Delan Azabani

Fog

A fog has descended upon my mind throughout this year, and it has become so thick that I can barely remember what life was like before it. If I were to kill myself tomorrow, it would no longer be because of my mood. It would be because my cognitive and executive functions have deteriorated to the point where I can barely do what’s necessary to operate as a human, let alone work, think, or learn. I don’t have the motivation to actually harm myself, but soon I’ll literally become bored out of my mind.

To start with some positive news, I’ve made some progress since I started consulting a psychiatrist soon after I last wrote about my state of mind. My problems with falling asleep and staying awake have mostly subsided by taking mirtazapine. Anxiety and panic attacks now rarely occur, and my mood has improved slightly, although the extent to which my treatments have influenced this isn’t clear.

Now that the waiting period for the upgrade to my health insurance has elapsed, I’m about to start a course of cognitive behavioural therapy as a day patient at Perth Clinic. The course will run from tomorrow for two weeks, full time, and I’ll only be leaving every night to sleep. Both friends and medical professionals alike have said that therapy should be effective, especially when combined with appropriate medication.

I feel like the challenges I’m now dealing with mainly revolve around thinking, planning, attention, and motivation. These symptoms could simply be part of major depression, or they could form part of one or more other conditions which may cause or otherwise interact with depression, but are yet to be diagnosed.

Let’s start by talking about executive functioning. I can’t remember a time this year where I’ve arrived at a meeting or any other commitment on time, and as such, I’ve gained a reputation for being late to everything.

I can’t find the energy or motivation to do anything at all unless it has become urgently necessary. I can’t even take a shower or brush my teeth unless I need to go outside, or I’ve gone long enough without doing so that my health would become at risk.

My parents are about to paint the inside of our house, and to be able to do so, I must vacate my room. This has been one of the best things to happen to me recently, because if not for it, I would continue to live in what I’d almost consider a squalid condition.

Among the clutter on my desk are 18 months’ worth of unsorted mail and other paperwork, which would honestly only take a couple of hours to organise, but I can’t bring myself to actually do so, and it’s incredibly frustrating.

About a month ago, I lost my pair of nail clippers. Some rational choices that I could’ve made once I needed to use them included searching for them, borrowing a pair from my parents, or even buying a new pair of nail clippers. I consciously knew that any of these options would’ve solved my predicament, but instead, I simply let my nails grow and grow until I stumbled upon them yesterday, while I was vacating my room.

I feel like I can no longer think. Simple tasks like reading and writing have become almost insurmountably difficult, and solving trivial problems like installing software have suffered a similar fate. Last week was my first week at my new job — a full time job — and all I managed to achieve was that I wrote one and a half pages of the introduction to my research paper, which is the easiest section to write by far.

I’ve tried several medications, with less than promising results. Reuptake inhibitors like escitalopram, duloxetine, and venlafaxine have done nothing for me, with a variety of adverse effects that were annoying at best. The only clear effect of mirtazapine has been the one side effect that I’ve had while taking it, sedation, which is thankfully desirable.

In response to my complaints about lethargy and cognition, my psychiatrist has suggested that the options I have going forward may include bupropion and reboxetine, and I agree with his implication that we should look into medications with noradrenergic effects.

I’ve occasionally taken stimulants that are used to treat ADHD and its related symptoms before, and they’ve essentially been the only way that I’ve been able to get anything done recently. The difference that they’ve made for me has been temporary but marked, and without any exaggeration, I’d describe them as the only way that I’ve been able to catch a glimpse of what my mind was like a couple of years ago. Without dexamfetamine, for example, there’s no way that I would’ve been able to write the revision material for an exam study session that attracted well over fifty students.

Even if my access to these medications wasn’t limited, I’d rather actually be prescribed them, for obvious safety reasons, but finding a way to effectively convey this to a medical professional will probably be fraught with difficulty. While I’m certainly not saying that I necessarily have it, some medical professionals don’t see ADHD or its related symptoms as a condition in their own right, some will never prescribe a stimulant, and many will treat anyone who suggests that they may be effective with condescension and suspicion.

My next week is certainly going to be interesting, if nothing else.