Day 17 of the mixed episode I’ve been residing in, longer than most mixed episodes I’ve tracked at this point. Mixed episodes are generally the biggest time for concern in the day-to-day of my bipolar life because each one brings something new to the table (a new concoction of depressive and manic symptoms) while adhering to an underlying theme of cynicism, anger, and hostility.
To top that off, mixed episodes are also the time I most often (though I do, at times, during mania as well) experience psychosis. Delusions, hallucinations, paranoia, and unbridled fear aren’t always present at these times, but they can pop in at a moment’s notice, rearing their ugly snake-covered heads and bringing down everything around me.
I often consider mixed episodes to be the trifecta of evil. My symptoms of rage and hostility put all of my relationships at risk, the unbearable agitation and confusing physical symptoms leave me desperate, and therefore put my own life at risk (via impulsive suicidally), and the ever-present chatter of what seems to be thousands of thoughts all being read aloud by different voices talking over each other in my mind (well, that and the psychosis) is a recipe for mental falling-down-the-rabbit-hole risk well outside the realm of what depression or mania seem to press on their own.
During my last hospitalization (April, 2011) where I was jumping between suicidal depression and psychotic mixed symptoms the house psychiatrist prescribed me Zyprexa. That was the first time I had ever taken an antipsychotic drug before, and though it seemed to help something at the time, I couldn’t convey to my psychiatrist upon leaving the facility exactly what that was.
I’m not particularly surprised by this, after all… I was pretty familiar with symptoms of depression at the time, and though less familiar with symptoms of mania I could identify them. Mixed episodes were, however, something I did not understand yet. All I knew was that I felt horrible at times, the most horrible I’d ever felt, and I couldn’t quite nail down exactly where that terrible feeling was coming from.
I continued taking the Zyprexa for two months and rapidly gained 40 pounds. Long red stretch marks began to appear across my entire body, and it seemed that any benefit the drug was giving me was being quickly outweighed (heh) by incredible weight gain.
Together, my doctor and I began testing other antipsychotics on my system. We landed on Risperidone, and though I had the least side effects from taking it I still had to deal with intense drowsiness (often knocking me unconscious within 30 minutes of taking it and elongating my sleeping habits to 12, 14, sometimes 16 hours after having taken it) and severe brain fog that made it difficult to put thoughts and words together.
Because of how sleepy it made me, both my psychiatrist and I concluded I couldn’t take it all the time (as I still had a job at the time). Instead he decided to give me a prescription and allow me to take the drug as needed.
As needed. Yes. The last couple years I have taken .5 mg of Risperidone as needed for symptoms like psychosis or… you know… violent hostility. Honestly, I’ve often opted to take Ambien instead because it put me to sleep immediately in a similar manner but didn’t leave me feeling like a total train-wreck the next day. Since most of my mixed episodes have been fairly short and sweet, it didn’t seem necessary to really bombard myself with drugs. I’ve been somewhat wary of taking more Risperidone because I was nervous about not being “on the ball” for plans the next day, and because I haven’t take it much, I often forget about it entirely.
It can be easy to fall into a place where I feel overwhelmingly awful and not be able to see the things around me that might normally help me feel better. I think this is part of the reason why I am on day 17 of my current mixed episode and only began taking the Risperidone on day 15.
And I found it. That thing, the elusive thing that I couldn’t discern when I was taking Zyprexa a few years ago. I knew that when I took it, something was different. Some symptom was gone, but my mind was just too foggy to be able to point it out.
Yesterday morning I woke up after a 14 hour Risperidone nap and there was the brain fog I was expecting. However, there was something else I wasn’t expecting.
My mind, so loud and chattery and unruly the night before, seemed to keep sleeping even after I opened my eyes. Yes, I felt a little stunted and perhaps a little dull, but this was a dullness I was thankful for. That brain fog that I had wrestled with so much a few years ago was now the thing that seemed to be making taking this drug worthwhile!
I feel like treating bipolar disorder is a constant game of “which is worse?” While some side effects from medications or other treatments might seem unbearable in times of stability (or during less severe episodes), there may be times where certain symptoms or types of episodes feel far worse than those effects. The biggest trouble is that ever-changing-symptoms make it incredibly difficult to discern when “worse” might become “worth it”.