Psych meds and mutant genes

A little while back, I mentioned that I was having a pharmacogenomic test done, i.e., a genetic test to suss out how my body might respond to different medications.  In my case, the test was looking at antidepressants and other psych meds.  The results are in; they’re nothing dramatic, but they’ve validated my experiences with certain medications.

For example, I had been taking aripiprazole (Abilify) as a sort of helper drug to complement my primary antidepressant.  I started out taking the very lowest available dose, and when that seemed to be going well, my psychiatrist recommended increasing it.  I tried that for three weeks, went “NOPE, not OK,” and dropped back to the lower dose.  Even though my psychiatrist had given me permission to do this, she seemed disappointed and continued suggesting the higher dose.

Well, guess what?  It turns out that I have genetic markers for processing aripiprazole very efficiently; the test results note that I should “use with caution” and “lower doses may be required.”

I was right.  I was right that the higher dose was wrong for my body, even though it’s a “normal” dose for other people.

The test also looked at a gene called MTHFR, which produces the gloriously long-named enzyme methylenetetrahydrofolate reductase.  It converts folic acid to a form called L-methylfolate, which is the form used by the body and brain.  (Moms, remember how important it was to take folic acid while you were pregnant?  It’s because L-methylfolate is super important for brain and nervous system development.)

Long story short, it turns out one of my MTHFR genes is a mutant version, meaning my body might not be processing folic acid as well as it ought.  There’s some preliminary research that this is associated with depression and maybe with low energy levels.  [Cautionary note: If you’re curious about this for yourself and decide to start Googling about MTHFR, put your critical thinking hat on tight.  Those search results are going to pull up a lot of BS.  Real medical research about MTHFR seems to be fairly scarce.]

In an odd sort of way, it’s exciting to finally have a test actually find something wrong with me.  I’m depressed and I’m anxious and I’m tired, and yet all the normal tests (iron levels, thyroid hormones, etc.) are always, well, normal.  I now have a new and different thing to try: taking L-methylfolate supplements.  I’m not incredibly optimistic that they’ll make much of a difference, but one can dream.

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My psychiatrist doesn’t know what to do with me

“Have you considered seeing a naturopath?”

“No, I’m not going to go to a naturopath.”

“They’re highly trained individuals—”

“I’m not going to go to a naturopath.”

So went the conversation with my psychiatrist this morning.  The topic under discussion was my ongoing fatigue, which comes up at these appointments because I’m pretty sure it’s at least partly a side effect of my medication.  SSRIs (selective serotonin reuptake inhibitors) put me to sleep.

I reached this point with a physical therapist once.  When her prescribed exercises failed to fix my hip, she started recommending meditation and some odd relaxation exercises that seemed to imply the pain was in my head.  (I’m not knocking meditation—it’s just that that’s when I knew she was out of ideas.)

By this point, my psychiatrist has suggested quite a lot of ideas for my depression and related lack of energy, including acupuncture and something called “somatic experiencing” (which might be a perfectly valid sort of therapy, but my insurance doesn’t cover it, so nope).  We tried megadoses of vitamin B12.  We tried regular talk therapy, which might be worth trying again sometime, but is an awful lot of time and effort when it doesn’t work out.

Now, apparently, we’re at naturopathy.

I get the impression that psychiatry maybe doesn’t know how to handle people like me, who have to manage depression in the very-long-term.  (To be honest, I think our medical system isn’t very good at handling chronic anything.)  It was obvious that starting me on an antidepressant was the right thing to do when I was falling apart after Little Boy’s birth.  The meds worked.  They still work, but they don’t work perfectly, and the side effects are becoming increasingly annoying.

At this point, you might be thinking that the obvious answer is to find another psychiatrist with some fresh ideas.  That’s easier said than done, but as it turns out, I have to do exactly that, because my psychiatrist will no longer be seeing anyone on an outpatient basis after next month.  She’s given me some leads on other people who take my insurance.

We’re also trying something new and fancy and trademarked, a test by GeneSight that will supposedly tell me which antidepressants will work best for my brain.  I’m a little skeptical—it almost sounds too good to be true—but hopefully it will offer some guidance on finding a medication that works better / makes me less sleepy.

So that’s my crazy report.  How’re you doing?

Going public with my decision to leave academia

Today I officially announced my plans to leave academia after the PhD.

By “officially announced,” I mean “told my thesis committee as a group and not in a wishy-washy I’m thinking of leaving academia way but a definitive I’m never applying for postdocs way.”

“Academia is not a healthy place for me to be,” I told them.  “And I’ve learned that I’d much rather mess about with code than come up with big-picture science questions.”

So I’m kind of freaking out a bit about that now.  Not as much as I was freaking out about it last year, when I was afraid to tell anyone that I was even thinking about exiting academia.  But a little.  Because it feels kind of permanent now, you know?

Still, I’ve made my decision, and academia is not for me.

Last year, I was worried that I might fall back in love with my field of study if I somehow figured out how to overcome the depression and anxiety that had become closely linked with it.  This year, I know I won’t.  Maybe someday, from a distance, I will learn to be excited again about cool related science in the news.  Here, though, in the daily grind of writing and stressing and making plots—no, I won’t love it.  This year I was fortunate enough to produce some really interesting results, and it helped, but it didn’t help enough.

I’ve come to properly realize that although anxiety and depression are parts of me that will follow me everywhere, they are made enormously worse by the environment of academia.  Isolation, lack of help, intense career pressure, an almost total lack of positive feedback: those things all feed the brain monsters and send me into places I cannot control.  I don’t expect that another career path will be all sunshine and roses, but it will be different and it will be outside the cult-like insularity of the ivory tower.

Of course, I still have to finish my PhD, which is freaking me out A LOT on a daily basis.  My thesis committee was divided between those who thought I was making good progress and those who didn’t believe I could do it in a year.  Not exactly the most encouraging of situations.  Still, I think if I can force myself to bang out the text of another paper by the end of the month, I might be able to convince myself that I can do it.  So that’s the current goal.  Expect to hear lots of complaints about writing.

The exhaustion monster strikes again

I’m sick and tired of being, well, sick and tired.  Mostly tired.  It feels like I’m always tired, but the past few weeks have been particularly bad.  I keep crashing at school and just having to put my head on my desk and nap.  (Which I recognize is a huge privilege to be able to do, but it certainly doesn’t help me get my PhD done.)  There’s a mental fatigue, too: just thinking about what I need to do next can be overwhelmingly exhausting.

So, yeah, this is a post of complaining and self-pity.  Because I hate this state of fatigue.  Especially when it goes on and on and on and doesn’t seem to get any better and there’s no good reason for it.  It’s not my thyroid or anemia or a B12 deficiency or anything that shows up on a standard blood test.  I have a sneaking suspicion that it might be related to my antidepressants, which have a tendency to either put me to sleep or prevent me from getting rest, only I’m not quite sure which one it is this time.  And we are all still fighting the latest daycare-sourced cold.  Cold and flu season needs to hurry up and end!

Sigh.

*Wallows in self-pity for a bit longer.*

*Realizes she’s too tired to think of anything else to say.*

Got any fun stories to cheer me up?

I made socks, and why that matters

My feet, in green stripey socks.

It’s self-striping yarn—they look a lot fancier than they are.

I learned how to knit socks about three years ago, not long after rediscovering knitting as a hobby.  (It’s a wonderful hobby for introverts.  It makes small talk roughly 87 bajillion times more tolerable.)  Socks turned out to be the perfect project for me: they’re wearable, yet a manageable size; challenging enough to be interesting, but not so hard as to frustrate; and there are only two yarn ends to weave in, if all goes well.  Plus, brightly colored socks have always been my thing.  Back in high school, I was known among my friends for always giving funky (store-bought) socks as gifts.

I cast on this particular pair of socks in May 2014.  I worked on them through many an evening night of television, and I brought them with me on our last big pre-kid vacation.

And then Little Boy was born, and I stopped knitting.

It wasn’t just the lack of time, although that was a big part of it.  It was the depression, and the way trying to figure out where I was on these socks seemed like an enormous and exhausting task.  I’d had some problems with the yarn on the second sock, and was worried about getting the toe in the right place, and about running out of yarn.  It just seemed so un-fun.  Why bother?

I tried, once, when Little Boy was three months old.  It wasn’t enjoyable.  I didn’t try again.

Finally, a few months back, I left this pair in a box, found a different pattern, and started a completely different pair of socks.  And all the fun I remembered came back.  Not right away, but it came back—the relaxing feel of having something to do with my hands, the pleasure of making something, the daydreaming of what to make next.

That new pair of socks isn’t quite finished, but I found myself suddenly motivated to pull these green ones back out.  As it turned out, there wasn’t anything complicated left to do at all, just a few rows of straight knitting and an easy toe.  All the ugh I’d imagined was just in my imagination.

Here’s why these socks matter: they’re another corner turned.  Another step back from depression.  Another step towards life.

P.S.  If you’d like to make your own pair of green socks, here’s the pattern on Ravelry.  (I love Ravelry.)

Deep down in the PhD blues

I was trying to explain to someone today the feeling of impossibility that surrounds finishing this PhD.

It’s the feeling that no matter how much work I do, it will never be enough to check off all the boxes.  It’s the feeling that there will never be enough time—except it’s not that, exactly.  Everybody imagines that I must have so little time, as a parent, and that’s totally true, but time isn’t the limiting factor when it comes to research.  The limiting factor is my ability to cope.

I can’t pull an all-nighter writing when I don’t know what to write.  I can’t push hard for a week, because that will just leave me with another infinite pile of work inviting an infinite cycle of things I don’t want to do.

Grad school taught me not to set goals.  I lost the ability to achieve self-imposed deadlines.  My department’s deadlines have always been nonsense, unreal, the sort of thing to which people pay lip service but privately ignore.

I’ve seen the master plan with its step-by-step checklist fall apart too many times.  I don’t know which direction to think.  I don’t believe I can do it.  And that’s a hard place to be.

Sorry folks—my mind hasn’t been on a happy level of late.  Trying to cope.  Trying to face the fear.

Depression and the desire to do nothing

One of the many frustrations of depression is that it’s hard to figure out how to cope with the feeling of “I don’t want to anything.”  That feeling could mean that I’m tired, sick, and/or worn out and could use a real break, or it could be the gray fog of depression making all possible activities seem like too much effort and not enough fun.  Unfortunately, the best course of action for the first case is the exact opposite of the best treatment for the second.  When I really just need a break from life, lying around and mindlessly browsing the internet can be a much-needed, mind-soothing rest.  When it’s depression, doing nothing in large quantities only makes it worse.  I get more bored and more stuck and more bored and more stuck until I can finally muster up the willpower to do something, anything—because doing something, no matter how small, provides a little bit of endorphin feedback and reminds me that it doesn’t always suck to Do Things.  (On this note, there’s a splendid post in the Captain Awkward archives about escaping bad mood cycles.  It’s so true.  And the illustrations are the best.)

And that’s why I’m making myself write something today.

My antidepressant made me dizzy

The sticker was the first clue.

It’s bright yellow, with a picture of a droopy eye and the words “MAY CAUSE DIZZINESS.”  It’s one of three yellow stickers containing terrifyingly generic warnings that adorn my bottle of the antidepressant escitalopram (generic for Lexapro).  These pills are what I was prescribed to help combat my postpartum depression and anxiety, accompanied by the hope that they would not put me to sleep the way sertraline (Zoloft) did when I was in college.

I can’t remember exactly when I started noticing the dizzy spells, but I want to say that it was very shortly after Little Boy was born.  Maybe before I started taking Lexapro?  Leaning over to lock his car seat into its base, I’d suddenly feel like the car was moving around me.  I figured it would go away with time.  However, as my body healed from birth, these episodes got worse rather than better, and I became annoyed and suspicious.

Prompted by the sticker, I’ve typed numerous variations of “Lexapro dizzy” into Google.  The results were always situations that didn’t seem like they applied.  Dizziness and vertigo are supposed to be initial, temporary side effects that wear off within the first month.  They’re also frequently reported as a withdrawal symptom.

When my pharmacy was closed for inventory and I had to stretch my prescription over a few extra days before getting a refill,* the dizziness got much worse.  At times, just turning my head made me queasy.

Putting logic to work, then:

– The dizziness is a withdrawal symptom.

– My dizziness had a predictable element: it was usually worst in the mid-to-late afternoon.

– I take my pills at night, right before bed.

Conclusion: The level of Lexapro in my system was lowest in the afternoon and evening, and this was causing my dizzy episodes.

Prediction: If I started taking my pills in the morning instead,** the Lexapro would be at its lowest level in the middle of the night, when I presumably would not notice anything because I would already be lying down and asleep.

Result: It worked!  I’m still tired as all get-out, but the vertigo has all but disappeared.  [Bonus(?) side effect that does not appear to be coincidental: very elaborate dreams.]
 

*Not recommended.  Stay on top of your prescription refills.

**In general, don’t modify your medication routine without talking to your doctor.

I needed that today

I started the day feeling discouraged and wrung out.  Both physically—I’ve been fighting a cold—and mentally—I’m always fighting to stave off the thought that I’m never going to finish my PhD.  My one significant accomplishment of late (the Paper From Hell was accepted for publication!!!) had been deflated by the realization that there were small errors in two of the figures.  Very tiny errors, really; little points in the middle of a bunch of other points on a plot.  They have no effect on our interpretation of the data or the paper’s conclusions.  Still, they are real mistakes and will need to be fixed before the official version of the paper is published.

Fixing the mistakes means sending updated figures to the journal when I check the page proofs.  I think you can do that, but I felt so embarrassed about having to do it.  How could I have missed these details?  What is the editor going to think about having to sign off on the changes?

I was feeling completely un-confident about my ability to do anything right.

In a perfect coincidence, that’s when the hashtag #FailingInSTEM appeared in my Twitter feed.  Scientists were sharing their stories about screwing up in ways big and small.  It was such a relief to be reassured that everybody makes mistakes sometimes, even folks who go on to be very successful in academia and in life.

I learned that someone I deeply respect once had to issue an erratum to correct some misplaced points in a published plot.  Suddenly catching a similar issue at the proofs stage didn’t seem so bad.  This is the stage when I’m supposed to double-check everything one last time, right?

Sometime, when I’m feeling a bit more coherent, I’ll write a longer post on how academia promotes a culture of You Should Be The Best Perfect Best Amazing Perfect Researcher and how that’s fed the hungry brain monster of my perfectionism.  For now, let me just say that I wish we talked more about our mistakes.  It helps those of us who feel terrible about ourselves.  It really does.

The worst part of depression is

Briefly trending on Twitter last Friday was the hashtag #TheWorstPartOfDepressionIs.  It dropped off the radar almost as quickly as it appeared, but produced some profound statements about what it’s like to live with depression.  Here are a few that stood out to me.

This is true, and it’s incredibly frustrating.  You can be doing all the right things, and still feel crappy.  Checking all the boxes on the list isn’t a cure.  That being said, not doing all the things tends to make me worse—if I don’t get enough sleep, for instance, my mental health crashes.

Answer: Everything and nothing.  Nothing and everything.  You want to be hugged and you want no one to touch you.  You want to be somewhere else but you can’t think of anywhere else to be.

Look at all the time you have to do exciting things today! says my brain.  But ugh, I don’t want to do any of those things, and now I can’t remember what all of them are, and what if you forget to do something more important? 

It doesn’t take very long to get to, I actually don’t have the energy to do anything and there’s no time to finish anything properly so why even start?  I wonder what it’s like to have mental energy every single day.

Because what if you forget that important thing you need to worry about?  My subconscious seems to believe that if it enjoys happiness it has not earned, something bad will happen.

Yes.

How can you be sure which parts are the lies?  What if you really are making a fool of yourself?  What if you really are ugly?  I get annoyed with discussions on how to combat “imposter syndrome” for this reason—the cures all seem to revolve around recognizing your true accomplishments, but that requires (a) having true accomplishments and (b) believing part (a).

Then there’s this one, which is utterly terrifying:

I’m just going to stay in denial about the fact that my kid has some of my genes, OK?  I mean it—if I never admit that this is something I’d ever have to worry about, then it must not exist as a threat.  Right?  Right?

I added a few contributions, including this:

It was kind of nice to know that this struck a chord with at least two other people.  That I’m not the only one for whom worrying about fatigue is a component of my mental health.

Finally, there was this guy, who, really, says it all:

 

Readers, what would you add?