Definition: The atypical antipsychotics (AAP) (also known as second generation antipsychotics) are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia. Some carry FDA approved indications for acute mania, bipolar depression, psychotic agitation, bipolar maintenance, and other indications. Both generations of medication tend to block receptors in the brain's dopamine pathways, but atypicals at the time of marketing were claimed to differ from typical antipsychotics in that they are less likely to cause extrapyramidal motor control disabilities in patients, which include unsteady Parkinson's disease-type movements, body rigidity and involuntary tremors. Oh Good.
So the side effeects are:
Headaches -- in up to 27 percent of people
A sedated feeling -- up to 23 percent
Agitation -- up to 19 percent
Insomnia -- up to 18 percent (see Abilify and Insomnia)
Fatigue -- up to 17 percent
Anxiety -- up to 17 percent
Drowsiness -- up to 16 percent
Nausea -- up to 15 percent
Vomiting -- up to 14 percent
Restlessness -- up to 12 percent
Constipation -- up to 11 percent.
Some other common side effects (occurring in 2 percent to 10 percent of people) included:
Dizziness
Indigestion or heartburn
Shakiness (tremors)
Weight gain (see Abilify and Weight Gain)
Restlessness
Fatigue
Dry mouth (see Abilify and Dry Mouth)
Joint pain
Throat pain
Blurred vision
Abdominal pain (stomach pain)
Pain
Cough
Nasal congestion
Increased salivation
Swelling or water retention in the arms, legs, or feet.
Bless my psychiatrist and his ways. This is his new idea to ensure my sanity and stability. He tells me that as well as ensuring a non hyper manic state the abilify should increase my mood to stop the dip that I am experiencing. After the quetiapine experience I am very reluctant to play ball but he promises me this will be a better experience and gives me 20 mg to set me off. I am also told that as the patent hasn't run out on this medication and is costs approx. £200 a pop for 28 days supply. Now I am an emotional burden as well as a financial one. Fabulous. So off I trolley with my prescription and try not to be worried about the extensive list of side effects. What a nightmare. Sometimes I wonder whether or not to risk just coming off of everything and trying to go it alone. I am sure everyone would completely freak out if I did this but sometimes I fantasize about a medication free life. I am sure at some time in my life I was well and didn't need a host of medicines to determine my every mood but it is a distant memory. Thinking the possibilty through of being medication free though makes me think about what I did use in order to stop feeling high or low before my diagnosis. I think everyone tries to manage their mood in some way by using a stimulus whether or not it's a film, a drink, a cuddle, a prayer. I didn't realise how much your mood can shift during a day until I kept a mood diary. It's exhausting. I did a CBT course on self esteem. Have I told you that already? I had to monitor my mood every hour I was awake for a week and explain what was going on and how I felt. When the week was over I was emotionally crucified. There's nothing like a bit of mood diarying to help you feel crap about yourself. Talk about down on yourself. I have the lowest opinion of myself going - you don't need to tell me how bad I am, I am a practised and qualified person at doing that all by myself thank you very much. My bottom line is a deeply entrenched one I can tell you.
So yes, my mood is dipped and I am struggling a little with self esteem.OK so I have no self esteem, and this is compounded by work stress, parenting and being a wife. More on this another day. So I take the damn abilify and will ride out the consequences. And the consequences begin quite soon. Sedation, my old friend, returns with avengence. I have to peel myself off the bed in the morning and hold my eyes open for an hour and force caffeine down my throat just to begin functioning. Don't let me close them again as I will sleep for a few hours without warning. I have to drive to work with music blaring and window open to keep focussed. I have a dry mouth permanently and want to EAT. EAT, EAT and EAT! Oh my goodness. Craving for food that cannot be diminished by any amount of food. After eating, give it half and hour and I feel like eating another meal again. It's an insatiable hunger that doesn't disappear. I want to gorge on MacDonalds beakfasts and cakes and all the bad things in the world. I keep wanting to buy family packs of whispers again. The quetiapine feeling is on the return and I have to trust that it will ease up at some point. If I carry on I am going to be the size of a house. I have to weigh up whether or not to carry on with these new tablets or give up on them altogether and be stuck in the depressive rut. It's not a great choice to make, but I need to decide, and decide soon.
Thursday, 20 June 2013
Wednesday, 19 June 2013
Work and WRAP
Well I got through Christmas and decided to return to work. I was allowed to drive again and had been feeling quite well really so it felt like the appropriate time. The 8th January will be forever emblazoned on my memory. At the time the date was of no significance. I eased back in to the office hum drum on a gentle phased return and thought that all was well. Then on returning to my allotted hours I was called in to a meeting with my manager and the human resources woman (I want to write the word cow/jobs worth/nasty words...all the nasty words I can think of) . I clearly remember the patronising face she pulled as she feigned concern whilst delivering me a written warning for sickness. OK. So I have a disability which I thought gave me a degree of protection against this type of procedure. I was sadly misinformed. I even called the equality commission and it turns out that they cannot give me special treatment really as I am only one person doing a single job and operationally they had been compromised too much so a warning fell within the normal remit of sickness. I know it sounds wrong but they toed the line. They'd let me have impairment related sick days, let me work from home and been supportive in the past.
Now how this works is that you cannot have more than 3 incidents of sickness in 3 months or 10 days in a block together as then you'll get pulled back in to another meeting for a chat. If that were to happen I would be given a final warning, and then if it happened again I would be fired pretty much. My lovely warning ran from the 8th January 2012 for an entire year. Considering at this point that I hadn't managed more then 10 months being well it felt like a mountain to climb. I couldn't envisage being well for that long without a relapse considering the stress they had just put me under. Essentially the warning would stay on my file for a year but the trigger system would then run again for the following year anyway, so for me to be warning free I'd have to manage about 2 years without a mental health relapse or any type of illness. Yeah right. The general response from everyone around me was one of disgust. I know employers don't want a lame duck on their team but lame ducks try hard to float and turn up most of the time when they are well.
So I showed up. I tried to do my best and tried my hardest not to be ill. Not just mentally ill but physically ill, not such an easy thing to do when you have small children full of germs. And then my mood started to dip. It was only a gradual dip, but it was definitely a dip. This is when the WRAP comes in useful. The Wellness Recovery Action Plan. It's a little booklet the mental health team give you that helps you to identify when things are going a bit awry and off beam. You have to write down what you are like when you are well, not so well, ill and under a bus. You are then meant to read through it and figure out where you are at and what intervention you might need. It is actually very useful to do as when you are becoming ill, a level of denial can creep in or the attitude of "It's not that bad really" can hang about. It gives you a fact based criteria to measure yourself against and gives you a clear direction about what to do next.
So I was at the not so well part of the plan. Needing some help but not a staged and intensive intervention. The intrusive thoughts were creeping in, the emotional fatigue, irritability, tearfulness and a general feeling of sadness. Back to the psychiatrist I went and shared with him my concerns and guess what? May I introduce you to abilify.
Now how this works is that you cannot have more than 3 incidents of sickness in 3 months or 10 days in a block together as then you'll get pulled back in to another meeting for a chat. If that were to happen I would be given a final warning, and then if it happened again I would be fired pretty much. My lovely warning ran from the 8th January 2012 for an entire year. Considering at this point that I hadn't managed more then 10 months being well it felt like a mountain to climb. I couldn't envisage being well for that long without a relapse considering the stress they had just put me under. Essentially the warning would stay on my file for a year but the trigger system would then run again for the following year anyway, so for me to be warning free I'd have to manage about 2 years without a mental health relapse or any type of illness. Yeah right. The general response from everyone around me was one of disgust. I know employers don't want a lame duck on their team but lame ducks try hard to float and turn up most of the time when they are well.
So I showed up. I tried to do my best and tried my hardest not to be ill. Not just mentally ill but physically ill, not such an easy thing to do when you have small children full of germs. And then my mood started to dip. It was only a gradual dip, but it was definitely a dip. This is when the WRAP comes in useful. The Wellness Recovery Action Plan. It's a little booklet the mental health team give you that helps you to identify when things are going a bit awry and off beam. You have to write down what you are like when you are well, not so well, ill and under a bus. You are then meant to read through it and figure out where you are at and what intervention you might need. It is actually very useful to do as when you are becoming ill, a level of denial can creep in or the attitude of "It's not that bad really" can hang about. It gives you a fact based criteria to measure yourself against and gives you a clear direction about what to do next.
So I was at the not so well part of the plan. Needing some help but not a staged and intensive intervention. The intrusive thoughts were creeping in, the emotional fatigue, irritability, tearfulness and a general feeling of sadness. Back to the psychiatrist I went and shared with him my concerns and guess what? May I introduce you to abilify.
Saturday, 15 June 2013
The depakote years part two
Ok so I've been climbing up the slippery pole, bonded with the crisis team, been banned from driving for six months and generally been feeling pretty rough at this point. But miracle of miracles, 3 months down the line I start to feel reasonably ok. It's an odd sensation coming out of the Deep, dark wood. The mist began to lift. I could string a sentence together and spell words again. My ability to converse with people and maintain eye contact was much improved. Everything tired me out but hey, I was functioning again. The depression end of my condition is savage. It is rapacious and destructive. Once it begins to abate even slightly, you feel the grip of it around your throat begin to ease and you can literally start to breathe again. Holding on through that phase is all you can do. The mania is rampant, unforgiving and makes you terribly vulnerable to complete breakdown. Even though the mania begins with the fluttery stomach butterflies and a sense of well being and exhilaration, it becomes your worst enemy. Thankfully in my case, it doesn't last longer than three to four days. Depression can last for months and months. I was glad it had started to release me from it's grip so soon.
It's worth mentioning here that I had started to go to Church again after many years on sabbatical. My choice as I had found it hard to engage with Christians. I know - Church is full of them right. But actually Christians are a microcosm of the normal world so it still has quite a lot of nasty people knocking about and I had had my fair share of abuse and judgement. Anyway, these Christians knew that I had this condition and when I had my relapse they were the most amazing bunch of people around. They prayed for me constantly, made up a rota to ensure that someone came to see me every day and generally carried me when I couldn't carry myself. Sometimes they took me to psychiatric appointment, sometimes they played with the kids but most of all they showed me love and acceptance. I love those guys. I felt safe with them and they are precious people in my life.
So at the three month point I am slightly less mad, a little skittish but managing ok. Then I get a call from my GP. A GP calling me at home. At first I thought someone had died and they had been nominated to tell me as I was so fragile. Turns out no one had died at all. The anti depressant I was taking had been deemed to be dangerous for the heart and I would need to cut it down drastically without much notice or stop taking it all together. Brilliant. Just coming out of a major relapse and now having to toy with medication. The risks of me reducing the citalopram and becoming ill again were quite high. Basically when I got to see the GP I was told that the rhythm of the heart beat could be drastically affected and that permanent damage could occur if I continued to take the maximum dose. We decided together to drop from 60mg to 40mg and to stay off work for another 6 to 8 weeks to ensure my survival! It's bad enough taking medication that can make you fat, make you have twitching arms and legs, make you have a dry mouth, mess with your liver function.... I could go on. Having a permanent heart problem was not on my list of must haves. I had to have a heart trace done to make sure I was ok. Who would have thought that medication that is meant to be making you feel well can do such horrible things to you physically. I remember asking my shrink how long it would be before I could be medication free. His response was not a welcome one I can assure you. "If you stay stable for between 2 and 5 years I will consider it." Two to five years!!! That is ages.
It's worth mentioning here that I had started to go to Church again after many years on sabbatical. My choice as I had found it hard to engage with Christians. I know - Church is full of them right. But actually Christians are a microcosm of the normal world so it still has quite a lot of nasty people knocking about and I had had my fair share of abuse and judgement. Anyway, these Christians knew that I had this condition and when I had my relapse they were the most amazing bunch of people around. They prayed for me constantly, made up a rota to ensure that someone came to see me every day and generally carried me when I couldn't carry myself. Sometimes they took me to psychiatric appointment, sometimes they played with the kids but most of all they showed me love and acceptance. I love those guys. I felt safe with them and they are precious people in my life.
So at the three month point I am slightly less mad, a little skittish but managing ok. Then I get a call from my GP. A GP calling me at home. At first I thought someone had died and they had been nominated to tell me as I was so fragile. Turns out no one had died at all. The anti depressant I was taking had been deemed to be dangerous for the heart and I would need to cut it down drastically without much notice or stop taking it all together. Brilliant. Just coming out of a major relapse and now having to toy with medication. The risks of me reducing the citalopram and becoming ill again were quite high. Basically when I got to see the GP I was told that the rhythm of the heart beat could be drastically affected and that permanent damage could occur if I continued to take the maximum dose. We decided together to drop from 60mg to 40mg and to stay off work for another 6 to 8 weeks to ensure my survival! It's bad enough taking medication that can make you fat, make you have twitching arms and legs, make you have a dry mouth, mess with your liver function.... I could go on. Having a permanent heart problem was not on my list of must haves. I had to have a heart trace done to make sure I was ok. Who would have thought that medication that is meant to be making you feel well can do such horrible things to you physically. I remember asking my shrink how long it would be before I could be medication free. His response was not a welcome one I can assure you. "If you stay stable for between 2 and 5 years I will consider it." Two to five years!!! That is ages.
Friday, 14 June 2013
The depakote years part one
Ok so I haven't blogged in a very long time. For some reason, I don't know why, I haven't felt inclined to write. Its been two and a half years in the depakote world. But not only that it's also been the abilify years, the "reduce the hours at work and get threatend with a awarning for sickness" years, the children starting school years as well as working, being a wife, losing weight then getting fat again and going back to church years.....Maybe I just started really living again. Oh yes and I had a major relapse and had the crisis team out and thought I might end up in hospital. Great. It's been a bit of a roller coaster.
Depakote worked quite well for me for a time. As well as being an anti-epileptic it acts as a mood stabaliser.Now free of the quetiapine I stopped being fat and being mad. Fat and mad is unatractive and difficult to live with.It stifled my self esteem and confidence massively. One or the other I can cope with but together it's soul destroying. Amazingly within a week or two of taking the depakote I felt really well. The sedation stopped, the weight I had gained on the quetiapine started to fall off as did my appetite, and the battle in my mind seemed to be calmed. I felt alive again. Things felt ok and I began to believe that maybe they had got the medication right after a very long time. It is so freeing to be able to wake up in the morning refreshed and energetic instead of slugish and sedated. I felt really positive for the first time in a long time. I started to use the gym regularly and also joined weight watchers. If you'd have asked me a few years back what I would be doing in my life, weight watchers would not be on the radar. But hey, it was llike a coffee morning with some older ladies. And I enjoyed it. Depression sucks the enjoyment out of everything. Life is grey and meaningless. It is joyless and bleak. Being catapulted back to normality is amazing but terrifying too. There is always an underlying fear of relapse and sense of "This is to be good to be true" hanging about. Practising being happy and trusting the medication and CBT takes time. Things felt like they were going to be ok.
So I am getting thin and enjoying life; things seems to be going well or so I thought. Then in the July after ten months of wellness BAM. Out of nowhere things start speeding up at a rate of knots. In hind sight, I was probably quite stressed and tired but didn't recognise this early enough. I couldn't sleep on Tuesday night and then on Wednesday morning I started to feel incredibly rushy. My breathing was fast, my heart rate was banging and I felt light headed and exciteable. The space in my head felt like it was mushrooming and becoming too enlarged to be held by my skull. At this point my hope was that I'd drunk too much coffee but it was too intense and almost a tidal wave of speed overwhelming me. It's a weird sensation almost like an out of body experience or floating along on a hovercraft. It's deeply unsettling and you feel completely powerless, and that includes my mouth running away from itself. And this is where the embarrassing behaviour begins. Running up and down the office to get involved in a leaving gathering. Jumping into other peoples photos being taken. Smiling maniacally at people and swearing at the top of my voice in teh office. Lack of boundaries and getting into peoples private space. Standing with a colleague in the street telling them I can write pornography for a book if they like. Striving to not spend £400 on clothes in my lunch break even though I had the cash in my pocket. Scary stuff for me and this is the begining of the ride. And so it continued. Explosive thoughts and speed of body. Agitation and fear and Panic. Paranoia that people can see you being mentally ill and giving you sideways glances as you appear different to your normal self. It's at this point I decide to call my CPN and explain what was going on. Reading back on this experience I left this call far to late in the day. The mania was already underway and out of control. I ran to a spare office in the building where I worked, curled up in a ball and called the lovely Fran. Sadly she couldn't understand a word I was saying as I was speaking at such a rate it was gibberish. She shouted slightly for me to shut up which worked a treat and asked me if I was feeling safe enough to manage over the weekend. The bottom line is that "if you can't, you need to get the extra help in and it needs to be now" she says. I agree to try and manage over the weekend as I thankfully had an appointment with the cpn on the following Tuesday. If I need extra help over the weekend, I either need to call the out of hours GP or go to A+E. Oh joy! I clearly remember leaving work, and when trying to cross the road heard a voice telling me to throw myself under a bus. I asked the woman next to me if she had heard the statement as I though it was the guy in front of me. She looked at me with some concern. Great. Hearing voices too, just to make my day even more special. I remember thinking that as long as I can get home, I'll be ok. If I can sleep, maybe it'll stop. I'm just going to have to trust that the mania will run it's course and be quick to finish. I cannot cope with the intensity for much longer. Hypermania only lasts a few days - full blown mania can last a week.
Friday. Oh my. What goes up, must come down. Sick, I felt so sick. Mentally sick and totally drained of energy. When your mind has been on fast forward for two and a half days, you feel like someone has put a bullet through your head and there is a wide and empty space of blackness. You are also physically exhausted. I dragged myself to work and spent most of the day staring into space or with my head on the desk. Everone knew I was ill it was obvious.I got home and slept like the dead. I wandered around most of the weekend like a lost sheep with a sense of complete detachment from myself. Stuck in Sylvia Plaths Bell Jar, I bounced around in what is fondly named a mixed phase episode for a week. Up and down and up and really down and then off the cliff into despair. This is all happening during the summer holidays too so I am trying to stay on an even keel for the children and its starting to become really tricky to say the least. I remember taking the kids to their aunts to meet granny on theTuesday. I needed to drop them off for childcare so that I could go to work and thinking I could leave them in safe care, and go and drive my car in the canal on the way home. When I gave them a cuddle goodbye I honestly thought I was saying goodbye for ever. It felt so catastrophic but ultimately there would be a sense of relief to stop the dreadful feelings I was having.
This is when the psychiatrist got involved. I sat on the little chair next to the desk where he pops the tissues and basically fell to pieces. I had definately hit the bottom. A mixed phase episode carries a high risk of suicide so he took me really seriously when I said I had thought about dying as a way of release. So now we welcome in The Crisis team. Welcome to the A team of mental health. If you have a problem, and you can find them, maybe you can hire them! Praise be for the lovely people who came to visit me at my house. I was banned from driving (Obviously) and they doubled my medication and tried to give me diazepam which I flatly refused. For six weeks they came and saw me every other day, and the only reason they kept me out of hospital is that I wanted to ensure that I could find the will to stay alive for my children, and being around them at home would be better than placing me on a ward. It was a tough six weeks crawling my way back up the dark and slippery pole but it was worth it. They didn't judge me, they listened with love and they encouraged me to keep going even when I though I might just give up. I think I have said it before that dying feels like a valid option as then your family can just get on with the business of living without the worry of you and your depression. I had to fight those feelings and try to believe that being alive was the valid option. Trying to use all of the strategies I had been taught and digging deep was the only way out of the situation and it really was the better option. I had to keep the faith that things were worth fighting for.
Depakote worked quite well for me for a time. As well as being an anti-epileptic it acts as a mood stabaliser.Now free of the quetiapine I stopped being fat and being mad. Fat and mad is unatractive and difficult to live with.It stifled my self esteem and confidence massively. One or the other I can cope with but together it's soul destroying. Amazingly within a week or two of taking the depakote I felt really well. The sedation stopped, the weight I had gained on the quetiapine started to fall off as did my appetite, and the battle in my mind seemed to be calmed. I felt alive again. Things felt ok and I began to believe that maybe they had got the medication right after a very long time. It is so freeing to be able to wake up in the morning refreshed and energetic instead of slugish and sedated. I felt really positive for the first time in a long time. I started to use the gym regularly and also joined weight watchers. If you'd have asked me a few years back what I would be doing in my life, weight watchers would not be on the radar. But hey, it was llike a coffee morning with some older ladies. And I enjoyed it. Depression sucks the enjoyment out of everything. Life is grey and meaningless. It is joyless and bleak. Being catapulted back to normality is amazing but terrifying too. There is always an underlying fear of relapse and sense of "This is to be good to be true" hanging about. Practising being happy and trusting the medication and CBT takes time. Things felt like they were going to be ok.
So I am getting thin and enjoying life; things seems to be going well or so I thought. Then in the July after ten months of wellness BAM. Out of nowhere things start speeding up at a rate of knots. In hind sight, I was probably quite stressed and tired but didn't recognise this early enough. I couldn't sleep on Tuesday night and then on Wednesday morning I started to feel incredibly rushy. My breathing was fast, my heart rate was banging and I felt light headed and exciteable. The space in my head felt like it was mushrooming and becoming too enlarged to be held by my skull. At this point my hope was that I'd drunk too much coffee but it was too intense and almost a tidal wave of speed overwhelming me. It's a weird sensation almost like an out of body experience or floating along on a hovercraft. It's deeply unsettling and you feel completely powerless, and that includes my mouth running away from itself. And this is where the embarrassing behaviour begins. Running up and down the office to get involved in a leaving gathering. Jumping into other peoples photos being taken. Smiling maniacally at people and swearing at the top of my voice in teh office. Lack of boundaries and getting into peoples private space. Standing with a colleague in the street telling them I can write pornography for a book if they like. Striving to not spend £400 on clothes in my lunch break even though I had the cash in my pocket. Scary stuff for me and this is the begining of the ride. And so it continued. Explosive thoughts and speed of body. Agitation and fear and Panic. Paranoia that people can see you being mentally ill and giving you sideways glances as you appear different to your normal self. It's at this point I decide to call my CPN and explain what was going on. Reading back on this experience I left this call far to late in the day. The mania was already underway and out of control. I ran to a spare office in the building where I worked, curled up in a ball and called the lovely Fran. Sadly she couldn't understand a word I was saying as I was speaking at such a rate it was gibberish. She shouted slightly for me to shut up which worked a treat and asked me if I was feeling safe enough to manage over the weekend. The bottom line is that "if you can't, you need to get the extra help in and it needs to be now" she says. I agree to try and manage over the weekend as I thankfully had an appointment with the cpn on the following Tuesday. If I need extra help over the weekend, I either need to call the out of hours GP or go to A+E. Oh joy! I clearly remember leaving work, and when trying to cross the road heard a voice telling me to throw myself under a bus. I asked the woman next to me if she had heard the statement as I though it was the guy in front of me. She looked at me with some concern. Great. Hearing voices too, just to make my day even more special. I remember thinking that as long as I can get home, I'll be ok. If I can sleep, maybe it'll stop. I'm just going to have to trust that the mania will run it's course and be quick to finish. I cannot cope with the intensity for much longer. Hypermania only lasts a few days - full blown mania can last a week.
Friday. Oh my. What goes up, must come down. Sick, I felt so sick. Mentally sick and totally drained of energy. When your mind has been on fast forward for two and a half days, you feel like someone has put a bullet through your head and there is a wide and empty space of blackness. You are also physically exhausted. I dragged myself to work and spent most of the day staring into space or with my head on the desk. Everone knew I was ill it was obvious.I got home and slept like the dead. I wandered around most of the weekend like a lost sheep with a sense of complete detachment from myself. Stuck in Sylvia Plaths Bell Jar, I bounced around in what is fondly named a mixed phase episode for a week. Up and down and up and really down and then off the cliff into despair. This is all happening during the summer holidays too so I am trying to stay on an even keel for the children and its starting to become really tricky to say the least. I remember taking the kids to their aunts to meet granny on theTuesday. I needed to drop them off for childcare so that I could go to work and thinking I could leave them in safe care, and go and drive my car in the canal on the way home. When I gave them a cuddle goodbye I honestly thought I was saying goodbye for ever. It felt so catastrophic but ultimately there would be a sense of relief to stop the dreadful feelings I was having.
This is when the psychiatrist got involved. I sat on the little chair next to the desk where he pops the tissues and basically fell to pieces. I had definately hit the bottom. A mixed phase episode carries a high risk of suicide so he took me really seriously when I said I had thought about dying as a way of release. So now we welcome in The Crisis team. Welcome to the A team of mental health. If you have a problem, and you can find them, maybe you can hire them! Praise be for the lovely people who came to visit me at my house. I was banned from driving (Obviously) and they doubled my medication and tried to give me diazepam which I flatly refused. For six weeks they came and saw me every other day, and the only reason they kept me out of hospital is that I wanted to ensure that I could find the will to stay alive for my children, and being around them at home would be better than placing me on a ward. It was a tough six weeks crawling my way back up the dark and slippery pole but it was worth it. They didn't judge me, they listened with love and they encouraged me to keep going even when I though I might just give up. I think I have said it before that dying feels like a valid option as then your family can just get on with the business of living without the worry of you and your depression. I had to fight those feelings and try to believe that being alive was the valid option. Trying to use all of the strategies I had been taught and digging deep was the only way out of the situation and it really was the better option. I had to keep the faith that things were worth fighting for.
Tuesday, 12 October 2010
the dawning of a new pharmaceutical age
So, I turn up at the psychiatrists office and I blurt out my prepared blurb. Remember I am mentally ill, have no self esteem an find conflict traumatic. Planning is everything. "I don't want to take the quetiapine anymore". He says, "Ok then." To say it was an anti-climax is an understatement. I was expecting some resistance, a fight, and a sharing of words or opinions. He then says, "well what would you like to take?". I am temporarily stumped as all of this is totally unexpected - I have to hand the power back to him as I have no idea what to take. He's the shrink and I've been politely put back in my place.
The list is slightly boggling and everything seems to do something nasty to you. Fat, anorexic, fits, jerks, nausea, skin problems, confusion, blackouts, disorientation. Sounds like alcoholism and food addiction to me but hey, I'm not a chemist. The up side (Yes there is one) is that my mood may actually stabilize, the hyper mania will stop and thoughts of hanging myself or dying in a hole with twigs in the woods may disappear. I'll pick one - Its worth a shot eh?
We choose Valporate semi-sodium, or what is commonly know as Depakote. Depakote can be injected into your backside, but they trust me to take it regularly so I get to take it as a tablet, thank goodness. It's actually an anti convulsant, not an anti psychotic. In lay mans terms, the different medications work on different types of places in my brain cells, altering the mixture of neuro-hormones to create happiness, wellness and lack of madness hopefully - so maybe it'll do something else more positive to my mood too. I imagine this microcosm of mini brain universes all banging around together in my head, squirting neuro-hormone guns at each other, then changing tactics to try and win the war. At the present time we haven't found the correct WMD - weapon of madness destruction!
So I'm off on another chemical journey - Its really hard to keep being hopeful when after 15 months of struggling to be well you're just not getting there. People often don't remember you're ill either, forget to ask you how you are, or assume that everything is ok because to manage to turn up and do things sometimes. Its like putting on your morning mask - if people can see the true face underlying it they'd be afraid to make eye contact. Its not contagious, but people fear mental illness still. Sometimes its easier just to shut up shop for a few hours to get through what ever it is you are doing. Going to bed sometimes is nice as you can pretend its like dying, just to give you a break from the doom and fatigue. But its great as you can actually wake up, and despairingly force yourself through yet another nightmare day. Remember, thinking about dying isn't about killing yourself necessarily. Its about being so damn fed up of fighting 24 hours a day to remain in the game that you want a day off.
So now I'm at the point where I have to risk all again to swap medication over. Its scary as I may come off this old one, start a new one and feel worse; or the same; or better. Or go completely mad.
Stand on the edge of the cliff and jump.....
The list is slightly boggling and everything seems to do something nasty to you. Fat, anorexic, fits, jerks, nausea, skin problems, confusion, blackouts, disorientation. Sounds like alcoholism and food addiction to me but hey, I'm not a chemist. The up side (Yes there is one) is that my mood may actually stabilize, the hyper mania will stop and thoughts of hanging myself or dying in a hole with twigs in the woods may disappear. I'll pick one - Its worth a shot eh?
We choose Valporate semi-sodium, or what is commonly know as Depakote. Depakote can be injected into your backside, but they trust me to take it regularly so I get to take it as a tablet, thank goodness. It's actually an anti convulsant, not an anti psychotic. In lay mans terms, the different medications work on different types of places in my brain cells, altering the mixture of neuro-hormones to create happiness, wellness and lack of madness hopefully - so maybe it'll do something else more positive to my mood too. I imagine this microcosm of mini brain universes all banging around together in my head, squirting neuro-hormone guns at each other, then changing tactics to try and win the war. At the present time we haven't found the correct WMD - weapon of madness destruction!
So I'm off on another chemical journey - Its really hard to keep being hopeful when after 15 months of struggling to be well you're just not getting there. People often don't remember you're ill either, forget to ask you how you are, or assume that everything is ok because to manage to turn up and do things sometimes. Its like putting on your morning mask - if people can see the true face underlying it they'd be afraid to make eye contact. Its not contagious, but people fear mental illness still. Sometimes its easier just to shut up shop for a few hours to get through what ever it is you are doing. Going to bed sometimes is nice as you can pretend its like dying, just to give you a break from the doom and fatigue. But its great as you can actually wake up, and despairingly force yourself through yet another nightmare day. Remember, thinking about dying isn't about killing yourself necessarily. Its about being so damn fed up of fighting 24 hours a day to remain in the game that you want a day off.
So now I'm at the point where I have to risk all again to swap medication over. Its scary as I may come off this old one, start a new one and feel worse; or the same; or better. Or go completely mad.
Stand on the edge of the cliff and jump.....
Wednesday, 1 September 2010
Chemical chaos - should I ignore my shrink or ask someone else???
Something that is very difficult for me is knowing when NOT to listen to medical professionals and trust my instinct. I'm not a shrink, but I do know my own body and how legal chemicals affect it. However, I often defer to wiser counsel as I'm lacking in self esteem and believe on a deep level that everyone is cleverer and more grown up than me!
So here is the situation. I'm feeling slightly mental - not the whole hog psychotic or suicidal, but definitely on the dark side of dicey. I'm trying to decide if its a dip or a relapse beginning. I call a mental health professional, as my CPN is on a jolly with the older persons team. She told me she felt like a change of scenery. What a choice. Psychotic and delusional adults, or, spongy brained dementia clients. Anyway, the duty cpn isn't sure either as she doesn't know me very well. Neither of us is sure whether I should ride out the storm (hoping it'll pass and I'll Improve) or, not leaving it, come into the mental health team for a chat, and try to sort out what to do.
So I come in to the mental health ranch for a chat and my shrink increases my medication. Obviously I'm not happy. I increase it for 2 weeks; my mood lifts but physically I feel shite. Side effects fill as per normal make me feel like I am filling up with concrete, the appetite of the starved man returns and generally I am knocked about the head with cotton wool and fluff in my mouth. I go off to work leaving the front door of the house with the keys in it, leave the car door open in public spaces, forget what I'm doing whether mid sentence or mid task and just can't get it together. So I reduce it back down and feel mentally in the abyss. So I have to return and yet again he increases the meds (even higher than before) and tells me this is the recommended dose for bi-polar. Take 400mg at night and then 200mg when you get up in the morning. Quite frankly, I feel like giving up. I'm so medicated I can hardly function. I'm experiencing the same symptoms as I do when I'm hideously depressed (Over eating, sleeping, phasing out, lacking in motivation, shuffling around) but I'm not suicidal. I gain half a stone in 3 weeks and am totally demoralised.
I turn up at the gym for my near death experience on a bike session, and a personal trainer asks me if I have got a second opinion about the medication situation and have I challenged my psychiatrist? To be honest it had never occurred to me to challenge him.Later the same evening I sit in the bath and my husband sits on the toilet as we catch up on our day. He asks me exactly the same question, as HIS carer support network mention the benefit of getting a second opinion in their literature. It's definitely something I could consider. It's also glaringly obvious that lack of talking support from my cpn does affect my sense of well being as I feel slightly lost in my so called, "care program approach". Not so much care and absolutely no approach. I suppose the program bit is something I have to make up as I go along - a program of confusion.
So I take the bull by the horn and make some calls. First to my psychiatrist to tell him I really can't take the quetiapine anymore and the second call to my ex-psychotherapist for some advice. She used to run the Lithium clinic years ago so I trust her opinion about medication. I am regaining control. It feels good.
So here is the situation. I'm feeling slightly mental - not the whole hog psychotic or suicidal, but definitely on the dark side of dicey. I'm trying to decide if its a dip or a relapse beginning. I call a mental health professional, as my CPN is on a jolly with the older persons team. She told me she felt like a change of scenery. What a choice. Psychotic and delusional adults, or, spongy brained dementia clients. Anyway, the duty cpn isn't sure either as she doesn't know me very well. Neither of us is sure whether I should ride out the storm (hoping it'll pass and I'll Improve) or, not leaving it, come into the mental health team for a chat, and try to sort out what to do.
So I come in to the mental health ranch for a chat and my shrink increases my medication. Obviously I'm not happy. I increase it for 2 weeks; my mood lifts but physically I feel shite. Side effects fill as per normal make me feel like I am filling up with concrete, the appetite of the starved man returns and generally I am knocked about the head with cotton wool and fluff in my mouth. I go off to work leaving the front door of the house with the keys in it, leave the car door open in public spaces, forget what I'm doing whether mid sentence or mid task and just can't get it together. So I reduce it back down and feel mentally in the abyss. So I have to return and yet again he increases the meds (even higher than before) and tells me this is the recommended dose for bi-polar. Take 400mg at night and then 200mg when you get up in the morning. Quite frankly, I feel like giving up. I'm so medicated I can hardly function. I'm experiencing the same symptoms as I do when I'm hideously depressed (Over eating, sleeping, phasing out, lacking in motivation, shuffling around) but I'm not suicidal. I gain half a stone in 3 weeks and am totally demoralised.
I turn up at the gym for my near death experience on a bike session, and a personal trainer asks me if I have got a second opinion about the medication situation and have I challenged my psychiatrist? To be honest it had never occurred to me to challenge him.Later the same evening I sit in the bath and my husband sits on the toilet as we catch up on our day. He asks me exactly the same question, as HIS carer support network mention the benefit of getting a second opinion in their literature. It's definitely something I could consider. It's also glaringly obvious that lack of talking support from my cpn does affect my sense of well being as I feel slightly lost in my so called, "care program approach". Not so much care and absolutely no approach. I suppose the program bit is something I have to make up as I go along - a program of confusion.
So I take the bull by the horn and make some calls. First to my psychiatrist to tell him I really can't take the quetiapine anymore and the second call to my ex-psychotherapist for some advice. She used to run the Lithium clinic years ago so I trust her opinion about medication. I am regaining control. It feels good.
Sunday, 4 July 2010
Is it a dip or is it a relapse
Being a person of obviously fluctuating mood, I'm trying to learn when to panic and when to just ride out a stormy day or two. I've recently been told that if you've had 3 major depressive episodes, you are 90% at risk of having a relapse. Somber reading for those of us who are in that category. I could be one of the 10%. I could also have carrots growing out of my bum.
It's terrifying to even contemplate being so deeply ill again, so people in my position have to work really hard at relapse prevention and using coping strategies for if or when things do go wrong. It can feel like you're walking around with a loaded gun in your pocket most days, and sometimes the smallest thing can trigger a negative thought, which leads to a period of rumination, which in turn leads to your mood crashing. The triggers too, are those things that you are exposed to on a daily basis. Aggression, disappointment, money worries, family problems, illness, fear, stress. I could go on. But I won't. I think you get the picture. Every day can be a battleground of shifting sands.
The word resilience means to be able to bounce back into shape after bending or stretching or being compressed. When your mood is contaminated or pressed down by a negative thought, this is exactly what happens. Your mind can feel like it is suffering physical pressure or you are being dragged against your will to a very dark place. You try to force it back into a happy shape, but you can't do it by just trying to think yourself out of it. That doesn't work. This is why CBT has been so good for my daily mood management. I'm learning to allow the mood to bend my emotions, but not to snap the back of them, so I can return to a more manageable state. But its tiring work. I'm unceasingly working to stay on top of the quicksand, and it can be very demoralising.
Recently my mood dipped in spite of my guerrilla tactics. I could feel myself in free fall and the terror was fueled by the unknown depths to which I might plunge. The panic felt like straw in my throat and snakes in my belly. I tried to do a Mood trigger chain, to see where the slide began and yet again it linked to stress at work and tiredness. My fear was amplified as I'd been trying very hard to do all of the right things to stop a slide. And it didn't work. I called the Duty Community psychiatric nurse (mine is on a secondment to older persons) and gabbled down the phone trying not to cry. She soothed me somewhat, and as if by magic, she got me an appointment to see my psychiatrist. He actually called me at home first to talk things through, then called me in to his office anyway. He increased my medication although he said it was a temporary measure for a few weeks, and then we'd see how we were. I think in his view I was not as well as I could be, but I wasn't banging on the hospital door. He was the one who said, "Stop panicking". How easy for someone to spit out a platitude to soothe my chaotic soul.
And because most of this is going on in my head, noone is aware of crisis.
It's terrifying to even contemplate being so deeply ill again, so people in my position have to work really hard at relapse prevention and using coping strategies for if or when things do go wrong. It can feel like you're walking around with a loaded gun in your pocket most days, and sometimes the smallest thing can trigger a negative thought, which leads to a period of rumination, which in turn leads to your mood crashing. The triggers too, are those things that you are exposed to on a daily basis. Aggression, disappointment, money worries, family problems, illness, fear, stress. I could go on. But I won't. I think you get the picture. Every day can be a battleground of shifting sands.
The word resilience means to be able to bounce back into shape after bending or stretching or being compressed. When your mood is contaminated or pressed down by a negative thought, this is exactly what happens. Your mind can feel like it is suffering physical pressure or you are being dragged against your will to a very dark place. You try to force it back into a happy shape, but you can't do it by just trying to think yourself out of it. That doesn't work. This is why CBT has been so good for my daily mood management. I'm learning to allow the mood to bend my emotions, but not to snap the back of them, so I can return to a more manageable state. But its tiring work. I'm unceasingly working to stay on top of the quicksand, and it can be very demoralising.
Recently my mood dipped in spite of my guerrilla tactics. I could feel myself in free fall and the terror was fueled by the unknown depths to which I might plunge. The panic felt like straw in my throat and snakes in my belly. I tried to do a Mood trigger chain, to see where the slide began and yet again it linked to stress at work and tiredness. My fear was amplified as I'd been trying very hard to do all of the right things to stop a slide. And it didn't work. I called the Duty Community psychiatric nurse (mine is on a secondment to older persons) and gabbled down the phone trying not to cry. She soothed me somewhat, and as if by magic, she got me an appointment to see my psychiatrist. He actually called me at home first to talk things through, then called me in to his office anyway. He increased my medication although he said it was a temporary measure for a few weeks, and then we'd see how we were. I think in his view I was not as well as I could be, but I wasn't banging on the hospital door. He was the one who said, "Stop panicking". How easy for someone to spit out a platitude to soothe my chaotic soul.
And because most of this is going on in my head, noone is aware of crisis.
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