I Am Not Depressed

As we sat down to dinner this evening I noticed Xavier was wearing an apron. “Why are you wearing that?” I asked. He mumbled something which I didn’t catch and then replied, quite unlike a four year old, with a heavy heart and a flat tone “I don’t want to wear this bloody apron.” My first thought and in fact my reply was, that is the correct use of the adjective, and I held onto my laughter, although I’m sure some escaped through my eyes. Since dinner we’ve consulted a thesaurus to find some other words that can be substituted in, with all the feeling and minus the offence. He’s particularly tickled by ‘blasted’ and ‘darn’ and we’ve agreed to mutually remind each other of the alternatives should we ever forget.

I’ve been reflecting a little on whether things are working out between me and Quetiapine (Seroquel, Ketipinor). It’s a tranquilising psychiatric medication used to manage psychosis by blocking the receptors in the brain that dopamine acts on. My tablets are designed to be slow release, giving me relatively steady blood levels of the medicine throughout the day. This is why it’s important I take them on an empty stomach; food would speed up its absorption into my bloodstream.

So first I’m just going to take the symptoms I’ve been experiencing through depression and examine each one in turn – noting how things are now, compared with how they have been in the recent past.

Anhedonia, an inability to experience pleasure from activities usually found to be pleasurable, is what characterises depression the most. The numbness severs through everything, even my relationship with my wife and son, the two greatest joys in my life. The magical morning sunlight, my eager dogs, the sound of music on the radio; everything disappears into a blind spot. Now things are different, I can project the love and affection I have for my family, colours have come back into the world and everything around me is buzzing with life. I have a grasp on happiness again, although it is different to before – sort of a tethered happiness, not the vivid winged happiness I’ve known in the past. It is practical.

Feelings of grief and guilt, my two close companions during depression, keep me ruminating irrationally on past failures, conflicts and inadequacies leading me to a place of hopelessness and intense stress. This is when, combined with the anhedonia, life stops making sense and becomes something I stop fighting for – something I’m actually desperate to be relieved of. I’m grateful that these dark feelings have lifted and it has become easier to rationalise my thoughts and memories, and manage the internal stresses. Horrid thoughts still pop into my head and I get quite anxious, but they don’t imprison me as they did before; I am not the scratched record.

Psychomotor retardation is a slowing of thought and movement so that both can feel desperately heavy and cumbersome. Making simple decisions became difficult, as did other tasks that required a degree of concentration. I shuffled about, sloth like in darkened rooms, or more often than not – remained in my bed pinned down by my heavy limbs and the stress of my own debilitating thoughts. I slowed to the point of sleep – if fortune was kind enough to afford me the peace of sleep. I have to distinguish now between that feeling, which I’m glad to say has passed, and the sluggish feeling I experience because of the Quetiapine. Sure, I feel sleepy and physically tired a lot of the time and have brief bursts of activity and energy – but it isn’t the same as the depression.

So on balance my relationship with Quetiapine seems to be working out, except for the way it makes me feel physically. Now that my mind has returned to me I find it is keen to make plans and push on with work, but my body feels like it’s holding me back. This is a deep furrow for negative thinking to prosper and therefore something I continually need to keep in perspective. I must not let this physical slowness dishearten me – and I do have a knack for seeing the negatives. It has been interesting for me to get this all down on paper – things are more positive than I had realised. If Quetiapine is prepared to give me something of my energy back, then this relationship could well work out.

'Dad' Fit

A typical game of ‘Guess the Animal’ with Xavier goes a little something like this:

Me:                  Does it have four legs?

Xavier:             Yes.

Me:                  Is it a mammal?

Xavier:             (in a hushed voice) Are tigers mammals?

Me:                  (in a hushed voice)Yes.

Xavier:             Yes, it’s a mammal.

Me:                  Is it a predator?

Xavier:             (in a hushed voice) Are predators the ones that get eaten by carnivores?

Me:                  (in a hushed voice) No. Predators eat other animals.

Xavier:             Yes, it’s a predator.

It is endlessly fascinating understanding the world through the eyes of a four year old. For instance, Xavier thinks that when we get older we’ll need to move into a bigger house, and by bigger, he means taller. From his perspective he gets taller ever year and he doesn’t see that ever stopping, so at some point well need a really tall house.

Only recently he appreciated for the first time that he wouldn’t actually catch up with his older cousin in age. He was looking forward to the day that they would both be six together, but hadn’t considered that with each year his cousin would grow older too. Time, generally, is a bit of a strange concept when you are four. The other day he was really caught out when I was talking to him about a time before I knew Alicia. This was a real surprise to him; the idea that Alicia and I met, and before then we were not together, or more to the point, didn’t live in the same house.

Xavier loves winning and takes losing quite badly (much as I did when I was a child - but I’ve found it’s something you can get used to). He has just started to cheat at snakes and ladders, which is brilliant. I give him plenty of opportunity by looking away and getting distracted when he’s rolling or moving his counter. Alicia says when children start cheating at a game, that’s when you know they really get it and you can start to raise the bar a bit. He cheated at table football yesterday too, and then looked at me squarely to see if I’d noticed. I hadn’t of course.

He doesn’t play with toys that much. At first we both thought this was a bit strange. He doesn’t want for new toys; he has a stash in baskets and cupboards all over the house in almost every room, but it’s as though it rarely crosses his mind to take them out and play with them. But I think the truth is, he is really a social creature and what he prefers is to play with others. So he will play with anything, even if it is just a cardboard box, if we are playing together. Toys, by themselves, do not occupy Xavier for very long.

He totally adores his magic drawers. I have this small old chest with about twelve tiny little drawers in it. They are magic because whenever Xavier does something wonderful, he can open any drawer and he will find something inside. On all other occasions the drawers are magically empty. He chooses the drawer to open and he is always excited to discover what’s inside. He has found sparklers, popping candy, tiny wind-up toys, finger puppets, magnets, a parachute and lots of other fascinating objects that take him off on a curious tangent. The magic drawers came about when I was tidying and found that smaller things, no matter how wonderful, could just get overlooked and lost as they jostled with large, colourful toys, just like plants, competing for space, light and attention.

The world is so different for Xavier to the place I grew up in. His curiosity can drive every moment of his day. You Tube means that all his questions about the baby growing inside Alicia can be answered vividly and on demand. He dives into the ocean to see blue whales giving birth, then travels through time to see dinosaurs fighting over carcasses, then up into the sky to be with astronauts moving about in a weightless space station. There are so many wonderful events to witness from across all of time and space.

He is an active boy too. Only the other day he had been penned in somewhat by the rain and as I tried to talk to him I could see every limb in his body twitch and his eyes darting about - and I stopped myself and realised he is bursting with energy and that now was not the time for talking. When I am in better shape we walk the dogs together and chat along the way. There is always something he's trying to figure out, like what happened to all the even numbered houses on the street or what made that hole in the gound.

With Xavier devouring the world at an incredible pace and finding his place in it, and with another member of our pack on the way, I really want my energy and ‘me-ness’ restored so that I can be everything I want to be to my wonderful family. So that I can be that 'giant' that Xavier thinks I am, still growing skyward. But even when I'm not my best, he understands like a best friend would.

Tiny Little Goals

I’ve been taking Quetiapine for 26 days. For 14 days I have been on a dose of 100mg. I passed through a dark place where suicide held my hand for a little while and I achieved little outside my own thoughts. I’ve got two good reasons why it would never come to that so there is no call for alarm – it was just that my mind wondered onto suicidal thoughts in much the same way as anybody’s can become fixated and preoccupied.

The pace of mornings continued to be dictated by the medication’s side effects until very recently, when I became disciplined about not eating for two hours before taking the tablets, and for one hour afterwards. This places my evening meal at around 5.30pm and I take the Quetiapine spot on 8pm. Not the most sociable of habits but necessary, if I am to wake the next day alongside everybody else.

A month ago I was walking my dogs regularly and trying to be mindful, and then I found myself trapped inside a cumbersome, sedated and tired body again. I was tired too of having to start again, I had started again so many times. Each time it was hope that helped me make the first move - but now I was starting to feel a little cheated by hope. There seemed to be more snakes than ladders on my board.

About a week ago a flurry of articles about exercise and mental health were widely publicised by campaigns like Time to Change, which coincided with my own wishes to be more active. I accept that being active sometimes helps me fight the depression, but I recognise too (as more articles ought too) that sports men and women are not immune to depression. With the encouragement of others I took the first steps again, walking with the dogs around the block that encompasses the red brick church with its high walls. A short walk by any measure, and exhausting too – but it was a walk all the same. The tiniest of goals achieved. Yes, a month ago I could walk much further but this is where I am now. This is what I have to deal with – there is no good that can come from drawing that comparison.

As my mornings were returned to me and those short walks became once again a part of some kind of routine, I became useful again. My body was responding better to what I wanted to do, and my mind more able to focus. I was still astonished at the frequency with which needed to stop and rest, but I accepted it and tried to think of it all as exercise on the way to somewhere healthier.

My mood has been improving and the facial expressions that Alicia recognises as me are, at times, evident again. There is a component missing though – emotion feels muted somehow. Alicia has noticed it too. But I have been busy and can look back across a day and claim to have done something worthwhile.

Today has been a difficult so far but that means nothing at all. It says nothing of yesterday and of course can say nothing about tomorrow. It does bother me though, because I do want to be reliable. I want to have up and down days like other people who don’t find themselves completely derailed by the downs. I want an employer or client to look at me and be confident that my downs won’t keep me off work or critically alter my functioning – but they do. This is something I’d like to consider more another day in another post, when my energy and mood permits it. But for today I’ll just accept that this is what I can manage for now, just like my little walks.

Bipolar Disorder Versus Depression

At my meeting with Dr A, Consultant Psychiatrist, nineteen days ago, I was asked why I thought I had bipolar disorder. Well, the truth is, at the time of being asked - I didn’t. All I knew was that despite various courses of well reputed antidepressants, therapy and a great deal of effort and learning on the part of me and my family, I was still experiencing a roller coaster ride of depressive episodes. It wasn’t that I thought I had bipolar disorder, but given that the treatment regime I was under was not working, in the sense that I could not maintain good mental health for more than a few months at a time, it felt like somebody needed to questions either the treatment or the diagnosis of straight depression. That somebody turned out to be me.

This blog post may well lack continuity. It’s nearly 8pm and every few minutes Xavier brings me the Lego plane he is playing with - in three or four pieces, for me to put it all back together again. Bless him. I know 8pm might seem a little late for a four year old but that is another story. We abandoned bed times after a five day trial period. Before that bedtimes were a bit of a battle ground and the only way Xavier could win was to do his utmost to keep himself awake in bed long after his story had ended and the lights had gone out. This just made him grumpy in the mornings. Now he gets ready for bed around 8pm, including a bedtime story, but after that he does what he likes, so long as it isn’t watching a DVD or playing on my phone (far too stimulating). He falls asleep really peacefully in our company and gets carried up to bed whilst he sleeps, with an ego the size of a five year old!

During the conversation with Dr A it emerged that a diagnosis of bipolar disorder would not be clear cut. Other factors, like my perfectionist tendencies and low self esteem could also account for some of the symptoms making it difficult to give a definitive diagnosis. It was a frustrating discussion for me because the whole conversation was based on my appalling ability to recall facts from my life. I’ve met people who can reel off their life as though reading from a CV and I am not one of them.

After the meeting, away from the stress of it, I was asked to complete The Mood Disorder Questionnaire. I had never seen it before; it claims to accurately identify 7 out of 10 people who have bipolar disorder and screen out 9 out of 10 people that do not. In the quiet of the waiting room and without the social interaction, these questions were now much easier to focus on. I want to reflect on those questions again here because, as I found in my first meeting with Dr A, so much depends on the ability of the patient to communicate key information.

There are most certainly times in my life when I feel very, very good; sort of invincible. During these times I’ll be more prone to do things such as strike up conversation with strangers; be a bit reckless for fun like stealing something from a shop or an exhibition; and be a bit loud even without the alcohol – talking over others. I feel like I become very in tune with the world, as though I can see how it is operating beneath the surface. Experiences become vivid: painted marks on a canvass, a musical movement, light penetrating a tree canopy, a plastic bag caught on the wind; they all become intensely beautiful and moving. My creativity at these times explodes and I get an inexhaustible thirst for new information, usually fed by days of research on the Internet. If I talk it through, conversation jumps around unpredictably as thoughts quickly fire in and out of my mind and the exciting connections form. I become driven – working on projects harder and longer. Our very own modest Victorian terrace house is a good example of that: The completely renewed wiring and plumbing; the newly installed central heating system; the bathroom and kitchen remodel: the new loft insulation and boarding, the solid wood flooring installation; and so much more in this house was done with these two hands whilst I worked a full time job in a secondary school. And as for whether I’ve done things considered excessive or foolish, remember I have seriously attempted gambling as an occupation in the past, out run the police when pursued and live now with unserviceable debts, not related to the gambling I might add.

Something that is perhaps a bit more 'out there' is a feeling that I have some sort of power over the world, like an ability the think consequences into being. Totally awkward admission right there. I feel somewhat superior to others, as though I understand truths in a way they can't. Other people can irritate me with little aggravation because their thinking can seem so clumsy and their methods backwards.

I’m not proud of any of this. Actually I am quite embarrassed about some of it, and even a little ashamed, but I’ve always said I’ll be honest here - even if that means I have to admit I can be a thoroughly detestable person at times. This is a picture of life, as me, that I’ve never discussed before because nobody has every really asked about it. It is, in a quite perverse kind of way, now that I read these paragraphs back, something that has been absorbed into the image I have of myself when I am well. It doesn't sound at all well though, does it.

When I am asked, as I was, if I have ever been in trouble with the police then the answer is indeed ‘no’. I have never been in trouble like that but for a speeding infringement. When asked if any of my blood relatives have been diagnosed with bipolar disorder the answer is again ‘no’. But that isn’t to say they don’t exhibit all these traits too. My parents are first generation emigrants who keep themselves to themselves. What you and I might consider symptomatic of a mental health issue would never be spoken about in these terms.

So I am a little frustrated at both the questions I was asked by Dr A and the way I answered them, because I think we could have had a much more productive hour together. I have another follow up appointment at the start of May. The evening’s dose of Quetiapine has started to make me feel very drowsy again, so its time to go to bed.

Work Capability Assessment

People ask how we are coping financially while I’m unwell. The answer is that I’m on Employment Support Allowance (ESA). ESA is a benefit that provides financial help to people who are unable to work because of illness or disability, worth around £50 per week. I wrote about the complex application process back in this post. After claiming ESA we completed a questionnaire (limited capability for work questionnaire ESA50) asking about how my illness is affecting daily life and I regularly supply up to date medical certificates from my doctor, confirming that I am still unwell. In most cases the Department for Work and Pensions (DWP) request that claimants attend a face to face medical assessment, regardless of your GP’s or specialists’ judgement about your health. The report arising from this assessment, known as a Work Capability Assessment (WCA) is passed to a decision maker at the DWP who uses its findings to continue or stop your ESA benefit.

The prospect of having my health scrutinised by a Work Capability Assessment is a great source of anxiety, fear and stress for me as a depression sufferer. It is an experience I expect to find deeply uncomfortable, an event that I do not trust holds my best interests, and one I do not expect to be sensitive and understanding of mental health conditions and their impact on daily life. The prospect of this assessment is exactly the sort of thing my depression feeds on to hamper my recovery.

Atos Healthcare (a division of the Atos S. A., a private French technology corporation) conducts disability assessments for people claiming a range of disability benefits including Employment Support Allowance, Incapacity Benefit, and Disability Living Allowance. It’s a strange feather in the cap of this international giant with 2011 annual revenue of EUR6,812 million. Interestingly, Atos Healthcare came into being in London in 2007, months before the introduction of WCA and quickly dominated the provision of occupational health services to government departments and local authorities, as well as winning the contract to carry out disability assessments. In November 2010 Atos Healthcare was awarded a three year contract extension worth over £300 million by the Department for Work and Pensions (DWP).

Atos Healthcare recruits doctors, nurses and physiotherapists to disability assessment jobs, where they are known as disability analysts. They carry out over 800,000 face-to-face medical assessments for the DWP each year. Up to 40 per cent of all ESA claimants are claiming primarily because of mental health problems. Since the introduction of WCA in late 2008, these assessments have been a source of much controversy, much of which relates to the computerised script used by disability analysts and devised by Atos Healthcare.

Atos say: “The programme, called LiMA (Logic-integrated Medical Assessment), was developed by Atos Healthcare to improve and ensure consistency and quality of the reports.” However Baroness Sheila Hollins, past president of the Royal College of Psychiatrists, said in her 2011 address to the House of Lords: “There are real concerns about Jobcentre Plus and Atos assessing staff's knowledge and understanding of mental health conditions.” The Citizens Advice Bureau, an advocate for benefit claimants, expressed “grave concern at the number of people unexpectedly being found fit for work”. They said: “We still hear repeated reports of rushed assessments, assumptions being made without exploration, inaccurate recording and poor recognition of mental health problems.” The personal stories and campaigns are easily discovered by searching on Google, campaigning and personal blogs, and You Tube. I could link to them here but websites reporting on this have been taken down for a lot less.

Five days ago The Guardian reported the chief executive of mental health charity Mind, who also acts as a member of the panel responsible for monitoring the functioning of the work capability assessment, faced a moral dilemma.  This was: “should he continue to sit on a government advisory panel, charged with scrutinising a policy that his charity believes to be inhumane? Or should he resign, publicising his anger at the coalition government's refusal to listen to the charity's concerns, and remove himself from the room where improvements are being discussed?” He chose to resign, saying: “The DWP seems absolutely committed to pushing 11,000 people a week through a flawed system”.

In the DWP’s own July 2011 report it is confirmed that at least 390,000 people have gone to appeal since 2009; tribunal courts have been forced to open on Saturdays and to increase staff by 30% since January 2010, to deal with the backlog. Appeals are costing the government around £50m a year, in addition to the £100m it is paying Atos, to carry out the largely computer-led assessment.

Atos Healthcare was in the news again recently after The Guardian reported that medical staff assessing benefit claimants were told to sign the Official Secrets Act. Two doctors who work for Atos raised their concerns with the Guardian and online political blog Liberal Conspiracy after the company asked them to sign a document pointing out their obligations under the OSA. “Both doctors believed that signing the document would hinder people in the organisation from blowing the whistle on patient safety and issues around whether medical assessments were being carried out appropriately.”

Accessing information relating to the Work Capability Assessment continues to be a stumbling block. Wikipedia reads: “Attempts by advocacy groups, and even MPs, to secure access to LiMA in order to demonstrate its weaknesses have been refused on the grounds of commercial confidentiality”. In April 2011 Atos Healthcare sought to officially accredit disability analysts by teaming up with the University of Derby Corporate. The British Medical Journal reports that the University of Derby would not disclose its fees for hosting the course, and Atos would not disclose the course materials.

The difficulties surrounding Work Capability Assessments continue to be a concern to people like me, faced with attending one. From the collection of stories others have posted about their WCA experience, I expect to be asked how I travelled to the assessment, if I can make a hot drink, if I have pets, if I watch Coronation Street, all of which can be used to make extrapolated judgements about my mental and physical health. I have little choice but to put my faith in a system that others have found fault with, and that disregards the judgement of my own mental health team. It’s just me against the point scoring machine, LiMA – and everybody else that has been a part of helping me get better thus far can only watch from the sidelines.

Should you be unfortunate enough to be in the same strange position, I’ll leave you with a link to Rethink Mental Illness who provide advice in advance to attending a WCA.

Quetiapine Days

I’ve been on Quetiapine for 12 days. Quetiapine, pronounced kwe-TYE-a-peen, boy have I struggled with saying that. Swallow whole, do not chew, take one at night (8pm) an hour before food or on an empty stomach, may cause drowsiness, avoid alcohol. That’s what the ugly printed message on the squashed white box says.  Well, on the 50mg starter dose I think I’ve eaten my way to the next trouser size up - the lack of mirrors in our home is a blessing. The raised appetite thing might be undesirable, but it is expected. I’ve been struggling a little with taking the pasty pink tablet according to the instructions because of the raised appetite – I don’t think I have an empty stomach any more but for those few minutes before breakfast. Sorry, I think talking about my appetite like this all sounds a bit grotesque… but you know what… it is – a little.

Morning starts on Quetiapine can be slow. The first seven days I slept a lot, a couple of times joining the rest of the family on days out in Dorset, very much at my own slowed pace. The feeling of fatigue was offset at times by a lightness to my mood – I think connected to being away from anxieties and the rest that the medication imposed on me.

Every day, as the Fluoxetine wears off and before it is time to take the Quetiapine, my mood sinks and I become irritable, impatient and aggressive. It is a time when, regardless of the day’s progress, I am likely to become overwhelmed by events and recoil into myself. Having picked up on this, I try and keep myself from others in the late afternoon - because the ensuing arguments are inevitably my fault.

On Saturday, I shone through quite unexpectedly. I bolted from the bedroom, showered and walked the dogs with Xavier before breakfast. In that single day a lot was achieved. I picked up ingredients and made delicious Mediterranean meals for lunch and dinner. During the day Xavier and I went out to the playground where we both clambered up the rope nets, rode the zip wire and swept back and forth on the tyre swing. We made a visit to the sheds at the top of the garden and collected a small haul of objects that had been in storage since we moved here four years ago. When the weather held out we returned, after lunch, to play basketball and eat a 99 from the ice cream van on the West Hill whilst we looked out over the fishing fleet. After that we still mustered the energy and enthusiasm for a game of football on the artificial pitch next to the playground. I felt driven by a curious restlessness, and big plans were forming inside me that spread out into the imaginary days and weeks ahead.

The next day I was propelled along in much the same way by a taut, uneasy spring, But my mood was starting to buckle. I photographed some of our furniture and put it on ebay to bring in some much needed cash. This is time consuming but given that it will hopefully raise several hundred pounds – it’s worth getting right. People don’t easily part with that kind of money over a photograph. Xavier and I played with the pair of whistling spinning tops we had found in the shed the previous day, followed by games of dominoes and snakes and ladders – two of his current favourites. We have yet to try out the wooden balloon powered boat we found. Late into the evening the frantic activity continued as I fought off the sedative effect of the medication to post here just before midnight.

After that the bottom fell out of my world again and I went back to being the heavy, slow moving, bedroom dwelling creature that sits and stares at the nothingness. I collected refills for my medication today at the surgery and the Quetiapine goes up to 100mg tonight. I’m glad I had those two days where I could be more myself without employing strategies to get through each moment. Everything is uncertain. I just make it to the next day. This is not a time to be drawing conclusions, because day to day things can be so very different. Just go with it, keep writing it down, keep communicating with the team of different professionals. Revel in the times when I surface and sit tight when things are hard. This is mid process and nobody knows what’s going to happen next, sounds kind of exciting put like that doesn’t it. 

Socks See Off Depression

With the Easter break in full swing, thousands of holiday makers anticipating an enjoyable long weekend will instead be met with the misery that accompanies traffic delays and time with family. In doing so they will get a taste for what is becoming a growing epidemic, the malaise of depression. According to the Health Organisation of the World depression is set to afflict one in four of us, or put another way, a quarter of each of us.

From Top: Ben, desperate depression sufferer;
John from S4S; Prof Kirk's Sock Applicator;
New Swedish Sock Suspenders

Professor Kirk from the Institute of Depression said “depression is no joke, it is much worse than a bad back, in a way.” He added: “Without the work of our institute, depression would see the economy grind to a halt as shoppers close curtains and take phones off the hook”. He explains: “The secret rests in elevating the Sock Line (SL) relative to the ankle so that the sock is itself at its maximum tension” or put simply, that pulling up our socks can indeed pull us out of depression.

Father of two and depression suffer, Ben (pictured anonymously) said: “Other people don’t realise how hard it is. I often can’t even find my socks, and when I do I’m having to pull them up every five minutes. They don’t always go with what I’m wearing either” (Ben gestures desperately towards his sandals, pictured).

It’s difficult not to be touched by Ben’s story and the stories of many others like him. Thankfully, the work of Professor Kirk brings renewed hope. “We recognise the difficulties that arise when applying socks and found our patients responded favourably to Sock Applicator Therapy (SAT)”. SAT is helping hundreds in a pilot programme across the UK to return to therapeutic levels of sock wearing. The simple device slips over the open sock and allows toes to easily be aligned with the sock neck (pictured).

Local footballer and general team player, John (25, single) said “I’ve been using SAT for my depression for a few months now. It’s helped me enormously and the lads have really got behind it.” The club now champion charity Socks for Solidarity (S4S) which sees players pull their socks up together before each match in unity against depression (pictured).

As for the problem of socks falling from the requisite therapeutic height, a Swedish company has stepped in with a unique solution, the Sock Suspender (pictured). When used in conjunction with a shirt, Uric Jenova, inventor and mental health entrepreneur, guarantees elevated moods correlating with sock height. The Sock Suspender is awaiting a decision on its UK licence from the Board of Supplementary Therapies following revelations that trials were conducted on mice wearing tiny little socks.

Peter Fellows, holiday maker and depression sufferer remarks: “Personally I don’t see the problem with socks and sandals.”

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Alicia's Post

As I have been with Mehdi through his depression, I have seen and learnt many things. My own experience of the illness some years ago has gone some way to helping my understanding but, nonetheless, depression being such a different thing for each person, it has been an experience for us full of twists and turns, a road through steep hills where sometimes we can go along miles of blind bends. You learn to expect the unexpected though, and what that really means in the context of being a couple and having a (gorgeous) little boy. What I can never learn not to be surprised by, though, what always knocks me for six, is the people who ask me, quite unabashed, 'yes but how long are you going to put up with this for?'
Well. Where do I begin?

The 'this' in that question obviously refers to Mehdi's mental illness. I always am silent for a moment after I hear that awful question ; I think there is a moment of shock that Mehdi's brave battle with such a nasty illness, for which I admire him very much, has been casually described by someone who clearly doesn't understand as 'this'.
Once I've taken a moment to inwardly address that initial shock, then the second one sets in. This is the idea that this person expects there to come a time when I will no longer be with my soulmate, the love of my life, because he has depression. When phrased as above, as I find it so often is, the question gets me as well because it isn't an 'if ': it's clearly a 'when ', as if my love is sand in an hourglass that will eventually run out. My answer is always in the vein of 'I will never leave or give up, I love Mehdi, our happiness is bound up in each other and I don't see why our overall life long happiness should be another tragic casualty of his illness.' The person who most frequently asks this question of me being Mehdi's mum, that's usually where I leave it to avoid rocking the boat too much. I've had long conversations with her, just the two of us, trying to help her understand. That sounds a bit patronising, but I don't mean it like that; I just think that if Xavier needed help and I didn't understand why I'd be grateful if someone helped me understand. But these conversations seem to have an effect that quickly wears off.

But I do want to volley a few questions back to her, as I do to anyone else who might pose the 'how long' question (weirdly enough though, my experience is that this is rarely asked by those outside the family) .

First I want to ask what other illness someone could possibly have for it to be acceptable to ask of their spouse how long they will stay; then I want to ask why it's OK to ask this about mental illness. I don't need to ask though, not really. I'm pretty sure I know. I think it's because some people just can't shake the idea deep down, whatever they might say outwardly, that the afflicted person can somehow help it. I think that's been the worst blind bend to come across in the last few years: the one where I realized that when Mehdi, and also we two as a couple and we three as a family most need compassion and a kind smile, we are in fact under scrutiny by some (a minority I must add - we know lots of amazing people)  to see when it will all fall apart completely. But it won't. It's not always easy, some days it's rarely easy, but it won't fall apart. It's hard to explain because I know it may be incredible to some given our situation but we are happy. And when I think of Mehdi, in all honesty the first word that springs to mind is happy. You see, for me it's not related, who he really is and his depression. He is and will always be that joyful person, so in love with life, whom I first met and fell in love with. It's just the depression means you can't always see that person. One day I hope I'll see that person more. But just because I can't see oxygen doesn't make me afraid I won't be able to breathe.

Leaving the Nest

Yesterday I sat quietly amongst the Mute Swans of Abbotsbury. I watched a pen arrange her angular nest neatly about herself, studying the movements of her chalk white neck as she reached for disobedient reeds and lifted them into their architectural place. She stretched out in defensive attack of passers by that drew too close. Too close to her nest, and when she rose up and flexed her arched wings in celebration of natures structural perfection, I caught sight of her prize... a single grey blue egg.

She looked at me a moment and appeared to study me back in silent contemplation. A moment later she left her nest to join the colony in their hundreds feeding on the generous servings of wheat in the lagoon. I felt responsible, as though she had asked me to keep vigil over that single precious egg. And I did watch over it with such mindfulness that I didn't notice the crowds disperse and the buckets of wheat being barrowed away, and the colony thinning once again into their inseparable pairs.

The vivid experience of life as I see it is still present and yesterday it reached out to me. Yesterday it entered my body through its sights and sounds and softened me from within, sculpting away the anxiety from my once petrified face.

With my own wings outstretched in anticipation of flight I visited a grocery store to collect some ingredients for a family dinner. The grocery store, a hornets nest of human existence where too many of us share the same space in mutual competition. It's been many months since I set foot in a place like this. I came out some time later, fragile, upset, beaten and without a single purchase. This is a helpful indicator of how, for the moment, day to day activity can trigger a stress response in me akin to what you would experience if your life were in danger. And the evolutionary glitch that is memory permitted the self analysis of my failure to reign through the afternoon until its energy dissipated into sleep.

I awoke later feeling restored, but such glitches are important in measuring out the size of my strides on the road to recovery. My mood feels more even, although fragile and susceptible to derailment by life's teacup tempests. The sedation is easing away and my waking hours are stretching out into the day.

Another day beckons.

Excess Baggage

I've been sleeping during the daytime and thinking about food when I wake.

The chemical pathways that are acted upon by antidepressants to alter our moods are somewhat crudely tweaked. So sleep, appetite, aggression, and sex drive are all tweaked too, inadvertently, by antidepressants. I remember how my appetite crept up when taking mirtazapine until one day I couldn't walk past food without tucking in. I looked and felt awful. The hunger drive is a powerful one and I satisfied it, whether I needed the calories or not. The weight gain was rapid and, because the behaviour didn't show any signs of subsiding, it continued rising indefinitely.

Quetiapine has a similar action on appetite and, given my dose is expected to increase steadily from 50mg to perhaps 300mg, this battle with my weight is set to be a long one. Sadly, some patients refuse to take Quetiapine because they fear the weight gain. It might seem strange that someone with a mood disorder would leave it untreated to preserve their appearance. However, low self esteem is a common foundation stone in cases of recurrent depression, as it is with me. Low self esteem ... that's looking in the mirror metaphorically and literally, and finding all sorts of reasons to dislike what you see. It isn't a good context for binge eating and weight gain. The mystery is why pharmaceutical companies consider antidepressants that cause weight gain a success.

One blogger taking Quetiapine recounted how he awoke each morning to find food on his mouth and open wrappers beside the bed. He had been sleep eating! Another told of how she now set five different alarms to wake her - but still found she couldn't make it to work on time! In her sedated state she had turned each alarm off in turn and smothered her iPhone under her sleeping chest.

I can appreciate the feelings in each of these stories. My brain's focus on food is akin to what you would experience had you fasted for 24 hours, only I am eating and I've yet to feel full. My sleep has been a dreamless void into which I disappear indefinitely without means to reach me.

I want to avoid the weight gain and the excessive sleep. I'm well past the vanity of attending to my appearance ... I just want to be fit enough to do the things that fathers do. So even now, as the Quetiapine makes its first claims on my appetite, I'm fighting back... albeit with apples and water! There, I've said it now, so you can hold me to it.

Quetiapine-lets

I woke up a great deal earlier today. I've had my little green and yellow capsule this morning and my chunky red one last night. My mind and body feel out of sync.

Since I started taking the chunky red tablet I've been thinking about food a lot. The search for a bowl of cereal is what raised my sedated limbs from the bed this morning. Last night I fell asleep to dreams of chocolate biscuits. Sweet foods dominate my thoughts in a way that I find strange and unfamiliar. I can only imagine this is a consequence of the Quetiapine. This is a bit of a worry, but it is early days on this new medication. Every drug has affected my appetite, citalopram and cymbalta gave me a diminished appetite whilst mirtazapine and fluoxetine raised it. Appetite, like so many other drives, is controlled by chemical switches. Chemical switches which antidepressants tamper with.

I have as much control over my appetite as you have over your bowels. Just consider the way your thinking can be dominated by a need to toilet.

Whilst my body feels knocked out by the sedative effects of Quetiapine, my mind does feel a little calmer. Admittedly I haven't been conscious for much of the time over the last 36 hours, but my waking hours are an improvement. This tranquil white cottage and the spring light is making this a comfortable time for me. This is what it must feel like to be a peg doll living in the opulent paper surroundings of a miniature dolls house, away from the stresses, great and small, of real life.

I'm hoping the lethargy will subside today long enough that I can investigate the landscape around this little cottage and meet some of the horses, whose hooves I've heard echoing through the thick Jurassic walls of this old stone cottage.

Today marks the end of the first trimester, yes, Alicia is now three months into her pregnancy with our second child. Somehow that gives us permission to ratchet up the excitement a notch more. To enjoy the hope that passing time brings as little limbs and organs form against the odds in nature's finest of magic tricks.