Messages

I did a sink full of dishes. I'm trying to be very conscious of how I spend my energy and not overdoing things. I am a bit shaky right now. So one sink full is a start.

Not today, because I am in a good place for self-reflection, but lately, I have been feeling so much overwhelm, anger, and some dismay. Like almost every person I encounter reminds me of some past situation in which I was powerless. As a result, my conversations have leaned into the negative pretty heavily. On one hand, I am speaking my current truth. On the other, I don't want to be around anyone.

I think about how I plan to move away and start over again. In a whisper my inner critic tells me I'm a coward and quitting too soon and not working hard enough. My inner cheerleader thinks I'm brave, and willing to face a difficult decision that many people turn away from.

I'm slowly re-calibrating and getting ready for the next phase of my life. I haven't done it yet, but will be looking for a new therapist. This isn't a terrible thing. We may have reached a natural end in what I can gain from my work with her.

*shaking is gone. Just really sleepy now.

I really need to monitor my autocorrect better. Lots of complete nonsense sentences lately.

I managed to make the most of my day at home despite feeling rotten for most of it. I did laundry, took out garbage and recycling, and did my taxes. So tonight's blank page is filled by me celebrating the fact that I'm clawing my way out of my despair pit, one small act at a time.

I stayed home from work today. I had major insomnia last night after already not sleeping well every other night this week. I'm a bit nauseous and have upset stomach, too.

The whole first half of this week was so stressful. I'm behind in my work for a multitude of reasons including missing information and interruptions, but am sure from management's perspective it looks like I can't  prioritize my workload. I am completely overwhelmed and there's nobody to help.

Work that used to be done by 6 is being covered by 3 on our team. Half our managers quit in the last 5 months. The remaining ones are constantly travelling across the country for training that we may or may not ever see ourselves. We are grossly under-staffed throughout.

And still I feel guilty about taking a sick day. I'm that well trained.

I can't balance my life and my work life for a long period, sustainably. Especially not when it's like this. And it seems to always be like this. In fact, things at work have gotten worse and worse consistently since I started here.
The company is too big and the gears grind with no feeling for the cogs they're crushing.

Maybe I'll clean today. Maybe I won't. But I needed today to rest and refocus. 

[Moderators, please feel free to contact me if I should edit the post or break it up to better comply with standard forum guidelines.]

A long post, but worthwhile for those who wish to access hard data. Moderators, please feel free to contact me if I should edit the post or break it up to better comply with standard forum guidelines. I placed this here as it's not specifically about C-PTSD, but about the treatment of Major Depressive Disorder by many different medications.

A new study, combing through vast amounts of clinical trial data,  published in The Lancet, has confirmed the effectiveness of antidepressants in treating depression.

My own opinion is that antidepressants are most effective in combination with other non-drug therapies. But much better than nothing, if medication is all that the person can access, for whatever reason. C-PTSD is more complex than major depression. I would argue that major depression is one of the symptoms of C-PTSD and other serious conditions. I am not a doctor, just someone who prefers scientific evidence in my treatment journey. I believe this information will be beneficial to many people,which is why I am sharing it here.

Brief excerpt:

"We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89–2·41) for amitriptyline and 1·37 (1·16–1·63) for reboxetine."



Full text:

"Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis.

Background
Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions. Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder.

Methods
We did a systematic review and network meta-analysis. We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers for published and unpublished, double-blind, randomised controlled trials from their inception to Jan 8, 2016. We included placebo-controlled and head-to-head trials of 21 antidepressants used for the acute treatment of adults (≥18 years old and of both sexes) with major depressive disorder diagnosed according to standard operationalised criteria. We excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness. We extracted data following a predefined hierarchy. In network meta-analysis, we used group-level data. We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were efficacy (response rate) and acceptability (treatment discontinuations due to any cause). We estimated summary odds ratios (ORs) using pairwise and network meta-analysis with random effects. This study is registered with PROSPERO, number CRD42012002291.

Findings
We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89–2·41) for amitriptyline and 1·37 (1·16–1·63) for reboxetine. For acceptability, only agomelatine (OR 0·84, 95% CrI 0·72–0·97) and fluoxetine (0·88, 0·80–0·96) were associated with fewer dropouts than placebo, whereas clomipramine was worse than placebo (1·30, 1·01–1·68). When all trials were considered, differences in ORs between antidepressants ranged from 1·15 to 1·55 for efficacy and from 0·64 to 0·83 for acceptability, with wide CrIs on most of the comparative analyses. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0·43–0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1·30–2·32). 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low.

Interpretation
All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants.

Funding
National Institute for Health Research Oxford Health Biomedical Research Centre and the Japan Society for the Promotion of Science.

Research in context

Evidence before this study

Antidepressants are routinely used worldwide for the treatment of major depressive disorder, which is one of the most important global health challenges; however, in the scientific literature, there remains considerable debate about both their effectiveness as a group, and the potential differences in effectiveness and tolerability between individual drugs. With the marketing of new antidepressants and increasing numbers of trials published every year, an updated systematic review and network meta-analysis was required to synthesise the evidence in this important clinical area.

Added value of this study

This network meta-analysis represents a major update and extension of our previous study, which addressed 12 antidepressants with data for head-to-head comparisons only, and provides the best currently available evidence base to guide the choice about pharmacological treatment for adults with acute major depressive disorder. We now include a more comprehensive list of 21 antidepressants and placebo, consider three new clinical outcome measures and many potential effect modifiers, and use the most advanced statistical methodology for network meta-analysis to date.

Implications of all the available evidence

Our findings should inform clinical guidelines and assist the shared decision making process between patients, carers, and clinicians in routine practice on selecting the most appropriate antidepressant for adults with acute major depressive disorder. Future research should seek to extend network meta-analysis to combine aggregate and individual-patient data from trials in a so-called individual-patient data network meta-analysis. This analysis will allow the prediction of personalised clinical outcomes, such as early response or specific side-effects, and the estimate of comparative efficacy at multiple timepoints.

Introduction
Psychiatric disorders account for 22·8% of the global burden of diseases.1 The leading cause of this disability is depression, which has substantially increased since 1990, largely driven by population growth and ageing.2 With an estimated 350 million people affected globally, the economic burden of depressive disorders in the USA alone has been estimated to be more than US$210 billion, with approximately 45% attributable to direct costs, 5% to suicide-related costs, and 50% to workplace costs.3 This trend poses a substantial challenge for health systems in both developed and developing countries, with the need to treat patients, optimise resources, and improve overall health care in mental health.

Grouped into various classes of drugs with slightly different mechanisms of action, antidepressants are widely used treatments for major depressive disorder, which are available worldwide. However, there is a long-lasting debate and concern about their efficacy and effectiveness, because short-term benefits are, on average, modest; and because long-term balance of benefits and harms is often understudied.4 Therefore, innovation in psychopharmacology is of crucial importance, but the identification of new molecular targets is difficult, primarily because of the paucity of knowledge about how antidepressants work.5 In routine practice, clinicians have a wide choice of individual drugs and they need good evidence to make the best choice for each individual patient. Network meta-analyses of existing datasets make it possible to estimate comparative efficacy, summarise and interpret the wider picture of the evidence base, and to understand the relative merits of the multiple interventions.6 Therefore, in this study, we aimed to do a systematic review and network meta-analysis to inform clinical practice by comparing different antidepressants for the acute treatment of adults with unipolar major depressive disorder.

Methods
Search strategy and selection criteria
We did a systematic review and network meta-analysis. We searched the Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, AMED, the UK National Research Register, and PSYNDEX from the date of their inception to Jan 8, 2016, with no language restrictions. We used the search terms "depress*" OR "dysthymi*" OR "adjustment disorder*" OR "mood disorder*" OR "affective disorder" OR "affective symptoms" combined with a list of all included antidepressants.

We included double-blind, randomised controlled trials (RCTs) comparing antidepressants with placebo or another active antidepressant as oral monotherapy for the acute treatment of adults (≥18 years old and of both sexes) with a primary diagnosis of major depressive disorder according to standard operationalised diagnostic criteria (Feighner criteria, Research Diagnostic Criteria, DSM-III, DSM-III-R, DSM-IV, DSM-5, and ICD-10). We considered only double-blind trials because we included placebo in the network meta-analysis, and because this study design increases methodological rigour by minimising performance and ascertainment biases.7 Additionally, we included all second-generation antidepressants approved by the regulatory agencies in the USA, Europe, or Japan: agomelatine, bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, venlafaxine, vilazodone, and vortioxetine. To inform clinical practice globally, we selected the two tricyclics (amitriptyline and clomipramine) included in the WHO Model List of Essential Medicines). We also included trazodone and nefazodone, because of their distinct effect and tolerability profiles. Additionally, we included trials that allowed rescue medications so long as they were equally provided among the randomised groups. We included data only for drugs within the therapeutic range (appendix pp 133, 134). Finally, we excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness.

The electronic database searches were supplemented with manual searches for published, unpublished, and ongoing RCTs in international trial registers, websites of drug approval agencies, and key scientific journals in the field.8 For example, we searched ClinicalTrials.gov using the search term "major depressive disorder" combined with a list of all included antidepressants. We contacted all the pharmaceutical companies marketing antidepressants and asked for supplemental unpublished information about both premarketing and post-marketing studies, with a specific focus on second-generation antidepressants. We also contacted study authors and drug manufacturers to supplement incomplete reports of the original papers or provide data for unpublished studies.

Six pairs of investigators (ACi, TAF, LZA, SL, HGR, YO, NT, YH, EHT, HI, KS, and AT) independently selected the studies, reviewed the main reports and supplementary materials, extracted the relevant information from the included trials, and assessed the risk of bias. Any discrepancies were resolved by consensus and arbitration by a panel of investigators within the review team (ACi, TAF, LZA, EHT, and JRG).

The full protocol of this network meta-analysis has been published.8

Outcomes
Our primary outcomes were efficacy (response rate measured by the total number of patients who had a reduction of ≥50% of the total score on a standardised observer-rating scale for depression) and acceptability (treatment discontinuation measured by the proportion of patients who withdrew for any reason).8 All-cause discontinuation was used as a measure for the acceptability of treatments, because it encompasses efficacy and tolerability.9 Secondary outcomes were endpoint depression score, remission rate, and the proportion of patients who dropped out early because of adverse events. When depressive symptoms had been measured with more than one standardised rating scale, we used a predefined hierarchy, based on psychometric properties and consistency of use across included trials.8 In the absence of information or supplemental data from the authors, response rate was calculated according to a validated imputation method.10 We recorded the outcomes as close to 8 weeks as possible for all analyses.9 If information at 8 weeks was not available, we used data ranging between 4 and 12 weeks (we gave preference to the timepoint closest to 8 weeks; if equidistant, we took the longer outcome). We checked trial protocols where available and compared published with unpublished data. We extracted data following a predefined hierarchy described in our protocol and gave priority to unpublished information in case of disagreement.8

Data analysis
For studies published more than once (ie, duplicates), we included only the report with the most informative and complete data. Full details of the applied statistical approaches are provided in the protocol.8 We estimated summary odds ratios (ORs) for dichotomous outcomes and standardised mean differences (SMD, Cohen's d) for continuous outcomes using pairwise and network meta-analysis. In network meta-analysis, we used group-level data; the binomial likelihood was used for dichotomous outcomes and the normal likelihood for continuous outcomes. The study effect sizes were then synthesised using a random-effects network meta-analysis model. We accounted for the correlations induced by multi-group studies by using multivariate distributions. The variance in the random-effects distribution (heterogeneity variance) was considered to measure the extent of across-study and within-comparison variability on treatment effects. Additionally, in network meta-analysis, we assumed that the amount of heterogeneity was the same for all treatment comparisons. To assess the amount of heterogeneity, we compared the posterior distribution of the estimated heterogeneity variance with its predictive distribution.11 To rank the treatments for each outcome, we used the surface under the cumulative ranking curve (SUCRA) and the mean ranks.12 The transitivity assumption underlying network meta-analysis was evaluated by comparing the distribution of clinical and methodological variables that could act as effect modifiers across treatment comparisons.8 We did a statistical evaluation of consistency (ie, the agreement between direct and indirect evidence) using the design-by-treatment test13 and by separating direct evidence from indirect evidence.14

We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions. Additionally, we assessed the certainty of evidence contributing to network estimates of the main outcomes with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.15

We evaluated whether treatment effects for the two primary outcomes were robust in subgroup analyses and network meta-regression using study year, sponsorship, depressive severity at baseline, dosing schedule, study precision (ie, small study effect), and novelty effect.16 The appendix (pp 133–36) summarises the definition of covariates. The sensitivity of our conclusions was evaluated by analysing the dataset with the following restrictions: studies with reported response rate, studies using accepted doses in all groups, studies with unpublished data, multi-centre studies, and head-to-head studies. We used comparison-adjusted funnel plots to investigate whether results in imprecise trials differ from those in more precise trials.17

We fitted all models in OpenBUGS (version 3.2.2)18 using the binomial likelihood for dichotomous outcomes, uninformative prior distributions for the treatment effects, and a minimally informative prior distribution for the common heterogeneity SD. We assumed uninformative priors—ie, N(0,1000)—for all meta-regression coefficients. Convergence of models was ensured by visual inspection of three chains and after considering the Brooks–Gelman–Rubin diagnostic. The codes of analyses, statistical details of the meta-analysis, and meta-regression models are presented in the appendix (pp 182, 183). Statistical evaluation of inconsistency and production of network graphs and result figures were done using the network and network graphs packages in Stata (version 14.2).19 Network meta-analyses of the primary outcomes were duplicated using the netmeta 0.9-6 package in R (version 3.4.0).20 The appendix (p 289) lists the changes to the original protocol. The study was done from March 12, 2012, to June 4, 2016, and data analysis was done from June 5, 2016, to Sept 18, 2017.

This study is registered with PROSPERO, number CRD42012002291.

Data sharing
With the publication of this Article, the full dataset will be freely available online in Mendeley Data, a secure online repository for research data, which allows archiving of any file type and assigns a permanent and unique digital object identifier (DOI) so that the files can be easily referenced (DOI:10.17632/83rthbp8ys.2).

Role of the funding source
The funder of this study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit for publication. ACi, TAF, GS, ACh, LZA, and YO had full access to all the data, and ACi was responsible for the decision to submit for publication.

Results
28 552 citations were identified by the search and 680 potentially eligible articles were retrieved in full text (figure 1). We included 421 trials from the database search, 86 unpublished studies from trial registries and pharmaceutical company websites, and 15 from personal communication or hand-searching other review articles. Overall, 522 double-blind, parallel, RCTs (comprising 116 477 patients) done between 1979 and 2016, and comparing 21 antidepressants or placebo were included in the analysis (appendix pp 6–64). The appendix (pp 65–114) summarises the characteristics of included studies. The mean study sample size was 224 participants (SD 186). In total, 87 052 participants were randomly assigned to an active drug and 29 425 were randomly assigned to placebo. The mean age was 44 years (SD 9) for both men and women; 38 404 (62·3%) of 61 681 of the sample population were women. The median duration of the acute treatment was 8 weeks (IQR 6–8). 243 (47%) of 522 studies randomly assigned participants to three or more groups, and 304 (58%) of 522 were placebo-controlled trials. 391 (83%) of 472 were multi-centre studies and 335 (77%) of 437 studies recruited outpatients only. 252 (48%) of 522 trials recruited patients from North America, 37 (7%) from Asia, and 140 (27%) from Europe (59 [11%] trials were cross-continental and the remaining 34 [7%] were either from other regions or did not specify). The great majority of patients had moderate-to-severe major depressive disorder, with a mean reported baseline severity score on the Hamilton Depression Rating Scale 17-item of 25·7 (SD 3·97) among 464 (89%) of 522 studies. Response rate was imputed in 20 608 (17·7%) of 116 447 cases. Rescue medications (typically benzodiazepines or other sedative hypnotics) were allowed in 187 (36%) of 522 studies. 409 (78%) of 522 studies were funded by pharmaceutical companies. We retrieved unpublished information for 274 (52%) of the included trials. Consistent with the study protocol, the primary analysis was based on the 474 studies (comprising 106 966 patients) that used drugs within the licensed dose range (ie, the dosage approved by the regulatory agencies in the USA and Europe; appendix pp 133, 134)


Figure 1 [viewable at source website]
Study selection process

RCTs=randomised controlled trials. *Industry websites, contact with authors, and trial registries. The total number of unpublished records is the total number of results for each drug and on each unpublished database source. †522 RCTs corresponded to 814 treatment groups."

Source: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/abstract

[One that my brother has.]

Back awake in the middle of the night. I don't  even fight insomnia anymore. I try to sleep well. I just don't sleep well.

Had an interesting experience. I went for an eye exam, first in over 10 years. Have been experiencing minor double vision at times, finally saw to it.

The eye exam form asks family medical history. I realize now that any time any medical questions are asked, for the rest of my life, I will have to remember my father's death.

This is the other point that I never got to a few entries ago. Appropriate it came like this. It's exactly the same as in life. I guess it's memory problems. I think there's an element of inner critic, too. That I'm not worth the time I need to express myself.  I have so much trouble with getting everything I need to say out. I often leave out something important. Then I remember it later and feel lousy about it. It causes problems sometimes. This is frequently triggered by circumstances, too. But most people see this as "excuses" because they lack empathy.

So anyway, in the exam, for whatever reason, I didn't tell the Dr that I have one tiny dark spot in my vision. In my left field of view. It doesn't impact me negatively, and I don't know when it appeared. It's just there. Sometimes I see it, mostly not. I specifically got my eyes checked and didn't mention it. Ugh.

I also have a tendency to downplay my own discomfort. I think mainly this is from being dismissed so much that I have internalized it. So the Dr asks about my eyes, which are pretty red in the eyelids. And I have itchy, red eyes almost all the time. Nothing makes a really noticible difference. I've been living with it. "I figured it was just allergies", I told him. He tells me I need to wash my eyelids with baby shampoo every day now.

I pick a couple basic frames and head for home. Later, I start Dr Googling. And then  .

Red, itchy eyes that feel gritty with no obvious cause is one of the symptoms of a rare auto immune disease. One that my brother has. One that I have never mentioned to any health professional, even though he was diagnosed several years ago. One that can attack any part of the body with differing severity, and has no specific test. It can only be ruled out by process of elimination. It could explain pretty much every random and mysterious health issue I've had that didn't just resolve itself since childhood. Or I could be a hypochondriac, which is how I feel people see me.

Is this a path I want to go down with Dr's? I suffer, but am not incapacitated. Yet. I fear the years of my life this could take. The uncertainty. Test after test, some traumatic. But it is a real disease, "visible" with hard evidence.

My next step is to talk to my brother, I guess. Then I can decide.

Again I'm left with more questions than answers, and never enough time, space or energy to express everything I am experiencing.

(If one is asking, the answer is probably "yes")


I "have" a therapist who's on leave for a year or so. I have been without a therapist for 5 months.

I have a Dr that refills my med scrips and little else.

Thought I'd try and save money while my T was away. I've got issues that I've been pushing aside and that's impacting other areas of my life. I haven't listened to my voicemails since the summer. I haven't done dishes in weeks, since I got back from my work trip. I'm not cleaning my place; am lethargic in general. Not exercising at all.  These things gnaw at my self-worth. I'm not sure what the root is per se, just that I'm going through a long, quiet, self-destructive slow spiral and can't pull up on my own.

My therapist has helped me a lot. I feel like I need a team of therapists if I'm ever going to get "better".

And yet, I have had a number of bad experiences with people, so it's hard for me to trust.  So my relationship with my therapist feels somewhat irreplaceable. I've been holding out for things to get better. I try to tell myself hopeful things to motivate myself, but they're just empty words.

Anyone have any validation/advice?

Woke from a dream that was kind of a time travel dream but in which I also died multiple times. Groundhog day meets Star Wars meets Star Trek. And I seemed to be the only person aware of the repetition. Which figured in a way because I was the one who was tasked with the suicide mission, wherein I would live if I succeeded, and die and have to replay my life until I got it right if I failed. Come to think of it, this dream is also basically Westworld and that Tom Cruise space war movie whose name I can't remember. I woke completely anxious even though I did eventually succeed in the dream.

Although on the surface it's unrelated, I am sure this is a work dream. In life I feel like I am experiencing the same awful situations over and over and I can't figure out how to navigate them properly with the people I have to work with. I don't get enough training for my "mission", rush through my work, doing the best I can for the time I have, and it's somehow not up to standard, even though I followed the rules I was given. And then I have to do it again, with even less time, and everyone is frustrated with me. Is it any wonder that I wake up anxious, and that work is the biggest stress in my life?

So far working as an adult has again and again mirrored my relationship with my family. I get what I get, and it's never what I actually need to succeed. Eventually I find the courage, or out of desperation or innocent ignorance, I ask for what I need, and that request is met with derision or judgement or anger. So I stop asking, and go on suffering. Family and work, same bullcrap, different pile.

And now that I am an adult, I am judged poorly for failing by most people, and judged poorly for asking for more help by some of the same people. People who get to evaluate my work as part of their jobs. And yet I get no chance to evaluate theirs, and culture frowns upon even mentioning their shortcomings because we're supposed to be a team. Well, lol, they actually use the word "family".

On top of all this, I can't afford to live anywhere near work, and can't afford a car. And this is modern life. And people hear my job and say "sounds fun!" and I think, if they only knew.

I don't know how to keep on pushing past breaking. Work breaks me again and again. Actually, it's really people that break me again and again. I am functional enough to fall through the cracks and be judged for failing. I hate this culture so much sometimes. Where "collaboration" actually means "conformity", and respect only goes one way. Don't I dare comment on what needs to be improved.

So then anxiety gets worse and worse, and eventually panic attacks and other issues. Like it's not hard to see why I'm suffering... It's been the same story since I was a child. I live in fear because someone always holds power over me to make my life more miserable. And when I think I'm doing ok, that's often when the rug flies out from under me. Blah. I know I'm basically describing a lot of people's lives.

Anyway, Monday, yay. Time to go prove my worth as a human for another week.

It's snowing in my city tonight, and my city is a place that isn't equipped for snow. So I am half expecting that I'll have a snow day tomorrow.

I remember how anxious and deeply stressed I was by this last year. At that time, not making it to work for a day meant not making rent. Things have improved a little since then.

I'm a bit sick, and came home and napped after work. So wide awake now.

There are a couple of C-PTSD "symptoms" I've been puzzling about.

The first, I've kinda written about before. I posted about ADD and focus elsewhere in the forum.  This relates to that. I struggle to remember things if I have to focus on something else specific. This manifests as general difficulty focusing on tasks, rapid forgetfulness, and appearing/feeling scattered. This is very hard to cope with at work and I struggle with it nearly minute by minute. I've been trying to actively observe it happening, and the circumstances in which it's most troublesome. Worst seems to be when I am listening to someone in a conversation, and there's a point I want to make in relation to their statement. I have a habit of enthusiastically interrupting. It's rude, and I know it, although I don't mean to be insulting. So I make an active effort to stay in the moment and listen only. Unfortunately, even concentrating on listening to the other person. In that moment is usually too much input, and I forget what I wanted to say before they finish taking. Sometimes, the effort of staying in the moment is enough that I don't even retain what the person said. It's pretty embarrassing, and I dread lengthy verbal instructions because I will either forget to clarify something important, or forget the instructions themselves. I try to cope by writing down all instructions but it's time consuming and not fool-proof, either. My short-term memory is almost non-existent, sometimes.

Writing made me sleepy. Will hit up the other point, soon.

Today I'm feeling wry amusement at my desperation to be a functional person in a dysfunctional world. Why bother? Meh. What else would I do with my life? Lol.

I've been avoiding coming back to write. The level of self-examination I need to complete right now felt too heavy for work days.

I want to take the stress out of my life, or at least turn it down to a manageable level. And yet, I have ambitions. Given that I'm wired to hypervigilence, it seems to be a recipe for difficulties. I think my expectations haven't been realistic.

A lot happened while I was away. I "broke up" twice, first with my friend with benefits, because his situation with his girlfriend was too harmful and triggering for me. A couple weeks later,  ended the more serious relationship I had, after learning that he was going to Mexico for a week with his other girlfriend, the entire week after Christmas when I was back in town,  and could have seen him. I felt pretty bummed out about this. But on my fwb's advice (still friends), I tried to date while out there.

I had already realized I could see myself out there. And then I met someone. We more than clicked. We want basically the same things in life, have similar philosophies, enjoy each other's company, have both mutual and individual interests, and our strengths compliment our differences. It felt "right" almost from the beginning. Different in a good and natural way. He's caring, considerate, and altruistic to a reasonable degree. He's stable and communicative.

We dated up until Christmas, then talked every day while I was gone, then spent almost every night together when I went back out there. He loves me, and I love him. He treats me amazingly, and I have seen no red flags. I even wrote him "20 questions" to try and find any points of caution, and didn't.

He's not a perfect person. But he's not broken, and not stunted. He says what he means, and lives by the golden rule. He can learn from me, and I can learn from him.

In a roundabout way, this takes me back to my last post. How do I proceed in a world that has so many harsh contradictions? One that is so full of cruelty and abuse.

Being away made me realize that I am deserving of better, just as I am, now. I am flawed but not worthless. I think I am a mediocre person, and that's not bad. It takes some pressure off. I do bad things unintentionally sometimes. But I am not bad. And the same would have to be true of most people except for the chronic abusers.

So for me to get beyond the blocks I am experiencing now, to be able to stay involved in this world, with any energy to cope, I think I have to do 3 main things:

1) regularly doing yoga, at least every other day.
2) cultivating some faith that most people's actions aren't intentionally negative
3) working on forgiveness/gratitude for all the small things that I do. I am intentionally leaving out "big" things. I am hoping to change the nature of the hundreds of battles in my body.

I think those are 3 minor ways I can free up my mental and emotional bandwidth. In starting with me, maybe I can be more ok with others. Eventually. Not that this will be easy.

It's really important for me to remember that there will be times I forget, and setbacks, but those 3 steps should be able to get me back on track.

There's a lot of bad in the world. But if I can make a little good, for myself and maybe a couple others, I should do that. There's a little willful blindness in the simplicity of that statement. But I'm hoping that by starting small, I can find the strength to reach further.

Such an about face from the last entry. This is what being on the retreating end of an anxiety attack looks like. I want to remember this.

I just finished rewatching Westworld. Such a good show, such layered storytelling and meaning. But I wonder if the meanings I start to realize from the show were at all intended, and can't help but think only some were.

Each day I see more clearly.  People so broken, systems so broken, and societies so broken, that I am reaching a point of simultaneously raging and freezing. I cannot cooperate with people I cannot respect, and I cannot respect abusers. I cannot complete my loops.  This leaves me quite lonely in the world, because all of us carry the seeds of abuse in us. Not all of us will let that seed grow, or worse, condone abuse or actively abuse,  themselves. But those who do are so destructive that they leave trails of trauma behind them. And I think they are the majority of people. They live in their loops and never question a thing in themselves.

I have abused, and if I'm honest, I'm likely to again at some point. Not from a desire to control, but more likely in an emotional flashback, when I react from instinct and programming. I'm imperfect, naturally, and I don't think I'll reach some enlightened place where I'll never act abusively again. It's funny, I mentioned before how I feel on the edge of a breakdown, but it's really that I can't accept garbage anymore.

I see systems built with layer upon layer of oppression, and the only way out of our particular type of oppression appears to be to climb on up to the next layer. Do I shrug and climb, being glad I get to a place "a little better" than I was at, knowing it will have a high cost to others? Do I shrug and accept this as the way of the world? Or do I stop participating in the broken world, and try to build one of my own? One that to my heart at least, is less broken, with as little to do with this world as possible.

It's funny to me because my first round of therapy, it occurred to me that the goal wasn't actually to heal me, just to make me productive again. Useful to society, whatever that use is. And that realization has faded in and out over the years. But it's back in a big way now. And I don't know what to do now. I don't know if it will fade away again. I don't know if it just sounds like crazy babble to most people outside of me (oh yeah, most abusers).

I have been to therapy. I have taken communication classes. And I realized that I wasn't really the person that needed these things.  They help me, and I learn. But chronic abusers won't recognize themselves, won't want to increase empathy, and won't consider such activities as worthwhile. And I only partially hurt myself, if I've intentionally gone into harm's way. Otherwise, it's other people. They are the sticks and stones that break my bones, and also the name callers and abusers that scar me.

I need to carve my secret spaces and find a small group of people I can really trust. Can I do that in a lifetime of seeking? I find the people I trust come into my life until something happens and the trust is violated. Respect declines, and eventually I move apart from them. Which is also another way of looking at self-isolation. And here I am on the brink of doing that again, yet I can't find compelling enough reasons to stay. Nothing is strong enough to hold me.

It's a lot to parse, and probably a lot to try and follow. Too much for tonight, but I hope to revisit this line of thinking soon and expand on it.

Not sure if today was a breakthrough of some kind. It was certainly some kind of progress.

I started my last day off before work again as pleasantly as I could, to ease myself back into the early starts. Nice coffee, yogurt &  granola, a pastry, and yoga.

I knew I was in a tender place when she said the point of the practice was "loving ourselves" and my heart caught in my throat. Okie dokie, right to the insecurities at 7am!  But I continued on, determined to get a healthy routine going again. I had only done yoga a couple of times the entire time I was away. And it was a very stressful for me. I catch myself clenching my jaw, just thinking about it.

So I do a few poses and man, am I sore. Tighter that it seems I've ever been. We get to stretching the shoulders, which have been hunched at desks, wedged into airplane seats, and supporting my enlarged bossom (yay, sedentary weight gain), and carrying most of my stress. They have been very painful over the last few weeks.  All of a sudden I burst into tears, less than 5 minutes into practice. And I sob through the rest of it.

I'm grateful I do yoga at home, alone, because I was unprepared for this, and it was ugly crying. I have been feeling squishy all day. I wish I could say I feel better, like I released something. But not yet. I think this pain is deep enough that it'll take time.

I joked that the work experience traumatized me. It's not much of a joke, though.

I've been carrying stress about my work, my home, and my finances for over a year. I think I might be nearing a breakdown. If breaking down means being done with other people's abuse and expectations, packing it all in and leaving.

After all this I ran into my landlord. I told him I was back, but work is likely to send me away again in July, so could I please sublet again? He said no, and in fact it was never ok the first time. Which was a surprise to me given that he never replied to the email in which I informed them I had to leave for work and was planning to sublet.  The email I still have, in my sent folder.

So I was pushed to leave for work, had to foot my own expenses  for a month and wait to be reimbursed, and needed to sublet to free the cash to be able to go to work. And this was unacceptable to my landlord.  I'm not even sure anymore if I'm done with this city anymore, or it's done with me.

Feeling a bit sorry for myself, but no wonder I ended up sobbing. The last few months had some amazing things happen, but it was also really, really rough. Something I think only a couple of people I know might have "kind-of" experienced. And I don't believe all this struggle is worth it here, anymore.

It's been so long since I wrote anything.  Life has been interesting and crazy. I am home now, but it feels weird. Perhaps it will take a while to feel like home again. I am jetlagged. I spent the entirety of yesterday in bed, except for a walk to get breakfast and groceries, and to eat.

I don't even know where to start. I'm such a jumble of emotions that I can't describe anything simply.

Things I am sure of:
I want to leave this city and province, and move to the area I was working. I liked it a lot. And if I liked it for 3 months in the dead of winter, chances are good that I will continue to like it. The life I want seems possible there. It's not possible here. I tried for 10 years.

I have "friends" who say I just have to try harder. Work more. I already work full-time and have my physical and emotional health to maintain. That is a lot, and it's all I can do. I can't really keep up. I feel betrayed that friends, all in more privileged positions, think I need to work more. They have husbands/partners to support them. They have higher incomes and everything that goes with that. It could be that they love me and don't want to lose me. But it doesn't feel like love.

I need so much more therapy to undo my faulty programing. I suffer so much because of it. Even still, I made progress in the last few months.

I learned I can go on in the face of suffering. I can work through my pains. I know that I am strong, determined, and more capable than I was giving myself credit for. But do I want to work in pain? Aspects of my job are agony, and I can't hide it. On one hand I love it, and on the other, I hate it. The aspects I hate have to do with other people. And that's the crux of the work. It makes me feel bipolar, to swing from joy in my work to loathing. I'm sure in the long term it's not worth the toll it takes on me. What I don't know is if there is anything else I can learn about myself through my work. I know there will always be skills to gain, each day will be different, etc. I believe in my company's values for the most part. I just don't believe they actually follow them a lot of the time. And I think that will get worse, too. I'm not a "drink the kool-aid" person. And that's what most people seem to want in a worker. So many coworkers are coercive and abusive. I see it and it disgusts me.

I'm punishing myself less for the things I want and need. I'm gradually growing more confident that the way I want to live is as valid as anyone else's ways. I think maybe I'm less aligned with my friends than I thought, than I pretended to be. I feel like I always have to pretend for Someone. I'm tired of not getting what I want.

So this trip was good for me. And if I respect my desires, major life changes aren't through with me, yet.

This post contains triggers for inner critic abuse and negative self-talk. There is no censorable language.

It's a really long one. I don't have any expectation of anyone reading it. I just had a lot bottled up since the last time I wrote.


Delving further into feeling things this week. Been spending a lot if time alone again. I think it's been good but it's also been quite sinful at times.

In addition to learning that I have to do a lot of the scary things if I want a better life (I hope it's better... The jury's still out on that) I am recognizing some patterns of suffering. I kinda knew about these before - the severe anxiety, procrastination and overwhelm I experience. But I'm seeing a bit more what takes shelter under those covers.

When confronted with a situation in which I could fail to meet expectations, I experience some deep-seated panic and grief. And it happens all. The. Time.

Say I need to do the dishes. My inner critic starts up that I'm a failure if I can't clean up after myself and nobody will love a slob. That was really painful to write. But it's what a big part of me believes. It's such an automatic thing that I don't even notice it usually. The words of the ICr almost don't matter, it's always some variation on that theme.

And it could be any task, I have probably a 75% chance of reacting the same no matter what it is. And then there's this other part of me, I guess it's my inner child, that's so wounded that I either freeze in anxiety or else actually go through levels of grief and reckoning with that before I can get on with what needs doing. Sometimes it comes as a reaction to the ICT, and sometimes it's in anticipation of failure and shame. Any task, any time. That's the essence of the hundreds of battles a day. And I don't usually have enough energy to win all of them, or even most of them. And certainly it affects the speed and confidence with which I do my work. It can also make me very conscientious if I'm not in a rush, although I usually have to be due to tight deadlines imposed by management.

I don't know how to stop any of this before it starts. Once it's started, I second-guess and get distracted so easily. Anything to take me away from the pain of the unknown outcome.



In more external matters that affect my well-being:

Money stress is close to resolved now. Hopefully in the next couple weeks, and that should last a few months. Fingers crossed.

The dating world sees me with one fewer paramour. I can't deal with the emotional labour that was being placed on me by one of the 2 men I was dating. He has been going through some genuinely traumatic things with his primary girlfriend, and I was supporting him through his hard times. I came to feel taken for granted, maybe even abused a little in light of the awfulness he won't end with her. They shouldn't be together. She self-harms and acts out and betrays his trust.

I tried to tell him gently multiple times that he deserves better (not me, haha). But their drama is escalating and is dangerous. It triggered a lot of the old traumas from my relationship with J. I finally tried to tell him a cautionary tale of what I went through by losing myself in a partner's illness and unintentionally enabling it. He chose to not see the parallels, and I told him I couldn't handle it anymore.

But I love him for his kind soul and good nature. I have missed him a lot this week. Ending things is hard... Even the 2nd or 3rd time... Even when it's for the right reasons.

My more "stable"  relationship feels lopsided as well. I am here alone, and he has months to spend with his other girlfriend. I don't think he loves me much, I know he takes me for granted, and I feel he prioritizes me below her even though we were dating first, even though he rushed things with me at first and then back peddled. And still I love him, too. I'm a hopeless romantic.

But I don't have time, energy or availability for more than the occasional date. And spending too much time with him (or anyone) cramps my style pretty quickly. Maybe that's because while good people, these have been the wrong people. Not *quite* worthy of all of me.

When I look at my dating pattern with both of them, I'm mostly too accommodating, teaching them that I'll forgive transgressions. And instead of accepting forgiveness and learning to appreciate me, they continue taking, emotionally and physically.

And still, if I stand up for myself, as I did, I'm the one who ends up lonely, not them. That's the harsh reality, and why I accept less than I think I deserve, never mind any love I feel.

I love my friends, too, but if we grow apart I am ok with it. Why not with lovers? Somehow I have grown to believe romantic love is the most important love, even above loving myself.

I'm slowly getting better, illness-wise.

I've spent most of the first 2 days in my new role sorting out my living/transport/money situation. It's been such a mess. It's not even totally sorted, so I will have to check up on things as time goes on.

Insomnia followed me to my new workace. The impression I got was that I was sick enough that I could have called in and stayed in the hotel for the first day but I would have missed a lot of info that's pertinent to my job.

The job seems ok. I'm in a better position than I thought. There was training on things my manager had said I was expected to know going in.  Now I just need to get busy with actual work, not sorting my living situation mess.  I still worry I will be too slow.

On a personal level I confronted some fears and came out on top. I rented a car by myself and drove it on a major highway during rush hour. All huge for me. The car puts more pressure on my finances short term but I got a measure of control and independence in my situation. I am a commuter, even when traveling for work. At least I can come and go as I need to, now.

I'm feeling that being an adult is mainly  about developing a tolerance for the scary things in life and doing them anyway. Of course, some people don't get scared, and some get petrified. I'm not sure where I am in the spectrum. At least I'm moving forward.