I heard you like emotional stress
November 19, 2013 4:56 AM   Subscribe

Managing my mental healthcare has become stressful at precisely the worst time for it to be stressful. Please can someone advise me on how to play this. I feel like the anxiety about what happens next is making things worse right now.

My depression is back. Which is horrible and not at all what I wanted to happen. It probably has to do with a with a misguided attempt to reduce the dose of my antidepressant in June, but I have been back at the top dose for one week and five days now, and am still not feeling like a person yet.

This episode has been going on since mid-September (at first we didn't change up my meds, in the hope that I'd learned enough coping strategies in therapy to get through on my own), and I'm getting a bit frantic. My GP put in an urgent (NHS) referral to psychiatry the Wednesday before last (also when the meds were changed), but the psychiatrist's office has been humming and hawwing and as of the end of last week I still didn't have an appointment.

In the end I cracked and told my parents what had been happening (which I don't usually do) and got them to arrange me an appointment with a private psychiatrist. I hate doing this, but I really don't want to end up in hospital or worse. I am off sick this week, which I've never done for depression before. I am so sick of this I can't even describe it. The private psychiatrist can't fit me in until early Thursday morning, although they have promised to let me know of any cancellations.

Meanwhile, I called up the NHS psychiatrist today, and they have finally made me an appointment for next Tuesday. It seems like an age away, but I am starting to waver on my decision to bypass the NHS; part of me worries that private treatment isn't going to be as good or as joined up. Should I go to both appointments? Is that just going to piss everyone off? I don't even know how to explain my decision to my NHS GP. I feel as if I'm losing faith in pretty much all avenues, and I'm very very tired of calling up all the time to chase appointments and be annoying to people.

My GP has given me some diazepam to take while I'm waiting for further advice, and I've been taking it, but sporadically because I'm worried that it's going to prevent me from doing the other things I need to do to get better. Except I don't know what those things even are right now. Plus, it doesn't make me less depressed exactly, just sleepier. I don't feel like I have time to wait for this to be over, because every day it goes on makes it less likely I'll get my life back in any kind of shape at all. I mean, I've already fucked things up with my job (who won't feel like they can rely on me any more) and my parents (whom I was trying to protect by keeping them in the dark about all of this). I feel like I'm making a real idiot of myself, but I'm really getting to the end of my rope here. What the hell do I do?
posted by Acheman to Health & Fitness (14 answers total) 3 users marked this as a favorite
Breathe. Get yourself in one piece the end of this day.

You are in the throes of a period of depression and anxiety -- and it can take 3-4 weeks for some drugs (you're on some type of SSRI I guess?) to kick in. You're not there yet. These meds have worked for you before, yes?

One of the cruelest parts of depression is just when you need to get help, and navigate a maze of doctors/appts/decisions, is exactly the time when just getting your socks on seems impossible. You've done great with that so far. Don't worry about pissing doctors off. This is their job. You're not annoying -- you're sick and need care.

The extent to which you've made complications in the rest of your life (your job and your family) is not something you can reliably judge right now. The depression talking in your brain wants to tell you IT'S A DISASTER that can never be fixed. Try and shelve all that long-term evaluation for at least another couple weeks until the meds are kicked in.

You've got a week off work to practice radical self-care. Do that. Hang in there.
posted by pantarei70 at 6:04 AM on November 19, 2013 [2 favorites]

I don't even know how to explain my decision to my NHS GP.

What's to explain? You've been urgently waiting for a referral; your parents offered to help pay for a private psychiatrist so you could get seen sooner. GPs see this all the time for all sorts of fields. They can even make referrals to private doctors. S/he won't be pissed off with you.

I don't have any experience with psychiatry in the NHS so I'm not going to tell you which appointment (or both!) you should go to, but I do think your GP would be a good person to ask, assuming you feel comfortable talking to him/her. You can call up the GP surgery and say that you need to speak to your GP - or any GP at the practice - now, today, over the phone, and it is urgent, and then ask what you recommend they do re: the appointments. Even if you don't feel comfortable doing this, or if you're just tired of phone calls and chasing appointments, you can authorise your parents to ask on your behalf.

Your worries about fucking things up for your job and your parents are not things you can address right now, and it sounds very much like that's your depression talking. Just hang in there and hold on right now until you see the psychiatrist.
posted by Catseye at 6:18 AM on November 19, 2013

I have been back at the top dose for one week and five days now, and am still not feeling like a person yet

If it's an SSRI, taking well over a week to kick in is par for the course. So keep taking that top dose (regularly! don't let your depression tell you that doing so is useless, or make you fuck around with missing days!) and you will feel less hopeless quite soon.

Should I go to both appointments?


Is that just going to piss everyone off?


I've already fucked things up with my job (who won't feel like they can rely on me any more)

A year or two ago I got a herniated disc in my lower back, and had to stay flat on my back in bed for three weeks on medical advice. My employer survived, as did my job. So will yours. Illness happens.

and my parents (whom I was trying to protect by keeping them in the dark about all of this).

You can't protect people who love you by hiding from them something that might actually lead to their losing you.

I feel like I'm making a real idiot of myself

You're not. You're just ill.

What the hell do I do?

Let people who love you, and people who are paid to look after you, do those things. Accept help.

More importantly there's something you need to not do, and that's give up on yourself. You feel like crap right now. It will pass. You've felt good before and you will again.

Remember to breathe.
posted by flabdablet at 7:59 AM on November 19, 2013 [3 favorites]

Have you told your supervisors at work that you're battling issues? You don't need to go into total detail but simply mentioning 'I'm getting treatment for depression' for instance to your boss will put things into better perspective. IDK how the laws work but it'll at least establish you're not some clutz messing up his job, you have an illness.
posted by thermonuclear.jive.turkey at 8:13 AM on November 19, 2013

Response by poster: It's Mirtazapine, not an SSRI. When I've changed doses before I've seen at least a bit of an effect by now.

I feel like a self-indulgent twat because I am still just about able to act like everything's normal, like when I saw my Dad yesterday (I needed him not to think things were too bad). It's just that that takes a lot of effort and increasingly, I don't want to be in situations where I have to do that because it's so draining. Right now I'm sitting in bed trying to put trousers on and crying. It's fucking ridiculous.
posted by Acheman at 8:17 AM on November 19, 2013

Best answer: I feel like a self-indulgent twat because I am still just about able to act like everything's normal, like when I saw my Dad yesterday (I needed him not to think things were too bad). It's just that that takes a lot of effort and increasingly, I don't want to be in situations where I have to do that because it's so draining. Right now I'm sitting in bed trying to put trousers on and crying. It's fucking ridiculous.

I am not a psychiatrist, but I've battled depression for more than 35 years and I would urge you to think of these feelings (bolded above) as symptoms of your depression. In my experience, one of the most horrible things depression does to you is make you feel like this disease is your own fault, like if you were just a better, more motivated person you could have this licked. It's a lie, one of many lies depression tells you, and one of the worst.

Keep both appointments. You've not mucked anything up. You are proactively seeking care you urgently need in the nearest possible timeframe. The doctors will not judge you for it unless they are shit doctors, and if they are shit doctors, then the problem is that they are shit doctors, not that you did something wrong.
posted by KathrynT at 9:07 AM on November 19, 2013 [2 favorites]

Re: Diazepam... depending on how strong they are, you can cut them into halves or quarters.
You can "take the edge off" of being anxious or worried without getting too sleepy.

And KathrynT pretty much said what I was going to say.
posted by luckynerd at 9:44 AM on November 19, 2013

I take mirtazapine, too! It's only one little part of the cocktail my psychiatrist and I have worked together to achieve over time. Here's some things to know about mirtazapine:

You know how at a really low dose, say 15 mg, it can make you really sleepy? It's a night med for that reason, often prescribed for depressed folks who can't sleep. But when you push it to 30 mg, the sleepiness effect doesn't kick in as much. At 45 mg, it's non-existent for most folks. Actually, the medication can have a weird anxiety-upping side effect at high doses.

So it may be that you need the diazepam along with the mirtazapine. Did your doctor give them to you to take as-needed, or to take at prescribed times daily? If it's at prescribed times, that may be to tamp down any anxiety associated with being on a high level of mirtazapine, so you might want to try taking the lowest dose possible -- even during the day, for a few weeks -- to keep things steady.*** Obviously, talk to your doctor about all this. And the psychiatrist(s) you see.

What you do now is just be astoundingly kind to yourself. Take hot baths. If you can focus enough, watch your favorite movies. Read your favorite books. Spend time with people you love, and whose company puts you at ease. Eat things you like. Get a massage or a pedicure. Breathe.

If you can, try to do as many of your ADLs (activities of daily living) as possible. This means wake up, shower, brush teeth, put on clothes, eat, go out of the house. Keeping up with those sorts of things is important, especially if you're not able to go into the office, because doing your daily stuff can keep you from spiraling even further downwards. It also provides a sense of satisfaction. "See? I'm still a person. I just put on BOTH my socks. Take that, depression!"

***Note: I am not a psychiatrist. I am a psychiatric patient. Please adjust your expectations accordingly.
posted by brina at 1:20 PM on November 19, 2013

I have no advice for you except to say that I did the same thing--I was in trouble, couldn't get in to see a psychiatrist quickly, and found a psychologist who could squeeze me in sooner and help me over the hump. I kept both appointments. There's nothing wrong with that.

It may help for you to let your parents know how much you are struggling right now. Seriously, it is hard enough right now--let them help you.

Good luck, and hang in there. I know every hour feels like a year but you will make it.
posted by elizeh at 4:26 PM on November 19, 2013

I don't know the dynamic in your family at all but in my family everyone seems to try hard to keep everyone else from worrying and the ones being protected from worry hate it.

I know my own (adult) children want to protect me from worry (and, sometimes, I suspect, don't want to deal with my worry either) I WANT to know if something is going on. It is in my job description as a parent - allowing me to know what is going on, even if I can just listen and can't actually help makes me feel like I'm doing my job as a parent.

Actually if works the other way too. As an adult child, I want to know what is going on with my parents and in-laws. It wasn't until my husband was in the hospital three times in 18 months, that I finally convinced his parents that if they wanted us to tell them about his health, they needed to be equally forthcoming about theirs.

I know families are complicated but consider whether you can be more open with your parents about what is going on and if there are any other ways they can help you. (Stock the frog? Drop off some hot food? Call just say hello? Go the doctor's appt with you?) Good luck.
posted by metahawk at 4:46 PM on November 19, 2013

Hi there. Nthing all those who said to give your medication more time to kick in again. I'm not familiar with what you're taking, but it's likely that playing with the dose can cause some (unwanted) effects.

Don't mental afflictions kick up when we least need them intrude in our lives? I've been there; heck, I AM there. Anyway, don't take it as a sign of failure to master coping strategies. If you couldn't cope at all, you certainly wouldn't be seeking help from multiple sources. I, too, have also felt that an "episode", for lack of better term, has caused all sorts of ripple effects in my life re: job, social circle, etc. Turns out it usually does not. And, if it does, you will get through that, too. But, one thing at a time, here.

As far as the doctors and keeping or tossing appointments, I would keep them both. You are responsible for seeking care when you need it and advocating for yourself (which you are doing), not for the feelings of one provider or another. Sometimes you have to be persistent (read: annoying) to get things moving, so don't worry about calling multiple times regarding your appointment. I know it's tiring, believe me! But sometimes that's the only way to get what you need.

Take a breath; you will make it to the day of your first appointment, even though it may feel like you won't (been there, too). I know how it feels to feel like I'm asking for help all over the place and that behavior is making me look ridiculous. Persist, however, in making sure you are getting the treatment you need. It is highly likely that the scenarios you see in your mind (of how you're acting and/or feeling) are not at all what those on the outside see. It's much more of a clusterf**k in the head!

Sometimes we have to put ourselves into a different mindset to get through the day, regardless of the cause of pain. See if you can find that place in your mind and make the decision to go through each day as "normally" as possible, meaning, doing your usual routine.

If you trust your parent or parents (or siblings), go ahead and talk with him/her/them about what's going on. You will feel better, they will be better able to help you, and you won't be carrying the burden of what you're going through alone, as well as that of being responsible for their feelings (by trying to protect them).

One thing that helps me when I'm anxious or having a panic attack is remembering that, "This isn't the end of the world. Everyone will survive if I x, y, or z".

Please update us after your appointment(s).
posted by msbadcrumble at 3:00 PM on November 20, 2013

Response by poster: Went to the Thursday appointment and ended up in hospital. :( I really wish I'd been able to stop this happening, but I suppose it could have been a lot worse.
posted by Acheman at 2:07 AM on November 25, 2013

Oh, no, I'm so sorry!

I wish the hospitalization hadn't been necessary, but I'm glad you got some acute care. What's your situation now?
posted by KathrynT at 7:22 AM on November 25, 2013

Response by poster: Still here but yesterday I got taken of one-to-one supervision and am now allowed to be alone in 15 minute intervals. Everyone keeps telling me this is going to get better. I think my housemate Bows of Bow just asked a question about trying to find some running shoes without laces.
posted by Acheman at 12:00 AM on November 26, 2013

« Older Unwanted Stuff On My Cat   |   From Dixons to Nixon Newer »
This thread is closed to new comments.