Shit I am sick of hearing

First and foremost, I am sick of people saying if stuff sucks, you can just go and change it. I can’t make my adrenal glands start working again, and the majority of my problems are caused either by this or by the medications for this. I am very sick of people saying you just need a positive attitude. If you’re in pain from the minute you wake up until you go to sleep at night, it can be somewhat challenging to be cheerful all the time.

That being said, I am also sick of people telling me I probably complain to people all the time. I can’t remember the last time I complained, out loud, to another person. I avoid human contact if I am not in a good enough mood. And then, at the same time, people tell me I should talk to people about myself and then I’d feel better. [*facepalm*] In any case, I don’t talk to people about myself much at all and have very much crawled up my own asshole and died, to paraphrase Vonnegut.

I’ve also had numerous people tell me that I can’t possibly be suffering from things like impaired cognition, poor executive functions, short term memory loss, and attention problems, despite these being listed as side effects or symptoms from my meds and health problems. I’ve done things like making lists, but writing things down is a poor substitute for being able to think clearly and remember things. My former therapist suggested maybe I would benefit from ADHD-type meds, but I have not tried this or discussed it with my regular doctor yet, and I have enough trouble as it is remembering to take the pills I’m on and dealing with the side-effects of those.

I also think about parallels with dealing with grief. People often say that it is work, that you need to do it and get through it rather than repress it and remain in denial. That tends to be how I think about negative feelings in general: that they are often valid feelings and maybe you shouldn’t repress them 100% of the time. If things kind of suck, I think it’s probably ok to acknowledge that they suck now and then.

Anyway, I don’t think my current situation is the result of mental illness alone. I think I coped with things quite well before getting seriously physically ill (adrenal crisis can kill you quit rapidly and I’ve come close more than once). If I am sometimes in a shitty mood, it is because I am sick and I do not see a way out. I only see things getting worse. I’m subscribed to various groups for adrenal and pituitary-related diseases, and am bombarded with “in memoriam” posts about people with the same and similar illnesses dropping dead before they are 45. That and the medical literature also makes it seem like I don’t have a very long life expectancy, and that all that remains of that life expectancy is going to be miserable most of the time.

Anyway, though I am sure positivity has its uses, people telling me to deny that anything is wrong with me physically or that my meds have a very negative psychological affect does make me want to say “fuck your positivity.” Unless your life is perfect, you probably can’t be positive all the time. I have seen my entire life turn to shit and all my dreams and goals in life as well as my health crumble within the past 10 years.

I used to at least enjoy things like writing or painting, but the brainfog has impaired any sort of creative urges to the point where I find myself unable to write, no matter how much I push myself. Some might consider this unimportant, but it tends to mean that there is absolutely nothing in life that I am able to enjoy or feel good about, so I consider it a great loss. I didn’t even let people see or read most of my shit, I did it for myself, but I enjoyed it, and I don’t have that anymore, either.

It is possible that someday in the distant future, I will be able to get off of the corticosteroids. The endocrinologist said it will, at the very least, take years. I’ve also read that the negative side effects of long term corticosteroid use can persist for years after stopping the meds, and it’s quite possible that 10 years of high doses of steroids has really fucked up my insides and lessened my life expectancy, and yes, that bums me out sometimes. And I feel like it’s ok to be bummed out about that sometimes, especially since I only mention it on the internet and no one is forced to read it.

I’m back, I think

I spent the past several days heavily intoxicated. I figured it was an appropriate time for another midlife crisis, I suppose. I think I’ve more or less come to terms with the idea that nothing is ever going to change. The bipolar symptoms are not likely to get any better while I am still on prednisone, and I am not likely to be on less prednisone, since nothing else seems to work for my skin. My doctors have never really taken me seriously when I say it fucks me up in the head, and I am apparently unable or unwilling to talk to therapists (and can’t really afford that anymore anyway, but if I could, I still don’t see any point in it). It was a pretty bad week or so, but that’s pretty normal around my birthday.

Psychiatric disturbances and corticosteroids

There doesn’t seem to be all that much in the literature about psychiatric disturbances caused by corticosteroids, but here is a good overview I found:
http://williams.medicine.wisc.edu/steroid_psych_effects.pdf
In the following, I will make some short quotes from the article and respond to them based on my personal experience.

The most frequently identified symptoms include agitation, anxiety, distractibility, fear, hypomania, indifference, insomnia, irritability, lethargy, labile mood, pressured speech, restlessness, and tearfulness.

I’ve probably had all of those at some point. I’ve been on corticosteroids for about 10 years now. I tend to divide that 10 year period into two distinct portions: the first 9 years, where I was severely depressed, often unable to leave my room (causing me to drop out of college), severely indifferent, anhedonia, tearfulness (there were times I cried about things like pizza toppings), insomnia. Then a few years when by in which I was so apathetic I couldn’t cry about anything.

The second portion began in August 2015 with what seemed to be a rather severe psychotic manic episode. The first thing I did was stop seeing my therapist. This episode wound down after about a week and a half, but continues to this day. It would probably fall under the category of a “mixed episode” now, with symptoms of mania and depression at the same time. Overall though, I am much more energetic, I have trouble sleeping, I have a disturbing and constant desire for drugs and alcohol, suicidal ideations, irritability, I cry all the time, I spend too much money (spending money makes me feel good for 10 minutes or so). The major differences are the energy and the ability to enjoy things, though. I am now more or less able to enjoy some things some of the time.

The most commonly reported corticosteroid-induced psychiatric disturbances are affective, including mania, depression, or mixed states.
Most often, patients receiving short-term corticosteroid therapy present with euphoria or hypomania, whereas longterm therapy tends to engender depressive symptoms.

This fits with my experience.

An overly stimulating environment can exacerbate a patient’s condition.

This is why I am largely avoiding Facebook. It’s a constant, overstimulating, unpredictable stream of unrelated nonsense. There is too much going on. Everyone uses it for a different reason. It’s complete chaos. On a related note, this is probably why I can’t stand going to bars anymore. Too noisy, too many people, chaotic.

Among patients with corticosteroid-induced psychosis, as many as 33% experience suicidal ideation.

I am not surprised, and I fall within that 33%, without a doubt. I have spent many, many hours thinking about killing myself. There was only one time I think that I really intended to do it right at that moment, but certainly I’ve done a lot of things that could have killed me, also, and spent a lot of time thinking about how much I want to die. On wikipedia’s page on suicidal ideation, there is also mention of role-playing: I actually purchased an air gun that looks reasonably similar to a real gun, and I keep it in my desk so I can take it out periodically, point it at my head, and pull the trigger. It’s never been loaded with anything and only takes plastic BBs anyway, but that’s not the point; the point is that I like to point a fake gun at my head and pull the trigger. It’s worth mentioning that, before being on steroids, I never had a suicidal thought in my entire life.

While the article says that some people respond to antipsychotics and antidepressants, it also notes that treatment success can be unpredictable. I have not had any success with various mood stabilizers and antidepressants. Due to adrenal insufficiency, my steroids cannot be stopped. At this point, I am not seeing any options other than learning to deal with it on my own, since drugs and therapy haven’t helped, and I can’t afford to just keep throwing hundreds of dollars at the problem anymore.