Understanding Mental Disorders: The Brain as an Engine

I’ve written a lot about my use of Prozac as just one of many tools to treat my OCD. [See The Bad Pill Kept Me From The Good Pill]

Mood music:

As a result I’ve gotten a fair amount of questions about the true value of anti-depressants. I’m not a doctor, so don’t take my perspective as Gospel. Also remember there’s no one-size-fits-all solution here. What I write here is based on my own personal experiences. What works for me may not work for the next person.

http://activephilosophy.files.wordpress.com/2009/11/brain-engine.jpg

The more I read up on depression, mental illness and the drugs prescribed for it, the more I see the human brain as an engine. Comparing it to an engine makes this whole think easier to understand.

We know that the engine of a car is made up of many small parts and when one part gets worn out the rest of the engine can fail. We know that a car needs just the right amount of oil, transmission fluid, brake fluid etc. to function properly. If the oil runs out, the engine seizes up. If the brake fluid runs dry, the breaks fail. On the flip side, too much of these fluids can harm the engine.

We also know that the auto mechanic uses many different techniques to keep engines healthy or fix them when they break.

The brain works much the same way.

[ImgPet.jpg]

Think of the different drugs as different tools to deal with very specific problems in the engine.

http://i2.cdn.turner.com/cnn/2009/images/08/04/gall.antidepressants.jpg

In my case, Prozac addresses the very specific fluid deficiencies that spark OCD behavior. The effect is not as simple as the image below suggests (though I do like the image and need to find the artist so I can properly credit him/her):

https://theocddiaries.com/wp-content/uploads/2012/04/prozac.jpg?w=218

It may also be useful to think of the therapist as the auto mechanic who is well versed in how to regulate the different engine fluids and pinpoint specific fixes for specific problems. It’s also true that there are good mechanics and bad mechanics who sometimes make the problem worse. [More on this in my previous post: Have Fun With Your Therapist (A.K.A.: The Shrink Stigma)]

In the brain, when certain fluids are running low, the engine stops working properly. The result is depression and a host of other mental disorders.

Since OCD is essentially the brain pumping and spinning out of control, I like to think of my specific problem as a lack of brake fluid.

But the good folks at WebMD explain it much better than I ever could. Here’s some WebMD wisdom I included in a previous post, Prozac Winter:

How Antidepressants Work

Most antidepressants work by changing the balance of brain chemicals called neurotransmitters. In people with depression, these chemicals are not used properly by the brain. Antidepressants make the chemicals more available to brain cells like the one shown on the right side of this slide:

Photo Composite of Neurotransmitters at Work

Antidepressants can be prescribed by primary care physicians, but people with severe symptoms are usually referred to a psychiatrist.

 

Realistic Expectations

In general, antidepressants are highly effective, especially when used along with psychotherapy. (The combination has proven to be the most effective treatment for depression.) Most people on antidepressants report eventual improvements in symptoms such as sadness, loss of interest, and hopelessness.

But these drugs do not work right away. It may take one to three weeks before you start to feel better and even longer before you feel the full benefit.

And, just as weather can impair the performance of your car engine (my father‘s car went for a swim when Revere got flooded out in The Blizzard of 1978 and never worked properly again), too much bad weather can keep the brain from working properly:

Why do I seem to get so gloomy each winter, or sometimes beginning in the fall?

You may have what’s called seasonal affective disorder, or SAD. The condition is marked by the onset of depression during the late fall and early winter months, when less natural sunlight is available. It’s thought to occur when daily body rhythms become out-of-sync because of the reduced sunlight.

Some people have depression year round that gets worse in the winter; others have SAD alone, struggling with low moods only in the cooler, darker months. (In a much smaller group of people, the depression occurs in the summer months.)

SAD affects up to 3% of the U.S. population, or about 9 million people, some experts say, and countless others have milder forms of the winter doldrums.

So this worsening of mood in the fall and winter is not just my imagination?

Not at all. This “winter depression” was first identified by a team of researchers at the National Institute of Mental Health in 1984. They found this tendency to have seasonal mood and behavior changes occurs in different degrees, sometimes with mild changes and other times severe mood shifts.

Symptoms can include:

  • Sleeping too much
  • Experiencing fatigue in the daytime
  • Gaining weight
  • Having decreased interest in social activities and sex

SAD is more common for residents in northern latitudes. It’s less likely in Florida, for instance, than in New Hampshire. Women are more likely than men to suffer, perhaps because of hormonal factors. In women, SAD becomes less common after menopause.

I’m still learning the science of mental illness, and remember I’m not a doctor. I just share my personal experiences and explain what works for me.

Class dismissed.

Have Fun With Your Therapist (A.K.A.: The Shrink Stigma)

Mental-illness sufferers often avoid therapists because the stigma around these “shrinks” is as thick as that of the disease. The author is here to explain why you shouldn’t fear them.

Mood music for this post: “Just Another Psycho” by Motley Crue:

[youtube=http://www.youtube.com/watch?v=Ko23M-4AAbg&hl=en_US&fs=1&]

It’s a funny thing when I talk to people suffering from depression, addiction and other troubles of the mind. Folks seem more comfortable about the idea of pills than in seeing a therapist. After all, they’re just crazy “shrinks” in white coats  obsessed with how your childhood nightmares compromised your adult sex life, right?

Since I rely on a therapist and medication as two of MANY tools in my recovery, I’m going to take a crack at removing the shrink stigma for you.

I’ve been to many therapists in my life. I was sent to one at Children’s Hospital in Boston as a kid to talk through the emotions of being sick with Chron’s Disease all the time. That same therapist also tried to help me and my siblings process the bitter aftermath of our parents’ divorce in 1980.

As a teenager, I went to another therapist to discuss my brother’s death and my difficulty in getting along with my stepmother (a wonderful, wonderful woman who I love dearly, by the way. But as a kid I didn’t get along with her).

That guy was a piece of work. He had a thick French accent and wanted to know if I found my stepmother attractive. From the moment he asked that question, I was done with him, and spent the rest of the appointment being belligerent.

That put me off going to a therapist for a long time. I started going to one again in 2004, when I found I could no longer function in society without untangling the barbed wire in my head. But I hesitated for a couple years before pressing on.

The therapist I started going to specialized in dealing with disturbed children and teenagers. That was perfect, because in a lot of ways I was still a troubled kid.

She never told me what to do, never told me how I’m supposed to interpret my disorder against my past. She asked a lot of questions and had me do the work of sorting it out. That, ladies and gentlemen, is what a good therapist does. They ask questions to get your brain churning, dredging up experiences that sat at the back of the mind like mud on the ocean floor. That’s how you begin to deal with how you got to the point of dysfunction.

She moved to Florida a year in and I started going to a fellow who worked from his house. I would explain my binge eating habits to him, specifically how I would down $30 worth of McDonald’s between work and home.

“You should stock your car with healthy foods like fruit, so if you’re hungry you can eat those things instead,” he told me.

That was the end of that. He didn’t get it. When an addict craves the junk, the healthy food around you doesn’t stand a chance. The compulsion is specifically toward eating the junk. He should have understood. He didn’t. Game over.

The therapist I see now is a God-send. He was the first therapist to help me understand the science behind mental illness and the way an inbalance in brain chemistry can mess with your thought traffic. He also provided me with quite an education on how anti-depressants work. Yes, friends, there’s a science to it. Certain drugs are designed to shore up the brain chemicals that, when depleted, lead to bi-polar behavior. Other meds are specifically geared toward anxiety control. In my case, I needed the drug that best addressed obsessive-compulsive behavior. For me, that meant Prozac.

That’s not to say I blindly obey his every suggestion. He specializes in stress reduction and is big on yoga and eliminating coffee from the daily diet. Those are two deal breakers for me. Yoga bores the dickens out of me. If you’ve been following this blog all along, I need not explain the coffee part.

I also find it fun to push his buttons once in awhile. I’ll show up at his office with a huge cup of Starbucks. “Oh, I see you’ve brought drugs with you,” he’ll say.

Thing is, he’s probably right about the coffee. But I’ve given up a lot of other things for the sake of mental health. I’m simply not putting the coffee down right now.

I think part of this is about testing him, too. I can’t help but push the buttons sometimes just to see what I can get away with.

But on balance, it’s a productive relationship that has helped me to find a lot of peace and order in my life. I thank him for that.

He kind of reminds me of Dr. Keyworth, the shrink who counseled Josh Lyman and President Bartlet on “The West Wing.” He took their crap with a straight face, not the least bit concerned that these were powerful, intimidating people.

The main point of this post is this:

There are good therapists and not-so-good therapists, just like there are good and not-so-good primary care doctors; just like there are good cops and bad cops.

But if you feel like you need to talk to someone objective and you hold back for fear of being in the same room as a quack, well, then you’ll never know what you could have accomplished.

I chose to talk to a professional despite my deepest reservations. I’m grateful that I did.

The Mood Swing

Back in the day, when I was throwing parties in the basement of my house in Revere, Mass., I would reach a certain level of intoxication around 2 a.m. where I’d freeze in place, yell “mood swing!” and throw candy and other food items around the room.

People seemed to enjoy it, so I kept doing it. Even then, the ego was there.

Looking back, I now know that those mood swings, which were real, were the beginnings of some mental damage.

To this day, I experience it, even with the Prozac.

I can wake up in a perfectly good mood. Then, two hours later, a wave of melancholy will hit me for no good reason. Then I listen to some angry music and it eventually passes. Other days I’ll wake up with a feeling of dread for no particular reason and an hour later the mood turns sunny and I’m ready to take on the world.

It’s been happening more frequently in recent weeks, which I’ve come to realize is the winter effect. Minimize my sunlight and throw a lot of cold, gray weather my way and it gets a little tougher to hold it all together.

I started taking an extra 20 MG of Prozac last week, the idea being that I take a higher dosage for the duration of winter and dial it back to where it was come spring and summer.

It’s just starting to have the desired impact. The mid-afternoon mood swings I was having last month have gone away. But I still get up on a morning like this one, where I feel the brooding impulse for no particular reason.

And so I put on music like this:

[spotify:track:2yWOMbhPN2XJAiVy46Bhvz]

And now I feel better.

That’s how it works.

A tricky thing to manage, but it’s much, much better than it used to be. For that I Thank God.

Even Dobermans Get The Blues

I’m taking Sunday off from writing on here because some of my readers say they need to catch up. But I can’t resist sharing this article, flagged by my good friend Ann Ball, about how dogs battle a little of their own OCD.

Guess I should have abstained from faking the throw all these years. But what’s done is done.

Here’s that article:

Scientists Learn Why Fido Circles the Bowl

By Jeremy Kaplan – FOXNews.com

Ever wonder why your Doberman circles five times before sitting down or eating? So did the researchers at Tufts and UMass, who spent about $70,000 to find out.

http://www.foxnews.com/scitech/2010/01/07/scientists-learn-fido-circles-bowl/?test=faces

Andrea Hoffmann/Wikipedia

The Third Brother

Remembering Peter Sugarman, another adopted brother who died too early — but not before teaching the author some important lessons about life.

The first time I met him was my second day as a reporter for The Stoneham Sun. He was an oddball who wore a jacket and tie to go with his sneakers and sweatpants. He was rail thin with a mustache that could comfortably hide a pound of whatever crumbs got caught there.

He wore a a strange-looking hat over a thick mop of hair. I was absolutely certain from Day 1 that the hair was fake, but never asked about it.

This is the tale of Peter Sugarman, another older brother who left me before I was ready. But he taught me some important lessons along the way and — oddly enough — his death was the catalyst for me finally getting the help I needed for what eventually became an OCD diagnosis.

My friendship with Peter really blossomed over the course of 1997, though it was a year earlier when I had first met him. I was in a bad place. My best friend, Sean Marley, had recently died and I had just taken a job as editor of the Lynn Sunday Post, a publication that was doomed long before I got there. I just didn’t realize it when I took the job.

I worked 80 hours a week. To get through the pressure I binge ate like never before and isolated myself. I had no real friends at the time because no one could compete with a dark room and a TV clicker.

But Peter was a bright spot, even though he was infuriating my editor side. A lot. His writing could be off the wall and opinionated when I was looking for straight, objective articles from him.

He once wrote about a blind man who, instead of offering a story of inspiration and living large in the face of adversity, led a bitter existence and talked about that bitterness during his interview with Peter. I opened the story on my screen for editing and saw the headline “Blind Man’s No Bluff.” I let the headline go to print, though I shouldn’t have. But the dark side in me thought it was funny, and the higher ups weren’t paying enough attention to The Post to notice.

He would write one story after the next questioning the motives of city councilors and the mayor. He would tag along with firefighters and write glowing narratives portraying them as heroes. That would have been fine if the assigned piece called for opinion. But it didn’t, and I edited it heavily.

That Sunday, I found a voicemail from Peter. He was furious, ripping into me for letting the J-School in me take over and ruin a perfectly good piece of journalistic brilliance.

I quickly got used to getting those messages every Sunday.

At the same time, we became constant companions. Whenever I left my dark bedroom, it was either to be with Erin, by then my fiance, or Peter. We hung out in every coffee shop in Lynn. He showed me the dangerous neighborhoods, introduced me to the city’s most colorful characters and showed me hidden gems like the Lynn Historical Society, where I was treated to boxes of old correspondence from former Mass. Speaker Tommy McGee, a colorful pol who, like many a Speaker who followed, eventually left the Statehouse under a cloud of corruption. I wrote about the old correspondence and interviewed McGee in his Danvers condominium. I couldn’t help but like the guy.

Peter and his wife, Regina, became constant dinner companions. When I finally escaped from The Post, our friendship deepened. I still hired him for the occasional freelance article in the Billerica paper I was editing. He would show up to cover meetings wearing his colorful collection of hats, including one that had “Yellow Journalist” emblazoned across the front.

He became my favorite person to talk politics with. He was at every family gathering. He and Regina were a constant presence when both our children entered the world. They were at every kid’s birthday party. They were here for our Christmas Eve parties.

Peter was in bad health, though, and was often in the hospital. His colon had been removed long before I met him and he continued to smoke. He was also a ball of stress when traditional J-School editors were tampering with his writing. I would call him and he would rage at whoever the editor was at that moment.

I enjoyed the hell out of it. His tirades always entertained me, whether I was the target or not.

I ultimately came to understood what it was all about. He wasn’t in journalism to write the traditional reports people like me were taught to write. He was in it to root out the truth and help the disadvantaged. He was a man on a mission to right the wrongs he saw. And he did so cheerfully. Even when his temper flared, there was a certain cheerfulness about it.

In the spring of 2004, he developed shingles. He grew depressed, though not beaten by any stretch. Regina later told me he was “bolting” down his food. Swallowing quickly without chewing because the shingles had irritated the heck out of his mouth and throat.

One night, he choked on a piece of chicken. He lost his breath just long enough to cause insurmountable brain damage.

He lingered for about a week in the hospital, essentially dead but still breathing with the aid of life support. For the first time in our friendship, I saw what he looked like without the hairpiece. I was right all along.

In the months following his death, I really started to come unhinged. The OCD took over everything. Fear and anxiety were constant companions.

I finally reached the deep depth I needed to realize I needed help. In the years that followed, I got it. It hasn’t been easy, but then I can always remember that things weren’t easy for Peter. And yet, he carried on with that warped cheerfulness of his.

I’ve endeavored to do the same. I’ve also come to understand the value of the writing he tried to do, and have embraced it.

Thanks, Peter.

Marley and Me

The author describes the second older brother whose death hit harder than that of the first.

Mood music:

[soundcloud url=”http://api.soundcloud.com/tracks/48842027″ iframe=”true” /]

It doesn’t seem right that a friend’s death would hit me harder and fuel my insanity more than the death of a biological brother. But that’s what happened.

This is the story of Sean Marley, who introduced me to metal music, taught me to love life, and whose death was one of the cattle prods for my writing this blog.

I had known Sean for as long as I could remember. He lived two doors down from me on the Lynnway in Revere, Mass. He was always hanging around with my older brother, which is one of the reasons we didn’t hit it off at first.

Friends of older siblings often pick on the younger siblings. I’ve done it.

Sean was quiet and scholarly. By the early 1980s he was starting to grow his hair long and wore those skinny black leather ties when he had to suit up.

On Jan. 7, 1984 — the day my older brother died — my relationship with Sean began to change. Quickly. I’d like to believe we were both leaning on each other to get through the grief. But the truth of it is that it was just me leaning on him.

He tolerated it. He started introducing me to Motley Crue, Ozzy Osbourne, Van Halen and other hard-boiled music. I think he enjoyed having someone younger around to influence.

As the 1980s progressed, a deep, genuine friendship blossomed. He had indeed become another older brother. I grew my hair long. I started listening to all the heavy metal I could get my hands on. Good thing, too. That music was an outlet for all my teenage rage, keeping me from acting on that rage in ways that almost certainly would have landed me in jail.

We did everything together: Drank, got high, went on road trips, including one to California in 1991 where we flew into San Francisco, rented a car and drove around the entire state for 10 days, sleeping and eating in the car.

This was before I became self aware that I had a problem with obsessive-compulsive behavior, fear and anxiety. But the fear was evident on that trip. I was afraid to go to clubs at night for fear we might get mugged. When we drove over the Bay Bridge I was terrified that an earthquake MIGHT strike and the bridge would collapse from beneath us.

I occupied the entire basement apartment of my father’s house, and we had a lot of wild parties there. Sean was a constant presence. His friends became my friends. His cousin became my cousin. I still feel that way about these people today. They are back in my life through Facebook, and I’m grateful for it.

He was a deadly serious student at Salem State College, and his dedication to his studies inspired me to choose Salem State as well. Good thing, too. That’s where I met my wife.

In 1994, things started to go wrong for Sean. He became paranoid and depressed. He tried to hurt himself more than once. I didn’t know how to react to it.

That fall, he got married and I was best man. I wanted to be the greatest best man ever. But I was so self-absorbed at the time that there was no way I could effectively be there for someone else, even him.

Over the next two years, his depression came and went. He was hospitalized with it a couple times. By the summer of 1996, he was darker and more paranoid than I’d ever seen him. But I was so busy binge eating and worrying about my career that I didn’t pay enough attention.

In November 1996, I got a call at work from my mother. She had driven by Sean’s house and saw police cars and ambulances and all kinds of commotion on the front lawn. I called his sister and she put his wife on the phone. She informed me he was dead. By his own hand.

I spent a lot of the next 10 years angry at him for doing such a thing. He had everything going for him. And he chose to end it. I didn’t understand it, even as I was descending into my own brand of craziness.

The reason his death hit harder than my own brother’s is complicated. I think it’s because I had been burned for the second time, which is always worse than the first. It’s probably that I was an adult the second time and had a greater awareness of circumstances behind his death. Or it’s probably just the nature of the ending.

It took my own struggle with depression and OCD years later to truly grasp what he had gone through. I wasn’t there for him, but by sharing my own struggles I can hopefully be there for others.

Life has been good in the years since his death. I married a wonderful woman, followed a career path that’s produced many Blessings, found God and had two precious children.

We named our first son Sean Michael Brenner. And with that, I guess I was able to move on.

My son is every bit as smart as the man he was named for. His wit tickles me every day. And he’s caring beyond his years.

You can bet your ass I’ll be watching him like a hawk to make sure he doesn’t become too much like the man he’s named after.

Continued in “Death of a Second Sibling

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http://www.theocddiaries.com/2009/12/22/ocd-diaries-12-22-the-ego-ocd-built/

Lost Brothers

When my older brother died Jan. 7, 1984, a trend began where I would befriend people a few years older than me. A couple of them would become best friends and die prematurely themselves. It was also the day that sparked a lifelong fear of loss.

It’s been so long since Michael was with us that it’s sometimes hard to remember the exact features of his face. But here’s what I do remember:

We fought a lot. One New Year’s Eve about 30 years ago, when the family was out at a restaurant, he said something to piss me off and I picked up the fork beside me and chucked it at him. Various family members have insisted over the years that it was a steak knife, but I’m pretty sure it was a fork. Another time we were in the back of my father’s van and he said something to raise my hackles. I flipped him the middle finger. He reached for the finger and promptly snapped the bone.

We were also both sick much of the time. He had his asthma attacks, which frequently got so bad he would be hospitalized. I had my Chron’s Disease and was often hospitalized myself. It must have been terrible for our parents. I know it was, but had to become a parent myself before I could truly appreciate what they went through.

He lifted weights at a gym down the street from our house that was torn down years ago to make way for new developments. If not for the asthma, he would have been in perfect shape. He certainly had the muscles.

He was going to be a plumber. That’s what he went to school for, anyway. During one of his hospital stays, he got pissed at one of the nurses. He somehow got a hold of some of his plumbing tools and switched the pipes in the bathroom sink so hot water would come out when you selected the cold.

He was always there for a family member in trouble. If I was being bullied, he often came to the rescue.

I miss him, and find it strange that he was just a kid himself when he died. He seemed so much older to me at the time. To a 13-year-old, he was older and wiser.

He was close to a kid who lived two doors down from us named Sean Marley. After he died, I quickly latched on to Sean. We became best friends. In a way, he became a new older brother. Sean died in 1996 and the depression he suffered has been one of the cattle prods — next to my own fight with mental illness — for this blog.

A year after Sean died, I found another, much older brother named Peter Sugarman. He died in 2004 after choking on food.  His death sent me over the cliff with the OCD firing in every direction. That was the year I realized I needed help.

I was lucky to have known these guys. They certainly helped shape the person I am today. I am forever thankful for that, because I have a life that’s Blessed far beyond what I probably deserve. I would not have reached this point without their lessons and love. Even in death, they each taught me to see the things that truly matter.

Thanks, guys.

Growing Pains

Despite all the progress I’ve made in managing OCD, there are still times where I forget to use my skills — momentarily, at least.

This morning is a good example.

I woke up depressed. Two hours later I was angry. Maybe I was getting tired of the winter outside my window. Maybe I was just plain tired. I was snapping at Erin and the children. I realized I was letting the crazy side loose and went upstairs to the bedroom because I didn’t want to lash out at my family for things that weren’t really their fault. Even if it were, lashing out is not my preferred way to deal with it.

The kids came into the room one at a time to see if they could do anything to make me feel better. Then Erin came in and we talked through it.

I feel no need to explain what exactly triggered my inner demon this morning, though through talking it over with Erin I figured it out. The important thing to point out here is that I can now see how I am managing things better than before.

1. I retreated to the bedroom instead of blowing up at those I love.

2. Instead of keeping it inside, I talked to Erin about what I was really feeling. She deserves much of the credit for bringing me to a place where I can purge the darker emotions.

3. I told everyone involved that I was sorry.

Now I feel better, and I can move on and have a better rest of the day.

Prozac Winter

The author discovers that winter makes his depression worse and that there’s a purely scientific explanation — and solution.

My therapist and I recently agreed that my Prozac intake should go up a bit for the duration of the winter.

I’m doing well for the most part, but there’s a three-hour window of each day — usually late afternoon — where my mood slides straight into the crapper.

The reason is simple: People who suffer from chemical imbalances in the brain are directly impacted by daylight levels. When the weather is dismal, cold, rainy and the days are shorter, a lot of folks with mental illness find themselves more depressed and moody. Give us a long stretch of dry, sunny weather and days where it gets light at 4:30 a.m. and stays that way past 8 p.m. and we tend to be happier people.

There are lessons to be had in the history books:

— Abraham Lincoln, a man who suffered from deep depression for most of his adult life, went from blue to downright suicidal a few times in the 1840s during long stretches of chilly, rainy weather. [See Why “Lincoln’s Melancholy” is a Must-Read.]

— Ronald Reagan, a sunny personality by most accounts, was a man of Sunny California. Once, upon noticing that his appointments secretary hadn’t worked time in his schedule for trips to his ranch atop the sun-soaked mountains of Southern California — and after the secretary explained that there was a growing public perception that he was spending too much time away from Washington — Reagan handed him back the schedule and ordered that ranch time be worked in. The more trips to the ranch, he explained, the longer he’ll live.

The WebMD site has excellent information on winter depression. Here’s an excerpt:

If your mood gets worse as the weather gets chillier and the days get shorter, you may have “winter depression.” Here, questions to ask your doctor if winter is the saddest season for you.

Why do I seem to get so gloomy each winter, or sometimes beginning in the fall?

You may have what’s called seasonal affective disorder, or SAD. The condition is marked by the onset of depression during the late fall and early winter months, when less natural sunlight is available. It’s thought to occur when daily body rhythms become out-of-sync because of the reduced sunlight.

Some people have depression year round that gets worse in the winter; others have SAD alone, struggling with low moods only in the cooler, darker months. (In a much smaller group of people, the depression occurs in the summer months.)

SAD affects up to 3% of the U.S. population, or about 9 million people, some experts say, and countless others have milder forms of the winter doldrums.

So this worsening of mood in the fall and winter is not just my imagination?

Not at all. This “winter depression” was first identified by a team of researchers at the National Institute of Mental Health in 1984. They found this tendency to have seasonal mood and behavior changes occurs in different degrees, sometimes with mild changes and other times severe mood shifts.

Symptoms can include:

  • Sleeping too much
  • Experiencing fatigue in the daytime
  • Gaining weight
  • Having decreased interest in social activities and sex

SAD is more common for residents in northern latitudes. It’s less likely in Florida, for instance, than in New Hampshire. Women are more likely than men to suffer, perhaps because of hormonal factors. In women, SAD becomes less common after menopause.

Here’s where the Prozac comes in for me:

As I mentioned in The Bad Pill Kept Me from the Good Pill, Prozac helps to sustain my brain chemistry at healthy levels. Here’s a more scientific description of how it works from WebMD:

How Antidepressants Work

Most antidepressants work by changing the balance of brain chemicals called neurotransmitters. In people with depression, these chemicals are not used properly by the brain. Antidepressants make the chemicals more available to brain cells like the one shown on the right side of this slide:

Photo Composite of Neurotransmitters at Work

Antidepressants can be prescribed by primary care physicians, but people with severe symptoms are usually referred to a psychiatrist.

Realistic Expectations

In general, antidepressants are highly effective, especially when used along with psychotherapy. (The combination has proven to be the most effective treatment for depression.) Most people on antidepressants report eventual improvements in symptoms such as sadness, loss of interest, and hopelessness.

But these drugs do not work right away. It may take one to three weeks before you start to feel better and even longer before you feel the full benefit.

I’m convinced the drug would NOT have worked as well for me had it not been for all the intense therapy I had first. Developing the coping mechanisms had to come first.

I’ve also learned that the medication must be monitored and managed carefully. The levels have to be adjusted at certain times of year — for me, anyway.

So next week I’ll start taking the higher dosage and let y’all know how it goes.

OCD DIARIES 12-30: The Break

The author tries to take a break from writing, but chaos in the form of his two sons reminds him of another lesson worth sharing.

Sean and Duncan have the audacity to fight over video games at this early hour, my usual writing window.

Back before I found control over the OCD, this normal childhood behavior would send me over the edge. Fighting children equals chaos. People like me don’t do chaos well. I am, after all, someone who craves order.

The good news is that I don’t go over the edge anymore. I look up from my laptop screen, tell them to knock it off and get back to my writing. A lot of their fighting amuses me because of the zingers that spill out their mouths.

So I tell them to knock it off and, once hidden behind the computer screen, grin broadly.

I appreciate that I can enjoy these moments instead of being undone by them.

It’s a nice break.

Today will still be a day crammed with chaos. This morning I’m taking the kids to play with their cousin Madison and Uncle Dave’s vast Lego collection. This afternoon I’m babysitting the children of one of Erin’s best friends so the two of them can go have a girls’ afternoon out. It’ll be me and four kids. They’ll be wrecking a house other than mine, so I’m actually looking forward to it. Tonight Erin and I will take the boys to the N.E. Aquarium — one of their favorite places on Earth — for a members-only event.

I never thought it would be possible to feel relaxed with a day like that ahead. And yet I am relaxed, even as the coffee begins to course through me.

It’s nice to embrace life instead of trying to run from it. I’m enjoying a week off from work without worrying about all the stuff I need to do when I get back. If anything, I’m looking forward to all the things I have to do next week. By Saturday, I suspect I’ll be itching to get back to it.

The original purpose of today’s entry was to announce I’m taking a break from blogging for a couple days. It’s a forced break. I’m trying to give folks a chance to catch up with the torrent of writing I’ve done these last three weeks.

For someone with OCD, the compulsion is to keep going. To stop is to lose precious momentum.

But that was the old me. The new me is happy to take a break and enjoy the precious present.

Somewhere along the process of writing today’s entry, I got sidetracked and started going on about my kids. No apologies for that. I kinda like how this entry turned out. It’s all over the place, but it’s nice to meander once in awhile.

It sounds stupid. But it’s true.

Happy New Year, friends.