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.

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!

Something I need to think about

The last few days have been nice in some ways, and weird in others. My mood has been stable, and I’ve continued to enjoy being at my place of work, purely because of the friendly and supportive people I’m surrounded by. There is even talk of my contract being extended (although I’m not sure I buy into it yet; we’ll see in April).

The weird side of things is illness related; I guess we’ve reached that time of year when most people are ill with one bug or another, and slowly but surely all the people at home and most of the people at work have gone down with a virus. Surprisingly given my exposure, I haven’t shared their symptoms.

There is something wrong with me though; I’m exhausted most of the time, and walking tiny distances etc really wears me out. It can be quite scary – today when I walked from work to Dr T’s office I wasn’t sure I was going to make it, and I had to keep stopping. I was mentally praying I wouldn’t end up on the ground, and fortunately I did manage to complete my journey. I also keep having prickly hot flushes. I wonder if I’ve got a mild form of whatever bug is doing the rounds at the moment, although it would be odd for my immune system to be stronger than other peoples’.

On the topic of health, I’ve been thinking about my recent stability in the mental health arena, at least in regards to dangerous behaviours and suicide ideation, and it lead me to tell Dr T today that I don’t think I need to see him twice a week any more. I was expecting him to be thinking ‘Oh thank goodness, MQ has finally realised this…’ and feel relieved, so I was surprised when he actually said he wasn’t sure that was a good idea; that there’s more to therapy than managing stability, and that I might need to maintain this level of access to the resources of our therapeutic environment.

To be completely honest, this had not occurred to me. I’ve always measured my need for certain frequencies of sessions in terms of how much I’m struggling on a day to day basis, but as Dr T said, there is a lot more to the work we do than just risk management. If I have recently started to ‘come alive’ as Dr T suggests, I might set back the speed of progress in the long run by withdrawing from therapy, especially if it is therapy that has fostered the improvement.

I guess I’ll have to think about it. I might mention it to my psychiatrist when I head up to the psych hospital for a medication review tomorrow. I wonder if she will change my medication; I had a blood test on Monday and today I learned my lithium level has dropped to 0.4, which isn’t great news. We shall see.

Bare truths

The weirdness continues – the low mood that seems to follow me around like a shadow, but doesn’t quite touch me. The symptoms are adding up; in addition to the things I mentioned yesterday, I’m strongly drawn to non-cheerful TV programmes (I’m currently alternating between The Walking Dead and House), sad songs stick in my head, and my self-harm urges are building. Big time. My sleep is broken by unpleasant dreams, so waking early is almost a relief. Sometimes I feel sick, and sometimes I have no appetite at all.

I got a letter today informing me that I have an appointment to see my psychiatrist on Christmas Eve…I think this is a good thing. I find the Christmas period really hard to get through, but if I know I have to go to the hospital on the 24th I can pretend Christmas isn’t even here until the day itself.

It occurred to me earlier to try an exercise – to write a list of truths, about things relevant to what I share in this blog. Bare truths, with minimal thinking. Whatever comes to mind…

  1. I am mentally ill. The specific label is always in flux (based around ‘depression’), but that clinical term will never quite capture the details of this illness. I’ve fallen out of sync with the ‘normal’ world, but I haven’t fallen so far that no one can see me – the WordPress community has taught me that.
  2. For me, the future does not exist beyond the next month. While I’ve lost the worst of the suicide ideation, I’ve believed for a while that my life span probably doesn’t stretch all that far ahead of me.
  3. I am alone, but not lonely. I have friends and I have family, but my social life has shrunk dramatically, and that suits me now that I hold everyone away at a distance…
  4. ...because I lie a lot. They aren’t malicious lies so I don’t feel guilty about it; they’re lies to stop people worrying. I’d feel guilty if I didn’t do this.
  5. I’m terrified of dependency on anyone, to the point that I damage my relationships with people to ‘protect’ myself.
  6. I don’t hate myself. I don’t love myself either, but I don’t hate myself. I’m fine with who I am, I don’t have huge regrets, and I wouldn’t change the things I’ve done in the past – they make me who I am.

Six straight truths, two secrets, and one confession. I think this list really sums me up at the moment.

The ‘K’ countdown ends

…tomorrow. The closer I get to starting this ketamine treatment, the more I feel nervous, but overall it’s not too bad. I just hope it’s worth the gamble of lying to my parents.

I saw my psychiatrist this morning, and I’m increasingly realising how lucky I am to have her; she’s nice, but not sickeningly-sweet-smiling-all-the-time nice, and she seems to actually give a s***. We’re tweaking my lithium dose to see if it improves the memory problems I’ve been having recently. There wasn’t much to say apart from that, as now we need to wait and see if the ketamine treatment works. I’ll see her again in about a month’s time.

My mood isn’t amazing at the moment, as evidenced by some recent shopping sprees. Dr T cancelled therapy yesterday, and I guess that didn’t help.

I just keep struggling with this big question of ‘what’s the point (of living)?’. What am I looking forward to? What do I want from life? Currently it feels like the answer is ‘nothing, I’m done’, but given what I’ve learned recently about the deceptive nature of depression, I’m managing not to act on it. It is hard though, and when my mood falls I know I might lose that insight. This is why I was nervous when my psychiatrist said we should lower my lithium dose, since I have found lithium to live up to the anti-suicide claims, but we don’t have much choice.

So, I plod along, waiting for a miracle like a breakthrough in therapy, or a good response to the ketamine-infusion tomorrow. But it does feel exactly like that, waiting for a miracle, which makes it frustrating that I’m putting myself through the potentially endless waiting period.

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.