Tauren,

Thanks so much for replying. You cannot imagine how much it means to me to know that there are others actually listening. My experience for the past couple of decades has been that the state and federal governments pay, through my insurance company, for someone to listen to me.

I'm still in the process of trying to determine if there is, realistically, any 'hope for the future' AND trying to come to a lucid conclusion if any yes or no determination that I make is influenced overwhelmingly by my depression or overwhelmingly by sound and reasonable practicality.

I don't believe that severe major depression, even when combined with auditory hallucinations and severe anxiety precludes the ability to make sound and realistic decisions. When I started having the hallucinations again I knew that they weren't real. I went into my den, the 'source' of the sounds, and assured myself that they weren't real – even though they began again when I was comfortably back in bed.

When I reached the point where my depression was causing me to doubt my sanity, I made the completely rational and lucid decision to immediately seek help. And, despite the side effects that I first suffered, I have responded well to Effexor (venlafaxine) and do not presently feel as if I am nothing more than a tumorous mass of grief. I am 'pleased' to be sad and empty. But I have two avenues of hopelessness that can take hold on a 'bad' day – one, an old fear of how I might spend the remainder of my life; the second, a new and far more realistic fear of the same.

Both of my hopeless fears involve reasonable assumptions and realistic expectations of the future. I'm not under the delusion tha I can see or foretell the future but I do believe that I have gathered enough data and know myself well enough to be able to make accurate predictions.

My initial hopeless fear, before I sought help, was that there would be no recovery this time. Sixteen years ago I became mute and virtually non-communicative. I did not respond to medication or other types of treatment. Over a year passed and someone finally came up with the bright idea to use ECT. The first round, a total of 48 sessions, worked well. A few months later a 'booster' follow-up of 24 sessions did the trick. I slowly began to speak again – and you can't imagine the pain that I felt in my throat. That was one of the reasons that I had to use few words and speak slowly at first; it hurt.

Since that 'recovery' I never made a return to society. Also since that time, I have had numerous physical ailments, many involving my heart. I have a list of thirty different cardiac 'conditions' and eleven different cardiac 'procedures' (operations). I also have a pacemaker/defibrillator implant. When I saw my new psychiatrist for the first time we reviewed my history. He told me that with all of my cardiac problems I probably would not be a candidate for ECT again. He told me that he would consult with my cardiologist but that he was of the opinion that the mortality risk would be too great to warrant the procedure.

So this very realistic hopelessness set in. No medication had ever had any effect on me (except the antipsychotics which almost drove me insane and did nothing to stop the hallucinations) and the nursing home psychiatrist and, later, my GP, had been trying different medications on me (including Pristiq, the synthetic form of Effexor). I started Effexor at 150mg daily. For two weeks I believed that no medication would help, that ECT was not an option, that my depression was basically untreatable and that I would continue to slide down until I reached the point where I would need to be hospitalized for the remainder of my life or spend that time in a mental ward of a nursing home.

I considered that as a possibility. A probability if there was no other treatment.

I did not even think of suicide at this time.

Two weeks later and I had my second session. The Effexor was doing something – doing a lot of things – but those things were all over the place and changing several times a day. One thing that I was certain of, though, was that my mood was elevated. That my mind was no longer just a festering ball of grief. It would have been a lie to even imply any type of 'happy' feeling but the hopelessness that I was fearing was sated somewhat. There was now a chance that I could be treated. I didn't consider what that might mean for the future, only that it might not mean living in an institution until death.

I grew impatient with my shrink for not contacting my cardiologist so I did it myself. He is in a huge group of partners, over fifty of them, and it took me two days to finally talk to him. I had faxed him a letter on that first day (when I could still write with some brevity) and explained the situation. He told me that there was no problem with me having ECT sessions. He told me that my ICD would have to be turned off (there are two different ways to do this, but the simplest way is to place a strong magnet on top of the device) and that his preference would be that one of his junior cardiologists be present during the sessions. That was great news – I was on a medication that seemed to be helping but, if it failed, I had ECT to go back to. My shrink contacted my cardiologist for confirmation.

At that point, I still had not even thought of the word 'suicide.'

But the Effexor seems to have reached a plateau, it seems to have helped as much as it's going to help. My doctor keeps putting off the decision to increase my dosage to 300mg daily but told me that when I see him next week that he would have the staff psychopharmacologist meet with us and that we would reach a decision together.

As I wrote, I began to despair when I met with him last week and when I asked him, "What if this is as good as it's going to get?" and he answered by asking, "What if it is?" I came home and thought about that and realized that there is absolutely no 'quality of life' in my existence and that's when suicide became a consideration.

Again, you're right, I have no power to see into the future. An increase in the medication may enable me to accept this way of living as 'good enough.' My doctor may decide to augment the effects of the medication with a round of ECT sessions and that may lead me to believe that this life is 'good enough.'

I will wait and see.

I am, however, going to begin to make preparations. With my physical and financial limitations, and my uncertainty at this moment if this is even an option for me, I want to be prepared should I decide that it is an option and should I go further and decide that it is the best option for me.

I'm off to visit some websites. There are two that I know that I want to join – almost $200 to join both! I have right at $50,000 in credit card availability and about $5,000 in credit card debt. I don't own a single item worth more than $500 after depreciation and I have no savings or relatives that the credit card companies could come after to collect those debts when I die. So I suppose that my suicide would cause a blip on some credit card companies screens.

Thank you for your reply. I should keep a plain text file open that contains a single sentence apologizing for my hypergraphia disorder that I can copy and paste into the beginning of each message that I begin. I assure you that I appreciate your kind reminder that I must keep my limitations in mind when intent on making the most accurate forecasts possible before carrying out mortal actions.

Thank you, again,