Thank Christ(ine) for Christine

A lot happened this week, but I have neither the time nor inclination to discuss it in detail. Perhaps next week. In summary: I saw Paul on Tuesday for our first ‘proper’ therapy session of the new stint. A bit of a weird dynamic was present – I babbled relentlessly, flitting from one random tangent to another rather than discussing anything remotely meaningful. Not that he agreed, of course; he opined, as he always does, that anything that runs through my mind (aside, perhaps, from “oh, look, the sun’s out” – though could that be read as an example of avoidance?) is worthy of raising in the therapeutic setting, and can give insights into my psyche. That said, he did admit at the end of the appointment that things had been a bit up in the air (I forget his specific terminology), and said we’d get down to some proper work next week. I await it with interest – but not at all without trepidation.

Last weekend I decided I was going to turn a corner of the kitchen into an office. I don’t think I can do much about it right now, but I think if I have a future, then I ought to have something to aim for – and I’ve decided that this will be professional writing. My dream: to register as a sole trader business, and make at least a part-time income from writing – and no longer have to claim at least some of my welfare benefits (I would like to think I could keep my Disability Living Allowance, on the grounds that the disability remains, but that in having my own workplace I don’t have to engage with general office tradition, which would exacerbate my illnesses). I know I’m capable of professional writing now – or, at least, I know other people think I’m capable, and that matters much more in this arena than my own self-assessments – and I’m building a few contacts. For now, that is all it is – a dream. A few commissions here or there doesn’t really mean much, but I’ve narcissistically (why is that not a word, spellcheck? Incidentally, why is spellcheck not a word when it’s the precise term WordPress uses to refer to this utility?) got it into my head now that I can achieve this if I don’t do myself in any time soon. When I mentioned the proposed office to A, he suggested that instead of setting it up in the kitchen, I actually reconvert our former study – lately, since the advent of The Everythinger, nothing more than a place for dumping stuff we can’t be bothered to sort out.

It seemed more palatable than the kitchen, admittedly: for one, it’s fucking cold in the kitchen no matter how long the heat stays on. Secondly, as I am not wont to be in the former study much, with a bit of re-configuration, it will feel more like an office than part of this house. Currently I do all my work sitting on the sofa with the laptop on my knee – but I do all my fucking about in this fashion too, and ergo it is difficult to associate the environment with work specifically. The study in many ways resembles – or will resemble, when I have it sorted – my office in my last job: small, but with everything necessary to get on with the task at hand. As such, I feel that I can ‘trick’ my brain into thinking that the proposed office will actually be a workspace, rather than a mere spare room.

We ordered a new desk, which arrived on Wednesday. I sat down to it last night and, aside from a few side panels that A had fitted, built the entire thing from scratch. It is (optionally) an ‘L’ shape, and has ample surface area, meaning that aside from the PC and laptop, I’ll have plenty of room to write by hand, consult the Writers’ and Artists’ Yearbook, or study the professional writing course materials I bought several years ago.

All of that, particularly my suggestion about setting my writing projects up as a business, is a long way off – because right now I’m not a professional writer, but a professional mental. I even get paid for it! Though for how much longer?

As you may have gathered from the last couple of posts, things are dreadful. It’s at the point now where people are noticing: when I can no longer maintain a fa√ßade, then I know things are bad. My mother has even realised that the excrement has been liberally sprayed in the general direction of the thermantidote, and that is a tremendously dangerous sign, since I have always attempted to muster every last atom of energy my mind and body possess into convincing her that everything is fine (the reason being that she shouldn’t have to worry about me all the time).

As if things were not bad enough, therefore, when I got up yesterday morning and found an ESA50* form waiting for me, I thought I was literally going to have a heart attack – I hyperventilated so fucking much that I could see no way that my heart could continue to pump blood around my not-insubstantial body.

My ma immediately said, “we’ll take it to the Citizens’ Advice Bureau.” Reasonable advice, to be sure, but she’d missed the point; the point was that, re-fucking-gardless of how competent the CAB may have been in the completion of the bloody thing, I would almost certainly still have to attend a medical examination with the fuckwitted social security agency. I know I’ve written in passing about one of my previous exposures to this immense trauma…where?…ah yes, here it is. (*This post also explains a bit about ESA ((which stands for Employment and Support Allowance)) to those of you outside the UK. Basically, it’s a disability/illness benefit – but it has two components that complicate it, which the aforelinked posts discusses). After that experience – and even regardless of it – I genuinely don’t think that I can go through another assessment of this ilk (or of any, come to that). Not any time soon; pipedreams or not, I’m still really ill. I told my mother that if I had to go through such an encounter, that I would end my life.

Fortuitously, I had an appointment with Christine in the early afternoon. Since the hospital in which I see her is close to the CAB, I took the form with me. I went in, sat down, when asked reported that since our last encounter everything was still appalling, uncopably (new word) terrible, and that “the icing on the fucking cake” had just arrived, at which point I pulled the ESA50 out of my handbag.

She shook her head in frustration – “everyone’s getting those bloody things!” – and I repeated my promise that if I was called to a medical I would commit suicide.

Christine said, “I’ll complete it for you. At least that will be a weight off your mind.”

“That would be brilliant, thank you,” I replied, “but won’t they still send for me anyway?”

She told me that she is getting the impression that the Social Securitcunts have been sending out the forms to weed out the few “scroungers” that exist in the system, and also to catch out those with a mild to moderate illness, who they (quite possibly erroneously) perceive as being able to work. She exemplified by telling me about a patient of her’s that has mild, borderline moderate, depression. “She’s been found fit for work,” Christine explained, “but honestly, Pandora, there are things she could do. Not everyone’s in that boat, and in fact most of my patients haven’t even been called to a medical, and these forms have been arriving through their letterboxes since the start of January.”

“Are you saying that you think I won’t have to go to an examination?” I checked.

“I’d make an educated guess that when I’ve finished with this” – she nodded with contempt at the form – “it’s highly unlikely.”

She smiled conspiratorially at me, but I pressed on with my concerns. She wasn’t saying definitively that I’d not have to go to the fucking thing, after all.

Eventually she said, when I had finished yet another monologue of social security-driven angsty misery, that if they did call me to an examination, that she and NewVCB would write to the bastards advising them that I would be unable to attend, as to do so would be “severely and dangerously detrimental to my mental health.”

I stared at my CPN in something akin to wonder. “Really?” I murmured in a small voice laden with disbelief.

“Yes,” she said definitely. “So don’t worry. I’ll deal with this, send it off to them, give you a photocopy at our next appointment – and if an ‘invitation’ letter turns up at your door, contact me, and we’ll make it go away.”

“Thank you,” I almost-sobbed. “Thank you. I really appreciate it.”

Christine dismissed my gratitude – not in an unappreciative way, just in the sense that she was happy to provide the service and information that she had – as part of her job. Then she said, “you’ll be horrified when you read what I’ve written. Try not to be. They need to hear the very worst aspects of your illness; yeah, some people could accuse me of extending the truth, but I don’t think that’s the case. The case is that all of what I am going to write has happened and even though you’re taking measures to control these things, the unfortunate truth is that they also have the potential to happen again…possibly at any point.”

“Why would I be ‘horrified’ that you accurately explained the most severe symptoms of my illnesses?”

She sighed. “The voices tried to get you to kill yourself. They tried to get you to kill your baby cousin. Cameras follow you wherever you go and GCHQ are obsessed by you. You’re endlessly suspicious of people, and are cripplingly anxious when you’re forced to be in any proximity to them. Some days you can’t get out of bed due to overwhelming depression. You have, at times, to be watched to make sure you don’t harm yourself. There will be occasions on which people have to remind you to take your tablets – or even make you do so.”

She paused, flicking through the form, then added that one of the key parts of the mental health section of the ESA50 was about interaction with other human beings. “Given the aforementioned symptoms, that’s not…er…well, it wouldn’t really work for you, would it?” Ah, the sweet scent of diplomacy.

We talked about other stuff. Paul. Writing. Mum’s cancer scare. Rhona’s operation (with which there were no complications but lots of pain followed by a hook-up to morphine, which was removed five days after the procedure and even then caused quite significant withdrawal symptoms). An increase in Lamictal to help me with this current vault of depression (she’s going to discuss this with NewVCB on Monday). The exact nature of how low I felt, not that I could quantify it in words. I was acutely aware that I was acting very differently around her from my norm; regardless of how I’m feeling, I usually witter on and on and on, engaging with her non-verbally too – often it belies the reality of my mental (ill) health, but it seems to come naturally around her anyway. This was completely different. I steadfastly avoided eye contact, one of their favourite observations, and apart from issues surrounding the ESA50, I didn’t speak much at all. In fact, to my abject horror and disgust, at one point I believed I looked like I was close to tears. I didn’t cry, thank fuck – I can’t imagine the shame that would have been wedded to that – but I suspect that Christine thought I was on the verge of it.

Anyway, she was brilliant. My current episode continues, and no doubt will not abate for quite a while – either more Lamictal will help, or the vileness of the low will end itself in some sort of cyclical fashion, or I’ll off myself before any improvement manifests. But for now, what would have been one of the most serious stressors this year – as if there have not been enough already – has been removed from my responsibility. I didn’t thank her enough, because I can’t thank her enough.

The only downside to her brilliance is that it makes me even more sad and distressed that thanks to non-sensical bureaucratic bullshit I may well lose her. Good mental health professionals like her, ones that actually seem to care about you, are sadly uncommon ūüė¶

I’m in a rush so haven’t proof-read this, for which my apologies are due to you. Please forgive the probable multitude of errors of grammar, punctuation and spelling in the foregoing. Thanks x

…And the NHS Cocks It Up Again

I had a psychiatric appointment on Wednesday morning. In terms of interaction with NewVCB regarding myself, it was fairly unremarkable. I apprised her of the various events that had occurred since I’d last seen her – Maisie’s death;¬†seeing Paedo;¬†the fact that the doctor’s bloody “surgery” screwed up my Lamictal script for several weeks; the kitten, Srto Gato, had temporarily (yet stressfully) disappeared (the latter two being stuff I’ve not ((yet)) discussed here); and that¬†I saw Paul again.

Essentially, although she had intended to decrease my dosage of Seroquel at this appointment, she decided against it because of the fuckery of the last few weeks. She wants me to get back on some sort of even keel that involves a minimum of external stressors before pissing about with the stuff, an assessment with which I agreed wholeheartedly. I said, “in light of particularly stressful events that previously occurred with various personnel from [Hotel California], I was very, very¬†glad to be taking anti-psychotics over the last few months.”

NewVCB understood. Although 400mg, the dose to which we are intending to reduce the Seroquel (at least in the short-term), had at one point prevented some of my psychotic symptoms, given that the last six weeks or so have been really shit, it would be ill advised to take any chances at the minute.

I did ask about increasing the Lamictal, however. I’m currently taking 100mg, and my internet readings have suggested the therapeutic dose is generally between 150 – 200mg. NewVCB disputed this, though; she said that 100mg is the usual standard in the (admittedly uncommon) circumstances in which she prescribes it.

“I’d prefer to keep it at 100mg for now,” she advised, “in part because you had a break in it enforced upon you, so it’ll take some time for you to entirely re-adjust to it. Thus it’ll take a few weeks to see its full effects again. Then, we can see.”

That seemed fair enough. In terms of the Seroquel, I said to her that I’d lost a lot of my appetite in the last, say, eight to 10 weeks, so at least in terms of weight gain, reducing the dose wasn’t as ‘urgent’ as it had once seemed. I told her that I’d read that Lamictal could sometimes cause weight loss, or at least a reduction in appetite, and she confirmed that this was indeed the case from time to time. She said she was pleased that this had been the case for me, not because she dared to opine that I had a plenitude of blubber surrounding all corners of my body (though clearly I do), but because she knew how annoying my weight gain had been for me especially when I’d been losing¬†so much of my pre-existing fat until I started taking 600mg of this heinous drug.

And that was pretty much that.

Except that it wasn’t.

“Um…now, Pandora, there’s, er, something I need to discuss with you,” she said ominously.

Oh my fucking God. She’s leaving.¬†Oh fuck! Fuck! Just when I thought things with the NHS were actually getting me somewhere!¬†The¬†incipient dread I felt as soon as each word of the sentence left her lips grew overwhelming very quickly.

“The NHS are changing things again,” NewVCB sighed.

Again?! [I can’t find any posts on this, aside from my review of my first appointment with NewVCB, but it was due to NHS changes that my consultant was changed from (Old)VCB to her in the first place, and that was only two years ago. What the fuck? More bureaucratic – and no doubt costly – bullshit from the fucking¬†NHS. What a sack of shite!].

She saw my face, and shot me a sympathetic glance. “I’m moving to [Big Scary Hospital],” she said. “Until recently, it was just assumed that I’d take all my patients from your GP’s surgery with me – but…God, this drives me to distraction! They’re re-drawing geographical boundaries, so right now I don’t know what’s going to happen. I may or may not be taking all such patients. I really have no idea at the minute.”

She was clearly frustrated by this fuckwank herself.

I drew a breath, then ventured, “Obviously – and I know you can’t do anything about it – I’d prefer to ‘stay with you’ if I possibly can.”

“I know. I know. I wish I could give you something more concrete at this stage, but I can’t unfortunately.” She shook her head and twisted her mouth in obvious vexation.

She continued by asking me exactly where my address was in the area, but although I could see her trying to mentally calculate whether or not the house was affected by the boundary change, she came up with nothing but a blank.

“When is this taking place?” I asked. “I mean, if I don’t move with you, will I see you again?”

“Oh, yes, yes – I’ll see you again in six weeks or so. This shouldn’t be happening until two to six months hence.”

I nodded, but something else occurred to me then. “Assuming for a minute that I do¬†move with you. What about Christine?”

“Well. In the long-term, they’re planning on moving the whole team – whatever ‘long-term’ means. But it certainly won’t be any time soon, so if you come with me, you’ll have to get another CPN.”

FUCK!

“And if I don’t go with you..?”

“Then you’ll still have Christine, here, but you’ll be moved to a new consultant.”

FUCK!

This is so fucking unfair. Just when things were going so well with my psychiatric team. Having both¬†a CPN and a consultant that you really like,¬†both¬†seeming to genuinely want to help you – that’s not at all common, especially in this bloody Health Service. And now, regardless of what happens, I’m going to lose 50% of that to a quantity entirely unknown. For all I know, the replacement for either the psychiatrist or the nurse could be fucking amazing – but my longer-term experience of the Psychiatric Service does not lend me to having a great deal of hope about that. Furthermore, even if the person were¬†brilliant, I’m happy with things as they are. I like¬†them! I like NewVCB and Christine! I want to stay with them both!

Don’t cuntwits like Mr Director-Person – who, as the head of mental health at the Trust, is at least partially responsible for this idiocy – realise that this kind of¬†upheaval is likely to only increase¬†illness, and therefore increase costs?¬†That, as a mental, it takes long enough to become settled with members of staff – and that breaking that confidence and trust is likely to lead to breakdowns, misery and crippling anxiety?

Well, of course Mr D-P doesn’t realise that. He doesn’t realise anything¬†about mental health, because he’s nothing more than a general manager, and always has been – he comes from a business-y private sector perspective, that isn’t even remotely tangential to mentalism.¬†So no, despite all the fucking risk assessments they’ve no doubt claimed to have undertaken, he and his cronies have no idea what it’s like on the fucking ground, in the fucking real world, of someone with (a) mental health condition(s). It’s alright for him to sit in his inviolable ivory tower of an office, and play about with geographical lines on a computer (or, more likely, ‘getting his secretary to play about with geographical lines on a computer’ whilst he plays that little mini-golf game you always see¬†executives¬†figuratively masturbating over). It’s not alright when the ramifications of that feed back down to patients who are, as a direct result, going to suffer like fuck.

And nobody can do a damn thing about it. Fuck the Trust. I can’t for the life of me work out what it is¬†that they care about, but it certainly¬†isn’t their patients ‘service users’. Bastards.

Absolutely Damn All Squared

I’m still in the land of the living. Or the existing, as you prefer. I know I haven’t written anything in what seems (for me) like ages, but there’s not a great deal to report.

I had written an entire post and when I went to upload it, my WP application crashed. So I won’t bother to recreate it; I’ll just make the basic points I was initially going to.

One: voting is still open, until midday next Saturday, in the TWIM awards; just click here. Thank you to those of you that voted for me, thank you: I genuinely appreciate it. However, in the interests of impartiality, I’ve disqualified myself so the votes won’t count – but thank you anyhow. I still don’t understand why you read or like this blog. But that you do genuinely touches me, so thank you.

Two: I probably won’t be writing here much until at least January; I’ll try to do my traditional “what happened this year” round-up, but I won’t promise. For one thing, I’m very stressed (and also disproportionately upset – I so need to get a fucking life) about something I can’t (at least yet) discuss here. More importantly, I have a major piece of professional writing deadlined for 2nd January, and of course that will take priority over my usual garbling bollocks for here. So I have, for once, a genuine reason not to crap on on Confessions, rather than my failure to post being attributable to anhedonia, avolition or laziness (though I must admit to the presence of the former two nevertheless).

Also, please note that I will not be doing anything TWIM-related until at least Tuesday. I’m even temporarily removing the relevant email account from my phone!

I haven’t been on Twitter for days (other than to tweet the odd article via third party apps, or to text a random observation or something), and probably won’t be for…well, some more days. If you’ve @mentioned or DMed me, I’m honestly not ignoring you and will catch up before too long ūüôā

Three: after seeing NewVCB on Wednesday, I am now taking 100mg of Lamotrigine. Unfortunately 50mg of this is in the morning, which doesn’t sit especially well with my daily Seroquel hangovers. On the latter, by the way, I am going to be a fat bitch for a good bit longer than anticipated because she NewVCB wants to increase my Lamotrigine dosage again in the new year, and isn’t keen on modifying two medications at the same time (which is fair enough).

Four: A and I are at my mother’s; we’ll spend Shitmas Day here, and then head to A’s father and step-mother’s house for Cocksing Day. It is a good way to spend Christmas, insofar as that’s ever possible, because it’s so delightfully fucking quiet . A pity about the cunt TV, but you can’t have everything I suppose.

Five: the important one. I may hate this time of year, but it doesn’t stop me from hoping that you don’t. For those of you that celebrate Christmas, have a very happy one. For non-Christians celebrating concurrent festivals, I’m sending equally good wishes to you too. In case I’m not here again before January, I’ll also take this opportunity to wish you a very happy, healthy and prosperous 2012.

I don’t say it enough, but I sincerely appreciate every one of you. Thanks for your unending support and friendship. I do love you.

Be safe everyone, and take care.

Love

Pan

Initial Side Effects of Lamictal…and a Long Overdue Rant

If you follow me on Twitter, you may have been the unfortunate recipient of a number of tweets yesterday evening that contained almost epic levels of ranting. I had written an entire post for this blog on A’s iPad, which, whilst better for typing than our iPhones, is not as conducive to creating lengthy prosaic lamentations as a proper keyboard. Unfortunately for me, I’m in my laptop-phobia zone this week, and to that end only the iPad and the iPhone are safe for use (don’t ask for an explanation of this fatuity, because I don’t have one. Maybe I’ve simply grown to hate Windross so much that I fear even seeing it. Time to put Debian on the laptop, perchance).

Anyhow, I was a complete moron and decided to use the Blogpress iOS app to aid me in this ignoble endeavour. Just as I had finished, with the usual laughably stupid length of post completed, and went to save the entry – the cunting, fucking, shitting bastard of an application died on me. I lost every single word. I tried all the usual wank in an attempt to save it – close the app, turn device off and back on, etc – but circa 2,000 words and just over an hour of my time were lost to the dark realms of the e-ther (geddit?!) and try as I might to continue the rescue effort, the bloody thing just crashed, crashed and crashed a-fucking-gain. Shitting fuckery hell and bollocks.

So, iOS V users – don’t use Blogpress, OK? Not, at least, it’s been thoroughly updated and tested. It used to be a great wee app – it is, ostensibly, a much more fully featured blogging program than WordPress’s own. But at least (eventually) the latter fucking works. So that is where I find myself as I type this attempt at a re-write.

First though…

JESUS FUCKING CHRIST BUT I AM SO ANGRY. THE POST WAS ACTUALLY NOT BAD, UNLIKE FUCKING EVERYTHING I’VE WRITTEN FOR MONTHS. I WOULD HAVE BEEN FUCKING CUNTED THE FUCK OFF IF THE BASTARDING PIECE OF FUCKWITTAGE LOST A MORE CHARACTERISTIC LOAD OF FUCKING SHITEY CUNTFLAPPED BELLENDERY, BUT THE FACT IT LOST SOMETHING VAGUELY NOT COMPLETELY BLOODY AWFUL MAKES ME WANT TO SMASH THE LIVING BECHRIST OUT OF EVERYTHING. YOU CAN NEVER BASTARDING WELL REWRITE SOMETHING TOLERABLY BLOODY PASSABLE TO THE SAME PSEUDO-ALRIGHT LEVEL AS IT WAS THE FIRST SHITHEAD OF A TIME YOU FIRST BLOODY WROTE THE BOLLOCKFIST OF A FUCKING THING, SO WHAT FOLLOWS HERE WILL BE BACK TO MY USUAL DICKHEAD STANDARD OF UTTER COCK. FUCK TO THE ENDS OF ALL THE KNOWN BALLWIPED DIMENSIONS. FUCK. FUCK. FUCK.

Well, it’s been a while since there was a proper rant here, hasn’t it? And lo, I used to be the Queen of Rants in the Madosophere. But anyway, now that we’ve got that out of the way…

I’m having some difficulty adjusting to Lamictal. Don’t worry, if you’re one of those odd people that may in some way give a flying arse about my existence, there’s no “FUCK I’M DYING” rash or anything. But the drug has brought me an insane level of fatigue (for example, I nearly fell asleep yesterday afternoon whilst playing Saints Row: The Third, which had delightfully arrived here early. I mean seriously, what the actual fuck? No one with even five per cent of a pulse falls asleep whilst playing Saints fucking Row!!!), my eyes have gone cross-eyed, my levels of forgetfulness that began with Venlafaxine (curse it) are amplified to objectively hilarious points of pseudo-dementia (cf. in people’s company a few days ago: “A, what’s my name again? Oh yeah. And, old chap, should you be so obliging as to advise me on the word one uses to intimate the device used to take a crap? Yes! ‘Toilet’. That’s it.”) and my regular migraine-level headaches are now even more frequent. The last point is especially irritating as, in off-label indications at least, Lamictal is used to treat headaches. Go figure, eh?

The exhaustion is not simply that frustrating but familiar kind of languorous weariness to which we are all often slaves – oh no, this is hardcore stuff, even by my own insomniac standards. It’s that kind of exhaustion that is like an gaping vault of oppressive darkness, sucking you in, dominating you entirely, screwing with your mind until it hurts but rendering you useless to do anything about it. It’s that kind of interminable, preponderant bleak tiredness normally wedded to the very worst of depressions – you know the ones I mean. That old familiar hangdog horror in which rising from your bed is not just a difficulty, but an impossibility. The old foe that leaves you helplessly staring at the wall, willing it with whatever mental faculties you have remaining to somehow show you some mercy and let you die. The old knocking on the door of the mind that reminds you that you have no escape, because you are utterly devoid of enough motivation to even end things yourself. The old living hell that seems unresolvable.

Normally such exhaustion and a depressive hell are thus united – but not in this case. It would be a lie to say that the tiredness does not impact upon my mood in some fashion, but for someone whose mental agility and body alike are so heavily enervated, I actually feel pretty stable in this regard. Indeed, Null thinks I’m high. As I was trying to write the original of this post last night (RIP), I must confess that I did wonder that myself; the style of my prose, whilst slightly better than my shitty norm, did have something of a manic quality to it (perhaps that’s exactly why it was slightly less rubbish than as is typical!).

Allow me to exemplify how OK I am, despite Lamictal’s nefarious side effects. I have exactly ¬£1.06 to my name right now, and even that’s part of my overdraft – yet I am not panicking like an old lady denied her copy of her all-important Bella magazine like I normally would; instead, I’m tolerably riding the wave of patience until I get paid next week. It’s November, and I don’t want to run out and throw myself off the nearest bridge or towerblock. Indeed, even bastarding, fuckwitted, hateful, cunting Shitmas has been surprisingly kind to me this year: the hackneyed and improbably dainty ads for the accursed capitalist nonsense only began registering on my radar about six weeks in advance of 25 December, rather than the 12 or 13 weeks to which I am normally frustratingly used. And, next week, off I go to London, where I am short-listed for a Mind Media Award. I am excited, rather than entirely petrified, by this. I mean, of course I should be excited – but as someone with social anxiety issues which are, at times, very severe, it’s a surprisingly gratifying thing that being faced with being in such a busy venue with – dun-dun-DUN! – famous people does not scare the living bejesus out of me right now.

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Lest anyone think I’m in the midst of a narcissistic delusion of grandeur regarding the awards ceremony, no, I do not – not for half a second – entertain the notion that I could possibly win the award. No way. But it doesn’t matter; what matters is being there. It is enough to have the opportunity to meet some incredibly interesting and highly influential individuals operating in the arena of mental health; it is enough that someone, somewhere has considered this silly blog even worthy of mentioning in the same breath as some truly excellent anti-stigma and exploratory material; it is enough that I dare to see my name listed in honour of the late Mark Hanson, a stalwart of the social media world who suffered from horrendous depression; and it is enough that I have the opportunity to see some of my wonderful old friends and, indeed, to meet one of my oldest and most supportive online friends for the first time (so excited, bourach! :D). Although it would be beyond absolutely incredible to win, to be in the position I already am is more than enough.

So, although I’m fighting medication side effects from every angle, I’m doing relatively well. As for the side effects themselves – well, according to most of the literature on Lamictal, they will pass. Indeed, I already feel them abate, ever so slightly. As the days pass, my eyes will blur things a little less, my energy levels will increase a little more, and my headaches will revert to the mediocre but liveable standards to which I’ve long been accustomed. Maybe the current drug cocktail will, in the end, work for me after all.

What’s that you say, fair reader? “Oh dear God, Pan’s defining characteristic of cynicism has been lost?” No, fear not – I have not become so washed away by some sort of bright absolution that I have become an optimist. Christmas still sucks, the world is still a cunthole, I’m still an infernal misanthrope and I still can’t stand the sight of happy couples frolicking around the shops like some sort of silly vapid bunnies. I’m just a misanthrope that can’t stand the sight of happy couples frolicking around the shops like some sort of silly vapid bunnies who happens not to feel opprobriously atrocious for once.

If you don’t like that…suck it up ūüėČ

(NB. I haven’t proof-read the above folks, sorry. I humbly beg your forgiveness for any poor turn of phrase, grammar, spelling etc, and I shall endeavour to correct such issues at my next available opportunity. Toodle-pip!).

Livin' La Vida Lamictal

Good afternoon my beauties.

Yes, I remain on this plane of existence. I simply have no idea what to write here – well, actually, that isn’t true; I have quite a few ideas floating around in my head, but in terms of actually recording them on this blog, I’ve failed to do anything with them. Never mind. Maybe next week I will feel more amenable to blogging? I have one piece of (unpaid but) professional writing to get done which will take priority, but perhaps the mere act of getting some words out of my system will help motivate me into putting more here.

I don’t know where this apathy has come from; I want¬†to write, but I just cannot work up some sort of inclination to do so. I’m not particularly depressed in the traditional mood sense, and in fact have at times found myself quite hyper of late, but this week has been a frustratingly busy one and let’s not forget that it’s November – a month that¬†I detest. How the fuck¬†did it get to be November? My life is passing me quickly by in a haze of malaise and anhedonia, and it reminds me acutely of how much I’ve wasted my fucking 20s and failed to achieve anything of any notable worth.

Still, this was not meant to be a post in which I complain about my failure at life; there’s plenty of material there for another post entirely! Instead, let’s have a brief, dull look at my appointment on Wednesday with my consultant psychiatrist, NewVCB.

Incidentally, I feel guilty for continuing to apply the moniker of ‘NewVCB’ to the woman, because it was borne out of my distrust and dislike for her predecessor and the implicit hatred does not apply to NewVCB. Let me use this as a disclaimer, then: I do not¬†think that NewVCB is a vingear cunted bitch. I actuall quite like her. Nevertheless, that has become the term by which people are used to knowing her, so I will maintain it for that reason alone.

She was running late on Wednesday, which is fairly unusual for her. I was mildly irked – not at her specifically, but more at her previous patients for taking up her time – because, carless as I was at the time, I’d had to get a combination of a taxi and a bus to get to the outbin, and had unnecessarily rushed like blazes. Waiting for her produced further frustration in the form of an¬†elderly¬†couple making whispered¬†judgements¬†on other patients wandering in and out of the building.

“Anorexia,” the man murmured, nodding to a girl walking out the main door.

“No, no,” replied the woman. “That girl looks haggard. Some form of anxiety, I think. Nothing too serious.”

What the fuck?! Firstly, what gives these two wankers the right to talk about personal issues pertaining to other patients? Secondly, anorexia and anxiety frequently co-occur, do they not, and either way, is it any surprise that the girl looked “haggard”? Many mentals do! And three – how the fuck¬†can anxiety not be “too serious”? Many forms of anxiety can be fucking life-threatening!

Grr. Normally I love elderly people but these two old gits thoroughly deserved a slap. Anyway, their presumptuous pseudo-speculation was cut mercifully short by NewVCB Рbut she was there for the two of them at that juncture, and not for me. Ballbags. I sought refuge on Twitter, as usual moaning about the nature of the situation.

Shortly thereafter, my mother appeared. She was collecting me from the outbin owning to the absence of my beautiful car, which was with the mechanic in preparation for his MOT. Mum assumed I was in the waiting room waiting for her, rather than NewVCB and was annoyed to find that she, too, would now have to wait. Sigh. As√≠ es la vida, ¬Ņno?

Anyhow, when I eventually did see her, I couldn’t have been in with her for more than 10 minutes. I told her a highly redacted version of my recent possible episode of hypomania. Christine, my CPN, had advised me that she would discuss the issue with NewVCB in advance of this appointment, and it must have indeed been the case because despite my discussion of it lasting little more than 30 seconds, she said, “it does sound like a period of elation.”

My brow furrowed slightly, so she continued, “well, you know what I mean; yeah, I understand that with it came¬†irritation¬†and uncomfortable racing thoughts, but nevertheless…”

I nodded, seeing what she meant.

She went on to say that she was very conscious of my dosage of Venlafaxine being pretty high. As she noted, she has no problem with my continuing on said dose, but thinks it is something which “we need to keep an eye on.” This kind of confirmed to me that she is now definitely thinking that I have some form of manic depression, though I didn’t ask her directly as I had intended to do. The thing is, she’s never even thought twice about how much Venlafaxine I take in the past, so this seemed significant. Venlafaxine is, of course (in common with SSRIs and other SNRIs), capable of inducing manic or hypomanic behaviour in susceptible individuals.

To be honest, I’ve been taking 300mg for so long without any madness of this particular flavour that I genuinely doubt it’s related, but that said, it is reasonable and sensible to monitor it nonetheless.

Anyhow, I reminded her that the last time we’d met we had discussed reducing my daily intake of Seroquel because of the preposterous amount of weight 600mg of it has caused me to gain. At that appointment, NewVCB had suggested that I continue to take the Seroquel at a reduced dose (to maintain its anti-psychotic properties) and then, to mitigate the loss of its mood-stabilising effects, add in…well, a mood stabiliser. You may recall at that appointment she had alluded to Lithium and Depakote, but the excellent discussion in the comments of the relevant post had put me off them somewhat (particularly the latter). Furthermore, a number of you asked in that thread (and elsewhere) if Lamotrigine (AKA Lamictal) would not be better for me, as although it is used in the general maintenance of bipolar disorder, it is considered particularly good for depression.

I therefore told NewVCB that I had been researching the drug, and that I’d like to try it. “Despite that episode last week,” I told her, “as you know, my symptoms are primarily depressive – so Lamotrigine seems, to me at least, like a good call. What do you think?”

She sort of waved her arms about in a gesture of agreement. “Yes, it is¬†especially good for depression, so yeah, I have absolutely no problem prescribing that for you,” she replied. “My ideal combination for you would be sodium valproate [Depakote] along with the Venlafaxine, but as I told you…well, it’s not considered ideal for women of your age.” She looked up sort of sheepishly at me. I think she was non-verbally intimating to me that she understood my decision to remain childfree, but that that might not go down terribly well with other whitecoats and fuckwit-managerial types that might find out about it.

For different reasons, this suits me perfectly well. I was horribly put off Depakote by some of my readers’ experiences with it – for example, I think it was tai that said in the afore-linked comments that she gained a lot¬†of weight whilst taking this medication. Since that is precisely¬†the reason I wish to reduce my intake of Seroquel, which has otherwise been a wonderfully successful drug for me, moving to Depakote with its potential weight issues would complete miss the point!

So, she got out her prescription pad, consulted her medication guidebook, and scribbled out a script for the Lamictal for me. I am to take 25mg daily for a fortnight, then move up to 50mg until I next see her (in about six weeks, she says, which should give the new stuff some time to start working). She said that she wanted to maintain the Seroquel at 600mg for now until the Lamictal has built up in my system, but that she’ll whack it down to 400mg the next time I see her (assuming the Lamictal seems to be working, of course).

I got the inevitable but important warning about the dreaded Lamictal rash, but that was pretty much it, and off I trotted to my GPs’ practice to hand in the script.

One thing I completely forgot to mention to NewVCB was that I take the contraceptive mini-pill. A little bit of research has suggested that since this pill is proestrogen only, that it and the Lamictal should not interact. Apparently, Lamictal can reduce the effects of the normal, ie. oestrogen, pill¬†– and said pill can, in turn, reduce the effects of the Lamictal! It does not¬†seem to be an issue with the minipill, but I’ve put on an appointment with Lovely GP just to check. In the meantime, if any of you have any information about this, I’d be very grateful to hear about it ūüôā

Shockingly, Fat Pharmacist did have my new prescription when I went to get it yesterday afternoon (of course, he didn’t have the Seroquel, Venlafaxine, Cetirizine and Zopiclone that I had requested, but why quibble about such mere niceties with the useless ginger twat? It is only my fucking health we’re concerned with here, after all…), so I took the first dose of it last night. I took a Zopiclone just in case I’d draw the predictable straw of insomnia that can potentially come with the stuff, and I was squinting a wee bit more than normal when I went to the shop (another potential side effect), but overall nothing seemed amiss – though, to be fair, it’s a bit early to tell.

So. I currently take the following medications:

  • Venlafaxine/Effexor, 300mg daily
  • Quetiapine/Seroquel, 600mg daily
  • Lamotrigine/Lamictal, 25mg daily (to be raised)
  • Cetirizine, 10 mg daily
  • Cerazette, 75 mg daily
  • Multi-vitamin, whatever-it-may-be daily
  • Zopiclone, 7.5mg as needed
  • Diazepam/Valium, 5 – 15mg as needed

Jesus fucking Christ. At this rate I could be a drug dealer. Still, I’m feeling positive about the new introduction to my daily¬†pharmaceutical¬†routine, and about losing some bloody weight when the Seroquel is reduced. But we’ll just have to wait and see.

Anyhow, I’ll try and write on those issues wafting around in my head in the next week or so. Have a great weekend in the meantime, lovely people.

(I’m in a rush so can’t be arsed proof-reading this. Sorry for the probable multitude of errors herein).

Change of Diagnosis

I finally saw my CPN, Christine, this morning. I say ‘finally’ as I had been meant to see her about – what? A month ago? Three weeks past? Something like that. I turned up on that occasion, early as usual, and reported to the CMHT/outpatients reception in the normal fashion. The bloke seemed a bit unsettled to see me, which should have been a warning sign that things were afoot, but then he told me to have a seat, as normal, in the waiting room. I dutifully did so.

And thus began the wait for which the term ‘waiting room’ was invented. To be honest, as soon as the allocated appointment time had been and gone, I somehow knew that she wasn’t coming – but rather than approach the reception bloke again and enquire as to Christine’s status on this plane, I just sat there rocking back and forth like the oversized bodybag of insanity that I am. Someone sat opposite me, curled up in her seat in a ball. Someone else sat to my right, shuddering and ‘ticcing’ with a remarkable frequency, as if afflicted by tardive dyskinesia (not such an improbable scenario in this realm, of course). I was struck by the obvious mental illnesses of all three of us: you might think that comes as no surprise in a psychiatric outpatients waiting room, but you’d be wrong.

In my two-plus years of attending the outbin, I’ve always been a little taken aback by how completely sane and normal most of the people looked – and then this makes me feel like a right stigmatising bitch. Mental health problems really aren’t that abnormal, and societal stereotypes on how people with such issues should look (foaming at the mouth, constantly existing in states of 1,000 yard-staring catatonia, running around wielding knives) are dated, inaccurate and sickeningly discriminatory. Madness can affect anyone – any age, any race, any gender, any religion, any sexuality, any class. It does not discriminate, and it can be well disguised. So why would I, someone who should have known better, have assumed that there must be a certain ‘look’ a mental must have, or particular behaviours he or she must present? Why does the the complete ordinariness of most mental health outpatients surprise me so? Because I’m a bigoted bitch, no better than the majority of the supposedly sane community who generally live in a similar ignorance – that’s why.

But I digress, as I am often wont to do. I knew Christine wasn’t going to turn up on this occasion because of the confluence of events in which (a) reception bloke had regarded me with an odd disposition; and (b) there had been a missed call from an unknown number on my phone earlier that day. No one had left a fucking message, though, so I did not consider it important.

Of course, it turned out that it had been the outbin calling me to alert me to the fact that some shit was hitting some fans in Shite Town, one of poor Christine’s unfortunate ‘community’-based stomping grounds, as poor reception bloke was forced to eventually admit to me. Not that I displayed it to him, but I was fucking irritated. Not with Christine – I fully recognise and accept that shit hits fans sometimes (especially in Shite Town…God, I hate that bastardhole with a passion) – but with her colleagues back at the bin for letting me drive all the way there when a simple fucking message could have saved me the petrol.

A secondary issue, of course, was that I was right in the midst of a major depression at the time, but meh. I was completely pissed about by (Old)VCB, but NewVCB and Christine have generally been very good in terms of seeing me, and have even afforded me the opportunity to contact them if I am in a non-crisis-team crisis – which, in de facto terms, means any serious (but sub-A&E) crisis, because it will be over my dead body when I ever deal with the bloody crisis team again.

Anyway, so it came to pass that this morning’s appointment was organised, and subsequently attended by both Christine and me. I was with her for about half an hour, which is relatively short by previous standards, but there wasn’t a huge amount of things to discuss. The poor cat had died since I last saw her, which was obviously rather a rather shit stabbing of fate, and it had come at a time when I was very mentally fragile anyway. Christine expressed what appeared to be sincere apologies for our loss, which I appreciated. Some folks say the words alright, but you can almost see them thinking, “but it’s just an animal..!” Others, of whom I’m guessing she must be one, realise that pets become your friends and family.

The odd thing is, apart from the first weekend after Ms Cat’s death, I think things have been stabilising ever so slightly. Obviously, one might reasonably assume that if one had atypical (AKA reactive) depressive symptoms, that such a horrible and untimely occurrence would have paved the way straight back into the depths of the abyss – yet in my case, it did not. It’s not because I’m cold or some sort of unfeeling droid – truly, I miss Ms Cat horribly and am horrified when I think about her being hit by that fucking car, her dying all alone in the middle of the road – but overall, putting a quite normal reaction to bereavement aside (and if viewed from an entirely pathological perspective), things seem to be ever so slightly moving upwards. This makes me feel smug. Why? Because I’ve been trying to tell the quacks for ages now that my moods are not reactive, and that my major depressions are clearly melancholic. What has happened in the wake of Ms Cat’s death exemplifies that well, to my mind.

Lack of a reactive mood suggests a lack of borderline personality disorder. I’ve discussed the fact that I don’t feel the diagnosis is relevant to me any more both here and here, in the latter case having made brief allusion to the issue with Christine herself. Today, I just came out and asked her: what the fuck actually is my current diagnosis?

The question was borne out of a discussion about mood stabilisers. As I had asked you lovely lot here, I so asked her about the pros and cons of Depakote and Lithium, both of which she actually seemed quite positive about. She must have seen some scepticism in my expression, because she asked me to articulate what it was that I didn’t like about them. I presented a redacted version of some of your responses to the aforelinked post.

“I know that’s a tiny amount of people compared to all of those that take these drugs, but still, I’m dubious,” I admitted. “What about Lamotrigine? I heard from various sources that it’s particularly good for depression.”

“Lithium and Depakote are the ones we most frequently use here,” she told me, “but yeah, Lamotrigine and [some other anti-convulsant-cum-mood-stabiliser whose name I have forgotten] are also used, and yes – Lamotrigine does tend to be good for depression. I know that [NewVCB] does recognise the severity of your depressive features. Would you say that they’re the most troublesome part of your illness?”

I thought about it for a moment, and then said they were certainly the most pervasive, which is undoubtedly correct. I kind of screwed up my face, though, because – although depression is a hell beyond the comprehension of those who have never truly experienced it – other symptoms I’ve experienced have been pretty ghastly too. ‘They‘ (especially on a bad day). The particular anti-delight that is the psychiatric mixed state. Insomnia. Fake Paedo and night-time peccaries. Dissociation. They all suck donkey balls that are bigger than I know how to quantify, but despite it all, I think that depression probably is still the worst of the whole sorry lot. It’s inutterably abominable.

For some reason, though, we ended up talking in some detail about my psychotic symptoms; Christine noted that whilst the psychosis had actually been pretty serious at times, that on most occasions it hadn’t been particularly prolonged (save for my ongoing GCHQ obsession, but then I don’t think that that is delusional. Those nosy pricks honourable men and women watch all of us: it’s simply a fact). This is true – in the past I’ve even suggested that my psychotic symptoms were perhaps transient and/or stress-induced, though as I continue walking this darkened path of lunacy and reflect on times gone by, I’m less and less convinced that any of it was (is) as simple as that. Either way, though, it has been uncommon for me to be verbally persecuted or delusional or whatever for long periods of time, as is traditional in the likes of schizophrenia.

One thing I told her, that I haven’t mentioned here for a long time, was that I missed Tom. Not all hallucinatory voices are malicious, y’know. Christine empathised; she says she has one particular patient that has an extremely settled and successful life now (hope, perchance?), but who really misses her voices which (like Tom) were killed by the anti-psychotics that, all things considered, the woman had little choice but to take.

Anyhow, that’s by the by, apart from my worry about reducing the Seroquel to 300mg and adding a mood stabiliser. This concern, as I observed in the appointment, was that even with a slow titration back down to the half-dose of the stuff, I would become psychotic again. Christine reminded me that when I had tried a self-inflicted hand at living on 300mg, that I had only had one day of psychotic mentalness – that the rest of those few weeks, whilst they appeared to have fucked with my mood, had not rekindled voices, paranoia, thought disorder and so forth. True enough, to be fair to her.

“So, maybe 300mg can work to prevent psychosis for you,” she said. “But yeah – I think the introduction of a mood stabiliser is a good idea to make up for the loss of such properties if you lower your dose of Seroquel.”

I nodded, also expressing my willingness to “just deal with the weight gain” if indeed it turned out, after all, that 600mg of the stuff was what I needed. She said that it was good that I had such a philosophical attitude to the whole thing.

“I suppose so,” I adventured, “but I’m going to be taking 300mg of Venlafaxine, 300mg of Seroquel and God knows what dose of a mood stabiliser. That’s a bit…well, mad.”

She shrugged, but not in a dismissive fashion. “If you had a broken leg you you’d put it in as big a cast as it required…”

“Oh don’t get me wrong,” I said, “I agree. I’m not at all one of those anti-medication apologists; the stuff has saved my life many times. It’s just a lot of medicine to be taking when…well, when supposedly dealing with a disorder for which NICE don’t recommend medication…”

Christine made some remark that seemed derisive of NICE, which left me feeling all warm and fuzzy inside. Then she continued by saying that, if I was referring to BPD, then NewVCB was seriously doubtful about my having it.

Good! (Though let’s be clear: I do believe that I did have borderline personality disorder, though I never met the stereotypes so nefariously associated with same – but then, very few people actually do. So here I am – proof that it can be recovered from). But if BPD is no longer applicable, what are we all dealing with, then?

“[NewVCB] doesn’t like to discuss diagnoses with me,” I complained forlornly. “But I’d like to know.”

Christine nodded and said, “I’d say she’s about 90% going with – predominantly depressive, bear in mind – bipolar affective disorder with psychotic features.”

Of course, bipolar type II was always my differential diagnosis, but it now seems that they’re looking at type I. In a way, it’s curious as I’m pretty sure I’ve never intimately danced with a euphoric mania – indeed, (Old)VCB (who met me about four times and was therefore the consummate expert on the idiosyncratic nature of my personal psycho-neurology) stated that I definitely didn’t have bipolar I. However, if I have had mixed episodes – and I certainly have – then clearly, by very definition under the current editions of the ICD and the DSM, it must be bipolar I. I’d always shrugged that reality off: these things exist on a spectrum. I haven’t changed my view on that, but an elevation from II to I is not exactly a non-issue for me, partly because specific diagnoses may (or may not) affect one’s treatment. In that regard – and it’s as unfair as fuck, because the popular, sensationalised images of it are not accurate – not being seen as having BPD any more is a positive development, even though it’ll obviously never leave my files entirely.

Anyhow, there is a window of doubt in this apparent bipolar diagnosis. It is, to no surprise of mine whatsoever, potentially filled with schizoaffective disorder. Essentially, the difference between it and psychotic bipolar disorder is that the psychosis can occur outside mood episodes in schizoaffective disorder, whereas in bipolar (or psychotic depression), such symptoms are exclusive to either depressed or “manic” states (I use the scare quotes* here ((which I normally loathe loathe LOATHE)) because I feel the term denotes euphoria, whereas clearly in my case – if I do have this – then my “mania” is of the dysphoric variety). Given my inability to properly rise from bed in the mornings, it will come as no surprise to you to learn that trying to keep track of my exact state of mood relative to other symptomatology isn’t entirely easy. My sense is that I have hallucinated when fairly euthymic, but then euthymic by my standards could be a mild to moderate depression by those of another, and thus I feel unqualified to judge this objectively.

Oh yeah, and let’s not forget that I still have a number of elements of C-PTSD, regardless of whichever one of the other two conditions is predominant.

I rattle when I walk sometimes, what with all the tablets I have to carry about with me. And that’s going to get even worse! And lo, my poor brain must rattle now, with all these diagnoses in place to form description of it. But, although I know the terms aren’t important and that the actual treatment is, I still see value in diagnoses. I read recently – I can’t remember where, sorry – that the point of diagnostic psychiatry is communication. Without at least some guidance – to be taken with a pinch of salt certainly, but which can act as something of a sign post – surely all branches of medicine, even those in which spectra and classification-overlaps predominate, would end up jargonistic free-for-alls.

Diagnoses may not help diagnosees, but I still can’t see how not having them does either.

* On the point of scare quotes, actually. The verb ‘to label’ and its nominal, adjectival and qualifying derivatives are unlikely to be used synonymously with ‘to diagnose’ on this blog – but if they are, they are the only terms I will always put in scare quotes. I cannot express how much I completely abhor this usage of the word ‘label’. I hate it. I despise it. I feel repugnance and disdain and derision and other derogatory d words towards it (though, it must be noted, not those that use it!).

It’s not a rational objection, but please don’t kick me – we all have foibles, do we not, and this, sweet readers, is one of mine ūüėČ

Random real life aside – in the wake of Ms Cat’s death, we decided to get a new kitty quite quickly. This was a pragmatic decision based on Mr Cat’s future wellbeing. It became quickly apparent that he really missed Ms Cat; so did we, obviously, but human mourning takes time – does the same apply to felids? We know not. Had it been about us, we’d have waited at least a few months before getting another female cat, but on balance, we reckoned it would be better for Mr Cat if a new adoptive sisterbling came sooner rather than later.

So here she is! ShHe shall henceforth be known as Se√Īoritao (Srtao) Gatao on this blog ūüôā [EDIT: As you can perhaps deduce from all the strikethroughs, we thought the bloody cat was a female when we got it, but alas it’s a bloke. We never intended to get another male; the possibility of territorial disputes was too unsavoury. But although Srto Gato annoys Mr Cat with his kitten ways, they actually seem to get on reasonably well. Thank Christ.]

Srta Gata

Any Thoughts on Depakote or Lithium? ***¬°Advice Please!***

Saw NewVCB last Wednesday morning.

Not much to report, really, and even if there was, as you’ll be able to tell from the appalling calibre of the following, I’m still not really in the form needed to competently review it.

She asked how things were and told her everything was fucked, thanks to my idiotic decision to reduce my Seroquel dosage. She checked that I was had gone back up to the 600mg dose, and I confirmed that I had, and had been doing so for about a fortnight.

Long and the short of it is that she claims it’ll take up to six weeks back on the high dose for things to start to improve. Wonderful. Well done, Pandora. It would be less annoying if¬†it wasn’t my own fault. She encouraged me not to berate myself – she says patients do it all¬†the time, and that if nothing else, it demonstrates to me what I do and don’t need. Well, maybe so – but I did this years ago when taking Fluoxetine, and should have learnt from that experience to leave such things to the quacks. But nooooooo. I know better, don’t I? Twat.

Anyhow, naturally she asked why¬†I’d decided I’d half the dose. I explained about the horribleness of the hangover effects and the preposterous weight gain. I said that I’d be willing to tolerate the former for now (and as she noted, if and when I go back to work, I am more likely to get a ((post-hangover)) afternoon part-time job anyway, since most part-timers prefer mornings), but that I hated the weight gain issue because I was down to a size 16ish at one point (I hadn’t been that size since I was¬†16), and that having put most of it back on was pretty soul-destroying.

Her plan, then, is to wait until my mood has re-stabilised on my current medications (which seems unlikely to ever happen to me right now, but she opines to the contrary), and then we can look at how to play this in the long-term. She does, to be fair, acknowledge that even ignoring the physical issues surrounding my gargantuan size, it’s not good for my mental health to see 14 rolls lopping down around my knees, hiding even the briefest glimpse of my toes and their ingrowing nails. What she has suggested is reducing, though not eliminating, the Seroquel – and then adding in a mood stabiliser to make up for the loss of those same properties from said drug.

She specifically named Lithium and Depakote, though she expressed a mild reluctance regarding the latter; she laughed and said that she knew I was filled with abhorrence at the mere mention¬†of breeding, but that nevertheless, she had to be very, very careful about the prescription of the thing to ‘fertile females’ on a ‘just in case’ basis. Apparently it can seriously fuck up a foetus/embryo.

I really don’t give a fuck about that, as – as she rightly noted, though I’m not sure how she figured it out as I don’t recall ever discussing it with her – I fully intend to never become pregnant. However, I think¬†I read somewhere that it can interfere with the mini-pill, which I take as a contraceptive and fuck-off-menstruation-and-related-pain medication. A quick look just now has suggested that it doesn’t stop it working, but could increase levels of hormones in one’s body. Which could be a bit wank as I’m not unconvinced that oestrogen has an effect on mentalism, specifically depression (sometimes of the particularly vile variety known as ‘agitated’).

She did say, though, that she would¬†prescribe it (regardless of my presumed ability to conceive) if she thought it best, on the balance of the foetus issue versus its active psychiatric indications. I was initially quite encouraged by this, because I’m not sure how I feel about Lithium: I’ve heard of others gaining weight on it (and one friend was constantly ill whilst taking it), so what would be the point in cutting the Seroquel (which I know works)? So, I thought, bring on the Depakote. Except that, since then, I’ve read the article on it on Net Doctor¬†and see that it too can cause weight gain!

So, maybe either it or Lithium would mitigate the undeniably shitty hangover effects of Seroquel, but it’s quite possible my main concern would not be assuaged in any way. So what would be the point in modifying my current cocktail which, whilst problematic, has shown itself to work very well in terms of its indicated usages, only to find myself at the mercy of the same cunty side effects I’d hoped to avoid anyway?

All that said, I have known people to take mood stabilisers (Lithium in particular) who’ve found that it completely changed their life. Indeed, the Net Doctor article on it¬†states that it’s a very good medication to take to boost the effects of pre-existing anti-depressants. So if I could get my depression and its related anhedonia/lethargy/etc to sod off (it’s never¬†really gone away – it’s only got a bit less shit), then I might be more willing to leave the house and get some exercise to combat any extra weight anyway. But that’s a bit of a punt, really.

Have any of you any experience of Lithium and/or Depakote, and if so, what’s your view on it/them – both in terms of how they help (or don’t) psychologically, and on what the side effects are? If you take an alternative mood stabiliser (whether a ‘true’ mood stabiliser or an anti-convulsant) and you’ve found it useful and/or lacking in side effects, could you tell me a bit about it too please?

NewVCB also mentioned other anti-psychotics such as Risperidone, which typically have lesser weight issues than Seroquel. However, as a form of anti-compensation for that, you lose the mood stabilisation, so one such medication would again presumably be needed in that circumstance.

Despite my dreadful mood, I managed to crack a joke during the appointment, and was pleased to make her laugh. She asked me about suicidal ideation, and I told her all I could think about was my body flying off the Golden Gate Bridge or the high-rise apartment blocks close to my house.

“But don’t worry,” I added drolly. “I suffer from vertigo*, so…”

(* And it is¬†((usually, though not always, height-triggered))¬†vertigo, as opposed to acrophobia. I don’t really have the latter, bizarrely).

She laughed out loud, caught herself on and apologised, then¬†started laughing (almost hysterically) again. I told her it was meant¬†to be humourous and to laugh away. I like humour in this arena. I remember once ages ago that¬†C cracked a joke¬†(oh look – it was my very first therapy post. How quaint)¬†about how my footballing allegiances were not at all good for my mental health (especially true that fucking season) – a comment made viscerally, for which he then apologised. Fuck that. Don’t apologise! Joke away. I mean, if you didn’t laugh, you’d have to fucking cry.

Anyway, medication issues aside, I handed NewVCB a copy of my last post, and that coupled with her usual questioning determined that I am “very clearly” in the midst of a major depressive episode. However, at least A and Mum are usually about somewhere, and my suicidality is operating “at fantasy level”, so there is unlikely to be any “danger”. I’d say that the lack of danger comes more from avolition and apathy rather than anything else, but there you have it. I shall, most likely, remain alive for the next while.

As I left the appointment (having managed to blag myself a script for Diazepam – which frankly I don’t particularly¬†need, but insurance is always good) she said, for the second time since I first met her, “nice to see you, Pandora.”

Incidentally, the first time she gave me a complimentary goodbye of this nature, I was also similarly mental to last week (and both occasions were caused by fluctuations in medication, rather than being distinct ‘episodes’ in their own right). Why do I find that probably coincidental and innocuous fact so intriguing and revealing?

In other news – I haven’t written anything in the last week…BUT! I’ve had this laptop completely closed – it’s literally not been open once – since…fuck, I don’t know, last weekend? Although I have tweeted some articles and suchlike, I haven’t checked Twitter at all (ditto G+ and the odious Facebook). In this complete abandon of social media, I’ve been working on The Book. I’ve not written anything, as noted, but I have been studying the distance learning¬†writing course I enrolled on when I first went off work a few years ago, and have been especially concentrating on the modules on novel composition. Much of it seems obvious – although this blog is factual and autobiographical, sometimes the narrative of posts takes on a tone similar to fiction, so I feel I have some pre-existing understanding of the idea. However, there has also been a lot of benefit in what I’ve studied to date, and I feel cautiously confident about The Book and its plot at the minute.

Furthermore, in my¬†absence¬†from internet sociability, for some reason I’ve been internally bombarded with quite a number of creative fictional ideas that I think I can turn into short stories, novellas, or perhaps a second The Book. There’s one about which I’m especially hopeful, which was garnered from a disturbed, haunting dream this very morning. At least nightmares have some¬†purpose!

On Thursday, Wendy Perriam, whose excellent book Broken Places¬†I reviewed for Mind, emailed me to thank me for said review. This was a wonderful buoyancy both for my own sake and for that of my writing (which Wendy was kind enough to compliment, which was incredibly flattering coming not just from a published author, but also from a published author who I hold in high regard). I asked her for a few tips, which she kindly gave me, and it’s added to my sense of ‘I can do this and it won’t be completely crap’. I’m not undaunted by any means, but neither am I totally petrified of my own potential incapacity.

The weekend was quite good. I’d been apathetic about going to one of our regularly organised poker nights on Friday because that meant fucking¬†seeing people, but in the end it was fairly good craic – and guess what? Muggins won ūüėÄ 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!

On Saturday we met W, A’s best friend who was back in Norn Iron from England for the weekend, and ended up spending all day talking complete and utter bollocks and laughing at puerile nonsense. It was good. In keeping with what’s been occupying my own life lately, I suggested a writing challenge to W and A, an idea that both seemed to embrace for their own reasons of escapism and intellect. As well as just being fun¬†(what even is that?),¬†I think this could be useful in terms of my self-imposed deadlines – if A and W are in competition, I am going to be more driven to compete within this cause myself.

So, all in all, ostensibly things are good – but the reality, of course, is far from as black and white as that. I’m back into a firm agoraphobic, hide-in-the-house-and-brood-with-the-blinds-closed mode. But I’m keeping up with the studying element of my (hopefully) soon-to-be The Book, so there’s a sliver of a silver lining (try saying that after six pints of pale ale).

I’m seeing Christine tomorrow. She asked me, the last time I saw her, to do two things before tomorrow’s appointment: (a) ask Daniel to write me a reference for the voluntary position I was considering applying for and (b) get in touch with Nexus again to organise my second stint of therapy with Paul. Re: (a)…well, I have¬†asked Daniel for the reference, to which he has agreed. However, I’ve not filled in anything of the application form, which therefore renders the request redundant. As for (b)…no chance.

Normally speaking, it seems like an uphill battle (at a bloody 85¬į slant)¬†to acknowledge the mere existence of others, which both of Christine’s challenges require. I simply can’t face any communication without A holding my hand (literally and metaphorically). Beyond reading, I can’t really do anything off my own bat, and even if I could, I wouldn’t enjoy a milisecond of it. I haven’t had a bath in about a month. I keep trying to rewatch Babylon 5, but I can’t concentrate on it.¬†I’m scared, I’m low, and I’m so,¬†so¬†tired. But I have something¬†to cling to, for now at least.

Anyway, any advice you have on Depakote, Lithium or indeed any other mood stabilisers would be greatly appreciated. Thanks folks.

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