Exams

I don’t know how many times I’ve had this dream, or something like it. It’s 5.30pm on Saturday afternoon. My final Year 12 exam starts in 3 hours and I’m absolutely not ready. Why an exam is scheduled for 8.30pm on a Saturday is never made very clear to me! I don’t have a cheat sheet ready, I haven’t studied all semester, I know nothing and I’m in a despairing panic. Or I’m in the last class of the term doing trial exams and unable to answer a single question. Or I’m studying at home and don’t even know where to start. Or I’m in a group study session and the others know everything and I’m absolutely lost, up the creek without a paddle! The subject of the exam is never one that you can cram overnight like biology or history; it’s always physics, maths, or chemistry where you have to understand the equations and be able to manipulate them in the exam to show your understanding. Or lack thereof in this case. There is no way that I can shove enough knowledge into my brain in time to pull it back out again in time for the exam. In other words, I’m doomed! Can you imagine the panic, stress, anxiety, despair, terror, the feeling of utter failure and of the future being bleak? In the middle of the night in my sleep it’s very real and very upsetting! Wishing I’d done better, afraid of the moment my teachers find out I’ve failed them, fearing my peers finding out I’m dumb and incompetent. Cheery stuff!

The thing is, I passed my Year 12 exams. I received my Victorian Certificate of Education in 2005. I did well in fact. I was in the top 10 of my year level, number 6 I think. I achieved 94.55 out of 99.99. This isn’t a brag. It’s an attempt to make my brain remember that actually I have finished this part of my life, and finished it well. I no longer need to fret, stress, despair, panic, etc about facing exams. I mean for goodness sake, it’s 11 years since Year 12! It’s 7 years since I finished my Bachelor of Pharmacy, a lot less academically brilliantly but still. Those years are done, finished; there’s nothing that can be done to change any of it. I can’t go back and do it again. And after all I did those exams and passed them. But these dreams, largely about Year 12 exams, persist! And it’s tiring to spend so much emotion in my sleep during the night on a situation that would never occur to me to think about during the day. But during the night, my brain can’t rationalise. It’s susceptible to the strangest things. And never more so than since I’ve been on antidepressants. Prior to starting antidepressants in mid 2013 I may have had this dream, but I can’t remember. I never dreamed that much and I remembered even less of what I did dream. I’d wake up and any dream would rapidly fade and become a vague thought, or just drift away. But then.

SSRIs, selective serotonin reuptake inhibitors, are the first class of antidepressant that you get to know if you experience your own battle with anxiety, or depression. They are the first line of treatment. Lexapro, Prozac and Zoloft are some brand names you may have heard of. I prefer the generic names because they never change: escitalopram, fluoxetine, sertraline plus paroxetine, citalopram and fluvoxamine. These medications can have a side effect of strange, or even frightening dreams or nightmares (NPS), otherwise described in some places as vivid dreams. Can, being the operative word. They don’t occur in all people, or all the time. I seem to go through phases then have a break for a while, then another series. I was amused at the beginning. I had these super realistic dreams of utter nonsense that were really quite entertaining. I just wished I could have hit the video button and recorded them; I’m sure my name would have gone down in history along with the famous movie directors. I could never write them down quick enough and in enough detail to really proper capture them; quite a shame. But then I started getting variations on this exam panic and it’s not anywhere near amusing; it’s very stressful and I wake up next morning entirely exhausted, as if I’ve hardly slept! It’s draining. And to what end? My psychiatrist doesn’t believe in finding the meaning in dreams, neither did my psychologist, nor does my GP. Rationally I know that dreams are just my subconscious processing data. But sometimes I’d just like a reason why I’m fighting with these emotions during the night. I mean I know why, in that it’s because of the medication. But why this kind of dream, why this stress about failing?

So. What to do about it? In my case, not a lot right now. I’m on an SSRI plus 3 mood stabilisers. Theoretically for bipolar patients, the antidepressant is no longer necessary once the mood stabilisers are in place. Theoretically. So in order to get rid of the dreams, and the sweating, my psychiatrist started slowly weaning my high dose of antidepressant. We got down to 375mg from 525mg, but when we went to 300mg, things started falling apart. It wasn’t worth it so we went back to the last dose that worked. We might try it again later, especially now that one of my mood stabilisers has been bumped up. But it’s a balancing act. Sometimes you have to accept some side effects for an otherwise good healthy life. That’s just reality.

In the meantime, my energy is going to trying to wake myself up out of these dreams and remind myself that although I did have some close calls with studying at the last minute during my university years, that’s long gone! It’s in the past and it needn’t bother me anymore. What’s weird is that it was my years at uni when I was less studious, but the dreams are always about high school. I guess that’s just proof that this is an irrational thing, and to just let it go as much as possible, let it pass, let it slide. Breathe in, 2, 3, 4, out, 2, 3, 4. Ahhh.

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Last night I had a dream…

Anxiety, depression, antidepressants.

Condition, condition, treatment.

Cause of dreams, cause of nightmares, cause of crazy, surreal, nonsensical, weird-as concoctions of ideas and sequence.

Either way, not a great night’s sleep!! And a poor night’s sleep leads to waking up tired and already sick of the day, and that’s no way to feel better about life!

In December last year I got started on a second and more sedating antidepressant to help with my anxiety, and depression. I was initially scared of being on two antidepressants simultaneously. The pharmacist in me was screaming “serotonin sydrome, serotonin syndrome!” [see author’s note]. But then I took it, as directed, at 9pm at night. Within in half an hour a warm fuzzy feeling was spreading all over me and I was feeling sleepy. So I went to bed. I fell asleep straight away, no tossing and turning and trying to force myself to sleep. No fretting, anxiety, stress, fears for tomorrow. Just pure sleep. Bliss!

I fell asleep, and stayed asleep. All night! In fact I couldn’t get up the next day! The doctor had warned me about this so I had started the medication on Christmas Day. I dragged myself out of bed about 9.30am, tried to keep my eyes open over breakfast and finally gave up after a shower and went back to bed about 11am. I slept solidly for two hours and woke up feeling a bit better, but still sleepy – luckily it was a small family lunch for Christmas so it didn’t matter too much. The next day was better, the next even better and within four or five days I could wake up bright and early as soon as my alarm went off and head off to work. And I was getting a full night’s sleep every night!! I was no longer waking up feeling like someone had “punched me in the face” as my doctor describes it, pretty accurately!

Oh mirtazepine! I still have a soft place in my heart for this wonder drug that put me to sleep, kept me asleep and then allowed me to wake up and get on with my life.

I’ve changed medications a lot since then. I had to get rid of mirtazepine because the doctors wanted to start quetiapine instead, an antipsychotic/mood stabiliser to stop me swinging from one end of  the spectrum to the other. It is also sedating. It does a pretty good job with my sleep: it certainly puts to sleep, and keeps me asleep, but I’m having this annoying phenomenon of waking up every morning at 4am or 5am bright as a button!

And to all the helpful people who say “just get up” – thank you for your advice but I respectfully decline!! What kind of time to get up is 4am?? What am I meant to do at that hour of the day? How am I meant to occupy myself all day? It’s hard enough as it is! So I go to the toilet and get back in bed and start the fight with myself to get back to sleep. Unfortunately by the time I succeed it is time for my hubby to get up and a much more reasonable hour of the day to be awake, and I’m conked out! Completely out to it! So my actual getting up time is more like 8am, 8.30am, 9am, 9.30am. Which doesn’t work well with a plan to go back to work eventually on a 8am to 5pm shift…but hey, I really shouldn’t be getting ahead of myself!

I asked my psychiatrist about this early waking thing. At first I thought it was just going to be a temporary thing, but it’s going on and on. He doesn’t want to increase the quetiapine dose anymore; I’m already fat and have cholesterol problems which are in part due to this medication and neither of us want to worsen that! Besides I’ve been started on lithium since which he hopes will be my main medication and the idea is to eventually reduce and possibly cut out altogether my antidepressant and mood stabiliser. His opinion on the matter is that depression is the cause. Early waking can be a typical sign of depression in his view. Bummer!! I was hoping it was something medication-induced that was more easily fixed than depression! Ah well, at least I got most of a good night’s sleep. Mostly.

There’s still the odd crazy antidepressant dream. I’ve heard about other people on antidepressants having strange out of context or deranged dreams, so I guess it’s something that can be part and parcel of treatment. I’ve had a lot more in the past but since being on a mood stabiliser they’ve been a lot rarer.

However I had one last night that got me thinking about this again.

Here’s the reality as background. My sister is a chemistry and nutrition teacher and mostly we get on well. We had a phone conversation last week that was really nice, we had a good chat about different things and only stopped because we had to go out for a date.

Now here’s the dream. I get invited to go to a private girls school to give a lesson on nutrition but I can choose exactly what I want to give the talk on. I choose to talk about waist circumference and it’s link to heart disease. I go to give the talk but I get lost and I’m running late so I have to call ahead and tell them I’m going to be late; not impressive for a guest lecturer! I finally get to the classroom and there are 5 girls; a bit surprising for a guest lecture but okay. Somewhere in the dream the classroom becomes a car and the number of girls drops to two!! Anyway when we get to the car part my sister (the nutrition teacher) turns up and begins heckling me about my facts, saying that they are not evidence-based, the greatest insult in modern medicine! I respond but suddenly I can’t find the evidence that I had before and can’t fight back against the allegations. It turns into a bit of a shame fest for me as a lecturer and then I start getting criticised for my lecturing style, my notes and my slides and it descends into a big higgle-di-piggle-di and I wake up!! Ridiculous!!

Questions: I have no idea on what authority I’m giving this talk, why me? I don’t really have to guess why waist circumference; it’s clearly because mine is well over the line and I need to do something about it other than eating chocolate! Why am I running late – I don’t actually do that much anymore; I’ve really turned over a new leaf. How did we get into the car and why? Why a private school; I went to public schools and have no idea what private schools are like. Why is my sister even there, she lives in a different state? Why are my facts being questioned, especially by my sister who would absolutely support them in real life?

There is no reasoning why with these dreams, they just have to be brushed off as we go on with life. Sometimes they are harder to brush off but I’m sure that looking for meaning in them isn’t very productive. If you beg to differ, and can find a meaning, I’m listening.

So sleep, dreams, life. All wrapped up together and getting the perfect balance is an art. It’s not perfect now, but it’s a long way better than it used to be so I’d like not to fight it but to be glad for what I’ve got and make the most of it!

[Author’s note on serotonin syndrome: when prescribed a high dose of a medicine that increases serotonin like SSRI and SNRI antidepressants, or when prescribed a combination of two medications that increase serotonin there is potential for a patient to develop serotonin toxicity or serotonin syndrome. I have been prescribed both at different times and have never experienced any problems; that is not to say it doesn’t happen, but it is not common. If you believe you have been prescribed one of these you should discuss serotonin syndrome with your doctor/psychiatrist. I am not an authority on the matter and won’t be giving a list of symptoms to look out for. ]

The faces of depression

I was walking around the back of the gorilla exhibit at the zoo and saw this excellent lowland gorilla out of the corner of my eye and it really looked like exactly how I feel some days!

That made me look differently at all my photos when I got home from the zoo. I’ve put together a few pictures that look like how depression feels, at least to me.

Silverback gorilla

lowland gorilla, bushes, grumpy

‘I’m sad and tired and sulky and just want to sit here and mope! Please leave me alone’ pose from this lowland gorilla

gorilla, eating, grass

‘I’m up, I’m eating breakfast but I’m still not convinced this is a good thing’ says another lowland gorilla

Seal

seal, water, rocks, zoo

This is a seal perfectly doing my ‘do I really have to move an inch today? Please tell me I don’t have to go anywhere!’ face!

seal, rock, water, posing

And here’s a seal doing my ‘please just go away and stop being helpful, I can’t take it today!’ face

Penguin

penguins, wooden bridge, zoo

This penguin is doing the ‘weighed down with the weight of the world’ pose

fairy penguin, beach, boardwalk, water

This fairy penguin is doing my ‘please tell me the day is over and I can go to bed? Please?’ pose!

Red panda

red panda, tree, hiding away

Here is a gorgeous red panda doing the ‘if I don’t show my face maybe everyone will leave me alone and I can just hide in here all day’ pose

Giant tortoise

giant tortoise, crawling along, heavy feet

A giant tortoise moving a slow ponderous step every few seconds, just like me dragging my feet on a glum day, heavy, slow, effort-ful!

Quokka

quokka, sleepy, grass, posts

This fluffy sleepy quokka is showing my ‘there is no way that I am opening my eyes or acknowledging in any way that its daytime’ face

Lemur

lemur, striped tail

Grumpy old lemur showing my ‘don’t mess with me today, I dont have the energy to be nice’ face

Pygmy hippopotamus

pygmy hippopotamus, swimming, zoo, blocked in

‘I’m stuck. Everywhere I look there are only obstacles. I can’t do anything. There are walls and stones blocking me at every turn’ says the pygmy hippopotamus after swimming into the corner!

Mandrill baboon

mandrill, rocks, zoo

The ‘please just let me sit here for as long as it takes’ pose by a mandrill

Goodfellow’s tree kangaroo

Goodfellow's tree kangaroo, zoo, trees

This Goodfellow’s tree kangaroo says you can talk to the back cos the face just can’t take it today!

Coati

coati, south america, zoo, next, tree

‘Should I get out of bed today? It doesn’t look too promising out there; maybe I’ll just stay here for a while’ says the coati

Sumatran tiger

sumatran tiger, leaves, zoo

‘I just don’t want to talk about it’ pose from the Sumatran tiger

Apologies to the gorgeous animals that made my day at the zoo so awesome for afflicting them with depressive characteristics!

Perspective is an interesting thing I’ve found. It can make all the difference. It can shade anything black or white into shades of grey. It can confuse things, complicate things, and completely change things.

A lot of work that I’ve done with my psychologist is around perspective, or the way I view the world, and trying to change that for the better to improve my mental health.

Identifying when our perspective is blacker or darker or sadder or angrier or bleaker or “more depressed” is step one to changing perspective. It’s interesting to me to see how a thought can change perspective on a larger part of life.

Seeing this gorilla, who is probably in fact happy and satisfied and just mulling gently on life, from my perspective as grumpy and sad and depressed, led on to thinking about my whole experience in a difference, “more depressed” light. I’m sure none of these animals are really depressed; it was just an exercise to demonstrate perspective (and gave me an excuse to share all my great animal shots!).

If I can notice this negative perspective and stop it in it’s tracks, that’s a great step. If I can then take away the negative glasses and see events in a neutral way that is a second and bigger step. If I can overlay the whole experience with a positive vibe, that is the third and greatest step of all! And it’s with these steps that depression can be beaten!

A big claim!! And it comes with a catch. It’s HARD!! It takes effort, motivation, concentration, self awareness, insight, persistence, energy. And these are the things that depression takes away. So that’s a complication right there.

This is why depression is attacked with a multi-modal approach.

One: medications to increase serotonin, reverse some of the effects of depression, and bump up the energy, motivation and effort.

Two: psychologist or counsellor help to identify negative thought processes and find ways to change them

Three: self help – learning all you can about your condition so that you can find ways to help yourself. And being willing to do these things!

Some people don’t like the idea of medication. Maybe they’ve had a bad experience, maybe they’ve had side effects, maybe they have misconceptions, maybe someone has told them something that has put them off. Interestingly people believe talk amongst themselves more than doctors; even though it’s illogical.

All I know is, without medication I would not be anywhere near as good as I am today. Without it, I was a sobbing blob on the floor, unable to move, do anything, see anything but pain and blackness.

And without the medication, everything is so much harder. Because you are fighting an uphill battle against your own self. Against a state of demotivation, lack of energy, unable to enjoy things, difficulty concentrating, sadness and pain that is serotonin deficiency.

Adding in the missing serotonin is so logical and such a necessary step in getting a person back on track. It’s helps so much, gives you such a boost along the path to recovery. Without it I can’t fight the depression. I can’t get up, go out, live life, work, shop, shower, do my daily tasks. Even with a massive dose of it I struggle sometimes, mainly due to swinging moods. That’s a whole other thing.

Serotonin replacement, or anti-depressants give the needed ingredients for me to make somewhere better in my head for my life to live. They enable me, help me, boost me, push me and give me the strength to help myself. To help me change my perspective, to improve my mental health, to make a better life. Here’s to it!!

 

Choices

Image

So here I am. Bright, beautiful autumn day, not quite 10am in the morning and I’m in the gorgeous Fitzroy Gardens wandering my way back to the city. What a fabulous way to pass the day!! And that’s right, not quite 10am and I’ve gotten out of bed, dressed, had breakfast, walked to the station, caught a train then a tram to an appointment and now I’m out the other side, carefree and almost dancing my way along. It’s a sweet happy day.

In my mind is always the question, is it a too happy day? Am I tipping the scale into the slightly manic?

Today, the answer is: I don’t really mind, I’m happy, it’s a good day and I’m out lapping it up 🙂

Why up so early? Two answers.

1) I’ve changed over antidepressants, again! I’m up to number 7 now, all within 12 months! 5 of them in the last 6 months! It’s been hectic up in my brain!! But to tell the truth, number 7 is actually a repeat of number 2 which I really liked and had to stop because of side effects. So I’m “cautiously optimistic” as my doctor would say, but keeping in mind that I may have to stop this one again. Which would be very disappointing cos so far I’m loving me with this drug in my system! It’s been all of 4 days but it’s made the most amazing difference! I now wake up at 5.30 – 6am like I used to when I was first starting antidepressants again in December.

Which is an incredible change from dragging myself out of a stupor at 9.30am to try to start the day, cutting out all non-essentials sometimes including showering and doing my hair. Now I’m up and ready to start the day with the normal people 🙂 And I still get a pretty solid sleep thanks to my mood stabilisers, although it is a bit more fragmented. But I’ll take that over being doped out!

2) I have a 9am sharp appointment with a private psychiatrist. So far I’ve only seen one psychiatrist, not sure if he was a fully fledged psychiatrist or one in training but I really like him either way. He was friendly, professional, asked questions no-one had asked before and got really quite a lot of information out of me.That was way back now, in early March, two days after I was sent to emergency suicidal and utterly despairing. That day that I saw the last psychiatrist was the day when I realised that the question mark over me having bipolar disorder did actually make a lot of sense. Because from acutely suicidal on Monday night, to that Wednesday midday was the biggest change you could possibly see in a person! By Wednesday morning I was happy, active, energetic, motivated, full of life and ready to go gangbusters!! It really was that dramatic and gave a lot of credence to that theory.

This visit is not at all acute, it’s really like an all over review of my treatment to date and making a plan into the future with the expertise of the specialist. I’m very happy and confident in my GP but a second opinion and eye on the situation never hurts. So yes, 9am sharp! Which a week ago would have been physically impossible but today it’s all good! Yay for that!

So, choices. I loved coming to this point in the path and having the options. Where to go?

I have been given choices in my treatment. Choices about where to next, about what’s tolerable and what’s not, about what’s important to me.

Given the choice between flat, unmotivated and doped out or somewhat anxious and a bit zingy I chose pumped up. So I know I have to take the lesser quality sleep, shaking hands and faint but persistent feeling of something not quite right. It’s been a while, I must say I’d forgotten just what it was like to have my heart on full alert all day. That vague feeling of anxiety about anything and everything, but at least I’m functioning and out enjoying the day instead of thinking about dragging myself out of my slumber.

I chose anxious over depressed. Because I can handle anxiety. I’ve been seeing a psychologist for months now so I have the strategies, the coping techniques, the knowledge of triggers and stressors. So although it’s not what I’d chose given a choice between anxious and not anxious, it’s what I chose over depression.

Depression I can’t handle. I don’t like it, I don’t like me in it, I can’t manage it away. Strategies seem so unachievable, thinking differently is just too hard, mind over matter just isn’t a thing! The awfulness, the horridness, the terrible feelings are just unconquerable. All I want is to run away, escape, go into a time warp. That last one is my favourite. It doesn’t involve self harm or permanent damage or death or anything undoable; it’s just somewhere I can go for as long as it takes until the pain has gone away. So if there’s any option other than having to suffer through depression I take it!

In this case it’s anxiety. You’re back, old nemesis. But this time I’m running the show, I hold the reins, I control the degree and depth and frequency, as much as I can. I have my strategies, my re-thinking, my knowledge, my support, so much on my side.

It’s going to take some getting used to, it doesn’t sit well. I have to be aware of it, and not let it get started so that it can’t get out of control. At the same time it’s important not to get anxious about getting anxious. So back to all that. But the upside: not depressed, touch wood!!