Appraising my suicidal ideation and assumed methods.

1. Plough car into a suitable concrete wall somewhere on the M4:

Well, I’ve only just washed it, not to mention having T-Cut that scratch.

2. Take a shower after dark, drink copious amounts of alcohol, lie naked on lawn on a chilly night.

It’s a bit cold out there, and cosy indoors – what with the thick jumper and the central heating. And ‘Homeland’ is on in a minute.

3. Cut wrists.

That’s going to hurt, isn’t it? And there’ll be blood everywhere, I’ve only just started Spring cleaning.

4. Drink copious amounts of alcohol, swallow a few sleeping tablets. Jump off high building.

I don’t like heights and high buildings. They make me want to jump off. Oh…

5. Shoot myself.

Don’t have a suitable weapon. Nerf gun with foam ‘bullets’ borrowed from son probably not going to do the job to be honest, even at point-blank range.

6. Overdose of meds.

Couldn’t understand the document about quetiapine o.d. I found on Google – it was far too technical. Does it or doesn’t it?? Also, fluoxetine o.d. seems unlikely.

 

As Samuel Beckett put it: ‘I can’t go on. I’ll go on.

22 of them

Time passing fast, almost the end of January.

I’ve been pretty much discharged by my psychiatrist as I’m seemingly one of her success stories; the meds appear to be working. The fluoxetine is clipping the extreme lows, with Quetiapine helping it out and of course clipping the highs as it does so. Poor overworked Q!

I returned to work at the end of last July, just before schoool broke up for the 6 week summer break. And I’m still there, having not missed a single day so far. That’s how stubborn, some would say how strong, I am. I’ve had a lifetime, middle-50 years, fighting, struggling, but ultimately winning.

It takes concentration, a continual fight, to exist. Yes, that’s what it comes down to: maintaining existence.

My enemy (well, part of the pack) is still that damned intrusive suicidal ideation that looks for any glitch in the system, any gap atomically small. And says “hey, do it! Why wouldn’t you?”

Why wouldn’t I.

And I’m in this war alone; single for almost 2 years. Almost friendless, alone. I was pretty much discharged by my psychiatrist at my latest appointment in the shadow of the New Year. Now I really am on my own. Me and my meds. Featuring battles such as “fat or mad” – I continue to put on weight despite my best efforts.

I don’t trust the meds; it would be extremely foolish to do so. Madness still breathes and creeps inside me. I still don’t sleep. I’m sedated much of the time, I’ve stopped writing (poetry, fiction). Meds and me, we’re like that chess game in “The Seventh Seal”.

 

 

Bipolar psychosis

There was no doubt a process that led me from Saturday night to Monday morning

I haven’t been very low for a long while (thanks to the 20mg fluoxetine / 550mg quetiapine meds) but I felt it had arrived during the night. Although I was wide awake at 5am Sunday morning I just couldn’t get out of bed. When I eventually did, I could barely move all day.

What dragged me down further was having to think through the logistics of the aftermath of the 3rd World War in 2030. And the 4th World War in 2032. I’ll be old and possibly not even still around, but my son will be.

This morning I knew I really shouldn’t go into work, but I’m stubborn and I pretend I’m in control of my own illness. Call it stupidity if you like.

So I went to work. And the day was marked with memory- and cognition issues. I must have appeared stupid and clueless to my staff. So of course I began to worry about that too, and decided at one point that I should hang myself from the overhead projector while the kids and staff were out at lunch.

Maybe doing this I could avert the next two world wars, seeing as how they and everything else anyhow are my own creation because life isn’t real.

Life isn’t real, I’ve mentioned before, because there was some kind of accident – probably car-related – and I am in fact in a coma or catatonic on a psychiatric ward. I am there creating all that is the world and being; nothing is real. (This is my most common, and overriding, ‘delusion’ – of course I don’t accept it is such a phenomenon.

All this is going on while I’m trying to work, either at home yesterday or in class today. It’s going to be one of those evenings where I can only laugh because it’s so ridiculous, so absurd, that I’m ending the day still alive. Driving home on the rush hour motorway was interesting, to say the least, as one of my planned suicide methods is to drive into a concrete pillar at speed.

But hey, I’m still alive. Again.

So long ago. So clear?

This October has marked one year since I began taking Quetiapine (Seroquel) and yesterday my son told me I am very much better (“nicer”) than I was thirteen months+ ago. Personally, I can’t see it, though I’m aware that the meds have worked their virtual miracle on my out of control, life-long bipolar symptoms. I have no reference point to ‘getting well’ as I’ve never been well.

Although I only sought medical and psychiatric help two years ago, at the age of 54, I can recall mood swings and what I now assume were brief psychotic episodes back to the age of four. So then, a half century of bipolar and depression, untreated and ignored by those who knew me. Who know me.

Having had eight months off from my stressful job last year, I have managed to stick at it for a couple of months now without missing a single day. I’m stubborn; I won’t let bipolar dictate its terms to me anymore. I must have always been stubborn, otherwise I’d have sought help before now. Actually, as you’ll know if you’ve been reading this sporadic blog (sorry), I did present myself to my GP when I was 20 with severe depression. He told me: “Pull yourself together” and sent me away without help. I was so embarrassed I waited almost a quarter of a century before handing my current GP a letter detailing my illness.

I know exactly when the light bulb above my head lit up regarding bipolar. I’d tried several different anti-depressants over the years for reactive depression: divorces, deaths in the family. That kind of thing. But these meds had made me ill; none of them worked. Then I read a book called ‘Why Am I Still Depressed?’ and it all made sense.

Which brings me to October 2016 and twelve months of Quetiapine (and at some point the addition of fluoxetine). The Q dose crept up and I now take between 500-550mg a day in three or four doses; the days I’m in work I take that extra 50mg for anxiety.

The biggest issue for me has been the Fat or Mad? decision. It became apparent early on that I had to make a choice, and I chose not to be mad. So in a year I’ve gained over a stone in weight and my general fitness has suffered greatly. No-one talks about the physiological symptoms of bipolar, but they’re very much there. I’m sedated half the day and I ache like hell from tip to toe.

I still don’t sleep through the night, not by a long way. I wake every hour or so then fall asleep again quickly. My anxiety level is still higher than I expected it to be by now, and my mild OCD with it. The meds haven’t really touched the OCD at all. Neither did the nine months of CBT I received last year before starting meds.

I look back on hypomanic and manic phases with more embarrassment and utter bewilderment. How on Earth was that person me? A stupid question as I have no idea what or who me is.

Some things disturb me more than others now. About the illness, I mean. The dissociation is scary and confusing. I tried to get help for that during my therapy but after dragging this issue out from the depths of me, it was then left unaddressed. Yes, the dissociation disturbs me; I don’t like it at all.

The meds have lessened the occurrences of ‘extremely intrusive suicidal ideation’. It’s clipped the top off the highs and the bottom off the lows. I’m more stable. The fact that I’m compliant – both with taking my meds and attending my psychiatrist appointments – shows that I’m in a better place than I was. Not a good place, just a better place.

 

 

 

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.