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I Guess It’s a Good Day

April 21st, 2009

From Bloggymommer

Anxious. Anxious. Anxious. Lonely. Angry. Anxious. Abandoned. Burdened. Anxious. Disappointed. Anxious. Stressed. In a hurry. Anxious. Unable to sleep. Anxious. Tired. Dragging. Anxious. Worthless. Anxious. Regretful. Anxious. Listless. Wistful. Anxious.

Today, the meds are working, and I am less anxious. A reprieve. It doesn’t happen often. But, when I’m less anxious, I’m left to deal with the other things rattling around in my head.

Anxious. Anxious. Anxious. Lonely. Angry. Anxious. Abandoned. Burdened. Anxious. Disappointed. Anxious. Stressed. In a hurry. Anxious. Unable to sleep. Anxious. Tired. Dragging. Anxious. Worthless. Anxious. Regretful. Anxious. Listless. Wistful. Anxious.

I should be celebrating. For the first time in twenty years, I have meds that help. Today I’m not anxious. Lonely. Angry. Abandoned. Burdened. Disappointed. Stressed. In a hurry. Unable to sleep. Tired. Dragging. Worthless. Regretful. Listless. Wistful. But not anxious.

I can sit still! Now that I can sit still: I can, I should… what should I do first?

I’m almost bored. The anxiety has waned, and now I have nothing to do, nothing to think about. Well, not nothing: Lonely. Angry. Abandoned. Burdened. Disappointed. Stressed. In a hurry. Unable to sleep. Tired. Dragging. Worthless. Regretful.

One foot in front of the other. One thing at a time. One. I can’t remember the last time there was a singular thought in my head. I can’t remember this sense of focus. The house is clean. The work is done. There’s nothing on the calendar until next week. What did I focus on, the last time that I had focus? I can’t contain this need to plan something, anything: a trip, a date, a movie premiere, a trip home.

Quiet. Birds chirping, and a bus passing on the street. There’s nothing good on T.V. I need something to do with my hands. I thought I got over this loneliness. I thought I worked through this anger. I feel raw and defenseless. A ten-year-old kid all over again.

I can’t remember the last time I lived a day without that pattern. Anxious. Anxious. Anxious. Keep Busy. Think of something to worry about. Anxious. Anxious. Anxious. It’s bizarre, but at least I knew what to do with my day. Is it strange to miss that?

It’s a beautiful day outside. The chores are done. The list is checked off. There’s nothing to finish up. I’m dressed. I can’t think of what to do or where to go. Now what?

Every Now and Then I Get the Bear…

April 19th, 2009

From Heather O.

Some days I wake up and the sun is shining. As soon as my feet touch the floor, I know it’s going to be a great day. I have a bowl of cereal, enjoy the morning sun shining through the front windows and smile to myself. Happy. Content. Comfortable.

I haven’t had a day like that but maybe once or twice in my life.

Most days, the bear gets me.

I go to bed, curl up on rumbled sheets and stare at the blackness for hours, willing myself to sleep. I cry until my insides ache and finally fall asleep two hours before the children come to wake me up for breakfast. I stumble out of bed, rest my head on the half-painted bathroom wall and try to psyche myself into getting through the day. I wash bowls and fix cereal with bleary eyes, pour the milk with shaking hands and fall into my chair to stare at the wall. I put a movie on for the kids and put my forehead on the desk.

I wish I could shut my mind up for just a few moments but I never can and the walls are closing in again.

Rent is due in 3 days, no money coming in despite my best attempts at sales and marketing, power due, phone due, need groceries, $7 to my name, thinking about spending it on a pizza for the kids for lunch but I know I can’t go into the pizza place without having a panic attack, need to go buy bobbin thread so I can sew, hyperventilating thinking about going in to buy thread, kids want to go to the park and I can’t, what if there are lots of kids there and I lose one of mine in the crowd and can’t find them or some kid’s parent wants to talk to me, just a casual “hi how are you?” that I cannot handle.

Think about Andy, about Chris, about Colin, about Mama and how I have no idea where we’re even going to live if I can’t come up with the rent but I don’t want to live with Mama again and she doesn’t want us there either, know they love me but can’t cope with “where are you going, when will you be back, how much gas have you used, aren’t you due for an oil change, how many pairs of shoes have you made today, how’s the job hunt going, are you taking your medicine”, think I suck as a parent but when everyone can hear every thing I say it makes it ring twice as loud in my head, can’t give up the last shreds of independence that are mine.

I need to get a job, third shift, leave the kids with Mama all night and try to sleep in the mornings after I bring them home while they rot their brains watching TV all day, how can I get a job when I can’t even say the word “job” without shaking, going to throw up during the interview, if I can even get to the interview, terrified just thinking about going to a job and dealing with people I don’t know who don’t know me, what will they think of me, will they think I’m crazy. Am I crazy?

Turn on the sewing machine but can’t sew without thread, can’t buy thread without driving to the store, can’t drive to the store until the kids are dressed and presentable because if they go in the store with unbrushed hair then everyone will know I’m falling apart and they probably already noticed that I can’t breathe and my hands are shaking so bad that I just dropped the thread on the counter, what an idiot, how could I be so stupid, those people all wonder what the fuck is wrong with me.

Have to get orders finished but can’t concentrate, don’t care, not many left anyway since no one wants what I’ve got so I can put these off another day or three, packages stacked here that need to go out but have to wait until after 5 to go into the post office to weigh them so no one is there and don’t have to see or talk to anyone, back home to print postage out, drive back to the post office to drop them off in the privacy of my own car with the music on loud, loud enough that I can drown out the nagging voices in the back of my head for just a little while. Loser. Fat girl.

My kids think I’m okay and for them I am. They are all that I have and I summon every ounce of sanity I have to take them places and let them live a happy life. They hug me and tell me they love me and they are the only ones I believe. They aren’t old enough to hate me for my inadequacies yet. Give them time, give them time.

3 weeks until my appointment at mental health and god knows what they are going to think of me. It’s their job and they see lots of crazies so maybe I’m really quite normal, who knows? Haven’t talked to anyone who isn’t related to me in weeks, lost my only friend because I couldn’t shut up, nothing but online friends left and they’ve got to be sick of hearing me by now, supposed to hold it together online because otherwise my business could be damaged but really not much left there to damage so might as well fall apart everywhere.

I walk around every day and my family thinks I’m doing so much better, holding it together so well, oh she’s on the upward swing. Lie. Bullshit. Inside my head I’m screaming weeping hurting dying and maybe if I could cut the pain out it wouldn’t hurt so bad but I don’t think anything will help.

Can’t believe I’m going to post this on the internet where everyone can see it but maybe I’ve not been honest enough because I’m so afraid of what my mother-brother-in-law will think and maybe they just don’t matter and will think badly of me no matter how good I try to be and how much I tried to care and how much I loved Andy so what difference does it make what they think. Never tried to be my friend, never gave one bit of caring or understanding. Money isn’t love, isn’t caring, isn’t understanding, doesn’t make a house a home, doesn’t make someone love you who just doesn’t even though that would be nice. Never believed me and still won’t when I say that I did want to be a part of their family, I wanted them to think of me like a daughter, wanted them to care about me. Doesn’t matter now, doesn’t matter at all. Your son is free of me, free to wash his own dishes and play computer games all day if he wants and yell at my kids on his only day with them and be glad to be rid of my abrasive insanity that only wanted us to be happy and love each other. Wasted years.

Doesn’t do any good to love because who wants to kiss a crazy girl, give me vodka but don’t come by to talk to me even when I plead, let me bare my soul and then walk away, ignore me for years, treat me like the laundry-girl but now even less than that, not worthy for your affection, who is, who wants it, do you treat everyone like this or just the crazy girls who bug the shit out of you.

“For as long as our love shall endure” was the vow, not enduring, never had a chance, escape clause built in from the beginning, “I don’t love you” to absolve from the responsibility of a marriage, stand back and watch me crash and burn.

And it’s better this way, better this way.

Originally posted here.

(Written June 27, 2006)

On Mental Illness and Stigma in Medicine

April 18th, 2009

From mysadalterego

Today I saw a patient for a pre-operative evaluation. This is a consultation for a patient that needs surgery, but who has other medical problems that make the surgeon nervous, and the surgeon basically wants someone like me to sign that I evaluated the person so that I can be blamed if something goes wrong. At least that’s my semi-cynical version of it. My fully-cynical version of it is that surgeons make relatively little money seeing a patient in clinic (though a lot more than a family doc or internist does), and they don’t want to waste time evaluating a patient when they could be operating and billing for the real benjamins.

Of course, I’m messing with the details of the story, but it went something like this: this woman was elderly, but under 80, and had the usual medical problems that go with that age, but not more – mild diabetes, mild high blood pressure, a few other things like that, but no history of smoking, no lung disease and no significant heart disease.

I think that over time I’ve collected a few doctor readers, so I’ll add this list of meds, more or less: some vitamins, a beta blocker, metformin, maybe there was an ACE inhibitor in there, can’t remember, a statin, a laxative, a bisphosphonate and some ranitidine, and a few other drugs, which I will get to in a minute.

She also had a recently discovered cancer, which was the occasion for the operation. The operation is a large one, but not “heroic” or the kind of thing they call people to come sit in the balcony to observe. It’s not a Whipple or anything close, but it’s not a lumpectomy either. It probably will not lead to a cure, but will almost certainly lengthen her life considerably, and will definitely prevent at least some of the uglier complications in the future. It is the standard of care.

Now, the rub: one of her diagnoses was “Depression.” No further explanation. In addition to the above, she also receives lithium at a healthy dose as well as paroxetine. This was the first time I saw her and she is an immigrant who does not speak any language I speak, so we had to speak through her son translating. But she was perfectly pleasant, totally coherent (able to give full medical and surgical history since childhood) as far as I could tell without speaking her language. To my shame, I didn’t ask what her profession had been. (I just didn’t think to while trying to sort out a complicated medical history.) I had never seen her before, and she came with almost no written medical information other than the recent imaging and investigations that were directly related to this cancer. I have no idea how her depression presented, why lithium was added, how long she had been stable or ill, or anything about that particular illness other than what I saw. To be fair, I also had no information about the history and control of her diabetes or blood pressure, though all three issues were controlled during my examination – blood pressure was good, sugars fine as well as HBA1C.

And then this: among all of her documents, I come across a paper that is a statement by a consultant psychiatrist that she is competent and able to both consent to and undergo the operation.

The surgeon and anesthesiologist had both refused to treat her without this evaluation. The surgeon’s referral put the demand for a full psychiatric evaluation (at the family’s expense) above cardiac, geriatric, oncologic, or functional evaluation, and refused to proceed or even make a tentative statement on her suitability for operation without this.

The surgeon, for that matter, does not speak her language either. But I assume he saw a similar patient to the one I did, as he had seen her less than 3 weeks before.

Just the fact that she came in taking certain medications, with a psychiatric diagnosis, one that, for that matter, has no bearing on her ability to decide how to live her life or to comprehend information, could have caused life-prolonging, standard-of-care treatment for cancer to have been withheld, to have been considered “inappropriate” or “unnecessary” or “unsuitable.”

In her case, fortunately, the psychiatrist did not write a full three page summary of her personal flaws (as I have seen sometimes in these types of evaluations), but rather summed it up with a line something like, “Patient understands implications of illness and treatment options and is competent to make any and all judgments blah blah blah.” But how many of these cases never make it that far? How many times, when surgery is an option, do surgeons see a diagnosis like that, or a drug like lithium and decide that the patient simply isn’t a candidate for surgery, or decide not to present all of the options?

I also wonder, if it had been an older man with “depression,” whether he would have been put through this humiliating evaluation, or whether only hysterical women need to be qualified as competent. Or if it had only been the paroxetine and not the lithium? What was it that pushed her into questionable incompetence? Does the referring doctor understand the implications of demanding an evaluation like that – that they are essentially calling into question a person’s sovereignty over their own body? I am hard-pressed to think of any kind of mental disability, including those conditions that include intellectual disability, in which a person cannot be presented with options in a manner fitting their understanding.

I don’t know whether to be angry, or to want to cry, or what. But I think mostly I’m afraid that someday I will be that little old lady with an ugly diagnosis on my chart, whose life is seen as only questionably worth saving.

Previously published here.

I Need a Vacation Away from Myself

April 16th, 2009

From Mariposa

I am skilled at making everything look good on the surface, but something isn’t quite right. It feels as if the truth keeps slipping away from me just as I get closer to it. And I’m trying to make the most sense out of it.

My mind is tired…my body aches. I don’t have fever…but I’m feeling I’m suffering from some sort! Muscle pain is horrific…nothing too serious, yet everything seems to be a discomfort.

I skipped work yesterday to just stay in bed. I had been sleeping most of the time since weekend, waking up TIRED.

My mind is in a race and it is stressing my body!

I’m trying to shelve my mind. I’m trying to make my thoughts STOP. I’m trying not to focus on everything.

Ah, compartmentalization, I beseech you!

Small and Still and Undisturbed

April 15th, 2009

From Dodo

I was diagnosed schizophrenic about nine months ago, and had moved into a new world with antidepressant and antipsychotic medication since then. It was a slow and frighteningly revealing journey. I found out I was pregnant after we took a long vacation in the States over December. My psychiatrist advised me to quit all meds over two days, which I did. Then a week or so ago I miscarried. But the hospital wasn’t sure I had. I had to go in every day for four days for bloods, scans, examinations, internal scans and, eventually, ‘the talk.’ The one where they say that there’s nothing you could have done differently. Being off the meds made me feel different about the prospect of having another baby. Made me feel different about the strength of my relationship with S. We had a very difficult year last year. While we were away, the idea of new year, new start, new baby, new house seemed natural. Obvious. Now I don’t know. I don’t feel any particular connection to the baby I lost. Or to him.

“small and still and undisturbed. its what i want. and what i’m afraid of. wanting because of the absolution that’s bound to it. turn down the lights, muffle invading sounds. be still. and inside. and quiet. trying to find a way to let go without letting go. to be able to achieve distance from the outside for the hours i have to myself. lose the time that’s mine to lose. now that i’ve walked away from my job i have three whole days to indulge myself. with solitude. not solitude. a kind of comforting vacuum.

but the show must go on. P has to be taken to nursery. Adult conversations must be had. dinner made. dog walked. How much of the outside function can i maintain while secretly willing myself further and further away.
the longer i leave it, the harder it is to get back. one day without brushing my teeth, two days without washing my hair. deliberately not taking the meds in case they strengthen my fingernail grip. stop me from disappearing. but not committing, medicating intermittently. enough for ” and how was your day?” and putting on clothes. enough to take P to the park with a neighbour. enough to take the cat and talk to the vet. joke even. enough to give S a plausible account of a productive day. so he doesn’t despise my sloth. seek pastures greener. again.
outside is jagged edges and piercing sounds. clumsy intrusions. it’s too bright, too loud. too personal. abrasive. other. too much.

so few tools to challenge myself to consider the inevitable conclusion. yet here i am. what would happen if i disappeared completely. i’ve backspaced over that line twice. can’t answer my own question. except I can. i know i’ve felt this way before. i know i’ve lived through it. i remember this feeling – that S is a great father and that there’s lots of people who love P. that the clouds would soon pass. how ridiculous. how indulgent i sound. such melodrama. how pathetic.”

Previously posted here.

ADHD and Me, My Wicked Little Friend

April 13th, 2009

From Mommy of Mayhem and also drunkenlore.

Thursday, June, 26, 2008

You can blame this one on the hormones that accompany my “this means you’re not pregnant even though I don’t need you to tell me that because I know it for various other reasons” friend that is visiting this week. All my LAYYYdies….you feel me? (That last line SHOULD have been read using the sing song voice in your head, so if you didn’t, try again. Thank you.)

I am here today to talk about my one and only flaw, which is my inability to have one single day, with one single organized thought in it. I have two reasons for writing about this. I was growing a bit tired of all of you thinking that I am perfect ALL the time, but most importantly, I needed to capture the topic in writing before a certain best friend of mine beat me to it via a blog entry based on her visit to my circus house of horrors yesterday. (Love ya GUUURRRL!) I am mildly exaggerating. VERY mildly. I was diagnosed with adult ADHD at the age of 28. This diagnosis came after several attempts to name “it” something different. There were doctors who treated my symptoms of ADHD as the main issue. By products of this, such as depression, impulsive behavior, aggression and anger were thought, by several, to be my “sickness”, when in fact, they occurred as a direct result of the as of yet undiagnosed ADHD. In an attempt to combat any and all of the above mentioned issues, doctors doused me with drugs left and right, adding and subtracting like bad mathematics when yet another failed to do it’s job.

Antidepressants left me feeling soul-less. Instead of extreme highs or amazingly extreme lows packed with crying and long periods in bed, I felt nothing. I cannot imagine I could have continued that way for very long. I never discussed it with my parents, and I still haven’t to this day. This is partially because I believe this condition, or variations of it, run in my family.

Around the age of 13, I remember us driving home from Sunday lunch in order to make ready the house for my grandmother’s visit later that afternoon. As we pulled into the drive, the entire family was surprised to see my grandmother crouched over on the front steps of our house, silver head bowed, sobbing into her Sunday dress . Thinking that something was terribly wrong, my mother rushed to her. I will recall her words for the rest of my life. “I thought you all were never coming back. What would I do if you never came home again?” She was 3 hours early.

My brother and I had a lovely childhood, given almost anything we wished for. I know that we were both loved (and still are) deeply by my parents. The only sadness I can really recall came from my mother, and usually from the front seat of our car as my brother and I sat, not so quietly, on the drive back from church. We would cross a bridge that arched over the cemetery where my grandfather had been buried over 20 years before. I soon came to silently accept the tears that ran down my mother’s cheeks each time we made that journey, though we weren’t exactly sure what they meant. I now think she was weeping for the childhood that ended when her father and grandmother died in an automobile accident when she was only 13. My mother was in the car. This could also explain why my grandmother lived the rest of her life afraid that people she loved so much might never come home.

This knowledge leaves me wondering if I was born unable to accomplish ordinary tasks that come so easily and naturally to others, or if I learned it (or didn’t) due to the fact that the women in my childhood did not model those behaviors for me because they themselves were too busy suffering. Whatever the reason, “it” has plagued me for as long as I can remember. I didn’t know how to explain the frustration, simply because it had always been the way I “worked”; I just thought everyone operated on the same level. I liken my brain to a television that is continuously on, though changing channels at a maddening pace. Sometimes I am paying attention to things that I don’t even care to pay attention to, all while ignoring something or someone very important, right in front of me. I do not do it on purpose, though I sometimes come across as snobbish or unconcerned. I often interrupt others in conversation with a seemingly unrelated comment or topic, though in my mind it has relevance and should be shared immediately.

I have had to learn how to think about how my actions impact not just myself, but everyone around me. Note: it is not a good idea to take credit card to MAC cosmetics counter. My organizational skills are non-existent. If I do not make a list before going to the grocery store, I may come back with two packs of vacuum cleaner bags and no milk, or peanut butter and not jelly, though they’re right beside each other, and we’ve been out of jelly for 2 months. I know that people forget things at the grocery, or buy two of one and none of another, but this is an every time sort of deal. I have not mastered the “I know what goes in everything I cook, so I don’t need a list, let’s go shopping with a purpose” method. Without a list I will spend $800 on food that looks cool. Truffle butter and frozen ostrich burgers, anyone?

My mother didn’t raise me with “instructions” on how to do household chores. OR, maybe she did and I just missed it. I don’t see a natural order in how one’s house should be or look, and I can spend an entire day trying to clean one room. The majority of this surfaced when Leonidas and I (bless his big heart) first started dating. We lived together before we married, and he would “bring to my attention” the fact that, should I start trying to help clean our apartment around 11am (before kids wake up time), at 6 pm, things just looked “moved around”, due to my inability to focus on anything for longer than 2 minutes. Start laundry in one room, walk to another to put away said laundry, spray Lysol on bathroom counter. Go begin another load of laundry (that I will remember and have to rewash tomorrow) then decide to clean out the pantry as I walk past… get it? He wasn’t complaining, just commentating. He is a master laundry doer.

My frustration at knowing I was a fairly intelligent individual (I always did well in school without ever having to study) who was incapable of completing everyday tasks finally led me to seek help from a psychiatrist. After diagnosis, I was put on Adderall for the attention deficit, Valium to lessen the aggression that resulted from the Adderall, and a couple of other drugs whose names I don’t remember anymore. After starting the Adderall, I could focus SO well that I was up at 3 a.m. scrubbing the baseboards of my house with a toothbrush. I folded my underwear. One might say I became obsessive. At 5’9, I went from 170 lbs. to 109 lbs. in 5 months. I was happy to be shopping in the pre-teen section of stores for the first time in my life. I would move my food around on my plate during meals to disguise the fact that I wasn’t eating it. My heart raced each time I stepped onto the scale, only to find I had dropped yet another pound. I argued and resisted every time Leonidas suggested I may need to stop taking this medicine, or at least get a 33rd opinion from a different doctor, one not so willing to dole out drugs to a walking skeleton every month for my $20 co-pay. I avoided my parents and brother, who were all, at the time, still in South Carolina.

Then I cracked. One day, irritated that my toddler wouldn’t sit still and my infant would not stop crying, (go figure), I put them safely in their cribs, walked to the kitchen and proceeded to remove all of my plates from the cupboards. I carried them to the enclosed patio out back and methodically smashed them into the concrete floor. I then took a pair of kitchen scissors out of the drawer, walked to the bathroom, climbed into the sink, and began cutting my hair off, bit by bit, until I felt I could breathe again. I believe that fate intervened at that point, in the form of a phone call from my father. I calmly told him what was happening, at which point he instructed me to stay put. They were four hours away, so he called my husband who was home in what seemed to be under 3 minutes. After checking on the babies, he swept up the glass, brushed my hair, and put me to bed. My parents and brother arrived not long after. I underwent a quickie intervention and unwilling detox, thanks to my husband and family. My brother took me home where he and his wife force fed me for a week, allowed me to paint, draw, write, go for walks in the woods and be silent. When he told me one day that he was afraid I was dying, I told him I was. I hope that he knows his love saved my life.

A week later, my husband held my hand and brought me home. With clear eyes I looked at my children for the first time. It was at that moment I decided, that no matter what I had to deal with in regards to ADHD, I would do it drug free. I have managed this condition with humor, tears, and lots and lots of support. In a selfless gesture of love, my parents sold their dream home and moved to North Carolina to be with me and to help with the babies. My family has made sacrifices that I will be forever grateful, and alive, for. I make lists that I never complete, but at least I have a starting point. I still leave my coffee somewhere until it’s cold, then reheat it in the microwave only to forget where I put it. I bake muffins for my children and forget they’re in the oven until the tops are burnt because I forget to set the timer sometimes….like this morning. But now, instead of smashing things, I cut the tops off and add sugar free whipped cream and berries. Now, I can laugh. And I do.

Originally published here.

Depression- A View From the Inside

April 11th, 2009

From Sara

Imagine waking up one day and looking out the window to very gray skies. Rain is coming, and there will be no playing outdoors today. All you want to do is stay under your blankets where it is warm, but life calls.

You get up, but you are tired. Breakfast time, but nothing sounds good, even your favorite 3-cheese omelet. It will probably just add another 5lbs anyways, why bother? Grab a Pepsi and chug it, waiting for the rush of caffeine and sugar. Ahhh, a little bit of energy, finally. Only 6:20 and kids are whining for juice, breakfast, a different cartoon. Holy hell, I only just woke up, lay off already!! Do what needs done and collapse in the chair. Maybe they’ll leave you alone for 5 minutes now.

Nope. Diaper changes, spilled milk, the dryer buzzer goes off. The phone rings, the dogs want in-out-in-out. The kids have the tv up too loud, AGAIN. Turn it down before I unplug the damn thing! There is a list of things to do before naptime, but the list has disappeared, like everything else these days. Keys? Debit card? Hairbrush? The dryer gnomes got them all; they are nowhere to be found. You know you should clean the bathrooms, only the chair feels so good and you are so tired, the bathrooms aren’t going anywhere. Do it tomorrow. The phone rings again, it’s the cable company with a polite reminder your bill is overdue. Shit, shit, shit!! I knew I forgot something!

Naptime is far too short, and if they don’t nap at all your day has just sunk like the Titanic. You try not to snap at the kids, but every sound grates on you. Best to ignore them for awhile. What’s on tv? Oh, look at that, it’s nearly 5. Did you just say 5? Hubby is on his way home and will be expecting dinner. The thought of cooking is as appealing as the thought of taking a vegetable peeler to your fingers. Frozen pizza, again. Hubby comes in annoyed- didn’t we have pizza Monday? Did you call so-and-so? Did you remember to pick up…. from the store? No? What did you do all day? *sigh* Another day you can’t do a single thing right, so why try? Why? Because something is not right, you know it isn’t. You want to have your energy back, you want to play with your kids, you want to feel more than just tired and anxious all. the. fucking. time.

This is depression, from the inside.