A Second Appointment

Last week I had an appointment with the psychiatrist. She is very nice, and seems to be up for at least a bit of discussion, rather than pronouncing a mood state and sending me away with a prescription.

This was the second time I’d seen her, but I barely remember the first. What I do remember is a few strange questions, or at least questions that seemed strange at the time: have you made any new friends? Why are you thinking about the nature of the universe and infinity? Have you been taking your medication?

The answer to the first was “yes of course, why wouldn’t I be?” I’d been meeting people at bus stops, in cafes, in the waiting room at the CMHT, and just talking to them. Why shouldn’t I? I didn’t understand why not. I never went beyond just talking, never a suggestion of a second meeting, but I still considered them friends. I think, and this might be largely guesswork, that most people were happy to chat. I remember a few slightly worried or bewildered faces, but I just couldn’t process what that meant, and I didn’t want to stop talking anyway. I must have said some strange things, but no one actually walked away from me. I think.

The psychiatrist asked me again this time. The answer was no, I hadn’t met anyone new to make friends with. I’d forgotten about her asking the question the first time around, and it really threw me. I’ve been feeling like I’ve actually been faking the whole bipolar thing somehow and that actually there’s nothing wrong, but the reminder of how I was feeling and behaving then was a little bit of a shock. It wasn’t how I’d remembered the episode, if that’s what it was, what little of it I do actually remember seems like it was me as I truly am. So no, no new friends, even if I am naturally an extrovert and a fairly gregarious person.

She asked me last time why I was thinking about maths, the nature of the universe and infinity. I won’t go into too much detail as it’s vaguely triggering for me, or at least upsetting to realise I can’t think about such things without losing quite a lot of my marbles. Suffice to say, it interests me to think about what might be and what could be. So that’s why I was thinking about it – it’s interesting. What I didn’t understand at the time was why this was even an issue. Why shouldn’t I think about interesting things? It’s not like I was psychotic and planning to save the world through creating clean, cheap energy like I have done before. I’m not sure if I made that clear. She seemed to think that thinking about maths, the universe and infinity was not normal. And it probably isn’t for some, but if I actually don’t have bipolar, then maybe it’s fine to think about. Maybe it’s normal for me, the real me. I’m all in a mess about this and I can’t quite work out how I feel about it all. I’m probably wildly contradicting myself. That’s really all there is to it. I thought it was interesting, and I wanted to understand things like modular forms.

This time she asked me if I was still thinking about these things, of course. It hadn’t even occurred to me to think about them. Now I know I can’t, not without going down that path again, and I’m not sure I’d even understand it if I did. But if nothing is wrong then I can think about them. I’m so conflicted. Again, last week at least, the answer was simple – no. I’m thinking about more practical things like getting a job, making blankets for my friend’s babies, and concentrating on cooking suitable meals with burning the house down. There’s no time for the universe.

I’m sure she asked several other questions both last time and this one. I remember something about too many projects, annoying people, and my ability to sit still. Last time she asked me to rate my mood on a scale of one to ten, five being normal. I said six, so I must’ve had some insight. She put me at an eight. I’m not sure what that means for a psychiatrist. I wasn’t sectionable anyway, by anyone’s standards. I think.

The big one. “Have you been taking your medication?” The answer both times was the same. Yes. I might have forgotten once or twice a week while my mood was high, but I remembered enough. I remember about the same amount now. My brain is foggy these days. She told me I had to take it “religiously”, and promptly increased my aripiprazole dose to 30mg. I remain slightly confused by this. If I was manic, then why not increase my mood stabiliser rather than my antipsychotic? Aripiprazole doesn’t exactly bring people down fast, so why not take that time to stabilise with lamotrigine rather than maxing out my aripiprazole dose? Perhaps she was hoping it’d bring me down faster. Perhaps i should have asked. I wasn’t happy about taking more meds, and I’m not quite sure why I agreed to it. That bit is lost to the sands of time. I’m told that if I can’t remember what happened, that should give me an indication of how high my mood was. I’m not so sure. She also increased my clonazepam dose from 0.5mg per day to 0.5 twice a day, plus 1-2mg at night depending on the amount of sleep I was having. I was barely sleeping at all then. The clonazepam did mask those feelings of clarity a bit. I felt very slow, and it was frustrating. I took out though, and again I don’t know why I agreed to any of it.

And now, of course, I am still taking the aripiprazole (I dropped the clonazepam about five weeks ago). It’s an issue. I don’t want to, I definitely don’t want to take it at the dose I am taking it. So why am I taking it? It’s a good question, if I don’t want to then why should I? There is no simple answer for this one. Mostly I don’t want to piss people off – if I don’t take it people will worry. “You will get ill if you don’t take it.” To paraphrase my husband, “don’t you want to get a job and have kids and a house?” I do want those things, but I’m not sure that the meds will help with that. If I don’t need them, then not taking them would still result in all those things. I’m working on it.

People keep presenting me with evidence of my having bipolar. I don’t remember it, my mood was clearly manic and scaring my friends and family, I was climbing trees and making friends with strangers, I wasn’t sleeping, I was barely eating and yet somehow still alive and running at three times the speed of everyone else.

I don’t know what to do with this information. It doesn’t tally with what I remember. I remember everyone else being very slow, for example. I’m questioning myself – is it everyone else that had a problem, or was it just me? Is it more likely that I was fast, or that every single other person was slow? I suspect this was the case, logically. But my experience is so firm in my mind. It was like there was a time dilation bubble going on. Very sci-fi. I don’t remember taking risks like climbing large trees or driving too fast and recklessly. I can only take other people’s word for it, and I don’t know how much their perceptions are skewed by the label. It’s possible I was just a bit hyper and everyone else panicked and read too much into it.

This is the crux of it. Was I really manic or was it just the perception by others? If the former then meds are necessary, and perhaps I can reduce them or come off them in time. If the latter, then the meds are not necessary and are only causing unnecessary side effects like this god awful tremor. I don’t know how to work out which way around it is without coming off the meds, and I can’t do that because people will be angry and scared and worried, and because I run the risk of being wrong, and I’m not perfectly healthy. I could end up back in hospital, I could end up dead. I could of course be fine. It’s a mess. This post is a mess. I’m stopping now.

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!

Oh.

Almost two months ago NiceGP poked the CMHT to get me an urgent appointment with Dr ArseFace the psychiatrist, which has yet to materialise and I am beginning to suspect that it will not. In the meantime I have seen my CPN … er… once I think, and spoken to her on the phone once, and although she said she would phone again the following week (to follow up my reduction in duloxetine down to the teeny tiny dose of 15mg (that is one 30mg pill every other day as they don’t make them smaller than 20mg apparently) and I’m not actually sure if there’s any point in taking it since studies seem to show no efficacy in doses below 30mg (or 60mg depending on the study you read)). Where was I? Oh yes, CPN – anyway, she never phoned back (which actually is surprising as she’s normally very good), even though I phoned twice during the following week to see what was going on (which is even more unusual), so no phone call and now I’m reluctant to phone again.

I’m disinclined to be on their radar because they never believe what I’m saying it’s always ‘it’s your illness, you’re unwell’ etc. Rather than oh yeah you might actually be right, go save the world woo. Grraaghh. Ah well. Husband is suggesting that perhaps quetiapine is not so brilliant a medication and duloxetine is worse and maybe asking about going back on olanzapine again (which was just amazing when it eventually started working) as it stabilised my mood so well.

And in the meantime the clouds are giving me messages that the voices are helping me interpret and turn into saving-the-world physics, so it’s all good!

Medication – The Outcome

Well for now I’m carrying on with the meds. Husband has stated that although he won’t force me to take them, he knows I’ll get ill without them. Really, what has settled it for now is that as a mental health nursing student he gives people these exact meds all the time and he knows it doesn’t hurt them. He says he’d never let me get hurt so if the meds were going to hurt me then he wouldn’t want me to take them.

The problem with this is still the same – he doesn’t hear what I hear and he doesn’t believe what the voices say is true. I tried to explain that they’re on my side and just trying to keep me safe. The noise wants me to take the meds.

Every morning and every night is a fight to take the meds. The tap water is still poisoned – so no water, nothing cooked with water, so I drink juice, or I don’t drink. I think I’m drinking enough, no thirst or other problems to speak of other than being a bit tired (but that could be a touch of anaemia judging from the colour of my lips). I’m on a protein shake diet so I’m getting 660ml of liquid a day that way anyway. I won’t die of thirst anyway.

I don’t want to die. I don’t want to get hurt. People are trying to hurt me and kill me. I don’t know how to fight them, I don’t know how to go on the offence. Everything I do is reactionary and defensive.

The Pros and Cons of Medication

I’m having some trouble at the moment with the voices and those-who-cannot-be-named-in-the-public-sphere-because-it’s-not-paranoia-if-they’re-really-out-to-get-me. They’re all arguing back and forth about my moods and emotions and how necessary medication is. The problem is that if They are controlling my brain chemicals (and therefore moods) then I am not ill but do I need medication? It’s inorganic in origin. Does medication help?

Pros Cons
Might help with re-uptake of additional chemicals Medication could be poisoned
Keeps family and friends happy Medication could be making the additional chemicals worse
I can’t sleep without it Medication could be blunting alertness
Possible that I do still have bipolar despite additional chemicals Taking unnecessary drugs

I think I need to talk to Husband about it all. Which unfortunately means broaching some subjects I struggle to talk about in person.

Sleeping like the Dead

I’m lying here, waiting for sleep to come. I have to wait until the quetiapine kicks in because I am incapable of sleeping without any medication these days. I’ve forgotten how. Like those times you forget how to speak and stumble over your words, but rather more of a stumble over a basic function. But sleep will come, and when it does I will be out for the count, sleeping like a log a baby the dead, practically unconscious.

Come the morning I will be unable to wake up. I will have to fight my way out of sleep, clawing up from the dreamy depths. Some mornings, if I wake too early, I can’t even move my arms and legs. Helpless.

I hate quetiapine. I’m not even completely convinced it’s working. There’s not much I can do about that though.

My Recovery Goal

Things, at the moment, let’s be honest, are less than ideal.  I am (more than) a touch depressed, but it’s early days yet.  I have increased duloxetine from 30mg to 45mg, so we’ll see how that goes.  My prescription is for 2 x 30mg every morning, so that I can go back up to 60mg if necessary, although it did make me rather hypomanic.  What is more troubling is the volume and constancy of the voices and the noises, things smelling of spilt beer all the time, the Fear, and generally being overwhelmed by everything.  I tried to make pizza last night, frozen pizza, but I couldn’t even work out the first step.  In the end my dad did it for me.  Feel like an utter failure for that.  That and my mum having to take me to Sainsbury’s because I was too scared and muddled to go on my own.  Tonight I’m making green Thai curry.  I’ll be spending some time in advance writing down every single little step so that I know what I’m doing.  It’s even little things I’m not able to work out – putting the shopping away, for example, I’m having to put each thing away one at a time.  I can’t manage the fact that the milk and the cheese and the tomatoes all go in the fridge – each one goes in separately one at a time because I just cannot process the thoughts.  It’s like the voices are making a huge block and using up all my focus.  I’m not driving at the moment for the same reasons.

Earlier in the year I had set myself a mid-year target of getting a job.  It didn’t really matter what, but that’s what recovery (*shudders*) means to me – being able to work.  My CPN and family have basically told me I need to scale that goal waaaaaay back.  So my mid-year recovery target is now ‘being able to go to the cinema’.  That’s it.  This is not where I wanted to be at 27.  I wanted a house, a full-time job and a couple of kids.  Instead I’m living at my parents’ with my husband with no kids and essentially no job.  Although I do have cats. So that’s good.  And Husband of course.  I quite like him.

TL;DR I suck at life, the voices aren’t helping.