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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Dinah on July 12, 2003, at 11:47:54
Is productivity the measure of the best course of treatment?
I was unproductive on SSRI's. I slept a whole lot. I felt stupid, and that self-perception was confirmed by others.
I can't take atypical antipsychotics on a long term basis because of my diabetes. My pdoc has said that all of them cause weight gain that I just can't afford health-wise.
I'm not terribly productive now either, on a regimen of therapy and minimal medication. I've got no bottom at all. Things upset me way beyond what is reasonable. I sleep a lot to forget.
There were other things I didn't like about medications. I didn't like my apathy towards things that were important in my life.
But I have to think that my only consideration in deciding the proper course of action is productivity. What keeps me most able to work, most able to function.
And I'm having trouble evaluating that. I just haven't been a productive person for so long, with or without medication. I feel like a worthless waste of space. A lot of space. I keep thinking that I could do better if I just try harder. Yet somehow I can't seem to manage to try hard enough. Am I just plain lazy?
I need to DO more. I need to hold up my obligations better. But I'm at a loss as to how to best do that.
Posted by Dinah on July 12, 2003, at 11:54:29
In reply to Weighing the alternatives, posted by Dinah on July 12, 2003, at 11:47:54
Isn't self contempt for lack of productivity justified? And shouldn't it be prodding me to fulfill my obligations better?
Posted by fallsfall on July 12, 2003, at 13:06:26
In reply to Weighing the alternatives, posted by Dinah on July 12, 2003, at 11:47:54
I think that "ability to function" is important. Contrary to what I have believed for my whole life, that is not the same as "productivity at work". So "functioning" might include taking care of kids, participating in a hobby, exercise (wow, she would be so proud to see that), and part time work or volunteering or a job that is clearly below expectations for your education level. I think that _balance_ is the goal. If you house is so clean that you can eat off the floors, and your curtains and furniture are perfectly coordinated, but you aren't working/volunteering then I think you are out of balance.
I have a friend who works 20 hours a week because she can't work more. She's been in therapy for 14 years. With her schedule she functions well most of the time, though stressors get her every once in a while. If she worked 40 hours a week she would be a mess all of the time.
Are you trying to compare one treatment regimen to another? Or are you trying to decide if you are "good enough"?
Were you lazy when you were a kid? I don't know that "lazy" is a trait that you pick up in mid-life. Do you ever have a really good period (an hour, a day) when you feel like you used to? I had a day a while ago and it reminded me how easy it is to do things when you have some motivation. The next day it was gone. But I know that if the motivation came back for me that I would get all kinds of things done. Is this similar to what you are experiencing?
You need to push yourself to see how much you can do. This is true. But pushing too hard and forcing things is counterproductive for me. I've learned to push a little, but if it is too hard then I need to back off. And I have to do that every day - to see if today is better than yesterday (and sometimes it is).
You need to look at your obligations to see if they are realistic for you. Then add a couple of optional ones on so you can grow. Those of us who are chronically depressed can't expect ourselves to do what healthy people do. You wouldn't expect someone with MS to match what healthy people do - they can do some of it, but they may need to rest more, or baby a cold.
It's not like you are sitting around saying "Woe is me" and not trying at all. You've tried certain drugs, others aren't available to you. You are actively in therapy.
Be kind to yourself. Be realistic. What would you tell someone else who came to you with this same problem?
(Maybe your hobby is Babble!)
Posted by Tabitha on July 12, 2003, at 13:30:00
In reply to Re: Weighing the alternatives, posted by Dinah on July 12, 2003, at 11:54:29
I don't think self-contempt is justified, or helps. You're a very concsientious (sp?) person, which is the opposite of lazy. Doesn't self-contempt just make you want to curl up in a ball and retreat more? Your little girl needs encouragement and reward, not contempt. She has to feel happy and safe to come out and help you with her bubbly energy. Tell her what a good job she's doing and she'll want to do more.
Posted by Dinah on July 12, 2003, at 14:42:08
In reply to Re: Weighing the alternatives, posted by Tabitha on July 12, 2003, at 13:30:00
Yes, you're right. It does. But she *isn't* doing a good job. (I'm incorrigible.)
I think when my husband suggested, in all seriousness, the other day that I look into disability, it really threw me. It really hit me how badly I'm covering up.
And I know my bosses are not happy either. And I am so used to being the good girl and having everyone delighted with my work.
My boss the other day was questioning (in an oblique manner) the quality of my work, as well as the timeliness. I think he's wrong. I think he just doesn't understand. But then I start wondering....
Posted by Dinah on July 12, 2003, at 14:51:45
In reply to Re: Weighing the alternatives » Dinah, posted by fallsfall on July 12, 2003, at 13:06:26
I have always been lazy, but I never used to be so lazy that it interfered with doing what I needed to do. It's awful to say, but achievement has always been a big part of who I am and a major contributor to my self worth. Even in my work, I was always considered a person who could be relied on. Someone that everyone wanted working for them. Not anymore. :( I was even fine while I was pregnant. But since my son was born I've been not productive. Not at home, not at work, not anywhere. I don't even know if I'm depressed. I don't really *feel* depressed. I feel really anxious a lot. I feel agitated and itchy-crawly.
I keep thinking I need to do something before I destroy everything. I keep thinking that I just need to try harder. And I know it's true. I just need to try harder. I just need to try *harder*.
Posted by Penny on July 12, 2003, at 15:43:57
In reply to Re: Weighing the alternatives » fallsfall, posted by Dinah on July 12, 2003, at 14:51:45
> I keep thinking I need to do something before I destroy everything. I keep thinking that I just need to try harder. And I know it's true. I just need to try harder. I just need to try *harder*.
OMG- that is totally what I was trying to say earlier about me. I feel like such a failure - like I'm completely unreliable, like I don't deserve the job I have because clearly I can't do it, but I feel trapped at the same time because I have to have health insurance and money to live on and so forth, but part of me halfway wishes I would lose my job even though it would exacerbate the bad financial situation, because at least it would be one less thing on my plate. The financial situation is already bad and I don't know how much worse it could make me feel, but the job stresses me out so much because I feel like I should be able to do what is expected of me, but I'm just not doing it and I keep telling myself that I need to try harder, but I just can't. I just can't.
I don't, however, think you are lazy - I think lack of motivation is not laziness. It's laziness if you don't want to change - and you do, from what you say. You're not choosing to be unproductive. Neither am I. But it's what we're dealing with. I don't know the answers Dinah. I sure wish I did, as it would make life much easier.
I really wonder sometimes what my brain felt like when I was in college, pre-medication and pre-major depression. I don't remember, but I do think I'm losing my sharpness. I feel my mind getting duller. Foggier. I can't think. I can't concentrate. I don't care about things anymore, even though I *want* to. Yet I keep taking them because they're supposed to help me and because I don't like feeling like I don't want to be here anymore. But when they're not working, or when the side effects are such that the benefits are not outweighing them, then what?
Right there with you, babe.
P
Posted by Dinah on July 12, 2003, at 17:22:35
In reply to Re: Weighing the alternatives » Dinah, posted by Penny on July 12, 2003, at 15:43:57
Yeah, that sounds where I'm at, all right. My finances are a mess, partly because I'm not working as much as I think I should. So I can't afford to quit. So I'm trapped here.
I do remember how I felt before childbirth. I wish I had a magic crystal ball though, to give me a clue as to whether my brain chemistry permanently changed or if the increase in responsibility just threw my delicately balanced life out of kilter. (My therapist has told me how impressed he is with my ability to intuitively structure my life to compensate for my weaknesses.) But I can remember myself them. Competent, smart, and everyone happy with me. Now everyone's unhappy with me, and I only occasionally feel smart, and never competent.
Gabbi and I are planning a party (see thread below). Let's kick back for a while and forget money and work.
Posted by Dinah on July 12, 2003, at 17:35:45
In reply to Re: Weighing the alternatives » Penny, posted by Dinah on July 12, 2003, at 17:22:35
You know, a lot of it is the somatic stuff. The migraines, the irritable bowel syndrome. The sudden involuntary naps. And on more meds, there are just as many somatic things. The migraines are more frequent, for example.
I think it would be easier to work and to concentrate if it weren't for those things. Sigh.
Posted by fallsfall on July 12, 2003, at 19:23:31
In reply to Re: Weighing the alternatives, posted by Dinah on July 12, 2003, at 17:35:45
Dinah, I think you already ARE trying. Maybe you need to try something else. Look at things a different way. Set different goals. I don't know. I just know that if I tried harder I would just be working harder to bash my head against the wall. I need to push my head in the other direction.
The one thing that struck me was that you said that you started feeling badly after your son was born. So many things change in your body during a pregnancy. Has anyone checked those physical things out to see if they are responsible for the depression? Hormones? I don't know what all the things are - but some doctor does.
(((((Dinah)))))
Posted by Dinah on July 15, 2003, at 8:32:44
In reply to Re: Weighing the alternatives » Dinah, posted by fallsfall on July 12, 2003, at 19:23:31
Yeah, maybe I'll try to see if my internist or ob/gyn will check my hormones. It can't hurt, and my help.
I spoke to my pdoc yesterday about my level of productivity being unacceptable, and he responded with something like he felt confident that my emotional bubble would rise again. I can't recall the exact words, but they weren't all that inspiring. I came pretty close to asking him why he had confidence in that when it's been seven years now.
I just can't reconcile who I am now with who I was then. I'm afraid I'll cause my employer trouble, and I'm afraid I'll be fired. I'm afraid that my family will suffer because I can't be what I should be. My husband thinks that imposing more external structure is the answer. My therapist, I think, agrees. Both agree that my current level of functioning is not adequate.
I don't know what to do. I have a new prescription in my hand, but no real confidence that it will help. It affects the dreaded norepinephrine, the bane of my psychiatric existence.
I spent last night shaking, having my husband hold me tighter and tighter. My head is throbbing, and I'm still shaky. I don't think this will ever be ok again. I don't think I'll ever be what I used to be. And I don't know if I can live with that. I don't know if I can live with the restrictions that acknowledging that will put on my family. I feel like such a disappointment to them.
I just don't know what to do!!!
Posted by fallsfall on July 15, 2003, at 10:16:23
In reply to Re: Weighing the alternatives » fallsfall, posted by Dinah on July 15, 2003, at 8:32:44
"I can't be what I should be."I look at who/what I used to do - Software Engineering manager for 48 people, determining how 3 children would be raised etc. I look at what I do now - I cleaned my kitchen counters yesterday, and they'll stay clean because my daughter is at camp (this is a lot more than I was doing 6 months ago). Compare the discrepancy between the potential and the actual. What a disappointment.
And as you say, will it get any better, or is this the end? The level of effort to gain even a tiny bit of progress is astounding - and you never know if it will help.
I feel so guilty for not being mentally and emotionally there for my daughter while she finishes high school. I feel guilty that I can't give the world what I have the potential to do.
But I think that (at least) I have to accept what reality is, and accept what I can and cannot do to change it. Sometimes I think this makes me try less hard that I should, but the alternative is to see myself as "bad" (evil) all the time and that would be a dangerous road to travel. I guess I'm trying to accept where I am today, and push a little for improvement tomorrow. Sometimes the improvement comes, sometimes it doesn't. I think that if I try too hard that I get too many expectations and then they are not met, and I use too much effort which means I lose energy. I may miss some opportunities to make progress by being this conservative, but right now I think this approach is safer.
Will I ever "get better"? I can't see being where I was before. I think I'll get better than this (I'm better in the last month - go figure). I guess I'm taking it one day at a time - and not trying to look too much farther ahead.
I hear your pain, and I know of it. Right now I think I am avoiding that pain by putting blinders on.
If nothing else, Dinah, you are a blessing to Babble.
FallsFall
Posted by noa on July 15, 2003, at 16:42:19
In reply to Re: Weighing the alternatives » fallsfall, posted by Dinah on July 15, 2003, at 8:32:44
Dinah,
My impression is that you've been in a low spot only recently, with your therapist moving offices and then being on vacation.
Before that, you've had the anxiety, etc. sometimes, but you didn't seem so low to me. When you talked about work, the impression I got was that they had loaded you up with some extra responsibilities not long ago and you were worried about becoming very overwhelmed. I think you inherited responsibilities when someone left and were made to do your job as well as that of your superior. Am I remembering this wrong?
I don't have the impression that you have had a long period of lack of productivity. Maybe you should wait a bit and see how you are after you and your therapist get back into the usual routine, and you get used to the new office, etc. before concluding about where you are.
Posted by Dinah on July 15, 2003, at 17:49:43
In reply to Re: Weighing the alternatives » Dinah, posted by noa on July 15, 2003, at 16:42:19
Wow, Noa. Thanks for the reality check. I really needed that. I get so much negative feedback from my bosses, my husband, and even my therapist. And I get so frustrated falling behind in everything.
But you're right. When I dropped to part time after my son was born, my goal was to work 25 hours a week, and I do average that although it's clustered around deadlines. Moreover my total hours are way down from the forty hours a week I used to put in, but my billable hours are only a bit less, like 90% of what they used to be when I worked full time. I tend to forget that.
And you're right in that a lot of the reason I'm constantly behind is the retirement of my prior boss (and my father) who used to share the work I currently do. So there are additional work responsibilities on a planned reduced work week. (Of course, my plan was to do mom/household things, not lie like a slug in bed).
On the other other hand, I do spend way more time than I would like asleep, or incapacitated in some way. If I put in another five or ten hours a week, maybe everyone wouldn't be mad at me, and my financial situation would be better, and I know I can do it if I can just get over the migraines, irritable bowel syndrome, depressive episodes, and agitated meltdowns. I know I could.
Ok, I'll cut myself a bit more slack while I try to figure something out. Thanks for remembering things more clearly than I do.
Posted by Dinah on July 15, 2003, at 17:54:17
In reply to Re: Weighing the alternatives » Dinah, posted by fallsfall on July 15, 2003, at 10:16:23
Thanks, Fallsfall, for a post just filled with some much needed wisdom. I do think I'm wasting a lot of energy considering myself a "bad girl". (which is absolutely one of my most serious ongoing issues)
I don't know if I've gotten around to telling you, but you've made a terrific contribution to the board with your presence. I know you always manage to make me feel better. Thank you so much. :)
Posted by noa on July 15, 2003, at 18:32:35
In reply to Re: Weighing the alternatives » noa, posted by Dinah on July 15, 2003, at 17:49:43
>Thanks for remembering things more clearly than I do.
I think we need to do that for each other. Moods can color our perceptions and it is our friends that can remember more objectively sometimes.
:-)
This is the end of the thread.
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