MYOB

[6th June, 2017]

Okay, wait. Just give me a minute, read on and it will all (hopefully) become clear.

“What other people think of you is none of your business” – various, or unknown

I had never heard of this philosophy until I needed psychology and psychiatry to fix my mind, or before I got into self improvement-type thoughts and ideas to do my part. Before the last 4 years, what other people thought of me was a major part of my daily life. Anxiety about who thought what about me, insecurity about how others saw me, fretting over any less than perfect social interaction, losing sleep over a joke at my expense, nightmares about potentially horrific social scenarios; I could go on. But I’ve tried hard to put these things in the past with helpful sentiments like the one above. It doesn’t always work, but it works a lot better than it did before I ever tried it! Now I try to mind my own business when it comes to my life, and just do my own thing.

It doesn’t always work out that you can afford to ignore other people’s thoughts about you. This last week I’ve been dealing with a not-so-hot probation review, a first  ever for me. It seems like it doubles as a first warning so its been pretty hard to process that one without losing sleep and getting pretty ruffled in my mind! More about that later. In the meantime its a challenge to work out what is my business to attend to, and what I can let pass through my brain and somehow spit out without it doing too much damage on the way through. And isn’t this the central dilemma of this philosophy? Applying it 100% would lead to big problems, but knowing what degree to apply it to a situation is not a science; its definitely an art!

So…any ideas? I’m still thinking.

For now, I’m going to go and do the things that I know I can do, and do well, which today is bird watching and photography. And isn’t this a clincher for bird of the day? It’s slightly out of focus here due to how WordPress handles cropping photos, sorry.

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Superb Fairy Wren, male at least 4 to 5 years of age

Something to enjoy, to feel good about, to distract from unpleasantness in life: that’s birding to me. Never mind that for about half of the 3 hour walk it was showering rain. Doesn’t matter that my socks and shoes got thoroughly wet and I squelched all the way back to the car park. Don’t worry that my legs got chafed and my feet got sore. Can’t help it that the long distance photos were all blurry and foggy from the rain and mist.

It was a day out of the house, where I had to get dressed, and eat meals, and talk to other humans; lovely humans who wanted to talk about our common interests and nothing else. Where all I had to do was mind my own business and attend to my own interests and needs. Somewhat selfishly I suppose, but in a therapeutic way. I saw 41 different types of birds myself in 3 hours, which has to come close to being a personal record. I walked for hours in picturesque surroundings which were beautiful, even through rain. And captured photos like the one above, like this one here. Photos that soothe my mind, pictures to look back on maybe, to publish somewhere possibly. And it made the day a good day. Today was a good day. Better than any day since that review. This is a good thing. So for now, I’m good. The rest will come back in time, and I’ll deal with it then, but for now I’m minding my own business.

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Red-browed finch

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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.

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. ]