On Christmas Time

In the past week or so, both parents have checked in with me to make sure that I’m ok with Christmas.

As the days wind down I have to say I’m doing fine.  The most stressful part of Christmas for me is the shopping and shopping centres in general.  As December rolls around the local Wesfield fills up with stressed out people, finding a park takes ages, it’s always too hot and claustrophobic no matter what they do with the air conditioning.  This is the reason why I do most of my shopping online and well before the last week.

Trying to find a car park is really the worst though isn’t it?  To a point with the crowds I can put my head down, stick my elbows out and just barrel through to focus on the task at hand.  But you can’t focus on anything if you can’t get into the building in the first place.  Some shopping centre parking situations are so ridiculous they’re getting media attention.

Three hours?  Really?  Everyone’s parking tickets would have expired!

My mother went to the shops twice yesterday – once at midday to do the food shop, and then returned at around 4 to do the last minute presents.  At midday she was circling the parking lots for ages, at 4 she got lucky because someone left.  Today she returned at 9.30 to get some fish and there were no parks.  None.  After driving around for ages she gave up and came home.  She intends to return at about five because she thinks there will be a lull in between the people on holidays and the people who work rushes.

As for me, I asked my family what they wanted in mid November – trying to be organised and all that – but no-one knew what they wanted.  I had known what I was getting my BF for months – new Nike running shoes.  He knows what he’s getting because he couldn’t tell me what shoe size he is, so I had to have him try them on.  The wrapped up shoe box was sitting in our living room long before our Christmas tree was.

My sisters continued to be coy about present ideas so I got sick of waiting and just bought them both surprises that they’re just going to have to like.  One is getting a new Lorna Jane top for the gym and the other is getting Peter Alexander pyjamas.

My parents did eventually give me some ideas – mum wanted a cooling jacket for her wine.  Huh?  I had no idea where I would find such a thing and in the end just googled “wine jacket” until I came up with something I could order from an online store.  Dad wanted a bottle of port so, given that my BF lives close to a bunch of vineyards we went up there to source a bottle.  It just so happened that as we went to the cellar door for this vineyard where we got the port I saw a whole lot of these cute and colourful wine jackets for sale, but these ones had handles to carry around.  I couldn’t resist buying another for mum.

And yes, this is a secret blog.  My family definitely aren’t reading here.  My BF might be, but he already tried his present on, soooooo…

The last few things I have to do before Christmas is clean the house and help with the cooking.  My jurisdiction of the house is done – upstairs hallway, bathroom, toilet, stairs and my room – and mum will do the ham tomorrow.  She ordered a smoked ham from the local butcher which she picked up this morning.  It smells great.

Today I will go to church with my grandmother and when we come back from that we’ll have the ham and fish.  On Christmas morning – I either wake up inordinately early or sleep in on these meds so we’ll see what happens.  Either I’ll be pestering everyone else to get up for presents or they’ll be waiting for me.

Christmas lunch will be with Dad’s side of the family and Christmas dinner will be with my BF’s family.  I’m not sure what’s happening on boxing day but I know mum has a rib roast.

Christmas is a stressful time for many people but I don’t really feel that stress.  This year is very different to last year when I was in hospital, which was added stress for me and everyone around me.  I’ll be able to enjoy the day more now that I’m not adjusting to new meds, or having to go back to a ward and marinate in all the other patients’ dramas.

Of all the anxiety inducing things that happen to me in a year, Christmas is really unremarkable.

A Doctor’s Appointment and Lots of Hairballs

My hair is falling out.  In freaking sheets.

I can’t quite remember when it started – maybe at the end of last year sometime – but I’m shedding like cat coming out of winter.  I fill up my hair brush in just one brushing session.  There’s always masses of it on the back of my shirts.  When I wash my hair clumps of it can be seen on the floor of the shower.  I swept out my bathroom and created a massive blonde tumbleweed.

It ends up absolutely everywhere – all over my clothes, through my car, my boyfriend’s beard – everywhere.

I’ve been a bit concerned even though I don’t appear to have thin spots on my scalp, but I do have way more hair than the average person.  I’m not sure what’s causing it, my meds, my anxiety or bleaching my hair.  I’m pretty sure it’s not the latter because it appears to be falling out at the root, not breaking off.

My anxiety has been up and down this year depending on what’s going on in my life – I had a particularly stressful end to the college term, but the hair loss has been steady and constant.  As for my meds, I don’t know what could be causing the shedding.  I’ve been on meds before that did it – on epilim I nearly went bald – I had never heard of any of the current set causing hair loss.

After a frustrating afternoon of pulling my furballs out of his shower drain, my boyfriend insisted that I raise the issue with my doctor.  I had an appointment coming up so I promised to do just that.

I haven’t seen my doctor since the Zeldox discussions.  She’s only seeing me six weekly now, as opposed to three.  I’ve been handling things well I think.

On the day of the appointment though, it was obvious that I was having an off day.  I usually take my night time meds early in the evening so I can have a good long sleep and wake up early.  Even though I take the maximum dose of Zeldox I don’t usually experience a hangover effect, but this morning was different.

My boyfriend pretty much had to drag me out of bed when his normal alarm tactic – rolling a chilled can of diet coke across my face – didn’t work.  I slept in the car and when I got out I was immediately overcome with a wave of nausea.  Unfortunately I didn’t have my ginger pills on me.

It was obvious to my psychiatrist was soon as I came in that I was doped up, and she questioned whether I was on too much medication.  I assured her that this episode was unusual.  I must admit I panicked a little – I think every appointment I have with her I’m going to be worried that she’s going to take me off Zeldox.  It’s not just that it works, I’m keen to stay on it because it keeps me thin.

Shallow, I know.

I didn’t talk much because I was so tired but somehow I convinced her that I’m going ok.  We raised the hair loss issue with her and she told me what I already knew – that none of my meds were known to cause this.  She also said that while it might seem like a lot of hair falling out, if I can’t see any thin spots then I probably shouldn’t worry too much.

I was probably in and out in under twenty minutes, and that was me done for another six weeks.  It looks like I’ll still be scraping furballs off my shower floor for the foreseeable future but hey, at least I get to stay blonde.

Mac

Antipsychotics Update

The Zeldox saga continues.

At my recent psychiatrist appointment we were discussing my Zeldox dosage again.  My BF came with me because he was unhappy that I’ve been taking both doses at night – he read up on the drug online and came across this from the NPS website:

Unlike most other atypical antipsychotics, ziprasidone must be taken twice daily with food. Absorption of ziprasidone may be significantly reduced if taken without food”

He interpreted that to mean that I shouldn’t be taking both doses at night and complained to my doctor that he thought it wasn’t safe.  She assured him that it’s perfectly safe, and that loading me up at night is the best thing to allow me to sleep.

Also, my sleeping has improved a lot now that I know I have to take it with food.

I asked her if I could have a script for maxolon due to some nausea I’ve been experiencing in the mornings and she refused – apparently zeldox can interact with maxolon and cause dystonia.  I’ve been told to go to a health food store and look into natural therapies for nausea.

She also sent me to get an ECG to make sure I have no abnormal rhythms which is a risk for the drug.  Not going to lie, that has been bothering me ever since.  I got my ECG that afternoon and haven’t seen the results yet, but this is just another example of my mental health messing with my physical health.  I did some more reading on the nps website and found this:

A small but increased risk of sudden cardiac death has been observed for all antipsychotics — consider the individual’s cardiovascular risk profile before prescribing an antipsychotic

Yikes.

I know it’s a small risk but it’s just another thing to worry about.

Mac

Antipsychotics and Me

Finding the right medication is often a balancing act between how well it works and how many side effects you can take.  While I’m aware that I have to live with some effects – there’s no such thing as a quick fix in psychiatry after all – I’m still holding out hope that I can find medication that works and doesn’t pile weight on me, or zonk me out all the time, or give me such bad memory loss I’m blanking on my personal details.  I’ve been through quite a few now and I’m really hoping that this current one is the one that sticks.

I started on Zeldox in December last year.  I had been on it before, and it was a disaster because my doctor put me on 40mg straight away and I was violently ill for weeks.  This time we started with me taking 20 mg to start with, with my psychiatrist aiming to have me settled on 100mg.

I talked about my experiences getting on the new medication regime in the rehab diaries, but the complications with my medication didn’t end once I left hospital.  There have been side effects that only became problematic later.

So, back to the end of my hospital stay.  I’ve just been discharged and I’m taking 80mg of Zeldox – 20 mg in the morning, and 60 mg at night.  I persisted with the daytime dose for about three months but midday drowsiness was a persistant problem, and is a problem for me for any antipsychotic medication I’ve taken.

I’d take the pill at about nine a.m.  I’d feel great for a couple of hours, then start feeling a bit seedy around midday.  Generally I couldn’t get through the day without a midday nap.  For those eight hours between the nap and night meds however I can’t deny I felt fantastic.

I put the problem to my psychiatrist in an appointment scheduled when I would normally be napping.  She agreed that I appeared over medicated, and put a stop to the morning Zeldox.  But, would I mind trying to take all of it at night?

So I did.  Still on 80mg of Zeldox but all at night.  While I was much more animated during the day, and could go places without worrying about crashing suddenly in public, not taking the drug during the day did see my productivity go down.  I had trouble focusing,  I was restless, and just generally more anxious.

Then came something that every happily medicated person with bipolar disorder dreads: I stopped sleeping.

Generally when this happens it’s time to change up the meds but I was not prepared to give up on Zeldox just yet because….well, I’d been losing a lot of weight on it.  That might sound petty but I’m willing to hold onto any drug that doesn’t push me in the other direction.

I went back to my doctor and told her what was happening – and had her despair over my continued weight loss – and she agreed that we should persist with Zeldox for now.  While my weight loss has been bothering her, I previously gained 20kg in a couple of months thanks to other antipsychotic drugs.  She’s very mindful of not putting me on anything likely to repeat that.

So to fix the sleeping and other positive anxious symptoms she decided to jump from 80mg to 120mg of the Zeldox.  She told me to try taking 40 in the morning and 80 at night, but to switch to all at night if the daytime dose was knocking me out.

That worked – for a week or so.  Eventually my sleeping became problematic again, and taking 40mg during the day was making me drowsy.  Though again, in the afternoons I was feeling fantastic.  But life isn’t forgiving of a need for a siesta so I started taking it all at night.  I still wasn’t sleeping, and my anxiety symptoms returned during the day.

So at my most recent appointment she told me to jump 40 mg again so that I was taking the maximum allowable dose, 160 mg a day.  Because I do seem to do better when I take it during the day she told me to split it 80 mg at night, 80 mg in the morning and to persist with this for a while just to see if we couldn’t make it work.

I tried to make it work.  Taking 80mg of a sedating antipsychotic as soon as I got up had me feeling like I had been hit by a train for the first half of the day (and of course feeling fantastic the second half.)  I persisted for a few weeks but it just didn’t get better.  I tried setting an alarm for 4 am to take it, hoping to be able to sleep the sedation off before I had to be anywhere but it still lasted until about 11 am.  It was so strong that if I had to be anywhere before that time, I had to get someone else to drive me.

So now I’m back to taking it all at night.   I have been sleeping fine, still a little drowsy in the mornings but not scary sedated.  While my mood might be more stable on a daytime dose of the antipsychotic it looks like taking something at that time just isn’t realistic.  I can’t deal with the sedation.

I wish I could be one of those people who gets on a particular dose of medication and stays on that dose for years but medicating me is like a game of jenga – carefully building a complex structure and taking pieces away, hoping the whole thing doesn’t collapse.  Which it inevitably does.

Mac

What is CBT, and how will it help me?

So in my absence, I’ve been attending a weekly CBT group therapy session.  The decision to refer me to this group was made when I was discharged from hospital back in January to tackle my anxiety.  I went onto a waiting list then a spot opened for me in April.

So what is CBT?

Cognitive behavioural therapy is a problem based, action focussed form of psychotherapy – it identifies problematic behaviours and thoughts, challenges them and encourages you to form new ones.  It has been proven to be effective in treating many different mental illnesses but in this group was focussed on depression and anxiety.  It can be done individually, or in a group setting.

I’ve done group therapy before but that was DBT, a therapy more oriented at reducing problematic behaviours in people with personality disorders.  I had to do the group something like four times before the therapists decided that they were done with me.  What can I say, old habits die hard.

With that in mind I was apprehensive towards CBT.  I was hoping it wouldn’t attract the kind of drama that comes with a DBT group, where you don’t tend to end up unless your life is well out of control.  My own life was pretty chaotic at the time, and I’m sure there were plenty of people in the group who got sick of hearing about me getting into the same dramas over and over.

My brother in law also tried individual CBT to treat his depression and didn’t like it.  Which is fine, not all therapy styles are appropriate for every individual but he really felt it was too impersonal.  He likened it to treating his brain like a computer that needs rebooting.  Which is interesting because I find that to be an appropriate metaphor for how my anxiety works.  It’s like my brain is programmed to dread unspeakable horrors at all times for no goddamn reason and if reprogramming is what CBT can do for me, then I’m all for it.

So I went along to this group.  It runs for three and a half hours, separated into three sections, sharing, mindfulness and doing worksheets.  When we first arrive we take turns sharing situations where we struggled with our anxiety and/or depression, and where we have done our homework from the last week which generally consists of identifying some problematic thought patterns and connecting them to our behaviours

After sharing – which usually takes twenty minutes or so per person – we have a twenty minute break, then go back to do a mindfulness exercise lead by the therapist.  This is the part I struggled with; I can’t keep my head clear to save my life.  Intrusive thoughts are a big deal for me.  I can do some mindful deep breathing but I’ll guarantee I’m also thinking about my favourite Archer quotes or something.

We then spend the last hour and a half working through the info and exercises on our handouts for the week.  If you follow me on Instagram you’ll notice I’ve been posting them as I get them; they are separated into two seven week modules, one on anxiety and one on depression.  Each week we explore some aspect of thoughts and behaviours that might be shaped by both.

Even though I was put in this group for anxiety, I found the thought challenging exercises in the depression module to be more relevant to me.  I love to catastrophise and obsess over possibilities – and I have a double whammy of autistic spectrum disorder and paranoid delusions from mania facilitating that – and I found the exercises grounding.

So about the people in the group…obviously I can’t share details about them, but was I right in assuming that they would be less dramatic than our mates in DBT?  The answer is yes…mostly.  People with anxiety as opposed to personality disorders tend to be higher functioning I’ve found, but there’s always some individuals who can’t not escalate any drama they get into and don’t want to help themselves by using the therapy tools to challenge their behaviour.  But one of our group rules is accepting that everyone is at a different stage of their recovery journey, so I just have to take it for what it is I guess.

After all, One of the benefits of group therapy that they’re too polite to tell you about is that there’s always something to be learned from other people’s mistakes.

Mac

Bipolar Disorder Feature On Australian Story

This week the ABC’s Australian Story did a feature on the Newling family’s journey with two out of three children diagnosed with serious mood disorders, with two very different outcomes

Watch it here:

Or read the article on the younger brother Nic here

This feature provides an insight into the way kids with mood disorders are treated in the Australian system; Nic had access to more help than most but getting the right diagnosis is still so difficult.  Like me and so many other teens with bipolar they persisted with a depression diagnosis and feeding us anti depressant drugs that that just make us worse.

Getting a timely diagnosis for bipolar is difficult at any age but it’s so important because generally the longer we go without treatment the harder it is to control.

This story does have a happy ending for Nic and I feel so much more motivated just for having watched it.

I hope you all get something positive from this

Mac

The Rehab Diaries Week 6 – Get Me Outta Here!

I’d started getting restless.  It was obvious that I was getting overcooked.

I’ve heard staff and patients carry on about the evils of becoming institutionalised.  Getting used to being taken care of.  I don’t know that I’ve ever experienced that but I do know that after a certain amount of time in hospital I start feeling very anti-institution.

It’s not that it doesn’t happen – for the long term unemployed chronically unwell, particularly the youngsters, hospital seems be their primary social outlet.  I’m sure I don’t have to explain why that’s problematic.  But me, I’m independent by nature.  Even six weeks in I’m struggling to take set meal times in good humour.  Breakfast at 7.30-8.30.  If you sleep in like a normal person who hasn’t got anywhere to go, bad luck it gets cleared away and you miss out.  Lunch at midday.  Dinner at 5.

I miss being able to go for a walk without signing out and specifying a return time.  I miss driving.  I miss having the freedom to choose what I eat.  I miss baths.  I miss shaving.  I miss being able to watch more than an hour of youtube videos before I’ve used up my downloads for the day.

I’d established on fluoxetine and had seen definite improvements.  My irritation had toned down a lot and I was feeling general good will to those around me.  Even hearing guitar boy mindfully strumming away down the corridor didn’t make me uneasy at all.  I know my irritation towards him has been unfair; he keeps to himself and refuses to participate in the drama and politics of the other youngsters on the ward.  I can respect that.

To test my anxieties I went on leave one night with BF for a dinner and movie date.  A few weeks ago that would have been impossible but with the improvements I’d been seeing I was keen to try some regular world stuff again.

It went well.  I sat through it, even though it was a long movie and the cinema was very crowded.  I’m still hyperaware of the movements of all people around me so when there’s a lot of people in one space I get overwhelmed.  There were no meltdowns in the cinema that night however.

After last week I finally felt that I’d had some quality time with my therapist.  I was talking with her on the Tuesday of that week, saying that I was doing so much better in just one week and that I’m totally ready to go home.  I was prepared in my doctor’s appointment that week to ask for a discharge appointment on Friday.  She reminded me that, being a voluntary private clinic, I can actually leave whenever I damn well want.

Generally when a patient has reached the end of their treatment plan discharge planning begins a week or two in advance.  We talk about the support systems that we have in place, which outpatient therapists we’re going to see, whether or not a referral to day programs is appropriate.  The doctor has to record a final diagnosis (which in my case is practically a paragraph) and fax a bunch of discharge summaries to our various community care providers.  The number of appointments is usually planned around the patient being discharged on the day of the last appointment.  As we know however, patients can abruptly decide to check out without discharge planning.

I hadn’t had those conversations with my doctor yet.  I like to think that discharge planning for me isn’t hugely complicated; my care team is well known to my doctor and hasn’t changed much in the last few years.  I believe she was waiting to see how I established on fluoxetine before she started talking about it but in our appointment she accepted that I was doing better.  I told her I wanted to leave tomorrow.  I expected her to be taken aback but she said she was willing to support that, and set about writing discharge summaries.

Given that I’ve mentioned patients checking out without discharge appointments several times now, you’re probably wondering…how does this happen?  Well, all it takes is to inform the nursing staff and they’ll bring you the discharge papers.  My doctor ordered them and that evening a nurse sat with me and asked me a bunch of questions from a sheet of paper like, did I have accommodation? (yes.)  Who would be picking me up? (BF would.) What is your plan for the next few weeks? (moving house.)

I signed off on my details again, and when they provided me a feedback form, I wrote about the Christmas fiasco, saying I think everyone would have coped better with some more staff on.  That was that, and she left me to pack my things.

The morning of my victorious exodus discharge I was really only waiting for one thing before I could leave – scripts.  And the CMO took his sweet time with those.  BF arrived at 9.30, we got kicked out of my room at 10 so they could clean it for the next patient.  We finally got hold of him at 10.45

And by then I’d started feeling unusually drowsy.  While we were waiting for the scripts the nurse unit manager burst in and asked me if I noticed anything different about my medication that morning.

As soon as she asked I realised what must have happened.  I take 80mg of zeldox a day.  60 at night, 20 in the morning.  This morning I’d taken the 60.

My nurse came in at 8 as I was preoccupied with trying to force my running shoes into my carry bag (how do I end up leaving with double the clothes I came in with?)  This particular nurse hadn’t dealt with me and my meds before.  I took the cup, swallowed it without looking and got back to work.

I couldn’t remember if there were extra pills in the cup, but I did think it went down harder than it usually does in the morning.

The nurse was trying to say that my meds couldn’t have been wrong because I would normally question them if I saw something odd.  And it’s true, after the contraceptive pill debacle I always looked over my meds before taking them.  This mornings, of all mornings, I decided to make an exception.  ARGH.

So my return home wasn’t the joyous occasion it should have been because I rolled straight into bed and crashed, leaving my poor BF to work on his laptop instead of celebrate.  Then I couldn’t sleep that night because I could only take a 20mg tablet to balance the overdose out.  Nurses, take note.  Double check what you’re giving out, just because it’s not life threatening, doesn’t mean this shit doesn’t matter!

So that’s it.  My rehab journey this time around.  I may do a post talking about what I’ve been up to since I’ve been out –  I haven’t been overly interesting but there has been some changes.

Mac

That Time I Ran City 2 Surf and Didn’t Die

Ten years ago, showed up and I ran/walked/crawled in the City 2 Surf with no training.

For non NSW people, the City 2 Surf is an annual 14k fun run that stretches from Sydney’s CBD to Bondi beach.  My dad has been running it for 15 years, and at the time my sister and I, aged 12 and 15 respectively, decided to give it a go.  I showed up wearing a singlet and boardies, having done no cardio leading up to it as I said, and I believe I even ate a maccas breakfast on the drive down.  I was in pain for days afterwards.

Of course, I was a child at the time.  If I tried that same strategy now, I would need an ambulance.

My family was reminiscing that day over dinner last night with great amusement.  My mum remembers how proud of myself I looked when I finally crossed the finish line, not being able to believe what I had done (and with a final burst of energy darted into the seeded runners marquee and stole a finger bun – this was back before all athletes were paleo and long distance runners were all about masses of carbs for energy.)

I had finished with a time of about two and a half hours, my sister about ten minutes or so in front.  I idly wondered out loud how I would do if I actually trained.

To which my family responded, “well, why don’t you?”

I totally should.

I’ve never been a big fan of cardio.  I consider myself quite active and I do go through periods of regular jogging but the reason I tend to run hot and cold is because it’s what I do if I can’t think of anything better to do.  I prefer sports, or weights, or yoga but can’t always be bothered coming up with a routine.

And then there’s the fact that bad things tend to happen to me when I run.  I fall over things, or into things and hurt myself.  And let’s not forget the Frisbee incident.

But maybe letting a few injuries put me off this form of exercise is unfair.  Your body best responds to a varied exercise routine, so I should be trying to mix things up.  Running is a great mindfulness exercise too.

The event is five months away and the website has a ten week training plan but I reckon I’ll use ten weeks to build the intensity then keep going at that level until the race, maybe repeating the last three weeks.

I’ll keep you guys posted on how I’m going.  I’m going to need a lot of quest bars…

Mac

The Rehab Diaries Week 5 – Hitting the Wall

I’ve hit the wall, and hit it hard.  To think it only took me four weeks.

My anxiety is spotty.  It’s kind of on and off but when it’s on it’s intense.  I’ve had days where I spent hours just pacing and ruminating.  Leaving the hospital is still making me feel sick.  Le boyf is making me go out, and is getting concerned over how I’m somehow not getting less shaky every time we do go out.

It seems to be spiking at night.  At night, anxiety is just on.  I guess it’s because it’s the time of day when the zeldox levels in my system are at a low but I just run in circles around my room, so dizzy and shaky, trying to wear myself out.

I have an agitating factor at night time; there’s a very real issue that can prevent me from sleeping.  My neighbour’s.  Fucking.  Snoring.  It has to be heard to be believed.  And it can be heard through the wall with the door shut.  They gave me ear plugs which do work, but they’re uncomfortable and I don’t like wearing them.

The rational part of my brain tells me that I shouldn’t be expecting to not be a competent, non agoraphobe in just a few short weeks.  The depressed all of my brain asks when I will ever not be an incompetent agoraphobe.  Suicidal ideation is back.  I just can’t do this for another fifty-odd years.

I had to make the decision of whether to return to my regular inpatient psychiatrist who was returning to work this week.  This was more complicated than it sounds.  On one hand, I’ve seen the regular doctor for five years, we work well together and it’s important to keep her in the loop.  On the other hand, I’ve come to realise that these two have very different philosophies.  While I was frustrated at my current doctor to begin with, I came to realise that his comparatively conservative approach isn’t always a bad thing – bringing up my drugs slowly allowed me to tolerate them much better, and adding them to my chart as PRN rather than standard gave me greater control over when I increased the dose.

The deciding factor was whether I would have to change therapists.  Each doctor has a different psychologist working under them, and I was concerned that if I went back to my old doctor I’d have to change my therapist as well.  I just wasn’t prepared to change both at this late stage.  When I asked him though he promised that he’d fix it so I could see my regular doctor and his therapist.  So it was settled.  I’d leave his care and move to hers.

I was worried about this appointment, not because I’m scared of her – as the staff kept teasing me – but having explain my entire case summary to a new person is exhausting.  Plus with her less conservative approach to medication I was afraid that she’d effectively blow up this current regime and put me straight on a different cocktail which would make me violently ill, and keep me in hospital for several more weeks.

Despite my fears she did no such thing, but explained to me that she would normally be treating anxiety with a certain type of anti depressant.  Which as we know, for bipolar patients, is problematic.

She contemplated prescribing lovan, which is apparently a safer class of the drug but I know I’ve been on that before, I just can’t remember when or for how long.  If it was for a long time, that would indicate it was working.  She promised to dig through my files to see if it was in the last five years, I promised to check with my parents because I suspect it was long before that.

She also made the morning zeldox a permanent addition to my medication chart, so I don’t have to explain to the nurses every single morning why I need PRN just after I’ve woken up.  Taking it in the morning is definitely getting easier but I’m still struggling some days where I end up doing sweet FA all day really.  I have what my dad would call ‘bed days’ when he talks about his nursing home patients, where I just lie around and watch tv.   Of course dad would say that bed days are reasonable in elderly folk on their last legs who have slowed right down, not a young person like me.

Another addition to my anxiety is the demographic shift in the hospital’s residents that has happened suddenly this week.  I’ve noticed over my admissions that the hospital does go through stages of being either mostly young or mostly older folks over periods of several weeks. And there never seems to be a whole lot of inbetweeners like myself.  Maybe because they tend to assign themselves to one of the groups and manage to blend in but I’m not interested in either.  Although there are a few who, like me, do keep to themselves.

Anyway up until now, including over the holiday lockdown period, it’s been a decidedly old timers scene.  But this week has seen an influx of youngsters and whenever this happens the hospital turns into a giant sleepover party.  Shrill laughing, gossip, cliques, running in and out of each other’s rooms.

That last part I find particularly anxirty inducing.  I know that seems irrational but truth be told I would never go into another patient’s space.  And I would not tolerate them coming into mine.  In fact it’s against the rules to have another patient in your room.  Even if it wasn’t I would be enforcing that as a personal boundary.

The nurses don’t appear all that concerned; certain rules aren’t strongly enforced when nothing is being hurt except maybe the sensibility of personal boundaries.  One good thing about the youngsters is that they all want to hang out the smokers area so at certain times of the day the hospital completely clears out when they want their nicotine fix.  I do appreciate the quiet.

Something that has made a huge impression on me in my personal therapy journey is the importance of appropriate personal boundaries.  Generally – there are some exceptions of course – the older crew are totally on board with this idea, as many have been in therapy for years but watching the current lot is good for meditating on that concept.

I’m not saying that all young people suck at boundaries but, as I said seeing certain ones running into wach others rooms and jumping on their beds makes me wonder.  I could do I could do a whole other blog post on the topic but the gyst of it is, we are told that while socialising in here is fine, we are discouraged from maintaining friendships once we get discharged.  And after being admitted with certain people a number of times you often come to understand that despite presenting well freinship with them can be exhausting.  I include myself in that description, I suck at maintaining friendships.

Some food for thought might not be a bad thing, hey?  Anything to distract me from the anxiety.

Mac

Link Between ASD and Substance Abuse

An interesting article from Psychology Today appeared on my Facebook wall today:

Autistic Symptoms Make Higher Risk For Substance Abuse

Which apparently doesn’t mean people with an autism diagnosis:

‘As you would expect, previous research shows that people with autism tend to have low rates of substance abuse – the preference for low risk and avoidance of social situations means less drinking or drug use. But new research from the Washington University School of Medicine found the opposite: in their study of 3,080 Australian twins, people with symptoms of autism were more likely than people without symptoms to abuse alcohol and marijuana.’

So I think this article is saying that people toward the lighter end of the spectrum, as opposed to those with HFA, are at a higher risk of substance abuse issues.  It’s been observed that Asperger syndrome has a higher risk percentage of mood disorders than the neurotypical population.  One in three people with an Aspergers diagnosis will experience depression in their lifetime, as opposed to the one in five in the general population.

People with mental illness do tend to self-medicate.  A mental illness diagnosis reduces your life expectancy by up to twenty years and no, it’s not because of suicide.  The biggest killer of the mentally ill population are diseases acquired through smoking.  Also significant causes of death are cardiovascular diseases and diabetes.  Diseases acquired through various forms of self-medication.

Me, I have an addictive personality.  At any given time I indulge in a number of obsessive behaviours but as we know I am a hotbed of assorted psychological malfunction.  To blame my behaviours solely on any one of the conditions would be disingenuous.  Labels are useful tools for getting help but not always for treatment – rather than worrying about what was causing my obsessive behaviours the most helpful approach has been to address the psychology behind the behaviour (hello DBT.)  That way we can break the cycle and form some new ones.

So what does this mean for people on the spectrum?  It’s important to remember that association is not the same as determinism.  If you have a higher risk for substance abuse, that does not mean that you will be a substance abuser.

Like how I have bipolar disorder which means I have a life expectancy of 60.  That does not mean I’m going to drop dead on my 60th birthday, it means I have to take care of myself.  I don’t smoke.  I need to eat better and exercise more.  But also accept that there are no guarantees in life – I could walk out my door and get hit by a car tomorrow.

Be mindful of your own behaviour.  Acknowledge when your lifestyle changes and be honest with yourself as to why.  So you don’t socialise as much as you used to.  Why is that?  Maybe you’re under a lot of pressure at work right now and having to stay back long hours for a while?  Fine.  Or has your confidence slipped?  Do you not feel as close to your friends as you once did?  And do you find yourself reaching for the bottle more and more now that you’ve got more time sitting on your own in front of the tv?

Changes in weight, sleep, lifestyle should always be examined.  It’s not always going to be a cause for alarm, life is about change after all but change is not always positive and not always necessary.

Take care of yourselves

Mac