This is what happens when I don’t blog for a few days…

My depression and obsessive compulsive symptoms have been declining for a few weeks now. Unfortunately, I cannot choose which of a number (or some combination) of factors is causing this decline.

It is not that I don’t feel depressed anymore or don’t have intrusive, anxious thoughts – but they are softer. They don’t demand my attention so insistently, forcing me to ruminate on them for hours, insisting that the rest of life must be put on hold until they have been satisfied with my attention and care directed towards them.

I feel optimistic that the depression and OCD will remain stable at this low level (which is even lower than I have been used to in past years), but I don’t have the same optimism about my ADD. I have certainly felt relief from my ADD symptoms – but I attribute this largely to the significantly decreased responsibilities I currently concern myself with…as pressure and responsibility grows, I expect the ADD to grow as well.

I have been reading several books on ADD and I can still see myself so much in the pages. I am writing down the strategies I think will work best for me (I already take medication and utilize some strategies) – but I know that one of the curses of ADD is the difficulty one experiences in trying to stick with strategies. I’m currently researching ADD coaches and whether such a coach would be beneficial for me (and affordable).

My OCD and Depression at this juncture seem to be primarily correlated with my ADD. That is, when I fail at something or when tasks feel too overwhelming, I feel depressed and guilty. When I feel guilty I attempt to ritualize my way out of the guilt. While this is bad news it is also good news – b/c traditionally my OCD and Depression have had much deeper roots – roots that stayed present no matter how well I was doing in other areas of my life.

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One of the biggest frustrations right now, which may be the ADD or something else, is my sleep. I cannot go to sleep before midnight (I can, but wake up within a few hours and can’t fall back asleep for two to four hours) and I usually don’t sleep uninterrupted through the night – even if I do go to bed at/after midnight.

Then during the day I feel an overwhelming drowsiness and the only way to relieve it is by napping – 2-4 hrs (I nap a maximum of 2.5 hours at one time, usually 1.5-2 hrs, so I have to take two separate naps). Oftentimes when I am motivated to work on some complex task, I feel overwhelmingly sleepy and can’t. Then when I’m not motivated to work on a complex task I feel wide awake!

I talked to my psychiatrist about it yesterday. I suggested we increase my dose of Adderall XR from 20 mg to 40 mg – but we both agreed that this would cause a significant increase in my tics (most people have never seen/heard these…I am able to control them with significant effort when around others). I also suggested that we might step my Prozac down from 60 mg to 40 mg. This, however, also carried some significant risk. Namely, OCD only responds at high levels of anti-depressants (e.g. you might take 20 mg prozac for depression, but 60 mg prozac for OCD before feeling significant relief), and if I reduce my prozac level it will take several weeks for the level to lower in my body – and then if I begin experiencing symptoms it will take several more weeks to bring it back in – and I can’t afford to have a prolonged period where my OCD is bad. I was only willing to reduce the prozac if we had another quick acting, short duration medication that I could use to treat the OCD if it appeared after reducing the prozac until the prozac levels could be raised again (this is probably still an option, but…)

The psychiatrist recommended another option – treating the drowsiness directly and seeing if it reduced the ADD. The hope here is not that I would have to remain on the medication long-term, but that I might be able to normalize my sleep patterns and then go off the medication – or at least use it only on rare occasions.

Initially he was going to give me a prescription for provigil – but the out-of-pocket cost was around $1000 for the generic (for a one month supply)! So, instead he gave me an older medication which he said is more “hit or miss” as to whether it works to reduce drowsiness, but it was much less expensive. This medication is Symmetrel (generic: Amantadine). It is used to treat a wide variety of issues including Parkinsons and the flu. Off-label it is utilized to treat chronic fatigue (in multiple sclerosis patients), ADHD, and sometimes as an adjunct treatment to other antidepressants.

I took my first dose this morning and I’ll take a second one in a few hours…we’ll see how it works.

….

Yesterday I did the complete seven minute workout. Don’t laugh till you try it. Then I thought to myself, “Hmmm…Why not give the recumbent bike another try?” I used to ride a bicycle for hours most days as an adolescent and continued recumbent biking in college and afterwards but around two years ago (when the mysterious illness came upon me) I lost the ability to bike. Within two or three minutes of starting my legs would hurt wickedly. I could push through it for ten minutes or so, but then it was hopeless. This has been extremely frustrating for me. How am I supposed to get exercise when I can’t bike? (Run? That would be nice, but I have other problems that prevent that for extended periods).

Anyways, I mounted the bike and began pedaling – and pedaling – and pedaling. I didn’t feel any pain in my legs. I kept going – over an hour later I decided to stop – not b/c I was too tired or in pain but simply b/c I figured I’d do another hour today (which I plan on doing after this).

What changed? I have no idea. Could it be the Wellbutrin? Sure. Or could it be the Shakeology? Sure. Or could it be the days off? Sure. I think the first two are more likely than the latter.

….

I noticed over this break that my tongue kept on getting sores. This is very annoying when you read everything aloud, as the sores rub against your teeth, causing constant pain, as you read. I realized that this was probably b/c I was rubbing my tongue against my teeth – which I grind in my sleep (this is called bruxism). I had a mouth guard I hadn’t been using (it didn’t fit well and was uncomfortable) but I resized it and began using it again. It makes me feel a bit like I’m choking, but it definitely keeps me from rubbing my tongue against my teeth while sleeping – and the dentist has been telling me I needed to wear the guard anyways, b/c I’m wearing down my teeth with all the grinding.

These nights if you were to peek in on me while sleeping (please don’t) you’d probably see me with the mouth guard jutting out, a sleep mask (goes over your eyes to block out light) on my eyes, and carpal tunnel hand/wrist supports. Yup, I look pretty strange…but that isn’t new.

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Every year around Christmas Steam has a huge sale on their games. This year I purchased X-Com: Enemy Unknown. The game series has been around since I was a kid. They are turn-based and addictive. It has been a while since I’ve been able to enjoy wargaming. For a few months I lost interest in all my hobbies (this is common with depression)…but it has come back.

When I work intensely, I can only go two or three hours before needing a break…but when I play a wargame while working intensely, I can go for six, eight, or more hours without a break. I’m not entirely sure why. I suspect it has to do with the fact that the prefrontal cortex in the ADD brain shuts down under intense thought – and the wargaming allows me to interrupt this shutdown process, bring the brain back up, continue working on the complex task, and as it begins to shut down again take another turn in the wargame.

This is probably why I love turn-based wargames. They go on forever and ever (many hours of playability) and they have natural divisions – e.g. you take a turn, then the computer takes a turn. Every computer turn I can return to my complex task.

This doesn’t really work in the workplace…but it works well for now while I’m on leave. I’ve been reading like crazy – and the interspersed wargaming has allowed me to consume much more (dense) material than I would be able to if I just tried to read straight through.

….

I feel optimistic and hopeful about 2014 – for me personally and for the church as a whole. There are still a lot of stressors in my life – some new ones have flown in of late – but I think I am coping with them better…which is important, as the stressors never seem to abate, when one goes away another quickly fills its place…learning peace in the middle of the storm is my constant challenge.

I’m doing my best to learn everything I can to improve myself for 2014. I pray God will see fit to work greatly in and through me and through CCC this upcoming year.

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