Bipolar 2 From Inside and Out

Posts tagged ‘medications’

Divisions in the Mental Health Community

It’s sad when communities that ought to work together for the betterment of all are divided by strife. But that’s just what has been happening in the world of mental health.

Even saying “mental health community” is controversial. There are different segments of the population who say that “mental illness” is the more accurate term. Then there are those who advocate for the term “brain illness” while advocating for adequate supports and services.

Indeed, what to advocate for is another discussion. Many people are trying to root out the stigma that goes with having a mental illness. Others say that’s a waste of time – that what is really needed is advocacy for improved treatments and more accessible services. There is, of course, the possibility that one could advocate for both, but the issue seems to be that the stop-the-stigma people are pulling focus away from those who campaign for social and political (and financial) reform. The situation seems complicated by the fact that many “It’s okay to have difficulties” promos actually promote online therapy businesses.

Then there are the different “what causes bipolar disorder?” schools of thought. For years we attributed it to a chemical imbalance – neurotransmitters such as norepinephrine, serotonin, and dopamine not performing their job properly. Now many people think it’s caused, or at least exacerbated, by something else – heredity and genetics, environmental and lifestyle issues, or some combination of them all. Treatment with psychotropic medications, which is the most common for bipolar, tends to lend credence to the neurotransmitter theory, although it’s generally accepted that we don’t have any real idea of how they work.

The drugs used to treat bipolar and other disorders such as schizophrenia are controversial too. Many people credit them with saving their lives. Some others describe them as “neurotoxins.” One typical Facebook post said, “They are powerful, toxic drugs which can cause a chemical lobotomy and terrible adverse effects such as akathisia, dyskinesia, Parkinson’s, dystonia, and many other tortuous, real effects. Many people are left on these drugs for life.” This is one of the milder posts reacting to psychotropic meds. Many also speak of withdrawal symptoms and lives ruined. They also state that Big Pharma is partly to blame: “The sale of psychiatric drugs will continue to increase and force will still be part and parcel of psychiatry….If we have hearts we will not expect psychiatry with all its terrible past of fear, force, and fraud to understand any human being or society!”

Treatment for various disorders, particularly schizophrenia, is widely debated as well. Some people are appalled by involuntary commitment or “forced hospitalization and drugging,” while others see it as a valid procedure for anosognosia (the inability to recognize that one has an illness), as this increases potential harm to self and others. “Assisted Outpatient Treatment” or AOT, a form of supervised drug administration for those who have been released from treatment facilities is gaining adherents. Lynn Nanos’s book Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry makes a strong argument for AOT.

In fact, psychiatry itself is a disputed issue, and not just by Scientologists who feel that all mental illnesses are caused by whatever it is that can supposedly be cured by their practices. (You can probably tell that I don’t give any credence to their beliefs.) But psychiatrist Dr. Thomas Szasz railed against psychiatry in books including Psychiatry: The Science of Lies and The Myth of Mental Illness. Here’s a quote from The Science of Lies:

Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the “mental patient’s” inability to prove his “psychiatric innocence” makes psychiatry one of the greatest dangers to liberty and responsibility in the modern world.

With divisions like these, it’s no wonder that mental illness diagnosis, treatment, and priorities are large contributors to the broken system in the United States. Is it a healthy debate? Are they irreconcilable differences? Is there something to be said on both sides? Does science back up any side or does passion prevail? And will any of these debates be resolved in the near future? I believe that until the community gets together on a lot of these issues, not much will get done that will truly help sufferers.

Going Off (Some) Meds

I regularly tell people not to go off their meds without consulting their psychiatrist. I yell at them, in all caps. It’s not just a bad idea, it can result in withdrawal and even lessening the meds’ effectiveness if you do go back on them. Yet recently, I went off two psych meds without my psychiatrist’s prior approval.

Here’s what happened.

My husband and I recently had COVID – probably the Delta or Omicron Variant, as we have both been triple-vaxxed. That is to say, my husband tested positive for COVID and I have close contact with him, plus I had the same symptoms that he did.

Since we didn’t need expensive and rare treatments or hospital stays and ventilators, we relied on over-the-counter medication to treat the symptoms, which included sore throat, coughing, fever, congestion, and fatigue. We recovered in a couple of weeks to a month and my husband is back to his job, where he regularly interacts with numbers of people. I work at home, so I didn’t have that problem. I just needed to take some time off when I felt truly crappy.

When we read the directions on the OTC symptom-relief pills, however, there was a warning that said not to take anti-anxiety agents or sleep aids with them. My regular routine has been to take a sleeping aid at bedtime and an anti-anxiety pill in the morning and at bedtime, with an extra dose allowed if I have an anxiety attack during the day. I have been taking both of the meds literally for years and have never had any problems with them. (I won’t say what any of the medications are, since everyone has different reactions to different medications, and my reactions, while fairly typical, won’t hold true for everyone.)

Perhaps out of an excess of caution, I decided not to take the anti-anxiety and sleeping meds while on the OTC ones. When I quit taking them, though, I was worried that I might experience some of the ill effects that were possible.

Throughout the course of my bout of COVID, I didn’t notice any withdrawal symptoms, excess anxiety, or difficulty sleeping as I feared I might. In fact, I slept better than usual and had fewer attacks of anxiety. So I decided that I would try going off the two meds for a while, even after I felt better. It was about six weeks until my next med check with my psychiatrist.

Of course, when my med check came around, I told my psychiatrist what I had done and why. I thought he might react badly when I said that I did this on my own, without his advice and consent.

Instead, he seemed thrilled.

“Good for you,” he said. “You’ve stopped taking the two addictive ones, too.”

I had known those drugs were potentially addictive, which was why I was watching for withdrawal symptoms. I took the lack of these as signs that, though the drugs were addictive, I was not addicted. (My psychiatrist has to regularly have an analysis done to show whether his patients have a high risk of abusing psych meds or taking more than needed. My score was 0%.)

It felt good to have my psychiatrist validate that I had done a good thing and not a bad one. But even more, it felt good to be taking fewer pills each day. I’ve never minded having to take pills or felt ashamed of taking them, but it was still significant to me that I had lowered my medication schedule to just the ones that had beneficial psychotropic effects, such as antidepressants and mood stabilizers. I was delighted to find that I didn’t need as many pills as I had once thought.

All in all, my experiment was a success, but I was lucky, and my experience is not medical advice. I don’t recommend it to anyone else. Consult your prescribing physician before you cut back on or stop any medication. I MEAN IT!

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In One Side and Out the Other

For a while, I managed to do it. I spent literally years writing a mystery novel. Optimistically, I sent it to over 180 agents. A lot of nothing. At last, one of them was honest enough to tell me what was wrong with the manuscript, instead of just saying, “not right for us” or not answering at all.

And they were absolutely right. Once it was pointed out to me, I could see exactly what they were saying. I had had beta readers vet the first four chapters and gotten positive responses. They didn’t know anything about writing, or possibly even reading with a writer’s perception. But that wasn’t their fault. It was mine, for not selecting my readers more carefully.

Did all this depress me? Hell, yes, it did. I wouldn’t be human if it didn’t.

But I’m also bipolar. Depression for me isn’t just regular depression. Bipolar depression is something different. A darker place. A deeper pit. One that can be almost impossible to claw and climb one’s way up from.

When I was a teenager and undiagnosed and unmedicated, I had several major depressive episodes, and any number of smaller ones. Since at that time I had no idea what was going on or how to get help, I developed a philosophy: Go through it until you come out the other side.

Basically, it meant that I was staying depressed until I magically became un-depressed, whether it was because my brain chemistry backed off enough to let me see a way out, or hypomania kicked in (though I didn’t know what that was at the time). Basically, I suffered through it until I didn’t anymore.

And I thought that was the way it had to be. In one side, wait till I came out the other.

Later in life, I had other major depressive episodes. I tried a lot of things for them, including therapy and medication, but still the best I could manage was to wait it out – even though it took literally years.

Right now I’m in a similar position. All the rejection has put me back in that deep pit, and I don’t see a way out of it. I can’t even think of a new thing to write. Or a way to fix the book that failed. I am even applying for other writing gigs, but so far they have brought only more rejection. I don’t want another major depressive episode, but I can feel myself slipping. It does sound like reactionary depression, a result of the rejections, the realization of bad writing, and other recent blows involving deaths and other traumas. But it feels like endogenous depression, the kind that comes from inside, with wobbly neurotransmitters the major cause.

Of course, I’m a little better off than when I was a teen. I have a proper diagnosis – bipolar type 2 – and proper medication. I still have work that I can do – transcription – which is boring and ill-paying, but keeps me from sitting all day in front of the TV, watching train wreck shows that remind me that other people have more screwed-up lives than I do. I have self-care. I have my husband to be my caregiver.

But basically, I am just waiting to come out the other side.

I am doing the things I ought to do to get me out the other side. I am taking my meds. I have an appointment next week – a telehealth session with the psychologist that I haven’t seen in a year. In the past, she has done phone sessions with me when I wasn’t physically or mentally able to come in, so I know those do me good. And at the end of the month, I see my psychiatrist for a med check (15 minutes). I’m not sure how a session that short will help me in finding the other side to come out of.

I just wonder how far away the other side is.

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