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Teetering on the edge of inpatient


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Hi guys. I've suffered from depression and anxiety since the beginning of high school. I got cancer in my early twenties, and that really, really, really didn't help. That was almost a year and a half ago, and I've had surgery, chemo, radiation, antibody treatments, and hormone treatments. The cancer is gone, at least for now, but it will probably be back someday. That knowledge is a little hard to live with. Instead of making me appreciate whatever time I have, I end up just hoping that it comes back and kills me sooner rather than later, to get it over with. I am definitely not the model ~cancer survivor!~ that the media loves to show off, hah.

I've basically just been on slightly different combinations of these two for the past four years:

- Lexapro, currently 5mg, up to 20mg in the past

- Wellbutrin XL, currently 300mg, up to 450mg in the past (the max dose was awful--twitching, shaking, irritable, sleepless, anxious, obsessive, etc.)

I was "functional" through college, just usually miserable, with occasional suicidal ideations. I found a short-term job in my field that I enjoyed, and was in the process of applying to grad school when I had to drop everything and move back in with my parents for cancer treatment.

I don't know if the 5mg lexapro is even a therapeutic dose. My current pdoc reduced it from 10 because I have so much fatigue left over from cancer treatment. (All of my "active" treatment is done, but I'm still on shots that shut down my ovaries and put me into medical menopause.) The change from 10 to 5 made me sit around feeling like I wanted to die for a while, but eventually I stabilized. I don't know if I'm any less tired, though.

I've had insomnia since I was about eight years old (and had night terrors before that), and when I had surgery that forced me to sleep on my back for months, I was given lunesta so that I'd sleep at all. Now I'm at 3mg lunesta pretty much every night, and it's still not a guarantee that I'll actually fall asleep, even if I take it with 1mg ativan (which is a pdoc-sanctioned combo).

We recently added buspar (5mg BID at first, up to 10mg BID), in an attempt to stave off some of the anxiety that's intensified since my cancer diagnosis. I had been taking ativan, but I wasn't comfortable with benzos on a daily basis. Not long after, for the first time I wanted to kill not only myself but also as many people as I could take out with me. It took me a few days to realize, oh, shit, that's new and different, I need to tell someone. I told my therapist, since I know her better, and she said I really needed to tell my pdoc. So I worked up the courage to call him on Monday. I stopped the buspar immediately, and yesterday I finally met with him again. He referred me to a partial hospitalization program, which I got in touch with today. They're checking my insurance and I can start Monday.

The problem is, I am having a lot of trouble determining whether or not I really should be inpatient instead. I've never cut myself, but I start biting my hands, hitting my head, and pulling my hair when I'm at my most distressed. I tore apart a microbead pillow the other day as a substitute for hurting myself (satisfying, but holy shit so messy), and now I'm semi-obsessively still trying to clean up all the tiny styrofoam balls that got everywhere. I come across swiss army knives in drawers (I own several, since I used to do a lot of outdoorsy stuff) and for the first time, I think about using them to slash through my skin. When I saw my pdoc yesterday, I actually really wanted to go into an inpatient program, so I'd be safe and my horrible sleep schedule could be regulated a bit. I want my meds changed, but I want it done under close supervision. The partial hospitalization program sounds good for the med-changing, but I was scared and crying by the end of the appointment because I was basically being told to just go home and wait. But I "present well," and I've gotten so good at covering up my emotional problems even to myself that when I'm feeling more OK, I start second-guessing myself and thinking, jeez, stop being so dramatic, you don't need to go inpatient. It's not like I'm actively trying to kill myself. But my mood changes so quickly, and other times I feel like I should probably go to the ER and see if they'll admit me, even if only for a few days, to get me stable enough to deal with partial hospitalization.

How do you know when it's time to get emergency help, before it gets too late and you actually end up hurting yourself?

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If you have to ask the question, then it's probably time to get help. You would not be wondering about this if you felt ok, and it's not a matter of drama. I sometimes feel the same way when I get manic- I think I'm just being melodramatic and need to get my act together. Trouble is, I can't, or at least I can't for more than 5 minutes at a time. I think it's more a recognition that I'm not behaving/thinking the way I normally do, and that's a actually a GOOD sign. It means I'm not totally out of it yet.

So between now and Monday, if you think you need to go the ER, then go. They're always open! So you needn't plan ahead.

There's no prize for waiting until Monday. And I can tell you from experience, it's no fun to go to the ER after you've hurt yourself. Not for you or your family.

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hello, and welcome.

i'm sorry you're in this really awful position. i can't imagine having to manage MI and cancer.

i hear you loud and clear that you are not okay, and that presenting so well is not helping (i have always had that problem too). i have to agree that there's no prize for waiting to get help. you have so much room for trying out different meds and being inpatient means you can be safe in the meantime. i may have to go this week myself, depending on the success of the latest med, and boy i know the waffling (i'm not that sick, i'll be fine, i'm just being dramatic). doubting yourself doesn't mean you don't need immediate help. the fact that you have a plan on only a short stay, then partial sounds like a good thing to me. it sounds hopeful.

i hope you find something that helps soon.

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Thank you for the replies. My sense of time is so confused lately that I thought I'd posted this yesterday.

I guess I kind of "knew" that if I'm questioning my safety this much, I should probably seek help. My pdoc basically told me that I shouldn't go inpatient, because they'd just hold on to me for a few days and then spit me back out without really fixing anything, and that I'd be in with the really crazy people. (Uh.) Unless, of course, I'm in crisis, in which case I should go to the ER right away... to... not be fixed? I don't know. I get what he's saying, that inpatient is for acute crisis stabilization, and they're not going to want me hanging around any longer than I "need" to in order to stay alive. (Or, at least, my insurance sure won't want me to.) I guess I was kind of hoping for something where they could aggressively manage my medications while inpatient. I think the partial hospitalization will do that job well enough, but for some reason I felt abandoned and scared when I found out I wasn't going to be hospitalized unless I go to the ER.

I've realized that I'm anxious about going to the ER and having this forever be "the year turdus ruined Easter!" Except if I actually did hurt myself instead, it would be the year that I REALLY ruined Easter. hah. ugh. I'll see how tonight goes.

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My pdoc basically told me that I shouldn't go inpatient, because they'd just hold on to me for a few days and then spit me back out without really fixing anything

this really sucks. i'm in a very similar position. my pdoc said he would have me admitted right away if that's what i wanted (so i can skip the whole ER drama), but that on a holiday weekend, i'd get... nothing. well not nothing, but pretty much the same scenario you're describing. i'd be safe, but nobody would be doing any fixing. so we're waiting to see if i still feel unsafe after the holidays (and the beginning of a new med), then if things haven't changed i'm still going in.

i understand feeling scared because pdoc took that option away for the time being. let's just pretend he is right and it would be SO CRAPPY in there right now, and whew aren't you glad you at least have a few more days with your own stuff in your own space, even if everything sucks. that's what i'm doing. pretending that i've narrowly escaped having an even worse easter by going someplace where everyone feels as bad as i do and nobody's helping anybody. thinking like that wouldn't be useful in the long term (for sure!), but it's helping me stay home in the short term.

and you are sure right that hurting yourself makes for a FAR worse easter than going IP. i'm just trying to create a third scenario where, even as desperate as i am, easter is better at home. maybe you can too?

besides all that, hanging out at CB for the holidays is loads more interesting. hang out here, or anywhere that distracts you out of the pain for a few minutes at a time. you'll be in good company here too - it'll be like the hospital in that we're all crazy, but hey, we're crazy and FREE here heh. you don't even have to report it to insurance. ;)

(edited for atroshus spelling)

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Thank you. Cancer is really shitty, for sure. Long-term, I feel like I was better able to handle it than the rest of my psychiatric stuff, though, I guess because I couldn't find any way to blame cancer on myself. And I'm a champ at blaming everything on myself! Everything's my fault, because if I just "tried harder" (to do what?! I don't even know) it wouldn't be a problem. Yeah, right.

Lysergia, I'm sorry you're in a crappy position like this, too, but at least it is reassuring in some weird way that others have gone through this as well. It is really weird to really not know if you can trust yourself. You know, even though I'd been thinking about this happening around a holiday, I didn't even make the connection that hospital staffing on Easter might be less than ideal.

Last night I had some kind of akathisia incident! I was feeling agitated, and then antsy, and then I just couldn't stop moving. I was sitting down and my legs were thrashing around. Voluntary movements, not spasms, but still uncontrollable, you know? I kept making fists and shaking my arms really hard, even headbanging, kind of stamping my feet. I had this weird idea that I wanted to bite off all my skin (I don't even know what that means). I took 1mg ativan after a while (prescribed for anxiety), and it wasn't seeming to calm me down that much. I live with my parents, and my mother eventually came into my room because apparently I'd made enough noise bumping into something to attract her attention. I told her what was going on, and she asked if I wanted to go to the ER, but for some reason I said no. My speech was even very slightly slurred at times. She did stay with me and talk to me for quite a while, and I slowly calmed down. I kept shaking my wrists back and forth (she said I reminded her of her grandmother, who had Parkinson's) or opening and closing my fists or tapping things, but no big violent movements. I usually have a very hard time talking with my family about depression, but I told her about some of my anxiety regarding my family's response to me going inpatient, or even doing the PHP (they were all totally traumatized by me getting cancer, which I can't blame them for, but I internalize it nonetheless). She assured me that everyone just wants me to feel better, and not to worry about them, and to focus on myself. My mom has some pretty bad anxiety problems, too, and I'd previously been afraid that if I asked her to take me to the ER at some point, she'd panic and make the whole situation even worse. She stayed level-headed last night, though, and I feel a lot better knowing that she'd be able to deal with it. (She's been doing therapy of her own recently, and I think it is helping.) I eventually calmed down enough that I was content and sitting still (about three hours after it had started), so she went off to bed and I eventually did, too.

And today I feel OK, like I'm not at all in danger. Distracted enough by small pleasant things to be calm. I colored some eggs and played Pocket Frogs. I feel like I'll be able to deal with seeing more family tomorrow, and I look forward to starting the PHP on Monday. I have no idea what caused that last night, because the only medication thing at all out of the usual was that I hadn't taken lunesta the night before, and hadn't slept very long. But that's certainly not a new situation. I haven't been able to figure out a likely cause. I stopped the buspar on Monday, and that has a short half-life, so it should've been out of my system already, I imagine. I was on a low dose, and I can't find much info on buspar withdrawal. It seems that most antidepressants can cause akathisia, but why now, all of a sudden, after months of no dosage changes? Also, amusingly enough, propranolol seems to be the go-to treatment for akathisia, and I'm already on a low dose of propranolol for tachycardia (long-lasting chemo side effect).

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we're on some kind of similar wavelength here, heh. not that i want you to feel crappy either, it's just strangely comforting when someone's going through such similar symptoms at the same time.

i am so glad your mom handled things well! speaking as a mother with anxiety who has dealt with her own daughter's struggles, let me second that your mother really REALLY wants you to put yourself first and be honest! no matter how scary, i always wanted to know what was really going on. it was actually easier than the anxious scenarios i would create in my head about how she might be feeling - my fears were always worse. and i would absolutely hate if she were to put protecting me first! being able to help feels so much better than being protected. i think your mom will be okay and you can keep being honest. :)

yesterday and so far all of today i feel those same feelings of physical agitation just sort of teasing me - not fully like you're going through (god that sucks, i know how awful it is). and i've suddenly stopped crying. stopped thinking at all, almost. i'm... uncomfortably aware of my body and can't seem to make it happy no matter how i sit/stand/move. but i know the cause, it's the new TCA and BOY i was not expecting to react this quick on such a tiny dose. and yeah, like you, i'm much more easily distracted today, even if i do have to keep switching activities, there's not that prolonged period of desperation/crying in between.

last night sounds like it really really sucked... sounds like what i go through in a "mixed" episode (that nobody ever calls the same thing twice, heh). no wonder you're trying to figure out where it came from out of the blue, though. maybe for some weird reason the lunesta and the buspar were keeping that from happening. i wonder what the dosage difference is for treating tachycardia vs akathesia... as a kid i took propanolanol for tremors and tachycardia (hyperthyroid stuff). but i've never tried it for anything else.

glad it's abated today, and i hope it stays away tonight, too! that's one more day we've got through.

oh yeah, and benzos don't seem to do a whole lot for me during those times either. AAPs do, though. seroquel or zxprexa knocks that right out until the episode's over. i'm on seroquel for sleep, so yay. maybe something about your night meds (lunesta) was helping.

keep checking in!

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I'm sorry for all that suffering.

I am definitely not the model ~cancer survivor!~ that the media loves to show off, hah.

Have you ever read the book smile or die? It specifically talks about breast cancer and the intense pressure on patients to be positive and upbeat and how it can be really harmful.

Anyway, now probably isn't the best time for book recommendations. I'm glad you're feeling a bit less agitated. Keep us updated on how you are.

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Hello

I read you post and I was wondering if there is something else wrong, like maybe your electrolytes are off.

I hope you are feeling better and if you don't have to go to the ER this weekend, please follow up with doc on Mon.

When I feel on the "edge" I avoid isolating but also work to keep the stimulus low. I call it my low stimulus plan.

You know not too loud, I try to talk with folks who seems happy grounded and with a glimmer of joy.

Good that you posted your feelings and I am sending out warm fuzzies your way.

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I was reading my post and realize that I used the words happy and joy quite freely here.

I think it may have been better if I had said "accepting" people. Sorry to sound so superficial.

People who can be cool with where I am at that time.:mellow:

Much like the folks on CB.

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Man, I almost got through Easter without any problems at all. But my mood suddenly tanked at night, and I should've taken the cue to gracefully remove myself from social interaction, but I didn't. Instead I got so upset at my mom and sister that I wanted to scream at them. My sister kept referring to partial hospitalization as "depression summer camp." Over and over. I get it, she was trying to normalize it, but it felt really patronizing. She and my mom had both got it in their head that one of the things I'd be doing was "art therapy," and were like, "man, I want to do art!" Jesus fucking christ, they can go to the craft store and get some fucking art supplies and do some fucking art at home then. (In retrospect, I kinda wish I'd actually said that.) Then they proceeded to list everything bad that's happened to me in the past year and a half, all the things I have stacked against me: I was already depressed, and then I got cancer, and treatment was physically very hard, and emotionally hard, too, and I have the fear of recurrence, plus I was thrown into menopause, and everything I'm on has side effects, and I was at a transition point in my life, and now I don't know what to do, and it'll just take time for me to recover from all of these things! I think they were trying to give a "reason" for everything, so that all my troubles have an identifiable and therefore potentially fixable source, but instead it just made me feel so much worse. I went back to my room and bit my hand to keep myself from screaming and crying or breaking things, and then just sat around and cried for a while. My hand is still sore to the touch. :\

Well, anyway, today was my first day of the partial hospitalization program. I didn't sleep much last night, despite lunesta+ativan, but I made it there on time. There are only two other patients right now. I have no idea what's typical for programs like these, but the small group size is nice. The sessions were fine. I have lots of handouts to read. I liked the pdoc who evaluated me. He suggested I discontinue my probably-not-therapeutic-anyway lexapro dose, and add seroquel. I haven't tried mood stabilizers before, and while I definitely don't exhibit "classic" bipolar symptoms, the descriptions I've read of mixed states sound an awful lot like how I am all the time. I'm trying not to get my hopes up TOO much, but oh, it would be so wonderful if it turned out that I respond well to mood stabilizers, and we were just using the wrong meds, and now I can live happily ever after (until I die of cancer. kidding! well, kinda).

I'm exhausted, but I don't feel like hurting myself at all, and I'm optimistic. I'm looking forward to continuing the PHP for however long I need. I really think it will help, and I really want to feel better. Thank you all for your replies.

Lysergia, I hope you had a good Easter and are doing well today.

I didn't recognize the title Smile or Die at first, but I realized that its other title is Bright-Sided, and I have it and I've read part of it. I LOVE the part on cancer. Breast cancer is what I had, and pink ribbons drive me nuts. I was diagnosed during Breast Cancer Awareness Month, which made the series of tests leading up to diagnosis all the more traumatizing. When I was bald from chemo and going out hatless in public because the hot flashes were too much, I at least had some fun picking up really stupid pink-ribbon-placement products in stores (breast cancer awareness guacamole to match your breast cancer awareness socks) and really loudly saying, "Oh, look! A pink ribbon! This was made JUST FOR ME!"

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Wow about the depression summer camp. Wow. I would tell her to stop it. It *is* patronizing, not to mention belittling of a serious illness.

And being bipolar you can only make art when you are crazy, haven't you learned that? Crafts from the store wouldn't have that all important touch of madness.

When I was really active in the gay community in Pittsburgh, a lot of my friends felt the way about rainbows that you do about pink ribbons. Barf. Fly the flags, for sure, but I don't need a triangular rainbow bracelet with a fake pink triangle gem.

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