Mirtazapine Withdrawal - 9 months on..

Hi Folks,

It's nice to be back again after a wee break. Unfortunately, I wasn't sunning myself on a beach somewhere or hiking in the hills.. Rather, my choice of destination was in fact my bed, where I have been practically living for the last month.

Mirtazapine Withdrawal - 9 months on and things haven't been so good...Lots of tears, feeling like a dead statue, plans to do a runner and feeling suffocated and hemmed in with stress.

I think I'm starting to pull out of it now, but mind you..every time I say that, the next day turns out to be terrible!

It's been pretty bad, and I've been shit scared about the possibility of having to go back on the drug. It's not made any easier by friends and family telling me to restart it..'It doesn't matter how bad the side effects are dear' (Yes, but you don't have to put up with the bloody side-effects) ..'You were much better on those pills'... (You obviously have a very short memory!)

Considering how I was affected by the medication, (see my previous posts Mirtazapine Withdrawal and Mirtazapine Withdrawal - 6 months on.. for more info), I don't see restarting it as an option. Although I've been feeling bad, I still enjoy the perks of 'freedom' from Mirtazapine. My mind is clear(er), I don't have the terrible thirst I once did and my sleep is so much better.

The way I see things..in the last 9 months I have given up my flat and moved in with my partner, my financial circumstances have changed, I started my first job in over a decade, I gave up that job, got a new therapist, have an ongoing battle with "the Establishment", changes in support staff, one of my dearest friends passing away, the mirtazapine withdrawal and a big and exciting (but stressful) project at my other work. When I look at the above..it's no wonder I've crashed! Anyone would. Nothing in my life is the same as it was 9 months ago. Everything is different and I don't have that familiarity I once had to fall back on for reassurance and stability. 

Thankfully, things seems to be getting better and after a month of trying to get me to the gym, my boyfriend finally succeeded 2 days ago by resorting to bribery. Surprisingly it worked, and what do you know?! I actually felt much better after it!

My therapist has always advised me that if I am experiencing a depression, I need to take a look at my life (or my way of coping with life), identify what is wrong and do something about it.

In this case, I knew my job wasn't right for me, and I don't regret giving it up. Sad, yes. But it was the right decision. 

People around me didn't really understand, and were extremely disappointed, but I know that it doesn't take a lot to tip me over the edge and I came very close.

Now the job situation is out of the picture, I'm much better and don't feel the threat of medication anymore. I'm still wrestling with the "what the hell am I supposed to do with my life" thing, but I guess I have to take that in baby steps..

As for withdrawal symptoms from the Mirtazapine - They are over now. My appetite is pretty much back to normal and it's nice to feel hunger again and to have cravings for certain foods.

I had depressions when I was on the drug, but it's very easy to forget that! I've got to expect that depressions will come along, but the key is not to panic when they do. 

Kerry.

Eating Disorder recovery. (Part Two).

Arriving at the decision.

Time and time again I started out with good intentions to get rid of my anorexia and bulimia, but subconsciously I wasn't entirely committed to giving up all I had known and I inevitably chickened out after only a couple of days, thankfully returning to my security blanket and the familiarity and safety of the toilet bowl.

I'd tried and failed many times to break free from my crappy disordered eating patterns but I was so scared of the weight I would put on, or that I'd never be able to stop eating once I had started. Deep down I knew those weren't the real reasons but I didn't want to - or maybe wasn't ready to contemplate those.. 

The fear of the unknown was overwhelming and I would do anything rather than face up to this. 

But things were gradually starting to change. It was getting harder and harder to be anorexic. When I started out, it was exciting to see how far I could go with it. Initially it was very easy to lose weight, but as the years went on, it took me a lot longer to lose the weight. My metabolism was completely fucked up. 

Once my doctors latched on to what I was up to, they were much more vigilant and hospitalized me sooner and sooner. Eventually I was tired of the slimming down/fattening up drama in hospital. What was the point in going to all that pain and effort in getting emaciated if I was just going to be stuffed up with food yet again?

Latterly I noticed a shift in my attitude towards my eating disorders. In the beginning I had enjoyed the rebellion, the challenge, the excitement and the sense of achievement, but later on I began to feel a huge sense of guilt over it. I'd pushed my family to the limits. My friends had all but deserted me and I knew from my medical results, seizures and irregular heartbeat that I was killing myself and that it could happen at any time. Dying was and still is one of my greatest fears. This sounds weird considering I tried to take my life many times, but I guess with the suicide attempts I was "in control" of my life (or death)..but the thought of a heart attack or ruptured stomach, when I later knew deep down I wanted to live? It was frightening and I lived in constant fear.

My anorexia was once my identity..a thing that belonged to me which made me stand out from the crowd. A thing which few people had. I used to believe people looked at me and think "what strength!" But later I got uncomfortable with this and developed a paranoia about people staring at me..and when they did stare at me..I saw pity in their eyes..or anger. I'm not sure why people were angry with me..but it was deeply distressing. Those looks were probably there right from the beginning but I never noticed them..or maybe I chose not to notice them.. 

I was sick and tired of being sick and tired. And cold..lonely..miserable and broke. I had wasted so much money on binges..frequently to the extent of having just £5 a week to live on. I wanted to be able to afford nice things. I was sick of a life of poverty. Bulimia got me in to serious debt which I'm still paying the price for now..

I started to yearn for a normal life. I hated the life I had and I wanted more. I had punished myself long enough and I wanted to be free from this crippling illness. After being banged up in an institution on and off for a decade, I wanted to travel the world. I wanted to see places that people talked of. I wanted to be free.

I wanted to enjoy food..to experience foods I had never tasted before, and I wanted to be able to enjoy a cup of tea and a cake with my friends without the fear and panic and the obsessive calorie counting that went with it. 

I wanted to be able to go out where no-one would stare at me or look at me in pity. I wanted a normal body with boobs, hips, and an arse you could grab on to..and so that I could buy a pair of jeans without having to hunt for hours in the children's clothing section in department stores. 

I envied women who were so obviously women..

Finally, I wanted a partner. Somebody to share my life with and who found me attractive. And maybe have children one day. The longer I went without periods, I knew I was significantly reducing my chances of the possibility of that happening.

Spring 2008. I was back in hospital. Again. But somehow it was different this time. I just had a feeling deep down that this would be my last admission. 

The week leading up to my final discharge I mulled things over. It wasn't exciting any more. It wasn't a challenge any more. What was the point of it if you never ever achieved what you set out to do? My ED made me hate myself and I felt like a total failure. 

If I wanted a better life, only I could do something about it. And that's when I had this thunderbolt moment and realized I couldn't go on like this and that I'd have to give it all up. It just wasn't worth it any more.

Around the same time as this, I received the news that a friend I had lost touch with years ago had passed away. She had been bulimic though I never knew. The cause of her death had been a heart attack due to an electrolyte imbalance after a binge. She was in her 30's.

I went round in a stunned fog for days afterwards. This was real. It wasn't just some distant person that you have no connection with..I knew her. If it happened to her, it could happen to me. This fuelled my determination to finally recover and for the first time, I felt excited about the prospect of recovery. The world was out there, waiting for me! There was so much I wanted to do!

Ironically, my final hospital admission was also my most violent. I won't go in to the gory details but I absconded as much as ten times in a day and ended up attacking a member of staff. I've deeply regretted this ever since, but at the time I felt threatened and vulnerable and justified in my actions. 

I've thought often about the aggression and violence during this last admission and wondered if it was my final rebellion against the mental health system. Yes..I know..that sounds totally bizarre! But looking back, it's the only explanation I can give..

Despite all this, I complied with the diet plan and put on the weight they asked. An Occupational Therapist suggested I sign up for a 2 year carpentry and upholstery course, which I did.  

It was a start anyway.

On my discharge, I told them this would be my last admission. I don't think they believed me.

This time there was no going back. I knew I had a very difficult journey ahead of me..

Kerry.

Eating Disorder recovery. (Part One).

I was at an open eating disorders meeting the other night which was really interesting. There were all sorts of folk there - people who were interested and wanted to know more, sufferers from all over the ED spectrum, advocacy workers, health workers, those in recovery and loved ones of sufferers who wanted advice.

Heading home afterwards a young woman in her twenties caught up with me. She was obviously anorexic, and her pain was visible in her eyes. I remember those eyes well..they stared back at me every day in the mirror for years. Misery..hopelessness..fear..despair.

She was quite shy, but after talking about the meeting for a few minutes she quietly asked me the question I'm often asked but dread.."How did you get better?"

I remember asking the exact same question myself to a recovered anorexic years ago, and being baffled by her enigmatic answer. She had made it sound so simple and had this air of belonging to some exclusive club which I didn't have admittance to.

As I was making a hash of trying to explain my recovery to the young woman, I could see the same look of awe and disbelief on her face I had all those years ago. Then came the inevitable, "You make it sound so easy." It wasn't and there were just no words to describe to her just how difficult it was.

We parted a few minutes later and I felt a little uneasy that I couldn't give her the magic answer she was looking for, but as I walked home I started thinking about my own recovery..

It wasn't easy. It was one of the hardest things I've ever had to do, though as the years have gone by it has faded from my mind quite a bit. But I've been thinking about it a lot since that meeting and I hope that I can somehow get it down on paper without it sounding like a total breeze in the park or that I'm in that exclusive club or something..
This post will be mammoth, so I have split it up in to a series of posts to make for easier reading.

Looking back, my ED had 3 distinct phases:

Phase 1 was the new and exciting bit, almost like a new romance, and then there was the added thrill of rebelling against my doctors and pushing my body to extreme limits. It did feel unnatural at first, but I ploughed through that. I had a brief liaison with excessive exercising but I soon gave up because I'm lazy as hell and not even the anorexic voice inside my head was going to get me off my backside!

I think this phase lasted a year or two..certainly 3 or 4 hospital admissions anyway.

Phase 2 was the comfortable period. My ED was established and I felt safe and secure. Despite this, there were huge family arguments that I was ripping them apart. I couldn't see why they were so upset..this was my problem..not theirs. I also isolated myself to avoid those awkward social food events that people take for granted. My Anorexia and Bulimia were my life, and there was no way I was ever going to give them up. They were my comfort and my reason for living.

Phase 3 was the time things started to change. My eating disorders no longer satisfied me and I wanted something more from my life. I wanted to be normal, and the only way that was going to happen was if I gave them up. Despite this, it was not easy to break out of those ingrained habits that had served me so well..

All in all it took me five years to get to the point that I realized I wanted to get better, but it took several years after that, and many, many false starts before I succeeded on the journey.

The following posts in this sequence will try to explain how I finally recovered and what led me to make the decision. Part 2 focuses on arriving at the decision, Part 3 - the recovery process and Part 4 - afterword all of which will be added later.

There's a lot I've probably forgotten or missed out but I hope this gives you an idea of my journey anyway!

If you want to know anything more about my recovery - anything I've missed, or even to share your own story - don't hesitate to get in touch.

Kerry.

Understanding Self-Harm..

The concept of self-harm is disturbing to many. It is difficult to understand what would drive somebody to deliberately hurt themselves. Common methods of self-harm include cutting, burning, non-fatal overdosing, hitting and swallowing objects. Other behaviours such as excessive drinking, drugs, eating disorders, risky sex etc. can also be seen as forms of self harm.
 

Because self-harm is little understood there is still a huge stigma attached to it. It frightens people. A common belief is that people who harm are attention-seeking. This is not true. It is not a suicide attempt though tragically it can go wrong. Often self-harm is seen as a life saver as it can release those feelings of deep emotional stress which may lead to a suicide attempt.

I began harming at the age of 12. I don't really know what happened. One minute something in me had stirred up in to an uncontrollable anger, the next minute I was grating a large elastic band against my chin just below my lower lip. It hurt. A lot. And it caused a wound.
 

Afterwards I remember feeling a huge release of pent-up emotion. All was well again. 

I still have that scar on my chin though it's barely noticeable. To account for the wound, I told people that an elastic band had snapped near my face and caught my chin. I never told anyone about my shameful secret. I just knew instinctively that this was something I should never talk about.

My initial scars were fairly superficial and could be blamed away on scratches but it was after I was admitted to the psychiatric hospital for the first time that it started getting serious.

Later, I tended to cut more than anything else. I kept an old Stanley knife blade in my top drawer for emotional emergencies. I'd never heard of self-harm or see anyone do it and it wasn't until I got to university that I encountered it in an acquaintance. I never talked to her about it. I wanted to but couldn't... I felt very uncomfortable about it..but I could see her pain.

Later, in hospital when it had all come out, a close friend with her usual directness asked me why I did it and what it felt like. She was the only person to ask me. I think most were too freaked out by it to bring the subject up.

It was hard to describe to her, but after a while I told her to imagine a kettle on the boil. This resembles emotional pain and distress building up and up. The kettle has reached boiling point, but it's refusing to turn off. It keeps boiling and boiling...you can't bear to watch any more.. Just as it looks like its about to explode, it suddenly turns itself off, thus letting the boiling water cool down and be calm again. The moment the kettle switches off, is the moment of inflicting a wound - a huge release of pressure that has been building up for a while.

There are many reasons why someone resorts to self-harm. Many talk about "Matching the emotional pain with physical pain". I tend to agree with this and I would agree that seeing blood flowing has the same releasing effect. Other harmers have a different experience of things and would disagree with me. Some people may have been numb and harming is a way to feel something..anything.. 

For me, it was all about pain, and the blunter the instrument, the greater the pain. It also served as a sort of cleansing..afterwards I felt 'clean' and free from my internal demons again.. Unfortunately, relief from torment was only temporary, and it would gradually build up again and have to be repeated a few days later.

Ironically the majority of my severe harming episodes happened during the periods of hospitalisation receiving ECT.

The treatments gave me what I called a "bad energy" and made me very aggressive towards myself and others. It gave me hellish Restless Legs Syndrome which only made me more agitated and desperate.

Being stuck in a mental ward, which was understaffed, with nothing to channel your energies made things unbearable and looking back, it was frightening the lengths I'd go to to get objects to harm with. Once I was so desperate, I smashed up my glasses. Occasionally I would be taken to the locked ward to use the punch-bag which was very effective.

The attitudes of hospital staff towards me if I had harmed were not great. I felt discriminated because of it and I was once refused treatment at A&E because my wounds were self-inflicted. I overheard myself being described as "one of those" and sent home to patch myself up.

I've not been in that situation for a long time, but I'm told that attitudes of medical and nursing staff are beginning to improve as there is more awareness and understanding of the problem.

In extreme cases, if harming is the only way that the person can cope with the severe distress, "Safe self-harm" is practised where there is supervision, or somebody on hand, clean blades and dressings etc.

It sounds shocking that this would be allowed, but in reality it's not really that different from organisations offering clean needles for drug use. 

Back then, for me self-harm was a tried and tested method of releasing emotional pain if only temporarily..but it's not a reliable way of dealing with emotional distress. I was never really told how to combat the urge to self-harm when things got too much, but I remembered back to the punch-bag on the locked ward..It got my aggression out..I felt cleansed and with a buzz at the end of the thrashing, and I decided that if I ever got in to that state again, I would engage with short, but intense bursts of physical exercise (or cleaning!). It worked and I haven't harmed for 5 years. (By the way, Wii Sports is also great for this! - Especially the boxing game). 

If I see somebody out and about who has obviously harmed at some point in their lives, it does make me uncomfortable. Not because I'm thinking "that person is a weirdo and a freak", but because he or she must have experienced considerable emotional distress and gone through very dark times when the scars were inflicted. And it upsets me the thought of someone else going through that amount of suffering. Another part of me thinks 'Wow! You're so brave", and "Good on Ya for having the courage to bare all without shame or embarrassment!"

As mentioned in a previous post Self-Harm. Baring all and dealing with comments (April 2013), it took me a long time before I had the guts to bare my arms, but now it doesn't bother me. I still get the odd person staring at my arms, but I ignore them and carry on with what I'm doing.

I want to leave you with one thing.. When was the last time you had a really, really crap day and reached for the bottle of wine?..Or a manic spending spree you knew you couldn't really afford?..Or eaten huge amounts of junk food just to make yourself feel better? 

If you think about it..we've all self-harmed to some extent at some point..

Kerry.

The Ludicrous side of Mental Health.. #004

It's amazing how quickly you get used to the outrageous sights in a mental hospital. At first you're shocked..your naivety taken forever..Then a few days later you're like, "Oh yeah..that's him roaming up and down the corridors naked again," and not batting an eyelid..

The work/life balance?..I just don't get it!

The work/life balance is something I have great difficulty in getting right.

I've never had to juggle it before - I've never really worked and in the space of a few years I've gone from literally just seeing my doctor fortnightly - zilch, to working and volunteering around 25 hours a week.

It's quite nice having something to get up for but it backfires sometimes. I'm a people-pleaser and find it very hard to say "No". Frequently at the expense of my health. I get intensely busy for 2-3 weeks, then I end up crashing in bed for a few days with exhaustion and burnout, each time cursing myself for my inability to put myself first for a change.

Putting 'me' first is not a thing I find easy. I'd rather everyone else was happy, content and thinking well of me. I never stop to think that I have little quality of life, or that it's damaging my health, and it's only as these burnouts are becoming more regular and the depressions accompanying them more severe, I'm realising I've got to do something about the whole situation.

But it's not easy to keep everybody happy (myself included) or to get the right balance.

Not having any structure can be equally as bad. When I find myself with a much needed free day, again I find myself in bed because I'm so bloody bored and don't want to do anything. I don't see the point of being awake which leads to another depressive spiral doubled up with a nasty agitation.

So what's the answer?

I take more care now in planning my week and scheduling my appointments. I used to be buzzing about all over town to several meetings in one day, but now I put them on different days which leaves me with more energy.

I'm still a bit lazy about the exercise side of things, but as it really helps with the depression, stress, the agitations, my immune in general and will finally get my therapist off my back to do more, I intend to make a real effort to put gym time in my schedule!

I now take 2 days off every week. It's something I've found hard and which I'm still getting used to.
When you work, you usually have set days off and holidays, but volunteering can be a bit different and the line is more blurred. I used to find myself going for months and months without a proper break and often I got worn down by it all. Sometimes, the more you do, the more people expect.

Of course, it's going to take a while before I get the balance right. Things don't always work and it will take a little tinkering before I get a lifestyle I'm completely happy with.

I'm still experimenting, but the days I don't have structure I've learned that going back to bed is NOT AN OPTION! I oversleep by hours and then wake up with that crappy, fuzzy, sore head feeling that can last well in to the next day. If I really need a nap, I set my alarm for 15 minutes, have my quick snooze and get up and continue with my day refreshed.

It's OK to have a free day, but a planned free day to do the stuff I want to do and not just sitting around for hours thinking about the darker things in life or doing nothing! Not good for my brain! Don't get me wrong..sometimes I do sit around contemplating the darker stuff, but I have given myself permission to do it, and only for a set time. This way I don't feel so guilty about wasting my time. On free days I do not think about work.

It took a long time for me to learn to say "No", and as time passes it's become easier.

I told someone recently I was reducing my hours slightly to make more time for myself and I was quelled by a raised eyebrow and the look of disapproval - as if I had done something wrong! They had gotten used to my obliging ways, and it was taken for granted if anything needed done, Kip would do it.

The irony is, since saying "No", I seem to have earned myself a little more respect from others, and the self-respect I have gained from the knowledge that I am taking time for me and looking after myself has increased substantially.

Kerry.

Imposter Syndrome..

I've just started a new job. My first job in 13 years actually. Not only did I think I'd never ever get a job with my past, or be vaguely capable of it but now my mental health experience is being used to help others who are now going through the same thing!

  

I've never really had a job before. Well..that's not strictly true...I wouldn't count the 6-week supermarket job (which I apparently loved, but have no recollection of) or a boring summer stint as a changing room assistant when I was 16. But at the age of 34, I find myself feeling totally unprepared for life in the workplace. 

My university degree was music..and let's face it, it's one of those degrees that you can't actually do very much with outside of the music world, plus I don't really remember that much of it anyway.

Looking around me when I was younger, a job was a thing that grown-ups did which they hated, left them exhausted, paid them very little money, and left them no time for their families, so why on earth would I want to get one? I have no idea where this mind-frame came from because I knew people who did love their jobs, and were very happy, but they were a minority. 

Naturally as time went on, a job was built up in my mind as one of those unattainable things - like sex before you have it. 
I went straight from school, then uni, then in to "the system" and as years and years went by the thought of getting one of those things seemed a million miles away and virtually impossible.

But I got one. And I got it sort of by accident and very unexpectedly..but that's another story!

The thing is (if I'm completely honest)..I feel a total fraud. I haven't got a scooby as to what I'm supposed to be doing. I'm naturally quite shy, and find the public aspect of the job very challenging at times - They must have made this huge mistake in hiring me, and will very soon be asking me to leave!

I confessed all to a colleague and was stunned to find she felt the same way despite being there years, and from asking round various friends and acquaintances it seems I'm not alone. 

There have been several times where I've taken fright and thought of giving it all up, but after years on benefits dreading very nosy taxi drivers, it's kind of nice to be able to say "I do this..I work for this organisation"..It really makes all the fear worthwhile...plus the feeling of self-respect and of finally having a place in the world..it's indescribable!

I'll stick with it and give it my best shot. I can't do any more than that. I'm guessing a lot of it is fear of the unknown, and a misconception from childhood that stuck with me. All I need to do is build up the confidence to take my first shaky toddler steps on to the ladder..but I'm sure I'll get there in the end - one step at a time.

Oh!..If anyone's interested - those nosy taxi drivers? I used to tell them that I was a pole-dancer which shut them up pretty quickly!

Kerry.