Today I had my third appointment with new psychiatrist. I have to be honest and say I was utterly dreading it because the last two appointments with him have been extremely frustrating and of no help whatsoever. But lovely support worker came with me and when she first picked me up I was very very anxious, did not want to go, but after sitting talking to me and calming me down for about 20 minutes I finally got out of the car and went into the main hospital building.
I had gone over with her what I wanted to say to new psychiatrist today and just hoped that I’d both remember it all and get the opportunity to say it all. I can’t remember if I have already mentioned this here, but basically I had decided that if this appointment went as shite as the last two with him then I was going to ask my GP to refer me to see a different psychiatrist. I may live in the middle of nowhere with very little in the way of mental health support but I do believe there is one other psychiatrist that does cover this area.
So, bang on 2.30pm his door opens and he calls me through. I hesitantly walk through with lovely support worker behind me. We sit down and he asks how I have been since I last saw him. I took a breath and told him that my mood has remained flat the vast majority of the time, that there have been a couple and I do literally mean a couple of OK/good moments but really for… well… so long now I’ve lost count my mood is flat, I rarely find enjoyment in anything, my self harming continues, I have fleeting suicidal thoughts, my sleep is crap, even the very basics like having a shower and getting dressed and taking the dogs a walk sometimes just proves to be too much for me.
Yes, I know I went out for the first time in at least six months on Saturday night and ended up having quite a good time but I think that was mostly due to the amount of alcohol I’d consumed. I did not mention anything about the recent brief substance misuse because I don’t want that splashed onto my case notes again… and anyways… it’s over and done with now with no plans of any repeat episodes. I told him about the two visits to A&E for self harm wounds and stitches, I told him I am trying my hardest to plod on with my part time home based uni course but that I’m failing to concentrate and struggling with it massively. I told him that sometimes I hear a little niggling voice encouraging me to hurt myself but that I can tolerate it as it’s nowhere near as bad as when I was hearing several voices and hearing them constantly. In that respect I think the 750mg a day of Quetiapine (Seroquel) is still working.
He asked how I’d found the increased dose of 45mg a day Mirtazapine and again I told him that it was fine for the first couple of weeks but then I started having such severe physical symptoms of anxiety (when I truly thought my heart was about to pack in and ended up getting the ecg done) and how lovely GP had wondered if it was actually the Mirtazapine causing it as anti-depressants do take a while to build up in your system. So I told him my GP told me to go back down to 30mg a day and see if the anxiety improved and yes, the heart palpitations did stop and have continued to be minimal. But the ‘psychological’ anxiety, the constant worrying and fears are still very much present. Some days I’m so scared to even walk out my front door to cross the road and walk the dogs for ten minutes then other days I dope myself up on whatever anxiety med I can and force myself to face a potentially scary situation.
He then asked how I had found the Pregabalin (Lyrica) that he had prescribed last time I saw him as the plan was for me to use it on a long term basis for my anxiety and finally start to taper off the Diazepam seeing as I’ve been taking it daily for three years now. But I had to tell him that had been a disaster as well… that I didn’t realise it had the same/similar ingredient as Gabapentin which it appears I’m allergic to. So the two medication changes he made at our last appointment a few months ago were both unsuccessful.
This of course brought us onto the discussion of reducing my Diazepam and I firmly told new psychiatrist that yes I am willing to reduce but I am most definitely not doing it at the moment. I feel horrendous enough as it is without trying to taper off from that. To my surprise he did actually say that he agreed now was not the right time, especially not as we are fast approaching my two worst times of year – Christmas and then my little boy’s anniversary in February.
He asked what support I was getting from the mental health team and I quite honestly told him how utterly useless I find cpn#2. He asked why and I explained about her super structured way of working, her setting of agenda’s, her constant ‘positive goals’ and her reluctance to talk about anything that is making my moods low. However I did tell him that I am now top of the waiting list for psychology and have been given a provisional date of mid to late November for my first appointment. It’s the same psychologist I used to work with so in a way I am looking forward to going back to see her even if I don’t feel particularly convinced that this Compassion Focused Therapy bollocks is going to work for me.
So all in all it was actually quite a good session. I managed to get across to him that the two medication changes he proposed last time I saw him had failed, that I was not ready to taper off from the Diazepam yet, that my moods are low and flat, that I’m self harming again and having occasional suicidal thoughts, that I am generally struggling with life a lot, that I’m struggling trying to continue with my studies, that the only person who lets me vent is lovely support worker, that I find my sessions with cpn#2 useless, and some days I seriously do wish I just hadn’t woken up that morning.
His first response to all of this was to ask me if I thought I would benefit from going in as an inpatient in the bin for a while? I said no, that place makes me feel worse, trapped, none of the staff give a damn, the other patients are too stressful to be around, there are too many rules… just no.
His second response was the one that surprised and to be honest shocked me (no pun intended). He said that as he looked back over all my medication history for the past four years we have pretty much exhausted every med now. There really isn’t anything different we can try. We could maybe try new combinations of something but I have pretty much tried every anti-depressant, mood stabiliser and anti-psychotic and benzodiazapine there is. He asked if it’s my depression or my anxiety that is worse and I said both of them. The anxiety can be managed to a degree with medication, the depression is just constant, constantly ongoing flat crappy moods that for months and months and months if not closer to a year have just stayed shit. Every day is an effort, every week is an effort, some mornings I open my eyes and my first thought is “I think I might kill myself today” or “I wish I was dead”. But I don’t act on them because I don’t want to put my parents through all that heartache and frustration again. I carry on painting on these fake smiles and trying so hard to make everyone think I am coping. Although I did let slip to my Mum the other day that I had recently self harmed and had to go to A&E. The thing is I’m still self harming – first through cutting… then misusing substances… then drinking… now back to cutting again. I try to put on this persona of being someone in recovery but I’m so far from recovery it’s scary. All these people telling me how well I’m doing because they don’t fucking let me talk about how bad I feel, they insist on only talking about positives and therefore have a completely skewed picture of how my life really is.
So new psychiatrist says here is the plan of action: he will not make any medication changes at the moment (mainly because there isn’t really anything else we can try), he would give me a couple of months to start seeing the psychologist again and see if psychological input helped my mood in any way, he encouraged me to be honest with cpn#2 about what *I* need from our sessions (told him I’d already done that and got nowhere)… he asked lovely support worker if she would carry on seeing me and she said yes she would see me weekly for as long as I needed it, he encouraged me to try and open up to my family so they know I’m actually not coping that great right now and all these fake smiles are simply that: fake.
And then he hits me with it… “there is one other thing we can try but I’d like to wait at least six months before trying it as I only like to use it as a last resort… have you heard of ECT before?”
I sat there kinda shocked but nodded my head. A very lovely fellow blogger tried ECT some time ago and I read all her experiences with it with interest even though it didn’t seem to work for her. It is something that scares me a bit… I mean nobody really likes the idea of being knocked out, put into a seizure and having your brain zapped do they? It’s pretty hardcore stuff. Then add in the quite possible and quite likely short term memory loss. It’s not the most appealing of treatment options. But whilst he did reiterate that it would be a last resort I suppose it sort of shocked me that it was even suggested. He said it doesn’t work for everyone but a point has to come where we try and break this depressive and unproductive cycle once and for all… and maybe, just maybe ECT would be the thing that finally works for me. But like I say, he wants me to try a few months of psychology first and then review things again. He wanted to see me back in a couple of months but he is away for most of January so my next appointment is February 6th… five days before my little man’s anniversary so I’m bound to be in a super depressed state of mind next time I see him. Again, lovely support worker said she would come with me.
I can see that my life is not good at the moment, far from it if I’m brutally honest. Yes on the one hand I haven’t given up on the studying (yet) and yes I managed to travel to a new faraway place recently (doped up on diazepam) and yes I even managed to go for a night out on Saturday (full of alcohol). But then we look at the flip side: I’m self harming a lot although managing to keep it reasonably superficial at the moment purely to avoid having to go to A&E, I’m having lots of thoughts about ending my life, my anxiety levels are ridiculously high and out of control most of the time, other than that one night out on Saturday I have next to no social life whatsoever, no friends that I see on any kind of regular basis, a constant niggling voice giggling away in my head at how pathetic I am and fuck just a couple of weeks ago things became so desperate I put that shite back into my body for some sort of an escape. I feel unsupported apart from by lovely support worker, I feel alone, I feel miserable, I question the point of everything, I don’t cook meals or eat properly I just binge on junk food, I’m lucky if I shower a couple of times a week. Things are not good. And I can’t go on pretending that I’m OK any longer because I’m not. I didn’t want to admit it but there you go, I’ve said it. I just don’t want to worry my family so I keep it bottled up… but it’s getting really bad again.
I cancelled my appointment with cpn#2 for tomorrow because I just cannot face her “positive goal setting” bullshit… I left a message for her saying I had too much studying to do and couldn’t go and asked her to give me a call back to rearrange another appointment but to be completely honest I will probably cancel that one as well. What’s the point when I get no benefit from them? And now I know it will only be a matter of weeks until I start seeing the psychologist again maybe it’s time to just stop seeing cpn#2 because I feel like I’m getting nowhere with her and I just cannot work to her super structured approach.
Has it really come to a point where I need to give serious consideration to trying ECT? Could that be the one thing that just blasts my brain back to a state of normality so I can get on with my life in a happy and meaningful way where I actually want to be alive and enjoy my life? Could it break away from all these desperate little attempts of escapism? I don’t know… And I’m not going to give it much thought for the moment because it wouldn’t be happening for at least six months anyway. And who knows where I’ll be in six months time… Who knows if I’ll even still be here? The way I feel at the moment that is somewhat doubtful.
But if I’m totally honest with people, if I lay my cards on the table and admit to how bad I feel then I enter back into the conversations like those of today: talks of admission into the bin… talks of ECT… Do I want those conversations, or worse, for them to actually happen? No.
I just want to feel normal whatever that is. I just want to feel happy. I want to wake up and look forward to the day ahead. I want things to be easy and free and effortless.
And yet I also want to go to wherever my little boy is… wherever it is we go when our body has died and our soul has moved on… and well…. I guess I can’t really believe that I’ve ended up back in this place again. I’m scared… the feelings of things about to fall apart and hit crisis level feel imminent and I’m genuinely truly terrified of that happening to me again.
