Starting to rattle

I started going downhill again a month ago. GP tried to get me seen by assessment team the same day but it took a week. Then I had to describe it all again; for what seemed like the hundredth time.

And again, another long assessment. My psychiatrists said something about juggling my medication a little and trying to get me more (1:1) CBT therapy. Last time I had therapy for several months I’d yet to start on the meds and it did very little for me I think. If I get more therapy now it will be interesting to see how it goes alongside medication.

So a couple of days ago I had my follow-up meeting with the psychiatrists; another ‘20 minute’ one that turned into 50 minutes.

The bottom line of which is that my Quetiapine has been increased almost to maximum dose – up from 500mg to 600mg. Fluoxetine remains at 20mg. And Valproate has been added into the mix, at minimum dose: 500mg. Lithium was discussed but I was told the side effects wouldn’t agree with me – and anyway, Valproate is better for OCD (and its anxiety trigger).

I’m starting to rattle.

epilim

 

Been a long long..

Last post was ages ago. I was waiting for my Assessment meeting, hoping for diagnosis. Obviously that was overly optimistic, due to me knowing nothing of the system back then.

Things have changed a bit in the past 6 months.

I’m on Week 13 of CBT to address my anxiety (as opposed to my bipolar issues). It’s going ok, but it isn’t helping one iota with the lows, the highs, the suicidal thoughts, the despair. I learnt the general idea of CBT in no time; recognise one’s ‘bad thoughts’ and turn them into ‘good thoughts’. Theory’s great, isn’t it?!

Some other, scary, stuff has surfaced. Physical and psychological abuse going back to childhood, from my mother. Nothing sexual has surfaced.

I come out of some sessions exhausted. Sometimes they trigger hypomanic episodes.

I’ve seen the psychiatrist twice. I almost walked out that first time; she was arrogant, unprofessional (imho), confrontational, unhelpful and with no empathy whatsoever. She told me there was no chance of getting a diagnosis; there were only a few doctors in the Authority assigned to such a thing and thousands waiting for diagnosis already.

She wrote down the names of 4 medications and suggested I go home and Google them to see which one I fancied trying (yes, really). Lithium… hmm, don’t think so. Quetiapine… I think not. At the end of the day I have to get up early and go to work, do that job whilst alert, and more importantly keep that job and not spend months at a time ‘on the sick’ for fear of losing that job. I’m a single parent 50% of the time too.

Same goes for treating my chronic insomnia (I haven’t slept right through the night even once in 20 years); I have to get up at 6.30am for work or the school run. Sleeping tablets aren’t conducive to such social commitments.

So at our 2nd meeting I had to decline the offer of medication for my (undiagnosed) bipolar II. And go with the CBT for now. After all, I’m still alive after a lifetime of this illness. And as the psychiatrist said, I shouldn’t have such a strong work ethic, should I?

I contacted MIND to see what courses and support it could give me. As with the ‘system’, those of us who fight to hold down a job aren’t catered for; the courses happen during office hours, on the whole.

When the CBT ends, which of course it will do, I’ll be dealing with this again with no treatment or support. As if the past year+ of seeking treatment and support has never existed.

Who knows what the answer is? I’m not even certain of the question.

Finally, the day is here

Secondary Care assessment and diagnosis appointment this morning.

25 mins late going in, for their first appointment of the week.. doesn’t bode well. Spent 90 mins with an OT who asked almost all of the questions, and a psych doctor who wrote reams of notes.

Conclusion? Who knows? They like to ask ‘what treatment do you want?’ I tell them: ‘I don’t know, whatever’s best and works. That’s your job! I wouldn’t let you do my job but I wouldn’t expect to do yours either.’

I made a stab at a guess: medication to get me stable then off it as soon as possible and some kind of therapy. He said ‘you’re not far off there’. I was ‘off’ with the ‘coming off drugs asap’ bit it seems…

I pushed for a ‘label’ for diagnosis but they wouldn’t say. Apparently the thing these days is not to use labels as it’s not about a name but a treatment. *yawn

He said: ‘there are a few things going on here.’ They focussed a lot on anxiety as a symptom and a trigger. I hope they don’t do what our Ed Psychs do when they’ve filled their ASD quota and diagnose ‘Anxiety’. I will have to wait to see a consultant now for medication. That won’t be this year..

So again, like the past 8 weeks, I have no help to call on, no treatment. I’m on my own, same as it ever was these past 35 years.

Disclosure

Although my Secondary Care assessment and diagnosis appointment isn’t for another 5 weeks yet, I decided (while lying awake at 4am) that I would make a ‘gesture of trust’ with my boss in work and talk to her about what’s been happening to me since I approached my GP in early July this year.

So I gave her the very short version; that bets were now off on me getting a diagnosis of bipolar II and had in fact had this all my aduly life, 35 years or so, without getting any help, advice or treatment.

My thinking about revealing this now was that I would be able to access some Occupational Health support and would be protected by the Disability Rights Act if not now then after late November.

She was very supportive, or at least suggested such. Time will tell..

Confusion, confusion

It seems I have been confusing what is Primary- and Secondary care and have got them the wrong way round.

So far I have been meeting with a PRIMARY care nurse – the 3rd (and apparently final) meeting was this morning. Now that SECONDARY care have given me an appointment for assessment and, hopefully, expedited diagnosis, I cannot meet with the nurse I’ve been speaking with over the past months. You can’t be on the books of both levels of care.

I now have no contact with the Mental Health team until my Secondary care appointment at the end of November.

This morning we discussed ‘magical thinking’, which I somehow hadn’t heard of before. It’s what I do, habitually, it seems. I admitted that I believe the many ‘coincidences’ that happen in my day to day life aren’t such at all but are manufactured by me. How else would such coincidences occur? Most of them are very narrow and virtually impossible. Sorry, ‘impossible’.

I also admitted that I’m not entirely certain all THIS is real; I fancy that I might be in a coma or psychiatric ward somewhere (or even dead) imagining all of this existence and creating it all. Solipsism. Or, magical thinking.

Having spent 4 meetings telling the nurse all my symptoms (for want of a better word) I will now have to go through all that again in 7 weeks time at the Secondary care assessment appointment.

Mood Diary

For my 2nd assessment meeting I handed over a detailed ‘Mood Diary’ I was asked to keep. I think the psych. meant a simple chart with a 1=low, 10=high thing. But it didn’t quite work out like that..

“2pm

Coming down now after a few days. Now feel edgy, anxious, slightly confused and have a headache.

I was asked about delusions.. I have one that I have always had but which has been more frequent the past several months. I have moments when I think that perhaps this life isn’t real and that at some point I had a serious accident, or shock (I am almost too frightened to consider it might involve my son) and am perhaps in a coma imagining all this.

If I talk about it now it sounds like a story, but when it happens I believe it totally for a short time until I can snap out of it.

I am thinking again about something I have sort of believed in all my life: solipsism. Also, photos of me, my reflection in mirrors, they have never looked like me.

Mood coming down: always introspective, examining, tired.

* * *

6pm

Coming down still, tired and moderately low. Washing up, started thinking of the day my mum died and I found myself considering how sensible it would be to end my own life. A fleeting idea, soon passed. No particular importance given to the thought, I was also listening to the radio at the time.

6.30pm

Anxious, nauseous.

9pm

Stable, mildly low. Buzzing has turned into slight trembling in arms and legs. Anxiety, nausea.
11pm

Very tired. Will be awake in a few hours. Mood stable, ‘normal’.”

Assessment

Well that was quite intense. Not knowing what to expect, I’d got quite stressed, anxious, about the meeting.

She didn’t have a copy of the letter I’d given the GP originally so I had to tell her about what the problem is. It’s not easy to sum up one’s entire adult life, 35+ years, to a total stranger. Particularly decades of depression, highs, mixed states, anxiety..

I’m buzzing; as I explained it, you see those animations of atoms on TV with protons etc. buzzing around them like wasps on speed, and that’s what the inside of my body, my limbs, is doing.

Describe secrets going back to age 6 or so; the ‘mystical’ experiences that I tell absolutely no-one because they’re so personal, and which I now interpret as manic episodes.

The days spent sitting and fighting back tears, until almost understatedly they begin to fall, slowly, salty, and a levee has been breached. And the waves that have been moving inside me, swaying my own atoms, leak a little.

‘How would you kill yourself?’ is never going to be a question that can be considered or answered without emotion. After all, I’ve considered this same question tens of thousands of times over the decades. ‘I wouldn’t. I haven’t.’ Hopefully.

But the control – the self control – that I’ve always had is breaking down somewhat as I age; as anxiety and the highs become more commonplace than the lows. The mixed states are the most dangerous for me; when everything bad appears to be logical. Why not do it? Why not?

Because I have a son.

An hour and a quarter isn’t enough to relay facts of this magnitude and so I have another appointment in 2 weeks time. This is to gather more info to put forward for a diagnosis. This sounds scary; 2 mental health professionals and a ‘medic’ doing a longer (!) assessment. Longer? 75 mins has exhausted me.

So 2 weeks time. Watch this space and I’ll tell you how that goes. And maybe some more in the meantime as I have to keep a ‘mood diary’ by the hour. I explained that some of my extreme highs last 2 minutes, during which time I might have written 1000 words of fiction or painted 2 or 3 small canvasses..