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. 

Next tattoo

 It's 3:43 in the morning and I've been awake for about the past hour thinking about my next tattoo. I'm supposed to have a consultation tomorrow to talk about it with an artist. I guess that's why I can't sleep. I'm still trying to decide if it's the artist I want to go with, for sure what tattoo I want to get next, and if I should wait until after the holidays and after our next trip. My husband is very supportive so he said I could get it now if I want to. Tattoos are always so healing for me.

I'm looking to get a tattoo of three butterflies to represent the three pregnancies I've lost. I want them to look like 3D like they're sitting on my skin. I'm thinking I'll get one purple, one light blue, and one lime green. The guy I'm going to see tomorrow is one of the cheaper ones in town, but his work looks nice. So I'm leaning towards going with him.

I was originally going to get the butterflies on my foot. I think they'd be cute there and symbolic because what happened was painful and the foot is said to be very painful. However, now I'm thinking if I get it on my foot I'll see it more than I'd like to. I don't really wear sandals. Only really when I dress up and when I'm at the beach, but I'd see them every time getting in and out of the shower too. And I'm nervous about how they'd heal in my shoe. Will it get infected? Will it hurt to the point where I want him to stop?

So I'm thinking I'll get them on top but towards the back of my shoulder, under the mountains on my neck, or the back side of my arm I can't really see unless I twist it. I thought about getting it on the inside of my ankle or my calf too but I think I'd see those too much as well. I overthink everything. So I'm thinking if I get it on top towards the back of my shoulder what will I wear while getting it. A bathing suit top then pull my arm out. However, then I'd have to cover up my stomach with a shirt in order to feel somewhat comfortable. And how would it heal with my bra strap right on top of it. I think it'll be cute so I'd like someone to be able to see it, just not all the time myself. I'm afraid every time I look at it it'll bring back the pain of losing the pregnancies rather I'm already thinking about them or not. 

I'm also hesitant to get them right now too because it's right before Christmas and we have a trip planned at the end of March. Wondering if I should wait until after then, but tattoos are so healing for me. I'm wondering if getting it now would be best.

I also want a tattoo of two dolphins swimming side by side. One big, one small to represent my son and I. I kind of want to get that one first, but I'm thinking the butterflies will help me heal so maybe that's the one I get next. Plus then I could see if I like the artist before getting the dolphins. I think the Dolphins might be harder, possibly cost more, and they'd be on my arm in a spot where I'd see them a lot so I'd want them to look really good and realistic. 

TMS therapy 2nd week

 I'm currently in my second week of TMS. The positive I've noticed is that I have more motivation and energy to do things particularly in the morning around the house. I'm not sure if that's due to the ketamine, the TMS or that I went up on Lamictal from 250 to 300. I really don't think it was the Lamictal. So it was either the ketamine, the TMS or a combination of both. However, that's about all the positive I've noticed. Overall I'm not doing very well. I don't want to die which is good, but I don't really want to live either. I hope things get better very soon. I've tried talking to my psychiatric nurse practitioner and she told me to talk to the provider in charge of my TMS. I tried to talk to that provider, but I can't talk to her since I'm doing TMS. The way billing works it has to be one or the other. So I spoke to her nurse who relayed a message to her who relayed it back to me. Basically they told me that with TMS things get worse before they get better. I could wake up one day crying and not know why I'm crying. I could become pretty irritable. Mood tends to get worse before it gets better. However she assured me if I stick with it there is a light at the end of the tunnel. I'm not supposed to change any of my medications while going through TMS. Mainly because they don't want to over treat. Why I can't talk to the provider in charge of TMS about my feelings while going through it is beyond me. You're messing with my brain and I can't talk to you.

I've been having a hard time getting through the day, especially the evening. I feel overwhelmed with how much time there is. My counselor mentioned maybe it's like a restless feeling. I'm trying to figure out what to do with my time now that I have a little more energy and I'm not just sleeping for 12- 15 hours a day. I try to sleep to get through the night which sometimes works. However my son told me he feels alone and sad when I sleep. That made me feel really bad. 

Last night I tried to figure out how to stay awake through the evening. I was pretty successful and didn't fall asleep until about 8:30. I don't understand how in the past sometimes I can literally just take life moment to moment and not even think about the rest of the day. So why now am I getting overwhelmed with having so much time. To me that tells me life isn't going too well. When you feel like you have too much time you're not doing well. When you feel like there's not enough time in a day I feel like life is going pretty good.

My husband and I recently spent a lot of time exploring the option of getting a new insurance through his work to cover IVF. In the end we opted to stay with our current insurance which does not cover IVF at all. Therefore if we decide to do IVF it'll be all out of pocket. We don't know if we'll ever do it. Hopefully things work out where we never have to. I've been trying not to think too much about having another child and just take the time to focus on my mental health for now. However I did talk to maternal Fetal Medicine and the provider told me that all my medications are fine to take during pregnancy. If I need to go back on lithium it's not as harmful as they once thought. If I took it after 12 weeks there would really be no chance of harm to the child. Before then would be very minimal. The main thing is I wouldn't be able to breastfeed on lithium. I'm really hoping I don't have to depend on lithium, but at least I know it's an option. However I would want to breastfeed so that would be a big problem. I won't worry about that unless the issue arises. 

I have an appointment next week to talk to a different doctor about the possibility of mini IVF. My current fertility Dr. does not believe in it. I kind of want to cancel the appointment because I don't want to think about it right now. However, right now I don't have to pay a copay for it so I'm thinking I might as well at least talk to her.

Ketamine #5 and #6

 I finished my acute phase of ketamine infusion therapy. Overall I'm not feeling life and I've still been pretty down. I'm pretty upset/ disappointed. The first ketamine treatment helped, but ever since then hasn't been any better. I've been sleeping a lot, like 12 hours a night. Last night I slept about 12 hours, but I woke up and was able to do things. I still didn't particularly want to do things, feel like doing things, but I had the energy to. And I was able to. A lot of days I wake up and I just can't. Today I woke up and I could. I've been pretty productive so far today. Not sure what I'll do with the rest of the day. I start TMS therapy tomorrow. I'm still hopeful, but not as hopeful as I was that it'll work. I'm just tired of feeling down every day.

I was feeling really off/ anxious before my 5th ketamine treatment. Therefore I was given Ativan. It worked really well. My current nurse practitioner doesn't prescribe that class of medication so I'd have to switch providers if I want to take it again. Debating if I should or not. Ativan increases the chance for dementia with prolonged use and it can easily become habit forming. I'm wondering if it's worth it to use it short term. If it'd somehow cure this off feeling I get. 

I was told that maybe ketamine hasn't been as helpful as I'd hoped because I went off of lithium at the same time. Maybe it was helping more than I thought. I was hopeful that the ketamine would make up for the loss of lithium and I wouldn't notice a difference coming off of it, but that didn't seem to be the case. The nurse practitioner said I'd probably notice a difference in a couple weeks. I'm supposed to get a maintenance treatment of ketamine every month from here on out until I no longer need it. If I get pregnant I'll stop doing it as well. 

I've been doing a lot of research on different insurances offered by my husband's work. We'd be spending quite a bit more money a month and for the year but it includes IVF. So if we were to do IVF we'd actually save a ton of money by switching insurance. However, if we end up not doing IVF then we'll have spent a bunch of money unnecessarily. At this point I don't know what I want to do. Sometimes I wake up and I really want a baby and I want to grow our family. Other days I wake up and I don't have the energy, I don't want that level of responsibility again, and I don't know if I could take care of a baby anyway since I still feel off so much and have nausea everyday. Hopefully I get clarity sometime soon that lasts.