It just hurts

Last night was rough, and I had hoped that the increased mirtazapine (Remeron) dose would bring it to an end…but no. If anything, it was harder to get to sleep, which was bad timing.

The crisis team phoned this morning to see how I was doing. I’m usually okay in the morning, so I didn’t have much to report. The lady I spoke to asked about my plans for the day, and on hearing that I didn’t have any she urged me to try and meet up with a friend. An hour later Spike and I went for coffee.

Spike is possibly the only friend I can be almost completely open with (he has his own struggles in the world of mental illness), and it was good to tell him about the referral to the day hospital etc, but somehow I came away feeling like my mood was slipping. In no time at all it fell through the floor. That pain is awful. Excruciating. I can’t shake it off.

I don’t know if I can win this battle. There have been some positive signs – last night/this morning I became a bit obsessed with the idea of travelling back to the coastal town where I first decided to end my life, but I knew that it wouldn’t be safe for me to go there a third time, especially in this state, and I managed to stop myself. I haven’t self-harmed in a couple of months, despite some REALLY strong urges (risk taking doesn’t count!). I’m not sure I’ve ever been this safe while feeling so bad.

But my fears over how long I can keep this up reassure me that being admitted to the day hospital is what’s best for me. I keep questioning whether or not I need to go, worrying that I’ve somehow said or done the wrong thing to cause my psychiatrist to make a mistaken referral, but I just went to the appointment and told the truth. I guess my psychiatrist knows as well as I do (or better) that while I might be safe in this exact moment, it could change rapidly, and I am not known for asking for help when I’m on the brink of hurting myself.

Please can tomorrow feel better. Please. I can’t take much more of this.

A step closer to inpatient

I saw my psychiatrist this morning, and within the first five minutes I found myself disassociating. I had explained my situation, and it was being suggested that we up the lithium dose by 50mg. If that was it in terms of help, I could almost feel the crash starting.

But changing the lithium was just the start.

As of Tuesday I have to start attending the Day Hospital. I’ve seen this part of the psych hospital in passing with Nurse L; there’s a big group room with plenty of chairs, puzzles, books etc, a kitchen, and a couple of smaller consultation rooms.

There are also motivational messages on big whiteboards, and lots of leaflets. Doors that only the staff can open. This is the closest to inpatient I dare go, and if I’m perfectly honest, I really don’t like that I won’t be able to let myself out of that part of the building.

You’re supposed to be there 9am-3pm everyday, but I’ve already said no to that. Apparently we will negotiate a schedule on Tuesday.

I’m going to begin ketamine-infusion therapy. I doubt it will start for a couple of weeks because I need to see the trial leader and have a physical assessment first. I haven’t told anyone about it, and I don’t really plan to.

The crisis team will resume phoning me daily until Tuesday. Joy. I hate talking to random health professionals on the phone about my safety etc, but I couldn’t give a real reason why it would be bad for me.

My mirtazapine (Remeron) dose is being doubled. Bring on the sedation.

It feels like a lot to get my head around, but I have to say, I’m impressed. I kind of wanted to give my psychiatrist a hug by the end; she just knew all the things I wasn’t brave enough to say myself, and she understood that this appointment was as much about giving me hope or something to hold on to as it was about the meds themselves.

I’m fine with the med changes. I don’t think 50mg of lithium is going to make much of a difference, but at least that goes for the chances of experiencing side effects again too. 30mg of mirtazapine is probably going to turn me into a slug for a little while, but it did that at 15mg and my body adjusted within a couple of weeks. As for the ketamine-infusion therapy…why not give it a try? It’ll be done tentatively; you start with one infusion a week for three weeks to see if you can tolerate it before they up the frequency to achieve the target infusion. If it’s not for me, I can drop out after that 3 weeks.

Day hospital….this sucks. At least, in my head this sucks. I probably shouldn’t judge until I’ve been there a day or two. I just keep picturing getting extremely bored, not wanting to do group therapy etc, not wanting to interact with any of the other patients…Pfff we’ll see.

Dr T will not be pleased by any of this, but that’s another matter.

Embrace the fire

I sit here poised to write this post not quite knowing what the contents will be. And yet at the same time, I know beyond a doubt that I need to write something. It’s like there’s a huge blob in front of me, jumping up and down while waving flashing signs, but the words are too blurry for me to make out.

Let’s start with how I feel. I feel…weird. I know I’m too drugged up; illness alone can’t account for how much time I need to spend asleep at the moment. It’s ridiculous, but probably not surprising when you combine mirtazapine (Remeron) and tramadol. I sleep in until late morning, need an afternoon nap, and then go to bed around 9pm. I’d go to bed earlier if I thought no one would notice.

Mentally I feel weird too. Very weird. I think that without lithium, I’d be angry, and ironically it’s frustrating that I can’t feel that. Like a blocked pipe; I’m just getting drips. But I have to keep reminding myself that lithium is also keeping me alive. Brain dead, but breathing.

Today I saw my old GP’s car parked outside the surgery (I notice these things), and it hurt. At least, I think it did. I do miss him, and I felt something unpleasant, but it was watered down enough that I can’t be sure. Or lithium-ed down, if that can be a word. Once someone I cared about/trusted leaves, I need them completely gone from my life. For some reason I’m very black and white about it, so once my GP retired he was GONE, in capitals. Forever. It’s uncomfortable when life doesn’t follow my absolutes.

I also realise I could walk away from therapy right now. I say that a lot, and it’s not often true, but today it really is. It’s a statement about trust. And a statement about giving up on ‘hope’. Finally. Now that my psychiatrist has mentioned ECT I feel like we’ve come to the end of the medical road, as I’ve always imagined that would be the last resort. That leaves therapy. And after 2.5 years, where are we? I’m more ‘fluent’ (I filter faster). I understand more about why I am the way I am. I value these changes, genuinely. I just don’t see a conversion to life-change, past, present or future.

Last time I lost all hope I tried to commit suicide for the second time. When all the doors are shut (because there’s nothing you want behind them) the logical thing to do is End. It’s annoying I can’t naturally die of it; I certainly feel like I should have by now. If I think about it, it’s quite tempting to stop taking my meds, or at least the lithium. It isn’t removing darkness; it’s just taking the fire out of my ability to act on it. Makes me think of machines making a heart pump and lungs breathe when the body is really already dead.

I could let depression reach it’s conclusion. By all means tell me that I’m not my illness, but this partner isn’t ever going to let go.

I can’t tell you how tempting this is. Stop meds, and embrace the fire.

Question marks

I don’t feel great, physically or mentally. Physically I feel hot a lot, and weak, like gravity has suddenly intensified making it a struggle to drag myself anywhere. Earlier I wondered if I’d actually be able to get off the bus I was on (I managed). Mentally…I’m lacking an accurate descriptive word.

Having had some time for reflection on the job rejection, I’m okay with it – the sadness I sensed this morning isn’t about having ‘failed’ (I haven’t); it’s more like disappointment that I have to resume the job search. It’s tedious, and it leaves a lot of question marks hanging over my semi-immediate future.

I wish there was a dial I could turn to improve my mood. My mirtazapine (Remeron) is living up to it’s reputation by giving me the munchies, which is affecting my weight and getting me down a little. When I listen to music I find myself drawn to the songs that express anger, so there’s something floating under the surface. My dreams continue to be unpleasant. I’m struggling to concentrate. And clearly, I’m also struggling to find any positives.

On Friday, I have therapy with Dr T (who has just returned from a six week vacation).

I. Don’t. Want. To. Go.

Actually it’s more complicated than a simple aversion – I feel like I can’t ‘do’ therapy at the moment. I’m living in Survival Mode; getting through the trials of each day by trying to shut out unwanted thoughts and feelings. That’s not compatible with therapy, especially given the events of the last six weeks. I could turn up to the session, but I don’t know how to switch off this mindset and open up.

And more importantly, I’m not sure if I even want to.

School runs and candy floss

Today heralded the start of busier times, and that’s definitely a good thing because my depression tends to be easier to handle when I’m focused on a task. 

I’ve resumed childminding with some kids I saw over the summer – now it’s time for the school run routine, and with three kids in three different schools scattered across the city I’ve ended up walking miles. My feet hurt, but at the same time I’m pleased to have had the exercise; my limbs have been feeling so heavy recently that I haven’t been inclined to really move much at all. I’ve blamed the mirtazapine (Remeron), although I’m pleased to report I haven’t fallen over today.

I’ll be doing this three times a week (two early mornings, one afternoon), which will earn me enough cash to stay afloat while I continue the job hunt. It’s really nice to be able to stop worrying so much about money.

There is a huge funfair in the city today, and I walked through it this evening on my way back home. It was buzzing with people and certainly had a great atmosphere, but if I’m perfectly honest, I found it all a bit…overwhelming. So many bright lights, so many colourful flashes, so much noise. As much as I liked that atmosphere, there was something uncomfortable about it. And I noticed there were a lot of really young children at this fair after 9pm – this really, really bothered me. School in the morning, anyone? Part of me finds it quite funny that I was so concerned – I’m not even a parent myself!

That’s all for now; time to crash.

Drunk on mirtazapine (Remeron) ?

I feel like an old lady for saying this, but today I had a bit of a fall. I was sitting on a stool (fortunately a low down one) in a cafe, and when I’d finished my drink I moved to stand up…and then I’m not quite sure what happened, but I was almost on the floor, desperately holding the edge of the table, trying to pull myself back up. 

When I eventually righted myself, the elderly man at the next table very kindly said ‘I’m glad you didn’t fall all the way; I couldn’t have picked you up. You’re too heavy!’ (Cheers for that, just what I needed to hear…). I shrugged it off, and was laughingly going to say ‘You’d think I was drunk!” when I realised: I upped the mirtazapine last night.

Coincidence?

Given today’s additional difficulties in walking in a straight line, it is almost like I’m drunk (except I almost never drink alcohol). I think I’ll take 15mg mirtazapine again tonight and see how I do tomorrow. If I’m struggling, I’ll have to go back down to 7.5mg, but last time I tried cutting the 15mg tablet in half I stabbed my finger (you’d be surprised how much blood there was). I need a proper pill-cutter!

The uneasy middleground

Despite my self-reminder yesterday, I was still surprised by how strong 7.5mg mirtazapine (Remeron) is. I swallowed, and about 10/15 minutes later I felt extremely tired. I then slept like the dead. This is with only half of a pill. I don’t feel terribly tired today, but I was able to sleep in until about 11am. Tomorrow I have to get up early to go and puppy-sit, so that’ll be a better test of how long the drowsiness lasts.

The extreme-sounding suggestions from the psychiatrist yesterday are continuing to play on my mind, and the more I hear about it, the more I come to think ECT is something I really don’t want to have. I’ll keep researching both ECT and ketamine-infusion, but I do wonder if they’re both a step too far.

If my regular GP hadn’t retired, I’d ask him. Sad times. I don’t feel like I can discuss this with Dr T, who’ll be back from his six week holiday in a fortnight. He’s pretty anti medicine, so I’ve been filtering out that side of my treatment for a long time. He has even phoned up my GP to suggest taking me off meds altogether (without telling me). I have no doubt he’d have a negative reaction to what my psychiatrist has said, but then again, I expect he’d react the same if she’d said I should have more vitamins or something minor like that! This is one of the reasons my GP was so valuable; he sat in a perfect middle ground between medicine and talking therapy – he could see and appreciate the merits of both, with no vested interest himself. Dr T didn’t believe that, but I’m pretty sure of Dr T’s bias from what I’ve heard from another of his patients. 

It is hard to find a balanced view, when most of the medical professionals sit pretty firmly in one camp or the other. Of course Dr T is going to largely disregard meds in favour of therapy given the focus of his training, and of course my psychiatrist is going to push meds over talking therapy given her background. And I would have expected my GP to push meds too, but he made it clear from the start he didn’t want me taking anything I didn’t absolutely need. We only started my medication regime after we’d established therapy alone wasn’t enough (as evidenced by a lack of progress in 10 sessions).

Sometimes it feels like the patient has to sit in an uneasy middle ground, where navigating the way forward is a real challenge. I have a feeling that most people who have a therapist and a psychiatrist see more of an alliance between them, or at least don’t see them in conflict/opposition to each other.