Ok, I’m going to try to wrap up the post from last night. I still don’t have a clear idea of what I’m trying to communicate or accomplish, so bear with me.
Since I began seeing my psychiatrist a couple of years ago, he’s tried me on several different medications. Pristiq, Cymbalta, Wellbutrin, and I think there was another one early on that I’m forgetting. None of them did much of anything for my moods, but they had some level of success in getting me out of bed in the morning (Wellbutrin most notably). A few weeks back he decided to try me on Adderall, and has slowly increased the dosage each week until now I’m taking 30mg a day. I didn’t realize this, but Adderall is pretty much just an amphetamine, like speed (in fact, my receipt from the pharmacy just said “amphetamine”, since I guess they gave me the generic version).
I want to pause here. Since about half of my depression is energy-related, a lot of the drugs my doctor has tried have been in an effort to boost my energy levels. When he first started me on such a drug, a long time back, he told me to be sure to wait until the next morning to take my first dose. Our appointment was at 2pm or something, and he said that was much too late in the day to take it — it would keep me up all night. I did as he requested. I set my alarm for 9:30am the next morning, took the pill, and went back to sleep for several hours. My doctor was amazed, since most people are wired and jittery after taking it, and certainly not able to sleep. I had no problem sleeping and didn’t notice anything resembling the other symptoms he described. Anyway, this sequence of events repeated itself several times over the next two years. He’d start me on something new, caution me to take it early in the morning, and then would be surprised when I could take it and still go back to sleep for several hours. It got to the point where he would warn me and I would say “Remember, you gave me this exact warning before, and it wasn’t a problem.” But every time he would say “I know, but this stuff is even stronger. I really mean it this time.” But apparently my body is a finely honed sleeping machine, or is very well trained at shrugging off stimulants, or something along those lines, because nothing he ever gave me ever had a strong effect on me. The most any of them ever did for me was make it so that I wouldn’t just unconsciously choose to go back to sleep without even really being aware of it. Before being on the medication I almost felt drugged and sedated when I was supposed to be waking up. The medication would alleviate that, but it certainly wouldn’t prevent me from sleeping, much less get me leaping out of bed.
Anyway, I mention all of that as background because when he started me on Adderall, I got the same schpiel from him. And of course I reminded him that he’d said all that before, and of course he told me that this time he meant it, that Adderall was basically speed, etc. Well, on the lower dosages of Adderall (5mg and 10mg), as usual, I didn’t notice anything. But once I worked my way up to 15mg, 20mg, and then 30mg, I started actually noticing some results. In all cases I could still choose to go back to sleep if I wanted to, but as the dose increased, it would make it very difficult to fall back into a deep sleep. My mind would become active a little while after taking the pills, and so while I could stay in bed half-asleep, my mind would still be going and eventually I’d decide to get out of bed. This doesn’t sound like very much to most people, I imagine, but for me it was a very big step. If I had gone to bed very late the night before, then I would sometimes be able to sleep for a bit longer, but generally I would want to get out of bed within an hour of taking the pills. This would even be the case if I was dreading the day ahead of me (which is often tied to my desire to remain in bed — the upcoming day often seemed overwhelming, and thus it was easier to just ignore it and stay in bed). With the Adderall, I may still have the thought process that the day was going to be tiring and overwhelming, but somehow the Adderall prevented my mind from just shutting itself down at the prospect of facing the day. I’d still feel melancholy about facing the day, but I wouldn’t retreat back into sleep.
Furthermore, the Adderall helped my energy levels during the rest of the day. Which I guess you’d expect from an amphetamine. But it doesn’t feel like I had imagined it would feel to take speed (I’ve never tried it). I don’t feel jittery or nervous or wired or driven or bursting with energy or unable to sit still or anything like that. In truth, I *feel* much the same as I did before. But somehow I am able to make myself start working on things where before I would struggle to find motivation to do that. I’ve been markedly more productive since starting on the Adderall.
Okay, so that all sounds good. But what’s the problem? Well, as I think I mentioned in the last post, along with all of this good stuff, my “dark moods” became much more intense. I know I’ve tried to explain what I mean when I say things like my “dark moods”, but I don’t know if I’ve done a good job of it. Basically what I mean is that I’ll be going about my business, maybe in a good mood, maybe in a neutral mood, maybe in a slightly bad mood. Whatever — nothing out of the ordinary. Suddenly my mind will be flooded with a sense of dread or hopelessness or sadness or despair. And it will attach itself to whatever thought process had been going through my head. So if I was thinking about work, then suddenly work would seem oppressive and hopeless and awful. Or if I was thinking about money or bills or whatever, I would feel like that situation was hopeless. Worst is if I was in a relationship and thinking about the other person, because I would then feel those negative emotions about her or our relationship. In all of these cases I am able to realize that the emotion isn’t really caused by something that is actually wrong in my life. My brain just has to tie it to something, so it picks whatever I had been thinking of.
Anyway, so prior to the Adderall, these moods would happen. Usually they would happen many times per day. It’s hard to say exactly, though, for a couple of reasons. First, once I learned to distinguish these moods from “real” emotions, then I got in the habit of trying to push them out of my mind as soon as they would occur. In the past I would sometimes dwell on them, and that would make it even worse. So now, once I realize what’s going on, I try to ignore the emotion and not let myself get worked up about it. So that can make it hard for me to remember just how often it happens, since it has become my habit to not dwell on them at all and not pay attention to it. And the second reason is, largely because of what I’ve just mentioned, the moods don’t tend to stay very long. Back when I would dwell on them and overthink them, the moods could remain with me for some time. But now that I don’t allow my thoughts to linger on the moods, then they tend to go away faster. So the bottom line is, while I know they happen many times over the course of a day, I have a hard time really being more specific than that.
So what changed with the Adderall? As I said, the moods became much more intense. One will hit me and it’s almost a physical response. I mentioned in the last post that when they hit, it will sometimes fill me with the urge to cry. I still recognize the emotion for what it is, but because it is that much stronger, it is harder for me to dismiss. And it tends to bring down my overall mood even after it is gone. And it’s exhausting. I almost feel like I’m walking through an emotional minefield, wondering when the next blast will go off and throw me off kilter.
All of this has left me pretty torn about the Adderall. I really really like the way it has impacted my energy and productivity. But the enhanced depression is not fun. I saw my psychiatrist yesterday and we discussed all of this. The current plan is to keep me on the Adderall at this dosage and start me on Prozac. So we’ll see how that goes. If nothing else it will give me an excuse to sing the Prozac-related verse from “I Don’t Want To Get Over You”.
Now I’m left to wonder why I decided to write all of this. I mean, it’s not like I consider any of these things to be secrets, even though I generally don’t talk about them. I don’t think depression is anything to be ashamed of. I think the main reason I don’t bring my depression up is that it seems like it would only serve to bring other people down, and I don’t see the point in that. Plus, if I became one of those people who posted melancholy, whining statuses on Facebook, then it would seem too much like I just wanted to use my depression to get attention. And there’s also the fact that I obviously have no rational reason to be depressed. It would seem weird for someone like me, with a pretty great life, to complain about being depressed. Of course I realize it’s chemical and not my choice. But it’s weird being in a position where I feel all of the negative emotions associated with depression, but at the same time have clarity enough to realize that the emotions are not anchored in reality.
Writing about it does help a little bit, but sadly it’s not so cathartic that it makes it go away. I’m also not sure if being single makes this better or worse (oh yeah — Jen and I broke up a while back). Being single makes it easier in that I don’t have to worry about my depression impacting someone else. When I’m in a relationship, sometimes that can be a source of strength to fight the depression, but other times it can be an additional burden. In a relationship I can’t just do what I need to do in order to cope, I also have to take into account the other person. But that said, I think the longest period I’ve gone as an adult without being especially troubled by depression was the 5 years I spent in a relationship with Keri. So maybe a relationship can be a help, but it has to be the right one.
Oh well — that’s about all I’ve got for now.