The Great Clomipramine Shortage of 2018 is continuing.  To cut a very long and boring story short, I should be able to get a repeat prescription tomorrow, but not the 50mg tablets I want and had been prescribed initially or the 10mg tablets the doctor prescribed as a ‘here’s one I prepared earlier’ fallback, but 25mg tablets.  The pharmacy are at least saving them for me while the surgery comes up with the requisite paperwork.  But I think when I see the psychiatrist on 8 November (if the NHS ever deigns to tell me when my appointment is…) I need to talk seriously about changing meds, because these aren’t available and aren’t doing much when they are available.  No idea where we go from here though.  MAOIs?  ECT?

The other thing I need to talk to the psychiatrist about is alternative diagnoses.  I’m still going back and forth in my mind about autism and social communication disorder.  Tony Attwood writes in The Complete Guide to Asperger’s Syndrome that diagnosis is like putting together a jigsaw puzzle.  When it is 80% complete (enough diagnostic criteria are met), the jigsaw is considered completed, BUT only if the corners and edges are in place too (certain criteria have to be met, regardless of how many other criteria are met).  I have the 80% complete, but I don’t have all the corners and edges, there are some symptoms I just don’t have, or not at a high enough level, to count as autistic.  I can see the autism picture, but because I haven’t got the right pieces, no one will give me any help with it.  So maybe social communication disorder is a better bet, or going to a CBT therapist and trying to work directly with self-esteem and social anxiety.

The other thing I get from reading the book at the moment is gratitude.  I thought my childhood was not great, but it could have been so much worse.  The bullying could have been even more intense and violent, I could have been unable to defend myself in any way except violence (which would have got me in bigger trouble) and, most of all, I could have been without my “mentor friend” who guided and protected me (literally protected me – he was tall and strong and even though he was a geek, he wasn’t bullied as much as I was).  No wonder I used to get upset and maybe even anxious if he missed a day of school.  My Mum wanted to split us up, because she thought he was holding back my social development and I would make more friends in another class or school, but I suspect I would just have been even more alone if that had happened.

Speaking of mentor figures, Attwood says of romantic partners sought by people with autism, “The partner they seek is someone who understands them and provides emotional support and guidance in the social world – someone to be a ‘mother figure’ and mentor.”  I’ve realised this before about myself.  It makes me pessimistic.  I’m a weird enough person to be trying to matched up as it is, without putting pressure on women to mentor me and even mother me (even without getting into the complexity of my far-from-straightforward relationship with my actual mother).  This seems like asking too much.  I can’t imagine anyone ever consenting to marry me on those terms.  But I worry about what will happen when my parents are gone.  Complex though my current relationship with them is, they are still doing a lot of mentoring and guiding, e.g. today, when Mum came to resolve the clomipramine prescription confusion at the doctor’s surgery, when my social anxiety/autism/social communication disorder/shyness/whatever was just making me shutdown and run away.

I just got back from shiur (religious class).  It’s become quite difficult.  I really enjoy the content, but the number of people going has gone up and I feel uncomfortable with the number of people in the room, especially as some are noisy and constantly interrupting with questions and interjections (Jews don’t really do quiet listening).  I don’t really cope very well with people who like to talk for the sake of talking, or because they like the sound of their voices, doubly so if I’m trying to concentrate on someone else talking.  Plus just being around so many people is anxiety-provoking for me – Attwood says that for autistic people the difficulty of being around people, in terms of energy needed in alertness, anxiety and reasoning out the correct social interactions on the spot, increases exponentially (rather than linearly) with the number of people.  At shiur, as well as normal fears of a social faux pas, I’m worried about a religious faux pas too.  Just to make things worse, I’m juggling more balls because some people at the shiur know a bit about my mental health issues and some don’t and some have been acquaintances since childhood and some have not, so there is a lot to think about.

I’ve been thinking again about pets.  Attwood recommends them as affectionate and understandable companions for autistic children (unlike neurotypical children, who are difficult to understand).  I’ve see them recommended for people with depression too.  As a child I had a couple of goldfish, but that was it.  My family aren’t really pet people.  But now I wonder if it would help me to have a pet.  It would also let me see if I can cope with responsibility, given that I want to have children one day (although, as I say, that seems unlikely to happen).  Small mammals seem the best bet, guinea pigs or rabbits (both are social animals and should ideally be kept with at least two – I’ve done some reading on this already).  But I haven’t got the confidence to mention this to my parents (who in any case think the pet will die and leave me even more depressed), not least because I worry whether I am non-depressed enough to look after a pet, especially when I come home from work exhausted.  And then there’s the financial cost.

In other news, my contract isn’t being renewed at work, if I happen not to have finished the work by the end of my current contract (23 November).  I was told it was because of internal problems and bureaucracy, but I worry that it was secretly because I was a disappointment and they aren’t happy with my work and the mistakes I make.  It’s rather academic, as I strongly suspect I will be more or less finished by 23 November anyway.  To be honest, I think I might be self-sabotaging my job hunting.  I don’t really feel capable of working, at least not until I have dealt with my self-esteem and social anxiety issues and the autism/social communication disorder/whatever issues, plus I’m just plain exhausted from two months (with another to come) of constant alertness and anxiety to deal with social interactions and noise at work.  I need to stop for a bit and calm down and get my bearings.  I know that sounds lazy and entitled, but I feel like I’m at breaking point and I need time out – more than the three day weekends I have (which tend to be spent on chores and job applications and sometimes volunteering).  Although I was tempted by the job I saw advertised for Information and Records Manager for MI5 and MI6.  I want to be licensed to kill people who talk in the library or bring back books late.

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7 thoughts on “The Great Clomipramine Shortage of 2018

  1. Maybe the contract not getting renewed is a blessing in disguise.
    I say go for the guinea pigs! Granted, I’m rather biased, but I’ve managed caring for mine even when my depression is really bad. I keep them in my bedroom, so even when I can’t make myself care enough to take them out of the cage, they’re still getting some stimulation from me being in the room with them. The only real effort is doing a full cleaning of their cage, and with 2 guinea pigs that could probably be done every 3 weeks, depending on what kind of bedding you use. I don’t think there’s any need to get more than 2, as a pair is usually quite content together.

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  2. Yes, I think you’re right about the contract, I just feel guilty for thinking it, like I’m trying to get out of work.

    Yeah, I thought you might have something to say about guinea pigs! How long to well-cared for guinea pigs live for (being morbid, but I worry that my Mum is right that if a pet dies I’ll just go even further into depression).

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  3. You might consider transcranial magnetic stimulation (TMS) as treatment for depression. It doesn’t have the side effects of ECT and is said to be a very effective treatment for many (most?). It’s a new treatment, however, and I don’t know how Britain’s healthcare works and whether it would be allowed.

    Have you considered going on disability for your mental health issues? Might be worth looking into.

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    1. There are more general benefits, but I don’t qualify for income support because I have too many savings (the classic thing of government inadvertently penalising the careful and subsidising the extravagant) and I would only comment for job seeker’s allowance if I can’t get a job, and they would make me apply for really inappropriate jobs or cut off the support.

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  4. I’m not sure if that’s available in the UK. I haven’t heard of people using it here.

    I’ve been on benefits before, but I no longer qualify. It’s really hard to get benefits for mental health issues, because the questions they ask are all about doing practical things like walking, cooking and so on. I was deemed too functional and they stopped my benefits, but even before that I was only getting less than £25 a week.

    Liked by 1 person

    1. It is difficult to get disability for mental health issues here, too. I’ve applied, and the lawyer has said it’ll be another 12-18 months’ wait. I don’t think mental health isn’t given a priority anywhere in the world, unfortunately.

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