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How does it feel to take anti-depressant medication?

I recently attended a talk called “All Kinds of Minds: Let’s talk about mental health” at a software testing conference**. My “a-ha!” moment came when Aaron admitted that he really didn’t want to present this topic, and that the only way to reduce the stigma around mental health issues was to start having these discussions. To honour Aaron’s effort, I’m sharing this experience of a time when I switched anti-depressant*** medication.

pills

When I need to change my medication or dosage I try to wait until my next holiday from work, to avoid the side-effects from impacting my career as much as possible. It does take some fun out of the holidays, and it can be hard on friends and family. It also means that I try to make the change over 2-3 weeks rather than the recommended 4-8 weeks. Please note that I never adjust my dosage without consulting my GP.

After almost 2 years my Cymbalta (SNRI) medication was no longer effective, and my GP recommended I switch to Citalopram (SSRI), using Mirtazapine to assist with the changeover. This post is in NO WAY a recommendation for others. I recorded the notes below only to assist in conversations with my doctor. Looking back now, I realise that my notes may provide insight for others when suggesting that somebody “just take some happy pills”, or when wondering why a colleague seems a little vague for a few weeks.

After reading this you may wonder – “Is it worth it?”. Obviously I think it is, and this is what I’m willing to go through for a few weeks per year so that I can feel normal-ish for the rest of the year.

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6 days on half Mirtazapine tablet with 1 Citalopram:
Chest pains with anxiety attacks, dizzy

29 Dec: Switch to 1 Mirtazapine and 1 Citalopram
Swollen feet and ankles, anxiety strong, chest pain, mood swings/rage, wind, insatiable appetite, headaches.

31 Dec: Feet & ankles mildly swollen, anxiety, feel slow and heavy like underwater, want to do nothing, irritable (not rage), no wind, no headaches, eating lots and often – need to use will power a lot more than usual.
Chest pains and anxiety during self criticism. Major one when I decided to change dosage without getting doctor’s advice. So I didn’t do it.

3 Jan: less anxiety and hunger since evening of 1 Jan, neither is an issue now. Not irritable etc.
Feet are uncomfortably swollen. Sleep of the dead, I don’t wake until I’m woken.

5 Jan: feet still swollen, left one is slightly worse. Very deep sleep. First day back at work, got more anxious as day progressed.

9 Jan: 1 Citalopram and 0.5 Mirtazapine
Base level of anxiety higher today 5/10. No depression, very swollen all over.

10 Jan: swollen, achy, anxious 5/10, had to lay on the floor for a while, not depressed, still sleeping deeply.

14 Jan: great day yesterday. Today 4-5 anxiety attacks at work. Felt like my family and I would be better off if I moved away. Cried myself to sleep, swollen feet, slept like a log.

15 Jan: down to 0.25 Mirtazapine and 1 Citalopram.

18 Jan: good, swelling basically gone. Easier to wake. 1 anxiety attack yesterday, none today. Feeling positive.

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** WeTest Weekend Workshops 2015 in Auckland #www15
***Antidepressants are useful for anxiety and depression, and a bunch of other things

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From Oz to NZ: 1 year later

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A year ago I moved from Sydney to Auckland with my husband and two young children, aged one and three at the time. We had always lived in Sydney, and we knew nobody in Auckland…
For anyone considering a similar move, here’s a short summary of my past year.

1. Missing family and friends
This is clearly the hardest part of moving overseas. To help with keeping in touch, most mobile plans here include calls to Aus as if they were local calls. Then there’s Skype and FaceTime. In the end there’s always trips back to Oz for holidays, and we’ve been extremely lucky to have family visiting us here. It’s such a great feeling to have familiar faces around and have a chance to really catch up.

2. Making new friends
All four of us have made new friendships in the past year, through work, daycare and neighbours. One week after arriving we celebrated our son’s first birthday in our hotel room, with just us. For his second birthday we had some close friends over for a proper backyard party, and I really felt that we had settled in. We were also honoured to be invited to a friend’s wedding recently, where it was hard to believe that we’ve only known them for a year.

I’ve found Kiwis to be very friendly. There’s also a large immigrant population here in Auckland who understand what it’s like to arrive in a new country, and are happy to help each other settle in. Check out the wide variety of local Meetup groups.

3. Expanded vocabulary
We have lots of Kiwi friends in Sydney, so I was surprised by all of the new words which I’d never heard before.
Waitangi, pukeko, tui, bach, pohutukawa, whānau, marae, Shortland St – I’m now able to use all of these words in conversation.

Saying ‘chilly bin’ (chully bun) seems way too hard compared to Esky, and I’ll know I’ve forgotten my roots if I ever call my thongs ‘jandals’ (jendels). pukeko4. That accent
We ate a lot of fush n’ chups on arrival, just for the fun of saying it. Twelve months later I still can’t help but order fush n’ chups and have an internal fit of giggles, even when other options on the menu look more appetising… If you think that turnabout is fair play, try booking a restaurant table for six!

Inevitably our children are developing Kiwi accents. I thought I’d mind but I really don’t. What I hadn’t expected was that they’re also picking up a Pommy accent for some words, due to the large number of British immigrants in our area. As for me, I find myself saying hid instead of head and bid instead of bed.. It’s especially noticeable when we have visitors from Oz, or when I first land back in Sydney.

5. Ours vs Theirs
Pavlova is not from Australia! I’m scared to even ask about lamingtons, meat pies and Vegemite.

Pavlova6. Rugby
Unless you’re a die-hard Wallabies fan, be prepared to follow the All Blacks. They’re local heroes, their faces are on lots of billboards, they’re always on the radio and TV, and the Silver Fern flags are flying year-round. And they do win a lot of games, to be fair. It’s only a matter of time before you succumb.
All Blacks7. The Rain
The Auckland Summer weather has been gorgeous. It may say 24 degrees on the thermometer but it honestly feels like 29, perfect for a swim. The water’s not even that cold once you’re in 😉 All of the local pools are heated, and they’re often free for kids aged 16 and under.

Then came the rain, and the locals told us it was the ‘Autumn showers’. That was a bit misleading, because in Winter we were told about ‘Winter showers’, and guess what happened in Spring? Yes, ‘Spring showers’. Sometimes it only rains lightly for an hour, while the clouds loom all day and you’re never quite sure when it will rain next.

Some advice we had before arriving proved to be useful – “Don’t change your plans based on the rain, just get out there and do it anyway”. It helps that the museums in Auckland are free for local residents, and that the main attractions (zoo, aquarium, MOTAT) have season passes available.

8. Getting away
In Auckland you can drive for an hour North or South and be well out of town at amazing mountain, farm or beach locations. If you’re from Sydney and used to driving an hour each way to visit friends on weekends, you’ll think nothing of zooming down the motorway for a day trip most weekends. There are also lots of excellent camping sites and a wide variety of holiday houses available in every town.

9. Public transport
It pains me to say this but for now just forget about it, buy a car. There are a few exceptions, particularly if you work very close to Central (Britomart), but for the most part public transport can take almost as long as walking. As in many major cities, there are improvements to public transport “coming soon”.

10. Exercise
Locals seem to be jogging, cycling, kayaking or sailing all the time. Eventually even I had to start exercising, just to fit in.

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Our plan was to live in Auckland for one year. That quickly became two years because of the hassle and cost of moving. Now we’re enrolling our daughter in primary school, with no plans of moving again any time soon.

Paying It Forward

Last year I received generous donations from the global online testing community in order to attend Let’s Test Oz.

As promised, I’ve started paying those funds forward. Wow, it feels good!

$50 per month is going to Oxfam NZ.

Also, so far $200 (of $900) has been paid forward to Per Scholas.

Both of these organisations run life-changing programs and have a huge impact in their community. It’s an honour to be able to support their work.

http://itesting.com.au/2014/07/24/how-a-test-community-became-a-family/

A Mental Health Exercise

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These are some of the thoughts which cross my mind when I think about getting some exercise.

Anxiety – What if?
What if I look like a loser when I exercise, huffing and puffing, all red-faced and sweaty?
What if I can’t even jog to the end of our street before I need to slow to a walk and catch my breath?
What if I can’t keep up with the others at boot camp?
What if I start a fitness plan and I don’t see it through?

Depression – Who cares?
Who cares if I’m fat and ugly?
Who cares if I get diabetes and need insulin?
Who cares if I just stay inside all day and do nothing?

In 2015 I’ll be trying to counter these thoughts with So what if?! and I care! I’ll need to recognise the thoughts for what they are, then try to replace them.

So what if I look like a loser, huffing and puffing, all red-faced and sweaty?! I don’t know or care what others will think.
So what if I can’t even jog to the end of our street before I need to slow to a walk and catch my breath?! I’ll walk when I need to, and try to jog a little further each day.
So what if I can’t keep up with the others at boot camp?! They all started somewhere, I’m sure I’ll improve over time.
I care if I feel fat and ugly! I care if I get diabetes and need insulin! I won’t just stay inside all day and do nothing!

Let’s see how it goes.

#100DaysOfExercise

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Lounging around on New Years Day, thinking about resolutions, eating leftover snacks. Lacking in motivation for getting off the couch and leaving the house…
I’ve decided to give myself an excuse to exercise. I have plenty of good reasons to exercise – Improve my mental and physical health, ward off type 2 diabetes, improved stamina when playing with my kids, improve my self-image… I think that each of those reasons are so enormous and important that they combine to keep me on the couch somehow.

Some of my reluctance comes from demand resistance. I can beat this by making exercise fun so it becomes something I want to do, not just something that I need to do.

Then there’s my fear of failure. This makes no logical sense, as not attempting to exercise means that I automatically fail to get fit anyway!

And there’s my anxiety and depression – the very things which are likely to be improved by exercise also combine to prevent me from exercising.

Here’s my idea to make exercising fun, and to give myself added motivation to do some exercise each day:
#100DaysOfExercise
Each day for the next 100 days I’ll post to Twitter and Facebook using this hashtag, to broadcast the exercise I’ve just completed. The self-congratulations pat-on-the-back aspect will also give me some motivation to keep going.

I’ll enjoy it that much more if others join in too – hint hint nudge nudge.

What’s it like to have Anxiety?

My GP says that anxiety and depression are the same, that they’re on the same spectrum. My psychologist specialises in this area, and he describes anxiety and depression as “best mates who like to hang out together”. Well these best mates of mine behave differently, and they’re both bastards. Here I’m focusing on anxiety.

Anxiety – What If?

When I’m feeling anxious I’m almost overwhelmed by a mass of non-specific “What if…” questions. It feels particularly strong when I’m about to leave the house or look after our kids. It’s not that I actually think I’ll crash the car, or forget to take my phone, or make a lunch that the kids won’t eat… it’s all of these and more. These thoughts gather, not fully-formed, and combine to make me feel on-edge for no specific reason.

My mild anxiety attacks feel exactly like having low blood sugar. Sometimes I even check my blood sugar level during a mild anxiety attack to see if I need to eat some jelly beans or not. I feel shaky, like the opposite of standing on solid ground – imagine a small earthquake or tremor. My hands tremble visibly and I become clumsy. I feel like everything around me has sped up, or like I’m moving in slow motion. My thoughts become foggy – a bit like having a head cold. I can’t carry on a conversation, complete a train of thought or focus on anything. When I can, I try to remember these things: Take a deep breath, relax, it’s just a hassle – nothing more, it will last less than 15 minutes.

Sometimes using common sense can help to get me through these feelings of anxiety. I try to articulate the thoughts which are making me anxious and replace them with logic. Other times I genuinely can’t work out why I’m anxious so I try to “fake it till I make it” by pretending I’m fine, which works surprisingly well.

Prior to seeing a psychologist I had a few major anxiety attacks and the worst one felt like a heart-attack. Strong, sharp chest pains, shortness of breath, accelerated pulse… It was extremely scary, which only made the symptoms worse.

What’s the cure?

I wish there was one… My main tools in this ongoing battle are medication and therapy. The medication allows me to feel more like myself in the short-term. Therapy helps me to understand my condition in depth; it teaches me how to cope and move forward; it helps me to be comfortable with discussing difficult topics and makes it easier for me to be honest and open with my friends.

Once I relocate my willpower I’d like to add exercise and a healthy diet to my toolkit. I’ve heard that they can also help a lot.

Help and Support

This post describes specifically how anxiety affects me, other people suffer in their own ways. The only advice I have for others is to find a doctor you trust and talk to them openly. It might help to practice what you want to say, or to write down some key points. For example:

I get nervous about leaving the house.
I’m not looking forward to things which I used to enjoy.
I’m dreading doing [something] next week and I don’t know why.

I highly recommend checking out at least one of these:
SuperBetter TED talk
Beyond Blue

Pregnancy complications – Part 2

Following on from Part 1

At 12 weeks pregnant the NT scan showed extremely low odds for our baby having Down Syndrome which was great news. The figures were presented to us with “Well done, congratulations, this is a really great result.” My husband and I are like-minded, and we left the consulting rooms mildly angry at being told “Well done” for something we had no control over. If we’d had high odds for Down Syndrome, would we have been reprimanded and made to feel guilty? Thankfully we’ll never know. At a later scan we learned that bub was a girl.

The 26-week gestational diabetes test was a sickly-sweet non-event. I continued seeing the obstetrician every 6 weeks. These visits usually consisted of getting weighed, sitting in the waiting room for an hour or so, seeing the doctor for 10 minutes, then paying another ~$300 towards his bill. During the appointment the doctor would answer any questions I had and do a quick scan with an outdated ultrasound machine. I always loved seeing bub’s little heart beating, and the occasional glimpse of a nose, hand or foot. The doctor always mentioned that she was a very active and healthy baby. I felt that I was putting on weight faster than I should, but I was within normal weight gain ranges.

At 33 weeks pregnant my job suddenly got very stressful, and not in the usual way of tight deadlines etc. There were some necessary budget cuts to be made, and two of my four team members had to be let go. I had two contractors on the team so they would be the ones to go. One contractor had just gotten married and was in the middle of purchasing a new home. The other had just been hired the previous month and had a two week old baby. Both of them were doing excellent work. They both understood and handled the situation in their stride, and aside from feeling stressed I didn’t notice any other effects immediately.

A few days later I realised that my nightly swollen ankles were still swollen in the morning, instead of returning to normal overnight. My pregnancy bible What To Expect When You’re Expecting listed this symptom under “Call your doctor if…” but it didn’t really say why, and I had no other worrying symptoms. It was after work (i.e. outside of doctor’s hours) so I called the maternity ward, and a midwife asked me to come in and get my blood pressure checked.

The hospital was only 10 minutes away so we left our half-prepared meal in the kitchen and my husband took me to the hospital. Apparently my blood pressure was quite high because I was admitted to hospital on the spot and restricted to bed rest. I was referred to a specialist for hypertension, and told not to return to work. I think this sent my blood pressure up higher, thinking that although I’d starting preparing for a handover I hadn’t actually done one yet. I sent my husband home to get my laptop, and some pyjamas and toiletries.

When he returned he said that half our street was blocked off to the public, with police cars and flashing lights everywhere. There’d been a drive-by shooting on our street. (We found out the next day that no-one was harmed.) There’s one every 2-3 days in Sydney but this was way too close to home… Not great for my blood pressure.

I logged in to work for 2 hours, wrote up hand-over notes, notified my manager and team, and tied up some loose ends. With that out of the way I was able to focus on my health and pregnancy, and I started to wonder if I’d be in hospital for the next 6 weeks. It was strange to be in the maternity ward as the only patient without a babe-in-arms, and it was very difficult to sleep at night with all the crying going on. I was sent for another ultrasound (upstairs), and this time I saw the blood flows in bub’s body appearing as blue and red on the screen. Obviously I couldn’t fathom what it all meant, but I was relieved with the report that everything was normal.

After 3 days – and some complaints about lack of sleep – I was discharged from the hospital provided I kept off my feet as much as possible. As I was leaving a midwife decided to check my blood pressure one last time, and checked my blood sugar as well for good measure. My blood glucose level was 10.8, and the acceptable maximum value was only 7.8 apparently. So I was ordered back into bed to await further testing. Another specialist came past and said that I could still be discharged that day, provided I visit the diabetes clinic next door for some education on how to manage my gestational diabetes with a strict diet. It was a relief to come home.

The next few weeks were uneventful. I was relaxing with my feet up watching lots of TV, reading books and doing crossword puzzles. It was frustrating to be home all day while unable to help out much with the housework, but my husband had it all under control. I followed the diabetes diet and pricked my fingertips 6 times a day for blood glucose tests at home. I bought a blood pressure monitor for home as well, and I checked my BP twice daily. Twice weekly I drove to the hospital for monitoring. This involved sitting in a room with around 10 other pregnant women, waiting for my turn on the baby heartbeat and activity monitor, eating hospital sandwiches with toppings that pregnant women aren’t supposed to eat, and waiting to see the doctor and nurse who were rostered on that day.

The medical staff measured my blood pressure and blood sugar, and reviewed the results I’d taken at home along with the readout from the baby monitor. The good news was that I wasn’t going to need insulin, but my blood pressure remained high. One nurse commented that bub’s activity rate was on the lower side of normal, but still within normal range. The results were all forwarded to my obstetrician after each visit. It did occur to me that my once very active baby was becoming less active, but I figured that space was getting tight in there by that stage. She was a big bub!

At 35 weeks my obstetrician said that he’d be inducing labour at 38 weeks. My high blood pressure could be a problem for a full-term delivery, and the risks to bub from being born early would be minimal because she weighed more than average. I had carpal tunnel sydnrome in both wrists, back pain, cramps, etc. and I liked the thought of an early delivery. We made final preparations at home, and arranged to donate the umbilical cord blood to the Sydney Cord Blood Bank.

At 38 weeks I was induced, and for 16 hours of labour bub was monitored constantly on the heartbeat and activity monitor. At that point bub still wasn’t engaged (i.e. ready to come out on her own) and I was taken down to theatre for a caesarean section delivery. Thankfully no-one used the word ’emergency’ at any time, but they did move quickly and efficiently.

My operation went smoothly and I felt that I was in great hands with my own obstetrician. I had a chance to quickly hold bub before she left with my husband, while the doctors continued operating. What I didn’t know as I was laying impatiently in Recovery, is that the midwives had quietly debated whether there was even enough time for me to cuddle bub before they rushed her up to the Special Care Nursery…

Back in the maternity ward the paediatrician on duty started explaining to us that there’d been a foetal-maternal haemorrhage in utero, and that our daughter had low oxygen levels in her blood and needed a blood transfusion. Bear in mind that I was high on morphine at this point and I was asking the same questions multiple times… Through my confusion I was able to understand that there was a problem with our baby girl, that she needed some more blood, and that a blood transfusion would solve the problem and she’d be healthy. She also had low blood sugar, which they would fix with some glucose. She was a 4kg baby, and she made the premature babies in Special Care look positively tiny.

P1060577It took less than 100ml of donated blood to save our daughter’s life. Over the next 3 days she fully recovered. Apparently it can take babies up to a week to recover from a transfusion, so perhaps her size helped her to recover faster.  We sat by her bed watching the oxygen percentage on her monitor and willed the number to climb from 85%-88% to up above 97%. We learned that somehow the barrier in the placenta wasn’t working properly, and she’d been losing blood into my body. A blood test confirmed that my blood contained foetal blood cells, which should never happen. The cord blood bank representative checked in on us, because her team had also noticed the low level of oxygen in our baby’s blood.

As for me, my diabetes disappeared almost immediately after giving birth and my blood pressure was back to normal within the week.

During my next pregnancy the diabetes returned and this time I needed insulin. At the Diabetes Clinic the topic of my daughter’s birth came up, and the nurse recognised my daughter’s case immediately. She used to be in charge of the Special Care Nursery. She remembered where she was that night when her staff called to explain the situation. Our local hospital normally wouldn’t perform blood transfusions, they’d transfer the babies to the Sydney Children’s Hospital which is less than 30 minutes away. But our daughter’s case was so urgent that there wasn’t enough time for an emergency transfer. I was finding this out 2 years after the event, and the news still gave me chills. I didn’t realise how close we’d come to losing our baby.

My daughter is 4 years old now. She’s in perfect health, tall for her age, caring and clever. She’s also a wonderful big sister to her little brother.

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