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.

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.

What is bipolar disorder?

October 11, 2009

Cheesy old ad with a young woman saying - so simple

If experts don't understand bipolar, how can patients?

“Bipolar disorder” is a spectrum of disorders whose symptoms include periods of mania and depression; it is thought to be largely genetic, but research is not yet conclusive about the causes, neurology, or treatment. There is a 15% fatality rate, due to suicide.

Here’s a more eloquent definition, exerpted from my favorite resource, “Break the Bipolar Cycle” by doctors Elizabeth Brondolo & Xavier Amador:

Bipolar spectrum disorders (BSDs) are a group of disorders all of which involve cycling moods.  But BSDs are also accompanied by a wide range of other symptoms that affect not just your mood but also your energy, your memory and thinking, and your connection with other people. Because the symptoms change or cycle, it may feel like you are always losing ground, never gaining control over your life.

Then there’s the more clinical DSM-IV diagnostic criteria for each of the 4 types of bipolar it defines:

  • Bipolar I Disorder – at least one Manic or Mixed episode, but there may be episodes of Hypomania or Major Depression (this is what people typically think of when they think of Bipolar or Manic-Depression)
  • Bipolar II Disorder (here I’m quoting Wikipedia, which is quoting the DSM)
    1. Presence (or history) of one or more Major Depressive Episodes.
    2. Presence (or history) of at least one Hypomanic Episode.
    3. There has never been a Manic Episode or a Mixed Episode.
    4. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, delusional disorder, or Psychotic Disorder Not Otherwise Specified.
    5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • Cyclothymic Disorder – Highs and lows that impair functioning as with Bipolar II, but without meeting the criteria for a Major Depressive episode or a Manic episode
  • Bipolar Disorder NOS – “This designation abbreviated NOS can be used when the mental disorder appears to fall within the larger category but does not meet the criteria of any specific disorder within that category.”

The DSM-IV definitions immediately lead one to ask “what’s mania?  what’s depression?” — there are plenty of links here to lead you to the answers, but I think this is all more than enough for one post.

Hello, I hate you -- that's bipolar