How I stop the sh*t from hitting the fan (a.k.a) relapse prevention.

Relapse. Feels like a dirty word. A personal failure that happens when you thought you had your shit together. Statistically, it’s more likely than not that you will relapse at some point in time.  Depressing thought but all is not lost, here’s a little more about how I stop the shit from hitting the fan.

 

Use a (free) sleep and mood tracker:  There are many free trackers for logging mood and sleep patterns. Stepping on sleep problems early (for example being strict with bed times, using a short course of sleep medication as recommended by your doctor) can avert a full blown crisis. Secondly, having information about thoughts and feelings leading up to mood changes can help identify subtle negative thought patterns which can be challenged using techniques such as cognitive behavioural therapy to reduce their impact on mood.

 

I know my triggers: Extreme stress, too much alcohol, poor sleep. Day to day I cope with stressful events pretty well. We all have stress in our lives and living completely stress free can potentially hamper our creativity (anyone who has waited until a few days before an important deadline to start a project will know what I mean). I’m talking about major stressors. I can trace pretty much all of my depressive episodes back to specific life events (giving birth, a 2 week bout of being in bed with flu, grief). As for alcohol, if I have a few nights of 2 or 3 drinks each night it makes me depressed and anxious. Even at Christmas I try to moderate my alcohol intake as much as possible as the fun never seems to be worth the drop that happens afterwards.

 

Use healthy coping mechanisms: When you know what your triggers are you can utilise positive coping mechanisms to balance them out. I like to exercise, especially when I’m stressed. Out goes the negative energy and in come happy chemicals**. I also like to knit (the focus of making sure I don’t mess it up takes my mind off everything else), keep a journal and read. Find something you enjoy and deploy it often!

**This has backfired once during the early phase of a hypomanic episode. I did my usual zumba class and stayed awake until 1am that night. Lights, latin music and jumping around are not good for the overstimulated mind.

 

Accept that not every bad day or different emotion means that a relapse is going to happen: If you have kids, do you remember when they were born and you were obsessed with their toilet habits? Have they pooped today? What colour was it? What does green poo mean anyway? If they haven’t pooped should we talk to the doctor Before you had kids did you give any thought to other peoples bowel habits? Probably not. This is my way of saying that when we focus on one small thing we can become bogged down and miss the bigger picture. When I’ve one bad day (tired, hormonal, bad day at work), I often decide a relapse is coming. I’m on that downward spiral, I haven’t noticed and there’s nothing I can do. Then I wake up the next day, laugh that I had a bit of a shitty day yesterday and go about my business. One bad day does not make a relapse. Feeling elated because you had a great time with your family at the weekend does not mean hypomania is coming. Recognising and accepting the contrast between different thoughts and feelings can be hard if you’re prone to over-analysing but it’s important to know that everyone (regardless of mental illness) goes through a spectrum of emotions.

 

If the shit does hit the fan, remember that you’ve done this before. You can handle this. You can follow your plan to the letter but there’s no foolproof way of avoiding relapse.  It’s going to take some time and effort but you can and will get through. Scale down your expectations, if showering and brushing your teeth is the only goal you can achieve then that’s okay. Lean on your support network and be kind to yourself. Slowly and steadily things will be rebuilt.

Demi Lovato and the fragility of mental health and substance misuse.

I was saddened to read of Demi Lovato’s suspected drug overdose this week. Whether or not her relapse was related to her bipolar diagnosis is impossible to know. We do know that mental ill health and substance misuse are a bad combination. The statistics are frightening: in the UK, 75% of individuals in drug services and 85% in alcohol services have a co-existing mental health condition. More on this here.

 

A significant issue in considering mental ill health and substance misuse is the chicken and egg nature of the problem. Did the substance misuse start first or was the mental ill health the cause of the substance misuse? Long waits to access specialist mental health services mean that self medication with substances can provide an outlet from troublesome symptoms. The chaotic lives of some substance misusers make engagement and ongoing treatment problematic. If you’re homeless, how do you receive appointment letters? If you aren’t earning, how do you afford the bus fare to get to appointments? When the day is structured around relieving immediate discomfort, are you going to regulate your sleeping and eating patterns and remember your meds? The answer is a resounding no.

 

I don’t do illicit substances (if my boss is reading this I’m sure she’ll be relieved) but I do drink. When I’m having an episode I tend to drink more. I’m sure that the motivations of each individual to misuse substances are different but here are my personal reasons behind using alcohol to cope with bipolar:

 

When I’m hypomanic, I love a party. I’m outgoing, chatty and definitely up for doing shots of tequila (yuck) at 3am. Hypomania gives me a super human tolerance to alcohol. It’s easy to get caught up in the fun especially if you’re with the wrong crowd as Lovato was reported to be.  What’s fun and exciting at first ends up in a slow car crash when you inevitably fall off the hypomanic cliff.

 

When I’m depressed (and I’ve been depressed waaaay more than hypomanic), sleep tends to go out the window. I sleep 4-5 hours a night, waking at 2am and then wanting to drift off around 5:30am when I need to get up. I’m anxious and sad. Drinking helps me to relax,  sleep and socialise when I’d rather hide in my room with the lights off. I don’t binge drink when I’m low but get into the habit of having one drink several nights a week, more on weekends. I completely get how 1 or 2 can turn into 2, 3 or 4.

 

Alcohol doesn’t help, not really. It’s a depressant, it stops your medication from working (in some cases its downright dangerous to mix your meds with alcohol). If you’re using other substances to self medicate then you’re adding to the adverse effect.

 

Situations like Lovato’s illustrate the need for a watertight crisis plan. This needs to be done when you are well. Who is looking out for you? What will they do if you hit a crisis? What do you want to happen when you’re unwell? Mine has various sections- a note of my early triggers (not sleeping, not eating), giving authorisation for my husband to discuss my care with my doctors if I’m acutely unwell, what I would be happy to undertake treatment-wise (would I agree to hospital admission- yes, would I ever have ECT, no). The plan needs to be shared and agreed by everyone involved. Not only does the plan help those around you in a crisis, it gives you a sense of security. I know if the sh*t hits the fan I’ve got a strong team who will step in even if it might not be what I want at the time. That support is worth its’ weight in gold.

 

Get well soon Demi Lovato, we’re all human, we all relapse, it’s what we do in the aftermath that counts. She needs support, she needs a crisis plan and above all she needs no judgement.

 

If you are struggling with substance misuse, it’s important to see your health professional. You can also find more information here.

The chicken and the egg: Fatigue and mental ill health

I’m full of the cold (again!), hubby has a chest infection and the little person isn’t well either. I’m so, so tired. Yesterday I had a nap and guess what- I’m still tired. I’m taking some pretty sedating medication but come on, I feel like I’m 62 not 32. I’ve lost count of the number of times I’ve put my kid to bed and woken up beside her several hours later still fully dressed, make-up smeared on my face and contact lenses still in. I’ve had enough.

 

According to the Royal College of Psychiatrists, at any given time, 20% (1 in 5) of us feel unusually tired. Think of how many people you know, that’s a LOT of tiredness.

 

Tiredness (or fatigue) is a common symptom of depression however there are multiple other causes of tiredness including physical problems such as anaemia, coeliac disease and thyroid disorders. You can find more information about physical causes of tiredness here. Around two-thirds of people who see a GP for tiredness have an underlying physical or mental health disorder which may be contributing to their symptoms.

 

It’s impossible to break the cycle of constant tiredness without reflecting about how and when the tiredness started. When I try to pinpoint what came first, the depression or the tiredness it seems like a chicken and egg situation: my depression makes me tired and being constantly tired makes me feel depressed.  My tiredness (and that of many others) is likely due to several factors: work, stress, sedating medication, looking after small children and underlying depression.

 

Something that resonated with me was the concept of an activity roller-coaster. Going from intense, full on activity during the week to low activity at the weekend causes increased fatigue because you’ve put all your eggs in one basket then have nothing left at the end of the week leading to burnout. Whilst it’s only natural to want to push yourself and do more, trying to self-insure against the bad day that might come tomorrow by cramming in as much activity today creates unhealthy patterns. When the bad day inevitably comes, we blame our illness and start a cycle of negativity by thinking of all the things we aren’t doing today but should be (see, there’s that should word again).

 

So what is the answer? Are we doomed to live in a cycle of energy abundance followed by crashing lows of energy depletion? I sure hope not.  Careful planning of what activities to do on what day (seeing free time as time to be free, not time to do more housework), tweaking my medication regime (I’m slowly weaning off the sedating drugs**) and appreciating the need for rest even if I feel fine are my strategies to tackle the tiredness. That and the occasional bar of chocolate!

 

Got any tips for fighting tiredness? Please feel free to comment below.

 

** remember, adjusting your meds should only be done as part of an agreement between  you and the clinicians treating you.

Resolutions in reverse: 5 small things for a happier, healthier 2018.

Happy New Year! You’ve survived Christmas, eaten your body weight in chocolate (well done- that’s an achievement) and drank more alcohol in the last month than in the other 11 months of the year combined. What better way to kick ourselves when we’re down than by making a long list of resolutions to change our lives for the better.

Thanks, but no. Not me. I’m so sick of making resolutions which see me either deprive myself (chocolate, looking at you…), rob me of my already stretched time (gym three times a week, nah, I’ll slob in my PJs after work instead) or are frankly unrealistic (declutter my entire house by January 31st…only if I divorce).

Instead of promises that’ll be forgotten by February 1st, this year I’m going to do 5 small things to help me feel happier and healthier. Tip: don’t do them all at once, you’re destined to fail that way! Choose one small thing you feel will make the most difference and start there.

5 small things for a happier, healthier 2018:

  1. Just add (2 cups of) water. I love tea, I drink gallons of it. On a work day my body is at least 75% tea. What I don’t love is dehydration: headaches, tiredness, poor concentration and dry skin. I’m not giving up tea but I’m adding in a glass of water first thing in the morning and one herbal tea after my evening meal. Bonus points for putting the glass of water beside your bed the night before so you don’t have to get of bed to fetch it in the morning. Rehydrate first thing, avoid headache later.
  2. Sort your outfit the night before. Morning. My least favourite time of day. Why didn’t I iron that top last night? Where are my work shoes? H lo reduce the morning rush by laying your outfit out the night before. Clothes, shoes, underwear, EVERYTHING! Looking like you’ve got your s**t together by arriving at work smart and polished: priceless.
  3. Pack a snack. If like me you get a food mood when you haven’t eaten for a few hours, it’s worth always having a snack in your bag. Low blood sugar is linked to anxiety and increases the chance of you having a panic attack. It’s hard to grab a healthy snack from the corner shop so instead take on me with you. Rice cakes, fruit, nuts, you name it. Pack it and bring on the smug!
  4. Take 15 minutes to do something you enjoy EVERY SINGLE DAY! I know, you’re cold/tired/bored/sad/busy and can’t possibly fit anything else in. Making time to do something you enjoy resets you mentally and boosts your self esteem. Here’s the best bit, it doesn’t NEED to be healthy. Wanna spend 15 minutes drinking tea and eating biscuits? Do it! Fancy a 15 minute phone call to your bestie while drinking a small glass of wine? Go for it! How about 15 minutes to read a chapter of that really trashy novel whilst wearing your PJs? Nice! Do something for you every single day. Not only will you enjoy it at the time, you’ll also have something to look forward too when your day isn’t going so well. And of course if you DO decide to do something healthy for 15 minutes (power walk, meditate, eat an entire bowl of fruit) I won’t judge you.
  5. Say no. Small, powerful, a complete sentence. “No” might well be the most underused word in the English language. Unless you have toddlers of course. That small word can make a big difference to your life if you tend to take on too much and end up overstretched. I do, especially at work. “Can you just…?”  Or “While I’m here…” No. No, no, no and no again. I’m an adult and I’m responsible for my emotional and physical wellbeing. If I’m already stressed and doing one extra thing is going to make my day even worse then I’m gonna say no. And maybe if you start saying no to some stuff it frees up time to say yes to stuff you actually WANT to do!

I hope you’ve enjoyed my resolutions in reverse. Like I said earlier I don’t believe we should kick ourselves when we’re down so choosing the darkest, coldest and poorest month of the year to launch into a programme of reinvention is never going to work. Like the story, the tortoise wins every time.

Christmas a.k.a how to relapse in 24 hours

What are your plans for Boxing Day? Roll out of bed to eat leftover Quality Street whilst watching a boxed set? Hitting the sales for some bargains that maybe you don’t really need?

I’ve decided to blog today because I need to talk about how one day of excess can trigger a serious mental health relapse. Every year I think “It’s just one day, I’ve got this, I don’t need to stick to the rules.”

So instead of sticking to a routine, eating well, moderating my alcohol intake and doing some exercise, the day tends to unfold like this:

Get up at ungodly hour with excited child and slight headache after having too many gin and tonics the night before.

Skip breakfast, crack open a bottle of something bubbly around lunch time.  Extra points for drinking in ridiculously hot kitchen prepping lunch so dehydrate quicker.

Eat huge Christmas dinner, washed down with more fizz and some wine too. Screw sleep pattern by having  ridiculously long nap in the middle of the bloody day.

Get up in the early evening, not hungry but squeeze in some Quality Street/leftover roast potatoes/cheese and biscuits. Put a film on, crack open some gin, get tipsy and chattier than usual and reward self with another few drinks, go to bed at ridiculously small hours of the morning, sleep badly because you have heartburn and slept too long during the day.

Bonus points for: making a mental list of ways you’ve messed up previous Christmases/missing relatives who are no longer with is/looking at social media and berating self because everyone else seems to have their shit together.

So although I thoroughly enjoyed spending time with my family, eating gorgeous food and sampling some of the amazing gins I was gifted, today I need to be a little more responsible and manage myself better. That means eating regularly, not drinking today, going for a gentle walk and remembering that one day doesn’t have to start a downward trajectory.

Can someone remind me of this post on December 24th next year?!

Happy World Mental Health Day (and a rant about mental health in the workplace)

Happy World Mental Health Day 2017. I’m slightly grumpy as I wrote a nice long post then my internet broke, also I’m still receiving random parcels following a hypomanic episode last week which almost certainly means a very large credit card bill! Seriously, WTF did I even order?!

 

Anyway, moving swiftly on, the theme for World Mental Health Day 2017 is mental health in the workplace. A sensible choice given that $1 trillion is lost every year from the economy due to mental illness. I’ve been on the receiving end of some pretty poor treatment at work due to my mental health (ex-manager who told me I just “needed to pull myself out of it”, I’m looking at you).  I’ve also had some wonderful employers and colleagues who’ve done kind things like invite me in for coffee (just so I don’t feel excluded from the team, no work related chat allowed), sent me cards and helped me with a gradual return to work rather than going all in and risking relapse.

 

Working full time in a demanding job isn’t always great for my mental health and there’s certainly frustration on my part that I can’t put in as many hours as my colleagues (I try to take a lunch break each day- even just 10 minutes and try and leave work within 20 minutes of my official finish time). Yes there are times when I go home and straight to bed, or avoid opening my emails because anxiety girl decides there is bound to be a message from my boss telling me I messed something up/forgot to attend a meeting/am fired, despite no evidence of any of these things!

 

Like physical illness, mental illness reduces my resilience so I have to take it easy to avoid the merry go round of getting better vs. burning out again. For me, work by far outweighs staying at home, I need the human interaction, I need to challenge my brain, I need the structure of being somewhere for 9 hours a day otherwise I’d get lost in a sea of spending my days in pyjamas and probably drinking endless cups of tea (who am I kidding, I DO drink endless cups of tea).

 

One thing is for sure, opening up to my colleagues about my mental health problems has largely been a positive experience. Sometimes people will tell me their own experiences, or offer me words of support. What helps most for me is when people ask me how they should respond to my mental health issues rather than avoiding the subject during conversation. It lets me joke about it (not always politically correct but I don’t mind calling myself crazy, the problem is when words are used with a negative implication), or when someone asks if I’m tired, allowing me to own up and say “Yeah, shit nights sleep as my anxiety is bad” makes a huge different because putting up a front is tough work.

 

So here’s to happy, fulfilled, healthy work! Keep talking and take care of each other.

 

 

5-things to do when you’re struggling with your mental health

Having hit rock bottom (with a splat) several times in my life, I’ve built up an awareness of what does and doesn’t help my symptoms.  Now, before I share this list, I’m want to say: this stuff isn’t rocket science but in the middle of a mental health crisis getting out of bed is hard, let alone anything else. It’s also easy to dismiss small changes and activities that stuff that psychs/nurses/relatives tell us will help.

During one particularly bad call to my crisis team I remember being told to slow down and start breathing deeply. I wanted to scream down the phone:”Breathe?! WTF do you mean breathe?! Of course I’m bl**dy well breathing, I’d be dead if I wasn’t. I’m calling you because I feel like I want to die and the best advice you can give me is breathe?!”

As it was, I did the breathing exercise like I was told and after a couple of attempts felt much better. I still remember the name of the nurse who took my call, her nagging me to breathe made a world of difference. I’m not going to say if you get your breathing right your mental health problems will vanish, we all know it’s not like that.

So without further rambling, I give to you my list of 5 things to do when you’re struggling with your mental health:

1. Write it down: I’ve journaled for about 15 years now, my journal provides a safe space for me to vent but it also helps me track my mood and look for patterns in my behaviour. It also means I get to splurge on stationary (particularly stuff that’s shiny….I love shiny!). If you’re struggling to open up to loved ones or professionals about your feelings, show them your journal instead.

 

2. Exercise (at the right time and with the right type of activity): I do not enjoy sweating. I don’t like lycra. You won’t find me in the gym. BUT I love how I feel when those happy chemicals are floating around after an hour of dancing. There’s plenty of research about the benefits of exercise to help regulate our sleep patterns, reduce our stress and increase our energy levels. The key is finding what works for you, I don’t run anywhere but I love yoga and cycling. On the days that feels like too much, a 20 minute walk is enough to give me a boost. A word of caution- time your exercise well, during a particularly highly strung phase, my evening exercise class gave me such a buzz I was awake until well after 1am. The Royal College of Psychiatrists have a nice leaflet about exercise and its’ impact on mental health here.

 

3. Avoid excess alcohol: Yep you feel more relaxed after that first drink. Maybe you’re drinking a few drinks to get you off to sleep each night. But remember: alcohol is a depressant. It wipes out that happy chemical serotonin (which is also the chemical many antidepressants work on). So not only are you making yourself more depressed, you’re also making it more likely that your antidepressants won’t have the full effect. Drinking to excess also puts you at risk of making poor judgements calls by decreasing your inhibitions.

 

4. Use technology to help, not hinder your recovery.  I love the internet. I love being able to research, read the news and access support groups at the same time as stalking people I know on social media. I also like to go on pinterest and make boards about tattoos I will never have the guts to get and recipes I will never actually make. Social media can bring out the worst in us: never ending comparisons about people we haven’t seen since school (Wow, she looks so happy, her family are gorgeous, I’m so jealous of that car etc) or reading too much into situations (two of my friends went for coffee?! Why wasn’t I invited?! I’ve obviously upset them and they don’t want to be friends with me.)  Lets not forget the sleep destroying effects of blue light emitted from phones and tablets. At its’ worst tech leaves us overstimulated and anxious. Can’t take a break? Force yourself to let a loved one change your passwords for a week- the temptation is gone. Or make a firm decision to put the tech down an hour before bed so that blue light doesn’t impact on your sleep.

 

5. Do something to occupy your mind. Distraction is a useful tool and yet one that we struggle to use. When I’m low, an hour can feel like a week and I don’t always see the value of doing something to take my mind off things, I’d rather sit in my pyjamas and stare into space. Do something to take your mind off things: read a book, do some colouring in (I’ve got a swear word colouring book that I love, intricately colouring the worse Asshole with pencils always amuses me), walk, knit, paint your nails, do some puzzles, download a free mindfulness app and try one of the exercises. Even if you set a timer and do it for 10 minutes, just DO it. You’ll feel proud that you have and often when the timer goes off you’ll carry on with your activity. I love to read but when I’m a bit manic I can’t focus on the words so instead I like to bake cakes. When I’m down I watch Youtube videos of baby animals, also a good way of keeping little people amused if you have them.

 

What small things do you do to help look after yourself when you’re struggling with your mental health? What baby animals would you watch on YouTube (panda’s are my fave). Let me know by commenting or e-mail. Pictures of sparkly stationary are always welcome too!