Everything is Conditional

Just as the borderline perceives acceptance as conditional, so rejection can also be seen this way.  If I were only attractive enough, smart enough, rich or demanding enough I would get what I want. 

Adjusting to a world that is continually inconsistent and untrustworthy is a major problem for us.  Our universe lacks pattern and predictability.  Friends, jobs and skills cannot be relied upon.  I have to test and retest all of these aspects of my life; I am in constant fear that a trusted person or situation will change into the total opposite absolute betrayal.  Experience has taught me this is always a likely outcome.  A hero becomes the enemy; a perfect job becomes the bane of existence.  Our need for reassurance is insatiable.  We fear that support will be withdrawn the moment we cease to please.

Taking Your Psych Medication for the First Time

Picking up from where we left off last week, let’s continue with the subject of medication.  For the second time I introduce my friend and fellow mental health advocate Mike Douglas.  Mike is a talented blogger and podcaster who mostly focuses on issues surrounding mental health but from time to time he also blogs/casts about various other interests.  You may remember Mike from the podcast we did together a few months ago, which you can find here or on Mike’s website ( here is the direct link: https://www.acast.com/mikesopenjournalpodcast/ep13-discussion-with-joy ).  

This week Mike kindly wrote a post for me about his experience taking psych meds for the first time. You can find his work on his website mikesopenjournal.com, on Facebook at https://www.facebook.com/MikesOpenJournal/ , on Twitter (@Mike_Douglas_ or @Open_Journal) and on Itunes by searching for Mike’s Open Journal.  -Joy

Hi there.

I have recently had a checkup with a Doctor at my local mental health unit, so I thought this would be a good time to review my medication with some of you (as its all in my mind at the moment).

The start of my medication journey involves the first trip to the GPs, my first trip in 16 years. At the time the GP recommended antidepressants and iTalk. As some of you will be aware iTalk is a great source for CBT. However there would be a notable wait for this service. I was very apprehensive about having medication, I accepted the medication and put it in a cupboard at home. To begin with just knowing I had it if I really needed it was ok.

I was reluctant for a number of reasons. The stigma around taking medication for a mental health related illness. Why do I need this, why can’t I deal with this on my own. What would I say to people, what will they think, does this mean I can’t cope, does it mean I have failed? What other people think probably did not affect me as much as it would some people. I think it was more what I would think of myself. The feeling that by taking medication I was failing myself. Additionally, I felt that taking medication could lead to an addiction or dependence on something. Being dependent on something is something I have an issue with, in that I don’t want it. I would rather struggle (and potentially fail) on my own, than have help and potentially succeed.

During that period I would constantly analyse myself, probably not a great thing to be doing. But I would try to make it through each day, or to the end of the week. I would also think about the fact that the medication would take two to three weeks to fully take affect. Anyway I muddled through. However, at New Year I had an episode that led to seizures, raging and self harm. A couple of days later I realised this was too much for me to do alone. I started taking the medication. By this time I was also worried about any changes to the medication or coming of it as I had heard about the side effects you could have. However, I knew I was also likely to have some of these when starting the medication. The medication I started on was 20mg citilapram.

In the first ten days I felt physically sick every morning when I woke up, this would last for a couple of hours but be at its worst when I awoke. My sleep was very disrupted, but that hadn’t been great anyway so it may have only been slightly worse. Either way I was waking up about four times each night. I found myself increasingly tired in the early afternoon, which could be related to medication or it could just be that my sleep had become so disrupted. After the first ten days the sickness started to cut back to occasional and then not at all. I had (now I think about it) also noticed that my sex drive lowered quite a lot in that short period of time around two to three weeks. The broken sleep continued to happen though I would only wake two or three times in the night, or I would sometimes struggle to get to sleep in the first place. The tiredness continued.

After just under three months my medication was reviewed. At that stage the medication had helped to lower the intensity of my negative and dark thoughts, however it had not lowered the frequency of them. As such at that time my medication was increased to 40 mg. This increase meant I did have some of initial side affects again, such as morning sickness. However it did not last as long this time. I adapted quite well to 40mg.

I have had some days when I've forgotten to take my medication. I don't notice much / if anything on the day it's usually 2-4 days later. I'll 'feel' a lot more and am definitely less stable. Or it at least feels harder to stay level / balanced. My ideas around self harm and thoughts of suicide are less frequent and intense now. However I do still have them. This has led to me again being concerned about coming off or changing the medication. I have noticed that I still have trouble concentrating or focusing for an extended period of time. I think this is as much a problem or a symptom that related to mental health rather than the medication.

As part of this recent review I have spoken with my GP and a mental health focused doctor about my medication. Recently my family have become more aware of the struggles I am having and have expressed some concern about the medication I'm taking. For me I feel that the medication has helped, maybe there is a better antidepressant or type of medication. But I am afraid to come off my current meds and dosage. I'm not sure I would describe it as being dependent, but I don't feel stable enough at this stage to make a change to my meds. I believe my recent struggles have to do with my personal situation, not my medication.

That being said I have asked for my meds to be reviewed again in two months time. Hopefully I am better equipped to deal with / discuss a potential change at that time. I have been advised there is an alternative medication I could move over to. But, that would involve decreasing my current dosage and then stopping my current medication before starting the next one. That is something I’m not quite ready for at the moment. Maybe in a month or so, but not right now.

I have found talking to my GP to be a great help, however, they are clearly not specialists in this area. They will simply advise taking medication and CBT. Then review it with you at a later stage. Personally I have found so much support, information and guidance in the mental health online community. That has helped as much if not (way) more. Unfortunately though it's your GP that holds the keys; to medication, to referral to workshops, mental health units and more.

If your struggling with your mental health do go to your GP talk with them. Then really look into the options they offer you. Find online support groups, or IRL ones if you can find accessible ones and you’re open to that. If it's an emergency call the Samaritans. It's ok to call, that's what they are there for .

I've written this post for two reasons:

1. I need to get these things out and this is often the best / more suitable way for me to do that.

 
2. I hope that by writing about my medication I help to break the stigma around that medication for mental health issues / illnesses. We would talk about it if it was a cold, hayfever, infection, or cancer. So why not for mental health?

I don't have all (or many) of the answers. But I hope I've helped promote the discussion and maybe some questions.

My post, blog, story, journey continues...and so does yours!

-       Mike Douglas

YNA (You’re Not Alone)

Medication Change

A change in psychiatric medication can break the strongest mind and the sturdiest body.  Last night I took the plunge and replaced the medicine I’ve been taking for years with a new one.  The new one costs $700 for a month’s supply, but with a special document sent to the manufacturer, I can get it for $5 at the county hospital.  My family feels that the new medicine must be more effective and higher quality because it costs so much.  I’m not convinced.  Every individual’s brain is different, and the way a psych med affects your brain is equally unique.  A five-dollar medication may work wonders for someone while the more pricey med might cause a psychotic break.  (My auto-correct is telling me I should say ‘priceyer’ or ‘pricier’ but neither of those options look right to me.)

It has been a forty-eight hours since I last took my old medicine.  The withdrawals began a few hours after I usually take it.  It begins with lightheadedness and escalates to an out-of-body experience.  I am an astronaut floating in zero-g, but my body is sore from head to toe as if I were covered in bruises.  It takes every ounce of strength in me to brush my teeth.  Indeed, it was my biggest accomplishment of the day.

I have seen a few women go through Heroin withdrawal.  The experience is similar in some ways.  When the brain is daily given a substance that alters its chemistry over a period of years, it becomes addicted to this substance whether or not the substance is harmful or helpful.  Someone who has been using crutches for years will have a difficult time learning how to walk again on their own.  I am willing to put that hard work in, to have my only brain heal and not require medication for the rest of my life.  Nothing, no one, is beyond hope for absolute healing.