Be patient with depression meds

This is an old article I did for a national mental health website. I'm posting it again because I've had questions about it recently. 

I no longer take the same drugs. And not near as many. My life is better now, but it's still challenging to maintain good mental health. That's true for everyone, but especially those of us with mood disorders. We aren't just moody. We have an illness, no different than cancer or diabetes.

I'm now on an MAOI. I take it and a drug for anxiety on occasion and a sleep aid. That's it.

When I wrote this, I was on enough medication to sedate a large horse.

Genetic testing later showed most of what I had taken for years (SSRI's you've heard of) probably never had a chance to work for me. The merits of genetic testing are debatable, but that's another blog for another day.

Having the right doctor and the right plan is a huge part of recovery. At least it has been for me.

There should be no debate about that. I believe it's essential.

By Jack Smith

I’m an impatient patient.

When I was first diagnosed with depression seven or so years ago, my doctor prescribed me an antidepressant medication, warning me that it might take 2 to 4 weeks before it made any difference.

Boy was that an understatement. I vividly remember getting worse before getting better, even dealing with physical pain caused by my depression.

The first depression drug he prescribed proved ineffective, even after a month, so we tried another. The same cycle repeated itself. I didn’t start feeling better until my third antidepressant prescription—a few months after being diagnosed.

I know that is not very encouraging to those who have recently been diagnosed with depression. Hearing that it may get worse before it gets better is frustrating. But it’s true.

It takes patience to get the payoff from antidepressants. Two to four weeks is generally the minimum to see any improvement, and it may take up to six months to get the full benefit of a new depression drug. At least, that’s what my psychiatrist tells me.

Changing antidepressant medications can be just as frustrating as taking an antidepressant for the first time. The last couple of weeks have been extremely difficult for me. I began to slide back into a deep bout of depression, and my doctor wanted to be aggressive in trying to stop it. It got so bad that my stomach ached and I could barely get out of bed for a day or two, so we had no choice but to try something different.

And we did. We changed my antidepressant. While I’m generally a compliant patient, I didn’t follow the doctor’s orders exactly on how to switch antidepressants safely and make the transition. Big mistake.

Out of the Darkness & Into the Light

Out of the Darkness Walk. October 2015

By Jack Smith

Three weeks had passed since the night I reached a place so dark and desperate and painful that I began to believe the lie. 

It was the night I gave up. The night I lost hope. The night I said to hell with this, I quit.

I gave up on my children. I gave up on my family. I gave up on my friends. I gave up on my coworkers. I gave up on all the people praying for me, including many I didn’t know.I gave up on many who were suffering in silence, people I had never met who found inspiration in the words I wrote about my struggle. 

I gave up that dark and surreal night because I believed the lie. The lie that I was broken beyond repair. The lie that my family and friends would be better off without me. The lie that I could make the pain go away if I just shoved as many pills down my throat as possible.

I believed the lie because depression is a cruel disease. It is cunning and relentless and opportunistic. It crouches in the edge of the wilderness of our minds, waiting for just the right moment to pounce. 

It waits until darkness and clouds cover the stars and obscure the moon, making it impossible to navigate the storm in the blackness of a bitterly cold, long winter’s night.  

It waits until we are weak and vulnerable, and then it comes on slowly at first. It pushes us down a slippery slope into a dark and lonely abyss. We begin to believe the lie because depression and other forms of mental illness are like cancer of the mind. 

The cancer spreads from our minds to our hearts and even our souls. It feels like there is no cure, and there isn’t. It feels like there is nothing anyone can do to help us, but that is a lie. 

We believe it even though part of our mind knows it is a lie. We believe the lie because we have lost hope, one of the most powerful forces on earth, second only to faith and love. 

We feel like we are standing on top of a burning building, and the only thing we know to do is jump.What we don’t realize in that surreal and disconnected moment is that when we jump, the dreams that so many others have for us come crashing down with us. 

We don’t realize the collateral damage we are inflicting on those who love us the most, those who would give away everything they have just for one last chance to tell us they love us, one last chance to tell us hope is not dead, one last chance to tell us they will stop at nothing to get us the help we need. I jumped from the burning building. 

Twice. 

But I’m still here. I don’t know why I am here and your friend or loved one is not, and I know it isn’t fair. But I am here. I didn’t know it at the time, but God was holding my hand as I walked through the Valley of the Shadow of Death. Somehow, he saw me through to the other side, and today I stand in the sun. 

I am telling my story because I can’t just stand in the sun and soak up the glory of God’s creation without thinking of those I left behind in treatment who have relapsed, never made it out or decided they could no longer fight because they were so weary from it all.I am here telling my story not because I want to….it is easier just to bury it deep in the dark corners of my heart and hope that it never sees the light of day again. 

I have learned we can’t bury pain in our hearts and ever hope to be truly happy. I have learned that holding onto secrets is dangerous and toxic. Thanks to God’s grace and the faith and wisdom of my then 14-year-old daughter, I finally learned something important: Our secrets lose the power to hurt us when we drag them into the light. 

That is the wicked power of stigma….it keeps us from getting the help we need and from believing there is still hope. That is just part of my story. But today isn’t really about my story. It is about your story. 

It is about the student who wrote that he was putting together a team for this event because the campus ministry he serves lost two members to suicide in one year.It is about the young college student who lost a dear friend because she never shared her pain with anyone else. 

It is about the grandmother here with us today who lost her grandson to suicide, then her own son only months later. I can’t fathom how much pain he must have been in after losing his own son. That’s why I can’t stand here and judge him today. I know what it’s like to hurt. 

It is about a friend I made just yesterday who lost her sister to suicide three years ago. She wants to start a program in the schools so teenagers become more aware of suicide risks and warnings. 

The statistics tell us we should have done that yesterday. Suicide is the second leading cause of death among young people. It is about mothers and fathers here today whose lives were devastated and whose spirits were crushed because their son or daughter lost hope and for whatever reason just couldn’t ask for help. 

It is about 1 in 3 Auburn University students who say they have thought about suicide. That is what surveys tell us. I am not good at math, but think what that means. That means there are 8,000 students on this campus who either have been hurting or are hurting so much they were tempted to believe the lie, too. 

That is a big number that doesn’t really put it into perspective. Maybe this does. The next time you are walking through this Student Center, try to grasp that every third person in line at Starbucks may be struggling at that moment. Some of them may have cried through the night, wondering why the only thought they have is the world would be better off without them.

Try to grasp that every third person you walk by carrying the weight of their books on one shoulder and a whole lot more pain and stress and worry on the other has at some point contemplated suicide. Today is about their story, too. 

Back to my story for a moment. It had been three weeks since I tried to take my life for the first time.My brother had joined me on a flight to Houston on our way to a world class treatment center. 

I had lost hope. I had become disconnected from God in many ways. Then I pulled my Bible out from under my seat. I flipped it open, looking for answers. Inside I found a note from my 14-year-old daughter. 

With her permission, I would like to share it with you now... 

Her letter got me through a terribly difficult time. It changed my perspective and changed my prayer. I quit praying for a cure that night. I started praying for God’s will for my life, even if it meant I had to suffer along the way. 

After reading her letter and changing my prayer, the pain and guilt began to lift, at least long enough for me to go through treatment that time. The dark clouds of depression rolled back into my life again less than two years later, but I still think that change in my heart and my prayer is why I am here today to tell you my story. 

Many of you here can relate to the toxic nature of guilt. Guilt is like poison in our hearts. It must be flushed away before we can forgive others or even forgive ourselves. My prayer today is that those of you are living with guilt and regret can let go of them. 

It will always be hard to forgive your friend or loved one who made a tragic choice unless until you let go of the guilt. Ask God to flush it from your heart. 

Your friend or loved one did not understand that by attempting or completing suicide, they were only taking their pain and multiplying it by a million. They did not understand they were merely giving it to those who love and care for them the most.If they had, they would have asked for help.

Today, I want to ask you to do a few simple things: Please support the American Foundation for Suicide Prevention with a donation or at least your prayers. If you are a student here, get involved with Active Minds Auburn. 

It is a great organization doing the important work of eliminating stigma through awareness of mental illness. If you have ever struggled with depression or bipolar or anxiety, make a list of 3 friends you can call at 3 am when it’s dark and you are lonely. Put them in your phone under “Favorites.” 

They may one day be much more than “favorites” in your phone. They may be guardian angels that save your life.Before you go to sleep, pick up your phone and text 3 friends or loved ones that you sometimes worry about. 

Tell them you love them and that you will always be there for them. Tell them even if it’s 3:00 a.m., they can always text or call. Tell them you will just be there for them to listen and try to understand. And if you like music, go listen to Matthew West’s “Strong Enough.” 

It is about giving up. Not quitting. It is about giving up on the lie that we are strong enough to handle the storms of life on our own. It is about recognizing that no matter how dark the skies, no matter how loud the thunder, no matter how heavy the rain, no matter how much fear we have in our hearts, there is a way out. 

It is about admitting we aren’t strong enough to do it on our own. Admitting that is not only okay. It’s the only way out when we can’t see the lighthouse in the distance. I love one verse in that song. 

This is what it says:Maybe that's the pointTo reach the point of giving upCause when I'm finally, Finally at rock bottomWell, that's when I start looking upAnd reaching out...I’ve learned that having the right doctor, the right diagnosis and the right treatment plan is vital in the struggle against mental illness. But I’ve also learned something more important. 

We must learn to lean on friends and family. Mine saved me. They brought me out of the darkness and into the light. My family never once judged me. They just loved me and stopped at nothing until I finally got some answers. Friends and family are critical, but I would not have turned my life around and found hope and happiness again if God had not stayed faithful to me. 

I kept my faith even when I didn’t understand God’s plan. My faith has sustained me through some hard times, including times when I didn’t have any courage. When I was at rock bottom, a dear friend gave me a little black book that has helped save my life. 

Inside are hand-written verses, songs and quotes. She even left blank pages so I could write my own favorites down.I find one thing in my little black book that helps me every day. The words on the last page say it all.“Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying ‘I will try again tomorrow." 

You don’t need the courage to conquer it all in one day. God, your friends and family will do that for you in time. You just have to let go and let them. You just need the courage to try again tomorrow.

Anxiety attack like jumping out of plane without parachute

By Jack Smith

I felt it coming like a freight train barreling down on me and  I was hopelessly strapped to the tracks.

My mouth dried out within seconds. My pulse quickened.  My hands started to tremble. Even my legs shook as though it were the dead of winter and I were standing naked in the snow.

My wife realized what was happening, so she looked me in the eye and said go where you need to go. I scanned the area looking for an escape, which I usually plan out in advance for times like these.

[caption id="attachment_132" align="alignleft" width="300"] Anxiety attacks can feel like free falling. Hard to stop once they start.[/caption]

You would have thought I were in a war and the enemy was after me.

I was really just attending a football game with 80-something thousands of my closest friends, as the t-shirt goes, when I had an anxiety attack.

I did what my wife and my instincts told me to do when it got out of hand. I got as far away from that huge mass of people as I could.

The best way I can describe a panic attack is that it feels like jumping out of an airplane...and then realizing you aren't wearing a parachute. I feel fine one minute. Then all of a sudden I'm in free fall, the ground getting bigger and bigger by the second.

When panic attacks hit, I'm suddenly overcome with angst. It leaves me with  two choices: fight or flight. Sometimes I stay and fight. Other times I get the hell out of there to gather myself.

When it happened yesterday, I walked away from the crowd to the safety of open space and a lonely bench. I tried a mindfulness exercise that I learned in treatment. It worked more or less.

I closed my eyes for a moment, took some deep breaths and focused on my senses. I listened to the roll of drums from the band playing in the distance. I felt the weight and the coolness of the wrought iron bench on my thighs and back. I drank in the smell of meat sizzling on the grill.  I inhaled deep breaths through my nose and exhaled them through my mouth.

I soon felt sane again, relaxed enough to enjoy the game and the time with my family.

I'm not sure if what I experienced Saturday afternoon was a full-blown panic attack or just social anxiety I sometimes get when I'm surrounded by too many people.

I once coped with these episodes by working or drinking. Neither was an option on Saturday, so I had to fight through it.

My guess is a lot of you reading this blog have had similar meltdowns. I've been having them for years.

I remember another time maybe 10 years ago when I bailed on a newspaper banquet before it even started. It was one of those times when I had quit drinking cold turkey with no support group. I didn't know how to handle being sober and being one of only a handful of people not drinking.

I was holding a glass of water when my usual hand tremor turned into the full-blown shakes. It was like Ted Striker's "drinking problem." I couldn't raise the glass to my mouth without spilling water everywhere. So I just got the hell out of there.

I jumped in my car and drove over two hours to my home without telling anyone I was leaving, including the hotel. I avoided phone calls from my mother because I was too embarrassed to admit the truth.

I have it easy compared to others. Some have unrelenting anxiety so severe it makes daily living a nightmare. God bless them.

Instead of asking why in the hell a grown man can't just suck it up and deal with it, my wife is usually patient and compassionate.

I'm harder on myself than she or anyone else is. I  get mad at myself and wonder why I can't just be normal.

I don't have many answers, except that I was born with an anxious disposition. That's what one one anxiety specialist told me anyway. He said I've developed some maladaptive coping mechanisms over 40 years-plus years, and I won't be able to fix them overnight.

I'm sure going to try, though. Life isn't supposed to be lived this way. 

 

 

The right words offer hope in battle with depression

By Jack Smith

Bridgette never has a bad day. Her sweet and soothing voice is well known to customers at the Chick-fil-A drive thru in my hometown.  Bridgette always makes me feel better—even when I feel guilty for ordering yet another chocolate milkshake.

Her secret? Bridgette adjusts her emotional level based on her customers' first words into the drive thru microphone. If they sound grumpy, she dials down the sunshine. If they sound perky, she matches their emotions.



It works. I've never once had a bad experience in the Chick-fil-A drive thru thanks to Bridgette's sweet voice.

I think we can all take a cue from Chick-fil-A when it comes to saying the right thing in the right way to those suffering from depression and other mental illness.

Words can help or they can hurt. They can heal or they can harm..

I've found almost all people have good intentions, but I've also had some tell me they didn't know what to say to me or someone else struggling with mental illness. Maybe this list will help.

5 good things to say to those with mental illness

On drinking and depression

So this is the blog that might scare away men I’m hoping to help. Not a popular subject. Depression and alcohol.

The bottom line? A lot of one can lead to a lot of the other. Depression can make you want to drink more. And drinking more can lead to more severe depression.

It’s not cool to lecture others or say "here’s what you need to do." Therapists and AA folks call that cross-talk. You’re supposed to say “I can relate to that because….”

So here’s how I’ll start. I can relate to the intractable problem of alcohol and depression. I drank enough beer in college to float a barge. I drank enough beer after college to drown a dragon. Only the alcohol never killed the dragon. It only made him angrier.

I kept on drinking, and drank even more when the first real tests of my life came. The loss of a loved one. The stress of owning a business. The stress of parenthood and trying to be a good husband, good career guy and good father at the same time.

The worse it got, the more I drank. The more pain I suffered, the more I tried to dull it with alcohol. I was quite clearly self-medicating, only this medicine has horrendous side effects. Hangovers. Even more anxiety. The inability to concentrate. The obsession over when the next drink can be consumed.

I once quit cold turkey once with no professional help but lapsed back into the same old patterns nearly a year later. Then my depression got worse than ever, and the abuse of alcohol became as bad as it had been in college.

Even though this is an anonymous blog, allow me a little room for rationalization here. I was never a Bloody Mary in the morning or bottle in the desk guy. But I was a prolific binge drinker. After Katy Perry-like Friday nights, I’d be hung over until Wednesday. And then I’d start again on Thursday with heavy drinking.

And it never, ever made me feel better. Only worse. My first therapist equated it to pouring gasoline on a fire. It’s simple, really. Alcohol is a depressant. Depressed people, umm, I should say people like me that I can relate to, probably don’t need more depressants.

If you want to read a great blog about depression and alcohol, which is the chicken and which is the egg, check this one out. If you want to read some scholarly articles about alcohol and depression, click on this link.

Praise God, alcohol abuse is not a problem for me right now. Not today at least. We’ll see about tomorrow.