Category Archives: meds

It gets better(ish)

I was messaging back and forth with someone on my tumblr blog about something I’d reblogged about being middle-aged (ish, I know 40 is the new 30 *rolls eyes*) and mentally ill.

I tagged myself as being 42 and having bipolar 2, which prompted that person’s message, and thus far we’ve had a few back and forth messages about bipolar 2.   Among other things, I mentioned that I think (and still do) that I am a better writer when I am really depressed.

Something they said in response struck me (to paraphrase):  “I don’t know who I am without meds.”

I used to feel that way, and when I went to check out their tumblr profile I was reminded that they were in their late 20s.

It made sense, even though I don’t know how long this person has been struggling with their diagnosis.  Here I am, 42, and I’ve been doing the bipolar diagnosis thing for 10 years.  I’ve had this blog under one name or another for 10 years, however lately neglected it’s been.

And gosh, do I remember how fucking agonizing life was for a really long time.  First, because I was miserable and couldn’t fix it.  Then, miserable because I knew what was wrong with me but the meds weren’t a cure.  Then, more miserable because the meds would work for a while and then just stop working.

Never mind all the stuff about the impact bipolar has had on who I have managed (or abandoned) relationships with– family, friends, and work– and how hard those relationships were to navigate around trying to keep a stuff upper lip and keep going.  Never mind all the stuff about work and achieving what other folks expected of me and castigating myself for not being enough of a success.

A very big part of the angst and the agony was about questioning my identity– was I just malfunctioning neurotransmitters and faulty hormone levels?  Who was I if it required medication to change my perceptions to something “normal?”  Wasn’t there, surely, a “normal” that existed outside my ups(ish) and very deep downs? Wasn’t it really a character flaw inside my personality (whatever that was) that meant I wasn’t morally strong enough to just push my way through the depression?

I said to this tumblr friend that I had been through that and at some point it had stopped bothering me.  I guessed that in all the thrashing towards leaving my marriage, I’d unconsciously resolved the question in favor of “I am worth it,” and stopped questioning whether “meds me” or “non-meds me” was the real person who deserved to have attention paid to them.

I think this is probably true– although heavens know, I could go back to when I was blogging here then and re-read my posts to see if that’s what I was thinking then.  I’m not going to, though– because it matters less than what I know to be true now.

Here’s what I know to be true now.

It mostly gets better.  Better(ish), if you like.

Infuriating, right?  Everyone who’s not inside your head tells you this and it is so damned hard to believe in the midst of the darkness.  Someone told me this back then and I emphatically refused to believe it.

It’s true anyway.

I don’t want to navel gaze about self-help or sports-jargon words like “resilience” or “adversity” or “living with your struggle.”  I think that “keep calm and carry on,” is as close as I can come to paraphrasing what I’ve come to accept makes sense for me.  Or maybe Winston Churchill’s “if you’re going through hell, just keep going.”

I kept going and decided to do that even when things were objectively terrible– and not just because my perspective was tinged by depression and panic and very little hope that things would improve or that I deserved to keep going.

A lot of times I tried to trust in the therapeutic value of work– not in some big, high-minded way, but in an “at least I accomplished something today” kind of way.  I have journaled erratically over the last several years, and when I have it’s been focused on what I have been doing that means I accomplished something.

Sometimes it’s been– I fed someone something delicious.

Sometimes it’s been– I got someone back their health insurance, or hired someone who’s succeeded, or I gave someone the space they needed to attend to their health and still keep their job.

Sometimes it’s been– I made someone I care about laugh.

Sometimes it’s been– I cut back that overgrown, unblooming rosebush that scratched up everyone who came near it.

I hacked back that rose hedge the week after I left my marriage and moved.  I was scratched all to hell by the end, and I sweated the whole way through it, sore and tired from all the work.

It’s been 6 years since then, and that hedge is more or less orderly, blooms all summer long, and it’s beautiful in its own droopy, old-fashioned, slightly scraggly, occasionally thorny way.  Those things are all true, standing right up on top of the hedge.  But three feet away, it’s a well-put together rose hedge that delights everyone who sees it.  (We get notes through the mail slot about how nice a rose hedge it is.)

It’s work, though.  That first pruning was not a magical fix and it was ugly and bare for a while.  I have to tend to that hedge every year and cut out the dead parts, feed the roots, and take a step back to figure out how to fit other parts of the garden around it.

That rose hedge is a little too heavy handed a metaphor, but it’s true.  I had to hack my life back down to the ground for it to grow back– but it worked.  It got better.

Gardening metaphors aside, though, it doesn’t mean I don’t still get depressed, or anxious, or agitated and doubtful and occasionally helpless.  It does mean that having decided to keep going, there are more and more successes over time that are objective proof that I am mostly making the right decisions, and that whoever I am, with or without meds, I’m doing okay.  And then, I feel better more quickly than I had in past years.

It gets mostly better.  And when it doesn’t, it’s okay.  It will get better(ish) again.  Just please keep going.

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(Easier than) waiting around to die

(Trigger warnings for discussions of suicidality, family drama, and other A+ parenting issues.  Also, as usual, language.  This is a sort of undecided, sort of open-ended piece because I need to tweak my meds again and am feeling more than a little blue, but I have already called my shrink & let my therapist know I feel lousy, in case you’re wondering.)

I read some author’s line someplace that we sometimes feel like can’t be who we really are until everyone who’s known us is dead.  Sometimes, it’s even true by circumstances of money or other constraints– you don’t have the freedom to tell other people and their expectations to go screw, and sometimes just heading out for the hills and reinventing yourself somewhere, somewhen else is not in the cards. Continue reading

Doing something

In between meds means in between states.  I am tapering off the 100 mg topomax @ 50 mg and hoping to maintain that dose while getting the rash that developed @ 100 mg x 1 week to recede.  So far, it is receding, but slowly.  So is the initial mood lift and subsequent dip from going off the wellbutrin 100 mg cold turkey because of those pesky suicidal ideations.  Since I tapered back to 50 mg on the topomax, my anxiety dreams have slowed, and I feel about 40% less panicked/ nauseous/ enraged by situations at work, but I still am exhausted and prone to inner rage storms even if I’m less overtly weepy.

Monday, I started on 5 mg lexapro.  It takes up to 3 weeks to be effective, so we will see.  Today, though, I feel my “usual” hypomanic lift from starting an SSRI, which seems to indicate that the lexapro’s doing something.  If it’s not just a hypomanic “crash” from the topomax or the cessation of .5 mg doses of klonopin throughout the day to manage my panic and suicidality instead.  Either that, or the resurgence of spring sunlight this weekend, even with yesterday’s snow, and hence an up tick in my circadian rhythms.  Although I did sleep 10 hours last night.

Then again, that hypomanic productive mood I feel today, where my head feels stuffy, my chest and stomach feel hollow, and I can laugh at any joke as long as it’s mean might be the result of knowing that come Saturday, I have 3 weeks to figure it out and get some of the personal crap in my life out of the way so it looms less if/when I go back to work.

It will tease itself out, I hope.  If I do lots of things, surely something will work.

Side effects may include (not as described)

Any drug is going to have side effects.  Any psychoactive drug, either when it stops being effective, or causes you to be in overdose (the “mild,” not-dead, not in the hospital yet kind of OD) often has side effects that mimic the symptoms you’re trying to treat.  Sleep disturbance, anxiety, paranoia, lethargy, apathy, catatonia, insomnia, suicidal ideation, you get the drift.  In something cyclical like bipolar, it’s hard to tell if it’s the meds that aren’t working, if it’s too much meds, if it’s the change in season (bipolars’ diurnal & circadian rhythms are really sensitive and prone to getting extremely messed up), or some external stressor that has set off a dip or upswing in mood– but it can be a slow creep, and sneaky, and even practiced, self-aware, general ly pretty in-control folks can find themselves in the midst on an onset before they realize they’re having an episode.

And then there are the physical side effects.  These may or may not be listed on the drug label– my own experience since 2007 is that some of the side effects are always going to be idiosyncratic to the patient, especially when dealing with psychoactive drugs, which doesn’t mean they still aren’t real to the patient, and that some aren’t listed because they’re not widely known yet, because a lot of bipolar drugs are off-label anti-convulsants, and so, obviously, bipolars’ reactions are going to be a little different from people with seizure disorders.  (This is why patient med wikis like crazymeds are so integral to feeling like you aren’t totally nuts when you experience symptoms that are listed nowhere official.)  I mentioned the sleep disturbance– so, multiply that by weeks or months, and then see how your joints and muscles ache because you’re exhausted.  See how your patience and moods fray, and your sense of humor disappears (and makes your mood swing even worse). Sometimes, there’s muscle stiffness, so painful you can’t turn your neck, and it brings tears to your eyes to touch your own skin to rub in some arnica cream or Tiger Balm or whatever other placebo-self-care balm you think might possibly help.  Some of the meds make you clench your teeth so that you wake every day with a headache or walk around with a permanent frown that turns people off because they think you hate everyone.  (You don’t.  Just your meds, the same ones that make it possible to get out of bed everyday and come to work to frown at everybody in sight.)  They dry out your mouth, or leach out salts so that all you do all day is drink water and crave a salt lick.  Sometimes, the meds dry out your skin, so that no lotion is thick enough and you have to go to the work bathroom three times a day to lather up just so you won’t claw your skin off.  (But it’s spring, and you’re hitting a middle age hormone change, it makes sense that your normal spring dry patch would just be worse this year, that’s what you tell yourself…)  You take ibuprofen to deal with the headaches, the jaw pain, the muscle stiffness, the aches of exhaustion, and suffer the bruising that comes with too much NSAIDs as a result.  Another side effect.  Not so bad, right?

And then you realize, maybe after the fourth time you’ve closed you’re office door because you’re leaking tears again, OH, I’m having a mood swing and I need to adjust my meds and maybe I’m also overdosing because– what’s this weird rash on my chest?  DO NOT IGNORE THE RASH ON YOUR CHEST, DO NOT IGNORE A RASH ANYWHERE, I REPEAT, especially if it’s raised & it itches, take a benadryl right away.  Cut your dosage, call your shrink, look up your meds to see if you need the ER, if your shrink does not call you back, call your primary care doctor, call your therapist– tell someone your meds do not work and you need to get off them and onto something else, pronto.  Keep calling until someone calls you back.

I try to not completely discontinue meds– withdrawal sucks cold turkey & it has dangers all of its own– but so does strong suicidal ideation, and sometimes complete cessation of meds = cessation of strong urges, plus sometimes there is not enough klonopin/other anti-anxiety med du jour (or sometimes, there’s just enough in exactly all the wrong ways) to make those wrong, ugly inner voices quiet down so you can hear something besides your mood swing.  A bridge medication is good, even if you still are going to feel, over all, pretty bad for a bit– because a bridge helps you cross the chasm, and if it makes you feel a little dopey, a little zoned out, a bit unable to spit the words out, a little less in touch with the finer feelings you’re going to have to deal with at some point– well, at least it gets you over the fiery pit part in the middle.  (That is a crappy metaphor.  Sorry.)

No one ever tells you this in the psychiatrist’s office.  I don’t know if it’s because they don’t take the meds so they don’t know (or because it’s unprofessional to admit they they feel your pain) or because they think it’s scare you to know that at some point, you’ll have to switch it all up, and that at a certain point you’ll have to start down a new road, your old bridges burning behind you– such that you’ll never start off in the first place.  I do know now, what I didn’t a while ago– the lessons learned smell like ash, but they still illuminate, even if it is just at the brink.  (Oh, crap, it’s a rash– that’s an illumination.)

My therapy homework this week is– every day– to write down something that I did right, at work or at home.

Just like when I was sitting in my therapist’s office and he said that to me, all kind intention and just brimming with empathy– this man is good in the essential sense of that word– I’m leaking and choked because I can’t hear it, can’t think it.

Medication changes and more severe than usual spring mood swing aside, I don’t get enough thanks or praise, and when I do get it, it’s often laden, conditioned.  “You’re the best,” because I did something so ridiculously, outrageously pampering of a grown-ass adult, just to get the work off both of our desks, even though it means it pushes the boundary back toward me though it’s not my job.  “It’s nice that you work late & weekends,” (because the other guy didn’t.)  These aren’t words that mean they see me– it only means that I exist as a contrast, an outline against some other condition/behavior/thing they want to avoid and make their life easier as a response.   And I feel like it’s insincere when I hear it most of the time, because people just want things from me that make their lives easier.  They don’t care about me except as a delivery vehicle.

I feel pretty invisible, most of the time– partly my role, partly my introversion, who knows what else– and when I’m visibly upset, most people don’t ask if I am okay or even let the pause be awkward before leaping in to the thing that they want– either because they’re oblivious, or selfish, or because there’s some perceived power dynamic and it’s better not to acknowledge that someone “above” you is having a shitty day in case they’ll get… what?  I don’t know.  I don’t understand the dynamic of it.  I guess it’s mostly that it’s my job to be the one to deal with people’s feelings and people can’t deal with the idea that I might have some of my own.

At work, too, there’s a power dynamic between “just” the admin and the sales teams.  It’s shitty. The sales leadership aren’t as well trained as they could be, and they’re allowed to get away with inconsistent & lacking behavior as long as the sales are on point, while the administrators run around mopping up after them.  It’s the same any place, but the rhetoric here is that it’s supposed to be different and the divide from reality is stark, isolating, and disenheartening in the extreme.  When you feel overworked, under-appreciated, overwhelmed with entitled stupid questions & never given a pause to train anyone in order to stop the stupid questions or any subset of of them, it’s– misery, pretty much, pure & simple, especially when you’re more or less suicidally depressed and no one seems to notice except your second assistant in a year and oh, yeah, guess what, she’s going to grad school so you’re going to have to start training somebody else by mid-summer.

There are smaller things that I did right this week.  I admitted that I made a mistake about something that won’t be the end of the world.  I helped someone qualify for housing benefits.  I helped someone with a leave of absence and explained how short term disability worked.  There is more.  I can’t recall any of it in the constant onslaught of shit I deal with, day in & day out.  Some of it’s firing people for stupid mistakes (the worst reason to fire someone, imho, at least be blatant about it), some of it’s wading through unqualified applications, some of it’s saying no for the 40th time and handing the person the explanatory form they’re too lazy too fill out themselves.

I can’t help feel, though, that the main thing I did right this week was admit that right now, I really do hate my job and I need to take some time off before I do something stupid like mess up something for someone or quit.  (Like, you know, last time.)  I don’t feel better about it, for managing to pull myself up short of my 2009 mistake and having admitted weakness, reached out for help, and asked for a leave of absence, without disclosing all the particulars of my diagnosis.  I still feel stupid and paranoid and crazy and like there will be a negative impact on my job when and if I return, and who knows.  Maybe there will be, but I suppose this all still buys me time.

I’m still really scared and anxious and depressed the moment I start thinking about it, in terms of– what will happen if I come back?  Do I want to?  What do I do while I’m off?  What if the med change doesn’t help?  I can’t fucking look for a new job in this state of mind.  (You know, the usual crazy morass of anxious over-thinking.)  I actually left early for the first time since I started work, after overreacting to something my two-weeks-brand-new boss said in– what I think were objectively understandable circumstances for context he didn’t have and didn’t bother to have before he set me off– and people are probably all gossiping about me at work by this point because I was clearly upset & in tears when I left and was shutting things down in my office.  I idly looked at things I might theoretically otherwise want to do as job search queries (after isolating the parts of my job I like the most) and started to panic because it’s not that I hate the company or the job, really, it’s that I can’t draw a breath without 5 people shoving into my office– so I went right back to time-wasting internet shit– but it’s one thing at a time, I guess.

Things I did right this week.  I didn’t stop showing up for work, because: crazy, and I went home early for a long weekend after a somewhat weepy but otherwise reasoned discussion.

I guess we’ll see how the rest plays out from here.

Decisions, decisions (it’s only dinner)

I didn’t make supper tonight.

Is that a failing or a freedom?  I don’t really know.  It is a decision, though whether it’s a capital D Decision or a small decision just for the right thing I needed today, I’m not really sure.  I do know I started to assemble things out of the fridge, all knackered out, and then looked at the ingredients out on the board in the pantry and said to myself– no.  I don’t want to.

When I came in, my dad had been sitting there for at least a half hour, snacking on all the various food he didn’t have to cook or reheat that was there in the house– and I was just wrung out when I came in on automatic and started to housewife, you know, in the ways that we do.

I didn’t want to, though.  I’m not hungry, because I’m upping the dose of the particular meds that kill my appetite dead (anorexic anti-convulsants, woohoo!), and also because I had a late snack/drink at the store in accordance with the preset alarms I’ve got in my phone and which I obey whether or not I am hungry, on the hard lesson learned that your body needs fuel whether your stomach feels like it or not.  But– having had protein and some carbs and some veggies on three occasions today, not to mention too much caffeine and other fluids, the idea of doing it all again just because I have let my dad get into the habit of me doing the cooking made me kind of sick to my stomach, physically and mentally, too.

Instead, I said– sorry, I was really just tired, I didn’t know what to cook & didn’t feel like eating in any event, and that there were X & Y leftovers to heat in the fridge & I was going to bed.  Dad did not understand the not hungry thing, so I explained, for the fourth time in two weeks, about not being hungry with the increased dose of the meds and feeling grossed out by food– and then retired upstairs.

I supposes it’s a measure that the increase dosage is working that I didn’t have a temper tantrum of rage or start crying because he just can’t pay any attention to what’s going on outside his own head.  And I suppose it’s good, too, that I still feel pretty calm and chill about the fact that I said no, sorry, I’m not your wife or your nurse, feed yourself, and am not feeling horribly guilty or like a terrible mooch.  The fact is, I do buy a lot of the food, cook & clean, do the yard work & heavy lifting.  If it’s not money, it’s still work, and it’s value– and valuable.  I’m starting to know that.

There will be a time when my dad can’t “do” for himself at all anymore, including the cooking, and then I will have to take care of him whether I feel like it or not– but right now he can, whether or not I’ve fairly/unfairly stepped into the cook/caretaker role in an attempt to pick up some of the slack my not paying rent leaves.  He taught me how to cook, after all– if he’s too tired to do it, well, then we’re both in that boat.  Any stupid decisions he makes about salt intake or junk food or excess fat or calories are just that– stupid, small-d decisions, rather than life-impacting Decisions that are the product of someone who’s senile, demented, or some other process of aging or illness.

Maybe, for example, an Illness Decision could be: someone who’s manic-depressed and making bad life choices instead of self-caring ones because they’re not really lucid?  Then again, Bad Life Choices can be really good learning experiences,  even if it takes a while in the rearview to bring them into perspective.  I think skipping dinner, though, isn’t so big as that.

Ask me next week.

Crush

(Re-post from my fannish tumblr)

Up-front disclaimer— I don’t recommend just discontinuing your meds to anyone who’s bipolar and having escalating mood regulation problems.

That being said, I went off my wellbutrin (100 mg) last night, because I’ve been feeling more and more like crawling under a rock, quitting my job, and/or running out into traffic, plus everything, everything hurts. (Anyone who tells you depression is all in your head is a steaming sack of dog shit.)

I’ve been diagnosed bipolar since 2005.  I’ve blogged off and on about it as a way to get the thoughts out of my head and maybe because it’ll be helpful to someone else to know they’re not the only one feeling nuts and still getting on with their life.  It hasn’t been easy; I’ve had some real setbacks, including starting over in a new career path after I self-sabotaged my old one during a bad depressed phase, plus realizing I needed to end my marriage because my husband (who had his own problems) couldn’t deal with being supportive when I was being crazy.

But since 2009 I’ve been on a drug cocktail that has more or less worked well enough to give me good insight into escalating mood problems— not in a *ooh, lightbulb* kind of way, but at least in a *oh, I’ve been working myself into a lather and I’ve been crying a lot and I hate everyone and I’m really angry and I don’t want to go in to the job that I love and I just want to sleep* kind of way that takes me only a few weeks to see, rather than months.  Having a therapist who asks if it’s time to adjust my meds rather than tell me it’s all Freudian shit (fuck you, last therapist, for undermining the fact that I do have a neurotransmitter disorder as well as a fucked up family life, you can’t just turn off the biological disorder like that) helps, too.  Plus, there’s that whole blinding headache all the time thing, kind of a clue.

Accordingly, I’ve discontinued the wellbutrin, because the mixed states I’ve had before have always resolved when I’ve gone off the SSRI* for a few weeks & then either reintroduced it or switched out that med, while increasing by 25 mg. the anticonvulsant (topamax) I take and bringing more of the benzo-class drug that I take (klonopin, 1 mg nightly) with me for day time anxiety swings, .5 mg prn,2 mg. max. daily.

I feel better this morning already, with the crushing headache absent and the body aches mostly gone.  SSRIs* are controversial for bipolars and bipolar IIs (my particular diagnosis) because a little can maybe help but it builds up and then you get depressed— and me, I get depressed and angry and despairing and— hate everything, including myself.  But up until they don’t work, they do.*  It’s a catch 22.

We’ll see how the mood is affected tomorrow when I go into work and all those situational stressors reassert themselves.  I did leave a voice mail for my shrink (it’s the weekend) of what I was planning to do.  I did tell my dad, who I live with, how I was feeling and what I was doing, but that I was basically ok if he just gave me some real quiet time this weekend.

It’s a rollercoaster and a ferris wheel— because it’s both up and down, but also it’s a slow cycle around.   I’ve been here before, in this crushing, aching, self-hating place, and I have to take a step back and give myself perspective even as I employ all my coping skills.  I have to be my own best cheerleader and say— you’ve deployed your support system, you’ve let people know you might need time off, you’ve been proactive, you’re taking time to yourself, you’re balancing quiet time and coping mechanisms like reading fanfic and listening to music with normal adulting stuff like doing laundry and taxes.  I have to remind myself that yes, it’s up and down, yet again, but the relative volatility isn’t as much, and if I was a jerk to someone at work, I did apologize right away and tell them they weren’t at fault— and they accepted that apology and let me be human, which is also a credit to me because this time, this career change that was a little more voluntary, a little less self-destruct, I chose a workplace where, for all there is too much work, at least I am allowed to be human.

Maybe this time, out of the crush, there’ll be some wine to drink— not just me, feeling like pulp.

*I have been on two other SSRIs from 2009-present before switching to wellbutrin in 2011-ish, and my shrink has always called wellbutrin an SSRI.  The wise ladyofthelog has noted, however, that wellbutrin is actually a DNRI, which I did not know until today, and which may well explain why I’ve been on it more or less steadily with two or three two-week-breaks, maintaining a pretty good mood state at low dosages (100 mg combined with the rest of my cocktail) for the last three years, when most of my other SSRIs usually only work for a year & a half at most.  Thanks, verity!  ❤