Depot or hospital?

[SnowyMouse]

I'm not taking all my meds because voices are telling me not to. I've been told that the 2 options are either hospital or a depot injection. I don't want hospital because it's a horrible place to be, don't want to leave my flat. I don't want the depot because it might not work and if you get side effects you can't take the medication back out. I don't know what to do!

I would just take the tablets. Voices are not real.

Hello, I'm sorry you're having a difficult time right now. None of us can tell you the best option as you need to make the decision. It can be scary to try and think things through.

When you were well, you were taking medication. This suggests your voices are wrong, because stopping your meds has made you unwell.

You have 2 options.

1. Go to hospital - you don't like this as it means leaving home, and it's scary. Honestly they will medicate you in some way if you're unwell enough for admission, before you can return home.

Have you been inpatient before? Sometimes it can be helpful to be safe and to get back on an even keel, so you can manage better at home.

1. Accept the depo. This means you can stay at home. Your RC is the expert and will prescribe something they believe will help, and not something they think will give you negative side effects. If you were to get side effects, you would report these to someone involved with your care and something would be done to help you. Have you spoke to anyone about your worries and the chances of side effects?

Please do engage with your team. Non engagement means you're going to end up on a faster road to hospital, and this would likely be under the Act.

I know the thought of a depot can be scary. Do you have a good relationship with your care coordinator where you can look at the pros and cons of each and coke to a decision you feel the most comfortable with? I've seen depots have really great impact, but sometimes it takes a while to get it right, so you have to be prepare to stick with it. I take it oral meds haven't worked out for you? Wishing you well OP, I know it's hard

Thanks both. Hospital would be to retitrate my clozapine - but they might change the plan once I'm admitted (I've had bad experiences before). I have been in hospital a few times, I know it can help but at the time it's very difficult to do. Thanks for the comments about the depot, a dr is coming out with my cpn later in the week to discuss, but my cpn has said those are the options.

I really don't want either option, I wonder how much time they will give me to decide.

How are you doing today?

I'm really struggling @cakeandchampagne
The voices are bad and I really don't want either 'option'.

I'm sorry you're going through a hard time OP. Might I suggest you have a think about the depot medication? There are less side effects, and any that you experience can be managed with medication. If you go into hospital to be retitrated onto Clozapine, it will be regular obs and bloods until you are at your therapeutic dose. I know you don't want to go back on your meds or go into hospital, but thats because your voices are telling you not to, which means that you do need medication and support. Can you at least talk to your cpn or gp about the depot?

Were the meds helping?
Maybe there is a third option— is there someone who could help you take your meds every day and get things back on track?

Thanks @Justcashnosweets That's useful. I see my CPN and doctor tomorrow, so I'm trying to think it through, it's just really hard with the voices.

@cakeandchampagne Yes the meds help. the HTT/crisis team did visit me twice a day for two weeks with some strong encouragement, but it was unsuccessful.

@SnowyMouse do you have any as required medication like Haloperidol that you could take just now to help quieten the voices a bit? I know you don't want to take anything but it will help. Let us know how you get on tomorrow, I hope you get the support you need. 💐

@Justcashnosweets Thanks, I have lorazepam as prn. That's a good idea. Thanks, I'll try to update if I can - I'm worried that if I say no to both options, they'll MHA me.

Hi @SnowyMouse MH nurse here 🙂
Are your worries about the depot just to do with side effects? If so, it’s pretty normal to try a smaller “loading dose” for exactly that reason, to make sure that any side effect aren’t too bad. If you’re on clozapine you’ve probably tried other medications before, like olanzapine or risperidone. Those are available as depot too so they’ll likely try one of those so you know you can tolerate it.
I really hope this helps.

I assume the clozapine is an alternative to the depot? How do you feel about clozapine? I know it can have side effects which is why you're closely monitored by blood tests and as you say if there are side effects they'll be out of your system quicker.

Some of the newer depots have less side effects. Because they're water rather than oil based they're easier and less painful to administer and can be injected into the arm which is a lot more dignified.

Good luck x

Just realised clozapine is what you're already on.

@JennieTheZebra Thanks, that's really useful to know and does help. I've previously tried aripiprazole, quetiapine, olanzapine, risperidone - some didn't work and some I couldn't cope with the side effects.

Thanks @Spidey66 . Clozapine does work for me, I just need to take it. That's interesting re: the new depots.

Interestingly, the meds you’ve tried before and struggled with are all “newer” drugs but you tolerate clozapine which is one of the older ones. Two of the most common depot meds, flupentixol and zuclopenthixol, are “older” and so more like clozapine, meaning you might tolerate those better.
These are just my musings and not clinical advice but it might be worth bringing them up with your doctor/CPN.

@JennieTheZebra Thanks, that is interesting...