Just Another Manic Monday: Lists of Then and Now to Fight My Anxiety and Depression

At the weekend I planned to write a piece on authenticity. As a business woman I am exploring what this means. We all have our work personas, and our others. One of the most interesting things I've read is that we can change - we won't stay the same and shouldn't expect other people to either. It's part of our evolution. That's why we do performance development and change management. Because we need to change. However, one thing that isn't going to change is my list making...(see below!)

I don't believe we have to show everything to be 'authentic', but at the same time, being able to be honest about the part of me that has depression and anxiety.

Today I'm feeling really unwell, so this is what I can do. I'm hoping to write more on authenticity - especially in business. For now, here is a blog about how I've made changes to try and combat Monday morning anxiety.

Five years ago, if you asked me what Sunday night looked like, I'd say this:

Just to avoid misinterpretation, no, dear reader, I am not George Clooney.

1. I would pack my suitcase for the week ahead, make a note of all the things I needed to remember to do (that I hadn't remembered to make a note of on Friday)
2. I'd look forward to a cold, crisp glass of sherry and a delicious Sunday dinner.
3. I knew I probably wouldn't sleep well because I'd be thinking of all the activities ahead of me (which despite taking careful note of, were whirring around my little head like a carousel whirring and blurring at 100 MPH).
4. I'd be aware of the earlier-than-normal time I needed to wake up to ensure I got the train to wherever work was taking me, and this would mean my sleep would be broken - I'd wake up half a dozen times to watch the clock, even though I would have set an alarm.
5. I might have dreams about work - often - and I might think of new things to add to that to do list. All in all, I'd have a fairly rough start to the week, which I'd treat with a bottle of diet coke (or two), a fair breakfast bought at the station and a blurry Monday trying to get through various meetings whilst not falling asleep or seeming manic because of the amount of caffeine I'd consumed to make Monday working even a possibility.

Overcaffeinated? Yep.

What has changed? It's Monday morning.  I woke up feeling horrific, but now I know that I can employ various things to try to ease this and help me get through the day.

I feel terribly anxious after a nightmare-filled broken night of sleep where I dreamed of a wider to-do list including both life things (like trying to sell the house, tidy the flat, clean, and a long list of work activities). This means that I'm feeling physically sick, with bile present in my chest and rising in my throat.

There is nothing I can do about that, or my bad dreams if I've practised healthy behaviours before bed. Here are my best behaviours. I try to do these every day.

1. I go to bed in time to be awake for a decent amount of time getting comfortable in bed and 'finishing' the day in my head. 
2. I drink water with my tablets and only drink water (and plenty of it) after bed and beforehand. I don't drink any caffeine at all but I used to not drink any after 2pm
3. I read something that is not too challenging and not upsetting before bed on my Kindle, on the lowest possible light setting that I can manage during the dark. I find that looking at my ipad or iphone before bed can disturb my brain with the backlighting and make it harder for me to get to sleep.
4. I put on a programme to listen to before sleep which my brain will focus on (meaning not on the 1000 alternatives possible) and this concentration relaxes my brain and usually is the magic silver bullet to make me go the f*** to sleep.

You can buy this excellent book here.

Having done these last night, I'm feeling just as tired as I would have been five years ago, and have a list in front of me that I'm crossing things off from. A list is helpful to me for these reasons:

1. It helps me to realise that it's unlikely I've forgotten something, and stops my mind from racing around trying to repeat the things I have to do the next day / in general again and again. 
2. When I cross things off (even if it's just writing an email) I feel like I'm making progress and it makes me feel more in control. (And yes, I am one of those people who even puts things already achieved onto that list...it's good to remember that you've achieved something already!)
3. I can build on it throughout the week and decide to allocate some of the items to other later days depending on how my health is.

On the other hand, I didn't have anything to drink on Sunday night (or at any time on Sunday in fact); I didn't have a suitcase to pack because currently I don't have to work on client work away from home, because of the project types I'm working on. I didn't eat a Sunday roast.

I went to bed at around 6-7pm because I wasn't feeling at all well. I also now have a host of drugs to try to help my depression and anxiety and the medication that I take to allow me to take that medication, that is, to help with side effects of insomnia, restless leg syndrome and, yes, anxiety.

What else do I do to make myself feel better? There are quite a few things that I know can work (even though they don't always). Here is a view of what I do to try to combat anxiety and depression and allow myself to work and get through the week ahead. Let's start with work things:

1. I decide to work from home (or I give myself the option to do this). I know this is not possible for everyone, and I feel that my current employer KPMG is absolutely essential to allowing me to do look after myself when I'm feeling really unwell. For some of the #selfcare activities I'll need to do, working from home for me is - today and on many other days - the difference between being able to work and having to take the day off sick. I'd much rather work if possible, especially because I enjoy my work and work is a welcome distraction from feelings of depression and the ruminating / worrying voices in my head, so, for me, this is the best possible outcome.
2. I make the list (hahaha, now you know I make lists!) (see above) both for work and for my non-work activities. It's really important to me that I set up my teams for success and that I set myself up for success (in spite of mental illness) by making a plan which I can put in place to support everyone I work with through the week, and enable me to be useful, work effectively, and not hold people or projects back (which would make me feel worse).
3. I am open with my colleagues about how I'm feeling. Today, for example, I can't take phone call after phone call as the constant contact might increase my anxiety levels, so I've made some calls and rescheduled others for tomorrow, ensuring we still make progress but not to the detriment of my health.
4. I arrange some critical meetings face to face for tomorrow, so that I can prepare for useful meetings on one day, in a reasonable (2/3 day) space of time to give me breaks to sit alone, quietly and have food and water between these. I need breaks to enable me to keep going.
5. I use technology (which is my business anyway!) to help myself to stay connected with colleagues and support them: Skype for Business (which allows desktop sharing and collaboration on group calls between India, USA...the world). I can review many of my fab team's work products through our online document storage options and lots more. It's good for my mental health if I can stay in touch with everyone - stay connected - and feel a part of my team even if I'm not well enough to go into the office.

And on the non-work front, here are the things that I have done (and do) to try to help myself feel as well as I can:

1. I get up and go for a run. My energy levels are better in the morning and if I manage to complete a run then, that's the best chance I'll be able to do exercise because after a day of work I'll be shattered.
2. I don't drink caffeine of any kind except very, very rarely (I've had 6 diet cokes this year). Caffeine can have an impact on my medication and make me high / then low after the post-caffeine crash. It's a mood altering drug so I'm avoiding it to try to give my medication the best change of working. This might mean I am more tired than normal in the day, so if I am shattered, I build in breaks (as above). 
3. I make myself (or buy) juice from breakfast (beetroot, carrot, apple and ginger). More from the Mayo clinic on anti-anxiety nutrition guidelines here. 
4. I drink plenty of water all the time. It's great that I don't like coffee, tea etc. but I do miss diet coke. I love the no added sugar fizzy drinks from Marks and Spencer and I certainly am not a perfect diet person - it's just some things I can do, but I'm not a paragon of nutritional virtue - far from it.
5. I eat nutritious food, but also nice food. Crisps are a non-negotiable. I also can't give up bread. I. Love. Bread. And I will eat cookies too. Refined sugar might not be the best thing, but it tastes nice.

It's only 12.03 and I've got a lot more hours to get through. So here goes. But I hope for anyone reading this and wondering how they're going to get through the next few hours. Me too.

You Matter. World Suicide Prevention Day #WSPD15, #RUOK

I think few would disagree that suicidal thoughts are in themselves very frightening. However hard we may find it to live in this complicated world of wars, births, deaths, marriages, losses gains, progress, recession and so on, suicide is not something that we often discuss, at least not among my friends. Imagine, though, a person whose world has become so unbearable that it seems a release to consider letting go of all of the things that are making life seem impossible for a different choice – a choice where none of these struggles exist anymore, and where that person will be freed from expectations and constraints of life placed on him / her by others, or, most importantly, by him/herself.

I recently spoke to a group of senior leaders at work about resilience in my definition of the term. More to come on that in another post. During my talk, I mentioned how bad things had been last year and how things still were, quite often, very very bad for me with depression and anxiety invading and dictating various aspects of my life – what was possible and impossible. I told the group that at my lowest ebb I had not been suicidal, meaning I had not made plans to kill myself or set about putting those plans into practice. What had happened to me, though, was something very damaging: I had stopped wanting to live. I awoke each day with a heavy head as I looked out of the window at a world I no longer wanted to be part of. I felt a total failure, despite the promotions, the new job, the happy marriage, the friends I had. I felt awful. I felt I was awful, and that feeling this terrible way each day was my life sentence, a sentence I wanted to give up.

Nothing if not practical, I eventually realised that the tears every day before work and the panicked feeling that I couldn’t shake no matter how much exercise I did, sleep I got, reading or other distraction techniques I employed, the feelings of absolute hopelessness, were not going away, and that I had to do something about it. I chose to see my psychiatrist and explain how I felt. He made me fill out a questionnaire to assess the severity of my depression, and as I circled ‘very frequently’ against ‘feeling of not wanting to be alive’ I started to cry and cry, realising when I saw my self-assessment on paper just how bad things really were. I was dreadfully ill. I was living not even a half-life, even though from the outside every aspect of it was going well.

And this is how to interpret...

Mind puts it like this:

Mixed feelings
You may be very clear that you want to die – or you may simply not care if you live or die. However, for most people, suicidal thoughts are confusing. As much as you want to die, you may also want a solution to your difficulties. You may want others to understand how you feel and hope that they can help. Yet, you may not feel able to talk to anyone who offers to help. Having such mixed feelings and being unsure about what to do can cause great anxiety.

The latter description is more relevant to me – I just did not care whether I lived or died. But I did want a solution and I did want others to understand.

In hospital I met many other patients who were stuck and wading through the treacly mess of depressive thoughts. Looking into the treacle to try to find meaning, but seeing only blackness. Trying to get out of the treacle, but being sucked back into its sticky, strong mass that we had not the means to counterattack.

One patient who became my friend was very silent almost the entire time that I was there. Many more were like him. I was pretty well versed in the language of therapy and (no surprises here) had always been something of a talker, but others, particularly men but not exclusively, were so immersed in the terrible depths of their illnesses, so entrapped, that their mouths and gestures were glued shut and slowed by the treacle. And even if they opened their mouths to speak, many times they had no language to say what was going on.

You may be aware that more men commit suicide than women, by which I mean that more men succeed in the attempt. It is always dangerous to make generalisations, but the rates of suicide among men are rising over the past few years, whereas for women they have stayed broadly the same.  Wikipedia says: “The rate of nonlethal suicidal behavior is 40 to 60 percent higher in women than it is in men. This is due to the fact that more women are diagnosed as depressed than men, and also that depression is correlated with suicide attempts.”

The Guardian says: “The Adult Psychiatric Morbidity in England 2007 survey found that 19% of women had considered taking their own life. For men the figure was 14%. And women aren’t simply more likely to think about suicide – they are also more likely to act on the idea. The survey found that 7% of women and 4% of men had attempted suicide at some point in their lives. But of the 5,981 deaths by suicide in the UK in 2012, more than three quarters (4,590) were males“

As I have said before, I am not a doctor and have no qualifications in this field other than the benefit of my own lived experience.

I personally believe that we need to do more to support each other – whether we are struggling or not – to prevent ourselves and others potentially struggling to the extent that life ceases to be enjoyable. Even for me, while I may (may, no proof) be genetically predisposed to depression and therefore have life’s experiences + genes to thank for my seemingly effortless propensity to become depressed through various times in my life, life can be enjoyable and often is. I am so lucky that I have people who ask me ‘Are you okay?’ and really mean it.

The hardest thing for me about feeling so dreadful was the loneliness of it. And I talked about it as it was happening to my husband and my doctor, and still I felt alone. What must it be like to be someone who is experiencing these terrifying thoughts that a world without them in it would be a better reality than one with them?

We cannot move mountains to end all suicides today. But we can do little things to connect ourselves to one another and seek to invite connection from others, so that people feel that they are not alone, and that someone – a lot of someones, in fact – cares for them. We can ask each other how we are, not as a throw away ‘hello’ platitude, but as a real question expecting (and accepting) a real answer.

We can ask about each other’s lives and share something of our own, so that we make connections with each other. We can smile at the person we meet out running and wish them a good morning. That might be the only time that person sees a smile or hears that all day. Simple steps like these can be very powerful. And at the end of the day, we can say thank you to our work colleagues for what they have done for us. We can ask them what their evening or weekend plans are, and listen and share our own. We can thank our friends or partners for helping with dinner (whether ordering Domino’s or cooking a three course meal, whatever!).

By connecting ourselves with others and by sharing things about ourselves, especially if we are not having a good day and we feel we can say it aloud, we are inviting others to do the same. So when I next ask you how you are, or how things are, or if I ask, “Are you okay?” I promise: I really want to know the answer.

You Make Me Sick: My Week of Anxiety

This week has been distorted with a weird whirl of media because of public appearances (even though they were staged, pre-recorded, pre-written etc. weeks ahead of broadcasting / publication). Media distorts things, whereas the reality is very different. Tuesday and Wednesday were bizarre, as I was tagged on Facebook appearing on the BBC without knowing anything was going to be broadcast that day, and being published in Metro.co.uk writing a light-hearted piece about anxiety.

Metro piece - a lighter look at Anxiety

Of course, as I should have realised, Anxiety likes to have the last word, horrid sarcastic words that sting and endure. Anxiety showed up with bells on for the rest of the last week. I’m still trying to ask it, as nicely as I can, to get the hell out of town.

Talking about depression while pretty ill with it, on BBC London

So in case you read my Metro blog and thought I have only a humorous view of anxiety, that’s not true (would that I could see it from just that perspective, would that it never got any worse than the quirky behaviours I mentioned in that piece). There are many more serious things that come out of an anxiety condition. I will never stop making fun of myself for my quirky traits stemming from anxiety, but I will also take seriously the symptoms that debilitate me and that I must address if I am to have a chance at handling this condition in the longer term.

Tuesday 1^st September

I smiled when I heard colleagues in the elevator already exclaiming pressure over too many activities and an overextended "to do" list for a four day week. I had been careful with my planning and thought I could handle it. Anxiety doesn't care about my good diary management, though, it prefers when I over book myself to turn up unannounced.

I suppose I am only providing it with good reason to show up at those times. It's when I've made every effort to plan my week sensibly, though, that it is most annoying to experience. And despite making fun of my experiences of anxiety in my blog for Metro this week, and my firm belief that it's good for me to be able to laugh at the silly things I do because I suffer from anxiety (and, as I've said before, my medication escitalopram happens to affect me with anxiety as a side effect. Great). I'm changing to a new type of medication - which will be the sixth anti-depressant I've tried in 15 years. Hey, at least I still have new ones to try!)

For the very reason that today - Sunday - I'm still feeling pretty anxious and ill - I've written a blog that again is fragmented, because I can't calm down or focus long enough to feel able to write something consistent. What I can do is present something that is true - the peaks and troughs (panics and peaceful moments) of how a week with anxiety has been, for me.

These all resonate for me. It's amazing how physical the body's repsonse to anxiety is.

I can understand the sense of these repsonses in a situation of real danger. But attending a social event or a meeting? These symptoms in these situations are debilitating and (literally and figuratively) painful.

Friday 4^th September

Although I ate a salad for lunch today it may as well have been uncooked pastry or carelessly mixed cement, as far as my body is concerned. In my chest, among my main arteries and the networks of veins connecting my rapidly beating heart to the rest of me is a cold, glutinous congealing mass of something sticky that has got in there and won't budge. It nauseates me to the point where I push random fingers into my chest to try to find it and remove it; it won't go. I am breathing in and out slowly and deeply but still it doesn't move. It isn't digestible but makes me try to remove it through swallowing, gulping again and again without success. It isn't expiring with my outward breath. It is so constant that I hardly wonder why a couple of years ago I barely noticed it was there every day. This is one physical manifestation of what my anxiety feels like.

I times I bruise my chest by pushing at it trying

to shift what feels like a hard lump inside

I'm one of the lucky ones who isn't anxious all the time. In my past life living alone in New York in a very pressurised and stressful job, as I realised today when I felt the physical symptoms described above, and realised it had been at least three days without a let up.

This happens to me again and again, so I have

 to step in and stop it until I unravel completely

The worst time this happened was at my job interview for KPMG. I was really, really ill at the time with depression / anxiety. I have always made the effort to ignore my anxiety and go for things anyway (I suppose, that cliche "Feel the fear and do it anyway" applies perfectly to one of the ways that I operate (see below - overcompensate), It was in the very first exercise that I was presenting back to a large panel at my assessment centre when I needed to refer to the consulting firm in a 'mock client proposal pitch' that the word "Del- " (Deloitte) slipped out of my mouth in my mock-confident pitch patter. Even though the director observing said, "We'll pretend we didn't hear that", I was absolutely horrified. 

Me at my interview in reality. 

How I presented myself at interview. 

Hiding behind a suit and a smile

Every physical response - the fight or flight mechanism in its rawest form - suddenly invaded my body and overwhelmed me. I felt dreadfully sick and wanted to leave immediately, but it was only 10am and the first part of a whole-day interview. I couldn't leave. I had to stay. My brain does not work properly in a period of intense anxiety. My brain needed to work for me to get the job. Worry. Stress. Sweat. Nausea. Trying to ignore all of these and carry on through other case studies, partner interviews, even through 'lunch'. I have no idea how I got the job given how unwell I was. I did go back for a final interview another day, and at that point I was not in the primal phase of panic, thank goodness.

I now try to deploy the measures that I've learned can help of course. I do breathe deeply because at least I can reassure myself that there are genuine physical and mental benefits to this, even if it doesn't remove or lessen my anxiety: I know rationally that I'm supplying my brain with oxygen, which means that I am giving myself the best chance of being able to think and operate even though I feel physically so unwell.

I do practise mindfulness, which means I put my brain to work focusing on things other than the physical feeling of anxiety. It's a distracting technique that requires effort and a discourse with my brain where I ask it to pay attention to a single thing at my command, and politely wave or tap it in the shoulder when it drifts off to thinking about the fact that I need to send off the proposal tomorrow, that I need to go for a run, to the bank, to get the car through its MOT and buy more loo roll and answer my emails and update my time sheet and so on and on and on.

It is hard for me to practise mindfulness lying down without falling asleep- largely because if I do manage to get my mind to focus on some one thing then my brain has a chance to sense my body's total exhaustion and takes advantage of the time to shut down and rest. I have to try to sit up, and then I struggle so much to keep my mind on one thing, even for ten minutes. In anxiety I find my mind rushes here and there and everywhere but on the body scan or shape to which I'm meant to be paying attention.

Also I know mindfulness is what I should be doing, but mid-anxiety I find I often feel overwhelmed and that in adding mindfulness to my list of things to do I will cope even less well with an even longer list of expectations.

However, “I should I should I should” isn't helpful. I need to be well. I need to look after myself. I need to provide some comfort and support to myself.

Saturday 5^th September

I am now sitting here on Saturday evening wishing today had been what I thought it might be: an anxiety-free day. I’m not working; I haven’t had to spend ages cleaning the house or doing other admin chores; I even went to have my hair cut (which is usually enjoyable not stressful since I see the same person each time). Unfortunately it hasn’t worked out that way, and the physical nausea of my anxiety, my shakiness, my racing thoughts, and every other symptom, are still with me to quite a significant degree.

What else do I do when I'm anxious? Panic. It is not an exaggeration to say that it affects the brain in the same way as if there were a genuine fire, an attack or another calamity.

We are programmed to respond primitively in these situations and what that means is a release of adrenaline and cortisol to the brain. This allows us to flee or fight- giving us a spur of energy and stamina for a period of time. What happens to me is that this reaction occurs when I am in a variety of situations where this is completely unhelpful. In place of the rational person who can make decisions and lead teams, organise the house sale, my career, my blog and volunteering, among other things, appears a vastly debilitated version of myself, paralysed by fear and stress to the point where rational thought is almost impossible and the ability to do anything other than flee (whether from the office or under the duvet or whatever) is massively limited.

It repeats and repeats and repeats unless I work at fighting it. 

Unfortunately if I'm already exhausted by it it feels an impossible task.

I have to soothe myself first. Breathe, rest, walk, eat, take a moment. I can’t do anything until that’s done. When it is, that’s when I can do is split things up into manageable chunks. Maybe one small thing from the to-do list. The one thing I can do. Then the next. Then the next.

Sometimes it's more like 25% calm. At that point I could potentially achieve something.

Beforehand, nothing's going to happen unless I bring my anxiety levels below 80%

I do these when the countering, healthy behaviours I know are better but which are just too bloody hard to do at times. The closest I come to helping myself when I’m really panicking is – at best - to climb into bed and shut out everything that is causing me such stress and worry.

Also, no caffeine. I have caffeine once in a while, but 

any more than once a month or so and it negatively affects my mental state

I’m trying to learn to do this in advance of anxiety reaching its full force. I know that I am prone to pushing myself so hard in many directions that anxiety can paralyse me. I have to try to plan ahead so that I’m less likely to have an anxiety attack with the above, with a balance between work, life and rest, with the right amount of exercise (not too little, not too much).  

Sunday 6^th September

I made it to today. Doing the right things today were: 

1. Going for a run and loving seeing the deer. (Exercise also helps digestion, raises my endorphin levels, uses up some of that nervous energy, and gets me out into the fresh air to breathe.) 
2. Eating lunch with my husband. Burgers. Chips. Chat. 
3. Having a rest: this is controversial (as sleeping during the day can disrupt sleep at night), but since I cannot catch up on tiredness at any point in the day during the week, it's a real luxury for me to be able to lie down and read, watch a film or listen to a podcast without the need to go back to my calendar and prep for the next meeting.

Bushy Park today. It was glorious, and I'm happy I made it out

 and won a small victory over my anxiety

On the other hand, the horrid lump in my chest is still there. I'm trying not to worry about it! I'm still breathing. I'm still here. Small victories, even if the war with anxiety isn't over.