Days 90 – 180

June 10, 2007 at 12:21 pm 1 comment

So, 90 days ago I wrote a post about what had happened to me in the first 90 days of my treatment, since that night in December when I turned up at casualty with cuts on my arm. In summing up, I said that “I’ve yet to receive any effective treatment”. This remains the case, but things are slightly more hopeful than they were three months ago. I had been seen by two psychiatrists then and was waiting for a couple of referrals to come though.

Calling PALS

Someone suggested in the comments of my previous 90 day post that I should call my local Patient Advice and Liaison service about finding out when my referrals to a sleep specialist and to a psychologist would come through. So on the 12th March I did. She called me back the following day to tell me that I should hear about both referrals in 4-6 weeks.

Changing GPs

While waiting, I’d become rather dissatisfied with the way my GP was treating me. While he was obviously well intentioned, his advice was fairly useless and he didn’t seem to be able to offer the kind of support I expected. So I changed GP’s and ended up seeing my new one on the 26th March. I explained at the time that I’d be wary about trying another antidepressant due to my possible bipolar tendencies and my previous reaction to Sertraline. The new GP went ahead and prescribed Citalopram anyway. I agreed on the understanding that we’d monitor it closely.

Citalopram Side Effects

Citalopram sent me soaring up to hypomania, then on the 31st March, I crashed down and self-injured.

Sleep Spec Appointment

On the 7th April, I finally received my appointment with the sleep specialist. This was for the 24th May, which made my wait exactly 100 days from my appointment with the referring psychiatrist.

More Self-Injury

Another Citalopram-related crash on the 10th April, more cuts.

Back to the GP

I saw the GP the next day, on the 11th April. We agreed I would stay on the Citalopram and see if my moods stabilised over the next couple of weeks. I was prescribed some relatively low-dose diazepam.

And again

I saw the GP the following week on the 18th April. My moods were still riding a roller-coaster and I was flipping between being high enough to be incapable of doing anything other than laying on my sofa waiting for the rush of thoughts, images and visual distortions to go away, and being low enough that any thought at all was an effort. She informed me that it was normal for my moods to be disrupted while adjusting to the medication.

Calling PALS Again

The 24th April marked six weeks since PALS had told me I’d hear about both my referrals within six weeks. I called them again, they went off and liased and I was told that someone from the psychology department would call me that week.

Once more to the GP

I saw the GP again on the 26th April and showed her a mood graph I’d made, clearly showing the rapid cycling I was experiencing. She asked me to make a double appointment so that she could get details to refer me to another psychiatrist and said “I think we need to look at whether some kind of mood stabiliser would help with this rapid cycling.”

Goodbye, Tendon

On the 27th April, I got drunk, took my last few diazepam and slashed my wrist. After bleeding quite a lot, I fell asleep. The next day I got myself to the local accident and emergency unit, where it emerged that I’d cut through a tendon. This turned out to be the palmar tendon, which is probably the least essential one I could have severed. I was admitted to a ward and had an operation to repair it and close the wound on the morning of the 30th. I was expecting to see a member of the mental health team that day so that I could be discharged on the 1st of May. This didn’t happen. On the 1st, I waited most of the day, until I was told that they were “too busy” and I’d have to stay overnight again. Since I was feeling fine by this point and there was no real reason to stay, I discharged myself.

Talking to PALS Again

The next day, the 2nd May, I called PALS again since the psychology department still hadn’t called me, despite their promises. I was also less than happy after getting home from the hospital to find a letter from the Sleep Specialist’s office telling me the appointment had been moved back to 12th July. PALS contacted both offices and told me that the Sleep Spec’s secretary would call to arrange an earlier appointment. The psychology people had promised to call again, but I was given their number in case they didn’t.

Surprise Appointment with the Sleep Spec

I had an appointment with my GP for the 3rd May and was waiting for it when I received a call from the Sleep Specialist’s secretary advising me that there had been a cancellation and could I come in in half an hour. I leapt at the chance, cancelled my GP appointment and went to see the Sleep Spec. She asked me to fill out a sleep diary and see her again in June. She also told me to come off the Citalopram, tapering down over a week.

Double Appointment with the GP

I finally saw my GP on the 8th May. We discussed recent events. I told her I still thought the referral to another psychiatrist would be a good idea, if only to get a treatment plan worked out. I had previously mentioned that I was not confident in the first psychiatrist’s diagnosis, particularly with regard to her decision that there was no bipolar or cyclic element to my moods and also her decision not to medicate. My GP told me that she would need to go through my notes and asked me to make another appointment.

Contact from the Psychology Department

The same day, I finally received some correspondence from the psychology department. This was, however, just a letter telling me that I was on a waiting list. I called her on the 10th May and learned that they psychology had received the referral from the first psychiatist I saw (the locum) on the 1st of February and I’d been put onto the waiting list then. The second psychiatist, who had returned from her time off, put a hold on this referral until I’d seen her on the 13th February. It seems I was eventually restored to active status on the waiting list, but nobody bothered to tell me. I asked how long the waiting list for the assessment with the psychologist was. The secretary told me she’d call back the next day. I called again on the 14th May, only to be told she would find out and get back to me.

Finally, on the 15th May, nearly 15 weeks after they had received the referral letter from the locum psychiatrist, they called to tell me I had an appointment with a clinical psychologist the next week.

GP yet again

I went to see my GP as she’d requested on the 17th May. She told me that, having read my notes, I’m not bipolar, my depressions aren’t severe enough, the timings are wrong. Previously we’d agreed that whether I could be officially diagnosed as bipolar or not, there certainly seemed to be a cyclic element there somewhere and it was worth looking into. (And of course, there’s a catch-all Bipolar Not Otherwise Specified diagnosis in the diagnostic manuals, for cases where there is clearly bipolar-like activity going on, but the formal diagnostic criteria aren’t fulfilled.) She decided there would be no benefit to another assessment (despite my concerns that the psychiatrist’s diagnosis was based on parts of my history that are no longer particularly relevant to me). I had always been open about my opinion on this and the only significant element that had changed was that she had read my notes. The conclusion we came to was that I should “wait and see”.

Seeing the Psychologist

I saw the psychologist on the 22nd May. We went through some of my history and problems and she asked to see me again the following week. I saw her again on the 29th and she referred me for cognitive analytic therapy, though she warned me the waiting list can extend up to a year. With this in mind, she also referred me to a clinical study, where I may end up doing cognitive analytic therapy or another type of therapy, but within a more reasonable timescale.

Back to the Sleep Specialist

On the 7th June I went back to the sleep specialist, with my completed sleep diary in hand. She worked out the average time I slept and told me to pick a time I wanted to wake up. I chose 10am, mostly at random. Since my average sleep time was 6 hours, I’m now going to sleep at 4am. I have my doubts about how likely this is to work.

So, six months have gone by since I turned up at hospital with my “Oh, God, I need help” cuts, and so far, not much has happened. I’ve been assessed by all manner of people. My GP tried medication and gave up, so two trials of antidepressants with no follow-up, along with the rather unsophisticated sleep regime suggested by the sleep specialist are the totality of the treatment I’ve received. I do have an appointment with a CPN later this month, though and maybe things will start making sense at some point.


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Circadian Hijinks Kick It

1 Comment Add your own

  • 1. krissy  |  July 5, 2008 at 6:52 am

    hi. i am 24 and i struggle with depression and anxiety disorder. i am also a cutter. What i think is going on is that you have an anxiety disorder. A lot of what you are saying seems to relate to deep depression and worse anxiety disorder. for instance not trusting any phycologist,fears and anxieties of possibly losing your mind, time is of the essence and you need answers and a solution now. Anxiety feels like standing on the edge of a cliff with the wind blowing. cupple that with deppression (negative thoughts and outlooks) and anxiety(unrealistic fears) can last all day for months and sometimes years. I am sorry if you may be feeling this way. I know it is hard to understand why. I started feeling dam i cant live like this . But the key is to isolate the problem. i too have cut myself and i did it before i ever even had anxiety attacks. it is a way to express physicaly what i was feeling emotionaly it was a release. And trust me i know it is shitty to feel that way emotionaly. i think that anti-depresants can help peolpe i believe they can hurt people as well. I think it is unrealistic to assume that all we need to do is take a pills. Try meditation, reading, singing, drawing, yoga, vitamens, good diet and stress management , with your medication.And dont cut your self scares are painful reminders that will make you feel worse about yourself. medications are a process of elimination for most of my friends. There are a lot medications out there so hang in there. And not in a wrong way but love yourself.

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Hi, I'm James. I'm a 26 year old guy from England with bipolar disorder (currently well controlled). I also have a circadian rhythm sleep disorder (not so well controlled). This blog has charted my journey from mental illness, through diagnosis and, recently, into recovery. It's not always easy, but then, what is?


Self-righteous note about smoking

As of 12th September 2008 it has been forty five weeks since I quit smoking. So in another seven weeks it'll have been a whole year.

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