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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