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Paedo, Venlafaxine and Suicide

Posted Jun 05 2010 7:02am

Life continues to revolve around being mental; this week I saw both my psychiatrist and, of course, not-for-much-longer-my psychologist (blog to follow on him), and next week it’s my (lovely) GP and, again, not-for-much-longer-my psychologist.  Yippee.  Joy deep in my heart.  Being this mental is a full-time job, you know.  Those of you that actually have full-time jobs whilst being simultaneously floridly crazy amaze me.  How do you do it?  You absolutely have my every admiration.

So.  Wednesday morning.  NewVCB.  She kept me waiting for 15 minutes, after I had rushed like blazes and broken the speed limit on a number of occasions to get there in time, believing I was going to be late.  I had dithered and procrastinated and wasted time for far too long before leaving the house ages late; all that was because I didn’t want to go.

Why do I always get worked up over psychiatric appointments?  I mean, they’re generally not that bad (or at least they’re not that long), especially since NewVCB took over the reins.  But of course, despite rationalisation of this description, I was a wreck anyway.  It’s the whole thing, isn’t it, that the thought of whatever it is is actually much worse than the reality of it.  Still, psychiatrists are an occupational hazard when one is as batshit as I am.  They have it within their power to section you, and I’m still bitterly terrified of that.  I assume that’s what always leads to the fear – I consciously or unconsciously convince myself that I’m imminently going to be sent to the bin, and I lose the plot even more.

As it happens, I still believe that the last time I saw NewVCB she made what I considered a thinly veiled reference to hospitalisation.  I don’t think the OldVCB would have done that.  I think, strange as it seems, that because NewVCB is nicer, because she actually appears to give a fuck, she is much more of a worry to me than her predecessor.  OldVCB would never have sectioned me (or recommended a voluntary admission), I’m fairly sure – she just didn’t care that much.  NewVCB wants to act in my rational best interests, and that is dangerous.

Anyway, when she finally came to get me, she led me to her room and I sat down close to her, as I always do.  She began with, “OK, how…no, sorry, I can’t not mention it.  I love your hair!”

It was a better reaction to my new pink hair than the one C had given – she happily acknowledged it, but didn’t make some banal, pointless statement telling me what I already know.

I couldn’t believe that a consultant fucking psychiatrist was complimenting me on my new hair colour.  I asked her if she was serious.

“Yes, absolutely,” she enthused.  ”It’s really nice.”  Her tone appeared to be genuine, so I thanked her.  She wore a sort of surprised but pleased smile, the function of which I couldn’t entirely decipher.  Maybe she read the fact that I’d bothered to do something like this as evidence of psychological improvement (which it’s not particularly, to my mind).  Maybe she’s simply one of those people that takes an interest in others’ hair colours.  Ho hum.

Anyhow, the appointment didn’t go on for that long (despite this being a fairly typical 2,000+ word post!), as there wasn’t a great deal for me to tell her I suppose.  The crux of it was that (a) the hallucinations are markedly reduced (not eliminated, but a hell of a lot better), (b) my mood has been quite low, to the extent where my suicidal ideation is quite considerably heightened again and (c) as detailed the other day , I am freaking out about how to face or avoid Paedo.

We agreed that Quetiapine had been a wonder drug and whilst things are not exactly fabulous, they are very much better than before I was first prescribed it in January (just after I tried to do myself in again).  She again emphasised that psychological therapy was key (someone apparently needs to tell the Trust and Mr Director-Person about that), but that medication did appear to be helping me deal with that sort of work.  She expressed concern about my suicidal thinking and low mood, and asked if I would object to her increasing my dose of Venlafaxine.

I’m not even sure that Venlafaxine makes any difference – it’s really been Quetiapine that’s helped me, in my estimation – and even if it does, I remember really horribly well adjusting to taking it in the first place – and then to an increased dosage thereof.  It is very, very much not in the least fun.  I must have given my reticence away, because she continued by advising me that for the most severely chronically depressed (like me, apparently) her personal observations were that higher doses of the drug made significant differences.

“I suppose it sounds obvious,” she said, “but the reality is that quite often moderate doses of anti-depressants make major differences.  In this case, however – in the worst cases anyway – I think higher doses are generally more helpful.”

I suppressed a self-satisfied smile, thinking back to Dickhead GP’s contentions that, at 150mg, I was already on a “really high” dosage of Venlafaxine.

I told NewVCB that I was scared about adjusting to a higher dose, given what had happened previously, but she actually felt that that was good: “you know that you are to expect that, that it isn’t your normal behaviour, and that it will pass.  Not everyone has that insight, even if I try to provide it.”

“But,” I said, pessimistically, “what if I want to come off it at some point?”

“Don’t ever do that!” she exclaimed, looking up urgently from writing the prescription.  ”Do.  Not.  Do.  That.  If we decide in the future to take you off it, I’ll be bringing the dose down by 37.5mg each week at most.”

She went on to tell me about another patient that had usually been relatively stable that came to see her one day literally clawing at his face, as if trying to peel it off.

“It turned out he’d not been taking his Effexor for three days,” she revealed.

Well, that’s tremendously encouraging.  I’m going to be taking the cunting, evil stuff for the rest of my life, aren’t I?  Shit.

Anyhow, I slightly reluctantly agreed to let her increase the dosage of Venlafaxine to 225mg, with a view to considering 300mg in future.

This should be interesting.

Leaning forward towards me, she looked conspiratorially me straight in the eye and said, “I have to ask.  [Almost whispering] Just how strong is your suicidal ideation at present?”

I admitted that I frequent pro-suicide newsgroups and that I ergo know what would be most likely to kill me and what wouldn’t.  ”I keep thinking about overdosing, and I am very well aware that unless you have exactly the right ingredients and you plan it very well, ODs are very unlikely to work.  I don’t have the energy to plan something like that, so an overdose would be an impulsive act and therefore probably non-lethal.  Plus I don’t have the figurative balls to jump off a building and I won’t deliberately crash Disraeli, my car, because I love him too much.  In short – I don’t think I’m in any imminent danger of offing myself.”

“OK,” she replied, seemingly relieved, though I’m not sure if relief is the appropriate response to the admission that I can’t guarantee I won’t take an overdose.  ”Because you’ll be aware,  I’m sure, that starting to take Effexor – and, indeed, increasing the dose thereof – can lead to increased suicidality in the short-term.”

I’ve always loved this irony about anti-depressants.  I know that that risk is, generally, only temporary in nature – unless you actually do top yourself, and then it’s kind of permanent – but I find it amusing that the very thing that is meant to alleviate depressive and suicidal thinking can increase it.  Bizarre indeed.

I confirmed that I was thus aware and reiterated that I did not feel in real danger.  I don’t know that I completely agree with that assertion, but I’m not going to give her any more ammunition to throw me in the bin.

She said, “I don’t think you can expect your suicidal thoughts to go away any time soon, given your long history of illness and the intensity of therapy, but hopefully, after the initial few weeks, medication can at least ease the strength of them.”

I laughed.  ”I don’t expect to ever be rid of suicidal thoughts.  There has not been one single day that has gone by in – oh?  At least 20 years? – that I have not thought about killing myself [see this post ].  It’s simply a matter of the degree of strength that those thoughts have.”

She accepted that, and agreed that if this line of thinking could be reduced in (a) frequency and (b) intensity, that would be good progress.

For some reason the bloody child abuse topic surfaced, as it usually does.  It never came up with OldVCB, except perhaps briefly in the assessment session that I had with her and her SHO, Dr N.  Again, this disparity seems to be because NewVCB gives a shit.

Anyway, I don’t remember the intricacies of the conversation, but at one point I know that I whined about how I didn’t know how to cope with  seeing Paedo .

She interrupted me mid-sentence, shaking her head violently.  ”You can’t see him,” she said simply and definitely, making a ‘no’ gesture with her arms.  ”It would be damaging, given the strength of your reactions to at Christmas and indeed to discussing matters in therapy.  No.  You can’t see him.”

I pointed out how difficult not seeing him would be to execute, given that my mother doesn’t believe me about the sex abuse and loves her family almost to the point of reverence.

NewVCB said, “can you say to her something like, ‘I know you don’t accept what I told you about this man, but nevertheless I cannot see him – not at this point, anyway.’  Would that work?”

I admitted that I had never really considered bringing the topic back up with my Mum, and that I was petrified of doing so.  ”It’s a right can of worms to be opening up,” I sighed.  ”I don’t know if I can do it.”

We pondered on whether or not I could blame my social anxiety issues, given that Maisie and Paedo’s house always seems to be full, always seems to be loud, always seems to be a situation in which I cannot cope, irrespective of Paedo’s presence.  I agreed to give this lie excuse a go.

[As it happens, A has actually come up with a very good short-term excuse to avoid Paedo and friends.  Because the increased dosage of Venlafaxine will, in all probability, fuck with my head for a few weeks, he suggests telling Mummy Dearest that for, say, four weeks or so I need absolute routine without any deviations whatsoever.  I think this could work quite well in my quest to avoid Paedo.  My mother will object, of course, but I can say that I am under medical orders.  Which, if you bend the truth slightly, is not a complete lie, because I am under NewVCB's orders not to see Paedo.]

In any event, NewVCB then announced that she she would be off for four weeks in July, adding, “would you like to see someone else or wait for me to come back?”

I asked would the alternative someone be a consultant – ie. someone who can muck about with the medication if required, rather than an SHO on rota to his/her GP training – and she confirmed my suspicions that it would not be.

I advised that I would therefore wait until her return, remembering the pathetic debable of incompetence that took place when I last saw an SHO.  If something major happens during the period of NewVCB’s absence, I suppose Lovely GP has some knowledge of psychiatry and can try to help.

All in all, I suppose it was a relatively successful encounter, though I am worried about the increased Venlafaxine dosage, particularly when she’ll not be about to monitor it.  Still, as she pointed out, it is considered one of the most effective anti-depressants, and if I need a higher dose to get the full value from it that I need, then so be it.

If nothing else, losing my mind yet again for a few weeks could lead to some interesting blog entries..!

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