Back and forth

I hope you had a good start into 2021. NYE was quiet here, and the furbabies enjoyed that there were less fireworks.

Right now my thoughts are constantly jumping from past to present to future and vice versa. Mostly I’m just watching, I know this will stop and I will finally arrive in the present time again. But sometimes I have to be mindful when the demons from the past rear their ugly heads.

Again and again my thoughts stop at a very bad time twelve years ago. I was really in a dark place back then, I suffered from debilating panic attacks and had the impression no doctor really wanted to help me. My GP told me there was nothing he could do for me. The first neurologist/psychiatrist handed me a prescription, told me just to get back to work and forbade me to go to the outpatient clinic at the local hospital. I called him several times, I was really desperate, the med made me feel even worse and I had definitely reached my breaking point. He didn’t budge, I felt misunderstood and left alone for weeks.

Finally I did what he had told me not to do and went to the outpatient clinic at the local hospital. More than once. But eventually I was put on the waiting list for inpatient treatment, and I was put on sick leave until then. That was a big relief, even if it didn’t help with the panic attacks per se.

My boss started pressuring me about when I would come back to work. I told him that I couldn’t answer that question, because I was still waiting for my treatment in the hospital. He didn’t accept that and kept asking.

Looking back the worst was the feeling of forlornness. The doctor, who stuck to his routine. The boss who wouldn’t stop calling me and only cared about work, but not about me. When I needed understanding and protectetion the most, my doctor and my boss didn’t seem to care. These weeks were hard.

I found my way out. I limited communication to my employer as much as I could, I found doctors who helped me. I learned to stand up for myself when I was at my worst.

I try to figure out why I am thinking about this so often now. Maybe it’s about making another step forwards on my journey and leave the past behind again.

The first days

When I had checked in at the hospital on Friday I was told my bed was needed for an emergency. I was given the choice to go home until Thursday or stay on another ward until then. I chose the latter. The medical exams are completed now, and we started changing the medication. Of course there are the usual side effects, a confused brain and going through every emotion and back. But I can deal with this, and I know it will pass. But I really hope I can change wards on Thursday and start treatment in earnest…

It sucks… continued

Yesterday I went to the psychiatric institutional outpatient’s department again to talk them out of admitting me for my med cange. But the colleague of my psychiatrist also recommended a inpatient stay. Well, then this is how it should be handled, I think. On a positive note, they were able to offer me a quick admission date, so treatment will start on Friday.

I am thinking about one thing the doctor said: “You always wait so long before you do something!”

Well, that’s right. For the last weeks I have been watching my energy disappear, finding thousands of excuses instead of looking for help. Typical me.

I am still somehow shocked. At the same time I am preparing everything. I will follow your blogs as I can, we will see how often I will be able to post something. The first weekend I have to stay on the ward, after that I will go home from Saturday to Sunday at least.

It sucks

This is my opinion on my last quaterly meeting with my psychiatrist.

During my last inpatient stay I started taking a tricyclic anti depressant.

First: Things could be better. I have difficulties going to sleep, have to take another medication for that and am tired in the morning. Second: I gained a lot of weight and am pre diabetic now. That has to stop.

My psychiatrist recommends another inpatient stay to switch anti depressants, she thinks that would be better. I wasn’t too happy about this. There are nicer places than a psychiatric ward.

The more I think about it, the less I like this idea. If I continue to feel bad about it, I will talk again to my doctor. In the past I often changed meds safely at home. On he other hand I feel like the psychiatrist puts my well-being first, and this is a good thing.

Therapy Options

The last few weeks were very difficult and dark, so I am thinking about other therapy options. Sometimes waiting until the bad times are over is the best thing to do, but when the soul does not stop hurting, other options has to be considered.

Right now, I have talk therapy (DBT) every two weeks. And I have occupational therapy sessions twice a week (single and group). Last not least: Medication – three psychotropic meds every day, and one as needed. But I don’t feel like: Hey, life is good. Feeling overwhelmed, withdrawing from the world and self-hatred are the rule. And my body acts up, too: The pain in my back is worse, and my unsteady gait causes more problems – I fell yesterday evening and today at noon.

Talk therapy will end in a few weeks, we maxed out the what is covered by the health insurance. We started in fall 2015, and I dare say not one of the appointments was wasted. My therapist is brilliant, the therapy really good. When I am still feeling awful it is not because the therapy is bad, it is because of my many, many issues. Maybe my pain doctor is right, she suspects there are some deep buried problems I am so afraid of that I didn’t get them out in the open yet.

So what can I do?

The local hospital offers inpatient and outpatient (day clinic) treatment. My last inpatient stay was October 2017, and somehow everything I learned in therapy was gone when I came home, and I promptly fell into the next hole. I haven’t tried outpatient therapy yet. This would mean I would be home every evening. It would also mean the double burden of handling intense therapy and chores for weeks.

Another inpatient therapy would mean another painful seperation from my pack. I am not sure if it would really help me after the last failure. It seems as if my mental illness became immune to the treatment plan of this hospital and laughs all of us in the face.

My pain doctor recommends an inpatient stay in a hospital specialised on psychosomatic symptoms. This hospital is located in Cologne, too far away for outpatient therapy in a day clinic, but near enough that I could go home for the weekends. What I don’t like about it (except for leaving my pack) is the long duration of this kind of treatment – eight to twelve weeks. And of course there is no guarantee it will work.

My general concern is if I am strong enough for a out/inpatient therapy. I know therapy requires a lot of work.

And there is this voice in my head, saying: “It’s too late, you are a lost cause!” Everybody tells me this voice is wrong, but it can be very convincing!

Sometimes it sucks to be me. One part of me is grown up and tells me to make up my mind (because there are waiting times), and then make the most of it, whatever I chose. The other part sits huddled in a corner, covers her ears with her hands, squeezes her eyes tightly shut and hopes for the storm to pass.

 

One week Milnacipran

I have been taking Milnacipran for a week now. First it was 50 mg in the morning, then 50 mg in the morning and in the evening since Wednesday.

If I had it my way, I would feel wonderful by now, but not a bit of it. I am very aware of the fact it is way too early to say if Milnacipran is working for me or not, but I am just very pissed and tense right now. I suffer from annoying side effects, especially dizzyness (which increases my unsteady gait) and anxiety attacks (of course the scary ones, that seem to come out of thin air – even though I take more anti-anxiety medication).

This makes life more difficult for me, I don’t trust myself to drive a car in this condition. I postponed appointments when possible, and I wasn’t very sad that occupational therapy had to be cancelled this week because so many therapists called in sick. But it annoys me that some things couldn’t be done, for instance my parents’ tax return.

 

I rely on my safety net right now, and I don’t like that feeling, although everybody is very understanding. It’s a good thing I have talk therapy and my monthly podiatrist appointment tomorrow morning, a little distraction will make me feel better.

Homemade Horrortrip

In yesterday’s post I mentioned that psychotropic drugs are no panaceas. Taking Milnacipran for the first time today reminded me of this and turned out to be a drama in three acts. Acting persons were sensible Viola (sV) and crazy Viola (cV).

 

1. Act

sV und cV: Ok, let’s give this a go! [take Milnacipran capsule]

[sV und cV have breakfast, drink tea and talk to the postman, everything is fine with the world.].

cV zu sV: I feel a little off…

sV: Let’s find a nice place to lay down.

[cV und sV lay down on the bed and surf the internet to see what happened in the world… Denmark’s Prince Henrik has died, things are looking better at the German Stock Exchange, sunny winter days ahead…]

cV [jumps up]: Help! I’m dying! My heart is racing, I feel sick to the stomach, I am dizzy and my head is about to explode! sV, call an ambulance, this must be f*cking serotonine syndrome!!!

sV [mouth agape]: Well, shit!

2. Act

cV stumbles aimlessly around and mutters nonsense, like, “Why did I agree to try this; always the same with this stuff; what should I do; I am home alone…”]

sV [does some research concerning possible side effects and elimination time of Milnaciprane, connects with some friends and starts to feel better. Taps cV on the shoulder]: Calm down now, this will pass! This happened before, we will survive! But right now, we really better hurry for the toilet, something wants out!

Half an our later.

[cV to sV]: Shitty situation, isn’t it?

sV: Literally. But I think the worst is over.

3. Act

[cV and sV chill on the bed and nibble on a piece of toast].

sV: See? Everything is so much better now.

cV: Yes. I hope we will not have to go through this again tomorrow.

sV: I hope so, too…

Joking aside: I learned to not completely lose it. If I lose it, I may have to go to the psychiatric outpatient clinic. It is a well-known fact that symptoms can worsen before the patient feels better where anti depressants are concerned. This has to be taken seriously.

I am aware of this, and I know what I can do in case of a crisis. It was so helpful today that there are people I can talk to. Sometimes you just need somebody who listens and says: “Well, this sucks!”

 

Milnacipran Hydrochloride and other tongue twisters

This is the new anti depressant that is supposed to help me in the morning. I tried lots of psychotropic drugs, and I can tell from experience that patients need lots of patience and often have to try several meds until they find the one that works best for them. My experience is no exception in this regard. It’s all about try and error, and if you ask five people about a psychiatric drug all five take, you will probably hear five different stories.

My first contact with an anti depressant took place at my primary care physician’s office, when he very casually handed me a blister pack of Zoloft (Sertraline). I refused to take it. My advice to everybody else would be to take this kind of medication only under supervision of a qualified physician with lots of experience. Psychotropic drugs are no cough drops, they really change something in the brain. While taking them, blood levels and heart (ECG) have to be checked on a regular basis. So it is important to think about possible benefits and risks before you start taking them.

 

My next try was Opipramol. I didn’t like how it made me feel – like I was in a bubble, and I couldn’t reach out to the world around me. The anxiety attacks remained, so I stopped taking it.

During my first inpatient stay on the psychiatric ward in 2009, I started taking Sertraline. The first days were hard, I felt very uneasy and couldn’t sit still. But then, things improved: My anxiety attacks almost disappeared, and I enjoyed life again.

In winter 2012 it suddenly felt like the Sertraline stopped working. At the same time, the pain in my back increased. At my next inpatient stay on on the psychiatric ward I was put on Duloxetine for a short time, and then on Venlafaxine. Everything got better again.

 

After about one and a half year later, my liver enzymes were so elevated that our family doctor transferred me to the oncology unit. A liver biopsy showed that I had to discontinue the Venlafaxine. Since then, I never found a medication that helps so much with my mood again (Tianeptine, Escitralopram, Bupoprion…). I often had the feeling the medication stopped working after a short time, even when I upped the dose.

This shows psychotropic drugs are no panaceas. It is wrong to condemn them, I am very grateful for the many happy years they gave me, and I know many peole who feel the same. But they are no miracle cure, either.