A long and frustrated mental health post

Creative Scotland has taken over my blog for far too long. I’m still talking about the latest twists and turns in the saga over on Twitter, but the most recent piece of [headdesk]-worthy action took place while I was caught up with the double bill. Besides, Hannah McGill has been well and truly on the case and I don’t really have anything to say that she hasn’t already covered. I doubt I’ve written my last Creative Scotland post, but there are other things I need to write about just now.

So back to one of my other major topics: The Crazy and how to live with it. It’s that time of year. The dawn simulator has been back on my bedside table for a while. Mornings are just that wee bit harder than in summer (yes, even Scottish summer). And after my last self-sabotaging battle with myself, there’s an alarm set on my phone to remind me to take my antidepressants.

I wish it were as simple as just taking the bloody things, but instead it’s a minor skirmish every time that alarm goes off.

You  see, I hate taking antidepressants. I understand why I have to. My body is physically incapable of producing, transporting and absorbing sufficient serotonin by itself. So I get it. If my body won’t do this by itself and it’s a chemical I can’t do without, medication is necessary. But I hate it.  Logically, I understand that this mental illness is a manifestation of a physical problem and that I can’t overcome it through willpower alone. But to hell with logic – the point is that I hate that this is something I can’t control without relying on drugs.

Having established that, let me make it clear that any comments suggesting that I don’t really need antidepressants and could probably just take St John’s Wort or do more exercise or find god instead will not be met with grace and gratitude. I’ve spent the past 12 years learning the hard way that I have to take these drugs. Believe me, there’s only one possible outcome to my not taking them – my mental state deteriorates to the point where I stop eating or talking and start causing myself physical harm.

Earlier this year I had to increase my dosage. The dose I was on was no longer working for me. I could feel the symptoms of depression kicking in again, so I did the sensible thing and asked my GP for a higher dose. She put me on the next dose up. I’ve been round the block often enough to know that side-effects are to be expected and that the best thing to do is just hold tight for a while and see whether they subside. When the side-effects emerged, that’s what I did.

Within a few days of starting the new dose I noticed nausea, increased anxiety and problems with my short-term memory. I persevered for six weeks to see whether these side-effects were just teething problems, but nothing changed. I can deal with the nausea – it’s not pleasant, but as long as I eat little and often and/or suck sweets or sip water, I can manage it. The memory problems were much more of an issue. I’m used to having a rather good memory, but now I find that I reach for information and what I get is fog, or that tasks and appointments are completely forgotten unless I write them down (and I don’t always have time to write them down before they’re forgotten.) That scares me. It’s really unhelpful, especially as I’m self-employed, and it’s really worrying considering that I will probably have to increase my dosage again in future and don’t know whether that will make things worse.

Knowing that short-term memory is affected by concentration and that my concentration has always been affected by increased anxiety, I went to the GP to ask if there was anything I could do to control the physical manifestations of the anxiety. I was given beta blockers, which made me so dizzy I couldn’t stand and then made me fall asleep.

As you can probably imagine, that wasn’t ideal for getting through daily life. I stopped taking the beta blockers and asked to be referred to a psychiatrist to help me find antidepressants that will keep me from being depressed and suicidal but will still leave me in a fit state to live  and work. In the meantime, I was already struggling with self-destructive behaviour patterns. I got married at the beginning of the summer and found myself caught up in a massive internal battle between my newfound happiness with my husband and the depressive part of my brain that tells me I’m not allowed to be happy and that everyone I love dies. (Yes, that is what my brain is like even when I am taking antidepressants.) In my infinite depressed wisdom I decided the drugs weren’t working so I wouldn’t bother taking them.

Well, that worked out predictably badly. My mental state deteriorated, I found myself relying more and more on the façade and increasingly scared of being around lots of people. I did a bit of self-sabotage. Then finally the sensible bit of my brain remembered that I’ve done all this before and that it might be wise to take my tablets. Just for a few days. So I went back on them and voila, the greyness started to retreat… taking my short-term memory with it and leaving anxiety and nausea in its place.

After that I began trying to work out a viable pattern. Halving the dose doesn’t give me enough to keep the depression fully at bay, but more than half lets the side-effects run riot. Taking one tablet every two days is the same as halving the dose. My next move is to re-time the alarms on my phone and try one tablet every 36 hours rather than every 24.

I also went back to the GP for something unrelated, but while I was there I asked how my referral to the psychiatric department was coming along. The GP looked in my notes. Nope, nothing there about a referral to see a psychiatrist – just some stuff about my time with the community psych nurses. Why, did I want to go back for more CBT with them?

No, I damn well didn’t. If I want to do CBT worksheets (which I don’t, because the way I learned to do CBT was much more free-flowing and didn’t rely on worksheets as if I were still in primary school) I can do that by myself. I can certainly do it with a hell of a lot less judgment than I encountered from the two community psych nurses I saw before deciding that this really wasn’t for me – all they seemed to want to do was contradict my existing diagnoses and do those bloody worksheets. (Forgive me if I don’t give much credence to their contradictions, but I’m more likely to trust an actual psychiatrist who gives a diagnosis based on considerable observation and proper assessment techniques than a psych nurse who bases it on a five minute conversation and the infallible logic and clinical analysis that says “you couldn’t possibly have had a personality disorder at 18, that’s far too young”.)

So no, there will be no more psych nurse visits for me. Perhaps there are excellent psych nurses out there, but I got burned twice in quick succession. Also, CBT is not the answer here. CBT helps me with day to day management of my mental health, but it does precisely nothing to cause my body to produce, transport and correctly absorb serotonin. It’s the drugs that do that, and it’s the drugs that are causing me problems so I need to talk to someone who, you know, knows about drugs. GPs are barely trained in psychiatric medicine, hence my request for the referral in the first place.

I explained all this to the GP who told me that she was new to the area and didn’t know what was available, but she’d find out and let me know. To her credit, she did – but her letter was deeply disheartening. Apparently my options are 1) go back to the psych nurses for more CBT worksheets, because somehow that’s going to achieve something and not just waste resources that might actually benefit someone else or 2) go to a private clinic for which details were enclosed.

I checked out the private clinic. All it offers is psychotherapy. I have found psychotherapy useful on many occasions, but this time I do not need a therapist to talk to. I need someone who can advise me about medication. A psychotherapist cannot do that. A psychologist cannot do that. Who can do that? A psychiatrist. I’m not asking to see a psychiatrist because I think they’re higher status than psych nurses or psychotherapists or because I want preferential treatment, I’m asking because they are the people qualified to do the thing I need them to do.

So realistically, my options are 1) continue with the medication and see how long it takes for me to get myself into trouble for forgetting something important or simply being paralysed with anxiety and unable to do things, 2) find a private psychiatrist and hope against hope that I find a good one first time because at their hourly rates there’s not much room for trial and error, or 3) come off the meds and see how long it takes for me to deteriorate to the point where I am hospitalized, because at least there’ll be psychiatrists in the Royal Edinburgh. That last one really scares me. So far I’ve always managed to avoid being put in hospital. Even first time round, when I absolutely couldn’t take care of myself, my parents looked after me at home. Even last time round, when I was breaking my own bones, I only ended up in general medical. It’s unknown and I’m scared of it, and it would be the ultimate confirmation that my mental health is not under my control. And the path to get there is really horrible and involves the risk that I’ll succeed in doing myself permanent or terminal damage before I succeed in finding help.

I’m not particularly keen on any of these options, but most of all I’m frustrated – not just by the lack of care available, but more than anything else by the fact that the GP doesn’t appear to know the difference between psychotherapy and psychiatry. This is one of the biggest and most exhausting obstacles that you face in dealing with the Crazy. The GP is your first port of call, and even if you can get them to believe you (easier with depression than with just about anything else, but still tricky) it’s a real struggle to get access to any help. You might be lucky and win the antidepressant Russian Roulette where the GP prescribes you whatever’s cheapest and it either works for you or it doesn’t, but if you lose, my current situation is about the best you can hope for. I don’t know where this will end and all I can do is hope I don’t lose too much along the way.

The option I choose, unsurprisingly, is to start looking for a private psychiatrist and hope I can find one who isn’t charging £300/session. I have to keep reminding myself that while the illness is forever, psych sessions are not (because, guess what, I don’t like them either – not a fan of anything that suggests I can’t deal with this entirely on my own). All I need is long enough to get advice and a new prescription. I’m very good at monitoring on my own and following up with GPs. All of this is about making that very first step. I wish it didn’t have to be the most difficult and disheartening step of all.