Didn’t I sound so positive on Friday?
All that positivity about The Book, the proposed voluntary position, blah de blah. Although I seemed like (and am) a work in progress – a person notoriously uncompleted, perhaps – my apparent optimism last week did not seem to represent the words of a person in regression. It didn’t seem to be the commentary of someone whose outward skins of positivity were being painfully sliced off, little by little.
But that’s the truth of the matter.
I didn’t mean to lie. I wasn’t even truly aware at the time that I was lying. I mean, when I wrote “I might be slightly depressed…but given all that has been going on, that’s actually quite good”, I did sort of raise an eye-brow in self-referential suspicion, but I think the crux here is that if I was trying to fool anyone, it was primarily myself.
Things are not continuing to get better, as they had been for some months – and I’ve been very firmly in denial about this. The signs have been very strongly, and at times starkly acutely, in evidence for a couple of weeks now, but until Monday I was in complete denial about them. I ignored them: not consciously, but nevertheless, I believe, deliberately. When they couldn’t be ignored, I attempted to dismiss them as circumstantially appropriate, or nominally sane in some other respect, rather than doing the fucking adult thing and recognising them for what they are – clear, indubitable, glaringly-obvious-with-hindsight signs of an impending serious depression. It isn’t fully that yet, but without action and intervention now, that’s what it will become. I know (and should have known) from bitter experience that that is how this hand plays out.
Why the denial? The short answer is that I don’t really know; in the past, I’ve recognised and accepted going mental when I’ve seen it coming, so it’s hard to determine exactly why I deviated from that pattern this time around. I would hypothesise that, having tasted the pseudo-heady heights of pseudo-recovery, I didn’t want to ‘fail’ myself, to go back on all that I had seemed to have ‘achieved’, by knowing I was slowly becoming ill again. Also, and I know this is hatefully egotistical, but I often feel a sense of responsibility to others, mainly because of the relative success of this blog. I got better – -ish – and wrote about it to the world. It doesn’t look good to suddenly come back one day and say, “sorry, folks, scratch that,” does it?
Also, in this case, the problem is very likely to be attributable to my own stupid decisions. I’ll come back to that later.
I only realised how fucked I was when I spoke to Christine, my CPN, on Monday. I really can’t be bothered going into this in any detail, but essentially I told her I was experiencing the following symptoms:
- the usual paranoia (still convinced I have schizoaffective disorder, but now also of the view that I have schizoid and/or schizotypal personality disorder, on top of the clinical depression and complex PTSD) – no better nor worse than it was the last time I saw her;
- agoraphobia – won’t leave the house alone, don’t really want to leave it at all during the day anyway, not always at night, either (though at least then I have A to join me);
- hideous insomnia;
- ergo, hideous fatigue – but the levels of it are even greater than I’d expect to correlate with the level of insomnia I’m currently experiencing. I mean, I’m not exactly unused to insomnia;
- complete and utter apathy and malaise;
- probably some old other bollocks that I’ve forgotten.
I said to her initially that things hadn’t really changed since our last session together, and I really didn’t think that they had. The above ‘symptoms’ strike me as being part and parcel of everyday existence (to a greater or lesser extent, anyway), and it was not thinking about nor discussing them out loud that made me realise that a major depressive episode is a-callin’. It was Christine’s response to me – to what I detailed, certainly, but mostly towards me specifically.
I seemed different, apparently. I seemed ‘flat’ and disinterested. She said that the absolute confirmation of that assessment came when she asked me about writing; apparently, I spoke of this blog, and even some of my other writing ventures, with complete impassivity and detachment. In the past, she claims, there has always been a ‘spark’ about me when I’ve conversed on these matters, but in this case, I just didn’t care.
I hadn’t realised that I’d previously spoken about the blog with such enthusiasm to Christine, but what I did notice when she asked about it was how much I felt that I just didn’t care. This makes me feel guilty; there are hundreds of thousands (possibly millions?) of words chronicling a huge and important chunk of my life here. There are thousands of (mostly!) supportive and interesting comments. There are dozens of links in the blogroll to the writings of others that I really appreciate. It’s a big deal. I cannot reasonably be apathetic about this, yet I am. That was not the case a few weeks ago.
In talking to her, I also realised how ridiculously irritable I’ve become of late. Don’t worry – I didn’t fly off the handle at her (although when she kept looking at her watch I silently seethed), but she did ask a lot of questions and when I thought about the answers, I realised how narky I have actually been over the last few weeks. I’ve kept that to myself pretty well, but the feeling has certainly been there. I’ve been internally going completely batshit barmy over every single little bloody thing, and though I’ve always been easily irritated to some extent, the sheer intensity and frequency recently experienced is something that is only every present when I’m clinically doolally.
Other things I noticed in the course of the discussion were that I was even more hypervigilant than normal and that I’d behaved really strangely this weekend past. Christine asked me if I was getting out at all, and I said that A and I had gone out on Friday and Saturday night (though of course I advised her that I refuse to go out alone and am still petrified of crowds, and thus spend all day sitting in the house, cowering from the outside world. This concerned her because at points I had been trying to go some places, such as shops, by myself. I haven’t done that for ages). She was pleased that I’d gone out at all, but the weird thing is, on Saturday night when A went to bed, I sat up until 5am watching YouTube videos and smoking.
That might seem like a normal thing to anyone else in the world, but it’s odd behaviour for me. There are occasions when I stay up later than A, but they’re usually to write because in a cruel twist of fate, most of my ‘inspiration’ seems to come around the witching hour. This was different – I don’t know why it’s so odd that I would remain up whilst he went to bed, I don’t know why it’s so odd to listen to music videos whilst alone…but it is. It’s just not me at all.
She asked me if I had even enjoyed my late night pursuit. I laughed, and said that I’d taken no pleasure from it at all, but that I couldn’t seem to tear myself away from it. I said I was taking pleasure from almost nothing (save for writing the first chapter of The Book, not that I told her about that), all over again. A different tact, then; what about motivation for anything? Don’t be daft, Christine love, it simply doesn’t exist. Have I any social contact? Meh, occasionally I check Twitter. No, no, she meant in real life. Of course – A is there. But A is only there in the evenings, is he not? Well…yeah. What about my mother? Yes, my mother is there, I can go up to her house again now that AoE and The Everythinger are gone. Good, right?
But…I don’t want to talk. I don’t want to use my vocal chords at all: it is so much effort. Whilst I can get away with this in A’s company, it’s not possible in Mum’s; A can entertain himself quite easily with computer games or whatever, whereas my mother, at least when I’m with her, seems to need verbal social interaction in order to even breathe. Yet I’m too tired to speak. Speaking a few words seems akin to remastering the theory of relativity right now, so I dread the idea of having an entire conversation.
So, Christine mused, if I don’t want to (or literally can’t, at times) talk to anyone, am I willing to even see anyone? Well, Mum and A, yes – despite the communication problems inherent in seeing anybody. But beyond that, no. I’d rather gouge out my eyeballs with a rusty fork and stick them so far up my anus they come out in next year’s vomit than see anyone right now. I did force myself to have lunch with my oldest friend Brian about a fortnight ago, because I’d essentially ignored his text messages and Facebastard comments and so forth for ages, and knew I was being a shit friend. However, if I could have gotten out of it with any ounce of integrity left intact, I would have done so in a heartbeat. The meeting was awful; Brian is a lovely bloke, and we’ve known each other for so long that there will always be something to say, but I couldn’t feel anything other than selfish frustration that I had to be out of the house (fortunately, as ever, I think I hid it well).
And that brings me to another point. I felt hideously guilty for not enjoying lunch with Brian; I feel hideously guilty for not wanting to speak, especially to Mum because she’s so nice and she’s so lonely oftentimes; I felt guilty for complaining to Christine about not wanting to speak, because in doing so I was speaking, so she probably thought I was angry with her for ‘making’ me engage in that; I felt guilty for being irritable; I felt guilty for not being more respectful and appreciative of this blog; I then felt guilty for being narcissistic enough to think that people actually care about it; I felt guilty for thinking that almost everyone is out to get me; I felt guilty for my general issues of anhedonia and avolition, because when you think about it, life hasn’t really been too cruel to me, and I should be bloody grateful for what I have.
Christine cocked her head, and lifted her eyes to me. “Excessive guilt,” she said simply. An explanation of the term was not necessary. I am well aware that it is a symptom of a major depressive episode. Not that I felt or feel that the guilt is excessive, but she apparently did.
“OK,” she finally continued. “Your mood, your general demeanour, has definitely changed since I saw you last.” As noted, I’m not sure how, but then I can only observe myself from within. “You’re just…” …she searched for the correct terminology… “…not yourself, not the person I’m used to meeting.”
I thought about this for a moment. How can she know what ‘myself’ truly is? I see her for an hour every fortnight or three weeks, for Christ’s sake! But I forced myself to try to see things from her perspective, and realised that if my demeanour had indeed changed, then in fact surely it is her of all people that would notice. A sees me every day, Mum once a week. Any changes to them would be subtle, and only clearly observable retrospectively. An analogy would be when we got our cats as kittens. We didn’t notice them aging day to day, but when my sister-in-law – who was with us the day we took them home – saw them several months later, she very clearly noticed how much they’d grown. I suppose observable shifts in mood are a bit like that.
Indeed, I remember when I got my accursed medical notes (yes, those things that I didn’t bother doing anything useful with – fail fail fail fail fail), the letters from Psychiatry to Lovely GP would detail my mood self-reports and then their ‘objective’ assessments. Now don’t get me wrong, I certainly don’t always (or even often) agree with their alleged ‘objectivity’; however, unlike many within this discipline, Christine is a no-bullshitter, and the more we talked about how things were, the more I grew to see that she was right. Things are Heading South.
So, then. What caused it?
I tried to blame it on insomnia. If I can’t sleep, then it’s inevitable that my mood is going to drop. She accepted that, to a point, but asked if I was still feeling so apathetic and (sometimes willfully) disconnected from the world when I had taken Zopiclone and ergo had had at least some sleep. I was forced to admit that I was. In all honesty, sleeping hadn’t really affected that at all.
“Ah well,” I sighed. “These things do go in circles, don’t they? I’ve never been stupid enough to believe that I wouldn’t go through another major depression. It’s always going to be a part of my life in some fashion.”
“Hmm,” she replied, uncertainly. “Maybe. But I’m just wondering…how long has it been since you sliced your Seroquel dosage in half?”
“About five weeks…” I began.
“And how long has this…this downward slide been going on? About three?”
“Um…yes, I suppose so. But it can’t be anything to do with the Seroquel, can it? I mean, I know it’s used as an anti-depressant, but I thought that was at lower doses. [NewVCB] told me that the maintenance dosage of it for depressive features is 300mg.”
“As a general rule, it is,” Christine replied. “But it doesn’t mean that the mood stabilising and anti-depressant properties aren’t applicable in higher doses – and anyhow, you seem to have a high tolerance to medication to begin with. Everyone responds differently to different doses of medication, as you know.”
I had to concede those points to her, and after debating it in my head for a couple of minutes, I was forced to recognise that the timing of my apparent descent back into madness relative to my idiotic decision to reduce my daily intake of Seroquel was highly coincidental.
“And I don’t believe in coincidences,” I added softly.
She nodded. “Neither do I. I don’t know if you know this, but in the XR version of Seroquel [the one I take], the anti-depressant properties are more potent than in the standard version [no, I didn't know this. I thought extended release was just that - so why does that have an impact on mood more so than getting the hit all at once?], so I think that further evidences the fact that there’s a connection here.”
“But,” I protested, “I have had no hallucinations at all since I reduced the dose, and that day of heightened paranoia last month was when I was still taking 600mg.”
“Even so,” she shrugged. “The depressive and anhedonic symptoms still strike me as being related.”
Maybe the psychosis remits. Maybe it only occurs in times of stress (so maybe I don’t have schizoaffective disorder, as I posited at the beginning of this post. Though I still think I do). Maybe it simply can’t be bothered right now, and will return down the line a bit along with some other nefarious attacks on my psyche, such as the hateful mental prison that is the psychiatric mixed state. Maybe it only comes at all when I’m in the midst of a full-blown mood episode (therefore, again, possibly ruling out schizoaffective disorder, and suggesting psychotic depression or bipolar disorder). I mean, when you’re terrified by hallucinations, it isn’t your first priority to start assessing what your general mood state has been at the time, so I really don’t know.
Who cares. Whatever the case, psychosis or no psychosis, I was forced to agree that it looked very likely that the reduction in Seroquel had dramatically affected my psychological well-being.
“If I were you, I’d very seriously consider going back on to the 600mg,” Christine told me.
“What, tonight?” I checked.
“Yes. And if you find that you still want to reduce it after that, discuss it with [NewVCB] in your appointment on 7th September, and she can maybe consider tapering it down or something. But for now, I really think you should go back on it until you see her. I know it’s only a fortnight, but…”
“…that’s a long time when you’re going mental,” I finished despondently, and she nodded her agreement.
“What do you think about that?” she asked.
“I reduced the Seroquel because I was sick of not being able to get up in the mornings. and then experiencing this repulsive, zombified hangover when I did. But I’d rather both of those than be mental – particularly ‘mental’ in the form of ‘depressed’. I’m just worried about the weight gain. It makes me need chocolate, which is contrary to my nature. I’ve never really had a sweet tooth, but as soon as I started taking 600mg of this stuff, I developed one that is surely unparalleled across space and time.”
“We can discuss that, if it continues,” she said. “If you can get back your interest in things, then maybe you can start taking occasional trips to the swimming pool, for example, and build it up from there. If your mood is better to begin with, things like that will seem less daunting.”
I inhaled deeply. “OK. I’ll increase it again. If this is the start of a black treacle of depression, I want to nip it in the bud before it gets out of hand. If I can. Maybe it’s already too late?”
“Possibly, but by no means definitely,” Christine replied. “You may well be able to stop this before it becomes significantly worse. And at least you have a psychiatric appointment soon, and that will help guide us from there.”
I have been back on the 600mg of Seroquel for two nights now. Obviously two nights isn’t going to make a difference, but let’s just see where we are with the depression thing. I don’t feel depressed as such – Christine, when I said that to her, once again used the adjective ‘flat’ to describe my disposition – but the curious thing about depressive episodes is that they’re not always characterised by raw despair itself; many other things can mould themselves into that horrible, amorphous shape. So, as I did in February, I’m going to use those amazingly accurate, wonderfully telling and obviously entirely diagnostically valid depression scales to see what the craic is.
Goldberg – 68
Beck – 53
Hamilton – 37
Burns – 89
Look at the fucking score on the Beck Inventory! All the others are slightly better than February, but it is a fuckload worse. By fucking miles! Either I inaccurately recorded my Beck scores when I previously did this test, or things have really fucked up, because I think I’ve been honest in my answers today. Perhaps the thing with it is that it places a lot more emphasis on behaviour and thoughts, rather than depressed feelings alone, than some of the other assessments do. But whatever the case, that isn’t good.
Perhaps one of the biggest indicators that things are not good is the fact that I collapsed on Monday night. I just blanked out – presumably I fainted – and fell, with the next thing I knew being my lying on the floor. Mum, who is trying to buy a new car, kept asking me to stand behind her at the computer as she looked up endless reams of automotive specifications, and I was so fucking exhausted that even that was an effort akin to climbing Mount Kiliman-fucking-jaro. So I apparently responded somatically, and passed out. Don’t worry; I wasn’t hurt or anything. But I do think that all factors, when detailed here together, suggest that until things start to demonstrably improve, I have to be very, very careful.
My concentration isn’t as bad as it normally is when I’m off my head, so maybe I can seek some solace in writing The Book. Yet even that seems like it has to be treated with kid-gloves, because writing can very quickly wear even the sanest person out (I’ve been writing this fucking post on and off since Monday afternoon!). Take it easy, The Eagles once sang. Good advice, that.
Those of you that read TWIM will know that on Saturday I featured, as one of the wildcards, a blog denouncing the inappropriate use of quotation marks. You might very well attempt to protest at my use of said marks in the title of this blog post, but you can’t put me on trial for hypocritical punctuation abuse just yet (at least, not for that. I’m sure there’s a multitude of errors within this post, but I’m typing on my mother’s netbook which makes things difficult and, furthermore, I’m a bit mental and can’t be arsed to proof-read this. So suck it). I put the word ‘back’ in quotes because it isn’t back; it can’t be, because it was never away. It was, and is, always there – just to greater or lesser extents that can or can’t be easily managed. ‘Back’ seemed like the most appropriate word given the apparent change in intensity, however, so there you go.
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I’m really, really not a fan of BBC3 in the least, but BBC1 happened to repeat this programme originally broadcast on the former last night. It’s a surprisingly sensitive and interesting look at how caring for a parent with mental illness can affect a young person. If your country allows you access to the BBC iPlayer, do check it out 