Tuesday, 26 July 2016

How I Manage - and I DO Manage. Mostly.

First of all, I want to say thank you to everyone who has sent me messages as a result of my first three posts.  So many people identify with what’s going on for me, and have thanked me for putting it into words.  So here’s to you all - you’ve done it now - I’m going to have to keep writing!

So, I’ve been dealing with depression and anxiety issues for at least 14 years.  That’s consciously.  I think, actually, I’ve had bouts of depression throughout my adult life, but just didn’t know what they were.  So I’ve had a long time to learn how to deal with my condition and how it presents itself.  

It’s still hard.  At times, it’s excruciating, but I do know now that it comes in waves and that I WILL feel better again, even if I don’t believe it at the time.  Here are some of the things that have helped and continue to help me live the best life I can.

Medication
It took me around five years to agree to taking medication.  I had a terrible bout of post natal depression which I couldn’t admit to for a very long time. I felt inadequate, a failure. I was ashamed at my inability to cope.  But after lots and lots of counselling, I finally agreed to start on medication.  

Let’s be honest, medication has not fixed things totally. But it does give me enough to at least think rationally about how to manage my moods.  Without it, I’m totally out of control and can’t function at all.  

It took three attempts to get the right medication for me.  Everyone reacts differently, which makes treating depression even harder.  I started on prozac, but it just slowed me down so much I ended up driving at 10 mpg and went to bed thinking I was shipwrecked. The second one I tried was Trazodone, but that was awful. It sent me to sleep within minutes, but gave me very manic, very loud dreams. I would wake feeling exhausted and wrung out. So Trazodone had to go.

Then the consultant psychiatrist (I know, sounds scary right?) prescribed me Sertraline and I’ve been on it ever since  It’s not perfect - I get the jitters and weird creeping sensations in my legs sometimes, but on the whole it does help.  

If you have been suffering for a long time, and feel like things will never change, I would urge you to consider trying medication. It might not work, in which case you can stop.  But if it does work then you might just start to get your life back a bit.


Therapy
As I said before, I’ve had lots of counselling.  Mostly it’s been helpful, though it can take a while to find the right person.  The wonderful thing about the NHS is that you can ask to see someone different if the person assigned to you is not really helping.  I was lucky enough to be referred to a local charity, the Derwent Rural Counselling Service which allowed clients to pay as much as they felt they could afford.  At more than £40 a throw, private counselling can be expensive, so this was a real life-line.  I was out of work at the time, trying to become self-employed so money was an issue but now I’m doing well, I’ve made several donations to try and pay back some of what I owe.  The charity has now been taken over by the NHS but still provides invaluable support.

I’m also registered with my local Community Mental Health service.  This is where the consultant psychiatrists reside.  The man I saw was young and up to date, though I suspect that not all are as good as him.  They also provide talking therapy and have been a great support.  I’m sure it’s not the same in all local authorities though.  And it did take me a long time to find the services I needed. Largely, I think, because I found it incredibly difficult to admit I even needed help, let alone ask for it.  

Those first five years were the hardest, and I would have really benefitted from a “buddy” to help get me the support I needed.  I now try to be that person for others I know who are suffering as it can be really daunting and very lonely and scary trying to get support initially.

One counsellor I saw suggested that a lot of my “symptoms” fitted with a particular diagnosis, and recommended me for a course of DBT.  Dialectical Behaviour Therapy to be precise. You can find out more about it on the Mind Website.

This was very much a taught “course” rather than therapy itself, which was great as it was not an emotional arena, but a mainly practical one.  For me, this was a massive turning-point as it gave me insight into why my brain is the way it is, and left me feeling empowered rather than a victim

Exercise
I have realised recently that I'm happiest when I'm walking, cycling, doing zumba or kayaking. Particularly when I'm doing these things with people I relate to. But sometimes it can be hard to get out of the door, let alone do any exercise.

I have a dog who needs a long walk every day, and I usually feel good once I'm moving, even if I've felt drained or overwhelmed in the house. But I'm not too keen on walking on my own. Sometimes I walk with friends, which feels like a real treat, but more often than not, I plug myself into my phone and listen to an audio book. Audio books have been a real hit for me because when I'm listening to a good one, it makes me want to get walking so I can find out what happens next. It also squashes any other thoughts from my mind. Often they don't come back as the walk itself will have given me enough momentum to cruise through the rest of the day and even be productive.

For me, it all starts with a walk. Everything else follows.

Sleep
If exercise doesn't work, I sleep. And, as I’ve already said, I sleep a lot. Sometimes I get stuck in a spiral of emotions that is very hard to break out of.  Sleep resets those emotions so that I can wake up and function again.

Medics say that people with depression do sleep a lot.  I think it’s because trying to constantly modify your feelings and behaviour is knackering!  The adrenaline produced during bouts of anxiety put your body into hyper mode, and coming down from this is when you feel exhausted.  So for me, sleep is hugely important.  

Pacing
My GP once talked to me about pacing. It's something I've never been very good at. I'm either on or off and there's not much in between. But over time, I've learned to pace myself better. It's tempting to go mad and do too much when you're feeling okay, which can lead to a crash, as I've discovered many, many times to my cost! Living in the extreme can be exhilarating and rewarding during the highs. It's when I'm at my most productive. Feverish almost. I just have to remember to leave space for recovery once the bout of activity is over.

I would say that this is one of the most practical things I do to manage my condition. I accept that I will have flurries of intense activity, and that afterwards I need quiet time to recover. I do this by blocking out time in my diary and usually staying in bed, or meeting a friend for a walk or lunch. Which leads me on to my next point. Acceptance.


Acceptance
If you lose a limb, or have cancer, or chicken pox or break your arm, you know you are ill, or have something medically “wrong” with you.  You feel physical pain. There might be blood, or spots or the absence of something that was once part of your body.  There is a concrete diagnosis and course of action that you have to take, be it physiotherapy, chemotherapy or cool baths and chamomile tea. Your doctor recommends treatment and you manage your activities accordingly.

But when you have depression, it’s really difficult to believe that you are actually ill.  This is partly driven by society and its expectations that you are just sad, or that you should “get over it”.  And partly because it is a condition of the brain, which interferes with your rationality.  

It took me years to admit that I was ill, and not just useless.  I still find it difficult to believe, but I know better than to rely on how I feel.  When I’m low, I try to rely on my rational beliefs.  I pay attention to what I KNOW, rather than what I FEEL.  I know I am ill, even though I feel that I’m just a time-waster and generally useless person.

The DBT counselling I mentioned focuses quite strongly on questioning your perception and asking whether your thinking is based on what you know or what you feel.  It’s a good way of testing whether you are dealing with things in the most helpful way.

Accepting that you have depression and that it is an illness might seem simple. But it’s not.  It helps me to separate my emotional (chimp) brain from my rational (human) brain. I force myself to believe what the doctors tell me, even though believing it feels like admitting defeat.  I have found that the only effective way to manage is to tackle my depression head on.  So I have depersonalised it.  I see it as a separate entity that messes with my mind and I deal with it accordingly.  It’s not easy, but it helps me.

Some people even give their depression a name.  I think mine would like to be called something like Weasel, or Gargantua, or Colossus.  But I think I’m going to call it Beetle, just to annoy it.


Next Time: A letter to my Depression

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