Feeling green

Today has been a day of feeling very, very sick. I woke up early, and I was at work by 7:30am, not really deliberately. More of a ‘I feel so yuck that if I don’t go to work right now I’m scared I won’t go at all’.

I do have anti-emetics – Stemetil (Prochlorperazine) – but they’re not brilliant, and they make me really drowsy. My GP prescribed me Metoclopramide but warned me ‘not to take it alone’ because at my age there’s a chance I could have a nasty adverse reaction…funnily enough, I haven’t taken it. If I start actually throwing up I’ll reconsider.

At work one of my colleagues is leaving – my boss gave me a collection fund, and casually asked me to go and buy them a present after work. My heart sank. I had to drive to a supermarket, and I was full of anxiety there and back, mentally shouting at the cashier to hurry up so I could get home. I hate how tiny little things that I used to take for granted are so difficult now.

I was kind of hoping the psychiatric hospital would ring me today for the referral, but no joy.

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Battling mental illness has become a game of Whack-A-Mole

I’ll skip over the bit where I lament how crap I’ve been at posting here, and get straight to business – I beat depression (WAHOO!!!), and found anxiety.

That’s a gross over-simplification; I’ve always had anxiety, even when I was a little kid. I was the worried sibling, the one who needed to know the daily schedule ahead of time, that kind of thing. My brother used to tease me for feeling uncomfortable if there wasn’t an itinerary on holidays. If I did something wrong at school (only ever by mistake), I’d worry so much about getting in trouble that I’d end up being ill. And my phobias were strong enough that I had a reputation with friends and family, cue more teasing.

The earliest anxiety I can remember was when I was four or five years old. It feels silly to write it, but I was anxious about needing the toilet – specifically that I’d get ‘caught short’ in public, and not make it to a toilet in time. For a few days, this anxiety was crippling. Mum took me to see our family GP, and as we walked there we had to stop at every shop and cafe so I could use the toilet. I didn’t think I could last thirty seconds!

I remember the GP feeling my tummy, testing my urine, and then he asked ‘So, what are you worried about?’. I said ‘Wetting myself’. And he nodded and said, ‘Yes, but what are you worried about?’ Like I was wrong, and there was something else. But there wasn’t anything else. That was genuinely all I was worried about. The GP didn’t have a solution, and Mum and I went home, again stopping at each shop that had a toilet.

That phase passed, and it’s come and gone in similar phases throughout my life. Most of the time I’m fine, but then one day it’ll suddenly occur to me that I could be caught short and the anxiety floods back. Every daily activity has to have a toilet break planned into it etc, and then…after a week or two…I get over it. This happens once or twice a year.

In November of 2017 I entered another of these phases, but in no time at all I realised this was turning out to be the worst phase I’ve ever had. If I’m not at home, or at my desk, I need the toilet constantly. I stress about any journey I have to make, even if it’s tiny. Just the prospect of getting the bus to work, a 25min journey tops, is enough to make me need to throw up. I worry about sitting through meetings. I worry about getting to meetings – today my boss asked me to accompany him to a meeting over the road, and I immediately panicked I’d have an accident on the way. I can’t even go round a supermarket without desperately needing the loo.

I know it’s all in my head, and that there’s no real biological need. I never need to get up to use the toilet at night, so my bladder is strong, and there’s no pain or anything like that so I don’t think I have an infection. The real giveaway is that I might be DYING for the toilet on that bus journey to work, but then when I actually arrive at my desk (i.e. I’m safe), I don’t actually need to go anymore. I’ve invested in all sorts of weak-bladder pads etc, but somehow they don’t make me feel any more confident – and I’ve done the ‘pouring water on pads’ etc to prove they would work.

I went to see my GP about this before Christmas, and she pointed out that the timing coincides with me coming off my various psych meds; apparently fluoxetine (Prozac) at the dose I was previously taking it – 60mg – helps with obsessive thoughts. I had no idea. So after three or so months Prozac-free, I’m back on it in the hopes it can help me stabilise. We’ve been in touch with the psych hospital and they’ve suggested things like buspirone if this doesn’t work. Has anyone tried buspirone, or any other anxiety meds?

I’ve also found a new therapist to see from next week in case that helps – Dr T is no longer in the picture. I was hoping to be therapy-free this year; I didn’t think I’d need it post-depression, but trying to get free of mental illness is turning out to be one big game of whack-a-mole.

I just hope I win before I lose my job.

Missing some Zs

A while back I took myself off of lithium and Prozac to reclaim some mental sharpness. That’s left me with mirtazapine (Remeron) and propranolol (Inderal), except I’m slowly having to admit that neither are really doing much for me.

I was put on mirtazapine to boost the Prozac, and I liked it because it helped me sleep – it did such a good job that I stopped abusing over-the-counter sleep meds. But, and that’s a really sad ‘but’, for the last couple of months it’s been getting harder and harder to fall asleep. It’s not that I’m thinking about anything in particular, or that something’s overly worrying me – more that I’m just restless somehow. When I do get to sleep I get locked into these strong dreams that mean I wake up feeling exhausted. Dr T would say that’s good in a way, because it means my brain is processing something. It’s hard to hold onto the positivity when you’re really tired.

It doesn’t help that I’m not very physically well either – I’ve had an infection for a little while now that I can’t seem to throw off, and over time I’ve felt increasingly nauseated, dizzy, and sometimes a bit feverish. MQ, go see your doctor. No. I don’t want to show the infection to anyone, let alone a doc. (And no, not because it’s self harm or anything like that). I know that’s stupid, and childish, but it’s not enough to get me over the line to ask for that help.

I felt so unwell yesterday that I couldn’t go to work. Truth be told, I didn’t really feel a whole lot better today, but it struck me that I could be off work indefinitely if I didn’t toughen up. That won’t work; as ever the world demands money.

I might try and cut down on caffeine, see if that helps with getting to sleep. And I’ve got a bath bomb kicking around somewhere; I could have a long, late bath.

 

I don’t remember anyone mentioning this when prescribing Prozac…

Having made such great progress taking myself off lithium, I keenly decided Prozac (fluoxetine) was the next to go (after six years, most of it at 60mg a day) – and why not right now?

= mistake. Oh boy.

I went from 60mg daily to 40mg, stayed there for two days, then cut down to 20mg. That was early last week.

On Sunday the nausea kicked in – I thought I’d caught a stomach bug. Except it was more than that. It was like having a cold too with sniffles etc, and maybe flu because my joints ached and it hurt to move. Yesterday the nausea subsided, to be replaced by all-mighty brain-zaps. It feels like there is WAY too much electricity in my brain. Every movement seems exaggerated, like I might fall. I can feel my pulse in my head. I’m sure that I’m physically twitching, although my housemate is assuring me she hasn’t noticed.

Venlafaxine withdrawals were hard for this reason, but they were intense and over in a couple of days. This seems really drawn out, and I can’t keep taking time off work. At the same time, I’m not safe to drive. I’m not really that safe to walk!!

I’ll post again in a few days when hopefully my brain has settled down, but in the mean time I just had to wave a flag to say Prozac withdrawals can be a real *****. I found ‘SSRI Discontinuation Syndrome’ on the interweb, read the symptoms and yelled ‘THAT’S EXACTLY WHAT I’M GOING THROUGH.’

Given the really long half life of fluoxetine, I was under the impression it would be really easy to come off, especially if I didn’t go cold turkey. If I had known it could hurt like this, I’m not sure I would have stayed on it for six years.

 

Slow and steady wins the race, but does she have the patience?

Since Wednesday I’ve gone from 700mg lithium daily to 500mg. I haven’t noticed any withdrawals, but I think the flush out takes a good 48h plus, so early days.

Its killing me to go this slowly. Every night when I pop open my pill box I have to fight the urge to remove some more. Get this over with. But the responsibilities of a full time job win over – last time I went cold turkey and had a hard time, I could stay at home and keep out of sight. I can’t now. Especially given the recent…screw up.

On that note it’s been okay at work – I had to talk to a couple of heads of division to explain myself which was a bit nerve racking, but my co-workers have been very supportive and laughed it off like nothing. It’s amazing how quickly the pessimist in me can take over – when I realised my mistake last week I was immediately thinking through the consequences if I resigned, and where else I might look for work. I feel pretty pathetic for crying, but hey, I felt terrible.

I wonder how I’ll feel post-lithium. For me it’s a buffer, numbing everything a little – which was perfect when I was suicidally depressed because it took the heat out of my worst moods. The thought of feeling those achingly bad moods again scares me a little, but I don’t think I’ll be able to forgive myself if I don’t give my all in therapy, now that time is limited. I need to be sharper. I need to feel my anger, sadness, and fear in order for them to pass. I think losing lithium could really help.

I just need to not rush the withdrawal and end up dealing with some stupid med drama that detracts from the real work.

Waking up

The last few days have felt horrendous, but they’ve been worth it. I forced myself to keep reading my old journals, and cringing aside, something stirred inside me. I know who I am. Where my head is. I know I’ve been sleep walking through the last two years, hiding from anything that might cause anxiety. I chose blissful ignorance, the easy life, avoiding problems by not actually doing anything. 

Today I wrote a new journal entry, and it felt like clasping hands with an old friend. 

I told Dr T that I can’t coast through the six months of therapy we have left to work with. I’ve been going to him for five years now and I STILL struggle to be open with him despite the trust we’ve built – I don’t think I’ll ever have that level of trust again, so if I don’t somehow beat my depression now I’m really scared I never will. And he listened. Asked the things I wished he wouldn’t. It’s hard, harder than running 5k, but it’s right. Now the low mood has a twist of hope, and that makes it bearable.

Therapy isn’t the only arena of change – I’ve decided it’s time to lose the lithium. I’m not bipolar – I’m on lithium to boost the fluoxetine – so I don’t think it’s a dangerous move. For now I’ve gone from 700mg to 600 – I don’t know if I have the patience to go this slowly. Surely the withdrawals if I go cold turkey can’t be worse than they were for venlafaxine? 

If anyone reading this has come off lithium, I’d be very interested to hear your experience.

ECT? Ketamine infusions??

I saw my psychiatrist this morning, and it turned out to be quite an…interesting…half an hour.

She realised the lithium dilemma without me having to explain it, and the upshot is that we’re reducing my dose from 800mg to 600mg nightly in order to reduce the side effects I’m experiencing. This means we definitely won’t be hitting our original target of a lithium level between 0.55-0.7, but she says that target is more relevant to bipolar patients than patients with depression. Hopefully 600mg will still be useful to me.

We’re also adding in another antidepressant to try and boost my serotonin levels: welcome back mirtazapine (/Remeron). I have to admit, I’m a bit nervous about this – I’ve taken it before to help me sleep (which is another reason my psychiatrist wants me to take it now), and in December I wrote myself a warning before discontinuing this med for being too strong. I’ve been told to cut the pills in half and see if a lower dose is tolerable, and then increase in a fortnight. 

The whole medication vs insomnia battle really sucks; the meds are either so strong that I’m barely conscious in the daylight hours, or so weak I might as well be swallowing chalk pills. The only med that hit the right spot in the middle was zopiclone (/Imovane/Zimovane), but I’m not trusted with it in case I overdose. Grrr.

With this all established, my psychiatrist sat back and said we should think about what the next step is. When I see her in two months time, if the mirtazapine hasn’t helped much she wants to add in aripriprazole (/Abilify), an antipsychotic. After my bad experiences of olanzapine (/Zyprexa), quetiapine (/Seroquel) and risperidone (Risperdal) I had sworn I never wanted to touch an antipsychotic again, so we’ll see how I feel if it is decided this med is necessary.

And then my psychiatrist said she wanted to say something that might horrify me…that I should consider ECT. I’ve read enough blogs on WordPress to know that for all the scary assumptions we hold about it, it can have it’s good points, and my doc was quite encouraged when I didn’t immediately say no. She reckons it’s really underused, especially with patients like me who are managing to function, but are having a miserable time of it. 

Apparently I should also consider ketamine infusion therapy, because a UK trial has just finished and found some patients respond really well, so it’s opening up to referrals. And yes, that’s ketamine as in the horse tranquilliser/Class B drug, but used at a much smaller dose. 

I was a bit shocked by these suggestions – I’d thought that ECT especially was for very severe cases of depression, but now I know that’s not true (..and I’ve been reminded that my diagnosis is ‘severe depression’). I’m not exactly shut against the suggestion of having ECT, but the memory loss bothers me. I’d also have to have it as an outpatient because the hospital is really short on beds, but I’d need to have someone to care for me for 24 hours, and that’s not an option. 

With the ketamine infusion idea, I was pretty skeptical, but having looked up the details of the study etc I’m actually kind of intrigued. But, hopefully none of this will be necessary because the mirtazapine will help. Or the aripriprazole if it comes to that.

All in all, it wasn’t a bad meeting. I really like this psychiatrist (and yes, I realise that means she’ll be next on the list to disappear off somewhere else), because she is nice, but not too nice, and she clearly knows her stuff (not surprising given she’s a consultant psychiatrist). The loss of Nurse L was mentioned in passing – as I suspected there will be no replacement, and I have no interest in asking for one. My GP won’t be happy because she specifically told me to ask about it because she thinks it makes me safer (true), but letting someone else in is also dangerous in it’s own way.

We’re already rocking the med boat, so lets leave the rest alone, at least for now.