I have deliberated whether or not I should write this post for quite some time. It may be oversharing. But when I started this blog it was my intention to document the entire cancer experience, and that is ongoing, so what the hell.
Recently, I have been somewhat out of sorts. Mentally. To the point that the mental health crisis team have been coming round every day for several weeks, I’ve seen a psychiatrist, and I’ve had to learn very quickly how to deal with not having a clue what’s real and what’s not.
They are calling it Post Natal Depression and Psychosis, but they never call it Medically Induced Menopause, which is what I think is behind most of it. Or at least triggered my brain to go into meltdown.
This all started when Ava was about 3 weeks old. This falls into the timeline for Post Natal Psychosis to start, but it was also a week after I embarked on my Tamoxifen and Zoladex regimen, so it’s hard to know where post natal hormones end and cancer meds begin. It’s hard to know anything at the moment, not for sure, because reality hasn’t been that real for me for a while now.
For instance I:
- thought Nate was trying to abduct the baby
- was convinced the baby was going to die
- was convinced anyone who came towards me in the street was going to steal her or do something horrible to her in her pram
- thought Nate was trying to make me think I was insane whenever he tentatively told me I should probably get some help as I didn’t seem to be coping that well
- thought everyone else was ‘in on it’ with Nate and was trying to help him steal the baby
- was convinced I have cancer again and am going to die
- got completely and utterly lost on Albert Road, didn’t have a clue where I was or what was going on.
- as above on Francis Avenue
- at one point I even thought Ava had already died months before because Nate took her out for a walk, and then when he brought her home I thought the magic link between us was broken and she might not even be my baby
Luckily, the day I thought Ava had died, I was so distraught I couldn’t contain it any longer and had to ask Lesley her honest opinion on what she thought Nate was actually doing. I can remember sitting there thinking ‘Well I’ll tell her, but if she acts suspicious, I’ll play it down and leave’ (for some reason I was convinced at this stage that all my friends were helping Nate, and he really wanted to know his evil plan was working, and if he knew that I knew what he was up to, he’d be winning. Yes I actually believed that. That was my reality). To Lesley’s absolute credit, she managed to negotiate me sitting on her sofa sobbing and telling her all these terrible things were going on without making me think she was part of the problem. She very slowly and carefully led me towards an understanding that I was finding it a bit difficult right then to know what was real and what wasn’t. She gave me plausible reasons for why Nate wouldn’t be trying to make me go insane so he could steal the baby – things I hadn’t even considered – and she encouraged me to get some help but also to talk to Nate about it.
I was dubious about that, as even though what she said made sense, and I really did believe she wasn’t in on it after that, I still couldn’t accept that Nate wasn’t doing what I thought. But I trust Lesley’s judgement, she has never failed me in the past, and she has a lot of respect for Nate, so I told him.
Instead of laughing maniacally and telling me he’d won, he gave me several very logical reasons as to why he wouldn’t want to do that. Things I hadn’t considered, even though I’d felt like I was completely compos mentis and had been cleverly analysing what he’d been up to for weeks. I mean, that time he didn’t sterilise Ava’s bottle properly was a clear sign he was deliberately trying to make me insane. He knew I was worried about her dying, so messing with her bottle was obviously just another part of his scheme, right?
He wanted me to get help, and the NHS mobilises pretty fast where young babies are involved, so within a week I was sat in front of a post natal depression counsellor telling her all this, and also about how when I’d come back from my parents’ house on the train the day before with Ava and the boys there had been an eye in a poster advert watching us, and then every person we walked past on the way home was going to abduct Sami and Zaki. She told me she was going to refer me to the mental health crisis team, but when they turned up the next day, I freaked and was convinced they’d come to take the baby. They assured me that wasn’t the case and said they’d come back the next morning, which they did, and every day since. The psychiatrist came here to assess me as they felt I’d be more stressed if I had to go to the hospital, and he said that as I was aware I was having delusions, I wouldn’t need to be hospitalised unless things got worse.
It’s taken them a while to convince me this is post natal depression as I don’t feel ‘depressed’ as I have in the past (after the cancer diagnosis for instance), but they’ve insisted that anxiety comes under that term. If you imagine a glade in a forest on a nice warm, sunny day, and in that glade there are little animals moving about at a leisurely pace (your glade will be different to my glade, but it’s calm and serene). The animals are your thoughts, going about their business in the way that thoughts do, sometimes being intrusive, but mostly just coming and going in a steady way, BUT THEN ALL OF A SUDDEN THERE IS A HERD OF STAMPEDING ELEPHANTS RUNNING THROUGH THE GLADE. THEY’RE COMING FROM EVERY DIRECTION AND SQUASHING LOADS OF THE OTHER ANIMALS, KNOCKING DOWN TREES, CRUSHING THE UNDERGROWTH. THERE’S DUST EVERYWHERE, IT’S RAINING AND THUNDERING, THE ELEPHANTS ARE OUT OF CONTROL.
That’s my brain as soon as things get even slightly stressful. It’s like my own thoughts are attacking me from every direction. That’s why I got lost on Albert Road, somewhere I know like the back of my own hand. That’s why even though I know the bad thoughts aren’t real any more, I am still having to constantly talk myself through even simple things like walking down the road, going to the shops, making the dinner, picking the boys up from school… And none of this is helped by the constant hot flushes, achy ankles, numb hands and various other side effects from the Tamoxifen and Zoladex. (It’s hard to know which one is causing which side effect, so I just blame them both.)
Tamoxifen is an oestrogen antagonist – it helps to prevent cancer cells feeding on oestrogen and reduces the risk of a recurrence, a new cancer in the other breast or metastases. It’s a tablet I need to take daily for the next ten years. Zoladex causes all your hormones to shut down, and it’s a monthly implant of a pellet into my stomach for the next two to five years, or until I can have my uterus and ovaries removed. Oestrogen does loads of things in the body and one of those things is increasing the concentration of neurotransmitters like serotonin, dopamine and norepinephrine in the brain. A sudden drop in oestrogen, say after child birth, or when in a medically induced menopause, can cause all sorts of problems, so it’s not really surprising my brain went a little bit batshit for a while there. It’s still having its moments, but I’m a lot more adept at recognising them and responding quickly to nip things in the bud. The hot flushes don’t help because if you’re in a shop or public place, the overriding urge is just to get out quickly, and that increases your anxiety which makes you even hotter and so on…
Fortunately the Citalopram has started working to reduce my anxiety and level things out, so that even when I am delusional, it’s not the terrifyingly consuming experience it was a few weeks ago. I can cope with doing the small daily things, like thinking about what’s for dinner, without having an adrenal response to them, but the bigger things take a lot of effort to negotiate. I’m constantly having to police myself and ask myself if my reaction to a situation is appropriate, and that in itself is exhausting, so I realise I am blessed that Ava has started sleeping all night from about 8.30pm. Although it really wasn’t easy putting her to bed and leaving a baby alarm to watch over her for me.
I can’t stop taking the Tamoxifen and Zoladex, but hopefully I’ll get used to the new feelings, and the side effects will lessen in time. It’s a big stretch for the body to go from birth to the menopause in just two weeks, so I’m not really surprised I’ve experienced some problems, I’m just surprised at the intensity of those problems.
I’m really lucky to have a lot of support from family and friends, from people coming to the baby clinic with me, coming round for coffee, or coming with me to places so I’m not alone, I’ve been overwhelmed by the generosity and understanding of others. I’m really lucky the NHS mental health services respond quickly to this kind of thing when there are young babies involved, because I dread to think what the process would have been like otherwise. In fact, the crisis team were meant to be coming round to discharge me this morning because I’ve improved enough not to need them any more. They didn’t turn up though, so maybe I had the wrong time. Or day.
Or maybe they’re sat outside watching the house to check that I am actually going out for a walk with the baby like I’m meant to? Maybe they’re trying to mess with my head so they can lock me up? They’re probably doing this to make me think I’m losing my mind… lulz