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.