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The Curse of the Strong

Depressive Illness.
“The Curse of the Strong”
by Dr. Tim Cantopher, Consultant Psychiatrist, Priory Healthcare Services
We all feel depressed at times. I certainly do, particularly on Monday mornings. But, because we all know how the emotion of depression feels, we tend to assume we know how someone feels who is suffering from a depressive illness, or clinical depression. In truth though, we haven’t the first idea of what a victim of this illness is going through. At its worst, it is a glimpse of hell which the rest of us, thank goodness, will never come near to experiencing in our lifetimes.
There are many misunderstandings about clinical depression. One of the commonest is that people who get it are in some way weak. This is ironic as in fact the opposite is true. Stress induced clinical depression does not happen to weak people, but is an affliction of people who are too strong. There are several different causes of clinical depression, but by far the commonest and the one I will deal with here is stress. Life, sadly, is getting more stressful and as it does so an epidemic of depressive illness is underway – up to I in 3 consultations in general practice involve patients with the disease.
And yet it can be prevented, is not difficult to treat and can be prevented from recurring in those who are unfortunate enough to suffer an episode.
This illness nearly always happens to one particular type of person.
He or she is strong, reliable, and diligent, with a strong conscience and sense of responsibility. But he is also sensitive, easily hurt by criticism and has a self-esteem which, while it may look robust on the outside, is in fact quite vulnerable and easily dented.
This is the person to whom you would turn in times of need, and she would never let you down. When the going gets tough, this person gets going.
Why should this type of person be the one to get ill? The reason becomes clear when one understands what clinical depression is. Here is the key: clinical depression is not a psychological condition or a state of mind. It is a physical illness.
A depressive illness happens when one part of the brain, called the limbic system, malfunctions. The limbic system is a set of nerve fibres arranged in a circuit. Essentially this circuit acts like a complex thermostat which controls a number of systems and functions in the body. Probably the most important of these is the control of mood. It usually works well with mood returning to normal reasonably quickly after most of the day to day ups and downs of life. But like any other physical system, the limbic system has a limit and if it is stressed beyond this point it will break. When this happens, the part of the system that fails is the transmitter chemicals, serotonin and noradrenaline. These are the chemicals which allow the electrical impulse to pass from the end of one nerve fibre to the beginning of the next. In depressive illness their levels fall rapidly, resulting in the circuit coming to a. grinding halt.
So what happens if you put a whole lot of stresses on to someone who is weak, or cynical, or lazy? The answer is that he will immediately give up, so he will never get stressed enough to become ill. The strong person on the other hand, reacts to stress by redoubling his efforts, pushing himself way beyond the limits for which his body is designed. When he starts to get symptoms, because he is sensitive and fears criticism and failure, he still keeps going, with the inevitable result that eventually something must give way. What gives way is the limbic system. If you put 18 amps through a 13 amp fuse, there is only one possible result.
Stress related depressive illness is essentially a blown fuse.
The symptoms of clinical depression (you don’t have to have them all to have the illness) are depressed mood, feeling worst in the morning and better as the day goes on, and a host of “Loss-of’s”.
That is, loss of:
 Sleep
 Appetite
 Energy and enthusiasm
 Concentration
 Confidence and self-esteem
 Drive
 Sex drive
 Enjoyment
 Patience
 Feelings
 Optimism
 and almost anything else you can imagine; pretty much everything goes.
So you have identified that you have a depressive illness and you recognise that it is a physical illness. What do you do now?
Answer: exactly the same as you would with any other physical illness; rest and take the prescribed treatment.
The trouble is that on the whole the people who develop this condition have overcome every problem they have encountered in the past by extra effort. The concept of giving in to the illness is anathema. Yet you wouldn’t normally try to overcome pneumonia through only the exercise of your resourcefulness. Neither can you with clinical depression.
Beware family and loving friends. However well meaning they will often give you the benefit of their homespun wisdom: “Go on, pull yourself together, get more interests, get out more, get more friends, come and have a party, we’ll cheer you up”. If you take this advice you will probably get worse.
Rest, especially in the early stages is crucial. This doesn’t mean going to bed or sitting in a chair doing nothing, that would give you far too much time to ruminate. It does mean avoiding any unnecessary challenges and only, where possible, doing what is easy. If it is possible to take time off work, do so. If you can get someone to clean up, look after the kids and do other chores, do so. Cancel social events that you are not looking forward to. Watch more TV or do anything else that comes easily to you.
Another difficult issue is antidepressant medications. While there is no doubt that they are an important part of treatment, they have had a very mixed press and people hold strong views about them. Again, misunderstandings abound.
Maybe I can dispel a few. Antidepressants are not addictive, though if you come off them too quickly you can get withdrawal symptoms; withdraw them slowly by tapering the dose over several weeks at the appropriate time. They don’t work straight away, usually taking a few weeks to kick in properly. They don’t give you a false high, Or make you a better, more creative person, or turn you into a murdering psychopath. Prozac is a good antidepressant but doesn’t deserve either the cult following or the condemnation it has attracted. Above all, if an antidepressant helps you get better, don’t stop it as soon as you get well. It takes the limbic system several months to heal properly, even though the symptoms of clinical depression have gone. If you do keep the drug going for long enough, you are unlikely to relapse when you come off it, in the same way that, when a plaster cast is taken off a broken leg which has healed, you can walk without a return of pain.
Once recovery starts, things get more complicated. You need to start doing a little more, but how much? The truth is, I don’t know. But you do, because at every stage, your body will tell you. You can divide activity into three categories: mental, physical and social.
 At your body’s physical limit at any point of recovery you will start to feel heavy and lethargic.
 For mental activity, you will find you don’t take anything in.
 At social events, you will start to find it difficult to talk sensibly.
At this stage, or before, stop. If you do you will continue to recover, if you don’t you will feel rotten for the next 36 hours or so. The harder you push recovery, the slower it goes. So take it gently and listen to your body.
Even following these instructions you will get ups and downs, but they will be minimised. At the beginning there aren’t many good days. In the middle Of recovery some days are nearly back to normal and others almost as bad as ever. Nearing full recovery the bad spells become shorter, further apart, less bad and eventually peter out.
Beware extremes of emotions during this period. Your first good day isn’t the end of your problems and the rotten day that follows it doesn’t mean you will never be well. Don’t overdo it on the good days and don’t despair on the bad ones; this is normal recovery, and in any case, the bad days are often a message
that what you did yesterday was a bit too much.
Once you are somewhere near full recovery, it is time to ask some basic questions, such as: What is it all for? Do I have to run my life this way? Can I say ” no” occasionally? What do I want from life? Why do I always have to be everything for everybody? etc., etc.
These are difficult questions and there are many more. They involve you identifying the choices you have in your life and making them. If you don’t think you have any choices, because of your commitments and responsibilities, you are wrong. However you may have to give up your image of yourself as the perfect mother/father/employee/friend etc. to find them. If you do, you can stay well.
It isn’t always possible to achieve this on your own. This is when a psychotherapist comes in. There are a great many different forms of psychotherapy, but mainly they can be divided into exploratory (or psychodynamic), cognitive and behavioral. I won’t go into these therapies here, as that is another article, but they all work for different people, depending on their particular route into the illness. The essential point though is that effective treatment isn’t a matter of drugs or change of lifestyle or psychotherapy, but is often a combination of all three.
After that it’s down to you. If you have changed the way you operate and maybe the way you think, you have a great chance of remaining not only well, but happy too!
TWELVE ESSENTIAL FACTS ABOUT DEPRESSIVE ILLNESS
 It is primarily a physical not a mental illness
 It happens to strong, not weak people
 It is not the same as “feeling depressed and fed up”
 You don’t know how a person suffering it feels unless you have had it yourself
 You cannot pull yourself out of it
 It gets better eventually, sooner or later
 It gets better quickest if you rest
 Anti-depressants are not addictive. Anti-depressants usually take a few weeks to work
 Don’t stop your anti-depressants as soon as you feet better
 When recovering, increase your activity slowly, as your body dictates
 in order to stay well following recovery will need to make changes to the way you operate, and possibly the way you think.

article, source unknown read at Swanage Depression Support Group in May 2017

review of he book by Cantopher is on this site

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Bi Polar Disorder and Self Management

I have not blogged much over the last 9-12 months which makes it glaringly obvious that I have not had my finger on the pulse, especially where my Bi Polar mood swings are concerned.

I became ill at Christmas 2016 and descended into a mire of depression immediately. I had felt well for months. In fact I had felt supremely well for months. Sound familiar? During the hypomanic phase which can last for a considerable time I am extremely productive and experience ‘flow’ but eventually this becomes more than a healthy state of mind and can gain momentum leading to lack of insight, rash decisions and can send your life spiralling out of control. Only it doesn’t go out of control in your mind. You still think your life is normal and you are well while everyone around you is muttering behind your back that …

‘something has to be done’.


My family and my partner tried to alert the medics but without success something that the Psychiatrist found appalling. I eventually wrote a letter to my GP asking for a referral. My psych then always visits me at home for good reason – I am at the stage when I can’t leave the house. He then returns in a few weeks after which appointments are made at the nearby cottage hospital.

In the letter I said the family had been refused access to the Psychiatrist and to the GP. We now have a procedure in place which, in future, will ensure that family do get to express their concerns. Changing my GP is also on my to do list!

I had been on a Living With Bi Polar course not once but a second time as a refresher, but could only present him with a small piece of paper with four ideas of how to get well. Drink more water, go to the shops for a few things etc.

There is nothing on here about doing something you enjoy, he said.

Of course, when depressed, we no longer enjoy anything, so all our hobbies are now forgotten or our brains cannot cope with the challenge or necessary concentration.

Leaving me with a list of about 9 things to do on an action plan, he departed saying he would be back in three weeks. After all recovery has to come from me and I know that. I was to do relaxation exercises three times a day on the floor or more often when sitting in a chair. I was to get back to yoga, using my CD and go for walks, extending the distance each day. I was to review the course material from the Bi Polar management course and he stressed it is all about self management. By this I know that we should do the opposite ie if we feel high and energetic we should do yoga, go to bed early, read, calm ourselves down, cut down on activities rather than increase them. When depressed and unable to move out of the bedroom we should get up, move about and go out in the fresh air. We should exercise.

In reality I exercise and go out a lot when I am high. I socialise extensively and talk a lot. I make plans. In fact, what I should do is socialise less, listen to music so I do not talk so much, watch romantic films to keep me seated on the sofa. When low I sink beneath the duvet and do very little s

In Depressive Illness, The Curse of the Strong, Dr Tim Cantopher provides many ideas for helping us work through our depression. One idea he gives is to refrain from supermarket shopping which may be overwhelming but to go to the corner shop and buy a few items, a trip which is more manageable.
Dr Cantopher describes the build up to depression as likened to a thermostat which overheats. Those of us with Bi Polar do not make the chemicals in the brain which stop us overdoing things. We cannot regulate our brains which is why we continue to talk fast, go out to much, take on too many activities and commitments when our brain is about to fuse whereas those without this mood disorder will actually release chemicals which stop them before it is too late.

This was heartening to me as I have always blamed myself. However, it is still up to me to manage the condition.

Sleep, relaxation, keeping occupied, attention to diet, exercise and mindfulness all contribute to managing the condition.

Over the next few weeks I compiled my own manual using the course materials, the internet, blogs on mental health, library books, self help books and leaflets from Mind. I did my own research. As a writer it was good to have a writing project that centred on my mental illness. However, we are all individual and the condition is unique to us. We all respond differently and I have found that each episode is slightly different and requires some fine tuning. For example, sometimes puzzles can keep me occupied as I work my way out of the mire. In another episode the puzzles irritate me and I find another way, perhaps writing a diary or listening to music.

Next time I descend into deep depression the family and my partner know to push my manual in front of me and tell me to read it. In the book I have simplified all the advice and information that is out in the public domain.
In my next post I will explain how I achieved this, what the manual contains and provide an overview of strategies to help stay on an even keel.

Do let me know of your experiences with mental illness so we can share information for all those affected.

Di Castle

Di Castle has Bi Polar Disorder and has struggled to manage the symptoms over the years. Self-Management is the key and she hopes her posts on this blog will help others. She welcomes feedback.

Her debut, Grandma’s Poetry Book, is available by post via dcastle32@talktalk.net or on her website http://www.dicastle.co.uk .
This poetry collection spans sixteen years capturing the experience of a first-time grandmother on her sometimes wobbly journey in her new role. It includes many facets of unmissable moments and childhood milestones, some humorous and others more poignant, even sad. Such treasured times can easily be forgotten so the book acts as a nostalgic memoir. Touching and funny in turn, readers will be reminded of the joys of witnessing childhood development and the effect o n their own lives. Even those yet to reach grandparenthood including fathers, aunties and primary school children have already enjoyed reading this book. Grandma’s Poetry Book makes an ideal gift for new grandparents, birthdays, Christmas and Mothers’ Day and many readers have returned to buy more copies for friends and relations. Each poem has its own laugh-out-loud illustration by an artist who has been likened to E H Sheppard.

Some comments have included ‘Pam Ayres meets Winnie the Pooh’, ‘made me laugh, made me cry’, ‘charming book’ and ‘every grandparent should have one’.

HER SECOND BOOK IS OUT NOW
SHOULD I WEAR FLORAL and other poems on Life, Love and Leaving, By Di Castle and illustrated by Denise Horn.
You can follow her on twitter @dinahcas and on Facebook https://www.facebook.com/pages/Di-Castle-Writer/266866193324409parted16formation o

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My Staying Well Plan

In January this year I suffered a serious relapse. I had been managing my Bi Polar Disorder well but looking back I was seriously hypomanic for most of 2016 dipping occasionally and taking some days ‘off’ unwinding sotospeak but just before Christmas I began falling out with people, became stressed and tearful. I still did not see what was happening but hopefully, since going on an Early Warning Signs course, I shall recognise what is happening and take action earlier in future.

When my psychiatrist visited me at home he was surprised that the two Living with Bi Polar Courses that I had attended had not resulted in me managing the disorder more effectively. He told me to revise the course material. I did this and came up with the idea of making a personal manual.

The first two pages list what I have to do to stay well. Requested by Swanage Depression Support Group after I shared my list. I have edited it somewhat and added extra items.

MY STAYING WELL PLAN

  • Accept the phase when you need to lie in bed most of the morning. Your brain needs to rest. This prevents further stimulation.
  • Read the first few pages of Depressive Illness, the Curse of the Strong, Dr Tim Cantopher. An excellent understanding of the true meaning of depression.
  • Note Dr Cantopher’s point that something has to change if you are to stay well and not relapse. People relapse as they have not made changes to their routine, action or behaviour which may have been maladaptive
  • Put on Smooth radio or Classic FM
  • Keep off the computer for a while and, if you cannot bear it and are frightened you will have to give it up altogether, remember you will come back to it.
  • Play CDs, dance, use party CDs
  • Play relaxing music in the background when writing or reading.
  • Use lavender oil and massage temples and neck each night
  • Keep occupied
  • Do some tidying every day
  • Do some clearing out every day, just one shelf or a drawer. One small step
  • Drink more water
  • Eat healthy food. Cut out junk.
  • Use 3.75 Zopiclone and if necessary take 7.5mg and then reduce after one month. 8 hours sleep minimum is essential for Bi Polar Disorder
  • Shop each day for a few things. Use the local corner shop if the larger store is overwhelming
  • Don’t spend unnecessary money. WAIT
  • Walk each day. Once and then later go out twice. Increase the distance each time
  • Use a relaxation tape, 3 times a day on the floor if anxiety is crippling
  • Do yoga. Arrange for a lift to a class if you cannot drive. Use the yoga CD if you cannot go out.
  • Practise deep breathing all the time, when waiting in shop queue or watching tv.
  • Do puzzles, crosswords.
  • Don’t read the news in newspapers. Look for the funny comment columns or the letters page.
  • Read self help books to revise relaxation, stress reduction and get positive ideas.
  • Watch tv on catch up, not live, If attention is poor you can watch a short part at a time.
  • Do NOT watch the news while anxious or depressed
  • Go to bed 11-11.30 Read for half an hour after tablets
  • Visit the library and sit with a book, just feel the warmth, feel the nearness of the company and the ambience of books around you.
  • Use the internet for following mental health blogs and self help. Look at the MIND site and read what people have written. Contribute your own positive idea which will make you feel good.
  • Print out anything useful and put in your Getting Better file.
  • Face up to Finance. Instead of regretting overspending, look at your accounts. It may not be as bad as you think.
  • Write a diary of what you have done each day.
  • Keep a notebook/diary of thoughts, feelings, actions, what you did each day and write helpful things down.
  • Write down 3 things you want to do tomorrow
  • Write down 3 positive things that happened today.
  • Sing
  • Sort out some books you no longer want and take them to Oxfam
  • Make notes from previous courses, reduce them and put them in the Manual
  • Do something you have not done before
  • Use Power Work Out DVD (Keep Fit) £1.50 on Ebay
  • As you feel better start to speak to people when you are out.
  • Go for Reflexology
  • If you are a writer (I am) ease the block by reading through some work on the computer and start editing small parts. The creative urge will return.
  • Use the idea of the Morning Pages (from The Artist’s Way by Julia Cameron). Write 3 pages each morning of the first thing that comes to mind, even rubbish. Free association. Do not try to write something serious until you have emptied your mind first.
  • Visit the Library 2-3 times a week, take a few books out and return those that do not appeal. Stick with those you like after the first three pages. Try to sit down to read several times a day.
  • Start to listen to talking radio when you feel up to it eg Woman’s Hour and other discussion programmes. Use catch up for the periods you could not bear the inner noise of talking radio.

Remember that eventually you will get back to some semblance of normality (as it applies to you) and you might even begin to write a helpful mental health blog such as this one.

Please comment and add your ideas to this staying well list.

 

Di Castle has Bi Polar Disorder and has struggled to manage the symptoms over the years. Self Management is the key and she hopes her posts on this blog will help others. She welcomes feedback.

 

My debut, Grandma’s  Poetry Book, is available by post via dcastle32@talktalk.net or on my website http://www.dicastle.co.uk .

This poetry collection spans sixteen years capturing the experience of a first-time grandmother on her sometimes wobbly journey in her new role. It includes many facets of unmissable moments and childhood milestones, some humorous and others more poignant, even sad.  Such treasured times can easily be forgotten so the book acts as a nostalgic memoir. Touching and funny in turn, readers will be reminded of the joys of witnessing childhood development and the effect o n their own lives. Even those yet to reach grandparenthood including fathers, aunties and primary school children have already enjoyed reading this book. Grandma’s Poetry Book makes an ideal gift for new grandparents, birthdays, Christmas and Mothers’ Day and many readers have returned to buy more copies for friends and relations. Each poem has its own laugh-out-loud illustration by an artist who has been likened to E H Sheppard.

Some comments have included ‘Pam Ayres meets Winnie the Pooh’, ‘made me laugh, made me cry’, ‘charming book’ and ‘every grandparent should have one’.

OUT SOON  SHOULD I WEAR FLORAL and other poems on Life, Love and Leaving, By Di Castle and illustrated by Denise Horn.

You can follow me on twitter @dinahcas and on Facebook   https://www.facebook.com/pages/Di-Castle-Writer/266866193324409

 

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ANXIETY BANGING AT THE DOOR

I have a bad spate of Anxiety at the moment. I don’t really know where it came from only that I became anxious about a holiday I had booked that I felt might go wrong … and it did. Well some of it went right. On a positive note we went to Portugal and flew from our local small airport which is the antidote to a fear of flying. Complete absence of stress, an easy journey, no overnight hotel stop, easy parking – we drove the car to a space and walked across to departures – how easy is that? Of course, security was still a nightmare as the boundaries keep moving. This time it was finding I had packed a lithium battery in my carry on. No problem if I was going to carry it on but, no, they wanted some passengers to put their carry ons in the hold and apparently that is where lithium batteries cannot go. So a major reshuffle at check in and a once-tidily-packed case resembles a bomb site until the errant battery is located and then relocated into my hand bag.

On another positive note, I will never forget standing at the viewpoints at Praia da Rocha and marvelling at the red sandstone and the large rocks with a sudden blast of sunshine that was horribly absent for the rest of our stay. Stunning is the only way to describe the view. Similarly, we loved visiting Sagres, the most westerly point with its fantastic views, again in a window of sunshine.

But things had been going wrong before this holiday. I should have expected Anxiety to rear its ugly head as I had just passed through several weeks of stress until I managed to stand back from what I had committed to and hold my hand up and say ‘I just cannot do this’. Of course, once the stress was removed, I expected to feel better straight away but that is not how Anxiety works. Being on red alert for several weeks is doing invisible damage to one’s mental health and mine was seriously compromised. I knew it would take time. It will pass … my main mantra for overcoming anxiety or depression or both. I am still waiting.

So what went wrong? For a few years my partner and I have enjoyed hotel breaks in Italy, Croatia and short breaks in the UK and in Krakow, at hotels where the Reception staff speak good English and there are other British holidaymakers around which makes for some semblance of security. We are collected at the destination airport and transported without any hassle to our holiday hotel. We do not have to worry about shopping for breakfast items or where to eat out in the evening as our hotels have been lavish in their care of our gastronomic needs. We are not averse to using local public transport to see prime locations and sightseeing tours. Reception staff are on hand with advice. We explore our surroundings and pride ourselves on being able to cope in any situation.

This holiday involved an apartment in a sleepy village in a remote part of the Western Algarve. It necessitated car hire to enable us to get to our accommodation. Years ago we hired cars in France, drove into Italy without any difficulty. I possess sufficient French to read road signs, traffic warnings and ask directions. I can decode a menu and make myself understood when we arrive at our bed and breakfast.

This time there was a sudden realisation that my now slightly older partner had lost driving confidence and our ‘bottom of the range’ car was manual and inclined to lurch over every pothole – of which there were many. In France the roads are excellent but for the main part of this trip we bounced in and out of potholes and the lack of signs ensured we ended up on industrial sites and waste ground with increasing frequency.

It was the quiet season and there were few people staying on the complex. My partner became ill with what can only be explained as ‘plane flu’ within 48 hours, shaking so badly one night that I feared he was having a stroke. We felt isolated and vulnerable and silently vowed never to embark on another independent holiday at our age, especially in a country where we do not speak the language, where road and roundabout signs are notably absent and where we had no point of reference. No reception desk. No travel company rep. I quickly realised why so many people in our age group go on cruises. The idea was suddenly very appealing. Within three days we could not wait to go home. The weather was the worst the country had experienced in 38 years. I told myself that if the sun shone we would feel better but it only made brief appearances in the afternoons following mornings of torrential rain.

As the week passed we consoled ourselves that we would relax when we arrived back at the airport which, to some extent, we did but we were feeling fragile following further illness. The deep sleep I anticipated on our first night home did not happen and I entered a phase of ‘not sleeping’ night after night. As someone with Bi Polar I need comfortable set routines, relaxation and the absence of stress. Stress can affect me badly. So very quickly Anxiety came banging at the door. The insecurity and nine days of being on ‘red alert’ had damaged my usual state of living in the moment. I was constantly wondering whatever would happen next and this feeling would not go away on our return.

This attack has shown me why Anxiety is often referred to as ‘crippling’. I seem unable to act to move myself forward. Eventually, I visited our library, leaving armed with five or six books on relaxation, anxiety and combating depression. The librarian on duty knew me and my heart sank as I saw her expression when she logged the books out on my card. Once home, I revisited all the advice I have read repeatedly in the past. I always think there will be something new … The Answer … but no. I am thoroughly bored with myself. I have listed the fears and worries, rated them out of 10, re-phrased the worry into a ‘can do’ statement. I have gone for walks, breathed the fresh air deeply, returned to my yoga practice on my lounge carpet, put on stress busting CDs and everything else that they recommend. I am so bored with it all as I have been here before. But when Anxiety bangs at the door, I forget all my positive strategies. I forget what it is I do when I am well.

Every time Anxiety bangs at the door and holds me in its crippling grip, I tell myself ‘this will pass’. This, despite being unable to get up in the morning and face up to what is happening in my life. But one mantra beats everything and that is …

‘Deal with it.’

The worries may be simple and not something that would bring any normal person to a standstill but ‘dealing with’ these anxieties one by one is the only way to get out of this hellhole of a trap. I force myself to make the phone call that I have been putting off. I answer the email that has triggered some concern. I go out to the shops with a small list – anything longer is unmanageable. I list my outgoings aware I have financial worries which will not go away until I address them. I cancel some of my less-needed standing orders. I google ‘Anxiety’ and find some consolation and tips on Pinterest and the web. I go for a walk. I force myself to smile and say hello to strangers. I write down things I should be grateful for. I list my recent achievements. I write a To Do list. It is all exhausting but I keep doing it as I know …. it will pass.

It is all these actions which will eventually change my negative thoughts to positive ones and build up to bring me back to a state of homeostasis where I am relaxed and happy about life and willing to face up to what is ahead of me, no matter what.

I know it will pass. It is just knowing what to do while I am waiting that is the problem!

 

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Here I go again …

So it is Mental Health Awareness Week. I think.

I say, ‘I think’, as I am not properly tuned into life at the moment. I have good intentions – sometimes – when I plan to watch something on television or do something simple like go to the shops, only to find that the time has passed and I have missed whatever it is that I was going to watch or do. Perhaps the special week was last week or the week before that. Who knows?

The lack of concentration is the worst ever. I walk from room to room wondering what I was going to do. I write a To Do list but lose it under a pile of other pieces of paper that, at the time, seemed so important. I am overcome with an urge to simplify my life. To rid myself of its complications.

The theme of MH Awareness week this year is a focus on relationships. When I am well I seem to have lots of friends, contact with family and I have some connection with many others. Once I crash, all this is lost and I feel totally alone. My partner pops in several times a day and he cares, I know he does, but it doesn’t seem to make me feel better. I speak to family but know that I am not really saying what they want to hear which is that ‘I am fine’. That phrase rings in my head all the time but only because I know it is a lie. I know I am not ‘fine’.

Yesterday my partner said it would rain today so we went out for a ride in the car. It was too late by the time we reached our destination to get a sunny walk in and so we sat in the car. He slept. I closed my eyes but I can only sleep after my meds at night. Sleeping in the day is only possible if I am ill – physically ill, that is. A virus or some other physical illness will allow me to sleep either on the sofa or in bed. Not so this illness. This one actively prevents any switching off of the nagging thoughts, the internal negative chatter, the worries – real to me but apparently not a problem for others.

I am signed up to several newslists from organisations such as Mind and people who write about their struggles with mental health. When I’m well I scroll through without clicking on the content but now I am clicking on everything as I think the answer must be out there somewhere.

But it isn’t. The answer I know is inside myself. I don’t even think it is inside my head as I think the answer is to get out of one’s head. Walking can take me out of my head and into my body as I feel the vibrations and rhythms of step by step movements, travelling onwards. It doesn’t matter much where this happens as in my deepest depression I don’t see the world around me but walking can bring about awareness of one’s surroundings … eventually.

The worst part of crashing is feeling a fraud. All my abilities have vanished and my present reality is that I really cannot do anything properly at all.

Some weeks ago I wrote two blog articles for Depression Alliance. One was on early warning signs and the second was on how to cope with these early warning signs and first symptoms. They were retweeted and favourably commented on. I even received emails saying how much they had helped sufferers. So I felt good about that. But I haven’t taken my own medicine. I did spot the early warning signs but the spiralling descent into inertia which followed was so fast that I did not have time to address them. In fact, the truth is that I had probably ignored earlier signs. All the busyness and frenetic activity. The projects I was starting and not finishing.

Some years ago a colleague said ‘don’t stir up more snakes than you can kill’. It was her motto for managing her busy life but how true this is for those who have mental health conditions especially Bi Polar when, during active phases, we take on projects, start courses, agree to do things, join committees, and generally ‘bite off more than we can chew’. We don’t see the end result – the reality – which is that all of this is impossible once we crash down into depression. The buzz of activity cannot be sustained when the brain starts to close down on us.

Every time this happens I try to think how it can be avoided. Once everything becomes an effort and the body and brain become dull and inactive I am full of regret that I have overstretched myself and brought myself to this point. I am furious with myself for falling for it once again.

But, what is the answer? It is not to sit about not doing things for fear we will not be able to complete the project. Somehow, I need to be a better judge of how much I can usefully deal with. It is our judgement that is impaired with this illness. We do not see what is round the corner or the consequences of what we are doing. When we are well we feel we can cope with everything.

The inspiration for this post came from an article from The Blurt Foundation, the mental health organisation, the ‘blurtitout’ post dropping into my inbox. I identified so much with the writer that I just had to put my own view down. A comment box would not have allowed sufficient space. It opened my eyes to how I am now and is the most accurate account of how it feels to be truly depressed that I have ever read.

You can read it here

http://blurtitout.org/2015/02/04/depression-and-me/

One interesting point made was how time flies – we are not having fun but we lose track of time and life seems to be zooming past ignoring us. It seems as if life is a fast moving train that we can’t catch. We don’t know where the days have gone as they are full of emptiness, lacking in structure and interest. I just cannot wait to get back into bed even though I have not been out of it for long.

Wherever possible I try to keep a diary, even if only for events although logging mood is helpful. When I look back I am often surprised at how short a time it has been since I was ‘out of action’. It seems like this has been going on forever but I can often see that one month ago I was fine with a brain that was working properly and happy with life. And, yet, it seems as if it has been going on forever.

Certain phrases ring true in this article. ‘My mind has run out of juice’ and ‘the batteries are flat’ were two but her final comment ‘everything has become so complicated’ sums up everything I am feeling right now.

But as I said in my last post on here, it will pass. It always does.

I just hope it does not take too long.

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Bi-Polar, Uncategorized

Suicide in those with Bi Polar

Living at the coast I am well aware of the power of the sea and how it should not be underestimated but in coastal areas there are other dangers, one of which is the accessibility to cliffs for someone wishing to end their life.

Recently this happened near to where I live. The person was Bi Polar and had stopped taking her medication a week prior to the incident. The dangers of ceasing taking medication when one is Bi Polar are profound. A friend whose Bi Polar son passed through a difficult phase, was advised by a doctor to cease taking one of his mood levelling medications. Within weeks he had committed suicide with devastating effects on his family.

It is easy for me as a compliant BPD sufferer to say we should never, ever cease taking our medication even if we feel particularly well. In fact this is the dangerous point in this most evil of diseases. Sufferers pass through a well phase, feel they can cope with anything and stop taking their tablets. The effect is to cause a sudden sharp dip in mood when the person will become suicidal.

While not wanting to cast an opinion on the role of relatives in this case, those close to the patient should be alert, particularly if they appear resistant to taking medication which is common. If you have a relative who appears reluctant and complains that the medication makes them drowsy and complains about other side effects, this relative is probably vulnerable to believing he or she can do without it.

Those close to me know I am such a fan of my medication they need not worry. This is because for years my non-aware GP failed to refer me for psychiatric help despite the fact that I had received regular checkups at my previous address and all this was documented on my notes. The result was a few years of miserable times coupled with manic highs when I risked much financially and fell out with people. When I was finally referred after the intervention of my partner’s GP, I was put on Quetiapine and immediately felt the effects (once the initial dizziness and muzziness had passed). Eight years later and this has changed my life. I sleep well – Quetiapine has a sedative combined – and the regular sleep has made a difference. Whereas before I had weeks without sleeping or only sleeping 2-3 hours and long periods of early waking – that awful jump start at 5am and the sinking feeling in the stomach that reminds you how depressed you are – I now sleep a regular eight hours and wake refreshed. At night, I fall asleep quickly which prevents rumination and anxiety.

I am not saying it is all plain sailing. There are difficult life events and periods when I may wake on and off and wake up anxious but I use Mindfulness and take a herbal remedy such as Kalms for a week or so until  the symptoms subside.

Years ago I often had suicide ideation – when you do not make plans but the idea is there that one day you might use that way out but this has passed. This is partly because of the medication and partly that I have seven grandchildren and made the decision some years ago that I would not want them to live with the knowledge that their grandmother had taken that route out of life. I want to be a role model for them so they have been my salvation.

My writing is also my therapy and absolutely free. I make sure I write something every day even if it is only a diary entry – when low sometimes the creative juices dry up. However, depression is common amongst writers and research has not established whether it is because depressed people turn to writing as therapy or whether writers are more vulnerable. It is a solitary occupation so writers need to have networks to keep up social interaction.

I feel intense sadness for the family of the person who chose to jump from our nearby cliffs. I can only guess at their heartache and the possible guilt they may feel that they did not recognise the signs or take any action. In mitigation I would say that Bi Polar sufferers are canny hiding their symptoms and mood swings. I am sure that, in this case, the nearest relatives were kept completely in the dark. We are quite private people. We may talk a lot at times and disclose much but we do not wish to burden people with tales of our darker mental states. Also those who sink to such low levels become quite secretive and quiet.

It is therefore no wonder that relatives find themselves unable to prevent such a tragedy. Beyond investigating if medical intervention and monitoring was sufficient – and lets’ face it the mental health services are in disarray with lack of funding, all of which is a disgrace to our present government –  all I can say is they should take some comfort from the fact that this was an action of choice albeit an unfortunate one.

If you know someone who might have stopped taking their medication you need to speak to a medical professional ideally someone with experience and expertise in mental health. Some years ago, it was planned that there would be a point of contact in each GP surgery – a mental health professional or counsellor who could deal with distressed patients or worried relatives on a ‘walk-in’ basis. As far as I am aware this has not happened.

It is time for the government to place importance on mental health services with a view to preventing such tragedies in the future.

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Uncategorized

Early Warning Signs

 

Well here we are in February. A year ago I wrote about January depression but I seem to have escaped that this year, possibly because I am practising Mindfulness, which I will write about in another post, but also because I am applying strategies that I write about in this post. While this post is about Early Warning Signs, I have learnt that by working on the strategies listed further down, the EWS are no longer a problem.

 

There was a time when, following a move and a new GP, I struggled with depression and would pay visits to the surgery in the hope that some help would be forthcoming. When I related my symptoms I was told that I was being super sensitive to my feelings and these had arisen because I was frightened of descending into previous illness that had resulted in hospitalisation. I often wondered if she had read my notes.

 

After attending a self-management course, I learnt that these thoughts, feelings and behaviour are important for they are our EWS (early warning signs). While these may differ between us, many are commonly experienced by sufferers.

 

If you are reading this because you suspect you are depressed I hope you will be heartened by the knowledge that all these feelings will pass but there are some things you can do to make yourself feel better in the meantime.

 

My trigger is usually a period of stress even if I think, at the time, that I am coping. Sometimes, I may have a fall, a sign my balance is off centre or that I am not concentrating. I may have been exceptionally busy with normal activities. Holidays and Christmas can cause this.

 

So what are my early warning signs of depression? First I begin to wake up tired rather than refreshed and find it difficult to get up. I am aware that something in my life is missing and that is the sense of joie de vivre, being able to enjoy simple activities and generally looking forward to what life has to offer. Over a few days I notice I am feeling overwhelmed with a range of daily activities that I would normally take in my stride. I begin to forget things and find it difficult to plan ahead. Time becomes short and I cannot fit in what needs to be done. Time drags but also seems to fly and leave little time to complete tasks. This causes some anxiety and I become aware of a few worries. These increase over a few days. I begin to worry about my worries. I worry about getting more worried. It is a vicious cycle.

 

My sleep is disturbed. Whereas my medication usually knocks me out, suddenly I either cannot get off to sleep or I wake with a start in the night and cannot get back to sleep. Early waking might happen a common symptom in depression. While I have previously been enjoying my food, I feel sick in the mornings and am uninterested in food.  I may have difficulty swallowing, particularly where tablets are concerned.

 

As a writer, one sign my mood is dropping is that I stop writing or find it difficult to engage with a manuscript that previously had excited me. I begin to spend more time sitting on the sofa but achieving little. I get things out and do nothing with them, start to read an article but fail to finish. A number of half read papers start to pile up. By now the kitchen is untidy and my normal attention to cleanliness is notably absent. Dishes in the sink and cold cups of tea sit forgotten on the table, made before I wandered off to do something else, distracted. I am now feeling unsociable – after all I cannot ask anyone round to my messy house and I am reluctant to answer the phone or make arrangements to meet with friends. If one of my friends cannot meet up I may experience a feeling of relief.

 

Now none of the above is a serious warning sign on its own. As the peer specialist told us, ‘it is when several EWS are observed and they hang around.’ The key is being aware.

 

Luckily I now recognise these signs and rather than ignore them which my GP thought I should, I recognise that I need to take some action.

 

There are a few strategies which can bring you back on to a previous mood level before depression takes a more serious hold. Some cost money and others are there for free. For example, you may not have a computer but you can use them for free at the local library. The librarian will also help you and there are Adult Education courses for beginners which are free. You do not have to buy books to enjoy reading, you can use the library.

 

The following ideas are a mix but most cost nothing. You may not find them all helpful but some should suit where you find yourself at the moment. It might help to tick the ones you feel you could carry out at the moment and mark others for later attention. Perhaps colour code the strategies ie Green for go ie something to do NOW, orange for might do this soon, red for something you would find too difficult. Try to work out your own coding system. Here are strategies which have worked for me:

 

  • Getting out for a walk, however short, in the fresh air and, hopefully, sunshine, will boost endorphins.
  • Writing a mood diary and recording daily activities will get you writing. This also gives you something to read back on when you think you have not achieved much.
  • Reading poetry takes less concentration and might help. Try humorous poetry.
  • Setting achievable goals especially when tidying up neglected areas. Choose a few shelves or one file at a time. To plan to tidy the whole house is unattainable and will result in failure and increase your despondency.
  • If you can find a reasonably priced therapist and can afford it, book a reflexology session for deep relaxation.
  • Experiment with ‘tapping’ techniques. Tapping therapy or EFT (Emotional Freedom Techniques) is explained on various websites along with videos. If you are unsure it would be worth paying for half an hour of therapy for a demonstration and help with setting intentions.
  • Write a To Do list every day with achievable tasks. Keep it short and cross off those completed. This aids memory too.
  • Phone or visit a member of your family.
  • Try to speak to someone each day, perhaps a shop assistant.
  • Smile at people you pass on the street. This has been proved to have the effect of receiving a smile in return which can make you feel good about yourself.
  • Watch ‘happy’ television programmes and avoid the news which can increase anxiety.
  • If reading is a problem, watch an interesting documentary dealing with a topical debate. Read a blog or website on a subject of interest. There are many blogs on improving mental health and reading these is easier than reading a book and you will engage with the writer and be able to comment. Try to post a small comment. A few words will do.
  • Write down three positives for each day. These could include cooking a meal, phoning a friend or watching tv. A walk in the sun, sending an email to a friend or writing your diary also qualify.
  • Take the pressure off yourself. Instead of berating yourself for not getting out of bed in the morning, give yourself permission to stay in bed for a short time. After all, your depression probably came about from being stressed and over busy so allow yourself to be lazy for a certain period of time. If it is a choice you will feel better. You will soon be getting up more smartly when you feel better.
  • Accept you have an illness and that this phase is part of your illness. I was told this a year ago and found it liberating.
  • Tell yourself that your brain worked hard and was overstimulated before this phase. Depression is often the brain’s way of ‘having a rest’. Let it rest and don’t fight it or force yourself to do things you find difficult at this time. Make a choice to rest your brain and keep occupied with physical activities that are possible at the moment. Sorting some photographs, or browsing magazines can keep you occupied. This is NOT giving in or being lazy. It is allowing your brain to recover.
  • Listen to music or play an instrument.
  • Do some stretching exercises each day. Practise yoga and feel the difference.
  • Remember depression does pass. You will not always feel like this.

 

Some of the points above I have already written about on my blog eg the idea of writing down 3 positives each day.

Other points here will be expanded on in future posts.

NB this blog first appeared in January 2015 but has since been updated.

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