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).

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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I Lied – The Mentalism is 'Back'

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.

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 ūüôā

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How Do You Work Full-Time When You're a Mentally Ill Seroquel-Gobbler?

Seroquel has tended to dictate that I sleep until at least 10.30am each day, and often much later. When I say ‘sleep’, I don’t necessarily mean that literally, because of course Seroquel regrettably loses its soporific effects over time, and I have an apparent predisposition to insomnia anyway; however, one way or another, the hangover effects of the drug leave me in a zombified stupor the whole of each morning.

Seroquel may dictate that I don’t do anything at all in its wake, but unfortunately of late circumstance has demanded the polar opposite. You may recall that A and I were burgled (for the second time) about a month ago. Two requirements arose out of this: one was the need to urgently repair the damage caused by the tossbags responsible (that being the broken back gate and the door between the kitchen and living room) and the second was, in respect of our probable desire to move, to get the house into some sort of cosmetic order. A and I live in perpetual mess and don’t really give a shit what the house looks like ordinarily. Of course maintenance of a house is a general chore to anybody, but I appear to have a specific phobia of it. Not that I’m using that as an excuse to get out of it, mind you, because I wouldn’t fucking do it whether I had said fear or not. (At least I’m honest, yes?).

Anyway, A’s father and step-mother have a mate who’s good around the house. He paints, tiles, joins, does minor structural work, blah blah de blah fucking blah blah. He’s trusted, being a family friend, and he charges reasonable rates. Excellent. Brilliant. Amazing.

Does that sound sarcastic? It is, to an extent, but seriously – we’re very lucky to have this connection, because of course it would be just our luck, were we to seek out a similar sort of individual via classified ads or something, that the person contacted would be an unscrupulous wanker with a criminal record the length of one of my more…um…exploratory posts on this blog (that’s c. 4,000 – 5,000 words, for current readers fortunate enough to be uninitiated). Furthermore, the bloke in question is a nice bloke; he’s fairly easy to chat to and seems to do a good job.

However. Fuck me but I’ll be glad to see the back of him.

I have a routine. An inane and, perhaps paradoxically, fairly un-regimented one, admittedly, but something that suits me nevertheless. I get up when Seroquel allows me to get up. Then I write, read or occasionally watch the pointless but inexplicably addictive rolling *ahem* news¬†(read: sensationalised bullwank) on BBC News 24. I sound like a work-shy fucker, I know, but even in these not-so-heady days of pseudo-“recovery”, this is genuinely all I am capable of. I don’t like lying in half the day, and I don’t do it through choice. I do it because the medication forces me to do it. In turn, the threat of potentially dangerous psychosis forces me to take the medication.

Our builder-joiner-decorater-Everythinger, and his penchant for showing up at eight in the bloody morning, has screwed up this seemingly idle but oddly workable routine on an epic scale. I haven’t felt this chronically and soul-destroyingly fatigued since I was plagued with literally months on end¬†of insomnia. In fact, I’d go so far as to say that it takes me back to when I was still at work full-time and plagued with literally months on end of insomnia (God, that’s a vile memory. I would lie in bed, awake, all night – every night, for months. I’d get up at 7am and almost throw coffee beans down my throat. Then I’d go to work for 8am, stay there to 6pm in a futile effort to wear myself out, come home, stare blindly at the TV for a few hours, then repeat the whole hideous cycle for another day, and another day, and another day. And¬†this was before my 2008 breakdown came a-callin’. How the fuck did I do that every day?).

It’s the Seroquel’s fault, of course. I would probably be tired if I wasn’t taking it, but I don’t think I’d be so completely devoid of any atom of energy whatsoever. It’s the drug that demands that I rest (if you can call existing in a stupefied Seroquel hangover ‘rest’) so much, and when I don’t do its bidding, it punishes me, like some embittered monarch lashing out at a traitor.

Anyway, whilst I’m on the themes of Seroquel and working both, herein lies a huge issue. Last month, Differently left the following comment on my rant about knobend MP Philip Davies (who, incidentally, was one of the ones to question the Murdochs and Rebecca Rebecka¬†Rebeckah Rebekah Wade Grant-Mitchell Brooks over the News of the Screws phone-hacking allegations – how the hell did Parliament let him¬†on that committee?):

…realistically I‚Äôm unsure that I‚Äôll ever be able to work full time, since a combination of my experiences and the meds I take mean that managing 2 weeks at 10-4 left me looking physically unwell, pale and tired and feeling horrendous, thereby meaning that I hope to work part-time…

Seaneen, who is presently working full-time, has also alluded recently to how much Seroquel has inhibited her at work in the mornings (and she has, as a consequence, withdrawn from it).

I had been thinking, much to my chagrin, that part-time employment was becoming my own only realistic option as far as future return to work goes, but I kept trying to tell myself that¬†eventually¬†that wouldn’t be the case, that¬†eventually¬†I could back to working full-time. But this exhaustion-debacle with the Everythinger has left me seriously questioning that feigned optimism.

I cannot function without devoting most of the morning to a complete state of bleugh. I just can’t. Not whilst 600 daily milligrams of Quetiapine addles my entire system. So, if I continue to take the stuff – certainly at this dosage – there is no way in hell that I could work full-time. It is simply impossible.

I keep looking at other people (especially, to my personal feminist frustration, other women) Рrandoms in the pub, the street, whatever Рand I silently ask them, how Рhow?! Рcan you possibly work eight hours a day, five days a week? How is that even remotely physically feasible? And then I remember that I too did this Рfor years, some of it whilst doing a sodding postgraduate degree Рand I shake my head in stunned disbelief. How did I do that? How was that even approaching possible? Was I an imposter in my own body? (I do love a bit of ((self-directed)) Capgras). I am certainly not that person now. Was I ever that person, really? Who was I then? Who am I now? How did it all change? (And, you might ask, who fucking cares, Pan?).

Those that are masochistic enough to regularly read this blog may be remember that, at my last psychiatric review, I asked NewVCB if I could consider reducing my dosage of Quetiapine. You may also recall that she was potentially amenable to this, citing a maintenance dose of 300mg.

This could¬†help, and I might notice the difference more markedly after coming down from such a high dose, but my recollection of taking 300mg in the past was that it was still very – if not quite, as currently, absolutely and unequivocally –¬†debilitating¬†the next morning. Besides, I’m not convinced that 300mg adequately functioned on the psychotic features of my illness. It sated some of the voices a little I suppose, but it was only when I started ingesting a daily whack of 400mg upwards that they actually shut the fuck up (and random, probably stress-related delusions¬†are¬†notwithstanding).

So, herein lies my dilemma. You all know I don’t buy into anti-psychiatry ideals and (conspiracy?) theories. Seroquel works. I know I whinge about weight gain and have launched a virtual diatribe against the stuff in this post, but it has truly made my life better. As long as I have my get-over-the-hangover routine, I am fine. Venlafaxine at a high dose has worked wonders – well, quasi-wonders, anyway – in terms of my mood; Quetiapine has probably aided in that too, but the key issue with it is that I am almost entirely without psychosis at the minute, and have been (bar that one episode the other week, as linked to in the previous paragraph) for aaaaaaaaaaages.

But, much as I don’t want to be normal in what seems to be the standard, societally accepted version of the word, I want to be able to do the things I always wanted to do. In other words, I want to work. A career – not a job, a career¬†– was all I ever really wanted. Thus far, mentalism has denied me a career, but has periodically at least allowed me to have jobs, which may have – in another place and time – led to careers. Is being mental now going to rob me of both possibilities? Will I be a dolescum forever? Are part-time workers actually commonly sought by employers? Besides which, why is it fair that A works full-time (fuck knows how he does it) and I don’t?

Bah. I don’t know. It looks to me like I have a choice between relative sanity and full-time work. Please don’t tell me to kick the Seroquel, by the way. It isn’t going to happen, at least not in the short to medium term. I’d rather not live with a bunch of nefarious fucktards telling me to kill myself (or, worse, others); I’d rather not live with Paedo following me about the place; I’d rather not have to make sense of contemptuously vicious peccaries and stupid fucking gnomes randomly¬†harassing¬†me; I’d rather not live convinced that cameras are watching my every bloody move. Waaah waah waah, whinge whinge whinge, ad infinitum.

We could argue the toss about the true roots of psychosis all we might like – Paul of course held (and, presumably, holds) that psychosis is an entirely logical response to severe trauma, and he may well have a point – but I don’t think I’m ever going to go all R D Laing/Robert Whitaker on this. At the risk of being infuriatingly repetitive, Seroquel, for me at least, works. It does exactly what it’s indicated to do. (Or, as I mistyped, tindicated¬†to do. Geddit?!!!?1?!!!?11????!!eleven?!?! It does exactly what it says on the tin? Tindicate? No? Meh. Sorry. Humour ain’t my strong point).

So, sanity or full-time work. Full-time work or sanity. Why is nothing ever simple or easy in this enforced existence that the fabled they (not my¬†‘They’ ;)) smugly refer to as ‘life’? Why do we always have to make choices, to compromise, to ‘make do’?

Am I an immature little brat for being irate that mutual exclusivity exists in this context? (Actually, don’t¬†answer¬†that).

Anyway, enough.

(And yeah, by the way, I have¬†sold out and stuck PayPal begging buttons on some posts and on the sidebar. What can I say? I’m a slave to a capitalist world, a traitor to my fellow benefit claimants, a betrayer of my lefty principles, a self-serving money-whore of evil, a rabiator of [insert hated multi-national¬†conglomerate¬†of your choice here]¬†proportions, a twat, a dick, a __________, a &%$(“($, a…yeah, you get the idea. A few of you also did ask about it, in my defence ;)).

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Missing a Dose of Venlafaxine, and Inevitable Post-Consultant Blah

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

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