This is an older article from Slate that provides a good primer on how different medications treat anxiety and depression:

Prozac vs. Wellbutrin: How do newer antidepressants work?

I hate being medicated. I hate that I have to rely on a drug to function and I hate the side effects that comes with them.

Rationally, however, I know that I need something to balance out my wacky brain  chemistry and keep me from vicious self-fulfilling prophecies.

For years I was on Celexa, 40mg, and it did wonders. It also had a plethora of side effects. Celexa is supposed to be the most advanced SSRI on the market and the drug companies will tell you that SSRI side effects only affect a small number of users. For me, the side effects started to outweigh the benefits: I felt lethargic, I had weird sensations throughout my body and after a while, I became very depressed.

My GP at the time suggested perhaps switching from an SSRI to an alternative, Wellbutrion. While SSRIs such as Celexa focus on serotonin levels, Wellbutrin is more about dopamine levels. Most importantly to me, it doesn’t usually cause weight gain and sometimes it even leads to weight loss.

When I first started Wellbutrion, I transitioned from Celexa. The adjustment was fine. But this time, I am going onto Wellbutrin with nothing in my system, and the side effects in the adjustment phase are very noticeable – insomnia, anxiety and tremors, to name a few.

The adjustment phase takes about three or four weeks I’m told. I am just starting week three and desperately hoping things get better soon. When I tried it a few months ago, I gave up on Wellbutrin after a week because I found the adjustment cycle too difficult, too overwhelming.

My new GP doesn’t want me on SSRIs anymore, especially because of the weight gain (my weight is a source of depression and anxiety), so that leaves very few alternatives aside from the Wellbutrin. If it doesn’t start to have more positive benefits than side effects, I’m not sure where to go from here.

Denial is often the initial reaction of someone diagnosed with a serious, perhaps even terminal illness. We don’t want to believe that something so awful such as cancer is working its way through our system and that we may not win the battle. We want to believe it’s something other people get, not us.

Mental illness is no different. No one wants to accept that we are not quite right in the head, that somehow something inside our brain is off, that we’re not like everyone else.  We deny our mental ailment because we think it means we are somehow defective, weak or damaged goods.  We fear rejection from family, friends and colleagues.

One in five Canadians will experience a mental health problem at some point in their lives, potentially causing them and those around them significant distress. Mental health problems have a huge impact at the personal, community, and societal level, wrote York University researcher Madalyn Marcus recently in The Mark: “Of those experiencing a mental health problem in Canada, only 50 per cent will actually receive professional care. The largest barriers to getting help are not waiting lists (although these are too long) or financial costs (although these can be too high). Rather, it is our negative attitude towards mental health problems and lack of effective support systems. If you worry about how others will view you, you may be less inclined to reach out and ask for help. Awareness is vital, but it is our actions to improve these attitudes and support systems that will lead to change.”

I have been actively grappling with anxiety and depression for seven years now. I’ve gone through phases where I accept it and make use of medication and other times where I convince myself there is nothing wrong with me, that I just need to think positive, exercise more and I will be normal again because I hate the side effects of the medication and the idea that I can’t solve my problems with sheer willpower alone.

Going between these two states has left me feeling much like Sisyphus. Sometimes I feel that I’ve hit a point where I’ve made it to the top of the hill, only to backslide again. But being at the top of the hill often means I’m feeling well but completely disengaged from life. Meanwhile, being drug free means intense highs and lows but most of all feeling lost and alone in a dark place.

Coupled with some physical health scares and other challenges the past few months, I barely managed to put a brave face on everyday and I know sometimes I have failed. It’s affected the people around me, both personally and professionally. There have been moments where I thought I was having a nervous breakdown. (Someone who’s had one assured me I wasn’t there yet).

Today I actually have moments where I can see the top of the hill and believe I can get there and stay there. But regardless of what direction I am going on any given day, I am not going to do it quietly because there should be no shame in being mentally ill. I should not have to hide it.

This blog started because I wanted to make a major shift in my life and my mental health is a crucial part of that journey. I am no longer in denial, and if I have to struggle with this the rest of my life, something good should come of it because no one should have to feel this lost and alone.

I worry. A lot. In the past, I’ve been told it’s anxiety, but plenty of things that are supposed to freak out anxious people don’t bug me – public speaking for example. I’m great in front of a room of strangers.

And since I started treating my sleep apnea, I’m certain I never had any true anxiety disorder, just a tendency to worry a lot. I think I’ve been conditioned to worry through my upbringing and experiences.

Certainly, cognitive therapy is something I should explore. I’ve done meds and I don’t believe they are a long-term solution. In the meantime, Psychology Today suggests you make an appointment with your worries:

“What if you decided that you would put off the worry until later? Set aside a time of the day-say, 4 pm-when you will sit down and methodically review your worries.

If a worry shows up before or after your WORRY TIME, you jot it down, put it in your pocket and get around to it later.”

A wise Klingon once said, “Worrying just wastes energy and creates its own enemy.”

I have a lot of worries these days, but I’m going to give this a shot.

Make An Appointment with Your Worries

February was rather a craptastic month for me. I felt so down, so depressed, worse than I’d ever felt in years, even though life really is pretty good.

The older I get, I’ve concluded, the more sensitive I am to seasonal affective disorder (SAD). Two weekends ago I was absolutely wretched. And despite being aware of SAD, I found myself unable to get a handle on my moods. At the beginning of last week I constantly had to battle mood swings and emotional outbursts.

By the end of the week I was feeling a little more in control. I had ordered an SAD lamp to be delivered this week and I started reading Gretchen Rubin’s The Happiness Project (another post in itself). This week, thanks to some of Gretchen’s ideas, the improved weather and having my SAD lamp on at my desk, I feel fantastic.

My doctor scoffs at the concept of SAD, so I think I shall get a new doctor because there’s something very Occam’s Razor about SAD and I think many people are misdiagnosed with depression and prescribed medication when all they need is a little more daylight.

Here’s a few articles on SAD:

The SAD Artist
It’s Time to Be SAD

I woke up feeling fairly decent today. Not early enough to go to the gym, but early enough to make breakfast, brew coffee and make a lunch.

I have no idea why. I felt lousy the night before. I had a headache and didn’t go to bed until after midnight. I ate more than I should and I didn’t go to the gym (Wednesdays is not a gym day, although I did walk halfway home).

I still feel pretty good as I write this. I’m sure part of the reason is that I’m getting lots of sunshine through my office window (which I’ll miss when my company relocates next month). It makes wonder if I should invest in an SAD lamp.

It’s also possible that after a week of making sure I’m getting enough protein, I’m starting to feel that benefits. I’ve also upped my vitamin D intake.

Regardless, it’s important for me to find out why I feel good just as much as I feel bad. Today is a gym day, so I’ll be going after work. I wonder how I’ll feel tomorrow.

I’ve often heard that three weeks is an important milestone when developing a new habit; I probably remember this so well because I often fall off the wagon before I hit the three-week mark.

But I’ve come to realize that Day Three is just as significant. It was always the day I started smoking again after quitting numerous times and if it falls on a Wednesday, it’s also the day where I succumb to food cravings.

Today is Wednesday, Day 3 of my new eating regime and so far so good. New Year’s Eve was my last session with my personal trainer (I simply couldn’t afford to continue right now). The last half hour of the session my trainer sat down with me and made some recommendations on how often to exercise, what my focus should be on each day, as well as some eating guidelines.

Changing my eating habits has always been a challenge for me. It’s not just the calorie reduction that’s difficult, it’s eating the right food. More importantly, real food and not simple carbs and refined sugars. However, the suggestions my trainer gave me coupled with the fact that I’m actually sleeping properly has got me thinking that eating better is more achievable than ever.

In a nutshell, I am limiting my carb intake to two servings per day – ideally for breakfast and post workout. That doesn’t include vegetables of course, which I’m doing my best to eat more of, as well as fruits recommended by my trainer.

Here is a breakdown of his recommendations:

• Learn about insulin resistance
• More protein
• More water
• Work towards 2 servings of carbs a day. One for breakfast, one after workout. Try removing carbs completely for a week every 3 months.More Veggies from the  Brassica family (any leafy green, cabbage, broccoli, cauliflower, turnip, rapeseed, mustard, radish, horseradish, cress and watercress)
• More fish oils
• Get a nutrient screen
• Fruits that are free: cucumber, tomatoes, apples, berries, any squash, melons, any citrus
• Fruits to eat sparingly: Bananas, mangoes, pineapple, avocado, grapes, cherries.
• All veggies are free foods!
• Good ideas for snacks: Cottage cheese, Small amounts of dark chocolate, veggie sticks, nuts, hard boiled eggs, hummus with veggies.
• Try to cut out all soy products to lower estrogen in the body
• CUT DOWN ON THE BOOZE!!!! This is self-explanatory.

For the most part, this strikes me as doable, aside from the last one. So far, planning meals ahead and trying slow-cooker recipes are helping quite a bit.

As for today, I am doing pretty good, even with two meals from Tim Hortons (I got a gift card for Christmas): Coffee and a breakfast sandwich (600 calories) and chili with a bun (600 calories). I am eating some fresh cut berries as I write this (50 calories) and some carrots with hummus as a snack to hold me over until dinner later this afternoon (100 calories).

Dinner will be a plowman’s lunch plate of sorts, with some lean deli meat, a little bit of cheese and lots of cheese veggies.

As for exercise, today is an off day from the gym, but I went for a walk over lunch and plan to walk home (so I can stop at the comic book store).

A couple of weeks ago I took my first vacation in years. I’ve taken time off before, but usually stayed at home here in Toronto or visited the folks for Christmas, Thanksgiving, etc. near Ottawa.

This time I made a point of getting out of the city and going somewhere, albeit still visiting family, with a trip to my aunt and uncle’s cottage near Bancroft.

Getting out of town always provides a different perspective on my life and problems, and escaping the big city for cottage country is a great way to get perspective. Don’t get me wrong, I’m a city person, but I love the cottage life too (I just can’t stand anything in between, e.g. suburbia).

There is a lot less noise. Not just literally, but in terms of voices, distractions and demands. At the cottage, there are only two TV stations available via rabbit ears, and in the four days I was there, they were never watched. If the radio was on, it was tuned to CBC Radio. And while I got decent connectivity via my Blackberry, there was no Internet attached to a computer.

Stress and anxiety were suddenly fiction. The day-to-day challenges that worried me at home no longer seemed important and / or insurmountable. I found myself wondering how I could maintain this sense of perspective when I got back to the city and returned to my regular life of work, the TTC and the noise of people who have opinions on things they know nothing about.

As soon as I hit Toronto traffic on the return trip I could feel that sense of perspective evaporating and within 10 minutes of walking through my door I was already online on my computer getting inundated by noise. Holding on to the serenity of a cottage vacation is a job of work when it comes down to it. It doesn’t help that despite its decent square footage, my one-bedroom apartment feels claustrophobic because of where the windows are and how it’s laid out. Even though I was coming back on a Saturday afternoon and had more than half the weekend remaining, I was already wired, feeling as though I should be productive rather than relaxing (is that a Toronto thing?).

Still, I have managed to leverage my short vacation in some ways. For example, rather than surfing the television aimlessly I’ve begun listening to CBC Radio and very much enjoying programs such as As It Happens. I’m also trying to simplify my life a little by trying to focus on fewer hobbies and purging the apartment of unused items. When you go a few days without these things, it’s easier to part with them.

It takes concerted effort to keep perspective, but I hope that with some effort it will become second nature.

OK, not really, but Psychology Today has a few articles on sleep which don’t do me a darn bit a good but might be helpful for those who have ruled out sleep apnea.

Can Insomnia Be Fatal?

How to Get Great Sleep

Losing More Than Just Sleep

Even before being diagnosed with sleep apnea, I always believed good sleep habits were essential to good physical and mental health.

I’ve grappled with anxiety and depression over the years, and with the revelation that I have a sleep disorder I realize how much my lack of sleep has influenced both my mental health as well as my physical health. In fact I’m almost certain all of these issues could have been avoided had I been diagnosed with the sleep apnea a decade ago.

In the past, insomnia and other sleep disorders have often been pegged as symptom of mental illness. Now there’s a growing body for research that suggests mild anxiety and depression are actually symptoms of poor sleep. However, the knee-jerk reaction of most GPs is to treat the symptom with medication instead of asking a patient how well they are sleeping – at least that’s been my personal experience.

Psychology Today has a round-up of articles on managing depression that make for interesting reading that can help contribute to a strategy that works for you:

Depressed? Jolt Your Brain

How Food Can Improve Your Mood: Delicious Ways to Prevent Depression

10 Little Known Facts About Depression

Eliminate Depression—Naturally!