A Bittersweet Return to Psychiatry

As you may remember, the healthcare reform required that I find a new psychiatrist… only to have that one present itself as unreliable. After a few desperate phone calls and a miracle (the fact that my old psychiatrst is now taking my new insurance) I made an appointment with him a few weeks ago.

The appointment was yesterday, and though I’ve only been without a psychiatrist for three months it has felt like forever. While I waltzed into his office feeling quite chipper and very glad to see him, the appointment was rather bittersweet.

At this point it seems like my mood swings have developed something of a pattern, something that hasn’t happened in the three years I’ve been mood charting and tracking my symptoms. I could be jumping to conclusions here, after all the pattern might have been spurred by the pain and/or medication from when my ovarian cysts have been rupturing (now two for two, two months, two cysts). While I would be thrilled to be able to expect some level of predictability with what I’m dealing with, I’m not holding my breath for at least another month so I can see what happens next.

So far, the pattern looks a little something like this:

16 days hypomanic level euphoria dominant mixed episode
6 days with multiple depressive mood swings per day
5 days of stable mood
6 days with multiple depressive mood swings per day
17 days hypomanic-manic level dysphoria dominant mixed episode
6 days severe depression

I realize this is like… barely a pattern, but it is more like a pattern than anything I’ve experienced before.

Anyway, bittersweet. Great to see my old psychiatrist, but somewhat alarming to realize he has given me every medication (save the newest one, Saphris) that is available or reasonable for me to try. Three months ago I knew this, so why did it feel like such a shock to hear again yesterday?

It seems like I’ve exhausted nearly every possibility when it comes to psychiatric medications without any luck. I say nearly because, again, I can try Saphris (though I want to make sure I can get it for free before consenting to that, it currently has no generic and is terribly expensive) and I’ve agreed to try Seroquel. Again.

The thing is, I was first given Seroquel (quetiapine) while hospitalized, and they gave me a massive dosage first thing in the morning. Within an hour I couldn’t stand or walk because I was so dizzy, and because of that I told them I wouldn’t take it again. 

I think things might be different if I can take a little bit at a time at bedtime and get my body used to the effects (as long as they aren’t as horrible as they were taking a massive dose). You see, I have a very sensitive body chemistry and I tend to feel side effects somewhat exponentially, in conjunction with most medications having little positive effect for me (treatment resistant symptoms!). I’m more than willing to try this again, because frankly I have few (two?) options left in this realm of medicine.

By 2 pm yesterday I was feeling completely despondent and suicidal. I mean, nobody likes to hear that they feel like shit but there are no medications left to treat me. Talk about hopelessness!

That is, until I started thinking about the other options out there. I know there are still many other types of treatments I can try, it just gets my goat how often people (patients, doctors, pharmaceutical companies) promise guaranteed relief from pharmaceuticals when that hasn’t been my experience at all.

At this point, though I’ve tried acupuncture, there are other alternative treatments out there I can try. The trouble is that the ones my insurance covers are the ones I can afford at this point. I went into a terrible amount of credit card debt when I was trying acupuncture as a treatment method and unfortunately it didn’t do much to help me at the time.

My mind circled back to the idea of ECT. I don’t think my psychiatrist has brought it up lately because I really freaked out on him the first time he did. My reaction was the same as the first time I was suggested lithium, namely;

“Seriously? My symptoms can’t be THAT bad, right?”

Here, three years later, I can’t hold down a job. I’ve given up doing most of the things I love to do. I’ve tried every medication available to me (well, nearly) with no improvement. I yell at people in public uncontrollably while manic, I deconstruct my relationships while depressed, and I can’t tell the difference between reality and delusions while in mixed episodes. Are my symptoms bad enough to warrant ECT? Yes, I dare say I think so.

So… there. That’s an option. And just feeling like I have an option (albeit a bit of a scary one) makes me feel slightly better. After my last hospitalization I’ve always said that if it came to being hospitalized vs. trying ECT, I would rather try ECT.

I’ll try the Seroquel thing first and see how that goes, and I’ve got Saphris to try as well. Having said that, I’m planning on putting the option of ECT back on the table next month when I see my psychiatrist and see what he says.

I know I’m not the only one out there who has had trouble finding treatment options that work for them. I know it is simply the sickly, syrupy voice of depression when I feel singled out of a group that has already been singled out. The truth is not that I’m an “outcast’s outcast”… but so much of our lives involves comparing ourselves to the people around us that the things that make us unique often feel like pitfalls. I have to (and I will) find a way to make life work for me… and given my tenacity I can’t imagine anyone better suited for the job.

15 responses to “A Bittersweet Return to Psychiatry

  1. I am unfamiliar with bipolar disorder except maybe as a laymen. As I understand it, one’s mood will shift between two different “poles.” It doesn’t necessarily have to shift between happy and sad states which most people associate as manic and depressive states. Are these states of mind triggered environmentally? Or, is it naturally cyclical. I may not be using the correct verbiage as I mentioned I only have a passing sense of what it means to be bipolar.

    • Bipolar disorder can include a number of things, but generally starts with moods that are more intense than people would normally have. That could mean extreme moody overreactions in situations, episodes of mood states that can last minutes, hours, days, weeks, or months triggered by more environmental variables (sleep, eating, pain level, etc.), or mood states (like I just described) brought on by the disorder’s natural cycling (extraneous to what is going on around us). I think this is part of what makes it so difficult to treat, because medication often offers some relief from the natural cycling part but episodes can still “break through” for people when they are very stressed or triggered by intense situations.

      Though the name suggests the “two poles” concept I have found that people with bipolar disorder don’t always just experience a more intense sadness (depression) or elation (mania) but also have symptoms that can be equated with more intense anger as well. While moods shift between these intense mood states and stability (a “normal” mood) it isn’t uncommon to experience multiple symptoms from different moods at once (which can be quite confusing). This is what I was referring to when I denoted the periods I had as “mixed episodes” in this post.

      The cherry on the cake is that bipolar disorder can also contain an element of psychosis (delusions, hallucinations, paranoia) that, when mixed with any given mood state, can be extremely detrimental to things like work, relationships, and other everyday elements of life!

      In general, I must also note that people’s experiences vary greatly. There are different “types” of bipolar disorder that denote what kinds of episodes the person normally has (not everyone experiences all types of inflated moods, some people only experience more of the depressive side, others only the manic side). This is another reason the disorder can be so difficult to treat, as there is no one model for how bipolar disorder looks across the board!

      I hope that helps provide some clarity, and if you are curious to find out more there are many different resources available with more info on my blog. Thanks for asking about it, I appreciate you taking the time to learn more!

  2. I have found it so incredibly important to explain what mental illness is. Raising awareness can only help society at large. It’s difficult to explain how differently one can experience the world around them. It’s taken for granted that the ability to interpret information correctly is a homogeneous feature of brains. Brains like any other organ in the body can malfunction. This malfunction can vary tremendously in its severity or in its effect on behavior.

  3. Have you tried Effexor for depression and Lamictal for mania? This combo has been my saving grace. I still feel emotions but I typically don’t go completely overboard with desperation. If I experience a PTSD trigger and go into a panic attack I will take a small dose Ativan which will calm me down quite quickly. I rarely have panic attacks but I have to keep it with me at all times because I never know when a trigger will occur.

    It also seems that you may have menstrual problems. I too have maybe one week that is normal, and the other three weeks are unpredictable. My medical doctor diagnosed me with PMDD. Have you considered your patterns could be related to pre-menstrual syndrome?

    • I have considered hormones being a big factor but have yet to meet an OBGYN who has seemed the least bit knowledgeable. I have really bad luck with them, and they’ve often suggested or prescribed me things that made my bipolar symptoms significantly worse (to the point of requiring hospitalization). Who knows though, this year might be “the year”!

  4. Your this post is amazingly truthful. I especially like the last 2 sentences and would like to quote you on my wiki on character strengths under the “grit” heading.

  5. I was eased onto serequel and it has worked wonders for me. I did sleep 14-16 hours a day for the first month or so, I have no real memory of it except that I was a zombie and I thought it would never end. But I adjusted and I just want you to know that it is possible to feel human on it! It just takes a little while 🙂 I’m hoping for your sake it works for you! My best friend went through a ridiculous amount of medication with no results during her treatment of bi polar, and I have seen how utterly exhausting and draining it is. Sending all my positive vibes your way xx

  6. I love your cogent writing style. I do hope and pray that you and your psychiatrist find a medication regime that helps you. If ECT helps, then go for it. Whatever works for your brain.

  7. The side effects of one month on Serequel were very bad after I quit the medication. I was suicidal for 3 months. Then I spoke to another patient on the medication who went off of it and had the same response. Buyer beware. I know NIMH has tested Ketamine for depression for 10 years and NPR had a story on a young bipolar patient who used it with some success – maybe a study only and we cannot get it yet.

    • Sorry – problems posting.

      • No worries! Yeah, I posted about those ketamine trials back when news came out about them, it would be great to get an update on how that is going, and if I find one I’ll post it!

        Good to know about what went down when you stopped Seroquel. Thanks for the heads up!

  8. The side effects of one month on Serequel (for me) were severe after I quit the medication. I was suicidal almost daily for nearly 3 months. Since I have never experienced that specific kind of hell I attributed it to the drug. Then I spoke to another patient who had been on the medication and subsequently went off of it and had a similar response. Buyer beware. I know NIMH has tested Ketamine for depression for 10 years and NPR reported that a young bipolar patient who used it with some success – maybe a study patient only and we cannot get it yet. It is supposed to literally end crippling depression within 45 minutes. The depression tends to be the worst part of the experience. Of course, this is because mania is a great trip if you don’t have any sense of self-awareness. Reading your blog is about the only therapy I have so I should probably try to get help again soon. It is sort of like group therapy. I thought I drove my last talk-therapist crazy and didn’t find another when I moved back to Central California.

  9. Pingback: My Seroquel Journey & Questioning Reality | bi[polar] curious

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