Progress, or lack of such

To be honest, I thought I’d have seen more progress by now. Three years after CBT started (it lasted about 8 months) and just over two years since I began taking meds. These have changed and dosages upped several times to where they remain steady at the moment. Daily: 600mg quetiapine, 20mg fluoxetine, 500mg sodium valproate.

And yes, they’ve topped and tailed my more extreme moods. In that respect there’s been significant progress. I still get frequent – and fleeting – suicidal ideation, but I don’t have the strength and wherewithal to actually do anything about it. I tend to ere on the side of caution and add ‘yet’ to that statement. It wouldn’t do to think I’m cured. I know there’s going to be no such thing.

So two years.. I’m holding down my job and – I think – doing well at it. My team gives me some support by way of accepting and dealing with my many cognitive and memory issues that pop up daily more than once.

I have no-one to talk to about my illness; at least, not in detail. Twitter remains a source of support, albeit from people I’ve never met and never will meet. There are loads of us on there exposing our souls and craving help and attention. Whenever it’s good to talk, Twitter offers a (usually) one-directional ‘conversation’ outlet. I have no input from my GP or any other medical service. I saw a psychiatrist last before the summer but that was only because my GP referred me due to a down-turn in moods. I have no future appointment set.

It would be interesting to see if I could hold-down a relationship at this point in my treatment. Bipolar destroyed all the romantic relationships I’ve ever had, and I still feel so bad about that. Some of these were good for me, and I let them go through my – admittedly uncontrollable – moods. As it stands now, three years since talking therapy began and just over two years since meds started, I have no such relationship. Indeed, I’ve not had a girlfriend (or even a date!) in two and a half years. That’s the meds for you; I’ve been stripped of emotions, feelings, libido and effort. I create no writing work, and barely any art work – the things that I’ve always done and done well.

I don’t really live; I exist. And even then, there are occasions when I get hypomanic and don’t even believe that. I exist with moods and delusions, my physical health has taken a hard knock (illness and meds) and I generally ache all over 24/7. I still don’t sleep. My short term memory is f*$*&d, basically. I’ve put on a couple of stone in weight since starting the meds but from looking at other people’s experiences I could have put on an awful lot more. Who knows, maybe I will? I’ve had to get rid of a load of clothes and start acquiring from scratch. (Though that’s actually been quite therapeutic!)

The biggest shock to me lately has been a letter from the Pensions people; I still have 9 more years to work in this stressful job. Until I’m over 66. How the hell’s that going to happen? I’m living day to day. Small mercies.

 

https://upload.wikimedia.org/wikipedia/en/thumb/e/e5/Magritte_TheSonOfMan.jpg/225px-Magritte_TheSonOfMan.jpg

 

 

 

 

 

 

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From depression to brief relief

I’m having a brief evening’s break from depression it seems and it’s such a relief. There are signs it’s coming, before I realise it’s here:

I’ll have a drink – not much left of that bottle of white wine. Small glasses, straight or tall glass of kir.

I’ll listen to familiar ‘up mood’ music: invariably this will consist of Underworld, Mew, maybe some Psychedelic Furs. But always Underworld. ‘Two Months Off’ especially

Such a relief; just to lift that mood that’s persecuted me for weeks, months. Try to forget that this break will more than likely last no longer than an evening. I’ll wake tomorrow filled with anxiety, low mood, suicidal ideation and OCD-driven thoughts and ideas I wouldn’t wish on my enemies.

An evening off.

The music in my head and in my body. Moving. Feeling. Being.

An idea that everything might be alright; not forever. Hell, not even for a day. But for now, it might be good. Shift those thoughts, overcome those blades and car crashes, live for another day.

Such a relief, so impermanent. A relaxing of muscles, a loosening of nerves. Just being someone, something, other than who I am. That can wait.

Breathe in, breathe out. Sleep, because tomorrow’s going to be the usual bastard of a day.

 

 

Easter Sunday

Easter Sunday

 

 

 

Today, again, I’m not me. Today,

again, I see reflections of elsewhere;

else-one. Some other to be. Buzzing

with a particle pulse of happening,

sampling on another level, distant.

 

Withdrawn and imagining how the

smooth cut of a wet stem makes

the flower undone. I’m not here

today; something is, but not me.

I am that close to the atom, see?

 

 

Exhausted

‘You want to know why I feel exhausted?’ I asked.

‘No, not really. But go on, if you must..’

I haven’t slept right through the night even once in perhaps 30 years. Not once. I ache down to my very soul; if you thought bipolar is solely a mental illness then you’re mistaken. It’s also a physiological illness, a painful one. Between the disease and the medications they pound away at muscles, joints and bones 24/7.

Then I have to hold down a job. A stressful job at that. And when I’m not holding down a job I have to run a house and be a single parent. Not wanting to end up living in a sty that has hundreds of baked bean cans stacked on the stairs or newspapers going back to the 80s, I have to cook and clean the same as the rest of you. Pride, necessity. Being civilised and human, I guess.

And the moods.. they’re all over the place as I have a layered illness, that’s the best I can describe it. I might be hypomanic for months and depressed for months but on top of this I have acute shifts in mood, often very brief intrusions of one mood type upon another. Ultra-rapid cycling. Ultradian.

That means my mood can shift dramatically within one day: periods of hypomania and periods of depression, and most significantly periods of mixed-mood which for me are always the most dangerous and unwanted. When I’m mixed I am depressed enough to want to die but high enough to be able to make such a thing happen.

Today I stood by the kerb at a pedestrian crossing. Lorries were thundering past at 30mph and it took all that I had not to take one step forward just as the next lorry was approaching. Fighting this urge is exhausting. On the way to the crossing I’d experienced some kind of hallucination (more than, I think, a delusion per se) where I was suddenly walking along seeing the ground from 7’+ high. I’m 5’ 5”. That lasted just a few seconds, but dealing with this was tiring nonetheless.

It’s all one thing on top of another. Chronic, acute, a bit of this a bit of that.

Then there’s the meds: 20mg of fluoxetine in the morning (slightly sedating) with 100mg of quetiapine (more sedating). Then another 200mg of quetiapine mid-afternoon, followed by yet another 200mg of quetiapine in the evening.

This isn’t even a lot of meds for someone with bipolar (plus anxiety and OCD). I’ve met people who are taking 15+ doses of meds per day.

Spending most of the day (and night) sedated is physically wearing. I have to fight myself to leave the house, to walk, to exercise. To live rather than simply to exist. Plus, I self-medicate with alcohol by late afternoon though thankfully I’m in control of this and I manage to keep within my weekly recommended consumption as an adult male. That’s a miracle in itself!

I have to put on a brave face, a smile for my son so he doesn’t worry about me too much. This act requires energy and focus and tires me out also.

All of this, and more. Not just for a day, a week, a month, a year; I’ve been battling this more seriously for a couple of decades and on the whole since my late teens and indeed probably my childhood. I’ve only been on meds for several months, only sought treatment 2 years ago.

Everything I’ve described happens almost every day. Most of it happens every day.

It’s no wonder I feel exhausted.

 

Update

Wow, it’s been a while since I updated this! Is it a case of ‘no news is good news’? Well, yes and no.

My medication seems to have been settled though a mistake on my repeat prescription indicated ordinary release Quetiapine rather than the extended release I’d been taking. I decided to stick with this mistake, if only because my eating pattern wasn’t dictated by the need to take the meds on an empty stomach.

I jiggled (is that a medical term?) the dose throughout the day to suit me further so now I take: 20mg fluoxetine and 100 mg quetiapine at breakfast time; 200mg quetiapine late afternoon; 200mg quetiapine an hour before bedtime –ish.

The quetiapine has worked well at controlling moods, especially hypomania / mixed. As for side effects, I’ve put on three-quarters of a stone in 6 months and I have chronic lower back pain and a variety of other aches. I’m always sedated to some extent though even on 500mg quetiapine I still haven’t slept through the night even once in decades.

For some reason I’ve never been able to fathom I am always – always – worse on Sundays. I assumed it was because of work on Monday but being off for 8 months recently, and now being on 6 weeks summer break, hasn’t made much difference. My anti-anxiety medication of choice (as long as it’s mid-afternoon+) is a glass or two of white wine. Well, it works.

I still have some delusions; always the same ones as I’ve been having for a few years now. I have (manageable.. so far) psychotic episodes, particularly when in a mixed mood. Anxiety and OCD go hand in hand and can be a nuisance. I have extremely intrusive instances of suicidal ideation and these are worrisome; they too generally happen in higher/mixed mood.

I returned to work in my stressful job a month or so ago and it went OK. The start of next academic year this September will dictate how I am and how I feel.

 

So happy I could die.

 

 

Suicide is a complicated business. Or rather, bipolar suicide ideation is a complicated business.

Being ‘suicidally depressed’ and wanting to die is how most people imagine the subject. To be so low, so clinically depressed that life has no meaning other than that it should end. Wholly and completely. It is utter despair with, in that moment (which might be a prolonged moment; linear time doesn’t always apply here) nowhere to go, no escape route. No solution other than un-life.

But as I say (and of course I can only speak about my own, personal experiences) suicidal ideation in bipolar can be a very different kettle of fish. So to speak.

Medicated (Quetiapine 400mg, fluoxetine 20mg) I haven’t had an extreme low or high for a while. What I do still have however is the hypomania and mixed mood episodes I’ve always had. Rapid – or ultra-rapid – cycling, at least they don’t last long. Not long enough to dig themselves a sizeable hole or system of clogging trenches I have to drag my metaphorical feet through.

Having suicidal thoughts because one is ‘happy’ is where the complicated bit comes in. And I imagine those people who’ve never experienced it – personally or with a family member perhaps – find it impossible to comprehend.

Put some favourite music on, loud: maybe those old or new Underworld tracks, that Oceansize song, anything from ‘Definitely Maybe’ or the first Strokes album – basically anything upbeat and rowdy, something singalong.

Have a glass of wine or three. Get lost in the moment.

I’m never happy, per se. Never have been. Anhedonia. So when I feel like I might be, like in these moments I’ve mentioned, I get suspicious. I’m aware (but perhaps not entirely aware, consciously) of the mood; but it’s a very welcome relief from the usual overwhelming pain of bipolar and anxiety (with its associated mild OCD).

Fuck, yeah… I’m happy! I’m dancing, one with the music. With the wine. With the universe at that moment!

WBBcc

So hell, yes, why wouldn’t I kill myself? Why on Earth not? It’s the logical thing to do. I’m – unknown to me at the time – depressed enough to want to die but high enough to have that energy, that ultra-rare joie de vivre to carry it out.

Mixed mood suicidal ideation is the most dangerous for me, by far. Then, it makes absolute, perfect sense to kill myself. As I say, Yes! Whyever not?! I’ll never be as happy again as I am at this moment and I want to celebrate, to prolong this happiness.. by dying. Confusingly and ambivalently however, I want to live forever. In fact, I will live forever! How could that fact possibly not be true?

“Life has no meaning the moment you lose the illusion of being eternal.” – Jean Paul Sartre.

Fortunately this kind of mood state pays me a visit at home. Occasionally it descends (or ascends?) upon me when I’m driving, alone. Music playing, sun shining, countryside slipping by each side of that motorway or A road. I’m so happy that I see a lorry speeding towards me in its own lane and for a moment think I want to remain in that ecstatic moment by turning the steering wheel sharply and ploughing into that vehicle. Did I mention the sun’s shining? I’m doing 60, he’s doing 60.. that a 120 mph impact. Sorted!

Then the moment passes. For now at least. What was the trigger? Well, it was probably nothing external. Just me; my electricity.

Was I aware at the time? No, or at least barely. Was I ‘myself’? No. Was I in control of my actions? Subconsciously, automatically, hopefully. Consciously, no. But I’m alive. At least, for now, same as it’s ever been.