Sometimes you just need a break from life. It can be because of a lack of motivation, general irritability, zero interest in work or activities you once enjoyed, or feeling overwhelmed and like you’ll never check off everything on your to-do list…. All of these things can contribute to feeling overwhelmed, anxious, and burnt out. 

Here are nine signs that you might be experiencing burnout:

1. Irritability & quick temper. ✔️
2. Withdraw from things that used to be fun or meaningful. ✔️
3. Constantly feeling anxious. ✔️
4. Feeling detached from both work and others. ✔️
5. Cynicism. ✔️
6. Lack of motivation or focus. ✔️
7. Feeling exhausted. ✔️
8. Lack of self-care: exercise and nutrition. ✔️
9. Feeling physically sick. ✔️

Do these sound familiar to you? I know for me they do. It checks all my boxes. For no apparent reason, I have been unusually irritable lately. There are things that used to be fun, that I just don’t want to do. With the coming election, I am definitely feeling anxious. Working from home has me feeling detached not only from work but form others as well. The current Republican administration has me feeling cynical, because who can trust any of them. In general, I am lacking any kind of motivation. The only motivation I have is to occasionally rant in my posts about politics. I am exhausted all the time. I have not been exercising nor have I been eating the right foods. You all know about my headaches, which are part and parcel to all of these.

While my Botox treatment seems to be helping my migraines, they are not helping my sinus headaches. The weather has been changing drastically here in Vermont. Each day we are having 30 to 40-degree swings in temperature, and there is a storm front that will be moving through in the coming days. These things wreak havoc on my sinuses. This weekend was not a good weekend, and I’m to the point that I need a mental health day. The problem is, I have meetings today, a class to teach tomorrow, and I have to be in the office on Wednesday and Thursday. Therefore, I am checking out today except for the short meeting I have this morning.

The truth is, we can all benefit from a day to clear the fog from our heads. I have read that taking a mental-health day can improve energy, motivation, mood, and one’s ability to manage stress, and time off might actually increase overall productivity rather than decrease it. While officially, I will be working today, I doubt I will be doing much of anything.

Today, I am driving down to Dartmouth-Hitchcock Hospital’s Headache Clinic for my first set of Botox injections for my migraines. The Botox will be injected around the “pain fibers” that are involved in causing my headaches. According to the Botox website, Botox enters the nerve endings around where it is injected and blocks the release of chemicals involved in pain transmission to prevents the activation of pain networks in the brain. Botox is supposed to prevent migraine headaches before they start, but I’ve read that it takes time to work. It can take two to three treatments (6-9 months) before the treatment reaches its maximum effects. A treatment lasts for 10-12 weeks, and patients report that in as little as two Botox treatments headache days are reduced by approximately 50%.

In general, the FDA-recommended dosage of 155 units costs between $300 to $600 for each treatment. As I understand it, Botox is packaged in 200 unites, so many doctors inject the remaining 45 units into the worst affected areas so as not to waste the medicine. Luckily, my insurance company seems to have approved the treatment. I have not heard anything to the contrary. It has taken over a month to get the treatments approved. My insurance company has fought my doctor and me on each of these new migraine treatments, but my neurologist is very good at getting appeals approved. I have tried the CGRP migraine preventive medications (Emgality and Aimovig), but the first was not deemed successful enough by my neurologist, and the second caused no improvement at all. In fact, with the second, I went back to having daily migraines. Throughout my life, I have also tried a variety of antidepressants and blood pressure medications that are typically used to prevent migraines. I am unable to take any of the anti-seizure medications because I have a sulfur allergy and thus would likely be allergic to those medications. The Botox injections are getting close to the end of the line of possible treatments. I’m not sure what the next step would be, but there are some alternative medicine techniques that have been helpful in some migraine sufferers.

My appointment is expected to only take about 20 minutes, a short appointment for an hour’s drive down to the clinic. The doctor will use a very small needle that I was told would feel like a pinprick. At my last visit, she told me that it would be painful and/or uncomfortable but with my history of migraines, it should be a breeze. Each treatment typically involves 31 injections in seven key areas of the head and neck. Sadly, it can take up to six months to see the maximum benefit from Botox. I just hope and pray I see some improvement fairly soon. I am at my wits end with these migraines. I’ve read that I could see results in as little as two to three weeks after my first treatment.

UPDATE (2:30 pm): I just got back home from getting the Botox treatment. It was a little painful and uncomfortable but nothing too bad. The whole procedure took less than 10 minutes, actually closer to 5 minutes. I have little red dots all over my head form where I bled at the injection spots. I am not sore from the injections which is good. Time will tell how well it works. I currently don’t have much of a headache, but I slept wrong last night and my neck and shoulder are in a lot of pain, so that is overshadowing any headache I have. I just wanted to give a quick update and say that all went well.

On Friday, I had an appointment with my neurologist about my chronic migraines. I’ve been going to the Dartmouth-Hitchcock Headache Clinic for nearly a year now. The initial visit took about two hours’ worth of questions. My doctor did a full medical history, especially concerning my headaches and completed a neurological exam. She decided that I would start taking the Emgality injections once a month. It usually takes 2-3 months for the medicine to get into your system and start working. I was on Emgality for 6 months. The frequency of the headaches did improve; I went from having a headache every day to having 3-4 a week. For my neurologist, a 50 percent decrease was insufficient progress, so it was decided that I would switch to Aimovig, another injectable that I took every 28 days. With the Aimovig, I saw no improvement; in fact, I went back to having a headache every day. Not only was it ineffective against the migraines, but the side effects were excruciating. Aimovig is known to cause severe constipation, and some days the stomach cramps were worse that the headaches. Maybe that’s TMI, but I am just being honest.

When I met with the headache clinic’s nurse practitioner on Friday, I discussed the issues with her, and she determined that I would be taken off the Aimovig. However, since I did not respond sufficiently to the Emgality and the Aimovig was completely ineffective (both medicines are calcitonin gene-related peptide inhibitors), she believed that the third CGRP inhibitor, Ajovy, would likewise be ineffective. Furthermore, the anti-seizure mediation that has proven effective for migraine prevention is also out of the question because they all contain sulfur, and I am allergic to sulfur-based medicines. Therefore, the next option is Botox injections. There is one problem though. Aimovig has a half-life of 3-4 months, so it will be a while before my digestive tract returns to normal.

My first Botox treatment is scheduled for September 21 and should take about 20 minutes. The doctor will give me 31 injections in seven key areas of the head and neck. Each injection will contain small amounts of Botox that will go into shallow muscles in the skin. According to what I have read, it can take up to six months to see the maximum benefit from Botox. I will have to drive down to the clinic, which is about a 50-minute drive, every twelve weeks. The appointments cannot start for at least another month because it will take at least a month for the insurance appeals to be approved, hence the September 21 date. We already know that the insurance company will deny the initial request for the procedure. They have denied all of the migraine medications I have been prescribed, and my doctor has had to make appeals. Thankfully, all of the appeals have eventually been successful.

The fact that the procedure has to be appealed to the insurance company and is not automatically granted is one of the greatest failings of the healthcare system in the United States. Thankfully, Obamacare did require health insurance companies to cover preexisting conditions. Before the Patient Protection and Affordable Care Act, i.e. Obamacare, was passed in 2010, most insurance companies would not pay for my migraine treatments because I had previously been diagnosed with migraines. I cannot understand how it is legal in the United States for an insurance company, whose claims officers do not have medical degrees, to determine if you can have the treatment that a doctor prescribes. This is, in my opinion, the greatest failure in the healthcare system.

When I was young, I had frequent migraines, but I do not remember having headaches every single day. Since I have been an adult, I have a headache nearly every day, sometimes they would be so debilitating that I could not function. Through all of it, I was expected to continue my studies in college and graduate school. I was expected to work through the pain. If I took off every time, I had a migraine, I would rarely be able to work. Even if I took sick days for the most debilitating migraines, I would burn through my sick leave within six months. 

I have soldiered on. I’m not saying that for sympathy; I am just stating a fact. Besides the migraines, I have suffered through some pretty awful treatments. When I was on Elavil, an antidepressant with sedative effects, I suffered from night terrors. If you have never experienced night terrors, you are very lucky. In my experience, I would wake up, but I could not emerge from the nightmare I was experiencing. My mother always told me she would have to fight me to wake me up, and it was very upsetting for her, as I would be screaming for her but never know she was already there. This was a very traumatic experience for a kid. I’ve already told you about the depression effects caused by Ativan. Those were just two of the preventatives. When I took the triptans to relieve my headaches, I often felt like I was having a heart attack with severe chest pains and arm pain. The one time I tried Imitrex, it intensified the headache so much that I dropped to the floor and just cried. Sometimes, the treatment is worse than the chronic migraines.

So, I will try the Botox. I pray that it will give me the relief I crave. I don’t know what other options are out there. I feel fortunate that I have the Headache Clinic at Dartmouth-Hitchcock nearby. There is one at the University of Vermont too, but the one at DH is considered the best in the area.

Jeremy Ryan is a fellow blogger and new reader to this blog. His blog is called, New Homo Blogo. There is a link to his blog in the sidebar. This past Monday, he posted about his depression. It got me thinking about my own journey of depression. I’ve talked about depression a few times here, but I’ve never said a lot about when it started or how it progressed over the years.

By now, all of you know I’ve suffered from migraines my entire life. When I was a teenager, I was prescribed Ativan to help control them. Most doctors will only prescribe Ativan for a week or two. Taking this drug for more than two weeks can lead to dependence, tolerance, addiction, and withdrawal symptoms. It can also worsen depression if take for long periods. I was on the medication for over two years. At the time, I didn’t realize I was also suffering from depression and anxiety due to either not understanding my attraction to guys and/or not being able to come to terms with being gay. I knew I was different and not the most masculine kid; all the bullies at school reminded me of this daily. Then there was my father who hated having a “sissy” son. I remember one time I accidentally grabbed the electric fence around our property, and I screamed. I got into trouble not for touching the fence or being where I shouldn’t have been; I got into trouble because I screamed “like a girl.” Touching an electric fence hurts like hell, and it’s very difficult to let go once you do. While you might think my dad would have been concerned whether I was all right or not, the truth is, he only cared about how I reacted. I know I was yelled at and probably got a spanking because of it. There were numerous instances like this of him wanting me to be more “manly” and not embarrass him.

As someone who was already struggling with anxiety and depression, Ativan worsened my symptoms. I had been taking this potent drug for too long. Eventually, another doctor realized how long I’d been on the drug, and slowly weaned me off of it. This new doctor understood the harm the drug could do. But I still had a small handful of the pills. One night, when I felt I couldn’t take it anymore, I took all the pills hoping to end my misery. Thankfully, it did not work, but it did make me terribly sick; I vomited all night long. After that, the depression got worse. I still didn’t know how to deal with my sexuality or fully understand I was gay. So, I poured myself into studying to get a scholarship and to go away to college which I did.

College was not too bad. I began to deal with my sexuality. I discovered the internet and did a ton of research on being gay and what it all meant. The local Barnes and Noble also had gay books, fiction and non-fiction, that helped. I was finally able to admit it to myself, but it wasn’t until graduate school when I told anyone else. Graduate school was tough and did not help my anxiety and depression. Plus, I did not know how to ask for help. I was poor and in debt. When money issues came up, when I didn’t know how I was going to afford my next meal, when bill collectors called, I would become paralyzed with fear. These money issues would continue to plague me for years especially once I had to start paying off my massive student loans. 

After getting my master’s degree and completing my PhD. coursework, I desperately needed a job. The problem was Mississippi used to, and may still, have a law that says if you are a graduate student on assistantship, you can only work within your academic department, and only for 20 hours a week. Since the stipend was less than minimum wage, I continued to depend on student loans to live while also getting an additional job outside of the university. When my assistantship ended, I either needed a permanent job or I needed to move back home. But there was one major problem: this was in the middle of the financial crisis of 2007–2008. I applied for dozens of teaching jobs; all but two cancelled their searches because of budget cuts. I did get interviews for those two, but I wasn’t hired. I had one option left: move back home. So, that’s what I did. 

I continued applying for jobs while trying to finish my dissertation. I had a regular routine. I got up each morning, had coffee and breakfast then sat at my computer to research and write. I took a break for lunch then back to work. Around 4pm or so, I cooked dinner for my parents so it would be ready when they got home. While my parents knew I was gay, that had come out a few years before, I was essentially back in the closet living at home. This would not be good for anyone’s mental state. They’ve never accepted my sexuality. I was also struggling with my dissertation committee chair assigned to me when my original chair left for another university. We did not get along. He questioned everything about my dissertation and made my life a living hell. I kept my deadlines, but he wouldn’t keep his. When I would get feedback, it was always unnecessarily harsh and disheartening. At times, I couldn’t continue writing because I was waiting and waiting for his feedback. I got so depressed I would just burst into tears at the slightest thing. I had never gotten along with my dad, and we fought constantly which didn’t help. One day, when my mom came home from work (she was a nurse), I broke down crying, and told her how depressed I was. The next day, she talked to the nurse practitioner she worked with; the NP prescribed Prozac to help with the depression. And it did help.

Things, however, continued not to go well with either my dissertation or my job search. I was stuck at my parents very rural home, and rarely went anywhere. It drove me crazy. At some point, I started blogging in my free time; I was bored, and it relieved some of my stress. I was mailing off application packets once or twice a week. The postmaster at the small-town post office knew I was applying for jobs. One day, he told me a local private school was looking for a history teacher. His wife was a teacher there, and as the postmaster, he knew everything that went on in that town. Since the other job applications were going nowhere, I applied at the private school, got an interview, and got the job. I found a place to live and moved out of my parents’ house. Thus, began a five-year nightmare. I was working so hard and was so tired, my cat and I took a nap every day after I got home from work. The kids, the parents, the headmaster were all awful. Each day was horrible. Also, during these five years, I lost my beloved Grandmama and my sweet cat who was so special to me.  Fortunately, though, it wasn’t all bad. I did make friends with some of the teachers. But, if the school had found out I was gay, I would have been fired immediately so I constantly lived in fear. As for my dissertation, I tried to finish it, but due to the problems with my dissertation advisor and having two jobs (teaching full time at the private school and part time at a local university), I was unable to complete it in the maximum number of years allowed.  

After about two years in the house I was renting, my landlady decided she no longer wanted to rent it out. I had to move. After my Grandmama’s death, my aunt, who had cared for her, was now living alone and not taking it well. I had been going to see her every Wednesday to make dinner and give her some company. When I needed a place to live, I ended up moving in with her. My aunt didn’t try to micromanage me like my parents had so I was able to discreetly date a few guys. That’s when I discovered the downside to Prozac: sexual disfunction. Most of the time, I could get erect, but I was not able to have an orgasm without difficulty if I could achieve one at all. A friend suggested I talk to my doctor about switching to Wellbutrin; it did not have the same side effect. That helped. The Prozac had not been working as well for my depression anyway, so the change was doubly beneficial.

The school finally got a new headmaster, and I thought things were improving. There was no indication the new headmaster didn’t like me, but apparently, he secretly did. After five years of teaching there and becoming more popular with many of the students and parents, not to mention creating a highly successful drama club, the school hired a football coach who could “teach” my classes. So, the headmaster gave this new coach my classes and didn’t renew my contract. I was devastated, and on the job search again. This time, I chose not to focus on teaching, but to do something else with my history degrees.

It has turned out mostly for the better. I found a new job in faraway Vermont. I would be living 1,100 miles from my family, my boyfriend, and all my friends. Getting far away from my family has allowed me to be more open about my sexuality, but a long-distance relationship was not going to work with my boyfriend. We broke up. Little did I know just six weeks after moving to Vermont, my world would come crashing down. I had a friend I talked to everyday. He was one of the few gay friends I had; we talked about anything and everything. We texted all the time. He was the last person I talked to every night and often the first person I heard from in the morning. He was there for me when my Grandmama died and when my cat died. He had become a major part of my life; I loved him like the brother I never had. At Thanksgiving that year, he had met his boyfriend in Dallas. As he was driving back home, he had a fatal car crash. I learned about it from another friend of his. I had been frantic all day because I had not been able to get in touch with him. I knew he would text if he was ok because it was my birthday. No text ever came. I got an email from a friend of his saying he had died in a car crash on his way home from Dallas. As I read the email, I began to cry uncontrollably. My friend Susan had known I was worried about not hearing from him. I emailed her with the sad news. She immediately called. I just sobbed on the phone.

Because I was still in the evaluation period of my new job, I could not take time off to grieve. I remember sitting at my desk the next day and crying all day long. I cried for weeks. When I went home to Alabama at Christmas, I made an appointment to see my doctor. I explained what was going on and was prescribed the drug Abilify in addition to Wellbutrin. It helped enough that I could at least stop crying all the time. One problem with Abilify though, was after being on it for a while, I realized I would become very emotional, very easily. I would tear up over the slightest thing. I didn’t feel depressed so much as I felt emotional.

Susan got me through a lot of that too. I would regularly talk to her on the phone; she became my lifeline. No one else understood the relationship I had with my friend. She did, and she was a great comfort. When I tried to tell my mother why I was so sad, she just told me sometimes friends die. She offered absolutely no comfort. My best friend in Texas had a new child so she was too preoccupied for me to lean on. Susan became a best friend, and now we talk almost every day. I will never be able to fully thank her for all she has done. She truly saved my life. I had lost the will to live, and she offered me hope and comfort.

Eventually, I got a new cat, Isabella. This was another saving grace. Cats can do so much to alleviate sadness. She doesn’t really cuddle, and she comes to me only on her terms, but she will lay on my hip if I’m lying on my side; that’s as close to cuddling as she gets. Most of the time, though, she is within a few feet of me. That, however, has changed a bit since I’ve been working from home. I think she’s getting a little tired of me. She also hates the air conditioner. So, she’s been spending time in other rooms. With Susan’s help and Isabella’s companionship, I was able to get off the Abilify. The hyper-emotionalism I had felt with it has gotten much better.

I still feel sadness when I think of the losses I’ve suffered in the past few years. When I think of my Grandmama, the friend I lost, or even my cat, I miss them all greatly and do sometimes feel overwhelming sadness. Now, though, I can think of them and remember the good things, and not just feel the loss. For a long time, I couldn’t talk about any of them without tearing up. I doubt I will ever be completely “cured” of my depression. Presumably, I will continue to take medication for it. It’s always close to the surface, but the overwhelming sadness only happens occasionally now.  

If you’ve never suffered from long-term depression and anxiety, you are a very fortunate person. It’s hard to describe what a person goes through. Different people have different symptoms. Some of the common depression symptoms are:

• Anger, irritability, or aggressiveness
• Feeling anxious, restless, or “on the edge”
• Loss of interest in work, family, or once-pleasurable activities
• Problems with sexual desire and performance
• Feeling sad, “empty,” flat, or hopeless
• Not being able to concentrate or remember details
• Feeling very tired, not being able to sleep, or sleeping too much
• Overeating or not wanting to eat at all
• Thoughts of suicide or suicide attempts
• Physical aches or pains, headaches, cramps, or digestive problems
• Inability to meet the responsibilities of work, caring for family, or other important activities
• Engaging in high-risk activities
• A need for alcohol or drugs
• Withdrawing from family and friends or becoming isolated

Not everyone who is depressed experiences every symptom. Some may experience only a few while others may experience many. Over time, I have suffered from most of these symptoms. The most important thing to know is that depression and anxiety are real. And aside from getting and taking the proper medication, the best help you can have is love and support from those around you.

I think that most people who read this blog know that I have had a long struggle with depression and anxiety. It is something that I have struggled with since I was a teenager. As a general rule, the medicine I take helps to control it, but there are days when, for whatever reason, it doesn’t seem to work. Yesterday was one of those days. I was just down. I felt like I wanted to cry for no reason. These days aren’t something I experience on a regular basis, but they do happen.

It can be difficult for people to understand what it’s like to have anxiety and depression, especially if you are like me and try to hide it from most of the world. Generally, people who have anxiety or depression disorders display significant disruptions in their ability to work, go to school, or participate in social functions. But with my anxiety and depression, although those disruptions are not as apparent, they still can occur. There are days when I shut down almost completely. Many people don’t see signs and symptoms of my depression, because I am usually able to manage my daily activities. With the exception of a few friends, I tend to suffer in silence. To the outside world, I appear to be fine and even excel at accomplishing tasks and goals, but inwardly, it is a much different story. I have a fear of being seen as weak, and I don’t want to be pitied. 

Each January at the university where I work, we have a Staff In-Service day. It’s supposed to be an employee appreciation day that provides the staff the opportunity to get “out of the office, socialize, develop skills, and meet new people.” They claim it is a fun day that consists of a keynote lecture, workshops, lunch, and prizes. I hate it. I often teach one of the classes, so I don’t have to go to one of the other stupid activities. One year, the keynote address was by a guy named Eric Karpinski, a.k.a. The Happiness Coach. What a crock of bullshit he was! He said that when people have days like I had yesterday when I was feeling depressed that most of this depression is self-inflicted. He also claimed that through the power of positive thinking that we can do away with depression and anxiety on our own. We just needed to think positively, cheer up, and smile. This may sound friendly and supportive to someone, but it is oversimplifying the sadness associated with depression.

Someone who is depressed can’t force their depression away by just thinking positive thoughts and smiling. In my opinion, Karpinski’s claim that depression was our own fault and that positive thinking can be used to cure yourself is insulting. The people in charge of that years Staff In-Service day were flooded with emails of people who let them know just how insulting this guy was. You can’t just wish away depression. As much as you’d like to, it just isn’t possible. It’s like when our orange dictator says that COVID-19 is going to disappear like a miracle just because he says it will, or when he says, “If we didn’t test so much and so successfully, we would have very few cases.” It will still exist dumbass, just as depression will still exist. Even when medication is largely effective, there are still going to be days when the depression pops up. It’s always there.

So, what I am trying to say is that if you know someone with depression don’t say to them “Cheer Up!” Your well-meaning exhortations to “cheer up” or “smile” may feel friendly and supportive to you, but they oversimplify the feelings of sadness associated with depression. Just as someone who is depressed can’t force their brain to make more serotonin, they also can’t just “decide” to be happy. While there are certainly benefits to practicing positive thinking,  it’s not enough to cure someone of depression.

For the past two nights, I have had really bad migraines. I seem to be fine during the day, but once evening hits, the pain begins. A lot of times, I can just brush off the pain and go about my business the best I can, but these have made it hard to even fall asleep at night. I’ve had to just turn off all my lights and be quiet. I haven’t even turned on the TV in the evenings.