Illusions and delusions- Stress, pain, depression

I don’t know that the title of this blog is totally appropriate, but I can say that this first week of rotations was interesting, frustrating, rewarding, EXHAUSTING, and reaffirming.

Pain, stress, and lack of sleep are highly entertwined. When someone hurts, they are stressed, and they sleep less, and so they are stressed more, which causes more pain, which causes stress, which causes lack of sleep….you get the idea probably by now. So, many of our patients have sleep problems. On top of that, they may be coming in because their pain management regimen isn’t working. During the interview, we usually uncover all kinds of new stressors…. family stress, deaths in the family, domestic and/or caretaker abuse, uncovered addiction patterns, etc. I commented after a particularly odd day to my preceptor that I felt mentally stable that day, relatively speaking (you learn to appreciate how well off you are very quickly), to which he replied “that’s an illusion”. That statement keeps popping in my head, especially after yesterday.

I feel I have a bit of a leg up on many of the other students on this rotation, for I have dealt with many of the prominent issues either personally or first-hand. My first husband was a drug addict and alcoholic, verbally abusive and controlling, and occasionally physically abusive. I have dealt with my own addictive tendencies and understand the mentality of an addict, the single-mindedness they are possessed by. Anyone who has traveled with me has seen this first-hand. My first thought is “where can I get REAL coffee to start my day?” I seek that out as soon as I have reached my destination and unpacked. It’s my addiction of choice. Perhaps it’s a weak example, but trust me that I have dealt with bigger issues. I still have that single-mindedness though, it’s just about things like exercise and coffee. I also have dealt with depression, and I am not talking about ‘being down’. I have suffered from clinical depression during several periods in my life since my teenage years, and yesterday I saw someone who looked so much like one of my cousins and reminded me of where I was just a few short months ago. I will call this person TP for This Patient, for confidentiality’s sake.

TP came in with not very much pain, especially compared to most of our patients. What I did notice right off the bat was a somewhat nervous demeanor and a shaky voice, as if the waters were bubbling and threatening to spill over at the slightest mention of what may have been bothering TP. I saw the twitch of the side of the mouth, trying to control the facial expression… (if you attempt to turn up your mouth in a smile, it can stave off tears for a bit, sometimes)… the averted eyes, the wringing of the hands, the adjustment in posture to attempt to ‘hold it together’. I knew that the tears would flow at some point. I had a lot of questions to ask, so something was bound to come out….the tears did come, and TP fought them back to which I replied, “It’s okay” while I tried to stear the conversation back to solid questions, more for TP’s sake than mine. I was not uncomfortable in the least, and I think TP somewhat gathered this. TP was suffering from a depression that had a stronghold on TP’s life, that threatened to pull TP under….like quicksand. I knew all too well that feeling.

I was talking about it with my fellow student on the rotation afterward and telling her that clinical depression is real, but for anyone who hasn’t experienced it, it’s very hard to truly empathize and understand. I told her that most of last semester, I was often on the verge of tears, and didn’t always know why. I told her about a day last semester when I left class and headed to my car. It was a beautiful day out, and the day had been pretty easy…nothing stressful had happened, and nothing in particular was on my mind…and then the tears started flowing. I was walking along, tears streaming down my face, all the while thinking ‘what the hell is wrong with me?’. No one thought had tipped me off. I was not obsessing over something bothersome…it just happened. At times like this, one wonders what’s wrong with them, which only makes things worse. I just wanted it to go away. That is a small example of a manifestation of clinical depression. It takes a hold of your lapels, picks you up and spins you around, throws you up and down. Sometimes it takes you from behind, grabs your collar, and holds you back, pulls you down on your ass and holds you there…sometimes it wraps around you, suffocates you….squeezing the little life you feel you have left right out of you. Sometimes it’s in your face, clouding the rest of the world, completely obstructing your view of the world around you, of reality, of YOUR LIFE. The concept of having control of your emotions is completely lost. Someone like me, a goal-oriented person that is seemingly very ‘together’ has a very hard time with feeling completely out of control. I have too much on the line to be out of control.

During these times, I have a whole host of physical problems. This time, I was gaining weight, had odd pains, lack of energy, coupled with insomnia, severe acne, other skin problems. I felt like I was completely falling apart, and I kept searching for a medical explanation for all my odd ailments. In retrospect, while I am still dealing with the lasting effects of a few things (weight and skin problems), I feel it was mainly depression, which does not show up on any lab test they can perform on you. Do you see where I am going yet?

Many patients we deal with have depression. Either the pain caused the depression, and they compounded each other, or the depression worsened the pain. So, while I am in a Chronic Pain Management clinic, we treat a triad-… sleep, psychological, and pain. One cannot treat pain without taking the others into account. You can treat pain, but if you don’t address the psychological issues compounded by it, it won’t resolve. If you don’t address the sleep issues, the body and mind won’t have a chance to heal, and the pain will not resolve.

I am taking some of our questions and trying to ask myself the same things, assessing my level of stress, my ability to cope currently, etc. Athletes are great at convincing themselves they aren’t doing enough, when often they are doing too much. Often, when an athlete is injured and can’t exercise, all those natural opioids that are normally released during exercise aren’t being released, and the injury hurts worse, and the depression sets in. Then the person doesn’t want to exercise, which makes him more depressed, which worsens the depression, and the cycle continues. These endogenous natural opoids are our own version of the drugs we give to patients for their pain. Those narcotics such as percocet, morphine, codeine, vicodin, oxycontin, etc…. they are essentially potent versions of what we can produce ourselves, just in a different delivery form.

So, next time you are down, know you are not alone, get your butt out there and exercise. Don’t let your mood take control of your life. If you do feel out of control, seek help. There are places to get help from because so many people have problems with depression, stressors in their lives, obsessions, etc. It’s OKAY. We are all human.

As my preceptor would say, “Go out there and LIVE WELL.’

Here’s an article on the program I am interning at:

Provision of Pain Management by a Pharmacist With Prescribing Authority: Description of the Program

************************************************SOME SOURCES FOR HELP**************************

Christian Counseling Centers of New Mexico -You don’t have to be Christian to go here, and I have heard it’s a great resource.

Rape Crisis Center-24 Hour

It is NEVER okay for someone to do something to your body that you are not okay with. NO means NO. It’s never your fault when someone violates you, and there does not need to be violence involved to be considered rape, nor does it need to be a stranger.

New Mexico Domestic Violence Crisis And Support Resources
Scroll down this page for the resource listing. There are many avenues for psychological support, financial and legal support, and more. There is always a way out, and if you don’t have family nearby to help, there are people you don’t yet know just waiting for your call or your visit who will help protect you, support you, and guide you.

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4 thoughts on “Illusions and delusions- Stress, pain, depression

  1. Amy-I so identify with your/your patients’ issues. At the heart of all hard core athletes is some sort of addict, in my opinion. I love the anti-D effects of the training for sure…I remember about 20 years ago, in the grocery store just burst out crying for no apparent reason. I had no idea what the f was wrong with me-come to find out depression was sneaking up on me. All these years later and a MA in counseling and it is much more clear.
    Much luck to you as you learn for all of us! Thanks for sharing..

  2. Honestly thanks for sharing this on your blog!

    There is one story you just told where I wanted to comment on and contribute one more perspective. When you said that on the last day of school, you should have been happy and instead you just went to your car an cried, my chiropractor in Beverly Hills (he really is one of the most amazing healthcare providers on the planet) actually pointed this out too me:

    When a great stressor or pain has been lifted, people often cry because the relief is so overwhelming! He has said that in his practice he has adjusted people and they just started bawling, not out of pain, in fact the didn’t know why, but later they would call him back and say that they felt so much better both physically and mentally from the adjustment. They might have only gained a little more range of motion, and yet, tears came out and the whole body released its stress.

    Let it be known that pharmacy school is a Great Stressor! On that day when class was actually over and you were in your car, I hope that on that day, maybe more than depression, you may have had a cathartic breakthrough (and to have had such a breakthrough certainly does illustrate how upset/tired/stressed you were in the firstplace!)

    Almost everyone I have known who has gone through pharmacy school during the past three years has had multiple occasions where they were just depressed, just tired, just wanted to give up, just wanted to cry for no reason. I think that’s important to mention because each one felt alone or felt that their situation was so much different, and that they had to hide it from others to appear as well adjusted as their neighbor. If only they knew, their neighbor was no better off! It is true we all had other unique factors that added more stress, but ALMOST EVERYONE, was feeling that way at some point and hiding it. But then again, if we all started sharing, because we are competitive, there probably would have been showmanship, (trying to one-up each others’ depression). It’s no-ones’ fault, the situation breeds that. Crazy what we put ourselves through!

    When all was said and done, I cried too, and have been sleeping almost 14 hours a day every day, even when partying with my sister in California. I woke up only to go to go out or do some fun activity,then went back to bed! It’s as if i am trying to make up for 3 years of being mentally and physically exhausted. But the catharsis is coming through!

    I didn’t want to overshadow the rest of your blog with a not-deserving-of-too-much-pity example from pharmacy school. I am thrilled that you share the lessons you continue to learn as you go out into the field. I find it a breath of fresh air to be working with patients and learn something new everyday. Not to scorn my academia, those building blocks were necessary if I am to go out there and do a reasonable job, but it is great to see and read how each one of us is growing in their new environment.

    Best wishes,
    Eleanor

    • Elly, I agree with your comment entirely, and I appreciate you sharing. I can’t remember if I cried after the last day of school or not. My example was from a random day last semester. No tests, no projects, just a random, low- stress day. When big stressors are over, I half expect to cry for the catharsis, and I have had rolfing done on me where I cried so hard my eyes were puffy for 2 days afterward. I have a lot of shit built up in me, evidently. Having been a ballet dancer for so long, I understand the connection between the emotions and the body. Sometimes, it’s good to get a reminder though.
      Hope you are on the up and up! I haven’t had a chance to sleep that much….

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