Revisit Angry Depression

My husband now has a list of medical conditions that could make any physician scratch their heads. His PCP last week had to deal with his newer condition of Depressive Anger.

The least little thing will set him off now.

It was a pretty bizarre evening last night. I had made a cake and a pretty decent supper. I know eating supper together has always been pleasant for us. Well not last night.

MDD, Major Depression Disorder has come back something fierce. At first I thought it was acceptable because of his issues with the Pulmonary Emboli in both lungs and the hospital stay and the pain in the knee from the bursitis that was excruciatingly painful..
However he said he 'hurt all over' everything hurt. [I've learned over the years that MDD causes the body to hurt all over...it is a sign that he is going into a very bad place.]

He had a major fight with his daughter and yelled at his mother on the phone last week.

Instead of leveling off, the internal and external anger has become more pronounced.

Living with MDD is interesting. You need to have thick skin and emotional walls of concrete.
I set him off in a rage yesterday after working outside for hours, I came in to check on him and to make him something to eat.
I walked into the bedroom to see if he was okay and would like something to eat.

He blew up.
How dare did I interrupt his nap?
Why couldn't he get any sleep around here without someone bothering him?
He got up and tossed the covers aside.
I'm tired and I wanted to sleep so I could shower! And you won't let me!
I replied that I'd been outside for hours and ....how was I to know? I knew the nap for a shower wasn't really a reason for sleeping. Showering had become another new issue for us. Before I could assist him with showers while he was recovering. The last time he did a major portion of it by himself.

The fact that he did not care if he was dirty or smelly and would fight my suggestions for getting washed up was a huge indicator of his depression.

YOU just won't stop bothering me!
He came up and began to poke me with his fingers and imitated as best as he could my voice:
How are you? Do you want something to eat? Can I get you something? Why don't you take a shower? Want to wash up? NAG nag nag!

He poked and poked.
I'm going to wake you up every 30 minutes tonight, see how you like it.

I stood still and silent. No arguing with Depression Rage or whatever you want to call it.
I silently wondered if I could get him in the car and take him to the VA Emergency Department. Sundays were generally bad days for that. And the thought of a 2 hr drive with Rage in the other seat was not anything I wanted to consider.

He went on to other small inconsequential things that I have done over the week. One of the items he was furious about was that I was selling one of my older cameras. He simply went on and on.
I remained silent as One, it was my camera. Two I rarely used it anymore, and Three how did it matter in the larger scheme of things?

Silent. You can't argue with The Transformed Man. Once that ball of anger gets rolling it keeps getting larger and larger.

Last night we went to bed.
He pulled the covers off me.
Then waited until I put them back on.
20 minutes later he started poking my shoulder and asking Are you Awake? How do you like that?

It was juvenile, I admit. But I knew he'd fall sound asleep soon.
I decided to move a bit later when he fell into deep sleep.

I don't understand why his PCP didn't ask for intervention when he argued with her earlier this week.

The scary part of this? I responded with nothing. His tirade never even phased me.
After his oxygen delivery today I will risk asking him to go to the VA ED.

MDD

Major Depressive Disorder sometimes doesn't respond well to medications.

My husband has battled ... or lived with depression for many years. Treatments come and go in the form of "Let's try this medication or try this medication". Sometimes the meds fail miserably.

Rich is a very unusual person in that most prescribed meds seem to have severe side effects in some way. His medications for depression seem to take the edge of for a few years and then stop working.

During his treatments for Throat Cancer he had an anaphylactic reaction to a 'safe' chemo medication.

The cycle came around again. The last time we saw Lindsey [Rich's psychologist] I told her exactly what would happen. I also met his psychiatrist in the hallway and cornered him with Rich's previous psychiatrist.
I warned the doctors of what was going to happen and what had happened over the years.

"Rich is a train wreck speeding towards a crash and burn again. And you guys need to know this, it gets worse and worse ... he speeds like a locomotive out of control and then hits the end of the tracks..." I took my hands and threw them in the air, "..and boom. I am sitting in the ER with him and I keep coming back until he is admitted for an in hospital evaluation." I pointed at the doctors and then said, "You know it. You do. Look at the records for the past 20 years. Let us prevent that train wreck."

Oh they nodded and agreed. And as before, they suggested a change in medications.
I'd made my point that day but knew I'd be making that drive to the ER soon enough, but hoped that I wouldn't have to.

Over the past week Rich's depression worsened. He did get up a few times and interacted with our company but retreated to the bed. I noticed that he didn't want to take his medications, he didn't want to drink fluids, he just wanted to be in bed and then complained that all he could do was lay down and stare at the ceiling fan.
By Monday morning he had withdrawn completely.

I called and talked to the triage nurse and I knew that we'd be heading to Madison.

He was admitted for MDD that was severe.
Different treatments were discussed and reviewed by the Mental Health team.

It seems that he will be a candidate for Ketamine Infusion.
I'd never heard of it before.

...And forever, I will support him and help in whatever way I can...

You're broken down and tired
Of living life on a merry go round
And you can't find the fighter

When the silence isn't quiet
And it feels like it's getting hard to breathe
And I know you feel like dying
But I promise we'll take the world to its feet
And move mountains
We'll take it to its feet
And move mountains

And I'll rise up
I'll rise like the day
I'll rise up
I'll rise unafraid
I'll rise up
And I'll do it a thousand times again
And I'll rise up
High like the waves
I'll rise up
In spite of the ache
I'll rise up
And I'll do it a thousands times again
For you
For you
For you
For you

[Andra Day: Rise Up]

The Heart Brain connection

For all of the time I've known Rich, he has struggled with depression. 

Yesterday I was talking to a nurse from cardiology who wanted to discuss the Holter Heart Monitor versus the Medtronics Loop Implant that Rich had.

His stress test had come up with some 'abnormalities' and so his PCP had ordered a Holter Monitor for him.

The Medtronics Implant recording any A-fib incidents. This could have been the causes of his stroke and TIA's.

The Holter would look for PVC's or Premature Ventricular Contractions. 

I told the nurse that he'd worn one in 2015 and the last echo was done either then or in 2012 when he was having so many problems with his anti depressants medications.

She confirmed that he had PVC's in 2015 and also an echo done then. She had seen that they had been done previously also.

I hung up the phone after our discussion. Rich would get the monitor and they'd try and figure out how often he had PVC's.  I did a bit of research as a pattern started to form in the back of my head.

Every time Rich's anti depressants stopped working for him, he had more fatigue, dizziness, and had been pointed in the direction of cardiologists who did tests added meds because his blood pressure would fluctuate wildly,...did more tests, and generally could not figure out what the issue was.

What happens to the body during a period of severe depression?

Any stress or anxiety sends the blood pressure through the roof, causes heart flutters, dizziness, and sometimes confusion.

The brain is the master of the body organs. When the brain cannot function properly the heart and other organs cannot function properly.

Every single time 1998, 2002, 2012, and now 2018 there has been a pattern. The doctors of the physical being don't connect with the mental health doctors and vise versa. 

Rich's statement, "I can't do anything, I feel weak, a bit dizzy, and feel like I will tip over."

When the depression meds slow down and stop working the anxiety builds. It is slow and insidious. 

Put it all together and the pattern works.

I will say that the VA facility we go to have excellent doctors. Some of the very best! However.

Most of the PCP docs and the psychiatric or psychologists rotate out of the VA every few years. There are no doctors that have been through even one full cycle of depression recovery and the pitfalls with Rich. 

I've been there since 1996 and have seen a pattern develop over the years.

We fight the heart, dizziness, fatigue, mental stress issue with the physical doctors. Nothing seems to work as he declines.

The mental health doctors talk and try to adjust the current mental health medications.

Rich spirals downward until there is a crisis. 

Rich is admitted through the ER.

Rich's 'team' changes his meds and monitor him.

Rich is discharged to home. Much better and out of that dark place. 

We all feel relieved.

We skate on a fine line holding off that dark place of depression for a while until it slowly creeps up again and takes hold.

The cycle starts again.

There is a heart - brain connection. It is there.

The Link Between Depression and Physical Symptoms

Look at the studies regarding dementia and strokes. There are studies also that research depression and its physical manifestations.

Treat only the physical symptoms and the mental issues do not go away.

Depression 101

We met with Dr. Lindsey, she is young bright and a psychologist. She is doing her stint at the VA Hospital.

She asks Rich if he knows why he is there? He squints his eyes and seems to think. I've noticed over the years that the eye squinting comes just before his answer which is:

"I want to feel better. I just want to feel better. I feel like I am dying bit by bit."

This has become his new mantra of sorts. Anyone asks him how he is or how he is feeling, that is his answer. As I watch the doctor glance at him and scribble notes, I realize that the words are slightly different but the answers have been consistently the same for all of the years I've known Rich.

Lindsey asks him if he knows what causes him to feel this way.

"I don't know. I just want to feel better. I am tired of feeling like this."

She looks at him and me and then prompts him by asking if he read the letter from the neuro-psychologists. He shrugs. Their letter with multiple diagnosis of his medical issues weren't of interest to him. I let her know that but tell her that I did in fact read it to him.

Rich shrugs.

"Rich do you know that you have also been diagnosed with Major Depressive Disorder?"

Another alphabet diagnosis I think. In medical shorthand MDD. A light goes on somewhere in the back of my mind. And for some reason I am not surprised at this diagnosis. It makes sense, I felt his meds were starting to fail him, but as always his re-occurrences of depression always have a way of sneaking up on us.
So it was official. MDD. This explained quite a bit.

Lindsey continues, "So Rich I am here to help you figure out how to feel better and break this depression cycle."

He looks at her and squints again. "I have no idea how you think you can do that."

She doesn't get discouraged. Good for her, I think. Lindsey begins to explain the methods of getting a person out of major depression. She asks questions and he haltingly answers.

It almost seems as if he doesn't want to get better. But then I am not surprised as this is the depression stacked on top of COPD, and PTSD along with stroke and the some level of dementia or cognitive dysfunction. I wonder how in the hell are the doctors and I are going to pull him up and out of this.

Lindsey draws a map for Rich to explain what she is talking about.

"You want to feel better," she says, "this has to do with your thoughts and feelings, we need to help them. One of the ways is to get out and do something. Get away from the bed and be more active."

He grimaces. "I can't. I hit that wall and if I don't lay down, I'll tip over."

She thinks a moment and then asks, "Are you a fall risk?"

"No, I am fine. I just get so tired." I can see by his expression that he doesn't believe her.

Lindsey draws out something on paper and shows it to him.

[I took the liberty of going into Photoshop and making the following graphic to mimic her hand drawing. I chose bright colors because I always want to feel hopeful]

"Your behavior effects your thoughts. If you start here and get moving, doing something different that you used to enjoy then your feelings will improve and your thoughts will improve."

He stares at the paper and I know he doesn't see it.

The discussion goes on for a while. I suggest fishing. Rich says he 'can't'. What if he gets short of breath? I reply we'll have 02 along. What if he gets tired? We have seats in the Subaru that recline. What if he can't ... make it to the car? We bring fold up chairs.

Lindsey uses encouragement and Rich is given an assignment to go fishing. [Now looking at my calendar and the weather, I see no time for fishing.]

Then Lindsey does something surprising.
She turns to me and asks, "How are you doing?"

"Honestly? Some days I have no idea. I get frustrated, short tempered, ..."

"What sort of support do you have?"

"I have a neighbor who will listen. There is a group that meets in Viroqua once a month but generally I have appointments that day and it is during the time I need to be doing chores."

"Would you consider counseling?"

"Can't afford it now that I quit work to take care of Rich." I state.

Lindsey reads her notes and then says that the VA will provide those veteran spouses with care when the veteran is 100%. I am surprised, I knew about that but never had anyone at the VA approach it.
Lindsey says she will look into it. I believe she will.

Our ride back from the VA is long and I am tired after 3 appointments. Rich uses his 02 while he sleeps in the passenger seat. My mind mulls over the depression issues and how can I work to get him to 'move'.

When we get home I tell him that he will feed the two donkeys every day like he used to.

He fires back at me: What if I can't make it? What if I can't walk there and back?

Me: Then I will sit with you in the dirt until you can make it.

Him: What if I get out of breath?

Me: I'll bring you oxygen.

Him: Oh like this is going to cure me huh?

Me: Nope. But if you keep laying in bed all day long and never moving, you will make yourself worse, your heart will fail, your lungs will fail, and your mind will fail. Move it or lose it. You tell your mom to move, you need to take your own advice.

Him: I'm going to bed.

Yesterday though, I stood my ground and he did walk to the shed and get flakes of hay to feed Thor and Bob. It took an extra hour or so of my day. But it got done.

Depression is an ugly thing.