I mentioned recently that my psychiatrist has decided to change directions in how we try to treat the mood swings I have emanating from treatment resistant bipolar disorder (type 1).
In the past six years I have actively tried several benzodiazepines (like clonazepam, or lorazepam) , antipsychotics (risperidone, ziprasidone, olanzipine to name a few), mood stabilizers (lamotrigine, oxcarbazepine, gabapentin & more), and antidepressants (sertraline, fluoxetine, bupropion, etc.) but have always experienced either:
- worsening symptoms
- side effects severe enough to warrant stopping the medications
- or tolerable side effects with no response from my symptoms.
The only psychiatric medication I’ve been able to keep taking regularly is Lithium, and while there is some debate on whether it is helping I’ve been taking it for long enough that I am having no side effects so the consensus is usually just to keep taking it.
Starting any of these new medications has typically made my mood swings worse (more frequent and more severe) so it has been a bumpy ride. After my new(est) psychiatrist got a good look at this happening she decided it is probably useless at this point to keep trying in these same classes of drugs I’ve had problems with. Needless to say, this was both a relief (hooray for no more psychiatric drug barrages!) and a little disheartening (alright then, now what?) but after all I’ve been through I’m more than willing to break away from this cycle and try something new.
Like anyone who finds themselves chained to the great lithium beast I have to go get my blood checked every few months to monitor the level of lithium in my blood. During these times I often also undergo other tests to check things like kidney and thyroid functioning.
Apparently my thyroid level doesn’t appear to be outside the range of “normal”, but my doctors have found that for me a tiny change can make a huge difference (as seen with my reactions to most drugs). My psychiatrist also told me that sometimes thyroid medications can be used to treat resistant depression, so our next route is to give liothyronine (cytomel) a shot and see what happens.
I always get a little nervous when I’m given a new drug to try and my doctor asked if I thought it would be better to start it when I am feeling more stable or unstable. That has always been a tricky question for me because if there are significant side effects a drug can easily take me from stability to a place of being unstable, and having less stability I tend to want to take advantage of those times as much as possible. At the same time if side effects occur when I am already very unstable I am less likely to cope in a healthy way so I told her don’t think there is a right answer here.
Ultimately, I’ve had the flu for the last week so as soon as I feel better physically I’ll start the liothyronine regardless of what my mood decides to do. This one comes with all kinds of obnoxious directions (take on an empty stomach at least 30 minutes prior to eating, no antacids for at least four hours after taking it, can’t be taken at the same time as vitamin or mineral supplements -sheesh!) so I need to do some work shifting all of my medications into a system that will allow me to follow those rules.
As scary as it can feel not knowing what will happen, I always feel some element of hope that this time might be different. If I didn’t feel that I’m sure I would have given up ages ago. It might be that I’m just stubborn or absurdly optimistic at times too, but it is easy to gamble when I feel like I don’t have much to lose and there is potential for increadible gain.