Today marks the fourth day that I've been home from the hospital. While I feel light years better than I did when I initially went to the emergency room two weeks ago, I am not completely well. I have been in the process of adjusting to the major changes that were made to my medications when I was in the hospital. I, think, however, I am getting ahead of myself a bit here.
I have been struggling with depression since November 2015. While the holiday season is typically not a very good time for me due to a confluence of stress, anniversary dates of past trauma, and a touch of seasonal affective disorder, it was especially bad this time around. I tried working with the people at the clinic where I receive services for my mental health stuff. The general reception to my statements of 'there is something wrong here' was for them to argue that I needed to better manage my stress and to say that I was being too anxious over it all. The argument that improved stress management was necessary came from the therapist I see and the one that I was being too anxious about everything came from the psychiatric nurse who oversees my medications.
We tried waiting to see if things were going to improve through December and January. This did not happen. Thus, my medications got a few minor changes that had a net zero effect on the situation. In March, I was taken off of Welbutrin and put on Effexor. At the time this change was made, I clearly stated I was concerned about this. This was when I learned that my diagnosis apparently was not for bipolar disorder but unipolar depression. My concerns about the changes with respect to the antidepressant were brushed off. So too were my concerns about the fact that my diagnosis had been changed with out my having been informed of this. The statement given was 'Diagnosis is a formality. We treat the symptoms.' I heard this from the nurse who is working with me and from my therapist. Keep this little bit in mind as I move to my next part.
The change in medication was not made by weaning me off of the Welbutrin and then gradually introducing Effexor. It was done via the method known as simultaneous switching. I stopped taking the Welbutrin and started taking the Effexor. In theory, this meant that as the Welbutrin processed out of my system, the Effexor would be building up in my system and the problems that had arisen due to my acclimating to the Welbutrin would be resolved. This, however, did not happen. After two and a half weeks on the Effexor, my depression got worse and two weeks go, I went into the hospital struggling with suicidal depression.
The hospital staff were very receptive to my needs. They carefully monitored the effects of medications as they adjusted them. They also looked at the sheer volume of medications I was on and openly said (politely) 'what the fuck is going on here?' As they reviewed the information in my file from the clinic, a few things came to light that I'm honestly not sure how to approach. In the span of the time it took from my meeting with my therapist (which was a few days before I went into the hospital) to when the hospital had a copy of my file, information in the papers got changed. My diagnosis was changed from unipolar depression to bipolar. The antidepressant that was my 'primary' antidepressant was changed from being listed as the Effexor to the Remeron. (When I went into the hospital, the medications I was taking were Remeron, Geodon, Effexor, Ativan, and Minipress. I was told the Remeron was to control my chronic nightmares. The Geodon was to control the psychotic features that come with severe depression. The Effexor was to resolve the depressive symptoms. And the Ativan and Minipress were to help me control my anxiety problems due to c-ptsd.)
I spent a good amount of my stay not feeling well physically. The exhaustion I felt due to the high dosage of Geodon I was on was only exacerbated by the fact that I had problems sleeping at the hospital because I didn't feel safe and my bed was a layer of rubber foam padding on a steel platform. (My bed here at home felt like a brand new feather bed when I got home after that. It was really nice to wake up in the morning and not have my hips feel slightly bruised because I slept all night on my side.) As the medications were tweaked and things were eliminated, I found myself progressively moving out of the suicidal mindset. I also found the psychotic symptoms were going away. It was hard, though, because much of the chaos going on in the ward was triggering flashbacks on a daily, if not hourly, basis.
When they took me off of the Geodon and put me on Seroquel, I found the psychotic symptoms lifted. It was like someone flipped a switch in my head and I no longer heard the voice of my mother saying horrible things to me. The moment that happened, I felt like a weight was lifted off my shoulders. I still felt horribly depressed, but I no longer had the experience of a voice telling me that I was worthless and a coward for not killing myself (along with a lot of other hurtful garbage). When they took the Effexor out of the picture and increased the Remeron dosage, the depression lifted to a point where I could be functional. That was where things stood when last Friday rolled around. Thus, I came home.
Yesterday, I saw the psych nurse at the clinic. She talked about how she was pleased that the hospital took me off of so much. (Previously, I was taking 7 pills before bed, not counting my vitamins. Now it's 3.) I was told how she couldn't make such big changes to my medication and I found myself questioning why she was in charge of handling medications if she couldn't do so. And then there was the argument that my suicidal depression was triggered by the stress of my children being on break from school. I was told that I needed to plan for what I was going to do when the boys were on break from school over the summer because that was when she said it appeared I had the most problems.
For my part, I bit my tongue. I said something blandly to the effect of I was planning on us spending more time with the extended family over the summer to help me cope with the stress of managing the kids when they were on break. I realized as the nurse was talking to me that in many ways, I was going to just have to smile and nod as I went forward. There is a narrative that they have decided is the correct one. In that narrative, they have done no wrongs and when I have periods of time where I am severely depressed it is because I am 'reacting' to the situation around me.
Never mind that functionally every single hospitalization that has happened over the last five years was due to medication screw ups exacerbating problems that were already present. I acclimate to antidepressants after taking them for a while. Then I get very depressed. When I try to get the clinic to help me, they conveniently are unable to do so. Thus, I go to the hospital. I am at a point now where if the Remeron stops working, I honestly don't know what we're going to do.
I've tried discussing the problems that come from when I am hypomanic. The general response to this has been that I am being too anxious over something that really isn't a problem. I know that my mood cycles. I have a hard time remembering the differences that come with my mood cycling. When my mood is up, everything is clipping along so quickly in my head that my attention span is that of a butterfly, it seems. When I'm depressed, I struggle to remember the simplest of things. I try to track my mood but it is very difficult for me to do so because of these memory issues.
The people at the clinic basically tell me that I am worrying about things for no reason. It makes me angry. I have dental problems because when I get majorly depressed (which happens for about 3 months a year, if not a little longer), I forget the most basic of things to care for my health. I have problems with my anxiety and social phobia being worse when I am in a mixed episode, though the clinic doesn't believe these are really an issue.
I've been told that I'm working with the person who is the best for handling trauma. This does not give me warm fuzzies. My therapist is a very sweet woman. I know she is trying to provide care for me. At the same time, I question her methods. When I come in for a session and she is talking about how she is doing research for how to handle my case, I get uneasy. When she is giving me self-help books and talking about youtube videos I should watch, I get uneasy. I recognize that I am a particularly tough case.
I have trauma from multiple incidents in my past. It makes for a clusterfuck and disentangling it all is kinda ridiculous. At one point, I was told that my case with respect to the ptsd was such that it had a lot in common with what would be seen for people who have come out of combat zones. I've been told by a few different psychiatrists that they're surprised I'm as well adjusted as I am because of the variety and extensiveness of what I have gone through. So, I understand I am a difficult patient because of how complicated my case is.
At the same time, I look at how the clinic is handling all of this and I can't help but feel angry. Every time I have had a crisis, they've functionally thrown their hands up in the air and done nothing to help me. When I try to be an active participant in managing my care and advocating for my wellness, I am either told that I am blowing things out of proportion or patronized. I would go up to the city for care but my health insurance won't cover it. I'm suck with these people and I don't know what to do. Their bullshit handling of my case has resulted in severe problems for me and I anticipate more of this garbage happening in the future.
How much do I have to endure until I can reach a point where things are at least tolerable? I'm getting tired of this constant fight. It's hard enough to have to fight my illness to get through the day. Fighting the people who are supposed to be helping me just makes it harder.