Goodbye Abilify, hello Lyrica

I didn’t get on well with the Abilify (aripiprazole) – I tried it for four weeks, and I struggled with insomnia the entire time despite already being on 45mg of Remeron (mirtazapine) to help with sleep. You’d think that being exhausted all day would at least mean the anxiety would die down, but no such luck.

I called my GP and we agreed to move on to the next drug – Lyrica (pregablin). I’ve been keen to get started with this one – it’s commonly used to treat anxiety, whereas the Abilify was an antipsychotic. Today is Day 2, and I have to admit the side effects are…interesting. I take it twice a day, and when I got to work yesterday I felt drunk. Mentally I was sharp, but physically I was lurching all over the place; I doubt I could have walked in a straight line. I’m working from home today so I can manage the symptoms from my sofa.

Work/anxiety-wise, yesterday was fantastic. I didn’t vomit. I didn’t panic. And, most impressively for me, I sat through an hour long meeting without having to run out once. It was amazing – I haven’t been able to do that for weeks now. Work are being really supportive – Occupational Health are very keen to do whatever they can to help, and I spoke to my boss who’s letting me work from home once a week and adjust my working hours. Maybe Lyrica is the reason yesterday was so good, but on a general note being in the office is less stressful than it used to be.

I’m keeping everything crossed that this lasts.


The working day

When I wake up in the morning, I feel so sick with dread that I have to take anti-emetics immediately. I then feel stuck to the loo, and I sit there wondering how the hell I’m going to get to work. After about five or ten minutes, I order myself to get into the shower, and then I order myself through the rest of the getting-ready-for-work routine. If I find myself worrying about the journey in, it means I’m not concentrating hard enough on getting ready, so it’s back to it. It’s a difficult hour, but eventually I get in the car, and not too long after, I’m safe at my desk.

The working day is secretly spent measuring my fluid intake, and calculating an optimal toilet-visit schedule in anticipation of the journey home. I don’t feel hungry, because anxiety has stolen my appetite, but my stomach still rumbles, and I order myself to eat, walk, keep my body ticking over. It’s hard to juggle all of this with actual work I need to do, but the time does pass, and I eventually make it home.

Evenings are free – time spent feeling relieved that my time out of the house is over, and I’m safe for another twelve hours. I can watch TV, play games, drink plenty, and eat properly. Mirtazapine knocks me out pretty effectively at bed time, and then we start again.

What do you do when every day is difficult like this? You celebrate the little things, and take it one day at a time. Yes! I completed another day! Hey, I lasted through that meeting – well done MQ! It sounds phoney, but if you do it relentlessly enough you can absorb some of it – I’ve been in a reasonable mood all day, despite feeling yesterday like I was falling to pieces. That in itself is a bit of a victory.

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.


New year, same crap

It’s a sorry state of affairs when someone is nice to you and your brain goes WARNING WARNING DON’T GET ATTACHED. That said, part of me is grateful for that warning, like I’ve just subverted a threat. A friendly woman (who I’ve known a little while) was caring towards me, and it becomes an attack. Stupid brain.

I’ve been reading through some of my old posts here, and current me seems pretty similar to old me so there’s a lot of solidarity high-fiving going on. In particular I’m drawn to that post I wrote when my old care-coordinator finally understood why I was suicidal (‘A strange kind of closure‘) – because I didn’t look forward to anything – and that’s something I said to Dr T yesterday.

Life is just endless cycles of stress. Get anxious about A, go through A, get anxious about B…etc etc. Even holidays make me stressed, so I don’t have any, which probably makes me ill.

I don’t expect to find a job I truly and thoroughly enjoy. Why should I? My one true, lifelong passion, to write science fiction, is over before it began; my creativity died long ago. I’m not interested in relationships.

I’m here because I have duties, to people like my parents, and I’m here because of the meds; the lithium dampens the suicide ideation, and the mirtazapine knocks me out so at least I can be unconscious if I’m not at work. Literally, I wake up, go to work, come home, and take the mirtazapine as soon as it’s socially acceptable for me to do so (I have housemates). I kill any time in-between with Tetris (I may not be cool, but I do have quick reflexes).

Is this a life at all?

An escape hatch at the base of my neck…?

Last night when I opened my pill box and emptied out ‘Friday’, I realised I was a pill short. The 45mg mirtazapine (/Remeron) was missing, and there wasn’t one in either of the Saturday or Sunday boxes. Actually, I haven’t taken it all week. My reaction: hey, maybe that’s why I feel so miserable!

Can you smell the desperation?

It is an interesting accident though. The withdrawals don’t seem too bad, despite the high dose. What’s even more interesting is that I credited mirtazapine for helping me sleep, but I’ve done just as well without it. Maybe that’s because I believed I was taking it. Ugh I hate psychology sometimes.

I had a night out with some old friends, and during the routine of photo-taking and teasing I found myself secretly wanting to go home, and curl up. Don’t get me wrong, I love my friends, but sometimes it’s so hard to go out and try and be the old me that they’re expecting. And yeah I know you shouldn’t have to pretend around friends, but I don’t think I could stand the concerned looks and awkward questions. I want the easy, ‘blander’ life.

Again I find myself really battling against the old destructive urges. There’s just so much hate floating around; self-hate, life-hate. I hate myself even writing that sentence, it just reeks of self-pity.

I told Dr T I don’t want to be in my head anymore, and I think he thought I was joking. I really wasn’t.

Mentally Stable

Newsflash: MQ has graduated from psych land! Or in other words, I’ve finally been discharged from the psychiatric hospital (outpatient).

Mentally Questionable has become a little less ‘Mentally Questionable’, and more stable.

It was weird walking out of there for what was hopefully the last time on Thursday. Unsurprisingly that place is full of memories; the rooms of the day-hospital that opened my eyes to other patients and problems, the clinic where I let them jack me up with ketamine, the wall that moved when my CPN quit, the crisis team…etc etc.

And I don’t need any of it any more.

After two years of experimenting with all sorts of drugs, my awesome psychiatrist found the right combo to keep me moving, and keep me safe. Applause for her, and applause for:

  • 60mg fluoxetine
  • 600mg lithium
  • 45mg mirtazapine
  • 80/160mg propranolol

She suggested I continue taking these for at least the next two years, and then if I’m feeling stable come down very, very slowly, one drug at a time. I was hoping not to be on lithium for that long (I’ve already been on it a year, and I know it can be damaging long-term), but perhaps I’ll review in a year’s time and see how I’m doing.

Now I’m off the psych books, the main sources of change for me have to be therapy, and obviously myself. I’m not sure how I feel about this. I’m certainly not brimming with confidence. But I’ll deal with that later. For now, I’m just going to celebrate a significant step in the right direction 🙂

When the heart wants change, at any cost

I had an appointment with my psychiatrist today up at the psych hospital, and it’s made me realise that I need to have a really good think about meds – about my expectations of them, and expectations of my psychiatrist, and how I can end up working against myself.

Let me rewind a little bit. For a few days now I’ve been stuck in a sad/low-funk, reminiscent of really bad phases I thought I’d left behind. Naturally, it scares me to be back in this position, and I encounter a fresh sense of injustice at having to feel like this, when most people couldn’t even imagine it.

I see my psychiatrist every 2/3 months, so she is really just getting a snapshot of how I’m doing at any given time. When I realised this appointment was coming up, I knew there was a danger here. If I told my psychiatrist how I feel right now, it could undermine the impressively stable period that came before it, and discredit the combo of meds responsible.

Because the truth is, I think that after years of experimenting, we’ve finally found a combination of pills and dosages that works for me; 60mg fluoxetine keeps me functioning, 600mg lithium numbs the suicidal urges, 45mg mirtazapine beats insomnia, and 80mg propranolol takes the edge off anxiety.

But I realised that despite this, I wanted my psychiatrist to add something, or take away something, or change the dose of something. Because I was feeling crap (and regardless of that being short-term so far), I wanted her to DO SOMETHING. Even if it would be a massive mistake.

I didn’t want her to do something because it might make me feel better. I wanted her to do something because it would mean someone acknowledges how horrible and unfair this situation is. That’s the naked truth here; I was prepared to sabotage years of side effects, withdrawals and other crap just to have my psychiatrist say ‘this really doesn’t sound alright; I think we’d better change something’.

I knew all of this when I went into my appointment today, and I still found myself having to be really honest about what the last few days have been like. Thankfully, my psychiatrist didn’t make any changes to my prescription (she said she’s wary of adding anything else to the cocktail I’m already on), and I’m grateful to her for this. I also suspect I’m not the only person to have this problem, because my psychiatrist even said ‘I know that doesn’t sound very satisfactory…’.

I wish I could have been stronger, but I can’t deny that if I’d walked out of the hospital with an altered prescription I’d have been pleased.