This weekend is my daughter's first birthday. With all the celebration there is another side to this important date for me. The perinatal mental health team only looks after women who are pregnant and up to the first year of the child's life. So I am bring discharged to the back to the community mental health team.
This handover is somewhat of a double edged sword for me. On the one hand this is a good thing, it means that I am better, well on the way to being stable and well again. However the perinatal team have been the the very best mental health service I have ever encountered, in fact possibly the best NHS service I have ever used. They have kept all appointments, visited me regularly, looked after me with care and sensitivity during my inpatient stay. Between them they rebuilt my confidence, got me back to work and helped me rebuild some normality in my family life. They have laughed with me and cried with me, and got me psychological therapies that I have been waiting for for over three years. I cannot express in words how wonderful they are and how grateful I am to them and all they have done for me and my family.
On the flip side community mental health services have been somewhat hit and miss. There was the time that I was first referred to mental health services and spent months being pushed back and forward between different services- one claiming that I was too unwell to be seen by then and the other saying I wasn't ill enough. I was referred twice for CBT and therapy and was lost on the list when the service reshuffled from South to South East to East. At 32 weeks pregnant I changed Psychiatrist (after another reshuffle) and it was only then that I was referred to perinatal (despite the guidelines stating I should have been referred immediately). And finally there was the community psychiatric nurse (CPN) who was brushed off my comments about hallucinating (it would cause a lot of paperwork) and reported me (wrongly) to social care against the advice of my perinatal CPN and psychiatrist.
In many ways I will be glad that this 'year' is over. It is been the hardest I have ever known and has tested the limits of my mental and emotional strength, as well as my relationships with family and friends. What I do know is that the year wold have been made much worse without the wonderful work of the perinatal team at The Mount. They do amazing things every day with very little in the way of resources. In the whole of Yorkshire there is one mother and baby unit which has five beds. Five. The next nearest is Newcastle of Manchester. They didn't just hand out pills and feed me. They nourished me, they supported me and they gave me the confidence to drag myself out of depression. Mental health services are often described as the 'Cinderella service' and if that is true they are the fairy godmother, because they made so much our of very little. If only all mental health services could be so good.
Wednesday 31 July 2013
Wednesday 3 July 2013
Medication's what you need...
"Just keep taking the pills" is what my Dad says to me regularly. Few people are surprised that I take medication for my Bipolar, it seems the obvious option. Why wouldn't you? If your brain chemicals are unbalanced, simply straighten them out with some drugs- balanced brain equals normal life. It isn't quite that simple however, firstly because there are no specific drugs for Bipolar Disorder or in fact many of the psychotic mental illnesses including Personality Disorders and Schizophrenia. In fact many, if not all the drugs used to treat and manage these mental health conditions were originally developed for other uses. Anti-convulsants, developed in the main to treat epilepsy, are still the most commonly used drugs used to treat Bipolar Disorder. Medication for Bipolar Disorder is often a case of trial and error, and many sufferers will try several drugs and often end up with a combination of drugs to control their symptoms. The most commonly used and oldest drug is Lithium, which is in fact an element rather than a compound. It was first discovered to have behavioural effects on subjects in the 1950s, and yet we are still not entirely sure how or why it works for Bipolar Disorder. And this is the same for many of the drugs used to treat Bipolar and other mental health disorders. We know they work for some or all symptoms, for different people, but we are still unsure why. What all the drugs have in common is that they all come with pretty significant side effects.
Side effects of drugs are common place, nearly all prescribed drugs have some other, often unwanted or unpleasant effect on the taker. However the majority of us will only take medications for short periods of time, and for the most part side effects are manageable or avoided. Most people with Bipolar disorder will take a combination of medications their entire lives, from the point of diagnosis. For me that was when I was 29. So I potentially have another fifty years of medication to control and manage the symptoms of my condition. It is the side effects and the impact they have on a sufferer's life that lead many people to stop taking the medication. That might sound crazy (ha, ha!) to most people, to stop taking a drug that prevents significant mental illness. But many of these drugs are physically damaging and cause side effects that day in day out are difficult to tolerate. I can only talk of my personal experience, but three years in I am struggling with balancing the side effects with the benefits of the drugs.
On the surface many of the side effects may seem inconsequential, but added together, over a period of time they become frustrating. I take two drugs at the moment, the first lithium which I started taking after my diagnosis, and venlafaxine, which I began in hospital after my daughter was born. Lithium is my mood stabiliser, there is no set amount prescribed, as different people metabolise it at different rates. In fact the line between therapeutic and toxic is narrow. Lithium toxicity can cause kidney and liver damage, as well as thyroid disease. For this reason I have regular blood tests to check my levels and my organ function. It is unlikely I will take it for my whole life because of the damage it does. It also make me very thirsty, because it is a salt; it makes my hands tremor slightly, especially in the mornings and itchy skin. Venlafaxine is an antidepressant, it causes me to be hungry all the time. By that I mean I eat a large, healthy meal and an hour later I am ravenous, a real craving hunger. This means that if often causes weight gain. It makes me sweat more (nice!), have very vivid and strange dreams, and if I am even an hour late taking it I get dizzy, brain shocks and feel sick.
These are manageable, except at the moment I am trying to lose weight. My drugs mean the only way to do this is to be really, really hungry most of the time. It is hard to concentrate when so hungry! I am eating enormous amounts of fruit and low fat yoghurt, but it doesn't touch it! These drugs meant I couldn't breastfeed my daughter, couldn't even really consider it. I have to be very careful with alcohol, I get drunk much quicker and if I get too dehydrated I can go into lithium toxicity.
Soon I will hopefully be reducing the venlafaxine, and perhaps even consider a change all together. But unfortunately for me most of the drugs come with the side effect of weight gain. Which might seem a vain worry, but when you are overweight already, facing a lifetime of these drugs it becomes more than an irritation and yet another kick in the teeth from this diagnosis
Side effects of drugs are common place, nearly all prescribed drugs have some other, often unwanted or unpleasant effect on the taker. However the majority of us will only take medications for short periods of time, and for the most part side effects are manageable or avoided. Most people with Bipolar disorder will take a combination of medications their entire lives, from the point of diagnosis. For me that was when I was 29. So I potentially have another fifty years of medication to control and manage the symptoms of my condition. It is the side effects and the impact they have on a sufferer's life that lead many people to stop taking the medication. That might sound crazy (ha, ha!) to most people, to stop taking a drug that prevents significant mental illness. But many of these drugs are physically damaging and cause side effects that day in day out are difficult to tolerate. I can only talk of my personal experience, but three years in I am struggling with balancing the side effects with the benefits of the drugs.
On the surface many of the side effects may seem inconsequential, but added together, over a period of time they become frustrating. I take two drugs at the moment, the first lithium which I started taking after my diagnosis, and venlafaxine, which I began in hospital after my daughter was born. Lithium is my mood stabiliser, there is no set amount prescribed, as different people metabolise it at different rates. In fact the line between therapeutic and toxic is narrow. Lithium toxicity can cause kidney and liver damage, as well as thyroid disease. For this reason I have regular blood tests to check my levels and my organ function. It is unlikely I will take it for my whole life because of the damage it does. It also make me very thirsty, because it is a salt; it makes my hands tremor slightly, especially in the mornings and itchy skin. Venlafaxine is an antidepressant, it causes me to be hungry all the time. By that I mean I eat a large, healthy meal and an hour later I am ravenous, a real craving hunger. This means that if often causes weight gain. It makes me sweat more (nice!), have very vivid and strange dreams, and if I am even an hour late taking it I get dizzy, brain shocks and feel sick.
These are manageable, except at the moment I am trying to lose weight. My drugs mean the only way to do this is to be really, really hungry most of the time. It is hard to concentrate when so hungry! I am eating enormous amounts of fruit and low fat yoghurt, but it doesn't touch it! These drugs meant I couldn't breastfeed my daughter, couldn't even really consider it. I have to be very careful with alcohol, I get drunk much quicker and if I get too dehydrated I can go into lithium toxicity.
Soon I will hopefully be reducing the venlafaxine, and perhaps even consider a change all together. But unfortunately for me most of the drugs come with the side effect of weight gain. Which might seem a vain worry, but when you are overweight already, facing a lifetime of these drugs it becomes more than an irritation and yet another kick in the teeth from this diagnosis
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