Warning: this post contains content surrounding suicide and self-harm which may be triggering for some readers.

A little over a month ago I tried to kill myself.

That’s a fucking scary thing to write in a public place, and I don’t do so lightly. This is not the first time I have tried to take my own life, and I can’t trust myself at the moment that it will be my last. This time, and the previous times, I experienced all the same shame and humiliation, the depression and disappointment, that I had failed in my attempt. I rarely talk about my suicidal feelings, even with my closest friends, and I have never spoken about this in a place where the whole world can hear my voice or read my words. It is terrifying to write this, but for some reason I feel like I must, like the words and the feelings are bursting to be set free, that I just need to get it all down in one place. So here it is, and here I am.

A little over a month ago I tried to kill myself. It was the twenty-first of January. I won’t forget that date in a hurry. I had been leading up to it for months, for that day was the day I would finally see the fabled psychiatrist. Finally someone might take the terrifying things going on in my head seriously, might be able to help me understand what was wrong, might be able to help me learn to manage them, perhaps even to get better. Unfortunately, my hopes were misplaced. The doctor I saw listened to everything I had to say, told me he was referring me for a therapy with a year-long waiting list, but that he didn’t consider there was anything going on that was really problematic (apparently even my depression was ‘in remission’ according to him) and was basically dismissive and condescending. He made me feel like I was wasting his time.

For a long time I have believed I have two options. I can get better, or I can kill myself. I only have those two options because the third option – carrying on like this for the rest of my life – doesn’t even bear thinking about. As I walked out of that appointment I felt like the former option had fallen away, leaving me only with the latter. I walked the short distance home planning my own death. I got home and spent a few hours with my son as well as my my partner and my best friend, neither of whom knew what I was planning. After I put my son to bed and my friend had left, I tried to self-harm (for the first time in many years), getting no further than a few superficial cuts before realising that it wasn’t making me feel any better, that somehow my one outlet had stopped working for me.

My partner was working away at his computer, oblivious to my actions. He is not unfeeling or stupid; I am just very, very good at appearing normal on the surface even when my ability to cope is crumbling away. I went into the kitchen, collected up every paracetamol and codeine based painkiller I could find, and began swallowing them in groups of ten. In hindsight ten was a bad number to choose because by the third group of ten I was gagging. Twenty-eight, twenty-nine, thirty, slipped reluctantly down my throat as my stomach tried to empty itself. I have a cast-iron stomach and was able to hold them, but had to stop a while to drink some water in case I vomited and wasted the tablets; I had a limited amount and wanted as many of them to stay as was possible.

I made a cup of tea. To my partner, the sound of the kettle is like the bell to Pavlov’s dog – teamaking means it’s time for a cigarette. He came out with me and we smoked, and I drank tea, and I was shaking and terrified and I felt totally out of control of my mind. By then any semblance of normalcy had gone and he knew something serious was up. After some pressing, he elicited a confession. Immediately I was marched up to the bathroom to be sick. He telephoned NHS Direct to find out what he could give me to make me sick, and was informed they had sent an ambulance. Apparently large quantities of paracetamol and codeine can be very dangerous, who’d have thought?

I remember very little of the following few hours. The quantity of codeine in my system was sufficient that I was barely awake. I remember monitors and blood tests and kind nurses, far kinder than I remembered from previous experiences. Mostly I remember nausea, consuming nausea. I lost count of the number of times I vomited. At around four in the morning my blood test results came back. I had taken considerably more than the lethal dose of paracetamol, but the blood tests showed the levels were low enough that I would not need treatment. Apparently being fat had worked in my ‘favour’.

I had just returned to my bed in the observation ward from a particularly nasty bout of vomiting when the doctor came on his rounds. He was polite and compassionate, and he asked the nurse to give me a shot of an anti-emetic so that I could have some rest from the nausea. A little later I saw the hospital psychiatrist, who was very friendly and loath to send me to a psychiatric hospital; she didn’t think it would be any good for me and I didn’t want to be away from Orion if I could help it. She released me “into my partner’s care” with a leaflet from the Crisis Team with their telephone number and instructions to call them to make an appointment for them to come and see me.

My partner made the call. For the next few days they visited every day. I was told that on the 27th their consultant psychiatrist would visit me to see what the long-term plan should be. I had been talking with my partner and he pointed out that face-to-face with people I don’t know, I come across as very ‘together’ and it can be difficult for them to see that under the surface, I am barely holding on. Like I said, I am very good at appearing ‘normal’ and I find it impossible to open up to strangers in person, however well-qualified they may be. However, I do write – prolifically, though not always legibly. He suggested I write down everything that has been going on in my head as a journal entry for myself to make some sense of it, and possibly to show to the psychiatrist to tell her in the written word that which I would be incapable of expressing in speech.

I’m going to copy here what I wrote then, because it is relevant to the rest of the story. Warning, it’s long and possibly boring and more than a little ‘emo’-sounding.

Fredrik thinks it would be a good idea to print out yesterday’s journal entry to show the doctor tomorrow. He also said it might be worth writing another one today sort of explaining where my head is at. Being intelligent and articulate is useful most of the time but when it comes to speaking with health professionals it sucks as I come across as really normal and ‘together’ and I don’t know how to let down that facade adequately to explain to a doctor how if you scratch the surface I am just hanging on by a thread.

So how am I? Well first of all I’m tired, both mentally and physically. My brain seems to be dealing with so much that’s going on internally that it barely has the energy for everyday thought and reason. My thoughts shout at me, clamouring for attention, often not in my own voice but that of screaming harpies, screeching sounds that are hardly human and make me want to clap my hands over my ears to drown them out but of course, that won’t work because they are me, my own thoughts in my own head and it is impossible to quiet one’s own thoughts. It’s exhausting, and it seems like the mental exhaustion bleeds into my physical state and sometimes it’s an effort just to keep my eyes open.

I do things compulsively, as if trying to sabotage myself. I eat compulsively, keeping my fat as a protective layer against the outside world. I eat until I am sick and then I eat some more. I spend compulsively, driving myself deeper and deeper into debt buying random objects I neither need nor particularly want, for the simple buzz of spending money. I lie compulsively, telling untruths about small, trivial things and important things alike. I can’t even remember the majority of the lies I tell. Some of them have become ingrained in me, so often I have no idea whether something I say is true or false because honestly I can’t remember the original truth any more.

I often feel like I am not really in my head. It feels like I am outside my body watching myself in a film. The things I do don’t feel like things I’m doing at all, but things that are happening to somebody else. I sometimes walk across the street and believe I am not really crossing the street, I am in a coma or dreaming I am crossing the street when in reality I am doing something else entirely. Other times I feel very much like I am myself, but this time it is the world that isn’t real. Sometimes when this happens, everything seems very loud and bright but somehow fuzzy, as if behind a frosted-glass window. Sometimes it is just the opposite, where everything seems subdued in hue and volume and size, like I am Gulliver and this is Lilliput and it is shrinking under my feet because none of this is real, not really.

It’s like a pervasive feeling of emptiness. It’s like loneliness but I feel fraudulent calling it that because I have this great support network of people around me all the time. How could I possibly be lonely? But I do feel empty, like there is nothing inside me. Sometimes I feel like the gods gave me eyes and hands but forgot to provide me with a soul. I don’t understand other humans. I react inappropriately to their emotions, and rarely feel any response to the emotions of others. I am good at appearing warm but most of the time I feel ice-cold. An empty house is a cold house, as an empty room is a cold room. I think if I was not so empty I would not feel so cold or perhaps vice versa. I have love in my life and yet I feel eternally empty, which in turn leads to guilt, which leads to depression, which magnifies the feelings of emptiness until I feel like I am being swallowed by a void, sucked into my own black hole of cold nothingness.

Sometimes I think Orion is not real. I will walk down the street talking to him and imagine that other people are watching me warily as I speak to thin air. Most of the time logically I know he is real but well… how do I know, really? I could have made up the memories in my head. There is no guarantee that other people are real either so their affirmation of his existence means very little. I often believe things exist which I later realise do not. I believe there is a person under the bed waiting to stab me. I believe there are invisible people, maybe dead people, watching me while I go about my daily business. I believe that someone will break into the house and pour acid all over Orion’s head. I believe this so fully that I see it happening. I see his skin melting, eyelids collapsing into eyeballs, his mouth fizzing and open wide as he screams for me. When I am having these beliefs, they are true. They are as true as my hands being attached to my arms. If I can believe all sorts of things to be true which others can tell me are plainly ridiculous, how can I be sure of anything I believe – and how indeed can I be sure I even exist, let alone Orion?

I don’t know who I am. People see Anji as a woman who knows herself, who has somehow ‘found’ herself. I wish that were true. I feel so lost most of the time that I don’t know whether I am coming or going. I feel like I am drifting, I don’t know what I am doing here, so purposeless, so empty. Some days I want to be an earth mother baking bread and making jam. Some days I want to be in the trenches fighting for women’s liberation on the front lines. Some days I want to train to be a veterinary surgeon. Some days I just want to pop out babies. I can’t decide who I am and I’m a different person depending on the day, so how am I supposed to decide on one career for the rest of my life?

Thoughts of suicide and self-harm are never far from my mind. Sometimes I love myself – but sometimes I hate myself, loathe myself to the point that I feel like I need punishment. I swing between believing I am the most important person in the world, head blown up with delusions of my own grandeur, to feeling tiny and insignificant and disgusting, an insect which needs to be stamped upon. When I feel suicidal it is for one of two reasons; despair at the state of my thoughts and the distress I feel on a daily basis, or this intense hatred for myself and the feeling that I ought to do the world a favour by taking myself out of the picture. Death doesn’t frighten me any more, instead I idealise it as the ultimate escape, the ultimate release. It fascinates me and tempts me and seduces me from inside my own mind. Even when I am feeling ‘well’ I have suicidal thoughts often, and thus far I can’t pinpoint a reason for that.

Self-harming thoughts are often for those two reasons; a release from the pain in my mind via physical pain, or a method of self-punishment. Sometimes though it is far more prosaic, simply wanting to ground myself, to remind myself that I am real. When I feel like I am unreal, like I am not really a person or that the world around me doesn’t truly exist, self harm can be the one thing that helps me re-associate my mind with my body. I see myself from the outside self-harming, and then I feel it from the inside, and it’s like a reminder that yes, this is me and this is my body and I am really real. Since I ’stopped’ self harming I feel distant from myself a whole lot more and I long to be able to self harm just to remind myself that I am me.

Often I feel like I am being watched. Sometimes I think there are cameras watching to make sure I am not abusing Orion. Sometimes I think the Government are watching me with cameras and wiretaps and goodness knows what, because I am somehow important to national security. Usually this coincides with my feeling-important episodes rather than the feeling-insignificant ones. Other times I truly believe I am in some kind of real-life Truman show; that all of the people around me are actors, that everything that happens to me that seems to be new or spontaneous or random, is already written by a screenwriter, that people I do not know and will never meet are watching me on this grotesque reality television show.

At the moment I am scared to leave the house. The world outside is huge and the people in it are dangerous and unpredictable and I don’t trust them. For that matter I don’t trust myself. I don’t trust myself not to step into traffic or throw myself off a motorway bridge or all manner of other ways I would have out there of killing myself. But even aside from suicidal thoughts I just can’t face the world. My little world here in my home is safe, I know it well, Fredrik is here to look after me. I am terrified, so terrified, that this is all going to get too much for him and he’s going to run away as so many people have in my life. I am terrified of being abandoned. For now he is here and as long as I am in my house and he is here helping me then I feel fairly safe. Outside, all manner of things could happen, and I just don’t feel up to going out into the world at the moment.

Fredrik is probably the first person who I have managed to have an equal, long-standing relationship with – not just romantic relationships but friendships as well. I think this is another reason I am so scared of him leaving me on my own, as with most people I get into very intense, fierce relationships quite early and then sooner or later, they blow up in my face quite catastrophically. Like I said earlier, I find it difficult to understand people, I am bad at dealing with them and I am bad at relating to them. I am scared Fredrik is going to eventually realise I’m a horrible person and make his exit. Orion seems to be particularly clingy too, and I know he is only three and logically I know that’s probably totally normal but I can’t help being scared that he gets hisclinginess from me, that he will be perpetually dependent on other people as a result of my own faults being passed on to him.

Along with all of these bizarre and distressing thoughts and experiences, there is my mood itself. I don’t imagine any of these things would be easy to deal with even if I felt stable but as it is, I feel like I am on an emotional roller-coaster every waking minute of my life. I have massive mood swings, from suicidally depressed to high as a kite, and there is no pattern to them. They last anything from ten minutes to a few hours. I never know how I will feel five minutes from now.

When I am high, I can’t stop moving – I feel like I have all the energy in the world. I sing stupid songs, I talk nonsense and say inappropriate things, I shout or squeak or tell stupid jokes, I embarrass myself. I clean until my hands are red and raw. I talk incessantly and never remember what I am talking about; it’s like as soon as a sentence is out of my mouth I have forgotten what it was and I have to ask “What did I just say?” I am particularly forgetful most of the time anyway, a fact I have always put down to the amount of other stuff my brain has to deal with – but when I am high or just coming down from a high episode, I can remember basically nothing of what I have just been doing or saying.

When I am low, I can’t even force myself to stand up. Eating, showering and housework seem like pointless activities. Orion is irritating and I just want him to sit in front of Cbeebies or a colouring book and leave me alone, because I can’t handle him. I don’t want to talk to people. I don’t want to do anything. Reading a book or watching mindless television seems like too much of an effort. Often when I am low, I sleep if I can. It’s all I feel like doing that is safe, because in a low episode left alone and awake with my own thoughts, I often get to thoughts of suicide and/or self-harm so sleep seems like the safest option.

So that’s my head in a nutshell. There are a whole lot more things going on than this, but this is as bare-bones a way of describing the environment inside my head as I can write. The doctor I saw on Wednesday afternoon basically told me there was nothing wrong with me, that it was just the way my personality is, and that he saw no need for further help (aside from referring me for the cognitive therapy with the 12 month waiting list) because my mental state “isn’t impacting on my life significantly.” This is my way of writing out what is happening to me, and to try to describe the significant ways my life is being affected.

As I said before, I can’t go on like this. Either I am ill, in which case I will get help, or there is indeed nothing wrong with me and I’ll be back to square one, suicidal because I can’t face the prospect of being like this day after week after month after year. I said at the beginning I’m hanging on by a thread and I meant it. I reached my limit on Wednesday and now I am only surviving because my friends and family are holding me up, hoping that there is someone out there who can help. Right now, I just don’t know.

- 25th January 2009

The next day, the psychiatrist came for our appointment. She was friendly and accessible with a wonderfully soothing Scottish accent. Fredrik gave her a printout of the above before we spoke. She read it and agreed that it had been a really good idea to write it and present her with it, because it got everything across far better than if I had tried to explain it to her face to face. She diagnosed Borderline Personality Disorder (also known here in the UK as Emotionally Unstable Personality Disorder of the Borderline type). She asked if she could keep my piece of writing, because it was “excellent and articulate account of what it’s like living day-to-day with BPD”. A diagnosis isn’t important to a lot of people, but for me it felt like having a weight lifted off my shoulders. It was that realisation – that I’m not just being melodramatic, that I’m not making things up in my head, that someone is taking me seriously and now I have a name for this, I might be able to start finding out how to deal with it effectively.

Of course that wasn’t the answer though, and it didn’t make everything better. The Crisis Team were scatty at best and thoroughly disorganised at worst, and I was sinking further into depression again. On the seventeenth of February I fell apart again. I spent much of the day either catatonic or actively suicidal, everything I looked at I was wondering how I could use it to hurt myself or kill myself, I was shaking violently from stress and a complete lack of control. I broke a glass on the patio just so I could have something with sharp edges. My partner convinced me to call the Samaritans, who were very nice but I still felt the same way afterwards, so he made an appointment with the GP for that afternoon. The GP referred me to the Orchards, a local psychiatric hospital, to meet with the crisis team there.

The two men from the crisis team were nice enough, though one of them seemed insistent that there wasn’t much they could do and I’d just have to learn to deal with it by myself. They did however agree to make an appointment to see Dr McFarlane (the nice Scottish one) again the next day. So I did – and I think that may well have been my turning point. She wanted to change my medication; I have been on Paroxetine for the better part of four years and the thought of coming off it terrifies me. She said that we would simultaneously decrease the Paroxetine and increase the Mirtazepine, which is the new drug she wants me to try, which should minimise the effects of Paroxetine withdrawal. I have experienced its withdrawal symptoms in the past and they in themself would be reason enough to feel suicidal, so I am glad we are taking it slowly.

She also told me about something I’d never heard of before – hospital day treatment. Basically you go in Monday to Friday for about six weeks. They do all sorts of group talks and sessions about all aspects of managing mental illnesses, art sessions, relaxation techniques, mood management, all sorts of things. She made an appointment for me to go in to speak to the two people who run the Day Treatment and basically to sign up for it, stressing that if I decided in the meantime that it wasn’t for me, I was welcome to phone and cancel.

We spent the weekend with my parents as they’d offered to have us so I could have a bit of a break, and then on Monday morning I went back to the Orchards. The Day Treatment people were so, so nice and the course/whatever you want to call it seems really productive and proactive and it’s all very flexible. For once I’m feeling positive about something to do with my mental health. The Day Treatment will hopefully help me learn the skills and tools I need to cope with and manage my mood and deal with unwanted thoughts in positive ways, to keep me alive and coping until my therapy begins in a year or so.

So I’m now on day 3 of Mirtazapine, I begin Day Treatment on Monday coming up, and take my last Paroxetine tablet on Tuesday. It’s sad that it took a suicide attempt to get the help I needed, but now I am being offered it I am going to do my best to make the most of it. Get better or die, remember? I am still experiencing suicidal ideation and desires, and I haven’t managed to stop self-harming again yet, but I am at least having some positive moments as well. The universe decided to work with rather than against me for once, and maybe I can be successful with that first option after all.

Congratulations if you made it to the end of this. I promise my next post won’t be so wordy.

So, things were going well & then halfway through last week the withdrawl symptoms kicked in. Sheesh, major waves of dizziness and nausea, despite having carefully cut down on my dose before stopping the pills.

I felt reassured that it was withdrawal symptoms, rather than some fun, new ME symptoms, due to the previous comments on here. Plus, some googling revealed hundreds of posts on message boards from people complaining about dizziness & nausea when coming off citalopram.

Ended up having a couple of days off work, as I couldn’t cope with the dizziness on top of my ME, but I’m pleased to say that everything is abating now. Back at work and minimal dizziness.

I have been waking up at about 3am every morning this week, which I suspect is another symptom of my body adjusting to coming off the pills, but I’ll re-instate my sleep hypnotherapy CD tonight and see if that helps.

Overall, I’m pleased to be off the pills after three years, despite the small hiccups.

So, I thought I’d share how things have been going on the fluoxetine (Prozac) recently, and see if anyone has any ideas…

1. It’s stopping working… slowly, over the past 2 months, it’s been getting less and less effective. Firstly, the feeling of general contentment slipped away, putting me back to the usual base level of continual insecurity and worry. Then the bad thoughts started to reemerge, and the depressed moods return. Don’t get me wrong, it’s still better than it was when I wasn’t on medication. It really is. It’s just losing its efficacy with every day, it seems.

2. I went to the university health centre, and they won’t let me see any other doctor than the one I’m registered with. Last time, because he was on holiday, I saw an amazing doctor who was really positive about alternate types of drugs and was very reassuring. The doctor they assigned me just sits there in silence most of the time and then hands you a prescription. Nurses have told me he’s very shy, but I feel really uncomfortable around him. And now he’s back I have to see him on Wednesday and tell him how badly things are going… and I just don’t feel comfortable doing that. I’m dreading it.

Any advice?

I’ve been on Prozac for three weeks now, so I thought I’d report back on its effects, and also offer a bit of a forum:

Comment, if you want to, sharing what medication you’re currently on, or have been on, (doesn’t have to be anti-depressants) and the effects it’s having/had on your life and mood.

Basically, I don’t think people talk about this enough! So, yes, Prozac has been… great. Unexpectedly so. The awful recurring thoughts of badness have pretty much disappeared, and when they come are much MUCH less persistent and less potent. I’ve also generally been feeling pretty ok a lot more of the time – actually contented.

So far, side effects have been minimal, although I am feeling tired in the afternoons more. At the moment that’s ok – I can either have a caffeine overload on the days I’m at work, or have a nap (yay for being a student…), but that’s not really going to be possible when I’m (hopefully) working full time in about 2 months. Apparently Prozac side effects do decrease with time as your body gets used to it, so I’m well willing to give mine the next two months to find out, but if it doesn’t get any better I know I’ll have to make some hard choices.

It’s made me think about quite a few different things, too. I had a brief email conversation with Dr Ben Goldacre (of Guardian Bad Science column fame) about SSRIs, of which Prozac is one, which have been in the news recently. Studies have shown that for people with mild to moderate depression (I would class mine as moderate, as it’s not totally debilitating, but without drugs I am depressed, anxious and suffer upsetting thoughts every day for significant amounts of time) SSRIs were about as effective as placebos.

Obviously, this was shocking news for a lot of people, and various people on here talked about it. To put a different perspective on the issue, a friend of mine who is a psychology student at Sussex University rubbished the revelations, saying they’d only looked at surveys of patients up to one month after they started taking the drug, and that it normally takes longer than that for some people to feel the benefits.

Which, of course, led me to wonder – is Prozac having a real effect on me, or is it a placebo, and I’m effecting the change on myself? I suppose it’s unknowable. Medication for depression is often likened to using a sledgehammer to crack a nut, so delicate is the brain’s internal chemistry and so primitive is our knowledge of it. Yet I do feel better, even though I’m consciously aware of the findings of that study, so I think that’s really the only important thing to consider.

The other thing I’ve been struggling with is my personal history. I’ve been on anti-depressants before, during 2003-2004, in my first few terms at university. At the time, I made lots of new friends and was feeling happy and confident in my life. I remember that time as beautiful – full of drunken nights out, laughing endlessly with new mates and being amazingly, intellectually challenged. Up until now I’ve always thought of that time as a result of the circumstances of my life, not the citalopram, then escitalopram that I was on. But I’m being forced to reconsider, now, with the clear, obvious effects Prozac has had on me. It’s patent that my cynicism was, in some ways, unfounded, and that much of my general enjoyment of that time where I felt unanxious, free, fun loving and happy was down to the drugs. I’m not discounting the experience as helping – I’m sure being at uni for the first time had a big effect on my mood. But I’m also fairly certain the drugs had a big effect too.

I’ve recently started to realise, too, that I’ve been depressed, anxious and prone to upsetting thoughts for most of my life. I remember having them, and compulsively overeating, as young as five or six. They’ve never really stopped, or gone away, but have just been influenced by different things, such as grief or love. As such, I’m starting to wonder how long I will need to be on medication. For the rest of my life, perhaps? I’m still reeling from how much Prozac has helped me in what is really a very short time, and wondering how this year, last year, all the other years of upset and sadness and anxiety would have been different if I’d just been put on it sooner. I guess it’s unknowable, too.

Conclusions from all this soul searching aren’t easy to come by, except that I’m going to be far more tolerant of side effects this time. The escitalopram and citalopram I was on before made me drowsy every afternoon, so I was napping a lot and ending up sleeping for twelve to thirteen hours every day. At the time, unsure as to whether the drugs were really having any effect, I gave them up, reasoning that I needed to be awake more of the time so I could work better on my essays and reading. I spent my second year in a haze of extreme anxiety, deep depression and self harmed a lot. I also often got work in late and didn’t read enough, which, I am sure, contributed hugely to me getting a 2:1 instead of a 1st. I don’t want something like that to happen to me again, so I’m going to stick with these a bit longer, and see how it goes. I’ll report back, anyway.

So, what are your experiences?