Trauma Therapy: Eye Movement Desensitization & Reprocessing (EMDR)

If you struggle with painful memories from a past trauma, and are considering what types of therapy might be most useful, let me be your guinea pig today and tell you about Eye Movement Desensitization & Reprocessing (EMDR).

In a nutshell, EMDR basically aims to help you reprocess memories of past traumatic events that your brain has failed to properly process. 

The hippocampus is an organ in the brain that deals with storing emotional memory.  When a traumatic experience happens to a person, the logic and reasoning centres of their brain are overwhelmed, so the hippocampus fails to communicate with them effectively to process the memory of that event.  

This can result in a person experiencing severe distress when remembering this trauma, and sometimes finding they relive the experience as though it were occurring in the present, because the memory has not been properly stored by the brain as a (sometimes very distant) past event.

The purpose of EMDR is to reprocess traumatic memories by manually involving both the emotion side of the brain and the logic side of the brain, given that they previously may not have been working together, to properly place that memory in the past.

During EMDR, I was guided to remember the traumatic memories that I continue to find distressing by bringing into conscious awareness the memories themselves, as well as the thoughts, emotions and bodily sensations that come with them.  

This means that if you are considering EMDR, you need to be willing to experience reliving a distressing memory through recalling it in detail.  Your therapist should help you to come up with a safe place to use if you need it.

This is quickly followed by having to follow the moving fingers of the therapist rapidly for a brief period of around 30 seconds.  And I mean, RAPIDLY.  It was actually a little bit hard to keep up at times!

It is possible for this therapy to be conducted using other external prompts, like sound or touch, but prompted eye movement is usually the most common and most accessible for the majority of patients.

The process produces a distinctive and naturally occurring pattern of electrical activity in the brain, which causes the stored trauma memory to quickly change.

During EMDR the therapist is not meant to talk or offer suggestions.  I was not asked to change any aspect of the memory, but just to notice the experience.  

At the end of each set of eye movements I was asked to report how I was feeling.  I found the emotional and bodily sensations reduced in intensity quite consistently during the whole process.  Sometimes the physical symptoms would change or come back a little bit, but then further "rounds" of eye movement helped those feelings subside again.

The next step is to associate a more useful thought to the now more distant trauma memory.  The EMDR process is complete when the new perspective feels true even when the old memory is recalled.  For me, I worked on accepting ideas that "I did the best I could" and that "I was only a child" to help me experience these memories in a less distressing way, as previously I had been experiencing strong feelings of shame, self-blame and guilt.

It's apparently common to feel tired after an EMDR session, and this was definitely true for me.  I recommend scheduling in time for rest or something soothing afterward.

Whilst EMDR sounds simple (and let's be honest, a little bit like hocus pocus!) there are many important procedural steps for the therapist to follow.  It actually takes over 50 hours of training and supervision to fully train an EMDR therapist.

EMDR can be effective whether it is conducted once or over a series of sessions, depending on the patient's needs.  I am currently approaching my fourth session.

Overall, I can say I do recommend it as being very useful.

Falling Apart & Beginning Again: Jess' Story

Today I've decided to share a bit about my story.  

You may find it interesting or entirely purposeless :) either of which is okay, but I thought it might be useful for giving you an idea of context when reading my blog. 

I'll start when adulthood sort of did...  The first two years out of high school weren't that exciting for me.  I finished school at 16, when the usual age for graduating high school in Australia is around 18, because I was skipped a grade after being told I had a high IQ.  I have my doubts about this!

Aside from a retail job and a hospitality job during school, my first "real" job as an adult was a youth worker position.  This 25 hour per week job had very little support, and I did it while I tried to simultaneously pull off a full-time study workload at University.  I ended up just doing a second-rate job of both tasks and didn't find much fulfillment.  

I also enjoyed a little bit of travel and had a couple of healthy relationships.  I sometimes got the sads, which affected one exam period at worst, but life was alright.

Then at eighteen I entered an industry in which I would spend the next six years of my life and where I would meet some of the best and worst people I've ever known.  I worked full-time in very intense and stressful environments during which I experienced upwards of half a dozen instances of workplace bullying.  (Of course, I am now better able to acknowledge my role in these situations, and no doubt those people were influenced by their own distress in our ridiculously high-pressured industry, but it truly was horrible for me and some people were just jerks... Perhaps a topic for a future post!)  

I also spent most of these years in and out of an extremely traumatic relationship with someone who was twice my age and newly divorced.  They and their ex-wife worked in the same industry as me.  Everyone knew and had to work with each other despite hatred and tension.  It was unpleasant, to say the least.

Throughout these years there was not a single day that my work tasks were limited to working hours.  There was a constant expectation to attend events and socialise with colleagues out-of-hours, which was made all the more unpleasant by the goings-on of my emotional life.  And socially it wasn't that great either - there were complex networks of who liked who, who hated who, and who was undermining who just for the heck of it.  Even my recreational reading time needed to include media and literature relating to work.  I was passionate about the cause and willing to work hard, but geez!  Years of this stuff wears you down.  On top of this, all of the actions and choices in your personal life reflected directly on your career. 

I should also point out that there were some great aspects to the jobs I worked in and that I was very privileged to have had some of the support and opportunities I did.  In amongst the hard times there were some people who were great to me and there was some very cool stuff I loved doing.  I really believed, and still do believe, in the cause behind my work, and I wouldn't change that for the world.

But it was still killing me.  So, why didn't I change anything?  Why did I stay?  And why did I lock myself into a lifestyle that was clearly making me unhappy?

I'm not one of those people who is particularly wrapped up in money or appearances.  I never pay for designer labels and I'd seriously rather shop at K-Mart.  But I locked myself into a cycle of expectations where I had to keep earning money and then keep earning more.  Once you sign a rental lease, you pay that for a year.  Once you've rented one place, you want to rent a nicer one.  Once you have your own place, you pay bills.  And once you are sitting alone in your own place with all bills paid, you eventually get bored or lonely, so you go out with friends or do some activity to keep your mood up.  (Especially when you're always feeling the blues!)  

I also did all this because I just thought I had to, because it was what adults did.  Adults have their own place, buy furniture and groceries, drive their car, go to dinners, work their jobs, get promoted, get new jobs... meanwhile, my mental health kept deteriorating.  I couldn't understand why I was feeling worse and worse despite doing all the "right" things with my life.

I really was trying hard to improve things for myself.  I would complete an extra university subject or make a new friend or try to find hobbies and projects I could volunteer in.  There were even a couple more overseas trips with family and friends.  But my condition kept going downhill.  I began to dream about just throwing it all in and running away to join the circus.  As time wore on, I dreamt about doing worse things.

 

[ TRIGGER WARNING APPLIES ]

And do worse things I would!  Sometimes I was just sad, and I would fill my time with sleep or food to escape.  Sometimes the emotions were stronger.  Emergency rooms and ambulance rides became a nauseating blur.  So many times I fought off the panic of oncoming pain with drugs and alcohol.  If I really couldn't even bear the minutes it would take for those to kick in, I would resort to self-harming - cutting, scratching, burning, hitting.

I've poured boiling water on myself.  I've torn my flesh off in chunks.  I've smashed my forehead onto cement walls.  I know that there are others who have no doubt experienced worse than me, but I can tell you that within myself I went over some cliffs.  Whatever I could do to fight off the surge of emotional pain that was coming, I would do it.  And sometimes the emotions were just a never-ending dull ache that made me choose not to put my seat-belt on when I was driving or be pretty careless about looking before I crossed roads.  I would imagine my funeral or the actual process of dying just to soothe myself a bit that there was an ending available.  In general, it was safe to say I spent upwards of 80% of my life wishing not just for death but for respite from my feelings.

[ END TRIGGER WARNING ]

By the time 2012 rolled around and my family had caught on to all of this, I found myself hospitalised and on four different psychiatric medications.  Something had to give.  Eventually, it all did.  The ridiculously dysfunctional relationship finally began to cave in for good.  (Though, he only ever truly left me alone when he found a new half-his-age partner.  Make of that what you will.)  I couldn't handle being bullied at work each day by my line manager and gave my notice of resignation.  I opted not to renew my lease, sold my furniture instead, and told everyone I was leaving to go travelling overseas.  I didn't know what I was going to do, but I just had to get away.

I was alone in Amsterdam when the nervous breakdown hit.  Hard.  I ditched the rest of my travel plans and came home to a serious psychiatric hospital stay and more medication and even more therapy.

I'd quit my job and relationship.  All my things were sold or packed up.  I had almost no friends left.  (My social circle had become entirely full of work relationships and pretty much no one was interested in me once I quit my job - like I said, they weren't the nicest of people.) 

It feels like a doomed airplane was careening and breaking apart through storm after storm for so many years, as I desperately taped its wings together and pumped the fuel lines and wrestled the yoke, like some maniacal pilot... when what I really needed was for the whole mess to finally plummet into the sea.  Now I'm sitting on a life raft, alone, at last able to tend to my wounds, and rest.  I'm bobbing along in this deafeningly quiet stillness.  You get the metaphor.  It's over.

And it's a new year, I've had a break and a lot of treatment, and I'm officially "stable" according to three doctors.  So does this mean I'm almost Recovered?  HAHAHA!  No, wow, not even remotely close.  What I am is (finally) Beginning to Recover. 

Or, more accurately, I will be in a process of "Returning to Work/Study" for some years to come - which is an Australian concept of only having one job or course of study at a time, and only doing this on reduced duties, while incrementally returning to a full-time capacity, under the supervision of treating doctors.  This means I can do things, but they will need to be balanced with medication and therapy for a long time.

I've chosen to move to a bigger city and go back to University.  I'd like to study so that I can enter a new industry, and because I truly enjoy it.  I also think a new city is going to give me the space I need from old friends and old habits.  I'm still keeping some of the support with me though, as my best friend and her lovely sister are also moving at the same time.  (Plus the city is super cool and much bigger than my boring old home town.)  My family have even agreed to help me out with financial support and ensure that I'm returning home very frequently for stability.  This all fits in with my doctors' plans, so it's looking good.

In finishing my story, here are some lessons I have taken from my years of misspent youth which I implore you to consider lest you ever find yourself in the same place I was in...

A job is a huge part of your life, and any problems at work should be taken seriously.  How you are treated and whether you have a healthy work-life balance are especially important.  Report instances of bullying or harassment.  Talk to your boss about fair expectations from you as an employee.  And if you just don't enjoy your job, keep looking around for others until you find a better fit.

Try not to get stuck in one mindset and never cut off your own options.  All the cliches are true, the world truly is full of limitless possibilities and if you want to wake up tomorrow and do something completely different, DO IT.  

Screw the norm.  You don't need a big house, car, or impressive-sounding job, to be truly happy.  In fact, you can have all these things and be very unhappy.  Believe me!  What really matters is family, friends, and doing what you love.  The rest is negotiable.

Never sell yourself short because you really do deserve every good thing in life.  You deserve happiness.  You deserve a vocation that you love.  You deserve happy and healthy relationships.  Even if you have some crazy dream job or lofty ambition, give it a go!  You'll never regret the immense love and respect you show for yourself when you seek to achieve your goals.

If I could speak to my seventeen year old self, they are the things I would tell her.  Instead I have written a long and boring blog post to you!  If you have managed to read it, please know I am sending you a genuine and heartfelt thank you for doing so. 

P.S.  Of course, I should say that my mental illness likely required a genetic predisposition and would have involved contributions from other traumas in my life.  But, would I have ever reached such a severe point of crisis had I spent those years in a normal workplace and normal relationship where I was not prevented from living a healthy life?  No.  Never.  (Again, I'm an adult, and I am responsible for my choices.  But seriously, I encountered some messed up people and was put in some extremely distressing situations.  TO THE MAX.  If I ever write a book it'll be titled "Crap After Crap TO THE MAX" and no one should read it.)

P.P.S.  If I can somehow keep myself intact despite many attempts to achieve the opposite, I truly believe that other people going through mental health challenges can get there too. 

Is It Hot In Here, Or Is It Just Me?

It's ALWAYS just me.   Today I will be telling you about my struggles with anxiety and... sweating. Please accept my apologies for grossness in advance.

As you may be aware, one of the telltale signs of Social Anxiety Disorder, or any form of anxiety, is sweating.  There are others - such as blushing, trembling, palpitations, nausea, stammering, and rapid speech.  And I experience all of these too.  

Blushing, however, can be overlooked as nerves, or a sign of alcohol ingestion.  I've also had a person tell me they just assumed I put on too much blusher make-up!

Trembling and palpitations can be hidden.  Even when holding a drink, it's possible to steady your arm across your body.  And nausea is also invisible to the naked eye.

Stammering and rapid speech are noticeable, but often written off as behavioural or personality traits.  Ironically, it sometimes happens that people will assume you're so relaxed you aren't even bothering to speak too formally!

But sweating.  Ugh, sweating.  Sweating is the give away.  Sweating is obvious, awkward, and embarrassing.  

It can't be hidden.  It can't be stopped or slowed on cue.  And everyone knows what it means - you're embarrassed, you're very uncomfortable, or there's just something wrong with you.

Here are a list of things that make me sweat:

• Being outside my house - this will often begin during the car journey
• Entering or exiting a store, restaurant, cafe, pub, building, or other venue
• Talking to anyone, be they friend or stranger
• Doing anything whilst being watched, by friends or strangers
• Meeting new people (this one's a killer)
• The point of check out and payment when shopping (also a killer)
• Lastly, the "normal" causes, such as hot weather or exertion

 

When I sweat, it's always concentrated on the eyebrows, forehead and upper lip.  If I'm trapped in the situation and can't leave, this will extend to the eye area, chin, and hairline.

The worse is when I sweat to the point of it being visible in my hair.  It's humiliating.

And that's just my face!  I don't have enough hours in the day to go through all the places one sweats on the body, but suffice to say that anxiety promotes sweat better than anything...

So, if you ever see me in public, I'll usually be dabbing away.  Eventually it will become too much sweat, and the panic about sweat causes more panic, and I have to leave.  My options are usually only the bathroom.

Alcohol makes it worse.  Nicotine makes it worse.  Caffeine makes it worse.  Even a hot meal exacerbates the situation.

Basically anything you do socially can make it worse, but even if I stood there with a glass of chilled water, I'd still be sweating away.

The only time the sweating stops is when I am sitting in a cooled area and not talking to more than one person.  Or when I go home.

 

To be honest, it's horrible.  It gets in the way of every single thing I do outside of my house - work, meetings, university, friends, family, dates, shopping, errands, doctors.  I sweat them all.

And it's not just the embarrassment of being sweaty.  It's also deeply upsetting that your body is misrepresenting who you are to the world.  

Excessive sweat makes it look like I'm a deeply nervous person, or a drug/alcohol addict,  or someone who dislikes being around others.  There is nothing wrong with any of these things - but they aren't accurate about me, and I just want to be myself!  

I don't want to be sweating, I don't need to be sweating, I'm not hot/nervous/drunk - why so much sweat?!  

 

It's because anxiety is your body letting you down.  Anxiety is the firing of a bunch of physiological responses to perceived dangers or threats that aren't actually there.

To try and stop the sweat, I've tried botox, aluminum based skin products, and altering my diet.  No good results.  I've also used more natural alternatives, such Aloe Vera and Witch-hazel based skin products, which have helped a little more. 

And I am working through Cognitive Behaviour Therapy with my Psychologist so I can use better skills in everyday life.

So, that's my sweaty story.  I am sorry to post about something less than palatable, and believe me, it was a difficult post to write.  But I did it because I think it's important to to be speaking openly about symptoms of mental illness, and because maybe one day another sweater will read this, and feel just a bit less like an alien.

Am I Scared Of Getting Better?

Now that I am discharged as an outpatient and living at home with my folks while I work on my recovery, we are looking at my options for next year.

However, any time I think about recovering and the bigger picture, like future plans, I feel overwhelmed and extremely anxious. I think I'm scared of relapsing worse than previously. At every stage of my illness I have truly thought that it was rock bottom, and every time I have thought this there has always been further to fall later on.

One year ago I was living independently alone, working full-time in an Executive level job, seeing friends not often but when I could, paying bills, driving my car, flying interstate for work or for leisure, planning my round-the-world trip... Just generally keeping things roughly together.

Now my main activity for the day can be something like beading a necklace. And even this can be a challenge - to physically bring myself to outpatient therapy, to ride fluctuations in my moods, to deal with the social anxiety that comes with leaving my room.

I feel like I have lost so much ground, that I don't want to regain it and feel the loss of losing it again. Thinking about this, I have two strategies for tackling my fears. 

1. Opposite Action. This is meant to be used whenever the fear of something is not useful or proportional to the threat. For example, I shouldn't be scared of feeling better, because this is a good thing that I will find enjoyable. So I am trying to chose the actions that a non-scaredy-cat would chose. Today I looked online at rental properties just to get an idea of costs and locations.

2. Achievable Goals.  Breaking things down into achievable parts is useful and realistic. No one is expecting me to wake up one morning and miraculously recover from mental illness. I don't have to immediately fix my life overnight. In fact, this isn't possible. Recovery is done in bits and pieces over time.

It's ok to not be perfect and to go backwards as well as forwards. I also won't morph into a younger version of myself and be back in the middle of a previous crisis, because that isn't possible - the experience that I've gained can't be lost or taken away.

So while my future might not be Easy Street, and there will be ups and downs, I know that this is normal for everyone - even people without mental illness - and that the experiences I've already had will help me deal with things better as they come.

Doing My Homework

Recently, Debbie at Healing From BPD posted the DBT Emotion Regulation Worksheet 1A and encouraged us to consider using it in times of intense emotions.

I have just taken this advice and have found it extremely helpful, as with all aspects of DBT! 

It has allowed me to think a bit more clearly about what is going on in my head when I re-experience traumatic events in my mind. I hope that over time I will become stronger in dealing with this.

For now, here is my "homework" below. I hope to use this worksheet more often.

Emotion Names:

Hurt, Sadness, Anger, Abandonment, Panic, Anxious

Intensity:

75

Prompting Event:

Reading my journal from a time of distress in a previous relationship.

--- TRIGGER WARNING ---

Interpretations:

No one will ever want to be in a relationship with me, I am worthless. My ex-partner has moved on and is extremely happy. I will never feel this way and will be stuck living in the past painfully forever.

Body Changes and Sensing:

Tight chest, sick in the stomach, mild headache, lump in throat.

Body Language:

Frowning, tensed.

Action Urges:

Contact him to beg him to understand the pain he caused me and still causes me. Hurt myself by cutting/scratching my leg to distract me.

--- END TRIGGER WARNING ---

What I Said or Did:

Filled out this sheet. Tried to Radically Accept my emotions without suppressing or blocking them as this can only make them worse. Mindfully listened to crickets chirping outside.

After Effect of Emotions:

Emotions eventually eased, still felt waves of anxiety and hurt from time to time.

Function of Emotion:

These emotions are trying to tell me that I was treated badly by someone who did not love me and that I need to look after myself because I am still recovering. For me, painful and invalidating relationships should be ended as they are unhealthy and unsustainable.

Glitter Jars!

If you haven't already seen this via sites like Tumblr, Glitter Jars (also known as Calm Jars) are a great craft idea for anyone looking for a soothing activity.

When you shake the jar, it's basically just very pretty.  It's an easy form of form of Distraction as part of Distress Tolerance skills, as well as a way to Self-Soothe. Double win :)

I have also heard of them used in place of self-harm, with the idea being that if you feel the urge to do so you shake the jar and commit to yourself that you won't take any action until all the glitter has settled, then repeat as necessary.

There are lots of different versions of instructions but here is my summary...

You will need:

• Clear jar with tight sealing lid
• Glitter, 3 - 6 tablespoons (depending on jar size)
• Clear gel glue or clear craft glue,  approx 1 tablespoon per cup of water in jar
• Hot or boiling water
• Fork or anything pointy that can get messy (for stiring)
• Food colour/dye

Add the glitter and glue to the empty jar. Fill half-way with hot water. Stir, stir, stir! When it is a totally even mixture, fill the remainder of the jar with cool water and add food colouring if you want. Glue lid shut. Allow to dry before testing.

If I'd give any extra advice, it would be to use a few different sizes of glitter, so that when the smaller pieces settle slower than the large pieces you end up with pretty layering. Also, possibly prepare to have a few attempts at this, as I know I needed to!

And lastly, be careful when opening glitter packets :(

I Think I'm Trying To Tell Myself Something...

The last time I was hospitalised, one of the projects that we were most encouraged to work on in our group therapy program was a "plan" for being ill.

This sounds a bit depressing at first, but to me it's a way to utilise the DBT technique of Radical Acceptance - radically accepting that I do suffer from mental illness and that I will become unwell from time to time and that it's my responsibility to do my best to manage this.

The first part of the plan was to come up with a list of Warning Signs - these are the thoughts or behaviours you notice yourself exhibiting when you're becoming unwell. Here are mine!

As my symptoms might be triggering, I'll indicate where this starts and ends if anyone would prefer to skip this. (Thanks to Debbie at Healing From BPD, my favourite blog ever, for this idea.) 

1.  Sleep

My sleep will become of very poor quality, with frequent waking and some scary dreams, but I'll continue to spend huge amounts of time in bed.

2.  Social Isolation

I'll start saying No to everything. Leaving the house becomes harder and harder.

3.  Irritability 

Oh yeah, I become irritable as all get out! Nothing is too small to tick me off when my mood is worsening. Friends, my parents, the cat.. everyone gets some nasty words.

--- TRIGGER WARNING ---

4.  EDNOS

Eating becomes a minefield, because I'll either stop for anywhere from one to three days, and/or then binge uncontrollably. For anyone wondering, this is a terrible idea for weight loss! Your body thinks it's starving and so the OPPOSITE occurs. I'm just saying.

5.  Self Harm

For me, I cut my upper right leg when there's too much inside. (This never used to happen before I met a person who was not very nice. But I've already covered enough about them!)

6.  Alcohol Abuse 

During a time when my condition is not going so well, it's far more likely that I'll challenge my body to a drinking contest. I notice that I am actively trying to dull my feelings or distract myself from them when I do this. 

7.  Suicidal Ideation

I just start thinking about it a lot. Not much more to say.

8.  Suicidal Plans

For me, there's a noticeable difference between thinking about it and really thinking about it.

--- END TRIGGER WARNING ---

Did you like the little rainbow colours of increasing craziness? :)

The second part of the plan is to have a clear idea of what steps to take when these Warning Signs show up.

For me, it boils down to:

• Telling a friend or parent that I'm not doing so well.
• Telling my Psychiatrist, Psychologist or GP that I'm not doing so well.
• Telling a Mental Health Crisis Team that I need help.

This way I can pick a response that I think suits the signals I'm giving myself. I guess it could depend on how long I've been noticing a difference, or how strong my symptoms are.

In any case, although it seems like obvious stuff, I find it helps to have it written down.

Do Drugs Work?

There seem to be a lot of different views within the mental health community about the usefulness of medication in the treatment of BPD, and I thought I would add my one experience to the discussion.

Personally, based on my experience, I am in favour of the use of medication to assist in the management of mental illness if it is suitable.

Understandably, some people feel concerned about the idea of being "on meds" or feel there might be a stigma attached. However, I strongly believe that someone considering medication options shouldn't have to be restrained by these social or emotional pressures, and should be able to focus on the facts about what's best for them and their health.

This does not mean I am advocating that:

• Drugs fix everything,
• If you take medication you don't need any other therapy,
• Everyone who feels ill should be on medication, or
• Medication is suitable in the treatment of all mental health issues.

What I am advocating is that I frequently see it stated that "there is not much research on the effect of medication on BPD" or that "there are no medications commonly used to treat BPD" when in fact there are many people using medications to successfully help treat BPD symptoms and that there are a variety of medications that can be used.

So, now for my experience! It has taken a long time and a lot of adjustments, but the current equation of meds that I have worked out my body responds relatively well to is:

• Pristiq (Desvenlafaxine) antidepressant, 200mg daily
• Desvenlafaxine is an SNRI antidepressant which basically works by blocking the reuptake of key neurotransmitters, like serotonin, leaving more available to your brain. I have been taking it for two years, and the most noticable difference was at the 200mg mark, whereas you typically start at 50mg. The only side effects were that it could make it difficult to go to sleep, so I take this in the morning.

• Valpro (Sodium Valproate) mood stabiliser, 800mg daily
• Valpro doubles as an epilepsy medication, in that it combats seizures. For unknown reasons this also assists in managing the parts of the brain that struggle with panic and anxiety type disorders. I haven't experienced any side effects.

• Seroquel (Quetiapine Fumarate) antipsychotic, 200mg daily
• Many people feel uncomfortable when they hear the term "antipsychotic", but aside from treating schizophrenia and bipolar disorder, it is mostly used to augment (or enhance, improve, etc) the effects of an antidepressant. It makes you very sleepy though, so I take this at night. One side effect experienced was hand tremors, which went away after the first three and a half weeks.

• Ativan (Lorazepam) antiaxietant, 1mg PRN
• Lorazepam is an antiaxietant, in that it combats anxiety. "PRN" means the dosage is "as required". This means I can take it to help me fall asleep, or if I am finding my symptoms unmanageable, or if I am expecting a very stressful event or activity. As you can imagine, this is very helpful with the unpredictable nature of BPD. I have found the effects don't last longer than 12 hours and have experienced no other side effects.

• Avanza (Mirtazapine) antidepressant, 30mg daily
• Mirtazapine is a tetracyclic antidepressant, which just refers to its' chemical structure. This is used to augment the effects of my initial antidepressant. However, this one does make you sleepy, so I take it at night. I haven't experienced any other side effects but have only been using it for one week - so I will update this.

So how has medication helped me? All I can go on is a comparison of my moods and behaviours before and after. Before, I used to be able to continue conflicts for hours to the point of screaming and screaming until I threw up - with no regard for neighbours, police attendance or life structure. After beginning medication, I have never done this again.

It's my best guess that it seems medication has "taken the edge" off my symptoms, rather than totally "curing" them. Even though I still have horrible moods, suicidal thoughts and irrational overractions to things, it seems like these just aren't as sudden or destructive as before.

Essentially, it's like the roller coaster has slowed down a little. (I just wished it helped more with the depressive symptoms.)

But overall, given I have no major ongoing side effects, this means medication is worthwhile in treating my BPD symptoms.

I hope this gives any other sufferers out there a better idea of their options.

(This isn't to say that I am cured or that I am never going to relapse in any of these ways. The thing about medication is that your body can and will adjust to it over time. This is why it is so important to consistently take medication as per your doctor's instructions, as well as to review dosage and application along the way. In addition, I am no scientist and I write this only from the basic understanding of a consumer. Obviously, you should confirm all facts and details with your doctor when deciding what is right for you.)

Recovery

--- TRIGGER WARNING APPLIES ---

I found this image while browsing the web, and it just really struck me as how recovery feels.

Recovery isn't this gradual steady climb up a hill with guaranteed timelines of improvement until you're standing at the top saying "phew, glad that's over!"

To me, at least, recovery is ups and downs and relapse after relapse. It's like being lost in a fog and feeling so defeated at the end of each day you can't imagine starting again the next morning. But somehow there are some changes that do occur - but it's never what you plan, it's never easy, it's never logical... It sucks, basically.

And always, always, the road before you looks impossible and terrifying.

Image credit: "Til the End of Days" by Javier de la Torre