Should I be allowed to know this?

Yesterday, I ended up seeing the referral letter my general practitioner wrote for the psychiatrist.

I’m not sure why I got to see this, or whether I should be permitted to, but I did as part of a discussion of what/how much of various drugs I have been taking and some confusion over it, because while I did fill out paperwork permitting my psychiatrist’s office access to my prescription record, that paperwork hadn’t yet been filed.  New office, new practice.  I think they’re still having trouble with the computer system.  Dr. K himself expressed some frustration with having to learn how to fill out a prescription on the computer.

But I did see this, or part of it.  My GP’s suggestion is that, should the cipralex not work, I should be put on buspirone.  I spent some time reading that over.

This shit is scary.

Extreme levels of caffeine ingested while taking Buspirone may result in extreme nervous breakdowns, followed by amnesia of the event.

Define “extreme levels of caffeine.”  Define “extreme nervous breakdown.

Jesus christ, let the cipralex be working.

I’m not always very comfortable with taking psychiatric drugs.  They make me, as a rule, very nervous, far too nervous for someone who has so many bottles of them over her desk.  They do strange things to the chemicals in your brain, they are not always predictable in their effects, there are unfortunate side effects.  I am not entirely comfortable with the cipralax and the seroquel, but I take them because I’m hoping the former will work and I know the latter is working, even if it does still make me sort of sleepy.

But the potential for problems worries me, as does the idea of being on these things forever.

Then again, what doesn’t worry me?  Ba-dum ching.

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I saw the psychiatrist yesterday.  I think it went well.

He’s South African, which I did not expect.  His diplomas on the wall were from some university in Johannesburg, the name of which struck me as amusing at the time but I forget now.  He’s a big, black South African doctor with a moustache, and I like him.

And I told him everything.

Which was exhausting.

I told him how amazing I had felt on the clonazepam, but how it was losing effect as I was clearly building a tolerance to it, and that the last week had been hell.  I told him about how, during my bad panic attacks, I felt suicidal and inclined to self-harm, although I had never gone so far as to act on any of these thoughts, short of biting very hard on my hand.  During the entire appointment I was so nervous I couldn’t stop moving, restlessly shifting in my chair and wringing my hands and clenching my fists.  It felt like torture.  A few times, during lulls in the conversation, I looked out the window, couldn’t see much but the hospital and a parking lot, but it helped.

We ruled out diagnoses like bipolar disorder or schizophrenia or OCD.  Just… general anxiety, which surprises no one at this point.  I’m puzzled by the question, though, of if I’ve heard voices or experienced hallucinations.  I said no, but I said to my father last night, how would I know? What if I was unaware that they were hallucinations?  Dad thought that was pretty funny.

The doctor doesn’t like me being on clonazepam either, and since it’s unwise for me to go on a higher dose, and since the effectiveness of the Cipralax will be weeks away, he has given me something called co-quetiapine, or Seroquel.  It’s an anti-psychotic, which is weird to think of.  Also apparently if my parts of my life really are hallucinations, I’ll find out soon enough.  It definitely has a tranquillising effect, though.  Luckily I have a couple of days to get used to the loopiness before I go back to work.  Working on cutting down the clonazepam now, not that it’s doing me a lot of good right now anyway.

The Cipralax is probably a good fit for me, but he mentioned another drug we can try if it doesn’t help.  Again, it’s the sort of thing that takes weeks and weeks to work, so we should at least give the Cipralax a chance first.

Speaking of my father.  We got on the topic of self-medication last night, and he asked me why I thought I had never got into that alleyway.  I said I wasn’t sure, although perhaps if I was a chain-smoker I’d be more functional than I am.  With alcohol, the line between “buzzed enough to be unanxious and happy” (and I am the happiest drunk in the world, for good reason) and “uncomfortably intoxicated” is too fine to walk regularly, and I can’t drink every night, although there have certainly been periods of my life where I’ve had, say, a beer every night for a week or two.  And later in the evening, thinking more on it, it occurred to me that when I’m at the low point in this cycle that I’m beginning to recognise in myself, where I am anxious and depressed and more anxious and more depressed and doing everything in my power to force myself to go out to work and accomplish tasks, I do self-medicate that lack of energy.  The amount of coffee I’ve had in the last week is… astonishing.

And of course, caffeine makes anxiety worse.

How much simpler would my life have been if I’d started smoking in high school?

I Has Snow

I am struggling along.  I seem to have hit some sort of valley in between the rush of the clonazepam and the effectiveness of the cipralax.  The last few days are a struggle.  My boss has been gone this week but the temporary replacement, the old manager (who I sort of replaced when she left and who comes back on occasion as a favour) coincidentally also has anxiety issues, and is also taking cipralax, and we’ve compared a few notes on medication.

She’s perfectly happy to be on drugs for the rest of her life.  I’m not.  But I think, too, that her issues were always more centered around severe panic attacks (she told me her first one had her in the ER, because she was sure she was having a heart attack) and mine seem to be more around consistently high levels of anxiety with occasional peaks into panic attacks (which I have always, always had, although I was probably about twenty before I could identify them as anything other than periods in which I felt awful and ill and suicidally despairing and certain I was losing my mind).

It did mean, though, that the other day when she ran out for an errand, called to check up on me, and I, in a state of high anxiety and near a panic attack told her I was freaking out, that she returned immediately, and allowed me to go for a short walk.  It was -15 C or so, didn’t bother with my coat (I have a warm sweater, working partly outdoors) but grabbed my gloves and walked to the other side of the parking lot to calm myself down.

The parking lot ends in a high slope next to a radio station, almost a cliff, that overlooks an industrial area and railway tracks and cutbanks over the distant river.  There are trees.  It was quieter than inside.  I ended up sitting down in the snow, and then lying down with my eyes closed for a little while until I felt better.

I told a friend of mine about this, and she immediately thought of this:

I am okay with that, I think.

I am very anxious today.  I have to go out.  I don’t wish to.  It will be for my own good.  I have managed to shower and dress, I have taken my meds.  When I am out I have my counselling at 3:15 (weird time), which will be good.  I have to pick up groceries, since I’m out of the meal replacement bars I’ve been living off of when I need to but can’t eat and also had to borrow some of Audrey’s margarine last night.

I am not eating well.  I know I’m not.  It’s not a lot, and it’s not balanced, being mostly carbs.  My boss believes, I think, that I have an eating disorder, combined with my doctor-recommended three weeks off and my continued weight loss.  I am trying but food is hard to face.  I have to eat breakfast because the cipralax makes me very nauseous if I take it on an empty stomach, and we’re having meal bars for lunch, but besides that… all bets are off.

So I continue to lose weight.  In April, I weighed 200 lbs.  I don’t mind saying that.  Apparently I carried the weight “well,” whatever that means, but I was aware that I was eating extremely poorly, with the occasional tendency to binge eat, and that bothered me more than my weight.  I made a lifestyle change, a vow to eat healthy without dieting, not to starve myself but to not make bad decisions constantly.  I said to myself that if I lost twenty pounds it’d be great, thirty would thrill me, and then I just sort of kept losing the weight.  I’m at… well, somewhere between 130 lbs and 135 lbs.  I’ve gone from a size 14-ish to a size…. I’m not even sure, actually.  Size 3 or 4?  All my clothes are too big.  I haven’t bought more in some time.  Buying new clothes makes me, well, anxious, like everything else.

I was stable at 140 lbs for a while, and I was okay with that, but I’m not stable now, and I’m still losing weight.  I haven’t discussed that with anyone, because I don’t know what to say about it.  It’s a perfectly healthy weight for my height — I’m 5’5 1/2″, with a large frame, broad hips and broad shoulders, big hands and feet.  My family has joked that if I hit the point where I’m as thin as the Mongoose, they’ll intervene.  My youngest sister is one of those people who is just very thin by nature, much like my father is, with a speedy metabolism and a hyperactive nature, who never stops moving and naturally tends to graze constantly rather than eat heavy meals.  She’s only thirteen now, and still growing (though she’s only a couple of inches shy of me, now, and I’m the tallest of my sisters, and I suspect she’ll outpace me soon enough), but she’s never succeeded in packing on more than the smallest amount of body fat.  One summer she sprouted six inches over the course of about two or three months.  She looked almost skeletal, although she ate like a horse that whole time.  A thought, about the media’s influence on body image: she has a body many girls strive for, now, thin and lanky but becoming decidedly more feminine and curvy all the time, although still with overlarge hands and feet that suggest she’s got more growing to do (although we’ve all got big hands and feet).  The Mongoose, however, has confessed to me that she worries she’s too thin, and wishes she could gain just a little bit of fat.

I worry that that intervention will be necessary, though, because as I said, my weight is still dropping.  Slowly, but it is.

Sliding backwards

I feel like the clonazepam is losing effect.

I was doing so well, I felt competent and capable, and I thought, “maybe this is what it’s like for normal people” but I can feel myself sliding backwards.  No more skipping doses, maybe, it might be a short-term acting drug but let’s stay safe.  Let’s hope for the cipralex to start working, and soon, but antidepressants take weeks.  Doctor’s appointment on Friday to review the drugs I’ve been taken, we can see what she says.

Oh.  Oh my god.  I cannot.  I am fighting this, I am trying to be calm, but this terrifies me, to feel myself slipping back into the anxiety.  Yes, this is the way I’ve felt nearly constantly for years, but I’ve had a taste of something else and I don’t want to give it up.

I’ve always had good days and bad days, as far as this goes.  Possibly this is just a bad day, and it if weren’t for the clonazepam, I’d be doing a hell of a lot worse.

I have an appointment today.  I need to leave to catch the bus in about twenty minutes.  I should eat, can’t face food, am rocking in my chair.  This is that stupid counselling appointment that I initially tried to make in mid-December, had to wait two weeks for an intake, and had to wait another month for an actual appointment.  What sort of bullshit is this, that it takes this long to get help?  Thank god for my temporary counsellor, is all I can say.

Speaking of which, the temporary counsellor asked me to make a list of everything that makes me anxious.  Everything.  I’m adding things as they occur to me.  It’s becoming… a daunting list.

Letter to my mother.

This is what I would like to say to my mother, but seem unable to make her understand.

Mom, you seem to have no problem comprehending what I’m going through.  You seem to have no problem letting the pieces settle in and admitting that an anxiety disorder is very likely what I’ve been struggling with for the majority of my life.  You’re aware yourself of the many issues with depression and anxiety on your side of the family.  You work in mental health.  None of this is difficult for you.

Why is it difficult for you to accept me being on clonazepam for a short time?

Yes, it is a drug that can be abused, that become addicting.  So can morphine, but I don’t recall you being verbally worried about Cortana receiving morphine several times in the emergency room when she was having troubles with her gall bladder.  Please, please think of it like this.

I suspect if I could probably explain to you what this experience is to me, you might grasp it, but I can’t seem to really be able to bring myself to explain.  I censor myself a lot, because I know you take it hard, and I know you are upset by it, and I hate, hate doing that to you with my own troubles and pain.  So I will likely never be able to tell you this.

The truth is, I’ve been fighting this a long time.

I have been depressed for a long time.  You became aware of my having suicidal thoughts when I was about fifteen, but truthfully, I was having them years earlier, when I was thirteen, when I was younger.  I am twenty-seven now.  There were antidepressants at some points, counselling at others, and the latter was more helpful than the former but it was all just band-aid solutions, because I never, even at the good times, the times when I felt okay and was reasonably functionable and could handle it, felt all that great.

And I have been declining.  You know this.

I’ve had breakdowns before.  Quite a few of them.  You know this.

But this last one has been devastating for me, and I am thankful as hell that this time I managed to put into the right words what was going on in my head, or someone listened to what I was saying, or someone put the pieces together, or whatever it was happened, and that someone realised that the depression was only a symptom.  Because this last breakdown?  I was feeling so worn down trying to drag myself through everything, trying to face everything I had to do to “make myself better” and “get through this” and even when I was being reassured that I always get through these things and come out stronger, getting through it felt so very, very beyond me.  To get over depression, they tell me, you must do this and this and this, you are socially isolated and should do this and this, and it all only made me feel overwhelmed and anxious and worse to think of all these things I had to do.  I didn’t feel capable of any of it.

And it was becoming harder to imagine ever getting through this.  Under normal circumstances, I don’t think I was a danger to myself, but there were a few panic attacks where I seriously considered doing myself harm, because it hurt too much, and making it better seemed beyond my means.

Having a label of “potential anxiety disorder” and the first appropriate prescription for that in my life has made a world of difference, Mom.  Even if you don’t like the clonazepam, even if you worry that I will become addicted, I wish I could tell you properly what it means to feel like this.

Because, for the first time in probably fifteen years, I feel like I can handle the things I need to do.  It’s not going to be an exhausting, will-destroying battle to do my day-to-day tasks.  It’s not going be anxiety-provoking to try to get better from the depression caused by anxiety, because, without that anxiety, I am miraculously not depressed.  It is worlds better.  I recognise there will be effort in keeping in this state of mind, I do.

But I feel alive.

And I feel competent.

I feel like a new person.  I am not entirely sure who this person is, exactly.  I’m still learning that.  But for the first time in a very long time, I like her.

The good drugs.

I skipped the clonazepam last night.

You’d think that a drug that makes you drowsy would not cause problems when taking it night, but paradoxically, it is.  Sure, it puts me to sleep, and I sleep like a rock, but I’m sleeping ten hours and still feeling exhausted, and I’m groggy in the morning, and it’s almost a hung over sort of feeling, and I can’t do that every single day.  I just can’t.  I’d tried taking it earlier in the evening.  That hadn’t solved the problems of the morning, and meant I spent the evening falling asleep.  I thought about taking only half a pill, but last night I decided that why do things halfway?  I forwent (as an aside, there has got to be a better past tense for “forgo,” because that sounds wrong, just less wrong than “forgoed,” which I think is surely wrong) it entirely.

It was an experience.

I slept much lighter than I had been.  And while I can’t remember much of anything I’m reasonably sure I was dreaming a lot.  This is a big thing, since apparently, according to my researches, clonazepam suppresses REM-sleep, which would be why I’m sleeping like the dead and yet so exhausted in the morning.  A little before 3:30 I woke up, very suddenly, as though something had startled me awake.  If anything, I suspect something I was dreaming.  Wide awake, I tossed and turned for a little, reached over for my iPod and checked my email and answered an email to my sister who works the night shift.  This is neither Florence nor Mongoose, but… hm.  I shall henceforth refer to her as Cortana, because she will kick your ass at Halo.  She would certainly kick my ass at Halo, anyway.
I then rolled over and attempted to sleep again.  And this is where things got odd.

I’m not sure how much I actually slept, because for the remainder of the night I was aware of being in a bed, but it was very confused.  I seem to have been in a dreaming state for much of it, despite the fact that I can’t be sure I was asleep.  Some of the time I was aware I was in my own bed, while at other times I was sure I was in the bed in my basement room in the house we lived in when I was in high school.  For much of the night there was something beside me, either our old cat Samantha, curled up beside my head and purring (and it was distinctly her, and not, say, my mother’s cat Grace who occasionally slept with me when I lived with my mother),  and at other times it was our dog Tilly, a border collie/blue heeler cross who was fond of sleeping in bed with me despite the fact that she understood perfectly well that while I would let her up beside me it was not actually allowed, stretched out beside me  and occasionally disturbing me by scratching an itch behind her head.  Both of these animals are dead, now, Tilly a few years ago of kidney failure, and Sam some years earlier of a stroke, both of them living into arthritic old age.  At other points, I was aware of my own bed and my own room, but my sense of spatial awareness was skewed strangely, my head and hands huge, or myself tiny and my pillow huge.  I was aware of a strange throbbing in the air around me, a pulsing that seemed to come up through the floor and vibrate through the bed and into me.  At one point my mattress began to undulate under me, violently.  Maybe like a water-bed with someone vigorously jiggling it?

And I can’t swear to having been asleep for any of it.  And except for the undulating mattress, none of it bothered me to any particular degree.

Maybe I should be more worried about this than I am, but I can’t really bring myself to be concerned.  I’m perfectly aware of the fragile nature of our own sense of reality, and how very little it can take to cause a hallucination.  I”m also well aware that there is a state of mind between full sleep and full waking in which it’s possible to “dream” while still partially awake.  And if my REM-sleep has been suppressed lately… who’s to say it’s not just kicking into overdrive?  Is that possible?  I’ve had experiences like this before, too, although not nearly on this scale.

On the other hand, it may just have been very vivid and very weird dreaming, and my dreams have always tended towards the vivid and the weird.

I was groggy in the morning, but not like I have been.  Tired, but like I said, I can’t swear to how much I actually slept after waking at 3:30.

But I feel rested in a way that I haven’t been all week.  I will try this again and see how it goes.  And on Friday, I will confess to my doctor that I’ve been screwing with the recommended dosage.  Awesome.

I had a wonderful conversation with my father on the phone last night, too.  My father struggles, a little, to understand all this.  I may have said so.  But I love our conversations, that can cycle around from science fiction to things we find fascinating about the way we dream to music to technology to the roots and reasons for various racial traits, science and philosophy and religion and everything that fascinates us.  And like my father, I am fascinated by nearly everything.

Last night he said two things of note to me.

I think I’ve said that my mother is very anxious, and admits to it, about my being on clonazepam.  I said so to my father, and he had a very different point of view.  Some years back, he had a kidney stone.  When he was going through this, he took what the doctor offered and described as “the good drugs.”  And yes, these were the sorts of drugs that were powerful, that could invite abuse, but my father took them.  And they made things better, because he could get over the pain and get on with his life and work on getting better.  And as he sees it, and as I’m starting to see it, the clonazepam is the same way.  It’s a painkiller for my brain, and it’s temporary, but it will help me get better.

(One of my roommates, who I shall refer to as, ahh…. Audrey, for her love of classic movies and Audrey Hepburn, because who cannot love Audrey Hepburn… anyway, she said to me when I was telling her what’s going on that I, unlike herself, don’t have an addictive personality.  My father has said the same thing about himself, and it’s certainly true in his case, so this is possibly an encouraging thought.)

The second thing my father said was a quote, or possibly a misquote (knowing Dad) from a movie I have never heard of but that my father happened to see on television the other night.

“The gods don’t make life easy for us.”

And this is very true.

He went on to add just how good it feels to overcome the difficulties.  And this is also true.

I have had, variously on my desk or near my desk for the last five years, a small, poor-quality brass statue of Ganesha.  One of the several things he’s named as is the Lord of Obstacles.  He removes obstacles, but he also places them where they need to be.

And sometimes — and this is why I’ve kept this little figurine, because I need sometimes to remind myself of these things — those obstacles need to be there, so that we can overcome them and be stronger.

This is what I’m hoping, anyway.

Catch-22

I’ve always been, well, not exactly a morning person, but someone who doesn’t sleep very much.

I wake up early by necessity, and have for a long time.  The alarm is set for a nice, round 6.  The job I had before this, dough cook at a pizza restaurant, required me to start at 7, and my alarm was even earlier.  I stay up because I get busy doing things, or because I am too anxious and upset to sleep.  There have been several incidents in my life where, rather than go to bed at a reasonable hour, knowing full well how early the alarm for the next morning was set, I stayed up far past midnight, or later, because I was simply too anxious to sleep.  Usually I would play video games until I was so tired I literally could not keep my eyes open.

On clonazepam, I am happy as anything, but I want to sleep all the time.

The 6 am alarm is now problematic.  Going to bed after ten is now problematic.

 

My appetite is awful.  Recently, after the event that has crystallised everything into Something Must Be Done, I went a week and a half hardly eating.  I simply couldn’t; I was afraid that forcing myself would make me vomit.  I would look at food and suffer a hideous contraction of my stomach.  At times I felt light-headed with hunger but it was an effort to eat because my stomach was so knotted I did not feel hungry at all.

This does not help the case of those who, not knowing exactly what’s going on with me right now, believe I have an eating disorder.  When you lose sixty-five pounds and then suffer some sort of mental breakdown at work, people tend to make connections.

And then the Wellbutrin, of course, didn’t make it better.  One of the side-effects of Wellbutrin is appetite suppression.  I was no longer fighting a stomach clenched with anxiety, but I simply didn’t feel hungry a lot of the time, either, and had to constantly remind myself to eat.  It would be better for a few days, and I would eat normally, and then I would have a Bad Day and be unable to eat and it would take me several days to get back into the swing of eating normally.

I’m no longer on the Wellbutrin, of course.

But this morning, I am looking at a piece of homemade honey-wheat bread, with chunky peanut butter.  I have a big mug of poor man’s mocha — coffee and hot chocolate mix.  It should be delicious; I can barely stomach it.  I have two pills to take: the clonazepam, and half of a tablet of Cipralex.

Cipralex is, of course, the long-term drug, the one I am waiting to work so that I don’t have to take clonazepam.

Cipralex must be taken with food, or it makes me very ill.

And I cannot get any food into me this morning.

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