Some Thoughts on Suicide

Suicide is a touchy subject. It is, isn't it? The proverbial elephant in the room. Mental illness is bad enough, but bring suicide into the mix . . .

There are two things that that really get my goat about talking about suicide. Two stereotypes that people seem to hold onto.

1. People who talk about suicide are looking for attention

2. Suicide is selfish

Going into a talk about suicide with this mindset is a recipe for disaster.

Let me start by saying this: unless you've been at the point where suicide seems like the only answer, you don't get to tell me how I feel. You don't get to tell me to "buck up and look at the bright side."

There are a few things I want to address and I don't think I will do this as eloquently or as straight forward as I would like. My brain is scattered right now.

We all know what suicide is - taking one's life. We all know there is attempted suicide, completed suicide, and suicidal ideation (thinking about suicide). And there are warning signs, which often go unnoticed. I will be addressing the warning signs, don't worry.

Here's a point I want to drive home to y'all: most people who contemplate suicide truly don't want to die. They simply want the pain to stop and they see ending their life as the only way to accomplish this. Let me sat this again: WE DON'T WANT TO DIE.

Have you ever been in that much pain? That much emotional pain that you want to die? I have. Several times. Sobbing, rocking myself, knowing that things can't possibly better, that I'm a burden on my family and friends because of my constant mood swings and neediness. Knowing that my illness, bipolar disorder, will be with me my entire life and that I'll face more episodes like this, worsening depression, mania, and shorter periods of remission. I can't face the truth that I don't feel - that I often don't feel love for my husband or son - I can only fake it. That I don't feel joy or happiness and everything that once has meaning is now dead to me. That sometimes I'm so apathetic I can't even move. It's a physical pain too - exhaustion beyond belief, headaches, nausea. I'd give anything to make it stop. I'd do any thing to make it stop. And in those moments, in those moments of weakness . . . suicide seems plausible. Suicide seems like the only answer.

But I'm lucky. I'm still able to rationalize things. I think of my son and husband and I don't want to hurt them. I mainly don't want to scar my son with losing his mother. He's the reason I haven't taken pills. He's the reason I've had my husband lock up all of my pills in our safe, to which I don't know the combination.

Why am I telling you this? Why am I getting so personal with this? Because it's real. Because it happens. Because an educated, rational, once happy person has recently considered taking a whole bottle of propanolol to end her life - even though she has a wonderful family and group of friends and support system.

I've been talking about suicide lately, about not wanting to exist. I always say that I don't want to die, but that I don't want to exist. If I could just not exist until I felt better. Or that I want to sleep and just not wake up . . . those are words to pay attention to. Those are words of someone looking for help - not someone looking for attention. Do I get attention from saying things like that? You bet your sweet ass I do. I get attention from my hubby and my therapist mainly. My manager. But I need that attention. I need for someone to say, "you matter. You're important. I'm here for you." And that's all. I need to hear that. I have all the reasons I need to kill myself - give me a reason not to. And not by chastising me and telling me that I'll be hurting my family - do you think I don't know that? Trust me - I know that. But part of me thinks they'd be better off without me. Gently remind me that you'd rather have me around, even if I'm depressed and moody and sullen. That you love me no matter what. Don't make it about you. Don't tell me how it would affect you.

So is suicide selfish? In a way, yes. But when you're in that frame of mind, when you see it as your only out, it doesn't seem selfish. It seems like your only saving grace. It seems like you're doing everyone else a favor. When you go on about how my suicide will affect you, about how it will affect your family, my family, my friends, this person and that person, you diminish my feelings. You're telling me that everyone matters more than me and what I'm feeling and what I'm going through. What I'm feeling is real. Even though it may be twisted, illogical thinking, it's real. And to stomp on that, well, it does more harm than good. Acknowledge my feelings, try to understand them - even you you may not. Tell me you care and you want to help. Validate me. Hear me. Let me vent. Don't make my feelings about you.

Let's look at some warning signs for suicide:

1. Talking about suicide
2. Preoccupation with death
3. Feelings of hopelessness/despair
4. No hope for future
5. Self loathing
6. Withdrawing from others
7. "Getting affairs in order"
8. Self destructive behavior
9. Sleep problems
10. Sudden changes in mood or appearance
11. Sudden calmness

If you notice these signs in someone, talk to them. Let them know you care. Ask them about suicide - asking them isn't suddenly going to make them suicidal if they weren't before. On the contrary - it lets them know that you're open to talking to them about it and helping.

I have many things on this list tucked under my belt right now, which is why I'm worrisome to my hubby, therapist and psychiatrist. But we've taken precautions. We've talked openly about it. And I feel safe. Help someone else feel safe. Please.

If you're feeling suicidal, call the National Suicide Prevention Hotline at: 1-800-273-8255

Want to more things NOT to say to someone who is suicidal? Read this blog post.

Oy vey

So here's some fun stuff. On Wednesday I had therapy. My therapy sessions are an hour long. Except for Wednesday. On Wednesday my therapy session was an hour and a half. With the last 20 minutes involving my psychiatrist.

Why?

So I wouldn't be hospitalized. I really didn't want to be hospitalized. I begged, through tears, to my therapist not to send me. That I could keep myself safe, that my hubby would keep me safe and that I couldn't hurt myself because it would only hurt my hubby and son as well.

I was having pretty strong suicidal ideation. To the point where, if I didn't have my hubby and son, I would have killed myself. There was no doubt in my mind. And my therapist knew this. But we put a safety plan in place and it was understood that if I started feeling worse I would admit myself.

My psychiatrist wants me to up my dose of Depakote from 1000mg to 2000mg - he doesn't think it's the cause of my suicidal ideation. Last night I went to 1500mg and this morning I paid for it with unrelenting grogginess. After 2 more nights I'll increase to 2000mg.

My moods have been . . . not good. Yesterday I had a panic attack during our charge nurse meeting. As in tapping feet/shaking/rocking panic attack. I did my best to stay unnoticed. That didn't happen. After the meeting one of the nurses approached my manager and pointed it out to her. I had to take a Xanax (well, 0.25mg, a quarter of a Xanax) to calm down and then give my manager an update on my mental status and explain what happened. Not a good way to start the day. And my day ended with a crash c-section that resulted in a bad outcome. Only 2 months since my last bad outcome.

I did, however, get some good news today. I have an appointment at Mass General on Monday, June 9th. My psychiatrist has been wanting to send me there for a year and a half and now I actually have an appointment - and I won't even have to miss any work. Fancy that!

I had gotten a second opinion from a med specialist 2 weeks ago, but Dr. C still wants me to go - always a good idea to have a backup plan in place (plus, I'm seeing the bipolar specialists in the mood clinic there).

Good things and bad things. Hopefully now there will start to be more good things. I like good things.

Why is everything so hard?

Seriously. Why?

On Med Changes

Cinco de Mayo heralded in major med changes for me. I wrote about them in my last post, but let me refresh your memory:

I stopped lithium, decreased my lamictal by half, and started depakote. I will be stopping wellbutrin but not until I finish what I have left in my bottle (I figured that maybe that would be way too much of a change all at once).

My body and brain, true to form, are not liking the changes. Almost overnight depression. With suicidal ideation. It has been . . . not fun.

If I'm not horribly depressed and sobbing, I'm stuck in a state of apathy - of not caring. And no matter what state I'm in, there's a strong sense of anhedonia.

Nothing that should bring me joy or pleasure does.

I'm merely existing right now people, and existing and living are not the same.

I'm trying to keep in perspective that this is all most likely thanks to my med changes and it will pass. With time, it will pass. But that's difficult to do when your thoughts are so dark. When your thoughts are becoming increasingly more centered on death, dying, and suicide. It's difficult to do when you count how much propanolol you have (178 pills) meticulously, several times, to know for certain that you have enough to do the job (that's probably 5-6 times more than enough - propanolol is a blood pressure medication).

I'm not going to take it.

I have self control, even though it wears thin sometimes. I'm thinking it best, though, that I give the bottle to my hubby, just to be safe. Just to take away that out.

The apathy and anhedonia are almost worse than the sobbing and despair. I don't know what to do with these feelings. I don't want to play with my son. It's tiring and bothersome and I just don't care. Which is horrible because I should. He's spending the weekend at his grandma's house which is good for me because I don't have to deal with the horrible feelings I get for not feeling anything for him. I love him - obviously - I just don't feel it.

The same, too, goes for my hubby. I love him, dearly. But I don't feel it. And it makes me feel terrible.

Work is the same. It's a chore. I can't feel happy for the new parents. I can't share in their wonderment of their new child. I can't honestly joke with my coworkers (I can fake it, though not very well any more).

My art, sewing, writing? All desire, and hope for desire to do these things, is gone. Picking up a pencil is a chore - not something to look forward to and enjoy.

I can feel despair, depression, anger, and nothing. And that's about it.

I'm going through the motions, I'm existing. I'm muddling through as best I can.

Hubby had me make an appointment for next week with my therapist. I've been trying to see him only every other week, with the goal of spacing it out further. But now I'm seeing him next week. Which I'm honestly not happy about. Sounds stupid, yeah? I feel as though it's a waste of his time. That I should suck it up and deal with what I'm going through. It's probably the med changes anyway and it should get better with time. Put on your big girl pants and get through it. I feel weak and embarrassed and stupid for making the appointment.

But I probably need it.

Just this morning I noticed how preoccupied with death I am when looking up new books to read. They were all stories about death, suicide, or very dark in nature. I've had a couple ideas for macabre paintings again, though I have no desire to paint them. These are warning signs I should probably heed. And, I guess, I will.

In the meantime I will continue to exist, I will go through the motions and hope things get better and not worse. I will try to find some meaning in life. I will remind myself that anything I do to hurt myself will only hurt my hubby and my son - more profoundly than it could ever hurt me.

That is the only thought, honestly, that keeps me going.

Changes

Because we need to shake shit up.

My changes are coming in the form of medication changes. Major ones. Namely, stopping lithium, stopping Wellbutrin, decreasing Lamictal by half, and adding Depakote. All pretty much at the same time. It's a possible recipe for disaster.

Why the changes?

Because I'm treatment resistant. Because my previous combo wasn't working. And because my psychiatrist sent me to a medication specialist because he no longer knows what to do with me. Said specialist thinks that I'm toxic on my lithium and made all of the above recommendations. So we'll try it out and see what happens. I'm nervous as my body doesn't seem to handle med changes very well. And all these changes at once . . . scares me.

The night before last, my first night taking Depakote, I didn't sleep. Well, maybe I got 1-2 hours. Yesterday I was irritable, angry, and depressed. I cried more times than I care to admit. Today I'm depressed yet apathetic. I can't focus. I don't care if I do anything or not. All I'd really like to do, honestly, is not exist. I don't want to die, really, just not exist.

Makes no sense, I know.

It's just that everything that used to give me pleasure doesn't anymore. My creative side - which has always been hugely important - is gone. Completely gone. Playing with my son is a chore - one I would rather avoid. And sex? Seems we're back to the no desire, no arousal, no orgasm phase. At work, at my job that I love, I find myself annoyed and irritable. I find it difficult to relate to or bond with my patients. I don't want to go out with friends.

I want to not exist.

Aside from being depressed, I'm unhappy. I want to be hypomanic. If I could just be hypomanic - controlled hypomanic - well, I don't even know. I'd want to be that way all the time. But that's not feasible or safe.

I need a reprieve from how I've been feeling for the last 2.5 years (and most notably since November). Hopefully this med change will be what I need. Hopefully it will stabilize me. Hopefully it won't make things worse. Time will tell.

So here's something fun . . .

I had an appointment today with Dr. C which lasted waaaaay longer than normal - an hour rather than 20 minutes (I feel sorry for the people with appointments behind me). We're tweaking my meds again. And he's contacting a colleague that he'd like to have see me - a second opinion type thing on my meds.

But here's the fun part - while in my appointment, he got a phone call. A phone call from Mass General in Boston. They've agreed to take me as a patient for a consult. Only thing? I don't know when yet. Dr.C will be doing the scheduling - the appointment may be a month or two out - we don't know. But they agreed to see me, which is the hardest part of the whole process.

So it looks like I'll be going to Boston in the future. Go me!

It's been awhile

So yeah. It's been awhile since my last post and quite a bit has happened. Let's see, last post was about depression coming back.

And that is still the case I'm afraid. But I also have this really awesome thing called anxiety. And it's been bad. I have panic attacks when I try and sleep. At first it was just with trying to nap. Then it started with going to bed at night. Racing heart, feeling of impending doom, shakiness, panic. It happens at random times throughout the day too. Sometimes it's constant throughout the day.

Hell, I'm almost in a full panic attack right now, writing this.

I've had irritability and insomnia - to the point where I've been taking klonopin to sleep.

I have all the symptoms of a mixed episode starting. At first I was thinking it might be caused by Deplin - a folic acid supplement that my psych doc put me on. I found one site that listed insomnia, irritability and anxiety as side effects. But I looked it up on my work's fancy info site and it seems that this is not the case (at least for 99% of people - who knows, maybe I'm that 1%). It can cause acne though - which has gotten horrifically bad. So I stopped taking the Deplin, just in case.

The anxiety and irritability continues (the insomnia has gotten better, thank God).

I've had some other issues (that I won't discuss here) which has led to my psych doc having me increase my geodon back up to 80mg - which I really do not want to do (last night was my first increased dose and I certainly feel the effects today - namely fatigue and grogginess). He's also considering starting me on Depakote, which we'll discuss when I see him on Monday (I have strong reservations about going on this drug because of the side effects). He's also started the process of trying to get me seen by the mood experts at Mass General in Boston. I want to go so badly but I'm not terribly hopeful that it will happen.

I've taken to rating my mood on a scale from 1-10, and most days it's around a 3. I'd like it around a 6. I've had some 2's, and I've had a few 4's as well. But, still pretty low. And did I mention anxiety? And irritability? Oh I have? Okay.

What else . . . I was in on a code on a baby and the baby died. This was my first infant death (though I've coded many babies). I took it pretty hard - harder than I thought I would. So hard, even, that my brain went into overdrive giving me full blown depression with suicidal ideation for a day. And then - poof - gone. My brain does not handle stress well at all apparently.

Speaking of stress, I still get overwhelmed at work. I'm keeping my shit together just fine, I just feel overwhelmed and exhausted after working. And during working. Especially since almost every day I've worked we've done 8-10 deliveries. So crazy busy. But I'm handling it better than I was even a month ago, which makes me feel hopeful that at some point I'll be able to go back to full time. Probably not anytime soon, but at some point (I still have a hard time handling two days a week - let alone 3 right now). But I'll get there.

And lastly, my son has been having some anxiety issues of his own - mostly about something happening to my hubby or I (or his uncle). This has been going on for weeks. A few days ago he asked me tons of questions about my bipolar (not that he called it that - he's 7). Wanting to know why I act the way I do, why do I get angry or cry for no reason, why am I sad, why doesn't my brain work right, why do I have to take so many pills, will I always be like this. That kinda stuff. And he made a request that actually kinda hurt - he asked to see a therapist. He wants to "talk to someone about this like you do". It broke my heart a little because I know that quite a bit of his anxiety is cause by my instability. But I'll find a child therapist for him so he can talk - as much as he needs to. Maybe it's only one session. Maybe it's several. I don't know.

Alright. I've written enough for now. A brief overview of what the hell has been going on.