Trouble with tramadol

Today is a dark day. Not dark because anything terrible has happened, but dark because I can see the darkness. Dr T made a casual comment in therapy today about how the world might seem like a joyless and heavy place, and it hit me afterwards that that was spot on for me. I don’t look forward to anything. I start to doubt the concepts of happiness, and love. Creativity. It all melts down to obligation and pressure, with no real ‘win’.

I thought about sitting down and drawing out a mind map of what the world looks and feels like through the eyes of MQ, but my instincts warned me not to. Outlining all the reasons I don’t enjoy living (now and/or in the forseeable future) could be dangerous, and I could do without that given its the time of year when support networks (docs, therapists) tend to be away on holiday.

I’ll come out and say it: I don’t feel all that safe at the moment, because the theme of overdosing has emerged again recently. When I started taking lithium, I had to stop taking ibuprofen (Advil/Motrin) which had always been a bit of a lifesaver for me, so my doc started giving me prescriptions for tramadol. These prescriptions started at a time when I was rebuilding my overdose stash after the last lot was confiscated (after I ODed), and I got in the habit of asking for more tramadol every time I went to collect my lithium. I deliberately hardly ever took those pills, even when I REALLY needed pain relief, because I was dedicated to piling up this stash *in case I needed it*.

A year or so later, circumstances have changed slightly, and I can take ibuprofen, so now I have absolutely no excuse to ask for tramadol. But I will keep asking for it. I know I will. I’ll just feel more guilty about it.

(Yes, I know I should hand all the boxes over to a pharmacist or someone, but I can’t bring myself to do it. I’ve collected boxes of tramadol for months, and I can’t let it go. My brain just tells me I might need it.)

I never claimed to be intelligent…

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A confession

It’s confession time. I wish it wasn’t. I wish everything could be normal, and I’d post about my day. I guess I willingly gave that up. My confession is that last night I overdosed, deliberately, on tramadol (/Ultram).

I’m not sure I even really know why I did it. I was swallowing my nightly med mix, and the thought entered my head that I could add in a tramadol pill (50mg), to help knock me out. And once the strip of pills was in my hands, it occurred to me that I didn’t have to stop at one. I quickly popped them out and chugged them down, knowing that if I didn’t do it fast I would change my mind.

I don’t have any difficulty sleeping now that I’m on mirtazapine, so I really didn’t need any help from tramadol in that sense. I didn’t get high, and I wasn’t hoping to. But there was something about the danger – the possibility of something bad happening – that was irresistible. I’ve never ODed on tramadol before, so I didn’t know what to expect, but from ODing on Nytol (/diphenhydramine) and sertraline (/Zoloft)) I know the effects can be quite dramatic.

I am not proud of myself.

I don’t get why I did it.

A decision

**TW – you might want to give this a miss if you’re not stable. This post isn’t going anywhere **

Pill one and pill two

I want to feel the pull. Gravity calling out to the tops of my eyelids. I want to start a fight that I know I’ll lose. I know the pills will win, and pull me under. But even though I’ll fight against it, secretly, that’s exactly what I want.

Pill three and pill four

The hallucinations. Patterns where there are none, wriggling and twisting in the shadows. A heaviness that will pin me to the bed.

Pill five and pill six will make me sick, literally. Pill seven, eight and onwards aren’t within reach. At least not tonight.

Pills one and two will bring guilt. By pill three, I’ve moved on to shame.

But this side of the mistake, it doesn’t seem to matter. Things aren’t right. I don’t feel right. I’m not sure what is right at this moment in time. So even though I know overdosing is stupid, it doesn’t seem out of place right now.

So, a decision and a gamble; will there be an interaction? I don’t think I’ll be complaining if there is.

Flip a coin

Temptation burning

Trigger warning. Trigger warning. Trigger warning.

I’m looking for something I’ve lost, and when I rummage through my desk drawer something plastic and silvery catches my eye. I pull out a tray of un-popped pills, and stare. I remember these, although I haven’t touched them in a long time. These used to be my escape. My OTC sleeping pills.

It all comes back to me: Go on MQ, take three to knock yourself out, or take five if you want to go off the rails. Put your bin next to your bed incase you puke. Go online and check for interactions with your other meds; if it’s not a huge deal, shut the door, and chug them downWatch the pretty patterns dance across the walls as you wait for sleep to find you.

I feel the shame in advance. The embarrassment at my weakness. The rolling eyes and the shaking heads of my imagined critics.

Stand strong MQ. Please don’t do it.

Swaying in the wind

Today I made a bit of a change and told my doctor I want to go back to having monthly prescriptions (I’ve been on weeklies for a long time to reduce my OD risk). In truth my OD risk hasn’t really disappeared, but I know that if I wanted to OD and didn’t have enough prescription meds, I’d just turn to over-the-counter sleeping pills.

The reason this change feels noteworthy is that it’s me finally acknowledging the loss of the second part of my ex-treatment trinity; my GP. This time a year ago he had me coming to see him each week, and I knew that if things were rough he could help me through it. He retired last summer, and I switched over to a different GP who is quite possibly the loveliest, politest woman in this town, but she’s not the same. The support isn’t the same, and the trust isn’t there. My old GP knew my mental state by looking at me. He knew when I was lying, and he knew what was best for me when I didn’t.

As you can probably tell, I miss him a lot, and I valued his support so much that I continued going to the surgery every week to get my prescription and sometimes see the other GP, just in case things changed. But they haven’t. I’m giving up, and saying goodbye to the hassle of phone calls and pharmacy queues every single week.

The other news today is that I’ve got a job interview lined up, for a (temporary) flexible and well paid job near where I live. It’s very computer-system based, but the person I’ve spoken to knows I have little relevant experience and is still interested based on a positive reference from my last employer. If this works out (and I don’t dare hope that it will), it would solve an awful lot of problems. Bye bye stressful-childminding. Hello financial independence, most importantly the ability to pay my own therapy bills.

I’m going to head up to my Dad’s office tomorrow to try and get a bit of relevant experience by playing around on their systems (safely, of course).

For now, I’m going to bury myself in hobbies again, and pretend that I’m okay.

Batten down the hatches

I can’t deny that I’m feeling pretty horrible right now. Horrible enough that I want to crawl into a small place and lie there curled up in a ball. I’ve felt on the brink of tears for much of today, which is unusual and uncomfortable for me, and my old self-harm urges are prickling.

I had therapy with Dr T around noon, and I tried to communicate this feeling to him as accurately as I could. I told him about yesterday’s ‘Do I want this?‘ post, and I think he understood. If I try and open any of the potential doors into the future, be it ‘career’ or ‘family’ or whatever else, pain starts to walk through (e.g. I might not like the job, or I could be a bad parent etc), so my defences slam those doors shut. Dr T says I think I’m protecting myself, when actually closing these doors means shutting out the goodness I need too.

He’s right.

That doesn’t solve anything.

It can never solve anything. have to. I have to find the motivation to open those doors, and face down the demons. Risk the hurt for the chance of something better. A meaningful relationship. A career that builds my self-worth.

And I want to scream as I write those words. They don’t seem real. They’re ideas that are here to taunt me, unobtainable, but so available to everyone else that they can’t understand me falling behind.

The problem with asking ‘Do I want this?’ is that it very quickly leads me to the questions ‘Am I broken?‘ or ‘Is this permanent?‘, and I can’t find positive answers.

I told Dr T this situation scares me because I’ve been here before. These questions aren’t new, and I know where they end – the one, logical, answer. My inability to act on it, like my seeming inability to recover, depresses me further, and makes me feel like my head should explode under the pressure.

I will not hurt myself. I will not touch those tools, or reach for the pills. I will not run away. Not today. I’m trying not to be that person anymore.

But the post-DSH/post-overdosing-me doesn’t have any better ideas for coping.

Coping. Continuing.

Alternatives to short term self-harm (TW)

I have a history of DSH in response to feeling emotionally overwhelmed; when I cut/burn/overdose, I effectively shut myself down. A year ago, my (now) ex-CPN was the first to address this, and she introduced me to two techniques: 1) wearing a rubber band around my wrist to ping myself with if I felt the need to self harm, and 2) delaying: if I want to self harm, I have to wait five minutes and see if I still want to do it (and repeat until the urge goes away).

These are good ideas in theory, and I found they worked for a while, but eventually they weren’t enough. My CPN couldn’t understand why my DSH persisted, and apparently decided that since she ‘wasn’t helping’ (her interpretation, not mine) she might as well discharge me.

Since then I’ve been relatively un-supported regarding my DSH, until today at my weekly ‘Reasons Not to Kill Yourself’ session at the psych hospital. First off, Nurse L identified that my DSH methods are intense and short term, (as compared to alternatives like denying food/drink etc), so she wanted to give me alternatives that would have the same kind of immediate impact but without any lasting damage. She came up with the following, adapted from techniques used with adolescents:

1) Ice bowl: Fill a bowl with water and ice, and then dunk your face in it for 15 seconds. Come up to breathe, and then repeat until you’ve done this 5 times.

2) Cold shower: As it sounds, turn the shower to the coldest setting, and jump in WITH your clothes on. Stay there until you’ve counted to 60.

Nurse L explained the theory behind these suggestions; primarily that they are painful, and will cause an adrenaline rush, but they won’t actually harm you (in fact, the ice bowl is apparently really good for your skin). After the temperature shock from both of these, you’ll be freezing, and all those overwhelming emotions will be dampened for the time being – all you’ll want to do is wrap up warm and sleep. This is what they used to do before tranquillising patients in psychiatric hospitals: put them under a cold shower, and a minute later they’ll calmly go to bed.

I like that Nurse L explained to me how and why these techniques work. I like that they’re private, and relatively easy to do. The trick is turning to these methods before your brain goes for the old (and more damaging) ones; that’s why you have to get in the shower with your clothes on – in the time it would take to undress, you might change your mind and do something harmful to yourself.

People aren’t born with tendencies to self-harm; it’s a learned behaviour. I don’t remember where I learnt it, so I would guess I must have seen it on TV, or read it in a book. There’s something really sad in that, but there’s a positive to take away too – if self harm is a learned behaviour, it can be unlearned, or altered.

That’s what I need to remember now. It may be a long time before I lose the urges altogether, but I can learn better ways of acting on them.