A little unstable…

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.

8mg…

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.

Days pass by…

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!

Short-lived Up…

After ECT today, I’ve had a bit of a short period of up-ness. I am exhausted now though so the diazepam has come out to settle any restlessness and hopefully allow me to sleep. I woke up about 3.30 am last night which really hasn’t helped things.

Today, has been okay though. My mood has been lifted by the nice weather and the ECT. I’ve had a splitting headache all day but have been talkative and a little restless. I wish my mood would hit normal though. All this up and down is so frustrating!

Anyway. Hopefully this diazepam will kick in soon. I’m worried I am going to end up addicted but it’s the only thing that actually works. Zopiclone is evil and makes me psychotic. My quetiapine dose is being reduced and even at 400mg it didn’t really sedate me. I can’t have phenergan after my OD and promazine doesn’t work at all. I just wished something would! Must get Dr G to sort something out.

Should I go…?

I have an appointment to see my GP later. I don’t really know why I am going. I originally made the appointment to sort out medication, but then realised I needed to get the prescription last week before my All I Can Eat Certificate expired. I managed to get that sorted out by asking one of the other doctors to do the repeat and adjust my dosage (as requested by Dr G). This means the main impetus for seeing Dr. N is gone. I do need another sick note as I forgot to get one last time I saw him and my current one is out of date, but that’s not all that important. I don’t want to feel like I am wasting his time, yet I still want to see him. Considering I’d do anything to avoid doctors appointments in the past it’s funny that today I want to go and I don’t really have a reason to be there. Yes, I am actually ill, but there’s not much he can do. It’s probably as useful as going to the doctors with a cold. I feel like I am not worthy of his time.

I don’t really know what to say. I’ve been shaky over the past few days and up and down. I was very restless and agitated on Saturday morning. My partner battled with me to try and get me to sit still and calm down, but the more he tried, the more I found myself resisting. I was giggly and unable to stay still. I just wanted to be on the go and doing things. I didn’t want to stop, as my mind was racing. This was short-lived and by evening I felt very drained. I was very low in the evening and felt withdrawn. This mood continued on Sunday, although I was a little better by afternoon. We visited my relatives (Grandma and Aunts), which was weird, as they still do not know about my illness. White lies about work were necessary to keep up the illusion and I hate it. I know I should tell them, but I don’t know where to start. This side of the family are not known for their sympathy towards depression.

So, what do I say to my GP? I wonder if I should just cancel, but I find myself not wanting to. I want to see him, although I don’t know why. I wonder if he can just give me a bit of moral support. I think I need some encouragement to get me through the next few days. I’m tired and fed up of this endless depression. I am frustrated about treatment. I think I need someone sensible to convince me things will change, although I don’t know how much use he will be. I don’t know what to say to him. I don’t know where to start.

Medi-go-up and one-to-ones…

My Quetiapine (Seroquel) dosage is going up to 400mg. It seems like a lot for someone who is being prescribed off-label and doesn’t have a diagnostic label to match, but nevermind. I saw my consultant again today. It was better than recent visits, perhaps because she has changed something rather than just asking me to wait and be patient, but it is still difficult. I go into my appointments shaking. I seem to lose my tongue and forget what I wanted or needed to say. I forgot to bring up the fact my eyesight has been bad lately and I am still not able to drive, despite knowing I had to. I will have to try and catch her at some point before the Christmas break, but I do not know if she will be in on Friday. She often takes it off.

Anyway, the other revelation of today is that I am being referred for one-to-one therapy at last. I am apprehensive, as I do not know what I am expected to use the therapy for. A few weeks ago, one-to-ones were discussed and it was decided that I wasn’t well enough yet and didn’t really have any key issues that were going to be possible to tackle in one-to-ones. Since then, nothing seems to have changed. I have no idea what I should talk about. I go into group sessions and have no idea what to tackle each week, but I can’t ask for the spotlight to skip to the next person in one-to-ones. I still do not have any answers or even the right questions. I just don’t know where to start. I am lost in this quagmire of shifting moods and negative thoughts. I am still struggling to see much further ahead than the next few hours and I’m still uncertain of what the future brings. I am still depressed more often than anything else and I am still frustrated and agitated. I feel like I am staring at brick walls in all directions and I don’t know which way to turn or how to break through them. I am glad that I am being referred to the therapist that I did my life maps with. I trust her and she seems to understand my frustration and confusion. She understands that I feel trapped in this limbo, not knowing where my diagnosis lies or how to fix the problem. The only problem with this is, I also know she doesn’t know how to fix the problem, so I am unsure of how much use an hour a week with her will be.

I am scared of therapy. It can bring up more things than it solves and it is hard work. I know I need to put the work in if I want to get better and I can’t just wait for medication to do it’s magic, but it is still daunting. Therapy seems to just drag up all these things and makes you question everything. It leaves you sitting in a mess of confusion and not knowing where to start or how to solve it. I don’t know where to begin untying all the mess.

I think most of all I am left feeling frustrated. I am worried that treatment will never work. I only feel that I am more and more confused and the fact that I am doing all the things I am told I need to do to get better and it is not making any bloody difference only adds to the desperation I feel. WHY AM I NOT BETTER!?! IS IT ALL MY FAULT?! WHEN WILL IT BLOODY WORK?!?!!!! WHAT ELSE CAN I DO?! ARRGHHHGHGHGHGHGH!!!

You get the idea.

I…am…fed…up.

Knowing how it feels…

As Chouette pointed out, it is no secret that I met up with her, Kate, Colouredmind and Eccedentesiat this weekend. It was good to attach real people to the blogs and stories that I read. I enjoyed the meet, however brief for me, but am conscious I was talking far too much. It is a trait that comes from nervousness and agitation, but one I struggle to keep under control. Thanks though. I hope we can do it again.

It was great to just chat about everything and anything. Although we all know how it feels to suffer at the hands of mental illness, it was good that we could be “normal” and talk about other things too. We all know what it is to be students and to live in the city that we met. We all have a life aside from this. I think it is good for all of us to remember that. My partner thinks that I have become too wrapped up in being ill and that I shouldn’t spend all my time with “depressed friends”, but I think doing just that has helped me to remember the other side of life.

That said, I also appreciated being with people that know how it feels. I agree with both Hannah and Chou that we have all lost much to this illness. I too, have a list of wishes and a collection of regrets. I too, wish I didn’t have to take medication to live and sleep, wish I could find enjoyment in things and wish I could erase many things from my memory. I wish I didn’t have to spend days in therapy. I wish I could drive without being a risk to myself or others. I wish I could spend time alone without someone worrying about me. I wish I could turn off the negative thoughts that infiltrate my mind. I wish I could return to the career that I loved and not head straight for a nervous breakdown. I wish I could get on with life and want to live.

I have all these big wishes, but it was weird. The thing that struck me most from Hannah’s post, was the line:

I want to wear my hair parting on the otherside and not have scars to hide underneath my hair

I too wish for this. Worse, I wish I could part my hair anywhere and not show the scars of a lifetime of destruction. This is something I am so ashamed of, yet I still continue to wreak havoc. I have scratched my scalp to the point of bleeding and picked at every scar, every single night, for as long as I can remember. My hair no longer grows in the worst places. Elsewhere, it grows in tufts, as it tries to recover from the abuse. I cannot get a haircut, for fear of what the hairdresser might say when they see the mess that is my head. I am deeply embarrassed by it. My scalp constantly hurts and itches and I can feel the blood in my hair. I hate it, yet I am unable to stop. It is a compulsive act of nervousness, a compulsive act of self-destruction, a compulsive act of distraction. It is worse than ever at the moment. I lie awake at night and give in to the urge to hurt myself., leaving blood on my pillow. I sit in therapy and find my hands wandering. I hope no one notices, but fear that they do. I stand at the mirror and look at the scars. Most of the time I don’t even realise I am doing it, but I am painfully aware of the consequences. I wish that I could stop. I wish that wish was enough and I’d have the willpower. I know that I don’t. It is another one of those wishes, but I think it’s another one that is hopeless.

Yesterday I saw my consultant. I didn’t know what to say to her. I said that I’ve been frustrated that I feel no better. I said that the insomnia has returned. Her only answer was sleeping pills, Phenergan (Promethazine) again. I tried it on the ward and don’t think it helped, but it’s all I can try. I refuse to take Zopiclone, Promazine had no effect on me and Trazodone gave me all the silliness and uncoordination of drinking five pints, then left me with the hangover to match. Diazepam is off limits outside of the ward, as she doesn’t want to leave me with a nice addiction at the end of it all. She looked through her bible of psychotropic drugs at the sleep disorder pages, but didn’t find any other suggestions. Only Mirtazapine, which she discounted with a shake of the head. She went through the sleep hygiene list with me, but she knew better than to push that one. Admittedly, the fact I only had an hour or two’s sleep at most last night, was probably exacerbated by the diet coke I’d been drinking, but nevermind. Anyway, I have a note to give Dr N on Thursday, so my green slip will have the new one on the end.

Back to Dr G. She wants to put up my venlafaxine, but is scared of the consequences. The constant background agitation of the past few weeks makes that seem like a bad idea. She wants to put up my quetiapine, but is scared of the consequences of that too. My chronic apathy and considerable numbness are the issue here. Instead, she has done neither and left me in limbo-land with meds that don’t seem to help. I am fed up of the medi-go-round. I just want them to work. She is waiting and hoping that they kick in soon, but I’ve been on these for over 7 weeks now. Surely if they were going to work, they would be by now? Maybe I need to have more faith. How is the placebo effect going to work if I don’t believe in them? It’s still frustrating though.

She seems to think the way forward for me is therapy though. She isn’t holding out too much hope on the meds front. I wish I had as much faith as she does that splodging some paint around, talking about my life story, or getting annoyed at CBT will do anything to help me. It may be a short term distraction, help me to be more honest with myself and others about how I feel and give me a chance to think about stuff, but at the end of the day I still feel like crap and still battle day in day out with the intrusive thoughts. I don’t know how much “working through my issues” I can take and where it is going to leave me ending up.

I am chronically frustrated with this chronic depression. When will things change? I keep ending up in the same place. I keep waiting for things to improve. I am fed up. I feel like screaming it.

Frustration…

So since I’ve returned to blogging I haven’t actually had that much time to write about how I’m actually feeling at the moment. I’ve caught up on the past, but not looked at the present, let alone the future.

I’m currently frustrated and agitated. This has basically been the case on and off all week and I’m not sure how I feel about it really. It feels like I’m on edge and it could go either way. I could either become more and more hyper or I will drop off a cliff fairly soon. Neither option particularly appeals, as I suspect any hypomania would be of the dysphoric form. The experience that is a mixed mood is one I am frequently familiar with these days, but not one I enjoy that much. As Seaneen describes it, it’s a particular form of hell. Alternatively, the falling off a cliff is not much fun either and I’d rather not go there if I can!

I saw Dr G yesterday. This is the primary cause of my current frustration. I wrote to her, as I’ve felt that I’ve not been getting anywhere lately trying to talk. I asked about diagnosis again, but she was fairly evasive. She talked about how I had various issues, primarily that of a mood disorder, but there were other things at play. She mentioned the question over a personality disorder diagnosis and was quite vague about this. She said that although personality disorders are one of her specialties (especially Borderline PD) she is reluctant to apply the label of a personality disorder on anyone for various reasons. Mainly she said that it is such a misunderstood label and can often be bandied around to avoid giving treatment. I don’t know if that means she does think it could be applied to me or not. I couldn’t really tell from what she said and I suspect she is still not sure.

I also tried to discuss the best treatment options for me going forward. I explained that I didn’t feel I was making much progress, if any, and that I was frustrated by this. She seemed to think I was making progress, but that it was going to be slow. In terms of therapy, she didn’t think there was much else that we could do. She seemed confident that it will help me to manage my condition and will make a positive difference. So far I’ve not been so convinced. I want it to work and I want it to help, but I just don’t know if it is. In some cases I’ve been using many of the techniques for years to manage my condition, but I’ve just not been able to keep it up over the past few months. These skills just aren’t working anymore and it makes me feel like a failure for not feeling the benefit. CBT frustrates me, because as much as I try to counteract the negative thoughts with evidence, rational thinking and the rest, it doesn’t work. There is still this inner commentary counteracting everything I do, telling me it is all pointless and that I am wrong. I don’t know how to stop it. I sometimes wonder if I am just too ill for therapy at the moment. A lot of the time I just feel like I cannot engage and make the most of it. I don’t know when or how that is going to change.

She also went over my meds. She wanted to put up the Venlafaxine, but decided it was probably not a good idea due to agitation I had been experiencing. She’s going to review in about ten days, but said she may put it up then if I’m not feeling much improvement. We also moved all the quetiapine to a night dose, so I’m now on 225mg Venlafaxine in the morning and 350mg quetiapine at night. I am not sure how I feel about the quetiapine. I suspect without it I’d be sky high or unbearably agitated, yet I hate the numbing feeling it leaves me with a lot of the time. I just feel fuzzy, foggy and empty a lot of the time, but maybe that’s not the quetiapine at all. Maybe that is just how I am at the moment. I don’t know.

I left her office feeling extremely frustrated and even more agitated. I didn’t know what to say. I just felt like I wasn’t getting anywhere. She is still avoiding the question of diagnosis and is still telling me to be patient and keep trying. This was not the answers I was looking for. I had gone in there with my notes, hoping that I’d get some answers to my questions, but the reality is I left with the same questions I entered with and a feeling that she isn’t really listening. I don’t know if that is really the case, or if she is just powerless to help. She doesn’t think there’s much else we can do at the moment. She tells me there are no guarantees, but she hopes that I will get there slowly with the right medication, right therapy and enough will power and patience to stick at it. I don’t know how I am going to find the will. I just feel that I am battling and battling and not getting anywhere. Every step forward is followed by two steps back. I didn’t really know how to tell her I am so close to giving up. I cannot handle the waiting and uncertainty much longer. I can’t handle feeling like this much longer. I don’t really see where I am going with this and don’t see any way out. It feels like I’m never going to get anywhere, I’m never going to get better, I’m never going to understand this illness, I’m never going to be able to really talk to people, I’m never going to just be happy and content, I’m never going to win against the negative thoughts, I’m never going to want to live, let alone know how to handle it. I know that sounds awfully defeatist and pessimistic, but I’m being driven that way by illness, frustration and constant disappointment. I just don’t know what else I can do.

Today I saw Dr N, my GP. As always it was nice to see him, but it’s more of the same really. He was concerned by the agitation, but was convinced the venlafaxine is to blame. He didn’t really know what to say. He said he felt pretty impotent at the moment and it’s true. There’s nothing he can do whilst Dr G is managing my medication. He suggested it might be worth adjusting my meds, but we have to wait and see what Dr G says. He just tried to be encouraging, telling me to try and distract myself and channel the agitation and to just stick with it. I don’t really know what to say to him anymore. He just tells me week after week that there’s no easy solution, but hopefully we’ll get there eventually. I feel like I’m letting him down by not getting better. I feel that I’m letting everyone down.

I think I’m on the edge. The edge of this mood, the edge of reason, the edge of life? I don’t know. I just don’t know what to do anymore and don’t see where this is all leading.

September/October: Meet the Shrink…

Late September: Referral to Psychiatrist

I returned to Dr N shortly after my trip to A&E. I was embarrassed about my previous visit to him and quite apprehensive, but it was okay. He was lovely as ever and showed his concern. He apologised for sending me to A&E, but pointed out he had to. He was concerned that I could have taken something else and not be telling him, so needed to get things checked out. I explained what had happened in A&E and following, with the crisis team. He was pretty shocked and disappointed that they hadn’t offered me more support or a proper assessment.

I questioned him on the borderline thing and he kinda avoided the question, horrified that the A&E department had been stupid enough to show me the letter, but did suggest that he wasn’t attempting to make a psychiatric diagnosis, more trying to assure I got the right attention in A&E. I wasn’t really happy with his response, but nevermind. He’s since redeemed himself.

Anyway, I asked him what other options there were and reminded him of my health insurance. In the end we agreed that a referral to a private psychiatrist was probably the best option and he arranged to do this.

When I saw him again, he explained he was referring me to Dr G and had written the letter. When I got to see the referral letter I was a little horrified. It was hard to see everything in black and white, honest and accurate as it was.

The referral process was quick and I managed to get a cancellation. An appointment was booked for October 2^nd.

October 2nd: See Consultant Psychiatrist, Dr G.

I was absolutely terrified before my appointment. So terrified, I managed to miss the turning on my drive there and took a while to realise I was going in the wrong direction. I was not really in the right frame of mind to be driving. I got there safely though and was pointed in the direction of a waiting area. She was running quite late, although no one thought to tell me, so I sat there nervously looking at the clock, worrying I’d been forgotten or was in the wrong place. Eventually she came down to find me and led me up to her consulting room.

I was relieved to see there wasn’t a couch. I was terrified I’d have to sit on the cliché psychiatrist’s couch. No one prepares you for what it is going to be like, so I was relying on Hollywood’s interpretation of the psychiatrist for clues. I sat in a small, blue armchair and she began. She explained that the session would take around an hour and that she wanted to go over some of the things discussed in the referral letter and gather an overall history. Then she left it to me to talk.

I am not good at talking. I find it very difficult to open up, but I knew I had to if I wanted to make the most of her expertise. So I went through things. I probably forgot stuff. I was very nervous and didn’t know what to say, but we got there. Afterwards, she wanted to lay out the options for how to proceed. We discussed medication and Quetiapine (Seroquel) was brought up as a possibility. Then she dropped the bombshell. She thought I should come in as an inpatient. I was completely shocked by this and did not know how to react. I had not expected it. She did say if staying as an inpatient wasn’t an option, day care would be the second best thing, but she really wanted me to stay. I couldn’t really think straight after this. I was worried about what my other half would think and terrified at the prospect of being admitted.

At the end of the appointment, she showed me down to the ward and the woman in admissions showed me around. I think they wanted me to see that it was more like a Travelodge than a hospital and were trying to put me at ease. There were no beds available so they explained I would be put on a waiting list and it was up to me if I accepted and came in.

A million thoughts were racing through my head after this. I was worried about what my partner would think. I was anxious about the argument that was likely to follow when I told him. I was worried it was all an overreaction. I worried that maybe I’d been exaggerating things to make them seem worse than they were, yet at the same time I was glad to be taken seriously for the first time. I was cynical and thought that she probably just wanted to make the most money she could from me. Mostly I was just plain scared. I didn’t know what to expect and also knew that if I was to be admitted I would need to tell my parents.

An argument did follow and it took a while for my partner to come around to the idea. He didn’t want me to go in at all. I’m not sure he had realistic visions of what it might be like and seemed to worry it would make me worse. I also suspect he didn’t want me to go because he’d miss me and he was probably worried about not having me around to look after the house too! He did say that he wouldn’t want to visit me there and considered going away for a few days, but in the end he didn’t.

I also went and saw Dr N to get his advice. He agreed that I should be admitted and was glad that I was finally getting some support. He told me he’d have wanted me admitted to the local NHS unit if he thought it would do me any good, but said that it was so terrible it would probably do more harm. I think that’s a sad reflection on NHS mental health services. He also told me he’d been a ward doctor at a Priory hospital for a while, so knew what it was like and thought it would be beneficial. We talked about the benefits of staying over day care, such as not having to drive to and from the hospital after a challenging day of therapy. He really helped me to make up my mind and I made the decision to be admitted.

Into the community…

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

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

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

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

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

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

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

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

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

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

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

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