What to expect when your brain wants to kill you: MEDICATION

Prescription medicine is a subject of much debate among mental health patients. Some view it as an unnecessary addiction with zombie-like side effects, while others consider it a lifeline to calm and their only chance of recovery. I have been told that no one, including Psychiatrists, knows precisely how this class of drugs works. It’s not as simple as replacing a chemical deficiency in the brain, as we are sometimes led to believe. Moreover, each drug has its benefits and possible side effects.

Many people have managed their depression through lifestyle changes and natural remedies. If this works for you, keep doing it. I’m not trying to persuade anyone to take psychiatric pharmaceuticals.  Likewise, if you need medication, don’t consider it an admission of failure; that you are somehow less of a person because you need it. Medication has nothing to do with strength; it is more about symptoms and relief. Find what works for you.

I am purposely not going to refer to any drugs by their name. What has worked for me may have an entirely different outcome for someone else. You have to be open to change.

I have not taken many prescription medications in my life. In fact, prior to the last seven years, I had only ever been prescribed antibiotics. So when my Family Doctor first suggested medication to manage my depression, I was a little taken aback. Was I really that sick? I hesitated for a few weeks but quickly found my symptoms were becoming unmanageable. In the end, I trusted her judgment. (see Chapter on Family Doctor)

 

The first drug we tried didn’t go well. To make matters worse, I didn’t tell my family doctor about the side effects I was experiencing; I had terrible stomach cramps but did my best to persevere. I didn’t realize that had I reported my side effects right away, she would have changed the medication immediately. I thought I was being heroic when, in fact, I was just being stupid. 

Most Family Doctors and Psychiatrists have their favourite drug combinations, but there is no reason to endure a severe side effect and suffer in silence. For medication to be effective, you must be open and honest with the doctor prescribing it. Tell him or her everything you’re experiencing, even if it is nothing. Side effects are not consistent across all patients. You have to tell your doctor how the medication is affecting you. Don’t settle just because they do. Let them know.

  

Over the last few years, I have tried many different medications and experienced many different side effects, everything from dry mouth to a brain fog, from an insatiable appetite to stuttering. It took a while and a lot of faith in my doctor’s intentions to continue following a path of trial and error. Every new drug had to be started with the smallest dose and titrated. I would spend weeks slowly building up the amount of medication in my bloodstream only to decide the side effects outweighed the impact of the medication in question. I would not take it strictly for the sake of taking medication. It had to provide some relief with minimal side effects.

Most doctors informed me upfront of potential side effects. The worst was when Pdoc told me a known side effect was death. That makes you take a pause! He told me that when I was on the drug, I would have to have monthly blood tests to ensure that my white blood cell count remained robust. This is the most helpful medication I am on. I have prominent veins, so it makes for an easy routine of “bloodletting.” Even better, the specimen collection lab is just down the hall from the patient pharmacy. This side effect is easy to mitigate.

Another extreme side effect is suicide ideation. Ironically, some of the side effects of mental health medications are indistinguishable from the disease. Don’t let this apparent oxymoron deter you from trying. Keep in mind that a potential side effect of Tylenol is a headache, and Viagra may cause blurred vision or make it challenging to tell blue and green colours apart. Just because a drug has specific side effects does not mean that everyone who takes it will experience any or all of them. If your symptoms don’t improve or the side effects worsen, tell your doctor and move on to another drug or take a different approach altogether. (see Chapter on Therapists; Chapter on Strategies)

The following are the top 5 worst side effects I have experienced on my mental health medication journey.

5. Vivid dreams and brain sparks.  Whenever I lay down, I would instantly be caught up in an all-consuming, vibrant-coloured, hyper-realistic dream. And when I wasn’t asleep, there were random lightning flashes behind my eyes or, as I called them, brain sparks. While I found these side effects fascinating, I was worried they were a symptom of some hyper brain activity that, over time, might cause permanent damage.

4. Deep sleep.  This one was more of a nuisance than anything. I would sleep so deeply that I would frequently wet the bed. I also drooled on my pillows, experienced night sweats and snored. A real treat for my wife. I ended up sleeping in my own bedroom in the basement, separate from the rest of the family. It was embarrassing and depressing. My self-esteem plummeted. For a time, I wore adult diapers to bed and washed my bedding every morning. My drool would soak through my pillows and leave a musky odour. Eeew!

3. Loss of sexual desire.  This was not a performance issue that could be addressed by Viagra or Cialis. Believe me, I tried. Instead, it was one of desire or worse. Intimacy never even crossed my mind. Interest in physical contact vanished. I was chemically castrated. Provocative images, words or sounds no longer inspired me. It was as if desire had never existed. What made it even worse was that I didn’t even realize what I had forgotten until I purposely stepped back and thought about it. I feel cheated.

2. Overeating and rapid weight gain.  For my entire life, weight has never been a problem. I was very lucky. If I gained weight over Christmas from all the treats, chocolates and nuts, I could easily lose it all by mid-January by simply eating sensibly. I had never had to diet. But when I went on one particular med, I gained 25 pounds seemingly overnight. I suddenly had a middle-aged “beer belly” distending over my waistband. I hated what I saw in the mirror and felt embarrassed to swim. This side effect was devastating. It took me a long time to claw back half of what I gained. My body image still suffers. The Pdoc did warn me about weight gain, but considering my past experiences, I didn’t anticipate it would be a problem. I was wrong. The fact I am no longer on this medication (because it didn’t help) makes this side effect all the more disastrous. I still have to live with it.

1. Lethargy.  The worst side effect I experienced was when I was left sluggish and apathetic. Everything was heavy. Lead coursed through my veins. When I tried to speak, I could not find the words. My brain was filled with cotton batting. My short and long-term memory struggled. This side effect was worse than the disease. Sure, it stopped my emotional swings, anxiety, and suicide ideation, but all it left was a shell. It was not a side effect. It was replacing one disease with another. What was the point? I didn’t stay on this med for long.

I still live with some side effects in varying degrees, but none of them are debilitating. Am I cured? No. I’m still in therapy, and I still take my meds, but at least now, a somewhat normal life seems possible. The medication helps to calm my baseline emotions. 

There is another type of medication that is designed to help with acute anxiety. These drugs are called PRNs (Pro re nata - Latin for “the thing as needed.” My degree is finally worthwhile (see Chapter on Latin.) In other words, it provides immediate relief. I have never needed such medication, so I can’t offer much insight. I have always been more of a slow burn than a flash pan. I can manage my anxiety with CBT (See Chapter on CBT) and other strategies. (see Chapter on Strategies)

One of my rules of suicide (see Chapter on The Rules of Suicide) is that I can’t go off my medication. If I’m going to make an attempt, the decision must not be based on some sort of withdrawal. The one time I went off my meds was completely unintentional. I went away for the weekend and forgot to bring along my psychotropics. The first day and first night were fine. I barely recognized a difference. But on the second day, I felt off. My brain was light-headed. I had a mild headache. I lost my appetite. Nothing terrible, just off.

On the second night, when I usually take my strongest medication, the terrors broke free. Dark and shapeless shadows, long and stretched, chased me down a never-ending corridor. No matter how fast I ran, I couldn’t get away. Then they grabbed my feet and dragged me down the bed. I tried to scream out, but I couldn’t make a sound. I tried a second time. I screamed louder and broke through the dream. I found myself screaming in real life. My wife woke me up several times because I was so loud. 

It took a day or two after restarting my meds for things to feel back to normal. At least now I know what will happen if I suddenly stop all my medication. I suspect the third day and night would have been worse; the shadows would begin to pursue me in the daylight, and the demons would devour me beneath the moon.  

Whether you decide to use medication or not, remember it is not a panacea. I had one Psychiatrist tell me drugs are only 30% of the solution and that exercise alone has a similar level of impact on improving mental health (see Chapter on Exercise). Ongoing therapy (see Chapter on Therapy), that is, talking to someone who is willing to listen, is also crucial to recovery, as well as mindfulness, Cognitive Behavioural Therapy (see Chapter on CBT) and other strategies (see Chapter on Strategies).

Recovery will require more from you than simply taking a pill with water. Success is non-linear. There will be many setbacks. The key is to pick yourself up and keep trying. When I finally found the right combination of medications, the Critic settled enough that I could hear myself think. (see Chapter on The Critic) It gave me the strength to look beyond the current crisis and to even consider a happy life. It’s not enough, though. I know I need more help. The SI is still the default in my brain. Suicide is still my destiny. 

I just want someone to teach me how to lead a happy life.  

I’m sorry, but it does not come naturally to me.

What does is the constant bombardment 

of what I’ve done wrong, 

am doing wrong 

and will soon fail at.

You’ve given me the drugs to consider success 

but not the tools to succeed.  

And so I go where my thoughts always have, 

to the pull that promises relief.

Withdrawl

I went away for the weekend and forgot to bring along my psychotropic medications. The first day and first night were fine.  I barely recognized a difference.  But on the second day I felt off.  My brain was light-headed. I had a mild headache.  I lost my appetite.  Nothing terrible, just off.

It was on the second night, the time when I normally take my strongest medication - the one for which I undergo monthly blood tests - that the terrors broke free.  Dark and shapeless shadows, long and stretched were chasing me down a long corridor that had no end. No matter how fast I ran I couldn't get away.  I tried to scream out but I couldn't make a sound.  I tried a second time. I screamed louder and broke through the dream. I found myself screaming in real life.  On a number of occasions over the night my wife woke me up because I was so loud. 

It took a day or two after restarting my meds for things to feel back to normal. The night terrors ended immediately. At least now I know what will happen if I stop my medication all at once again.  I suspect the third day and night would have be worse, the shadows would begin to pursue me under the daylight and the demons would devour me beneath the moon.  

.

I have changed my diagnosis

I have changed my diagnosis. I used to always say I suffered from depression, anxiety and suicide ideation. It was a disease I was fighting like cancer. It was win or lose. I lived in the hope that one day my medication and therapy would beat the disease, or at least send it into indefinite remission.

At our first appointment I remember telling my psychiatrist that suicide felt like the calm of a
shady river bank while life itself was the chaotic turmoil of the rapids below. Anxiety and fear felt like drowning. The doctor assured me that after treatment I would feel the exact opposite. Poor mental health would be the turmoil in the middle of the river while life itself was the calm on the bank. It was a promise I wanted to believe, after all hope is hard to resist.

But after four years, countless medication changes, dose adjustments, five different therapists, two different CBT workshops, three stints in hospital one of which lasted 6 weeks, it hasn't happened. I still get anxious. Suicide still seduces me with its promise of calm, its shady river bank safe from the turbulent river. I admit the rapids are not as chaotic as they once were, the overwhelming sense of drowning has settled but am I cured? No. Will I ever live without anxiety or suicide ideation. No. Without depression? No.

I have resigned myself to the fact, I will always have symptoms in varying degrees. Life still lives in the rapids and whirlpools. My thinking has not flipped. My psychiatrist lied. But at least now with therapy and medication, I have a life jacket and at times even a raft which I can pull myself up onto to escape the turmoil of living.

There is no cure. But there is a way to manage the distress and each day I get better at it. I have let go of the idea of being "all better". I no longer assess my progress based on how far I am away from a "normal" life. I no longer see myself as suffering from depression but rather living with it. I have decided my condition is more like diabetes than cancer. I have tools and strategies to manage the "glucose levels" in my brain. Do I sometimes make mistakes and let my thoughts get out of control? Yes. And the suicide ideation can be strong. But now I recognize the calm of the river bank is permanent. It's where life ends. And so I do my best to swim, to hold onto my safeties, my therapy, my meds and my resilience. The difference now from when I first sought help is that I now know I can do it. I know I can live.

The five most challenging side effects of my depression medication

 

I live with depression and chronic suicide ideation. Over the years I have tried many different medications and I have experienced many different side effects, everything from dry mouth to a brain fog. It took a while and a lot of faith in my doctor's intentions to continue following a path of trial and error. All along I insisted that the positive effects of any medication had to greatly outweigh any negative reactions. I was not going to take medication strictly for the sake of taking medication. It had to work.

The following are the 5 worst side effects I experienced on my mental health medication journey.

5. Vivid dreams and brain sparks. Any time I laid down I would instantly be caught up in an all consuming, vibrant coloured, hyper-realistic dream. And when I wasn't asleep there were random lighting flashes behind my eyes or, as I called them, brain sparks. While I found these side effects fascinating I was worried they were a symptom of some hyper brain activity that over time might cause permanent damage.

4. Deep sleep. This one was more of a nuisance than anything. I would sleep so deeply that I would frequently wet the bed. I also drooled on my pillows, experienced night sweats and snored. A real treat for my wife. I ended up sleeping in my own bedroom in the basement separate from the rest of the family. It was embarrassing and depressing. My self esteem plummeted. For a time I wore adult diapers to bed and washed my bedding every morning. My drool would soak straight through my pillows and would leave a musky odour. For me, living this way was not an option.

3. Loss of sexual desire. This was not a performance issue that could be addressed by Viagra or Cialis. Believe me, I tried. Rather it was one of desire, or worse. Intimacy never even crossed my mind. Interest in physical contact vanished. I was chemically castrated. Provocative images, words or sounds no longer inspired me. It was as if desire had never existed. What made it even worse was that I didn't even realize what I had forgotten until I purposely stepped back and thought about it. I felt cheated.

2. Over eating and rapid weight gain. For my entire life weight has never been a problem. I was very lucky. If I gained weight over Christmas from all the treats and chocolates and nuts, I could easily lose it all by mid-January by simple eating sensibly. I had never had to diet. But when I went on one particular med I gained 25 pounds seemingly over night. I suddenly had a middle age “beer belly” distending over my waistband. I hated what I saw in the mirror and felt embarrassed to go swimming. This side effect was devastating. It took me a very long time just to claw back half of what I gained. My body image still suffers.

1. Lethargy. The worst side effect I experienced was when I was left sluggish and apathetic. Everything was heavy. Lead courses through my veins. When I tried to speak oftentimes I could not find the words. My brain was filled with cotton batting. My short and long term memory struggled. This side effect was worse than the disease. Sure, it stopped my emotional swings, my anxiety and suicide ideation but all it left was a shell. It was not a side effect. It was replacing one disease with another. What was the point? I did not stay on this med for long.

Every mental health medication has the potential to produce a wide range of side effects. But they can also provide real relief. If you want to try medication understand it will take time to determine the dosage and drug combinations that work best for you. Be patient. Tell your doctor any side effects you experience and work together to improve your mental health.

I still live with some side effects in varying degrees, but none of them are severe. Am I cured? No. I am still in therapy, I still take my meds but at least now a somewhat normal life seems possible.

What helps when I'm suicidal (and what doesn't)

 

I suffer from chronic Suicide Ideation which at times becomes acute. In these moments of crisis, I am often asked "How can I help?" I know it is frustrating but in those moments I have no idea what to tell you. My mind is spiralling and overwhelmed. Part of me doesn't even consider suicide a problem. I have had these thoughts my whole life. They are who I am. Moreover, I am fiercely independent. I don't want to be a bother. I don't want to ask for "help". My answer will usually be, "It's OK. I'm OK."

I know you mean well but there are a number of things that only make the crisis worse. Minimizing my challenge does not help. Telling me a string of positive thoughts just betrays how little you understand. Saying "It's not that bad.", "Look on the bright side.", "You can do this." makes me dismiss your intentions. Your words and thoughts become trivial in my mind because you have no idea what you are talking about. "Don't worry. Be happy." is just a catchy song.

"Count your blessings" is also not helpful. You are just trying to change the subject. "You have so much to live for.", "Other people have it so much worse.", "Don't be so dramatic.", "You are being selfish." They are all insulting. They invalidate what I am going through. I know my thoughts are distorted but they are mine and they are stuck in crisis. At that moment, I don't care about anyone else. You suggesting that I should, tells me that you don't care about me specifically.

When you say "I know how you feel." and suggest my crisis is somehow common, you make me feel less important. I'm a failure. Clearly others have handled this. Why can't I? My thoughts will then become defensive. My SI is not like everyone else's.

The desperate appeal of "I would be devastated if you were gone." also invalidates my own experience. Now I don't only have to think of my own consequences but yours as well. You are guilting me into staying alive. My crisis turns to anger and resentment. It amplifies my distress. I can barely take care of myself and now you're dumping your happiness on me.

Telling me to think of my children, my wife, my extended family only makes me angry. They are already always in my thoughts. I know they will be devastated if I die by suicide. I know it will change their lives forever. Accusing me of neglect is not helpful. Instead you only heighten the guilt I am already feeling. I'm already ashamed of my disease. Your accusation justifies why I should die. Does it make logical sense? No. But that is the inevitable path my thoughts will take. I will shut down and not listen to your words.

Don't ask me for reasons to live. In crisis, there are none. The more you push the more I will dig in. We are not dealing with logical thoughts. Everything is jumbled and hyper-focused on distress and its relief by suicide.

Asking if I have been taking my medication feels like an accusation. It undermines my own emotions. It blames me for the crisis. The dark thoughts are not real. Rather they are just a chemical stew that has boiled over. For the record, I have never missed a dose of medication. The mere suggestion is enough to make me shut you out.

Also, don't tell me to call a help line. If you are there during my crisis that is not by coincidence. I have chosen you to witness me in a very vulnerable moment. I trust you. I understand why you would want me to reach out to professionals but by telling me to do so in that moment you are abandoning me, at least that is how it feels. Similarly asking for my safety plan is dismissive. If you are there, you are already part of my plan.

So, what can you do?

First off, stay quiet. Listen. Be there for me. Let me know I am not alone but don't try to talk me down. The more words you use the less I'll listen. Conversation only amplifies the agitation. Don't bombard me with questions or try to engage me in some sort of verbal distraction. Changing the subject is not helpful. I will just hide deeper in the crisis and put up my usual defences. I will quickly say "I'm fine." in the hope that you will leave me alone.

Demonstrate empathy not judgment. See if there is a way to give me more time, to free up my schedule and relieve external pressures. Is there an upcoming event or appointment or do I have to go to work soon? Is there a way I can cancel or phone in sick? Simplify my day.

Stay with me or arrange for someone to stay with me. I'm not looking for a therapist at this point. Don't try to explore my psyche or uncover past traumas. I'll do that later with my actual therapist. In the moment I just need time to de-escalate on my own. Having someone there keeps me safe. I'll initiate any conversation when I am ready. Just be patient.

If you do want to say something, the most powerful words you can use are: "You are important to me." If you just say "You are important." I will dismiss you because I do not feel that way. In my mind that is hyperbole. But by adding "to me" it changes the meaning. I can't argue with what you believe. These words make me stop and think. They make me see you. They give me value that in that moment I don't realize I have.

I know it is hard to watch a loved one suffer. The most important thing you can do when I reach out for help is to be there for me. Without a word, you are more supportive than you could ever imagine. You give me value so I can breath deeply again.

What to Expect When You're Depressed - MEDICATION

MEDICATION

Prescription medicine is a subject of much debate among mental health patients. Those who are against it are very vocal and certainly have legitimate concerns. I have been told that no one, including psychiatrists, knows exactly how this class of drugs works. It is not as simple as replacing a chemical deficiency in the brain as we are sometimes lead to believe. Moreover each drug has its own set of benefits and possible side effects.

It is your choice.
I'm not trying to persuade anyone to take psychiatric pharmaceuticals. Many people have managed their depression through lifestyle changes and natural remedies. If this works for you keep doing it. Personally, I have not taken many prescription medications in my life. In fact prior to the last year I had only ever been prescribed antibiotics. So when my Family Doctor first suggested medication to manage my depression, I was a little taken back. Was I really that sick? I trusted her judgment and agreed to try an anti-depressant.

Side effects and success
The first drug we tried didn't go well. To make matters worse, I didn't immediately tell my family doctor about the side effects I was experiencing, I had terrible stomach cramps but did my best to persevere. I didn't realize at the time that had I reported my side effects right away she would have changed the medication immediately. I thought I was being heroic when in fact I was just being stupid. There is no reason to endure a side effect and no reason to suffer in silence. For medication to be effective, you have to be open and honest with the doctor prescribing it to you. Tell him or her everything you're experiencing even it is it nothing at all. Side effects are not consistent across all patients. You have to tell your doctor how the medication is affecting you. 

I have tried a number of medications. Some required frequent blood tests, others gave me vivid dreams and still others gave me an insatiable appetite (and consequent weight gain). One even gave me a brain “stutter” where my thoughts felt like they momentarily locked up. It was not until I met my current psychiatrist that the right med combo was found; where there was a balance between minimal side effects and tangible benefits.

Medication is not the only answer
Whether you decide to use medication or not, keep in mind it is not a panacea. I had one psychiatrist tell me drugs are only 30% of the solution and that exercise alone has a similar level of impact on improving mental health. Ongoing therapy, that is talking to someone who listens, is also key to recovery as well as mindfulness, cognitive behavioural therapy (CBT) and other behavioural strategies.

Recovery will require more from you than simply taking a pill with water. That is why success in the fight with depression is non-linear. There will be many set backs. The key is to pick yourself back up and keep trying. Recover is not a destination, rather it is a choice made over and over again

Back to Table of Contents

What to Expect When You're Depressed - PHARMACISTS

PHARMACISTS

If you end up taking medication for your depression you're going to encounter pharmacists. There is not a great deal to tell about these health care professionals but there are a few things worth mentioning.

First of all, I hope you have a drug plan. Until you find out what works best for you, you will likely try a variety of medications and/or doses at the beginning of your drug therapy. Without a drug plan I'm not sure what I would have done to manage these expenses.

A little discretion, please
The main issue I have with pharmacists is the consultation they provide with every new prescription. It is not the information that is the problem but rather the delivery. Even though there was always a small consultation room available, I was never offered it. I suppose I should have requested a more confidential setting but I didn't. Instead the rules and effects of my latest “depression" medication were broadcast to the rest of the customers in line. To exasperate the situation, one pharmacist openly accused me of combining scripts from different doctors and self-medicating. She seemed to have a lack of experience with advanced psychiatric drug strategies. I understand she was just doing her job, it is just a little discretion would have been appreciated.

Returns
One last thing to keep in mind about pharmacists is that you can use them as a disposal service for unused pills. One time, I ended up with 6 different bottles of medicine which I could have used to harm myself. The pharmacist were more than happy to take them back for disposal. Just don't expect a refund!

Back to Table of Contents

NEXT: Medication

What to Expect When You're Depressed - HOSPITALS - PART 2: The stay

HOSPITALS PART 2: The Stay

My first stay in the hospital was terrifying. The ominous sound of the heavy reinforced door closing behind me and bolting shut, seemed permanent.. There was definitely no escape. Without my clothes, with out my freedom, I have never felt so lost and empty. Once my custody was signed off to the One West nurse, I was taken to a small conference room and asked a bunch of questions that I don't remember. By this time it was quite late at night and I was exhausted and defeated. That first day finally ended when the nurse showed me to my bed. My new roommate said “Hello.” then immediately handed me a set of earplugs and announced I was going to need them. I quickly learned the other man in our small room snored like a bear

A new routine

After a pretty much sleepless night, I woke up to what seemed like chaos. I was overwhelmed by a noisy crowd of patients gathering for breakfast. You see, in the psyche ward (One West) there was no food service in your room. You had to eat at specific mealtimes along with everyone else. Luckily (or unluckily) my room was close to the dining hall. I must have had a bewildered look on my face as I was immediately told to find a tray with my name on it. Those who had been inside for a while picked up their trays and moved together with their friends. The rest of us sat wherever our trays lay and ate in silence.

At that first breakfast, I discovered there was a patient hierarchy. Not everyone was wearing an ill-fitting hospital gown. If you made your bed, clearing your dinner tray and behaved safely, you soon got your clothes back. After another couple of days, you could get 15 minute breaks off the unit but only if you answered the nurses' and pdocs' questions correctly. And so with these incentives in mind, I diligently worked to get my freedom back. Getting better had nothing to do with the equation. I just wanted to get out. If making my bed helped then so be it.

The importance of food

I also discovered that the longer you were on the inside the more you understood the importance of food. First of all it was a good way to kill time. I learned to eat slowly. There was no reason to rush. There was literally nothing better to do. As soon as we finished one meal, we starting counting down to the next.

Secondly, there was a group mentality to save any extra food. You were not suppose to trade or save food but it was a spirited activity at the end of every meal as crackers or pudding, or the full meals of those who have been discharged were traded or saved in the communal fridge. The only food officially available between mealtimes was what wasn't eaten on the other hospital floors. This was kept under lock and key and only available by request. It was therefore not convenient while that which was hoarded could be accessed at anytime.

It is not that extra food was disallowed. If you had out privileges you could use your 15 minutes to hit the hospital Tim Hortons or if you had someone on the outside they could bring in food as long as it was not in a plastic bag or containing something sharp (i.e. something that could be used to harm yourself. ). I think the popularity of food hoarding and bartering gave patients a sense of control in an environment where none of us had authority. 

Boredom is your greatest enemy

The ward itself was a relatively confined space and so boredom and rumination were my greatest enemies. Electronics were not allowed nor was there any computer access. I was stuck with old magazines and newspapers, adult colouring books, scrapes of blank paper and mini-golf sized pencils (which were deemed less dangerous than full-sized pencils). There were also some old board games and a half deck of cards. I was the only one who saw the irony in playing solitaire with half a deck in a psyche ward. I guess humour is the first casualty of confinement.

To help pass the time, I asked my wife to bring me a novel and a pad of graph paper so I could draw mazes. The more complicated they were the more hours they killed. This one took 5 hours.

Once a day, except on weekends, there was a special group session put on by the ward. These included yoga, mindfulness, water colour painting or journaling. I tried them all to combat boredom. I never considered any of them as a means to getting better.

I should add, there was one TV with a DVD player which was inevitably tuned to something I was not really interested in, such as the original TV series, The Prisoner. (Another irony?) There was also the original Wii gaming system which tended to be dominated by the younger patients. Mind you, I did get in a few games when my son came to visit.

With little else to do, I ended up talking to people. This was a monumental step for me in that I prefer to keep to myself. The “elders” however advised me to be social. Staying in your room, in your bed will never get you out of here. And so I heeded their advice and actually enjoyed some of the conversations. I found that the new arrivals focused on how unfair it was that they had been admitted while those that had been there a day or two were happy to engage in a wider range of topics.

Us vs them
There was very much an “us vs. them” mentality in One West with the psychiatrists and the nurses being the “them.” This actually helped to break the ice with other patients. The One West “elders” were more than happy to share their knowledge. They pointed out the surveillance cameras which were everywhere but the washrooms. They also provided insights into why certain questions were asked and why specific routines were implemented. Our common goal was to get out of One West.

While I complain about the boredom, I definitely preferred it to high drama. Whenever a patient was physically threatening himself or others, a “Code White” was declared over the hospital PA system and security guards were quick to arrive. I never actually saw a code white - we were generally sent to our rooms when one was called - but I did hear them. "Code White One West, Code White One West. Code White One West" (Always repeated three times.) in a calm and measured tone. Then once the crisis was over and the patient was restrained (and drugged, if necessary) the all clear was given. On one such occasion I learned Code White etiquette. I overheard two security guards talking about how much they prefer subduing patients who were punching as opposed to those who scratched and spit. I made a mental note just in case I ever found myself in a Code White situation.

Good behaviour.
Surprisingly, it only took a few days for me to get used to my new norm. I was over my bewilderment and fear and was now actively scheming to get my freedom back. One of the One West “elders” had taken me aside and told me the keys to escape. He advised me to focused all my efforts on looking calm and sane. He told me to make my bed, clear my meal trays, take my meds without complaint and stay out of trouble (ie. No Code Whites) . Finally I had to make sure I answered the sanity questions from the nurses and pdocs without crying, shouting or showing any other signs of agitation. The questions with their appropriate responses were :‘Do you hear any voices other than mine?’ No. ‘Do you have any suicidal thoughts?’ No. ‘Do you want to harm yourself?’ No. ‘Do you feel safe?’ Yes.

And so after a week or so of good behaviour, I was discharged. Is this how I learned to manage my mental illness? No. But it was how I got out of One West the first and second time I was there. My second trip to the hospital, when the police escorted me was basically the same as the first time except I didn't need anytime to acclimatize myself. I was on my best behaviour right way and had my street clothes within two days. I was out within the week,.

Psychiatric Ward vs Psychiatric Hospital

My third trip to the hospital was split between two weeks in One West, then another 6 weeks at a psychiatric hospital. What difference! The psychiatric hospital was a much more relaxed and compassionate environment. When I arrived I was assigned a private room with its own toilet and shower. I was allowed to keep my clothes, my mobile, and my dignity. They even gave me the WiFi password.

Unlike One West, which treated every type of psychiatric illness, the hospital had a ward just for depression. It was quiet and reflective space. There was no feeling of “us vs. them.” There was no incentive to get out as quickly as possible. In fact they told me up front the exact day I would be discharged. I would be there for six weeks exactly. There were no “get out of jail free” questions here. I was there to get better.

Boredom and rumination were not an issue. There were lots of activities to do including walking in the mood garden, exercising on gym equipment, accessing a full gymnasium to shoot some hoops, yoga, art therapy, small group discussions on coping strategies, relaxation, mindfulness, community outings (e.g. bowling), three different TV lounges, pool tables/table tennis and computers with Internet access. Moreover, there was 24 hour access to snacks and coffee. After dinner there was no bartering for food or hoarding it in rooms. Everyone just got up and left.

I recognize that it's not practical for a psychiatric ward to have all these amenities and so drawing a comparison between a ward and a hospital is not really fair. I know the staff at One West did their best with the resources they had, but perhaps there are some ways they could improve.

When I was finally discharged from the psychiatric hospital, I walked out with confidence. My medications were working well with minor side effects. As aftercare I was set up with a number of appointments. I saw my pdoc within the week and was referred to a Cognitive Behavioural Therapy (CBT) class. I felt a good foundation had been laid for me to build my recovery on. Don't get me wrong, I was not cured but at least I was able to successfully challenge some of my distorted thinking. 

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NEXT: Therapists

What to Expect When You're Depressed - HOSPITALS - PART 1: The arrival

 HOSPITALS - PART 1: The arrival

I have been hospitalized three times over the past two years due to mental health concerns.

The first was a month or so after I initially reached out to my family doctor. The medications we had tried had provided little relief and my suicide ideation had become very specific. She therefore decided to Form 1 me which meant I was taken into custody for my own safety and locked in the psychiatric ward for a minimum of three days. I had not anticipated this move on her part. I didn't even know such a form existed. I was terrified at what would happen next.

My wife was called and she came to my family doctor's office where I was placed in her custody. We were warned that if I didn't arrive at the hospital within the hour the police would be called. We drove straight there and found the ER was expecting us. They already had a copy of my Form 1. After the initial paperwork was completed I was escorted into small room. The ER nurse was kind but it quickly became clear I had lost my freedom. My clothes were taken away and I was issued an ill-fitting hospital gown which slowed my every move. A security guard was even posted outside my room to ensure I remained safe and that I didn't get away. The first guard they posted was older and I joked to myself I could have probably out run him even though I was hobbled by the hospital gown. But when his shift was over, he was replaced by a decidedly more athletic guard. I was trapped.

Waiting and waiting

The worse part of the ER was the wait. By triage standards, mental health is a low priority. Also, it didn't help that there was only one psychiatrist on call. The ER nurse did her best keep me comfortable by bringing me some food and checked in on me periodically. Still I waited and waited. After about 6 hours, a psychiatrist finally arrived and assessed my condition. He promptly prescribed new medications and announced that I would be admitted into the psychiatric ward, or “One West” as they called it. I noticed that they didn't refer to it as the “mental ward” or the “psych ward” but rather stuck with the geographically neutral title of “One West.”

After the pdoc left I waited another couple of hours for a bed. Finally I was escorted by my security guard and a hospital porter into the locked ward. It was late at night and I was exhausted. 

The police

My second visit to the hospital played out basically the same except the police took me to the ER instead of my wife. My family doctor could not get hold of me after I left our appointment and fearing the worst, she called 911.

I arrived home that day, after having lunch with a friend, to find two police cruisers on my street. For the most part, the police were polite until it came time to take me into custody. The larger police officer warned me that if I tried anything I would regret it. For someone who sweats over a late library book, this warning terrified me. He then had me lean against his cruiser with my legs and arms spread wide open. Next he put on gloves and frisked me from top to bottom. As “luck” would have it, my neighbours were all arriving home with their children after school. I was mortified as I was locked into the backseat of his cruiser and driven away. I hide my face in shame as everyone looked through the window.

The police waited with me at the ER until a psychiatrist and hospital bed were found. My custody was then passed from the police to the hospital security staff. After a few more hours, I was again escorted by security and a hospital porter back to One West. The moral to this story was if you're suicidal make sure your Family Doctor has your cell number which she can call first instead of 911. I would have still ended up in One West, it just the ride would not have been so intense.

The ambulance

The third time I was taken to the hospital, I rode in the back of an ambulance. I don't remember much of the incident other than answering the front door and collapsing into their arms. I was on the phone with my family doctor at the time. My therapist had called me about a half hour before to conduct an exit interview for the group sessions we had. During our conversation she revealed that further assistance was unavailable for another 6 months. My mind collapsed and everything escalated quickly. She sensed my agitation over the phone and my growing distress. She told me to call my family doctor and that she herself would call back in fifteen minutes in case I couldn't get hold of her. I agreed but then as soon as I hung up I set my plan in motion. If you ask me why I did it, what was so wrong, the only honest answer I can give is everything and nothing. My mind was confused and the suicide ideation took over. I had visualized the steps many times before. The action was well rehearsed. Every other thought just shut down and it happened. I overdosed. I can't explain it. The best I can do is direct you to my poems where my distorted thoughts and raw emotions are better illustrated.

I remember a few snippets from the ambulance ride and some flash backs from the ICU but not much else. When my senses had fully recovered, I found myself in One West for another extended stay. After two weeks I was strapped to a gurney and rolled into a patient transport van. A nurse from One West escorted me as I was transferred to a psychiatric hospital for an additional six weeks. At the new hospital I was greeted by a security guard and another nurse who signed for my custody.

 

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NEXT: Hospitals - Part 2: The stay

What to Expect When You're Depressed - PSYCHIATRISTS

PSYCHIATRISTS

When you mention mental health services the first provider that usually comes to mind is a psychiatrist (pdocs for us in the know, “shrinks” for those over 60). My experience with this profession is decidedly mixed.

No couches or ink blots

First things first, get the traditional image of a psychiatrist out of your head. There are no couches or notepads or ink blots or even a cigar for that matter. They make it very clear on your first visit that they are primarily phamacologists. Their specialty is medication not therapy. I have often heard complaints from other patients that psychiatrists are only interested in pushing pills. I admit when I first started on this journey I said the same thing. I have since come to realize, at least from my experience, that that is what they are suppose to do. Complaining about a psychiatrist always prescribing pills is like complaining about a dentist who only cares about your teeth. Psychiatrists are what they are.

If you're looking for therapy and not medication, then you have to see a therapist. A psychiatric appointment does not typically allow for deep discussion. I saw one pdoc who started our first session by saying “I only have 15 minutes so don't go into too much detail.” She wanted the current problem with no backstory, pronto. Another psychiatrist kept answering his pager during our session. Clearly there is a shortage of psychiatrists but that doesn't change the fact that he made me feel entirely unnecessary. It was as if he already knew which medications he would prescribe from me even before I sat down. He already knew “the story.” He didn't need any details.

Pharmacologists

Psychiatrists are primarily interested in compiling a list of acute symptoms which they can then use to select the most appropriate medications. Follow up visits then focus on the side effects and the benefits of the chosen drug and whether or not there is a need for a dosage change or a different medication altogether.

I respect psychiatrists for what they are and I know that without my current medications I would not be able to write this book. That said, there does seem to be a bit of alchemy involved in the prescription process. No one really knows how psychiatric pharmaceuticals work and so selecting the right medication for a patient is not as simple as prescribing antibiotics. I have had experience with a number of psychiatrists. In fact I have seen a total of seven different pdocs in the past year. This was not by choice. My hospital visits availed me of such variety.

What I found troubling was that each doctor seemed to have their own drug preferences. In fact I often had to sit and listen as one psychiatrist would tell me why another psychiatrist's prescription was wrong. One doctor, for example, saw no sense in breaking pills in half. His attitude was to go up a full dosage no matter what. He also guffawed when he heard I was on lithium. He told me it was little more than a vitamin at low dosage and I was promptly taken off of it. I remember how he stroked his beard with a satisfied confidence when he revealed which “flavour” of medication he thought was best.

The very next day I saw another psychiatrist who proceeded to prescribe a different drug altogether. The most bizarre pdoc interaction I ever had was when one psychiatrist actually asked me what drugs I wanted. How would I know? Did I look like an experienced brain med user? I just shrugged my shoulders and said “I don't know.”

No follow up

What was even more frustrating than the variety of medications was the lack of follow-up. I was monitored for benefits and side effects in the hospital but once I was discharged that was it. Unlike my wife, who was given a very specific three-year appointment schedule for follow up after her cancer surgery, I was discharged with a bottle of pills and no appointments. I was instructed to see my family doctor who readily admitted she didn't have a strong knowledge of all the psychiatric drugs available and was uncomfortable making changes to my medications. I felt as if I had been pushed out the door and the door was locked behind me.

I didn't get any follow-up treatment until I was accepted into the mood disorder clinic. At my first visit there I saw two psychiatrists who independently confirmed my Major Depressive Disorder diagnosis. After that I saw one of them regularly. Only then did my medications became consistent and effective. What I found particularly reassuring was that if a medication had a side effect I thought was too severe, we immediately changed the it. The psychiatrist didn't have a favourite drug, rather he was interested in finding which one worked best for me.

I should pause here for a moment to clarify that my perspective on psychiatrists is limited to those I could access free of charge. My family doctor tried to find me a psychiatrist in private practice but either the waiting lists were ridiculously long (years in length) or they outright declined my case. Apparently being suicidal was deemed too needy and so I was turned away by one doctor, sight unseen.

My advice to those who want to access a psychiatrist is to have your family doctor put you on every waiting list available, whether that be urgent care, a mood disorder clinic or a psychiatrist in private practice. If you want to see a psychiatrist immediately, the hospital ER is your only option.

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NEXT - HOSPITALS - PART 1: The arrival