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Posts Tagged ‘Nitrazepam

Anger…

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This is something I’m really ashamed about. Over the past few weeks I’ve been agitated and struggling to manage my anger. Worse still, I’ve often resorted to violence. I have been afraid to admit that there is a problem. I don’t want to reinforce stigma. I am afraid of reinforcing the prejudice that mentally ill people are dangerous and violent.

Over the past month or so things have become more problematic. I have found myself getting angry and agitated, often for no real reason. Things seem to happen very quickly and there doesn’t need to be a trigger. Sometimes I just seem to be agitated and aggressive and I’ve been taking it out on the bloke, both verbally, and more recently, physically, mainly punching, kicking or throwing things. Sometimes I guess I could probably be compared to a toddler throwing a wobbler! I pretty much lose all insight and the smallest thing makes things worse.

Normally, I wouldn’t say I’m someone with a temper. I tend to be pretty calm and argue my point constructively. Although I can get frustrated and agitated at times, I am usually able to contain things and don’t lash out.

In the past I have snapped and thrown things during periods of depression and agitation, but I’ve never directed it at any thing other than myself or the wall. Unfortunately that has changed recently and I’ve started to lash out.

A week past Sunday there was an incident when we were out walking the dog. I’d asked my bloke to do something and he’d ignored me. I asked him why he had ignored me and he said it was because he thought what I wanted him to do was stupid. I argued with him and ended up throwing a stone at him. It was an impulsive action and I didn’t really expect to hit or hurt him. He ducked and it missed, but then he picked it up and threw it back at me hitting me on the head. I made no attempt to avoid the stone. It was almost as if I wanted him to hurt me and I felt I deserved it. It really hurt, leaving me crying hysterically, although I think I was more upset about losing control than I was about the pain.

Last Monday there was another incident. Similar trigger in that I’d asked my bloke to do something and he didn’t, although this time I was even quicker to anger. He didn’t respond immediately so I threw the pair of trainers I was carrying at him. He snapped and hit me back, but I didn’t seem to care that I was being hurt.

I know that my bloke will probably fight back if I hit him, but I don’t care., although often I don’t realise I’m doing anything until I get hurt. There are times though when I’ve punched my partner and he’s threatened to punch me back and I’ve continued even though I know it will eventually hurt. I seem to almost seek the pain. Perhaps it is some weird form of self-harm.

Sometimes these outbursts can be triggered. My bloke does have a habit of purposefully trying to wind me up and taking the piss out of me. I used to just ignore him or get annoyed but not lash out, but lately I’ve been unable to handle this. I just have no tolerance for unfunny “jokes”.

There seems to be this constant underlying irritability and it doesn’t take much to provoke it. I am getting agitated at the smallest things. I just feel so wound up and unable to relax or contain it.

I am worried that things are getting worse. Before, I was getting angry and irritable, but I wasn’t violent. I have threatened violence in the past, but never actually tried to hurt someone. Recently though I’ve even threatened to strangle or stab my partner. I know it’s not right, but at the time I really do want to. I’ve managed to resist and he is also pretty good at restraining me (he is far stronger than I am), but I’m scared that something bad will happen. I don’t trust myself. I never thought I’d throw a stone at someone and I have, so what is to say I won’t just throw a knife across the room if I’m using one and someone upsets me.

I did think that perhaps the Nitrazepam was to blame. After all, one of the worst episodes was the trip to The Peak District after the dose was increased. When I explained what happened here, I didn’t really mention the fact I was quite aggressive. I was too ashamed to admit it.

I admitted things to Dr G last Thursday and she seemed to be pretty concerned. I wrote her a long note as I didn’t think I could explain things face-to-face due to the shame. She wanted me to talk to her rather than use the note, but I found the note easier. I think she saw it as a bit of a backwards step as I’ve not had to write to her recently. We’ve come on a long way in terms of our relationship and I find it a lot easier to be open and honest with her than I used to.

Anyway, she expressed her concern and asked plenty of questions. She even went as far to say that she thinks this anger and violence is as dangerous as suicide. I guess risk of harming others is grounds for admission, just as much as risk of harming oneself.

She was worried that me and my bloke are making things worse for each other and that we are almost self-destructing. I think she is right.  She said that I just have to try and take myself away from the situation and calm myself down as much as possible. If I’m feeling agitated then I have to warn the bloke to stay away and not wind me up!

We have agreed that I should come off the Nitrazepam, although we are not convinced that is to blame. Dr G thinks that this agitation and aggression is a sign that the Bipolar Disorder is not controlled well enough yet. She increased my Lamotrigine again, but also said that we may have to reconsider adding Lithium as a top-up treatment.

We talked about sleep but she decided not to try anything else for now. She wants to see if the increased Lamotrigine helps my mood at all and doesn’t want any sleepers to interfere I guess. My sleep has been terrible both before and since I saw her. I am struggling to get any sleep before it is getting light each day.

She asked me to pop in to see her in a week as she wants to monitor things more closely again. I’m seeing her on Wednesday, so we shall see what happens then. I can barely afford more frequent appointments, but I understand her concern and think the support is probably more important than the money.

I now of course know when I’ll be seeing the NHS psychiatrist, so I guess I’ve got another 6 weeks of Dr G before someone else. I don’t know what is going to happen when I see Dr B. I was meant to stop seeing Dr G, but I don’t want to. I think I may consider continuing to see her privately, even though the CMHT aren’t happy with it. We shall see anyway.

Written by intothesystem

Monday, 10th August 2009 at 9:50 pm

Days pass by…

with 12 comments

I’ve been wanting to write for days now, but not got around to it. Things keep coming up or I get distracted.

I saw Dr N on Friday. It was the first time I’d seen him in weeks. First there was the secretary screwing up incident, then I was at Glasto and then he was on holiday for a couple of weeks. I’d missed him, but we didn’t have long to catch up, as is the norm with GP appointments. I told him I’d met my CMHT worker. When he asked if she was a CPN, he was pretty surprised and seemed disappointed when I said I had a social worker instead. I don’t think I’m the only person to be sceptical about the usefulness of a social worker. I left soon after with a new sick note and a couple of scripts.

On Friday night I took the increased Nitrazepam dose (20mg)  for the first time. Had a night of restless sleep, but more than I had been getting before. The problem is it sent me bat-shit crazy.

I woke up in the blackest of black moods. Far worse than anything I have experienced of late and that is saying something considering my mood over the past few months. My mind was focussed on one thing and I was agitated, irritable and highly emotional. I woke up with a splitting headache and generally felt terrible. I spent most of the morning in bed, virtually unable to stand my head hurt so much and completely unwilling to face the world.

In the afternoon, my bloke insisted on dragging me out to The Peak District with the dog. I felt awful and was not in the mood at all, but didn’t have much choice in the matter. During the walk I was angry and upset and unable to control myself. I was crying and shouting and taking everything out on my partner. At one point we stopped at a bench, my bloke determined to talk to me and find out what was wrong. I was pretty much screaming at him that I hated him and just wanted to throw myself off a cliff. There was one point when I realised that we were close to a steep drop down to the reservoir below and I walked straight at it contemplating a jump. It was enticing me, calling to me. I don’t think it would have worked, but it was all I had at the time. My partner was quick to respond, realising what I was considering and restraining me, pulling me from the edge. I did my best to try and calm down and we carried around the walk and then went home, myself occupied by the black thoughts, occasionally bursting into tears for no real reason. I spent a lot of time wishing I’d been quicker at the edge.

Sunday was miserable too. I’d taken the higher dose again, unsure if it was the Nitrazepam or something else that had caused the dramatic swing downwards. I was less out of control but just low and lethargic. The headache was even worse than the previous day. At puppy school I couldn’t stand up for the pain and had to leave my bloke to do most of the training.

I reduced the dose on Sunday night to 15mg. Halfway between my last dose and my new dose. I slept much worse again, but woke up with a clearer head. I emailed Dr G’s secretary with a message for her, explaining what had happened on Saturday and how I’d felt. I said I didn’t know if it was the Nitrazepam or just a natural swing, but that I would continue to take the reduced dose unless she suggested otherwise. She agreed to that.

I haven’t been sleeping well. I do not see much point me being on sleeping tablets when I still take ages to get to sleep, wake up in the middle of the night for a few hours and struggle with frequent waking and disturbing dreams. 10mg of Nitrazepam is meant to be the highest dose and should cause me to sleep for hours and still feel drowsy the next day. It just doesn’t. Even the 20mg dose didn’t have much of an effect on my sleep.

I don’t seem to respond to sedatives much at all. Zopiclone didn’t do much and makes me hallucinate and for that reason I haven’t been given Zolpidem. Promethezine Hydrochloride, Promazine, Diazepam, Nitrazepam all have had little effect. Quetiapine didn’t sedate me at all, even on 500mg. Depakote did have some effect, but generally just slowed me down all day rather than making me sleep. Only Haloperidol has successfully resulted in sleep, but even that included frequent waking and the subsequent hangover and drowsiness lasted all day.

I wonder if Dr G will find anything else to try. She goes through her psychotropic drugs handbook regularly under insomnia and never really finds a new solution. Melatonin was mentioned and may be the next attempt, but we shall see. She also suggested Temazepam but then prescribed Nitrazepam instead. Something I think she may be regretting. It all could have been very nasty indeed on Saturday if I wasn’t kept safe.

Also on Monday, my CMHT social worker came to visit. I hadn’t seen her for two weeks as she had been on holiday. We talked about what had happened on Saturday and I explained I’d contact Dr G about it. She didn’t seem too bothered. We spent the rest of the appointment talking about things that I spend my time doing. She seemed keen to get me to go to the cinema or swimming and spent far too long labouring the point. I know I have to try and find pleasurable activities, but when you find no pleasure in anything it is difficult. I remember her trying to explain a cycle of depression and how the way to break the cycle is to change our behaviour using CBT methods, but she didn’t have a clue about how the CBT model worked or much else for that matter. It turned into me explaining The Priory CBT model to her as she attempted to patronise and bluff her way through it. She kept saying how she’s only a lay person and doesn’t know much about psychiatry. I found this alarming when she is meant to be my first point of call on all things mental health. Why oh why do I not have a CPN? I keep wondering if it is too early to ask for someone else? I don’t like her, find her patronising and her lack of knowledge scary.

She was also meant to be reviewing what services to refer me to, but had forgotten and didn’t have any of the information. Surely I should be referred to these services asap as I’ll be waiting long enough as it is?! She said she’d put some info about other services in the post for me to look at so we can discuss next time, but I still haven’t got anything. She also asked if I’d got an appointment with the consultant yet, but I still haven’t. She was meant to have chased that up but hadn’t done.  No appointment and no information. The other thing she was meant to have done was refer me to some telephone support service that I can’t remember the name of. They were meant to call me when she had, but she clearly hasn’t done that either. Chocolate teapot comes to mind. A different one to Kate and Chouette’s though! Thankfully I don’t see her again for another three weeks.

Since Monday I’ve just been feeling generally low. Tuesday night was jovial, as we had our Ladies Circle meeting. I am always cheery when there, but it is only holding the mood back for a couple of hours, assisted in my act by alcohol. I suspect people find it hard to equate how I come across there, with the openly manic depressive person most of them know me to be. I’ve been open with the group about my mental health as they all know I’m on long-term sick. They probably wonder what, if anything is really wrong with me, but I can’t help the front. It’s second nature when with people I don’t know very well.

This morning I was left on my own for a short while whilst my partner went to do a couple hours work for his old company. Thoughts were running rife, but I kept them at bay. I am low, but managing to stay safe. I am just frustrated that I still don’t want to be managing. I know I should stay safe, but my thinking is still distorted enough not to want to. I have the insight to know this, yet still don’t want to and don’t know how to change it. It’s a trap I am caught in and I know it has to change, but when and how, I don’t know.

Anyway, I’ve rambled long enough. I hope everyone out there is okay. The madosphere is quiet, but then I guess it is summer. People are on holiday.

I see others are moving on or posting less. Paranoia about anonymity seems rife. I think it’s a shame, but understand why. I hope people can continue to blog safely elsewhere or are happy outside of the blogging world.

I’ve actually considered giving up on anonymity here recently. I’ve even mentioned my first name on one of my posts, although hidden. If anyone that knew me found this blog they would instantly recognise it as me. I think it’s important more people are open about mental illness and I have been trying to be a lot more open elsewhere, but here I am hiding behind a pseudonym. Maybe it is time for that to change. We will see anyway. I still worry about my future, employment and reputation and don’t want my moaning here to jeopardise that.

As an aside – what a lot of tags I’ve stuck on this post! Blimey!

More Evidence…

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Some of you may remember my post on Trichotillomania which I made a couple of weeks ago. In it I referred to this BBC article which mentions some research into the use of N-acetylcysteine (NAC) for the treatment of Trich. Today I saw Dr G and towards the end of the appointment my bloke mentioned the article and I explained it to her. I couldn’t remember the name of the drug involved, so she asked me to check and let her know. She hadn’t heard the news story herself, but was interested to know more and was happy to check if it will interact with any of my other drugs before I can give it a go. Dr G is quite progressive and innovative with what she prescribes anyway. She won’t always wait for things to become proven and approved before she prescribes something. She also mentioned a new drug, for which I could spot a leaflet about on her desk, that is meant to be good for sleep, but it’s also an antidepressant and she’s scared of the effect this may have being bipolar and my past experience of antidepressants. She said research is currently being done, but this one she didn’t want to risk.

Anyway, whilst I was looking up the name of the drug concerned in this article, I did a little bit of research and stumbled over the fact it had also been connected to improving residual depression in bipolar. Someone has done a some research into this and the paper was published last September. This article sums up the findings. If this really is the case, then there are two reasons for me to be taking it. I am certainly willing to give it a go. It’s a proven drug for other things, so should be safe and even if it isn’t, do I really care? Maybe that is flippant of me and my partner will be horrified to read it, but I really don’t worry about such things anymore. I guess that is the suicidal thinking that undermines everything. I should be thinking about this positively though and my willingness to try anything is the part of me that just wants to get better and doesn’t care how I do it.

For a change, Dr G was running on time. My therapist, M however wasn’t. With that in mind, we got started and did a quick meds review initially. The expected increase in Lamotrigine happened and an increase in the Nitrazepam too. I could do this prescribing lark myself these days! In two weeks time we shall do the increase again and I will then be on the 200mg she’s aiming for.

We talked about how things over the past few weeks seem to be showing signs of stabilisation and improvement. This is true but I say it with caution. In the past three weeks I’ve gone from rapid cycling every day or two between an almost okay mood and a horrifically suicidal one. This was followed by a week of consistant suicidal depression and generally feeling awful. Then over the last couple of days I’ve kinda felt depressed but getting closer to okay mood. The suicidal thoughts are still there, they never go away, but things are quieter.

The thing is, I don’t trust the cycles to not come back. My mood sometimes settles down and then the swings come back with avengence and I am up and down like a yo-yo again.  I also don’t trust the curve on the mood graph to continue rising. It has only been a couple of days of slightly improved mood and I’ve had that before. The bubble bursts as quickly as it forms.

Dr G is hoping that things are stabilising. Last week was stable but hell. If things stick like that it just isn’t going to work. I will get frustrated and then fall off a cliff, which is similar to what happened last January/February. She knows this and I think is as worried about it as I am, but I guess neither of us knows what to do about it. We just have to try and hope that this mood holds out.

M turned up and we talked a bit about what we’d said last week. Dr G was meant to have another appointment with the four of us there last week; Her, M, my bloke and me. At least that’s what three of us thought. Dr G was at her daughter’s graduation and had somehow double booked herself. The three of us carried on and had a session anyway talking about some of the relationship issues we’ve been having and communication. It is a topic that always comes up but an issue that doesn’t go away. Again the solution seemed to be to wait a few months and try not to think about it. Easier said, but they aren’t living with the torment all the time.

The rest of the appointment consisted of lots of ums and ahs whilst I grappled for something I felt comfortable to talk about. I generally failed until the mention of that article came up.

The previous couple of days have been spent at my grandparents. I hadn’t seen them since March last year, when it was my great grandma’s funeral. It was good I guess to see them although always a bit surreal and slow. It always feels like a bit of an act at the best of times, but even more so at the moment. I also saw my two cousins on that side of the family. H, the youngest, loved our puppy. My animal-mad aunt did too for that matter.

The future holds very little at the moment. I don’t know what to do with myself and that is scary. I have a lot of uncertainties and I want answers. I see my worker on Monday and Dr G in a couple of weeks. Aside from that, who knows?