Saturday, June 8, 2013

Bloody Nose, Liquid Prozac, and a Bell Jar.

I don’t know what to say anymore.  I feel like I hit this strange wall.  SMACK.  I have a bloody nose, and I’m trying to stop it from covering me red, but I am also trying to figure out why I even let myself run into the wall, and why I wasn’t paying attention.

That is me.  No that is me on PMDD.  I am being formally and aggressively treated for this plight a small percentage of women battle.  PMDD killed Sylvia Plath.  It usually hits women when they are in their early 30s.  Who knows what is happening at first?  I had months where I really thought I wanted to die, for a week every month.  I wanted to just disappear.  It made perfect sense to me.  I said things that others, who didn't know, could not understand.  Hell, I didn't understand what I was saying...  But it seemed like clarity to me, in those moments, and then it just scared the bejesus out of me.  "Who wrote that?  Me?  What is this?  Why did I say that?"

It's terrifying.  I know it's coming, and it will be bad.  I know I will slip away and I won't have much to hold onto.  Not reality.  I lose that in spurts.  I speak nonsense.  I see things that aren't visible to anyone else...

J: No, no, I’m not following my own order.  I said I would not talk to you about...  I don’t know what I said.  I would have to check.

T: In what world do proclamations like that have any weight?  Do you think you're going to just not talk?  Or I'm going to just ignore you?

J: I understand I talk way too much, so you would have to ignore me.  I’m a geyser:  Fine, fine, explode!  gushing, flooding my world with too much information, too much craziness, and then fine, fine, quiet, quiet.

T: See above questions!  Do you not want to talk?

Last time I saw an old lady in the mirror.  I was sitting on the side of the bed, with my bare legs reflecting back at me, and I saw withered skin and ropes of veins.  My arms too.  Sam told me that was not real, that I was not seeing what was real.  No!  Couldn't he see how old I was.  Look at me!  Look at me?  "Wait...I'm fucked up, aren't I?  This isn't real?"  No look at my hands.  What are those things?  They are going to rip through my skin.  They are coming out of my hands!"  And Sam held my hands until I could breathe and I said, "Check my hands...  Are they normal again?"  "Those are just tendons in you hand.  They move when you move your fingers.  Your hands were always normal.  I promise."  I couldn't look at my hands.

J: Thank you for asking if I wanted to.  That was nice of you.  I appreciate everything you are and have been to me.  I really do. I’m super fucked up right now, but I can still think clearly enough to know that you have made my life more beautiful.  And I want you to do something smart, and stay away from fucked up women... You are being silly.

T: So is saying, "Go!  Run away and be free!"

I know it will pass.  I am lucid most of the time during that week, just very dark and numb...  At the bottom of a well.  I'm just in darkness, waiting to be brought back up to the light and sun.  And when I feel the warmth on my face again, I'm okay.  I'm happy!  I'm happy I don't have to go back down there for at least 20 whole days.  

Yet,  how do I tell anyone, particularly male friends who can't possibly have the tolerance for temporary psychosis and dysphoria because of whacked out hormones and brain chemical fluctuations, that I'm sorry for my PMDD behavior?  "Hey, forgive me for being super craaazy pants last week.  You know, it's the luteal phase of my cycle, rearing it's psycho-bitch, Medusa head.  No probs.  Just ignore it."  It just seems like an extension of the crazy to even try to explain it.  And it's embarrassing.  So I hide now.  I try not to communicate with anyone but Sam.  I save up any and all sanity I can muster for my children, for that entire week, and just fucking lose it when they go to sleep.  I am despondent.

My mom saw me during the week once and said I was acting "mostly normal, just very sad."  I was proud that I only appeared sad.  I can explain sad.  "I'm crying randomly while we play this fine game of Zingo, because I miss our old horse Megan, kids... That's why mommy's crying..."

Poor mom.  Crying about the dead horse again.  Beating a dead horse with my tears.

J: You didn’t listen before, and you must see that that would have been a wise decision.  You actually did it, now that I think  about it. blah, blah.   it’s a million o’clock.

T: Using GMT, huh?

J: I love talking to you.  Sometimes I feel like talking to you makes my whole world happier, you know?  And last night, I realized that was really sad.

T: Why do you feel that's sad?

J: Because...  
We can talk another day, if you feel like it.  And then you’ll understand.

T: Why won't I now?

J: Ah, well, because you’re too nice.  And it’s late.  And because if you think about it, you’ll see it yourself.  Even last  night, yesterday, I felt this thing coming on like a freight train, and you disappeared--as well you should--to talk to someone else.  But you were just gone.  And that’s what you need to do.

I push people away because they don't need to worry about me or my crazy problems.  It's impossible to understand, even for me.  And dealing with PMDD feels hopeless when I read about it all.  Every month I see why Sylvia Plath placed a pillow in her oven after sending her children safely to the neighbor's apartment, and turned on the gas.  It scares me that I understand.  Yet, she didn't know what was wrong with her.  I do.

I'm getting help.  We are on the most aggressive treatment now.  Starting in, oh, 21 or so days, we'll see if it works.  I pray that it will.  In the meantime, Sam  is there to tell me it is not a good idea to cut open my vein to get all the bad blood out of my arm, or that I'm safe when I feel like I'm crazy.  He loves the unlovable Joanna.   I miss my other best friends.  I miss them when I am "normal," but I am so glad they left me when I am crouched at the bottom of that deep, dark, hole.  I don't want to bring anyone down, ya know?



I get to squirt liquid Prozac, from a little syringe, into my coffee, soda, juice...  Fun times, I tell you.  Can't even taste it.  To take such a small dose, the pill is liquified and can be measured carefully.  Now that I have started taking 2-5 mg of Prozac daily, during the week when PMDD would normally darken and confuse my brain, I am not as dark; I am not so confused.   

It seems that the The British newspapers are the only ones interested in covering a study that shows that a the very low dose of 2-5 mg of Prozac can help relieve some of the most severe PMDD symptoms.  I think that, understandably, only people who either live with PMDD, or live with someone who suffers from PMDD, won't care about the possibility of this treatment, any gosh darn treatment, actually working...  Unless you feel bat shit crazy, (or you live with someone who suffers from PMDD (i.e. 1.  Wants to die.  2.  Wants you to put her out of her misery.  2.  Loves you so much she doesn't deserve you.  3.  Thinks you are not awesome, 15 minutes later.  4.  Cries about horrific hypothetical situations.  5.  Cries for no reason at all.  6.  Asks you to knock her out with a 2x4 for a week... Seriously... She says, "Please" with great sincerity), for 7-10 days a month, you don't have to care about it at all.

2mg per day of Prozac is enough to:

1.  "Raise the level of sex hormones"(while reducing sex drive) which affect the ALLO levels in the blood and as such provide a 'calming effect'.

2.  Adjust a hormonal response that would otherwise "manifest behaviorally as anxiety and aggressive behavior."

3.  Enough to affect "anxiety, mood swings, tiredness, depression, headaches, feeling bloated and pains in the joints."

Dr Thelma Lovick, who led the research at the University of Birmingham, shared her findings:  

She found that the build up of the sex hormone progesterone before ovulation has a knock on effect on a steroid called allopregnanolone (ALLO).

This latter substance soothes the brain and has a calming effect on the emotions.
When levels of ALLO drop sharply during the late premenstrual period, this effect is reduced and symptoms of PMS, such as anxiety, irritability and aggression, emerge.

"As a consequence these brain circuits become more excitable, leaving the individual more responsive to stress, which is often manifested behaviorally as anxiety and aggressive behavior.
Dr Lovick hypothesized that if the sharp fall in ALLO levels is the factor that triggers these brain changes, then if you could make ALLO levels decrease gradually at the end of the cycle, the symptoms of PMS should not develop

Using this premise, the Birmingham group has devised an approach termed ‘neuroactive steroid replacement treatment’, which has been shown to completely prevent the development of premenstrual symptoms in rats.

"We knew that the widely used anti-anxiety drug fluoxetine (Prozac) could raise levels of ALLO when taken for short periods," she said.

"This effect happened quickly and occurred in response to a very low dose of fluoxetine’ says Dr Lovick.

"We thought that if dosing with fluoxetine was carefully timed to boost brain ALLO levels just when they were due to fall sharply at the end of the cycle, the normal trigger for the development of premenstrual syndrome would be absent."

Most significantly, the dosage needed to achieve this was only about one tenth of the standard strength of the most commonly prescribed form of fluoxetine.

The team were "astonished" to find that it completely prevented signs of anxiety and increased pain and sensitivity normally found in female rats during their version of the premenstrual period.

To our amazement it completely blocked the symptoms," she said.

"Moreover, it completely changed the way in which the brain circuits responded to anxiety-inducing stress,"she said.




No comments :