Me vs anxiety overload, with some thoughts at the end on wider public health delivery considerations for treating mental health.
It’s been about a week since I last took my last dose of medication for this cursed anxiety disorder, and about two weeks since I stopped taking it regularly. This was the stuff I was on from December 2006 until recently.
Back in the early 2000s I was diagnosed with depression. The anxiety was always there from childhood, though the depression started kicking in during the mid-1990s & only really shrunk from my conscience about a decade later. The psychological symptoms (as listed in this NHS article) are all there, as are some of the physical ones such as difficulty falling asleep (my overactive mind thinks too much), tension on the outside of my head & what feels like a muscle spasm of my intercostal muscles in my chest.
2006 was one hell of a roller coaster ride for me – from the lows of being made surplus within the old regional office I used to work in for the civil service, to the high of getting that letter saying I had succeeded on getting onto the Fast Stream, along with various foreign travels and other events. I started having CBT privately (my NHS provider wouldn’t refer me for it) in the autumn of that year, but there were so many things going on in my head at the time that its impact was limited. I was genuinely fearing for my future career having been turned down for several promotions within the civil service. It was one of the reasons why the ‘high’ of getting onto the Fast Stream was so intense – it was a promotion two grades above my existing one and one grade above the one that I was aiming for.
At the same time, the thought of commuting to London and working in a pressure cooker environment had me asking serious questions about my mental health. I knew the symptoms of trying to get onto the medication would be awful – and they were. It was lucky for me that it was the run up to Christmas because that gave me a good two weeks to get over the side effects. Spending an entire week not able to sleep and barely able to sit or stand up (let alone walk) because of the head rushes is not pleasant. But I got through it.
Every so often there would be what I’d call ‘panic episodes’ or times when I could not sleep at night. If anything, they were exacerbated by things going on both in work and outside – perhaps because things weren’t going as well as I’d hoped. Depression and anxiety-related conditions for me are not ones where the medication or the treatment does all the running while you sit there waiting to get better, as perhaps might be the case with a more ‘conventional’ short term illness like a common cold virus. What happens in the outside world has a real impact on your state of mind and overall health.
On leaving the civil service
My overall condition in late 2010 – and my overall outlook in the context of my mental health was a huge consideration in my decision to take a voluntary exit from the civil service. One of the big questions I asked myself was: Is this sustainable? At a wedding earlier that year I looked at how much weight I seemed to have piled on. “That’s not what I want to look like!” was one of my first reactions – just as the person I felt I’d become was not the person I wanted to be like. The same was true of where I was workwise as 2011 rolled in. “This is not the existence I want to lead”. Basically it felt like I was living to work at a time when lots of sand was being kicked in the faces of public servants – as it still is.
Taking the decision to leave (rather than being told “You’re out”) was a huge weight off of my shoulders. There were similar feelings both on my last day and also when I used my payout to clear off my debts that had hung around my neck like a huge millstone ever since university. It’s one of the reasons why I feel so strongly about higher fees and student loans. Ministers & those in favour of such a system talk about debt as if it is “impact neutral” on people’s behaviour, mindset and mental health. Debt is a prison. It was a prison for me as it is for so many other people. I can’t help but think that if the country was able to deal with the consumer/household debt crisis it might also have a positive impact on the mental health of people.
How long did it take to come off medication?
About eight months overall. I came close in October last year but crashed at the last hurdle. Coming off of long term medication is not the same as coming off a cold remedy or a short course of anti-biotics for a chest infection. It’s only been in recent weeks that I’ve realised the medication was suppressing rather than curing the anxiety symptoms. The emotions and symptoms I was feeling in the autumn of 2006 have returned. The challenge for me is overcoming them – without medication.
So what does this ‘post-pills-plan’ involve?
I threw it all together on about nine pages of A4 on the back of the last ‘panic episode’ last week. (No, I’m not going to type it all out here). Key things include a HUGE amount of honesty with the longer term causes of “how I got to here”, along with trying out new stuff. Diet and exercise almost go without saying, but there’s something still ‘missing’ in the exercise that I currently do – mainly swimming. It lacks the intensity of circuits (that I’ve been doing on/off since the late January) & lacks the sociability of a team sport. I miss playing football, but since I started wearing glasses regularly I’ve hardly played. (My eyes don’t like contact lenses). I also no longer get the ‘buzz’ from dancing that I once got some five or more years ago.
My overall point on recovery (as I set out in Going beyond a pill) is the number of changes that are needed for any chance of success. I worked this out back in 2002 when I first started down the road of recovery against depression. Like a bespoke jigsaw without the picture to work from, the challenge I face is putting all of these things together.
What I’ve learnt & what we’ve learnt.
The advances in knowledge and the changing of attitudes since I first really became aware of all of this in the mid 1990s have been significant. As with many things, there’s a part of me that wonders what things would have been like if I had access to the knowledge that we have now. Every so often I’ll stumble across something that raises my interest. This was the case when I first heard about CBT and Neuro-Linguistic Programming (NLP) – though the latter’s ‘celebrity endorsements’ have made me more rather than less sceptical about its usefulness. It’s one of the reasons why I try to go to the source of where the research, rather than the write-up in mainstream media.
One example is “transcranial direct current stimulation” – where one newspaper has written about it having an impact on depression while the BBC wrote about it ‘enhancing’ the human brain, noting a comment that some may see it as a method to help people pass exams. I guess there is the “physical pain needs physical intervention rather than ‘talking’ intervention” mindset that I have on this – in particular with the permanent tight chest and the tension within my head. A sort of “Oooh! A very mild harmless electric shock (the sort say that you’d get from an electric fence in a field full of livestock) might have an impact on those muscles that seem to be permanently tight” viewpoint. It was this sort of mindset that I got hold of one of those massage pads in the hope that it would help alleviate long term muscle tension. (Short term, yes; long term, no). It also got me looking into ultrasound massagers (in particular for my intercostal muscles) but it seems like one of those things best used by a professional.
On patient choice (Again)
Some of you may have read my earlier blogpost about this. One of the things that I didn’t cover was having enough relevant information in order to make such a choice. The internet is full of ‘noise’ and part of the challenge of using the internet is being able to just whether something is credible or not. Perhaps with a generalised anxiety disorder there is ‘choice’ – just not in the manner that politicians think or talk about. By this I mean the series of lifestyle choices that we make (& that I have to make) in order to deal with it.
From a public health delivery perspective, what I think is missing is something that people can go to when diagnosed with depression or an anxiety-related condition that says something along the lines of: “These are the things you need to consider, here are some actions you can take, and here are the people, places and organisations that can help” – with specific links to each action. (In civil-service-speak it would be called something like “The depression and anxiety patients’ framework”). GPs already do this with libraries where patients are pointed in the direction of certain self-help books. They also have information on local self-help groups too. It would be nice if public services could get together and expand it to things like exercise classes or courses on cooking to help people improve their diets.
Some might say the above is going a little bit over the top, and that people should take responsibility for themselves. With depression, getting out of bed itself can be a challenge. With an anxiety disorder, stepping outside of the front door can be a challenge. It took me about three months to summon up the courage to start doing circuits this year. If something like what I’ve described above would help both patients & GPs, then why not? Sometimes having a GP saying “Here are a list of options locally, which ones would you like to commit to doing?” Especially on something like exercise which bring in all of the complications of body self-image, having reassurance that group classes will be with people ‘just like you’ rather than athletic types, can go a long way.