Good days

 Yesterday was a hard day. It just felt like it was impossible to get through. Not sure why. Thankfully yesterday evening was better. I'm back to sleeping 10 or more hours the past two nights. Even though I slept a lot last night I have some energy today at least so far. 

This past week I had some good days. The first couple days were good because I felt like I had a lot of energy. It wasn't so hard to make a decision on every little thing. However, I was operating on 4 hours sleep those days. The other couple days were good just because I was calm. I actually had times where my mind was blank. Like I wasn't thinking about anything at all. It was peaceful. 

Calm, but down

 I don't really feel like writing tonight, but I am so I can better track my mood. Night before last I slept about 7 hours. I was kind of amped up in the morning until we went to look at mattresses. I laid down on a base that massages and I completely calmed down. I'm still calm. I don't think a few minutes of a bed massage could relax me for that long. 

Last night I slept 4 hours again. This time I couldn't sleep because my knee and ankle were killing me. I don't know if it's our old mattress or the weather or what. Today has been a lot different. Usually when I don't get much sleep I feel amped up the next day and have quite a bit of energy despite being tired and I have to work to not let my thoughts race in my head. Also, I'm usually in a better mood. Today was the complete opposite. I didn't get much sleep, but I've been completely calm today and feeling down most of the day. I don't think a few minutes on a vibrating mattress yesterday would cause me to feel this way. 

I've been down most of the day, but my mind was very calm. I feel flat almost emotionless though tears did come to my eyes when my brother told me he got to stay here. It was touching I guess. The past few days at tms I had been pretty animated and very talkative. Today I hardly said anything, just answered questions pretty much. I watched family matters and didn't laugh, I thought the episode was dumb. Tonight I'm having a hard time focusing on anything, but it's like my mind is more blank than usual. I'm not distracted by having too much on my mind, I just am kind of here having a hard time focusing on anything even thoughts. I haven't felt off tonight. At least not so far. 

Better sleep, provider response

 After having such a good day yesterday I took about a 20 minute nap and woke up feeling depressed again, having passive suicidal thoughts and feeling like getting through the night was nearly impossible. So much for the all up from here hope. 

All in all last night I slept much better. I went upstairs about 9:30 to lay down. I ended up having really bad stomach pains until 11. I was able to mostly resolve those and get back to bed about 11. I probably fell asleep about 11:30 and woke up at 5:30. Laid in bed until about 7 and got up. Not really sure how I'm doing yet today. Not amped up, not too tired, no desire or motivation to do much, but I feel like that could possibly change soon. It doesn't feel impossible like it usually does.  

The provider over seeing my tms and ketamine treatments emailed me back. I was thoroughly impressed because it was very thorough and thought out. I was totally expecting a few lines followed by we'll discuss further at your follow up next month. She said it was absolutely common to experience an emotional "purging" during tms as well as ketamine. It is common to experience very rapid and INTENSE mood shifts, tearfulness, and disruptions in sleep. Sure would of been nice to have been told this prior to treatment so i could've thoroughly thought out if i wanted to go through with it or not or at least be more prepared of things to expect beforehand. She said something important to note- ketamine can enhance the mood state you are in when you receive the infusion- positive or negative. She said you absolutely do not have to focus on anything intensive during the infusion. Ketamine targets glutamate receptors which helps ptsd, depression and anxiety. It also is one of the only medications that's creates growth of neurons and synapses. Ketamine will do that whether or not you are journaling/thinking/etc.

She also mentioned she thought I could really get improved symptom management with a medication adjustment. She said she wonders if the extremely high doses of welbutrin and latuda could be causing akathisia or restless leg syndrome. My current provider has mentioned this too. It could be the reason for the "off" feeling I get. However the medicine given to combat that doesn't seem to help. 

My "off" feeling has actually gotten better. I used to feel like I just had to escape and try to sleep through it and wait for it to pass. The past week or so I still have times where my legs and arms won't stop shaking which is annoying but I have been able to function through it and stay awake. This makes me think maybe it's being triggered by anxiety. The tms and ketamine are both supposed to help with anxiety. So maybe they're helping with that and that's why the "off" feeling doesn't affect me so much mentally anymore.

Diagnoses can really suck so much and it's amazing how they can affect you and make you over think so much. Yesterday i was over thinking everything. It's like even when I'm feeling good I question if I'm "allowed" to feel that way or if it's hypomania and a red flag I need to watch out before I become manic. When I'm sleep deprived I actually have more energy and feel kind of amped up. Is that hypomania or am I just not feeling depressed? I recently spent a lot more on a mattress and base than I anticipated. I went out not even intending to buy a base. I researched for days, visited multiple stores and spent countless hours trying to make a decision. I didn't just walk by a store and say yep I want that one and buy it. Was I hypomanic over spending and I need to watch out before it leads to Mania or am I just fed up with feeling like shit and want to be comfortable so I can sleep well so I'm willing to spend more? Why can't I just live without over thinking every little thing I do... 

Tms, ketamine, sleep, diagnosis

 I haven't been sleeping well the past few nights. Well really I never sleep well. I usually wake up about every hour or so. I was sleeping 10-15 hours every night. However the past few nights I haven't slept more than 4-5 hours. I've basically been going to bed about 10 and waking up about 2 with no naps. The first night I couldn't get back to sleep was because I couldn't get comfortable. I need a new mattress. Easily explained. The next night pretty much the same thing. The third night I couldn't fall back asleep because I couldn't stop crying. Tonight a combination of things. Can only breathe out of one nostril when I lay down, but I'm not sick. Not sure if my apap machine is making it worse. Couldn't get my mask to stay sealed correctly. Not very comfortable. I thought I'd be upset about not being able to sleep and be super tired. I'm tired, but functioning and just hanging out. Not too upset as long as this doesn't lead to Mania. 

I'm just over half way through tms treatment. I'd been going everyday the place was open for what seemed like forever. Now I'm finally in what they call the tapering phase where you go 4 days a week, then 3 days, 2 days and finally 1 day. I also had my first maintenance treatment of ketamine the other day. 

Two nights ago I think I had reached my breaking point with all my stomach issues. I've been battling nausea everyday and vomiting most days as well as constipation. Long story short maybe I'll add it later but basically my husband and I got in a fight about a burger. I was so pissed. That led to my break down. I just started crying and told him I hate life. Life right now just really sucks. 

I pulled it together for the rest of the night. Fell asleep about 10, woke up at 2 then at since point fell asleep and woke back up about 4, but this time I couldn't sleep because I couldn't stop crying. I laid in bed for probably a good hour crying softly. My son was sleeping next to me and woke up and said mom are you sweating. I said no I'm crying. Why are you crying? I'm sad. Why are you sad? It's hard to explain. Why? Because I'm tired of throwing up. Then he was awake so we went downstairs about 5:30. I usually don't let him get out of bed until at least 6, but we went down early because my stomach hurt. I felt like I was starving so I ate some crackers and took some ibuprofen because I'm pretty sure I had a headache. The crying never stopped. I cried probably two more hours. My son said mom stop crying it's so annoying. Please don't cry all day. 

I was crying about everything good or bad. It was like a movie of my life was playing in my head. One thing led to another and it was just constant. The whole time I never even thought about all the pregnancies I'd lost. It was like it was all the little things I'd never really cried about before. I was told about halfway through tms people tend to experience unexplained emotions that are just all of a sudden. Like they'll cry and not know why they're crying. The week prior I had a day or two where I was irrationally angry. I couldn't fall back asleep. It pissed me off and it ruined my whole day. I was angry all day. Now with the crying. I knew exactly why I was crying, but why now and why so much. 

I sent my psychiatric nurse practitioner an email and the provider over seeing the tms and ketamine an email explaining what happened, but I haven't heard back from either one of them. I'm assuming this is just a turning point in my treatment and everything will be up from here. But I've thought that before and obviously I was wrong because I've fallen back down. 

The provider that told me about the tms and ketamine told me about all the benefits of these treatments, but not really anything about the difficulties. Living with depression, anxiety and ptsd is hard. Going through this treatment is just as hard. I just hope it turns out to be worth it. 

After the 3 or so hours of crying I was able to talk to my counselor. She helped a lot. I was able to process what ketamine brought up for me. I was told if I brought something with me I wanted to work on to ketamine it would take me there. I was working with a new nurse who didn't really know me so we were talking a bit during my session. I mentioned witnessing the suicide so then I started thinking about it and I decided well let me focus on this to work on it, but it only made it worse. I started thinking maybe he did the right thing and I should do it too. I didn't really feel like I should tell the nurse because I didn't really know her and she's not a counselor. I started trying to watch family matters because it tends to make me laugh so I thought maybe it'd help distract me and put my mind on something else. Somehow I managed to put it on the only episode with a gun in it. Steve had invented a machine that would transport anything he put on it to Paris. By accident they discovered it would send not only objects, but people to Paris too. So the whole family decided to take a trip to Paris. Anyway the lady on the receiving end of this machine boyfriend decided he was going to still Steve's invention and then kill him. So I'm on ketamine like is Steve going to die. No it's family matters no one is going to die. There in Paris. Can I go to Paris? No you can't do that, that's not real. Am I in Paris? Then I started feeling like I was floating and I got really confused battling with this internal dialog with myself. I eventually got done with ketamine and settled back into reality. 

Then later that day I ended up having the break down followed by all the crying. I'm assuming it was all due to the lack of sleep combined with the stomach issues, combined with tms and ketamine and that's all it was and it's behind me. I guess time will tell. 

Talking to my counselor helped a lot because she just had surgery on her foot so she's stuck at home and can't do much. She's sarcastic so she makes me laugh. She was saying she is so bored she takes like 3 naps a day and goes to bed at 7:30. She can't figure out if it's physical or mental at this point. She said it so light heartedly I was laughing so hard because that's the way I feel everyday. I kept thinking there was something really wrong with me, but maybe I'm just having a hard time because I'm bored. She said I have too much time on my hands. Life is so much easier when you're busy all the time. 

The new psychiatric nurse practitioner I saw that put in for the referral for tms and ketamine left the practice. She told me when I met with her the one time that she couldn't diagnose me after only seeing me for an hour. She said she wondered if I really had bipolar disorder because major depression can cause psychosis. Mania is very similar to psychosis. The lack of sleep in the past led to the Mania, with bipolar the Mania usually causes the not sleeping. So maybe what led me to the hospital wasn't Mania it was psychosis. I don't have bipolar 1 disorder. I have major depression with a psychotic episode. After asking I finally found out she did diagnose me. She diagnosed me with major depressive disorder, generalized anxiety and ptsd, chronic. She is the first one not to jump to a bipolar diagnosis. 

Since she left a different provider is over seeing my tms and ketamine treatments. I have a follow up with her next month. I'm interested to see what she finds to be my diagnosis after going through all of this. 

I talked to my counselor and she said she agrees with the major depression, not the bipolar. She said she's never seen a bipolar person that has the perfect cocktail of meds to keep them from getting some kind of Mania at some point. Mine was a single episode many years ago and the post partum psychosis I experienced could've been linked to major depression as well. 

All in all it really doesn't matter what I have. They are all just labels. Whatever it is I just hope it gets better. I feel much better after the breakdown, all the crying and talking to my counselor despite the lack of sleep. Hopefully it just continues to get better from here on out.