Tag Archives: medication

Today is the day.

Today is the day: my first counselling session. I would like to write about how I feel, but truthfully, I don’t feel anything. It’s been nearly five months coming, and today, I feel much like I did five months ago. Numb. Empty. And exhausted. Exhausted by the daily grind of depression, the heaviness of trying to get out of bed, the dissonance of putting on an enthusiastic face for the outside world, and the pressure of wanting to be ‘getting better’ for the people in my life who were so relieved to see me getting professional help.

I ran out of citalopram a week ago and can’t find the prescription slip to order a repeat. I could go back to my GP to get a new prescription,  but I’ve explained to myself that since I didn’t want to be on medication anyway, this is a good opportunity to see whether psychological treatment alone is enough. That’s the rational explanation. The truth is, the thought of seeing him again makes my heart beat through my chest, so I’m avoiding it.

Now today, I have to talk. But what to say? My life is good. I have a well paid, interesting job; a partner who I love deeply and have fun with; a nice flat in an area lots of people wish they could live in; good relationships with family; and lots of friends who I love and who care about me. There is no good reason for me to be unhappy. I could dig out supposedly traumatic events from throughout my life, but in my experience, that’s true of pretty much everyone. So that leaves me back where I started: what to talk about? In my last go at psychological treatment, I remember endless silences because I didn’t know what I was meant to talk about.

A couple of months ago, I requested a copy of my patient file from the psychiatrist I saw in 2004-5. It was hard seeing things written down about myself, things that I didn’t recall being spoken in the room. Words like “anorexia nervosa: partial remission”, “drunk today”, “borderline personality traits: see for further assessment”. There were also the letters between my psychiatrist and my GP, which I’d not seen before.

I feel she is suffering from a mild to moderate Borderline Personality Disorder. She describes a long history of labile mood, and has been self lacerating for the 2 years. She also bites her fingers to cause pain, and can also be reckless with spending and sex.

And a year later:

If she remains engaged in therapy she should continue to make slow but steady progress.

I dropped out of treatment a month after that last letter was written.

I feel reassured that this time I am seeing a counsellor without an official referral from my GP, so they won’t share information about me. But I know I suggested in an earlier post that it would be useful for them to share information. The point is, I want information shared in a way that includes me. I want professionals who are collaborating in my treatment with me. If they communicate, I should be copied in. Instead, I get a choice between uncoordinated treatment from two separate professionals who don’t know what the other is doing, or coordinated treatment in which I have no voice.

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Six weeks on Citalopram.

It’s six weeks since I started taking Citalopram. As I’ve mentioned, I track my mood on Mappiness. The graph below shows how happy, relaxed and awake I’ve felt between the end of November and mid January. Overall, I think there’s been a slight improvement, although it’s not particularly clear.

Mappiness 2012-13

A comparison to the same period last year provides even less clarity (there’s more data here, as I was tracking twice a day): I had a more pronounced upward trajectory this time last year, when I wasn’t on medication.

Mappiness 11-12

I saw the GP for a second follow-up on Thursday and mentioned that although I felt a bit better, I had noticed a similar pattern last year so wasn’t confident the change was due to medication. He didn’t really accept that explanation:

GP: I mean it can be a combination of things. Normally around the winter months, there’s less sunshine of-course, it affects people’s moods. And if you are pre-disposed to developing low moods anyway, probably it can make it a bit, exaggerate its effect. Now, ah, the other thing about the tablets is that ah, sometimes you don’t see the effect because it’s so gradual and what tends to happen is the only time that people realise it’s working is when they come off, and then they realise that it was working. So I think, you know, they’re actually working.

It’s winter now and I was telling him that I’m feeling a bit better, so his explanation made me feel that he wasn’t listening. From our previous conversations, I feel like he is very confident in the efficacy of SSRIs and that it would be very difficult to change that belief.

I’ve also felt in my two follow-up appointments that he’s not really interested in psychological treatments, and has only offered it as a complementary treatment because I wanted it. This time, I don’t think he would have even checked in about the counselling he’d referred me for, except that I brought it up.

GP: You still feel bad about yourself, self esteem?

Me: Yeah, that’s, yeah that’s still there. I’m gonna start counselling with Mind, but that’s not for a few weeks.

GP: Okay, okay. You managed to get hold of them.

Me: Yeah, yeah. So I had my assessment but I’ve just got to wait for them to allocate me a counsellor.

GP: Right. Great. Concentration?

He didn’t change my Citalopram dose, but gave me a repeat prescription and told me to come back in 3 months. I left my third appointment feeling frustrated. In my own line of work (a different health field), we talk constantly of “partnership-working”. In my first appointment, the GP gave me the phone number for Mind, but he drastically under-estimated how long I’d really have to wait to access counselling, didn’t know they offered evening appointments nor the actual cost, and he couldn’t tell me what type of counselling they offered. Now, he knows I’ve accessed the service but he’s not interested in knowing anything more.

It strikes me that once I start counselling, my counsellor will probably have the best insight into how my mood is changing. But there will be no discussions between my counsellor, my GP and I about these changes and my medication. This leaves me stuck in the middle, responsible for coordinating my treatment, and trying to communicate with a GP who believes that antidepressants are the best answer.

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What happened next.

I went for my first GP appointment three weeks ago, you can read the full transcript here. Overall, it was more positive than I had hoped for. The GP was sensitive and took me seriously, and I was pleased to be offered counselling. I felt a bit pressured into taking antidepressants, and that he wasn’t really open to engaging with my concerns about medication. I also felt it would have been helpful if he’d been a bit more informed about the service that Mind offers, in particular what type of counselling it is (I’m assuming CBT) and whether they offer out-of-hours appointments.

The day after my appointment, I called Mind during my lunchbreak. The receptionist put me through to the counselling team and their phone number rang through to voicemail, so I left a message.

The following afternoon I still hadn’t had  a callback from Mind. I was feeling numb and tired; I had the Citalopram prescription sitting in my bag. I hadn’t thought I would ever take antidepressants again, but the lack of a call-back about counselling made me think that that could be a long process and I’d already waited so long to seek help. Although I know medication can be harmful, I hadn’t had unmanageable side effects previously and this was a significantly lower dose than I’d been on in the past (10mg compared with 40mg), so I figured I’d give it a go.

I filled the prescription and started taking it the next morning. After problems with extreme tiredness – falling asleep by 9pm every night – I switched to taking the medication in the evening. I then started having problems with waking up very early, which I thought may have been a side effect but the GP later explained that this isn’t a known side effect and my sleeping problems are most likely just due to the depression.

Twelve days after beginning on Citalopram I had my follow-up appointment. This time it was very brief. I’d had a blood test in the interim with a lovely nurse (a Bangladeshi doctor who was working through her qualifications to become a doctor in the UK) and the GP confirmed that I’m not even remotely anaemic. He asked how the medication was going, and I replied that so far I’d not noticed any difference. He didn’t ask about the counselling, but I volunteered that I now had an initial assessment booked for 7th January. He asked that I make an appointment with him for another month’s time and if I’m feeling a bit better but not a lot, then he will increase the Citalopram dose.

I also asked how he had made the decision to put me on Citalopram and not something else. He replied that GPs generally now prescribe SSRIs instead of the older TCAs, and its usually Sertraline or Citalopram. I said that I understood that, but wanted to know how he decided on Citalopram rather than Sertraline or something else such as Escitalopram. He explained that it really just comes down to professional experience, and that he’s had good results on Citalopram with his patients. He added that Escitalopram is expensive, so it would never be the first choice. This seems to be broadly in line with the NICE Guidance, which is fine, but I am left with the feeling that my GP views antidepressants as the central treatment option, with counselling as a slightly hippy-ish add-on.

It’s now just over three weeks since my first appointment. I’ve had some days of feeling quite a bit better, but today I’m feeling quite a lot worse, and I never know whether to attribute any gains to treatment or not. While Christmas is hard for many people, it’s a good time of year for me and I always feel better with time off work spent with loved ones, cooking for them and socialising. Today is the first day that all my family have gone home, and the numbness has descended again.

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