Mental Health Awareness 2013: 4 Points to Consider

It's Mental Health Awareness week (Oct. 6 - 12, 2013), and it is sad to know of all the people who have died due to mental illness, such as actor Lee Thompson Young. His story, like all similar stories, is tragic. I noticed that his particular story brings to light many of the things people are not aware of with mental illness.

Here are 4 points I think we need to consider in raising awareness regarding mental illness and suicide. (Reading this article first will help you see why I am raising these points in connection with Young's story.):

1. Medication does not fix everything. It is a myth that medication fixes mental illness in everyone. Young was on medication for bipolar and it was even found in his blood that he was actually taking it. Medication works great in some people, helps a little for others, may not help at all in some, and for others it actually makes them worse. We need to be aware and look at all aspects of a person's life if we are to help people treat their mental illness. We can't just put people on med's and think they will be fine. In fact, almost all of these medications have warnings on them that they can all cause suicidal thoughts and actions.
2. Being religious is not an illness. In the article about Young's death, it states that the coroner had made a point to report that Young had an altar in his house, implying that his religion had something to do with his mental illness. Then other news outlets have been saying his faith caused his depression, almost insinuating that the religion was cult-like. It is not weird to have an altar in your house. If someone had a wall of crosses in their house (many Christian's do), no one would even think to say this had anything to do with their illness. Can I also say that there is clearly a race and culture issue here as well? The only time religion should be considered a factor in mental illness is if the person was treated badly, shamed, or bullied in their faith due to their illness or any other reason. This could happen in any faith. There is not reason to think that Young's faith was a result of mental illness or a cause of it. When I first went into ministry and people found out I was bipolar, I often was asked "Are you sure you are not just experiencing hyper-religiosity? You know that's a symptom of bipolar."
3. Not all people with mental illness look "unstable." A lot of this article focuses on how Young never exhibited symptoms of illness. He was stable, he had a stable family, nothing seemed out of the ordinary. What people don't realize is that mental illness is ordinary. We live and work in your communities. It is an invisible disability and we should not be so shocked to find out someone who seemed "normal" has a mental illness. Mental illness does not always mean visible instability. Also, those of us with mental illness know we are not allowed to have a voice because of the stigma around our illness, and so we often hide our illness.
4. Believing "If only we knew, if only we paid more attention" does not always stop a suicide. No matter how hard we try, we can not stop death due to any illness 100%. There is no benefit in engaging in collective or individual guilt over a suicide. Young's story shows that we may never be able to adequately see the severity of a person's illness. True, we always need to do the best we can to help keep people safe, within the confines of the actual knowledge we have. In some cases though, there really are no visible signs, at least not ones that most people would recognize, before a suicide. In fact, many people seem to have a decrease of symptoms of their illness a few days or weeks before a suicide. Young saw his doctor on August 14 and he appeared fine. He died by suicide just days later on August 19, 2013. I recommend taking a Mental Health First Aid class in order to know how to properly asses a potential suicide, to the best of your ability, knowing that we can't predict everything.  

Blessings,

Rev. Katie

Treatment Isn't Easy

Treatment for mental illness has been in the news quite a bit lately due to the Newtown, CT shooting and then a blog post that came out from a mother with a child with mental illness. There have been many responses from people with other children who have similar issues and the difficulties in getting treatment. Some say they can not get enough help, and then there is an issue brought up by one mother that we need to accept that medicaiton is a good option for kids.

I am glad we are having this conversation and I cannot say what treatments I think are the "right" ones. In reality, I think that treatment is different based on every person. And that is why I think it is important to speak to the fact that for most of us there is no easy solution to treatment.

I have had different mental health problems since I was 6 years old but did not start to receive treatment until I was 19. That means I have been at this treatment thing with psychyatrists and psychologists for 15 years. And clearly we know from my blog posts that I am not free from my illness. For many of us, treatment is just not that easy.

Photo by Jeff Norris

First there is the issue of medication. Many people think if all mentally ill people just received medication and kept up with taking it that we would all be free from our illness. You can see through many of my previous posts that medication has not worked for me and actually caused severe side effects. It is promoted by many doctors and the media that most side effects include things like weight gain, nausea, lack of libido, sleep disturbance, dry mouth, and other things that people say we can put up with in order to be free of our illness. First, unless you have experienced those side effects, you don't know that for many people they are pretty debilitating and life altering. Furthermore, most people don't tell you about those of us who have severe side effects like decreased cognitive functioning, organ failure, heart disease, and more. We can not present medicine in simplistic terms and assume it is safe and/or effective for everyone. There is always the argument from people who see better behavior in an individual on medicine and then get angry when the person goes off the medication. However, if the medicine were really working, we would keep taking it. Clearly it is not working well enough if we stop taking it. Either it is not controlling the irrational thinking enough so we think we don't need it, or the side effects are so bad that we stop taking it. Medication works for many people but we should not judge those for whom it does not work. And finding the right medication is hard. It may take 8-10 years at the minimum to find the right medications. We need to be understanding when the illness is not treated quickly and easily.

Second there is the issue of all the other lifestyle changes doctors suggest for treatment such as exercise, diet, sleep schedule, and meditation. Everyone I know, regardless of mental state, has a hard time keeping a balanced life at all times. For people with mental illness, it is especially hard to do so and we have less wiggle room for how much can get out of balance. In college, other people could barely sleep for a week and be just fine functioning. They would need a few days of extra sleep and could get right on back on track with life. For me, one night of bad sleep meant possibly weeks of worsening symptoms and I needed a lot of help to get back on track. Here again we need to be compassionate about treatment. If someone can not keep the perfect diet, keeps forgetting to take medication, has issues sleeping, etc... that does not mean they are not trying. The worst thing you can do for someone trying to make positive lifestyle choices is to argue that because they don't stick with it that they are failing and need to learn to make better choices, or that they just should not do it anymore because it is clearly not working. Our lives are worth fighting for.

Photo by Jeff Norris

Third, people also have co-occuring disorders so they may have many road blocks in their treatment plan. Such as for me diet is a huge help in my treatment but I also have a binge eating disorder which makes it very hard to stick with the right diet. If you have PTSD it can sneak up on you in times that you would not think have anything to do with a past traumatic event so watch out for that getting in the way. If you can find the link it is often something you can work through. What I really like about my therapist is that he looks at every "setback" as an opportunity to learn more about me and what we might need to work on in order to help me be healthy. That is different than the usual mentality that if you do not get better instantly you are not trying hard enough, make bad choices, and you won't ever get better.

Last, there is the inevitable "if this is an emergency dial 911" message on your doctors phone. Many doctors and other people think if you go to the psychiatric unit you will be cured, but that typically is just between a few days and a few weeks of treatment. It takes at least six weeks just to see if a medication has a chance of working for you. And there is little support for how to live life out of a treatment center. Honestly, most of us can't keep going back into the hospital and we need much more support in our every day life than most of our communities and insurance companies (if you are even lucky enough to have insurance) are willing to give us. You see a therapist and/or psychiatrist every day in a facility and then in regular life you might go to therapy once a week and see your psychiatrist once every six weeks. You have none of the outside stimulus, none of the people and situations that might contribute to your illness, and far less that can trigger you in a facility. Then you go back into the same life you had before and don't know how to manage. Going into treatment is beneficial to many people but the success rate could be even higher if we didn't just assume a few weeks in a hospital cured everyone and if we had better programming out of the hospital. Good care for a psych patient includes a plan after the hospital. A great start is if you have a loved one who is in a facility, to think about what changes you might need to make at home to help them keep up with treatment or how much assistance they might need with taking meds, eating, sleep, and exercising.

All this is to say, treatment is not simple and I don't know that we always have an understanding of how complicated it is. Some people ask me why I would write my blog if I am not "cured" or my illness is not under control. I write because my situation is much more common than we think it is. It can feel very lonely to look for resources on mental illness and often have it portrayed that there is a simple fix- if we would just take our meds and do what our doctors tell us. I wish it was not that hard. I wish there was a simple solution for everyone. Sometimes we have to just keep trying even if it does not work over, and over, and over again.

Blessings,

Rev. Katie

It Matters Who Prescribes Your Medicine

I realize that I have never talked about what to do if you think you need treatment for a possible mental illness. There is really not enough information out there on how to find the help so I will be creating a few posts on the subject.

So today my first piece of advice on this topic is one I am adamant about:

NEVER LET YOUR PRIMARY CARE PHYSICIAN PRESCRIBE MEDICATION FOR A MENTAL ILLNESS!!!

While I love all you primary care physicians and I know you care about your patients, in my experience this has never worked out well. It has always led to larger problems.

You would not let your primary care physician treat you for cancer, heart disease, scoliosis, or anything that requires detailed knowledge of a condition. Mental illness is not different. First of all, you really need to be diagnosed by a psychiatrist to know if you have an actual mental illness. A primary care physician does not have the detailed knowledge of all different types of mental illness to diagnose you. Misdiagnosing you and giving you the wrong medication can be extremely dangerous, such as sending someone into a medication induced manic episode because they were misdiagnosed as depressed when they were really bipolar. "Studies show that 74% of people seeking help for depression will first go to their primary care physician. Of these cases, as many as 50% are misdiagnosed. Even of the cases that are correctly diagnosed, 80% are given too little medication for too short a time." Also, many primary care physicians do not know how to correctly take someone off a medication for mental illness which is dangerous as well.

Photo by Jeff Norris

Lastly, these medications are very tricky to handle and have many physical and psychological side effects. Your primary care physician needs to know the basics about many different medications in order to do their job. They do not have the time to know the detailed facts about specific medications for mental illness and the less common side effects they cause which are not listed in the drug information packet.

So, if you are in crisis and feel you need help right away, get admitted to a psychiatric ward. If not, then ask you primary care physician to refer you to a psychiatrist for prescriptions and a psychologist (or other licensed mental health therapy professional) for therapy. If you are on medication which you are worried about, do not just stop taking it. These medications need to be tapered down under a psychiatrists supervision.

There is an exception to my rule of never letting a primary care doctor prescribe for you, and that is if your insurance does not cover a psychiatrist and you can not afford one on your own. This happens to far too many people. My husband and I have accrued quite a bit of dept paying out of pocket for psychiatrists, psychologists, and other mental health treatments. For us, debt was better than death, but I am not recommending everyone make that decision. No matter what, get treatment though.  Fight for the best medical care you can get within the constraints you have.

Blessings,

Rev. Katie

For Some Additional Reading:
Antidepressants Over Prescribed in Primary Care
Should Family Doctors Treat Serious Mental Illness?

Medication...Again

As many of you know, for a few months I have been off of medication, except for anti-anxiety medication as needed, and trying to go with just a diet, sleep, and exercise regimen for the treatment of my bipolar disorder. We know 100% that the Paleo diet, regular sleep, and regular exercise keeps my bipolar disorder manageable. However, I can't seem to keep up with those things on my own. I should know that this is not surprising because this is what it is like to have mental illness. The choices many people can make with a reasonable mind are not choices people with mental illness are always able to make. Right now I just can not stick to a eating, sleeping, and exercise plan on my own. So, I am back on medication....again.

Photo by Jeff Norris

One thing we are really coming to terms with is that for me, having a treatment plan that hinges on diet is probably not something I can handle. This is mainly because I have an eating disorder. I guess I have never talked about that on my blog, but I have a binge eating disorder and I just have not been able to stick to the correct diet on my own. So, my eating starts to get worse, which negatively affects my brain chemistry. Then I stop sleeping and exercising and everything goes down hill from there. I end up depressed, manic, suicidal, and back on medication.

I have to admit that I am pretty upset about being on medication again. I really wanted to be able to do this without them. I know it is possible to be well without medication were I able to make the right choices for long enough. The problem with managing mental illness by lifestyle changes is that those changes do not create wellness immediately. You really need a few months of perfect adherence to become fully functional and well enough to have the possibility (not guarantee) of continuing the program on your own. But, if your brain is impaired due to mental illness, many of us can not stick to those lifestyle changes for enough time to truly become well and have a chance of being off medication for long. Some of us can, but not all of us.

My new medication has a host of scary side effects (no surprise there), but one of the medications is supposed to help people with eating disorders so hopefully I can get back to healthy eating. I really do hope that with the medication I can keep the lifestyle changes long enough for them to be part of who I am and slowly decrease the medication so I need less or maybe none one day. That is the goal but in the mean time it is essential to know when you are doing so badly that you need more help.

Right now it is all up in the air. Who knows if I will even be able to tolerate these medications or what will happen over the next few months. I just know we are running around in the same circle and I hope one day we are not doing this over and over again.

Blessings,

Rev. Katie

The Trade-Off: Is It Worth It?

Today Beth Mader, a blogger from BP Hope Magazine, wrote a post called The Trade-Off about the trade-off between the side effects that her medication is causing her and the wellness the medicine brings. I really feel for Ms. Mader as the side effects and health complications she deals with from her medications sound very difficult. She made the choice to stick with the medication despite the side effects because the trade-off is that she is happy and doing well mentally.

Weighing the Side Effects (photo by Jeff Norris)

I have been contemplating this trade-off recently too. My medication does get rid of some of my symptoms, such as much of the mania is decreased with one medication and the anti-depressant I was on decreased my depression and anxiety. However, the anti-depressant came with other side effects like very bad stomach problems and sexual side effects (yep, no one like to talk about the embarrassing side effects, but they are pretty bad.) The medication for my mania is heavy duty and makes me dizzy, sluggish, gives me nightmares, increases my anxiety a lot, makes me gain weight, and is risky enough that I need to have blood tests done from time to time to make sure I don't get diabetes or kidney problems.

For me the trade-off, right now, is too high to stay on so much medication so in consultation with my doctor, we have adjusted things a bit. This means that I need to be even more vigilant about diet, exercise, and sleep as I do not have the higher doses of medication to take some of the edge off of my illness. This also means that I have to keep close track of my moods and if things start to get bad again, I will increase the medication.

Clearly, making decisions like this is hard and each person needs to make the decision with their carepartner and doctors. For instance, I want to stop the medication for the mania all together, but my husband Jeff does not want me to, so I won't. It is his life too after all, and the mania before I started this medicine was seriously negatively affecting our lives.

People who do not understand mental illness often have the false belief that if we just take medication, we will be fine. But no medication has ever made me completely better and symptom free, and all the medications have come with lots of side effects. Medication is not a quick fix and not something to be taken lightly. The trade-off is hard to navigate

Blessings,

Rev. Katie

Goodbye Heavy Heart

Photo by Jeff Norris

I was at an event last night where I saw old friends. We were catching up with each other and asking how work and family life are. As I honestly answered them, with the good and not so good, I realized that this is the first time I have not had a heavy heart. Often I have felt so weighed down with life that when friends asked how I was, I always felt this sadness in my heart. Even though not much has changed about life, I no longer feel that weight of sadness. I was just fine with things being the way they are. Some stuff is really good in life, some things are hard to handle, like being a caregiver for my mom. It is not that I don't care or feel nothing (as has happened with other medications), I actually feel a bit at peace with the way things are overall.

I admit that I hate my medicine because it has side effects I am scared of. However, I like it too because it has gotten rid of the heaviness, the weighed down spirit, the extreme anger, and it lets me deal with life better. It has taken away a lot from me and this type of drug increases in risk the longer you stay on it, but it does work. What scares me now is what if the risks get too high and I have to stop the medication at some point? I don't want to go back to having a heavy heart and all the symptoms of bipolar that are so much better now.

I also know that what works today may not work tomorrow, or a year from now. The only thing predictable about this illness is that it is not predictable. That is why you take the illness one day at a time and enjoy what you can, which is why I appreciate the weight being lifted. Before, I could not enjoy anything without having a heavy heart, last night I noticed I feel free, which is new for me.

Blessings,

Rev. Katie

Two Steps Forward, One Step Back

Sometimes I hate my medicine. I hate that it makes me a different person than I was before. I hate that while it may help the bipolar, it gets rid of some of the things I like about myself.

For instance, I went to play Dance Dance, Revolution (a dance video game) with my son today and I can hardly play it. My coordination is awful now. This upsets me because I have fun playing this game, but more importantly, this is something my son and I love to do together.

When my bipolar is bad, I rarely have the energy to play the game with him. Now I am feeling a bit better, but I can't play the game because of the medicine. That just does not seem fair. I know I should not care and just have fun and play it anyway, but I do not like losing part of myself, something that I was good at. And honestly, it is really not the same and not as fun, to fail every time.

As I try to do things I used to be able to do, I am finding how much my medication has changed me and made some things impossible to do and other things much harder to do. I trip over myself running now, I am much more tired and dizzy all day, and my heart races when I am exercising.

I am constantly struggling with the question of: Is the medicine worth it? I don't know yet and I will just wait and see, but I know this is one of the big reasons why people stop their medication. While you gain some things, you may loose a lot of yourself.

Blessings,

Rev. Katie

Difficult Decision Part V

This is in follow up to my recent journey of deciding to take medication. (Part I & II, Part III, Part IV) I think this will be the last part of this series for a while.

After some cutting of pills to get a correct dose and timing, this new medication seems to be working out well, and I am learning to live with the side effects. I had all the tests done to make sure the more concerning side effects were not harming me in any way, and it does not look like they are.

This past week when I saw my doctor again, we did add in another medication (one I have taken before) for the depression since the new meds do not help with that. We will see how it works.

Overall, I am very glad I stuck with the medication and side effects to see what would happen. I thank my hsuband for the many nights he stayed up with me as I agonized over taking the meds.

Over the past seven months, my bipolar disorder had gotten so bad that there were many things I could not do. I was just too exhausted, angry, and unable to get myself together enough to really have the life I wanted. However, this week I decorated the house for Halloween with my son, which I really would not have been able to do before. And today we built a little fort on the couch and I read Harry Potter to him. I have started back on Weight Watchers for the weight gain, and I am working on other lifestyle changes.

In our "fort," after the collapse :-) photo by Jeff Norris

I understand that I have to live with and manage my bipolar every day, but it was at the point where it was taking over my life. Clearly we could not let that happen and I think that is one of the things people need to know about managing mental illness.

We do not choose to be this way, but when it gets to the point that we can't do things and be who we are because of the disease, we do have the choice to keep fighting and get more help. The help will change over time. I assume my meds will change again at some point. I assume I will have hard times, and even right now I am still in the mode of needing to do a lot of work to get stable. But there will also be times when I am stable and I am in a routine where I barely think of my illness.

We may not be thrilled with all the things we have to do to manage our illness, but many people have different kinds of illnesses and they all manage as well. The point is that we can help each other find what works, keep our routines, and have many wonderful days.

Blessings,

Rev. Katie

Difficult Decision Part IV: "100% Better"

This is a continuation of my reflections of how difficult it is to decide to take medicine. (Here are Parts I & II and Part III.)

Reading the many possible side effects of my medication.

I have been on my new medication for a week now. As I mentioned in my previous post, I started with side effects of dizziness, extreme fatigue, and feeling faint. Now we can add to that some side effects I prefer not to mention, weight gain (yes in one week), and racing heartbeat just walking up the stairs.

However, according to my husband and son, I am 100% better than I was before.

Dang it!! This would be so much easier if the medication did not work. Then I could just stop the meds and have lost nothing. Instead I have side effects for which I need to have more tests run to see how the medication is affecting my body and now I fear needing to stop it due to finding out that it is hurting me too much to continue taking it.

I actually have never been this stable. Even when I was "stable" before, while I was able to get through my life and be productive I still had a baseline of feeling miserable, sad, and angry. Now mentally I feel fine most of the time, which is really weird for me (post about that coming soon).

I can't believe after a life of misery and after 13 years of medications, that we have found one which works, only to have the risk of losing my sanity again if the medication is too risky to take. Or I continue to take it but have side effects which seriously limit what I can do. Such as, is driving safe? Will I ever be able to exercise again or go on a bike ride with my son with this increased heart rate? Will I be fat forever?

What the heck is that all about?

These are the times when I question what kind of God, Universe, etc... messes with people in this way. What is the purpose in this?

All questions I will be exploring further, but for right now, I just need to wait. Wait to see how long this stability lasts, and wait until all the tests are done and we see what we are dealing with.

Blessings,

Rev. Katie

Difficult Decision Part III

This is a continuation of my blog post Part I & II about the difficult decision to take medication:

I have been on my new medication for two days now and I am uncoordinated, dizzy, and speech is more difficult for me. I was not manic at night yesterday like I usually am, and I was a little more stable during the day yesterday.

Today my son and I were at the NAMIWalk for mental illness (shout out to all the wonderful people I met today) and I was tired again, but by mid-morning I was actually playing catch with my son as we waited for the walkers. I was thinking that maybe the medicine is helping and I was so grateful to be having fun with my son.

Then I was reading a book to him and I started to feel faint and like I was going to fall over. I tried to eat some cereal I brought with me but kept missing my mouth as my coordination was so bad.

I had driven to the walk because I thought could drive this morning, but now I knew I could not drive home. My Dad had to come pick us up.

This is why deciding to take medicine is so difficult. I might have been having a better day earlier just because it was sunny out and I do have some good days, or it might be the medicine. It is too early to tell if the medicine is working yet, but these side effects mean I can't really drive because I might get stuck somewhere and get dizzy. This means I need to stay at home for now.

The worst part today though was how my son was affected by all of this. I had to tell him that I felt faint and if I fall, I will be ok, but he should tell someone and call 911. I felt it was better to tell him beforehand so I did not just fall over and he would be scared and not know what to do.

So then my sweet 7 year old son was worried about me and acting as my caregiver. He wanted to keep my cell phone in his hand and as we were cleaning up the display table, he wanted to carry everything and make me sit on the ground so if I fell I would not hit my head on the concrete. I feel so awful about putting him through that kind of fear and in the position to have to get help for me if I needed it.

He told me I should not take the medicine anymore. I said it might make me better, more happy, so we can have fun like we were when we were playing catch. He said "What's worse: Being unhappy from bipolar or dying from medicine?"

Good question my beautiful child.

This is why the difficult decision continues.

Blessings,

Rev. Katie

Yes, I Wear My Glasses

I just found a fantastic book about bipolar disorder. Seriously, go out and get the book now. It is called "Welcome to the Jungle: Everything You Ever Wanted to Know About Bipolar but Were too Freaked Out to Ask" by Hilary Smith.

Smith is a young adult writer with bipolar disorder who has an amazing truthful and witty writing style. I can't stop laughing reading her book. I will have a full review for you in just a few days, but I wanted to highlight one part of her book that I just love.

As I mentioned before, I am struggling with the fact that I have to take medication. In her book, Smith has a whole section about medication including talking about how so many of us don't want to take it. She gives great advice on how to combat our objections to medication.

At one point she says:
"Do you wear glasses? Do you sometimes go off wearing glasses for a month to see if your eyesight has fixed itself? Why not? Why is it easy to accept that your farsightedness is real and permanent, but hard to accept bipolar disorder? Can taking medication become as normal and acceptable to you as wearing your glasses?"


Well, I do wear glasses, I am quite blind without them. I have never "gone off" my glasses (unless I replace them with contacts.) How stupid would that be? I could risk seriously hurting people if I didn't wear my glasses and got in a car accident.

Not taking medication does the same thing. I seriously hurt myself and others when I don't take my medication and work on finding a mix that helps me.

Why does it take such a silly example for something to become so clear?

That is what I love about this book. It is full of glaringly obvious information that really, I should know, but it took her writing style to make it clear. Thank goodness for people sharing their stories in order to help others!

Blessings,
Rev. Katie

The Medicine Dance

There is a song in the musical Next to Normal (about a woman with bipolar and her family) called "Who's Crazy/My Psychopharmacologist and I." It talks about the medical treatment for Diana, the woman with bipolar, and how her husband Dan feels about her illness.

The part about the psychopharmacological treatment for Diana is scary, sad, and yet funny at the same time. For those of us who have done this medicine dance, this song is all too real. You take a cocktail of medications which give you a ton of side effects, and you are declared stable when eventually you feel nothing.

As I mentioned in a previous post, I don't really want to be on medication and I would rather manage my bipolar with vitamins, diet, exercise, sleep, and other lifestyle adjustments. I am afraid of the side effects of the pills, yet my bipolar can not be managed without them.

I recently talked to a teenager who has been told they should be on medication, but they do not want it either. I don't think people should be forced to take pills, but part of the disease of mental illness is that we don't think we need and/or we don't want medication. We must get good doctors and get multiple opinions if we need to, so we can adequately determine if we truly need to be on med's or not.

Looking back, I wish when I was in high school or younger, I would have had medication. First of all, my illness was not quite as severe, and the anxiety was the biggest problem. Interestingly, anxiety is the one thing which is easy for me to get rid of with medication. To know that I could have prevented years of crippling panic attacks with one pill makes me sad. I wonder how much more successful I could have been at the things I loved liked dancing, singing, and color guard. I lost so much by not being treated for my anxiety.

Let me describe the difference for you. When I am not on medication, I have panic attacks when I preach on Sundays. In order to do this thing that I love, I must adequately prepare, have a plan if my panic attack gets too bad, and do a lot of mental preparation. I preach, all the while telling myself in my mind that everything will be ok. I am scared to death, heart racing, palms sweating, for an hour, and no one knows. Or, I take one pill and am a little nervous, but present in the moment, with wonderful congregants, sharing a sacred hour with them.

It's a big difference, and while medication scares me, if I can find something that works, it can be worth it. The problem is the darn medicine dance. The side effects can be devastating and sometimes it feels like you spend most of your life cutting pills in half, timing when you take them, and trying new ones.

All this is to say that taking medication is a hard decision. I am attempting to come to grips with the reality that I have to take the pills. I still have to take vitamins, exercise, maintain a sleep schedule, meditate, and eat right too. Medicine won't take the place of a healthy lifestyle. As they say in Next to Normal "Is medicine magic, you know that it's not. But it's what we've got."

Blessings,

Rev. Katie