A new dose & a vacation

January 6, 2010

Two weeks ago, I tried upping my lithium again, to a lower dose than before (450mg +2x300mg = 1050mg), then  I was out of my country for over a week on a family trip.  I think it was the lithium, but I had no serious mood problems on my trip!  However, I also had very few triggering (stressful) events….  I’m a bit apprehensive to start work again, since it seems to largely consist of stress.  I will try to practice observing it rather than reacting to it.

I am in limbo.

My job is so degrading, I almost quit on the spot today.   I am being treated like I have no skills at all, rather than nearly 10 years of experience in my field.

At the same time, a former boss has encouraged me to apply for a position at his company, and it looks like it would be great… and that they’d want to make use of my skills and put me to work on challenging problems.  It’s almost enough to empower me to dust off my resume and give it a shot.

…But I just feel that my confidence has been so shaken by this year — my work-related repetitive stress injury, family issues,  my diagnosis of depression & anxiety and then later bipolar, the medication trials & errors, my weight gain, not keeping the house nice, and my job just getting worse and worse.  How do I get into the confident place I need to be in order to get a job?  (A rhetorical question, but if someone feels they have a great answer, go for it.)

Some hope from bloggers

November 29, 2009

Collections of hopiness from various blogs

and

some science for the skeptical or uninformed.

Also,

a comic portrayal of bipolar patients from the perspective of a mental health professional.

More lithium, please

November 29, 2009

After a month on lithium, I’ll be emailing my psychiatrist today to tell him about my symptoms and see if he thinks I should increase my dose to 1250mg.

My symptoms have been a whole lot of anxiety, irritability, obsessiveness, and not being able to sleep much in the morning.  And occasional rage.  Sounds mostly like anxiety, but has enough of mixed state in there that more lithium might help.

I’m fed up.  There’s no one person or thing to be angry at, but I just feel angry that several months of acceptance, drugs, DBT (Dialectical Behavioral Therapy) classes, Bipolar informational classes, talking to co-workers and family….  none of it seems to have been effective.

It’s hard to keep going.  I’m in no danger of suicide, just in danger of losing the will to do anything but acquiesce to the couch.

Things that will make me happy include reaching out to distant friends, going outside, and doing interesting activities, but this all seems just beyond my grasp.

I feel haunted by something my doctor said at our last visit: “I can medicate you, but I can’t medicate your life”.  I hope just a little more lithium will help me make changes in my life.

I’ve now come out to my new boss, “Tim”, and his new boss, whom I work with closely, “Jennifer”.   Both conversations went far better than I’d expected.

Tim seems to suffer from anxiety, and he seems like a pretty sympathetic guy, so I figured it would be fine.  But what actually happened was that he opened up to me and told me about mental illness in his family, as well as some of his own struggles.  He completely understands (vicariously) how horrible bipolar rage can be, as well as the importance and difficulty of sticking with meds.  I gave him my husband’s phone number in case I ever start acting really inappropriate at work, and he put it into his cellphone.  I expected support from Tim, but he gave me more — he gave me understanding.  Since telling him a week and a half ago, he and I haven’t made any reference to any of this, but it feels very good knowing that he is supporting me and watching out for me.

I was more nervous about telling Jennifer –she’s a very logical engineer (I even had a dream where she was working with Data from Star Trek to solve some dilithium problem), and I feared she’d think the whole thing was BS or just a weak character.  When I told her, I then asked if she knew anything about bipolar.  It turns out someone in her family has a spouse with bipolar, so she’s vicariously seen how hard the medication trials are.   She told me that she’d had no idea, and that she thought I was managing extremely well.  We then talked about how I should handle it when I can’t come into work.

I know that not everyone is so lucky to have colleagues or managers to support them, and I feel grateful.   I do think, however,  given the percentage of people with bipolar in this country (almost 2%), that there is a good chance that if someone “comes out” to a co-worker, he or she will already know someone with bipolar.

Starting Lithium

October 29, 2009

The initial symptoms of Lithium are comparable to those of Depakote — with the big caveat that YOUR MILEAGE MAY VARY.

I’m feeling shaky and jittery and electrified as though I’m manic, but I’m pretty sure that it’s the Lithium.  The brain fog of my depression the last week seems intensified.  I’m also sleepy all the time, but that may be in large part to the Seroquel I’m taking to calm down the jitters.  My focus at work is shot to hell.  Hopefully next week will be better!

All this is affecting my work performance — I need to tell my new boss about my illness soon before she questions my dedication or judgment.  More to come on “coming out” about bipolar in the workplace.

Why am I unmedicated?

At first, it was because I was switching from Depakote to Lithium.

Then, in the mild mania presumably triggered by going off the mood stabilizer, I started a blog and began to question my diagnosis and my treatment.  I thought that treating my anxiety might be the way to go, since it’s the only diagnosis I felt confident in.

Then the mania turned into a few terrible days of mixed state — an activated, jittery, but negative place.  I was very irritable, and flew into several rages at my partner, after which I felt consumed by self-loathing and the desire to hurt myself.  I took some Seroquel during these days, because it was just too unbearable, and I was worried I would do serious damage to myself or my partner.

My horrible mixed state helped me accept that I have an illness — my partner pointed out, as he often does, that I would never choose to feel or behave like *that*.  It’s hard to distinguish the illness from myself — this mostly genetic, maybe environmental, uncurable, somewhat treatable disorder sometimes seems like all of me and other times seems so alien.

Having accepted that I need medicine to treat my illness, I called my psychiatrist.  I proposed staying off meds for another few weeks and documenting my moods, to give both him and me a better sense of my symptoms. He seemed to like the idea, and we made an appointment for November 13th.

Since then, I’ve been in a mild depression.  Showering is hard.  Going to work seems impossible, but I am still able to do it.  Everything seems hopeless and worrisome.  I’m tired all the time, but I can’t sleep well.

I think I might have rapid cycling, but regardless of my diagnosis, I just want some treatment. I’m going to call my pychiatrist on Monday and ask what I should take.

Break the Bipolar Cycle - link to Amazon.com

This book doesn’t spend much time on positive reinforcement (People with bipolar are great artists! Your symptoms are OK! You are not alone!), and I am more than fine with that. Instead, it focuses on practical approaches to getting through the day, meeting goals, and overcoming hurdles — even “small” hurdles.

Until I read this book, I felt alone in:

  • Dreading phonecalls
  • Being a medication guinea pig
  • Feeling “up” and yet so negative ( “mixed state”)
  • Every small task being so utterly difficult
  • Being such a finicky sleeper

The books introduces the reader to various symptoms along the Bipolar spectrum (Bipolar type I, type II, cyclothymia, Bipolar NOS, etc) by way of brief descriptions and then several stories of real people’s experiences.  These are helpful not only by way of illustration, but also as a means of practicing empathy: it can be easier to feel kindly towards others who have a diagnosis than towards yourself, and kindliness towards oneself is a precursor towards any positive action at all!

In addition to these descriptions and stories, the book contains a whole lot of worksheets.  There’s a certain amount of inertia you must overcome to make full use of the book, but if you can, the worksheets are very useful.  Some features include:

  • A worksheet to prioritize phonecalls, one at a time
  • Various mood-tracking worksheets — down the road, when you’re miserable/jittery/angry, they’ll remind you that you haven’t always been that way
  • Symptom worksheets
  • A worksheet for identifying stressors
  • Drug efficacy & side-effect worksheets
  • …And a whole bunch of others that I certainly haven’t tackled yet

For best results, have partners/friends/family members help with these worksheets; they can be overwhelming for someone who’s coping with a new diagnosis. The worksheets make a huge difference in the ability of your psychiatrist to treat you, since they offer a broad view of symptoms over time, and they provide you with that same broad perspective — it reminds you that you’re not always ___________ (fill in the blank of your current mood).

This book alone won’t “break the bipolar cycle”, but it is one of many useful tools (along with chocolate and drugs) that can make bipolar more manageable.  It’s the best book I’ve found, of maybe 5 at my local library.

Self-diagnosis

October 13, 2009

This is what I want to find out from my therapist this morning:

Is bipolar always treated in priority to anxiety, even when the latter is more currently a problem?

My first diagnosis was anxiety & depression, for which I was given a mild SSRI (celexa/citalopram), with the warning that it may trigger mania if I were bipolar.

The SSRI or extreme stress (not sure which) caused a hypomanic episode, months after I’d started the SSRI.

I’ve had 4 manic episodes & at least 1 major depressive episode (self-diagnosis), but they were all over 4 years ago.

Therefore it seems like the anxiety should be the primary focus of treatment, with the caveat that my meds need to not trigger my bipolar.

I’ve been self-medicating with some extra Seroquel the last couple of days, but it makes me too drowsy to function… it’s otherwise great.

UPDATE:

My therapist gently asked, “What about yesterday, when you emailed me about how unstable you were?”

Yesterday is a whole internal universe away, so I had no idea how to answer.

My next step? See the psychiatrist armed only with a few charts that give him a clear picture of my ups, downs, and problems, not with my ego.

From salted lithium (who is an excellent, excellent writer):

“I need a fucking intervention… I need people who know what they’re doing to stand up and hand me a plan. Because, really, I’ve spent twelve of nineteen years not knowing what it was I was supposed to do… and it’s gotten me exactly here.”

Exactly.

Slipping in out of lucidity and chaos.

Work is immensely difficult today — this chaos and confusion and rapid rollercoasters makes me doubt my diagnosis.

I was convinced a few hours ago that I really have a brain tumor instead.

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