a proper post

I feel better, calmer, less emotionally violatile since taking risperidone. Such a tiny dose and it still affected my appetite. It would be dangerous for me to put on any more weight, so I'm going to stop taking it and see what happens. Hopefully the two small doses were enough to calm me down after the horrible abilify experience.

agitation

Agitation and depression. The two most horrible things. When they occur together, it's most horrible. Agitation is like having a lot of energy, but in a bad way. It's the reason I'm writing and not reading or watching tv or doing something else relaxing. Maybe having energy is good when it's energy that can be put to good use (because you can still focus on things) and when it's energy that can be exhausted. It's also not just having the energy to do things, it's a constant pressure to do things. It comes from inside. I don't necessarily want to do anything but I have to. I have energy in my head but I can't so much with it because I can't focus. I can't sit down and focus on one thing for too long. It makes it hard to read a book or work on assignments.

In this state I think that I would rather be depressed, but of course I would think that now.

I thought the agitation was caused by medication, but obviously not.

In the past I've had a lot of energy, but it felt good. I felt driven to do things, but I also wanted to do things. I think "yeah, I was doing so well in 2007". It was the year before I became severely depressed. I was so HAPPY. I had so many friends, and oh how I loved my friends. I worked, I partied all the time, I exercised so much at the gym. I was just so freakin happy. I thought everyone loved me. I didn't bother with things like studying. I didn't get depressed after a night of heavy drinking. Having a hangover was just a relaxing day. Drinking was an ecstatic experience. So was dancing. When I went out dancing I could picture myself doing it forever. It seemed like the most important thing in the world. I felt attractive, alive, charismatic. All this is actually very unlike me. I change a lot, I guess. I miss that person, though. I miss being like that. I thought things would be that way again. I just miss feeling that way. I was on top of the world.

Was this some sort of pathology? Was I actually hypomanic, instead of being a normal, outgoing woman in her early 20s? Normal... no. Not normal for me. Maybe normal in that I've experienced these shifts in my social functioning before. Am I shy or am I that outgoing, confident, social, talkative person?

I remember feeling high sometimes, as if I had taken ecstasy. I didn't need drugs to get high. I just needed some music, some people and some booze. I've been chasing that high. I still go out dancing sometimes, and I wonder what happened to my high. It's not that I'm depressed, I just can't believe the huge shift in my experience. Of course, I'm older now. These things get less fun.

So maybe agitation is just energy without the high. Anyway, it sucks. But everything shifts, nothing stays the same. Maybe tomorrow I'll feel normal and subdued. Or maybe I'll have positive energy and try to write a book. I'm just so glad I'm off the abilify and I don't have to put up with that level of agitation and anxiety. I feel so much better now. No drugs. I'm supposed to take risperidone tonight.

Why am I being prescribed these drugs? I really don't understand. Maybe the doctor has some theories he's not telling me about, or maybe he just likes these drugs a lot. I certainly don't think that people are usually prescribed antipsychotics because they have anxiety. At least he didn't put me on another antidepressant. Well, which is worse? I don't know. I don't want to take anything, I don't want side effects on top of symptoms. It's too hard to know what the drug is doing to me. I feel so much clearer without any drugs.

Hmmm... risperidone. Should I try it? Just so I can say I did? It will just knock me out and make me feel weird. How can I possibly believe that it could be any different?

apprehension

I'm about to go to the psychiatrist. I hope I get something good out of it, like a referral, and some better medication options (even no medication would be good). I know I have to be realistic about medications, but I struggle with being on them when I don't even know what's wrong with me. Abilify gives me energy and that's about the only good thing. I could get more energy by sticking to a schedule, which I think I should do anyway. I'm already in the habit of waking up early, now. Abilify may have corrected my sleep problems, but then it created more. I woke up at 1am yesterday. I was agitated so I stayed up. It makes me feel so awake, so aware. Aware of every emotion, aware of sounds that might be someone breaking into my house (this has happened to me before, without the help of drugs, but I hadn't experienced it in a while).

Having energy is so good, being agitated is so crap. I think that you can't have one without the other when medication is involved. You can have energy and still be calm, which is ideal. I just want to feel like myself, which I do more so today after not taking abilify.

What if it's also really improving my mood? I almost forgot about how depressed I was before. Well, right before I started abilify I wasn't exactly depressed. I was already a bit agitated. My thoughts were racing and I had more energy. That was one of the things abilify was supposed to help with, but it's made it worse. Sure, I'm not depressed, but I go through so many intense and overwhelming emotions in a day. I've started to use the DBT technique of recognising my emotions without being judgemental. As soon as I feel sad or empty I usually automatically think that I'm slipping into depression. I've realised that's not always the case. It's just an emotion, and I have them a lot. They may be very intense, but that doesn't mean they will last forever. It's a big deal for me to realise this.

Anyway, I think that abilify will be exceptional when it comes to preventing depressive episodes. I would like to go on a lower dose, though. Hopefully then my anxiety and agitation won't be any worse than usual. I feel quite good this morning, and I didn't have abilify yesterday, so maybe the lower levels still do something good.

I'm trying not to think about this medication and black-and-white terms. Abilify is grey, just like everything else. It has good and bad effects on me. I'm supposed to weigh these up, with the help of the doctor.

If the abilify helps me to improve, then that is the most important thing. I'll improve with more energy and less depression, but I'll also be hindered by increased agitation and anxiety, plus the lack of sleep does not help. I don't want to be given seroquel to help me sleep. I have no trouble falling asleep, anyway. I don't want someting that will help me stay asleep, because then I will be sleepy all day, and that will cancel out the good things about abilify as well as the bad things. Or, I could always try. I guess I can't judge a medication until I try it.

I still want to try lamotrigine. It might actually help reduce the agitation. I think it's been months now that I've been feeling agitated. It's not just a transient thing. I haven't sat down and read or watched tv for a long time (or if I try, I feel too restless or get distracted). It's horrible not being able to switch off. It's great that I'm motivated to go to the gym, but I can't be at the gym all the time. I can't be doing things all the time, I need to be able to relax.

I hope this blog will give me some insight and help me along the way. I come up with things that I wouldn't if I were just ruminating. Rumination just leads to repetitive thoughts, anyway. Once I've written something down I'm less likely to write it again, so at least I come up with stuff that's different. I've been doing a stream of consciousness sort of thing, just writing what comes into my head. Hence the writing seems disjointed and abrupt. That's okay, though, I'm not writing a book.

Okay, it's time to go get on the bus.

DBT

I really like the idea of radical acceptance, and it's a technique I found myself using before I'd heard of it. For example, it's 1am and I'm awake after a few hours of sleep. After years of having problems with insomnia, I gradually stopped fighting it. If I can't sleep, I can't sleep. It usually doesn't kill me. Getting angry and frustrated over not being able to sleep definitely doesn't help. Focussing on something else for a while and seeing that if I don't sleep now, I will most likely sleep later, does help.

I guess not having a job makes it easier, as does being on abilify and having extra energy. When I knew I had to get up early for work, I used to get really anxious if I couldn't sleep. That's got to be the least helpful possible reaction.

Tonight I kept waking up, thinking of someone breaking into my house. I feel in a constant state of hypervigilance. I've been through this before. I wonder "why now?", though. Why, when I've found a medcation that seems to reduce my depression symptoms am I more anxious? I think that any medication that gives you so much energy is probably not going to do much for your anxiety. But, it's not a good reason to stop the medication. I would still have a problem with anxiety if I weren't taking it.

One of the reasons I'm so interested in DBT is because it was created for people who don't respond to other therapies like CBT. I think I'm a good client, one that is not difficult to deal with. I listen, I learn, I do my homework. I would never say anything mean to a therapist. I don't know them well enough, and I tend to idealise them anyway. Not to the extent that I would become attached, but I do tend to expect certain things of the therapist. If these expectations are broken I usually blame myself. Otherwise, I might decide that I'm just not comfortable with the therapist. I would never ever ever disrupt the therapeutic relationship. I might be too nice, trying to avoid not-so-nice topics like self harm and suicidal thoughts.

The only time I can be mean is in a relationship where I am sure that I'm completely accepted by the person. I don't ever have the urge to do or say anything mean to anyone, unless I'm taking some emotion out on my boyfriend. That's usually how it is. I wouldn't be able to do that to anyone else. It's not just that I'm completely accepted by him, I also know that he can take it. I don't think I've been so mean since I was much younger and I had my little outbursts. Most of my adult life, if someone made me angry I suppressed the hell out of that anger. When I was in high school I was more a fan of the cold shoulder method. I used that a lot as well in my first long-term relationship. I didn't know what else to do. At least now I talk about my feelings. I just express them in the wrong way sometimes.

Exercise and alcohol saved me from anger and a multitude of other negative emotions in 2006/2007. I thought I was doing well in those years, but maybe I was just doing well enough for my coping strategies to work. I drank socially, I did everything socially. Except for exercise, that was something that was for me. It's such an important part of mental health, I think. Exercise sure does make you feel good, unless you're depressed. That's how it seems to be for me anyway. If exercise works as a treatment for depression then it must take a while for the effects to kick in. I sometimes felt worse after attempting to exercise. Going for a walk made me see how desolate the world was. Depression is full of D words: desolate, dull, deformed, destitute, dreary, dismal, deserted, devoid, dismay, drab, devastating, deprived, depraved... I could probably come up with more.

DBT prioritises self harm as a behaviour to reduce, but the one I most want to reduce is binge eating. I don't do it to extremes, but it would help me so much if I had some control over my eating. Not full control, but not a loss of control either. I want to be able to eat just as much as I actually want to eat. I want to be able to stop eating when I don't feel hungry anymore. I want to eat sweets and savour them, not satisfy some intense urge that makes me feel out of control. I want to eat without that feeling of guilt. I want to see food for what it really is: a source of energy for my body. I want to be able to stop eating earlier without it feeling uncomfortable. Maybe that last one is asking a bit too much, but I'm hoping that with practice, eating normally will be normal to me.

I guess I could start by trying to stick to a meal plan and then writing down how I feel, and coming up with some self soothing activities. Right now I actually feel hungry but I still don't know if I "should" eat. Maybe I should make it a goal to eat when I'm hungry, and to not eat when I'm not hungry. Maybe the feelings of guilt will go away.

I spend a great deal of time and energy thinking about whether or not I should eat, whether or not I should stop eating, whether or not what I'm eating is "healthy", how many calories I might be eating etc. The difficult thing is that I want to change my eating habits while at the same time thinking about food less. How can I remember to work towards my goal without thinking about food? The more I try to change my eating behaviours, the more obsessed I become with food, and the more I just want to eat but try to stop myself.

I usually have those two things working against each other: I want to eat and I also want to stop myself.

coping strategies

My favourite coping techniques are eating, drinking booze, cutting and occasionally taking lots of OTC drugs. I should probably be more careful with multiple drug combinations. Take 5 that can't kill you at any dose and you're actually at high risk. When I had to get my implanon taken out and had extreme anxiety I took about 1000mg of valproate (which I hadn't taken at all in a while), 6 nurofen plus (probably about 75mg codeine), my usual 5mg of abilify and about 6 kwells. This was over the day, so at least I didn't take it all at once, but it was dangerous nonetheless. I didn't think of that at the time, all I cared about was getting through the implanon removal procedure.

I have had such terrible anxiety, which I was quick to blame on the abilify, but looking back at previous posts on this blog I can see that anxiety was already a problem. Agitation is usually dealt with using booze and food. Intense sadness is best dealt with by cutting. Anxiety is what brings on the drug use.

My friend just came around to say hi for my birthday and even just talking to her made me feel so anxious. There was a time when I was confident and outgoing. I was even pretty stable. I don't know what happened there, it's quite unlike me to be confident and stable.

I get all the physical symptoms of anxiety, which is the only way to know it's there. It's easy to not realise that what I'm experiencing is anxiety. I usually just focus on the problem I'm dealing with, not realising that the problem is actually anxiety.

Some things that make me anxious: making and receiving phone calls, reading text messages, checking email or facebook, opening mail, pretty much any sort of social interaction, checking my bank balance, attempting to do anything... and then there's the free-floating sort of anxiety that isn't connected to anything in particular.

I know that problem solving skills might help with the general anxiety but what is there to do about social anxiety? I don't always avoid these things so I'm getting plenty of exposure. I think some hardcore psychotherapy is what is needed. I'm just waiting patiently for a referral to a good psychologist.