Life Is Topsy-turvy

All my life I have been a morning person. I have never found it difficult to get up in the morning, and once up I was always raring to go for the day. By 9pm I would be starting to flag and 10pm was my bed-time for many years. I might not go to sleep straight away, most nights I would read for about half and hour and it was not uncommon for me to fall asleep with my book in my hand and still wearing my glasses.

Over the last year or so, I have found that I am becoming a night owl. I no longer find it easy to get up in the morning and it is not unusual for me to still be awake in the early hours of the morning. I know that part of this is caused by depression, but I don't think it explains it completely because even when I am not in the depths of depression, I am staying up later and sleeping well into the morning.

So, it seems as though my life is becoming topsy-turvy, that I am able to function well into the evening where just a couple of years ago it would have been impossible. This means that I am often still knitting at midnight, and it has meant that my eating habits have changed too. I rarely eat breakfast in the morning; my first meal of the day is more likely to be a kind of brunch taken at about 11.30am. My next meal will probably be in the early evening, and if I have a large meal this will be my last meal of the day, or if I have something more akin to a snack then I will probably have something else to eat at about 10pm.

This change to how I spend each 24-hour period is being reinforced by the medication that I am taking for depression. I have recently had an addition to this medication and it has meant that I am at long last getting a decent night's sleep most nights. But it also means that I am finding it even more difficult to get up in the morning. I seem to wake at about 7am to answer the call of nature but I have to go back to bed again because I am so sleepy. I will fall asleep almost as soon as I am in bed again, and will usually sleep for several more hours.

I'm hoping that this extreme sleeping will become less of a problem as my body gets used to the new medication. It makes me wake up with a very dry mouth but while at first that dryness would last throughout the day, I have realised that today that dryness was gone by mid-afternoon. And the extreme sleepiness that I have been experiencing well into the afternoon is now staying with me for far less time. Now I just need to see if I can experience an improvement in my mood so that I don't feel depressed all of the time.

Seeing Dr M

Although I started writing this blog to record how I was feeling and to document the methods that I use to try to help me when I sink into depression, I have also tried to make sure that it doesn't descend into a series of daily posts saying that I feel awful. I am still feeling as low as I did when I came out of hospital and I seem to be unable to do anything to lift myself out of this terrible blackness.

I went to see my consultant psychiatrist, Dr M, this morning. This was the appointment to make up for the one that was cancelled when I was in hospital. I arrived about 10 minutes before the time of my appointment and amazingly was called in immediately.

We had a long talk about how my mood has been since I last saw Dr M. I admitted that I am finding things very difficult at the moment. I am literally living each day as it comes. I make no plans in case I am unable to do the things that I have planned. I am very depressed all the time. I am not sleeping properly, nor are my eating habits anything like they should be. And while we were talking about all this, I burst into tears. We also talked about my recent time in the hospital and what had caused me to seek help.

Dr M has decided that I need significant help from the CMHT and is going to set that in motion. He has also decided that the dose of both the antidepressants that I take should be raised to maximum levels in an effort to both try to improve my mood and help me to get a proper night's sleep on a regular basis. I have to see him again in three weeks so that we can see whether there has been any improvement and if there hasn't, Dr M has said that a change of medication may be necessary to see if a different combination of drugs will bring about an improvement.

Having read of the problems that so many people with mental health problems have with their psychiatrists, I feel that I am very lucky in having Dr M as my consultant. He is very kind and he listens. Something that I know many people say that their psychiatrists don't do. There is no doubt that having confidence in the people who are responsible for your mental wellbeing can make a significant impact on how things go.

A Really Nice Consultant

I was there early, but then I always am; I can't help it. I sat in the garden having a cigarette while I waited for it to become a more reasonable time to go into out-patients. Having reported to reception to say that I had arrived, I sat in the waiting area until I was called.

My consultant was talking to someone in his consulting room when I arrived and when he called me I found out that it was a medical student that he had been talking to. He asked if it would be okay if the medical student stayed, and having agreed he invited me to take a chair. We then got down to introductions; he asked what I wanted to be called so I said that I didn't like being called by my full name so asked him to use the shortened version that I have used since I was about 11, He introduced himself and said I could either call him M or Dr S-M and then the medical student introduced herself. Then we got down to business.

First of all M asked me about the Home Treatment Team and my dealings with them. He said that as he was in effect their boss he would be interested in what I had to say and that I was to tell the truth. I was going to anyway, so I said that some of the people that I had seen were very good but with some of them I felt that they were just going through a mental checklist of questions and I felt that they really weren't that concerned about the answers. He took that onboard and thanked me for my frankness. He also asked me whether I was getting any other support and I said that I was having psychotherapy once a week at the moment and that this was likely to carry on until Easter and that JR, my psychologist, was going to refer me back to the hospital (which is the headquarters of the Mental Health Trust) where I had been receiving psychotherapy before.

Having read the notes from the HTT he said that when they had discharged me I seemed to be getting on quite well and he asked how I was now. I told him that I was very low and having asked why this was I replied that I had not got the job that I had seriously thought I had a very good chance of getting. We then discussed what the job was and when I had been told that I hadn't got it and he asked what my reaction had been on receiving the news. I said that I had been angry, devastated, felt that I was incapable of doing anything and that from that moment my mood had taken a nose-dive and I had lost what little self-confidence that I had built up over the last six months or so.

We then moved on to how other things were in my life:
Smoking - far more than I usually do when I am depressed (I don't smoke when I'm not depressed)
Sleeping - Not very good; can't get to sleep most nights and have to resort to sleep medication to ensure that I actually get some sleep once in a while
Eating - Just not interested; haven't cooked a proper meal for some time, didn't eat anything yesterday and made do with a cheese roll on Saturday
Energy - Haven't got any
Concentration - Totally gone; unable to concentrate for anything for longer than five minutes
Drinking alcohol - Normally don't touch the stuff but have been indulging over the last few days and I have drunk about half a litre of ouzo (purely because I had it in the house)
Suicidal thoughts - Yes, I'm having them and I thought about gathering all the tablets together on Friday but didn't do it

Having gone through these questions fairly quickly we concentrated on the eating and sleeping ones a bit longer. I was asked if I thought I had lost any weight and thinking about it I said that I probably had because certain things seemed to be a bit loose. Then I was asked if the reason that I couldn't get to sleep was because I had things whirling around in my mind. I have been asked this question many times and I have to answer in the same way each time. I am not aware of having things whirling about in my brain when I lie down to go to sleep; I try to read before going to sleep each night, but recently I have found it difficult to concentrate even on what I would call easy-reading books. At the moment it's Harry Potter and the Philosopher's Stone that is causing me problems; it has taken me a week to read the first chapter.

We talked about how my ability to concentrate had gone completely and that I had not done any knitting for about 10 days now, which is pretty unusual for me because I just love to have lots of things on the go so that I can pick and choose what to work on and normally I will do at least three hours knitting each day when I am well.

M then decided that as my depression is proving so difficult to bring under control for any reasonable length of time that the time had come to add a second antidepressant to the one that I am already taking. There was discussion of admission to hospital if I don't improve or if I get worse than I am at the moment but this time I will know what to expect so it won't be so traumatic. We talked about my time in hospital last year and M asked whether it had been helpful and I said it had because I really didn't feel safe on my own at home and it was definitely the right thing to have happened.

So armed with a prescription for the additional antidepressants I was almost ready to leave. All that was left to discuss was when I would see M again. He said that he normally saw patients every four to six weeks, but because I was so low and because he wanted to see whether the additional antidepressants were starting to have any effect that he wanted to see me again in two weeks. I was also told that if I felt myself getting worse that I was to ring him or leave a message and he would get back to me and we could talk about what should happen.

So what was M like? Well, he is young for a consultant and I have to say that I found him very easy to talk to which is not always the case. Having read so many accounts of the problems that others have had with psychiatrists, all I can say is that I think that I am very lucky with the consultant that I have been allocated.

Things Didn't Go According To Plan This Morning

Even though I was exceedingly anxious this morning when I set out for the hospital for my regular psychotherapy session I was determined to have another good session.  I was going to try and start talking as soon as we were seated.  I knew what I wanted to tell my psychotherapist about.  I was going to start with my meeting with There and Back last weekend, and move on to something that I am going to be doing next Wednesday evening which is a totally new experience for me (well new in as much as I haven't done it for a very long time).

I walked to the bus stop and didn't have long to wait before the bus I wanted arrived at the stop and I boarded it.  As has been the case for many months now, there are huge stretches of road being dug up for the water mains replacement programme, so buses are on a diversion at the moment.  But that is not all, because the road onto which they are diverted also has one lane out of action for these road works, the bus has to stop at traffic lights that are controlling the single alternate lane working, the lights are at the bottom of a very steep hill and the bus can barely make it up the hill.

Anyway, I was sitting comfortably on the bus indulging in my usual habit of looking out of the window to see what was happening on the route, when I suddenly became aware that my mobile was ringing in my handbag.  You will understand how unusual this is when I say that there are ony a handful of people who know the number so I don't usually expect it to ring: the phone is really for emergencies.  I scrabbled around in my handbag and managed to grab the phone and open it before the caller had rung off.  It was somebody from the hospital phoning to tell me that my psychotherapy session had to be cancelled because my psychotherapist wouldn't be in because he had an emergency at home.  They had hoped to catch me before I left home, but I left a little earlier this morning because I knew that there were likely to be delays because of the buses being on diversion.

So I got off the bus, crossed the road and walked to the bus stop to get a bus back home again.  Having coped with pterodactyl-sized butterflies in my stomach this morning, to suddenly find that I was not going to have the psychotherapy session that I had prepared myself for left me feeling very low and fighting away the tears.  This seemed such a strange reaction but I suppose that because I am now truly engaging in the therapy, to suddenly find that I was not going to have that opportunity to talk things through as I had planned left me feeling a little bereft.

I had started to write this post when a comment on this morning's post came in for moderation.  It was from 'alhi' from Random Musings from a Wannabe who felt that I had changed since she had been reading my blog and that she was considering seeking referral to a psychologist again.  There have been a number of comments over the last couple of weeks from people who say that they can see a difference in my posts; and I, too, have said that psychotherapy was definitely beginning to make a difference to me.

Psychotherapy is not easy.  It requires a great deal of commitment on the part of the patient and depending on the type of psychotherapy that is offered, can require a significant amount of work outside of the therapy sessions.  Treatment such as the type that I am receiving (psychodynamic psychotherapy) is not readily available on the NHS.  For many people the only thing that they will be offered is a short period of CBT (cognitive-behaviour therapy), but it was felt that this would be of no use to me as it would not get to the source of my problems.  

Evidence shows that the so-called 'talking treatments' can make a significant difference to those with mental health problems.  For some, such treatment is sufficient in itself to help them over their problems.  They are, however, the minority.  For many others it is a combination of drugs and psychotherapy that makes the difference, and I am one of those.  After taking various different antidepressants for 10 years, I have finally found a regime that is actually helping to make a difference to how I feel.  The problem is that the psychotherapy is likely to be time-limited.  Okay, so I wasn't only offered a meagre eight weeks of therapy, which is often the norm, but I know that I am likely to find that my psychotherapy comes to an end in a few months time and that this will happen whether or not I have reached a suitable place for cessation of therapy.  It will happen because the resources (that is suitably qualified psychotherapists) are not available for the number of patients that require the treatment.  What worries me is having my therapy stopped before I am ready to cope with all that the world will throw at me.