Bipolar 2 From Inside and Out

Posts tagged ‘hypomania’

Abilify: News or Not

I’ve been taking Abilify for several days now. Is it working? It’s hard to say.

I’m pleased to report that I haven’t had any side effects I can’t handle. In fact, I don’t know whether I’ve had any side effects at all. I’ve had a tiny bit of dizziness and some drowsiness. But I have those anyway, either from my other meds or from other physical conditions.

On the positive side, I’ve had a bit of an increase in energy and concentration – as you could probably tell from the fact that I’m blogging again. But is this attributable to the new drug, or is it just the usual up cycle of my own personal roller coaster?

It’s probably too soon to expect anything definitive. Like most psychotropics, it probably needs to build up in my system a bit. Or I may just be one of those people Abilify doesn’t affect, for good or ill.

I recently read an article in Discover magazine called “The Power of Single-Person Medical Expepriments.” The article discussed the fact that the usual clinical studies of new drugs and treatments – randomized, double-blinded, hundreds or thousands of participants (the “gold standard” of tests and trials) – give results that are only averages. The techniques will work for some people and not for others. Some experimental subjects will experience side effects to varying degrees. Or not.

The only way to see whether a given treatment works for an individual is for that person to try it. The odds may say it has a better-than-50% chance of working, but until the patient tries it, whether it will work for that one individual is basically a crap-shoot.

I think this may be particularly true of psychotropics. Every time I’ve asked how this or that med works, the answer has been, “We don’t really know.” Factor in the number of different meds I’m on, psychotropic and otherwise, and their potential for interactions with each other, and any new treatment’s effectiveness is likely a matter of trial and error.

I’ve certainly gone through a long, tedious, disappointing (or unpleasant) series of weaning off and ramping up different meds in hopes of mixing just the right cocktail for my particular brain.

I think that’s why they call it “practicing” medicine.

On Dithering

If dithering were a power source, I could light up Chicago. Good thing it burns nerve endings instead of fossil fuels.

The last couple of weeks have seen a lot of dithering and anxiety. I hardly ever get to enjoy the rush of hypomania – except for that one brief spell a few weeks ago – because it comes out sideways as anxiety.

I also have a third-degree black belt in catastrophizing.

Both have gotten a workout lately, since a cyst was discovered in my left breast. (I wrote flippantly about mammograms on my other blog, so irony gifted me with this.)

I checked my usual sources (Mayo Clinic website and a friend who is a biologist and had a lumpectomy), and the consensus was that I had only the remotest chance of the anomaly turning out to be anything really dire.

Do you think that stopped my dithering?

Hell no! Of course not!

What could have gone wrong?

They could have stuck a needle in my breast to aspirate fluid and get a sample for the lab. (A friend who should know tells me that some people do this kind of thing for fun. Somehow, it doesn’t appeal to me.)

If the results were worse, I could have been scheduled for a lumpectomy. There was extra anxiety on this one because my friend almost had a mastectomy instead of a lumpectomy when the surgeon started making the wrong incision. (An operating room tech noticed, saving the day and the breast.)

And of course, my anxiety told me that a mastectomy could be in my future (either on purpose or accidentally, I suppose). My mother had a mastectomy, which added extra oomph to the dithering.

A mastectomy would suck for oh so many reasons. Cancer, surgery, body image issues, obviously.

Also, I would keep falling over to the right. And before the operation I’d have to take my breast on a farewell tour for all its friends and admirers.

Maybe worst of all, I would have to put up with all the pinkness and positivity. Not to denigrate this strategy for those who find it helpful, but I am not that person. Anyone with my brain chemistry is not going to respond to slogans and cheerleading and daily affirmations. (Reminder – As always with my posts, YMMV.)

Barbara Ehrenreich has written about this phenomenon in Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America.  Apparently many breast cancer survivors feel they must get something positive from the experience – appreciating life and family more and so on.

We’ve come a long way from Betty Rollins’s First, You Cry. Now it seems like we’re never supposed to.

The anticlimactic but welcome result came today: Everything is OK. I just need to keep up with yearly mammograms.

And now I can move on to the next thing that needs dithering about – the work I wasn’t able to do while I was catastrophizing.

The Un-Merry-Go-Round

I submitted this for a mental health anthology and swore that if it wasn’t selected, I would post it here. It wasn’t. so here it is.

 

Back when I was diagnosed with depression (unipolar) and anxiety, I secretly envied the manic-depressives (as we called them then). At least if I had a manic phase, I thought, I could get something done.

 

Then I met Kate, who was bipolar – and not well controlled on medication, to say the least. My envy lasted through her ambitious plans to make identical green velvet Christmas dresses for her three daughters. And vanished when I saw her tear them apart, recut them, start over, change her mind multiple times. You can write the ending to this one. There were no dresses, not by Christmas and not ever.

 

Kate was riding the roller coaster – perhaps the most common metaphor for bipolar disorder – the peaks and troughs, swooping crashes, anticipatory climbs, stomach-clenching vertigo, and, for some, an abrupt stop at the end.

 

Type 2 bipolar is not like that. Type 2 is what my new psychiatrist diagnosed. Except I seldom got the hypomanic mini-jags of ambition and purpose. Instead, it came out sideways, as anxiety.

 

The challenge for both my doctor and me was finding the right mix of drugs to get me functional and keep me functional, at least at some sort of reasonable level.

 

While supposedly unipolar, I had been through most of the different sorts of antidepressants and anti-anxiety meds, including, of course, Prozac. When the increasing side effects of each outweighed the diminishing relief, I went through a lengthening list of tricyclics, SSRIs, and so forth. I learned not to ask, “How do they work?” I couldn’t get an answer. The more basic question was, “Do they work?”

 

I can’t remember all the combinations now. My memory has become Swiss cheese after the spectrum of chemicals I tried. (Actual conversation: “Doctor, I’ve been having some rather embarrassing memory lapses. I asked a friend how her father was doing, when he had been dead for three months.” “Yes, that medication will do that. Stop taking it.”) But in addition to (instead of?) the Prozac, I remember buspirone, Wellbutrin, imipramine. Desyrel, Lexapro? I think so. Effexor, Sinequan? Maybe. No MAOIs or lithium, though.

 

What I do remember all too well is when my brain broke. I don’t know what else to call it: nervous breakdown, decompensating, mental and emotional collapse. It wasn’t the first time this had happened, I later realized, but it was by far the most severe. That’s when I climbed on the merry-go-round.

 

It wasn’t a carousel. No painted ponies or dolphins or elephants or zebras with fantastical, bright bridles of flowers and whimsical saddles, steadily but gently leaping to the calliope music like the calming rhythm of waves.

 

This was a merry-go-round of the type that is no longer allowed on playgrounds because of the danger. A wooden platform, painted a color no longer identifiable, a metal pole speared through the center. Bent metal pipes dividing the surface into rough pie-wedges. No power to make it twirl but the force of children pushing and then jumping on, not to thrilling acceleration, but only to inevitable slowing. No lilting music; only creaks and rattles. No scents of popcorn and cotton candy; only playground dust and much-used sneakers.

 

The metaphoric merry-go-round would start rotating with each new pill or combo that promised (or at least proffered) “Better Living Through Chemistry.” I couldn’t handle the side effects of some – hideously vivid nightmares or the feeling of wanting to jump out of my skin. Others had side effects that I could live with, but little or no therapeutic effect. “There’s another drug I’d like to try” was the constant refrain.

 

The merry-go-round creaked on for years. Literally. With each new med, I had six weeks or so of slowly sliding back into the numbness and misery as my body sloughed off that chemical. Then six or so more weeks, waiting for the new one to work or not, prove tolerable or not, be any better than the last drug or not. Each new drug cycle amounted to a minimum of three months of hell. More, sometimes, as the doctor slowly, cautiously ramped up the dosage to gauge the effects, both intended and incidental. Lather, rinse, repeat.

 

Those years are mostly a blur to me now. I remember sleeping a lot. I remember sitting on the sofa watching “reality” shows so I could see people whose lives were train wrecks worse than mine. I recall not having the wherewithal to add water and nuke a cup of macaroni and cheese. Not bathing. Not feeding the pets. Not paying bills. Not reading. Not caring.

 

I know now how lucky I was to have a husband who lived the vow about “in sickness and in health” and took up the enormous quantity of slack required. He put up with a distant, unresponsive wife; frequent and apparently unprovoked bouts of sobbing; irrational panics; and all the other symptoms he knew by then he couldn’t fix. He didn’t know about the suicidal thoughts, or if he suspected, he never mentioned it. He often asked how he could help, but really, there was nothing else he could do.

 

Then came the day that my psychiatrist said we were just about out of options. He was thinking of recommending electroshock (or ECT, electroconvulsive therapy, its current version). As he talked about how it wasn’t like the bad old days and really showed quite good results in some people, his voice seemed to fade and I heard my inner voice screaming, “Fuck, NO! Keep away from my brain, you Nazi sadist!”

 

I had heard how in the 1950s electroshock was used as a way to punish or control unruly, uncooperative, nonconforming women. And of course everyone knew about the Cuckoo’s Nest. The Snake Pit. As far as I was concerned, electroshock was right up (or down) there with icepick lobotomy, the frighteningly efficient epitome of former psychiatric treatments.

 

Reeling, I made it to my car and immediately called a friend, a scientist, one of the most rational people I know, to talk me down. Her extremely sensible advice was to do some research. Research was something I knew about and remembered how to do.

 

I started digging. The Internet was little help. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.” I kept looking and questioning and slogging through the research as well as the dense fog around me. I lost one friend, my long-time go-to guy for comparing our conditions and our meds, who said, “Do it immediately or I will kick your ass.” (Hint: Advice phrased as a threat of violence doesn’t help, or have the desired effect.)

 

So there I was, on a merry-go-round that had jolted to a sudden, sickening stop by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life. The only part of my body I ever really loved.

 

What was I doing, considering altering that unique organ with electricity? But the brain in question kept pondering.

 

Electroshock caused memory lapses. I was already having those.

 

I would be allowing doctors to tinker with and alter the functioning – perhaps even the structure – of my brain. But really, hadn’t I been doing those very things with chemicals for years?

 

I went back to my psychiatrist, ready to tell him I was at least willing to talk to the doctor who did the shocking.

 

Then I got a surprise (at least as much as anything repeated for years can be a surprise). “There’s one more drug I’d like to try,” he said. “Lamictal. It’s an anti-seizure drug.”

 

“I don’t have seizures. How does it work?”

 

“We don’t really know.”

 

Oh, why the hell not try it? One more spin around the playground.

 

More misery. More weeks of weaning off and ramping up. More weeks of no change. The same-old same-old.

 

And then one day, something did change. It was such a clear sensation, physical as well as mental. I felt a sudden click in my head – an actual click, like someone throwing a switch located about two inches inside the back of my skull. I could hear my brain saying, “Oh, yeah. I remember this. This is how thinking and feeling are supposed to work.”

 

The click wasn’t a flick from a magic wand. I still had a long way to go, rebuilding the parts of me that I still could and still wanted to. Setbacks. More fiddling with the dosages. The creation of a crazy cocktail of drugs to keep the crazy at bay. But I was on my way back to functioning, with the help of anti-depressant, anti-anxiety, and anti-seizure drugs, plus a sleeping aid. And lots and lots of psychotherapy.

 

So what did I learn from this process? Not “There’s always hope.” I gave up hope lots of times, every time another med didn’t work. Not “Desperate times call for desperate measures.” I am infinitely glad I did not have electroshock. “It’s always darkest before the dawn”? Please. No truly depressed person believes that crap.

 

The lesson I took was “Stubbornness is a virtue.”  It saved our marriage countless times. It saved my father’s life for five times longer than the doctors gave him. And it saved my sanity.

 

“Stubbornness is a virtue” is different from “There’s always hope.” Even when you do give up hope, when you know it’s hopeless, when you realize the merry-go-round is grinding to its inevitable halt, you keep pushing it. Hopelessly, if you must, but stubbornly. As long as it takes.

The Seven Wonders of the Bipolar World

I wonder if I can get out of bed today.

I wonder if a different drug would help.

I wonder what would happen if I told my friends and coworkers.

I wonder how long this mood swing will last.

I wonder if I have enough spoons for all I need to do today.

I wonder if people can tell that I have a mental disorder.

I wonder if this is the best I will ever get, for the rest of my life.

From Panicky to Manicky

I’ve been having one of my rare, slightly manicky  upswings for the last few days.

Why? And about what?

Well, I survived the business meeting/lunch on Wednesday. I prepared for it with a lot less anxiety than the last time (hair, outfit, jewelry, car, arrival time – all came together with astonishing speed). I even made it through lunch without my hand tremors causing me to dibble all over myself. Yay me!

And although the subject matter could have felt like an attack directed at me, it didn’t. I didn’t get defensive (well, maybe a little) and I help uncover some problems that indirectly supported my point of view.

Maybe I am getting better at this stuff, or remembering how I used to do it.

Also, I was not completely spoon-depleted that evening or the next day, as I had told my husband to expect.

I’ve donated small amounts of money ($25 and under) to a few charities and causes. I don’t know if this is cause or effect of the upswing, but who cares? I was motivated, and I did it. A small enough accomplishment for many people, but summoning the will to care and to act constitute progress.

I have supported a friend in his first solo freelance venture, predicted its astoundingly rapid success, and reveled in it with him. It’s a good feeling to share, even if my own freelance efforts have been less spectacular (though significant to me).

I won’t deny that this upswing makes me wary that a crash may be on the way. You know how feeling happy always seems like tempting fate? With bipolar disorder, I know that there will always be another downswing waiting around the corner for me.

But at least, for now, I can enjoy the good. And that’s a major improvement.

Sideways Hypomania = Anxiety

My hypomanic swings usually take the form of anxiety. I was active enough today to start this blog. I am now experiencing anxiety over starting this blog. Perhaps I will go take some Ativan and lie down till it passes.