When I was struggling through my 10-year battle with depression, the most prevalent thing in the back of my mind each and every day was a silent prayer to recover and no longer suffer with the daily feelings of hopelessness and despair that were the hallmarks of my illness. Nothing else mattered.
Now at age 61 and over twenty years since my illness began, I have paid dearly (as have many of my peers) for not paying more attention to my primary health care needs. I was a heavy smoker, I kept gaining weight, my cholesterol and blood pressure were in the danger zone, and I looked and felt like a man twenty years older than I was. I was not surprised when research reported that people with serious mental illness have a shortened life expectancy of between 10-25 years compared to healthy individuals.
Throughout my illness, recovery, and until only recently, my declining physical health seemed to be unimportant and an insurmountable problem that I was unable to address in a meaningful way. I am sure many of my fellow consumers can relate to my story and are struggling themselves with the same primary health care problems that I have gone through. It is timely then, that we take a closer look at the medical needs of people with mental illness and substance use disorders in this issue of Mental Health News.
Psychiatric Medications and Weight Gain
In recent years, it has been well documented that many psychiatric medications cause patients to gain weight. According to studies, weight gain may be minimal—only a few pounds over six months to a year. But in many more cases, the weight gain is medically significant, with many patients reporting at least a 7 percent increase in body weight. Such increases in body weight can raise the risk of many health conditions such as high blood pressure, high cholesterol, diabetes, heart disease, arthritis and some types of cancer. The reasons why psychiatric medications cause weight gain has to do with the effects these drugs have on our brain chemistry; they may improve our mood, but they also affect our appetite, feelings of fullness when eating, our general metabolism and how our bodies store fat. During the course of my illness I was given a substantial variety of medications and combinations of medications meant to help alleviate my chronic depression. I experienced all sorts of side-effects as many of you can also attest to. Some of the typical ones were sleepiness, dry mouth, and even vision changes—which were especially aggravating because I wear glasses and had to constantly get new lenses with each new pill I was given. Some of the other side effects had to do with food. One medication I was given made everything I put in my mouth taste metallic and not like what it should taste like. Other medications I was given produced cravings for sweets, carbohydrates, and gave me the feeling that I was never full—even after eating a full balanced meal. The sad thing is that some people (including myself) become so distressed at the weight gain side effects of their meds that they stop taking them, which may be more harmful if they were indeed helping them overcome a serious psychiatric condition. Like many things in life, coping with the side effects of psychiatric medications are a double-edged sword.
Quit Smoking: I Gained How Many Pounds?
Any person in their right mind (I guess some of us aren’t) now knows the danger of smoking. Ok, I admit as a kid growing up in the 50’s and 60’s the Marlboro man made me believe that smoking was cool and real men smoked Marlboro’s. They never mentioned anything back then about lung cancer, mouth and throat cancer and emphysema. Well, it turns out my older brother was also a smoker and unfortunately, he didn’t listen either; he now has serious emphysema, is homebound and requires oxygen therapy to stay alive. When I saw him recently, I was crying inside because here was my big brother who I have loved and looked up to all my life, and his smoking related illness has robbed him of his stature, vigor and dynamic good looks and personality. Seeing him was like being struck by lightning and I went away thinking, “Wake up stupid and quit smoking.” I did quit and have been smoke free for almost a year now.
How rough has it been since I have quit smoking? You have no idea. Even now, a year later, I think about smoking every day and I even dream about it at night. Oh, and by the way, in the first 3 months I think I gained almost 30 pounds satisfying my craving for cigarettes and using food to comfort my added depression due to mourning the loss of a dear friend—the damn cigarette. For almost 50 years we had woken up together and spent every day with each other.
My primary care physician was thrilled that I quit. “I would rather you gain a few more pounds than continue smoking,” he said to me. I felt proud of myself and saw each day as a new beginning to a healthier self. After a few months however, I was frantic about how heavy I had become and how tired I was every day—I thought I’d have all this new energy after I quit smoking. What was going on with me? I couldn’t stay up for more than a few hours a day and I was napping all afternoon even after sleeping 7 to 8 hours a night!
Do You Feel Refreshed When You Wake Up in the Morning?
At my next doctor appointment a few months later, I told him I couldn’t take it anymore. Why was I so tired all the time? Several years prior to this I had complained about the same thing and doctors said I had a few minor blocked blood vessels in my heart, so they put me in the hospital and implanted 3 stents; the stents didn’t make me any less tired. Last month when my doctor saw how upset I was, he asked me, “Ira, when you wake up in the morning, do you feel refreshed?” “No,” I said, “Are you kidding me? I haven’t felt refreshed in the morning for as long as I can remember!”
“I’m going to schedule you for a sleep study,” he said. He suspected that I might have Sleep Apnea, and the only way to find out was for me to spend the night at a sleep lab. At the lab I would be wired up and the sensors would tell if I was sleeping normally through the night or being awoken constantly throughout the night with apneas (where you stop breathing because your airway is being constricted). Well my doctor hit the nail right on the head! I went for the sleep study and we found out that I indeed have what is called Obstructive Sleep Apnea. In the five-hour period I was wired up in the lab, I had over 160 episodes while sleeping where I stopped breathing. It was clear to me that I had probably been experiencing this for years and it could account for a host of physical maladies I was trying to cope with. Sleep Apnea affects millions of people and those most prone to it are overweight to begin with. The treatment for Obstructive Sleep Apnea is to sleep with a CPAP (Continuous Positive Airway Pressure) machine which is a breathing device you wear at night that forces pressurized air into your mouth and nose to open the airways to your lungs. In part two of my sleep lab study, I went in again and this time slept a few hours hooked up a CPAP device. During the few hours I was able to sleep with CPAP, I had NO apneas. A few days later I picked up my CPAP machine to use at home.
My Obstructive Sleep Apnea is definitely linked to my feeling tired and napping every afternoon. I read that it could also contribute to depression, which in turn makes it difficult to feel like exercising, and so you continue to gain weight. If that isn’t a vicious cycle, I don’t know what is. I have been using my CPAP machine for over three weeks and I feel better already! I am finally getting restful and therapeutic sleep every night and my daily energy reserves are on the rise.
What I Have Learned
Nothing in my life has been worse than battling severe depression for 10 years. How I ever survived that I will never know. But I did survive, and I went on to devote myself to bringing mental health education to many people in the community. I have learned that we all make mistakes, we all have faults, and some of us don’t always take good care of ourselves as we should. I think some people must have a special gene that enables them to never get depressed, to push through even the most difficult times in their lives, and to do what’s best for their health and well-being. On the flip side of that I have found that, even as I turn 61, I am learning new things about myself every day. We can change, we can learn to take better care of ourselves, and you must never give up trying.
New Reforms in Behavioral Health
It is said, “To everything there is a season, and a time to every purpose…” And so it goes for new changes in the behavioral health landscape. I think the integration of primary care with behavioral health taking place across the country is a good thing. The more we can encourage people to think about the importance of maintaining both their physical and mental health the better – even though it might not sink in right away for many. Sometimes, people have to find out for themselves in their own way and in their own time.
My Prescription: Do Something Every Day to Make Yourself Laugh
In Woody Allen’s funny 1973 movie Sleeper, there is a scene where two doctors are discussing Woody’s unusual behavior after waking him up 200 years into the future:
Dr. Melik: This morning for breakfast he requested something called wheat germ, organic honey and tiger’s milk.
Dr. Aragon: [laughing] Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties.
Dr. Melik: You mean there was no deep fat? No steak or cream pies or hot fudge?
Dr. Aragon: Those were thought to be unhealthy… precisely the opposite of what we now know to be true.
They say laughter is the best medicine. I think there is something to that. Since my recovery I have made an effort to enjoy some form of humor that makes me laugh and smile each day. The more I laugh and the more I smile, the better I feel. And there is nothing wrong with that. Try starting your day with a cartoon, a funny YouTube video, or if you like the funny antics of dogs and cats like I do, visit one of my favorite silly websites, www.icanhascheezburger.com and LOL (Laugh Out Loud!). Good luck in your recovery!!