Speaker 0: 0:10

G'day everybody. My name is Elliot Waters and you're listening to the Dysregulated Podcast, as always. Thank you for tuning in, alright. So today's episode is some feedback and an update on how things are as far as my medication regimen is concerned, because yesterday I had a psychiatry appointment and I'm going to tell you all about it right here on the show right now. So it goes a little bit deeper, though, or at least this episode will go a little bit deeper than just the medication changes, although there's been a little tweak which is definitely worth mentioning.

Speaker 0: 0:42

But as we, things in my world run very deep, and unfortunately a lot of this psychiatry appointment to me felt very surface level, through no fault of the doctor or myself or anything else like that. It's just the way it is. But unfortunately, these sorts of appointments, you're running to a bit of a time schedule and often you don't get the opportunity to advocate for oneself in detail or as much as you'd like to, purely and simply because of the constraints around the appointment, and that's the problem. See, that's the problem with the system as a whole. I don't think this is just for New South Wales or Australia, I think this is everywhere. But the system that we all try and work with and hope the system works for us is very reactive. So a lot of my story you would hear on this show is me trying to intervene because I see my prognosis is not going too well. So I try and intervene and be preemptive before things get to 10 out of 10 on the risk factor level. You know what I mean. But the problem is, unless you're a 10 out of 10, the system doesn't always pick up on you. It's usually once the person say me has done something, then the system will come and you know, do its thing and try and safely get me through that period of time. But until that point, until the something, whatever that may be happens, but until that point, until the something whatever that may be happens, quite often the system just is not responsive at all. It's not made really to come in and intervene at the earliest stages before the risk gets too high, because unfortunately the supply of mental health professionals or the demand for mental health professionals outweighs the supply big time, especially here in New South Wales at the moment, and I've done an episode on the New South Wales mental health system previously. If you want to listen to that I believe it's got some good insights into the system that I'm trying to navigate.

Speaker 0: 2:37

But the fact of the matter is you don't get enough time with psychiatrists to really go into things properly, so you've got to sort of go in there with a bit of a game plan. But the thing is, when you're anxious and depressed like I have been and am at the moment, when you're anxious and depressed, you don't come up with these plans because what's the point? They're not going to work, or you're not worthy of such a plan, or there's just not enough positive reasons to go in there and create a plan. You can't just create a plan from nothing. You've got to have some sort of energy, some sort of capacity to be able to think of this plan and then be able to speak it out loud, reproduce it and look for the results that you're gunning for. You can't do this from your bed. Until today, I've been in bed again for like two days, just scared of living and just sleeping my worries away, except they're always here when I wake up, and even in my dreams I'm having panic attacks. So there's no escape.

Speaker 0: 3:39

But it's very difficult to be hopeful and have some optimism and come up with a plan, present it how you'd like it presented to the psychiatrist and then them to get on board with whatever dream it is that I've come up with. It's very hard for that to happen when you're depressed and anxious because you don't have the energy first off to do it, because whenever you think of the future this is the thing with anxiety anxiety is very future facing. So me coming up with a plan that I believe could help me moving forward involves me having to imagine what life is like up ahead, and to me, because I've got an anxiety disorder, that is a very, very scary thought. A very scary thought. I look ahead and I see storm clouds and I see hail damage. I see trees blown over. My world, when I look ahead, is very chaotic and it's not a great place to be. So for me to come up with a plan that's future focused which it needs to be as much as possible that involves me having to step out of my comfort zone, which is right here in the moment, and look ahead and potentially see some sort of you know sun coming through the clouds and be able to come up with a way to manage the storm and then be able to get through it. So, like I said, that involves me looking forwards and when I look forwards I get a lot of anxiety, so I tend not to do it much anymore.

Speaker 0: 5:00

And then the depressing side of things the depression is very past focused. So when I'm looking for some energy to create this plan that I want to come up with for the psychiatrist, you know you look in the past to see what's worked, what hasn't, and then you come up with, hopefully, an idea from that. But when I look in the past, all I see is doom and gloom. It's the same thing, a bit like the future focus sort of anxiety. This past focus, depression is all bad and it's all doom and gloom and there's not much there that I grab onto and think, all right, I'm going to use this bit of positivity and I'm going to use this bit of positivity, optimism, for my future sort of focus, self. I'm going to put them together, I'm going to come up with a plan I'm going to present to the doctor and this is going to be the way forward and hopefully, all things going to plan. I'm a little bit happier moving forward but, like I say, I look to the future scares the crap out of me. I look to my past and it's all all gloomy, grim, depressing. The past is telling me we've tried so many medications, elliot, and nothing's worked. There's nothing here to suggest that a medication change is going to do the job. But despite that way of thinking, I've got to push past that and come up with some way to try and get my message across in a way that is understandable. So then things can be changed medication-wise, at least in this situation with a psychiatrist. Then things can be changed medication wise, at least in this situation with the psychiatrist. Things can be changed, hopefully looking towards a better future and building that life worth living.

Speaker 0: 6:31

But unfortunately, yesterday I was caught and I am caught. I'm still in it now. In this sort of well. The anxiety is always there. I'll say that a lot. But it's true, the anxiety is chronic. It never leaves.

Speaker 0: 6:42

But depression. The depression tends to swing a bit. I'll swing into depression for a little bit, then I'll swing out of it, swing into it again, swing out of it. It's all very fast moving, but unfortunately I'm in the depressing storm right now. I'm in a depressive state at the moment. It's taking a lot of energy just to do this episode, for example, and it took a lot of energy to go to the psychiatrist yesterday, have the belief that I could get my message across whatever the hell that message is meant to be and then have the belief and the hope that whatever changes we make moving forward will actually do something. So the problem is, a lot of people will present in these situations and the ability to advocate for oneself is severely diminished.

Speaker 0: 7:27

So you know, for me to go into this psychiatry appointment in the mood that I was in yesterday, which has been the way it has been for at least a fortnight now. You know I walked in there without much hope, let's be honest, and it would have been written all over my face, you know, like I was making zero eye contact, not a good sign. You know I wasn't able a bit like now not able to formulate my thoughts very well and get them across, very sort of superficial, simple, closed off answers to questions. You know these sorts of things are subtle, but a good mental health professional will pick up on it and will note that down as signs that things are troubling at the moment. It was a very short appointment because I went in there with little hope and I sort of just wanted to get the hell out there so I could get home and retreat back to bed, which I knew was not a good idea. I know that. But at the same time hey, you know, this is my perception of the world I'm scared, I'm petrified and I'm now very depressed about it as well. So, you know, I'm doing the best that I can, and part of that is going to the appointment yesterday and it's, you know, it's good that I made it. It was a good step that I was able to go, I was on time, all that sort of stuff.

Speaker 0: 8:41

But unfortunately, me presenting or the way I presented was not in a way that is in keeping with self-advocating in some good way, unfortunately, because I just didn't have the oomph to do it. I didn't have the drive, I don't have the belief, so anyway. So I went in there. I answered all the questions. One of them, for example, was have you had any suicidal ideation recently? And I said no, which is true, I haven't, funnily enough, because I don't know.

Speaker 0: 9:12

You would think me being in this depressing swing, along with the anxiety and everything else that comes with it. You would sort of assume, or I would anyway, that maybe there would be some suicidal ideation going on, but there's not, which is good. So big tick for that. But that's really what the psychiatrist focused on, which is fair enough, because you don't get much time with the doctor, you don't get much time at all in these appointments, so you've got to sort of run through it quick. And this is why it's hard, because if you're not in the mood to advocate for oneself properly, well then simple answers will be accepted without much investigation. Now, unfortunately, if you peel back the layers of my answers yesterday, there's a lot more there than what I was showing on the surface level. But you don't get enough time in these situations for that to happen. So I answered all the questions truthfully and properly, which was.

Speaker 0: 10:01

Things have been difficult. I feel very anxious. Still. My anxiety hasn't improved at all with the introduction of metazapine. I'm now having a depressive swing again, which is not unusual, but it's also very difficult to live with and handle.

Speaker 0: 10:19

But the main thing was that surface level things seemed okay Because again I've got insights. I'm able to explain this sort of stuff, and insight is one of those sort of measures that they look for to tell if you're in distress or not and if a person has a great deal of insight. Usually that's seen as a good thing, a protective factor, although, as I say to people, the insight can kill you, and it certainly can, because the insight I have into my situation is not very good. I've said this before, I'm not going to go through it here now, but I know what's going on. It's my ability to change what's going on and change those thoughts and behaviors and emotions. That's the bit I'm struggling with and that's the bit that, unfortunately, the medication hasn't been able to do much about either.

Speaker 0: 11:04

So, on the surface level, a lot of questions were answered, but answered in a closed off way. My shoulders were slumped, I wasn't making much eye contact and I've been speaking very softly lately as well, which I find when I'm in these sort of depressing moods that tends to happen. I don't speak much and when I do it's a bit of a mumble. That was happening again, but unfortunately, because you don't get much time in these situations, the psychiatrist wasn't able really to peel back the layers and see what's really going on. It had to be quick, you know you've got to get the next person in because unfortunately the system is on its knees at the moment and, as a result, there's not many psychiatrists, but there's lots and lots of demand for them, so it's a very difficult spot to be in. So, as you can imagine, a mental health professional is looking for the obvious signs of distress. If they're not there, that's a big tick and then we'll sort of go through the motions but have a tweak here and there and continue on. But unfortunately I'm not a happy chappy at the moment and it's starting to really get me down Before I go into the medication.

Speaker 0: 12:10

What actually has happened because of the medication review yesterday? It all comes down to the fact that I've lost my smile. I'm not laughing like I used to. I used to laugh a lot. I don't laugh at all anymore, and that's what I need to get back to try and figure out a way to build a life where I'm laughing again. That's the plan, and I know medications probably aren't going to do the full job, but I'd like the medications to help with the process in getting my laughter back, and I just don't feel as though they're doing it at this point. But, as I said, there's been some changes Very quickly too.

Speaker 0: 12:47

I was asked the question about how work was going and I did explain that I've had to cut back hours at work, the idea being because I feel so socially drained, because my work is very much customer focused, a lot of interpersonal sort of stuff going on, a lot of interpersonal sort of stuff going on, a lot of talking to people and fellow team members. And whatever my belief is, that is and I still believe this is that me working full-time in that capacity has been really quite detrimental to my mental health. Not any fault of the job or the business I work with or anything like that. It's just, you know, when you've got autism and, as well as you know, social anxiety disorder and everything else that goes with it, lots and lots of communication with people can be very, very tiring very, very quickly. So working full-time and talking to people full-time has proven to be quite difficult. So now I've dropped back to three days at work and I'm hoping that will free up some social capacity, some energy moving forward.

Speaker 0: 13:45

Of course, the trade-off being I don't have as much money and that causes a lot of stress and strain as well. But I'm trying to find the happy medium between having to pay the bills and also living a life where I'm in control and happy enough and having a good go of it. So that's what I'm trying to do and I explain that and to me that would ring some warning bells. But unfortunately we didn't focus very long on the fact that I've had to cut back hours at work. It was more about the fact that I'm still at work. So I don't know, maybe it's just me being negative again and my perception of everything is negative, but it did seem to me as though that little point, the fact that I've had to pull back from work, was glossed over a little bit. But again, you know, I maybe didn't focus on it enough because I didn't have the capacity to self-advocate in the way that I'd like. I sort of glossed over that point as well, because what's the point, what's the point of explaining all this stuff when nothing changes anyway and life's all doom and gloom? At least that's what I was thinking yesterday in the appointment.

Speaker 0: 14:48

So it is hard for people and this is why psychiatry, psychology, any mental health sort of stuff, related stuff, is difficult, because you do rely on the word of the person going through something. You know they're the way that you find insight into so-and-so's, you know demeanor and how they're feeling and what's going on inside in their inner world and unfortunately, if an individual doesn't have that level of insight, you know a lot of things can get missed. But unfortunately too, if you have lots of insight, like I do, that can in a way be used sort of against you, in the sense that having insight is a sign that things aren't traveling too badly, whereas that's not true and my insight makes me acutely aware of my deficiencies and where things are going wrong. I don't have much insight into positive sort of things. That's the whole point. That's why we're having this conversation. So again, my insight, when I do show it, has sort of been used against me.

Speaker 0: 15:45

But yesterday I wasn't offering much, I was doing very closed off sort of answers, like I said, there was no real eye contact, shoulders were slumped, it was. You know I went in there. But the thing is I went in there without risk. You know you look at me yesterday, I'd imagine, and you'd say, right, he's obviously depressed and anxious and all that sort of stuff. You know, the signs are there, it's pretty obvious. But he doesn't seem like a risk to himself or other people, and that's true In these sort of moods. I guess my energy and stuff like that, my levels are so low that I can't even be bothered thinking of those really bad sort of scenarios because I don't even have the energy to do that. And a doctor would look at me and think, okay, that's a good sign. Because I was asked about the suicidal ideation, I said no, it's not there, which is a good sign. So overtly I wasn't showing signs of distress, but there were signs there.

Speaker 0: 16:39

And unfortunately, if you peel back the layers as you know because you've listened to this show long enough you would know that there's a lot of deeper inner turmoil going on and unfortunately appointments with psychiatrists don't often have the time to be able to get into those things properly. And it relies on the individual to be able to self-advocate. And when I'm, at least in these very anxious and depressed moods I don't feel like self-advocating. I'm not very good at it because I'm scared of it and I don't have much hope for things turning out positive anyway. So my motivation, I suppose, to be able to self-advocate is just not there, because I just don't have the capacity to do it, and that in itself is a warning sign. But if you're a psychiatrist that's seen me like once or twice, you wouldn't really know that that's something to look for. So really what they're looking for was signs of risk, and I didn't show too many signs of immediate risk. So as far as the psychiatrist is concerned and this is a tick, it's a tick on the book, but unfortunately there's a lot of things working deeper that are not going so well that I don't think medication is necessarily going to help with. But I'm hoping the medication will help with the road towards that way of thinking, that positive thinking. So the medication itself isn't going to do it, but it's going to help facilitate my ability to do it. Does that make sense? I hope it does so.

Speaker 0: 18:03

Anyway, back on track, what actually happens. So metazepine, the antidepressant that I was put on remember I was put on seven milligrams, then it went to 15 milligrams, now I'm up to 30 milligrams. So that's the medication change there. It's interesting. Metazepine is an interesting medication, a bit like quetiapine, seroquel, in the sense that there's different therapeutic windows. So I guess for metazepine, between 0 and 15 milligrams you're looking at more sedation and sleep, a bit like Seroquel at low doses. But then 30 to 45 milligrams is when there's the antidepressant properties that show up more and and that sort of stuff. So the metazapine I've been on it and it was only really offering sedation, although not enough.

Speaker 0: 18:50

So the plan was I was going to go on metazapine and wean off the quetiapine. Remember, get rid of the quetiapine, stay on metazapine. The problem is I haven't been able to get to sleep without at least some quetiapine. So what's happened is I've had to stick with 50 milligrams of quetiapine at night just to make sure I get to sleep. But my metazapine has now been bumped up to 30 milligrams. So now it's in the zone for the antidepressant properties to come out and hopefully do their thing. So there's a little bit of hope, a little bit of forward thinking there.

Speaker 0: 19:24

So my metazapine was bumped up to 30 milligrams. It was decided that the quetiapine will stick with at 50 milligrams for now, still with an idea to try and titrate off it, but at the same time 50 milligrams just to get the sleep. And that's the plan there. But I am hopeful that metazepine at the therapeutic dose will do something. I have a family member, for example. He or she is on metazepine as well, same dosage, and it seems to work really well for him or her, for them. So fingers crossed, maybe there's some sort of genetic link. And the metazapine now at 30 milligrams will do the job for me? I don't know, we'll see. I'll let you know all about it. But at the same time another family member of mine is on Lexapro or escitalopram and it's worked really well for them. But that medication did very little for me except make me sleep. So I don't know.

Speaker 0: 20:18

There's always you know me, I'm all there's a potential for a bit of hope here, a bit of positivity, and then slam, I just bang down this negativity and just finish on the negative, and that's exactly what I did just then. You know, I could have just said that the metazapine's in the family and might do something good for me, but no, I had to answer with the Lexapro conundrum and how it didn't work for me as evidence Remember, I was talking about looking back in the past as evidence that things are not going to work. So anyway, there's a bit of me being negative in real time. So let's just focus on the positive. Metazapine has been good for my family member, so hopefully now it's at a dosage that it will be good for me too.

Speaker 0: 20:56

But it was an interesting sort of appointment yesterday. It was very surface level. I was in and I was out. There wasn't much sort of discussion. I knew that this was what was going to happen. I'd go up to 30 milligrams. I'd assume that was always going to be the case. So it all sort of went as I expected and as I sort of planned, I guess.

Speaker 0: 21:17

But it is hard in these situations because there's just not enough time for psychiatrists to be able to assess somebody properly and peel back those layers. That can be done in, say, therapy. There's more of an opportunity in psychotherapy, just because there's more time to go into these things. But these appointments, especially in the public system, you're in and you're out and there's not much time to expand on that. So you know, and as you know, there's a lot to my story. I guess in some ways I'm just a little bit sick of having to explain it all the time to different people, or at least different mental health professionals.

Speaker 0: 21:50

One of these days I'm going to do an episode which is just going to be an overview of me, of my mental health, everything, and I'm just going to say listen, here's half an hour of me talking, listen to that. That's my story. There you go and then come up with some conclusions from there. I don't know, maybe I'll do that. Moving forward, I'm not sure.

Speaker 0: 22:07

But self-advocacy excuse me, self-advocacy is a huge one because it's so important is able to convey a message that makes sense about what's going on and goes into enough detail, enough depth and focuses on the right things. Doing that requires a level of energy and also a level of belief that the person sitting opposite you may have the answer, or a potential answer, to some of the questions that I have in my life, and when you're lacking on the hope front and the belief front and don't have much energy to spare, the motivation and inspiration to be able to advocate properly for oneself is severely diminished. So anyway, as I said, the appointment sort of went as I planned, although I'm trying not to plan these things, it's more as I expected is probably a better way of putting it, and you know so I've got no complaints there, and what I do have some issues with is very much something that you know you can't have all day with a psychiatrist, unfortunately, especially in the public system. So you know, you've sort of got to roll with the punches, I guess, and that's exactly what I did yesterday. So I sort of got to roll with the punches, I guess, and that's exactly what I did yesterday. So I was in and I was out. It was pretty quick and I think my demeanor probably conveyed that I haven't been having a great time recently. But at the same time, I was asked directly about suicidal ideation and the answer was I don't have any of that at the moment, which is true. So if you're looking at me and assessing me for risk, you would say Elliot is low risk. That doesn't mean, of course, that I'm having a great time of things. It just means that I'm low risk to myself and other people and, unfortunately, those who are low risk, even if you're looking for a preemptive sort of move just in case things do escalate.

Speaker 0: 24:00

Unfortunately the system is very, very reactive and this isn't the fault of any individual, any doctors. I have no complaints about my psychiatrist that I saw none at all. That's just the way it is. The system is very reactive and it's not very good when it comes to preempting what might happen. The big explosion needs to happen for the emergency rescuers to come into your headspace and try and save you. Without the explosion, there's no impetus for the system to send in support Because, as far as this very superficial system is concerned, unless you're high risk of hurting yourself or other people, then you can sort of not be worried about too much because you're low risk. So the system is very reactive and I certainly don't blame any individual in the system. It's just the way that it is.

Speaker 0: 24:49

And it's very frustrating for someone like me who does have a high degree of insight, because I can see that things are not going well and I can see opportunities where some interventions in my past you know past could have really turned things and made things different. But unfortunately I haven't been afforded that opportunity because the system just is not built for that sort of stuff. So insight is a good thing and again, psychiatrists will look at me and see my insight and give that a big tick and use that as an indicator that my risk is low. But unfortunately the insight is also making me depressed because I can see that things aren't working, and that's very depressing knowing that things aren't working. Life isn't turning out as you'd planned. It's a bit scary that one. That's why there's a lot of anxiety associated with it as well.

Speaker 0: 25:43

I've been doing a lot of yapping, so let's get to the main meat of the episode, I suppose, which is my metazapine. It's now up to 30 milligrams. So I'm in that therapeutic window now, so it's going to start working as more of an antidepressant than it was as a sedative. I'm sticking with the quetiapine at this point just because I need to make sure I get my sleep in, still with the idea of titrating off that medication if circumstances allow. So I'm going to try and get off it eventually, but for now it's okay Low dose, it's just putting me to sleep. There's no real worry with that one. The problem is, though, that it's another medication, and and you know, the idea originally was that I would get off these medications, and yet I'm adding more and more, without the results that I'm hoping for. But anyway, you know, I'm trying to stay positive.

Speaker 0: 26:33

The metazapine has been adjusted. Let's see what it does for my mood. I'm really hoping, fingers crossed, that it does some really, really great things, because I need to laugh and smile again. It's been too long. So, to sum up my medication list. So what I'm now on is chlamypramine, metazapine, quetiapine, pregabalin sorry, pregabalin, I've got some dry mouth from these medications Vyvanse, lisdexamphetamine, as well as Dexamphetamine, clonidine and Propranolol. So quite the list. What's that? Seven or eight medications, unfortunately.

Speaker 0: 27:12

As I said, my hope was that I would start to reduce some of these medications. Unfortunately, that's not what's happening. It's actually the opposite, and I'm having more and more, but I just don't feel as though the results are there, because I'm still anxious and I'm still depressed. So it's not good. All right, so that'll do for me.

Speaker 0: 27:32

But the main point of this episode I suppose I want to get across is obviously the medication changes, but also how difficult it is to self-advocate when you're not in the mood to advocate for yourself. It's so so hard to find the motivation, the inspiration to be able to do so, but it's so important that you can because that's the only real way that these mental health professionals can help is if you can explain to them what's going on in your inner world in a way that makes sense, so then they can make decisions based on that. It's difficult because you can't just get a brain scan, you know, and put up the x-ray and go, or the MRI and go right, there's the depression, that's it there. We need to target that there. There is no tangible evidence as of yet of mental illness like that and, as a result, a lot, a lot of the ability for mental health professionals to do their job relies on the individual being able to self-advocate and unfortunately yesterday I was not in the mood to self-advocate.

Speaker 0: 28:34

But I did my best and medications have been changed. It's been tweaked a little bit. I am holding out some hope that the metazapine will do something, especially now that it's at a higher dosage, and of course I'll let you know exactly how things are traveling down the track here on the Dysregulated Podcast. All right, that'll do for now. I've done enough yapping. Thank you for listening. If you're enjoying the show, feel free to like, subscribe, give the show a great rating because it's good for the algorithm, and you can share the show around with your mates. And you can follow me on instagram at elliotttwaters, and you can follow the show on facebook at the dysregulator podcast. All right, until next time. Goodbye, thank you.