Goodbye to my CPN, hello Effexor

An effort to write!  I have really not been feeling like it recently. That’s strange for me as my first instinct if someone blew my arms off would be to write about it.  With my toes, but still to write.  Right now, my body feels heavy and useless and I can barely raise my head, let alone my hands, to actually write something.  I’m not thinking really straight either which makes it harder.  Writing is my greatest joy and even that is wriggling away from me.

The annoying this about me is that I think that if I didn’t have manic depression that I might be a happy person.  When I think back to the days of rare euphoric mania, I was never fazed by anything, I was fearless, sociable, creative and I think, or thought, that it was just an exaggerated version of what I was really like.  I am clearly naturally optimistic or else I wouldn’t be there and wouldn’t be putting myself through these fucking medications and appointments.  They take up an astonishing amount of my life. I don’t actually believe in “the real you”, I think who we are is fluid, not fixed.  But I think that the maybe natural me is not this person.  How I do not want to be this person.

The psychiatrist, the CPN and the social worker.  It sounds like the title of a low budget film.

While waiting for my appointment today, I noticed a rather strange man having a very animated conversation with himself.  He was dressed in a t-shirt and trousers, held up by braces, with a pink Barbie shoulderbag, an arm covered in jelly bracelets and a baby’s bonnet on his head.  He was about fifty years old with a sparse, rubbishy little beard.  I often see strange looking people in reception- it is a mental health centre after all- but he was the most interesting.  He wandered very jovially around explaining to himself, or to whomever he was hearing, how things worked.  He cast grateful clarity upon the light switch and waved his hand in and out of the automatic doors as if to prove that there was no mist or magic present.  I almost wanted to speak to him, but he seemed to not hear, or be ignoring, those who did.

Today I said goodbye to my wonderful, P.J Harvey loving, cigarette cadging heavily pregnant CPN.  It was quite a perfunctory farewell and I’m glad it was as I felt like crying.  I wanted to tell her how much she’s done for me, but in order to avoid gushing or appearing pathetic I just said, “Thank you for everything” and we had a hug.  I hope she’s back next year and hope that in November she gives birth to a baby and not a goblin or portable television or suchlike.

My last CPN was a revelation to me after an awful year in Haringey’s mental health team.  My previous CPN was crap.  I don’t know if she was hampered by Haringey’s general shitness for which it is renowned but she was almost entirely useless to me.  We’d meet once a month or so and she’d nod for a little while, scribble stuff down and that would be it.  I lived with Rob and couldn’t claim benefits so I was encouraged over and over again to work, and thus kept losing jobs because I was not well enough to be working in the first place.  It messed with my head because I was ill (still am) and it was humiliating and battering to have to leave jobs because of it or be sacked.  It was also excruciating to know that people easily picked up (and do pick up still) on the fact that I had mental illness because of my behaviour. The stress was immense and even just working while taking the medications I was and am was difficult. Even travelling to work was traumatic as I’m not good at travelling alone.  They, and my illness in general, makes it hard for me to concentrate, remember stuff or not trip over, and, most embarrassingly, when I was on Lithium I had terrible hand tremors and slurred and they thought I was drinking.  So, on lots of occasions, I stopped taking my medication so I could function at work.  The result was relapsing over and over into manic episodes.  She didn’t offer any advice, didn’t really do anything and I would have just walked away entirely had I not moved to Islington.

When I moved to Islington I had lost another job and was advised not to work.  The cycle was neverending and I was close to homeless.  Hannah helped me with my benefits and the DWP, which was a massive load off my mind (again, you can do a search on this site to see the amazing amount of problems I had getting benefits.  I have no idea how people commit benefit fraud, it’s impossible, they want to see your blood and bra size before they will help you.  I get DLA and Income Support amounting, and the forms were filled in by me, Hannah and the psychiatrist, who also wrote supporting evidence.  People under 25 are also very discriminated against by the DWP.  They seem to assume everyone has the same needs and has their parents.  I wouldn’t ask my mum for a light let alone help).  It took a while for me to actually get them but I did and now at least I have some sort of security.

We met weekly, she actually listened, she made me laugh and she took me seriously.  I had a very dim view of mental health services before I met her.  Now I can see how useful they are if they’re decent.

I’ll miss her.  I told her when my Radio 4 play was on (next year, although I can’t tell the world at large when yet) and hopefully she’ll listen and laugh at my ridiculousness.

I met my new care worker, who is not a CPN but a mental health social worker.  My first impressions of her weren’t good; she spoke very LOUDLY and slowly, as if I were simple.  If she tries to patronise me there might be fists.  She looks like one of my mother’s raucous friends.  But they’re first impressions.  Hopefully I will like her.  And hopefully she’s as good at her job as Hannah is.

I also saw the psychiatrist.  He is much easier with me than he was before, not as clinical and starched.  He refered to me as “profoundly depressed” which surprised me but which I know is true, I just don’t care much, about that, about me, about anything at the moment and haven’t done for months.  I used to be terrified of dying but it’s deserted me.  It was almost an insurance but now I don’t care if I get hit by a car, at least it means an end.  I don’t often get “ordinary” depression.  There is usually an aspect of mania to it, which is difficult for them and for me.  I am still having the horrible racing thoughts and I am exhausting myself pouring all my energy into distracting myself from it, which also means I have been doing Stupid Thoughtless Impulsive Things® that have been getting me into trouble.  I am physically fucked at the moment, which isn’t helped by the fact I have totally lost my appetite and have no energy, but have still somehow gained weight.  I hate the combination of feeling of tireless mental energy, but when you open your mouth you take about an hour to get one sentence out because you have to interrupt your own hideous spin of thoughts to extract something that makes sense and is relevant to the question.  I am noticably a bit “weird”, some would say, but I can’t help that.  I put it down to just being a rather “odd” and slightly eccentric- and not in a “Fnar, I’m MAD!” way- person.

I have zero concentration too so keep losing the thread of what people are saying to me.  Sociability feels like one grand performance but I still do it so I am doing something and I want to be happy.  I let my guard down in my psychiatric appointments.  I don’t pretend to feel better or worse than I do.  I don’t particularly like writing about this mood, either, because it isn’t changing and I don’t want to be melodramatic or depressing.  I need a modicum of control here, even for just my benefit.

I got the usual round of questions, some which made me think.

Are you hopeful?  Nope.

Have I been having thoughts of harming myself?  Duh.

How so?  Jumping off something high, hanging, train tracks.  Violent but definite ways.  I am afraid of overdosing again because it’s not reliable and in my experience has been painful and horrible.

Have you ever bought a rope?  No.  I have always resisted thoughts of hanging myself because it’s how my then-best friend Vicky committed suicide in 2001.  That, and Brendan and my dad’s death, is one of the main reasons I am still around despite feeling this way.  I am aware enough to know that no matter who you are in relation to someone, they will feel partly responsible for your death and it will haunt them, like those deaths haunt me.  It is in part being alive because I have to be, but I am not sure I can be that cruel.  For the most part I keep the thoughts to myself because I know how difficult I found it when Brendan, Vicky or my dad told me bluntly and plainly how they wanted to die.  I only really talk about these things when I am at my appointments.

Have I been feeling guilty?  Yes, about everything (particularly haunting me is the incident recently when I drunk dialled my ex and caused a massive fight which ended in him telling me never to contact him again.  I am mortified that my existence and stupidity upset someone I don’t even know and caused problems.  I also don’t want her thinking I am some stalker or mentalist, it’s not the case.  I hate the thought of her or anyone else reading this and thinking, “What a nutjob.  I’m glad I don’t know her”.)

Do I enjoy anything?  No, not really.  Hence the lack of writing or wanting to write, not being arsed to eat, barely listening to music, not being able to focus on reading,  the hardly bothering to have baths and the unusually for me not bothering much with make up or clean clothes these days.

What was the worse physical thing I have ever done to myself?  I was puzzled by this question.  Did he mean an accident or otherwise?  He clarified, he meant suicide attempts and self harm.  I found this hard to answer because the suicide attempts I have made are things I don’t have a clear memory of. I wasn’t exactly thinking clearly at the time although I do remember being almost robotic when I did them.  The most recent was last year and it involved taking every Lithium pill I had left.

Have you ended up in hospital, had stitches or such from these things?  No.  The truth is that I would never phone an ambulance for myself or go to A&E.  I have certainly needed stitches in the past, and have had them once on my face.  I have rather bad scarring because of the lack of stitches.  I held myself together and used cold stuff to numb the area (leading to me knocking a joint of meat down the side of the bed, which stayed there, rotting, stinking, before I cared enough to get rid).  I stopped cutting myself for a while and drank bleach instead.  I used to put it in my a cup at the side of my bed.  It looked like water.  I also used to use bleach to brush stains off my teeth which is one reason I have such terribly rotted teeth now.

Due to my ineptness, though, when I have taken overdoses, I have just vomited, a lot, for a long time and felt terrible and weak and sick.  I probably should have gone to hospital and I might have done a bit of damage to myself.  I didn’t tell anyone at the time, on any occasion, what I’d done.  One of them was when I was still at school and severely depressed, had just lost Vicky and also being stalked and harassed by every communication available by Robert’s then girlfriend.  I could barely move in the morning but my mother, usually a enabler of truancy, barked at me to get out.  I threw up in front of her and she made me go.  I puked out the window of the taxi (in West Belfast black cabs are a form of public transport), got out to ring her on a payphone to ask to come home, puked on the ground, she told me to go to school, I got to school, puked at the entrance then collapsed in my class.  And then went home and threw up combinations of blood and black stuff.  I remember very well standing above the bowl staring into the black, shiny surface of the water.

I think it worries them a bit to know that if I got really low and was thinking of doing something, I wouldn’t call anymore.  They keep reminding me that I can ring the Crisis Team (who I was with in April) or go to the crisis centre.  My rationale is that if I get that bad, I’m going to do whatever and it’ll be my choice, so.  Hannah’s rationale has always been that I am not thinking properly if that’s what I want to do so they try to prevent it.

He also asked me how often I laughed and cried.  I laugh more than I cry, but I am not the kind of person who cries at all.  I am the kind of person who cries at films and books, but not at real life.  I sometimes cry when I alone, I cry out of grief and sadness for my dad and Brendan and grandparents.  For the most part, though, I am almost stoic and unemotional when I am depressed.  I have been really anxious and panicky for months and that’s been tearing me up, too.  It makes me feel physically sick.

The new person asked me if this was one of the worst depressive episodes.  The psychiatrist thinks that it is severe depression.  It is not one of my worst in terms of your standard depression.  I have been depressed to the point of muteness and paralysation, but this, somehow, feels different because I am indifferent.  I have the acute feeling that this may be my last depression and the one that ends it.  I have no strong emotion either way about it.  I have been mildly surprised at the attention being paid to it; I have been having a lot of psychiatric appointments, and he is concerned.  I thought nothing would get through his implactable veneer.

She also asked on a scale of 0 being the lowest and 10 being the highest where I am.  I said I found that hard to answer because I don’t have the stereotypical type of depression that can be quantified as such.  But I told her that I felt pretty bad and have done nearly all year.  (Aside from one manic episode at the beginning).  I wonder what normal mood must be like.  I haven’d had a sustained period of it for over ten years.

Since having stickers gently placed on my breasts yesterday I am now starting Effexor which the doctor hopes will help and is a bit of a last resort.  I will try it, of course, will try anything, I don’t enjoy feeling this way.  Other antidepressants have kicked me into mania which is why they have been hesitant to start me on one.  I had fun today thinking of the medications they have tried in the past two years since I left hospital.  Read them aloud, it sounds like poetry.  There has been:

Lithium (mood stabiliser most commonly used for my type of bipolar, bipolar I disorder) (which didn’t work and made me ill)

Depakote (mood stabiliser used in conjunction with or when Lithium is not working) (which also didn’t work and on which I put on weight.  It has fucked with my hair too)

Seroquel (an antipsychotic used for schizophrenia, mania and psychosis) which I still take.  I put on a lot of weight when I started it but it has levelled of

Haloperidol (an old school antipsychotic) in hospital

Lorazapam (I think it is a tranquiliser) in hospital

Paroxetine (antidepressant) made me manic

Sertraline (antidepressant) did the same thing

Lamictal (mood stabiliser for Bipolar I disorder and apparently good for rapid cycling, which I have, and which has actually calmed down) which I am still taking to keep mania at bay.

Risperidone (antipsychotic) which gave me hypomania-inducing insomnia

Zopiclone (hypnotic, sleeping pill)

Valium (benzo, I think)

and before that, at 16 and 18:

Carbamazepine (mood stabiliser given to me when I was manic.  Made me worse)

Olanzapine (antipsychotic, used for schizophrenia, mania and psychosis.  Given to me for manic psychosis)

It raises a wry smile as, before I had to go into hospital, I was notorious for hating doctors and not even taking headache tablets.   It must mean something, that at least I’m trying.

I am worried about taking Effexor.  It sounds like the name of a fast car.  I hope it picks me up out of this, but if it doesn’t, I don’t think there is anything left to try other than ECT or something.  All I can hope for is for my mood to naturally switch, as is does, but then it would go back into depression, as it does, and I can’t be like this forever, I will not make it.

I’m vainly worried about weight gain, too.  It seems shallow but bear in mind I have an eating disorder and BDD.  It could pick up my depression but the other two would get worse and I would still be depressed.

I hate beginning medications as every time I get really unsettling nausea and vomiting and feel absolutely shit for ages.  Psychiatric medications are hardcore drugs and they fuck you up in the first instances.  I don’t think any further memory problems either as I have successfully forgotten to pay most of my fucking bills this month.  I bought a cute chalkboard for the hallway so that I could jot things down but it was counterproductive since I forgot to jot things down…

I’m also worried it will send me manic as I’d put money on it being a dysphoric mania.  Although I guess I am going through “agitated depression” at the moment, dysphoric mania (which I have written about before, you can search posts) is like hell made real.   It is difficult to medicate me because of the manic edge.  Mania has always been more of a problem for me than depression and always caused the most destruction, turning psychotic at its zenith.  Yes, I get depressed but usually the mixed episode type of lunatic despair.  People’s predominate opinion of me has been that I am stark raving mental rather than a depressive because of it.

Anyway, we shall see, eh?  Gosh, isn’t life exciting?  *Performs amusing dance*