Depression

Depression is a technical, psychological, medical diagnosis.  Therefore I as a person and I as a nurse cannot state that I am experiencing Depression.  That being said, having worked as a nurse specifically in several psychological areas and having dealt with the differences of diagnosing someone with depression vs having them be sad or grieving or mourning, I'm fairly comfortable stating:

I am depressed.  Severely depressed.  

A simple definition of depression (or Major Depressive Disorder) is:  A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

The thing that always stuck out to me in nursing school and in practice both in the prison and the mental health hospital was the 'loss if interest in activities'.  I mentally put that as an inability to experience joy in otherwise normally joyful activities.  But let's break this down and look at me through the various lenses. 

Persistently
Yes.  I'll get more into how I feel and how I express it below, but I've been feeling this way for almost all of 2024 and it's only been getting worse and worse.  

Depressed Mood

Yes.  I feel 'down' almost all the time.  I was never a happy go lucky guy or a clown or whatever, but I was 'up' most of the time.  I was able to smile and joke and try my best to boost people around me up.  Make them laugh and share my life with them.  Now?  Now, I can't do those things.  I don't care.  Most of the time I don't want to make people feel better.  

Loss of Interest in Activities

Yes.  The easiest is playing games on my computer.  I've had Stardew Valley, Horizon Zero Dawn, Assassin's Creed Valhalla, Hell Divers 2, Alan Wake 2, and other games on my desktop just waiting for me to play them.  I haven't even opened up Alan Wake 2 and Horizon Zero Dawn even though I've wanted to play them since they came out in 2023 and 2017.  I've barely played Assassin's Creed Valhalla since 2023 even though they've since released Assassin's Creed Mirage and announced Assassin's Creed Shadows, both of which I'd like to play.  I played Hell Divers 2 for about a week with my nephews and brother.  They still play often, but I just don't have the gumption to join them.  

And it's not just gaming on the computer.  I don't have the same interest in watching movies or TV shows.  I mentioned in my last update post that I started watching Billions.  Yeah, it's a fine series.  Might even be great.  But I just have it on to have something on.  I have no strong desire to watch it.  I normally salivate at the idea of going car shopping, but I barely put the effort into searching for what became Layla.  And now that I have her?  I didn't do it well enough.  I made mistakes and have a car that I don't like, let alone love. And now it's hitting my writing.  I've been on this particular part or chapter of Gamer Gurl since September 11th.  It should be an easy chapter to write as it's a little fun, a little sexy, but mainly a bridge between two bigger parts.  But while I've started writing in it twice, I've barely made a dent.  And this isn't a BIG chapter we're talking about.  I have a target of 2500 words and I can't get more than 500 in before I start to feel that I'm just spinning my wheels.  I save what I did and figure I'll try again later.  But when later comes, I pick it up, read what I've written and can't decide if I should fix it or start over and eventually just close it with no desire to do either.  

So yeah... I've lost interest in activities that used to bring me joy and have almost gotten to the point that NOTHING is bringing me joy.  

Causing Significant Impairment in Daily Life

Yes.  I'm already impaired for most days because of my migraines.  Even if I felt 'up' on those days, I couldn't do much as my mind is mush and light hurts my eyes.  But I used to feel better, feel happy, feel good, on days when I didn't have a migraine.  That's not true now.  

A few days ago I was actually feeling good.  I went out to help with dinner as mom was making some salmon patties.  I set the table and she said its going to be awhile so I could go back to my room.  If I had a migraine I'd have done just that, but I stayed out.  And since I was feeling good I was able to chat with Mom instead of just hanging around and being angry that she's not asking me to do more.  I was able to help her without making her feel bad about having me help.  When we finally sat down I thought about it and I haven't felt that good in months.  I haven't been myself, or been able to help because I've felt down and out and I just didn't care.  

So, I think it's pretty fair to say that I'm depressed.  But I'd also think it's pretty fair to say that I'm depressed because of my migraines.  I can't do anything.  I can't work.  I can't be a good brother or son or nurse.  I can't be a friend at all, let alone a good friend.  I can barely even keep in touch with people online when it's as easy as typing 'Hi!'.  It's especially hard because I can't work though.  I'm fairly certain that I'll be able to keep my long term disability going until it runs out in September of next year.  But what happens if I can't work even then?  I'll become a burden to Mom.  The very person I'm supposed to help.  

If it was just that, being depressed because of the migraines, I still might not do anything about it.  I mean, once I get the migraines under control the depression will take care of itself.  I'm fairly sure if I went six days without a migraine (which hasn't happened in over a year!) I'd start feeling less depressed.  At least temporarily.  No, the problem is the darker thoughts that are coming with it.  

I want to put out there that if you are ever fearful thinking someone you know may be suicidal, ask them.  Don't think that asking them will put the idea in their head.  It doesn't work like that.  Me talking about suicide here isn't a sign that I am suicidal or that I want to kill myself.  That being said, I'm on the path that leads to it and I realize I'm on that path.  

The path starts off simply with a desire to not continue to experience these debilitating migraines.  Read that part above again... I haven't gone six days without a migraine for well over a year.  I've only had two stretches of five days without a migraine in that time.  When I have a migraine I AM NOT ME.  I keep trying to do something, do anything, but I mess up.  Sometimes I hurt myself, sometimes I hurt others.  Sometimes I cut my toe and bleed all over the floor ruining the carpet.  Sometimes I burn myself in the shower because I forgot to turn the water temperature down.  Sometimes I forget the milk in the back of the car and cost myself $18,000.  I do not want to continue to live like this.  Without hyperbole, this is torture.  It's cruel and it's unusual.  And if dealing with it for over a year like this has brought me this low, what will another year bring?  

So I started with not wanting to continue to live like this.  But sometime in the past few months it's move to something more severe.  It's moved on to hoping I get a bad diagnosis.  That my neurologist or primary care doctor or endocrinologist or even my dentist says that there is a problem and that it's ultimately fatal.  That I'll die within six months of this problem.  I'd be so happy if that happened.  It would mean there's an end to the migraines.  An end to not being myself.  And that's a dark feeling to have and an even darker feeling when you realize what it means.  Death is better than living.  

If something is better than something else, the logical conclusion is to move to that better state, right?  I mean that's just logic.  If I'm in the right lane and traffic isn't moving here, but it's moving in the left lane, then it's better over there.  So moving into the left lane is a good thing.  Well, if death is better than life, then making that happen is.... you get the idea.  

I'll repeat this several times.  I am not currently suicidal.  But I'm starting to think about dying a lot.  Sometimes by natural means, hoping that I'll get a disease that will kill me, sometimes by accidental means, like a car crash, but sometimes my own hand.  And then, since I'm a logical thinker and try to move from point A to point B with as much efficiency as possible, I start to think what would happen then.  How could I do that.  How could I mitigate any pain and suffering from those I'd leave behind.  

Much of the time when I get that dark, I can pull myself out of it.  Or rather, I can distract myself into something else.  TV, movie, YouTube, online chat with friends.... just something else.  But sometimes I can't.  

I recently spent an afternoon going through my medications and looking at how overdoses of them would affect me.  You all know I'm diabetic and probably know that I'm on insulin.  Insulin is a scary drug.  My endocrinologist has me on a device that's attached to my arm that continuously monitors my blood sugar specifically because there's a chance, even just a small chance, that the insulin dose I'm on could push my blood sugar too low.  Go too low and you go into a hypoglycemic emergency.  Your brain shuts down.  You'll likely seize, but if not stopped you'll die.  Well, I'm on twenty units of insulin per day.  My pharmacy ships me enough doses for three months.  My insulin is delivered in pens where you dial up the amount you want to inject, attach a needle, and inject it into yourself.  Each pen has 260 units.  Right now I have five full pens plus my currently used pen which has about 120 units.  That's 1420 units of insulin.  I'm fairly sure that that alone would kill me, but if I wanted, I believe I could refill my three month prescription right now which would deliver ANOTHER 5 pens.  

Not enough?  I have another three medications in enough supply to probably kill me.  There are natural problems with researching suicide by medication as it's not just put out there.  "Oh, if you take a bottle of these pills with some vodka, you'll kill yourself".  Some pills will cause you to vomit if you consume them too  fast.  Some will knock you out before you've consumed enough to kill yourself.  Some simply won't work as your body will filter out excess amounts and you'll just hurt your liver or kidneys.  But I'm not just anybody.  I'm a nurse and know what to look for.  And yes, I have three current medications that I believe I could kill myself with.  If I took all three of those along with the insulin?  Yeah, I'm gone.  

That was one dark bitter afternoon.  I'll repeat again, I am not currently suicidal.  But I'm a planner.  I'm a gamer that games out future scenarios so that I'm ready for them when they come up.  

I know I can kill myself.  Beyond the medication there are guns in the house, I can buy other guns if my brother has all our current firearms locked away, there's the car, there's hanging, gassing myself.... I can kill myself.  But how do I mitigate my family's pain?  And how do I prevent them from stopping me.  Many suicide attempts are calls for help.  Cutting your wrists in the bathroom when you subconsciously know that a family member will likely find you before you're dead.  But I'm a planner and wouldn't want that to happen.  So NOT doing this at home is probably the best bet.  Let's consider the medication method.  I believe it will take about 10 hours from when I start injecting and ingesting the medications to fully and irrevocably die.  There are plenty of parking lots where I can park and be left alone.  Not completely empty ones as a car suddenly in one of those would arouse suspicion, but ones where shoppers aren't walking past the car and would see me seizing in the back seat.  

I'll reiterate, I'm not suicidal.  But I've had enough dark days that I've thought these things out.  

So I take my meds, find a quiet place, and set myself up to die.  While I don't want to be interrupted, I don't want my body to lie there for days or weeks unfound.  I certainly wouldn't want my family to go through the pain of wondering where I was.  I can set up a text to be sent out in the future.  I just have to make sure I have good signal, set up the text to go out 12 or 14 hours after I start, and then it will happen.  But what if my phone runs out of battery?  I thought about plugging it into the car, but the car will shut off after thirty minutes.  I do, however, have battery banks.  I can make sure my phone is fully charged AND plug it into the power bank.  The phone should last a good twenty four hours if it's not constantly searching for signal or doing other things.  The bank can charge the phone three full times.  So unless I screw the phone up, it can last four days like that.  The text would be to tell my brothers that I've committed suicide and can be found at this particular location.  That my car is locked, and they need to bring the extra set of keys.  That I'm dead and they will need the police and/or emergency services.  

I thought about leaving the car unlocked so that emergency services and/or the police could open it without breaking the window.  Layla has value after all and I don't want to deprive my family of it (I doubt they'd want to keep her after I died in her, but she could still be sold).  BUT, if the doors are unlocked a good Samaritan might find me and see what's going on before my death is irreversible and contact emergency services and/or the police.  So a broken window has to be risked as it might buy me another twenty minutes and that can be the difference between a successful suicide and an unsuccessful attempted suicide.  

Again.  I am not suicidal.  

I talked a bit about a digital goodbye.  It's something that I still want to set up.  Yes, the thought came from this type of dark thinking, but it's a good idea regardless.  While I was writing the previous 'update' post I had to go through my Facebook page to find something I posted a couple years back.  Going through all my posts was a reminder of good times.  It reminded me that if I were to pass away, it would eventually get washed away as no one would have access to it.  Or worse, it could be hacked and then my online memory would be destroyed as no one has the ability to shut it down.  That thought applies to practically everything digital about me.  So, I need to set that up.  It's be part of my suicide.  My suicide note couldn't exactly be sitting on my desk.  My brother might wonder where I am, step into my room and see the folded up piece of paper on my keyboard.  Read it, figure it out, find out where I am, call the police.. suicide gets transformed into suicide attempt.  If, however, my suicide note is a word document saved to my desktop?  Well, if I've given my brothers my digital passwords and such, my final text can simply say that my suicide note is on my computer's desktop.  I doubt they'd have logged in and checked there if I'm only gone for a day, but they would now have access to it. 

I think you can see that this depression is getting bad.  I keep getting stuck into these thought exercises that are steps toward suicide.  I'm not suicidal but the difference between here and there isn't much.  And if I keep thinking this way I'll have made it so that I can do this on a whim instead of thinking about it for a couple days when I'd likely kick myself out of the dark thoughts.  I can't just do this on my own.  

Earlier this month I mentioned that I'd talked to my neurologist about ongoing worsening depression.  He had four simple suggestions:  Religion, Exercise, Medication, Therapy.  I'm not religious, don't want to be on more medications, and can't exercise regularly.  That leaves therapy.  I called a psychological center and finally got an appointment.  It was rough as it was on a Saturday morning.  I say rough because I'd normally be meeting my brother as we prep to watch college football all day.  Obviously though, this is more important so I accepted the appointment.  

I've always gone by the process of "Early is on time, on time is late, late is unacceptable".  So with the appointment scheduled for 9 AM and the center being a ten minute drive from my house, I left at 8:35.  I arrived at the center at 8:42 (I drive fast, sue me).  There was another car in the parking lot so I figured this early in the day it was a one man show.  He was already inside setting up.  So I sat and waited until 8:50.  At that point I got out of my car and went to the front door... and found it locked.  I walked around the building and found another door.  It was marked with 'Private Entrance" (and it was locked too since I disregarded the sign).  

Confused, I texted the scheduler that had set up the appointment.  The Center obviously used to be a house, so it doesn't have a good normal business layout.  I went to Google maps street view and looked at the other side to see if there was an entrance over there.  There was, but even in Google maps I could see a sign that read "Entrance on other side".  I did, however, see a side entrance and a lower parking lot.  I drove down to that parking lot, parked, went up to the door and.... locked.  

With no return text from the scheduler I started considering leaving.  Talk about depressing, try going to a visit to a therapist to get help only to have them not show up.  At that point though I looked up toward the upper parking lot and saw my psychologist standing there next to a different car, looking down at me.  Yeah, he showed up after our appointment time.  

Early is on time, on time is late, late is unacceptable.  He was late and I found it unacceptable.  If it hadn't taken a month to get this schedule, I might well have rebuffed him then and there, but it HAD taken a month and I didn't want to wait longer.  So we walked in and yes indeed he was alone.  He had me fill out the paper work and took my insurance card (almost forgetting to give it back), and then realized I had more paper work to fill out.  When we finally sat down I let him lead the conversation.  I honestly don't have a good thought on what he can do or say that will help me.  That being said, I do believe in psychological help and that means putting myself in his care.   So he kept coming at my depression from different directions.  It's difficult to talk about myself that way.  It's showing weakness that I don't do except for here with you.  I don't tell mom or my brothers or my friends just how weak I feel sometimes.  I certainly haven't told any one of those people how much I've been thinking about death and dying and ways to make that easier on myself and those I leave behind.  But I laid out everything with this psychologist that he asked for.  

One insightful thing he noted that I hadn't thought of was that my thoughts can be rather obsessive.  Its part of that whole planning and gaming out scenarios.  I keep going after something.  Most of the time it's a good thing.  I want a car, so keep gnawing and working at the problem until I have it narrowed not down to just one type of car but to a small list of particular cars.  It helped me focus on becoming a truck driver and it helped me focus on becoming a nurse.  It's helped me somewhat on dealing with the migraines.  But now it's a detriment as I've locked on to killing myself.  And while I don't want to do it.... well, I didn't exactly want to buy a Mustang, but a couple years after I had the thought, a couple weeks after I started to seriously consider it and a couple days after I found one that might work.... I owned a Mustang.  

When he offered suggestions I was initially insulted and upset because his two suggestions were to exercise and to start taking an SSRI (selective serotonin reuptake inhibitors, or a major class of antidepressants).  I disagreed with him on the exercise as I honestly believe it won't be consistent enough to help.  Exercise releases dopamine and it's a great super powered distraction.  When you are exercising, you're generally not thinking of ways to kill yourself.  Then with the dopamine hit, you feel good afterward and are further away from thinking about things like that.  It's true and I believe that, but I can't exercise when I have a migraine.  The light and the motion will make that an impossible task. That just leaves a handful of days a month that I'll be able to do anything.  We continue to disagree about the possible effectiveness of exercise, but he's the therapist and I'm the patient so I told him I'd give it a try.  

The SSRI is something I thought I'd disagree with but he made a very good point.  There are SSRIs that can help with obsessive thinking.  I've seen it work both in the prison and at the hospital.  Yes, it's another medication and yes it's another set of side effects and interactions to worry about, but it might hit this depression in TWO ways.  Directly and by disrupting the obsessive thoughts.  

I look at it this way.  I've said that I can work through pain.  The pain of migraines won't stop me from working.  The disrupted thoughts prevent me from working.  Well, with the depression the depression itself isn't necessarily something I feel I need to fix with medication but I'd accept medication to prevent me from thinking about killing myself so obsessively.  

My next step is to talk to my doctor.  My primary care provider.  And let me tell you, I love having my doctor as my doctor.  I figured it would take about a week to get an appointment.  Most people seem happy when they can get an appointment in two weeks, but my doctor has always been pretty quick.  Well lo and behold when I tried to set up an appointment through their online portal (I really didn't want to talk to someone and have to say over the phone I want to see him about depression), it said I could get an appointment as early as tomorrow morning.  It even said I can go on the wait list and possible get called in today.  I took the morning appointment and will see him tomorrow.  

I give it a 20% chance that he's going to want to prescribe me a medication.  In simple terms, SSRIs mess with your brain chemistry.  So do all of my migraine medications.  Propranolol, Depakote, Ajovy, Namenda, and now low dose naltrexone.  Which SSRI would be best for obsessive thoughts AND not mess with or interact with any of those medications not to mention the other medications I'm on for diabetes, blood pressure, cholesterol, GERD, and allergies.  

If my doctor isn't comfortable setting up and/or managing an SSRI, he'll refer me to a psychiatrist.  That will kind of suck as it will be another referral and another waiting period before I sit in front of somebody.  And when I do, I'm going to have to cover just about everything I did with the psychologist.  But that's another worry for another day.  Right now I have that appointment with MY doctor.  

I also set up a recurring appointment with the psychologist.  I didn't mind speaking with him and if theres any help to be had there, I'd rather talk to him than get prescribed a bigger dose of medication.  I'll see him every other Thursday.  At least it won't interfere with Football Saturdays!  

I was just about to post this when I thought of something.  Maybe a way that I can express my depression, or rather how it colors everything I think, see, or do.  I saw this video of a dance group the other day.  It blew my mind and was just amazing, but I felt almost worse after watching it.  I didn't feel inspired like I would even for a sad dance and this isn't a sad dance.  

Here's the video:

It's an old song.  Goyte's Somebody That I Used To Know.  It came out in 2011 and I loved it upon release.  I never thought of it as sad before.  I listened to the lyrics and even made a cap based on the lyrics, but I never thought of them as dying or death or suicidal.  But here we are.  

Now and then I think of when we were together

Like when you said you felt so happy you could die

Told myself that you were right for me

But felt so lonely in your company

But that was love, and it's an ache I still remember

You can get addicted to a certain kind of sadness

Like resignation to the end, always the end

So when we found that we could not make sense

Well, you said that we would still be friends

But I'll admit that I was glad it was over

But you didn't have to cut me off

Make out like it never happened and that we were nothing

And I don't even need your love

But you treat me like a stranger, and that feels so rough

No, you didn't have to stoop so low

Have your friends collect your records and then change your number

I guess that I don't need that, though

Now you're just somebody that I used to know

Now you're just somebody that I used to know

Now you're just somebody that I used to know

Now and then I think of all the times you screwed me over

But had me believing it was always something that I'd done

And I don't wanna live that way

Reading into every word you say

You said that you could let it go

And I wouldn't catch you hung up on somebody that you used to know

But you didn't have to cut me off

Make out like it never happened and that we were nothing (aah-ooh)

And I don't even need your love (ooh)

But you treat me like a stranger, and that feels so rough (aah)

No, you didn't have to stoop so low (ooh)

Have your friends collect your records and then change your number (aah)

I guess that I don't need that, though

Now you're just somebody that I used to know

Somebody (I used to know)

Somebody (now you're just somebody that I used to know)

Somebody (I used to know)

Somebody (now you're just somebody that I used to know)

I used to know

That I used to know

I used to know

Somebody

When I hear this and hear the lyrics I hear myself talking to a version of myself from the past.  

Now and then I think of when we were together - When I was one person, not a 'before the migraines' and a 'after the migraine' group. 

Like when you said you felt so happy you could die - I was happy before the migraines.  Not fully true, but I was certainly MORE happy.  

But that was love, and it's an ache I still remember - Remembering how I was hurts.  I feel like I'll never get back and that was the best of me.  A highlight reel.  It hurts thinking that everything is downhill from here on out.  

You can get addicted to a certain kind of sadness

Like resignation to the end, always the end - I'm used to feeling down.  It feels right to feel down.  It's only proper that I feel down. And now that I accept it, it leads to the end.  Always the end.  

But I'll admit that I was glad it was over - It would be so nice if this life would be over.  

But you didn't have to cut me off - Did I cut myself off?  Could I have done something to prevent this?  It seems obvious that I blame my former self, my happy self.  It must have been him.  

Now you're just somebody that I used to know - Good me is gone and is just somebody that I used to know.  I may as well be fully gone and just be somebody that somebody else used to know.  

Now and then I think of all the times you screwed me over

But had me believing it was always something that I'd done - Clearly I did this.  I did something.  I screwed myself over.  An ever weakening part of me says that's not true, but it's overpowered by me believing it was something that I'd done.  

And I don't wanna live that way

Reading into every word you say

You said that you could let it go - I can't keep going on like this, reading the past as if it can help my present or change my future.  But I keep reading into it, what did I do wrong, what could I have changed.  I promise myself I'll let it go, but I never do.  I don't think I can.  

I'm somebody that I used to know.  

I don't want to be somebody that I used to know.  

I don't want to be somebody.  

I don't want to be.  Not anymore.  Not anymore.  

That's just where my head goes.  I find it difficult to watch that video and listen to that song, but I can't stop myself.  It calls to me and sings to me and tells me that... well, hopefully medication, exercise, and therapy will help with that.