Looking Into a Trileptal Mineshaft

I am pretty glad my psychiatrist’s office now has email capability (though I was getting to know the women who worked at the front desk pretty well over the phone). I just sent my psychiatrist an email about Trileptal, and unless he is able to pull a magic rabbit out of his hat, I am not expecting to continue taking it.

It is one thing to deal with headaches, nausea, dizziness, and fatigue, but I have definitely seen a severe and sudden change in my mood after starting Trileptal.

As a reminder, most people have an improvement in mood stability while taking Trileptal (oxcarbazepine), but I have seen an almost immediate downward shift into depression with cycling 2 or 3 times per day into an irritable/agitated mixed state and back into depression again. By yesterday it was bad enough that I had to take an antipsychotic before bed, and if I had the attention span to write the email out to my psychiatrist last night, I would have.

Obviously the major threat from this sort of mood change is suicidality, but the game changer for me is desperation.

Desperation is like suicidal thinking wrapped in a big bow made of justification.

If I am under a large amount of stress, or in a large amount of pain, desperation can make any form of escape feel justified, and all forms of escape feel welcome. That can mean anything from playing video games for days at a time, to being inebriated for long periods (or more frequently), or even fantasies of self-harm or suicide to escape the immediate situation. With depression it is easier for those fantasies to remain fantasies, but when I cross over into an irritable/agitated place where the negativity of depression lives hand-in-hand with the energy and impulsivity of hypomania (as I have the last few days),

shit gets tricky.

This moment of desperation is the only time I can think of where antipsychotics feel like a good idea, because I find being a zombie preferable to the agony of a mixed episode.

Personally, I find desperation to be one of the most dangerous places a person can be in, because someone who is cornered (in any part of life) is almost always more likely to do something irrational because they believe they have very few options. A wide view narrows to a small tunnel of vision, and a picture with 100 options becomes a picture with 5.

With depression I usually feel lethargic enough to withstand desperation, because giving in would mean doing something and I never quite feel like doing anything while depressed (at least, up to a certain point). I think this is kind of a nice fail-safe, though it really doesn’t feel like it when I’m there. This is something I can feel a bit good about, because I know desperation’s tactics; choose a course of action and take it immediately. 

When it is present, desperation chants repeatedly in my ear, “you have to do something! Do something, do something, do something!”

In the last few days this chant has come and gone like the tide rolling in and out again. This feeling works as something of a clear sign, and it says,

“This stared with the Trileptal…

…do the math.”

So there you have it.

I hope that my doctor will respond quickly and agrees with my reading of this sign, but I do also have a series of mood charts showing the change in behavior/activity and the overview, showing that this is the lowest point of depression I’ve had in three months. How unfortunate.

10 responses to “Looking Into a Trileptal Mineshaft

  1. I don’t know that “liking” this post is appropriate, but your comments about desperation vs depression are right on the money!

    I guess, the good thing is that you are so very aware of your reactions (and having access to the doc through email is nice; I was just given my counselor’s cell phone number last week, and it made me feel less isolated) that hopefully the situation will work out before your desperation gets to far gone.

    In fact, I am rather in awe of your awareness. I’ve always felt fairly aware of my physical health, but my mental health takes much more contemplation (which, since this is a blog post you do have time for). I wish I was more consistent in my charting. I lost 10 days during the confusion, which is data I would like to have. Although, I guess the lack of it says something, too.

    If you will allow a moment of geekiness, it is like gathering all this data and back story is like having a character sheet. You can predict what your character’s reaction will be in any given sort of circumstances with increasing degrees of accuracy.

    I think that is very cool :-)

    • Sarah @ bi[polar] curious

      Alas, my doctor is out of town this week! So much for that brilliant idea.

      I love the comparison to the character sheet, that is awesome.

      Thanks!

      • hehe

        I imagine you rolling a low score and the game master telling you, “You roll a 5. The wizard’s apprentice tells you the powerful prescription-writing one is away on a mystical journey and won’t be back until next week.”

  2. I think you’re right on with the observation that desperation is the dangerous part of depression. Depression can feel like a wet, stinky blanket cocooning you from the world, and as unpleasant as it is, there’s a certain comfort in it. But when you start feeling desperate, it’s bad news. I almost always get desperate depression; mostly I’m terrified that it will not leave and frenetic about all the things falling apart around me. Perhaps if the depression lasted long enough, it would get past that initial phase and settle into the nasty dark cocoon stage, but I’d rather not find out either way.

    • Sarah @ bi[polar] curious

      I have a couple different stages of desperation I go through when it comes to depression, the first is usually a desperation to eject myself from the sinking depression I find myself in. After that, the cocoon you were talking about. Next, a vague sort of suicidal desperation that increases into totally irrational desperation, followed by resignation. If I make it all the way to resignation, I’m in big trouble, and that is when I know to check myself into the hospital immediately.

      Really, it doesn’t start out so bad, but what gets me every time is that this process can happen over the course of days or months, or in a matter of hours its seems. If I am lucky, it disappears just as fast, but in the “year of depression” that ended about a year ago I apparently walked into the doctors office saying, “it should be over by now, I should snap out of it any time!” for months. It is hard to comprehend how unpredictable the timing is on these sorts of episodes!

  3. The desperation is truly scary. That is how I went to the brink of an aborted suicide attempt, then to the hospital. I wonder how many bipolar suicides are impulsive acts during that state of desperate, uncontrolled panic.

    • Sarah @ bi[polar] curious

      I would venture to say a good chunk of them are impulsive acts. I know personally that I can get extremely suicidal while depressed but be able to walk that line like a ridge pole while keeping my balance and not accidentally falling over the edge for weeks, even months at a time. When I am feeling impulsive, however, I am much more likely to act on a suicidal feeling, even if that feeling is only for a few minutes.

  4. I am still having trouble accessing your site-host@bipolarcurious.com…….. but wanted to comment on the feeling of depression & not being able to find the energy to do anything. I find myself on the couch far too often, even when I have things to do Just getting into the shower is challenging many days & even with all the vitamin D I take, this gloomy weather really gets me down. Then there are sunny days when I can’t seem to get going & I take Adderal in the morning to get me going- it usually works until late afternoon when I am ready for a nap. I hope your experience with Trileptal gets better- I am sure I have been on it myself.

  5. Pingback: Wrapping Up the Week | bi[polar] curious

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