This morning I got up early and decided to make an appointment to see lovely GP rather than just handing in a prescription request form. Now that I no longer see lovely social worker, the only person apart from Mr Psychiatrist who has been there consistently over the past few years is lovely GP. I was feeling really anxious when I went in to see her and told her that I don’t know if it’s just because I don’t really know new CPN yet, but that I’m not finding the appointments helpful because new CPN always wants to talk about the positives and whether she likes it or not I need to talk about the negatives as well. I need to talk about them to make sense of them and I need to talk about them because they are likely to affect my mood and destabilise me.
So lovely GP sat down her pen, turned her chair round and asked me what was making me feel so anxious. I rambled about the self harm urges being very very much at the forefront of my mind and I rambled about the persistent giggle and mocking comments I hear in my head. I told her how scared I was that this may not be my thoughts that I was hearing but that I was hearing a voice again. She said that Mr Psychiatrist had written in his last letter that my Quetiapine (Seroquel) could be increased from 600mg to 750mg a day if needed. Four weeks ago I jumped from 600 to 700 and today she said she is increasing it to 750mg. So that is me back on the maximum dosage. She also arranged for me to have routine bloods done on Monday morning.
I have been on the maximum dose before but whilst I’d had fairly good results from Quetiapine at around the 500mg mark it stopped working and so we increased and increased but it would only work for a very short amount of time and then the voices would come back. The voices got stronger and 750mg still wasn’t enough to stop them so we tried three other anti-psychotics: olanzapine (zyprexa) then haloperidol (haldol) and then amisulpride. None of them worked. And all of them apart from Quetiapine gave me horrible side effects.
So here I am back on the max dose and I have to go back and see her in 4 weeks time on the 6th of Feb which also happens to be the day of my next appointment with Mr Psychiatrist so I guess that will work out quite well if any medication changes are needed. I know the mocking voice and giggle are contributing to me feeling anxious and a bit paranoid. This in turn makes me distressed. So if I go and see Mr Psychiatrist and tell him I’m still feeling anxious and distressed but am now on the maximum dosage then he is likely to say he wants to try something else. I am hoping and praying that this extra 50mg is enough to quieten my head back down to a bearable level.
Anyway, lovely GP gave me prescriptions and then made a point of telling me that things will get better, things can get better and that it’s important to be aware that I have taken on something positive – my university course – and even though it’s part time and it’s from home it’s a good start. She encouraged me to try and remember the positives when I was feel low, but then she also looked at things from the other angle and acknowledged that I have been self harming for a very long time and it’s been my coping mechanism for so long that it’s such a hard thing to stop doing. But most importantly (to me) she didn’t sit and offer me praise for going 3-4 months without doing it, instead she said she could see why the urges to do it would be strong at the moment, 3 months is a long time to go without doing something that was (at times) a daily habit.
She told me to think of it a bit like quitting smoking. I’ve smoked daily for years. I smoke more when I’m stressed and less when I’m calmer. Just like self harming. When I’m not smoking I can be sure it won’t be long before the bells start ringing in my head telling me I need another cigarette. If I was quitting the first few days would be very hard. The first few weeks I would probably have the worst cravings and even though I had gone a few weeks without a cigarette I would be thinking about having one a lot of the time. I’d battle back and forth with myself and try to convince myself if I just had one cigarette then it would satisfy the cravings but it would make the battle to quit even harder for myself. However if I managed to get through it, deal with the cravings but not give in to them, then I would get to a place where six months down the line the cravings would be a lot less intense. And a year down the line they would be even less. The cravings would probably last for a very long time and may never go away completely, but I would have learned and developed the skills to cope with them and let them pass without acting on them.
So it remains to be seen whether I can carry on battling against them or whether the urges end up winning. But as new CPN continually reminds me, it is only me who can stop it from happening again… If only it were that easy…
I only had about 10 or 15 minutes with lovely GP but I felt like I had got a lot off my chest. She let me talk, calmed me down, looked for a solution and just generally made me feel like I’d been listened too. After leaving the doctors surgery I went to the pharmacy and sat for the usual half an hour that it takes them to make up my 4 weekly prescriptions (I only get a week at a time, I guess they still don’t see me as being stable enough to get a month’s worth of tablets at a time).
I also remembered I have an appointment with my support worker from Rape Crisis today. I get on with her a lot better than new CPN and although when I’m there it’s to talk about both childhood abuse and the assault back in August, topics such as self harm come up quite a lot and she is very knowledgeable about it and completely non-judgemental which is nice. Self harm and abuse seem to go hand in hand quite a lot, probably because the abuse memories make you feel so vile and disgusting and confused and messed up and then the self harm is like this magic wand that just seems to release all of those feelings and offer a temporary break from it all.
So I hope that tonight I will feel a little calmer, the mix of the increased dose of Quetiapine and having a good appointment with lovely GP and (hopefully) a proper good chat with support worker should all leave me feeling like I’ve got a lot off my chest today.
I might write another little update later if anything comes up at my appointment with support worker that I need to have a ramble about.