Day Twenty-three (a bit late): Rating My Depression

This entry is a bit on the late side as it ought properly to have been posted on the 23rd of October, but things being what they are, it wasn't. So, here it is. I've been struggling through a bad patch of deeper depression than normal and I'm not really feeling like continuing the story at the moment, but I'm trying to write something, so here's a bit of an aside, if you will. Oh, and it's two parts, just so you know.

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For me, depression is an odd sort of creature that mutates and bends and changes from day to day. Some days, it is easier, some days more difficult, and some days are so hard that I don't want to wake up to another day. It runs the gamut. You might wonder with such a wide variety of mood how I make sense of it or see patterns in it or how Pendragon knows what to do to help me treat it or how Gray lives with me and has any sort of understanding of what is going on with me. The answer is actually quite simple.

About five years ago, I went through Green Tree's partial hospitalisation program after struggling with a bout of severe depression coupled with using self-injury as a coping mechanism. I had been seeing Pendragon for a few months, every few weeks, but it just wasn't enough for him to be able to give me the help I needed. He suggested I might benefit from the intensive therapy available in that program and although I was very reluctant at first, I eventually made the decision to do it. It was three weeks, five days a week, from 9am-4pm each day. It took some time for things to start clicking, but once they did, it became something that was so helpful that it was like an answer to all my prayers. I learned so much from that program and once I graduated out of it at the end of the three weeks, I tried to keep doing some of the activities we had done in the program in an effort to help cement some of the things I had learned.

One of the skills that I learned in that program was a system of self-assessment that helps me keep tabs on how my illness is affecting me. It is part of the daily assessment that we had to do each day during that program. The assessment was a series of questions asking things like how much sleep we got, how we felt emotionally/physically/spiritually, what our goals for the day were, etc. For me though, the best part was the numeric rating of three different things -- depression, anxiety, and irritability. Those three things are huge hallmarks of many mood disorders and a lot of other mental illnesses and are a good way to get a quick idea of where you're at overall. The way it works is like this: you rate your depression (or anxiety or irritability) on a scale of 0 to 10. If you are feeling absolutely no depression at all, you would rate yourself at a 0. Obviously, rating your depression at a 10 means that it's about the worst you've ever felt it or as bad as it gets for you.

In the past five years, even when I've been in the darkest and deepest of depression, I have tried very hard to at least do a daily rating of those three symptoms. I have had some days when I have only rated my depression and even that one rating has been a helpful thing to know. I have an app on my phone that I use for NFP that has a place for notes and I try to remember to just jot down my ratings for the day in the notes. The end result for me with this has been that I've been able to easily convey both to Gray and to Pendragon where I'm at with regard to my depression. It's a kind of shorthand where I can send Gray (or Pendragon if need be) a text with a simple phrase like, "I'm sitting at a 8" or "depression = 8" and they immediately understand a wealth of information with regard to what is likely happening with me internally. It has been particularly useful for this current depressive episode that I'm going through as one of the goals that Pendragon and I set when we had that first appointment in his new office was to try to get my depression down to a 5 or below on a consistent basis. I wish I could say that we've accomplished that. Most days for me though are, at best, around a 6 and at worst, well...something approaching probably beyond 10.

Having such a scale has also had the benefit of allowing me to see certain patterns and understand how my symptoms tend to behave. It's not an exact science, but there are definite patterns there. For instance, the last three or four days I have been struggling at around an 8-9 with my mood. When it gets like that, I have a tendency to be even more tired than I already am but unable to get good sleep. Usually it also means my nightmares are more intense too. Often my appetite takes a nosedive and I have to fight with myself to eat at all. I also tend to be quieter, more withdrawn, and want to isolate myself more. There's almost always an increase in my irritability too and everything grates on my nerves.

(click here for part two: Day Twenty-four (a bit late): Patterns and a Fever Induced Delirium)