Oh! How It Burns! (depression checklist)

I have now been tracking my scores on the Burns Depression Checklist for four months straight! Go me!
(July-August, August-September, September-October)

This month, my average score was 18. My scores for more than half the days were in the teens (the low end of mild depression); I had an unprecedented 5 days when my score dropped below 10, into the “normal but unhappy” range. To put things in perspective, my usual level of functioning is mild-to-moderate depression; “normal but unhappy” days are the best days of my life! This month’s scores are a huge improvement over previous months (linked above), when I was moderately depressed on most days.

Ziya's scores on the Burns Depression Checklist from October 17, 2014 to November 18, 2014.

Ziya’s scores on the Burns Depression Checklist from October 17, 2014 to November 18, 2014.

Ziya's (standardized) scores on the subcategories of the Burns Depression Checklist from October 17 to November 18, 2014. The subcategories are Thoughts and Feelings (blue), Activities and Relationships (red), Physical Symptoms (green), and Suicidal Urges (purple).

Ziya’s (standardized) scores on the subcategories of the Burns Depression Checklist from October 17 to November 18, 2014. The subcategories are Thoughts and Feelings (blue), Activities and Relationships (red), Physical Symptoms (green), and Suicidal Urges (purple). I only had suicidal urges (mostly just thoughts) on 6 days this month!

The Lamictal / lamotrigine I’m taking definitely seems to be helping. I’ve consistently taken it around 4:00pm every day, starting September 29th. My dose doubled from 25 mg to 50 mg on October 27th (purple vertical line). I’m very pleased with the benefits I’ve been receiving from it and especially the lack of side effects. It also seems to be helping with my anxiety symptoms, and I feel less irritable (though to be honest I haven’t been tracking those symptoms).

There are definitely environmental / situational factors that influence my depression symptoms (not to be confused with situational depression). For example, on Election Day (red vertical line) my score shot up from below 20 to 43 and I experienced my first suicidal urges in 2 weeks. To be honest, I think that’s the only sane response to the new Congress that – among other things – has vowed to repeal the reason I can afford medication! I don’t want to know what else they plan to do, but none of it is good for the vast majority of the people in this country.

There was also my and Fox’s big family wedding on November 9th (green vertical line). I felt really good leading up to that day and had a ton of important things to do. I got to be creative and problem solve and collaborate with Mom and get my hair done at a salon full of awesome people I enjoy talking to and wear a gorgeous dress and be congratulated about a million times. Sure, there were some aspects of it that were stressful, but a lot of it was fun. I was proud of myself for running the rehearsal on the night before as well as I did. I got to forget about all the stress at the combined bachelor/bachelorette party our friends threw for us; that was a fabulous time! And then there was the day itself… I’ve already written about it twice!

My scores on the depression checklist increased gradually from 6 on the 8th and 9th (OMG, 2 consecutive days with such a low score! That’s heaven for me!) to 34 on Monday (eww). I felt every point of increase and it was incredibly painful. I didn’t have the energy to connect with Fox and I’d cry when he left for work each day. I’d cry for no obvious reason. I had no motivation. I just wanted to fade away and stop existing. The worst part is I knew that if I stopped playing The Sims 3 and went out to socialize I’d feel better. But I just couldn’t bring myself to do it!

Finally, yesterday (Tuesday) I dragged myself out of bed to go see Wakana for our regularly-scheduled music therapy session. Just being able to do that felt awesome. She witnessed me expressing how I felt through words, body language, and music. She empathized. She helped me address some of the things that are really getting me down. For example, Mom had brought up how much it costs each month to see Wakana, with the very strong implication that I should stop draining her of that money. She doesn’t seem to get how much I need and benefit from it, and I feel like that matters less to her than “getting ahead” financially. Sometimes it seems like she sees my whole life as a financial transaction; she’s “investing” in me and losing all her money. I can’t repay her – at least not financially. My love, the joy in my life from experiences like getting married and having children someday, whatever academic success I can muster, even the financial security I’m still striving for … these things cannot be a repayment of some debt! I owe her my whole life, but I can’t live it for her. I have to live it for me.

Wakana heard and understood and strongly encouraged me to apply for jobs. She also said I could invite Mom to one of our sessions. I’m kind of dreading it – assuming I can convince her to come – but I think it may be necessary.

Jobs. I signed up to be a tutor, which is kind of hit or miss depending on whether students decide to contact me. I think I’d be okay in the subjects I said I could teach. Today I was going to apply for a job I found yesterday that sounded awesome, but when I went to look at it the listing had been deleted. That undermined any motivation I had to do useful things.

Anyway, I decided to hang out at a nearby cafe after my session yesterday and enjoyed myself quite a bit (including saving potential job listings to apply for later). The food and drinks were good, it was a pleasant atmosphere, it got me out of the house and away from The Sims 3, and best of all I got to socialize a little bit. Even just being surrounded by people who were all doing their own thing was energizing. I’m still coming to grips with this whole being an extrovert thing. I like being around people. I need to stop isolating!

But how?

Burn, Baby, Burn(s depression checklist)

I’ve been tracking my symptoms on the Burns Depression Checklist for another month; so far so good. (view July-August & August-September) Scores have remained in the teens on half the days, a phenomenon that was previously unheard of. My average score for the month was a 22, which is 10 points lower than last month!

A graph showing Ziya's scores on the Burns Depression Checklist from September 16, 2014 to October 16, 2014.

Ziya’s scores on the Burns Depression Checklist from September 16 to October 16, 2014.

There are several factors I believe have contributed to my improved mood. Reading The Drama of the Gifted Child inspired some profound healing in the last full week of September. The most conventionally “sane” way to word it is probably that the emotional and presenting-myself-to-the-world aspects of my psyche became more integrated, so I can acknowledge, express, and act upon my emotions more easily. This helps me to feel more alive; all the energy that went into suppressing my emotions is now available for, well, whatever I want to do. It’s wonderful and amazing and just… Wow!

I started taking the Lamictal my APN prescribed on Monday, September 29th. This is represented visually on the graph above by a vertical purple line. I’ve been taking the Lamictal consistently at about the same time every day for over two weeks. I hesitate to say it’s working just yet, but so far I’m feeling very positive about it. In addition to the Lamictal, I started taking Omega 3 and Vitamin D supplements on October 8th.

Additionally, Fox was offered a job that he’s really excited about, and not just because he finally has income! His energy levels have skyrocketed since he started working; that’s been a huge inspiration for me. I get the time to myself that I’d been craving, and when he’s home I’m thrilled to spend quality time with him. We actually have things to talk about because we’ve been having different experiences all day! There are adjustments, as always, but overall it’s been a real boon to our relationship. I wasn’t kidding when I said the sexiest thing he could do was get a job…

Finally, the dates that have a blue horizontal line under them in the graph above are days I spent with Banji. This past weekend was particularly wonderful; we got away from the stress of our respective lives and got to spend a few days talking, making art, playing music together, and enjoying the fall foliage. I went about 24 hours without using a computer or smart phone and it was amazing! I had all this time; I didn’t know what to do with myself! So I colored in my sketchpad, took a walk outside, tried to sneak around like my Skyrim character, and interacted with living breathing 3-dimensional people using spoken words, vocal inflections, and facial expressions. And laughed, oh, the laughter! I even cooked and cleaned up afterward!

By the time I got home I was a bit tired of socializing and just wanted some time to myself. I tried to play The Sims 3 – not the best or healthiest choice, I know – and ran into all sorts of crazy glitches. I got very frustrated because people kept interrupting me, especially my mother. I try so hard and I think she does too but I still find our conversations to be emotionally draining – especially when she’s hounding me about the things I still need to do for the wedding. That just makes me want to shut down and block everything out even more!

Considering the abrupt change from vacationing with Banji to feeling emotionally drained at home without her and not coping all that well, I’m optimistic to see my scores gradually climbing from 13 on Monday to 30 yesterday. It’s less disruptive than the wild oscillations I’ve experienced in the past; I expect that I can bring the score back down (representing a reduction in depressive symptoms) by practicing some of the things I enjoyed so much while on vacation: less time in front of the computer, more time engaged in creative pursuits. Another way to reduce my symptoms is to actually do the things Mom’s been hounding me about, because then she won’t feel so anxious anymore, so she’ll have less emotional garbage to heap on me. This solution has the added benefit of completing the steps necessary to successfully prepare for my wedding. Win-win!

In addition to the overall lower scores, I had a truly amazing thing happen last week. For the first time since I’ve been tracking, and otherwise for I have no idea how long, I had 8 consecutive days without suicidal thoughts or urges. It was wonderful! (My “relapse” yesterday was triggered by a very specific situation that has been dealt with and is easily avoidable; if I choose to write about it in this blog I’ll do so in another post.)

A graph showing Ziya's (standardized) scores on the subcategories of the Burns Depression Checklist from September 16 to October 16, 2014.

Ziya’s (standardized) scores on the subcategories of the Burns Depression Checklist from September 16 to October 16, 2014. There are multiple instances when the purple line drops to 0 and disappears, indicating multiple consecutive days with no suicidal urges!

Considering the presence of other, shorter periods of time with no suicidal thoughts or urges earlier in the month, I’m optimistic that this has the potential to become my new norm. And that, oh wow! It’s not just about wanting to live. It’s wanting and being able to live while also being true to oneself. It’s having multiple options; seeing the full complexity of a difficult situation instead of just the discouraging parts. It’s knowing where my toolbox is, seeing the tools when I open it, having the confidence to use them, and making creative use of duct tape.

Beyond the Burns Depression Checklist

I’ve continued tracking my depression symptoms using the Burns checklist for another month. The oscillations have been a bit less extreme: There was a period of higher (worse) scores near the end of August when we had to put Trouble (our 2-year-old pet rat) to sleep. This was followed by lower (better) scores at the beginning of September when I got to spend some time with Banji and had my first in-person session with Wakana in about a month. Then I started a new game in The Sims 3 (my current family) and, well, I think the scores pretty much speak for themselves. I’m noticing that I tend to have much better (lower) scores when I go out and socialize; this is in part because some of the items on the checklist are basically asking “Did you interact with other people today?” but I think it tends to help my overall mood, too. My average for this month is 32.

Ziya’s scores on the Burns Depression Checklist August 17, 2014 to September 15, 2014

Ziya’s scores on the Burns Depression Checklist August 17, 2014 to September 15, 2014

The items on the checklist are organized into 4 categories: Thoughts and Feelings, Activities and Personal Relationships, Physical Symptoms, and Suicidal Urges.

Thoughts and Feelings

The first category consists of 10 items describing one’s subjective experience, including: “feeling unhappy or blue,” “feeling hopeless,” “criticizing yourself or blaming yourself,” and “difficulty making decisions.” I’ve been scoring fairly high in this category (relative to the others), with no particular items standing out as more or less problematic than the others.

Activities and Personal Relationships

The second category consists of 7 items that describe behavior and subjective experience related to work/hobbies and social life. Although I feel worse on days when I withdraw from my social network, the items I struggle with most consistently with are “motivation” and “avoiding work or other activities.”

Physical Symptoms

There are 5 items related to sleep, appetite, sex, and “worrying about your health.” This is the category I seem to consistently score the highest in. Even on really good days when my thoughts, feelings, and behavior would suggest otherwise, my body seems to be depressed. Hopefully soon I’ll learn whether that’s (in part?) because of a sleep disorder.

Suicidal Urges

The final category asks 3 questions: thoughts? desire? plan? Fortunately this is the category I score the lowest in – usually.

Instead of tracking each item separately, I decided to look at my scores for overall categories. To standardize the scores, I divided the total score for each category by the number of items in said category. As a result, all the scores represented on the graph below are between 0 and 4. (Well, 0 and 3, but they could go up to 4. I really hope they don’t!)

Ziya's (standardized) scores on the subcategories of the Burns Depression Checklist from August 17, 2014 to September 15, 2014.

Ziya’s (standardized) scores on the subcategories of the Burns Depression Checklist from August 17, 2014 to September 15, 2014.

Unlike the month I tracked last year, there seems to be a disconnect among my subjective experience, behavior, physical symptoms, and suicidal ideation; the lines don’t move with any kind of pattern that would suggest they have anything to do with each other (correlation?). One thing I do notice is that my Suicidal Urges are the worst (highest) when my Thoughts and Feelings are as painful as or worse than my Physical Symptoms. I can deal with having low physical energy, but when I feel really sad, hopeless, and hating on myself on top of that, it becomes pretty tempting to just stop existing. I think it’s way past time for me to start engaging in cognitive behavioral therapy (CBT)!

Finally, as I wrote when I first posted about this in Measuring Recovery: Part One, the Burns Depression Checklist doesn’t include everything I believe is important to consider when assessing my mental health (such as symptoms of anxiety). My goal is to eventually develop a way to keep track of changes in various indicators of mental health, including signs that I am becoming more healthy and not just less mentally ill.

I’ve started tracking other symptoms that concern me, rating them on the same scale: 0 = “not at all”, 1 = “somewhat”, 2 = “moderately”, 3 = “a lot” and 4 = “extremely”. Some of them are symptoms of anxiety, others have to do with depression … it’s actually kind of confusing. I’ve heard irritability described as a symptom of depression, anxiety, and mania/hypomania! I guess the point isn’t so much to associate them with the correct disorder as to be aware of how much they’re affecting me. This is an imperfect numerical representation of my recent subjective internal experiences.

I put the symptoms into categories that sort of mirror the ones on the Burns, but I haven’t done the kind of empirical testing that’s necessary to determine whether my “checklist” measures anything meaningful. For that reason I have decided to track each item separately, even though it makes for fairly messy charts. Here’s what I have for the first half of September:

Ziya's scores on anxiety-related symptoms September 1, 2014 to September 15, 2014

Ziya’s scores on anxiety-related symptoms September 1 – 15, 2014

Ziya's scores on physical symptoms September 1, 2014 to September 15, 2014.

Ziya’s scores on physical symptoms September 1 – 15, 2014

Ziya's scores on irritability-related symptoms September 1, 2014 to September 15, 2014

Ziya’s scores on irritability-related symptoms September 1 – 15, 2014

Ziya's difficulty concentrating and communicating September 1, 2014 to September 15, 2014

Ziya’s difficulty concentrating and communicating September 1 – 15, 2014

I’m inclined to see my tracking method for the additional symptoms as a work in progress, but I do like using one graph per category and graphing each symptom separately. I think I’ll stick with it as-is for a while, and make changes as I feel inspired. For example, I originally had 10 items; I added “excessive or out-of-control worrying” and “difficulty relaxing” on September 3rd. Though the graphs don’t reflect this, I also needed to re-arrange the items to create the existing categories.

The new items use the same scoring as the Burns specifically so I can compare them. Is there any relationship (correlation?) between my scores on the Burns Depression Checklist / its subcategories and the additional symptoms I’ve chosen to track? Honestly, I have no idea.

Feel the Burn(s Depression Checklist)

I’ve been using the Burns Depression Checklist to track my depression symptoms every day for the past month. For anyone who doesn’t know, the Checklist is a list of 25 symptoms, such as: “feeling unhappy or blue,” “loss of motivation,” “feeling tired,” and suicidal thoughts. It’s been about a year since I last used it.

To complete the Checklist, I rate each item on a scale from 0 to 4 – where 0 means I didn’t experience the symptom that day and 4 means it was “extremely” present that day. I find tracking my symptoms daily to be helpful because it’s hard enough to remember everything I felt, experienced, and did in one day – never mind trying to do it for a whole week! I add up my ratings on all 25 items to determine my score, a numerical representation of how depressed I was that day.

Ziya's scores on the Burns Depression Checklist from July 16, 2014 to August 17, 2014

Ziya’s scores on the Burns Depression Checklist July 16, 2014 to August 17, 2014

My scores (blue line) are usually in the mild (11-25) or moderate (26-50) ranges; my average for the month is 30. Days when I score above a 40 are particularly bad and I notice impairment in my functioning beyond feeling tired and not wanting to do anything. It’s like I can’t do anything.

In contrast, days when I score in the teens or low 20s are my good days, when I feel like I can get my life back on track and I want to do everything. They are days when I’m the most active and social… and (usually) spending time with Banji. Both of the days when I scored below a 10 (July 27th and August 2nd) were days I spent with Banji doing some of our favorite activities.

My scores oscillate wildly from day to day; a change of 10 points or more is not uncommon. I’ve even had the score jump almost 30 points in one day! (August 3-4: I was sick, but pushed myself to spend the weekend with Banji and other friends anyway. I needed the 4th as a day to say “fuck you” to the world and stay in bed. I ended up playing The Sims 3 for most of the day.)

To try and compensate for the oscillations, I had my spreadsheet calculate a 7-day average value for each day, using the scores from that day and the 6 before it. The 7-day average values are marked on the graph above as a dotted green line that never drops below a 16.

Ironically, my low 7-day average score of 16 occurred on the day of my psychiatric evaluation – probably the one day I’d want to exhibit depressive symptoms so they could be observed and evaluated by a professional. It’s been rising since. There are definitely other factors involved (well, mostly visiting Banji), but I think my hope that the advanced practice nurse (APN) would be able to help me reduced my depression leading up to the appointment.

[August 20, 2014 Update: Actually, my low 7-day average score of 16 was 2 days before the psychiatric evaluation – on the day I came home from visiting with Banji.]

In the time since that appointment: I have not been on medication, I’ve been unable to schedule the sleep study the APN requested, I’ve stopped taking the supplements that seem to help but cost more than I’m comfortable spending while I lack income, and I haven’t been doing music therapy with Wakana because she’s on a business trip. Most importantly, I haven’t seen Banji since August 3rd.

I’m also a bit stressed out about the summer class I’m taking, which is awesome but requires me to go out into unfamiliar social situations and be professional and on time and do independent research for a paper due in less than 2 weeks. It’s sending my anxiety through the roof! My responses to anxiety tend to be depressive symptoms: feeling hopeless, inadequate, ashamed, and guilty, criticizing myself, avoiding people and activities, eating like crazy, and my sleep cycle is a total wreck. It’s a bit overly simplistic to stay that my anxiety causes my depression, but it definitely contributes to it.

I have noticed a cycle where I start to feel better, start making commitments (applying for jobs, registering for this course, etc.), feel very anxious about keeping the commitments, fail to keep the commitments, feel depressed, don’t do anything for a while because I’m too depressed, rinse and repeat.

Where is this anxiety coming from? Well, our friend David Burns and other cognitive behavioral psychologists would say it (as part of depression) comes from distorted negative thinking, particularly about myself. I hate myself; I think I’m no good and I don’t deserve to live and it’s only a matter of time before other people figure it out. It doesn’t really matter where I got this belief; exploring its causes won’t help me feel better and will only open up an ugly can of worms that’s best thrown out. It’s in the past. I live in the present; in the present what matters is replacing the belief with something more realistic and healthy… at least, that’s my understanding of what cognitive behavioral therapy is about.

I’m ostensibly holding a key to overcoming my depression in my hands as I write this: the book Feeling Good: The New Mood Therapy by David Burns. It’s where I got the Checklist and its scoring chart from and I’ve read parts of it, but I have yet to fully absorb its wisdom – obviously, or else I wouldn’t still hate myself. I’d love to use the excuse that I need to focus on my class so I can’t also read this book, but let’s be realistic. I’ve been wasting time on random things that I could easily divide between schoolwork and doing things that benefit my mental health and have time left over for fun and/or social activities. The number one “random thing” is an online free-to-play “game” that some friends got Fox and me into.

I need to kick my computer addiction, but I don’t even know where to start… especially since I need my computer for things like the class I’m taking! Aarrgghh!!!!!

I wish it were as simple as deciding that this other stuff is more important and doing it, but if that were the case I wouldn’t have depression. I need some kind of support; I feel like a broken record because I don’t even know how many times I’ve said it since I started this blog. I’m having trouble focusing, deciding what to do (which causes me overwhelming anxiety), mustering the energy to go do it… I don’t know. I’m stuck. I’m just going to stop writing now.

Measuring Recovery: Part 2 – More Burns Depression Checklist

I reviewed my overall daily and weekly scores on the Burns Depression Checklist in my previous post, Measuring Recovery: Part 1. I’ll be taking a look at daily scores for subcategories of the Checklist today.

Subcategories

Thoughts and Feelings

The first category consists of 10 items describing one’s subjective experience, including: “feeling unhappy or blue,” “feeling hopeless,” “criticizing yourself or blaming yourself,” and “difficulty making decisions.” Criticizing/blaming and other items related to self-perception seem to be causing me the most difficulty. On a scale from 0 to 4, I tend to rank criticizing/blaming from a 2 to 4 – moderate to extreme.

Activities and Personal Relationships

The second category consists of 7 items that describe behavior and subjective experience related to work/hobbies and social life. Although I do seem to feel worse on days when I withdraw from my social network, the items I see myself struggling the most with are “motivation” and “loss of interest in work or other activities.”

Physical Symptoms

There are 5 items related to sleep, appetite, sex, and “worrying about your health.” This is the category I seem to consistently score the highest in. Even on really good days when my thoughts, feelings, and behavior would suggest otherwise, my body seems to be depressed. I guess this is why it’s so important to exercise.

Suicidal Urges

The final category asks 3 questions: thoughts? desire? plan? Fortunately this is the category I score the lowest in – usually a 1 in thoughts and 0s in desire and plan.

My Scores

Scores for the Burns Depression Checklist are determined by ranking each item from 0 to 4, where 0 means you didn’t experience the symptom at all during the given time frame (1 day to 1 week) and 4 means it was “extreme.”

Instead of tracking each item separately, I decided to look at my scores for overall categories. To standardize the scores, I divided the total score for each category by the number of items in said category. As a result, all the scores represented on the chart/graph below are between 0 and 4.

My (standardized) scores on the subcategories of the Burns Depression Checklist from July 29, 2013 through August 24th, 2013. The gap represents 2 days when I did not complete the checklist.

My (standardized) scores on the subcategories of the Burns Depression Checklist from July 29, 2013 through August 24th, 2013. The gap represents 2 days when I did not complete the Checklist.

What a Mess!

Although at first glance the graph/chart above appears to be chaotic, there are a few noticeable trends.

* First, with rare exceptions, all 4 lines tend to move in the same direction. If one line is going up, the other three most likely are as well, though the angle might be different. (One or more scores may stay the same.) Same is true if they’re going down. In other words, on good days (low score) I feel better and perceive myself in a better light and am more active and have less suicidal urges than on bad days (high score).

burnschart01a_0811-0814* The blue line (thoughts and feelings) starts out with a noticeably different shape from the other 3. By the end of the 4 weeks, however, it is moving in better unison with them. The “thoughts and feelings” subcategory seems to be more internal, while the other categories relate self to body and self to outside world – if such a dichotomy is truly relevant. I’m inclined to say there was a disconnect between these two aspects of my experience that has been (at least temporarily) resolved.

Another way of looking at it is that the biggest disconnect between the blue line and the others is around August 11-14, when I was grieving the death of my undergraduate mentor. It makes sense that I would experience increased sadness, crying, even guilt during such a time, without necessarily having a comparable increase in other depression symptoms.

* Whereas near the beginning of the 4 weeks there are noticeable vertical gaps between the lines, by the end of the 4 weeks the lines tend to overlap. This is especially true of the blue line and the red line, representing thoughts/feelings and activities/personal relationships respectively. How I think and feel is very closely related to my engagement with the world; I’m not sure whether the closeness of that relationship has actually increased or I’ve just become more aware of it. (This is, after all, a self-report measure.)

The Valley and the Peak

There are 2 days in particular that I think deserve some special attention.

burnschart01a_0816The first is Friday, August 16th, when we went to visit the bed & breakfast / potential wedding venue. It was a wonderful vacation; I felt energized, socially and otherwise engaged, I was active, and there was little room for self-criticism, sadness, and so on. I swam until I was completely physically exhausted – but felt amazing – and then enjoyed s’mores with my loved ones and friendly new acquaintances. Fox and I got to spend some time in a beautiful secluded outdoor area and be romantic. I felt so much more alive than I had for so long …

And yet, while I was swimming, I couldn’t help but think about drowning. For one day I was relatively free from depression, but a nagging voice remained, reminding me that all is not right in my brain. Is this a common thing, for someone who loves swimming but only does so when on vacation to think about how easy it would be to drown? I seem to remember a time when all I cared about was the feeling of the water rushing past my skin, the exhilaration as I propelled myself forward using my own energy, bursting through the surface of the water to fill my lungs with life-giving air, and the glorious feeling of weightlessness. Sure, it’s important to take safety precautions. But I always trusted myself to take them. This time I was less sure.

I should also point out that I completed my checklist for the 16th a day later, from memory. I like focusing on the positive aspects of that day, but there was some frustration and anxiety related to getting there, waiting for Fox’s parents (who hit traffic), and learning it was more expensive than we’d expected. I can’t know for sure whether or how my scores might have been different if I’d completed the checklist that night. I can say with certainty that, even with the frustration and anxiety, it was a much better day than I’ve come to consider “normal.” I woke the next morning feeling alert and refreshed – how wonderful!

burnschart01a_0819The second day I want to focus on is Monday, August 19th. I’ve noticed a tendency for my symptoms to oscillate, bad days (high scores) followed by good days (low scores) and vice-versa. It makes sense that, not long after such a good day (such low scores) I was bound to have a bad one (high scores). This turned out to be the worst day since I started my self-assessment.

I don’t really want to repeat what I’ve already said about this day, so I invite anyone interested to read No Space for Me (the post I wrote that day) and the paragraphs near the fourth picture under “Context is Everything” in Measuring Recovery: Part 1.

Suffice it to say – perhaps combining with the “natural” oscillation that would have occurred anyway – my experiences that day contributed to a very dangerous mental and emotional state, which is reflected neatly in that day’s Checklist scores. My scores on Thoughts and Feelings and Activities and Social Relationships both averaged a 3 (“severe”); my senses of agency, social belonging, and satisfaction in life were shattered. I was exhausted and slept during waking hours because that was the only relief I could find from my pain (Physical Symptoms average score 2.8). Not only did I think about taking my own life, but I wanted it to end and I even began contemplating a plan (Suicidal Urges average score 2). I think my fears were what kept me from going any further with it – particularly because I would have had to make noise, which increased my chances of getting caught doing something that definitely was not allowed.

While I’d much rather never feel like that again, I’m grateful for that fear.

Especially since all 4 scores dropped pretty dramatically after that day, and have been staying in the 0-2 range (for the most part) since. I have concerns about my lifestyle, things I want to change or do differently; those kind of require me to be alive. So do my long-term goals.

And the people I love … sometimes I need space from them, sometimes they drive me batty, and yes sometimes I forget they are here … but they’re way too important to just abandon so suddenly. I can’t live for them – I’ll be miserable – but I want to live because I want to spend time with them. I want to share joy with them; to be connected to something bigger than myself. I don’t know what comes after death, but I know what can happen in life because I’ve already experienced a decent chunk of it. And yeah, there are not-so-good moments, but there are also moments that can be wonderful.

The days when I lose sight of this are the worst days, the ones when I score the worst (highest) in all 4 subcategories. I don’t know how realistic it is to try and keep believing in it, blindly, when everything I’m experiencing (through that horrible depression filter) says otherwise. But I can look at this chart/graph and see how the scores oscillate. A bad day will be followed by a good – or at least not-so-bad – day. I just need to give myself a chance to wake up to it.

Measuring Recovery: Part 1 – Burns Depression Checklist

Completing the Burns Depression Checklist on a regular basis helps me to understand my depression better. However, it doesn’t include everything I believe is important to consider when assessing my mental health (such as symptoms of anxiety). In this post, I’ll review my scores on the Checklist and reflect on what I think they mean. My goal is to eventually develop a way to keep track of changes in various indicators of mental health, including signs that I am becoming more healthy (e.g. laughing and smiling, feeling at peace) and not just less diseased.

Checklist Scores: The Big Picture

My scores on the Burns Depression Inventory for the past 4 weeks. Daily scores are marked in blue, while weekly averages are marked in red. Although the severity of my depression symptoms can change drastically from day to day, there has been a steady decline in weekly averages from July 29, 2013 to August 34, 2013.

My scores on the Burns Depression Checklist for the past 4 weeks. Daily scores are marked in blue, while weekly averages are marked in red. Although the severity of my depression symptoms can change drastically from day to day, there has been a steady decline in weekly averages from July 29, 2013 to August 24, 2013.

I think the most noticeable thing about this graph/chart is that my daily scores oscillate. If I have a bad day (indicated by a higher score), things seem to get better soon afterward (causing the score to drop). Unfortunately the same is true if I have a good day (indicated by a lower score); in the days following, the symptoms that had been absent on my good day return (causing the score to rise). While I’m inclined to consider some oscillation normal, I think a reasonable goal would be to try and get to the point where scores are consistently low, with less day-to-day variation and only occasional bad days.

I’ve been tracking the average score for each week by adding up the daily scores for the week and dividing by 7 (6 for the first week). Admittedly it’s not the most statistically accurate method, but I believe it suffices for my purposes. Despite the daily oscillations – including some very difficult days – the weekly scores have been decreasing. I take that as a good sign.

Context is Everything

It’s important to put at least some of the scores into the context of what was going on for me at the time.

burnschart01wk1 In the first week I’d had enough of being severely depressed and felt motivated to finally take charge of my own life. I came up with a plan for taking care of myself and felt optimistic that it would help me beat the depression. I hit some rough patches though, particularly in regards to sleep. There were aspects of the self-care plan I needed to adjust. I was also still on the fence about whether to continue my seemingly futile efforts to make an appointment with a psychiatrist. Finally, I had just started taking SAM-e, a supplement to help my brain produce important neurotransmitters such as serotonin.

burnschart01wk2 Monday and Tuesday of the second week were bad enough that I didn’t even feel up to completing the Checklist. I repeated my scores from the Sunday for purposes of my chart/graph (particularly, to keep the average for that week from being too low) – though, I suspect the scores would have been much higher if I had completed the Checklist on those days.

I was coming down (arguably, crashing) from a high-energy social weekend, struggling with wedding-and-gender-norm-related family drama, and panicking over my pending loss of health insurance. Somehow, in the midst of all this, I was able to resume tracking my finances. The “return to functional humanity” did wonders for my mental health.

burnschart01wk3 On Sunday of the third week I learned that a mentor from my undergraduate years had died. Prior to learning the news I’d been having a rather good day, relatively free from depression symptoms. Afterward, understandably, I was very sad and angry.

I needed a few days to process the sudden change and grieve, resulting in higher scores on the Checklist as that was pretty much all I did. To some degree I believe the rise in scores is normal/healthy – anyone would experience some depression symptoms following the death of someone important to them. Mine were just more severe because my baseline is much higher (worse depression symptoms are “normal” for me).

I felt absolutely horrible the night of August 13-14, but with Fox’s help I was able to channel the immense energy of my emotions into creativity and efforts to change my environment for the better.

The very low score on August 16th was the result of visiting a beautiful bed and breakfast, where I was able to relax, savor delicious food, enjoy wonderful company, and reconnect with nature. I didn’t have my laptop with me, so I completed the Checklist the next day from memory.

Unfortunately, our visit to the bed and breakfast was not purely in the interest of getting away and enjoying a nice vacation. We were considering it as a potential wedding venue. Saturday August 17th was the beginning of horrible wedding insanity as we learned the venue we’d fallen in love with was much, much more expensive than we’d anticipated. Long story short, Mom, Fox, and I now have regular nightmares related to wedding planning. It’s become a horrible monster!

burnschart01wk4The monster posed a very, very serious threat to me on August 19th. That peak for week 4 is a score of 71, only 4 points away from “extreme” depression. Wedding-related family drama hit me especially hard on this day – but it’s really not anyone’s fault I responded this way.

The things that were said were a catalyst for something much deeper and darker in me: a sense that my existence as an autonomous sentient being is tenuous at best. Feeling like I need permission to do everyday things, even to breathe. I felt so trapped, like the Warden would come in any moment to punish me for daring to have my own thoughts, my own will – never mind to assert myself or act on my needs! Even just to write about it is terrifying.

Yes, I need people to respect my boundaries. But more than that, I need to know in my heart, to fiercely believe with every fiber in my being, that I am worthy of having boundaries. That it’s worth enforcing them. That if someone hurts me for any reason, I have every right to feel angry and to defend myself. That if someone hurts me, it doesn’t mean I did something wrong.

Sure, this brought out a lot of depression symptoms, but I don’t think “depression” really explains what’s going on. And sure, it involves fairly severe anxiety symptoms, but I’ve never heard anxiety described or explained like this. I felt like I wasn’t allowed to do anything, and if I made a noise I’d be caught, and if I was caught …

I don’t know, maybe it’s PTSD? Call it “Barbie” for all I care! The point is, it’s a serious problem for me, an underlying cause or component to all my mental health issues. Perhaps it is my mental health issue.

Fortunately, I was able to rebound from that day. Writing No Space for Me definitely helped because I was able to express what was going on, assert myself, and realize that Fox does respect my boundaries. I also did more wedding-related research on my own terms and learned that the venue we’d fallen in love with isn’t actually that much more expensive – and might even be less expensive – than the other options we’d consider. It helped me feel empowered to make decisions instead of feeling obligated to follow someone else’s rules.

Now What?

I’d intended to write about my daily scores on the 4 subcategories of the Burns Depression Checklist – Thoughts & Feelings, Activities & Personal Relationships, Physical Symptoms, and Suicidal Urges – but I think it would make this one post a bit too long. Stay tuned for Part 2, in which I shall examine these components of depression as they manifest themselves for me.

Planning A Head

I have had enough. Enough feeling horrible. Enough choosing not to go out because I don’t want anyone to see me. Enough living in clutter because I feel completely unmotivated to do anything about it. On Monday I didn’t even want to eat, that never happens (if anything, I usually overeat).

Saturday night was a lot of fun; Fox and I went out with some friends to a game store, where we could play board and card games to our hearts’ content and socialize with other people. It got a bit loud and overwhelming, but I was able to enjoy the social interaction and have fun playing the games. I even won Ticket to Ride: Europe and a hand of Magic: The Gathering. That felt really good!

A map of Europe with colorful train tracks connecting major cities.

The outcome of a 5-player game of Ticket to Ride: Europe. I played as blue – and won!

Unfortunately, it went a bit on the late side, and when we got home we were too excited to go to bed. We ended up pulling an all-nighter (sorting through Magic cards) and were a mess for two days. Our sleep cycles have been completely thrown off, our diets far from balanced (meals? what are they?), with barely any energy or motivation to do anything useful. We both seem to have some kind of cold or something. Yuck.

(Potential) Psychiatrist C-1 called while I was in my session with Wakana on Friday and I didn’t have a chance to call him back until Monday. No answer. I left a message. No return call. Now it’s late in the day on Tuesday. Nada. It’s been two business days, he might not even be in. But I’m sick of this nonsense. I know it’s unreasonable to blame him and I really don’t but I need to do something. Psychiatrist C-2 hasn’t called at all.

It’s time – past time – to take the matter into my own hands. I’ve had enough – more than enough – of this nonsense. I’ve written about treatment plans before but did I act on them? No. Well, not this time.

I really really hope, not this time!

Wake Up on the Right Side of the Bed

On Monday I made a 25-minute playlist of 5 songs to help me feel energized – or at least less dead – in the morning. I listened to them soon after waking up today (Tuesday) and wow, what a difference they made!

MP3 player next to a quarter.

This tiny little mp3 player is awesome.

The first two songs are from Barefoot and Flying by the Ebony Hillbillies, who play Black string music. They’re fun and active without being overly energetic or hectic, and I’m madly in love with the bass. The vocals are quite enjoyable, too. One song has a violin part that outright tickles me, and I enjoy the unique rhythms and timbres from the washboard and other percussion in both.

Two more songs are from Dance of the Celts: the first starts kind of mellow and picks up speed and energy as it goes along, while the second includes didgeridoo. The low drone and unique timber of the didgeridoo do amazing things for my mood; listening to it (for me) is like eating the most decadent chocolate while having absolutely fantastic sex. If that can’t perk me up in the morning, nothing will.

Finally, I ended the playlist with The Chieftains Reunion, an 11:22 monstrosity with a variety of changing instruments, very fun energetic rhythms, and a unique female solo vocal part around 8:30 that I can’t resist singing and sometimes even dancing to.

By the time I finished listening to the list, I felt calm, alert, ready to face the day, and even happy. I noticed that my mood started worsening pretty soon afterward, though, and the high energy to … well, nothing – because I wasn’t listening to music anymore – seemed to be the key contributing factor. I think adding a mellow, soothing song or two to bring my energy down more gradually would probably help quite a bit.

Break Your Fast

I’m usually pretty good about eating something very soon after I get up, even if it’s just a handful or two of raw nuts. Add some water, and I’m pretty much good to go – or at least less grouchy. My ideal would be to have eggs and whole wheat toast for breakfast every morning; it’s the most satisfying and energizing breakfast I’ve ever had.

A field of flax flowers, whose seeds will provide me with Omega-3. image from informedfarmers.com

A field of flax flowers, whose seeds will provide me with Omega-3.
image from informedfarmers.com

The harder thing for me to do is take pills. If I’m going to take them at all, around breakfast is the best time. I’ve decided to resume taking an Omega-3 supplement (1200mg flaxseed oil, which includes Omega-6 and Omega-9 as well but at lower doses) and a complex that has multiple forms of Vitamin B and includes Vitamin C for some reason. I’m thinking I should see if I can find a similar complex by a different manufacturer, though, because the one I currently have includes “inactive” ingredients I expressed concern about in my post, Ingredients.

I ran out of the Vitamin D supplement I’d once been taking, in part because I thought I’d be okay if I didn’t take it in the summer. Unfortunately, I just don’t seem to get enough sun for my body to produce what it needs. So maybe I need a lower dose of the supplement in the summer than I do in the winter, but I still need to supplement whatever my body is able to make naturally. I plan to resume doing so as soon as I’m able.

Finally, I’ve decided to go ahead and self-medicate with SAM-e. It’s a supplement that is supposed to help one’s brain produce the neurotransmitters it needs to run, well, considerably better than mine has been. Unlike Protazen (see previous post) – which explicitly has not been subjected to efficacy research “in order to avoid raising the cost to consumers” (according to their customer service representatives) – SAM-e has multiple empirical studies backing it up. It’s probably not any more – possibly less! – expensive than taking a brand-name drug, even with a prescription (insurance) plan. And I can get it in about 3 clicks, no phone tag required. I took my first dose today.

After shopping around a bit, I’ve decided to buy my SAM-e (and possibly other supplements) from Now Foods. They (say that they) use “natural” ingredients – things you could find in nature or synthetic chemicals that are essentially identical – and explicitly avoid the strange substances I expressed concerns about in my post on inactive ingredients (link). I’m hoping the stuff they use will be a bit nicer to my body and possibly even help (or at least not hinder) the active ingredient.

Spock Helps Those Who Help Themselves

So after I wake up to the sound of music, pop a bunch of pills “natural” supplements, and eat breakfast, I get to focus most of my energy on trying to feel good – or at least less like dying. (That’s not an exaggeration.)

a rat on a girl's shoulder

furry little companions make everything better!

The rats are wonderful. They’re cute and fuzzy and happy to see me – especially in the morning when they’re hungry. It’s really hard to interact with them without a smile breaking out across my face, whether I think I feel like smiling or not. The more I can spend quality time with them, the better.

Hey, you know, Fox is pretty wonderful, too. When he’s not being grumpy pants … and sometimes even when he is. 🙂

Our herb and vegetable garden is doing pretty well, all things considered. Sure, the parsley is a lost cause and the basil has seen better days (literally) and I’m not sure we’re ever going to get cucumbers from the strange prickly vine that’s waiting to ambush us from its pot. But the weed chocolate mint is thriving (seriously, looking for a delicious ground cover? get this stuff and hope your neighbors can appreciate it, too), our peppers are getting fat and starting to turn orange, and on Monday I harvested the first of our beautiful red Roma tomatoes! Just thinking about it makes me very happy. It would do me a lot of good to at least check on the garden every day, even if it doesn’t need weeding, pruning, or watering.

I’m enrolled in several free online courses on Coursera as well. To be honest I haven’t been paying much attention to the one that’s already started, but that’s okay because it won’t affect my GPA, I didn’t pay for it, and I’m taking it entirely out of interest. This gives me something to do and an opportunity to learn about diverse topics I’m interested in, for the fun of it, no need to stress. Win-win.

I’m still seeing Wakana twice a week, though we’ll have some breaks because she’s traveling in August. I stopped being consistent with massages but they’re still on the radar as something to help relieve stress. Aromatherapy can be added to the massage; maybe I’ll even get around to trying it at home, too. For starters, I can use the extra lotion I took home from past aromatherapy-enhanced massages. And I’ve been increasingly tempted to go see a chiropractor as my back, shoulders, and hips become increasingly painful.

Yes, I know, 30 minutes of exercise per day has been shown to help fight depression. It would probably do wonders for my chronic pain, too. I’m just not quite there yet. Nor am I ready to get out, join social groups, try new things, etc. – at least not without a lot of support, poking, and prodding by people I trust enough to share a bed with them. Let me practice on the foothills until I can climb halfway up one without struggling to breathe, before you ask me to climb Mt. Everest.

But speaking of climbing Mt. Everest, I have no idea where the Out of the Darkness Overnight is going to be in 2014. Wherever it is, I want to do it next year; whether I can attend the event or not, I want to start training for it ASAP. The more time I can give myself to get in shape, the better.

book cover: Codependent No More by Melody BeattieFinally, I’ve got some self-help books I’ve been meaning to read and do the exercises in. They have to do with time management, unlearning the lessons of an abusive childhood, and cognitive therapy for depression. One of them isn’t a self-help book per se, but might provide useful information for selecting music based on its potential therapeutic effects. (Just to clarify: that’s not music therapy, because I’m doing it for myself. However, it is one thing music therapists often do as part of their work with clients.)

I took another look at the chapter on Detachment in Codependent No More by Melody Beattie. I’m not entirely sure I’m done with it, nor whether I want to write another post about it, but I do plan to continue on through the rest of the book from there.

And How Will You Know If All This Stuff Is Working?

The Burns Depression Checklist is a very valuable tool for measuring severity of symptoms and tracking changes in said severity over time. It’s a self-report measure that’s been tested and found to be quite accurate and reliable. It’s used by many mental health professionals. The link above is only one of several that can be found via Google search; I selected it because it includes the scoring scale and will calculate your score for you.

I filled in the checklist Monday evening and my score was 60, indicating severe depression. It’s easier for me to focus in on one day at a time, but the severity of my symptoms can fluctuate pretty drastically from day to day or even over the course of a given day, depending on a multitude of factors. There were times Monday when I felt like I was perfectly fine, and yet also enough shitty moments that my responses earned me a 60. So, I think it’s probably best if I complete the checklist multiple times per week, focusing on a single day each time, and then take the average score for each week. Over time a pattern will emerge, and that pattern will help me see how my depression is doing.

It might also be helpful to make note of anything that might be having a particularly strong impact on my symptoms. “So-in-so visited for a few days and I was very happy to spend time with zir. It was great while ze was here, but a bit of a letdown when ze left.” “I had a very fun high-energy social evening, but didn’t get enough sleep afterward. Sleep deprivation made my symptoms a lot worse until I managed to fix my sleep cycle.” … I think you get the idea. Then instead of throwing up my hands when there are too many variables to have any clue which ones are having an effect, or whether the positive effects of my treatment are just being utterly thwarted by the shit life’s throwing at me, I can actually look at all (well, most?) of the variables and get a better feel for what’s going on.