Saturday, 29 March 2014

After some research I've decided to move things over to Wordpress. The old posts, doodles and of course Ewok, will be over there. Come visit!

Friday, 28 March 2014

Optimism, It's all in Your Genes

You know those people who always look on the bright side, they make friends easily, they are always bright and shiny? They make life look easy, fun even. We love to hate them, don't we? Well, we shouldn't. It's not their fault, they have a genetic advantage. That's right! Proceedings from the National Academy of Science have found a possible genetic basis for optimism, self-esteem and mastery. Mastery is the belief that you have control over your own life and place in the world.

It all has to do with oxytocin, the love/cuddle hormone. Genetic variation of the oxytocin receptor (OXTR) may influence personality traits. DNA is made of four different base pairs; adenine, guanine, cytosine and thymine. Subtle changes in these base pairs can change how genes function. In the case of OXTR, one variant has more adenine. Carriers of this variant are prone to lower self-esteem and mastery and are more prone to depression. Individuals expressing the OXTR variant with more guanine (as opposed to adenine) are more prone to optimism. Scientists aren't sure yet exactly how oxytocin release is affected by this change, but they are working on it.

Now don't go getting all bent out of shape, these happy, shiny people have it easy, I'm doomed to be depressed forever. This variant can influence how you see the world and your place in it, but it is not the be all and end all. Your genes and your environment work together. Having the adenine variant just means you have a vulnerability towards depression, it doesn't mean you are fated to be so. Your experiences and your attitude are major factors in your outlook on life.

National Institute of Health

Tuesday, 25 March 2014

Sugaring Off

In Canada, you know spring has arrived when you see smoke rising from the maple wood forests. No, we aren't burning the trees down. We're collecting sap and boiling it to make maple syrup. It's sugaring off season! Have you ever had real maple syrup? I don't mean corn syrup or Aunt Jemima. I mean the real stuff... straight out of a maple tree and boiled to perfection. Once you've had it, there's no going back.

Sugaring off entails going to one of the maple syrup making establishments. They aren't factories. They are little wooden shacks in the middle of the woods. A horse and wagon ride is usually required to get you into the woods. You get a demonstration on how the sap is collected and made into syrup and the associated maple products (taffy, maple sugar, maple butter, fudge etc.) There is usually a bonfire, some folk entertainment and activities for the kids. Of course there's lunch too....Canadian specialties accompanied by maple syrup and sugar pie for dessert. Sugar pie is basically maple fudge on a pie crust, except the fudge is the same consistency as the goo in pecan pie.You can only get sugar pie in Quebec. I've lived in Ontario, it's just not the same.

This past weekend was my first sugaring off experience in a really long time. I was feeling fine when I agreed to go, but as the date approached, I began my descent into doom and gloom. I was dreading the sugaring off experience for all the usual reasons depressed people dread outings, but on top of that, an extra worry. I was going with the in-laws.

I'm very lucky. I get along quite well with my in-laws. They don't know about my depression and anxiety problems though. My husband told me one time that his mother didn't believe in mental illnesses like depression, so I thought it best to keep the in-laws in the dark. This can be a bit of a burden sometimes. When you are feeling this low, the last thing you want to do is put energy into hiding it. I was relieved when I awoke on the day of to find a blizzard. Maybe it would be cancelled and I could stay home. I don't know why I thought that. This is Quebec, we don't call in the army when it snows. We shrug and start digging!

So as I put on my blizzard gear, I went through my acting check list to make sure I was ready. I like lists, can you tell? Here's my strategy for faking it when I need to.
  1. I smile. I hide behind a smile when I don't want people to know how I am really feeling. I usually don't feel like smiling. I try to have a joke or something in my head that I can't help but smile a little. Lately I've been singing the Lego Movie song, it works well for me. "Everything is awesome..." I didn't have to sing in the end, I was so bundled up that you couldn't tell if I was smiling or not! Score!
  2. I redirect the conversation. If someone asks how I am, I say fine and then switch the conversation to something about them. Something more than how are you. I ask about their work or their kids for example. People like to talk about themselves. They never notice that I've redirected the conversation.
  3. I try to look healthy. I slap on a little tinted moisturizer and some foundation to cover the darkness under my eyes and I'm good to go. There is nothing like a pale face or bags under your eyes to make people ask questions. I imagine doing this would be easier for women. For guys, or at least the ones that don't wear make-up, there is a little more preparation involved. I would make sure to get a good night's sleep the night before and stay hydrated. This keeps you looking fresh.
  4. I like to have support. I told my husband how I was feeling. Having someone know was a relief on its own. Throughout the day he would send me little smiles and put his arm around me. It made it easier knowing he was there to back me up.
  5. I don't give details. I say I'm just not feeling right if someone asks why I am quieter than usual or something. Giving details leads to thinking, which usually leads to tears. Never a good thing when you are trying to hide it.
  6. I give myself a break. It's okay not to be the life of the party or hide it perfectly. I'm participating, I didn't flake despite really wanting to. I have to give myself a little pat on the back for that.

Monday, 24 March 2014

Confessions of a Java Junkie

My crazy professor hanging from the auditorium ceiling
Coffee is my lifeline. It wasn't always like that though. I used to hate it, the nasty bitter taste made my stomach turn. Now, I drink it black, like my soul. I blame my coffee addiction on Physics 101 and my body image issues. It was my first year of university, I had a physics class that lasted an hour and a half in an auditorium that sat over 600 students. The auditorium was cold, so I always had my jacket wrapped around me. This, along with my level of interest in physics and my professor's monotone voice was the perfect combination for nodding off. I remember trying to take notes and falling asleep mid sentence. My notes would go from legible to chicken scratch. One time, I completely fell asleep at the beginning of the lecture and woke up to find my professor hanging from the ceiling by a bungee cord. Look, simple harmonic motion! he was saying. I thought I was hallucinating! Time to find a method of staying awake.

Getting cozy, wrapped in my jacket was not a good idea, so I had to find a new strategy to stay warm. Tim Hortons (THE Canadian coffee/donut shop) was near by, so hot chocolate would be good I thought. Then the little devil on my shoulder woke up and said too many calories to have that all the time. Coffee has no calories. So I started drinking it. It's an acquired taste. After having it several times a week for a semester, I started to like it. Now, I have it not only because I REALLY like it, I need it too. I'm not quite as alert without it.

Coffee has caffeine which acts as a stimulant. It increases heart rate, stimulates the central nervous system and temporarily boosts metabolism (yay!). Caffeine is similar in structure to a brain chemical called adenosine which makes us sleepy. Since our body can't tell the difference between the caffeine and adenosine, it ends up using caffeine instead, causing the spike in energy. Caffeine is not unique to coffee, it is also in teas, soda and chocolate, but you get the most benefit from it in coffee. Moderate amounts of coffee can improve your attention span, reaction time and other brain skills. Coffee contains antioxidants along with caffeine. Antioxidants are tiny molecular warriors against diseases like cancer and Alzheimer's. That's not all coffee helps to fight. A 2011 Harvard study followed the caffeine intake of 50,739 women over a ten year period. They found that those who drank coffee had a decreased incidence of depression compared to those who didn't. So more coffee = less depression. Hook me up to a coffee IV, stat!

Not so fast. It is recommended that the average person have 2 to 4 cups of coffee a day. Every body reacts differently to coffee. Caffeine toxicity is possible. The symptoms resemble anxiety and mood disorders, you can feel agitated, nervous and restless. Depression is often accompanied by anxiety and insomnia. Coffee can aggravate these. It best to see how you react to coffee before hooking up the IV. I noticed that if I have caffeinated coffee in the afternoon, I don't sleep very well. So now I make sure to unhook my IV or switch to decaf (which has much less caffeine) by noon.

Coffee can also affect you differently depending on your medication. I haven't read any research on this, I speak from experience and reading mental health forums. I recently increased the dosage of my bupropion (Welbutrin) to 300mg. This medication gives me more energy and a better outlook, but I have to put up with the side effect of tremors. They normally aren't too bad, my hands shake a little, no big deal. I don't know if this was because I was adjusting to the new dosage or what, but I had a pot of coffee one morning earlier this week and holy tremors Batman!! I was shaking so much I couldn't write, type or draw. My muscles were doing strange twitchy things, especially the muscles in my face and it felt like my eyes were vibrating. In addition to all that, I was sooo nauseous! I didn't actually throw up, but it kept coming and going in waves. I've never felt like that before. The last few days I've had two cups of coffee with lots of water and I haven't had the same reaction thankfully. I would be really sad to give up my coffee.

What's the moral of this story? Coffee has all sorts of benefits, but every body is different. Find out what amount is right for you. Also, watch out when you change your medication!

Sunday, 23 March 2014

Seeing Old Friends

I'm still feeling like rubbish, perhaps a bit worse, but I'm still working my way down my comfort list. Another list item is nostalgia. I like to remember good things, or good times in life. I need to remind myself that I've had them once, so I will have them again, no matter how bleak the future looks. Today I am thinking about my friends, my forever friends.

There are four of us who have been friends since elementary school. We're close, like The Sisterhood of the Traveling Pants, despite them living in Toronto and me in Montreal. I see them a few times a year. Part of me looks forward to seeing them while part of me dreads it. I get anxious about seeing people I haven't seen in a while. Once we get together, everything is fine and we pick up right where we left off, but until we meet, I'm nervous.

I had one of those experiences recently. Before seeing them, I was nervous and wanted to back out. I was in Toronto and had forgotten to bring my meds. Brilliant! It had been four days without them and I was starting to feel like hell. Would I be able to muster up enough enthusiasm? Would they notice the weight I've gained? Would they see through my "I'm fine." exterior and feel sorry for me? Would they see that I'm no further along in life, that I'm stagnating?

Robin is the one I'm closest to, which is a little funny because our lives are quite different from one another. I guess it's because I admire her. She is the single mom of a seven year old. It hasn't been easy for her, but she has handled everything remarkable well. Her daughter is really sweet and bright and Robin is a great mom. Being a mom terrifies me and she does it like she was born to. Robin is well established in life. She has a good job, a home, lots of friends and is dating a nice man. I feel like I'm still trying to get my life started.

Melissa just had a baby boy and she is over the moon to be starting a family. Melissa has always known what she wanted and went for it. She went to school to be a physiotherapist and got a job right out of school. She married her first boyfriend and they live in a nice big house in the same neighbourhood she grew up in.

Natasha and I are probably the most alike. We're both working on our doctoral degrees in science. For some reason the stress is making her beautifully thin and making me horrendously fat. I'm envious. She is finishing up her data collection and has already scored a post-doc position while I am still stuck in ethics.

I am happy for my friends and proud of them. I'm just ashamed of myself for being so far behind. I try not to let this get in the way though. They are my friends, my real friends. They will love me whether I weigh 100lbs or 3 times that. They wont treat me differently because I'm going through a slow patch in life and they'll encourage me to keep working for the things I want, the things that are good for me.

It's important to learn who your real friends are and not let them go. It's hard not to compare yourself to them and get anxious when you don't have any good news to share. Don't let things like weight gain or life set backs get in the way of seeing them and talking to them. There are enough people in life who just want to bring you down. You need to keep the ones that lift you up close.

Saturday, 22 March 2014

Down the Rabbit Hole

I'm feeling pretty low. That's why my last few posts have been about things I have learned either through experience or reading. I think it's important for you to either learn something new or feel uplifted after reading a post here. I've gotten to the point where my brain isn't working well enough to come up with something. I'm falling down the rabbit hole, but unlike Alice, I'm not going to land in Wonderland. There is nothing wondrous about the place I'm going. It's dark, lonely, hopeless and usually doesn't make much sense. Well, maybe Alice and I have that latter part in common.

I can usually tell when I'm falling. I start getting really tired for no particular reason. Then I start to lose what little motivation I have. That's how this spell started, but there were a few added perks. I changed the dosage on my medication and I'm having a hard time adjusting. The first few days I was really nauseous and shaky. The nausea went away, but the tremors stayed. It makes it extremely hard to draw which seems to be the only thing I can do without having to jump over the giant hurdle of dread. These symptoms, along with the lack of motivation have kept me from going to work. I think I feel guilty about not doing any work, or maybe I just think I should feel guilty, I don't know. I don't care enough to figure it out.

Yesterday was particularly wretched. I haven't been sleeping very well and the night before last I pretty much didn't. My lack of sleep has accumulated into that nauseating, photosensitive, headache-y feeling that leaves you stranded in bed or on the couch in the dark. So that's where I've been for most of the day....and night.

While I was rotting on the couch, I got confirmation that my husband will definitely be out of a job for the next school year. There are no full-time science contracts in the school board he is tenured with. All these questions are swirling through my brain. What are we going to do?! Will he find something else? Will I have to leave my Ph.D.? Will we have to move? This would normally start a panic which I would talk myself down from, except I don't have the energy to panic. So instead I curled up into a ball and prayed that I'd just disappear. Since it was not likely that my prayers would be answered, I needed a new strategy.

I've been told that when I start to fall apart I should try living life 10 minutes at a time so I don't get overwhelmed and can stop thinking about the future. There was nothing I could do about my meds, my work or his job at the moment anyway. What could I do right now? Try to feel better. How? I have a list of things that usually cheer me up. I have it written down for times like this when I'm not rational. Starting at the top of my list is my husband, who is not currently home, next... Find Ewok (my cat). Check. Sweatpants. Check. Cup of coffee. Check. Put on the Phantom of the Opera. Check. Watch until I feel better.

The Phantom played through five times. I still feel the same. At least I haven't completely lost hope yet.

Friday, 21 March 2014

Combating Cognitive Symptoms in Depression

Yesterday I told you about some of the reading I've been doing on the cognitive symptoms of major depressive disorder (MDD). It might have been too research-oriented for some of you, sorry about that. This stuff is what makes my heart go pitter-patter, sometimes I get carried away. Today I'll be more practical and talk about what I've read about treating these cognitive symptoms.

Medication Helps

Contrary to popular belief, antidepressant therapy is not the cause of you feeling like you've got a head full of cotton. Some medications can induce similar symptoms, but it is not a common side effect. Most people improve with antidepressant therapy. Only about 20% still have trouble with concentration and decision making after remission. Serotonin and norepinephrine re-uptake inhibitors (SNRIs) are pretty good at relieving cognitive symptoms. In a study comparing the cognitive status between depressives on selective serotonin re-uptake inhibitors (SSRIs) and those on SNRIs it was found that there was more improvement in the SNRI group. Those on the SSRIs were still having difficulty with episodic memory. They still had deficits in both verbal and visual memory. Episodic memory refers to memory linked to emotion and past experience as opposed to semantic memory which is memory of knowledge. So it looks like antidepressants that target more than one neurotransmitter are more helpful in the cognitive department. Remember, serotonin is involved in motivation and norepinephrine in concentration.

Bupropion, an atypical antidepressant has also been shown to improve cognitive symptoms. The primary focus of this one is increasing dopamine circulation in the brain. It also has an effect, although weaker, on norepinephrine and acetylcholine receptors. Again, remember, dopamine is for enjoyment and norepinephrine is for concentration. What about acetylcholine you say? That's a big one. It acts on neurons throughout the whole body. I'm not going to get into it, that's a whole biology lecture, but know that this is why bupropion is sometimes prescribed to help quit smoking.

Psychotherapy Strategies

Remediation techniques aim to improve someone's situation by targeting a specific cognitive skill. This technique is highly individualized. Programs are based on you personal interests and strengths. It involves various pen and paper tasks and some psychophysical computer tasks. The problem with remediation is that it is time-intensive. Your therapist needs to get to know your strengths and problem areas, then design the training program. Since it it's based on training, you have to do it often, sometimes several times a week.

Another strategy is compensation which relies on trade-offs. You find alternate ways of performing a task you have difficulty with. For this to work, your therapist has to be familiar with your learning style. You are basically taught to alter the course of your behaviour to suit your cognitive dysfunction. It has been found that doing this does not come naturally to people with MDD. From what I've read, it sort of sounds like cognitive behaviour therapy.

Finally there's the adaptive approach. Here you change the environment rather than the individual. This may mean changing jobs and/or depending on other people. This is used as a last resort when remediation and compensation are not working.

The Answer

There is no real answer, not yet. The cognitive side of MDD is only beginning to be studied. There is a long way to go. I have tried venlafaxin (SNRI) and it did give me better clarity. I couldn't handle the side effects and the withdrawal when I missed a dose, so I eventually came off it. Also, not a pretty experience. I am currently on bupropion in combination with some others. I did notice a difference when I added bupropion. Most days are alright, but the fog still comes and goes.

I recommend fighting through it. Don't throw in the towel on those foggy days. The brain is a wondrous thing. If those who lose their vision from traumatic brain injury can regain some of it, who knows what kind of adaptations we could build by just exercising our brains.

Office of Mental Health 
Trivedi and Greer, 2014