Taking the A-Train, Part II (I Think)

This is a follow up post to Part I.  But I repeat some of that post here.  So maybe forget Part I.  But there is new stuff here so this is really Part 1.5. (Shut up and tell the story already!) If I “shut up,” though, I can’t technically tell the— (Really? This is how you talk to people?)

Okay then.

Aong the myriad changes to my life this summer, I began taking a new drug: Adderall.

After visiting a new ADHD specialist, I started on Adderall XR 20 once a day.  After a few days, the plan was to taper in Wellbutrin as well, after I described my depression as “severe” (with accompanying documentation)  The first day I took the Adderall, I felt relaxed and clear.  I took it in the morning and did my usual mental check.  How do I feel about finances?  Job? Mortality?  All topics returned positive thoughts.  It was a Saturday, and my wife and I had a good long talk about difficult topics: the finances, aging parents, our kids’ autism, our younger son’s cancer, etc.  I felt unburdened; I could send my thoughts anywhere without the automatic anxious responses. I could see my way to fixing many problems that have been ongoing, even those that I have always had trouble with since leaving home for college about a bazillion years ago (okay, it was 1989).  Those things being finances and getting things done in general.

But I cautioned myself.  Being on Adderall was a new project.  It was fun and untainted and full of possibility and lacking any failure suitcases.  After a second day of feeling good and getting some things done, I took a risk and had an antihistamine.  I have seasonal allergies, but I find that taking any kind of medicine for them gives me bad mood side effects (in that I seem to hate everyone and want to crawl under the bed) so I endure the allergies rather than experience those side effects.

English: Adderall

I slept well that night and started the Wellbutrin the next day. I felt confident about the anti-depressant because I had taken it years before and it had worked adequately. The idea of the new stimulant together with the antidepressant seemed like a potent combination to battle my sitting-around-ness.

However, something in that mix did not sit well with my brain.  My wife and I ended up in a big fight about nothing and I ended up taking a long walk around town to cool off. My wife called a friend over to stay with the kids and went looking for me in the car because I seemed too unpredictable.  I was sure it was the antihistamine and took another Wellbutrin the next day.

I didn’t have another tantrum, but I ended up with the same problem when I started Wellbutrin years ago: insomnia.  I wasn’t willing to wait it out this time, though, and felt like the depression had lifted with the Adderall anyway, so I chucked the Wellbutrin idea.

For the first two weeks, it felt like the positive change I was hoping for was just around the corner.  I saw clearly how to fix broken things in my life, and the steps were attainable.  There were so many of them, though, that I had made little actual progress.  That, and there is always the backdrop of my son’s cancer to consider.

I started to notice the first side effect of the Adderall: jaw tension. Adderall cuts me off from certain body signals. I can have a bad night’s sleep and still function okay and not have the crushing sense of fatigue that I’ve always felt. I am also less hungry.  Instead of stress affecting my whole being, stress seems only to affect my mouth.  My lips get tight and I have the urge to clamp my front teeth together.  From doing yoga and practicing mindfulness, I know I typically carry anxious tension in my body, but my normal jaw clenching is my back teeth.

tiny mouth

tiny mouth

On Adderall, when I start getting “tiny mouth,” I have to think to figure out what’s going on with my body.  Oh yeah, haven’t eaten in six hours. Or only got four hours of sleep last night.  The jaw tension also happens when the slope turns and the stimulant starts to wane. Normally hunger and fatigue would be right there without my having to think about them.

The Adderall effect feels different from the Ritalin.  On Ritalin, I’d upswing (which I hesitate to call a “high,” because that suggests a hopped-up feeling) for an hour or two.  I’d feel energized and calm and, on good days, have a sense of well being.  Then it would drop off and I’d feel like my baseline anxious mess of a self.  And then take the next pill.  I’d take as many as five a day and be up and down that roller coaster.

If you’re a coffee drinker, my Ritalin experience was like having that first good cup of coffee after you wake up and then within two hours going right back to just having got out of bed and everything sucks feeling. And doing that several times a day.

At the end of the day I’d feel exhausted from all the yo-yo feelings, and my depression would creep in there and make me feel hopeless.  God forbid I’d wake up in the middle of the night.  I would be so far away from Ritalin at that point that I would feel like I was dying. Some nights I was sure that I had completely stopped breathing in my sleep and only through some miracle had woken myself up and started breathing again.  Try going back to sleep with that thought in your head.

I had tried to remedy the roller coaster feeling with Concerta.  The timed release is supposed to give you a more steady feeling.  On straight Ritalin, I took 40 to 50 mg a day.  On Concerta I was up to 54 mg a day without the positive effect.  Also, with the Concerta, I had no options after it wore off. It was impossible to work in the evening.

English: Kirnu, a steel roller coaster in Linn...

The next option was to boost the Concerta, but I couldn’t understand why 54 mg of Ritalin inside the mechanism of Concerta did not work as well as 40 or even 30 mg of plain Ritalin.  My doctor was also concerned about my blood pressure which was testing at borderline high.  More Concerta could increase my blood pressure.

I now know that my family doctor was the wrong person to manage my ADHD meds.  The new doctor, the ADHD specialist, said several things about why my treatment wasn’t working.

  • First, some people respond more to the slope of the medicine rather than the level.  Concerta has a more gentle slope, so it’s not uncommon to need more of that than straight Ritalin to get the same effect. And plain Ritalin has a vicious down slope.
  • Second, if I was taking time release pills, I needed to have a “booster dose” of non-time-release stimulant on hand if I needed to work late.
  • Third, the way my family doctor measured my blood pressure was all wrong. I’d barely get into the office and after the nurse would ask me a stream of stress-inducing questions (when was your last physical [25 years ago] did you have your flu shot [no] why not [um . . .]). Then he or she would take my blood pressure while I sat uncomfortably on the edge of an exam table.

My new specialist waits until we’ve been talking awhile and lets me sit in a comfortable chair the whole time.  If I test high, he moves my arm to a more relaxed position, lets me breathe a couple times and then remeasures.

He said the other method virtually guarantees a wrong reading.  I bought a home blood pressure kit and thought it didn’t work because the readings were so different from in the family doctor’s office. (My other doctor was aware of this “lab coat syndrome,” but his solution was to get it monitored somewhere else on my own. To quote Bugs Bunny “He don’t know me very well, do he?”)

The upshot of all this was that I had plenty of room to go upwards on the Ritalin/Concerta route if I wanted to.  I was ready to be done with Ritalin, though, and he thought the slope of Adderall would work better for me anyway.

Adderall XR felt very good, but left me without much benefit after 4:00 p.m.  He told me to call if I needed a booster dose, so I did and left a message.

If you don’t know, ADHD stimulants are controlled substances because people abuse them.  My personal and unscientific opinion is that if Ritalin and Adderall were naturally occurring in coffee beans, they would be a regular part of our society, and if caffeine were only synthetic, it would be a controlled substance. I had plenty of friends who abused caffeine in school; No-Doz and Jolt were the study aids in my day.  Plenty of people are addicted to caffeine and use it daily as a “crutch.” Also I can’t make out why alcohol and tobacco are legal and marijuana is not. (Climbs down off soap box.)

Because stimulants are controlled, they are less convenient.  They can’t be called in, no refills are allowed, and there’s a limit to how many you can get at one time.  I have to physically take a paper prescription to the pharmacy and often have to show a driver’s license. I worried about how this might be a problem with my new specialist being an hour’s drive away.

I called and left a message and didn’t hear back and was feeling worried that maybe this was not the best place for me to be going after all.  I was thrilled to be proven wrong when a new prescription sheet arrived by mail within three days.  And it had a neon green sticky note attached with a reminder of my next appointment!  The significance of this cannot be overstated: not only are sticky notes important to my life, but neon colors are essential; pale yellow ones just don’t cut it.  This practice knows how to work with ADHD people.

Overall, the feeling of Adderall is more steady.  It is indeed a long slope and does not have that horrible drop off.  I do have the occasional what are you doing anxious thought at night, but without all that inconvenient existential dread.  I feel almost like a normal person sometimes.

On the downside, I am more blunt in my speech and say things that I intend to be funny that come out as mean.  I forget to eat sometimes and I eat less overall, but I can afford to miss a meal or two. (Dear Taco Bell: Fourthmeal?  I scoff at your paltry little number!)  I have to be careful not to take a booster dose too late or have too much caffeine or I have trouble sleeping. There is a slight decline in sexual response.  And the weird mouth tension thing.

But overall I felt much more positive and focused and less anxious and avoidant.  Until the end of my summer got messy.  But that’s for Part III.  Or maybe Part 2.25.  Can you do decimals in Roman numerals?

Taking the A Train, Part I

Two months since my last post, whaaaat?

Summer time is always busy, but geez. Being Cancer Dad will sap your time.  At the moment, I’m staying in the hospital with my son (we’re on day 5 now) so I’ve got to write or risk climbing the walls.

On the AD(H)D front, I went to see an ADHD specialist about six weeks ago.  He’s a physician who specializes in ADHD treatment.  I had a recommendation from a friend about a year ago to see this guy, but, ahem, ADHD.

I went to see him on a Thursday morning his office is in East Grand Rapids, a tony part of town (there’s a yacht club, for Pete’s sake!).   EGR is about an hour from my house, and I had taught a class the night before in Grand Rapids and decided to stay over with my brother who lives downtown GR.  I did not sleep well, unfortunately, and was quite tired that morning.

I found my way to the Sundance Grill for breakfast, had some fabulous breakfast tacos, but felt weird dining alone at a place with table service. I kept eavesdropping on all the business meetings going on all around me.  The best conversation was at the next table; a business man from Ecuador was being entertained by a local guy.  At first, I thought the local guy was being kind of rude, all he had to go on was stereotypes.   You like soccer down there, right?  But it turned out Mr. Ecuadorian returned those stereotypes right back. You all play baseball up here, yes? Mr. Grand Rapids said he actually didn’t like baseball all that much.

I got to Gaslight Village early, found the doctor’s office, then hit the Starbucks down the street to wait. My nerves were getting the better of me.  As I said, EGR is a tony part of town, and I was surrounded by very successful looking people in sailing, tennis, or yoga outfits, with the occasional hipster thrown in for seasoning.  I’m more at home in the university crowd with a bit of earthiness thrown in by going to my local Biggby’s in a college town, where someone wearing Carhartts might have just arrived from a construction site or an art history class (or both).  In all honesty, the pending appointment probably kicked up my hyperawareness a notch; my first meeting with a psychologist many years ago I started to question the choice of magazines and muzak in the waiting room.

I forced myself to wait long enough not to arrive too early, and then walked into the door of the doctor’s second-floor office at five minutes before my appointment.  The office was empty, not even a receptionist.  Knowing that this doctor himself has ADHD, I wondered if he forgot my appointment.

Instead, he appeared at the door and said “You’re early!  Remarkable!”  I guess not too many of us ADHDer’s show up on time.

I took a seat and he got ready for me.  I went in a few minutes later and we started the consultation.  I had very thorough testing before, so he didn’t see the need to re-test me, and instead we talked about why I had come.

I talked about being on Ritalin and that it was sort-of working sometimes.  I got about two hours of benefit from each 10mg pill and then felt terrible when it wore off.  I had filled out extensive paperwork ahead of time with medical history and self-reporting of symptoms and we went over that. (Another sign that they were used to dealing with ADHDer’s: the staff would not schedule an appointment for me until after I had filled out and returned the paperwork.)  I also talked about my son having cancer and my needing to have more executive function so as to be more reliable and available to support him and my family.

We talked about my issues, such as not being able to get things done on time, not being able to stop doing things that I get involved in, my unreliable performance, etc.  I also talked about how I couldn’t understand why Concerta didn’t work for me.  On straight Ritalin, about 40mg a day seemed right (four 10mg pills) but the constant roller coaster was exhausting.  I felt constantly fatigued and downright hopeless most of the time.  On Concerta, I never got the full feeling of benefit even though I was taking 54mg (Concerta is Ritalin with a time-release mechanism).  And I had been working with my GP who basically let me decide what to try (“sounds like the wrong person is driving that bus,” he said).

The doctor had the simple answer to this confusing problem: “Some people respond more to the slope than the level.”  Ritalin has a sharp up and down level in the bloodstream.  The dose of Concerta I took had had a higher overall level, but a relatively weak up slope.


We talked through various other things and then he said I had sat long enough for my blood pressure to calm down.  My blood pressure always measures as borderline, but I was just the high end of normal, even though I had been nervous.  “Perfectly normal for a stressed-out dad.” At my GP’s office, they take my BP as soon as I get there, so I always measured higher than when I measured at home.  He also took my weight and height and, demonstrating his ADHD, forgot what my weight was in the time it took to walk over to his computer to record it.

He went through a lot of PowerPoint slides on his computer, showing me the different slopes of different drugs and talking about brain scan studies.  He was careful to say that the brain scan stuff is easy to oversimplify and overdetermine, but (putting it simply and deterministic) my brain is inefficient because it tries to use emotional motivation for almost everything instead of more logical motivation when it is appropriate. (And that everyone is always a mix of emotional and logical motivation.)

That trend in my brain is both inefficient and exhausting.  It means I have to be “in the mood” for everything, even routine things that should not have an emotional investment, and that I spend my life trying to generate mood and feelings to motivate my work. I felt that was an apt description of what I feel going on in my head.  I told him that when I need to write, one trick I use is to Google Image search for writers, writing desks, writer’s studio, etc. Looking at those pictures gets me in the mood to do the work a lot of the time. He thought it was a great example of using creativity to work the problem.  One of the biggest problems I have is switching gears.

So I left with a prescription for Adderall XR and Wellbutrin. He had noted I was reporting depression symptoms and asked me to rate my depression on a scale of 1 to 10. My answer was 8.5, hence the Wellbutrin.  I was to start the Adderall first for four days, then start on a low dose of Wellbutrin.

I also had an appointment in a few weeks and a fat bill I had to pay up front.  This office does not bill insurance.  That’s something that made me put off getting my first appointment, until I read this in Jennifer Koretsky’s Odd One Out:

In the United States, most insurance companies reimburse health care providers so little that they are forced to see 4–5 patients an hour just to make a living. This is unfortunate. And it’s particularly dangerous when a healthcare provider who sees you for 10 minutes a visit is your psychiatrist, or other doctor prescribing your ADD medication! I always recommend that my clients see a psychiatrist for their ADD medication. And, due to the current state of the U.S. health insurance industry, it’s not uncommon for a psychiatrist to stop taking insurance once they have established a practice.

While this doctor is not a psychiatrist, the insurance bit seems to apply.  I have good insurance, so it will be paid for, but I have bad follow-through and may not get around to submitting my claims.

Next installment: All Aboard!

You must take the "A" Train ...

You must take the “A” Train … (Photo credit: keithcarver)


Dear friends, colleagues, students, employers, creditors, family, editors, medical providers, yoga instructors, Facebook friends, WordPress readers, and auto mechanics:

I have ADHD.  It’s a real thing. It’s hard because most of the world doesn’t.  Our society is built on steady, goal-directed effort and my brain does not work that way.  I will be a valuable person to interact with for a time, and then I will probably disappear.  I’m trying to fix that. It’s hard.  I lived for 40 years without knowing what was wrong, and it’s going to take some time to undo my bad habits and poor choices and the negative feelings that have grown up around them.

I am not asking to be excused or pitied.  The life I have now is what I signed up for. No one twisted my arm and said I had to take a teaching job, and I am fully aware, dear creditors, that one has to pay back what one has borrowed. I want to be held accountable for my actions. That actually helps me improve.  Also, don’t tell me I’m brave. I am not. If I were, I would not have this problem in the first place.  Though it is tempting, I do not think martyring myself will be healthy. I want to be praised for my true talents and accomplishments, and bravery is not up there.  False flattery is a short-term fix that I’m trying to wean myself from.

The only thing I want is some way to explain my strangeness.

When I don’t do something I said I would do, I most likely did not forget about it. I do forget about tasks, but usually just minor ones. No, usually something happened to get in the way of my getting started or following through and I couldn’t do it.  I can guarantee it’s on a list or in a pile somewhere close by.

Motivation is tied to desire, but it is a complex interaction.  If you’ve ever tried and failed to quit smoking or stick to a diet you know what I mean.

I want to be the teacher that returns emails within 24 hours, for example. I think that’s an important and reasonable standard for my work. Sometimes I can do it.  Sometimes I can’t.  Even when I can’t, I think about it all the time. It’s not that I’m living this carefree life, trying to get away with doing as little work as possible, laughing all the way to the bank (my bank statement generally makes me want to stick my head under a pillow).  I greatly prefer being able to do my work, and the things I do to avoid it do not make me happy or satisfied.  I imagine my habits are similar to a maintenance alcoholic’s drinking; avoidance is a sort of self-medication.  It might help in the short term but it creates more problems in the long term.

Like every person, my interests and enthusiasm for projects and activities change all the time.  However, unlike the average person, it is really hard for me to work on something that does not have an intrinsic attraction or immediate deadline. When things get difficult or uncertain, my attention moves on to something else.  My waning attention does not mean I don’t value something in the long term. There’s just some minor hurdle that my brain’s turned into a wall.  Whatever hypothetical task we’re talking about now, I was interested and motivated to do it before and I will be again.  I’m just on a down cycle right now.

There are some things that are not going to change.  I have trouble recalling names and numbers, for example.  Can’t help it.    Remembering someone’s name has little to do with how important that person is to me. Sometimes I can’t even remember my own phone number. The hardest thing of all for me to do is sustain regular effort over the long term. I can do that sometimes and it will seem as easy as breathing, but sometimes answering my email is harder than eight hours of digging ditches.

I want you to understand that if I disappear on you, it’s most often not something that you did. When I disappear, something’s going on in my life that’s causing me to get stuck.  It often has nothing to do with you. In fact, sometimes, the more I value a person or a project the harder it is to get over my block. I’m working on changing that, and I am making good progress, but I have setbacks too.

One thing that helps is persistence on your end.  I know, that seems unfair, but kind reminders and contact helps me enormously.  Face time helps too.  If we can work together somehow, I’ll do much better work.  If I have to slog things out alone, I’ll get into trouble.  I think I’m the only person I know who likes long meetings.

And honesty helps too. If you tell me what you like and what you don’t, in the long run I like that better than guessing at what people are thinking. Although it is very difficult for me to hear criticism when I’m in a funk, it proves valuable in the end. (Apologies to my wife in that department.) You have to have an abundance of patience to work with me.  I’m fortunate to have many people around me with such patience.  Especially my wife.

I write all this because it is hard to understand for a person without ADHD to understand. Even people with ADHD have trouble understanding and thus explaining themselves.  I did not understand my habits for nearly 40 years; I’m used to hiding and covering for my deficits. I don’t expect the world to change for me. I’m finding a way to work in the world. Understanding my habits is not yet enough for me to overcome my challenges yet, but I’m on the way.

If I disappeared on you, all of the above is the real explanation. I can usually conjure a believable excuse which has some basis in reality, such as I was sick, my kids were sick, or the internet was down. Those things happen often enough.

But the real answer: I got into a funk, a freeze, a down cycle.  I’ll be back soon.


Ten Yoga Thoughts

I do restorative yoga, which is a mix of meditation and yoga, because it is phenomenal for my mental well being.  Also because it involves lying down a lot, which I find attainable.

During our mindfulness sessions, we practice being mindful of our thoughts.  Here are mine:

  1. If we always have to do yoga on a mat, why don’t they just make the floor out of yoga mats?
  2. Is there cursing in Sanskrit?
  3. Holding in the fart.  Holding in the fart. Holding in the fart.
  4. It’s a small, small, world [because I went to Disneyworld in January and YOU CAN NEVER GET THAT SONG OUT OF YOUR HEAD].
  5. Is all-male yoga called bro-ga?
  6. Why does the Buddha’s head look like an acorn?
  7. Shake Ey, Ey, Ey, Ey Shake, Ta Ta And do the Harlem Shake [It was funny the first seventy times. No. More. Please.]
  8. Finally figured out that Mitt Romney looks like the Mayor of Whoville.
  9. Is the song “Brown Girl in the Ring” a little bit racist?  How about the song “Everybody’s a Little Racist?”
  10. What this place needs is more windchime!

I have to add that my truly wonderful yoga instructor has told us that in India, you’re supposed to fart during yoga class, but that has not caught on here.

More Cowbell, baby!

The Umbrella Story

Since I had plenty of time to get ready this morning, I put off getting ready until the last minute.  My son went back to school today after a week of spring break. After he got on the van at 7:30 I had until 10:00 to get ready for my first class.

With that much time to get ready, I did the perfectly reasonable thing: I sat down, drank coffee, watched Morning Joe (which, despite my ranting, I still like as a morning news show) and did some writing.  At 9:30 I realized I was still wearing a bathrobe and my jeans were still wet in the washer, so I put the jeans in the dryer on high and then began my usual morning rush to get ready.

I got through my morning class and realized I had forgotten my power cord for my laptop.  Since I had a full day of conferences planned and I do all of my grading on the computer, power was a necessity. I had a break from 11:00 to 11:20, just enough time to walk home and get my cord.

At 10:58, rain began to pour down outside.

At first, I thought I could just grab a copy of the campus newspaper to get me home, but when I got to the door, I saw that the paper umbrella plan would last about thirty seconds. I went back to my office to ask around if anyone had an emergency umbrella.

My office neighbor said she did, rummaged around and gave me a bright yellow umbrella about the size of a hot dog bun.

“Wow, that’s small,” I said.

“Well, you’re a big guy and—“ she shrugged.  The shrug I understood to mean beggars can’t be choosers.

“I’m going to look like a circus monkey,” I said, grabbing the umbrella anyway. “Maybe I could get a tiny tricycle too?”

“I’ll try to hook you up with an organ grinder,” she said, and went back to work.

I went back outside and the umbrella proved to be just large enough to cover my shame.  My hair kept dry, but my pants, having only in the last few minutes gone fully dry after I had to pull them out of the dryer at the stage of dry-enough-to-wear-but-still-kinda-damp started to get wet again.

I arrived home, stuck my power cord in my pocket, got my giant golf umbrella (I do not play golf, but I like the umbrellas) and walked back carrying two umbrellas.

I didn’t know how to hold the now pointless small umbrella. I started to think of the picture I embodied, a giant red-and-black umbrella in one hand protecting me from the torrents of rain and a tiny, limp yellow umbrella held in the other, looking like a dead sunflower in my hand. Maybe people will think I need another umbrella for my feet because I am so tall I thought.  Maybe I could carry it opened, as if to cover an imaginary much shorter friend walking alongside me, a trained monkey perhaps.

I tried not to make eye contact with people.  How could you explain such a sight?  I kept the umbrella over my eyes until I passed another young man without an umbrella and then heard Sir? Sir?

Oh great, I thought.  Someone wants to make conversation.  Maybe I had him as a student and he wants to make this a reunion in the middle of the rain.

I tried to pretend I didn’t hear him and kept walking, but he was insistent.

“What’s that there?” he asked.  I turned around.

“Um . . . an umbrella,” I said, trying to make it sound self explanatory.

“No, I mean, can I buy it from you?”  He looked cold and wet.

“Sorry,” I said as nicely as possible.  “I borrowed this; it’s not mine to sell.”

The next logical question would be for him to offer to buy my big umbrella.  I could just give the big one to him.  But then how would I get it back?  Would it be my good deed of the day, or would it devolve into him wanting to bring it back and do you have a piece of paper so I can write down your address?  The potential conversations swirled in my head, fueled by coffee, Ritalin, and the fact that there were exactly three minutes to get back to my office.

“Oh, okay,” he said, smiled, and trudged on.

“Yeah, ah, thanks anyway!” I said.  Thanks anyway?

To avoid any further confrontation, I hid the little umbrella inside the big one when I got back to my office building.  It made my big umbrella look pregnant, but at least I would not have to explain two umbrellas.

“Raining out there, huh?” someone said in passing.

“Yes.  Yes it is.  Raining,” I said. What else is one to say?  Oh yes, and there’s oxygen too!

I got back to my office suite and delivered the large umbrella of its surrogate child and related the story back to my friend who loaned me the micro umbrella in the first place.

“Why didn’t you sell it?” she asked. “I could have used the money.”

I didn’t have an explanation, but I sat down with seconds to spare, just in time for my next student. Who never showed up.

Monkey School de Mae Rim

Mental Health and Stigma

I read the blog Popehat because I follow civil liberties issues (specifically, freedom of speech and copyright).  A post about the Aaron Schwartz case turned into a post about living with depression:

People think that the prosecution of Aaron Swartz must have been unusually oppressive and abusive, because only a rare abuse of power could have driven such a brilliant and promising young man to suicide. People saying that may have been depressed at some point in their life — but they haven’t experienced the disorder major depression.

I have. I’ve fought it for fifteen years. People — people of good faith, sensitive people, thoughtful people, smart people — don’t tend to fathom major depression if they haven’t had it.

Depression is not like sadness. Everyone has been sad. Everyone has been depressed on one occasion or another. But clinical depression is something else entirely.

Worth the read, even if you’re not interested in the discussion of federal sentencing that precedes it.