Tag Archives: Akathisia

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.

 

 

 

 

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The Hurt

When I start a new medication to treat bipolar disorder, there is a learning curve of the primary side effects.  This holds true for any medication; however, bipolar medications directly cross the blood-brain barrier and target the brain.

In the beginning with a new med, I am learning to be cautious in order to learn how and when it affects me the most.  In the case with my new med, I opted to stay indoors for the first two weeks and take advantage of my new way of experiencing my moods. It was a carefully forced situation where I turned down parties and hanging out with friends.  I had become somewhat reclusive but was content in my cocoon for now.  Safety and certainty permeated my surroundings.

In my apartment, I am surrounded by my art supplies, books on philosophy, political theory, art, and the rise and fall of nations and civilizations. On my new med, I can read for leisure again. I am changing.  Art and reading these books were all things I had loved but had lost during my years of rapid cycling.  At any given time, my friends reached out to me through text and phone calls with their constant invitations of going out to parties.  Sometimes, they would visit.

One evening, I decided to join a friend for her birthday.  What could go wrong? Well…I am a fun-loving type of woman and see the bright in everything.  I am not the type to stay home and fawn over tall tales and love stories.  I live them.  I write them. That is what can go wrong.

The evening started with a beautiful full moon covered by wispy clouds.  The weather was warm for this time of year, and the wind felt good on my face as I drove with the window down. The road opened up, and we played the music loudly, talked and laughed the whole way to our first place.  We went to a bar and instantly hit it off with the patrons. When they learned of my friend’s birthday, drinks were sent our way.

There was no reason, at this point of the early evening, to think about my med.  I felt great. Laughter filled the bar.  The evening ended in a wonderful restaurant with good food and much celebration.  My friend offered to continue the party, but I realized it was past my med time.  I had not brought it with me because I did not want to be sedated while out on the town.  We ended the evening at 10:30 pm, and I returned home at 11:00 pm with my med at the forefront of my mind.  See how this is playing out? So carefree at first.

My med time is at 8:00 pm, and sedation lasts for two hours until bedtime at 10:00 pm, but here, it was 11:00 pm.   Even though I am sedated for the first two hours after taking my med, I cannot sleep at all because I am mentally alert but sedated at the same time.  It is a restless mind.  Next morning was going to start early at 6:30 am so I had to sleep.  I thought about not sleeping in order to ensure I would be awake on time like many times during my more hypomanic periods in the past.  But, this was not the past, I was here, now, in my new treatment, which had to be taken seriously.  I just did not think going to dinner and drinking was going to end up so late and screw me up.

At 1:00 am, I finally fell asleep.  It felt like as soon as I fell asleep my alarm went off at 6:30 in the morning.  I opened my eyes and thought, “ouch” and “no, no, no this cannot be happening.”  I just laid there and stared at the ceiling.   Boy, was I out of it. I tried to fall asleep for a few more minutes but was restless–this is a side effect.  I need at least 12 hours to feel the med wear off from my brain.  Here I was, at barely over seven hours.

Slowly, I got out of bed and started my morning routine.  My shoulder hit the armoire, I tripped over the rug, walked into the wall, made it out of my bedroom, and then held onto the bathroom counter to get a fucking grip.  A moan escaped my lips.  I pouted and whimpered. This hurt. What does hurt mean? It is not a sharp pain kind of hurt or a headache type of hurt.

It is a hurt I have experienced before and know well but not from a med.  The closest thing I can compare it to is how I mentally felt during my times in the Army when I had to stay up physically exerting myself for 48 hours or more with only four hours of sleep–we are talking complete physical and mental exhaustion.  Where my mind was forced to stay alert and perform but was numb from exhaustion.  Numb, agitation,  buzz, narrow, focus and intense are all good words to describe that sensation.  My med on the other hand lacked focus and intensity and my thoughts sounded like sounds in a sound proof room.  It felt bizarre and mentally agonizing. The hurt.

Yet, the experience in the Army was a mind and body unison of hurt, and I could see why I hurt. I could make connections from what I was putting myself through to the hurt. That connection gave me focus.  The med on the other hand was invisible and my body did not hurt. It was isolated to just my mind.  My body and mind seemed disconnected.  For 16 years, the Army taught me how to push through pain. I knew how to will myself through the hurt.

My will is not a mood.  I think it comes from my Amygdala and is more an emotional reaction.  My honed response. A force.  However, my will is not a match against the affective mood changes such as hypomania, mania, and mixed state or this med or I would will myself through this entire disorder.  I can use my will to push through a moment.  It is a reserve stored for moments such as this.  It gets used up by one moment against this disorder and then takes awhile to become strong enough for another time.

I managed to arrive at work, which was actually at a different location than my office. Let us not even go into the details of the drive to work except know that everything was white from the sun.

All week, I was in a training class to learn new things.  I just met the instructor and barely new my other colleagues.  The class was eight hours long of lecture in a room with an echo.  The room was large with windows that looked out to the sky blue and manicured garden, but I sat in my chair and blankly stared ahead.  I could not understand the instructor because I was too busy trying to focus.  My brain has never felt so restless in my life, but you could not tell.  My body was still, and I was not jittery or anything like that.  My mind was obdurant and would not think, I could not receive transmission. Everything, including his words stopped at my eyes.  It was complete torture.

After the longest ten minutes of my life and thinking I could go stark raving mad if I sat for one more minute, I quietly stood up and and walked out. Now, this is my profession, and I have to be in the class.  What was I to do?  I realized I needed a few more hours to let the med wear off so I went back to my SUV, jumped in the back seat, stretched out and fell asleep in the parking lot. This is why I bought my SUV in the first place–to have a place to sleep in between classes during graduate school six years ago. After one hour, my alarm went off, and I went back to class.  It did not matter, my mind was still reacting to the med, but now, I also felt mentally worn out.

Again, I just could not sit in that class.  After five minutes, I left.  I did not care how I appeared because I was dealing with the hurt.  I returned to my SUV and rolled down the window for air.  This time I threw caution to the wind and stretched out in the back more. I laid on my back with my boots out the side door window in the parking lot. There, I fell into a deep slumber for more than an hour.

My alarm went off, and this time I opened my eyes feeling alert.  The hurt was gone.  I walked back to class with my long hair knotted up in the back, my make up smeared, and lipstick gone.  As I walked across the parking lot, I looked back at my SUV and imagined someone seeing my boots hanging out of the window and how ridiculous that probably looked.  With the sun in my face and a pep in my step, I continued to the building and thought, “yippee ki-yay mother fucker” to the hurt.