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 🙂

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I feel like I’ve done it. In reality I haven’t. But maybe I wish I had done it.

Today has been a real monster of a ‘trigger’ day, and for once it’s not all my fault.

To kick it off I’ve been reading this series of fiction/fantasy novels that I loved as a teenager, and more have been published since I first read them, so I’ve been devouring the new books and today discovered that the last one features a girl who self-harms. Cuts. When I read the blurb I was kind of dismayed, but I love the series so I’m reading it anyway, and the effect is that I have to keep reminding myself that haven’t cut myself. It’s really strange; I almost feel sure that I have self-harmed, and I haven’t.

And now this afternoon Netflix suggested that I watch ‘Girl, Interrupted’, which so far I’m enjoying, but again I feel haunted by my trips to the psych hospital etc, which compounds the self-harm stuff. I would have paid big money to have Whoopi Goldberg as my CRN though.

Actresses aside, the reason I’m even writing this is because I’m increasingly aware of how miserable I feel. Maybe that’s selfish, maybe I have no right to be miserable, I won’t argue with you, but ultimately I just feel like crap, and it’s getting worse. I’m even slightly jealous of some of the characters in ‘Girl, Interrupted’, because they may be stuck on a ward but at least they can act out how they feel.

Ketamine-infusion therapy: Day Two

Today hosted round two of the ketamine-infusion therapy I’m having on a fortnightly basis, and I think it happened to be well timed – my mood has been really low recently, so I was quite keen for a dose of emotional-numbness.

The experience itself was mostly the same as it was the first time, so if you’re interested in the details check out that post. Once again I was off my head within two minutes of the drip being attached, but since I knew what to expect I was better able to keep myself grounded. The nurse laughed at her memory of what I was like last time (‘You found it quite…profound!’), and I had already made a mental decision to stay as silent as possible today.

I can’t accurately describe how intense that forty minutes was, as before. You lose all sense of time, and you can’t remember what year it is, let alone what day it is. You can hear what’s going on around you, but it’s hard to keep a memory of it (this time I made a real effort, and I can remember the various things that happened on the ward, although I can only guess how much time passed between each one). When you reach the halfway point of the treatment the nurse (/’sitter’) asks you what you’re experiencing, and you come across crazy just because you don’t have the words. For forty minutes, life stops. The world spins too fast. Nothing stays still. There’s a time delay in moving your body, while the words in your head are magically heard by those around you unless you concentrate on keeping them private.

I told the nurse that as stupid as it might sound, the closest I could come to describing the scale of the experience was that it was like being in the matrix (as in, the film trilogy). The nurse told me that she’d had patients saying the same thing, and that they described being able to see the code of the universe, but that’s not what I meant. No hallucinating. Just the overwhelming sense that time has been stopped.

Towards the end of the forty minutes, I decided I didn’t like it. I had hoped that since I knew what to expect this time, I might have better luck fighting the worst of the dissociation, but I didn’t make much headway. and I struggle with that lack of control. It took me half an hour to even be able to stand up once the drip was finished, and I came away feeling like I’d been through more of an ordeal than last time.

That said, I don’t feel sad, and I did before I went in. I feel numb. I can’t even imagine feeling sad (or happy, or angry, or excited etc etc). The nurse says this treatment does seem to be helping me. I think I’ll reserve judgement until I can think a bit straighter.

Ketamine-infusion therapy: Day One

Today I had my first ketamine-infusion treatment for depression, and OH MY WORD it was not what I expected. The information sheet I was given a week ago said I might feel a bit drunk and disoriented…Ha. Ha. Ha. Understatement alert.

My appointment was at 10:30 this morning, and when I arrived I found the team was running late. The treatment is given in the same department as ECT, and it was a bit unnerving sitting in the shared waiting room with a confused patient who kept insisting she’d seen me before. Fortunately a nurse came and led her off to the ECT room after a few minutes, and eventually a nurse we’ll call Nurse K came to get me.

I had to make myself comfy on a hospital bed stuck in the corner of a room, and an anaesthetist came and put a cannula in the back of my hand. Nurse K took my blood pressure, and then connected the ketamine drip.

The info sheet said I would start feeling the side effects after about ten to twenty minutes.

Within two minutes I was losing touch with reality.

I don’t know how to accurately describe the next forty minutes. I’m not sure how accurately I remember it. My hearing was fine, but I had double vision, and everything was moving. It felt like my body was moving too, even though I was lying still on the bed. There was some kind of delay between thinking and acting, and I could hear that I was talking without registering that my mouth was moving.

The weirdest thing was that it felt like I kept waking up/coming round, repeatedly finding myself thinking ‘Oh okay, I’m back to normal alertness now, the last however long was dreamlike’, over and over, despite never losing consciousness. Apologies if that makes no sense…I guess that was the break with reality. Deja vu x 100, staring at the picture of a penguin on the wall and using it to centre myself now I was ‘back’.

Nurse K sat next to me the whole time, and I tried very hard to try and appear normal to her, even though I felt like I was on the trip of a lifetime. I’m not sure why I bothered. We were able to chat and joke, but she knew I wasn’t all that ‘with it’, as demonstrated by some crap attempts to explain what I was experiencing. She had to do a questionnaire with me at the start, middle, and end, asking about the side effects, and it was hard to concentrate enough to answer her questions.

The forty minutes passed (I lost all track of time, it could have been five minutes or a lifetime for all I knew), and once it was up Nurse K disconnected the drip and gave me some time for the worst of the disorientation to wear off. It took a good twenty minutes to lose the double vision etc, and once I was safe to walk I was led through to the recovery room where another nice nurse made me a cup of tea and some toast. I gradually regained my sense of mental-sharpness, and was finally allowed to spend the rest of the day in the Acute Services (Day hospital) centre. It was nice to spend the afternoon chatting to one of the friends I’d made there, and it certainly beat sitting around in the recovery room until 4pm.

Now I’m back at home, and while I do feel a bit odd, it isn’t too bad. I felt sick for a while this afternoon, but that has passed. Mood wise…I don’t know. I think I might be numb.

I’m going to try and sleep the rest of the ‘oddness’ off, and I’m curious to see how I’m feeling tomorrow.

But I will say again, I did not expect the treatment to be as intense as it was. I was almost completely off my head. Nurse K said some patients have panic attacks during treatment, and I can see why. And yet, the dose we receive is only 20% of what recreational users take – I can’t imagine what the full lot is like, and I don’t want to. This was not my idea of fun.

Check in: Just chugging along

First off, my apologies for the quiet spell; I’ve been finding it really hard to write here recently. I don’t know why, but I’ll bet it’s not a good sign. I also know I’m not alone in experiencing this at the moment, so I’m sending out a wave of empathy to those who are also finding their communicative channels blocked up!

Thursday of last week was my last day at the Acute Services Day Hospital (psychiatric), and I didn’t think that was a big deal until everyone starting saying goodbye and wishing me all the best at the end. I was a bit overwhelmed by how many people seemed to care, and I wasn’t a million miles from crying. I’ve swapped phone numbers with a couple of the friends I made there, and I hope we do keep in touch. It has been fantastic to spend time with people who’ve experienced similar problems that just aren’t talked about in the outside world.

I’m not exactly being cut loose from the hospital though; one of the nurses had a chat with my consultant, who has decided I should have a care-coordinator/CPN again. I think this is a good thing, but I’m nervous given the wounds left by Nurse L a few months ago. Perhaps the way forward is to have very, very low expectations of the new CPN.

My mood is stable at the moment, and a bit better than it was on Wednesday. I guess I calmed down, and that last day at the Day Hospital reassured me that my social skills aren’t non-existent. However I still didn’t feel up to attending a dinner party full of people I don’t really know, so I invented a reason to head to my parents’ house for the weekend.

Visiting them presented challenges of it’s own given the whole ketamine-infusion ultimatum thing, but I managed not to let slip that I’m going ahead with that drug therapy. It starts on Friday, and I can’t say I’m feeling nervous about it.

Not yet, anyway.

Not exactly reassuring

When I told my psychiatrist that I was willing to try ketamine-infusion therapy a few weeks ago, I made a conscious decision there and then to keep it a secret from my psychotherapist, Dr T. My reason? Quite simply, I didn’t think he’d approve. He’s not the biggest fan of meds, in my case at least.

But after dealing with the shock of the ultimatum from my parents on Friday, I progressively felt worse and worse, to the point that I had to tell Dr T what was going on when I saw him on Monday, ketamine and all.

Ten points to MQ for correctly predicting that Dr T would not like this new therapy.

What’s ruffled me is that he has a good reason for being concerned about this; he says the ketamine therapy may be raising patients’ moods by allowing them to ‘zone out’ from what’s troubling them – that’s incompatible with talking therapy that needs to address the very things we may be wanting to escape. In the past it has always been my instinct to cling to states of detachment, because they’re so much easier to bear. Dr T says I’ve made great progress since then, but I can see how temptation may soon present itself to me.

Of course, being a great psychotherapist, Dr T didn’t outright tell me not to go ahead with it or anything like that. He just made damn sure I understood his point.

At the Day Hospital today the lead doctor for ketamine-infusion therapy pulled me out to do some more tests, and I shared Dr T’s concern with him, wanting to know how exactly the ketamine relieves depression. Understandably the exact mechanism isn’t known, but he told me something along the lines of ‘it dampens your inner dialogue’. That was not reassuring.

This was made worse when he showed me out of treatment area; the nurse who assessed me on Friday was escorting another patient away, and this patient wasn’t okay – she was walking very slowly, and kept asking the nurse the same questions over and over again. It hit me – Tuesday is one of the ketamine-infusion clinic days – so could this be me next Friday?

I hope not. I really, really hope not.

To cap it all off, one of the activities we did at the Day Hospital has really depressed me by making me realise that I have one core goal in my life (to publish a novel), and that I’ve been procrastinating with it because I’m terrified of facing the possibility that I can’t do it. Because if I can’t do it, what do I have left to make me look forward? What do I really aspire to? I feel so dangerously stuck as it is.

Reaching out

Days seem to be flashing past, and I desperately need things to slow down. I’m tired, and stressed out. I can’t seem to relax at all. I can’t switch off. And as I mentioned in my last post, I have a strong sense that this can’t last. Or more accurately, that can’t last.

At the Day Hospital (part of the psychiatric hospital) I once again found myself floundering after the morning sessions; I can only keep up the smiling for so long. I made another friend, and watched my friend from Tuesday slip towards being sectioned. That was painful. By the afternoon I was really struggling to engage with any of the activities, and when my nurse offered me a 1:1 I knew I had to accept it, even though I don’t feel hugely comfortable with him.

I laid it all out on the table – my mood is nose-diving, my stress levels are rising, I’m making silly mistakes all over the place, and ultimately I’m scared about how this might end. Despite my misgivings, this nurse came through for me. He listened, and instead of blandly reassuring me he drew up an action plan – he’s going to contact my psychiatrist, and ask the assessment (crisis) team if they can offer me any more support. He wanted me to see my GP about the whole memory/mistakes thing, and he’s going to phone me tomorrow to check how I am. I’m really grateful to him for all this, and I told him that.

Tomorrow I have my screening for the ketamine-infusion therapy trials. I did manage to tell my Mum about this over the phone, and she immediately said she didn’t want me to do it, at all. She reckons my brain chemistry is more ‘delicate’ than other people’s because of the reactions I had to quetiapine (Seroquel) /risperidone, so I shouldn’t take the higher risks of a trial-stage treatment. I do want to explore this treatment option, but I don’t want to worry her. I’m considering lying and saying I’m not having it if I decide I do want to go ahead with it. Let’s see how it goes tomorrow.