Psychiatrist.*****Warning; Full blown BPD RANT

I saw my Consultant Psychiatrist this morning, bright and early at 9am, well I was there at 9am. She was late. REALLY late. So I was not only grumpy from being up at silly o'clock, I was also extra grumpy at her her inability to prioritize her patients. I went into the appointment feeling unimportant and like I was a hassle to her. 

She started out asking about how I was tolerating the increase to 60mg of Prozac (Fluoxetine). I haven't had any major side effects comparable to the nausea and increased anxiety I experienced when I first started. We then moved on to talking about whether it has had an effect on the frequency of bingeing  episodes. This is where I hung my head in shame and admitted that for it to have worked I would have had to let it stay in my stomach for long enough to enter my blood system. I explained that I had been getting sick after breakfast recently.

I was expecting a full on lecture, and even though I could sense her frustration, she very gently recommended that I try the liquid formulation of the drug. She explained that it is less easy to get rid off and will absorb quicker into my system. I will give it a go, and see how I get on! Fingers crossed it doesn't taste revolting!

I also moaned about my sleep issues (once again!) to which she suggested laying off the caffeine and that I should concentrate on practicing  sleep hygiene,  which, now, in retrospect, was the right thing to have said, as sleepers and me do not have a good history, especially if there is even a small niggle of suicidal thoughts going on.

I don't really know what I was expecting from the visit. Maybe I wanted her to just 'fix' me and for me not to have to put any work into my recovery. I think I also wanted her to read my mind and understand just how scared and terribly depressed I feel. Which, of course, is simply stupid.

Anyhoo.... she doesn't want to see me for another FOUR MONTHS! So either I didn't get across to her how shit I  am doing, she doesn't think she can help me, or she feels that I am doing just fine and dandy for the moment!

Ok rant OVER

DEARMAN Success with Therapist

Love this Meme!

Maybe it's the increased dose of Fluoxetine (Prozac), maybe it's not, but whatever the reason I am feeling lighter this week. I am not beleaguered by the familiar and frantic suicidal thoughts, urges, plans. My ability to stay out of trouble is surprising me. I have not binged/purged much this week, even though all the normal triggers are there. The urge is also still there, but I find myself able to resist the need to act on it. 

I had my individual therapy session today after a 2 week gap. It was because my therapist had to cancel one session due to the illness of her child and then was away on training straight after. I was deeply disjointed over  the abrupt phone call from her that day to say she had to postpone our meeting for 14 days. My immediate thoughts were; "She doesn't care about you" "Once again, you are not important" "She is glad to not have to see you" and so on....

I was really super emotional for at least 2 days after and to be honest, have only come back down to an even base level on the topic this week. Hence why I can only really describe it all on this blog now. I got some excellent support from the recovery network online, and was advised to write down how I was feeling. Which I did! 

I used it an an opportunity to practice the INTERPERSONAL EFFECTIVENESS skill DEARMAN. Here's what I wrote:

On Thursday 16th Feb you regrettably had to cancel our therapy session at the last minute due to the unfortunate sickness of your daughter. I felt disappointed that my appointment with you was cancelled. I had put a lot of work into DBT last week, and felt that I really needed to discuss it with you. I was and am very scared that you will be away for training and then away on holiday. I also feel upset in myself that I am so dependent on our session each week.

I understand that you had no other choice but to attend to your daughter who was sick, and wouldn't have wanted you to do anything other than collect her as she was unwell. I guess the reason I feel the need to write to you is that I think a back-up plan might need to be put into place for if/when this happens again as it is not the first time that you have had to cancel our sessions. I also feel that the gaps in therapy are really affecting my ability to sustain a constant motivation for DBT. Yet I totally understand they need to happen sometimes, we all need a holiday! None-the-less I feel very scared knowing that gaps are coming up.

With support to fill in the gaps when you are away I feel that I could continue with the DBT skills rather than feeling alone and unable to cope. Perhaps there is someone I could call within the service when you are unavailable that understands and is able to offer coaching in the skills?

At the moment I feel like I have no concrete support in my day to day life outside of DBT, and although we are working towards me becoming better able to deal with this, and I look forward to the day that I will be able to cope on my own, I am simply not there yet. This is why having these gaps are scaring me so much. I would like to further problem solve this difficulty in our next session.

Kind regards

Many people over the years have told me about the benefits of writing out a letter to someone about a difficult situation, And I always poo-pooed the idea, thinking it was a load of cod-ology. But I take that back. After minutes of writing this, I almost instantly felt a sense of relief, and as I found my self reading over and over it, noticed how nice it was to be compassionate to my emotions, to validate them as real and not react in way that I was ashamed of.

In the end I did not send or even show this letter to my therapist, as I felt much calmer and understanding after having the 2 weeks to evaluate everything. We came to an agreement about how to solve this problem should it ever arise again. I suggested that we E-mail each other, as I am much more comfortable with that then phoning for skills coaching. This way I always feel that I can turn to her for support, even if she can not get back to me straight away.

I am proud of how well I managed the situation, and happy that I now know I have other options rather than flying off the handle and ending up in A&E, just to feel validated. THIS is a BIG step for me. Long may it last!

Let me eat more Prozac

I am all motivated today. Maybe its the increase in medication. I saw my Consultant Psychiatrist yesterday morning and we agreed that I have been tolerating the 20mg of  Prozac (Fluoxetine) well enough for the last two months to double the dose to 40mg. The plan is to gradually get up to 60mg which is the evidence based dosage for bulimia nervosa. According to Healy D (2004) Let them eat Prozac. New York: New York University Press. pp 124–148.

"Fluoxetine dramatically, by 40-50%, decreased the frequency of panic attacks in two controlled trials of panic disorder patients. In three double-blind trials, fluoxetine significantly decreased the number of binge-eating and purging episodes of bulimia nervosa. Continued year-long treatment of the patients, who originally responded to fluoxetine, was more effective than placebo for the prevention of bulimia nervosa episodes."

I have to say that I am somewhat at ease taking a drug which has so much empirical research to back it up. My Doctor instilled confidence in me that I will see results when the dose is high enough. She described how she has seen it herself and has faith that it will work in conjunction (of course!) with DBT.

I feel a lightness coming back to my sprite. As if the fog is clearing and I can breath easier. It is most certainly due to the three pronged treatment approach (medication, DBT, and the right attitude.) Without each of these aspects in my treatment plan I have seen the devastating result of self destruction. 

Prozac Mind

Oh wow, what an odd week this has been. Trepidation and deregulation have burdened my mind with troublesome thoughts, causing me to suspend life and live apprehensively, awaiting some unforeseen dreadful event. The sensation lies deep in my thoracic cavity, somewhere between my heart and soul, like a boil ready to burst and spread its nasty disease to all unlucky enough to be nearby. 

My family are worried, heck my WISE MIND is worried too, but at both ends of the pole, the two destructive EMOTION/RATIONAL MINDS are at war. Devoid of emotion my RATIONALITY states that “all is lost, there is no hope, no-one wants you around, and no-one even likes, let alone loves your fat ass!” With that spurring it on, my EMOTIONS are loaded to attack and pounce on an opportunity to destroy myself with all the vigor and drive needed to succeed. So what’s stopping me? 

My exhaustion is. I have barely made it out of bed all week, too afraid to even go to the kitchen or bathroom for fear that something will happen, afraid of others and ashamed that they might see me this way. Surface to say, food is not high on my agenda. I haven’t eaten a real meal for days, and I am scared at the all too familiar glory I feel from my hunger pains. “Success!” whispers my ED in a snaky slighter of a voice! “Keep it up and soon you won’t feel anything except thinness and happiness!”

As long as I can stop myself from binging I think I will be ok, just until I see my Consultant on Monday and therapist then too. Just have to keep myself safe and out of the kitchen, away from temptation. Restricting is less destructive for me than binging and purging.

The dose of Prozac (20mg) makes me nauseas anyway so eating is not all that appealing to me right now, Add the intense anxiety I feel and a weak stomach is an understatement. Food repulses me at the moment. Long may it last!