Tags: depression, disability, medicine, TMI
In my last blog post, I wrote about losing about ~8 months to another bout of depression. I’ve had long episodes of depression off and on since I was a child. It’s been years since the last time I had depression. Frankly, I kind of figured this was going to happen again sooner or later, based on my own mental health history. For a long time though, the depression wasn’t an issue… or whatever depression I did have, could easily be attributed to a more pressing concern – chronic vulvar pain & painful sex! The pelvic pain problems were priority #1.
Eventually though, the depression came back, even though at this point I have most of the pelvic pain under control (most of the time, for now…) (I’ve often thought to myself, ‘If I have a lid on the painful sex and chronic pain, why am I still depressed?! I should be happy for that reason alone!’ Nope. It worked that way for awhile! But then it didn’t anymore.)
As I said in my last post, I started seeing a therapist for mental health counseling… with little to no improvement over about ~6 months. Things came to a head when I developed a new, unrelated pelvic problem – a vulvar cyst. Given my history of vulvar pain problems, the cyst was the last straw. The stress of the cyst + depression pushed me over my personal minimum thresh hold required to justify taking on the risks of sexual side effects due to antidepressants – and the risks of Stigma associated with medical treatment for mental illness. Some of you have heard the litany of Stigma before – I’m talking about having overheard and read stuff like, “Big pharma is inventing new illnesses and making big cash over it! The risks of side effects aren’t worth medication! Haven’t you tried alternative, natural medicine yet? You just need to take some extra vitamins, get some sunlight, exercise, etc. Americans are all over medicated anyway. You should be thankful for what you got! Willpower/Bootstraps!” (Obviously I’m paraphrasing; basically channeling stuff like this.)
I tried it the way proponents of more natural, less invasive, more holistic treatment options suggest.
The non-medical stuff didn’t work out for me.
I wasn’t making progress with talk therapy alone – or rather, talk therapy + the stuff that came out of talk therapy like: recommended reading + some homework exercises + goal-setting + etc. Unfortunately, additional supplemental holistic treatments in conjunction with talk therapy aren’t a practical option at this time either. I no longer have the time, transportation or cash up front to pay for acupuncture treatments. (Plus I no longer have access to my old, trusted acupuncturist.) I’m not comfortable with light therapy because there are questions about light therapy and eye problems for certain people (I’m at elevated risk of being one such person.) Vitamin D & multivitamin supplements don’t do anything on me as far as depression goes. And finally, the last time I joined a gym to work up a sweat regularly, I developed a series of months-long vaginal infections.
So the non-invasive, natural, etc. stuff maybe isn’t in my best interests after all.
Certainly the pressure to conform & minimize what I was feeling – or not feeling, more accurately, since I was shuffling around feeling completely Dead on the Inside – was making things worse. I felt so much pressure…
…Pressure to please some, vague ~idea~ of an expert.
…Pressure to behave, to “Get over it,” to continue to haul around the responsibility for other people’s actions. “Honey that was a long time ago, let it go.”
…Pressure to please all those people, journalists, and Ph.D.’s who claim to be ~just looking out for us after all,~ in steering me away from medical treatments…
…And unfortunately, that pressure to please others played right into the depression to prolong it and make it worse. When I went on the antidepressants, one of the first things I did when I got home with the medication was break down and cry about what a huge failure of a person I am, for actually needing medication. For “Giving up.” For “Taking the first easy way out.” For taking the path of least resistance, instead of confronting my fears head-on. Etc. Etc. Internalized bullshit.
And of course, I wasn’t a failure for needing medication or any other reason really – I’m coming to terms with the fact that I am in fact, not a failure at all. (We’re not quite there yet due to residual depression.) I wasn’t giving up, taking the easy way out, or running from the past.
I was just a person who needed more help.
Not that I should have felt forced to try the other holistic ways in the first place at all. It’s easier to find pressure from Big Pharma to attract customers and try new (or re-patented) old medication in the form of Big Marketing. But the pendulum can swing the other way too, and in my vulnerable state, I got pushed off of the other edge.
I asked my primary care physician to put me on Bupropion, better known as “Wellbutrin” or sometimes “Zyban.” I got a prescription generic for a half-dose (150mg) of extended release bupropion, for $10/month with insurance. I had the option to bump it up to a full (300mg) dose after 4-6 weeks of being on it, if I wasn’t satisfied with the results at half-strength.
It was not a decision I made lightly. In addition to the stigma of depression & using medical treatment for it, I had to anticipate the medication’s potential side effects. I selected bupropion because SSRI antidepressants have the potential to cause sexual dysfunction. SSRIs may cause some patients to experience things like, lower libido or difficulty orgasming, or more rarely, post-SSRI sexual dysfunction. I don’t have those problems; I have a history of pain. But I figure, I’m already stacked behind the 8-ball as far as sex problems go, so I should probably avoid medication that could throw something new into the mix.
One other factor to consider: I am aware that low-dose tricyclic antidepressants can be a treatment for vulvodynia. Part of the reason I stayed off of the tricyclics and opted for surgery all those years ago is that, at that time, I wanted to leave the option for using antidepressants for depression open in the future. I still don’t know if you can a tricyclic with another type of antidepressant, or if you can bump the tricyclic pain-treatment dose up for mental health, and still keep the pain effect in place.
After crying for awhile, I took my first pill. Then another the next day, and so on.
The antidepressant worked.
The bupropion kicked in surprisingly fast – I felt changes within like the first 2 weeks. The incessant, nagging, self-deprecating voice in my head quieted down. I was able to concentrate on my continuing education studies. The knowledge was sticking. I was doing better at work. I was starting to take interest in old activities again. I started to make more progress in therapy. I was remembering stuff I hadn’t thought about in a long time & making connections from prior events to my current beliefs & behaviors. I could actually feel feelings again, including anger! and sadness! and hope, oh god, the hope! The iceberg of depression started to melt & develop cracks… And it was still inherently me underneath the layers of Ice.
It wasn’t perfect. There were some side effects. I lost some weight. The tinnitus I’ve had since I was a kid sounded louder in my head. I had to take the medication in the evening before bed since it made me sleepy. My libido stayed at the same level, and I actually had an easier time orgasming on the medication than I did off it – Not that orgasm was ever a problem for me to begin with; I just felt more physically sensitive to touch on meds. The mental health improvement was noticeable and positive, but not complete. I felt about a 50% improvement in the depression on the 150mg dose. I was getting ready to bump up the dose to the full 300mg.
Then I started losing my hair.
Or more accurately, my hair stopped growing back in. One day I was getting ready to go out, I tied my hair up and saw a bald spot on the back of my head. That’s never been there before and it’s a problem.
It’s not like the hair fell out in big patches or clumps, or like I was shedding any more than normal. The hair was still falling out at the normal rate, there just wasn’t anything new coming in replace the old stuff. The effect was subtle, but over the next few days – and after comparing my current hair to old photos – I confirmed the hair was definitely thinning overall compared to before I went on medication. It’s subtle – probably something only I would ever notice.
Unfortunately that was the deal-breaker for me and bupropion. Please understand that me and my hair are very attached to each other. We’re planning on traveling to Paris together one day, you see. After a few days of deliberation (and feeling self-conscious,) I decided I wasn’t yet ready to change my hairstyle to something better for thinning hair. I talked to my doctor, and I went off the bupropion.
I had one withdrawal effect from going off the bupropion, a headache that varied in intensity from low to high for about a month. It responded to OTC painkillers and eventually went away. I’m still waiting for the hair to grow back though.
This is the point at which I could get angry and shake my first at Big Pharma for causing my hair loss. But actually, when I did the homework to figure out which antidepressants might work for me, I found out ahead of time that hair loss can be a very rare side effect. I was optimistic that I would be in the majority and not experience this side effect. It only happens to something like less than 1% of bupropion users, and usually kicks in after a few months. It’s weird because it kicked in fast on me – I noticed the hair loss about 6 weeks in. (Just to be on the safe side, my doctor ordered some blood screens to make sure the hair loss wasn’t related to some other medical problem. Apparently not.) It’s possible for depression to cause hair loss in and of itself, if it gets bad enough too. So although I’ll never know 100% for sure that it was the bupropion all along, it seems to be the most probable conclusion.
For me, the mental health effects of the medication were overall good enough so that I’ve decided, if I get depression again later… I’m just going to order a hairpiece, go to a nice salon and change my hairstyle… and then go back on meds. I’m annoyed about the hair loss but not angry… because the medication did something nothing else could do. It actually broke through the depression and gave me a rest from the self-loathing. It was worth it.
Unfortunately, I’m now back to relying on talk therapy for further mental health improvements. The medication did what it was supposed to do, but I couldn’t stay on it. It is a conundrum.
I’m not back to square one with the depression, but I’m not “All better” either! I switched therapists and I’m doing better with the current one than my old one. But it’s been rough. There’s a lot of bullshit in my past that I have to address now, and it still derails me.
What, exactly, in my past is so hard to recover from? What got triggered in the first place by recent events? This isn’t exactly a depression blog, and I’m still not 100% comfortable talking about the depression. It figures; I can go on for hours and hours about vaginas and feminisms and sex, but ask me to open up about what’s inside my head and I slam shut.
So let me put it to you this way:
It is simultaneously deeply liberating
and completely devastating
that all those times, when I was a little kid,
saying to myself, “No one loves me,”
Actually, I was right.
Ouch. Ow. Owwww. Oh come on, that’s the revelation?! So that’s what I have going on now. Emotional and verbal abuse?! Generation upon generation of fucked up parenting?! An actual paper trail of documented abuse and bullying?! All culminating in this one moment?! Mainfesting their legacies now?! Of all times?! And now I have to address the current thought patterns and the past stuff?!
What kind of revelation is that?! Why couldn’t have been something like a surplus of excess puppies, or something good. Brain, you’re really going to make me go through this now? Really? If I go through this now, will I feel better about it later?
I feel like Sgt. Hiller (played by Will Smith) when he’s dragging the unconscious outer space alien across the desert in Independence Day.
[Right about at this part of the movie. Remember this? Party like it’s 1996. Description: Actor Will Smith in military clothes, bare arms, sunglasses, mouth agape. Leaning/walking forward. Part of a parachute is draped over his right shoulder; you cant’t see it in this picture but he is dragging an unconscious space alien behind him, along the ground, wrapped inside of the parachute. Erin screengrabbed it @ Hellogiggles.]
Cuz I’m all like, “But no, now I gotta integrate this depression and family history of mental illnesses and develop into a something that I’m not, to get to where I want to be now, except you can’t do that right now, because one day at a time. Especially when you are minus the support that you’re supposed to be able to draw upon internally. Dragging your sorry ass across the desert… And what the hell is that smell!? I could have been at a barbeque!”
The antidepressants helped me crash & then punch out the alien thoughts inside of me – “Welcome to EARTH!” And the thoughts really are alien! But now that they’re quieter, I have to still have to deal with them, take them somewhere safe and figure them out.
Tags: blogging, cyst, depression, health, sexual health, TMI
Hello readers, blog mistress K here again, some ~4 months after the last entry. It’s a new year and I’ve been wanting to write something for awhile… something about going through depression yet again for what I initially thought was the 3rd time… but actually turned out to be more like the 4th or 5th time in my life. (But hey, who’s counting?) Of course, it wouldn’t be much of a party – or a blog post – if my vagina didn’t somehow get involved. Don’t worry – it did.
Feminists with FSD, now featuring soul-crushing depression!
My life has been kind of like this for awhile:
I can still do work, do stuff, and do a decent job at it, but I haven’t really been living, you know? Not really feeling it. It, referring to, everything.
It’s been a long 8 months. I’ve been struggling with depression since early 2012. I’m only just now starting to come out from underneath the worst of the most recent depression, after trying a couple of different treatments. I’m going to break it down for you over a blog post or two to catch up.
The trigger for this round of depression is most likely tied up with work-related stress. I’ve been (and continue to be, for now…) stuck at a dead-end job. The job is related to the skills and education I gained during college, so I am able to do what I trained to do. But I do so at a company where we’re understaffed, overworked, and where stratified office politics rule. (In other words, ~a typical office environment!) It’s not the best or the worst job I’ve ever had, but the most important thing is that I’m dissatisfied there. Since it’s clear to me now that there’s no room for growth with the company, I’ve been working on improving my career path by pursuing continuing education outside of work. Continuing education is not easy – it’s time consuming, it’s challenging, and even the continuing education itself is related to the depression – it’s forcing me to re-evaluate my old survival techniques and hang-ups about grades & perfectionism. Plus, my concentration is pretty poor – I can only go for short periods before I get interrupting thoughts and need to take a break. The worst interrupting thoughts are related to depression.
But after awhile – and before I committed to working towards the continuing education – the job wore down on me. Being stuck at work reminded me of being stuck at home in a toxic environment. Feeling like this went on for weeks that turned into months, and eventually, with no hope of escape, I developed depression again. It was bad. I couldn’t make the invasive self-deprecating thoughts Shut Up. I internalized every little mistake as reflecting poorly on myself as a person. I felt like everyone could see right through me. I was emotionally and occasionally physically numb, unable to express or recognize my own emotions – my emotions were absent, I felt only Static. During the worst of the anxiety, I was spacing out, unable to feel physical stimulation (hot, cold, textures, etc.) And I was having nightmares a lot more frequently than I do when I’m not-depressed.
This isn’t normal sadness. The easiest way to describe it is to say it’s more like the stuff featured in some webcomics I relate to:
This has happened to me before. I don’t know how I came out of previous depression episodes – my memory is that I just muddled through it until it resolved on its own. So I don’t know how to be more active about recovery currently without getting help & instructions. Due to Stigma, I wasn’t permitted by my (Insecure, problem-filled/causing) family to seek aggressive treatments (medication) when I was younger, and I never had a chance to confront & work out my issues in a supportive, therapeutic setting.
But I got Shit To Do now, and I’m physically far away from my counter-productive family members. It’s also worth noting here that I Have Insurance – which means I have the means to seek treatment. Not everyone has that option.
But what to do, where to start? I looked for advice on what to do, got advice and I took it. I called for a referral to a therapist and started going in for weekly talk therapy without medication. I read self-help books, some of which were more helpful than others. (I won’t be doing a book review of these, but I do want to point out some of the titles I personally found more useful than others: The Gift of Fear, Outliers, Trauma & Recovery, Will I Ever Be Good Enough, My Mother Myself, Toxic Parents – Based on the last few titles, you may be able to guess where this is going in the end…)
But talk therapy was slow and the results were almost imperceptible… Lots of two steps forward, 1 step back… 2 steps forward, 2 steps back… 1 step forward, 2 steps back… two steps forward, 1 step back for a net increase equal to or less than 1 [Unit of Improvement.] Sometimes I left therapy feeling worse than when I went in. So for months, I persisted, but felt stagnant. I tried to work through my issues – but I kept bumping up against walls, ruminating and getting frustrated. I tried the self-help exercises recommended in the books – and felt more embarrassed about having to confront so many of my own issues when I wrote them down. I tried being nice to myself – and kept defaulting back to self-deprecation. My inner monologue remained turned against myself.
Yet in spite of the mental hardship, my pelvic pain issues, for the most part, behaved. (Isn’t that incredible?!)
Sure, I could feel the pelvic muscles tensing up and getting uncomfortable when I was under stress – but I didn’t go through any acute pain. Even with the depression, I was able to have sexual activity solo & with my partner, and I enjoyed orgasms on a regular basis. My libido was the same as its ever been, so I still had sexual desire. In fact, sexual interest & pleasure were one of the main things keeping me going! I even started to be able to have all-out penetrative PIV sex, with little to no pain. (It’s still not perfect and will never be perfect – but that’s a big improvement compared to a few years ago!)
But then, that all went to Hell because I developed a Cyst.
And that pushed me over the edge till I hit Rock Bottom.
This cyst. This fucking cyst. Let me tell you about my cyst, because that’s how the depression ties into this being a “Vagina blog.”
This all went down over the course of about 48 hours…
Sometime around a weekend in October, I noticed an acutely painful vulvar bump, in between the labia minora and clitoris. It’s a bad, scary place to feel a painful lump. (I suppose all places are bad and scary to find cysts.) You’d think I’d have noticed something starting to go amiss sooner, but no: It hadn’t even been there a day or two earlier! By the time I found it, it felt huge…
…But the truth is, the cyst never got any bigger than pea-sized.
After I noticed the pain and found the source, the cyst grew more defined. Over the next ~2 days, swelling from a sore, vaguely internal lump to a visible, discolored, painful bump.
From experience and from having already read up on vulvar bumps & lumps, I knew it was a cyst. I’ve had one before, related to the vulvar vestibulectomy surgery. I knew going into surgery in the first place, cysts are a potential side effect, and I accepted that risk. So I wasn’t surprised when the old one showed up near the surgical site. That old one formed nearby one of my Bartholin’s glands, and at one point was big enough for my physical therapist to notice. But the old one just kind of resolved on its own and hasn’t come back in years.
The weird thing is, this new, recent cyst was nowhere near the surgery site! In between the labia and clitoris — WTF, what are you even doing there?! Nothing happened there! I was like, “CYST. CYST. WAT R U DOIN. STAHP!”
Since I knew what it was, I also knew what to do as treatment at-home. I called a nurse hotline to see if I should go to urgent care early, but was given the same information I already knew – take it easy, use warm compresses, sitz baths, hope for the best; maybe it will resolve on its own.
I followed the cyst care instructions. I kept warm compresses on it and didn’t mess around (squeeze) with it. Spent some time in the sitz bath. Walked funny. Complained a lot about being in pain, took some OTC painkillers. No sexual activity. Continued doing my continuing education study stuff in spite of it all.
And then of course, it broke.
By itself. And that made a mess. And it scared me. And luckily it broke while I was at home, so I ran into the shower and at this point I’m like, “Okay it broke on its own, whatdoIdowhatdoIdowhatdoIdoooo!”
(It may be worth noting here that, anecdotally I’ve heard that broken cysts can smell bad… this one had no odor whatsoever.)
After cleaning up the wound and washing my hands, what I did was call the nurse hotline again and got told basically, “Yeah you can probably go in for urgent care now…”
So I hauled ass to urgent care.
And of course by the time I got to urgent care, I already knew what the treatment for draining a cyst is: You can get an incision, marsupialization or a word cathether installation.
None of these really appeal to me since I don’t want to risk any more scar tissue in and around my vulva, especially not so close to the side of my clitoris. In the end, I was too chickenshit to get the usual treatment! I said to the attending doctor, “Just give me the antibiotics to kill off whatever infection caused this and make a follow up appointment for a few days from now in case I get a complication! I’ll take my chances!” The attending doctor agreed, took some swabs to check for germs and complied – for better or worse, I decided my best course of action was the least invasive one.
Cysts and depression don’t really have anything to do with one another. They should develop independently of each other. However, in my case, the wires got crossed and became interconnected: The cyst forming and breaking was enough to finally break me.
Depression alone is one thing… throw a vaginal problem into the mix and that’s where I draw the line. Developing a vulvar problem while depressed triggered all the other old memories and anxieties from when I was stuck in the worst of the vulvar pain. I felt like I was right back to square one with the Vaginismus and the Vulvodynia/Vulvar Vestibulitis. So not only was I dealing with “Regular” depression and anxiety, I was also dealing with old sexual problem shit and invasive thoughts!
I crossed the minimum thresh hold required to make going on antidepressants worth the risks of sexual side effects. By now I was a shivering ball of anxiety, anger, fear and sadness. I refused food; called in sick from work and spent some time in bed, hiding. None of the self-help techniques in my books or suggested by the therapist could reach me. No one could console me.
By now my thought process when I was hiding in bed was something like, “What is the point of staying off of antidepressants due to a fear of sexual side effects, if I’m just going to go around developing sexual side effects anyway?! Fuck this shit. I’m not doing this anymore. Oh but then people are going to say shit like, ‘Americans are all over-medicated and ~*~Big Pharma~*~ and blah, blah, blah, overdiagnosis, blah blah blah STIGMA.’ Well FUCK THAT TOO!”
At the follow up appointment a few days after visiting urgent care, the doctor confirmed that the wound was still draining on its own. All the swabs came back negative for the strains of bacteria tested for. There wasn’t much else to do or that needed to be done. No need for surgery or a word catheter at that point. Whatever caused the cyst to form in the first place, I still don’t know. The doctor okay’ed going off antibiotics early (I am fully aware that you’re supposed to finish the entire course. I was instructed by a medical professional to not do that in this case. Kids, don’t try this at home.)
And while I was still in the examination room, I asked the doctor to give me the prescription for Bupropion. Because seriously, fuck this shit, at that point I was like, I’m not doing this depression the hard way anymore. I went on medication for it…
…And for awhile, that worked out pretty well. The medication was doing its job. I started making more progress in therapy. I started to feel better…
…Then I developed a side effect: I started losing my hair.
To be continued…
Tags: blogging, depression
Hey readers, this is your blog mistress K speaking. It’s been over six months since the last time I updated Feminists with Female Sexual Dysfunction. That’s a long time for a blog to go inactive without warning, though not entirely unheard of.
So why the long pause? The short version is…
I told you I had a history with depression.
I mentioned it on this blog in passing a few times. I didn’t go to deep into my history with depression since it wasn’t an issue for awhile… My primary health concern for the last few years was addressing the vulvodynia and the vaginismus. But then, suddenly! (Not so suddenly) sexual dysfunction & depression changed places!
Although I’m feeling good physically and sexually, depression eventually did become a problem again. I’ve always felt like I had to look over my shoulder and wonder when it would appear again, and I finally got my answer: Right about now. It doesn’t feel as familiar as I thought it would be – the form & content of my current depression are different from the last time I went through it. I’m still dealing with some of the old unresolved issues I had when I was a teenager, plus a few new ones as an adult.
The good news is that I’m not completely alone; my partner is still supportive. I reached out for help and I’m seeing a therapist who accepts my insurance, so I am working on my issues under professional guidance. For better or worse, I’m still not on anti-depressants. I think I would do really well on them, but SSRI’s can cause sexual side effects – and I already have enough sexual dysfunction to deal with, thank you very much. (Note: I am fully aware that Bupropion has a better track record as an antidepressant with minimal sexual side effects; however I decided that the ~7% to ~22% risk is still unacceptably high at this time.) I want to try light therapy, if only to help me sleep… but I’m not doing that either, since it might not be a safe option for me – I have an elevated risk of developing serious eye problems later in life.
So I’m stuck with in-person therapy alone, for now. I’m worried and self-conscious that my progress thus far has been painfully slow. I keep reminding myself that when going through depression, you go at the rate that you go and you feel what you feel (but then what does it mean when you don’t feel anything? Am I doing enough?)
I’ve been writing as though the depression came up again from out of nowhere spontaneously, but that’s not entirely correct. A lot it is work stress. There’s no question that the stress of working at a dead-end job did and continues to exacerbate everything. The corporate culture stirred up memories of growing up in a toxic home environment and community. But work covers my benefits, so I cant leave without having something better lined up. My job search stalled out too once it became clear (after multiple heart-breaking post-interview rejections from companies I’ve wanted to work with for years) that I need to continue my education beyond just a bachelor’s degree if I’m going to be able to compete with my peers. Combine these ingredients all in a blender on medium setting for a couple of months and sooner or later, you get a depressed K.
What this all means is, now not only do I have to spend my free time on therapy stuff, but I also have to dedicate a lot of my free time going back to school! (Note that school in this case means online classes.)
And what that means for the blog is that, I haven’t had any time (or motivation) to write about feminism & sexual dysfunction. My interest and desire are still there – I’m not burned out. But I’m in a bind. This blog and writing are still deeply important to me. However, I can’t balance a full-time job, therapy, continuing education, and blogging. Something had to give.
So what happens next? Well, I don’t know. I want to write but I should focus on the self-care and education stuff first. (I keep on rationalizing, doesn’t writing count as self-care? Sure but on the other hand, shouldn’t I be doing the writing exercises suggested by the therapy book? Don’t make me choose!) Once again I’ll restate that if’n you have a guest post that would be appropriate for the blog, then you can leave a comment here saying so and I’ll get in touch with you. I’m keeping the blog up since the archives are pretty good and I want to return to it again later as time permits. But just be aware, the next 12-18 months of my life are going to be Hell. Thank you for your patience.