This isn’t going to be the most fascinating post ever, but I need to just bring the blog up to speed – especially as the last two posts may have probably seemed pretty alarming.
I’m OK. Is the bottom line. My mood has been much more steady, albeit slightly high (it’s been hard not to write, write, write all night, night, night and I’ve been a little physically agitated). No thoughts of suicide or absconding or anything horrible or sneaky at all, really.
And I have a pencilled-in date for my discharge: two weeks today.
My CPA meeting (care plan review) was this morning and went as well as I could have hoped. All the points I’ve been making to staff had been taken into consideration: my need to travel around London safely by myself; my total terror (justified or not) at the plan to move wards, something it is agreed can be shelved if I am only here for another couple of weeks; my desire to begin implementing ideas about meds developed with the pharmacist.
It was in that pharmacy 1:1 that I finally realised I wanted quick fixes to my medication problems, but there are none. I’m on a lot of quetiapine and it will take a long time the come off it. I also realised that I was looking to switch to the perfect drug, but there is none. I tried therefore to open my mind exceptionally wide and actually consider all the options, even ones I have previously rejected. And so I’m going to try the one drug I’ve always said an outright “no” to, aripiprozole. I need something that doesn’t elevate prolactin levels – I’ve already had the whole leaky boobs thing when starting/increasing quetiapine which has been demonstrated NOT to elevate prolactin levels, so forget about ones that do. And whatever I take must, must, must be weight neutral. The pharmacist did make a case for olanzapine but as it’s worse than Q for weight gain my answer was, if you’ll pardon the expression, a big fat no.
I’ve heard/read a lot of negative stuff about aripiprozole. Like I said, the idea scared me for a long time but I can’t carry on with drugs that give me physical problems related to metabolism/weight whilst not even controlling symptoms. I have to do something really different. This doesn’t mean I’m not anxious; I know aripiprozole makes many people agitated and I am really worried about that. So we can take it as read I know a lot of people will be thinking that I’ve made a bad choice, but I’d ask that you respect that choice and not bombard me with more scare stories.
But that’s all weeks away. We’re starting today with an immediate reduction of quetiapine. It’ll take weeks to come down to even half dose, at which point the aripiprozole can be slowly commenced so that the two cross taper. I have a lot worries. Will I get withdrawal symptoms as the Q is slowly reduced? Will I be able to sleep? Last time I forgot a dose I was awake for 37 hours without a glimmer of fatigue. Phasing Q out may well may mean phasing in hypnotics or antihistamines in, at least at the beginning. Will I feel physically unwell? Will I totally lose my shit and become psychotic?
So some decisions have been made but now we’re just onto the next layer of complexity and there’s a lot to take on board. As you’ve probably read, when I was first admitted I felt very ambivalent. I was very reluctant to take myself out of the community, out of my life, even though I knew that was what was needed to be safe. For most of the time I’ve dealt with homesickness by pretty much pretending home doesn’t exist, other than a place from which Tom can magic yoga blocks and thicker socks and my spare pair of glasses. Holding ward and world in my head has felt impossible and I have told staff that I don’t think I can handle home leave. I think going home then having to come back would break me.
I’ve been making sure to go out more, trying to bridge the gap, mostly with Tom and once, yesterday, with a staff member. Sometimes being out feels quite normal but I often become overwhelmed. My brain’s just not used to all the visual and audible “chatter” and I find I need quiet time alone afterwards. Today we went for brunch after the CPA meeting but I really struggled when I returned to the ward, aware of the shifting ward/world tensions and that I don’t know how the hold them.
I’m due tomorrow go out again with Tom as I don’t really have many clothes that fit properly, something that will matter more the more I go out, or any money to buy them myself. The idea is we take a little tube trip, two birds, one stone kind of thing.
To be honest, I don’t really want a gradual change from ward to community. I’m already finding the transition stressful. I want to be all in, or all out.