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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.

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Fear Factor

In this installment, the author describes years of living in a cell built by fear, how he broke free and why there’s no turning back.

“The only thing we have to fear is fear itself.” — Franklin Delano Roosevelt

This morning I led a meeting of Over-eaters Anonymous, a task that included standing before a room of people for 30 minutes to tell my story of OCD, addiction and recovery.

It was my third time “qualifying” at an OA meeting this past year. Meanwhile, I did a fair amount of public speaking for my day job as senior editor of CSO Magazine. I sat on panels at security conferences and did solo presentations in front of various information security groups around the country.

Five or so years ago, the notion of me getting up to speak in front of people would have been laughable.

I was too busy hiding in my cage of fear to do such things. Fear will rob you blind, forcing you to avoid life and retreat into the sinister world of addiction.

Breaking free of it was a gift from God. But it took a long time to figure out how to unwrap it and realize my potential.

For me, fear was one of the many byproducts of OCD, something that went hand in hand with anxiety. It kept me away from parties. It scared me out of traveling. I turned down a lot of living in favor of lying in my bedroom watching TV. There are a couple examples in particular that I’m not proud of.

1991

One summer night I was hanging with two friends in front of Kelly’s Roast Beef, a popular eatery on Revere Beach. As we started walking the mile back to my house, we noticed we were being followed by some 15 punks. It was clear they were looking for trouble. I panicked and ran to a nearby bar. As I looked back, I couldn’t see my friends.

The punks had circled them and started kicking and punching their guts in. I called the police and the beatings ended quickly, but I couldn’t get over the fact that I ran away. Worse, it marked the end of my walking along the beach at night for many years to come.

It was a huge fear-inflicted injustice. I grew up on that beach and loved the place. I walked its entire length daily. It gave me peace and clarity. And I allowed some punks to scare me away.

2001

A week after the 9-11 attacks in New York and Washington, Erin and I were scheduled to fly to Arizona to attend a cousin’s wedding. The night before were were supposed to leave, I gave in to my terror at the prospect of getting on a plane and we didn’t go. It’s one of the biggest regrets of my life.

There are smaller examples in between and in the years after, but those are two of the more vivid memories.

Fear also fueled the binge eating and kept me from standing up for things that were right in the family and workplace. It was better to keep my trap shut, I thought. To do otherwise would put my job in danger or have me blackballed.

Then there was the fear of loss I wrote about a few blog posts back — fear that if I didn’t overprotect my kids I might lose them to some imagined beast; that if I spoke my mind during a spousal spat my wife might walk out on me. In hindsight, these were foolish ideas. But in the grip of fear, you think this way and act on it even though you really know better.

When I began getting treatment for the OCD the fear actually accelerated for a while. If a toe went a little numb I’d think I was suffering from a blood clot. A headache would leave me wondering if a tumor was growing inside my skull. A pain in the chest became fear of a heart attack.

I can’t remember when the fear finally began to lift. I think it was in early 2007, shortly after I began taking Prozac. Once the medicine untangled the chemical imbalances in the brain, situations I had feared suddenly seemed manageable. It was pretty weird, actually. I didn’t know what to do with this new feeling. Or maybe it was the year before, when I converted to the Catholic Faith and increasingly let God into my life. When you have God on your side, there’s really nothing to fear, right?

Then little milestones came along. There was a business trip to California that would have consumed me with worry a few years before. There was the first time giving a presentation in front of a room full of security people who were almost certainly smarter than me. The computer holding my PowerPoint presentation went on the fritz and I was forced to present sans slides. I told the audience that I was just going to wing it and that broke the ice.

Today, I look for opportunities to give talks in front of crowded rooms. I have work to do on my speaking skills, but I want more. The more I do, the more my confidence grows and the smoother and more organized the presentations get.

I look for opportunities to fly as well. And though I work hard on the business at hand, I ALWAYS make a point of building in a day to go out and explore, especially if there’s a piece of history to see up close. I want to see it all. Staring at the hotel room TV will no longer do.

Sometimes I worry that the fear will return and I’ll again retreat to my old cage. I don’t think that’s going to happen, though, for one simple reason — the world has been opened up to me. I’ve experienced too much joy these last couple years to go back to the way I was.

I couldn’t go back if I tried. Not that I would want to try.

To be clear, I still worry about things. But I don’t let it shut down the rest of my life. Instead of being engulfed, I can put the concern in its proper mental compartment and move along with my life.

There will be difficulties ahead, I’m sure. That’s life. But I feel more ready to deal with what may come than I’ve ever been before.

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Fear of Loss

There was a time when fear of loss would cripple my mental capacities. I got over it — mostly.

It’s 6:30 Sunday morning as I write this, and a snowstorm is exploding outside my living room window. Sean and Duncan are already playing games on the family laptop.

I’m enjoying the precious present moment, more so since I can remember when my mind used to spin so fast with worry that I would barely recognize the wonderful things in front of me. Including my kids.

In fact, I was often looking at the miracle in front of me and, instead of enjoying it, would work myself into an anxiety attack. Because there was always the chance I could lose it all. Fear of loss.

A word about Sean and Duncan: Sean is an 8-year-old third-grader, one of the smartest kids in his class. Duncan is a 6-year-old kindergartner, equally smart but with more of a romantic streak. He gets crushes on the little girls in his class on a regular basis. They get their brains and their looks from their mom.

They constantly dazzle me with their razor-sharp wit and their kindness toward others. They can pray the Rosary from memory better than many adults. They love unconditionally.

Before I found a treatment program for OCD, I was in constant fear of losing them and their mom to imagined illnesses and other calamities. In 2005, long before the current H1N1 pandemic, when a much more deadly flu virus was killing people in Asia and health officials were worrying that that might blossom into a pandemic as lethal as the 1918-19 Spanish Flu, I worried around the clock that these precious children might someday be stricken with it. I searched five pages of Google search results every morning to get the latest news of every new death.

Looking back, it all seems incredibly stupid. But it also makes perfect sense.

Since OCD is essentially a disease of worry in overdrive, my mind was doomed to always be seeking out something new to worry about. Since I’ve watched a brother and two best friends die, fear of loss was destined to poison my mental juices.

I also used to worry relentlessly about impending snowstorms and hurricanes for the disruptions they might cause.

Then there was the fear of loss in work form, where I’d constantly worry that if I didn’t slave away 80 hours a week at work, I just might fall out of favor with the bosses.

Whenever I had to get on a plane for business travel, I worried that maybe — just maybe — the plane might blow up in flight.

Then I found my faith and found treatment. It was along time coming, but it came.

Don’t get me wrong. I still worry about my wife and kids all the time. When a former colleague recently lost her only child in a motorcycle crash, a fresh wave of worry flooded in.

But I don’t spin mental webs about things that MIGHT happen like I used to. I hardly spin those webs at all today. I know bad things can still happen. But I’ve learned that there’s no fruit in fearing things that are completely beyond my control. All I can do is be the best husband and dad I can possibly be, keeping everyone safe and healthy and giving them all the love I have to offer.

Instead of dreading the snow, I’m enjoying it, even though I have to shovel out the car in an hour because I’m on schedule to do the readings at the 9:30 Mass. Instead of dreading the next business trip, I find myself looking for all the cool, historic places to check out at my next destination. I’ll work hard while there, but I always build in a few hours to take a look at the things I don’t get to see everyday.

It’s a beautiful gift.

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The Stormy Present

A week and a half into this blog, I have most of the backstory etched in. There’s a little more backstory to come, particularly on how Faith has played a central role in my recovery and about how the signs of my craziness were there in my early 20s. More humor is yet to come as well.

Response to this blog has been tremendous, and I thank those who are taking time to comment.

Until the next entries, I’d like to direct your attention toward the right side of this page, where I’ve been fleshing out the Blogroll. There are two worth paying special attention to, both from former Eagle-Tribune colleagues.

Penny Writes, Penny Remembers is not an easy read. The author, Penny Morang Richards, experienced the worst kind of hell imaginable last month: The death of her only child in a motorcycle crash. The wounds are still fresh, and she writes about her grief with the same soulfulness I remember in her E-T columns back in the day.

That she can even face the keyboard every day and etch the pain in stone tells me that she’s ultimately going to emerge from this with a purpose that many, many people will benefit from. It’s a great blog about stumbling forward — falling and crying along the way, but moving forward all the same.

The Sweetest Reasons is Olivia Gatti’s chronicle of family, including her husband and two precious daughters. It warms the heart and is chock full of photos (she is, without exaggeration, one of the best photographers I’ve worked with in the last 16 years).

Taken together, the blogs are an excellent snapshot of the darkness and light we all experience in our life’s journey.

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The Bad Pill Kept Me From The Good Pill

In a previous post I mentioned that I take medication for OCD: Prozac. It’s been extremely helpful, but it took a long time for me to even consider trying it. Here’s why:

Mood music:

As a kid sick much of the time with Chron’s Disease, I was often put on the maximum dose of a drug called Prednisone. The side effects were so horrific that I forever after resisted the idea of taking medication until I reached a point in my OCD treatment where I felt so desolate I was willing to try anything.

Prednisone does an excellent job of cooling down a Chron’s flare up. If not for the drug, chances are pretty good I wouldn’t be here right now. More than once the disease got so bad the doctor’s were talking about removing my colon and tossing it in the trash. Each time, the medication brought me back from the brink.

But there was a heavy price — literally and figuratively.

The drug quadrupled my appetite, which was already in overdrive because of the food restrictions imposed upon me during times of illness. It contributed mightily toward the binge eating disorder I wrote about a few posts back.

The drug also fueled vicious mood swings and introduced me to a lifetime of migraines, many of which were so bad I’d end up hunched over the toilet throwing my guts up.

So when I started to confront my mental disorder and specialists started talking about different medications available, I balked. In fact, I told one therapist to go screw.

I focused instead on building up an arsenal of coping mechanisms. That helped tremendously, but it wasn’t enough. I found myself against one final brick wall; one I couldn’t seem to punch through.

And still I resisted.

I had plenty of excuses. I knew many people who had gone on antidepressants and were still depressed most of the time. Some had gained weight — a problem I already had. I just didn’t see the point.

I also couldn’t shake the memory of a dear friend — a man who essentially became an older brother after my real older brother died in 1984 — who had been on medication for depression but ultimately committed suicide anyway. I walked away from that nightmare with the theory that antidepressants made people worse rather than better.

Finally, I resisted because the depression that often sprung from my OCD wasn’t the suicidal variety. Truth be told, I’ve never once considered taking my own life. It just never occurred to me. Mine is a depression in which I simply withdraw, saying little to people and spending as much time as possible on the couch zoning out in front of the TV. To me, medication was for people in far more serious condition.

And so I resisted until I was so desperate I was willing to consider anything, no matter how extreme or stupid.

After researching the various medications and consulting the doctors, I started taking Prozac in January 2007. The results were almost immediate.

I stopped re-spinning old anxieties in my head. I automatically stopped obsessing over things I couldn’t control, like the possibility that the plane I was on might crash en route to a business conference. Suddenly, I had an overwhelming urge to experience all the things I used to fear.

I fell in love with travel. Work challenges became fun instead of something to dread. I finally became comfortable in my own skin.

The compulsive tendencies still surface on occasion. I still get batty over getting chores done. I still get bent out of shape if my sons use my desk and move a few trinkets out of place.

But the fear and anxiety went away in 2007, and haven’t returned. For that, I am grateful beyond words. Nothing robs a person blind quite like fear. You spend all your time hiding from all the beautiful aspects of life.

The medication also gave me the last little push I needed to stop living my work life in a way that was all about pleasing others and maintaining some imagined golden-boy image. By the time I moved over to CSO Magazine to be a senior editor, I was well past that sort of thing. While there, I’ve never had a problem speaking my mind, expressing ideas forcefully and simply enjoying the heck out of the work itself. I’m certainly lucky in that I work with a wonderful group of people. I truly like everyone I work with.

I did do some research on anti-depressant medication and found that there is an actual science to it all. I learned that while personal history is certainly a factor in the things that trigger mental disorder (a history of child abuse, for example), the root cause if often an imbalance in the fluids that direct traffic in the brain. The WebMD website explains it pretty well:

“One common theory is that depression is caused by an imbalance of naturally occurring substances in the brain and spinal cord … Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Everybody at one point or another will feel sadness as a reaction to loss, grief, or injured self-esteem, but clinical depression, called ‘major depressive disorder’ or ‘major depression’ by doctors, is a serious medical illness that needs professional diagnosis and treatment.”

It goes on to say that most anti-depressant medicines improve mood “by increasing the number of chemicals in the brain that pass messages between brain cells.” That’s a key point. Mental disorders that are often viewed as stereotypical insanity and craziness are rooted in a chemical imbalance. When the brain chemistry is out of whack, the thinking process is disrupted. In my case, side effects of that imbalance included compulsive behavior and the inability to move on from certain preoccupations.

A good example: In 2005, when I was still at the beginning stages of dealing with my OCD, the hype about bird flu started to circulate. There was endless talk about that strain evolving into a pandemic as deadly as the 1918 Spanish Flu; far worse than the H1N1 pandemic we are currently experiencing.

I spent the following months in blind, silent panic. I feared for my children. I scanned through three pages of Google News results per day to keep track of the bird flu deaths in Asia and elsewhere.

When I started taking Prozac, that sort of thing stopped.

Make no mistake: Medication does not turn us into uncaring, numb and slap-happy beings. I still worry when my kids get sick. I still worry when the economy tanks and layoffs occur all around me.

But instead of stewing over these things around the clock, to the point where I can focus on little else, I’m able to function and still enjoy the precious present despite the mental burdens of the day.

Medication isn’t for everyone. I have no doubt that a lot of people on antidepressants don’t need to be. But in my case, the diagnosis was dead on and the prescription has done wonders for me. Three years ago, the concept would have been absolutely absurd.

The ultimate lesson: If you are in the grips of mental illness and you face the prospect of going on medication, don’t be afraid.

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The Most Uncool Addiction

In this installment, the author opens up about the binge-eating disorder he tried to hide for years — and how he managed to bring it under control.

I don’t beat myself for having engaged in addictive behavior. That kind of thing is obvious for someone with OCD. If there’s a compulsion to be rubbed raw, you go for it, no matter how destructive it is on body and soul. Then you wake up the next day and do it again.

But on occasion I find myself wallowing in this question: “Why, oh why, couldn’t I be addicted to something more common like alcohol or heroin?”

Hell, many of the musicians, writers and political leaders who’ve inspired me drank to excess, smoked nonstop or even used needles.

Winston Churchill spent every waking hour of WW II buzzed. He dipped his cigars in brandy and port. Phil Lynott (Thin Lizzy) and Nikki Sixx (Motley Crue) almost made being a junkie look cool. It wasn’t cool, of course. But that’s how I think when under the haze.

In my case, the addiction is food, something we need to survive. It’s not the least bit cool. Certainly not a “normal” addiction.

That food would be my problem makes perfect sense. As a kid sick with Chron’s Disease much of the time, I was often in the hospital for weeks at a time with a feeding tube that was inserted through the left side of my chest. That’s how I got nourishment. I wasn’t allowed to eat or drink anything. At a very early age, my relationship with food was doomed to dysfunction.

It didn’t help that I was from a family of over-eaters who would stuff themselves for comfort in times of stress and fatigue.

In our society it’s considered perfectly OK to indulge in the food. Time and again, I’ve heard it said that overeating is a lot better than drinking or drugging. But for me, back when I was at my worst, binge eating was a secret, sinister and shameful activity.

Here’s how it works:

You get up in the morning and swear to God that you’re going to eat like a normal person. You pack some healthy food for the office. Then you get in the car and the trouble starts before the car’s out of the driveway. Another personality emerges from the back of the brain, urging you to indulge. It starts as a whisper but builds until it vibrates through the skull like a power saw.

The food calls out to you. And you’ll do whatever it takes to get it, then spend a lot of time trying to cover your tracks.

Before you know it, you’re in the DD drive-thru ordering two boxes of everything. It all gets eaten by the time you reach the office. You get to the desk disgusted, vowing to never do that again. But by mid-morning, the food is calling again. You sneak out before lunchtime and gorge on whatever else you can find, then you do it again on the way home from work.

You pull into McDonald’s and order about $30 of food, enough to feed four people. From the privacy of the car, the bags are emptied. By the time you get home, you wish you were dead.

The cycle repeats for days at a time, sometimes weeks and months.

For many years I hid it well, especially in my early 20s. I would binge for a week, then starve and work out for another week. That mostly kept the weight at a normal-looking level.

Call it athletic Bulimia.

In one inspired episode, I downed $30 of fast food a day for two weeks, then went a week eating nothing but Raisin Bran in the morning, then nothing but black coffee for the rest of the day. After the cereal, I’d work out for two hours straight.

In my mid-20s, once I started working for a living, I kept up the eating but couldn’t do the other things anymore. So my weight rose to 280. In the late 1990s I managed to drop 100 pounds and keep it off through periodic fasting.

Then I started to face down what would eventually be diagnosed as OCD, and I once again gave in to the food. The gloves were off.

The binging continued unabated for three years. The weight went back up to 260. I also started to run out of clever ways to mask over all the money I was spending on my habit. I was slick. I’d take $60 from the checking account and tell my wife it was for an office expense or some other seemingly legitimate thing. But she’s too smart to fall for that for long.

Then I discovered Over-eaters Anonymous (OA), a 12-step program just like AA, where the focus is on food instead of booze. I didn’t grasp it immediately. In fact, I thought everyone at these meetings were nuts. They were, of course, but so was I.

Thing is, I had reached a point in my learning to manage OCD where I was ready to face down the addiction. If it had to be through something crazy, so be it.

Through the program, I gave up flour and sugar. The plan is to be done with those ingredients for life. Put them together and they are essentially my cocaine. I dropped 65 pounds on the spot. But more importantly, many of the ailments I had went away. I stopped waking up in the middle of the night choking on stomach acid. The migraines lessened substantially. And I found a mental clarity I never knew before.

I can’t say I’ve slaughtered the demon. Addicts relapse all the time. But I have a program I didn’t have before; a road map unlike any other.

My odds of success are better than ever.

But before I could get there, I had to unravel the wiring in my head, learn to live with a mental disorder and then make a bold change in my way of eating.

It’s not cool at all. If you’re laughing because I let the food drag me to such a state, I don’t blame you. In a way, it is funny. Crazy people do stupid things. And stupid is often funny.