Doctors and my treatment for anxiety and depression

Looking back over the years I have seen a number of GP's (general practitioners) and have had varied experiences during my treatment cycles for Anxiety and Depression. Some have been excellent particularly my current GP who has a wealth of mental health experience and knowledge. He is always reassuring and looking to help with both medication and other healing treatments such as relaxation and CBT.

However I have also had some very bad experiences particularly from a GP who put me on 40mg of Citalopram within 5 days of starting that medication. Knowing what I do now that was really not very good! The same GP also told me to be ready for suicidal thoughts which sent my anxiety through the roof.

I have never had a single thought about harming myself or anyone else for that matter. But I do understand why doctors have to ask this question. However this particular doctor scared the hell out me and sent me into anxiety overdrive with 40mg of citalopram and sleeping pills.

The other poor experience I have found is the waiting time to see a CBT specialist or the mental health specialist teams. Often waiting over 6 months for an initial appointment. In the past medication has already made me feel normal ish again and I haven't felt the need to have these appointments once they have come up. My advice to anyone now is GO even if you are feeling much better. They can help stop the cycle of breakdown and repair that I sat in for a number of years.

But I am lucky really as I now have an excellent GP and have been given some fantastic skills to keep me on an even keel and medication free.

What are others experiences of health care both UK and further afield?

MW

The darkest hour

At my worst I was a nervous anxious wreck, I don't mind admitting it. I also know from reading around various blogs and forums that others have suffered much much worse. Anyone who suffers any form of metal illness has my deepest sympathy. It is often an unseen illness and many people including myself struggle on through life battling this debilitating illness.

At my worst I needed sleeping medication to get any form of rest and whilst awake could not focus on anything. I would sit with endless racing thoughts occupying my mind. I remember the feeling of peace just after I woke up during my illness. It lasted until I kicked my brain in to overdrive questioning if I would ever be able to relax or sleep normally again.

At those times I had convinced myself this is it forever. I would never be able to relax or rest properly again. Of course now in recovery I know this not to be true. Anyone who is currently suffering during an anxious period or breakdown please know despite what your own mind is telling you, you can and will feel better! Little comfort I know but as someone who has walked that road more than once I can promise you with support and help you can do it!

Mental illness is nothing to be ashamed of, in my case it was a symptom of caring to much. Of wanting to always come through for others and having a difficulty saying NO. I would take more and more responsibility in my life and greater and greater worries and poor chains of thought. I have now developed better thought processes to handle my life and work within the means of myself. Right now I am at my most stable time, I am actively involved at work and relaxed in my home life. At the moment I am med free and have maintained an even keel for a number of years by embracing relaxation techniques and CBT.

Despite everything and the dark places I have been to I wouldn't change a thing. I think I am a much better person and parent for going through what I have. I still have my rough patches but who doesn't!

The first step on my road to long term recovery was opening up to my family, friends and work colleagues and allowing people to support and help me. Anyone who is struggling right now due to similar reasons as myself I would encourage to get support from your doctor and support network. Make those steps to feel better and get well.

Some people will say 'just snap out of it' or 'cheer up' but that is more through ignorance than any real menace. I just used to smile and ignore people like that but now I would say yeah when I break a leg shall I just jump up and walk on it? Time is a great healer and your mind needs it just as much if not more than your body! Do everything on your own terms and to your own time frame. On the whole most people have shown incredible support to me during my struggles and showed great understanding. I never thought that would be the case but it was, perhaps I am lucky.

But as a guy and one who manages a family and staff it was hard to admit hey I am not mentally well. Those first words were tough and I wasn't sure of the reaction I would get. But boy I am glad I got the words out! It set me on a long and rather bumpy path to learn about my mind and how to look after it!

Best wishes and good luck to all who take up the battle to good health and happiness!

My Stress busting at work techniques

Stress is my Achilles heal, if you have read my prior posts you will have gathered that already. From a young age I have had trouble handling pressured situations often due to a lack of confidence.

Others will struggle in a different way to myself. It could be general anxiety for an unexplained reason or deep depression due to bereavement and pure bad luck. From much of my own research I found such a broad range of illness and triggers people shouldn’t be pigeon holed together under the anxiety banner.

One thing is for sure we all suffer this debilitating experience of anxiety and depression in one form or another. I can only really comment on my own experiences and what I have found to be useful. So that is what I shall do!

My big trigger point was stressful situations emulating from work or the work place. It boils down to my inability to use the very powerful word NO. Often when my managers, supervisors or bosses wanted something done and within a certain timeframe I would put myself under immense pressure to achieve those goals.  I wouldn’t say I am or was a yes man but I sure didn’t like to say no or question suggested work targets.

Having worked for some pretty damn awful bosses this led me into a terribly stressful state, unable to switch off from work and having racing thoughts throughout many nights. I can’t just blame others for this either, I have been my own boss. That was my worse boss of all! Never allowing a moments down time or family time. I pushed myself harder than anyone should ever have to. Regularly working through the night and making 600 mile round trips.

I won’t bog this post down with my illness or what caused it, stress in the workplace is fairly common. If you have found your way to my blog chances are you already know about the symptoms and reasons.

Along with figuring out breathing exercises and relaxation techniques I have also realised the power of the word NO. Also that the confidence to use it can be empowering. 

When I say as an anxious or stressed person you need to remove the stressor from your life. I am not suggesting you leave your job or whatever else and hide away for eternity. Quite the opposite in fact! To beat stress you have to remove it and the only way to do that long term is to think differently about yourself and work.

The first skill I practised with this was fairly simple. I used to be given work tasks and timeframes a lot. Nothing unusual or wrong here but I did used to accept those tasks and instructions without first asking myself if it was realistic. After all we have been employed to do a job, we should know how long it should take and how likely it is to be a success. The result was I constantly stressed about unachievable goals set by management and even myself.

Now the first thing I do is analyse each task I am confronted with. Treat it as a detached straightforward question removing the emotion of wanting to please everyone. So if a report is needed within 48 hours my first thought isn’t oh my god I am going to have to work through the night or my boss will fire me. It is more like Yes or No that is or isn’t possible. If it clearly isn’t I would then make clear to my boss or myself confidently! That if the goal was to be achieved I would need assistance or a longer timeframe. If you approach yourself and your boss confidently and express why it’s not possible you will find like me that they respect it.

No is a powerful word and it shouldn’t be feared. Once you express your thoughts on work tasks clearly people can’t argue with it. They either have to allow more time or support your task in other ways. The same principle applies to clients and customers. If you are honest and explain why things can’t be done quite how they would like often they appreciate the honesty and take on board a professional opinion.

So I went from worrying about pleasing everyone to using unemotional straightforward analysis. This was the first step to remove stress from my life. I had accepted what I could or couldn’t achieve and set a boundary to use right at the start.

The other big thing I did was enabling a switching off process from work. It started with a simple tidy of my desk at the end of day, or cleaning up the desktop on my computer. I would close my emails down, turn my desk phone off and take 10 minutes to tidy up! Sounds mad I know but it really worked. I stopped thinking about project x or y and concentrated on getting my desk ready to start the next day. Once I had left my desk I left my work with it, it took a lot of practice but now I can pretty much leave work and in be out of work mode within 10 minutes.

This was a revolution to me, I had time to think about activities with my family. Real free mind time to enjoy books or movies. I was no longer constantly distracted with lingering thoughts about work or projects.

I started small with the word NO, I remember the first time actually that I put this into practice. My boss wanted a demonstration unit getting ready for the next morning. He asked me with about 10 minutes of my working day left. 

The old me would have jumped through hoops and stayed back 6 hours to finish it. But I found myself uttering the words sorry boss but that just isn’t realistic in the timeframe. We need a better plan to achieve what you want. I then suggested we either get several people to help or delay the presentation in the morning by a few hours to make things happen. I was stunned by the fact he immediately agreed with me that is was un realistic and he offered to help himself and get 2 others to join in the following morning and start things off a little later. He had listened and valued what I had to say.

I am not suggesting anyone becomes a trouble maker, you don’t need to do that. After all when jobs are on the line you don’t want that tag. But when you express your professional opinion and ask for things to be done a little differently people will listen. It doesn’t always have to be yes sir! Well not in my experience.

Anyhow that is just my rambling thoughts on how confidence to say NO and be firm in the workplace can reduce stress. Often the most stressed are the ones who care the most. Also find a way to switch off from work like a physical switch if you like. Find a routine and stick with it.

My worst anxiety symptom, INSOMNIA!

As anyone who has suffered anxiety or depression will know it comes with a multitude of other unpleasant symptoms. I had a range of things such as tingling in my head, neck and hands, loss of appetite, lack of interest or the ability to focus or concentrate on even the simplest of things. Feeling panicked or nervous at the smallest thing, wanting to get back home to a safe place. Hot flushes, feeling faint, rapid heartbeat, PVCs, tiredness, exhaustion the list goes on.

But the worst part of my illness was always the insomnia, if I had to pick one thing it would be this. The feeling of loneliness during the night while others are peacefully sleeping is awful. I would spend many nights awake convinced that I would never be able to sleep again. Sleep is vital for any type of recovery but particularly for mental illness such as anxiety, well in my experience. But the vicious circle of this illness stopped me been able to relax and sleep. 

I also had children in the house and didn't like to disturb anyone else while I was struggling. So I would often sit in silence, alone thinking more and more negatively about myself and building things up into bigger and bigger problems.

Those periods were the worst of my illness as they often ran alongside starting up on anti-depressants and finally facing the fact I was unable to make myself feel better. I kind of felt pretty useless that I was so weak as to ever get in that state. At the time that is how many thinking went. But looking back I was showing great resilience to make a stand and run the fight back against the wind!

What I will say is each time I have felt that bad the moment I first admit how bad I am feeling and how difficult things have become is also the moment things start to get better. It is a slow process and no quick fix is possible in my experience, but it is worth focusing on the fact you can be better and feel 'normal' again.

I hate that description 'normal' after all what really is normal? We are all unique and if we was to live as nature intended 'normally' most of the common stressors and depression triggers would not exist, many are made through modern life in my eyes.

The timeline for my recoveries has been quite consistent over the years, once I have sought help things have gone fairly consistently. The first week or two I have had the side effects of ADs to deal with. In my instance I was also prescribed sleeping medication to help get at least a few hours rest each day. This has normally been enough and I haven't needed help from other medication like diazepam or lorazepam very often. But that is not to say these types of medication can’t help relieve some of the horrible symptoms of anxiety in the short term. I have always been careful to see these as very short term assistance and used them for a couple of days here and there when things have gotten really tough in my recoveries.

Those first couple of weeks have always been difficult but even during that time things did improve day by day. At the time you don't really notice it but looking back you can see how things were slowly working free. After that first couple of weeks I have normally started to pick up quite quickly. I try to work with the medication and keep away from stress and take regular exercise. Running was a great therapy for me. I would keep it simple for a good 6 weeks and just be positive about how much better I was feeling and focus on the fact I was getting more sleep and feeling more 'normal'. 

After about 6 weeks I would start to look at what had caused me to feel so bad. But again focusing on how much better I now was. The medication should be working well after 6 weeks and helping to support. It certainly did with me. I started to read and learn about the illness and develop techniques such as deep breathing and clearing my mind with simple focusing on my breathing and all the things around me.

I was lucky to have a supportive family around me and taking time with them was really helpful. Walks or trips to the cinema just been around each other showing love and kindness was really helpful. It always amazes me just how much better I can feel by helping someone else and showing kindness and love to others. 

I won't point anyone to a particular web reference or book as I believe we all have to find what works best for us. What I found useful might be completely inappropriate for someone else. I don't want to send anyone over to a website that you find completely useless and give up. Try all and everything at least once or twice is my advice, have an open mind. Deep breathing gave me almost instant relaxation after 2 or 3 attempts and these days I carry out deep breathing 2 or 3 times a day!

From 6 weeks to 6 months I would focus on myself allowing relaxation into my life and changing the way I think about prior stressful events. This is all part of CBT which I will attempt to delve into later. After 6 months if I had returned to consistent good health I would build back up with my work life watching closely for signs or symptoms at all times. Of course during the first 6 months I was still working but again keeping it simple. I appreciate we can’t often take 6 months out of work and in my case I didn't have to. You can still work and recover but it involves support and understanding from your work colleagues and employer. I know it feels like a tough thing to admit but once you do the support you get might be surprising. 

I would stay on my medication for at least 12 months if I relapsed again today. In the past I have been taken off them within 6 months and in my experience this can be too short a time to fully learn and understand ways to feel better for the long term. If I had the confidence and tools in place I would slowly withdraw from my medication between 12 to 24 months and then closely monitor how I was feeling and dealing with things. 

Some people require medication for the long term and this isn't a bad thing. It is due to your illness and you shouldn't feel bad for needing it. I guess I am one of the lucky ones who can live without the help of medication if I follow CBT and relaxation techniques. That is not to say that in the future I won’t need regular medication and support. We are all different and the decision on your medication should be made with your GP.

I often find people who are determined to get off the medication as soon as possible. This can be a poor way of thinking as sometimes the real cause of your illness will not be better. It just results in a constant cycle of breakdown/repair in my experience anyway. I know meds can be scary especially ones that effect your brain chemistry. But it is all part of a solid long term recovery and if long terms meds are part of that then so be it. Just like diabetics need insulin or asthmatics need an inhaler, don't be ashamed of mental health medication.

If you are lucky like me it might only be for a year or two while you have the mechanisms in place to live without the medication. But others who suffer more deeply than myself will require medical help long term and it isn't their fault or because I am stronger. It is just the result of the medical illness they are suffering. We are all different and require different treatments.

The lull before the storm

I kind of jumped around my time span in my first post and about page. I want to try and keep some kind of time line to my story if I can. I suppose it is my kind of therapy to tell my story and see if anyone has experienced similar or perhaps help those who are heading down a path I have travelled.

Firstly the time after my first experience of anxiety and depression was not all blighted with poor mental health. After my first episode which lasted about 6 months (2 of those were awful). I was quite well, I had a good job with little stress and the excitement of a growing family. I kind of naively thought that I just suffered one of life's curve balls and would be fine here on in.

I was right to start with! I think it was about 3 years and then I made the decision to start my own contracting business. What could go wrong :)! Well from a business perspective things went rather well, I grew a large and successful business working throughout the UK and employing people. But as a consequence I started to travel again and felt a lot of responsibility and pressure to keep things growing. I wouldn't say I couldn't cope with this but I wasn't allowing myself the time to rest my brain and recover. 

My body was and is super fit I enjoy physical work and early starts, I thrive on them in fact. But as a consequence my brain gets little down time to rest and when you run a business I can tell you that you have a lot to think and worry about.

After a couple of years I started to struggle with sleep again, notice a theme here the first sign I pay attention to is the sleep issue. In reality before that I had increased frequency of panic attacks, loss of appetite and reduced energy. All of those things I could ignore but when you lose the ability to sleep that just increases all the other problems tenfold in my experience.

My cure was a stiff drink or two or three before bedtime and for a week this did the trick. The problem is your body builds a tolerance and you begin to feel dependant on that drink for sleep. You also need more and more. It wasn't social drinking either this was literally 10 minutes before bed down a few glasses of whisky or wine. Not healthy and again alcohol only increases the other issues further adding to the vicious circle of poor thinking and decision making.

I also started to take St Johns Wart and 5HTP all seemed like a good solution non prescribed and a solution to my symptoms. I was certain I had chemical imbalances in my brain and I could fix it. How wrong was I!

I was hiding all this from my family and blindly carrying on. From the outside I had a successful business, plenty of money and a great family. All true but mental health doesn't take that into account. I was stressing myself to the point of a breakdown.

Things came to a head at a client meeting, I had slept 1 hour the night before. It was only a brief meeting about a fairly small contract but I had worked into such a state I entered fight or flight mode and left the meeting got in my car and went home! I felt so anxious it was untrue.

I went to stay with family for a few days as I felt a complete waste of space to my family and staff. Fortunately my wife was very understanding and held things together. She is truly unbelievable and without her I doubt I would have made it to this point. She understood the reasons I felt so bad and wanted to help find a solution.

This time I went to my GP and was put back on Citalopram at 20mg. Now this wasn't a great experience for me, I think my starting dose was way too high and the St Johns Wart had already done something to my brain chemistry. The first few days I felt huge waves of happiness, I think due to serotonin release within my brain that the St Johns Wart had built up. Anyway I didn't react well and my symptoms got worse, no sleep, no appetite and bad moods. The GP upped things to 40mg and boy that sent me into a more anxious state than ever before. I was constantly pacing around unable to relax or concentrate I was a mess.

At this point you can’t really help yourself in my experience. Well not straight away, perhaps those with greater mental will power could. I was in despair, what had worked before wasn't working this time. I thought that's it I will never be able to feel better, medicine can’t help me.

I needed rest badly and this time the GP prescribed Diazepam just the two 10mg tablets to help with sleep for the next 2 nights. Boy did they help, this immediately relieved my anxiety and I got some rest. I knew that this medication can be addictive and you can build up a tolerance very quickly so it was not a long term solution. I was told after a few days rest I needed to focus my mind on getting better and researching relaxation therapies. Of course I was also on the CBT waiting list for help..... This would take 3 months to come through and I will post about it later. In short it opened my eyes and pointed me in the right direction but only after medication had helped pull me from the depths.

I never settled on Citalopram during my second episode and my GP thought Mirtazapine would help better as this was good at helping with sleep. Antihistamine effects apparently. It sure did help with sleep but left me groggy for most of the next morning. After a few weeks I went up to 30mg and settled quite well on this drug. But the important thing was I felt an instant benefit on this drug, no 2 week build up etc. It helped with sleep from the first dose and stopped the need for any diazepam etc.

But I should stress that anti-depressants don't always agree with people in the same way. Even the same person at a different time can react differently, as I did. Patience and talking with your GP is the best advice here. It takes time for most of them to build up and help your brain recover often needing at least 2 weeks before a judgment is made on effectiveness. Many people don't like the groggy morning feeling Mirt can leave. I never found this to be an issue and had no side effects and settled quickly on this drug after the citalopram. But don't give up they can and do help!

This time while on my medication I researched extensively on mental illness, anxiety, depression, anti-depressants and therapies. I realised the drugs are buying me time to help learn how to take care of my brain in the same way I take of a muscle or my heart. I started to see I was working it to the point of breakdown. I realised I wasn't weak and could see how the workload I took on would make most people ill. My GP constantly asked if I would employ someone to do my job, if I would put another human through that. Of course I wouldn't so why should I do it to myself?

The big thing I learned is to remove the stress from my life. Otherwise you spend all your time hiding from it or masking the symptoms it delivers. Of course we are all different. Removing the stress doesn't necessarily mean you have to remove your job or partner or past experiences. It just means change the way you think about things to find them less stressful or not stressful at all.

Anyone who is struggling with stress, anxiety or depression please realise you are showing great strength by seeking help. Standing up and wanting to fight this illness is not a sign of weakness. It is courageous just like any fight with a physical illness. 

I stayed on Mirt for over a year and taught myself endless relaxation therapies and allowed chill time into my life. Making time for family and spending some of my hard earned money employing several people to manage the role I once did myself.

I will go into the various CBT and relaxation therapies I find the most useful later on. Don't worry about taking medication, in my experience it is all part of the healing process and some need that help for a number of years. No rule book exists it is what feels right for you and your return to health. 

But please understand you can feel better, you can sleep again, enjoy life, relax, take pleasure in things and live! It involves effort, strength, support and love but you can get there and I hope stay there! I have been well and AD free for a good few years now. I hope I have the skills and have learned how to spot warning signs to avoid ever falling so far to the bottom again.

But from someone who has walked that road I can say the fight is worth it tenfold. Those painful first minutes and hours, torturous insomnia and ruthless anxiety can be worked away from. Slowly and patiently. My advice is don't over think things, keep it simple. Short achievable goals such as 20 minute breathing exercises, short walks, reading a chapter of a book, small DIY project or anything to distract your mind. Along with GP help from anti-depressants and perhaps sleeping tablets (short term). Use the rest they give to recharge your brain, rest and relax. Then use the power of the Internet, your GP, support groups and family to learn and support your mind. Once you seek help you will be surprised just how many people go through this. It is a hidden illness and it is time that changed!

First Period of Anxiety

I guess my first post should start at the beginning so here goes.......

I was taking part in a project taking place in Portugal, it was a particularly stressful work project and I didn't have the most helpful shall we say employer. I was sent over to Portugal for a period of 8 weeks working with 2 other colleagues. At the outset I felt fine and had zero prior symptoms of Anxiety or Depression. I was healthy and played regular sports and I kind of felt indestructible.

But as the project went along things didn't go well, schedules slipped and I was put under immense pressure to get things done. What was been asked looking back was unrealistic and never achievable. But at that time I took responsibility for attempting to get things done. Working 16 hour days, eating poorly and never giving my brain a minutes rest.

The result was I started to struggle sleeping, even getting a couple of hours was near impossible. This just exaggerated things further and sucked me deeper into an anxious state. I didn't even realise that was happening to me, I thought I must have a virus and just carried on. At that point I started to suffer from a racing heart and felling faint, during one episode I really thought I was having a heart attack and dying. Looking back I was suffering from panic attacks, I still get the odd one now maybe 2 or 3 a year. But knowledge is a great thing and now I realise what is gong on I can ride them out relatively quickly and then be fine. Often it's a sign that I need to slow things down and clear my thinking other times its just happens!

Anyway back to Portugal! At this point I wasn't sleeping at all, had no idea what was wrong with me and was a complete waste of space at work. I dropped a £200 set of crimping tools down a manhole and lost them for good! I had to get back home and get some answers. I paid for flights and came home without my employers blessing but it was that or go crazy or worse. Looking back it was the right thing and thank god I had the strength to do it.

Rather randomly I developed an intense fear of flying at this time and I still have it today! I think all the worry about my imminent death had brought so many fears to the surface it was untrue. I really struggled on those flights home panicking at every bump or noise.

Upon getting home and seeing my family the instant relief was like a wave of happiness. My symptoms subsided within days and I felt normal again. The mistake I made here was to put it down to a virus and stress and seek no further help. For a couple of weeks I was fine but then I started to question what happened to me. I started worrying daily about my health and convinced myself I must be really ill. The anxiety started to build again and I felt more and more worthless everyday. Like I was failing my family and loved ones.

My fear of dying young comes from my grandfather and his brother dying in their early 30s due to heart conditions. I have had tons of checks since a very young age and have been told more than once that I do not have the same condition. But I think I always had this in the back of my mind and it played with my anxiety.

At this point my motivation disappeared and I spent days lying around the house is despair. I couldn't shake myself out of it and my poor wife was at the end of her tether. I think she believed I was so unhappy with her and that was the reason for feeling so depressed.

I eventually went to see my GP who was brilliant. He immediately diagnosed stress induced anxiety that had developed into depression. He prescribed a small dose of citalopram (10mg) and encouraged me to get out and take exercise even if I didn't feel like it. He explained the anti depressant was a very small dose and not to expect immediate results and that the dose might have to be increased within a couple of weeks. I now know what a small dose 10mg is and have since been on higher doses of Citalopram and other AD's.

Anyway within a week of forcing myself up and about and realising I wasn't about to drop dead I started to feel better. My anxiety dropped I felt fitter and stronger and I got a new job! For 6 months I felt more like my old self and had assumed I had been fixed for good. I didn't really read into my illness any further as I naively thought hey that's it I am better. My GP stopped the citalopram and I felt fine for over 3 years!

Unknowingly I had removed my main stressor of work and taken up regular exercise which suppressed and I suppose you could say fixed my symptoms. But at that point I didn't really understand or learn any further about what had happened. That all changed when I relapsed 3 years later due to starting my own business! I will cover that later and detail how I started to fight back for good learning, understanding and accepting this was a battle for perhaps the rest of my life!