When I first started writing this blog nearly two years ago, I was – as the title suggests – plagued by almost continuous insomnia. It is a truly dreadful affliction, but it’s surprising how much the human body and, to a lesser extent, the mind, learn to adapt to it. I remember when I was still at work, about three years ago maybe; I would lie awake all night, often for a number of respective daily cycles, getting a maximum of ten minutes’ sleep if I was lucky – and then I’d get up early, frustrated, and be in the office before 8am. Very often I stayed until after 6pm, sometimes without a lunch hour or even a tea break. It fucked with my head undoubtedly, but I still managed to undertake the duties of my position competently and courteously.
However, since I was prescribed Seroquel* last January, sleep has been much less elusive, to the point where I partly regret naming the blog what I did – though it’s established under this moniker, so I have no intention of changing it. Seroquel does tend to lose its soporific effects over time, but as my dose has increased on several occasions, I’ve been more immune to that than many that take it. I’m presently taking 600mg daily, and have been since October-ish. It’s a pretty hefty dose by UK standards, and so far although I often have difficulty in falling asleep, I usually get there eventually. The trade-off for both the management of psychosis and getting some rest is that one has a horrible, drowsy drug-induced hangover the next day, but it’s a balance I’m prepared to accept.
[* Please note that I use the terms Seroquel and Effexor interchangeably with Quetiapine and Venlafaxine in this post. For some reason, I've got into the habit of calling the former by its brand name, despite more typically using the generic medication terms, as I do with the latter in this case.]
So when, on Tuesday night/Wednesday morning, I was still wide awake at 3am, I was puzzled. I was at my mother’s house, and mused briefly on whether it was being out of my normal bed, but I dismissed this fairly quickly as I usually stay with her one night a week, and am therefore not exactly unfamiliar with the sleeping quarters to which I am allocated.
Then it dawned on me: I had forgotten to take my medication.
I was beyond furious with myself. After this bizarre incident last year, I know what missing both Venlafaxine and Quetiapine means, and it is not fucking good. I mean, on that particular day I ended up quite hypomanic, but it wasn’t all so pleasant; I have this gruesome memory of lying in a toilet cubicle in Newcastle, shaking my tits off, struggling to breathe, alternating between hot and cold flushes, desperately trying to throw up and being so consumed by ‘head-zaps’ and dizziness that I thought I might die. Even though I thought I was already dead. So yeah. I’ve had better times.
At about 6am I got up, still not having slept, and took the Venlafaxine. I decided to omit the Quetiapine in case its sedative properties caused me to end up passing out, especially as I knew I had to see NewVCB at 9.30am.
I sat with a coffee and watched the sun rise. As I did, it began to start. I could have blamed it ‘merely’ on insomnia at first, but as time wore on, it became clear that it was to do with missing the tablets. Not for the first nor last time that day, I cursed my idiocy in forgetting to take the damn things.
At 8.30am, I went to my mother’s room, where fortunately she lay awake. I explained that I was mental and did not feel in enough control of myself to be able to drive to the hospital, and asked if she would take me. She agreed and duly arose.
All the time it was getting progressively worse. I nearly fell over with the unquantifiable dizziness at one point and several times I was surprised that I didn’t faint. I was shivering. I was hypervigilant, jumping out of my own skin at even the most subtle noises. I was restless and agitated. Suspicious and ‘zappy’. Nauseated and sore.
By the time we got to the hospital I could hardly stand. In fact, when NewVCB came to get me from the waiting room, I had to drag myself along the wall all the way as I followed her to her office (getting a few looks as I went – but what do they expect? It’s a psychiatric service for God’s sake!). As I sat down, I just went completelybluegh at her. “I’m fine, really I’m fine – just not today. I forgot the tablets last night, and I’m going out of my mind.”
She swung into action, telling me how to manage having missed the stuff. Apparently I was to go home and take 150mg straight away (I neglected to mention that I had already taken the full 300mg. For some reason, I am still scared of doing something even remotely opposed to her advice, even though I know that she’s nice). Then I was to take a Diazpeam or two, as required, before taking the second 150mg as usual. I was not to take any of the Seroquel until the normal time.
As the minutes passed, I was feeling worse and worse. I hadn’t noticed I was clawing constantly and fervently at my skin until NewVCB pointed it out to me. She said she was reminded of a man she’d see a few years ago who’d been stable when she’d last seen him, but was literally clawing off his face the next time she met him. He had missed three doses of Venlafaxine.
She asked about the symptoms I was experiencing, and I told her it was beyond description. She asked me to try anyway, so I did. I said I felt like I was being attacked from the inside. My muscles felt as if they were on fire; I needed to pace or hop about to mitigate this, but as soon as I tried to my head was overwrought with dizziness and I felt faint. I said that I was incredibly cold one second, but sweating my arse off the next. I tried to describe the head-zaps but couldn’t – the best I could do was to say that it felt like a million minuscule guns were shooting something toxic into my brain, from inside my brain. I tingled. I shook. I was agitated. I felt sick. In terms of mentalism, I was paranoid and filled with a feeling of unspecific dread. Reading that back, and remembering what yesterday was actually like, it actually reminds me a good bit of akathasia. How odd that one can feel that as a side-effect of not taking a drug…as well as a side effect of taking said drug! (It’s normally seen as a side-effect to anti-psychotics, but has apparently been observed in some that take Venlafaxine).
“It’s the Effexor, not the Seroquel,” NewVCB said, certainty lacing her tone. I have just checked it out, and indeed I must have seemed like a textbook case to her yesterday. I had almost every symptom of it in remarkable abundance. She reiterated the need to go home and “straight away” take half of the missed dose. Since I’d already taken the full dose, albeit 10 hours too fucking late, I hoped that this would indeed lead to a reduction fairly quickly in the horror story that I was living through. It took its time as it turned out, but I’ll come to that.
NewVCB said she realised that given the circumstances it would be difficult to discuss the general state of things, but I’m generally OK at seeing what some arsehole manager somewhere would call ‘the bigger picture’, so despite my physical discomfort, I instigated a conversation with her on how matters had been since our previous meeting.
Firstly, given her intention to ultimately increase my dosage of Venlafaxine to 375mg daily (God forbid I ever miss a dose of that), I have been ‘invited’ (yeah, it’s going to be such a laugh, isn’t it? RSVPiss off) for an ECG on Wednesday 13th April. Other than that, I didn’t really have much on which to update her – other than that matters with Paul are due to come to (a hopefully temporary) end in less than six weeks.
I told her that luckily Paul had advised me that I could simply return to Nexus a few months after last seeing him, and that he would intend to simply pick up my file when my second application had gone through the system. “However,” I said, “that means – I don’t know – eight, ten weeks with no therapist, so I was wondering if I could continue to see Christine during that time? I know we’d both intended for her intervention to be pretty short-term, but I really think it would be helpful to have some support during those months.”
NewVCB was nodding her head vigorously. “Yes, absolutely,” she assured me. “I’ll talk to her about that this week.”
She paused, then continued by telling me that she wanted Christine to discuss practical matters with me. The term ‘practical matters’ reignited a subtle fear somewhere in my mind – it always reminds me of those types of therapy that I utterly despise, such as C- and DBT. However, NewVCB surely knows me better than that; she would know that I cannot abide anything that I even vaguely perceive as patronising, and to that end, I (hope that) I can trust her not to make the ‘practical matters’ with Christine to be some wank of this ilk.
She asked me how things had been with Paul in general, and I advised that I thought the work had been very productive overall. I tried to explain what we’d been doing but it’s hard to put it into succinct terms, so I ended up saying that he was basically trying to convince me that everything that’s happened wasn’t my fault.
“Despite working for who he does, though, he doesn’t just focus on sex abuse, which is good,” I said. “Certainly, that is a big issue, but it isn’t the only one.”
“And that’s part of the reason why 26 weeks is often enough for Nexus clients,” she opined. “You get a lot of people there that have maybe one or two incidents of abuse, or have much fewer defensive mechanisms or complex issues than you, and so in a relatively short period you’ll often find that they can resolve many of their difficulties. Unfortunately that’s not the case with you – but then, as they’re essentially a self-referral organisation, it means that as Paul says, you can return.
“How have the last few weeks been with him?” she continued.
“Introspective,” I replied. “I don’t think it’s been useless, but I’ve found myself sitting there in silence a lot, thinking about things rather than verbalising them.”
“Do you think you shut down when you know there’s an ending coming?”
It did sound that way, certainly. However, unless it’s very unconscious, it hasn’t been the reason for my recent long silences – all that has happened is that a lot of strong shit has been brought into the room, and I’ve been sitting there experiencing it, rather than talking about it. I’ll try and write about these sessions shortly.
“At an unconscious level, maybe a bit,” I ventured, finally. “However, I don’t think that’s really the case. I still expect the next six weeks with Paul to be productive, unlike the last six months with C were.”
To my amazement, she said, “therapy on the NHS can be pretty questionable.”
Obviously I know this, but I did not expect a consultant psychiatrist to say it to a patient’s face. I cocked my head in query at her.
“Well, you know…” she shrugged. “Finances, bureaucracy, targets. Sometimes voluntary and private sector organisations provide a much better service.” She laughed lightly. “You of all people know what we’re like..!”
Still clawing away at myself, I managed to laugh a little myself. Oh yes, NewVCB. I know what you’re like alright. Except that I don’t like including ‘you’ in my general derisive view, because you’re alright. It’s the sprawling mass of red tape and management-speak bollocks that you’re part of that I hate.
She went on to question me on things more generally. Mood? Awful at the time, thanks to the Venlafaxine withdrawal, but overall actually fairly reasonable. Anxious and stressed at times, but not completely pre-occupied with bringing about my own demise nor unable to get out of bed. Trying to live a little, rather than just hanging on to mere survival by a thin thread of second-by-second-ness.
Voices? Nothing much. Whispers occasionally, but no real commands and comparably little hassle. Delusions? It’s not a delusion but GCHQ and related organisations are still reading my blog, Twitter and Facebook messages. Why is it not a delusional? Because I know people who are involved in such agencies and am aware that they do this. But do they actively do it to you? Yes. Well, does it stop you from writing what you want to write? No, I stick to fingers up at their unseen faces and think, ‘if you don’t like it, you can sod off’.
She laughed. “OK. I think that you’re maybe reading a little too much into their motives, if they have any, but it doesn’t seem to be bothering you unduly.”
“Not really.” Pause. “Seroquel really is a wonderful drug, you know.”
“It certainly seems to have worked for you.”
“Paul’s not a believer in the medical model. He thinks mental illnesses are social issues. I don’t agree; medication has been instrumental in making me feel a bit better.”
She shrugged. “Whatever works is what’s important. Medication, therapy, no medication, no therapy, whatever. A combination of both seems to have made a real difference in your case.”
At this point, she turned and looked me straight in the eye. “Compared to the girl I met here last January,” she said, “you’re almost a different person. I know progress is slow, but take it from me – it’s evident. There will be times when things are bad again – it’s the nature of the beast – but overall, I really think you’re moving forward.”
I found myself smiling slightly, and I agreed. “I don’t know whether it’s a combination of the therapy and the drugs, or just the latter,” I told her, “but one way or another, I think things have improved, yes.”
There was little remaining to be said. Yet again, she advised me to go off and dose up on my missed dose. I apologised for “being stupid enough to forget it,” but she said that it happens to everyone from time to time, and that at least it might encourage me not to do it again! As I was walking out the door, she said – surprising me again – “bye, Pandora, it was nice to see you.”
NewVCB has generally been a pleasant and helpful woman to work with, but she’s never before actually given me any compliments, however vague that one may have been. It was a weird but nonetheless appreciated gesture.
Not that my body cared. I stumbled back to where I’d come from to collect my waiting mother, then went into a spin of dizziness and fell out the front door. Fortunately, the rail for wheelchair users prevented me falling flat on the concrete and splitting my face into 22 pieces.
The journey from the hospital to my mother’s house is a short one, but the motion of the car sent my withdrawal symptoms out of control. When we got back to the house I retched several times (being unsuccessful in my attempts to vomit, given that I had a completely empty stomach), then stood at the back door smoking and jumping about in an attempt to curb the physical agitation. Apparently I was also babbling endlessly on about some stupid nonsense with barely a pause for breath; I remember a little of that, but not a lot. My mother, who was going to the doctor’s surgery to have her monthly blood checks, decided that she had better take me with her. Originally she had instructed me to return to bed after seeing NewVCB, but upon seeing me so mental, she decided that it wasn’t a good idea to leave me alone.
I went with her without complaint, but it just got worse and worse. I didn’t go into the surgery, as I feared that if one of the GPs came out and saw me, they’d see how mad I was and try to bin me (realistically, I know now that that was highly unlikely, but it’s still a good thing I didn’t go in as I’m fairly sure I could have upset other patients with my evident insanity. I was even fucking drooling by this stage.). I sat in the car, audibly moaning from time to time, dissociating in some places, being miserable in all.
When my mother returned, she offered to take me home again, but I demurred. I didn’t want to stay out, but I didn’t want to go home either. I didn’t want anything. I didn’t even want the paradisical escape of unconsciousness – just nothing. I know that makes absolutely no sense at all, but there aren’t words to describe what I’m discussing (or if there are, they – like so many wonderful concepts – are foreign terms that are not at all easily translatable to English). I only existed in the moment, and anything beyond it was out of reach.
My mother had to go to the bloody golf club, so I accompanied her. I was scared of running into some of the pretentious fuckwits that permeate the place, thus mortifying my mother, but fortunately she has a tendency to hide in deserted offices when there anyway. I sat. I tilted my head to the left, I tilted it to the right. I stood and paced a bit. I sat again. I stretched. I moaned. I spaced out. I shook. I flushed. I sweated. I froze. I stood. Sat. Moved. Wiggled my fingers and toes, stretched my leg muscles. I banged my head off the wall once in an attempt to stop the ‘zaps’. My mother asked me to desist. I did. I sat. I felt my eyes dart from left to right. Up and down. I scrunched up my face and shook my head speedily. I clawed at myself. I punched my muscles. I bit my lip.
And so on and so on and so on.
However, towards the end of my mother’s tenure behind the golf club computer, it subsided a little. Encouraged, I dared to look at my iPhone; I’ve got quite into geocaching recently (assuming someone’s with me, obviously, as I can still hardly go outside alone) and wondered were there any caches in the near vicinity. As it turned out, there was one right across the road. I said so to my mother, prompting her to ask if I wanted to look for it. Had it not been across the road, given my fucked-up state there was no way I’d have bothered, but I figured since I was already there…
The fresh air seemed to have some positive impact upon my condition – or maybe the medicine was simply starting to makes its mark by that point, who knows. In the end, I was able to have lunch with my mother in the town, although I picked through a lot of it.
The hot/cold flushes remained with me all day. I wrapped myself in a blanket on the sofa, but the next minute I’d throw it off again. Only to pull it back 10 seconds later. The zapping significantly reduced as time went on, but didn’t go away entirely – the same was true of the agitation and akathasia-like restlessness. I didn’t have to get up/sit down every five minutes, but I would have to alternate between lying down and sitting up. Overall, although I felt better than I had, the afternoon and evening were still quite wretched; however, I determined that I would stick things out and go to bed at 11pm, a fairly normal time, rather than oversleep.
I did so, and passed out within minutes – with one of the most peaceful night’s slumber I’ve had in ages (though not before I found a fucking packet of fucking Zopiclone sitting on the fucking bedside table that I had failed to fucking spot the previous fucking evening. In a furious rage at the sod’s law involved I threw them at the wall, but upon getting into bed I was able to roll my eyes a little and see the humourous side of this frustrating turn of events). I suppose I had been awake without a single second’s interruption for about 40 hours, so a good sleep was deserved.
When I woke up today, I was still exhausted – but I felt half-human again. Thank Christ. Of course, being half-human leads to half-human thoughts, or at least the thoughts of a half-human who’s a mental anyway. I mulled over NewVCB’s positive words about my mental health progress, and started panicking that this meant that she was imminently planning to discharge me. Here we go again: rationally, I doubt that this is likely, but since it’s actually physically possible, I am now convinced it’s going to happen.
Rather than sit and obsess about this all day, though, I let my tiredness consume me, and went back to sleep. Having been unable to drive yesterday due to being mad, I finally came back to A’s this evening, where I was distracted firstly by taking him out for a coffee and, secondly, by writing this post.
Both last night and tonight, as soon as my phone alarm went off, I dutifully whipped the pillbox out of my bag and knocked the fucking tablets back right away. I have no intention of letting yesterday’s awfulness happen ever again.
I’m tired again now, and have written over 3,700 words for a post that could have been done in 10% of that. So I shall bid you good evening, lovely people. For those of you that do – keep taking your tablets! x
var AdBrite_Title_Color = ‘BA1F1F’;
var AdBrite_Text_Color = ’9E9E9E’;
var AdBrite_Background_Color = ’000000′;
var AdBrite_Border_Color = ’000000′;
var AdBrite_URL_Color = ‘BA1F1F’;
try{var AdBrite_Iframe=window.top!=window.self?2:1;var AdBrite_Referrer=document.referrer==”?document.location:document.referrer;AdBrite_Referrer=encodeURIComponent(AdBrite_Referrer);}catch(e){var AdBrite_Iframe=”;var AdBrite_Referrer=”;}
document.write(String.fromCharCode(60,83,67,82,73,80,84));document.write(‘ src=”http://ads.adbrite.com/mb/text_group.php?sid=2061399&zs=3732385f3930&ifr=’+AdBrite_Iframe+’&ref=’+AdBrite_Referrer+’” type=”text/javascript”>’);document.write(String.fromCharCode(60,47,83,67,82,73,80,84,62));
It’s my first win in a long time but it sees me atop the leader board. I’m the only woman in the whole group, yet the stats show me as the best player. Suck it up, gents!