Depression, Suicidal Ideation, Psychosis, and the Psych Ward…

Found here

There has been a lot that has happened over the last couple of months… so much, I don’t really know where to start. I guess the beginning is always a good place.

Back in October or November, I started getting more depressed. I couldn’t really place why, exactly. My mood just started crashing. My psychiatrist was getting concerned and started having me come in more often than I had been. Eight weeks apart went down to four weeks apart. My baseline is usually passive suicidal ideation, and I always have a plan of how I would do it if I got to the point of attempting suicide again. In December, the ideation got stronger and harder to fight, but I managed. During this time, the self-injury was getting a lot worse. At times, I was having to go for sutures 3 or more times a week and was having difficulty keeping things clean. A couple of them got infected.

In January, my psychiatrist finally convinced me to go for an assessment to do intensive outpatient Dialectical Behavioral Therapy, which is considered the only treatment for Borderline Personality Disorder. Usually, if a person has any history of self-injury, they get thrown into DBT, whether they want to or not. I have done the IOP probably 7 times already which was why I didn’t want to do it. I know everything they teach and I know that I don’t like DBT. I use the parts that work for me, but it’s hard to remember the healthy coping skills when I am triggered or in crisis. I made the appointment for the assessment and showed up. They decided afterward that my situation was too much for IOP and referred me to a partial hospitalization program, so that was another assessment I had to go through because the IOP location doesn’t do PHP as well. The partial programs are 6 hours a day instead of 3, and 5 days a week instead of 4, so it’s more intensive, and I would see a doctor once a week and there is a nurse on site every day.

I made an appointment at a local, private hospital for the assessment for the partial program. I chose that particular hospital because if I ended up getting admitted, it is the only one in my city that allows smoking while inpatient. I smoke 2 packs a day and have a history of getting so stressed from not smoking that I lie my way out of the hospital, just to be able to smoke. The assessment was stressful because it is the same as the assessment for inpatient. They take your shoes and jewelry and anything you can use to hurt yourself with, as well as your phone… so basically I was really bored while I was sitting and waiting during the whole process. The assessment took about 2 hours total, but only involved maybe 30 minutes of actual questions. I was approved for the partial hospitalization program, however.

I started the PHP on the 7th of February. I enjoyed it but was still struggling. I was still cutting quite a bit and needing sutures. I was letting the therapist and nurse of the program know when it happened as well as the doctor when I saw him. I was also having a lot of anxiety and kept having to leave the room and step outside for some fresh air and nicotine. I was having a hard time regulating. The suicidal ideation was getting worse every day, and I was reporting that to them, as well. Everyone was getting concerned, including me. On February 22nd, the doctor brought up inpatient again. He was starting me on an antidepressant and starting a cross-titration of antipsychotics. He also said that if the next day didn’t go any better didn’t go any better than that day was going, he would want me to be admitted. The 22nd was a Thursday, and he was seriously concerned about my ability to make it through the weekend alive. I wasn’t willing to tell them, but I was as well.

Friday started out better, less anxiety and less having to leave the group, but one of the other patients had a moment and threw a pillow across the room and my PTSD kicked in and I freaked out. I couldn’t regulate after that. The nurse called the doctor, and he said to walk me over to admissions. I tried to sweet talk my way out of being walked over. I tried everything… I had a lot that needed to get done over that weekend and the following week. I told them I was fine, that there was absolutely no reason I needed to be admitted, that I wasn’t going to kill myself and I would be back Monday morning. I was suicidal, but I was telling them there wasn’t any intent and that having a busy weekend would help me stay out of my head. They had to follow what the doctor wanted, though, so there wasn’t another option except to walk over.

So, there I was, back in the admissions area for another assessment. The doctor for admissions sided with the doctor from the PHP immediately, but I did not want to stay. I kept thinking of everything I had to get done. I was thinking of everyone else and not myself. I was more concerned about everyone and everything else and not myself. I fought the admission so much that I ended up on a 72-hour police hold. I was committed to the psych hospital, for the first time in my life. I have been in and out of the hospital for 15 years and had never been committed, until the 23rd of February. Once the hold ended on the following Monday, I was given a choice… sign in voluntarily or go to court. I wouldn’t be able to go to court until Thursday. I decided to sign the papers and stay on my own. The doctor released me on the following Friday, March 2nd, so I was inpatient for an entire week. For me, it was a reminder that there are things that I cannot control and I need to just accept that I am not in control and do what I need to do at the moment to keep moving forward.

I started the PHP again on March 6th, but I only lasted a week in the outside world. The antipsychotic that I had started back on the 22nd of February didn’t work, at all, for me. I had had a moment of hallucinations toward the end of the first hospital stay, but I thought it was a one-off because of stress. Apparently not… Over that week out, the psychosis kept getting worse and my depression was getting worse, as well, because my physical pain was unbearable.

On March 13th, I had a consultation with a rheumatologist because of some lab work I had drawn. The answer I got left me hopeless. I was basically told to do things that I was either already doing that didn’t work well enough or had been doing that stopped working. My brain went into “if I have to live with this much pain for the rest of my life, then the rest of my life won’t be very long.” That night was rough. I was severely depressed, seriously contemplating suicide. I knew if I didn’t go back to the hospital that I was going to commit suicide. I had PHP in the morning, though, and knew if I could just get to the group and tell the truth, they would not let me leave. It was the only hope I had to stay alive. It was all I could hold on to, the only spark I had left in the darkness. I packed up a few clothes and my CPAP and some meds that the hospital isn’t able to provide so I would be more comfortable while I was there.

The next morning, I got up early, because my car had been at the mechanic and I had a rental that needed to be returned. I dropped the rental and picked up my car and headed toward the hospital. The drive felt like it was taking forever. I got on the highway and was driving my normal route when I was the exit for a particular highway. My plan for suicide involves jumping from a certain cliff, off of that highway. I’m not sure why, really, but I exited there and started driving toward the cliff. When I got there, I pulled off the road and just sat in my car, looking up at the top. I didn’t get out of the car, just sat there staring at the cliff for about 15 minutes, debating my choices. Did I want to continue driving to the hospital or did I want to hike up to the top?

I finally started driving again and got to the hospital safe and sound.

At the beginning of PHP, we would always fill out a form that gave the therapist an idea of where we were at with suicidal ideation and actions. I answered every question with a yes, which is a bad sign. The look on her face showed concern when she glanced at it as I handed it to her. At check-in, she mentioned that there were more yesses than normal; I just nodded. Later in the day, I was starting to completely shut down. She asked what I was thinking about and I just shrugged. She asked if she was right to be concerned for my safety and I answered maybe.

That is when the admissions process started all over again, but I didn’t fight it this time. I went into the hospital voluntarily and stayed for 11 days.  Over the time between the two stays in the hospital, the psychosis had been getting worse. The medicine that I had been put on during the first stay didn’t work at all, and I had a complete psychotic break while sitting in admissions. While I was inpatient the second time, the hallucinations were commanding me to do things like banging my head or burning myself with cigarettes and even using the cord of my CPAP to hang myself. I submitted to the first two, but the last one, the cord of my CPAP, I was able to express to staff before acting on the command.

At the end of the stay, because of the amount of banging I had done, there was some concern I had done damage to my brain. I called my neurologist and made an appointment for the next day, Tuesday, to get checked out. Lo and behold, I had given myself a concussion. I went today for a CT scan of the brain, just to be sure there isn’t anything more serious going on.

Part of my discharge plan was to go to a Dialectical Behavioral Therapy intensive outpatient program, but they couldn’t even get me in for an assessment until Friday of this week, which is too long to wait, in my opinion. I’m having a difficult time, at the moment. The new antipsychotic, that replaced the one that didn’t work, seems to also not work. I feel like I am running out of options and I am stuck. I don’t want to have to live the rest of my life with hallucinations every waking hour of the day. I want to find something that works to make them go away, that makes these creatures that are literally screaming at me go away. I never get a break. I never get peace and quiet. They are always screaming into my ears, calling me names and telling me to hurt myself in a number of ways or to go ahead and just kill myself. I am doing everything I can to be strong, but honestly, I foresee another hospital stay in my future.

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