Into the system…

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Posts Tagged ‘Mirtazapine

Long overdue post…

with 16 comments

I thought it was time to explain where I’ve been, but I am not planning on staying long. Just a quick hello and goodbye for now. I feel bad it’s taken me so long, but I wasn’t sure what to say and kept putting it off.

I guess I have just been busy in the real world. That and the fact I had therapy. It seems that having a one hour session a week to contain any mentalism and to whine and moan, meant that I didn’t feel the need to come here. I have just 2 sessions of therapy left now, so by the end of August that may change. Maybe I will come back sometime, but I don’t know. My therapist was never keen on me blogging whilst I was seeing her and although I wanted to continue, in part to rebel against her disapproval, it just didn’t happen. I seemingly ran out of things to say.

I’m not sure how useful therapy has been. We have hardly looked very deep or at anything especially long-term. The therapy itself was neither very long term nor intense, but that didn’t surprise me. It might have been what I supposedly needed, but the NHS was unlikely to ever provide it. I will have had a total of 20 sessions, spread over 8 and a bit months. It would have ended a lot sooner had my sessions not been on a Monday, meaning plenty of missed weeks for bank holidays, my holidays, her holidays, sickness, her training etc. She’s away again next week. I can’t wait for the sessions to end and to get my Mondays back.

So aside from therapy I’ve been busy in the real world. My mood was really quite crappy in Feb and it got to the point where I gave in and started Mirtazapine on top of my other meds in the hope it would lift my mood and help me sleep. I wasn’t keen on the idea, but it seemed to help with the mood at least. It knocked me out for all of 2 days before the insomnia returned. Coupled with the arrival of spring, my mood recovered sufficiently that I stayed in work throughout the mini-episode, albeit on just a few hours a week.

Since then my mood has continued to improve and I’m now relatively “well”. My hours at work have been increased steadily and I’m now working part time, roughly 22hrs a week on some vaguely proper work rather than mundane tasks. I’m still internally based, but the work I’ve been doing has been pretty interesting and I’ve even had colleagues to work with, although we were at different ends of the country most of the time. I did get to spend a couple of weeks in London with them though delivering some training, which was awesome and I’m down again for a few days this week. I’m back to more mundane stuff again over the next few weeks though, but generally my employer have been good at finding me things to do and helping me to get back. I genuinely love my employer and my current HR team. They have been pretty instrumental in keeping my mood afloat and life feels hopeful. Dr N (GP incase you’ve forgotten in the last 6 months) said to me the other week he’s amazed at how well things are going and I’m inclined to agree.

The only remaining issue really is my sleep. It is still poor at best. When I have been working away it has been worse than poor. There have been nights where the whole experience has been painful and fear-inducing and I just wish night never happened and that my body didn’t need sleep at all. I take forever to get to sleep, when I do get to sleep I am drifting in and out of consciousness and dream worlds. I have frequent nightmares and strange dreams. Sometimes I am unsure where reality meets my dreams and everything becomes very strange and scary. I wake up and fall asleep dreaming and wake up and fall asleep and dream and wake up etc on a roughly 10 minute cycle for a few hours and then I can’t get back to sleep again and then often it’s time to get up. Or I am just awake for hours and it is only 6am or something when I fall asleep and then I should be getting up and can’t drag myself out of bed. There seems to be little to no sign of improvement, even after reducing the reboxetine in June. I explained how desperate it was making me to Dr N and he gave me an emergency supply of Temazepam in the hope that if I had a back up plan it might help reduce my anxiety about sleep. I’ve taken it on one occasion and it didn’t seem to help, but I’m too scared to take it on a night when I need to be awake the next day incase for some strange reason it decides it might work for once and I can’t get up! Benzos have never been much help though, but at least they don’t seem to make the whole dream/hallucination thing worse like the Z drugs do. Sleepers just don’t work. No chance of me ever getting addicted.

I’m still sleeping badly and basically just putting off the time when I should try and go to sleep this evening by writing here. I’m in a hotel again, which makes it worse. At home I’m made to go to bed at the time when my bloke dictates he wants to go to bed and I am forced to stay there so I don’t want to wake him or the dog up too much.. If I wake up from a nightmare or anything he helps to bring me back to reality quicker and his presence calms me down. Usually his snores are a reminder that everything is fine and normal and the wardrobe isn’t full of strange men trying to chase me (or whatever else decides to infiltrate my dreams and reality that night). Here in a strange hotel room the boundaries between reality and nightmareworld are a lot more blurred because there is no one to calm me down and I can never quite remember where I am. Monday night was bad. Just wide awake all night. No sign of sleep and increasing frustration at the lack of sign of sleep, which never helps. Yesterday was better, but still not great. I had a lot of dream stuff going on and the every 10 minute waking thing, but at least I got some sleep. I’m meant to be trying to keep a sleep and dream diary for the next fortnight for the therapist, but the problem is I often wake up panicked and even screaming, having no idea what it was that was making me scared. I rarely remember much content. I’ve been trying to keep the notebook by the bed and jotting things down, but that wakes me up even more and just prolongs the wakeful periods between the dreamfilled ones. The problem is though none of that sleep is quality. It isn’t restful and doesn’t recharge the batteries. Eventually I have to get the sleep somehow. During the first weekend of the last 2 week stint in London (a month ago) I just crashed and slept a lot (at least by my standards! I was in bed a lot). The second week was not so bad. The first week at home was better and last week less so. This week has been worse again. I could do with crashing and catching up again, but that is unlikely to be an option any time soon with a wedding to attend on the weekend.

If I could just get the sleep issue fixed I really could be convinced that life is getting back to normal and all will be well and good. Life is getting there. This may be “recovery”, but this is definitely holding me back. It still makes the prospect of full-time work scary and possibly impossible. My shortened days at the moment make the sleep issue less of a problem – I start work late and that seems to help.

Anyway, I should stop writing. I was only meant to be here to say bye and sorry for not saying it sooner. I seem to have written a massive post. Maybe I haven’t lost the ability to blog after all. I don’t think that means I’ll be back though.

I haven’t read many blogs of late either. I am very much out of the loop in terms of the madosphere and haven’t even read any TWIM since it moved. In fact I went weeks without looking at a single blog post, but I’ve read the odd one since, just to check you’re all still there. There are a few of you I miss a lot. Some I am in touch with in the real world. Some whom I’m not. If I’ve stopped reading, it doesn’t mean I’m not thinking of you. I do appreciate everyone who has been reading and around for me when I needed it and everyone that ever commented here. I feel a bit guilty for not being around for you, now that I don’t need it so much. Sorry.

I shall sign off. I may be back one day. I may be back another day. I may never be back. I don’t know.

Take care xx

Written by intothesystem

Wednesday, 3rd August 2011 at 10:46 pm

Too much to say…

with 12 comments

I have lots on my mind and plenty that I’d like to share, but the time and motivation has been lacking. I wish I could just empty my head onto this blog, without having to go to the effort to sit here and type. When I am lying awake at night, I think about what I’d like to post, but I rarely make those posts a reality. It would be brilliant if I could make posts happen just by thinking of them. It would make me a much better blogger and would save me a lot of time. It would give me something to do when I can’t sleep. It would also mean that this post wouldn’t have taken over two weeks to materialise.

So the big news is I’ve started therapy. Or rather I’ve started the assessment sessions for therapy with the new psychologist.

The first few appointments have been okay I guess. During the first appointment we mainly talked about the practicalities of therapy and she updated me on the changes going on in the service (change in Trusts). She asked me a bit about what has been going on for me lately and how I feel therapy can help. I didn’t really know what to say, but found myself talking about the whole diagnonsense malarky. I was scared about getting onto such territory, but I guess the fact I felt able to bring it up must suggest I was relatively comfortable talking to her. I was worried about how she would react but she seemed reasonably sympathetic and supportive of my concerns. I told her I was unhappy about how they were so quick to change my diagnosis to a PD, especially when I was obviously unwell and not exactly demonstrating my usual behaviour. I think she understood, but I don’t know if she agreed as such.

I felt completely exhausted after the first appointment. I had to go straight to work and had a few errands to run and wasn’t in any frame of mind to do so. I was feeling really dazed and found it was impossible to concentrate. I didn’t get anything useful done at work, but at least I didn’t have anything important to do. I got lost twice that afternoon too. Despite looking up directions, I would forget where I was going before I got to the first junction and have to pull over and look them up again. In total, I probably spent over an hour driving in circles on that day trying to find the depot to collect a parcel. One of the places I’d been to hundreds of times before too, which is even more frustrating because I never used to get lost. If I’d been somewhere, I could always find my way back. Not any more.

The second appointment was a lot less structured than the first and felt like it went all over the place. We covered ten billion things, yet I don’t know how much was relevant. It felt like we were skipping over things too quickly and completely missing out others. I guess it is hard to know where to start when there is so much history to cover and so many different layers. The appointment went in no time and I can barely remember anything which was discussed. At the end she suggested we tried to start from the beginning for the third appointment and she asked me to put together a timeline of key events, separated by good times and bad times. I’d done timelines and histories before, but was a bit worried about putting it together again and leaving things out.

So the third appointment was meant to go over my time line, but we ended up talking a little about the second appointment first. When we did get on to the timeline we didn’t get very far. We only managed to cover up until the end of primary school really. She asked a lot of questions, mainly about my family and what life was like as a child. I can barely remember, so this was hard and I didn’t know what to say. I have a few clear memories and a lot of fuzziness. The session disappeared in no time. We’re meant to be picking up on it again next week. Fingers crossed we will cover a little more. There are only two more assessment sessions left.

Aside from therapy I have got very little else done over the past few weeks.

I saw Dr N a couple weeks ago and we discussed the medication question. He hadn’t got the letter from Dr M. He said it usually takes her a while. I explained what her suggestions were and we discussed it. He thinks Quetiapine should be a definite no, which I agree with. He didn’t think it helped me the first time around and as I’m already on the Lamotrigine as a mood stabiliser he is not sure it will help. He was really keen for me to come off the Reboxetine though and was keen to find an alternative. He said that I have been “really quite unwell” since I started it. I know I’ve been struggling a lot with the side effects, but I’d never really considered the physical illness to be all that important even though it is problematic. I have always thought the mental improvement was worth it. When I was so depressed before, it was just a relief to feel different. He is not so sure that Reboxetine is good for me though. He still isn’t even convinced the Reboxetine was responsible for my mental improvement. I don’t know. He seems to like the idea of trying Mirtazapine. He considers it a more effective anti-depressant and thinks it will help with my sleep. We talked about the weight gain and he said I could always stop it if that became a problem. Overall, he seemed to want me to take it and he offered to write me the script, but I wasn’t so sure. I mentioned that the bloke wasn’t keen on the idea and he said that didn’t surprise him. It’s so common for people to want you to take less pills, not more. To be fair, I’d like to take less pills, but I know that is probably not a wise option. I decided I’d like to wait and think about it a while longer though. I also mentioned that I’d got the therapy appointment through and he agreed that therapy may be a reason to hold off making any changes right now. I wouldn’t be able to tell if something was making me worse or know what to blame. So that’s how I left things. I am going to see how the first few therapy appointments go and then decide. I could try and hang on until Spring and then maybe I can manage with a lower dose of Reboxetine again anyway, but we don’t know. It’s another case of “we shall see”. It’s a phrase I seem to use often at the moment.

I had my dental hospital appointment as well a few weeks ago. That was to discuss the TMJ (jaw joint) problems I’ve been having. I had an x-ray and after a long wait the consultant poked and prodded and moved my mouth about, to come to the conclusion it’s a cartilage problem. She didn’t really offer any solutions to this problem, other than the usual stuff. I was aware of the normal management techniques already – identify habits such as nail biting, night-time grinding etc, do some simple jaw exercises and take ibuprofen regularly. She agreed that there was no evidence of night-time grinding from my teeth, so she doesn’t think a splint or mouth guard will help. She did notice that I had short, bitten nails, but I actually tend to pick at them with my fingers rather than bite them. So she’s given me some jaw exercises anyway and I see her again in 3 months.

There was one weird thing about the appointment though. The consultant reminded me an awful lot of Dr Shock, who was in charge of the ECT. Considering I attribute the jaw problems to the ECT, I found this very unsettling. I don’t really remember what Dr Shock looked like, but this consultant was an equally large woman and I remember her voice was very similar. Something about her manner reminded me of her too.

Thinking of ECT, I drove past the hospital today. I have been past a couple of times since I had the treatment and every time I go past I feel a bit weird. I think of the taxi trips over to the other hospital and the strange nervousness that went with it.

Last week I had another appointment with Dr Occy Health. It was a strange appointment, made stranger by the fact he misunderstood me near the beginning and it only become clear towards the end of the appointment that he was mistaken. When I said I was still only working 6 hours a week, split over 2 days, he thought I was working 6 hour days, twice a week (12 hours). This is understandable because it is what we were aiming for. He went through most of the appointment under the assumption I was fine, had met the 12 hour target and we should set a new target of 15 hours by the end of Feb. I didn’t realise until he went to dictate his letter at the end. We had to back track quickly and he said we should just stick to the 12 hour target for now then. He was keen to stress that managing the 6 hours was an achievement, but I felt like I’d let him down a little. He seemed so pleased at my supposed progress, it was a little disheartening to admit I’d not made the target. Admittedly part of the reason for not making that target has been the reluctance to increase the hours from HR. Rehab Consultant Woman happened to contact me when I was at my worst in December and she had been somewhat concerned that I was struggling. It seems she passed this message on to HR, which is why they wouldn’t increase my hours. I hadn’t realised this at the time. Despite the fact I have been struggling a little, I’m not sure extra hours will make it worse. If anything it may even help. I often feel that the 3 hours I am working is not long enough and I try to cram too much stuff into that short period of time. A little bit more time may help me slow down. I don’t know. Then again, I don’t have enough work to fill 3 hours, so how I expect to fill 6 I don’t know.

Anyway, I should sign off. My mood is still up and down and all over the place. I’m managing though for now. Not getting much done aside from work, doctors/therapy appointments and walking the dog, but I am treading water I guess. It is a struggle, but I just have to keep reminding myself I’m miles ahead of where I was this time last year.

I hope everyone else is coping okay. Sorry I’ve been rubbish at commenting and stuff lately. I’m trying to read what I can, but I am also trying to step away at the same time. I find myself losing time and unfortunately reading blogs seems to eat time pretty quickly, so I am holding back until I can find the time.

A little unstable…

with 7 comments

I have been quiet over the past month or so. I keep thinking “oh, I really must get around to writing that post”, but it never seems to happen. I do start posts, but somehow they never get finished and by the time I get around to it they have become irrelevant and I end up having to start again. I guess if I started writing shorter posts, it might not take me so long to finish them!

My last proper post (excluding the 2010 review) was pretty negative, but an accurate reflection of my mood at the time. Things have improved a since then, although they still feel a bit shaky. I felt really really awful for a few weeks, but Christmas was bearable and I was able to keep going without slipping any further, so that is encouraging. If that is as low as I get, I can survive, but I don’t know how much lower I could go without ending up back where I was a year or more ago. There were definitely times when I didn’t think I’d make it to here, which was worrying – I’ve not felt like that for a while now, but it has passed now really.

Over the past week I have felt a little on the edge. Motivation has been somewhat lacking and I feel exhausted and low, yet there has been a strange bouncier edge to it too at times. Things don’t feel stable any more. 2010 was a year of relative stability. During summer things were pretty consistent and I felt quite well. Since autumn I’ve been consistently low, but mild depression is manageable. Now I’m all over the place. A few days feeling better, a few days feeling rubbish, one day where I feel all over the place, another where I feel strangely mixed, the occasional day when I just feel normal. There is no consistency at all anymore.

My sleep in particular is a mess. I really struggle to get up each morning and feel exhausted, but then I spend the late evenings trying to slow down my racing and flighty thoughts. I can’t seem to concentrate on any one topic but spend the night with random things darting around my mind. Even when I do sleep, my dreams jump about and I wake up frequently, often shaking or panicky. My dreams have been so weird it has been disturbing me. I find myself thinking about them in the day or unable to shake the uneasy feeling that goes with the nastier ones. Occasionally suicidal thoughts pop up and sometimes these thoughts can be so clear and urgent it can be scary, but there are also excitable flighty thoughts – plans about holidays, knitting, work etc, which would suggest a good mood. It feels slightly strange and can be somewhat frustrating when I can’t sleep, but it is preferable to feeling how I did before Christmas. I quite like the flighty-awake feeling and if I didn’t need the sleep I’d happily become nocturnal and make the most of it, but my body is really tired and I don’t want to keep the bloke and the dog up, so instead I lie in bed tossing and turning.

The last couple of days haven’t been so bad on the mood, but I have been struggling with nausea on and off. I’ve not been sick, but on Sunday night I felt awful. Being sick would have probably been a relief. Nausea does tend to calm down the flighty side of things as moving about just makes me feel worse. Not feeling too bad at the moment, but it seems to come and go.

I am hoping the recent instability can be put down to fiddling with the Reboxetine dose and not taking it consistently at the same time, but I’m not so sure. Things were going haywire before I started the dose experiment. I was told to try taking 8mg some days and 6mg on others to see if it helped with the side effects. I tried it for a bit over Christmas but I found it made the side effects worse than normal on the day I took 8mg and I didn’t feel much respite when taking the lower dose. I’ve also been struggling to get up, so was taking it later than normal, which definitely contributes to the insomnia at the other end of the day. I was trying to take a lower dose on those days, but that didn’t seem to help too much. Things are noticeably worse though if I take the full 8mg dose after about 11am. I’ve gone back to the full dose though and am taking it earlier again, so I hope that will help settle things down.

I saw Dr M on Friday. I mentioned all of this to her. The rapid decline in December, the slight improvement over Christmas and the up-and-downy-ness since. She seemed slightly surprised and a little concerned when I indicated how bad I felt in December, but relieved things have improved a bit since. She thinks I’m a lot stronger these days and that I will be able to manage things better even if I do get more depressed. I think she is probably right.

We discussed medication again. She does think something needs to be added to the Reboxetine. If we can boost the effectiveness of the Reboxetine then maybe I could drop the dose and reduce the impact of the side effects. She’s concerned about sleep too and wants something that will help on that front at the same time. Quetiapine was encouraged again, but I’m still not keen on the idea. It didn’t do anything helpful for me before and I doubt it will again now.

The other option was Mirtazapine. I’m not sure about this either, mainly because of the weight gain risk. I’ve lost a lot of weight over the past year and the last thing I want is to put all of that back on. Aside from that it could probably be a good option. It is meant to be sedating and also partly works on Noradrenaline, which should help. It has a longer half-life than Reboxetine, which could also help stabilise things.  I haven’t tried it before so it may be worth a try, especially as it can work when other drugs haven’t, but I’m not sure. I don’t know if it is worth the risk of it not working, although I guess if the side effects are bad I can always discontinue it. I think I’d also be slightly annoyed if it did work because Dr N and I considered it right at the start, but decided against it because of the weight gain risk. Imagine if it is the right drug and we’d chosen it right back then – maybe none of the past 2 years would have happened. Glorious hindsight. I am not sure though and the bloke is definitely not keen on the idea. He thinks I should just try and manage as I am and do what I can to boost the Reboxetine over the winter. Maybe he is right, but then again I don’t want to experience a sudden drop again like in December as if that happens maybe I won’t be able to manage.

I didn’t want to rush into any sudden decision with Dr M anyway, so she said she’d write to Dr N, tell him what she suggests and leave it up to us to make the decision. He can prescribe it if I decide to give it a try. I need to book an appointment to see him and see what he thinks. I think he would be pretty keen to get me off the Reboxetine if we found an alternative that didn’t send me mad, but it’s a risk and I don’t know if it may be better to wait and see.

Friday was also a year since I tried to freeze myself to death whilst overdosing (it sounds ludicrous to me now) landing myself in hospital for 5 weeks. It was weird to see Dr M almost a year on from when we first met and I mentioned this to her. We both commented on how much better things are now. Quite a lot has changed since then and I do wonder if her initial impression of me has changed. I realise now that I was delusional and paranoid at the time we met, as well as being suicidally depressed, but it still upsets me that my behaviour was put down to a disordered personality and not simply the fact I was somewhat mood-disordered and dealing with the after effects of an overdose. I was definitely not myself and I don’t know how anyone could take that first meeting as representative of my usual personality. I am still frustrated by the whole thing and find myself pondering over it again and again. I wonder if now is the time to challenge the whole diagnosis malarkey and find out what she thinks now she has had much longer to get to know me. I wanted to bring it up and I keep considering it, but I’m just too scared. I am terrified of being told they still feel I have a PD. At least before there was always that bit of doubt and a hope they would realise they were wrong. If I bring it up then I may have to face the fact that diagnosis is going to follow me around.

I’m not sure if I ever wrote about this before, but one of the main reasons I want to challenge the diagnosis again has come from the appointment I had with the locum GP a few months ago. When I was there, he looked back through my notes to find something. We were both watching the screen and as he scrolled through I could see that “Personality Disorder – NOS” was filled in the diagnosis box, visible in big bold letters. On some of the entries it didn’t even list “Recurrent Depressive Disorder”, which is meant to be my main diagnosis. In fact it is meant to be my only diagnosis, because I had been told that they wouldn’t give a proper diagnosis of a Personality Disorder unless the psychologist from psychotherapy (when I eventually start it) thinks I warrant it. I had assumed all mention of the dreaded diagnosis would be dropped until then. Apparently not.

So yes, this has concerned me and since then I have toyed with the idea of applying for my notes. I want to see what has been written about me, especially about diagnosis. I have been somewhat paranoid since. I worry about being seen as just another PD and that any physical problems are seen in this light. I worry that Dr N thinks I’m making things up. It has definitely damaged my relationship with Dr N, as I worry that he just sees me through PD disordered lenses and I don’t feel I can trust him as much anymore since finding out he has been using the PD as my diagnosis. I have found it a lot harder to talk to him since then. I have thought about bringing it up since that appointment, but the time passed and I think I missed my chance.

Another opportunity to bring it up may come up soon though. On Saturday I finally got my new assessment appointment date for psychotherapy. It has been nearly 18 months since I was referred. I have an assessment tomorrow with a clinical psychologist, HP. I hope it is less pointless than the last one, but I have no idea what I can say to her. I am worried about bringing up the diagnosis thing. I may just see if it happens. I don’t know what we are going to talk about though. I have no idea what may help or what I need to discuss. In general things are okay and the things that were identified long ago are no longer relevant. It is the more physical sides of depression that get me most these days. I’ve waited so long that I have to see what they can offer though. Maybe it will help in the long term. It may at least help to have somewhere to discuss how I’m feeling about work as I’m trying to get back. I’ve felt a bit on my own in that regard. Fingers crossed it goes okay anyway.

The other thing that Dr M brought up at the end of our appointment, was this blog. She asked if I was still writing. I admitted that I was, although a lot less often than I used to. I said that I keep wanting to write, but don’t often find the time. I go through fits and starts. She seemed to find my response interesting and seemed intrigued. I wondered if she would get curious and want to look at the blog since. I suspect she may have, as someone in the area visited the blog the day after my appointment. I don’t know whereabouts she lives in the area and I guess it could be anyone, but somehow I got a feeling it was her. I’d like to know if she has read it or not though.

So yeah, that was that. I have a lot half-written about work and more to say, but I will leave that for another post. No idea when I will write it though.