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.

Results

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?

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.

Today I am on drugs.

The clonazepam, while it lifts the anxiety from me to a point where I feel like I can think, for the first time in years, has some unfortunate side-effects.

I’m supposed to take it twice a day, morning and evening.  The morning dose makes me decidedly loopy.  Sort of a half-a-beer-drunk-too-fast sort of feeling, not really drunk but decidedly impaired.  I’ve worked two days like this, no problems.  I would not want to drive in this state, but then, if you’ve seen what the streets here are like, you’d understand that I wouldn’t be keen on driving, period.  I don’t own a car, actually.

Actually, the similarity of effects here may have a great deal to do with why I’m the happiest drunk in the world — alcohol does the same thing to me as clonazepam does, making my brain shut up for a while.

The evening dose mostly just puts me to sleep, but that’s all right.  The problem, I’m finding, is that I need to take it around supper — if I take it much later, I am groggy as fuck in the morning.

My mother is a social worker and works in mental health, particularly geriatrics, particularly elder abuse and… wait for it… addictions.   She is transparently very anxious about me being on a habit-forming drug, even temporarily.  She is quick to remind me of the negative aspects of the drug, and eager for me to try cutting back past what the doctor prescribed.  Today there is a blizzard, and my place of employment is not even opening, so to humour my mother, I’m skipping the morning dose.  Because it’s a quick-acting drug, this isn’t going to screw me up the way skipping an antidepressant would, and because I’m not working, because I’m not sure I should even leave the house today at all, I can see how it goes.  If it gets unbearable, if I have a panic attack, I can take one.  Little is risked with this experiment.

I’ve been up for an hour.  I can feel the tension building in my muscles already.  It starts in my legs, and then my arms.  It doesn’t bode well.  I will try to relax.

Most of the rest of my family has been joking for a couple of weeks now, as I go through this, that I really just need to smoke pot.  At this point, I’m wondering if that wouldn’t be a better solution.  Relaxing?  Potentially less addictive?  Get me a vaporizer and a medical marijuana license, please.   I’d hate trying to buy it off of anyone around here.  It’s all so skeevy.

My sister — and for the sake of clarity, because I have several sisters, I will give her the pseudonym of Florence since she’s a nursing student, also because I think she’d be righteously annoyed and amused at being called Florence — takes a different view, which is one I sort of need to hear right now.  She’s honestly interested in the entire diagnosis, because, well, this is what she’s learning, this is what she’s passionate about.  She worries about me, she says (perhaps more so because it was her birthday party I broke down at), observed that I don’t talk to people about this, but she has a great big drug guide and she can look up clonazepam and is more likely to see it as a useful tool than a potential addiction.

And I think I need to hear that input right now.

I am still reeling.

What a lot can happen in the course of a few days.

The evening I wrote my virgin post,  I went to my sister’s birthday party.  This was good, I thought.  My family will be there, I love my family, there will be pizza, there will be cake, I have been feeling down and miserable since that panic attack of doom of Friday, this will be good.

And initially, it was.  Until, near the end of the evening, I went off to the bathroom and found myself bursting into tears for no reason I could name.

I cried in the bathroom for a while, until I thought I had myself under control.  The last thing I wanted to do was to come out sobbing when this was my little sister’s day.  When I thought I was all right, I came out and sat down again.  I guess that I didn’t look quite as good as I hoped, because my father moved to come sit beside me and put an arm around me.  And I burst into tears again.

I don’t remember, now, exactly what it was I said.  I told dad about Friday, where I was up and on top of the world and could not stop moving, and then crashed into this panic attack and hadn’t really picked myself up from it.   I said that despite my talk of “there are good days and bad days” I really wasn’t doing as well as I was saying.  I’m aware that I try to screen my family.  I’m not sure why I do it.

I was denied permission to return home alone.

After some discussion between my parents, it was decided that I would spend the night at my dad’s, since my mom’s house is quite a ways out of town.  I didn’t sleep much last night.  The next day I went to work for a very brief period of time, just to do some necessary paperwork.  I wept often, seemingly unable to stop.  And I went to my doctor’s appointment.

I had been taking Wellbutrin.  This is never one of the first antidepressants they put someone on, ever,  but I hadn’t had a lot of luck with others.  For some the side effects had been so bad I couldn’t deal with them (gaining sixty pounds — I will have those stretchmarks forever — or the complete and utter cessation of sleep for several days, to give a few examples) or they just really didn’t seem to, well, do anything.  I had been completely disillusioned with antidepressants.  I only agreed to the Wellbutrin when it was pointed out to me that I was so very, very depressed and that I had an unknown wait until counselling and there really should be something in between.

Well, the Wellbutrin was not working.  Conceivably, it was making things worse.  So no more of that.

Four things came out of this doctor’s appointment.

1. We are no longer tossing around the word “depression.”  We have been trying to treat “depression” on and off for over a decade, and nothing comes of it, long-term.  My doctor is now of the opinion that the problem is not that I’m depressed and that it’s making me anxious, but that I’m highly anxious and it’s making me depressed, that this is an anxiety disorder and the depression is secondary.
2. Anxiety disorders are somewhat out of her realm of expertise, and she’s writing me a referral to a psychiatrist.
3. She replaced my Wellbutrin prescription for escitalopram (brand name Cipralex, apparently).  I have been on citalopram, but that “es” at the beginning is apparently important, because this one is an antidepressant that is extremely good for patients with anxiety disorders.
4. Antidepressants take a long time to work, and I am on the line of barely-functional-with-suicidal-thoughts right now, so for the short term she has given me a prescription for clonazepam, a benzodiazeprine.  Clonazepam is a  muscle relaxant, anti-seizure, and anti-anxiety drug.  It is also dependency-forming and addictive.

This last one.

I recognise that I can only been on clonazepam for a short period of time.  I recognise the possibility of dependancy and withdrawal syndrome, and these are scary things to think about.

But it has given me my life back.

Two days ago, I could not see how I could ever possibly manage to carry on any further.  I was so exhausted, so drained, in so much mental agony that I wanted everything to stop, to go away, to end.  Within a very short time of taking the first dose, Monday night, all the muscles in my body that had been taut and tight with tension miraculously relaxed.  I relaxed.  I went to bed, and I actually slept.  When I woke up in the morning, my father looked at me and said, “You look better.”  I went through my day, worked the longest day I have since I came back from my sick leave, and it was fine.  Things happened that would have upset me terribly, but I was fine.  I went home, briefly, had a nice conversation with one of my housemates, and went back out.  I caught the bus out to my dad’s, something I have never done.  I do not know the route, I am not entirely sure where to ring the bell, and the bus that goes out that way, being a not-very-highly-populated route, runs once and hour and uses one of the handicapped-equipped handi-DART mini buses instead of the full citybus, which I have never ridden on.  The reason I’ve never actually gone out to my father’s that way since realising it was possible is simply that it scared the crap of me, that trying to plan it out swept me up in an unstoppable vortex of agony and anxiety and nerves.  Yesterday?  None of that.  I even rang the bell at the wrong time, and it didn’t matter, and I even joked about not knowing where I was going to the bus driver, and I did not agonise about it for hours afterwards.

It’s not that the anxiety is not there.  It is; it’s just that it doesn’t consume my thoughts entirely, and I’m able to think about other things.  And despite that it makes me sleepy and the fact that there’s a lingering feeling of having drunk half a beer far too fast, that feeling of being free from that constantly, oppressive anxiety… it’s like being able to think clearly for the first time.  I feel better than I have in months.  Possibly in years.  I am over the moon.

This is like being forced to breathe only through a very thin and narrow straw.  Sometimes that’s fine, but if you want to get up and do things, take a brisk walk, clean vigorously, run a marathon — you can’t do it.  It bcomes difficult.  You can’t get enough breath.  Suddenly having this experience is like suddenly having the straw taken away, and being allowed to breathe through my mouth.  I did not know it was possible to think like this.

It is, alas, temporary.  Hopefully the therapy, the psychiatrist, the antidepressant will be doing a good job by the time I need to stop taking this.

But, my god.  What a difference.