When Anti-Depressants Don’t Quite Work (Or, Work Too Well)

So, it turns out that keeping track of medication and changes is a useful thing to do. Lately I’ve been feeling somewhat low; kinda-almost-but-not-quite depressed. I was chalking it up to being just one of those things but then the keeper of the medication (aka the husband) reminded me that until about two weeks ago I’d been taking 100mg Sertraline – sorry Doc P, we know you dropped it to 50mg a while back but we forgot to change it down. Sertraline, for the uninitiated, is an SSRI anti-depressant which is known as Zoloft in the US. Like many anti-depressants, it has magical powers that are sometimes too magical – sometimes, for people like me, it sends a person too far ‘the other way’ and triggers hypomania or even full-blown mania.

For me it was somewhere on the spectrum of low-to-mid range hypomania. Not awful, but definitely noticeable. So that’s why Doc P decided to bring it down when we added a mood stabiliser to the equation in the hopes the lower dose would work out better. Probably worth mentioning that when I first started sertraline I was tried on 50mg and it simply wasn’t enough to be therapeutic, so that’s why we bumped up to 100mg. Gosh, this whole meds thing is so confusing and delicate; not made easier by my hyper-sensitivity to weird but not wonderful side effects (yes, I am the girl who was knocked out by a single dose of aripiprazole on the way up the stairs to bed. Also, risperidone gave me incredibly high levels of prolactin and my body reacted as if I were pregnant. Weird.)

When we realised that I was still taking the higher dose a couple of weeks ago we immediately switched to 50mg. To be honest, the 100mg was working but we’re following the Doc’s advice here. We’re not experts on the whole medication malarkey! The lesson here is that I need to be closely paying attention to the changes that happen in my mood and symptoms when meds get changed. It’s taken two or three weeks to realise that this current slump in mood could well be directly related to the reduced dosage.

Of course, this happens whilst my CPN is on leave, but I’m not so bad that I need to call the office and speak to my Pdoc. It can reasonably wait till she’s back (and that’s only tomorrow, so definitely no panic). I don’t know if it’s worth asking to try 100mg again when I know I’ll most likely swing back into the hypo range of moods. Maybe a different anti-depressant? Citalopram is the only other one I’ve been on and wow was that a bad experience – back to the weird side effects; everything I ate tasted greasy and (less weird) it spun me into an extreme mania.

Going forwards from here I know I’ve learnt something; I know I need to be more on top of things when bits and bobs change. Things like going back to diarising moods and meds and various other factors sounds like a good idea. Hopefully next time we change something it’ll finally be the last piece of the puzzle and I can get back to functioning properly!

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When Anti-Depressants Don’t Quite Work (Or, Work Too Well)

Work, Illness and Speaking Out

I had a rather sad conversation online yesterday in a peer support chat room. The guy I was talking to asked the room whether it’s best to be honest with his GP about the state of his mental health. From what I gathered he has been struggling a long time without any help; I asked him if he had a diagnosis and he replied ‘nothing official, just a fucked up psyche.’

His main concerns seemed to be being locked away and losing his job – two things I can truly identify with; when I first started seeking help I tended to play-down things in fear of the psych ward and lost a job over my mental health when it was at its direst point. But the truth is that most health systems – or at least those that are run by the state – actively seek to provide support to keep people out of hospital, and as for workplaces, in most cases the person is protected by anti-discrimination laws.

A quick Google suggests a figure of around £350 a day to treat someone in hospital on the NHS whilst intervention outside of the psychiatric wards costs far less (although I couldn’t find any concrete figures). There is also the consideration that internment in a mental health unit causes considerable stress to the client; the wards are far from peaceful, recuperative places. In most areas here in the UK there are specialist teams for acute care outside of the clinical setting; Home Treatment Teams (HTT) are able to visit clients in their homes to help with medication and provide someone to talk to; they also have 24 hour phone services so even in the middle of the night a nurse will be on hand to discuss concerns.

There are also many care homes in the UK that usually support long-term residents in transitioning back into the ‘real world’ which have ICBs (intensive care beds) for shorter term stays. I’ve been in two of these homes and they proved to be incredibly therapeutic environments; space to recover, freedom to come and go and 24 hour support from trained staff. Whilst staying in the homes, clients are supported by their own psychiatrist and care co-ordinator so there is no variation in treatment plans or any stress of seeing staff that are unfamiliar to someone who is in a fragile state.

Hospital is a last resort here; there have been only two occasions when I’ve been threatened with a section and both were when my ability to keep myself safe went beyond the scope of what the earlier interventions could cope with. This is despite suicide attempts and self-harm; despite drinking to cope. There was a real push from the NHS staff I dealt with to keep me out of the psych wards until it was an 11th-hour situation; even then I remained out of the hospital thanks to redoubled efforts from the HTT and care homes.

The guy I was speaking to online was concerned about the security of his job if he wound up needing to take time off sick for his illness. This was in part due to the nature of his work; he had passed psych clearance tests in order to secure the role in the first place. With a little discussion I discovered that he was nervous that his employer would indirectly find ways to push him out of his job; despite my reassurance of discrimination law he remained convinced that he would not be able to stay employed if he sought help and treatment.

The fact is that most countries have solid disability discrimination laws; if the illness is significant and long term. Essentially – in relation to the workplace – they lay out a requirement to allow reasonable adjustments that ensure the employer facilitates the needs of their employee and also a requirement to treat their employees equally despite their disability. These laws are the backbone for activists to be able to speak out openly about their illnesses and go a long way towards true equality and the end of stigma.

I sincerely hope the online chatter is honest with his GP and gets the help he needs; he seemed desperate for someone to hear him and assist him in his recovery – unfortunately there is still such stigma surrounding mental illnesses that it remains difficult to speak up in confidence of not being judged for something we cannot change.

Work, Illness and Speaking Out

The Semicolon Project

The Semicolon Project

“Your story isn’t over yet.”

Indeed – it isn’t. There have been many – too many – times that I thought it was. Times I couldn’t see a way out of the daily hell I was living. Times I planned ways to end things; to end my life. I am still here; my story continues and I am grateful that I have the opportunity to run this blog and share with all of you in hopes of helping someone else.

The Semicolon Project has been all over the UK news outlets in the past few days and I instantly wanted in on the campaign. Officially the day to do it was April 16th 2013, but lately the vehicle of outspoken mental health advocates has been gaining so much momentum. Essentially, the message being broadcast is this: A Semicolon is used when an author could’ve chosen to end their sentence, but chose not to. The Author is you and the sentence is your life.

I am determined that my sentence will continue on its destined path; whatever that may bring. That is why I am adding my voice and lending a small patch of skin to the many people out there who are working so hard to raise awareness and end the stigma of depression, anxiety and other mental illness. This is my declaration that I am not ashamed; I am full of hope; this is not how it ends.

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P.S. I’m sorry mummy!

The Semicolon Project

A New Approach to a Healthy Life

Last Thursday was just one of those days. No particular reasons for it; just seemed to be cruising high and low all afternoon until I got home. Ordinarily I would have suggested a night in with a takeout to the hubster and most likely would’ve stewed until my frustration took me to bed for an early night. But that was the ‘old’ me – without wanting to jump the gun and being very aware that I do go through ‘new and improved’ phases, I think the new attitude is here to stay.

So instead of just vegging out in front of the telly and letting things simmer away I booked myself into a fitness class at the gym; a step class no less. You probably couldn’t put me further out of my comfort zone. I’m not fit; haven’t been for years since Luke and I stopped walking places for the fun of it. I am not body-confident either. I literally had no idea how I’d manage a step class when walking more than maybe 3 miles leaves me totally puffed-out.

I rocked up to the leisure centre a little earlier than I had planned and checked in with reception. They pointed me in the direction of the fitness studio and off I went to await my – to my mind – total humiliation. There was a circuits class happening in the main hall and I stood watching these ultra-toned men and women moving nimbly around the stations; even those doing strangely froggish squat jumps somehow looked sprightly. I felt anxious – I wanted to run away from this place that pushed my body-consciousness buttons to the max.

In the end, I stayed. And I’m glad I did – it turns out step class is great fun (and totally exhausting; but wasn’t that the point?!). The first ten minutes saw me obsessively watching my classmates – all gym bunnies – hopping off and on the step like they were born to do it. Pretty soon I realised that the whole time I was focussed on what they were doing I wasn’t paying enough attention to my own form; no wonder I felt clumsy in comparison!

Sure, I was silently pleading for it to be over before we’d even reached the half-way point. Sure, I felt absolutely ridiculous with my spare-tire stomach jiggling around. And sure, I had twice as many water breaks as any other stepper. But – I did it! I got through 60 minutes of high-intensity exercise and I felt amazing for doing it. So good that I am planning on making this a regular activity; especially given that historically Thursdays are my worst.

There’s a lot to be said for the benefits of exercise for mental conditions. For me personally it meant that I felt I’d done something productive with my day and that I’d worked out all the frustration in every bead of sweat that slid over my forehead. The science backs this up; when you move your muscles release hormones, not least of which are endorphins that act to reduce stress, ease anxiety and depression, boost self-esteem and improve sleep.

Exercise isn’t a panacea, but as a natural and holistic therapy it seems to work wonders. Now, someone be sure to remind me of that when the next class rolls around!

A New Approach to a Healthy Life

On Loving Yourself

Self-care is an important factor for any human – those who fight a mental illness will recognise that good self-care both indicates and mitigates the severity of an episode.

For me, I find that when I am running high my self-care will be mixed. I will take a lot more time over my appearance; I will file and paint my nails, wear make-up and style my hair. The flip side is that I begin to skip meals, drink too much coffee (at work) or alcohol (at home) and get through pretty much a pack of smokes every day. So outwardly I tend to look more ‘together’ but internally I am falling apart.

This pattern is flipped in a depressive state. I eat plenty (granted, it’s never healthy – I just graze more) and my getting-ready-routine is perfunctory at best. Showering feels like too much effort; after a shower I will need to dry my hair and that requires more energy than I have available. Usually showers get pushed into the evening, when I can allow my hair to dry naturally, and even then I’ll usually be seen with my hair pulled into a loose bun because it’s too greasy to leave hanging free.

Good self-care is the first bullet point on the crisis line operator’s script. Every time I’ve called the out-of-hours number the response has invariably been “Have you thought about taking a bath?” or “Maybe you could make yourself a cup of tea.” It’s known to my team that these things don’t work for me, but for an over-stretched NHS crisis service it is standard fare. Improve self-care; improve mood. And there’s a lot to be said for that approach; it’s just that when you’re in the depths of depression or on the summit of Mania Mountain you really couldn’t give a fig for looking after number one. Your energy is being spent on either avoiding a tearful meltdown or writing endless pages of nonsense. There’s nothing in the budget left for caring for oneself.

I think that if more people understood the subtle indications that good or bad self-care provide then there might be more awareness of how mental illness affects almost everything in day-to-day living. On the down days my roughly tied up hair and lack of foundation shows the world “I used all my energy up by getting out of bed.” And on hypo days you can read my rouged lips; “Hello world, bring it on!”

Self-care is a manifestation of loving oneself too. It means the difference between feeling worthless and worthwhile. If I can spend a little time on myself when I’m low, it can be a welcome diversion from the turmoil of loathing that characterises my mental state. One thing I have learned over the years is that self-care can be disguised in mindfulness. Instead of forcing myself to show myself some love, I will instead set myself a mindfulness exercise such as doing my nails, or making a cup of tea. This way I do not have to acknowledge consciously that I am worth more than I think I am. I simply come out the other side feeling an iota calmer – better – than I did when I began.

On Loving Yourself

A Level Of Functioning

I saw a tweet yesterday that said something about ‘getting to the point of functioning’ and I thought, yes, that’s me!

During the good times, I thrive. I can face life head on and enjoy things like work. The obstacles seem easy to hop over (or knock down). When the blips happen, however, things change. Simple activities like taking a bus home become hurdles that feel six feet tall. My perspective on life is different, and it’s hard to deal with. The key point becomes surviving – functioning.

In the run up to my crisis in December I was nowhere near thriving. Unfortunately, because I was functioning (going to work, getting home safely), my concerns were not heard properly. My CPN was fabulous and referred me on to the Home Treatment Team, but from that point on I felt I was not being listened to when I said I couldn’t face another day.

Every call I made to HTT for help went something like this:

ME: “I’m at work and I’m struggling to cope with it.”

HTT: “We’re sorry to hear that, but you’re still working?”

ME: “Yes, but I can’t concentrate and really don’t think I can last the afternoon.”

HTT: “OK well try to stay calm for the rest of the day and focus on getting home.”

I think I usually gave up at that point. They just couldn’t seem to get their head round the idea of someone working through such a tumultuous time. The problem is that I hate to take time off ill; I feel as though I’m letting work down, even when I know I really shouldn’t be at my desk. The idea of work piling up in my absence gives me massive anxiety.

In fact, it took an intervention from my CPN and psychiatrist to persuade me to take time off in December to go into crisis care. It was like I needed their permission to admit temporary defeat. I couldn’t do it on my own authority; even though I knew it would be best for me.

And now I find myself in a position of functioning again. Work is a little too stressful, but I’m still ploughing through; I’m definitely not thriving though. Once again, I’m doing what I have to to survive.

A Level Of Functioning

So What’s Good About This Anyway?

There’s a lot of publicity surrounding mental health awareness, and the mission to bring the general public to a better understanding of mental illness grows stronger every day. The fact is that mental illness sucks, but it’s not all doom and gloom. Here’s a few things that make it a little better for me each day (unfortunately they are in no way a reward for the struggles we face).

Depression has taught me empathy.

I am highly creative when manic.

My productivity and output at work benefits from hypomania.

Understanding delusional beliefs gives me insight into my own psyche.

I have a passion to make the world a better place.

My supporters have shown me true love (parental, societal and romantic).

I can relate to my father in a real way by understanding what it means to be depressed.

Writing is my outlet and I’ve been getting better at it.

Therapy has given me great skills and taught me how to be kind to myself.

I learn a lot about anger and sadness through my ‘alter’ – I am able to observe her pain and talk to Her about it. (Still not comfortable calling Her an alter, but I guess it’s as good a word as any!)

I get to see the world as a vibrant and exciting place.

When depression lifts I get to feel pleasure in things in a meaningful way.

What are the benefits you see in your mental illness? I think it’s harder to see the ‘good’ in relentless depression than it is to see it in bipolar disorder. And I’ve not got personal experience of any personality disorder, so I’m definitely not qualified to comment there!

So What’s Good About This Anyway?