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Posts Tagged ‘anti-depressants

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

Tiresome…

with one comment

Another week has passed and I’ve not written again. I don’t know where all the time goes.

On Monday someone came from Birmingham University to interview me for Mood Disorder research. It didn’t take as long as I thought it would, but that may be because I was hardly verbose. I just generally ended up saying “yep” to every question. There were questions about your family situation and stuff. Then there was a series of questions about depressive symptoms, all of which I have experienced at some point or another. She recorded that part of the interview and the following part about mania. There were questions about agitated depression and dysphoric mania too, both of which I’ve experienced and most of my depressions are agitated.

There was a section on psychotic features, most of which didn’t apply, but there were some things mentioned that I’ve experienced and never really considered psychosis before. Those dissociative experiences and weird feelings where the world don’t quite feel right were given air time. There are times when I lose all sense of size and relativity. Paranoia too, but I guess everyone experiences that at times.

There were questions about medication and treatment. I realise now that I forgot a load of drugs that I had been on. I don’t know if it’s worth emailing to let them know. It felt weird when there were questions about hospitalisation and ECT and it made me realise just how ill I have been.

Her list of symptoms and questions made me realise that I can’t deny having Bipolar Disorder. I had experienced pretty much everything mentioned for both depression and mania (although generally not as severe on the manic side). I sometimes wonder if I’m actually just plain depressed as I spend so much more time on that side of the coin, but I can’t deny that I’ve been manic or at least hypomanic plenty of times too. More so, it made me realise that I am really quite severely ill. I often think because I have Bipolar II disorder, rather than I, it means I’m not that bad, but I guess that isn’t really the case. I’ve been lucky to have not had any real psychotic experiences and severe manic episodes, but my depressions are pretty much as severe as they get and I’ve been through a lot treatment-wise too.

At the end the girl tried to take my blood, but failed. I have really terrible veins. Small and deep. She’s given me a pack to take to my GP so they can take it instead. I wonder if they ever will find a gene or two that causes all of this.

Afterwards I completed the questionnaires she left me. Millions of ticky, or rather crossy, boxes. A lot of personality type questions about honesty, social anxiety and esteem. A section on events proceeding first experiences of illness, which for me was pretty much uneventful. No bereavements, abuse etc during my childhood.

Tuesday was fairly dull, except my father popped in for a couple of hours. He was in the area for a trade show so came over for dinner in the evening. We went to the new Fish and Chips in Alty and then came home and had cake. Good food and it was nice to see him for a wee while.

On Wednesday I saw Dr N for my fortnightly visit. I was pretty honest with him about how the past couple of weeks have been. Things have gone steeply downhill since a month ago and he was concerned. We talked about self harm and suicide again. We also talked about my social worker and seeing the NHS psychiatrist. He warned me that the NHS psych will probably try and get me to try an anti-depressant again especially considering the drop in mood over the past couple of weeks. He made some comment about “that’s all they [NHS psychiatrists]  seem to do”, which amused me. I’m worried about this though. I don’t think it is a good idea considering how bad things were when I was on them, but then I wonder because things have not exactly been great without.

I forgot to take the blood pack with me, so he’s going to do it next week when I’ve seen Dr G. No doubt I will have a meds increase to sort out as well.

This morning I had a visit from J, my social worker. It was a long one and I found it tiring. I tried to be honest with her too, talking about the increase in suicidal thoughts and the agitated anger outbursts that have been happening for a while. It was shaming to talk about wanting to hurt people and myself. I felt uncomfortable and was fidgeting a lot. She was pushing for info though and I felt obliged to supply.

I was alarmed when she mentioned the crisis team and hospital. I managed to calm her down and say that I’ve managed to keep myself safe over the past couple of weeks and I think I will be able to going forward, but even still. She agreed with me in the end and said she will not take action, but she kept reiterating the fact we could get the crisis team out. I don’t trust the crisis team and I certainly don’t want to go through the NHS inpatient experience again. I don’t want to put my family through that either. I am scared that my bloke will be shocked it was even considered. I have not really let on that things have been much worse in the past fortnight. I have to phone her or ALERT if things get worse again, although I still don’t have their number so not sure how to do that.

She wanted us to talk about what her role was and what I want her to do for me. I didn’t really have an answer as I find her a little useless and wonder what the point of her appointmesnts is. I was keen for her to liase with other services and make referrals for me though. We discussed other things out there, especially therapy. She is getting me on the list but warned me it will be an incredibly long wait, even just for an assessment. She also suggested Beating The Blues in the interim, but it’s more CBT and I’m not sure Kate had much positive to say about it. I start Creative Remedies next week and Positive Thoughts in a couple of weeks so we shall see how those go. She also suggested I tried the Day Centre in Warrington. I’ve been once before, but was too scared to talk to anyone there and left after 5 minutes reading the notice boards. She suggested she took me in and introduced me, which may be better. I said I will see how Creative Remedies go first and then decide.

There was a lot of boring stuff about setting expectations for recovery and doing things to help. It was a repetition of much of what she’s said before and got quite tiresome. She talked a lot about my work and how if I am ever to go back things will have to be different. We talked about the competitive nature of the company and she seemed appalled at the way things work and shocked that I accepted it. I think she really wanted me to consider leaving and working elsewhere, but didn’t dare say as much. I know things will have to be different, but I am not sure I want them to be so different I leave my job. We will have to see.

This afternoon I need to get down to some serious baking. My friends who get married tomorrow have asked for contributions to the buffet and bar instead of traditional wedding presents. Hopefully I can knock up some yummy contributions and everything goes well.

Hope everyone out there is okay. Take care folks xx

more of the same…

with 3 comments

My life seems to be an endless stream of pointless days, filled with nausea, headaches and boredom. I sit at my laptop, trying to stave off the nausea that threatens almost constantly, refreshing three pages continuously, waiting for information to appear.

As always, I’m trying to write, but struggling to get my thoughts down. I seem to be collecting draft posts with one or two lines in them.

I am fed up of waiting to feel better. Three and a half weeks of mind-control pills and nothing seems to have changed much. I have just added side effects to the constant up and down and endless negative thoughts.

Last night, I’d returned to my state as a crumpled-up ball of agitated energy, fidgeting constantly and unable to slow down my thoughts. I had to retire to the spare room, where I could drum my fingers to my hearts content and stare out the window at the stars and clouds, waiting for daylight. I got some sleep, but I don’t think there was much. I wanted so desperately to sleep so I could get some respite from the endless nausea.

Today, the agitation has settled down a bit, although I can still feel the tension and energy bubbling away in the background. My thoughts are still far from clear, but are not the constant barrage that they were in the night. I am tired of this continual cycle. I am tired of everything.

Written by intothesystem

Tuesday, 12th August 2008 at 11:51 am

Side Effects…?

with 3 comments

I feel pretty awful right now. I’ve lost what good was mixed in with my mood and am just left with the terrible concentration, frustration and gloominess.

Physically, I’m feeling pretty terrible too. I have a splitting headache, am hot and bothered and feel sick. Last night my gums bled after I brushed my teeth and I woke up this morning with shaking hands, although that seems to have calmed down now. I have no idea if I’m actually ill or if they are all just stupid side effects or if it’s a combination, but I’m fed up. I wonder if I’m just been paranoid and it’s some evil placebo effect or if the medication can really be making me feel like this. I don’t know what to think or do about it.

Has anyone else had similar experiences with Fluoxetine?

We’re visiting my family this weekend. They don’t know about any of this, which means it could be a difficult weekend if I’m struggling with side-effects and having to put up my happy-front. I’m not sure I can face it.

Meh. I think I’m just going to go back to bed. I have stuff to do today, but I just feel awful.

p.s. is it just me or is the blogosphere quiet at the moment? I hope everyone is okay. I find myself refreshing the blog surfer page and wishing there was more to read.

Written by intothesystem

Friday, 8th August 2008 at 1:17 pm

All over the place…

with 3 comments

…is how I feel today.

Last night I got very little sleep. I was fidgety, so much so, my other half sent me to the spare room. I couldn’t sleep, so sat up and tried to read. I managed to settle into my book eventually and I read for a few hours, but when I stopped I still couldn’t settle down and sleep. It was getting light before I was even asleep, but I was awake again before my other half got up for work.

My mood is still mixed. Both up and bouncy, irritable and agitated, sad and low. I’m not sure how you can feel all those things at once, or at least within quick succession of each other, but it seems you can.

I seem to be experiencing a strange side effect of the medication, or at least that’s what I assume it is. Since yesterday, I’ve felt like there is a ball of cotton wool wedged at the back of my throat, making it sore and dry. There isn’t, my tonsils seem fine and I don’t have any other signs of a cold so I don’t think I’m imagining it. I looked at the fluoxetine leaflet and dry mouth and sore throat are both listed, so I’m going to blame it on that for now, unless it does turn into a cold or tonsillitis during the next few days. It’s frustrating though. Not particularly painful, just there and annoying. When you’re irritable anyway, you don’t need something niggling away. Swallowing isn’t exactly comfortable either.

Aside from that I’m struggling to do anything much, yet getting annoyed that I’m so bored. I don’t really know what to do with myself. I want to do things, but then I don’t because I can’t concentrate and get frustrated too easily. I find myself flitting from thing to thing but settling on nothing.

A classic example of this, seems to be the fact that I can’t seem to bring myself to write any more right now. I don’t know what to say and am bored of myself already. I’ll try again soon.

EDIT: There is actually more I want to write about! That’s another problem. My Short term memory and attention span is terrible at the moment. What I have to write about is too long and complex for me to work out right now. It involves HR, liability, suicide and other things, but it isn’t clear in my head. Maybe later.

Written by intothesystem

Thursday, 7th August 2008 at 6:26 pm

Going Backwards…

with 4 comments

So I’m back to where I was 7 weeks ago. I’ve just returned to my GP and have been signed off again. The appointment didn’t go as I’d hoped. The second I walked in the door, I was reminded of how frustrated she makes me. I had written a lot of stuff down, but failed to share it with her. I just couldn’t bring myself to show her and the paper remained screwed up in my handbag, unread. I go in there and feel flustered and rushed and unable to explain things. I lose all semblance of coherence and talk utter rubbish. She makes me feel patronised and pathetic.

I did manage to talk a little about my agitated mood. She suggested the agitation could be a side effect of the medication, but wanted to persevere with them, telling me they can take a month or so to settle down. I am unconvinced. I feel the same way that I did a couple of months back, long before I was medicated. I am not sure I convinced her how frustrated this makes me feel. I am not sure she realises the extent of this mood. I know I failed to mention the s-word again.

We talked about work and HR’s worries. I suggested part-time work and she seemed reluctant. She seems to have this theory that if you’re fit to work, then you work, if you’re not fit, you don’t. She doesn’t seem to like the idea of a phased return or working a bit. I tried to explain that I think it would help. Doing nothing drives me mad, but she just told me I wasn’t up to it. I’m not sure I’ll listen though – need to talk to HR and see what they say instead.

In the end, I was shuttled off with my prescription for the next month’s worth of pills, a sick note for the next 2 weeks and an instruction to see her again. I tried to book the next appointment, but she’s on holiday. I’m glad. I think the receptionist was taken aback by my keenness to see someone else instead! A new doctor has started at the practice so I will see him in 2 weeks time. I just hope I can be more honest with him than I can with her. I just hope I can get through the next 2 weeks to actually see him. I’m not 100% sure I can. I know I have to take things a bit at a time.

One thing I’d been worried about, was the fact I still haven’t been completely honest with my partner over the past few days, or even weeks. Although he knows I’ve been off and knows I’m still not better, I know that I’ve maintained the front I have always had. I know that I’ve hidden the worst from him and made out that everything was okay, even if it wasn’t. He doesn’t know that I have a secret stash of pills, there for if I need them, let alone how close I find myself getting to needing them.

After the doctors I talked to him briefly. I let him know I’d been signed off again and I think he was surprised. I tried to explain things weren’t as better as I’d made out, telling him I’ve been struggling to concentrate with work and feeling agitated again. He doesn’t think a lack of concentration is cause for concern, pointing out that everyone has trouble concentrating at work and he joked that he’d like to be signed off for it! I don’t think he understood what I meant, although I did say that things are like how they were before I was signed off and I think he might get it now. I’m not convinced though. At least I can try and shake off the guilt a little. I’ve tried.

I don’t know what my next steps are. For now, I’ve told my manager and I’m waiting on HR. What is next though, I really don’t know.

Back to the GP…

with 5 comments

My mood seems to have calmed down a little from it’s hyper, agitated position yesterday, at least for the time being. Okay – I thought it had, but half an hour since I began this entry (I got distracted!!) my mood is back to where it was yesterday and seems to be getting increasingly frustrating.

I hate this agitated state I’m in. It’s so much worse than the low, dull depression that has been my predominant mood over the past few weeks. My concentration is next-to-none and I’m so wound up. I can’t stay still and my mind is on overdrive. I’m really finding it difficult to be coherent. The few sentences I’ve strung together have taken me ages. I have to read them over and over again to check they do actually make sense.

It’s hard to explain how it feels right now. It’s something I’ve experienced before, but you forget what it’s like until you find yourself there again. The self-awareness that you are not yourself, but the inability to do anything about it, the inability to slow down your thoughts and actions. My concentration is shot to pieces. I can’t think about things properly. I have tried to settle down and work, but I can’t even distract myself with it – it just seems to fuel my mood. I find myself jumping between my tasks, but doing none of them efficiently. I find myself reading things a million miles an hour but making no sense of them. I know I’m incapable of completing anything useful at this point. I’m trying to slow down, but struggling to put a hold of myself.

I know that part of this is returning anxiety. I am seeing my doctor again today. I called up for an appointment yesterday, but had to resort to calling at 8am this morning for a book-on-day. I’m seeing her at 3.30pm and I’m wound up about it. I am scared of telling her the truth. Scared of telling her about this agitated mood. Scared of telling her about the suicidal thoughts that were dominating my mind over the past week. Scared of the knowledge that suicide is still floating around my mind, but now I have the agitated state that gives me the energy to act on those thoughts. I’m battling them and promising myself I won’t act, at least not in the immediate sense, but I’m scared of what might be done “for my safety” if I admit these thoughts. That is a thought that runs around and around in my head and I can’t seem to shake out of it.

I am full of self-loathing and fear. I am embarrassed by my mood. I worry about how I come across. I tried to explain things to A. A is the girl that has joined the comms team whilst I’ve been off. She is lovely, but I am jealous. It is weird being in the office, working with someone who is doing your old job. It makes me feel so self-worthless, as she is clearly capable of doing everything without me. I was getting frustrated that I couldn’t just walk back in and go back to what I was doing before. I know I couldn’t handle it on my own anymore. I feel like I’m on hand just to answer questions and do the boring bits. I want to do the exciting things, the interesting things, the big projects, but I know I can’t and I hate it. I wonder if I should have found a new role so I didn’t feel like this. I can’t think straight though and thoughts about work and whether I should be there roll around in my head. I’m confused and tired by it all.

I am worried that I am back to where I was before. It feels like deja vu. I had a call with HR yesterday afternoon, and it pretty much followed a similar pattern to one I had months back. They want me to go back to the occupational health for another assessment. They are unsure if I’m fit for work. That scares me. They want to support me and find a way to make things work and they want me to go back to my GP. My HR rep is in trouble because she didn’t call me before she went on holiday. Her boss called yesterday. She’s worried that I’ve returned to work on a full-time basis rather than using a phased return. I told her I only did that as I didn’t know what else to do and no one had given me any advice or support. She said I should have a think about what might work and I should see my doctor for advice. She told me not to do long hours, but I find myself unable to rein them in.

I’m still taking the pills. I have no idea if they’re working or not. I have no idea if they’re having an effect. Before I didn’t know if it was illness, circumstance or personality that made the cocktail that is my mood, actions and feelings. Now I don’t know if it is illness, circumstance, personality or medication. I worry if it is the pills that have flipped me into this state. I worry that they’re just not working on me in the way they should. Over two weeks in and the black thoughts are as strong as ever, but are mixed now with this agitated, hyper, frustrated ball of energy, that is my new mood. It’s even worse than before.

This entry as disjointed as my head. I’ve tried to pull it together and have wrote and rewrote it a million times, but I just can’t get my thoughts down and put them in order. My mind is like spaghetti junction, but without the road signs to guide you. Or maybe a jigsaw with no picture. Just lots of little pieces all spread across the floor, that don’t fit together or make any coherent whole.

I go to my doctor in 4 hours. I’m scared and don’t know what to say.