Apologies for the boringly prosaic and descriptive title.  I was going to call this post ‘Post-Mortem’, but then I realised that yesterday I was writing about being suicidal, so it might be misinterpreted.  I guess ‘The Story of the Day I Went to the Doctor About My Depression (Again)’ is a bit wordy.

I was up late last night talking to my parents about my mental health and what to do about it.  My Mum was very keen on me going to see the doctor and I thought she was right.  Really I was just waiting for someone to tell me to go, as I always worry in these situations whether I’m bad enough to justify seeking help, bearing in mind that I’ve been very depressed for most of my adult life, so it’s hard to recognise the point where it’s bad enough to take action.  I spent some time last night working out what to say to the doctor and also to my boss, realising that I would have to explain why I was missing work (I wasn’t sure when I’d be able to get an appointment at such short notice, so I was potentially missing the whole day).  One of my parents, I can’t remember which, suggested emailing my boss last night so that she would have something as soon as she got in to explain my absence, in case I was held up in phoning; as an additional bonus, it meant I wouldn’t have to explain too much over the phone, as I can get nervous and semi-incoherent when talking to people over the phone (social anxiety and/or Asperger’s again).  All this took a lot of time and I don’t think I got to bed until around 1.00am, especially as, after my experiences on Sunday (when I went to bed early without relaxing and couldn’t sleep) I made sure to shower and relax a bit before bed after a rather traumatic day.

I managed to get a doctor’s appointment for late morning today.  Fortunately when I was suicidal a year ago, the doctor put a note on my file saying I’m an ‘at risk’ patient (depressed young male living alone) and in an emergency I’m to be given an appointment that day, otherwise I could have been waiting days to be seen.  I got to see my preferred doctor too, which was good.  He was very sympathetic as I explained that my condition has worsened in recent weeks, building up to intense thoughts of self-harm and suicide yesterday.  I explained about family stress (my sister’s wedding) and work stress (relatively new job, my worry over making mistakes and my boss finding out about my blog and self-harm) and how this has all felt like it had reached an unbearable point yesterday afternoon, probably compounded by disrupted sleep over my long weekend (from Friday to Sunday I dozed every afternoon/early evening and then ended up going to bed late and/or struggling to sleep at the right time).

The doctor felt there was no reason to change my medication, which I sort of agree with and sort of not.  I think it’s doing something as if we change the dose or I forget to take it, I go downhill rapidly, but I wouldn’t describe my condition as ‘good.’  I was feeling a lot better from being put on clomipramine last winter until the summer, but since then I have been very depressed, albeit functional and not in danger of hurting myself (until yesterday).  It seems that, as with all the medication I have taken, it either does nothing or produces some improvement until an external event pushes me back into the depression, at which point it at best keeps a degree of stability and functionality, but not positive mood.

Then again, I would agree with the psychiatrists I have seen in the past who say that medication can only help me so much; I need to make changes to my life.  This is the hard part, as I’m not sure what to change or how, particularly when obstructed by social anxiety and my borderline Asperger’s.  Hence all the recent posts musing idly about career changes, volunteering or emigration and more seriously about trying to find a romantic relationship while also struggling to integrate better into my religious community (which currently feels like one step forward and two backwards – I haven’t been to shul (synagogue) on Shabbat morning (Saturday) for a couple of months now, as I’ve been too exhausted, but I suspect that is covering depression and socially anxiety that I need to confront at some point).  The result is a feeling of ‘stuckness’ which I guess I should raise with my therapist this week (a shame I only just thought of it now, not during my appointment with the doctor).

The doctor did, however, think that the immediate trigger for my agitation was my disturbed sleep over the weekend.  This may be true, as I know I need seven to eight hours of sleep a night just to be functional and any kind of physical need (fatigue, hunger, dehydration) can trigger mental health issues very quickly in me (depression, anxiety, OCD).  Still, I think a more likely trigger is the issue with my blog being discovered by my boss and the college hierarchy last week, which is further in the past than the sleep disruption, but Monday was my first full day at work since it happened, which may have been triggering, particularly as I was doing some (non-blog) writing during my lunch break, right before the agitated and self-harming thoughts started, which may have reminded me of writing my blog during my lunch break and inadvertently being ‘caught.’  I did mention some of this to the doctor, but he didn’t change his mind.  He did prescribe sleeping tablets for a few nights, saying I don’t have to take them if I don’t want to.  I think I’ll probably wait until a night when I can’t sleep or my sleep pattern gets messed up (more likely to be during the weekend, as on weekdays I sleep, if not the sleep of the just, then at least the sleep of the exhausted).  I do wonder if they will give me more refreshing sleep, as for many years the depression has made me sleep for long periods, but not refreshing sleep – I wake up as tired or even more tired than I went to bed.

I felt that this was positive overall, especially as the doctor booked in a follow-up appointment (by phone, so I won’t have to miss more time off work) for next Monday.

This took me to lunchtime.  I phoned my boss to let her know what happened and got no answer, just as I had got no answer when phoning in this morning to explain my absence.  I left a message (as I had done earlier too) and a few minutes later she phoned back, saying she was out of the office and had only just got my message (at the time I assumed she meant the message of a few minutes earlier, but in retrospect, she might have meant the first phone message and even the email of the previous night).  She said that she would like to see me tomorrow, which I’m a bit nervous about, but probably shouldn’t be.  She also said there was no point in my going in this afternoon, as by the time I arrived it would be nearly time to come home again, but I said I think I would like the structure of going to work; the last thing I wanted was to be stuck home alone again with my thoughts as I was on Sunday and over the winter holidays.  So I went to work for two hours, spending more time commuting than actually at work, but I think it was the right decision for my health.  It also gave me the opportunity to open up to another of my colleagues about my depression (but not the suicidal thoughts), which was a positive thing as well.

So now I’m home, feeling vaguely anxious about my meeting tomorrow.  I feel I should have some kind of positive action plan to put in place and I don’t have a clue what that would be.  As I mentioned yesterday, employers are supposed to make “reasonable adjustment” to illness under UK diversity law, but it’s hard to tell what is reasonable; also what would be running away from my problems.  For example, I think that even if I could somehow escape from being on the issue desk, it would be a backwards step to do so.  I need to have those anxiety-provoking and mistake-making experiences for growth (something else the doctor said today, actually).  The only real adjustments I can think of are some leniency if I’m a few minutes late to work (which has only happened twice in nearly eight months) or if I need to stop work for a few minutes to calm myself or just to be able to ‘shift gears’ between two different tasks (as I think I’ve mentioned before, I’m not sure how much this is a depressive problem or an Asperger’s one; I guess it doesn’t really matter what it comes from).

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