Category Archives: Medication Treatment

The Reality of A Bad Decision

I have been on my med for six months and have managed to attain stability through many trial and error.  Since I am not heavily dosed, a recent hypomanic episode can be felt simmering under my surface and does not float away with the steam.  Although the shower no longer screams, and the freezer no longer plans warfare against me,  I can still feel the other physical effects.  Over a week ago, I stopped sleeping regularly for three days in a row but managed to rest and sleep a few hours each night.  I became intimate with the dark.  My appetite is reduced to Ramen and beer.  Things become shiny and then fade.  My periphery waves hello and then fades goodbye.

My med keeps me anchored so I do not float away.  I flicker.  I flicker.  I flicker ever brighter and dim with the sunset.  It is times like these that my med seems like something I can live without because the hypomanic feeling of invincibility taunts me.  I take the pill from my pillbox and stare at it wondering out loud if I still really need it.  Of course, I need it and continue to take it.  It is times like these that the reality of a bad decision is at the forefront of my mind.

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Reveille

The alarm clock sounds off like reveille across a field.  It calls for me to wake up and start my day.  Through groggy eyes, I look for my alarm and shut if off.  A sigh escapes my lips and my head returns gently to my pillow.  It sinks into the comfort and warmth.  I am awake and become aware of my warm body under the warm sheets  I stretch like a cat and roll onto my side.  I look at my clock in frustration as if its the clock’s fault that I have to wake up.  Why can I not wake up perky and bouncy like I use to, but the answer is always there — my med.  Fortunately, my med does not effect my libido in the morning. Through the sleepy leepies I still want to play.  To feel.

 

The Wicked

How did I end up self admitting into a psychiatric institution for the first time?  I can still clearly see myself signing my rights away.  I remember the ilegible scrawl that scratched from the pen, which represented my signature, as I signed the official documents. I remember how at that moment in the emergency room, I felt surprised and oddly interested that for someone with beautiful penmanship, my messy signature was unrecognizable.  I was losing control of my mind and my body, and I was slowly losing the will to combat this insipid side effect called Akathisia.

To give some background, I had unknowingly lived with untreated bipolar for quite a number of years.  I barely sought medical treatment in September 2015 because the mania was swallowing me up one day at a time.  I was medically diagnosed and entered the realm of antipsychotic medication and therapy.  When I was prescribed 80mg of Geodon — 40mg in day and 40mg at night, I refused the prescription because I wanted to start at the lowest dose possible before moving on.  It is the way I think.  I wanted to titrate up and watch all the changes.  I wanted control.  So I refused the day med and only took 40mg at night.  I continued on 40mg at night for two and a half months.  This dosing only at night caused my side effect.  Apparently, some doctors believe Geodon should be taken two times a day; otherwise, one dose is spiking your brain.

Taking Geodon one time at night caused a side effect called Akathisia which caused me to end up in a psychiatric institution.  The horror of it all still lingers.  A memory that has yet to fade.  I watched myself lose a grip on reality over a three day period.  It was not like experiencing psychosis.  It was different because it did not hit me like a ton of bricks like psychosis where you cross a line and cannot see where you came from.  When I experienced Akathisia I could see my mind crossing a sanity versus insanity line that I could not control and then return back to me.  Each time was more powerful, and the restlessness, that it is known for, occurs in waves.  It rolls through your body.  You cannot stop the urge to move, to fidget, to walk, walk faster and then to run.  You cannot settle your mind.  You just want to move faster than your mind is capable of doing.  The mind and body are disconnected.

At the time, I did not know what was happening to me and this occurred over a three day period.  I survived three days of Akathisia and two minor episodes before this.  When I experienced it before, I called it “The Hurt” and I wrote about it in my blog in a short story titled, “The Hurt.”  The episodes that occurred on the first two days started two hours after I took Geodon and lasted one hour.  I dealt with it by putting myself to sleep with Benadryl. I did not know it was Akathisia until the third day of my episodes when it started at 8:00 in the morning during work.  I googled my symptoms and came to the conclusion that this was what I was feeling in addition to the wretched anxiety that presented mortality to me in ways that I never thought of before.  In ways only those who are terminal or in the gallows probably feel.  The anxiety was smothering me a little at a time and left me gasping for air.  For mercy.  It lasted a few minute but then returned for longer and longer periods.  It dragged me through a dark, chasm of helplessness.  I wanted to jump out of my skin and run full speed down the street away from it.  I realized that I could possibly end up running down the street – screaming.  I was convinced this would be my outcome if I did not get help.  These three days were no longer ‘The Hurt.’  They had become ‘The Wicked.’

Akathisia causes a distressful restlessness of the mind and body.  In the third day, as it progressively got worse, it made me walk circles around my office, around my building and then outside the building.  I got up and walked every 30 minutes for 15 minutes for eight hours on the third day.  I was worried that the security guards would notice me and this caused me to change my pattern of walking so that I was not so obviously and oddly walking the building.

So you see, I could still think things through.  I even read my crises plan that I had in my phone.  My doctor asked me to photograph the crises plan we wrote together, and it was in my iphone.  The photo was a list of things to do in crises and one item read “go to the emergency room if in psychosis.”  Although I was not in psychosis, the words “emergency room” jumped out at me.  I just knew then… I just knew this was my safe haven.

After work,  my boyfriend was driving me home and as calmly and as rationally as I could through the waves of Akathisia rolling through my body, I told him that I was not well.  At the same time,  I was willing myself not to jump out of the moving car.  Like in a major way.  He said we would go home, and he would take care of me.  I came to the conclusion in front of him that this episode was bigger then the both of us.  We were entering unchartered territory – the emergency room for a mental health crises.  When the ER Psych doctor asked me why I was admitting myself, I told him because I knew that when I started running out the door screaming, they would stop me.  With that, my first formal admission to a psychiatric institution was complete.

 

*I stayed in a psychiatric ward for six days while adjusting my medication.  My final treatment plan was Geodon 20mg day and 20mg night.  In order to stop the acute Akathisia, I was given Cogentin 1 mg which worked.  I titrated off Cogentin after one month and the Akathisia stopped.  I am still take Geodon.

 

 

 

 

Irritable Depression and Mixed State

This is a very important discovery for me because the part of bipolar disorder I detest is the irritable depression that occurs with mixed state.  It is the rattlesnake part of my disorder.  The more I learn about it, the better I can manage and reduce it.  For instance, I started taking Vitamin D3 and Magnesium supplements because deficiency in these minerals is linked to depression.  I have been diagnosed as vitamin D deficient in the past.  Hypomania is fine but not irritable depression. It causes me to snap at loved ones which leads to a horrible guilt.  It is a nasty cycle.  I hope this article helps those who havent figured out that depression does not only present as a sadness but can present as anger as well.  Click on the link below for more information.

Irritable Depression

CBD Can Effectively Treat Bipolar Disorder

How CBD’s Can Effectively Treat Bipolar Disorder Symptoms and Manic Episodes

How to Be on Antipsychotics.

This young lady, who calls herself “the misadventures of me” wrote the funniest post on Antipsychotics.  It’s my favorite.  Enjoy her good writing.

Recently I was told I may have bipolar disorder and was promptly put on, you guessed it, antipsychotics. Now something about the name makes antipsychotics sound really scary, or rather, the person …

Source: How to Be on Antipsychotics.

A Not So Tough Pill to Swallow

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.

 

 

There is no “I” in “Loneliness”

A discussion I had a few weeks ago with my psychiatrist came to the forefront of my mind.  This was not an intrusive thought or episodic depression breaking through.  Not dysphoria. I can tell the difference now that I am on medication treatment.  It is something that I am  working through, which is about the emotion of feeling “lonely.”  I realized I have never experienced it.  Even if I ever did, it is not an emotion I can remember.  When did it secretly depart? This realization lingered in my mind.

After the first week on my new med, I experienced the emotion of “loneliness.”  I was in my apartment relaxing as usual.  My life is somewhat effortless.  I have it made.  On one particular evening as I worked on a short story, a new feeling pulled at me in a disconcerting manner.  I did not like it and was unfamiliar with it.  My apartment was cozy, and I had my things around me.  I had my freedom.  My friends and family were all fine and available; however, this feeling of something I knew not what trailed after me.  It was subtle.  It barely showed its face and whispered its name–loneliness.  It was hollow.

At my next therapy session, I discussed this with my psychiatrist.  Our session was moving along as usual in her white clinical office with the bright lights of a surgical room.  Perhaps the lights helped her search for the darkest corners within me.  She asked me how loneliness felt, and I replied that it was unpleasant.  It tugs at things.

My psychiatrist said that I would experience a lot of new emotions and moods on my med. My med would clear a path for them like a pathfinder. That it would take time to learn how to manage them.  Manage is the clinical word for feeling an emotion in a more balanced way.  Being the curator of my emotions, I was dismayed that I had not noticed that loneliness had been missing from my collection.  What I was uncertain of was whether it was stranger to never have felt loneliness or to never have realized it. Perhaps both are equally puzzling.

Surely, I watched it play out on TV, read about it in books, and provided a shoulder for my friends to cry on after their most heartbreaking breakups where they expressed the depths of their loneliness. All those times, I thought I was relating to them, but really, I had not been at all.  I had been understanding their loneliness by knowing the definition but not because I was drawing from experience.  In order to relate to my world, I substituted the feeling of “longing” because I knew how that felt. However, longing means a yearning desire which is completely different from loneliness.  All my life, I had existed in a way where there was no “I” in”loneliness.”

As a person who exists in hypomania, the feeling of loneliness is nonexistent.  At least not in my spectrum. Some people would wonder, “What had gone wrong?” or maybe even “What had gone so right?”  Because loneliness is such a negative emotion, who would care to feel it? However, loneliness can cause people to form and hold on to attachments to others.  The consequences of not feeling it are much greater than I am able to understand at this time.  Again, I am working through it. I am fortunate to have a good friend to discuss this with because I trust him implicitly.  It is good to have a strong person’s view on these new emotions of mine.  His responses in words and facial expressions are my carpenter’s level.

It would seem that hypomania would be a wonderful place to exist in because it is a devil may care feeling.  The world is conquerable, but a more important statement that effects practical efforts of daily life, is that everything and I mean everything is possible. This sets me apart from most people.  Therefore, my feeling of loneliness is one of the three definitions that pertains to place and defined by Google as, “(of a place) unfrequented and remote.”

 

 

Restless

Oil running

Together

Along a smooth surface

All things

You mean restless is like agitation?

No

Liquid carrying

On

No place

Water flowing

In unity as one

On the move

Nowhere to go

You mean restless is like agitation?

No

Ebb and flow

On the go

Everywhere

You mean restless is like agitation?

No

Restless is fluid

Agitation is grating