get back to the point where I was doing all the things I love, not just loafing on the couch wishing it would happen again. I waste so much of my life waiting for the good to come. But most of the time I’m too tired to breathe. So I just wait some more.

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Out of the ashes, baby

by Heather Loeb
written by Heather Loeb

I’ve had depression since I was young; I can remember feeling anxiety in middle school and I definitely had depression in high school, I just didn’t know it then. It wasn’t until college (when my Mema died) that I really had a problem. When she died, I couldn’t handle it. I dropped classes because of the stress and overwhelming sadness I felt. I dropped so many classes that I was only going part-time. I can remember leaving campus to drive to my parents’ house multiple times a week.

I started therapy at my college and after a couple years, I realized I needed medication to help with the depression. I was so embarrassed. I didn’t even tell my parents. Now, my parents have always supported me and never really talked about depression with me but I had it in my head that this was a major flaw – my family seemed stronger somehow, that I should just pull myself up from my bootstraps and get a grip. But I couldn’t.

After I graduated college and started my first job hundreds of miles away from my family and friends, my depression got worse. It made me miss work….a lot of it. My other coworkers were resentful and I felt like my bosses hated me. I didn’t fare well in Corpus Christi and after a bad breakup I moved back home. I felt unsuccessful and like a loser. My depression got even worse.

Fast forward to me going back to Corpus Christi: I got married, bought a house and got pregnant. After my first pregnancy I felt ok but after having my second child I was not ok. Postpartum depression reared it’s ugly head. I had to stop breastfeeding at 4 months so I could get back on my antidepressants but even the meds couldn’t save me from being suicidal. It was awful. I spent my energy on making sure my kids were ok and I simply didn’t have enough strength to fight the ugliness that had infiltrated my body. One day I had to go to the ER for suicidal thoughts. Luckily my parents were with my kids. I was sent to an acute behavioral center and saw an awful doctor who wouldn’t listen to anything I was saying. I was released after a couple days and I found a new psychiatrist who started me on different meds. I’d like to say that fixed me but it didn’t. I was diagnosed as having treatment resistant depression, meaning my meds were not effective in fighting the depression off.

Things were pretty bleak and my depression was not controlled at all. The only thing keeping me going were my kids – they of course had constant needs that I had to focus on. It was when they were sleeping that my anxiety increased. I couldn’t control ugly thoughts like I was a bad mom, a bad wife and a total loser.

I was running on empty with no hope in sight. After talking with my therapist and husband, we decided that I would go to a psychiatric facility for help. It was the hardest decision I ever had to make. It would mean at least 6 weeks away from my babies and husband and I felt incredibly guilty. But I had to go.

At the Menninger Clinic I was diagnosed with major depressive disorder, generalized anxiety and avoidant personality disorder. I started electroconvulsant therapy (ECT) and different meds. I was able to come home after 6 weeks but I have to do ECT treatments every now and then.

I still get depressed. I’m actually in a little funk right now but I know I’ll get through it. I will always rise. I used to think that people with depression were weak but now I know that’s nothing but bullshit. We are strong. We fight to live every day. It’s hard and some of us don’t make it because they don’t have the means or a support system. They suffer in silence and that’s why I cannot. Please do your part in eliminating the stigma around depression and help normalize it. Check on your loved ones, let them know you care and shine a little light in their darkness.

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Ketamine/Spravato

A Horse of a Different Color

by Heather Loeb
written by Heather Loeb

The other day my doctor suggested a couple of Ketamine infusions to do until I can do ECT. I didn’t think much of this because I’ve done several ketamine infusions in the past and they didn’t do much for me, but I learned the clinic that I was going to in Corpus was doing the infusions wrong, or perhaps not in the ideal way. Let’s put it that way.

At the old clinic they were adding benzos (Ativan, Valium) to the ketamine, which actually lowers the efficacy of the ketamine. I didn’t know that until I got to Menninger. Also, the other clinic’s protocol was to give everyone 100mg/hour no matter what. Here, they go by weight. I was skeptical of that at first but now I see why.

When you do 100 mg per hour, rather when I do 100 mg per hour, I feel like I’m in a black hole. There’s a lot of dissociation and I just feel drugged up and then I’m tired for the rest of the day. When I tried ketamine at the clinic, it was almost a religious experience. It was the most calming, most relaxing, therapeutic experience I’ve EVER had. I felt happy – and I haven’t felt happy in a loooong time.

It was amazing. Now, this infusion lasted just 40 minutes but I’ve already noticed a shift in my behavior. I made some jokes with some of the patients and staff here. I cleaned up my room and generally my mood is a bit better. I still have depression, of course, but it did provide a respite from the constant pain I’m in.

This makes me hopeful. I’m scheduled to have another ketamine treatment Monday and then later in the week, I’m due to start ECT. I’m not expecting my life to change but I’ll take any improvement from my current state. Some days it’s just so hard to breathe and it’s so exhausting to be a wife, mother, daughter, friend, etc. It’s just painful. Everything is painful, so relief is all I want. I want to be there for everyone. I want to smile and laugh – just live in something other than this awful darkness. I know I have to work on my therapy, too, and believe me I am. Everyday here is emotionally draining and I don’t think I’ve gone a day without crying, but that’s okay. I’m just trying to get to the other side.

I hope I see ya’ll there soon.

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A Quick Hello from the Inside

by Heather Loeb
written by Heather Loeb

Look who has internet access! There’s so much to talk about, I don’t know where to start.

So, it’s been a week since I’ve been at the Menninger Clinic – it’s a psychiatric hospital in Houston. They’ve done a lot of psychological and cognitive testing and it turns out I’m severely depressed and I have anxiety. Duh.

Testing has also shown that I have a horrible memory, I have a hard time dealing with my emotions, I have no coping skills and my quality of life is at 25 percent. I knew the other things but when you see the results of a psychological test tell you that your quality of life sucks, and sucks bad, it makes you even more depressed. If that’s possible. And I’m here to tell you that it is.

I have a “team” that guides me through my journey here that includes a psychiatrist, psychologist, nurse, therapist and social worker. We all agreed that ECT was the way to go but what I didn’t expect was that I would have to be weaned off all of my meds. ALL OF THEM.

That’s:

Lamical
Topamax
Wellbutrin
Zoloft
Rexulti
Trentellix
Vyvanse
Klonopin
Ambien

That’s a lot. I’m surprised I haven’t exploded yet. Or maybe I should’ve exploded when I was put on all that crap. I’ve had little withdrawal except for the fact that I cry at the drop of a dime. I’m not all too sure that’s not normal at this point.

It’ll probably be two more weeks before I’m off most of the meds, then I can start the ECT, which I’m excited about. Some of the girls here have done it and said they’ve felt some improvement. My doctor said he hopes he can get me back to where I was before I had my little breakdown in 2017. That would be lovely. But I’m not putting all my eggs in one basket. The program I’m in asks me to go to classes, such as cognitive behavioral therapy, dialectical behavioral therapy, self compassion, grief journeys, chemical dependence education and more. They don’t depend on biological therapies only, they make you work. And teaching you how to mentalize and employ solid coping skills is a big part of the program.

My brain is super foggy right now, so I’m going to sign off.

I hope ya’ll are staying well. I’ll try to keep up the my blog as best I can.

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Ketamine/Spravato

Spravato: Treatments 1 & 2

by Heather Loeb
written by Heather Loeb

This past week I completed my first two treatments of Spravato. What’s that, you say? It’s a nasal spray with esketamine (very much like ketamine) that helps with depression and a host of other things, such as migraines – at least for me.

imgresMy first treatment did not go well. First of all, I HATE things going up my nose. Second, it gave my a horrible taste in the back of my throat and I got a little nauseated. I also didn’t dissociate, which is one of the biggest side effects of the drug. Under the FDA’s rules I had to stay there for two hours, so I was hoping for a little dissociation, otherwise it’s just boring. So, it had no affect on me besides being a little sick to my stomach and then I was bored for two hours. Plus when I got home, I got a huge migraine and for the next two days and had to see my neurologist to get a Nubain injection for my migraines to go away. Maybe it was just a coincidence but I was annoyed and didn’t want to go for the second treatment. It had been awhile since I’d had a migraine.

But to my delight, the second treatment went well. I got the hang of putting the nasal mist up my nose, got used to the nasty taste in my throat and this time they gave me Zofran for the nausea. I still didn’t dissociate but I was tired enough to take an almost two hour nap, so the visit passed rather quickly. Can’t say the same for my husband who has to stay there the whole time and give me a ride home. FDA rules again. He can’t leave the whole two hours while I’m receiving treatment.

I don’t feel a whole lot better, and since it’s hardly affecting me, my doctor is going to bump me up to the big girl dose next week, which is about 84mg of esketamine. When I go to get the ketamine infusions at the clinic via IV, I’m receiving 100mg, plus they give me a benzo in the IV – I don’t know why they do that. So, maybe the larger dosage will help me more.

Don’t get me wrong, it wasn’t a complete failure. I do feel better after the second one but I’m still dealing with symptoms of depression. But I don’t feel as blah as I have been.

I’m supposed to go three times to the clinic next week to get the larger dose, so we’ll see how that goes.

As far as my weight loss and journey to get healthy, I haven’t even been on the scale. I’ve been eating poorly and drinking Diet Coke again. My depression just hit hard this week and the week before. I think. I can’t remember last week. I’ll get back on track and keep you guys updated. Thanks for the support.

Stay well, my friends.

 

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Exhaustion

by Heather Loeb
written by Heather Loeb

You know when you wake up and you’re in a good mood? You don’t even have to think about it, you just have a good day…

I don’t.

If I wake up in a good mood, which is rare, I have to constantly monitor my emotions to keep myself in a good mood. My therapist pointed out to me that (most) other people just have emotions but I have to manage mine. And it’s exhausting. I think that’s why I have to compulsively eat, compulsively shop or take something, like an anxiety pill, just to feel ok. Anything throughout my day could set me off or unnerve me and I’m always on alert. It leaves me feeling so depleted all the time, and along with my depression, I’m just so worn out.

I’ll tell you a story that isn’t the best example but it’s the only thing I can think of right now. My husband told my daughter that she could get a new kitten. I wasn’t on board at first, as we have three older cats now. I finally got on board and I went to look at some kittens alone last week. I was excited. I was having a great day and almost felt manic, which when I look back, I probably just felt like a “normal person.” Even my husband commented on what a good mood I was in. Back to the kittens. I found one that I liked and called my husband. I thought we could bring the kitten home and surprise the kids. I thought wrong. My husband said no – that we would have to wait until we got back from out of town. We’re leaving for a week after the kids get out of school.

I was crushed. I immediately felt depressed. All the happiness that was running through my veins turned cold and I couldn’t stop crying. I knew this wasn’t over the kitten, I didn’t even like it that much. It took me a few hours to realize that I was scared and disappointed because the feeling of happiness could be gone just like that. That I’m so fragile. I had stopped managing my emotions.

Again, that was last week and I haven’t felt that great since. It’ll come back, I’m sure. I hope. And if it does, I can’t let my guard down for a second.

I’m tired just thinking about it.

Stay in the light, my friends.

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So Much Weight

by Heather Loeb
written by Heather Loeb

We all know that depression is a huge weight to carry but do you know what else is heavy? Actual body fat and I’ve got a surplus right now. I mean it. I’ve gained 20lbs in the past two months and it ain’t pretty.

At first, the weight started to just creep up, then I ignored the scale, ate Whataburger everyday and threw caution to the wind (and chocolate in my mouth).

I am so uncomfortable. My back is hurting again – it hasn’t hurt since my breast reduction last year. None of my clothes fit me right and I’m just disappointed with myself. I feel embarrassed and judged by strangers and those I love. I don’t know why.

There’s nothing like getting depressed about your weight while you’re actually depressed. I know some depressed folk who won’t take medication, effective medication, because one of the side effects is weight gain. The struggle is real. And for me, compulsive eating is a coping mechanism so this happens quite often. I eat my feelings and as it turns out I have a lot of feelings. Sometimes eating is the only joy I have in my joy as sad as that sounds. Also, if eating a certain meal felt good one time, I often go back to the meal to recreate feeling good. Even if it doesn’t work the second time, I still go back for more. I’m not a fast learner.

I know what I need to do to be healthy; it’s just hard when I can barely take a shower. But if I can drive my ass to Whataburger, I can drive to the gym, right? We’ll see.

There’s a 5K coming up in November I want to do, so I want to start running again. Along with eating healthier, I’ll make that my goal and maybe I can get these awful extra pounds off.

See below when I felt sexy and hot and a picture I took Saturday and felt blah.

 

 

I know I’m still beautiful and all that, blah blah, but I’m just so uncomfortable – did I mention that? In the picture on the left, I felt so sexy and wore cute clothes all the time. On the right, I feel like a hot mess – like fat girl in a little coat. I hope y’all are old enough to get that reference.

I’m going to shut up about it now.

So here I am going up a hill, depression/anxiety riding my back with the added bonus of 20 extra pounds.

I’m already sweating.

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Treatment Resistant Depression

by Heather Loeb
written by Heather Loeb

As I’ve mentioned in 389,432 of my other blogs, I have treatment resistant depression (TRD). It may sound like its not curable, but by definition it means one is non responsive to at least two antidepressants for a period of time. It also is characterized by extreme sadness, sleep disturbances, low energy, suicidal ideation and suicidal attempts.

TRD is experienced by 45 percent of patients with a major depressive disorder. That’s just crazy to me. It contributes to nearly one-third of patients attempting suicide in their lifetime, a rate more than double that of their treatment responsive peers, according to this article by Psychiatry Advisors.

While psychiatrists cannot pinpoint why some are treatment resistant, researchers have seen correlations in certain populations who are more vulnerable than others. For instance, women and senior citizens. Individuals who have had severe or recurring bouts of depression also appear to be more susceptible, according to Johnson and Johnson’s website on health.

What I found most interesting is other medical illnesses can play a part in TRD. The article states that thyroid disease and chronic pain (I have both thyroid disease and chronic migraines) makes you a greater risk for treatment resistant depression. Mind blown.

Other factors include substance abuse and eating and sleep disorders. I also suffer from compulsive eating and insomnia. I should donate my body to science when I die.

So, what happens with you’re treatment resistance and your meds don’t work? We do have options. We can go on the highest dosages of our meds – IF YOU’RE DOCTOR THINKS THAT IS RIGHT FOR YOU – or there are non-drug therapies which I’ve mentioned in the past, such as transcranial magnetic stimulation, ketamine infusions and ECT, which helps reverse symptoms of TRD.

I think the only non-drug therapy I haven’t mentioned in detail is ECT (electro-convulsant therapy), which is effective to 70-80 percent of patients. This is not to be confused of electroshock therapy, poorly portrayed in movies and TV. ECT uses general anesthesia intentionally triggering a quick seizure. It’s meant to reverse symptoms of mental health problems and as of now is the best treatment for depression.

So, as of now I’ve definitely more than two antidepressants/antipychotics: Doxepin, Zoloft, Prozac, Lexapro, Wellbutrin, Abilify, Rexulti, Saphris and Seroquel. For me, that’s a lot. I’m also tried Lamictal as a mood stabilizer.

I’ve also tried TMS (transcranial magnetic stimulation), ketamine infusions and I’m about to try the Spravato nasal spray which is based on ketamine.

Here’s to my people who are treatment resistant. You’re not alone and hopefully there will be better alternatives in the future.

One thing I forgot, there’s also a genetic test you can take that can tell you which antidepressants will work better for you. It’s called the cytochrome P450 (CYP450) test. Ask your doctor if this is an option for you.

Stay well. Stay in the light.

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When I Hit Rock Bottom

by Heather Loeb
written by Heather Loeb

About two years ago, I felt great. I was taking two HIIT (high intensity interval training) classes a week and when I wasn’t doing that I was training to run a 5K, a feat for me because I hate running. I felt so strong, so energetic and proud of myself. I was doing hard things, things I didn’t think I could do. I was a role model to my kids.

In June 2017 I ran the 5K. I was happy. A couple weeks later I started to feel bad. I wasn’t sick but I started to lose momentum with my workouts. Things that were once easy or doable became hard. Waking up in the morning was hard. I didn’t know what was going on. I knew I had depression but I was doing so well. It had been well over a year since I had Eli, it couldn’t be postpartum depression – I was over that.

I took whatever energy I could muster and put it toward the kids, which meant I suffered more. Showers seemed near impossible. I stopped working out. I just wasn’t myself.

In October, I hit rock bottom. I had suicidal thoughts. I was crying at every little thing. I felt anxious all the time and my marriage was suffering. Thankfully, my mother in law was helping with the kids.

During a school break, we took the kids up to my parents’ house. I had also made an appointment with a new psychiatrist who specialized in women’s mental health in Southlake. My then current pyschiatrist wasn’t cutting it. While my parents’ and the kids were at my parents’ lake house, my husband and I got into a huge fight and I just lost it. I was sobbing uncontrollably and suicidal. This next part is hard – I knew where some hydocodone was and I had a plan to take some but I didn’t want my mom to find my body. I called my best friend and she urged me to go to the ER.

I waiting for hours at the ER for them to transfer me to a psychiatric hospital. Around midnight, hours after I’d arrived, I was taken by ambulance to a psych ward at another hospital. I was there two and a half days. The psychiatrist there was a total dick. He wouldn’t release me until he “talked to my husband about my illness” and didn’t listen to anything I said. Because I had an appointment with the psychiatrist in Southlake, he ended up letting me go after talking to my husband of course.

When I met with Dr. Johnson, I saw the light at the end of the tunnel. She diagnosed me with Major Depressive Disorder, PMDD, generalized anxiety disorder and social anxiety. My old doctors just said I was depressed and never spent more than 15 minutes with me. Dr. Johnson spent more than an hour talking to me. She put me on medications I had never heard of, that my doctors never mentioned, and I left the office crying tears of happiness.

I did get better, I’m better than I was that awful October but I’m treatment resistant, so medication can only go so far for me. That’s why I try alternative treatments like TMS, ketamine infusions and soon the ketamine nasal spray. Right now, I’m definitely not suicidal but I have to struggle though days, some more than others.

If you’re suicidal, please go to the nearest ER or tell your doctor – any doctor. There is help and it does get better. You can also call the suicide hotline at 1-800-273-8255. Someone is there 24 hours a day to help you.

Thanks for listening. This blog was a hard one to write.

 

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Oops

by Heather Loeb
written by Heather Loeb

Oh, hey. It’s been since September since I last blogged. My apologies. It’s been a hard few months since. First, I was busy with the holidays and since the beginning of the year I’ve been depressed and haven’t felt like talking despite everyone’s urging to do so.

That’s the thing about depression, even when you need to talk the most you feel like you just can’t do it. I can say that I’ve been going to therapy on a regular basis but my meds have stayed the same despite me feeling like crap. Because I’m treatment resistant, there’s really nowhere to go from here medicine wise. My psychiatrist has suggested ECT but I’m just not ready for that. Yet.

I have been getting ketamine infusions which helps with my moods. It doesn’t last very long but thankfully we have the money to get them. I don’t know what I would do if we couldn’t afford it. If you’re poor and have MDD, you’re screwed. My medicine alone costs hundreds of dollars. So wrong.

IMG_2079My therapist and I started Dialectical Behavior Therapy. Basically, you identify your negative behaviors and teach yourself positive behaviors. Seems like common sense but it’s really helpful when all you’ve been doing your whole life is practicing negative coping skills. So far, so good. I’m working in a workbook, which I would recommend to anyone.

I’m also going to try the new ketamine-based nasal spray, Spravato. It was approved by the FDA in March. The doc that did my TMS treatments called and wants me to be her first patient. You have to be in the office and monitored for two hours after receiving the spray and I think you go twice a week for six weeks at first. I hate stuff going up my nose so we’ll see how this goes down. Waiting on insurance to clear my first, of course. It’s always insurance.

That’s my update for now. I’ll try to be more consistent with everything and I’ll definitely keep you updated on the Spravato.

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