Saturday, December 18, 2010

The Auxilaries of a Mental War

Knights of Seroquel

Quetiapine [Seroquel] is indicated for the treatment of schizophrenia, depressive episodes associated with bipolar disorder, acute manic episodes associated with bipolar I disorder (as either monotherapy or adjunct therapy to lithium or valproate), and maintenance treatment of bipolar I disorder (as adjunct therapy to lithium or divalproex)...

It is sometimes used off-label, often as an augmentation agent, to treat conditions such as obsessive-compulsive disorder, post-traumatic stress disorder, restless legs syndrome, autism, alcoholism, depression, Tourette syndrome, and has been used by physicians as a sedative for those with sleep disorders or anxiety disorders.

At very low doses (<25 mg), quetiapine acts primarily as a histamine receptor blocker (antihistamine)...

They prescribe this terracotta-coloured tablet to treat almost everything, from the look of it. Everything related to a fucked up mind, at any rate. And hayfever.

I do not have a prescription. The doctor dropped a sample box of 10 in my hands. "One of these every day," he said. "Immediately. It will take the edge off until the Cymbalta kicks in."

I think more appropriate wording would have been, "It will take you off the edge."

When I got home I immediately googled everything I could about the drug. It had taken a lot, too much, to get to the point of asking for anti-depressants. What I learned left me crumpled and weeping. Side effects. I didn't want to take it. I was afraid of taking it. I was afraid of what would happen if I didn't.

I started taking it.

The first tablet hit me like a brick. An intense sleep that was extraordinarily difficult to come out of. The struggle to simply gain a semblance of wakefulness left me without the resources to sit up, let alone get up. Gravity could not decide what angle it was aligned at. I had to sit down in the shower. That wasn't enough. I had to get out of the shower, throw a towel on the floor because I couldn't dry myself and lie there, hoping that soon, I would have control of my body again, and soon, the world would stop moving.

I was slow, incredibly spacey for the day.

At night I forced myself to take a second tablet.

The morning was still hard, but not as bad as the previous. As the days went on, the side-effects reeled themselves in. In a couple of days I was off the edge. I enjoyed knowing that taking the tablet would guarantee sleep.

On the Saturday, a week after I'd started taking Seroquel, I could not move. I did nothing but lay on my bed in a strange fuzzy stupor. My brain filling up with serotonin, I'm told. I cut Seroquel to a half dose.

After a few nights on a half dose, I fell apart. Upped the dose again. Halved it again. Determined to be clear of it before I ran out.

On the follow-up appointment a week later, I explained I'd stopped taking Seroquel all together and hadn't slept for three days. The doctor said that shouldn't happen, Seroquel doesn't work like that. But it did. I saw 4am three times in a row.

His solution was to give me another three sample packets.

Sappers of Cymbalta

The main uses of duloxetine [Cymbalta] are in major depressive disorder, general anxiety disorder, stress urinary incontinence, painful peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain associated with osteoarthritis and chronic lower back pain.

Duloxetine [Cymbalta] failed the US approval for stress urinary incontinence amidst concerns over liver toxicity and suicidal events; however, it was approved for this indication in Europe.

"One of these a day, in the morning," the doctor said. "This will take a few weeks to kick in."

My prescription was for 30mg. I went home and read and read and read and cried. There were so many risks that came with the drug, more than I had the strength to face. I couldn't take it, I couldn't not take it.

I took it, and told no one.

Side effects were immediate. Incredible bouts of yawning, accompanied by a super-saturation of oxygen in the blood, so that I had all the symptoms of hyperventilation without hyperventilating. My fingers and toes were constantly fizzing and thick, perpetual tight-wound energy in my belly, all of which increased dramatically if I should begin talking for any length. Laughing became quite the ordeal. My appetite vanished.

I was off the edge, and lost in space. But off the edge. Off the edge.

When I stopped the Seroquel entirely, and a few days had passed for anything like withdrawal to wear off, I was okay. Just okay. Merely okay. Solidly okay. Lower than the odd bout of mania that had struck me when on both drugs, not without sudden squalls of horror and despair, but far more level. Able to cope with the work place, the supermarket, the world we live in. I was sleeping okay. The yawning never really stopped, and my mouth is continually dry, but they are minor side effects, considering.

Cymbalta is slower to work, more insidious, but gentler too.

My dreams are stronger. This I love.

Siege Engines of Cymbalta

On the follow up appointment, the doctor issued me a new prescription for 60mg, to begin when I'd finished my current one. He didn't say why, and I, out of my mind, didn't ask.

The first day, my stomach began churning, and without warning I was vulnerable. Anxiety and dread. I went home early.

I could not sleep. At all. The following day this was augmented by the onset of restlessness. My bones ache. My muscles constantly feel as though they are about to spasm. I feel forever just shy of the peak of some massive eruption, and explosion of mayhem and energy and pure flailing.

Insomnia is no stranger. I could deal with insomnia. But restlessness? I don't know restlessness. Apparently I've taken for granted for 29 years my ability to sit or lie still and and comfortably.

It slays me. I thrash and thrash and thrash, mind and body together, doing absolutely nothing at all.

Nights of Seroquel

I am glad the doctor gave me these spare packets.

Half a tablet is not enough.

I take whole tablets. Last night, I tried a half dose. Just shy of midnight, I got up to swallow the other half. This morning, I was driven from bed when my body began to ache and the urge to thrash made my eyes hot.

...The Counsellor Asks Questions

I support the idea of counselling entirely. It does real good for a lot of people, guides many in the processing of difficult realities. I've encouraged many to pursue it, stick with it, simply consider the idea as an option.

Personally, I hate counselling. The idea is abhorrent. The verbal articulation of my emotions and thought processes is...look at the title of this blog; Silence Without. Because I cannot speak my demons aloud, and that is what counselling involves. There are a myriad of other reasons which I will not get into here, but suffice to say, counselling is exactly what I do not want.

I accepted the referral.

He listened well, very well. A good listener is an incredibly rare treasure. He paid good attention to the words I chose. The usual tactic of sitting without speaking to goad me into filling the silence of my own volition didn't work. I fear no silence. It was he who eventually broke every silence. I couldn't look at him, and when I cried I didn't want a witness, and would spend those hours with my face covered with my hands.

All his questions I answered frankly, not offering more than what was requested. I was trying, and that was the best I could do.

We did not agree philosophically. He belonged to a school of thought that focused on positivity, with a motto similar to, "You just gotta believe." His aim was to restore hope to me, to find a positive way out.

"There must be a positive way through," he said in the first session.

"Does there?"

He was taken aback. "Yes. There must be."

I wasn't challenging the idea out of despair or pessimism. I merely acknowledge that there is no 'must'. We not owed anything. I may get better. I may not. Both are equally possible.

I had my last appointment with him on Tuesday. Because he pays attention, he asked if I thought I had got any benefit out of these sessions.

In the balance of things...what benefit there may be is outweighed by the dread and anxiety they cause. These sessions leave me wrung out. They bring everything to the surface, and it takes me a couple of days to recover before I can function properly as a social creature again, and then I simply move on to dreading and stressing about the next session. I am not in a position of strength. This is more than I can cope with.

And no, I did not think there was much benefit to be had. There was nothing he had said that I had not already considered myself.

I tried. Knowing my own bias against counselling, I tried, and gave more than a good shot at it.

I never want counselling again.

What am I?

I'm on medication for bipolar. The counsellor said he saw something that looked like Post Traumatic Stress Disorder in me. I can function. Am I okay? My hands have been much worse these past few weeks. I'm on prescription pain killers too. The door trays of my fridge make me look like a junkie. I have the alarm set for 6.30 on the weekends so I can take my dose on time. Grocery shopping is impossible with no appetite. Is there a future here?


Something has to change.

EDITED TO ADD: I left this post slanting somewhat in the wrong direction. Apart from more coherent dreams (which I adore, but for people who are used to actually sleeping while asleep (MADNESS!!!!!), instead of saving the goddamn world, they can be the worst side effect of all; see Dooce's experience with Cymbalta, which led to her eventually switching medication), the Cymbalta appears to have sorted out my blood sugar, or metabolism, or whatever it is that our fuel systems are based on.

Previously, I had shyte blood sugar. I rarely had the opportunity to be hungry as a blood sugar crash would make itself known before minor things like an empty belly had the opportunity to occur. Some people get grouchy when they're hungry. I get faint, weak, dizzy, and pretty much live in constant fear of fainting. When that happens, I have to eat something, anything, right then. If I'm out and about I make sure I have food on me all the time. That's how ridiculous it is.

Now? Dude. Apparently this is how most people feel? You know, all...normal and...not about to collapse.


I am so totally okay with this.

And all side effects aside, the meds are working.

There is distance now between me and the horror, enough distance for me to cope with being a living waking entity, to take care of myself and even, occasionally, take care of others. I am not a zombie. (Well, apart from the tail end of the Seroquel in the mornings, but I was never a bright spark in the mornings anyway.) I feel. When I laugh, it's because I am laughing. I can have a good time and carry that good feeling away and inside me for the rest of the day. I can be upset and angered and brood like the champion brooder I am.

I can do all that, and I am not on the edge.

I don't want to be medicated. I remain afraid, very afraid of what the drugs are doing to my mind and thought processes, especially as I cannot control them and do not entirely understand how they work.

But, they do work.

I am alive because of I am medicated. I am alive. Because of that, I will not regret taking medication, nor will I be ashamed of it.


  1. I'm listening too, and hoping you find that change.

  2. Love and hugs are inadequate, and yet that is all I have to offer, so that is what you get.



    I have only tried counselling once, and I found that I couldn't do it. Although I know that it would probably be useful and even necessary to my mental health, I just couldn't vocalise, or couldn't find a way to turn the feelings and thoughts into some kind of external narrative to deliver to another person, without oversimplifying or cheapening them.

    And perhaps, if I'm honest, there is a terrible fear inside me too. A fear that, what if I go to a counsellor, or multiple counsellors, and I find out that it's all lies, that there is no hope, that all there is is despair? At least when I have not tried it I never have to face that discovery.

  3. I'm always listening. I wish there was more I could do from way the hell over here - it's very hard watching you go through all this from so far away. So I send you silly things from time to time and hope it puts at least a small dent in that chemical monster with its tentacles wrapped around your brain.

  4. God damnit, I love you. I /love/ you. Just... know that, k?

  5. Also, that up there was me. -miiru

  6. I'm always listening. You are one of the nicest, most wonderful people I've met, and there is nothing, /nothing/, you cannot overcome. If you need anything, you know you can always always always poke me and I will jump like a jackrabbit.

    <3 We all love you, Tess. We do. Promise.

  7. Put me into the list of people who are listening, and who love you.
    Your posts have always been my favourites. Everything from interesting book commentaries to silly cartoons and thoughts, to posts like this which make me think not only about the issues you are dealing with, but my own issues and those of others around me.
    I wish I could tell you how inspiring I find you. Even when you feel you're at your weakest, I feel an amazing amount of strength in your posts. Your willingness and ability to share as much of yourself as you do, even while admitting how hard it is, is amazing. I dearly wish that I could get to the point where I could do the same.
    I hope you know this all comes from my heart, and is meant in the most kind and sincere way. (I don't feel that I express myself well at all in words, either written or spoken, so also know that you can always ask me to clarify)


  8. Thank you all, my freaky darlings. (Especially Miiru for owning up - reading THAT email notification gave me significant pause. :P)

    Chris - plans are afoot.

    Ben - The thing with counsellors is that you do need to shop around and find a person who is right for you. If you're having trouble articulating, it could be because the counsellor is asking you the wrong questions.

    It isn't much comfort, but I'm one of those people who believes there is no hope. No hope does not equal despair, however. We simply are.

    Jaime & Miiru & Manu - <3 you my dear distant hussies, and YOU know that.

    Thank you, Selena. Some ridiculous melodramatic martyr complex in me hopes these posts help someone, somewhere. Better yet if it's a friend.

    And, for anyone else who may be reading up on anti-depressants are having doubts due to the stigma associated with taking such medication; please read this post. It has helped anchor me considerably.

  9. That is a great post. Wow.
    I'd never really thought about antidepressants and general mental health in quite that way.
    And it's funny (sad, really) how much of a double standard I have regarding my own mental health compared to that of others. Although this double standard is something I've been really coming to realise over the last couple years. (In regards to absolutely everything) People always laugh off "Everyone's their own worst critic..." but it can be a pretty big barrier to being... well, just being yourself.

    More fodder for my ongoing ponderings. Thank you. :)

    And more hugs for my favourite crabbadger. I hope today has some moments of wonderful for you to enjoy and use to lift your spirits.

  10. For what it's worth, I can really relate, Tessa. While Seroquel did work for me, they initially had me taking it during the day and I quite literally fell asleep in mid-conversation with someone. Once we had doses and timing worked out, it really did help level things out. However this was only after other meds had completely and totally f*cked me up. And I spent eight months of a case manager refusing to even put me on the waiting list to see a head shrinker to review my my meds.

    Hang in there, Tessa.

  11. Very belated hugs. I'm a lousy listener and I read blogposts two weeks too late, but I care a great deal. You'll find your way through (with tablets, without tablets - whatever works) - it's something you do. I wish I knew this about other people, but at least I know it about you.