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Archive for October 2010

Tummy Troubles…

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I am still struggling with the tummy troubles. I have been taking the higher dose (120mg TDS) of Alverine Citrate for a few weeks now and I do think it has helped a little, despite the fact I have also increased the Reboxetine to 8mg in that time. I was getting less cramps at least, although I was still having problems with diarrhoea or constipation all the time. My appetite had improved a little, which must suggest things have been a little better.

Unfortunately that slight improvement has been completely negated by the events of last night. A warning – this post definitely scores high on a rating of too much information!

I had been feeling fine and had enjoyed my dinner of roasted ham, mash, kale and carrots. As I was getting ready for bed and just settling down to watch Newsnight, I got a sudden shooting pain in my tummy and next thing I knew I’d had a somewhat messy accident. :S :( I was so shocked and upset, it took me a second to act and jump into the bathroom (which is within a metre of the bed), although by this point it was far too late anyway. The bloke was horrified and just shouted at me, called me disgusting and hid in the back bedroom, whilst I stripped the bed and took a shower. :( I was feeling pretty rough by this point and thought I might be sick as well, but managed to keep that end under control! The bloke eventually realised I wasn’t very well and that he was being unreasonable and he apologised and started to make the bed. I didn’t know what to do with myself. He wasn’t going to let me in the bed after that, so suggested I got the air-bed out! At least that is plastic and cleanable in case of further episodes. I didn’t expect to sleep much anyway, so decided to do this and settled down under the spare duvet on the lounge floor.

I was awake most of the night and felt pretty rough, but managed to survive without any further accidents. I’m still feeling pretty dodgy now, although by now I could just be hungry. I am too scared to eat anything though.

I don’t really know how to say this, but the poo didn’t look good at all. Very dark brown, sticky, runny and lumpy including some undigested carrots. Not nice at all. The fact it happened so suddenly suggests things aren’t very happy in there either. If I could have done anything about it, I would have. There was no warning at all, except for the shooting pain that came with the attack. It literally came out and exploded like the lid off a pop bottle that had been shaken up. bleugh. Sorry. You don’t need to know that.

The bloke wanted me to book an appointment with Dr N, so I am seeing him this afternoon. I am not sure what he can say or do. I have no idea how I am going to tell him without dying of shame. Part of the reason I am writing this, is to practice describing what happened! I am far too British and shy to talk about poo. Even with a doctor. It has been hard enough to tell him of my tummy troubles so far, but this is an extra level of embarrassment.

I wasn’t sure about writing about this here as it is so embarrassing, but it is the latest thing to happen in the whole tummy troubles saga and something so horrible seemed worthy of note. After all, this blog is an account of some of the more grim elements of mental health. Coping with the side effects of medication is a big part of dealing with mental illness, so I may as well be honest about it.

My bloke was very shocked and not very impressed. He wants me to stop taking the Reboxetine if that is what is causing this. He said he doesn’t like living with an 80 year old. I agree. I don’t enjoy feeling like one.

I had been struggling with the increase in dose aside from this. My sleep has deteriorated and I only find I can sleep properly when the dose wears off in the morning, when I should really be getting up and taking the next dose. It takes ages to get to sleep, I am waking up all the time and struggling to get back off to sleep and I am having nightmares and feeling restless. It is exhausting. I was getting palpitations at night too, immediately after the increase, although that seems to have settled down a little after a couple of weeks at the higher dose. I felt really low in the first week or so too, but that also seems to have improved over the last couple of days, so maybe it is starting to have a more positive effect now. That said, I feel crappy today after the night I’ve had!

I am too scared to stop the Reboxetine though. I don’t want to go back to how I was before. I don’t want to end up really depressed and suicidal again. The perpetual low mood and vague depression of late is draining enough, but that constant despairing depression is much, much worse. I don’t know what alternatives there are. Maybe I should just go med-free and sod all the drugs and their stupid side effects. I still wonder if my mood would have resolved itself a lot faster if I hadn’t have started taking bloody medication. Then again, it may have killed me first.

In good news. I got my driving license back!

I now have a 1 year license, so I need to stay sane over the next year or I will lose it again. Apparently, I will get a form 3 months before it expires to request a renewal. They will go through the medical enquiries again and decide if to reissue. No doubt it will take 5 months again to do that, so I will not be able to drive again for a wee while, but I guess we will see how it goes next time. If I get worse or am told by my doctors to stop driving for whatever reason, I have to let them know and presumably I will have to wait months for them to decide again, so I hope that doesn’t happen.

It is great to have my car back. I am looking forward to going places and having my independence again. I think it will make a big difference in helping my recovery. Being able to go where I want and not having to rely on public transport or lifts from the other half is going to be a massive help. I have a lot more choice about what I do with myself and will be tempted to go out more.

I had a drive on Saturday afternoon after I’d insured and taxed it and it didn’t feel too strange to be back at the wheel. The bloke went with me and we made it in one piece. My left arm has remembered where all the gears are and it felt pretty natural, so I am glad I hadn’t forgotten it all.

On Saturday night we went out in my car and got pulled over by the police! I wasn’t driving, the bloke was. It had flashed up on the policeman’s dash that the car was uninsured – obviously the database hadn’t been updated since I had only insured it that morning. I am glad I wasn’t driving or I’d have panicked. I would say I’d have shat myself, (I think I did on Saturday night!), but I’m not sure that’s appropriate now! *blush* At least we can say the police are on the ball! We were off to a beer festival and although my bloke was only going to have a pint as designated driver, we decided not to take the risk of being pulled over again later, so we left the car and got a taxi back. We went back to get it on Sunday morning and I took my first solo drive, driving my car back. I was okay, although I had forgotten which lanes I needed to be in a couple of times, so I made life harder for myself.

Anyway, I need to get ready for my doctors appointment. I haven’t got dressed yet and am just lying on the sofa with a blanket. Walking around makes me feel worse, so the temptation is to lie here all day. I have a meeting to go to this evening though, so will have to get up eventually.

Edit (3pm): Appointment with Dr N was very embarrassing and not too much help. I had been taking senna daily, plus the occasional dose of lactulose to counteract the constipation I was struggling with, but he thinks that won’t help on the maintaining control front, so I should stop that for now. If I don’t take it, I usually end up in pain and bloated from the constipation within a day. He has given me a script for something else to take if that happens, so we shall see how we go.

We talked about coming off the Reboxetine, but he didn’t think that was worth the risk at all. We don’t know if my mood picked up spontaneously or if the Reboxetine helped, but either way, my mood is a lot better and it doesn’t seem wise to mess around with it. I may have to drop the dose to 6mg if the problems persist, but I was struggling enough on that dose, so don’t suppose it makes much difference.

We talked about sleep and he asked if I wanted to try more sedatives, but neither of us really saw the point as they don’t seem to help all that much. He made the suggestion that actually getting back to work and having more brain stimulus may help, which in theory is true, but I never slept that great when I was at work. Even when I have been busy lately, it hasn’t made any difference, so I’m really not convinced by this. If anything if my brain is busy during the day, I really struggle to slow it down at night, especially if I get anxious too.

Mentioning work, I told him about seeing Dr Occy Health again on Thursday. He thinks I should push to agree a planned return to work as having a structure and plan may help give me something to aim for. I think he is right, although I am wary of the risk of too much, too fast. I told him about going in a couple of times and he agreed that was promising, although I also said that my work are very hesitant to let me rush back. They are being very cautious about how much I can do and when I can do it. I actually got told off for doing work-related activities whilst I was there the other day. We will see though.

Off to the Office…

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Friday 15th October – 11.05am

(I started this post on Friday, whilst waiting for the bus. I didn’t get the chance to finish it, so I am going to post what I did then and complete the post before publishing it all together).

I’m sat at the bus station writing this on my phone, waiting for the bus that takes me to the office. I missed the connection as the bus from my village was running predictably late, so I’ve got a 25 min wait for the next one. At least my renewed disabled bus pass arrived before I got the bus this morning, saving me about 6 quid in bus fares today.

I am nervous. This is not the first time I’ve been back since I’ve been ill. I got over that hurdle a couple of weeks ago, but it doesn’t feel any easier a second time. On my last visit, I went to a meeting I was invited to. I used to be on the office forum, which focussed on employee engagement and office morale. The committee had stopped meeting after I went on leave, but the Senior Exec who was in charge decided it was time we revived it, so I was invited along. I thought it was probably a good way to get updated on the situation in the office and to do something work-related without too much pressure. It helps that I have a lot of experience in this area from my last role, so I thought I could handle it. Plus there was free breakfast so how could I refuse? I feared that a meeting with two Senior Execs and a handful of others might have been a bit much for my first trip to the office in two years, but I decided it doesn’t really matter what they think of me. Dr Occy Health didn’t expect me to go to the office to do any actual work, but I decided that it would probably be easier if there was a purpose to my visit and chatting about charity work and office parties didn’t seem like too much of a challenge.

At the start of the meeting I explained that I had been off on sick leave for a long time and that I was in the process of getting back in touch with work, with a plan to start returning part-time soon. I wasn’t sure about doing this at all. I don’t know if it is a good idea to have too many people knowing about my situation and I felt quite self-conscious, but I think it helped to set expectations and put my comments into perspective. I think I would have probably come across as strange if I didn’t put things into context. I am very behind with the latest news on clients and projects! Over two year’s absence can’t really be left unexplained.

I think I handled the meeting okay. I had things to say and as the only person there from my level, I could offer a unique position. This made me feel a little more useful than perhaps I had feared beforehand. I think if there were others at my level, I would have been tempted to stay quiet and I would have felt surplus to requirements, maybe even a hindrance. Compared to others, it would have highlighted how out-of-date I am. I also struggled to remember things, partly because it is so long ago and partly because my brain has been fried by depression and ECT. I had to think hard about how things were back then and what I would have said 2 years ago and it made it a struggle to keep up at times. Things have definitely moved on whilst I’ve been away (for example, the client I worked for last, is no longer a client), but reassuringly we were still discussing and facing many of the same issues we always have. The stuff I had remembered, was still valid and I still had relevant answers to give.

After the meeting, I took a hot-desk for an hour or so and started to trawl through my old inbox. I decided the best strategy was to skim-read subjects and mass delete. A request from two years ago is hardly likely to be valid any more, so I assumed it could be ignored. There were a few automated notices I had many, many times over, so I thought I better look at sorting those out. I sent a couple of emails to old colleagues to see if they could point me in the right direction, but most of the people I would have asked, have since left the company. Hopefully, someone will be able to help me stop them from coming though. Pretty much everything else went in the trash. I have probably missed a few things, but the chances are that if it is important, they will ask again.

I was struggling to keep my mind on the job. Part of this was probably a lack of concentration, but I think a lot of it was just down to how I felt about being back. I was reminded of how much I’d missed and what had happened before I went on sick leave. My mind was wandering back to those times and thinking about what happened and what went wrong. I felt a bit strange when I came across some old emails. Stuff from when all of this kicked off. Emails to HR and my old line managers about how I was feeling, what occupational health had said etc. I wish I hadn’t seen them really. I don’t want to go back down that road.

It was also weird to discover how much has moved on. So many of the old systems have been superseded and I have no idea where to start when I sign in. So many of my colleagues have gone, been promoted, moved client, moved office. I will have a lot of catching up to do when I get back. I will need to re-learn a lot of things and it will almost be like starting a new job, even more so because I will be starting a new role with a new team. I am worried though that with a year’s work and 3 years in the company under my belt, people will expect me to be experienced and know what I am doing, but I’m not sure I do any more!

I felt somewhat weird about the whole visit. On the one hand it was fine. I coped, I took part in the meeting, said something worthwhile and I don’t think I made an idiot of myself, but on the other hand I felt really out of place and uncomfortable. Despite the fact the meeting went okay, I have no confidence and I worry that I can’t do that job any more. I don’t have the confidence or the concentration. I am scared of going to meetings, talking and working with others, having to make decisions and everything else that comes with the job. I just don’t feel up to it.

The culture feels really alien too. Just wearing smart work clothes felt wrong. I used to love wearing my sharpest suit and heading into the office. I was happy when I drove through the office gates and walked in, laptop and security pass in hand. Work used to feel like the right place for me. I was good at my job, I knew that I was and I really loved it. Now I feel lost and out-of-place and uncertain if it is the right thing for me any more. When I walk in to the office now, I feel like someone who has got lost and ended up in the wrong place. It feels like there are all these people staring at you, wondering why you are there and thinking that you’re an idiot. I worry about looking confused, forgetting where things are or what the etiquette is. For months, the only people I really dealt with on a semi-professional level were doctors, psychiatrists and the like. That is a very different relationship to a working one. You don’t sit down with your manager and pour out your inner woes. You have to maintain a professional front, appearing calm and capable, even when you feel like crap and really want to hide under the duvet or break down and cry. I am not sure how long it is going to take me to adjust.

There was a small part of me that got a real buzz from being there though. There was a little spark of excitement at the thought of going back to work. Being there and taking part in that meeting, really reminded me of what I’d been missing. I like a challenge and to use my brain. I’ve not used it enough lately. I enjoy working with people to come up with ideas and I like to get involved with solving problems. It is good to feel like you are useful and to have something to focus on and think about. When you enjoy your work, it can be the thing you live for. I didn’t really want to leave the office and go home afterwards and it was hard to pull myself away at the end of my permitted two hours. I wanted to stay and work and be normal for a while. I wanted to forget everything that had happened over the past two years and just get on with my career and my life. I didn’t want to be ill any more. I don’t want to be ill any more.

I’m nearly at work now and staring at my phone to type this on the bus is making me feel queasy. I’m only going into the office for a couple of hours today. There’s no real reason for my visit and I could do what I intend to do there at home, but I thought it would be a good idea to try to visit again. I’m going to sit at a desk, read through emails and try to update my company CV. I don’t know how much I will get done, or what I will be able to do, but it is worth a try. After all, Dr Occy Health didn’t want me to try to actually work, so just being there is a good start.

Afterwards…

(I have written the rest of this post over a couple of days, so I will do my best to complete it and publish it now).

After my first visit to work – that meeting I wrote about above, I was completely drained by it. As I left the office, my mood started to crumble away from me. It was almost as if by leaving the office and getting back on the bus, I was leaving behind the normal world and going back to the mental one. My mood seemed to change accordingly. Whilst I was at the office, my mood was okay. I pretty much switched off my emotions and got on with the task in hand, doing my best to act normal and remember how I used to be at work. It didn’t go too badly, so I was hoping it was fine and that I had nothing to worry about. Unfortunately though, afterwards I felt really rubbish. I guess I had been maintaining the front and this can be exhausting.

It was really hard going back to the mental world. I didn’t want to. I wanted to stay at work forever and not go home. Being back at work gave me a few hours to pretend that everything was normal. It was almost possible to pretend that none of the past two years had happened. I was back at work, doing a job that I loved. I could forget the world of therapy, medication and psychiatrists and distract myself with a world of email, meetings and spreadsheets. Two and a half years ago, I was using work to distract myself from anxiety, suicide and a mood disorder, within half an hour of arriving at the office, I was doing the same again. If only that distraction and front could be maintained.

I was really anxious afterwards. I dissected everything a million times over. I went over everything I could remember from the meeting, to check I didn’t seem too mad or make a complete fool of myself. I have always worried about how I came across at work, but usually I could be fairly rational and pragmatic about it. Evaluating your own performance is a big part of the job, but it is not good to spend hours catastrophising, pulling apart everything you have done and then using it as a stick to beat yourself with. Unfortunately this time, my evaluation was definitely closer to the latter. I knew I was doing it, but couldn’t seem to stop myself. CBT – where art thou?

I felt quite panicky about the future. I worry about whether I could ever do that job again and where I fit in. The drop in my mood, level of anxiety and complete feeling of exhaustion afterwards only made this worse, because it confirmed my worst fears – that I wasn’t good enough and that I couldn’t cope any more. I was annoyed with myself, because I didn’t see how a couple of hours could make me feel so bad. I was angry at myself for being depressed and angry at depression for taking my career away from me and stopping me from working. I was really disappointed that although the trip to work went okay, the fallout from it was less good.

My second visit to the office was not too different to the first, except I didn’t have a meeting to go to. I was actually a lot more nervous beforehand this time. I hadn’t been feeling very good mood-wise anyway and had very little sleep, so I was even more worried about what effect it would have on my mood. I haven’t been sleeping well at all since the increase in Reboxetine – I’d forgotten how bad it could be for insomnia.

I had emailed the night before to reserve a desk, but the woman was still grumpy when I asked her which one. I didn’t arrive until about 11.45, due to missing the bus, so I was later than I’d originally said. She said she had only reserved it up to that time, so if it’s gone it’s not her fault and I will have to do without. I did not like the idea that I will have travelled all that way and that I may not have had a desk to work at, but thankfully it was still free and I could set my laptop up and get to work. I had problems with the LAN though. I could get on the intranet, but no external websites were working, which seemed a bit strange. I managed to get on to the support website and worked out how to fix it, but it still ended up taking a lot of my time.

I spent most of the time going through the latest emails, including a couple of responses to my enquiries from my previous visit. Still didn’t have any answers, but I was a step closer to getting them. I did feel a little overwhelmed when I looked in my inbox and saw that in a few days I had over 3 pages worth. Considering I am on sick leave, so I am not getting anywhere near as many as I would normally, it was a little daunting. One of the biggest problems before I went on leave, was the fact I often felt like I was drowning in emails and there were times when I just couldn’t bring myself to answer any of them. I would check what I was writing a million times and would get a feeling of doom every time I clicked send, even when the message was a simple one-line answer. I would look at the list and not be able to summon the motivation to do anything about it. Certain names would fill me with dread, because I knew it would be more work.

After my inbox, I wanted to log in to my company CV, as it will need to be updated before I start looking for roles or internal work. It took me ages to remember where I needed to log in! Once I was in, I didn’t know where to start. It is obviously very out of date. I noticed the skills section doesn’t increment the number of years experience you have had, so decided that was a good place to start. There was a lot of skills missing and I didn’t even finish completing that section before my time was up. I wanted to stay and finish the job, but quite sensibly I had somewhere to be afterwards, which stopped me staying all afternoon. I felt really lazy arriving at the office just before lunchtime and leaving only a couple of hours later. I’m sure people were looking at me as I packed up and left. They must have wondered where on earth I was off to at 3pm. Leaving before 6pm is just unheard of, so that isn’t surprising.

I did feel a lot worse again afterwards, although probably less anxious this time. I didn’t spend any time talking to anyone on that visit, so I had no conversations to analyse afterwards, which helped I think. I literally spoke to the woman at the reception, took my desk, worked in silence and then got up and left. This is the way everyone works in that office, so I wouldn’t have seemed anti-social or anything.

I am still not sure how I feel about work now after dipping my toe in. I am scared that I won’t go back. I am worried that when I see Dr Occy Health in a couple of weeks, he will be concerned at my drop in mood lately and he will delay my return even longer. I feel very conflicted about it. Half of me is desperate to get back, to put the past two years behind me and to get on with my life. When I was at the office I felt okay and seemed to be coping, so there’s no reason why I wouldn’t cope for longer. I think it will be good for me to get back to work and feel useful again. I have been getting bored at home and feel very worthless. So much of my self-worth was tied up in my work and I think it still is. I will never feel like I have recovered or improved until I finally get back to work. I was a lot better over the summer and felt pretty well, but I still wasn’t at full capacity. I still wasn’t able to work.

Now, I am very scared. I am worried that I will not be able to cope. I am very worried that I will go full-steam ahead into a return and that in a few months I will be back to where I was. I will manage for a while. I can put up a front and get on with my job and everyone will think that I am fine, but it wouldn’t last. When I get to the office, even if only for a couple of hours, I feel myself going back to my old ways. I want to bury myself in work and feel the urge to push myself too hard. I don’t want to go home after two hours. I want to go back to full-time and to have responsibility again. I survived almost a year of overdrive last time, but I suspect it would only take a couple of weeks to break me again. Maybe even a couple of days. I worry that just a few hours of work makes me feel so terrible afterwards. That can’t be a good sign. Maybe my stamina would improve, but what happens if it makes me worse first? I have been wobbly enough of late, without needing any extra stress and pressure, so I don’t know if it is a good idea. Yet the thought that I may never get back to work makes me feel so worthless, I may as well just go kill myself anyway. I need to go back.

We will see. I am going to try to go in at least one more time before I go back to Dr Occy Health. I may try to spend a couple of hours working from home too. I am now checking my work email most days, which should stop that getting too overwhelming. Just ten minutes each day is a place to start, right? I need to have another think about what else I can do before I see him and what I need to ask when I go back. Sometime after seeing Dr Occy Health, I am meant to be meeting the HR manager who is looking after me whilst my HR rep is on maternity leave, so I need to think about what I will tell her too. I don’t know yet.

Written by intothesystem

Monday, 18th October 2010 at 12:32 pm

8mg…

with 8 comments

I saw Dr M this morning. I’d not seen her for ages. It was back in July, just before I went to Europe (I haven’t written about my trip, but anyone following my twitter feed will know that I spent 2 and a half weeks InterRailing during July/August), so a lot has happened since then. She suggested that it was a good sign I hadn’t needed to see her sooner, but I indicated that it wasn’t especially. It probably would have been if I hadn’t have wanted to see her about a month ago. I couldn’t get an appointment then. This was the first Monday we could both do.

She asked about my trip. She was impressed and relieved that I managed on my own whilst I was away. It feels so long ago now, I didn’t really know what to say, other than that I coped, enjoyed most of it, but found it really exhausting.  I could have told her more, but didn’t see the point. There was limited time and plenty of other things to cover.

We talked about things with the bloke. Before I went away, things between us had been somewhat up in the air. When I last saw Dr M, there was a very real chance that we would split up. I haven’t written about this here before now, because I don’t think the bloke would be overly comfortable about me sharing this with the world.

The whole idea of the trip to Europe, was to give us some time apart to reassess things. I was going to just take a “boring” holiday somewhere, but options are limited for solo travellers and I’d always wanted to go InterRailing, so I decided to give it a go. It also seemed like a great chance to test myself to see if I could be more independent and to cope on my own.

I’d talked about all of this at my last appointment and Dr M was keen to know what has happened since then. Things between us have settled down and pretty much gone back to how they were before things became difficult. It’s almost as if nothing had happened. Neither me, nor Dr M could decide if this was a good thing or not. On the whole, it is probably good. Things were not good at all when I left and it is nice to know that he missed me a lot, but it has also been a little disappointing. When I got back, we talked a bit about what had happened and how we should try to improve things and appreciate each other more. Unfortunately, it doesn’t feel like anything has changed or improved.

We talked about my trip to Occy Health. I explained what he said about not starting a proper scheduled return yet, but how we tried to think about the ways we can solve some of the problems that are stopping me from getting back to work. I told her that he’d said I could try to visit the office and that I managed to go to a meeting last week for a couple of hours, which she was impressed by. It was a really big step, so that’s good. However, she seemed disappointed that there was nothing further planned yet. I suggested that I will probably try to go in again in the next week or so, but I hadn’t decided when yet. She wanted me to try to commit to a time and hoped that I could start to go in on a more regular basis, even if it is only once a week for a few weeks. She thinks that a routine and commitment to going to work on a specific day, would help me prepare for it better. I said that is actually what I’d hoped for, but that Dr Occy Health wasn’t sure and she seemed to accept this, but she thought it would probably be okay if I chose to do it, rather than having my work-place imposing it on me. She may be right and I was considering this myself. I will try and decide when would be best.

We did talk about my mood and how it has recently dropped quite a bit. I don’t think she was too concerned or especially surprised, although she was possibly a little disappointed. She asked about the usual stuff . Sleep, suicide, anxiety… She was not surprised to hear of my nightmares or generally rubbish sleep (occasionally too much or usually too little and never feeling rested). I had to admit that suicidal thoughts had returned, although they were a lot less frequent and different to how they were a year ago. She hadn’t actually realised that the thoughts had pretty much gone away over the summer, which was a surprise. I’m sure I’d told her last time that I wasn’t really suicidal any more and that I no longer felt that life was completely hopeless. Although I can feel pretty awful at the moment, I have got my hope back that I can be well again. A year ago, I could never imagine a life without feeling horrifically depressed, so it was no wonder I could see no future and wanted to end it. I do get frustrated at the fact that I have got worse again. I wonder if I will always be waiting for the next relapse and if so, is it worth it? I am able to cope with these thoughts at the moment, as I still have some hope of a recovery.

We talked about the risk that I may do something impulsive if I have a particularly bad day. I told her there was no immediate risk of me killing myself and that I have no intention to make any detailed long-term suicide plans like I have in the past, but that I couldn’t guarantee that I wouldn’t just do something on impulse. I don’t tend to be impulsive and have never made the decision that way in the past, but if an opportunity presented itself, there are times when I can be very tempted to take it. She recognised this and I guess she knows that there is always a greater risk of completed suicide when people are either recovering or deteriorating. When you are really, seriously depressed, it is far too much effort to kill yourself, but when you’re having a bad day after a series of not-so-bad days it can seem a lot worse and you are also more likely to have the energy and drive to do something about it.

I mentioned that I felt that the arrival of autumn did not seem to be helping and she agreed that there was probably a seasonal element. She had noticed back in the spring that things seemed to improve a lot faster for me when the weather picked up in April, so it is natural, I guess, that things would get worse again when the summer ended.

We talked about my medication and she agreed that it probably needs a tweak, if only to help me get through winter. Her first instinct was to add Quetiapine. Apparently, it was licensed the other day in the EU as an augmentation treatment for Major Depressive Disorder, although she admitted that most psychiatrists had been using that way for a while anyway. She asked if I’d been on it before and I confirmed that I had. I was taking it along with Venlafaxine, back in February 2009 when I overdosed on it. She asked what doses I’d been on and I said I couldn’t remember but I did get right up to 550mg. She said that for MDD they use a max dose of 300mg, but I had been on that sort of a dose for a while too, so I’m not sure it would help. I also mentioned that it never seemed to help with insomnia and that I had put on weight last time. She said she didn’t expect it to help the insomnia and she seemed genuinely surprised about the weight. Although it didn’t help me with insomnia, I know plenty of people who find it knocks them out, so that seems a little strange. There are also plenty of people that have found it made them put on weight too, so I am not alone. Both drowsiness and weight gain are listed in the common side effects, so you would have thought she was aware of that. Anyway, I said no to Quetiapine.

The other options were to do nothing, increase the Reboxetine, swap the Reboxetine or try to add something else. I wasn’t sure doing nothing was a good idea and we both agreed that stopping the Reboxetine was a really stupid idea, as it is the first AD that has ever helped me. Reboxetine has shown that Noradrenaline is probably the key to my wonky brain chemicals and there aren’t many others that help on that front, so we’re not sure what else to do. She didn’t have any bright ideas of anything else to try really. If not quetiapine, then she said we’d probably be looking at augmenting with Lithium or another anti-depressant, but she wasn’t sure what would be best. She said she would have a look for some ideas though before I next see her and she was welcome to any suggestions I may have – so if anyone has any ideas, let me know. I’ve been on most of the common combinations already and my only real thought is perhaps bupropion, but it’s not licensed as an AD here (although it is used an awful lot in the US), so I don’t know if she’d give it a go. I know a couple of people who have found it helpful though, so it may be worth a try.

In the end, we decided that increasing the Reboxetine was probably the best option for now, although I am worried about how I will be with the side-effects. It is worth a go though and if it is too much then we will have to try something else. I hope it helps, without making me feel too awful. She said she’d get a letter sent to Dr N. I have plenty left at the moment anyway, so will just increase the dose myself for now. It only comes in 4mg tablets anyway, so it makes little difference. So yes. I am now going to be taking 8mg of Reboxetine. I didn’t actually tell her that I’ve occasionally taken 8mg anyway, when I’ve not been able to cut one of the tablets in half to make the 6mg. One day doesn’t make much difference though, but 8mg over a week probably will. We will see anyway.

After that, I remembered that I had also been for the therapy assessment. I told her what had happened and that I will probably be waiting for someone to come back from maternity leave. She named the person she thought it would be. We shall see what happens anyway. She isn’t impressed that I’ve been waiting over a year and was shaking her head saying “it’s probably only going to get worse, only going to get worse…” as she looked at her diary to book our next appointment. It really isn’t good.

Anyway, time was up then and I had to go. I see her again in 6 weeks, so we shall see how we go with the Reboxetine.

Written by intothesystem

Monday, 11th October 2010 at 2:08 pm

Other things…

with 7 comments

Aside from the therapy assessment, there is a whole host of other things that I want to write about. I don’t really know where to start, but I’m going to have a go, because I think it may help me to get some of these thoughts down at last.

I need to start giving myself some more time. I’ve taken a twitter hiatus lately to try and free up some time, but it doesn’t seem to have made any difference. If I was spending an hour a day or whatever (probably more like 3 if I’m honest!) on twitter, I want to know why I don’t have an extra hour spare each day?

I am not sure if I prefer to have twitter in my life or not. Leaving twitter should at least reduce the number of arguments with the bloke – twitter is quite often the trigger for them, but whether or not it really has remains to be seen. He will probably just find something else to criticise. If he gets to win the argument on twitter, he will go back to trying to get me to completely stop blogging as well.

It should in theory give me more time to do other things, but I don’t think it has made much difference. It is very much true that whatever you have to do, will always expand itself to fill however much time you have to do it in. It is the same in that I haven’t worked for 2 years, yet I seem to have filled my time with other things. I don’t quite know how I would squeeze work back into my life, although I’d work out how to somehow I guess.

I do feel like I’ve lost something without twitter. It gave me two things. A feed of interesting information about the world in general and a more personal support group from the madosphere. I am missing both of these for different reasons.

The lack of general stuff leaves me feeling just a little bit behind. Twitter is great in that it can keep you up to date with things, real time. I have to go to more effort to find out things and to keep on top of the latest goings on. If a band that I follow releases tour dates, they will usually tweet about it. Now I have to wait until I spot them on some listings or on their website. If someone posts a news story about something I’m interested in, chances are I’d see a link to it on twitter pretty quickly. I am having to pay more attention on BBC News to spot things of interest. I guess I can do without this info, but when you are used to having it fed to you all the time, it is weird to go back to having to look for it. Twitter is certainly convenient. You can pretty much find anything on there if you wanted.

I am missing the support group side of things too. I feel that by stepping away I am neglecting people and I really don’t want to do that. I hope that people don’t take my hiatus to mean I am not interested in them or don’t care about them any more. It is not about that at all. I feel like I am letting people down by not being there all the time. Of course I miss receiving the support of my twitter friends too. It is nice to know that there is nearly always someone out there to talk to if you feel like it. It makes the world a little less lonely.

I do miss it, but a lot less than I thought I would to be honest. I can live without it, which maybe surprises me a little. It is convenient though

I don’t know if I will go back, stay away longer or perhaps just change how I use it. Maybe I will go private for a bit? I don’t know. If you are waiting for me to go back though, don’t hold your breath.

I didn’t start out with this post to write about my twitter hiatus, but there we go. It was something I wanted to explain on my twitter feed, but hardly possible with 140 characters. At least by saying it here, I can feel like I haven’t gone without explaining myself.

_______

So what else is there?

Physically, I am struggling. I have been suffering with persistent “tummy trouble” and irritable bowel issues lately. It has been there for months now. I was too embarrassed to say much at first (no one really wants to share their toilet habits do they?) and I thought it would improve, but it just got worse and worse and has been making things pretty rough. Constipation, diarrhoea, both, often with urgency, occasional vomiting, frequent nausea, awful tummy cramps that rival the worst period pain, chest tightness/pain, bloating and lack of appetite… None of which are particularly fun and when it all happens at once it makes you feel pretty awful.

Dr N and I are both pretty sure it is the Reboxetine to blame. I saw the locum last week as Dr N has been on holiday for a few weeks. He got me to have a collection of blood tests to see if there was anything else to explain things, but they didn’t bring anything up. I phoned up for the results on Tuesday and the receptionist reeled off a long list of the ones that were clear, but said I should come in to see the doctor about my liver results. I had a suspicion that this would happen, as it has done in the past. Apparently, one of my liver hormone levels is slightly higher than it should be, but it has been for some time and it is actually a little better than it was earlier this year. The other doctor probably wasn’t aware of this, so wanted me to see a doctor, but Dr N wasn’t worried about it. He did tell me that I should really keep any drinking to a minimum though, as my liver will struggle with any heavy drinking. I don’t tend to drink very often or very much anyway, so this isn’t so much of a worry, but it is a little concerning if I am going to be taking this medication in the long-term. Dr N thinks it will go back to normal if/when I stop taking the Reboxetine and joked that I can hit the booze then, whilst chastising himself for being a bad doctor for saying so. I don’t relish the thought that my liver results make me look like an alcoholic though. It is probably worth trying to be careful for the time being, I guess.

When I last saw Dr N about 6 weeks ago or something, he started me on alverine citrate as an antispasmodic, but so far it hasn’t helped all that much. I am having a few less of the sudden desperate trips to the loo, but still struggling with the pain and diarrhoea/constipation a lot. Today, he’s decided to double the dose, so fingers crossed it will have some impact. I am not sure I can carry on with these kind of problems for much longer. How anyone survives a life of IBS, I have no idea. Hopefully for me this will be temporary and I guess if it is caused by the Reboxetine there is always the option of stopping the meds, but I am not sure I like that idea.

The only good thing about all of this is that I have lost quite a bit of weight. Although that possibly isn’t such a good sign for my health. I put on a stupid amount of weight at the start of this year. Considering I wasn’t eating that much because the food was disgusting, I think I put on about a stone whilst I was in hospital in January and that continued when I came out. I don’t actually know heavy I got, because I stopped getting on the scales when it went over a certain number. I have pretty much always been overweight, although it probably bothers me a lot less than it should do considering my weight is not good for my health. However, over the last 6 months my appetite has disappeared and the weight has been falling off, without much effort at all. I have been more active over the summer, especially when I was travelling, but I think the loss of appetite has made the biggest difference. I often feel too ill to eat and most of the time I could quite easily go all day without eating anything. I am fed, because the bloke does virtually all of the cooking, but if he wasn’t around I’d live on the occasional bit of toast or the odd crumpet. I have lost all of what I put on earlier this year and more. My weight has yo-yoed a lot, but I am now somewhere near the lowest weight I have been since I was about 17. Admittedly, I am still many stone overweight, but I have lost over two stone and getting on for three. My clothes which had all got too small are now all too big. I am fed up of having nothing which fits properly, but I don’t really want to spend too much on new clothes if my weight is still changing. I have cleared a lot of stuff out, but I am reluctant to get rid of stuff in case I put the weight back on. We shall see.

Unfortunately, the way I am feeling physically hasn’t been helping my mood at all. In general, my mood has been dropping off over the last couple months. I felt a lot better during the earlier half of the summer than I did in the latter half and I felt a lot better 8 weeks ago than I do at the moment. At first, there were just a few warning signs and I did my best to ignore them. Whenever I noticed them and started to worry, I tried to stop myself because I didn’t want it to be a self-fulfilling prophesy. Worry that I was getting worse, so I got worse. Unfortunately, that strategy doesn’t seem to have helped much, as my mood seems to have dropped regardless.

I haven’t wanted to tell anyone that I am not feeling so good. I am disappointed that my recovery has stalled and almost feel ashamed. I wanted this time to be the time where I get well and stay well. Instead it’s a return to the old “one step forward, two steps back”. I am worried that if I am getting depressed again, then maybe I am to blame for it all. I wish I had made more of the time when I was well, because I don’t think I really appreciated how much better and easier things were.

I hadn’t wanted to write about it here, because I was worried about what the bloke would think, but he had noticed the drop in my mood, despite my best effort to carry on and pretend that nothing had changed. I didn’t and still don’t want to worry him. I do not want to go back to how things were when I was really ill.

I wasn’t sure I was going to tell Dr N today, but he knows me too well now and I think he could tell before I even said anything. I was there about the tummy trouble, but he asked me about my mood and I couldn’t tell him that all was fine. He seemed sad and a little concerned, but he was reassuring too. I think I feel a little better now that I am not hiding it so much.

Thankfully, although things have dropped off, they are still better than they were a year ago or back in January. Most of the time they are still a lot, lot better, but I’ve been having some bad days. Last Wednesday was really rough. I felt truly awful all day. Cried on and off for most of it and at one point instead of sorting out the huge mountain of washing I’d put on the bed, I just lay down next to it and crawled under the covers for a while so I didn’t have to face it. I pretty much cried myself to sleep, but then woke up in a panic that I had less time to get everything done. We had guests around for dinner that evening and the house was a mess, so there was plenty to do.

Unlike usually when I have been depressed, I am not especially suicidal. The thoughts come and go, but it is not like before. I was chronically and painfully suicidal for so long, I thought it would never go away, but it did. Over the summer, I stopped wanting to kill myself. I had started to see the point in life and recognised that I could have a future where I didn’t feel at mercy to my moods or awful all the time. Thankfully, despite the fact I have felt pretty low at times, the suicidal ideation hasn’t come back with such ferocity. I think I have retained the hope that I can be well again. I had lost that before, but Reboxetine has given me that back. I thought I was always going to feel so depressed that I didn’t see any point in life. There are times when I feel like that again. When I think about relapse, I get so frustrated that again I am going backwards. This makes me feel pretty hopeless and I wonder what all the point is. I sometimes just want to throw in the towel and give up, but I am resisting. Occasionally, I do want to die. A lot of the time I don’t really care if I live. Even when I have been well, that hasn’t really completely gone away, but I am managing. The thoughts pass and for now I can handle them. Hopefully, it will stay that way.

I told Dr N today that I do think there is something in the seasons. He has asked me in the spring when I started to feel better if I thought there was and I said I didn’t know. When the Reboxetine showed the first signs of helping earlier this year, it was at the same time as the weather improved, so we weren’t sure if it was one or the other or both. Often my worst times have actually been in Spring, when most people are starting to feel better. However, I think about it now and I think the seasons do have some form of effect. My mood has definitely dropped in September/October for the last three years. Last summer I was better than I had been during the rest of the year (although still much, much worse than I was this year), but things went downhill from September. The year before was generally awful from June onwards, but it wasn’t until September that things completely fell apart and I first ended up in The Priory in October ’08. I used to struggle in October whilst I was at school too, but I always put that down to an increased workload and the fact it was usually a time for deadlines and the ramping up of rehearsals for Christmas concerts and the like. So maybe there is something in it? I don’t know. I just hope that January/February 2011 isn’t as bad as 2009 or 2010.

Anyway, I see Dr M on Monday. Dr N told me to mention the seasonal thing. He said it is worth knowing and perhaps we should be aware of the rough cycle of my moods as it may help us pre-empt things. I have tried to be aware in the past, but it is hard when you often forget how you have felt before, even when you try and keep track.

He said that she may choose to raise the Reboxetine, but he is worried about the side effects. I had of course thought of this too. I considered doing it myself, but thought I had better see what she said first. I am worried about the side effects too. Things are so bad on that front, that it may not be wise. It’s a bit of a chicken and egg problem, because the side effects are making my mood worse, but to counteract that drop in mood, I will probably have to make the side effects worse. I don’t know what is worst. It’s a hard balance to strike. I don’t think I can tolerate the side effects getting any worse unfortunately. They are trying my patience enough as they are. I had hoped that when I was settled on these meds, the side effects would subside and although some of them have done, the tummy troubles just seem to get worse.

Anyway. I have written enough for now. This is a long post and I must try and get to bed. I have been waiting for the bloke to come home from playing computer games with friends, but he is not back yet.

Therapy Update…

with 4 comments

So I had my second therapy appointment a few weeks ago now, but I haven’t had the chance to post about it yet. I’ve wanted to write a lot over the past few weeks, but for one reason or another I haven’t managed it.

The appointment covered pretty similar territory to the last one really and I am not sure it was all that helpful. I guess it was worth meeting again, if only to let us bring things to a close a little better, but it still felt a bit like a waste of time. It would have felt very rushed if we only had the one appointment though and I guess I may as well make the most of the psychologist’s time whilst I have it.

Unfortunately, she didn’t really have any further information on the future of the therapy service or when I might be able to see another therapist. They don’t know what is going to happen and it is unlikely that anyone else will be joining the team in the near future. It seems there are only 3 therapists working in the service at the moment, which explains why the waiting lists are so long. Two of those are CBT therapists, so are not really suitable, although apparently one of those is “much more than just a CBT therapist”. The other therapist is male and the assessing psychologist thought that a female might be better and more challenging for me (due to my usual preference of dealing with men). They all have full case loads anyway, so wouldn’t be able to take me on, even if they were considered suitable. It was suggested that perhaps the “much more than CBT” therapist could have maybe taken me on, but the assessing psychologist wasn’t sure if she had the space or if she’d really be suitable. She was going to talk to the team manager and discuss that possibility, but she did think that someone else would probably be better. If she can take me on though I wondered if I should just see her. At least there would be a concrete offer of therapy soon, which could mean I would get started before I am planning to go back to work. I am worried that if I have to keep waiting I will miss my opportunity.

The other option is to wait for the therapist that is out on maternity leave until November and hope that she will be able to take me on. She is a psychodynamic therapist and the psychologist I saw thinks she would be best placed to work with me. I am worried that she will decide not to come back to work or that she won’t have room in her case load for me though. Even worse, I worry that I won’t like her or be able to work with her. If I am going to have to wait a few more months, I’d like there to be some guarantee of a positive outcome at the end of it.

Otherwise I will just be waiting for someone else to join the service, although the likelihood of that happening and them being suitable seems pretty slim. I still can’t believe there are only 3 therapists for the whole service. I dread to think how many people they are meant to be covering between them or how many people are waiting.

As well as talking about therapists, we also talked about topics for therapy and what things I needed to address when I eventually get offered a therapist. We didn’t really identify much more aside from the previous session, but we did look at a few things in more depth.

We talked about school and about bullying a little. I never used to think much of the bullying I went through at school. I didn’t think it really bothered me, aside from making me a bit miserable at the time, but I’d been dreaming a lot about some of the main protagonists lately and some of the dreams or nightmares have been really upsetting. They have been less frequent in the past fortnight, but in the weeks before that they were starting to bother me a lot. I would wake up shaking and confused. I don’t know why it has suddenly come up in my dreams. There is no reason for it to be a problem all of a sudden. I’ve had a lot of nightmares in general lately, but school has definitely been the main focus. Some of these dreams are so realistic, they feel like buried memories and I wake up terrified that I’m back at school. Others are strange and convoluted and make little sense. It has made me think about how I felt back then, a little more. I wonder if things were actually worse than I remembered or hurt me more than I would like to admit. There are periods from school that are really clear in my memory, but other times are just gone and I wonder how much of that is me trying to forget the worst of it all. My  memory is patchy these days anyway, especially since the ECT, but my long-term memory is certainly less affected than more recent times.

Specifically we talked about how there were two kinds of bullying I went through and how they affected me differently. I was teased and bullied during a lot of primary and early secondary school. On the surface, most of the bullying at secondary school came in the form of name calling and the occasional push on the stairs from a bunch of lads in the year above. This was annoying, but I tended to brush it off and ignore them, or be pretty mouthy back. I was usually too quick for them..

On the other hand, even though it was less visible, it was the other stuff that got me. There was always a lot of teasing and bitching from most of the girls, many of whom were meant to be friends. There were a lot of things supposedly said in jest, that really hurt and worse of all, they were meant to hurt. People would pretend to be nice, but many of them were pretty damn cruel when they wanted to be.

In the long-term, this side of things has certainly had the most effect on me. I became afraid to get close to anyone, because they always seemed to stab me in the back. Even now I struggle to trust friends and worry about what they really think about me. I get anxious in social situations and never feel good enough. If people are being nice, I always worry they aren’t genuine. I try to come across as confident, but afterwards I always analyse everything to death and worry I came across as an idiot. I have little true self-esteem (although I can pretend), but when it was battered constantly for years, that is probably understandable. The only thing I have much faith in is my intelligence, ability at school/work and the like and over the past couple years that has somewhat taken a knock too, due to being ill.

Anyway, this wasn’t what I set out to write about, but we didn’t discuss all that much else aside from what I wrote about in the last post.

We left the situation with the psychologist planning to talk to her manager to discuss whether “Not Just CBT Therapist” or “Maternity Leave Therapist” would be best placed to take me on. She was then going to call me to let me know what is happening.

I thought she had forgotten about me, but she finally called on Monday. It seems I will have to wait for “Maternity Therapist” to come back. She may not be able to take me on straight away, but at least they will know more then. It could be months before I actually get to see someone now though.

I’m still frustrated by this. To think the wait is coming to an end and then to be let down is annoying. I just don’t know if it will be worth bothering by the time I actually get to see someone.

Oh well. I don’t know why I expected anything better.

Written by intothesystem

Wednesday, 6th October 2010 at 1:47 pm