Medication – A blessing or a curse?

Well a few months down the line from my recent acute episode, I’m starting to see a light at the end of the tunnel and it’s not an oncoming train. However, back on the road to normality, yesterday brought into question whether I am entitled to more than recovery.

You see, despite generally functioning reasonably well (recent circumstances excluded), I’ve always struggled with a relatively low mood. I just thought that was my lot and that I’d got it as good as I was going to get it. After all, I manage much better than most. However, during my recent episode, as outlined in my earlier posts, my psychiatrist prescribed me an antipsychotic to help me break the cycle of anxiety and hypomania that I found myself in. Yes, it switched off the receptors in my brain that made me feel full, I ate like a horse and gained weight but, I felt great, better than I did pre-episode. In talking to a few people who had been in a similar situation and my GP, I learned that there was another antipsychotic than didn’t have as big an impact on the appetite. So, at my appointment yesterday, I raised the possibility of switching to the alternative as it had clearly improved my baseline mood but, as a diabetic, the weight gain was an issue.

Simple eh? Apparently not. Now I’m feeling ‘better’, my psychiatrist wants to take me off the antipsychotic to see if I still need it. Now it’s important to state that atypical antipsychotics are not just used for psychosis, and that they can also be used for depression. It’s also important to note that polypharmacy (the use of multiple drugs) isn’t usually encouraged but, if a drug elevates my mood to a ‘normal’ level, has minimal side effects and adds just one more tablet to the cocktail I’m already on, shouldn’t I be allowed to take it? Using the usual analogy, would a doctor, on seeing that a diabetics’ blood sugars have normalised, take them off the medication that’s doing the job?

Should I have to return to a life that is less than I know it could be? Can I have more than I had before or should I just accept that at least I have some quality of life? I would welcome your views.

But You Don’t Look Ill Part 2 ….

I’m livid! Abso-bloody-lutely steaming! Probably not in the right frame of mind to blog but I have to get rid of this anger.

This morning, I built up the confidence to go to an exercise/dance class. I had been encouraged to do this by my CPN to build my confidence, my psychologist to develop relationships outside of work and my psychiatrist as the anti-psychotic is causing me to gain weight at a rapidly alarming event. So last night, I booked a taxi to get me there as I can’t yet do buses.

This morning, the taxi arrived. I was initially pleased as it was a driver I’d seen before a few times on trips to work. I got in the car and we passed pleasantries. He asked me if I was off to work and I explained I was off to the leisure centre for a class. The conversation went like this:

Him: “On holiday?”
Me: “No, I’m currently off sick”
Him: “And you want me to take you to the Leisure Centre?”
Me: “Yes please”
Him: *Long pause*
Him: “You’re not too sick to go to the Leisure Centre then?”
Him: *Uncomfortable laugh*

Now I do remember the days when, if I’d had a day off school, I wasn’t allowed to go out to play afterwards (if you’re not well enough to go to school ….) but this sort of attitude is just indicative of the demonisation of people with disabilities or long term health problems that @BendyGirl and @Suey2y highlighted in the ‘Ask Ed Milliband’ session at the recent Labour Party Conference, the image that the Daily Fail perpetuates throughout it’s pages and that middle England appears to wholeheartedly believe.

I honestly felt like Jeremy Kyle was going to pop up and accuse me of spending his tax payers money on exercise classes before I reminded myself that I am fortunate enough to be able to work and pay taxes too.

The confidence building exercise was an abject failure. I did complete the class but feel shame not endorphins running through my veins.

Suicide – Man’s way of telling God, ‘You can’t fire me – I quit!’

*Warning – Contains potential triggers relating to suicidal ideation and self harm*

A review meeting at work today led to further encounters with work colleagues. In particular, I met up with some of my team. After the usual ‘you’re looking well’ type comments, I thought I’d see how the truth of mental ill-health would be received within a relatively safe environment. I’d just seen the psych and been signed off for another four weeks while we do some more med tweaking so I knew questions would be asked.

So I outlined what had happened.

I explained that a number of factors, both work and personal, had come together which meant that I felt that my life was out of control. Although, for most people, the issues might seem trivial, for me they meant abject failure and an unmanageable situation. I had lain in bed for some time until I had to wake my husband up to let him know that I didn’t feel that I could keep myself safe and wanted to take my own life. I explained that, at the time the thought of having so little control over my life was so frightening that death seemed the only option.

I described the trip to A&E, the negotiation over admission with the duty psych, the input from services (daily for three weeks), the second potential crisis (Stanley Knives and scalpels were Plan B with drugs Plan A) and appropriate preventative measures and the lack of ability to ‘do’ people, cope with any sort of noise, read, go out without support ….. all those ‘normal’ things.

They were all terribly supportive, although I wish I knew what they were thinking and said after I’d gone. One senior colleague, a peer was blinking back tears at one stage. I hope I find a way of gaining an understanding of how they felt and what they thought.

Suicide is a difficult subject to talk about. Most can never understand why it is ever considered, why death is ever a better option. As always, I’ll cop out and leave the articulate stuff to others as they do it so much better than I do:

“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise.

“Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really.

“You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
― David Foster Wallace

But You Don’t Look Ill ….

Many tweoples will be familiar with the above ‘spoonie’ statement (for those who aren’t, please take the time to read The Spoon Theory written by Christine Miserandino http://shar.es/bnEDF ) and I consider myself a spoonie, albeit one that is fortunate enough to still be able to work. Or I have been able to until recently when too many life events collided to trigger my biggest acute episode in 12 years.

A brief synopsis (there is a point to this I promise):

I’ve had a problem with depression for as long as I can remember and been on a plethora of meds since the tail end of my teens when I started at A for amitriptyline which has a lovely logic to it. Despite a perpetuating low mood however, I always managed to work and gained significant self esteem from my achievements. Following an assault, I started to self neglect which resulted in a series of hospitalisations, some voluntary, some …. not so. Work stopped paying me, income went from £2,000 a month to £53.00 a week plus DLA. I lost my house, car, dignity, self respect and didn’t work for two and a half years. I finally picked myself up, managed to get work and regained a level of normality which included finding a husband.

About five years into life take two, I had a short bout of depression which had been preceded by a period of extreme pressure at work which I appeared to thrive upon. It was only when the person in the next door office, a Consultant Psychiatrist, asked if I had bipolar rather unipolar depression that I noted periods when I was ‘in the zone’, ‘a bit buzzy’ or saw things a bit more acutely (I can smell an ant fart* at 20 miles and memorise film credits without realising it).

So, back to 2011 and a diagnosis of manic depression to go with the diabetes I’d picked up a couple of years previously plus a hiatus hernia, dupuytren’s contracture in both hands, coeliacs and three lots of surgery in less than twelve months and I start dropping some of the plates I’m spinning whilst working for our great British NHS at about 170mph. This results in a 3am trip to the GP Out of Hours based in my own hospital with strong suicidal ideations. After all, if I can’t function ‘my way’, then there are no other options and I possess enough drugs to floor a baby elephant. With the agreement that hubby would take time off work to stay with me to avoid an admission (‘I’m not going in there, it’s full of nutters’) we go home.

Today was my 8 week Occupational Health review. The Consultant was great; I’ve been fortunate enough to have amazing care from my GP, Crisis/Home Treatment Team, Consultant Psychiatrist, CB Therapist, CPN and OH. When I came out of the office, I started to bump into people, colleagues and peers.

Now call me paranoid (no don’t, the anti psychotics are working perfectly well thank you) but the ‘you look really wells’ and ‘are you still offs?’ were occasionally accompanied with that ‘but you don’t look ill’ look that the spoonie theory relates so well.

So this is a bit of hurrumph* and a bit of awareness raising for those of you who may not understand that mental ill health is every inch as hard as physical ill health and deserves as much respect. Underestimate it at your peril, particularly in today’s economic climate and with the current rudderless government. There is excellent information around on, generically, the traits of a manic depressive episode and MIND and ReThink are particularly recommended. Everyone’s experience, however, is different. I personally like this blog post, http://bit.ly/oNoWrD by the FABULOUS Natasha Tracy (@natasha_tracy) which articulates my presentation far better than I ever could for which I thank her.

* Thanks to @Zoe_Smith for her olfactory insight
* A good hurrumph in the morning sets you up for the rest of the day – Socrates (quote care of the lovely @NormanTonner)