Suicidal but sane?

[Owlzes]

I know you guys aren't doctors, but I know there are some smart people here and people who have worked with psychiatric services and I’m trying to work out if something is normal.
So, I’m diagnosed bipolar, and on medication (lamotrigine and aripiprazole) and have a history of hospitalization, but have been stable for the last 3-4 years. Used to be diagnosed as type one, now type two (because I’ve not had a manic episode in a number of years). I’m on medication and apparently stable. I’ve been going through some stuff lately (parents in law hitting end of life stage, work stress, wedding planning stress, money stress) and it’s felt like it’s getting to me so my fiancé kicked me into talking to my CPN today.

I went in and explained that I’d not been sleeping properly lately, that since Thursday I’d been tearful most days, and that on Thursday and Sunday I’d been actively suicidal and making plans to die, including one day on which I acquired the method I was thinking of using (it was an inept plan, in retrospect, but that isn’t the point). I said I felt exhausted and drained and I just wanted to be dead so I could rest, and I felt so very alone. I also said I’d self-harmed for the first time in four years. I also showed her my mood tracker in my diary and how many days I was on a 1 or 2 (I track my moods from 1-10, with 1 being suicidal and 10 being ecstatic).

She said “well, that’s normal. You’ve got a lot on. You should try more exercise” and “what’s the point of that mood tracker? How can you track your own moods? You won’t be objective” and pretty much sent me on my way, with this vague sense that I was being whingy and a bit melodramatic. She didn't make another appointment to see me either, so apparently I'm not seeing her again unless I chase, although I'm still seeing my pdoc every four months. I don’t know if maybe I was just coming across as stable (I was freshly showered, with make up and nice work clothes) or it was the very neatly set up bullet journal with stickers and notes, and maybe that does mean I’m OK – her normal line is that if I think I might be unwell, I’m not. But it feels a bit too me as if I’m caught in a catch 22, as either way (either I’m too mad to know I need help, or if I know I need help, I’m not mad enough to get it) I get no support.

She’s done this before – in August I had a bit of a wobble where I decided that I was getting messages from Disney songs and just needed to run until I turned into sky – where she said if I could recognize those were odd thoughts then I wasn’t actually unwell – and I’m beginning to wonder if she thinks there is anything wrong with me. Which is OK, if there is nothing wrong with me, but surely none of this is totally normal? Or is it? Am I just being melodramatic?

And if it’s not normal, who am I meant to talk to? What am I meant to do? Is there any kind of alternative support structure away from a CPN that isn’t ‘whinging to my friends’? Or should I just get on with it (not the suicide, the gluing myself back together)?

Any advice very gratefully received.

This is not normal. I have no idea who you can talk to though :( I normally talk to my GP, who then sends a referral to the psychiatrist that reviews my medication. I'm on a very long waiting list for support.

I have same diagnosis as you, and same medication too (though I'm on a few additional ones).

Could you speak to the Samaritans?

I would be extremely concerned if I were your cpn based on what you've written. Can you access the emergency duty team instead? Crisis and home resolution they're sometimes called? Failing that, if you feel you can't keep yourself safe then present to a&e. Sorry you had such a dismissive response to your pain :(

How are you feeling now? Yes it's good to normalise having understandable reactions to crappy circumstances, but with your history and your presenting picture, no i'd say it's not normal.

Absolutely not normal.

It may be that she's not used to dealing with people who have significant insight into their own condition?

I also have bipolar and am able to explain my thoughts and can, if not immediately, relatively quickly spot my own hypomania.

I would absolutely change psychiatrists. I would actually raise a complaint once I was well enough - telling someone having strong suicidal ideations that nothing is wrong is frankly dangerous.

Do you have private healthcare through work or could you afford a private psych? It's the best thing I've ever done so would highly recommend it if you can (but realise many can't unfortunately)...

Thats pretty shocking. The CPNs I've known have been very keen on self monitoring mood diaries etc. Your DP also has recognised you are not well to prompt you to see her. I would complain to PALs or het him to if you don't feel up to it. Do it by email so you have a copy of what you sent. I would also ask your DP to speak to her about his concerns, so she can't say its just you being subjective. To be honest I'd be asking for a new CPN.

I called today and asked if I could make an appointment with my pdoc and was told his secretary was away until next week and when she gets back I can make an appointment for the next couple of months maybe.

So I gave up and am now asking for an appointment with my GP. I have talked to a friend at work (ironically, I work for a MH charity, and my boss is an ex-psych nurse) and he said she was being useless and I should ask to change CPN but I'm trying to pluck up the courage to get that in motion. I just keep thinking that if I ask to change CPN I'll be told she was right and I'm wrong and there's nothing really wrong with me and I'll be stuck with her with her being even more exasperated with me.

I went into work and my boss was lovely and told me to think about whether I needed some time off or to go down to part time hours while I'm unwell. I also slept for a few hours this evening and while I got up feeling slightly giddy, I'm OK. I'm not suicidal right now - just absolutely drained. I know that depression tends to manifest in a very physical way for me - like a weight on my chest or something. And everything feels really really hard.

My fiance was lovely and says that he will come with me into the CMHT if I want to make a complaint as he feels quite strongly she's being useless and he's really annoyed about the mood diary comment as he feels it's been staggeringly useful for both of us to be able to follow how my brain is working. I think I'll try talking to the GP on Weds - if I get much worse before then there is A&E. It is just so fucking hard to manage the energy to do all this.

Glad you're feeling a bit better. I really would look into the crisis team for your cmht - have you not been given any details? All the gp is likely to do is referred you back to your cmht... it's good to hear you have a supportive network around you though and maybe reducing hours is a good compromise for work? Having good insight into your thoughts etc doesn't render them invalid. You are your own expert.

I've got a number for the crisis team but they will forward me to my CPN. I called them once before in 2016 when I had my hypomanic and my fiance was worried, and got scolded by her.

I am seeing my GP tomorrow and will ask if he has any advice.

I am really sorry that you are going through this. I have a lot of experience both as MH services user and as a (MH) professional for a period.
Apart from the actual diagnosis I am very similar to you - high functioning even when very unwell and often suicidal.
It is frustrating when members of the team don't seem to take you seriously but... what are you hoping for?
A couple of years ago my SI was taken seriously and I was admitted for a week to an acute psychiatric ward and then endured a month of day hospital. Afterwards I saw the crisis team regularly and realised that:

1. Most of the team knew a lot less than me.
2. Because the team changed so often there was little continuity
3. The NHS could not provide what I wanted - which was long term, high quality psychotherapy and 4) The best person to manage my condition was.....me. Now I have a plan in place for those periods when I am actively suicidal which involves telling my DP how I feel, being nice to myself, spending time with friends even when I don't want to, staying physically active, chanting positive mantras and if that doesn't help I see a private counsellor for a few sessions. Costs about the same as a weekend away. I am lucky because I have met a really good therapist and I can afford it.

I should also say that they are so short of beds that if they can manage you in the community they will - and my experience is that its important for me to avoid being admitted as it just makes me worse!
You probably know all of this already, but I know when I am in that state I start to lose perspective and just want someone to do something when what is best for me is for me to start looking after myself. Anyway that's me.
- not meant to be trivialising just thought they might be nice 😀

I don’t want to be admitted. I don’t think. I think I want to know someone will notice if I get to the point where I need to be admitted – I am pretty certain that being admitted saved my life at least once before – and I think I want to know someone can take on the job of keeping an eye on me sometimes who isn’t my partner.

I had an awesome CPN in the last city I lived in, who was brilliant for both saying sometimes “you’re being overly vigilant – I think you’re stressed, you’re not having an episode” or “I think you can manage this” and also saying occasionally “I don’t think these thought patterns are normal for you. I would like you to see me more regularly/I’d like your medication adjusted/I want you to have a chat with your pdoc/you need to take a bit of time off work” and I think this kind of early intervention meant I avoided hospital twice. In the past, I’ve been hugely helped by short courses of zoplicone (to get me to sleep) and benzos (to stop panic attacks) which meant I could stay in work.

My GP won’t just prescribe me those meds because I say so. They say I need my CPN. I can’t see my pdoc unless I wait for months, and my GP won’t adjust the meds up or down – I generally try and get by on a slightly lower dose of mood stabilizer/antipsychotic than I maybe should have and it goes up if I seem to be getting rocky – which is something I need a responsive CPN for.

And I want to feel like there’s a safety net. What scared me was this sense that if I do hit the point where I’m a danger to myself, no one will care or listen. And one day I’ll die. I don’t want to die right now. But it’s a real struggle to keep myself feeling that way.

I just miss feeling like I had help. I don’t feel like I do right now.

Its horrible feeling as if no one notices or will care for you. I recognise that.

Your previous CPN sounds really good and you have internalised some of what they said. When I stopped seeing my therapist (who was great) she said that I now have the experience of being 'seen' and cared for inside me. I can sometimes imagine being with her when I am becoming ill. I also try and hear her voice and repeat some of what she said to myself which helps too.

I'm glad that you don't want to die now. That's important, so try and hang onto it.
Help is there if things get worse. As I said they will admit you if they believe you to be in immediate danger - even if it means holding you in A & E which is what has happened to me. And it sounds as if you've had similar experiences.

My previous CPN was amazing. Realistically, I think I got a lot of extra attention then because I was fresh out of hospital when I came to her and at first the CMHT wouldn’t take me as I was considered high risk (I had delusions, intrusive thoughts and suicidal compulsions). So they put a lot of work into me.

Whereas my new CPN met me when I moved cities, had been stable for a year, and hasn’t really seen me when I’ve been very unwell. Which I sort of logically know. But it’s still a bit sucky.

I don’t know. Maybe I do need to just get on with it, in which case I wonder if I’m better off just ditching the CPN and pdoc entirely. Except my GP is twitchy about prescribing my antipsychotics without them and I think I’ll get ill again if I have no meds.

Argh! Sorry! I know you’re being helpful. I’m just feeling awful and am fighting the urge to collapse in a nihilistic heap.

You sound as if you know what you need and maybe you need a more responsive GP too? Can anyone recommend a more understanding GP if you've already explained everything to your current one?

I'm not saying to 'just get on with it' by the way! Just offering some suggestions 😀

I think you sound very insightful and like a cpn's dream low maintenance case! She doesn't sound like a very empathetic professional; sadly there are quite a few in mental health services... you also sound like a good candidate for being an expert by experience. Would your psychiatrist vouch for you being managed by your gp? I'm not sure what a pdoc is but assuming psychiatrist? It means prolonged disorder of consciousness in some contexts!

Have you devised a crisis plan or keeping safe plan with your cpn? Detailing warning signs and what needs to happen? Maybe suggest that if not? What did your gp advise today?

Oops, you're seeing him tomorrow. Sorry.

I don't think I have a crisis plan except 'go to A&E'.

You have experienced an excellent CPN in the past so you know that your current one is mediocre at best. Can't believe you being scolded for calling crisis team. The tough thing is when we are not well we are not in the best place to make complaints either. I do think you would be justified in asking to change CPN. I think if you are able to state what you expect from a CPN (your previous experience) in your complaint that would be helpful too.

Does your DP know what to look out for and how to acess help for you if you arnt able to? Is he down as your nearest relative? Does he know what you want him to do if he has to intervene? I say this as a carer for DH having recently had a very bad experience of crisis care.

Something that might not be for now,but when you feel well enough is looking at an advance treatment plan. That is where when you are well you set out a plan with your CPN about how you may present when you are unwell, what things have worked for you in these situations in the past and what treatment plan you want for the future. I wonder if this would help guide your team and GP in the future.

DH also has various doses of antipsychotics at home from previous med changes so in a crisis has sometimes been able to up the dose himself whilst waiting to see the CPN/psychiatrist and discuss dose changes.

nolongeranxiouscarer

I also have a small stock of medication at different doses which I can take when in or nearing crisis. Fortunately I know what I am doing and what helps. It sounds as if you and your DH are similar.

Owlzes hope that you are OK.

Took today off work for the first time in ages - like - over two years. Just woke up and felt this grim clenching feeling in my chest and couldn't breathe and went giddy. DP also took today off work (he works for himself, so can) and is staying home with me.

I am due to see the GP this afternoon, but he also poked me to call the CMHT and ask if I could speak to a supervisor to talk about changing CPNs. It might be I won't get anyone better, and we just need to self manage more, but he reckons it's worth a shot, as we know there are good people out there.

I'm just so fucking tired. Everything feels very cold and bleak and I found myself thinking this morning that maybe I'm already dead and it's just that my body hasn't caught up. I sort of rationally know these thoughts aren't real, but it's very hard to keep on top of that.

Sorry to hear you're feeling so rough but it sounds like a good move to take the day off. I'm currently off work and found that when I stopped I actually felt worse but slowly will hopefully have time to heal. What helps you when you feel like this? It's so personal that it's difficult to ask advice I find. Does distraction help? Or just switching off and watching crap TV? I too feel so tired and drained but I think this is our body's way of communicating when we're not okay and need to stop.

I hope the gp is supportive and listens. Would ringing something like saneline be helpful if you're struggling to stay rational?

Oh god, I am now trying to rationally work out what makes me feel better. My irrational brain says 'nothing' but I don't think that's true.

Um. My DP was amazing and tidied the sitting room and kitchen last night so my house feels nice and calm and quiet and that really helps. I like nice space. I have set a fire this morning so I have fire and I am cuddling the cats. I think quiet helps. I think I might try for some costume dramas - Sense and Sensibility is an old comfort. Distraction maybe when I'm slightly less awful - right now my brain keeps turning anything I try to do into something else I can fail at which is ridiculous.

I have lists as well which I'm trying to make - get up, get dressed, shower, put on makeup. That's work, but I do feel better when it's done and I look as if I'm on top of things.

I use lists too when unwell and costume dramas sound like a good plan! I watch Frasier and feel like the characters are family!
Try to remember and use the strategies that you worked on with your first CPN.
Do you know what you want to say to the GP?

Sense and Sensibility was very soothing. I think Alan Rickman's voice may actually have medicinal qualities.

I had a bit of a dip after lunch - I called the CMHT this morning and was told they'd call me back. But no one did. I called back and was told the team leader was out at a meeting and wouldn't be calling me back now, but I could talk to the duty nurse. I spoke to him and tried to explain how muddy and useless my brain was. He said I sounded fine and suggested that I distract myself and get away from the things that were worrying me. I'm not sure I can get away from two members of my family with terminal illness.

But I've got my bullet journal and some new stickers which make me feel like I'm getting something in order. I gotta say, I really miss hypomania/mania. That was loads more fun than depression. Do you think I can put in some kind of request to the Powers That Be for a change in mood swing?