Update – I did it – thank you!
I also blogged about it for Mind – Exercise, mental health and taking on Ride London.
Yesterday we celebrated our first wedding anniversary. Our wedding was a magical day but, in the two years since we got engaged, life has taken some unexpected turns.
My mental and physical health has taken quite a bashing. I’m not fully recovered – and I’m working hard to challenge and change thought patterns and reactions that have been deeply ingrained for many years. But I’m gaining more perspective with each month that takes me further from the trickiest of times.
So what would I tell the Clare who said ‘yes’ under that tree on Hampstead Heath in 2015.
I thought I would be able to diet just enough to feel comfortable in a gently corseted dress – and then stop afterwards. But my disordered eating lurked much closer below the surface than I realised. It wasn’t long before my eating, exercise and emotions got horribly tangled. I thought I would never go back there but I slid into militant calorie counting, restriction and purging through exercise with the excuse that it was ‘just for the wedding’. The dress was too big, I spent our honeymoon struggling to find a manageable balance and it took my periods stopping to shock me into making a change.
“You were so proud of yourself,” my mother in law said. And I was. I had been fighting my medication for years, trying to cut down and come off. Stopping was the hardest thing I’d ever done.
And when I finally fought through the initial withdrawal symptoms I thought things would get easier. Instead they got harder. More chest pain. More tears, panic and anger. Suicidal thoughts. More running. More fighting my body. It took three months to realise I couldn’t do it. That nothing was worth the destruction those months had wreaked on my body, our health and our relationship.
Mind has been asking people to #TakeOffTheTape and share something that makes them anxious. Something they haven’t spoken about before.
I thought I would use the opportunity to write about something that’s hardly spoken about at all.
I’m finding it incredibly hard to balance trying to conceive with managing my mental health.
We don’t talk about this. We don’t even talk about the first twelve weeks of pregnancy much (as I’m well aware from my work with the Miscarriage Association). Trying to conceive often happens in almost complete secrecy. I didn’t realise how it would interact with my fluctuating mental health and I wasn’t prepared.
It’s taken a while to get to this stage. The doctor who removed my coil last year strongly implied that it would be best to continue with my efforts to come off my Citalopram. She moved me to Sertraline (it’s considered safer in pregnancy) and told me to try and reduce my dose completely over the next month.
In fact it took me three more months. I’ve been trying to come off anti depressants for a while anyway (after a muddled fifteen year relationship with them) and trying to conceive gave me the strength to make it through a hideous withdrawal period. It was probably the hardest thing I have ever done. Alex didn’t have much fun either. I’ve written about it here.
I’m more vulnerable to hormonal changes now. I still have very dark times when everything seems hopeless and I can’t see a way through the next ten minutes let alone the rest of my life. Difficult images and ideas jostle with an endless repetition of fears and doubts. Sometimes the same phrase over and over again. They whisper just below the surface of my consciousness. They’re loud enough to wear me down and shrink my focus to a single point of constant worry – but not quite conscious enough for me to recognise what’s happening in a way that helps me stop.
One these days I’m separated from the world by thick glass that bounces every negative thought straight back at me, infinitely magnified. My attention is forced inwards but my mind is everywhere but present, infecting all it can with worst case scenarios. I can’t look up and out, can’t see the variety of the world and my place in it, can’t take a long deep breath. My chest physically hurts and I feel constantly sick with the fight or flight chemicals flooding my poisoned body as it tries to deal with the powerful threat of my mind.
These times are getting further apart and each one adds detail to our understanding of the best way to manage them. But trying to conceive has made my anxiety worse. It’s given it another peg to hang its hat on. Issues with eating and body image are often about control (with an emphasis on control over your body) – and anxiety hates uncertainty. But trying to conceive is a very uncertain time. What my body does – and doesn’t do – isn’t completely under my control.
I was managing my mental health to the extent I felt I was in a position to come off medication – in order to do something that has made the problem worse again. The irony isn’t lost on me – although on bad days it just makes me want to cry.
Every time I go to press ‘publish’ on a tricky post exploring my mental health I pause for a moment. The way my blog has developed means that my personal struggles and successes sit alongside blogs about my work and details of my skills, training and experience.
I know stigma and discrimination around mental health in the workplace exists. I spent 2014 providing evidence based reports on mental health policies and support in a number of organisations across a range of sectors for the Time To Change Organisational Healthcheck programme. Tom Oxley writes a good piece about how the programme worked on pages 10 and 11 of this newsletter.
I spoke to people in every workplace who said that they wouldn’t tell their manager if they were experiencing a mental health problem. Many said they would lie about taking time off.
”I’d probably say I had a migraine or something”
Those who had been honest about taking time off for a mental health problem said they felt that now they had more to prove.
Unfortunately in some cases I could understand why. Some managers said they felt people with mental health problems couldn’t ‘cope’. Others saw investment in employees’ mental and physical health as a burden rather than something that makes moral and business sense.
”You’ve got to be careful or people will just take advantage, start using ‘depression’ as an excuse.”
”We need people on top form to do this job – if you’re depressed you just won’t be able to cope.”
1 in 6 employees are currently dealing with a mental health problem. Like colds, flu, delayed trains, bereavement and accidents it’s always going to be part of a workforce. It’s how employers deal with it that counts.
My mental health is part of what makes me. It’s part of what makes a life – and in many cases it’s part of what makes me good at the work I do.
In the run up to Time To Change’s Time To Talk Day on Thursday I thought I’d share some of the reasons why I press publish on those tricky posts every time.
I’ve recently come off Sertraline after 15 years on various SSRIs. It’s been a long and tricky journey but I think I might be almost there. I’ve written a bit more about that here.
I love a metaphor when it comes to managing my day to day mental health. Metaphor helps me identify and pin down my experiences. This is a step towards understanding and managing them. It helps me regain perspective and use the language of shared experience to transfer and talk about some pretty intangible feelings.
I haven’t had much perspective recently. Feeling anxious seems to magnify individual moments. It’s as though I am living life too close up. I don’t have the capacity to see beyond the worry I’m experiencing right now.
My nose is right up against the canvas rubbing in all the tiny flaws and bumps. From here they look huge and distorted. But we all know an oil painting looks better from afar. The swirls of dark colour and the lumps of paint add texture and depth to the bigger picture.
I’m not saying that this kind of anxiety is necessary or important to make up the picture of a life – it really isn’t. BUT I have found that whispering ‘remember the oil painting’ to myself has reminded me to step back and question whether the worry that’s causing overpowering anxiety right now will matter at all in a year (or even a month or a week). It’s helped stop those tricky surges of panic become uncontrollable.
As I write I’m on the sixth day without any form of SSRI at all. This is new territory for me. I’ve taken them every day for 15 years (with terrible healthcare making it much trickier).
Three months ago I moved to Sertraline. Two months ago I was down to 1/4 of a tablet per day. Then I started alternating days. One month ago I moved to one day on and two days off. Over the Christmas break I’ve been attempting one day on and three days off. This time round when it got to day four off I decided to keep going.
It’s been a LONG time coming. I’ve been bobbing around the 20-30mg mark for years. I tried to come off them in 2008 but didn’t get below 10mg Citalopram before an abortion and a move to London meant I needed more support again. I tried in 2012 but again couldn’t drop below 10mg. In 2014 I got to 5mg before it became unbearable and ended up slowly and frustratingly working my way back up to 20mg.
My chest sometimes feels uncomfortably tight and I’m still welling up at the slightest thing but I haven’t had any big uncontrollable surges of irritability (horrible), anger (scary) and panic (painful) since before New Year. The worst day was the first time I got to three days without. That afternoon there was little to be done except pick my sobbing self up off the bathroom floor and breathe deeply in showers as hot as I could bear. I would lie completely still in bed hoping for sleep but fearing the threat of my mind building, rushing and slipping away into a place of panic and pain that felt unknown and terrifying. It’s really scary to feel genuinely out of control of your mind. Luckily there was only one afternoon that bad.
I only feel completely safe when I’m exercising and in the calm and blissful hours afterwards when I’m myself again. I’ve ran hundreds of miles. When my knee gave out I cycled hundreds more. I discovered spinning. I’ve been chaining Kalms and I haven’t had a good coffee or a glass of wine in weeks (interestingly when you’re recently married and of a certain age people tend not to push alcohol on you, even at Christmas!). But I’m nearly there. I really think I might be.
I’m very very lucky to have such supportive and loving friends, family, work and (most of all) my husband Alex. My family love me unconditionally even when I’m unforgivably difficult. My friends make me feel myself again just by being in their company. But Alex is endlessly patient. Those surges of anger and irritability disguise themselves as reactions to things happening day to day. They show their ugly faces in snippy comments, slamming doors and helpless tears. He recognises these as symptoms. He knows that deep down they’re not my fault. He doesn’t react to them as if they are. This is perhaps the most helpful but also the most difficult thing someone can do to support your mental health. He’s an absolute hero.
(I’ve also written about managing depression and anxiety in relationships here)
There’s been plenty of dramatic lows and a few proud highs in this particular journey. But a lot of the experience of living with and managing this stuff is the day to day mental grunt work. Looking after yourself. Recognising triggers and identifying negative thoughts. I’ve been doing a lot of that too.
I love a metaphor when it comes to managing my mental health. Metaphor helps me identify and pin down my experiences. This is a step towards understanding and managing them. It helps me regain perspective and use the language of shared experience to transfer and talk about some pretty intangible feelings.
Over the last few months I’ve found a couple of new ways of thinking about my experiences which really help day to day. The tapes and the oil painting. I’ve written about them here: The Regret Tape and the I’m Not Good Enough Mix – new metaphors and thinking tools for managing anxiety and depression.
I don’t know what’s going to happen next and I’m going to try not to beat myself up if it doesn’t go quite as planned. But I’m cautiously pleased and proud to have made it this far. The sun is shining and I’m off out with the dog (he helps a lot too). I might even treat myself to a (decaff) coffee.
It’s worth emphasising that I spent a long time reducing my Citalopram and then Sertraline slowly in 2015. I did the withdrawal and reduction with advice from my doctor. This is a personal account of an individual experience. Mind has a lot of great info on coming off psychiatric drugs which it’s worth looking at if it’s something you are thinking about.
The doctor moved me from Citalopram to Sertraline last month (slightly better for any potential pregnancies) and suggested I try and reduce the dose a little (again in preparation for the same). I wasn’t sure whether this was a good idea considering I’ve been struggling more recently – but also felt it was worth another go given a) things have started to be a little easier and b) the doctors are always telling me my old dose was sub therapeutic anyway (pah!).
It was actually going pretty well until my period hit. Then those hormones smashed into me with a force I haven’t experienced for a while. Saturday was a real struggle, slow moving, anxious and crying on the kitchen floor (poor old confused Watson). Sunday was a little better – I felt exhausted and raw but calmer. We went to the Wildlife Photographer of the Year – it was good to get out of the normal routine but the crowds made me anxious and I cried in the bakery afterwards – overwhelmed by food choices for a birthday breakfast today. At least afterwards Al and I could laugh at some of my more ridiculous tearful utterings – “I just want some nice bread” (sob).
And today I’m struggling with some serious mood swings. One moment I’m feeling calmer. I’m more on top of things and able to see ahead to all the joy in my life. The next it’s really black. My chest feels very tight, there’s no good memories anywhere and I can’t see a way through at all – the mental trickery of depression taken to an extreme. It seems to take almost nothing to trigger the change. I’m treading on mood eggshells and wary of the world. It’s tricky to trust in any individual moment.
It seems that both medication withdrawal and day to day management of my mental health is massively exacerbated by hormones at the moment. The worst weekend in October was a period weekend too. I need to recognise it and ride it out but it’s hard hard hard. Hopefully the worst will be over this month.
Writing things down has helped – but on days like this I only feel myself when running. So I’m going to run and run and breathe deeply and listen to the world and watch Watson chase squirrels and hope I come back calmer – and ready for some birthday cake.
It’s been a few months since I last wrote about the tangle of eating, exercise and emotions I have found myself in this year.
I’m tired. More than anything I’m tired of thinking about food, eating, exercise and what I ‘should’ be doing. It’s just so tedious. Meditation, interesting work, DIY, time spent with friends and crafting gives me a break for a while but I can’t just turn it off completely.
I’m working on accepting that this particular punishing thought gremlin will take up brainspace for a while yet. I’m not going to waste the space I have left worrying about how much he’s around. That seems counter-productive.
Instead I’m trying to tame him by guiding my thoughts in a healthier direction and gradually diluting them with new perspectives and approaches. Sometimes this works. Sometimes it only gives me glimpses of how things could be. This makes it worse when he grips back hold.
When he’s got a grip he still sets tests for me and makes me feel awful for failing them . Do certain clothes fit? Do my fingers fit around? How does my body look and feel?
When I ran a 5k 10 seconds slower than my PB he whispered that it was because I was getting fatter. He didn’t care that it was still a sub 20 minute time. Achievements and compliments slide off him and fall forgotten.
Sometimes he chooses to berate me about how stupid I am to worry about it at all when so many people are dealing with astronomically more pressing problems. He’s not going to let me cut down on exercise too much right now – but he’s going to try and stop me enjoying it by telling me I’m doing too much as well.
A bad day
A tyranny of bartering and balancing. Reassigning guilt and promises. Negative and positive calorie credit. Pinching, pulling, judging and comparing.
Trapped by a grotesque distortion of natural processes that mend and fuel, store and burn energy. That keep me alive and moving hard and fast and well. I’ve hated every inch of skin. I know every fold and dimple intimately. Every tiny growth, bulge or change tells me I should be better.
What I have eaten today? Lost track, list it again. Over and over. Test my wrists, check my bones. If I list it in sections and move the biscuits to mid morning it sounds ok. Doesn’t it? Lost track, list it again. Maybe write it down. It’s ok that it looks like a lot, I ran yesterday and went spinning this morning. But that was to make up for last night when I had pudding. And couldn’t stop eating it (“because of your pathetic lack of self control” – thanks thought gremlin!). So I’m not really in credit, I should run this afternoon. But my knee. My bloody knee aches. If I was sensible I’d rest it. Even thinking of running on an injured knee shows I have a problem. But my trousers feel tight. I feel enormous. My wedding ring feels tight. I could swim. But that doesn’t burn as many calories. It doesn’t give me the FEELING. If I could just run today then that would reset everything. I can start being sensible tomorrow. If I cut down on food then I won’t have to exercise as much. But I don’t want to get back into restricting, it takes up too much headspace. I just want to eat normally. All this exercise makes me hungry. Maybe my knee is ok anyway. I’ll have a cold bath afterwards. Then I can have a nice dinner without worrying. Then the thoughts will calm down for a while and I’ll be able to focus on other things.
I refuse to restrict any more. I’m holding on to normal that way. And I’m HUNGRY. Instead I fight the urge to run and run and spin and swim and drain my body of energy then, as the voices quiet and I feel free of guilt, eat my way back to the same cycle.
On days like this it feels as if even a good day is one where the judgemental voices are appeased not forgotten. How do you stop when eating and exercise are always going to be part of life?
It started when I pressed snooze at 6am and cancelled my spinning class. I’d been in the gym at 6.30 all the previous week and had just returned from a busy couple of days running and walking in Cornwall. I was exhausted. But I didn’t get back to sleep. Anxiety levels rose. Getting dressed I was acutely aware of all my clothes, how they pressed against my skin. I couldn’t find anything I felt comfortable in. My hands felt swollen and my chest tight. My mind was whirring with calculations and lists.
It wasn’t until after a session on the cross trainer, a long swim and walk with the dog that I felt like myself again. A combination of relief from thoughts about overeating and, much more importantly, relief from the anxiety that made it matter so much in the first place.
Yesterday evening I ran a very long way* because I ate some cake and chocolate buttons at work. The morning spin class stopped being enough.
It’s not so much the calories – although that doesn’t help at the moment. It’s a craving for that feeling after exercise where your thoughts are calm and still, your body feels tired but deserving of care and nourishment and your mind doesn’t have to calculate or judge because it knows you’ve done enough to rest.
“a craving for that feeling after exercise where your thoughts are calm and still, your body feels tired but deserving of care and nourishment and your mind doesn’t have to calculate or judge because it knows you’ve done enough to rest. “
My knees and hips ache and sometimes even crunch. They need a break. I am finally cutting down the running in favour of spinning, swimming and cycling.
But the daily doublethink is still absurd. Cold baths and a knee support is not going to allow me to run miles and miles however much I wish it would. Immediate relief still trumps long-term sensible decisions too much of the time. Even if that relief is tinged with guilt and frustration.
I’m planning my next exercise session whilst I’m in the middle of the previous one. I try to be more sensible but those persistent thoughts keep popping up.
‘You could run tonight. You could just do an extra session on the cross trainer after spinning. You could fit in a swim tomorrow morning if you get up really early. Remember how good it feels when you’re done, how much more you enjoy your food when you feel you deserve it, how much easier it is to rest and to concentrate when that anxious energy is stilled’.
Once I imagine that feeling, it’s hard to turn away from it.
But that feeling is lasting a shorter and shorter time. When I’m exercising twice a day and feeling anxious and panicky when I can’t get moving it’s time to get some help.
Mind asked me to created a #mentalhealthselfie, a video blog about my mental health, for Mental Health Awareness Week 2015. The theme was mindfulness.
As I blogged for Mind about my Mindfulness Based Cognitive Therapy course in 2012, I decided to do something a little different this time and talked about how my dog Watson helps me to remember some of the core teachings – acceptance, curiosity and overcoming reverse motivation.