Medication shock

I tried a new medication last week risperidone, to replace the quetiapine I was taking to try and treat OCD. Something that isn’t always obvious is that the side-effects of the medication can be worse than what it is trying to treat. You should note that this is just my experience, and yours may differ, but this is the worst experience I’ve had with a medication.

In my case it caused me to wake up multiple times throughout the night, and by the second day of taking it I was highly anxious and agitated, both of which are common side-effects. This led me to me hating myself, a lot. The thoughts run through my head every so often, but function as intrusive thoughts that dissipate when I pay them no attention. Being agitated led to me paying a lot of attention to them

The effects took about 48 hours to wear off completely. Physical effects included my right eye not opening properly and being short of breath.

In a way it “helped” with my OCD, as it rendered doing any decontamination procedures so intensely distressing I took shortcuts and skipped steps to try and escape the procedures. I didn’t feel any better afterwards.

On the negative the agitation prevented me from watching TV and reading. I even burnt my mouth from eating too fast, as the agitation made me want to get eating out of the way as soon as possible. That is a disadvantage of rushing to escape agitation.

It permeated through the rest of my day, and the only time I felt sort of settled was when I was moving, on the bus. Walking was a problem as my breathing way short (a narrowed throat is a side effect of the medication, but anxiety can also tighten your chest shortening your breath). A normal way for me to cope with intense anxiety and distress is sprinting, but that wasn’t available when I couldn’t breathe normally.

After consulting my psychiatrist’s office I was advised to stop taking the medication, which I did. Unfortunately I still had to put up with the side effects until they wore off. To get to sleep I had to visit A&E, and got sedative to calm myself and averted any risk of me self-harming.

At the moment I’m just feeling the trauma of the event, but I’ve escaped the side effects now.

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Coping with sleep

My number one coping strategy is getting enough sleep. Should I fail to get enough sleep for long enough I will end up too exhausted to use any other coping strategies.

I forgot to get my repeat prescription on time this week, and as I usually rely on the sedative effect of quetiapine to get me to sleep, I had a few bad nights – when waking up the trouble of trying to get back to sleep made it feel like I was struggling to breathe. I don’t think that was the case, but my mind gave the illusion of it, probably because it had trouble expressing the feeling of being unable to sleep.

Historically a week with sleep disruption results in me acting implusively, not always dangerously, but always in a way that I regret.

Luckily this time around it was “just” two days, so I’m OK, and feeling, safe now, even if the feeling of fear when I try to go to sleep hasn’t faded yet.

Somehow, although it defies explanation I have found myself with too many things to do (programming, new series on Prime Video, and fitting in video games). That’s good, as it leaves me safe.

Bye for now.

Waking up

I have to do this every single day. It’s usually the worst part of the day though, with the behaviours generated by having OCD.

Step 1: Leave my bed

Leave my bed. This is the easiest part, so long as I don’t touch anything.

My OCD splits all the environments in my flat into different contamination states. In the past being in bed didn’t count as having any contamination, although in the last year it’s evolved into being avoid a state all of its own.

Step 2: Breakfast

At this point I have two choices.

  • I can wash my hands twice so that I can touch my cupboards (estimated time 30 minutes)
  • I can use disposable gloves as a barrier between me and the things I touch (estimated time 30 seconds)

Now onto making and eating breakfast. Put my granola with milk in a bowl and eat it.

Because of the contamination level from the contact between my mouth, which hasn’t been cleaned yet and (in)directly on other items, the bowl, spoon and surface now require cleaning before I can use them later in the day.

I usually don’t clean them until later.

Step 3: Netflix

I know have to change gloves to ensure I don’t contaminate my phone from the breakfast items. I’ll break my phone from cleaning it later, it has happened to more than one phone.

This step is just while I work up the motivation to have a shower. Depending on what I’m doing later and how anxious I am this state could last between 5 minutes and 5 hours.

Step 5: Shower

Including disinfecting the bathroom floor,washing my hands, cleaning myself and brushing my teeth this part usually lasts about 2 hours.

After this the bathroom floor and any sinks I’ve used are now contaminated from whatever I’ve washed off. Exactly what that is and why it’s a big deal doesn’t matter. It just is.

Step 6: Flat cleaning

This bit just eliminates any contamination created on any surfaces or sinks by the previous steps. It means that for the rest of the day I don’t need to worry about contamination as touching the items will no longer feel contaminating.

Done

I’m ready to start the day now.

If that seems tedious and and excessive, that’s because it is. With OCD I’m aware of the irrationality of what I’m doing, but I have no real means to control it.

This is my start of the day, every day. On the plus side, for today, I don’t want to hurt myself.

The real value of distraction

Trigger Warning: Post discusses self-harm and avoidance strategies.

Distraction

When interacting with mental health professionals they often advise you to distract yourself to avoid doing something dangerous.

It can feel like they’re being dismissive “just distract yourself”.

Sometimes distraction really doesn’t work, but most of the time it just buys time. Buying time is valuable though, often the impulse to do something dangerous isn’t strong enough to last a significant amount of time. By distracting myself Igive time for the impulse to fade, and when it does, I’ve “won” – I haven’t hurt myself.

For example, today, I wanted to burn myself. I don’t keep a kettle on hand, which means heating up water to burn myself in a saucepan is going to take a significant amount of time. Today, by the time I’d put water in a saucepan, and started heating it, the impulse faded giving rise to the thought “what on earth am I doing”, at which point I poured the water down the sink and went out.

Usually 20-40 minutes is the estimated time for a normal impulse to last. The problem is when I disassociate, as that can last for hours, or even days. Disassociation is a when I feel disconnected from reality, and it’s as if my mind is still operating, but I’ve lost control. The best analogy I have found is it’s like being in a car, with the brakes broken, accelerator locked down and doors jammed, hurtling towards the edge of a cliff. You can steer to adjust how you fall, but you can’t avoid falling off the cliff.

It’s like being in a car, with the brakes broken, accelerator locked down and doors jammed, hurtling towards the edge of a cliff. You can steer to adjust how you fall, but you can’t avoid falling off the cliff.

Me

There’s very little that can be done to prevent me from hurting myself in that scenario, unless another person realises what is happening and gets in the way. As I’ve discovered that is incredibly unlikely, see below about seeking help.

Similar strategies can work. In this scenario I find myself tricking myself into doing a quite long sequence of steps is needed to be completed before I can do that final action of self-harm.

The steps can include procuring the items I need, decontamination related to my OCD, or tidying up my room/flat under the reasoning that whatever happens I’m left with nothing to clean up, or whoever has to deal with what I’ve left behind isn’t left with much to do if I’m suicidal.

Seeking help, personally

Trying to indicate to someone that I need help when distracting myself is something I find incredibly difficult. When in crisis I can’t justify threating to do something dangerous or preventing myself from doing whatever it is. Hence the most I can justify is giving a minimal indication that something isn’t right. Generally people will have no idea that it indicates a crisis, but if they know me well enough they might or might not realise what it means. So technically I’ve left it up to an unlikely chance whether someone stops me, which as far as I’m concerned at the time isn’t the same as getting someone to stop me.

Part of the difficulty in seeking help is wanting to avoid being viewed as threatening to do a dangerous act. Not really seeking help is, as far as I am concerned at the time, very much not threatening to do something. From my point of view as I’m not actually saying anything about doing something dangerous.

Included in that is that I don’t want to bother anyone if I’m not actually going to hurt myself. Unfortunately by the time I know whether or not I’m going to it’s too late to seek help, as I’ve already done or not done it.

There’s also the fear that I’m not worth the help and support. As far as I can tell that is entirely irrational. At the time though, it’s hard to believe that.

A lot of the time when professionals realise something is very badly wrong, it’s way too late and I’m already need A&E for treatment.

I have requested help before a crisis, but it’s usually a long time before when there isn’t any immediate threat.

That can make helping me difficult, as I’m aware, and make me seem unpredictable. I’m not sure how to break the thought patterns so that seeking help is viewed as a valid option.

If you can seek help, do!

Transition and recovery

This blog will cover my experiences recovering from OCD and its complications.

In the last week I have been told that I am no longer ill enough to have the local CMHT follow me.

The CMHT is the community mental health team. They work with people whose physical health is at serious risk as the result of a mental health problem. That no longer applies to me as it’s been nearly 4 months since the last incident where I was at risk.

While it’s good to have a sign of progress, I’m going to miss the members of the CMHT who keep track of me. I will lose having someone reliable to talk as they will no longer be available.

The road ahead is unlikely to be smooth, but, fingers crossed, I’ll do more than just survive.