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 🙂

Anxiety Central

Apologies for the radio silence; things get pretty basic when your whole day, every day, is about managing anxiety. It’s a pretty nasty situation; I feel so sick ALL THE TIME, I struggle to eat anything resembling a meal, and I keep coming unpleasantly close to physically throwing up. Yuck.

Why the anxiety? I think it’s primarily because therapy has hit a nerve. I can hardly bring myself to speak with the current subject matter, which I guess is a good sign that we’re working in the right area. It’s still kind of broken though; I can’t shake off that Dr T might be looking at me disgusted, judging, and sometimes I actually feel worried that he might be about to say something along those lines.

So yeah, each day is just about getting through the waking hours without actually throwing up, occasionally interspersed with therapy which may or may not make a difference to that. Work, home, it’s all about survival, and trying to look normal.

But before I get too upset about it, I wonder how much worse it would be if I wasn’t taking the monster propranolol (anxiolytic) each day…

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.

Don’t light a match; you may start a fire

Despite all the whisperings to the contrary, it’s looking like my three month contract will not be renewed when it ends in April. As you can imagine, this will be one hell of a blow to my financial (in)stability, but maybe it was stupid to put too much faith in what my bosses said in passing. I will miss my current workplace, particularly the people in it, and I will miss being busy. Empty time can be deadly.

My mood is starting to dip, and I would guess it’s probably related to this work stuff. I can see all the tell-tale signs of a mood shift; I’m restless, fidgety, smiling one minute and borderline screaming the next. I found it quite difficult to concentrate on the things I was supposed to do today, which is going to give me some pain tomorrow.

I also can’t get therapy off my mind, which is intensely annoying. I mentioned in my last post that Dr T thinks I resent him for taking time off; I’m pretty confident that actually I don’t, but I think at some level I’m starting to resent this disagreement. In my eyes, if Dr T was right, that would make me embarrassingly needy, and as much as I wish I didn’t care, it bugs me that he might see me like that. I don’t think he is right, but if I were to argue it, it would look like I’m being very defensive. No win. I really, really wish I didn’t care. All my old avoidance defence mechanisms are kicking in, which will make Monday interesting.

The good news is that the daily-propranolol trial is going well; I was worried that it might make me feel dizzy given how it lowers blood pressure, but that hasn’t been a problem. And not feeling sick everyday is lovely. It makes such a difference; now I can return to regular meals three times a day, whereas before I had to just eat whenever I wasn’t feeling too anxious, and miss some meals altogether.

I wonder where my mood will go tomorrow.

All quiet

I seem to be having something of a quiet spell recently, and I’m not sure why. Maybe there’s less to vent; I’m relatively stable, and there’s no obvious life-crap at the moment. Work is going well. My social life is…well, empty, but no one’s giving me any grief about it. Financially I’m just about okay. Maybe I’m quiet because life is quiet. I think that has to be a good thing. I’ll consider it my annual holiday.

I saw my psychiatrist at the end of last week, and we’re only making one alteration to my meds; I’m now taking propranolol (/Inderal, 80mg slow-release) daily for anxiety. Now, I’ve had access to propranolol for a couple of years in differing dosages, and generally I’ve been very much against taking it on any kind of regular basis; I feet like I should be able to handle anxiety myself, without drugs, on the basis that everyone gets anxious sometimes, and the vast majority don’t have to turn to ‘treatment’. But my psychiatrist pointed out that I said I felt sick every day, when I don’t have to. And she’s right, so I’m taking the pills. I’m still not 100% comfortable with it, but I have to say, it is nice to feel less on edge.

It’s certainly nice to have my stomach quit somersaulting when I head over to Dr T’s office for therapy. Our session today was pretty interesting, because Dr T thinks I resent him for his upcoming vacations, when actually I don’t resent this at all. Unfortunately his argument is constructed in a way that I can’t defend my position, which is a bit annoying. He’ll be on leave three or four times over the next couple of months, but that isn’t too unusual. I won’t really notice very much since I’m working.

I don’t think I have any other updates; like I said, things are quiet. Hurray!

Hope is dangerous

On Wednesday I agreed to my GP referring me to a senior psychiatrist at our local psych hospital. I didn’t believe they would contact me *in time*, and I only agreed in order to take some of the responsibility for my care off of my GP, who I owe so much. So imagine my surprise when the hospital called me at 9am this morning, ‘asking’ me to come in at noon.

I felt absolutely sick, despite immediately reaching for the propranolol. I genuinely didn’t expect to hear from these people, and I hadn’t thought about how to handle an assessment. Usually my policy is honesty towards those who are trying to help, but I can’t risk being locked up. This was turning into a nightmare, and when I keep secrets it tends to show on my face.

The consultant psychiatrist I saw was friendly, and kicked off by reading me excerpts of my GP’s referral letter – I liked the bit that said ‘0sername is making a rational decision, and it is almost impossible to find a cogent argument to dissuade her‘. I disliked how much this apparently worried him. It then turned into the standard psych list of questions: why do you want to die/why haven’t you done it yet/are you sleeping okay etc.

End result: I’m no longer med free – they’re putting me back on fluoxetine (Prozac) because that’s worked for me before, and adding lithium as apparently that has anti-suicidal effects. Riiight. And I have to see the ‘assessment team’ (i.e. the infamous ‘crisis team’ in disguise) asap, to negotiate me handing over my bottle of X. HA, GOOD LUCK! Following that, I’m supposed to be seeing the psychiatrist again in 2-3 weeks. 

I’m not entirely sure what I make of all this. I think a few months ago I would have been delighted to go back on fluoxetine since I opposed being taken off the one drug that worked, but it takes 4-6 weeks to work. The lithium takes even longer. And to be frank…I don’t have that long. The idea of seeing the assessment team is irritating because I already know I’m not going to give up my exit materials, but I’m told it’s important that I give this a go. On the other hand, a positive is that the psychiatrist recognised how inappropriate it had been for me to see junior psychiatrists who rotated (aka disappeared) every six months, given that I have trust issues, and she’s going to find me someone senior who won’t do that.

…except again, given time is running out, what difference does this make…?

I’m anxious, because I can feel a tiny flicker of hope inside me, when I have been devoid of hope since Monday. Hope is dangerous. Very dangerous. It makes you sign up to giving things another go, and blinds you to the fall that always comes. It may be a week away, or a month, or longer, but you always end up back where you started or worse, wondering why you put yourself through this again. 

My position at this moment in time is unique. I have exit materials; my bottle of X. I have minimal commitments – I don’t have a job, I’ve just finished education, I’m not in a relationship, and there’s no one dependent on me. This is a real opportunity. I can’t throw this away just in case what happened today changes something. 

My brain hurts. I haven’t eaten since yesterday lunchtime. Once again, I don’t know what to do.

One down

I’ve just arrived home from my first exam, and I’m delighted to say it went really well. It wasn’t the paper I’d have written for myself, but instead the paper someone who knew my capacities better than I did would write. Perfecto. Sadly perfecto would never equal 100% in this university world, but I’m hopeful of a strong 2:1 for this paper.

It’s actually been a strange day – except for the three hours in the exam building (thank goodness), I haven’t felt very ‘with it’. It’s like I know the day is real, but somehow I’m not living it. I wonder if it’s the new dose of propranolol, and if it is, I have massive respect for this medication. I only felt sick once today, and even then I was no where near actually throwing up. I haven’t been shaking, or panicking. But as I said, today hasn’t felt very real – maybe I just don’t recognise exams without adrenaline. 

And I didn’t see Jane = bonus!

The sad tinge to all of this is that I knew today was going to be my strongest paper, so it’s quite likely to be downhill from here (for the record, that’s not me being pessimistic, as certain tutors would tell you). Tomorrow brings my hardest paper. But I know that if I get through that one, the others should be easier. And I know that by physically sitting there for each one, I never have to do it ever again.

One down, six to go.