Need help? Yes, but not like that.

I must admit I first saw reference to this in the Metro, run under some nauseating yet attention grabbing headline. I saw it re-run in the Expressly Fail which never instills confidence that the article is what it might first seem. But then I saw a link to this video on the BBC website.

In it, Gail Porter talks to Radio 5 Live’s Phil Williams about being sectioned under the Mental Health Act.  It is a compelling listen. Not only does Porter talk about the shock and anger of the experience (her partner signing the forms to section her, the drugs and the two Jesus on her ward), she also highlights the difficulties for any one struggling with fragile mental health to express their needs and the failure of the health service to offer help in the way that it is needed by the recipient.  Let me pick up two of her points as something I can closely relate to.

Part of Porter’s sectioning related to a text she sent that she was feeling suicidal. To those who have not felt this way this evokes strong emotions: the feeling of wanting to end it all is equated with an executable plan and will to do so.  The law in this case certainly saw it this way and as such there is an urge to “protect” that person from the harm they are intending to do to themselves. But in all walks of life there are different degrees of feeling and intention.  As was explained to me, the feeling that you want to kill yourself is not the same as making plans to do so. What seems a subtle distinction on the outside is a huge leap for the person in that position.  Explaining this can be a huge relief, it was for me.

Yet explaining this is all part of offering appropriate help, support and care. As Porter also highlights, her partner was signing the forms out of love yet the response of the system seems far from this. She was taken to a secure hospital, given drugs and queued up to see a doctor.  I have expressed my views on the approach of the health service before but again this case highlights the way in which mental health problems must reach crisis point for the sufferer before help is given. Porter’s words illustrate this better than me rehearsing my own experience again (click here, here and here to revisit them if you so wish). For Porter, as with so many others, asking for help is difficult and is expressed in what the wider world sees as a worrying and inappropriate manner. And when the response is as harsh as this is it any wonder we hold it in through fear.

Of course, each individual has a different case and it would be inappropriate of me to suggest that we all suffer in the same way. But at the same time there are many shared stories of both the way in which talk about our problems is difficult and the failure of statutory authorities to provide effective help at an appropriate stage. As much as it is about individuals feeling less fearful of speaking out it is up to the health service to demonstrate that the help is there.

There may be tumult ahead

Its well over a month since I went drug free and I’ve not updated many people on how it is going.  I know from the responses of friends and strangers that the honesty of this blog has been helpful for others. In all fairness, it’s a cathartic process which has also been useful to me – and of late I’ve ignored it a little at a cost which will start to become apparent. So, here’s an attempt to get the reflection and space to breathe back on track.

So far, so….well, that’s the tricky bit.  In some ways it has been good. Let’s start with the physical side. As those of you on medication will know, each type of drug has its own physical side effects.  For me this affected me in a number of ways.  Its hard to talk about all of them in this forum, but let’s just say that they left me feeling frustrated.  This is one side effect which I am glad has disappeared and with it there has been a reduction is some stresses of life.  However, since stopping the medication I have felt much more tired and quite lethargic. It’s almost as if somebody has taken the fuel injection away at times.  So shall we mark that one at 50%?

And what about my mental well-being? As the old song says, there may be trouble ahead and its a combination of things that let me face the music and dance.  Sometimes this is with outright success where my brain almost switches off and my reactions feel normal (whatever that may mean!).  At other times the second voice kicks in to remind me of what I need to to do. And there are the times when I feel like facing up to the challenge, shaking hands and sitting it out. You might think that is rather depressing and at the time for me it certainly can. But sitting here typing now I feel a small glow of satisfaction that I am aware of my limitations.  With time I can push at the edge of these and grow a bit more. But each step at a time and yes I’m writing that as much to remind myself as I am to tell all of you.  I think we’ll give this about 40% so far. In government speak there’s room for improvement, at least I’ve got the tools and resources to make it happen.

And with the start of the Tour de France, lets employ a few analogies that will no doubt be embedded in the commentaries for the next 3 weeks. My time on the drugs is almost like week 1 – a fast and furious ride, attacks each day and the focus of the race constantly shifting.  But week 1 is the start and by its end a pattern is emerging. Week 2 is where it all starts – the climbs increase in intensity, the mountains loom on the horizon and the real battle begin. This is what it is like being drug free.  But as has become the mantra of the British Cycling coaches, it’s all about marginal gains.  When you’re coming off the drugs its time to mark those margins, plug away at the next success, knowing that smashing records isn’t always what is needed, doing just enough to win is. In some ways I’m struggling. In other ways I’m winning. Each stage at a time and lets see where it takes me.

Cycling and depression: finding a balance

This afternoon I read Cyclismespandelles’ blog on cycling and depression. I think the blog speaks eloquently for itself and I’d encourage you all to read it – cyclists because our love can be a dangerous obsession, non-cyclists because…well, because you read my blog so must have some interest in this (and it still could happen to you!). I’ve also commented on the blog itself so you can read my additional thoughts there. And if you found it helpful please pass it on to others.

Ex-professional cyclist Tyler Hamilton (in the news again recently, which you will know unless you were asleep for 60 minutes) claimed in 2009 that his second positive test for doping (DHEA) was the result of his taking a herbal remedy to counter longstanding depression (Bonnie Ford of ESPN as usual does an excellent job of summarising here). Hamilton is not the only professional cyclist to have suffered from depression during or after their care … Read More

via cyclismespandelles

A view from the inside

I saw this post from @lamsimon retweeted by my good friend @MrsBYork this morning. Having previously posted about my own issues with prescribed anti-depressants, this is an interesting, considered and, yes, slightly sarcastic view of their benefits. Again, I’m amazed by just who can suffer from this mental anguish and never let on in their day to day life. Thanks Simon for this input.

16/05/2011

Drugs and Mental Healthcare

 
Recently I was accused of exploiting my illness for financial gains. That’s nothing new and whilst I write this from my anchored yacht just off the coast of Portofino, my latest antagonist isn’t the first and certainly isn’t going to be the last piece of sub-human scum to take that poke at me. He will simply be yet another difficult, uncomfortable person wishing us “loonies” would shut up about being mad and take our vicious, vile, evil and coarse language somewhere where we can’t be heard. In the past that is what used to happen. We were locked up in hospitals left to howl to the moon out of sight of the comfortable classes, who have jobs and pay their taxes. Then a lovely old grey haired lady came along in the 80’s and threw us all out onto the streets and that’s where the trouble really started. We got accused of all sort of evil things, we still do. Whenever something really bad happens the protagonist’s mental health is always first thing to be brought into question. We were out in the community, drugged up on anti-psychotics. Loons looking to eat your children!

Well nothing has really changed it seems, we still are looked upon in that way unfortunately and most of us are still on drugs. And that really is where the stigma of drugs comes from. Not only are we crazy individuals looking to abuse everyone and everything, but look out, if your doctor tries to give you the same drugs you will turn into one of us too. THE WALKING DEAD. Look out if one of us is angry or pissed off because you won’t know what to do with yourself. But don’t worry, you can still be angry with us. We might be mentally ill but we might also just be an arsehole. Damn this mental illness game we play it’s so difficult to understand.

But, this article isn’t about that. It is about drugs and why some of us need to take them, why they can be so scary to start, and why even the mentally ill who need them talk so badly about them.

Almost every person I know now, who has to reply on medication, hates to be on medication. We all do. It’s natural to want to be natural. But think of this. If your friend discovered they had diabetes. Would you criticise their need to take insulin? Probably not. Insulin is a major force in the treatment of diabetes, it would seem natural to take it if your body needed it. So why the stigma around mental health drugs? Depression is like diabetes, it is something that never really gets cured. It simply gets managed. We manage to live with it, sometimes well, sometimes not so well, just like the diabetic. Drugs for depression never really cure depression, they can’t, and unfortunately that is something that anyone who finds themselves suffering from this type of mental illness has to come to terms with. The drugs simply help the sufferer carry on and at some point we might need more or less. Sometimes we might not need any. Sometimes we might need a lot during a crisis in our health.

In the last four years I have taken a lot of drugs and had a lot of bad times all in the attempt to try and help control and manage my illness. Risperidone, Clozapine, Quetiapine, and Ziprasidone. Olanzapine, Aripiprazole, Lithium and Citalopram, Fluoxetine and Sertraline. I think that is most of them.

Some of them have helped and some of them have turned me into a walking zombie. Yes that last statement is true, some of these drugs will turn you into a walking zombie, especially Olanzapine that one is an evil little bugger. I do nothing but dribble into the pillow on that drug but unfortunately at some points in this last four years that is what I have needed to be like. My mind has needed that rest and just like the cancer patient whose drugs ravage their body some mental health drugs do the same to your body.

At the moment I’m pretty drug free. I only take a small dose of Prozac (Fluoxetine). Just to keep the wind in my sails. Around Christmas 2010 I was completely drug free, no drugs at all for three months and then I had a little breakdown again in March 2011 and had to go back onto the drugs.

The point I am trying to make is, that is how it goes. If you find that your doctor has suggested you go onto anti-depressants, or need to go back on them don’t be scared. Question their judgement sure, find a good doctor. Find out as much as you can about them first, do your own research, but really, the most important thing is don’t be scared and don’t think badly of yourself or your illness. You may only need them for a while but you may also need them for a long time. Unfortunately you are taking them because you are one in the four people in this country who might need to take them at some point in their life. So, whatever situation you find yourself in be it social, political, economical or whatever, there is a likelihood that someone else in the same room, same workplace, same school is going through a similar thing. Soon you will realise that talking about these things is not such a difficult thing to do because you aren’t mad you are just unwell and illness comes in many forms and is treatable in many different ways. All of those ways are valid to some point at any given time. Don’t rely on the drugs to make you better. They won’t, they will just help you get out of bed in the morning and sometimes that is all we need to then go and do something naturally beneficial like a good diet or exercise to help us back on the road to recovery and manage a stable life.

 

Scientist, you’re a failure.

Yesterday saw my regular prescription check-up with the GP.  Having now come to the end of my counselling and having thought long and hard, both on my own and together with MrsAB, I’ve taken the next positive step in starting to come off the anti-depressants.  Now, I have tried this before but as they say, hindsight is a wonderful thing and at the time I think I was making too large a leap far too soon.  This time I feel I am in a much better place mentally and physically. As I’ve previously said, the counselling has provided me with the skills and tools that I need to get through the ups and downs life invariably throws at us. So its time to throw away the crutch.

That’s almost an aside though from the real story I wanted to share, one which follows on neatly from last week’s series of posts about the eagerness of the medical profession to prescribe solutions via a pill.  Yesterday I went to see the GP for his professional and scientific advice about the best way to reduce and stop the dosage of anti-depressant I am on.  I have been taking an SSRI called Citalopram and I am all too aware that you cannot just stop taking the pills. Instead it is recommended that you taper the dosage to prevent withdrawal symptoms.  Not only did the GP, my sister in law (a former mental health social worker) and my cycling buddy (a medical writer who worked on developing Citalopram) all tell me this but my previous experiences of trying to come off it have shown that you can withdraw too quickly and spike when taking the next dose.  This latter experience though highlights another problem: how do you reduce the dosage and still feel good?

As I said, I sought professional, scientific advice from the GP about how best to do this. I was expecting a definitive answer. Actually, I wasn’t expecting a definitive answer as each time I’ve asked a different GP I’ve received a different answer.  At least yesterday the GP told me that there is insufficient advice about how to do this.  It would appear the instruction manuals only go up to prescribing the stuff.  Conspiracy theorists might want to suggest that this is evidence of the drug companies locking themselves into a lucrative profit cycle. I’m not really bought by that.  What concerns me more is that having been too ready to prescribe medication, the medical profession themselves are running blind during the treatment. Surely this is wrong. Surely a profession based on science should have a basis in hard, scientific evidence. Surely if you are to prescribe a form of treatment you want to understand the odds of it working and ultimately what the outcome for the patient should be.

Instead it seems that we have placed our trust and faith in a little white pill. As the pressures of modern life continue to build the answer seems to be to mask the real causes and try and carry on as normal.  To break that cycle takes guts on the part of the patient and shows up the medical profession for its blind faith.  If anti-depressants are part of the solution then we really need to understand the full course of treatment from prescription to end, patients and doctors need to be fully informed about the true extent of the course of action.

So I’ve taken another step. I’ve now reduced my dosage and we’ll see how it goes.