In my youth (age 16 to mid 20s) I experienced three periods of clinical depression. The longest lasted more than two years, the shortest about 18 months. I never received any treatment or medical management during these periods, and I can’t say whether that was a good or bad idea. I survived but as a result I have a strong appreciation for what it’s like to be clinically depressed, and a concomitant empathy for those going through the hell it can entail. [Updated; see end of article]
Now it seems that I may be suffering from a very low grade form of long term depression known as Dysthymia. It’s very tentative and not yet supported by a formal medical diagnosis.
For that reason I’m reluctant to head to the doctor to see whether I’m right (and also because I don’t have medical insurance and while I’m not working I’ve no funds to afford to see a specialist), so I’m going to test the waters by self-medicating using an OTC (over the counter) preparation called St John’s Wort (SJW or the Wort).
If I have no improvement I may consider going to the next level (i.e., a visit to my primary care physician, but only once I’m working again).
If I have some improvement I may continue with my self-dosing regimen until I’m back on Lipitor (which is one of the pharmaceuticals that has a warning of complications if taken with SJW, according to a pharmacist) at which point I will definitely need to go to the next level.
So what makes me think I have dysthymia?
Two things. One, my wife, who is formally trained in such things, says she recognizes some of the symptoms in my behavior. Two, when I checked the list of possible symptoms that might lead to a confirmed diagnosis, I found I possessed at least two of them (for at least two years) and possibly more:
- Feelings of hopelessness
- Insomnia or hypersomnia
- Poor concentration or difficulty making decisions
- Low energy or fatigue
- Low self-esteem
- Poor appetite or overeating.
I definitely have 3 and 4, occasional 2 (insomnia), rarely 6, rarely 7, and no 1 (a blip now and then but nothing to write home about) or 5 (too much ego :))
So in theory I may have a very low grade depression and it is getting in the way of achieving my goals, not the least of which is finding a new way to earn an income, since it seems likely that technical writing is now an offshore function for many businesses and that hits me hard.
Having re-invented myself more than once in the last 15 years, I’m left with nowhere to turn to try and exploit another facet of my skillmix. Tech writing was the last quill in my quiver, so to speak.
My long term goal has been to earn a living writing fiction (and self-publishing, to exert as much control as possible over pricing and profit), and that seems the only door left open to me. But I need to focus and stay sustained at writing tasks and that’s not happening.
It’s not writer’s block. I’ve never really suffered from that – one of the things I like about my brain is that I can sit down at a typewriter with no idea what I’m going to write and the ideas just appear and get put down on paper. Or they used to.
If I ever found myself stuck for something to write I used to take a long shower or bath and just let my mind wander. I’ve even been quoted to that effect in another writer’s book (Jenna Glatzer’s “Writer’s block: and other problems of the pen“):
I guess it’s motivation more than anything else – perseverance seems to be lacking, and that was one quality I have had in spades for as far back as I can remember.
Objectivity is going to be hard. It will be very difficult – if not downright impossible – to separate any real improvements from those that arise simply because I know I’m taking something that may influence my behavior.
For that reason I’m going to ask my wife to monitor my behavior over a full month (during which time I already know we’re going to be in serious trouble, being overdue for rent right now and also under threat of being levied onto the streets by the IRS for no good reason), as well as writing down my thoughts in this blog as best I can. One of my problems is that I’ve not written a single published post in two months and that needs to change too.
So, here goes.
Hank, our friendly pharmacy delivery guy, came round at around 1pm with some prescriptions as well as the bottle of SJW. Fifty pills in all, to be taken as one three times a day. That’s just under 17 days of treatment. I’ll need to re-order if I’m going to have enough to keep going.
I take one with some coffee around 2pm. I wonder: does caffeine impact SJW? Note to self: look that up! [EDIT: Haven’t found anything reported for caffeine, but also couldn’t find anything adverse with regard to Lipitor. I did find a negative report with regard to Prilosec (omeprazole, reduced bioavailability), which I do take, so we’ll have to watch that carefully. And guess what? One of the reported side effects of SJW is…lethargy. Just what I need.]
This will allow me to take another before bed this evening, giving me a solid 16 days (48 pills) of treatment. Barring any problems, of course. My biggest fear is that SJW – indeed, any psych medication – will interfere with my creativity. I know that genuinely mentally ill patients have that fear, but I don’t know whether mine is a legitimate one. We’ll see. I have a draft of Frankenstein and the Seven Dwarves that is long overdue for work…
If nothing else, the thought of SJW gave me an idea for a cartoon character called (and I’ll tell you how to pronounce his name ahead of time: it’s “sinn-junn”) St John The Wart.
I don’t even know whether I can draw a wart well enough for it to be considered a reasonable cartoon. I’ve thought about how to place it in context – it can’t be a plantar wart (verruca) because the location doesn’t give much opportunity for comedy, so it’s going to have to reside on a finger, probably on the right hand near a knuckle.
That gives St John the opportunity to read the back page of a newspaper and be close to the action in nose picking and bottom wiping, so that’s all right then 🙂
Day …er… well, something like 16
Well, that went well. I did actually feel some slight benefit from taking the Wort – sufficient for me to re-order a bottle today (it’s under $7 so it’s not a bank breaker) but in the meantime got so involved in working with various official bodies (mostly tax authorities) that I didn’t get around to maintaining this particular blog entry. D’Oh! (in spades).
The biggest problem I had was remembering to take the pills (which really do pong), so I didn’t maintain a regular dosing of one three times a day, but even at that (worst case: one pill in 24 hours) there was still some barely noticeable benefit, namely that the sinking feeling in the pit of my stomach every time I thought about our predicament (and the concomitant “I don’t want to deal with this right now” feeling) both disappeared.
Whether that stomach effect is the reason why there is a possible adverse interaction with a proton pump inhibitor is hard to say. And there’s always going to be the possibility that my perceptions of improvement are purely subjective and totally imaginary – but, at the end of the day, if I can get on and do the things that need doing, and all it’ll cost me is a few bucks (as long as it doesn’t physically harm me), then I’m going to go for it, at least for the near future.
I’m not big on herbal treatments, still less so on some of the egregious woo that passes for dubious therapies these days, and I prefer not to take even orthodox medication unless I really absolutely have to (and there are a couple), but for now Wort seems to be doing the job (even if it’s not the job I anticipated it would do) and that’s good enough for me.
I just wish they’d do something about the awful smell…
[UPDATE 2010.06.12: The product I tried initially consisted of a single 300mg tablet of 0.3% Hypericin (standard extract of “aerial parts”) taken three times a day. The manufacturer was LEADER.
Yesterday I obtained the same product from another manufacturer (WINDMILL) and it’s exactly the same formulation, exactly the same strength (300 mg) and yet the dosage instructions are different: a single tablet to be taken TWO times a day.
Why the difference, I have to ask? Most products that are the same but manufactured by different companies still have the same dosing instructions, whether it’s Alka Seltzer (aka effervescent antacid/pain reliever) or Aspirin.
Ironically, today I read that St John’s Wort has been shown to be effective for treatment of major depression – but not of dysthymia (!) Dang. We’ll see. One swallow does not a summer make (Aristotle).]
[UPDATE 2011.08.04: Well, it’s a year on and I have to say that – given our dire circumstances (homelessness, since March 9, 2011) – St John’s Wort has helped me stay on a reasonably even keel emotionally all this time.
How do I know it’s the Wort and not just me being me?
I have some confidence in it being mostly (if not all) the Wort. In the past (i.e., pre-Wort), whenever I pondered our awful situation (and I’m going to blog about that shortly, to make sure that no matter what happens to us, OUR version of events will be made a matter of public record) there was an awful sinking feeling in the pit of my stomach and a lump in my throat. Some readers (if there are any) may be familiar with this negative feeling.
That feeling has been absent all this time, but it wasn’t immediately apparent to me until I reviewed my feelings during the course of events over the last year. It was then that I realized that the sinking feeling has been totally absent.
That feeling used to (negatively) impact my motivation to do the things that needed doing (such as liaising with the IRS, for example).
I have had good experiences sometimes with IRS agents but the vast majority of the time I’ve been talking to people who evidently take a delight in being obnoxious, unpleasant, and unreasonable – the “little Hitler” syndrome – and it takes a spot of girding up the loins to pick up the phone and take the first step on that generally horrible path (usually because I have rarely had good news to impart).
The need to loin-gird has been noticeably absent, although to be fair that might also have something to do with the assistance of the Bookstein Tax Clinic, whose staff and students have been nothing if not supportive all this time); however, I’m confident that the Wort has played a significant part in keeping me at least on an even keel, if not endowing me with an excessively sunny disposition (Stepford Wife-style).
So, on balance, I’d say that the Wort has worked well for me, indeed better than I would have anticipated. That doesn’t mean I advocate it to all and sundry as a cure-all (although I’d certainly suggest trying it for a short period to see if it provides benefits; if it doesn’t, see your GP pronto. You may need bigger guns to be brought to bear).]