Perspective

[Written in 2014, finally finished today!]

One of the techniques that I’ve been working on is looking at life differently.

My psychologist first got me onto this with a technique called cognitive behavioural therapy (CBT) which tries to redirect thought processes.

For example, people with anxiety and depression often catastropise. I would have a thought like, I’m not working at the moment, which would then lead to, I’m not contributing to our finances, my husband is looking after everything and I’m doing nothing, and, what if I never work again and become a vegetable, and I’m totally useless and live forever with other people having to take care of me, and hating me!!

Obviously, to an outsider this is a drastic way of thinking and a rapidly snowballing thought process! Which is not even factual, as I’ve never had it suggested to me even once that I will be doing anything but returning to my previous active, contributing life. Neither is it at all likely! But depression just has to nut out the worst case scenarios and get you to think, ‘what if’?! And the thing is, at the time, you can’t see it for what it is. It feels totally real, and scary, and awful even though other people may dismiss it as illogical.

Depression, does not have logic.

But depressive thoughts can be changed. It isn’t easy, but if you work at it in the right way, you can slow or stop the snowballing and start to prevent the catastrophising.

Around the same time as I started to see my psychologist, I was already involved in the 100 Happy Days photo challenge that I’ve talked to you about before. Happy. Depression. The two don’t naturally go hand in hand. They’re kind of opposites. Making this a real challenge! This involved, every day, taking a photo of something that made you happy. I knew I was suffering generalised anxiety when I took it on, and during the course of the challenge got diagnosed with depression and bipolar.

Finding something in the day that makes you truly happy takes a real change in thinking. It takes noticing the detail in the day, the little things that are often overlooked, appreciating what is often taken for granted.

These were not the happiest days of my life! Needless to say. In fact, some of the worst days that I have ever experienced were smack bang in the middle of the challenge. But did you know that it never once crossed my mind to not go on with the challenge? I never once considered not doing the challenge, even when I was sitting in the emergency department beside myself with suicidal thoughts and in so much mental pain that I didn’t know how I would live. My happy day photo that day? I was wearing my favourite dress with the huge rosettes around the hem and I was eating my favourite Snickers bar!

There’s always something. That’s what the challenge taught me before I was even conscious of it.

Depression is called depression because it’s depressing.

It lowers you down, it lowers your mood, it lowers your mind. It’s the mind version of walking along in life looking at the gutter. All you can see is the dirty, the trashy, the boring, the bleak, the wasteful, the dead, the mundane.

I’ve always been a stare at the ground in front of me and watch for snakes kind of girl. You know, just in case. But now, instead of physically looking down and stomping along to the train to go to work, I started looking up, casting my eyes around me and began to see all kinds of things in that 10 minute walk alone. The wood ducks nibbling on grass beside the path; never even knew they were there! How beautiful the pond looked shimmering in the morning like. How green was the grass, how blue was the sky. How beautifully kept that lady’s roses are so close to busy Box Hill Central!

And it got me mentally looking up. Instead of snoozing my alarm until the last possible minute, and dragging myself begrudgingly out of bed, I started to wake up wondering what I would see today that would make me happy. There is no mistaking that my mental health was in a dire situation, but at least for a few moments of the day there would be something that I found that would give me a glimmer of a smile, a bit of satisfaction because I found it! That thing that could make me happy. And the memory of it could be taken with me throughout the day. It truly proved to me that if you put yourself to the effort of looking up, mentally or physically, you will surely be rewarded.

So in an effort to lift one’s mind’s eye to a more beautiful view we try this technique of purposefully, intentionally looking up. Some call it mindfulness, some call it practising gratitude, some people call it thankfulness; doesn’t matter what it’s called, it’s a thing. A method to get out of the grunge and into the pretty meadows, or paddocks since this is Australia.

Probably this is the most powerful method of changing perspective, although I’ve way under used it! I came to it as a compulsory part of my insurance, and having someone tell you that you have to do something that you think is stupid is never a good starting place!! But I had to change my thinking. I had an amazing logical sensible teacher who was on my wavelength, and the lessons I learned were incredible!

Mindfulness teaches you to slow down, to take more time to take in the things that we usually just rush by. By doing this, you get greater fulfillment out of life.

I’ve also always been a person to try to scrape the most out of every second, minute, hour, moment. I always got up at the last possible moment, showered for as long as possible til I absolutely had to get out, dressed as fast as possible and left the house only when leaving a minute later would make me nine minutes late instead of eight! Because I was always rushing I’d often leave my lunch, my wallet, my phone, my brain at home! I always squeezed the most time possible into my breaks, felt jibbed every time I had to go back, put off going back to bed so I could fit more into the day. Etc, etc!

But anxiety made me realise that this is not a feasible way for me to live anymore. The extreme anxiety I feel when I’m rushing, late, overcommitted is so awful with the nausea, the sweating, the palpitations. And mindfulness reinforced this again. What if you could walk slowly and calmly without a care in the walk on your way to work? How would that be? Wouldn’t that be nice? Mindfulness is kind of addictive in it’s own way, because it’s highly rewarding to your brain. Of course then there’s the real world, but for a little while, you are in total control and that is amazing!

Mindfulness also teaches you how not to judge yourself and others!! Could there be a more powerful tool than this? In mindfulness, you sit with yourself, which sounds funny to start with, but you just sit with your thoughts and all you have to do is acknowledge each thought as it comes, without it being “good” or “bad”. Do you know how often we are bagging ourselves out in our head and we don’t even consciously know it? It’s terrifying! That’s the worst 3 second wrap ever, but I do highly recommend it, and not only for people with mental health disorders; it can help with a lot in life.

Changing perspective.

Looking for the happy, the good, the joyful things in life.

Some people call it being positive, but I’m not a fan of that description. I feel like being positive is ignoring the reality and the badness, and trying to paste over it with being chipper and perky and upbeat!! Maybe that’s unfair but I feel my arm hairs raise and my spine tighten when positive comes up!!

I prefer to fully acknowledge exactly what is present, what the problems are, and try to work with that to change it for the long term good, not for the short term glossing over it. I’m sorry if that’s offensive; but I feel that if the problems aren’t realised, the treatments won’t be effective so it’s important to be honest.

Changing perspective is hard. It’s hard. It takes effort. It takes perseverance. It takes time. It takes motivation. It takes emotional energy, sometimes physical energy.

Most of these are the things that depression takes away from you. Before you even have a chance to notice, depression whisks away your energy, motivation, ability to exert effort. And leaving you a blob sitting in a chair, staring at a wall wondering what to do next, and how on earth you’re going to do it?

Looking up. Changing perspective. Mindfulness. Gratitude.

The outcomes are so worthwhile if you can put yourself to the trouble.

I highly recommend engaging a psychologist, a mindfulness coach, a doctor trained in CBT because it’s much easier to be guided than to have to do it all yourself. If the session is pre-booked and all you have to do is turn up and be coached, you are already on an easier path, from someone who knows.

Of course you have to participate, and at some point in time you will have to do it on your own, but let’s focus on getting started and you will absolutely benefit from whichever path you go down.

100 happy days is different. You can do this on your own, and unlike me doing it all through Facebook, you can do it by yourself in a notebook and nobody has to know. I can’t recommend blurting everything about your journey onto Facebook like I did; it worked for me, but not so sure about all the poor readers, and it might just not be something you are comfortable with. It’s your call, and there are lots of other options out there.

I wish you well on your perspective changing journey!

Tales of a missed dose

[Written 16th June 2015]

This is a story of what happens when I miss a dose of medication.

What happens depends whether I miss a morning dose or an evening dose. As I write this I’m suffering from missing an evening dose so let’s go with that.

At night I take several tablets: quetiapine, lithium, valproate, rosuvastatin, pantoprazole. Mood stabiliser, mood stabiliser, mood stabiliser, anti-cholesterol, antacid. Yes, it takes that many stabilisers to keep me going!

In the morning I take thyroxine, venlafaxine, Levlen, valproate, lithium. Thyroid hormone replacement, antidepressant, contraceptive, mood stabiliser, mood stabiliser.

All done! Hopefully...I'll still count the tablets out every morning and night to double triple check

In terms of missing a dose, lithium and valproate aren’t the worst to miss as a patient because I’ll be taking some again soon. This is not an official pharmacist, GP or psychiatrist recommendation! Lithium and valproate should ALWAYS be taken twice a day, as close as possible to 12 hours apart for the best effect! And I repeat! This is because for lithium a healthy person’s kidneys clear it out of you in that time frame so to keep a steady level you should take it consistently. And for valproate it’s your liver. That’s why you should respect these two organs very highly! They are very important. But what I’m meaning is its not the worst in terms of the adverse effect of missing a dose. If I miss taking lithium at bedtime, I take it first thing the next morning which gets it back in my system before I physically notice that it even left. My overall level will be a bit lower for a few days which isn’t ideal, but it will work back up to speed soon enough. And I do have a level at least.

Whereas for medications that I take once a day, I’ll miss the effect for 24 hours. Which sucks. Plainly and simply!

boxes, bottles, tablets, capsules

Quetiapine is one of the once a day tablets. It is prescribed to me to prevent mood swings, reduce my anxiety and has the handy effect of giving me a good night’s sleep. It was doing this a bit too well for some months there and I was doped out all of the time, but my awesome psychiatrist recommended a change in the times I take it and we’re back up to speed. Yes!

So, do I get a mood swing if I miss one dose? No. Really not. The chemistry isn’t that reactive. In the same way that it takes weeks of first taking the medication to get the benefit, it takes longer than one day to mess up the whole thing. But I do have a rough day afterward, and a rough night too! It’s a bit like I’m sitting in my car going along nicely and I know where I am and where I’m going and how I am and suddenly another car rear ends me, or bumps into the side of my car at a right angle. Slowly of course, not fast. So my mood just takes a hit, a bump and suddenly I’ve jumped along or across and I find myself somewhere other than where I just was, a bit disorientated about how I got there and sort of catching up with what just happened and where am I now and how I am and are we still okay? That following day I may be in quite a different mood from the one before, either peppy and edgy and anxious and manic, or slow, and silent, and flat and a bit away with the fairies. But that doesn’t qualify as a mood swing, just a sudden small change that affects my day.

After missing a dose here and there I have now gotten the side effects of missing my nightly dose of quetiapine down in a pretty clear timeline. Yes, there are side effects from NOT taking your tablets, as much as taking them. Something to consider.

So here’s the quetiapine absence timeline.

strips, tablets, capsules

10 to 11pm: I can’t get to sleep.

This is a terrible thing. I need my sleep. Always have, and always will I guess, but especially since I’ve been sick. So does everyone, I realise. If I don’t get a good night’s sleep the next day is a struggle, emotionally. So I toss, and I turn, and I turn, and I toss. After an hour of this, if I’m alert enough, I’ll think to myself, self, why can’t I get to sleep? I usually go straight to sleep! Then I’ll look in my pill box, see my tablets, mentally or physically hit myself in the head, take them and all is good in the world. Just like that. If I’m not thinking too clearly, I might think to take a Valium and at least get some sleep. If I’m dull-witted, which is at least half of the time, I’ll eventually wrestle myself to sleep. It sounds funny to say, but I’ve become very good at putting myself to sleep. I nap most days from necessity, and there is a skill involved in going from activity to sleep in a short space of time. I guess shift workers eventually excel at this sort of thing. So I’m quite adept at getting myself in a comfortable position, getting the temperature right (cannot sleep well unless it is right!), darkening the room, doing a conscious relaxation of as many muscles as I can, and stilling my mind into sleep.

Say I managed that. Next time check?

3am. Yep, wide awake, fresh as a daisy, ready to go at 3am. I toss, and turn, and can’t get comfortable, and I’m restless and my poor husband is rocking and rolling every time I turn and I’m messing with his sheets, and he has to go to work tomorrow even if I don’t, so I try to lay still and physically can’t! Why am I awake, I’m usually asleep, what is happening, oh….ahhhh! Tablets! I forgot them! Duhh! I hate that moment! I try to do my utmost to prevent it, but it still happens and it does feel like a failure every time I somehow mess it up! So, should I take them now? The dilemma! It’s 7 out of 12 or 24 hours through the medication time period. So I can’t take all of them. Maybe just some of them. Can’t take quetiapine, I’ve missed the boat on that one otherwise I’ll sleep all day. And I’ll be taking lithium and valproate soon anyway, and can’t double dose. What about the rest? Which are nothing really, in the scheme of me being wide awake at 3am! Cholesterol and stomach medication. Sure I can take them, they should be taken regularly but it’s too late for my sleep. The next dilemma then: try to force myself to sleep again, or just get up, take my laptop to the spare room and do something else? Who knows? Depends what I’ve got on the next day really. I can never decide!

medication list

8am: I’ve finally given up the ghost on sleep so I’m up and peppy and full of life and only just partially anxious and ever so slightly manic and energetic and going to run the world! If I haven’t already taken one to sleep, now is the time for a Valium to wind back the jets on being super woman and achieving all my life goals in one sweet day! And talking my husband’s ear off and planning one hundred chores like a complete going through of the entire kitchen plus 3 loads of washing on a rainy day and lunch with girlfriends and all kinds of magical things. ‘Woah, says my husband, that’s too many things for today. No do that another day, you’ve got enough things for today. How about you sit down for a minute, what about some mindfulness? I think you should do some mindfulness…how about you go and do that now?’ At around about this point I have now blown my nose for literally the THIRTIETH time since waking for the final time. THIRTY. You just can’t blow you nose till it feels empty; there’s always residual. And it’s pretty much like a tap. The medical term is rhinorrhea, like diarrhea but your nose is melting and there is a constant liquid dripping, dripping, dripping!! Quetiapine dries you out like anything so you get dry mouth (and want to drink Coke all the time!), dry nose which leads to sores and blood noses, some degree of constipation which no one wants to know about and some urine retention. The last one isn’t noticeable on any other day, until the missed dose day and then I realise that yes I really have been holding back! TMI I know, but you wanted the whole story right?

But the nose thing really gets me! If I notice nothing else in the middle of the night, I do notice my nose dripping incessantly! It’s an instant giveaway! It’s different to regular waking up in the morning and blowing your nose. It’s more like hay fever without the sneezing but the medication to stop it cannot be taken til nighttime!!! Cue fierce under breath bursts of ‘idiot’!

And then it’s just getting through the day like usual, but bearing well in mind that you’re a bit high today, a bit edgy, a bit fiddly, a bit anxious, a bit overstrung so remembering to breath, relax, calm, easy, gently does it. And I should mention that the other things ease off too, just not in such an obvious diagnostic way. I have the right amount of saliva in my mouth (who knew that was a thing!) and going to the toilet is a breeze, like really easy, like maybe a bit too much and too many times! So happy thoughts!

medication box, tablets

Now the morning lot and venlafaxine. Anyone who is involved in the prescribing, dispensing, and before too long taking venlafaxine knows about the withdrawals. It’s described in the textbooks and it happens like the textbooks. Exactly like. I used to think this was pretty cool. I still do theoretically, but in practice I either love or hate that they’re so reliable and unavoidable. I love them if I notice it before I’ve left the house for a work day because I immediately fix the shortcoming. I hate them if I notice once I’m already on the way to the bus stop and I don’t have time to turn back, or I’m on the bus, on the train, on the tram, in the building. Then it sucks because I know what’s coming and I can’t do a thing about it! Unless I can get to my doctor for an emergency script but that means paying full price, and after all it’s nothing life threatening. Not bad enough to pay three times the normal price! And believe it or not borrowing stock from the shelves is not strongly encouraged by my employers nor is it in any way legal!

What the symptoms/adverse effects of missing venlafaxine are: electric shocks/tingling in your fingers, light headedness/feeling like my head is spinning/wondering if I’ll faint, nausea. Nothing fun. Nothing dangerous. They don’t make for a good day, and I have to wait til the next morning to fix it! More banging of palm to forehead and severe muttering to oneself!

So that the what. The why is a whole other adventure and I don’t have time today, but hang in there and soon we’ll have another chat and look at the other part of the problem. Chat soon!