Tag Archives: Depression

Coming off anti depressants – withdrawing from Citalopram and Sertraline

Day six in Foster’s brain and all is reasonably calm…

trainers and pillsAs 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.

Dealing with withdrawal symptoms

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.

Luck, love and incredible patience

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)

New understanding and techniques to manage my mind

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 Mix tapesand 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.

P.S – An important extra

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.

PMT, hormones and withdrawal – treading on mood eggshells

Mood eggshellsIt’s fair to say I’m not compleeetely on top of things today.

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!).

Hormone smash

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).

Mood swings

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, running and cake

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.

Exercise addiction and eating problems – good days, bad days and thought gremlins

A non-artists impression (!)

Thought gremlins – a non-artists (!) impression

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.

In the grip of the thought gremlin

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?

Continue reading

Exercise addiction – managing the tangle of anxiety, eating and exercise.

Last Sunday I spent all day exercising

ImageIt 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.photo (1)

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. “

Immediate relief vs long term recovery

legs and knee supports

Knee supports – NOT the answer to EVERYTHING

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.
Continue reading

Running for Sane – Christie’s story

Exercise for mental health

I’ve been thinking a lot about sport, and running for mental health recently. This is partly due toChristies just giving page work – I’m involved in the development of Mind’s Get Set To Go programme through the Elefriends community. I’ve also written a number of posts for New Level on the benefits of exercise for mental health and wellbeing.

There’s a strong personal connection too. Exercise is a vital tool for managing my own depression and anxiety. Recently I’ve been struggling to balance my mental health needs against the need to rest and recover after physical injury (darn knees!).

It feels as if more and more people are running. There’s definitely more people out and about in the parks and along the canals. This spring and summer has seen thousands of running events across the UK. One of the best things about these events is that each one is full of people pushing themselves for charities that mean a lot to them.

Christie’s story

One of these runners is Christie Plumb. She’s running the British 10k for Sane after losing her Sane logoMum when she was 11. Christie told me she felt that the stigma surrounding mental health problems and a lack of support contributed to her mother’s death. The work of charities like Sane and Mind are helping to reduce that stigma and provide support to those who need it.

Fundraising has helped her to open up about her mum’s death, to talk about it and give people ways to support her.

But Christie has found that running has helped her too. She said that before her boyfriend suggested the NHS Couch to 5k she was convinced that running was “impossible, physically impossible for me”. But she stuck at it and found it was helping with her own anxiety, clearing her mind and improving her confidence.

I really identified with the way she described running her way out of very strong feelings of anxiety and panic.

“Within the first mile, my chest loosens up and I’m not shaking any more. It’s incredible…before the Couch to 5k I had never got past that first barrier. Now I always carry on and push through. In a way it’s an analogy for pushing through anxiety and depression. You just have to keep going, even if it feels like you can’t. You’ll get there in the end.”

In running she has found a way to honour the memory of her Mum, to talk openly about her loss to people around her, to support a charity that means a lot to her and to look after her own mental health. To sponsor her, take a look at her JustGiving page here. To have a go at Couch to 5k yourself, take a look at this page. Who knows where it might lead.

Take 5 to blog for Time to Change

Time to Talk for Time to Change

Today is Time to Talk day. Once again the Time to Change campaign is encouraging people to take some time to break the silence that so often surrounds mental health problems and have a conversation with friends, family or colleagues. Or, in this case, the internet.

#Take5toBlog

So here’s my 5 (ish) sentence blog.take 5

My name is Clare and I have experienced depression and anxiety. It’s made worse by my errant hormones. I’ve been on Citalopram since I was 17. I’m trying to come off them now but it’s HARD! I have stalled at the 10mg mark but will be reducing in tiny tiny instalments again soon (when I’m feeling strong and the spring sun starts to shine).

My mental illness has affected my education – I had to repeat a year of university – and my relationships. Before Alex, pretty much all of my serious relationships ended because of my mental health.

My greatest source of support has been my boy Alex. He also manages anxiety and that shared understanding helps us care for each other. I’m also lucky enough to have supportive friends and family, many of whom also experience mental health problems of their own and to whom I can talk openly. There were times when I couldn’t make sense of my experiences in my head or out loud and then my journals and writing kept me going. I wrote to them like a friend.

I’m deeply aware of how fortunate I am to have the people around me I do. I’m thankful for them every day. My hope for the future is that everyone is able to find that network of support. A lot of the peer support work I do online is motivated by the desire to help people build that.

I’m taking 5 on Time to Talk day because I’ve found that being open and sometimes vulnerable in the world helps others be the same to me. And if I can help someone take that very first step to seeking help, to feel the relief of sharing and normalising their experiences, I will. Every time.

How Headspace helps (or why Giles Coren is wrong)

Techno smegma?

Giles Coren just called mindfulness ‘cynical, capitalist, techno smegma’ in Time Out. Now while headspaceI know it’s not only Katie Hopkins who is paid to spout controversial and potentially damaging opinions and these things are usually best ignored, I still wanted to write something in reply.

Since my Mindfulness Based Cognitive Therapy course in 2012, I have been an advocate for all things mindful. I read the book, ran a Mindfulness expert chat for TheSIte.org and explored how mindfulness influenced my life in all kinds of ways.  And, when I could, I did the meditations.

But I have to admit I fell off the wagon. I tried to cut down on my Citalopram throughout last year (I’ve stalled at 10mg). When I needed it most I stopped. I was coping with mood swings and anxiety. I found it hard to sit still. I was impatient and restless and irritable. I worried about everything I needed to fit into my day, going over and over my schedule in my head.

I ran and ran. There were weeks where I only felt myself when running. Running is still the most no nonsense, immediate, endorphin loaded head-reset technique in my toolkit. I still couldn’t manage without it. But I realised I needed to revisit some of my other tools when I got to the point I felt I needed to run more than once a day to control the anxiety.

Bitesized Mindfulness

And so I turned to Headspace. I needed a controlled reintroduction to mindfulness. And so far it’s been perfect. It starts with 10 minutes a day, moving up to 15 and then 20 minutes. Cartoons and explanations give you new ideas to think about every few days. It’s a reminder of the detailed theory I used to know. It’s reminded me to recognise thoughts for what they are, weather in the sky of my mind. Mental events that will pass and don’t always need attention.

But it’s the actual meditative practice that has helped most. My depression and anxiety always get the better of me slowly. When my thoughts and attention are elsewhere, clouds gather above and sands shift beneath me. By the time I realise that things feel dark and cold, I’m no longer on solid ground. When it gets to this point it’s much harder to find my way back.

Spending a short time meditating (almost) every day enables me to check in on my mood and make sure I can still find the clear sky of my mind behind whatever thoughts are gathering, storming or scudding that day. I’ve only been doing it 20 days or so and already it feels strange when I miss a day.

Easy to disregard but well worth it

And, Giles, having an app to help me do that has been great. The thing with mindfulness is that is is easy to disregard, especially for those people who are feeling negative anyway. It doesn’t always make sense immediately. You can’t see the benefit straight away. You need to give it time and keep practicing. An app helps people do that. It’s provided structure and helped me rediscover how mindfulness works bit by bit.

When I press play and sit down, I can feel my breath slowing. That space is just mine until the time is up. So for those people who have given up on mindfulness because of Giles, give it another chance. It takes time but it is worth it.

 

Overcoming barriers to accessing therapy – a post for the RSCPP

RSCPP connects people with local registered therapists. It also contains articles and resources RSCPP logoabout issues you might face and the types of therapy available.

Of course, these are private therapists. And therapy isn’t cheap (although if you get the right help, it can be immensely valuable). Much of the work I have done in the past is with people who could not afford to pay for a therapist or who do not want to risk spending their precious spare cash on something they consider unpredictable and unknown. It can be a huge step to speak to an NHS therapist, let alone one for whom you have to pay.

RSCPP recently asked me to write a blog based on an interview with two of their therapists. With this in mind, I thought it would be helpful to focus on the barriers people face when accessing therapy and how RSCPP therapists suggest they may be overcome.

 “I’m not the sort of person who gets therapy, I should be able to cope on my own!”

I spoke to Dawn Davies and Sarah Lack, both registered therapists on the RSCPP site. Both of them felt that one of the biggest barriers to accessing therapy is the way we judge ourselves. Dawn suggested that there is still some stigma attached to having counselling and sometimes people feel that they are not the ‘type of person’ who would need counselling or that they ‘should’ be able to cope without help. Depression and low self esteem can make us judge ourselves harshly or lead us to feel hopeless about the possibility of anything helping.

Sarah says that often a recommendation from a GP can help people feel more justified in seeking help. In my experience, many people find it helpful to talk to others about their experiences first – perhaps in an online community such as Elefriends or TheSite.org. This can help normalise the need for support and see how it has helped others. Opening up in a supportive online community can often be the first step towards seeking further help.

Talking to your therapist about your concerns can help too. Dawn says:

“It is completely normal to feel a wide range of emotions before embarking on counselling and most people will feel a certain level of anxiety before seeing a counsellor for the first time. Counsellors will understand how difficult it may be for you to make that first step and will not pressure you to talk about anything before you feel ready”.

“I can’t attend face to face sessions”

Sarah says that “finding a workable regular, weekly appointment time amidst already busy work and home schedules” can often be a barrier to accessing therapy. School, college, work, disability, weather and family can all get in the way and take priority. If face to face sessions are impossible, you could consider accessing therapy through online or over the phone. A number of therapists on RSCPP offer online or telephone sessions – they call it ‘telephone therapy’ so search for that. To get the most out of these Dawn says that it important you find a private place away from family and external distractions if possible.

“I don’t know what to expect and I’m scared”

Fear of the unknown can exacerbate anxiety. Everything may seem much more manageable after the first session when you have found the room and met and talked with the therapist. But both Dawn and Sarah say that the first session doesn’t have to be scary. Your therapist will do everything they can to help you feel comfortable, especially if you tell them your concerns about the session. You’ll usually talk about confidentiality and how you could work together if you choose to continue. You’ll probably also be asked to talk a bit about what brings you to counselling and what you would like to get out of it. You might find it helpful to think about that beforehand.

“I tried therapy, but I didn’t like my therapist”

If you have built yourself up to attend a session and it doesn’t feel right, it can be a huge disappointment. You might feel that it was pointless or that this has proven that therapy definitely isn’t for you. But both Sarah and Dawn emphasised the importance of finding the right person. As well as the right professional qualifications, you need to find someone who you feel comfortable with. Every therapist knows the importance of getting this relationship right and all would respect your decision not to continue with them. Dawn suggests meeting more than one therapist before making your decision. This is easier with private therapy, as you do not have to wait for another NHS therapist to become available. Of course, it is also more expensive. It is worth asking therapists if they do a free or reduced fee introductory session to help you decide.

“There are many different counsellors out there and just like in our everyday lives we will get on better with some people more than others. If you have had a bad experience it maybe because you haven’t found the right counsellor for you.”

You might feel that it is hard enough to open up to one stranger, let alone finding the time, money and emotional energy to ‘shop around’. Dawn says that choosing a counsellor who uses more than one therapeutical approach can help, as they can offer different ways of working depending on your needs. You might also find it helpful to read up on a counsellor and ask them questions by email to help you decide whether they are right for you. Making a shortlist of your favourite options and only visiting the second and third if the first one doesn’t work out could be a good approach.

The main thing to remember is that there are as many different experiences of therapy as there are combinations of therapist and client. One or even two or three bad experiences does not mean that therapy cannot help you.

‘Crazy’ by Amy Reed – a review of a YA book about bipolar disorder.

A review of Crazy by Amy Reed – published by Simon and Schuster

Crazy by Amy Reed

It’s hard to truly imagine what depression or bipolar disorder is actually like. The language of mental health is woefully inadequate. The word ‘depression’ has become part of the spectrum of everyday language used to describe feeling sad. We’ve all said or heard it. “My team lost, I’m so depressed” or “God, this TV programme is so depressing”.  As a result it becomes harder to find the words to adequately distinguish between natural sadness and the entirely different experience of a chemically depressed mind.

Someone without diagnosed depression might fail to understand why those who have can’t ‘just cheer up’. Those who are ill might judge themselves a failure for feeling unnaturally sad or incapable. A greater linguistic distinction would be helpful.

But even if the words depression, mania, OCD or psychosis were only ever used to describe specific conditions, they still don’t explain what it actually feels like.  That’s where stories can play an important role.

Reed’s ‘Crazy’ is one of those stories. It explores a mental health crisis through the eyes of those experiencing it. Told in a modern epistolary style through emails and instant messages between two teenagers, it has an immediacy and deeply personal feel that works well with the subject matter.  After meeting at camp, Izzy and Connor start exchanging emails and chatting online. It soon becomes clear that something isn’t right. Izzy’s highs are too high and her lows are scary and dangerous. Continue reading

Motivation and depression

Exploring motivation, reverse motivation and getting motivated when struggling with depression

Mental Health Chat and motivation

Yesterday, just as I was finishing work for the day, I noticed that the #MHChat (Mental Health mh chat picturesChat) theme for the week was motivation. #MHChat is a twitter event where @MHChat poses questions on a weekly theme to encourage discussion. The question that caught my eye this week was:

MH twitter question

 

Given that this is  mental health chat, I responded with some thoughts on the reverse tweet about reverse motivationmotivation that depression can create.  To give an example; when I am depressed the last thing that I feel like doing is going for a run. I try and get out there and get going – ‘going through the motions’ – despite this lack of motivation. As I get going I gradually gain a different perspective and start to feel motivated to continue.

A few people in the discussion became interested and asked a couple of great questions back. how to motivate questons on external motivation

 

Doesn’t ‘going through the motions’ still require motivation?

I was really interested in Kathleen’s question. It really forces us to explore in depth what we mean when we talk about motivation. Continue reading