Tag Archives: Antipsychotic

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.

 

 

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.