Into the system…

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Into the community…

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So I was discharged on Tuesday, following four weeks as an inpatient on a private acute psychiatric ward. I was not ready to be discharged, but my insurance had a 28 day inpatient limit, so there wasn’t much choice. I certainly can’t afford to self-fund!

So I’ve returned to the community and so far it feels a bit strange, but I’ve been okay. If I’d been chucked out on Monday there might have been a different story. My mood was on the floor, suicide the only thing I could think about. The same horrid scenario replayed over and over in my head, blocking out all my thoughts and stressing me out. I couldn’t comprehend leaving the ward in that state. Luckily, my mood picked up around Tuesday lunchtime and I’ve been “okay” since. Still low, still struggling to think, but not too bad. For once, my mood shifted at the right time!

In terms of where I am now. I’m still not formally diagnosed; this episode of illness just has the vague description of “depressive episode”. Whilst I was in hospital, I had two short periods of hypomania, demonstrating the clear shifts of mood I’ve been experiencing for most of this year, but this still hasn’t been enough to solicit a diagnosis. My psychiatrist is hedging her bets a little. She believes I do suffer from a mood disorder, but she is not being more specific than that. She said that the predominant picture is one of depression, but that this is complicated by the fact I do have obvious shifts of mood, suggesting that perhaps my diagnosis lies within the bipolar rather than unipolar spectrum. She is still uncertain though and won’t commit to this. She also added that my condition appears to be somewhat complex, due to added complications with my personality (perfectionism, passivity, workaholic). I suspect she is weighing up the decision to slap on a personality disorder diagnosis or two. I’m sure my symptoms could be moulded to satisfy one if she deemed fit. This lack of diagnosis is both frustrating and a relief. I am glad she isn’t rushing into things. I’m glad she hasn’t just wheeled out a diagnosis of borderline personality disorder because I self harm and have been difficult to treat. Yet, at the same time I wish she wasn’t being so vague. I want to know if I need to accept this is a chronic condition that I will be dealing with for the rest of my life. I suspect that it is, but I can maintain a state of denial until she confirms this for me. I want to know what it is I’m facing.

My current medication regime is as follows:
8am: 225mg Venlafaxine (Effexor XL) & 50mg Quetiapine (Seroquel).
4pm: 50mg Quetiapine
10pm: 250mg Quetiapine

So far, I am unsure how much it is helping or not. I suspect the Quetiapine is helping with my sleep. The drowsiness kicks in fairly soon after taking my nightly dose and although I am still waking fairly frequently and not feeling all that rested, I am definitely getting more than before. I think it is also helping to level me out a bit. My mood isn’t spiking as much as before, but just seems to swing between varying degrees of lowness, instead of going from very low to a little high. I started on a tiny dose, but almost every time I see her she adds more!

I do not know if the Venlafaxine is helping. My mood is predominantly low at the moment and the suicidal ideation is still around fairly often (which I guess could actually be the fault of the Venlafaxine – it has a reputation for increasing suicidal thoughts), so I suspect not, but then if I wasn’t on it would things be different? I wonder what her next move will be with this. She has upped my dose a few times to get to this point, but I suspect she won’t up it again.

I start day care tomorrow, attending Mondays, Wednesdays and Fridays for the next six weeks. I will be continuing with some of the groups that I attended as an inpatient and starting some new ones. I am looking forward to some of them, but apprehensive too. Therapy is hard work and often makes you feel worse, not better.

Tomorrow, I have group CBT and Expressive Therapy. I am still to be converted on the CBT front. I’m not sure CBT is all that helpful to me, but the group is quite good as there are two therapists, which ensures everyone gets some individual support. Expressive therapy is a bit like going to playgroup and is different every week. We may be painting, playing games, doing role plays, singing or whatever, but it’s usually quite fun. A bit of light relief for a Friday afternoon anyway.

It will be really good to see people again. I should get to see some of the people who were inpatients at the same time as me, as well as the day patients I’ve met in group. You find that you make close friends easily when you are in a hospital environment or group therapy situation. You learn things about people that you’d never share in the outside world and become intimate friends very quickly. The empathy between patients is something that’s hard to find elsewhere. The only other place I’ve really experienced it is in this blogging community. It’s not just between the general psychiatry patients (depression & anxiety) either. Even the addiction and eating disorder patients have that sense of shared experience and empathy. I do miss the fact I could just walk into the lounge and there would always be someone you could talk to that would really understand. I think so far, that is the hardest thing about being in the outside world.

Generally I think I should be safe over the next few days assuming my mood stays roughly like this. I’ve got a friend coming over this afternoon so that should be good. Although my bloke is out this evening I think I’ll be okay. It’s a bit weird being on my own after 4 weeks of almost constant supervision, but so far I’ve not been too worried. Tomorrow I am in day care, which I am looking forward to, although I’m a little worried about how I’ll feel when I go home after a day at the hospital. Therapy can be draining and it might leave me feeling weird without the safety net of the ward to go back to afterwards. The weekend brings visiting friends and bonfire night, so I should be suitably distracted throughout and Monday brings a return to day care and a review with my psychiatrist. I dread the review a little as I am terrible at getting my needs across, but I will try and prepare a little beforehand.

I’m not sure that “being safe” should be all I’m aiming for, but it is all it feels I can aim for at the moment. I guess I should be pleased that I can feel safe. It is an improvement. A couple of days ago I really didn’t think I’d be safe in this outside world and so far I have been. I am still uncertain though and still don’t trust myself completely. I think I do generally feel as if I may be existing for existence’s sake. That doesn’t make things easy. I get close to giving up more often than I probably should, but it is incredibly draining just going through life for, what feels like, the sake of it. I just have to keep telling myself it will be worth it. I just have to get through this period of crapness and hope for things to change. Not easy though.

Anyway, I have written enough for now. I will update on the weeks before my admission sometime soon, although I don’t really know where to start. It has been a crazy few months.

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