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May 27, 2008

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May 11, 2008

I weighed myself after about nine hours sleep and I weigh 14 stone 7lbs which is 203lbs or 92.1kgs. It’s 3lbs less than last week though I think I really weighed 14 stone 8lbs last week rather than 14 stone 10lbs. I’ve been ridiculously pleased with this weight loss each time I’ve remembered it all day :-) Still humiliating that it’s 14 stone anything however …

I haven’t kept the food diary this week and I’m not sure what I’m going to do about that. Probably fill it in from memory as best I can I suppose. I didn’t eat much Tuesday, Wednesday and Thursday but Friday was an all day comfort eating session. I just kept on eating random stuff from the kitchen like a whole tin of olives and sweetcorn and mayonnaise with oatcakes. In the evening I also ordered a pizza, waffles and a whole tub of Ben & Jerry’s ice cream. Luckily I had really bad diarrhoea (proper frothy steatorrhoea which made me think I hadn’t absorbed as much fat as I could have) and have even lost a pound this week. Yesterday and today I tried to be better and eat on time and have snacks. But I ended up finishing the ice cream this evening. At least it’s gone which makes me feel better.

Continuing quetiapine

May 5, 2008

I restarted quetiapine on 19th February 2008 when I saw Dr I (in place of the usual doctor I was supposed to be seeing) at the Day Service. On 4th March 2008 I saw Dr X who I felt didn’t want me taking it and thought that an antidepressant (plus medications from before) would relieve my psychotic depression. In short, I disagreed and so stopped going to the Day Service and increased the quetiapine myself to 300mg. I then went to my GP Dr McD on 3rd April 2008 and told her what I’d done. She referred me back to my consultant Dr S, who I’m seeing this afternoon, and has continued the quetiapine at 300mg.

I’m not looking forward explaining the above to Dr S. I’m going to look like an arrogant idiot and someone with the dangerous idea that they know more about medication than their psychiatrist.

Even worse, I am really torn about whether I want to keep taking quetiapine. I’ve just realised by writing these dates here that I’ve only been on the 300mg for about a month or so. And I have been taking it very inconsistently. I have not given it a fair trial to see if the side-effects reduce to a manageable level. But I don’t know if I’m willing to try and put it all the effort required to give it a fair trial. I only have so much energy (surely that’s a fair thing to say?) and I don’t know if I can.

The advantages of continuing taking quetiapine:

  • Reduces depersonalisation (though hasn’t got rid of it like last summer and depersonalisation is also helped by psychotherapy)
  • Got rid of manic symptoms last summer
  • Cures my gut symptoms (though currently reboxetine is doing that too)
  • Seem to loose weight on it and definitely don’t gain weight like with other antipsychotics
  • Don’t have the sleeplessness side-effects from the reboxetine

The disadvantages of continuing taking quetiapine:

  • I can’t wake up until 12 hours after I have taken it the previous evening unless my partner makes me physically get out of bed
  • Until about 10 hours after I have taken it the previous evening I feel drunk and am clumsy and disorientated
  • After I wake up it takes a couple of hours before I feel fully awake
  • I can’t make myself stay awake for more than an hour after taking a dose
  • I can’t make a routine for sleep
  • I think the excessive sleeping is contributing to my depression
  • I can’t make a routine for activities because the sedation takes up so much time
  • I feel really embarrassed by the above

I also have in the back of my mind that I am just completely fucking sick of taking any medication. I am sick of the valproate side-effects and the reboxetine sleeplessness. Perhaps my best plan would be to see how things go with Dr S and simply keep taking the quetiapine intermittently like I am currently. Actually, no, the current situation isn’t an option because I can’t get into a routine for sleep and activities which I need to do to recover from the depression. Oh yes, and have a FUCKING LIFE. I wish I had Dr McL as my psychiatrist. I remember her saying that I could come off all my medication if I wanted to and she would help me pick up the pieces afterwards. She made it clear, obviously, what she thought of the idea but at least I felt like I had a choice.

I want to run away so much. I feel so trapped by all this.

Weight and food diary

May 4, 2008

I weighed myself this morning after four hours sleep (no quetiapine) and I am 14 stone 10lbs which is 206lbs or 93.4kg. That makes my BMI 34.7. Same as last week.

I have been filling in a food diary for my psychotherapy. On Sunday, Thursday, Friday and Saturday I ate well and didn’t restrict. On Monday and Tuesday I didn’t eat very much and on Wednesday I had a 2555 calorie binge. I have no right to be disappointed for not loosing weight but I am. Furthermore, I agreed with my psychologist A that I would maintain my weight for the next few weeks. This internal inconsistency is just hurting myself.

Quote: loving your losses

May 2, 2008

Catherine Brighton in Pendulum, Winter 2007:

“Sigmund Freud’s seminal essay On Melancholia and Mourning published in 1917, discussed the link between loss and depression in such a way as to have an enormous impact on the way we have thought of depression since. It compares mourning, characterised by deep sadness and withdrawal, to clinical depression, where sadness is not felt and is instead replaced by a debilitating attack on the self with pathological symptoms.

… what if it is possible to visualise your losses … to give them a shape, or a colour? What if, as education theory goes, it is possible to give your loss an image, or an imagined sound, or a movement, depending on your preferred learning style?

I am aware that I do not ‘get over things’ like other people. Fearful that as I get older, I will inevitably suffer more loss and my symptoms will accumulation, I need to have a plan of action. […]

What if a way out is to, literally, love your losses? These images I have in my mind, would they lose their potency if I loved them? So much is said about loving yourself. But what if you gave yourself something tangible to love that meant something, that had a story attached, was in your preferred learning style and was there in your inner world whenever you wanted to work on it? […]

What if any knotted, twisted emotion you feel could be personified and cared for until it loses its power? Then perhaps the effects of life events wouldn’t escalate and make the underlying bipolar condition worse over time.”

Appointment with clinical psychologist

May 1, 2008

This post is dated the day I had the appointment but I’m writing it the day after. I felt good after the appointment and that it had gone well.

B didn’t give a plan/agenda for the appointment which is the first time that’s happened. Maybe she only expected to talk about how I had got on with the food diary and to see what happened. I’m a bit worried that I rambled too much and wasted time. Writing that has made me realise that that is a common worry of mine and that I should actually say it to her. Perhaps I’ve got the wrong end of the stick or perhaps she could suggest some solutions.

She asked me how I had been over the week since she last saw me and how I had found the food diary. She noticed that O the rat had nibbled the bottom of it! I said that writing down all the food had initially made me count up all the calories and think it was too much but that I had stopped doing that. That’s not wholly true as I am still more aware now about what I am eating but that has both good and bad results. It is providing motivation to restrict how much I eat seeing it written down but then again it is also providing motivation to eat snacks and eat more regularly overall. I am also eating more healthily I think since someone else is seeing my choices.

I told her that I had binged badly the day before. It was 2555 calories. I was tempted to lie and exaggerate how many calories I ate but didn’t. I lied and said I had tried to make myself sick but hadn’t been sick. I didn’t try to make myself sick. I did think about it but couldn’t be bothered – I’m not really sure why. Apathy, disgust (I’ve read some horrible descriptions), fear? I said I felt physically unwell afterwards with abdominal pain, gut symptoms (I was trying to avoid describing this further) and sore throat. The abdominal pain, diarrhoea and having a sore peri-anal area was true. She was particularly interested in how I found the physical symptoms relieved the emotional ones and asked if that was a common thing for me. It is (the whole “translating” thing) and I said it was a distraction. I think she was also suggesting that it sounded like I was trying to punish myself too which I wasn’t too happy with at the time but now I think sounds right. I’m trying to find some sympathy for my poor body going through this rather than the usual hate and disgust. If I was talking to friend after they had binged I would make an extra effort to be supportive and nice to them and probably try to preempt my friend from beating themselves up about what they had done. There is also the whole issue of how I’d much rather have a physical illness than a psychological one as I think other people, and myself, would accept it better.

We talked about what had triggered the binge. I said looking back on my food diary I hadn’t eaten enough the two days before and also hadn’t slept the night before. Also my boyfriend J is away this week. It’s really quite horrible, pathetic, bizarre, etc, how little I see other people. I don’t see a lot of I but since we moved to B I don’t see anyone other than professionals. For someone who really thrives on social contact I’m being a fucking idiot letting this situation continue.

The last things B said about the food diary were that I was doing well in the days that I ate but even in those days I should eat more calories. I’m a sad cow but I loved hearing that. It made me feel like real ED patient, which is pretty sick, but it was great to hear that I get to eat more. However, I found out today that that isn’t actually as easy as it sounds. I’m running out of hours to eat in but I’m not hungry and don’t want to eat. Also a 75g portion (recommended amount) of brown rice was too much for me to eat and I threw the last part of it away. I am supposed to be aiming to maintain my weight not loose weight. Furthermore, to loose weight safely I need to learn how to maintain my weight and eat healthily so I can find where in my diet it is safe to reduce by a small amount what I eat. Then loose weight slowly without triggering disordering eating behaviours.

Bollocks, just re-read the last paragraph: “it’s great to hear that I get to eat more”. Get to? Who decides these arbitrary rules that I have for all these different things? I decide them. And I don’t even have to have them.

I said I had realised that to get myself feeling better I have to improve my brain’s biochemistry. Thoughts, feelings and behaviours come from the brain. Medication and lifestyle changes affect brain biochemistry. I can change things and make them better. This is a really simple idea but it’s never really struck me before until I saw gem61580‘s videos. My psychologist B said that Maslow’s hierarchy of needs shows the same idea.


So what I need to do is:

  • good diet
  • regular exercise
  • regulate sleep cycle
  • see friends and family
  • increase activity
  • avoid alcohol and drugs
  • regular meditation

That’s too much to work on all at once so I need to prioritise. I expect B will want me to do ‘activity scheduling’ at some point which will help with this list. Also I am seeing my consultant Dr S on Monday and I am going to talk to her about the quetiapine and my sleep. I asked B about the quetiapine/sleep/depersonalisation issue and she said that as I had been doing much better recently and had only been more stable for a short time she would not favour change at the moment (I’m paraphrasing of course).

In regard to sleep, B suggested cutting down or stopping caffeine. I don’t drink coffee but drink a lot of tea. Stopping caffeine would also have the benefit of reducing blood sugar swings (the mechanism is caffeine causes adrenalin to be released which then sharply increases blood glucose which will trigger insulin release and blood glucose fall). According to B, more than five cups of coffee a day is a problem. I love tea but I can’t tell the difference between decaf and normal. Bit of a no-brainer there: swap to decaf.

I mentioned that the term I was trying to remember at the last appointment was emotional incontinence. I know I don’t have that and in fact don’t think I even have emotional lability (unless my sex hormones or prolactin is seriously buggered). I have the ‘tearfulness’ symptom of depression. I’m sad. My heart hurts too much for me, other people and animals. I had talked at the last appointment about how this had happened to me in the past when I was recovered from depressive episodes. In my mind it was the numb part of me getting better. B told me that that would fit in with schema therapy though it was a part that was later on in the psychotherapy course. My schemas produce the Vulnerable Child mode but that is too painful to feel all the time, especially as a child, so you need another mode to cover them. My main mode is the Detached Protector which is the fancy name for all my avoidance behaviours like depersonalisation, binge-eating, sleeping too much, alcohol and drugs, self-harm, perfectionism, etc. There’s also the Bully mode which has generated a lot of negative automatic thoughts for me and the Angry Child mode though B said that didn’t really apply to me. The aim is to ‘heal’ the schemas so you don’t need the unhealthy modes anymore but instead can have the Healthy Adult Mode. There’s a lot more to it than that but a big thing I got from it is that the tearfulness is the Vulnerable Child mode and basically I want to be kind to ‘it’ (i.e. me). If I comfort and soothe ‘it’ with healthy things then I’ll feel better and not get the bad things from the unhealthy/avoidance behaviours.

When I got home after the appointment I threw out the remaining binge food (about 3500 calories). I have beautiful yellow and peach miniature roses instead :-)