When I Hit The Bottom (trigger warning)

I knew it was bad when I spoke to my husband and couldn’t bring myself to tell him I loved him. How could I say that to him when I was planning my suicide for that evening? I knew I was at rock bottom then, but I couldn’t tell anyone. What could they do about it? I needed a quick-fix, I needed to not feel this way for another day; and it was still three days till my appointment with my CPN.

The plan was fully formed in my head, and the wish to feel nothing was the strongest urge in my mind. I felt guilty, yes, but not so guilty that it was enough to discourage me from my plan. I tried to reason with myself, to think it through logically, but ended up frantic each time. The need I had to not exist tomorrow, to not have to face the office and my life, was overwhelmingly powerful.

That evening I walked home via the pharmacy and bought a pack of paracetamol. I wondered if the pharmacist could see in my eyes the pain I felt; I wished and prayed that she would recognise the look of desperation of someone who has reached the end of their tether. I even hoped she was somehow telepathic and could read my mind. She couldn’t.

It can seem somewhat contradictory that I was hoping for someone to stop me, yet hadn’t told anyone my plans. The thing about being so depressed is that you do not wish for death; you just wish to not exist, to not feel anything anymore. It doesn’t take away the guilt or the sadness over your actions. Death is still scary to someone planning suicide – it’s just that it’s less scary than facing another day of pain.

What can you say to someone in that state? All responses seem trite; ‘it gets better’ and ‘think of what you have to live for’ are meaningless words. I believed with every fibre of my soul that I was destined to spend the rest of my life in a real-world hell and chose to bet my life on death being the better option.

Looking back with the benefit of hindsight I know that what I thought was the end of my world was just another episode in the illness I live with. An experience I hope I can learn from; but there’s no guarantee that the rot won’t set in again – no guarantee that I won’t find myself in the place where I resent the people who keep me safe. There is nothing worse than being angry at your other half because they called an ambulance and want you to live, when all you want is to end the torture of living.

I hope I never return to that dark place for the rest of my life. I hope that if I do end up back at the bottom I have the strength and presence of mind to ask for help. Overall I hope I remember that things do get better; yes, it takes time but life is worth it.

When I Hit The Bottom (trigger warning)

Sertraline Dreams

Anyone who has taken psychiatric medication will be familiar with the meds-go-round – that process of trial and error whereby you start a medication, realise the side effects are not worth it, switch medication again and hope the side effects on the new one aren’t as bad.

I have been on sertraline (Zoloft) for around two years now and thankfully it has been a good match for me. It slightly elevates my mood, but not in any detrimental way. In truth, I think I’ve only had one major side effect on this medication – and it’s been kind of fun!

Sertraline gives me incredible dreams. Drugs.com reports that abnormal dreams as a side effect has an incidence rate of 0.1% – 1%, making it rather uncommon. Having Googled for others’ experiences of dreaming on sertraline I realise I’m not the only one having these night-time adventures.

Sometimes the dreams stay with me after I’ve woken up, and I can recount them in the same way I can tell my husband about my day at work. Other times they leave my head upon waking and it isn’t until something reminds me of them during the course of waking life that they come flooding back, as though they are memories of real things that have happened.

The ones I remember fully are totally vivid and real; right down to being able to feel things and smell things within the dream. I have been on the battlefield in World War 1 (totally terrifying) and I’ve climbed Mount Everest. There are still bizarre elements to them; especially the ones involving sexual encounters.

Other dreams don’t leave such a conscious impression. I remember one occasion in which I was surprised that my hair was still long when I looked in the mirror; I had a distinct memory of having it cut to chin-length. I’ve also been mad at my husband because of rows we’ve ‘had’. It isn’t until I talk to him about it that I realise the memory of the argument is actually a remnant of a dream.

One of the more upsetting incidents was when I spent a morning distraught over the loss of my Nanny Noo. For about four hours I mourned her, until something made me doubt myself and I asked my husband if it was real. The relief I felt when he told me that I had dreamed it was unbelievable.

I’ve had the whole Inception experience too. I’ve woken up into another dream a few times, and it isn’t until something truly bizarre happens that I either realise it’s a dream or wake up for real.

The dreams don’t really bother me too much anymore. It is weird and unsettling, sure, but as side effects go I’ll happily take this one over anything physical. I’ve come to enjoy most of the dreams, and have recurring characters within them now that I actually look forward to seeing, as though they’re old friends.

I’d be interested to know if any of you have experienced anything like this on sertraline or other SSRIs. Connect with me on Twitter (@dontsayimcrazy) or in the comments below.

Sertraline Dreams

The People Who Help

I wanted to write a little bit about the people in my life who have supported me over the last three years. Without them I believe I wouldn’t be here to tell my story.

The primary supporter in my life is my husband Luke. We’ve been together since we were in our late teens and got married in Dec 2011. When we first began getting serious (i.e. after about a month!) I explained my struggles with depression from my early teenage years and the anxiety that had gone along with it. He made a promise to always be there for me when I need him, and he’s gone above and beyond that time and time again in the years that followed.

It was Luke who first noticed my mental health deteriorating in early 2012. As you’ll hear a lot from people who have been psychotic especially, it’s those around them who notice it even before the sufferer. I was living in an alternate reality in which it was perfectly normal to be hearing voices, not sleeping and suffering paranoia over the people living next door. Amazingly, and thankfully, the paranoia did not extend to my husband. Although I’d visited the GP on my own to get help for the anxiety, the warning signs of mania and psychosis had not been picked up.

Luke has since stood by me through thick and thin. He has sat with me in the hospital following overdoses. He has accompanied me to appointments and talked to the mental health team on my behalf when I couldn’t speak for myself. He is my carer; I still struggle with being out in public without him if it’s not part of my routine, and he makes sure I take my medication morning and night. When I’ve been unwell he’s kept the house clean and us fed. The stress I have put him under is unbelievable and he is still his jolly, jokey self.

What do I owe him? Everything – and nothing. What he does for me comes from a place of true love. I couldn’t be more appreciative, and I have no idea how I can repay it all. But he tells me regularly that he did it because he loves me and couldn’t imagine being without me – that he’d do it all again in a heartbeat.

My family have also been there for me in an entirely supportive capacity. My mum has driven me to the hospital a few times, and never judged me for it. She is a lovely, warm and caring woman and I am so lucky that she’s supportive and understanding. Never one to shy away from anyone in need, she makes sure I know she’s there for me any time I need her; as she says, her kids come first.

I didn’t speak to my father for three years following an argument in the run up to my wedding. When we got back in touch early last year I debated with myself for a long time over whether to tell him everything or not. I decided that honesty was my best course of action and wrote him a letter that described what had been happening with my mental health. I was terrified that he would see me differently once he knew everything, but there was nothing to worry about. He told me he supported me.

Unfortunately there is so much stigma surrounding mental health issues that there’s no guarantee that people will be supportive of those who suffer. I used to feel ashamed of my diagnosis, that the important people in my life would somehow blame me for what I was going through. The fear of them taking it personally was huge; I was worried that my parents would wonder what they’d done to cause it, or that my husband would think my suicidal ideation was proof I wanted to leave him behind.

I am so thankful to those who have supported me over the last few tumultuous years. I have learned that I have nothing to feel guilty for; no guiltier than someone who’s suffered a heart attack feels. It is my hope that this blog is not just for those with mental illnesses, but that the people supporting them will read and understand that the best thing they can do is be there for their loved one.

The People Who Help

Spotlight on Self-Harm (trigger warning)

Self harm is a growing problem worldwide. Statistics here in the UK suggest as many as 13% of 11 to 16 year olds purposefully hurt themselves, but it’s not just a problem that adolescents face. It can be a life-long battle for many.

I started to hurt myself by cutting my arm aged 13. At first I used safety pins to scratch my wrist; small half-centimetre scars that have now faded with time. Over time I progressed to using scissors and the self injury became a ritual I used to cope with the pressures of teenage life. At the time I told myself it was temporary, just a stop-gap to last only as long as it took me to grow up and learn to deal with the world.

I want to use this post to talk a little about the problems with self-harm I’ve faced as an adult. I stopped my teenage self-harm aged 17, and managed to stay away from it until I got unwell aged 22.

People tend to associate self injurious behaviours with depression. For me, I’ve found that I struggle more with it when I am manic or psychotic (or both, as they normally come hand-in-hand for me). My mind turns to it when I cannot cope with the high, wild level of mood and I’m looking for ways to calm myself down. I have learned great coping skills over the years but they are not always the first thing I turn to when I am ‘in the moment’. In adulthood I know I ‘should’ know better, but my insight when I am unwell isn’t always great.

As an adult, I’ve found that the extent to which I hurt myself is greater. I no longer use blunted blades for example – and so the resulting injuries are far worse. I also find that I can do more damage when I’m manic than when I’m depressed. When I am in a low mood, I feel the pain more. When I am in a dysphoric state I don’t feel it, and it’s hard to recognise when it has gone too far. It is also a control thing for me; a way of getting my head clear and bringing myself down to a normal level of functioning.

It is hard to talk about self-harm in public. Writing this feels like I am baring an aspect of my soul to the world and it’s not entirely comfortable. But it is a topic that is increasingly important to focus on. It is not something we should be sweeping under the mat.

There are so many great ways to cope with the urge to self-harm. The Butterfly Project is one such way; the idea is that instead of hurting themselves, the person copes with the urge by drawing a butterfly on their skin. Other ideas that I’ve tried in the past and had some success with include the ice method (whereby you hold an ice cube in the hand) and the elastic band one (you ping an elastic band against the skin). The only issue I have found with these moderation methods is that it’s not always the pain I’m craving – sometimes it is the damage I want to cause that makes me need to act on the urges. I’m still working out how to mitigate those situations; I would appreciate advice if anyone has it!

This piece has so far mostly focussed on cutting as a form of self-injury. There are many more forms; overdoses without the intention of suicide, punching walls and burning oneself are examples. Substance abuse can also be seen as a form of self-harm. As many as 30% of those with bipolar also abuse drugs or alcohol, compared with around 4% of the non-bipolar population.

Self-harm is a conversation many people are now getting involved in. The key to overcoming it is to learn healthy coping skills. If you are struggling with self-harm, you will be doing a great thing to look after yourself if you seek out help from your GP or a therapist.

Spotlight on Self-Harm (trigger warning)

Spotlight on Bipolar

Bipolar is the modern diagnosis of ‘manic depression’. There are people out there who prefer the old way of saying it. The bipolar label just isn’t as descriptive of the issues faced by those diagnosed with it.

Bipolar disorder is characterised by extremes of mood. There are varying degrees of it; from cyclothymia (more chronic but less extreme), bipolar I and bipolar II. All forms feature a mix of depressive and manic episodes, but the severity of the episodes can vary between diagnosis.

Bipolar I is a disorder in which the person experiences full manic or mixed episodes. They only need to have experienced one manic episode for diagnosis to be made, the severity of which causes impairment to everyday activities. The manic state is characterised by extravagance, grandeur, elation, pressured speech, irritability, reduced need to sleep, along with potential risk-seeking behaviours. There should also be, during a depressive episode, at least three characteristics of major depression.

Bipolar II is differentiated from BPI by the absence of full mania. Instead, the person can experience hypomania that lasts at least four days. The depressive state can be the more common and the intervals of well-being are generally shorter.

The risk of self-harm and suicide is increased in those with BPII, and especially those in a mixed-mood state. This can be due to an increased motivation to engage in risk-taking behaviour, coupled with depressive hopelessness. Substance abuse disorders have high co-morbidity with the bipolar disorders.

Treatment for bipolar disorder involves the use of medication. Mood stabilisers act to suppress the swings between highs and lows. In addition, an anti-depressant can be used to combat the depressive episodes, especially in those with BPII. Some atypical anti-psychotics also have a mood stabilising effect.

Talk therapies such as cognitive behavioural therapy can be used to support well-being and help the sufferer with learning skills to cope, triggers and help with awareness of early warning signs of an episode.

Living with bipolar can be a challenge. Episodes of depression and mania effect the ability to conduct everyday life.

Spotlight on Bipolar

Spotlight On Depression

So often in life I hear the phrase ‘I’m so depressed.’ Around the office, in public, with friends; depression has come to be the buzz-word of choice for emphasising just how sad a person is. The fact is real depression is not just sadness. Whoever decided to call it depression rather missed the point.

A huge number of people are affected by depression worldwide. The stats are something like 1 in 4 people will either suffer depression or support someone who does in the course of a year. But depression is a mixed-bag diagnosis just like other mental health problems and it doesn’t affect everyone in the same way.

Most of us have experienced situational depression at some point in our lives. This can be linked to life events such as the breakdown of a relationship, loss of a job or bereavement. It is short-term and usually has an onset within three months of the event that triggers it.

The DSM (Diagnostic and Statistical Manual of Mental Disorders) outlines the criteria for Major Depression. The symptoms can be the same for situational and clinical depression – the difference lies in the impact it has on normal life. For a diagnosis of major depression the person will have at least five symptoms simultaneously, and those symptoms will be severe enough to prevent their engagement with regular living.

The symptoms can vary depending on the individual and includes sadness, hopelessness, anxiety and worry, lack of concentration and lack of pleasure (anhedonia). There is usually a withdrawal from normal work, leisure and social activities. For some people, suicidal ideation is present.

Treatment for depression can include the use of anti-depressants and talk-therapies such as CBT (cognitive behavioural therapy). In very severe cases ECT (electroconvulsive therapy) can be used. This treatment uses electrical stimulation to induce seizures and is administered under general anaesthetic. It has proven to be very effective (mind.org.uk suggests that 74% of people treated with ECT responded positively), but is a last-resort option.

My own experience with depression started when I was 13. In the last few years I’ve battled with mixed mood episodes that have landed me in crisis care twice. A mixed episode for me is characterised by rage, restlessness, agitation, hopelessness and suicidal ideation. Commonly I have experienced a total inability to see past the present; a feeling of no hope and no future.

I read somewhere (Matt Haig possibly?) that depressives do not wish for happiness, they just wish for nothingness. Happiness is a luxury. A good day can mean a day in which symptoms are mostly absent. A bad day is the kind where the symptoms are overwhelming and feel endless.

I would love to hear of your experiences with depression. Connect with me on Twitter @dontsayimcrazy – or leave a comment below.

Spotlight On Depression

Starting the Conversation – How to Approach Your GP About Your Mental Health

In one of today’s posts, I have talked about my initial experience attempting to access help via primary care services. I’m now going to flip that on its head and talk a bit about what did work for me when I finally changed doctors and started on the path towards recovery.

  • Be Prepared

This is so vital. Here in the UK, GPs have around 7 minutes per appointment to assess your issues and decide what to do. Anything you can do to make the reason for your visit clear will help. For me, that included tracking my mood swings on mood charts and bringing those along to my appointment. I used Moodtracker.com. It allowed my GP to see clearly that there was an issue with my moods and enabled him to take action based on that. I also had been keeping journals full of my psychotic ramblings, and my husband brought those with us to give the doctor an insight into my state of mind.

  • Don’t Be Scared

Well obviously it’s a scary prospect. Most of us aren’t good at talking about ourselves when it comes to the mysteries of mental health issues. But if you think of it like a physical illness (which it kinda is, seeing as it is effecting your brain!) then hopefully some of the fear will dissipate. You wouldn’t hesitate to visit your doctor for an ear infection after all. The other thing to remember is that this isn’t some middle-ages quack. Your doctor is a trained professional, who is in their field for a reason. They care about people’s health and will be open minded with your concerns.

  • Pick The Right Doctor

This one doesn’t necessarily work for everyone, but it is helpful if your doctors’ office has a good website you can research on. My GPs surgery has their team listed on their website, along with a little information about each doctor’s special interests. So if you can, see which one is interested in the field of mental health, and make your appointment with them specifically.

  • Advocacy Helps

Having someone (my husband) to speak up on my behalf took half the battle out the equation. If you can talk to a friend or family member about what’s happening, you probably will be ok to ask them to come to the appointment with you. There are also advocacy charities who will talk to you and arrange for one of their volunteers to sit in on your appointment with the doctor.

  • Know Your Options

Referring back to my earlier post, it is clear I’d have had far less of a problem if I’d researched the options available to me before I saw the GP. Know your mind; do you want to try medication, or would you give talk therapy a go first? If you are considering medications, ask your doctor about side effects and potential issues during the appointment. Talk therapies offered initially are usually conducted over the phone with a trained counsellor, or in group settings, so if you don’t feel happy opening up in front of a group of strangers, let your GP know this.

  • Be Honest

Your doctor is not going to be fazed by tears. Crying is a natural and understandable reaction to what you are going through, and it may well help for your GP to see that you are struggling. When I saw my doctor for the first time, I was manic and psychotic. I couldn’t sit still, I was beyond agitated and I couldn’t hide it – I paced the office whilst we talked and my rapid-fire speech was another sign to him that something wasn’t right. On top of this, let them know if you’re self-harming or suicidal. They are not going to judge you, and they can only be effective if they have the whole picture.

Sadly there are primary care doctors out there who have one eye on the budget and the other on the clock, as I found out the hard way. But if you go in with getting help in the forefront of your mind, the majority of doctors will be listening with a sympathetic ear.

Starting the Conversation – How to Approach Your GP About Your Mental Health