Resurgence

The past month or so has been dreadful for me. My clinical depression has had me firmly in its grip, so much so, I’ve been literally fighting powerful urges to complete my suicide. I think this stark statement may come as a surprise to many who have seen me on-line in my Twitter and Facebook personas, posting lovely photographs and typically Nick type cheery comments. This is the nature of my beast,

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Resurgence

Last year during my ‘Three Peaks by Kayak’ adventure, I found myself inspired by the various experiences I encountered to make meaning of my depression and understand how I can live with it. There was one particular moment when fighting against the tide in the middle of the expansive Luce Bay off the Galloway coastline, when I came to the enduringly powerful realisation that the discomfort I was experiencing at the time was not permanent, and when the tide I was fighting against changed in a few hours, it would soon pass. In that moment, I instantly embodied this awareness because of its powerfully analogous pertinence to my depression recovery process. In this moment of enlightenment, I finally believed what the many caring professionals had been telling me for many years - “This will pass. Given time, you will become stronger and feel better.”

Making the decision to believe the impermanence of my depression did not lead me to believing I would eventually be cured of it. Instead, this allowed to me to accept I will live with depression all my life, and it’s the deep depressive moments which will come and go. Likewise, the thoughts and beliefs I have about taking my life are associated with these deep low periods and I was now able to counter these with a belief that they are impermanent. I now understood the notion of making a permanent decision based on an impermanent feeling.

However, when my clinical depression takes hold of me and I sink into a deep and dark low, my ability to cognitively function is impaired by the wide ranging self-destructive and self-hating thoughts and beliefs I find myself struggling with. I find myself literally fighting for my life, voicing out loud (when alone), reasons why I shouldn’t kill myself. This is an internal battle which rages in my head and through my body. Thoughts and feelings merge to be expressed in my language, how I think, how I feel emotionally and how I feel physically. My energy and personal resources are expended on this battle and too, in masking this fight from the world around me. I do not want the ordinary world to know of my pain. There may be hints, or I may put out a Tweet which may be more explicit, but generally, I continue post lovely photos with asinine words. (At least I think they are at the time). Likewise around and about in my lived world, people will probably not be aware of the self-destructive thoughts I have running through my mind when I meet them in the street or when chatting over a pint or a coffee.

There have been a few moments recently when I have desired hospitalisation because the struggle to overcome my thoughts of suicide have been more than I could cope with. However, there’s always been one reason or another why I didn’t explicitly seek this and I continued to fight on my own. In a way, the now embodied adage “this will pass”, enabled me to remain with my distress in the knowledge that it was likely to diminish over time. I continued to live my life in the public realm as unobtrusively as possible, hoping few people would cotton on to the mask I was wearing. Karen was totally aware of course and lovingly supportive. Likewise, my C.P.N. was happy to see me twice a week for lengthy appointments. I wasn’t totally alone.

I’m often asked what the causes are for a particular bout of depression, something I can pinpoint as the originating source. Generally there is none. The malaise takes root, deepens and insidiously manifests itself to the point where I become overwhelmed by it. I’m aware of its early presence and determine I will not allow it to take hold of me, but despite making efforts to stall the process by undertaking health enhancing activities, the depression is the stronger. My mood sinks and I am engulfed with beliefs of self-hatred, self-loathing, and uselessness. No matter how heartening the reassurances from friends and family about my worth, these messages of genuine warmth and love fail to reach my core. I find it easy to counter them with the all to predictable response - “Yes, but…”. This in turn serves to make me feel even more unhappy, because then I add the belief I’m an unnecessary burden to those who love me.

Having met with a psychiatrist, I am on a new medication regimen which he is confidently hopeful will help me raise my mood and begin to feel the joy in life again. To be truthful, I detest taking anti-depressant medication because I have found the side-effects to lead me to feeling more unhappy than the opportunity for a cure. Feeling sluggish, doped, constipated, lost libido and other minor conditions, all serve to reinforce the futility I feel about my life. For the last eighteen months I have been medication free, determined to live with my depression in an organic, self-sufficient manner. To all intents and purposes I think I managed to do this successfully until the point this year, just after Christmas and my mood slipped past my ability to self manage myself. Even then, it took some insistence on the health professionals’ part to encourage me to consider taking medication again. It’s early days still.

Despite this desperate bout of depression, I have looked forward to the future, and found within myself a desire to plan for another kayaking adventure. Not only this, I have chosen to invite a new friend to share the adventure with me thus breaking with my usual process of kayaking solo. In getting to know Jack on-line and then meeting him recently, I have discovered a friend who shares my understanding of the world and a passion for exploration by kayak on the sea. Our common ground is our connection to the R.N.L.I. and it is the charity which forms the basis of this expedition. You can read more about this here.. Sharing a kayaking expedition is going to be a renewing experience for me because it’s many years since I last headed off into the wide yonder with someone beside me. I’m really looking forward to Jack’s companionship.

Today the sun is shining and the sea is calm. It is the last day of March and early this evening we move out to our summer mooring in the bay. I’ve readied the engine, checked the electrics and filled the water tank to the brim. Propane gas bottles for cooking and heating are charged, and the inflatable dinghy we use as our tender has been spruced up with a wash and a new seat. There is something in this transhumance experience of mine, moving from our winter berth to our summer one, which excites me and reminds me of the resurgence of life. Around and about there are the signs of spring. The cormorants are gathering materials for their nests on the nearby cliffs, the trees are beginning to show signs of green and the sea is becoming translucent again. I feel my blood moving within me, a sure sign that life is returning and soon the shackles of this depression will be shaken off. With the help of my medication, I’m hopeful in a few weeks I’ll be noticing the colour of the world around me again.

This Thing Called Depression

Yesterday I had my monthly appointment with the Psychiatrist who is responsible for my care. I like him and more importantly, I trust him. He is personable with an easy yet professional manner. He is a yacht owner too so we share yachting stories and he likes to tell me of his recent trips.  Amongst these short conversations we also speak of my clinical depression, how I'm doing with this, and checking how safe I am with myself. He is thorough in his assessment of my current situation and willingly offers suggestions for new approaches. This certainly was the case yesterday.

At the moment I'm locked in to a severe bout of depression which is not shifting in anyway shape or form. The medication I have been taking is simply not making a dent on my low mood or even imprinting any form of colour into my life. The upshot is a diagnosis that I'm struggling with 'treatment resistant' depression and if this cannot be overcome with medication alone, then other treatment courses will have to be attempted. 

My Psychiatrist has prescribed one last medication which he hopes will provide me with increased energy and thus motivation to turn my current lethargy around. However, there are risks attached to this medication (see my previous blog post) and it may not suit me. Hopefully this will not be the case and it will work the magic he thinks is possible. It's not a medication for depression per se but there is evidence that it works for people like me, who have been fighting a deeply stuck low mood. 

If this new medication does not work then I will be admitted to hospital for further assessment and possibly a referral to a specialist NHS unit for people with severe and enduring clinical depression. Apparently there are non-medication approaches which can be explored, some of these almost experimental. Thankfully it seems that I'll not be put through ECT again because this clearly did not work for me.

Bringing my session with him to a close yesterday, my Psychiatrist implored me not to give up hope, assuring me that we were nowhere near the end of the road and I was not going to be given up on. One of the struggles I'm dealing with at the moment is a strong sense of hopelessness, sometimes to the point where I believe there is no reason to continue fighting for my recovery. Associated with this, is the gnawing belief that I'm nothing but a burden to my family. I'm not sure if I was entirely mollified by his assurances that I will recover but I did leave the Health Centre with a little more hope than I had before.

I have started to take the new medication which is an adjunct to my current pill regimen. Time will tell if this will work or not. Sadly I will not be able to celebrate their success or deal with their failure with my Psychiatrist because he is moving on to new pastures. I will miss him for his professional and affable care, and the ease with which I'm able to communicate with him. 

Here's to HOPE.

Taking a Risk

I am an adventurous person and I'm used to evaluating and taking risks either in my sea kayak or in the mountains. I consider myself to be a person who seizes risk laden opportunities as they appear and I believe I'm fortunate that I do so. However, I have an opportunity before me which I consider to be risky and which I find myself feeling unusually wary of.

As many of you know I suffer from severe clinical depression. The psychiatrist responsible for my care has termed my depression as 'treatment resistant'. This is because despite many different interventions over the last year, my mood remains obstinately depressed, so much so that there are moments where I find myself staring into a dark abyss. I'm incredibly thankful for the treatment I am receiving from the medical profession here in Scotland and I do not expect them to solely work the miracle of cure for me. Rather, I view their care as a facilitative one where through my increased motivation and assistance from their prescribed medication and talking therapy, my depression lessens and my sense of well being increases.

Recently my mood has been incredibly low - worryingly so. Apart from my interactions on Twitter, I find myself paralysed with self-doubt preferring to hide here on the boat, away from my world, rarely venturing forth unless I'm certain I'll not bump into people I know. This time is not entirely wasted because I am writing and researching plans for adventures in 2018. However, I would prefer to be more outgoing and be as engaged with the Tobermory community as I used to be.

In response to this deep low and my seeming resistance to the treatment I am receiving, the psychiatrist has prescribed an additional medication for me to take alongside my existing anti-depressant. I won't say what this is because for some reason I don't want to make my medication details public. What I will say is that it is an uncommonly used intervention and is one not normally prescribed for depression cure. The hope is that this drug will shift the log jam I am experiencing in my tormented depressive thinking which leaves me inactive and paralysed by self-loathing. By all accounts, this drug when used for other people in a similarly stuck position as the one I am facing, has proved to be incredibly successful. It has been explained to me that in just about every case the patients had returned to full cognitively buoyant and rudely happy health. This for me is my Holy Grail!

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Without much more persuasion I agreed to give this medication a try and this morning collected it from the pharmacist. (As an aside, we are incredibly fortunate here in Scotland to receive free prescriptions & medication.) On opening the box and reading the information my heart slumped - it was like a punch to my abdomen. I had expected there to be side effects to the drug because there always are with psychiatric medication. I had hoped that this being an 'add-on' to my current medication regime, this wouldn't be as worrisome. 

I personally find the side effects of medication difficult to cope with, especially those which affect my nervous system - increased agitation and insomnia. It's an anathema to me how these drugs actually cure the illness they are prescribed for, when it appears that the side effects exacerbate it. There have been many times in the past I have stopped taking a drug because the side effects were more difficult to cope with than my illness itself. 

Looking at the side effects for this drug I'm left wondering whether to go ahead and begin taking it or to stop right now and leave it well alone. I'm in a quandary. It has been explained to me that this may be the wonder drug to cure my depression, albeit an unconventional choice. I certainly want this to be true yet..., I see the list of side effects and I feel incredibly reluctant to take it.

In essence I'm faced with a risk of sorts, and it's a risk I'm having difficulty evaluating. It's not simply a case of giving the medication a try and maybe stopping if it's not working. It's a commitment to giving it a good long try, despite the difficulties I may find I have with it. I am genuinely fearful of the side effects. When I'm kayaking or mountaineering I face fear as a matter of course when I encounter outdoor risk after risk. Invariably I'm able to rationalise  any fear I may feel and use this to my advantage in making a decision to accept the risk. However in this instance, the sense of fear is getting the better of me and I find myself struggling to consider taking on the risk, even though it has been explained that the possible benefits far outweigh the perceived difficulties.

There are a few days yet for me to decide what path to take and I have the opportunity to meet with the psychiatrist in the coming week to discuss my choice in greater detail. This will be helpful because right now I find myself where I hate to be - paralysed by uncertainty.