Treatment for Bipolar Disorder is based on a menu of medications. They Are a diverse group from Lithium, antieliptics, antianxiety to antipsychotics. Depending on where you lie in the spectrum of your disorder, the med menu will change. You may be challenged with having to take a polypharmacy and manage the side effects of many pills or be on monotherapy and contend with much fewer side effects. I am one of the lucky ones because monotherapy has been successful for me.
My treatment was determined by the bipolar symptoms I told my psychiatrist. This is very difficult because, in my first visit, I could not remember all the key things to tell my doctor. I did display some pressurized speech so that was a clue that I was in acute mania…again. But this was my first visit so it was not definitive. Maybe I was a chatty person. The doctor did not know. Determining your mental illness is similar to a treasure hunt. The psychiatrist discusses your behaviors, looking for bipolar indicators, and determining where you exist in the spectrum. Do I exist in the spectrum? Or does the spectrum exist as a sliver in me? We only had one hour to figure this out because one thing was for certain-I was in an episode of some sort. I sat in the doctor’s office laughing, hyperactive, and certainly mentally ill. There, I said it…mentally ill. My initial diagnosis was Bipolar Disorder II but later on it changed to Bipolar Disorder I.
Did I behave a certain way because I was tired, stressed, anxious or because I was in a bipolar episode? Some behaviors are evident such as manic and depressed behavior, but they have to be witnessed by a medical team in an inpatient setting to be certain; otherwise, they are considered subjective. In the beginning, my mental health picture had not formed. So you start with the moving target, and if you do not get it right, you start a “chance” of a med. The next time, you now have to explain to your doctor why you behaved a certain way but on a psychiatric med. Layers start to form from the side effects.
Once you are prescribed your med, the waiting game of seeing which side effect will occur begins. Do you need another med to counter a side effect? You have to wait and see if the new med stops mania or if it pushes you into mania. Bipolar Disorder is push and pull of your mind. You can stabilize, but now you have to be on the look out for break through episodes of mania indicating the med did not work. All this while you are living your daily life, interacting with loved ones, and trying to keep your career from imploding. Exploding. Side winding. The name of the game is to hang on while snowboarding an avalanche. Hang on. With your eyes open. Hang on.
Treatment is not a sure bet in the beginning which caused me great unease. Some people in our community are treatment resistant which means the menu of meds does not treat the disorder. Mentally, I was not prepared for the reality of psychiatric meds because of the uncertainty but more importantly, I had this idea that meds were my last resort. What if they did not work? I still had a long life ahead of me. Initially, I thought I would need them in my twilight years. Just in case, you know? Because now, I am strong, young, and could handle this through pure willpower, but I was oh so wrong. I since learned that this thinking is backwards. In order to not be the crazy later on, I have to be on a med plan now.
The uncertainty of it all was disconcerting. I wanted to hold on to something that was a sure thing because I could no longer hang on to my foundation since it was crumbling. Cracks a mile long were forming. Mentally, I was hanging on a cliff and could feel my fingers slipping. Just hang on. I wanted certainty. For instance, I know I can take an aspirin for a headache, and the headache goes away. There is a definite cause effect that can be experienced. When I realized that my med was not a sure bet, I became scared and opted out the first time. I was not ready to contend with the “possibilities” of “might” getting well or more worrisome that my med would not work. I stopped Lithium cold, and two months later succumbed to another manic episode. This one was fast and furious. I remember each one sort of. There was the one in Salinas, which was a drug and alcohol fueled binge; the second one was a flashback of Iraq and my first psychotic episode; and the third one I call Utah, which was my second psychotic episode. I am a rapid cycler and like clock work, I experienced my third episode in nine months.
During Utah, I called my doctor and well..I was in Utah and refused to voluntarily admit myself to an Emergency Room so my treatment could not start until I returned home. I have a short story on Utah called, “The Poop Story and Other Tales of Love.” The good thing about Utah was that I displayed very distinct bipolar behaviors such as psychosis that gave us the ammunition to pick a more precise med. Initially, I was on Lithium, and although this is known as the gold standard, it was not for me. I felt…like…the sound you make when you place your tongue on the roof of your mouth and click it. That sound. For me, that sound was how Lithium felt on my mind. After I made the click sound with my tongue my doctor asked, “You mean you feel blunted?” Her training and experience was good because that was the word for it. Blunted. For me, blunted is the sound of your tongue clicking off the roof of your mouth. After this episode, my diagnosis changed from Bipolar Disorder II to Bipolar Disorder I with Psychotic Features.
I was prescribed an antipsychotic that has worked well for me. Up until today, I have been in denial and embarrassed that I have to take an antipsychotic. It is the word is it not? A med that clearly states that I can become psychotic. This is a tough pill to swallow. However, the antipsychotic is helping me by allowing me to be mentally free. It keeps me somewhat in hypomania which is where I want to be. I am more of my creative self then mania ever allowed me to be. My med also helps me manage my daily stressors, which I am not so good at anymore. Stressors mentally fatigue me in ways I never could imagine. I am on a new path in my journey. It use to be that I was a “mental mountain.” Now, I need help. Even though I am managing my disorder, my core being is changing. It has to change I think. Not so much outwardly that people might notice right away. Certainly, your thoughts change; therefore, be and then become happens. You become a new normal.
The good thing about meds is, when you get the right kind and dose, the effect isolates the mood disorder. This enables you to see the paths to managing a stable daily life. You can separate from the disorder. It helps you discern trigger effects on your mood and behavior. Enables you to develop stress release actions and form crisis plans. Also, they reduce the cycles of bipolar episodes and protect my beautiful, sweet brain, which I love so much. Meds can be effective. It is what I call my good, hard work. My goal is to swallow this pill and stay of healthy mind, peaceful, and loving of heart. For this, it is not such a tough pill to swallow.