Tuesday, November 24, 2009

Plan Ahead, or Abilify Is a Hell of a Drug

Author's note: sorry if this rambles, but it will get somewhere eventually...

For a change, I thought I'd post an update within 48 hours of a change in my situation/psychiatrist visit/end of the world/etc., while it's all still relatively fresh in my mind.

To recap: I'm rapid cycling. This was pretty much confirmed by my doc yesterday. The short definition of rapid cycling is three or more depressive or manic episodes in a 12-month period. Currently, that's definitely me.

As I mentioned in my last post, I was running a bit manic. I had tons of extra nervous energy. There were several days in a row where I walked 5-6 miles a day, and still had energy to burn-- definitely abnormal for me. And for the first time, ever, in my life, I was having hallucinations. Nothing major, mind you, but some minor annoyances that caused me some concern and made life awkward. I never heard voices, but was always hearing music-- bad music no less.

My doc took me off my last remaining anti-depressant medication back in October, (Lexapro, 5mg-- a very low dose), as anti-depressants often cause mania in bipolar patients. In fact, that's often how doctors (at least, good doctors) distinguish between bipolar and major depression, but more on that later. Within two weeks of going off the Lexapro, I noticed that things were moving, ever so slightly, downward. My energy was a bit lower, my concentration got worse, and I got more irritable than usual. I was sleeping 7-8 hours a night again. The audio hallucinations got fewer and farther between, and I noticed that my hearing was not nearly as acute as it was when I was manic. Back to "normal" then. Good enough.

But as usual, "normal" was entirely subjective, which is why it's one of those words that is always used in quotes with me. Very soon, there were less "normal" days, and more days where I didn't feel quite right. I quit walking after work, and I noticed that even the smallest noises in my condo bugged me-- especially the sounds of the upstairs neighbors walking across the hardwood floors in their shoes and the out-of-sync noise from the furnace, which sounded like a boom car on mescaline as it rattled throughout my condo.

I had this sneaking suspicion, given how my episodes wind out, that I'd be feeling about knee-high to a grasshopper around the end of Novembeter. I planned ahead, and asked for the week of Thanksgiving off from work. If I was sick during that time, I could at least work on getting well. If I wasn't, I'd have my first full week off in over five years. I even moved up my appointment with my psychiatrist for Monday the 23rd of November, just to be extra safe.

Needless to say, planning ahead has definitely paid off. This latest depressive episode, while still difficult and painful, has been one of the easiest I've had in several years. And being prepared ahead of time has made all the difference.

It's taken several years, but I think I've finally learned to listen to my body, and my mind. This time around, I recognized that I was running a bit manic: difficult tasks at work became "too easy" for me, as did making music. I had tons of nervous energy. I was easily distracted by small things. I kept my spending under control, for the most part, but I had urges to make large purchases (*cough* new Gretsch guitar *cough*). After so many episodes, I knew what my signs were-- and because I knew they were signs, I followed them.

And whatever goes up, must also come down. I knew that I was going up, even if it was fairly small when compared to other episodes. Consequently, I got ready for the inevitable crash. I talked to my doctor. I made appointments. I took time off work, and arranged to spend the week at my mother's house, because I didn't know if I'd be able to take care of myself when I crashed.

And it has paid off.

Yes, I am still pretty depressed right now. I can't get out of bed before 9:00 a.m., and am in bed well before 10:00 p.m. I feel lethargic, and it has taken me two attempts and five hours to write this blog entry. I haven't gotten any exercise in almost a week, and feel like I've got a hangover (which is probably due to the side effects of starting Abilify, more than anything). However, I am able to get out of bed each day, I am able to feed myself, I am able to leave the house and spend time among humanity (I'm in a coffee shop as I write this). So yeah, things kind of suck right now, but they are bearable.

The moral of the story? Hell if I know. But what I do know is this: us bipolars needs to pay attention to what our brains (and our bodies) are telling us-- much more so than normal folks who don't have to ride this roller coaster. We need to be ever vigilant of the signs that we're having an episode-- manic OR depressive. We need to be pro-active, hyper aware, almost to the point of being hypochondriacs (better safe than sorry when it comes to having an episode, I say. Besides, we're the ones that pay the doctors' salaries).

We may not have asked for this condition, but we can learn to live with it. And make no mistake, it's very hard work sometimes. Sadly, our brains do not speak English. But we can understand them, if we only pay very close attention.

Friday, November 6, 2009

Did you hear that?

Jeez, it's been awhile. I really better update this thing.

Long story short: things are mostly okay. Mostly. I think I may be rapid cycling (google "rapid cycling bipolar disorder" for the gory details), and am having a tough time getting completely stable-- whatever the hell that means. Currently, I think I'm in a manic/mixed state, as my moods are generally pretty good, and I sometimes have trouble sleeping. I am getting a ton of exercise (comparatively speaking), and am walking 3+ miles a day. My appetite is good (almost too good), and I am at work most days (even if I am a couple hours late once in a while). My boss says I'm doing okay at my job, and most of my customers seem happy. I've had a few bumps in the road, but nothing that couldn't be cleaned up easily.

In the past few weeks, I've started having minor hallucinations. Nothing too serious-- no voices telling me to kill myself or others. Just a lot of strange audio sensations: music, odd noises, things like that. During a walk a few weeks ago, I thought I saw somebody hiding in the bushes. I've also noticed my hearing is extremely acute-- I swear I can hear a gnat flapping its wings in Oregon. I've never had hallucinations before, even at my sickest, so it's a new sensation for me. My doc has done some minor adjustments of my meds and I'm waiting to see what happens (most med adjustments take 4-6 weeks to kick in).

In other news, my band is playing its first gig in over a dozen years tomorrow night, November 7. We will be playing at least three new songs I've written since June of this year. We've been practicing like mad for it, and I have to say we are sounding really good. We're expecting approximately 30 people, most of whom are close friends and/or relatives. I'm nervous, but I've also never been as prepared for a gig as I am for this one. I've managed to cover every detail, and make contingencies for things that may not go right the first time.

I don't know if things are good or bad right now. They just are. And I can't ask for much more than that.

Tuesday, June 23, 2009

I'm still me

I'm still me.

I may be having an episode of depression (or mania, or even a mixed state episode) right now, but I am still the same person you know. Sure, I may be feeling a little out of sorts, but I'm still the same quirky, cynical yet caring guy I've always been. I still like and dislike the same things. I still laugh at the same things, and I still cry at the same things too.

I am still the guy who would never, EVER hurt you. I am not a violent person. I've never been in a fight in my life, and I'm not going to start now. I would just as soon hurt myself as I would hurt you, or your friends, or your family.

I know I've been a bit paranoid and/or obsessive in the past few weeks. I know I've caused you some pain because of that. I am sorry. I don't mean to behave that way. It is a byproduct of the depression-- one I am working hard at controlling, and one that is getting better day by day.

You don't have to be afraid of me. I am not going to come after you. Nor should you be afraid for me, either. I have an excellent support system in place to deal with this kind of thing. Unfortunately, it's all part of the disease-- it's still possible to have the occasional episode even if I'm taking my medications. I've been through them many times before, and I've survived. I will survive this one, too-- I promise.

I know that I'm going to be back to normal soon. Every day is better than the last. My sleep patterns are back to normal. I'm asleep by 11, and awake by 6. My appetite is improving, and I'm eating a healthier diet (I've lost 20+ lbs so far). The brain fog is lifting, and my concentration is improving. I am working more hours every day, and I even finished writing a new song-- the first one I've completed in ten years.

I am starting to feel like the same person I was back in the spring, only better. I realize now that I was sliding into depression back then because of some med changes my doctor and I had made. Those changes were a mistake, but unfortunately psychiatry is not an exact science, and no medication combination works the same on every person. If I could undo that med change, I would, in a heartbeat, because I don't like going through this-- nor do I like putting you through this, either.

I know you were worried that, because of this episode, I am the same person you knew before. I wanted to tell you that I'm still me. I'm still the same person I was. Even when I'm having an episode, I'm still the same person on the inside.

This disease is a part of me, but it is not me.

Thursday, June 18, 2009

An update

Well, I was working on a cool piece about how bipolars experience emotions different from normal people, but unfortunately I can't seem to pull it together. I don't know if it's because my brain is done with thinking today (it tends to "wear out" early when I'm recovering from a depressive episode) or because I can't think of what to say, but I've put that one back on the shelf and thought I'd just give everyone a general update on how things are going.

I'm sitting in a neighborhood cafe as I write this, having completed another six-hour day at work. So far, that seems to be about all I can work at this time. I'm actually pretty well mentally exhausted after four hours of work, but I'm able to do busy work for the other two to make it a six-hour day. After work, I've taken to writing either music or lyrics (or blogging), depending on what my mood is. I have not done anything remotely creative in years, and I don't think I've actually finished a new song in a decade. Pretty sad for somebody who claims to be a singer/songwriter/musician, no?

But this week, I have completed two songs: one that I've been toiling over for a couple of years and another that just kind of fell together in a day. I've written a number of songs both ways before, and one way is not necessarily better than the other. And the results tend to be fairly mixed, as well. Tonight, my band is going to go through them, and put some arrangements with the words and chords. Again, this will also be the first time we've learned a new original in a decade.

Getting my creativity back has been a godsend. I have struggled for so long to create something new, something original (something GOOD) that it's almost a relief to be able to be able to do it.
However, at the same time, I know I have to be careful, because hightened creativity is also linked with hypomania-- and the last thing I need right now is a manic episode.

However, I don't see that happening this time. For one thing, I don't have any of my usual manic symptoms: alcohol craving, road rage, rapid speech, or racing thoughts. But I know that if I start experiencing ANY of these symptoms, I will call my doctor ASAP.

As is common with people taking lithium, I suffered from hypothyroidism. I've been working with an endocrinologist for the past few months to remedy the situation, and I'm happy to report that my latest TSH check came back normal. Yet more good news.

Right now, I'm going to work on being creative, and getting back my attention span. I feel like I have ADD, as I am still easily distractable and have a hard time concentrating on things for any lenght of time. For example, it's taken me over an hour to compose the few paragraphs in this post. Normally I'd have that done in no time.

Still, I am thankful that this most recent depressive episode was relatively short, and that my recovery is happening much faster than I had anticipated (or even dreamed of, for that matter). Hopefully things will continue in that direction.

Tuesday, June 16, 2009

Reeling (some new song lyrics)

Spinning through April
Reeling through May
Careening through June
Crashing every day

Spinning through today
Careening through the night
Reeling into tomorrow
Never know what's right

Monday, June 15, 2009

Three wicked mistresses

May Nia: She's got me wired.
Ann Xiety: She's got me worried.
Dee Pression: She just brings me down.

Friday, June 12, 2009

The Rollercoaster Ride Continues

Yeah, I know, long time no update. But I've got a fairly good excuse for this one. You see, I had me another one of those big badass depressions that was so soul-crushing I nearly bought myself a short stay in the wacky ward.

And worse yet, it was almost entirely avoidable.

As those of you who have read this blog know, I had reached a fairly stable place earlier this spring. Things were as "normal" as they can get for a bipolar: I was at work most of the time, I was taking care of myself and I was engaged with the world around me. I was at such a place where my psych doc recommended that I go off a couple of my medications: Seroquel (an anti-anxiety/anti-psychotic also used to quickly stabilize manic moods) and Lexapro (an anti-depressant).

Like most bipolars, mania is not my main problem-- depression is. Most of my episodes are very deep depressions, and my manias tend to be "hypomanias"; that is, relatively small, short-lived, and easy enough to recover from. Consequently, we decided to drop the Seroquel first and see what happened.

We stopped the nightly Seroquel dose, and everything went fine. In fact, it went very well. One of Seroquel's side effects is that is messes with the hunger receptors in your brain. It makes you feel hungry, even if your stomach is full, so a lot of people who take it tend to put on weight (in my case, about 40 lbs. over the course of 18 months-- which still isn't the worst weight gain I've had on psych drugs). After I went of the Seroquel, my apetite went down markedly at night. However, Seroquel also has a sedating effect, and I noticed that I had a harder time falling asleep at night. My bedtime moved from 10:00 p.m. to midnight-- or even later. I even blogged about it right about the time I went off the Seroquel.

Going off Lexapro was also fairly easy, for the most part. I got a little imbalanced immediately afterward with my lithium, but was able to bounce back relatively easily. For the next few weeks, things seemed to be going alright. As spring had finally vanquished another bone-chilling Minnesota winter, I also stopped using my lightbox, too (my cycles are seasonal, like a lot of other bipolars-- big surprise, right?). The only thing that changed a bit was my sleep cycle-- I started falling asleep later, and waking later-- but sleeping less. However, I was still able to get to work by 9:00 most mornings, so I didn't pay much attention to it, as I was still able to function fairly normally.

Unfortunately, things didn't stay this way for long.

Right around the second week in May, things started to change. My energy level started running lower. My mood shifted, ever so slightly. I began to feel a slight bit depressed, and didn't take care of myself as well as I had previously. I quit riding my bike, and only occassionally went for walks. I started to get paranoid about my friends, coworkers, and even my new girlfriend-- a sad side-effect of my depression. This paranoia fed my growing anxiety and led me to actions that I highly regret.

Things seemed to be getting a bit better by the end of May-- not completely better, but slowly improving. But then, catastrophe struck.

On the early morning of Thursday, June 4, somebody (or bodies) broke into my home and stole a couple of laptops (one of them belonging to my employer), my cheap stereo, and (saddest of all) a Fender Stratocaster guitar that I'd owned for 17 years, and one I had written, recorded and performed most of the couple dozen songs I've written. This same guitar had been my solace through many hard times and had saved my life. I had just recently spent a couple hundred bucks having it refurbished and rebuilt into my "dream guitar", and was hoping to use it with my band when we start gigging and recording again.

Needless to say, I felt violated in the worst way. The burglars had broken into the house some time between midnight (when I had gone to bed) and 3 a.m. (when I walked into my living room, and the lights were on, and the side window screen was off and had a hole cut in it). I called the cops right away and filed a police report with the responding officer, but I knew that it was highly unlikely I would ever seen any of my stuff again.

Even worse was the sense of violation I felt. Somebody had broken into my house. While I was home. Asleep. In my bed. By myself. I wouldn't compare what happened to me to rape, but I can imagine it was probably something similar on a much smaller scale. Either way, it has left me traumatized, and I have not been able to spend a night in my home since then.

Unfortunately the break-in fed my already existant paranoia and anxiety, leading to a lot of strain my my interpersonal relationships (one in particular). By the next day, I was staying with my mother, and I had completely crashed.

Thankfully, I had called my psychiatrist earlier that Friday, and had explained the situation. She put me back on 5mg of Lexapro a day (1/2 the dose I was taking) in the hopes of keeping things from getting worse. As things did not improve over the weekend, the doc increased this dosage back to 10mg, and prescribed the light box to give me an extra boost.

By Thursday (yesterday), I was feeling a bit better. Nowhere near to normal, mind you, but normal enough to do things besides lay on the couch all day and feel horrible. I know that it will probably be another week or two before I get close to normal, but even today I'm miles ahead of where I was on Monday.

My biggest regret about this whole episode is that it didn't have to happen. If I would have stayed on the Lexipro, it's unlikely I would have had this recent depressive episode. I've lost quite a bit because of it: a few weeks of work, the goodwill of some friends, and also the affection and companionship of somebody that I love-- which is what I regret most of all.

I'm not quite sure how to end this, as there's no moral to the story and not much of a lesson to be learned. I suppose if there is one, it's that you need to try everything in your power to stay well, but also know that sometimes things don't go as planned and that you have to be prepared to fall back on your emergency plan to get through.

Oh, there is this: treasure your friends, and your companions, and your lover, every moment you are with them. Because some day you may not have them around, and you will miss them dearly.

Monday, April 13, 2009

What doesn't cure me can only kill me

Yes, finally, another update. My apologies again for taking so long between these things, but it's been a crazy past few weeks.

First, some good news: as of today, I have been off of Lexapro for a week. So far, so good-- mostly. I had a few withdrawal symptoms (headaches, "brain shivers", muscle aches, nausea) but nothing that didn't go away, or couldn't be treated with a couple of ibuprofen. So far, so good.

And unfortunately, some bad news: a couple weeks ago, I had a nasty cold. I treated it with OTC cold medication and herbal remedies. Both of these together (along with my daily dose of lithium) dehydrated me, and caused additional problems. I managed to get a mild case of lithium toxicity, which pretty much wiped me out for five or six days. I exhibited most symptom associated with it: tremors, diarrhea, thirst, drowsiness, nausea, blurred vision and weakness, and spent a week in bed or on the couch until I could get re-hydrated and get my medication levels back to normal.

Of course, this is not a frequent occurrence, but because lithium is a drug where the window between therapeutic and toxic is so small, it's still a possibility. And because it's still by far the most effective therapy for bipolar disorder (not to mention the cheapest, and most well-proven), there's not much choice about taking it (or not taking it).

If I take lithium, I can live a somewhat normal life. I can hold a job. I can live on my own. I can take care of myself. I can do the things that everybody else takes for granted every day. If I am off my meds, things go downhill. It may not happen all at once, but within a few months I have usually wrecked my life.

If I'm depressed, I don't leave the house. I sleep most of the day. I feel sad all the time. I can't concentrate on anything. I don't go to work. And I don't want to live. If I am manic or in a mixed state, I am constantly angry. I drive recklessly and get tickets or even have car accidents. I spend money that I don't have on things I don't need and will never use. I do things that I know are not good for me. I use people to get what I want and push them away after I get it, and then hate myself for doing so. I drink, a lot, all the time. And I don't want to live.

The choice for me is simple: either take my meds and live, or don't take them and destroy myself. When I was younger, I would have chosen the latter without hesitation. I never planned on living to be 40. But now that I'm four months shy of that date, I know what I want to do. I want to live. And because I want to live, I will take those three capsules of lithium every evening at 8:00 p.m. for the rest of my life.

Wednesday, March 11, 2009

One down, one more to go

As of right now, I've been off Seroquel for over a week. And I feel pretty good overall. I've noticed a significant increase in my energy level, a decrease in my appetite, and and decrease in the hours I spend asleep (I was sleeping 9-10 hours a night). I have a harder time getting asleep these days, so I may talk to the doc about getting a "better" sleep aid, if things continue. However, given what is coming up next in my drug situation, I may not need that sleep aid. Read on...

At my doctor appointment last week, my doctor also said I should get off of Lexapro, a commonly prescribed anti-depressant I first started taking in the fall of 2007, when I was in the hospital. This would leave me taking only lithium to treat the bipolar disorder (I would still be taking Restoril-- a benzodiazepine-- as a sleep aid, and testosterone and levothyroxin for my hormonal/thyroid problems).

At first I was nervous about getting off the Lexapro, but since the Seroquel withdrawal went better (and quicker!) than I anticipated, I've decided to start phasing out the Lexapro tomorrow. Our original plan was to go off of it beginning March 20, but I am feeling confident. We had been planning on going off the Seroquel and Lexipro for awhile now, and since things are going so well I decided that there's no better time than the present to take the next step.

Plus, I am a bit concerned that I may go a bit manic the longer I stay on Lexapro. Seroquel tends to sedate, while Lexapro is an anti-depressant (a stimulant), and lithium takes away the peaks and valleys. Since I'm not on the Seroquel any longer, I'm afraid that the Lexapro may "overstimulate" me, and lead me into a manic state, since the Seroquel isn't there to balance it. Also, the drugs I'm taking for my thyroid condition also have a stimulating effect, and may make me go manic. I'm sleeping less, which is oftentimes a symptom of mania. However, I do have a plan in place, and am monitoring the situation very closely to make sure that I don't have a manic episode.

Withdrawing from SSRIs/SNRIs anit-depressants is a real pain in the ass. I've gone of several of them in the past (Paxil, Wellbutrin, Effexor, Cymbalta, Zoloft come immediately to mind) and they can cause a lot of very scary physical and mental reactions. When I went off Paxil the first time, I had a full-blown panic attack that almost landed me in the emergency room. Thankfully, I've got some experience at this, and I'm prepared for the sweats, nausea, brain shivers, and body aches. I've done this before, and I've come through eventually. I'll get through this one, too.

I haven't had a major episode of depression or mania since I got out of the hospital in October 2007-- the longest I've gone in years. I've never felt as good as I do now, and things continue to get better.

Kicking Seroquel

EDITORS NOTE: This is a cross-post from my Facebook wall. I thought it was relevant to this blog, so I'm sharing it out here for those who don't have me friended in FBLand. Enjoy!

From Wikipedia:
Quetiapine (pronounced /kwəˈtɑɪəpiːn/, kwe-TYE-a-peen), marketed by AstraZeneca as Seroquel and by Orion Pharma as Ketipinor, is an atypical antipsychotic used in the management of schizophrenia and bipolar I disorder, and used off-label for a variety of other purposes, including insomnia and anxiety disorders.



I've been taking Seroquel regularly since October of 2007, when I was hospitalized for an acute bipolar episode (my second in three months). It was prescribed to help control my anxiety and to help control some of the symptoms of my episode. I started off taking 75mg in the hospital, and have gradually decreased that dosage to 25mg, which I take now every night at bedtime.

Seroquel's most noted side effect is sedation-- on which I am all too familiar with, as most drugs prescribed to treat bipolar disorder tend to have sedative effects. Right now, I am also taking very high doses of lithium, another drug used to treat bipolar disorder and one that also has a very sedating effect.

Right now, I feel as if I'm swimming through mud. I feel lethargic and half awake all the time, even though I get plenty of sleep (sometimes 10 hours a night).

My doc has recommended that I come off the Seroquel for the past six months. I even tried once before last fall, to no avail. At the dose I'm taking, I'm not getting much of the beneficial effect, but I'm getting plenty of the side effects (heavy sedation, weight gain, persistent appetite, etc.).

With spring coming and a recent increase in my lithium dose (and the crappy way I've been feeling the past several days), I've decided it's time to kick the Seroquel. I am currently taking seven medications to treat this disease (including the side effects from the medications), and I'd like to reduce that number.

The drug withdrawal side effects will be (and have been) pretty crappy, but I'll get through them after a few days. For now, I'll just expect the headaches, the nausea, and the bouts of insomnia. It's nothing I can't handle and nothing I haven't gone through before.

According to my last count, I've taken fourteen different brain drugs over the past fifteen years. This one will soon be another memory, too.

Thursday, February 5, 2009

Some randomness on a sick day

No, I haven't fallen completely off the face of the earth. I am, however, having a bit of trouble getting motivated this winter. A lot of my energy/creativity goes in seasonal cycles, and the winter tends to be one of my lowest times of the year. And unfortunately this year is like any other.

Sometimes I think I would have been better off if I was a bear. I could sleep all winter, crawl out of my cave, go totally apesh!t in the summer, pig out all autumn, then back into the cave for a three-month-long nap. Unfortunately we humans don't work that way, so here I am.

I finally went to the endocrinologist and discovered that I am, indeed, hypothyroid and hypotestosterone. One of the side effects of lithium is that it depresses thyroid functionality, and consequently a lot of lithium patients also take a thyroid supplement to alleviate the side effects. So, I'm still a bit lethargic, still a bit fatter than normal, but things seem to be getting better. I'm still eating fairly healthy, I still exercize 5x a week (I've got Buns and Thighs of Steel, thanks to biking), I get plenty of sleep, and mentally I generally feel pretty well. I'm a little fuzzy-headed at times and feel a bit ADD-ish (bipolar symptoms often look like ADD), but overall I'm okay.

I promise I will post a real update to this thing very soon (probably more tales of the various meds I've been on over the past dozen+ years). So don't say I didn't warn you.