What Next?

Following on from my previous post, a quick update. I saw my GP again, around two or three weeks later, still with suicidal ideation, and a plan, so he did in the end put me back on antidepressants for a maximum of one month and with strict instructions to come off them at the first sign of any loopiness. Within two weeks I was getting hypomanic and feeling just amazing, so I stopped the antidepressants immediately. Unfortunately the high mood seems to have stuck around and is getting out of control (this is according to Husband, I feel perfectly normal!)

I’m trying to be objective – no, I’m not sitting still, or managing to complete tasks without going off on a series of tangents. Apparently I’m talking quickly and jumping from topic to topic (although it doesn’t seem like that to me!). I don’t think I’m hearing voices but it’s so hard to tell what I’m actually hearing and what other people are hearing, and I’m not 100% sure about what I should be hearing. Does that make sense? People say it doesn’t but it does to me, maybe I’m not explaining well. I can’t tell if what I’m hearing is the same as what other people are hearing. I could ask I suppose, but Husband is already worried enough, and I don’t want to look like a crazy person. The things I’m not sure about hearing are mostly about numbers and their various levels of important, and about certain branches of physics and the associated experiments. There are also some bits about the danger of the physics from certain other people. 2058 is showing up everywhere.

Husband wants me to see my GP again – this is only five weeks after my last visit. I don’t want to be going too often, but at the moment he’s literally my only mental health support. I’m trying to tell myself that if I had a CPN, or support worker or something, a five week interval would be considered a huge break for most people. The thing is that there’s nothing he can do. He can’t increase my olanzapine as he only has the authority from the consultant to put it up to 10mg. He could refer me back to th CMHT I suppose, but I’ve managed to avoid them for over a year which has been brilliant because although they help I’m not that mental and I don’t need them. So what’s next? Husband says I’ve lost control and it’ll no longer get better by itself. But I’m still stuck on the idea that I’m FINE!

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How to deal with mania RIGHT NOW

When I’ve looked around, at books and on the internet, I haven’t found anything particularly useful for dealing with mania and hypomania RIGHT NOW (except this). There is a lot on spotting early warning signs, lots about making sure you sleep well, keep a routine, and eat properly, but nothing about what you yourself can do if you’re already past that point. The articles point you in the direction of doctors, therapists, and whatnot, but what if you’re on a bus somewhere and you need to calm down, stop talking to everyone around you, and sit still (or at least still-ish).

There’s nothing you can do to stop the mania in an instant, but I thought there might be techniques around that at least allow you to get home without getting sectioned. Or techniques you can use that get you through until you can talk to mental health professional.

Paced Breathing

Now Matters Now have a series of short videos on dealing with suicidal thoughts and anxiety, one of which is paced breathing. I’ve found this technique really useful to slow myself down physically, although it can take quite a lot of concentration to do more than a few breaths.

But a few breaths is enough! It acts as a sort of reset button, so whilst your physical agitation is likely to start up again any second now, it gives you just a short break. It takes so practice, but it’s well worth it.

I found paced breathing much easier when using the app they recommended in one of the videos (Tactical Breather for Android). The addition of a graphic really helped me to visualise the breathing.

Make Lists

I have a list of short, achievable tasks stuck to my wall for when I have no concentration but I need to do something. Think about what you could reasonably achieve right now. Some suggestions:

  • tidy a small area of one room
  • do a small bit of weeding in your garden
  • paint a 10×10 cm square of paper
  • colour in one page of a colouring book
  • put together a playlist

Exercise

Subtly.

Office exercises can be really quiet and strangers wouldn’t necessarily see anything you’re doing as more than a stretch. If you have the option to stand up there are some different exercises you could do. Just make sure not to overdo it – this is just a way to fulfil the need to move without other people noticing. Keep drinking water.

Use ADHD Techniques

Sometimes techniques for managing ADHD can be useful for dealing with some of the symptoms of mania.

In one technique, you direct your verbosity towards questioning your own actions. For example if you are pacing restlessly around your house, you would ask yourself “why am I pacing around? It’s because I’m agitated, I can’t sit still. So what should I do to stop pacing around? Maybe I could do some exercise.” This questioning of your actions forces you to slow down physically which can in turn slow down your thinking. Similarly, deliberately slowing down your speech can help to slow your thinking.

People with ADHD find making a plan for the day (or the next hour or two) helpful, and this goal-orientated approach can mean that some important tasks are actually achieved, for example at 12:30 pm I am going to make a sandwich and eat all of it. This is especially good if you have trouble remembering to eat and drink.

Break things down into short, achievable tasks. When it comes to complex things like cooking dinner, I find it impossible to work out the order of events, ingredients, and the like. Things get burnt a lot. If I can write down all the ingredients, and get the exact method down on paper then things get burnt less. Obviously making the least is a feat in itself.

Write

There is often, for me at least, a need to write and write. There are lots of ways I can deal with this and actually it’s quite a good technique because it keeps me relatively still and unobtrusive. I usually start out trying to write what I’m feeling and end up just writing out rhyming couplets over and over. You can also just write out the text from any book or website, just to feel the ink go on the paper. Some people do the same but with typing.

Dealing with Psychotic Symptoms

You can also write to help deal with psychotic symptoms – if you hear voices, writing down what they say can be a really useful way of acknowledging them without alerting other people.

If you really need to talk to your voices and you’re in public, put your phone on silent and pretend someone has rung you. That way you can say what you want and people won’t think anything more of it than they would if anyone else was on the phone.

If you’re agitated, use the paced breathing technique as above.

 

 

Obviously none of these things will ever cure mania, but they might just help you get through the next minute or hour until you can see a mental health professional, or talk to someone. Follow your crisis plan (if you have one).

As always, if you feel like you want to hurt yourself of others, go straight to A&E. Disclaimer over.

Rapid Cycling

When I was at university, yeaaaars ago now, I would cycling up and down pretty much daily, which was horrible and I hated it, but as I got older my mood episodes swung towards longer and more pronounced… things, which whilst also horrible, at least I could plan around them, and it also meant that I got long periods of stability in between. So now I’ve just switched from quitealotofquetiapine to alittleolanzapine and it’s not doing its job – I’m up to my ears in voices (pun intended, or whatever it is), my mood has switched three times in the last three weeks and a do.not.like it. I saw my GP today as an aside since my blood test results came back and I’m anaemic (10, but the worst it’s ever been is 8 – I work on “can I get up the stairs without getting out of breath?” if yes, I’m not that anaemic, and as I can I thought I was probably okay, but apparently this is an ineffective scoring method probably because I’ve got so used to it. Maybe running will be easier now, I always struggled with my respiratory system giving out before my muscles) and whilst he was concerned about mood (and some other things I may have talked about but I don’t want to if I haven’t already, here anyway – just don’t want it where They (you know who I mean) can get hold of it) he just didn’t have the time to go into it properly. He’s an amazing GP, but I can see the NHS stifling him.

The olanzapine isn’t doing its job, and there’s no one to call to help – I think I’ve talked before about the lack of accessible services in my area, I’m on meds, I should be well, so I don’t get any help. I do wonder if they’d change their minds if they actually talked to me though. I’m appalled by the lack of care I’ve received – some stats: I haven’t seen a psychiatrist (outside of the hospital admission in November 2013) since February 2013; I haven’t seen a mental health professional at all since August 2014 (ish, I can’t be arsed with looking things up), and god knows I’ve NEEDED to! I’ve seriously considered making a complaint, perhaps via PALS, but to be perfectly honest I’m not sure it would achieve anything other than get me blacklisted by the CMHT, and they’re really nice people besides, they just have limited resources.

I’m looking at other options for getting help – private is too expensive, although my parents have said they could pay for 3 or so sessions to get my medication sorted, but that won’t help with things like applying for benefits/jobs and other services the CMHT have (or at least used to have). The wonderful Sean has pointed me in the direction of Together UK, which looks like it could be useful. It’s hard though, I really don’t have the brain functionality to sort this out right now and Husband and my family all have too much on their plates, I can’t ask more of them and Husband (although he feels like a dick doing it) really doesn’t like me when I’m manic (and of course I don’t blame him, I’m horrendous) I don’t want this! The Voices aren’t helping with the whole thing, I’m trying to pretend I don’t hear them but I don’t know how well it’s working. Maybe people have noticed.

Dreaming

I’m not one for symbolic analysis of dreams; none of this bullshit, like a dream about a frog with red feet doesn’t mean I’m going to be lucky but if it has green feet it means the shower is going to break.

But last night I had three nightmares that were pretty indicative of what’s going on in my head right now. First, I was at school and the teachers kept making us do weird things like collecting chalk from all the buildings. Second, I was running around the local shopping centre like a nutjob. And third, I was trying to drive my car from the back seat and failing.

The theme was very clear in my nightmares – loss of control. I am losing control, I don’t want to lose control, I fear loss of control. I don’t know how to keep control.

But because there’s always a bright side – at least I slept long enough to have three whole dreams!

Warning Signs

Oh okay, did I maybe speak too soon with regards to my mood? It’s been escalating over the last few days. I am annoying, bouncy, unfettered but still in control. I can sit still and settle to tasks. But does it really matter if my mood skips up a bit? As long as it doesn’t skip out of control and stop me functioning, surely it’s okay, normal even? It’s not a ‘normal’ mood, as much as I want to normalise it, I don’t see other people doing the things I do and thinking like I think (unless they’re hypomanic/manic of course), but it is not hypomania. Let’s call it sub-clinical, if we have to call it anything.

The crucial point here is that I, with my ‘support network’, can deal with this without having to call in the cavalry (which is a word apparently from the Italian for ‘horse’ – cavallo), I just need to stick to the lists and keep taking the meds. I hate having to take them, because of course I don’t need them do I? But I do, I know I do, I need to learn from history. I need to think about that diagram from the last post. Break the cycle and avoid the triggers. The problem being that cold I had of course, but if I keep avoiding triggers but also avoid aggravating factors like physics, poor sleep hygiene (bleurgh), and oh wait I think I have four or five large projects on the go right now, so let’s shelve some of those for now. I am sleeping still, around six hours a night which isn’t too bad, but still less than I would consider normal for me.

I have alerted Husband to the fact that convincing myself to take meds is getting more and more difficult, so he is helping (mostly by nagging until I take them, but that is what is needed right now). I haven’t told him about the headnoise, mostly because I’m not sure it’s anything to worry about, and if I tell him he will worry. It’s not all real words, and the rest is nonsense. I’m not even properly ‘hearing’ most of it, more feeling it. I think I have heard the term pseudo-hallucinations in relation to this state of non-hearing. The problem is that this is what has preceded every single manic episode I can remember, which have all resulted in full on voice-hearing, messages from the TV and so on. Phase one doesn’t always result phase two, but phase two is always preceded by phase one. For now, being aware of it is sufficient.

Er… Meds and Stuff I Suppose

Oh I am so happy, oh I am so happy *sings*

Possibly too happy… BUT I trusted other people’s judgement and they said phone your CPN, so I did.

She wasn’t there.

(Because she works between HomeTown and two other nearby towns).

But the duty person has emailed her.

I (and husband has agreed) want to drop my duloxetine back down to 15mg (that is 30mg one day, nothing the next, rinse and repeat).  I may have to change antidepressant – this one seems to make me loopy, although only recently! I’m only on 30mg now and have been for two weeks (up from 15mg, and I was kind of low, but I was also on more quetiapine then and I’m now down to 200mg, so that may also be partially to blame, I don’t even know anymore).

So I expect she’ll phone on Thursday, when I can’t talk properly because I’m O-U-T-side. I don’t know what else to do, I’m avoiding everything on my trigger list and aggravation list (coffee, certain types of music, some other things I’ve forgotten already).

Oh I don’t want the quetiapine put up again. Too much makes me lethargic and hungry. It’s not like the voices went – they were quieter yes, that’s true, and much easier to deal with, but they were coming back and those saving-the-world thoughts were coming back (although they are back now – but can I do it? I think I can and I think I have to). I don’t know what I want even. I don’t want to be drugged into zombie-uncaring-state-of-gradual-depression. I don’t want to be damagingly manic, but although I was that before, I don’t think I am that now, and I don’t think I will be as I am on more meds than before.

I can’t think now, I’m having a hard time controlling my thoughts. And my sleep is dropping off again. And my moodscope score is increasing again.

I alarmed people on the train I think – no one sat near me and people kept glancing at me nervously. I assume these specific people were in.on.it. Police everywhere. It’s all part of it. The notebooks are filling up again.

Urgh, I can’t even remember the point of this post. Like the last one. I think I just wanted to try and get some thoughts in order. Hmm. Bullet points:

  • I want duloxetine down to 15mg.
  • I want quetiapine the same or less.
  • I want the voices to go away (I don’t like that word, you know the one).
  • I want the meanings to come clearer so I can get my saving-the-world done.

Right – so if I write that down somewhere accessible I can repeat it back to my CPN!

Sleep

Or lack thereof.

At what point does it become insomnia?  I’m wary of using the word; there are so many people that really suffer with it.  And here I am with a few days of nosleep.  I’ve slept approximately 5 hours out of the last 72.  I woke up Sunday morning and that was that.  Now it’s Wednesday.

It’s starting to affect me physically.  I have a mouth ulcer and a sore throat, so clearly my immune system is crying out for a rest.  My joints ache purely through overuse (and my hip joints suck anyway).  I’m clumsy – all my spacial awareness is off.

I think I will take a sleeper tonight.  I’ll deal with the hangover for the sake of not being dead.  It’s a good trade-off!

My impromptu holiday is mostly not going to plan.  I’m enjoying it, but I had intended to have quite a lot more walks and quite a lot less anxiety attacks over the idea of going outside.

Must take steps to not get manic.