Category Archives: Mixed

The Number You Have Dialed Has Been Disconnected

I don’t know if you have ever spoken and felt like nobody could hear you, but for me this feeling can potentially trump symptoms like delusions and hallucinations for the most maddening feeling I’ve ever experienced. Even when I am experiencing hallucinations or delusions (and maybe even don’t recognize it) I can talk to someone about it; but the times when my mouth and body do not convey what I want them to (or they do but in such a way that nobody can understand them) have left me (the innermost me) feeling like a phantom limb.

Last weekend, in a matter of days, I became engulfed by that feeling. Everything I was trying to say, the jokes I was making, the observations I attempted to casually convey, became hostile. It seemed no matter how I spoke or stood or gestured, people were genuinely afraid of me. Those desperate sorts of pleas hoping to convey my intense sorrow came out, instead, angry.

My manic episode from the week previous had turned dark, and as the depression I was experiencing became more and more intense, so did my apparent rage. The rage left me incapable of conveying the depression, and being unable to express myself left me feeling so isolated and alone that I could feel the depression feeding on it and growing exponentially.

When Monday rolled around I tried everything I could think of to crawl out of the disconnected, suicidal funk I was in. I emailed my psychiatrist only to find out he was on vacation. I called the intake coordinator for the new clinic I’m trying to access therapy through but she did not have time to talk. I called the crisis line (as I’ve been calling them a lot lately) but all the phones were busy! This, if nothing else, seemed like a sign, so I grabbed my purse and a book and went straight to the emergency room.

It can be very confusing to watch yourself begin to destroy your own life (your job, your relationships, maybe even yourself through impulsive drug or alcohol use) and feel like you are a passenger during the whole experience. Unfortunately, this is a feeling I am familiar with so I knew that the only real card I had left to play was hospitalization.

What I didn’t know was that I would be spending all day and all night in the emergency room before reaching that inpatient bed. I was awake for 36 hours and extremely alert and energetic (as I said, mixed episode) fueling those depressive and hostile waves that kept coming until I was (somehow now in an inpatient room) crying uncontrollably for hours, and periodically ripping up anything in my room I could find to rip up.

My goal was to outlast the episode until it switched into depression or stability (whichever came first), a fairly easy goal I figured, since my episodes cycle so rapidly and I was already 12 days into the mixed episode. Though it wasn’t fun (but hospitalizations never are) I seem to have outlasted the hostility and was expelled through the other end of the hospital Friday experiencing severe depression instead.

So I am home now, and though my decision-maker seems to be broken and I had a panic attack trying to go into the grocery store I am, seemingly, a free woman again.

My mind has still been trying to whisper all manner of horrible things to me, but I can eat food that wasn’t produced in a hospital now… so it makes all that a bit easier to live with.

Needless to say, my posts may be somewhat spotty for a bit. I’ve been very overwhelmed by a lot of the things that have happened this year, and several more big things are scheduled to go down this month.

In the meantime, take care of yourselves! I’ll be doing the same.

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Back to the Basics

Things seem to have reverted back into a state of normalcy for me. Of course, when I say normalcy, I mean my normalcy. This change definitely has it’s plusses and minuses (less physical pain and vision problems, a return to a flip-flopping of psychotic mixed and depressive states, and the typical health care team issues I tend to run into every six months or so) but I wanted to address this return “back to the basics” that has occurred over the last two weeks before writing about anything else that has been on my mind.

My current psychiatric medications have returned to a regimen of  lithium only. 

I’m sure it was pretty clear that the seroquel I tried the last few months brought on some serious health problems, but it wasn’t until the issues with blurred vision, dizziness, nausea, and light and motion sensitivity that I began to suspect the wellbutrin I’d began in the last two months might be contributing to the problem. After having my eyes, ears, and stomach checked out I began a systematic stop and start of the medications I was taking at the time to see if any changed occurred. I pulled the plug on the 150 mg of wellbutrin I was still taking (after decreasing a week earlier and seeing some improvement and speaking with my psychiatrist) and about ten days later (Saturday) I was able to sit through watching a movie for the first time in five weeks without thinking I was going to vomit.

Not having been able to watch tv or movies for that long was pretty agonizing, movies are one of the few things I generally still feel passionately about and being without that sense of comfort was very jarring.

I was a little surprised (but glad I didn’t have to go see a neurologist about this) because the warnings for wellbutrin list “eye pain and vision problems” but that isn’t very specific. What really tipped me off was that I found out that wellbutrin can trigger problems with vertigo, and though I have experienced plenty of vertigo in the past and what I was dealing with this time was different, there were aspects of my symptoms that felt similar. At any rate, this issue is improving… and I wont be taking anymore wellbutrin in the foreseeable future.

The swings are back in action. 

While the seroquel seemed to keep me from swinging around the mood spectrum, it also kept me in the depressive end where I was sinking very quickly into a dangerous place. Now that I’ve stopped it, I’m back to my typical, sporadic swings lasting anywhere from thirty minutes to days or weeks at at time.

“From your perspective, which is worse?” I asked my boyfriend. “When I am depressed all day every day, or when I seem ok one second and then fly off the handle the next?”

He paused for a moment before replying, “I can’t really call one ‘worse’. They’re both equally devastating.”

I feel like I ask myself the same question a lot, because remaining in a single state (like depression) can sometimes feel better, more stable to me than rapid cycling because I can often do a better job of predicting my future mood; depressed. At the same time, everything shuts down and my mood rarely stays “somewhat depressed”, usually moving toward “earth-shatteringly depressed”.

If I’m rapid cycling, I can usually experience one or two hours a day where I feel relatively ok, and if I’m really lucky, maybe one day in a week where I feel relatively stable. Sometimes, just the fact that these moments are possible makes rapid cycling feel somewhat better to me.

I find the negatives of rapid cycling to be much worse though. It grinds on my relationships, I have no way to make any kind of predictions about how I will be feeling from one moment to the next, and switching into mixed episodes (which has become more and more common for me) becomes extremely dangerous.

Annnd health care team problems… as per usual.

I feel confident today in saying my concerns about my healthcare team the last week have had nothing to do with delusions.

Usually when I have problems with healthcare, it has been because of insurance coverage, or co-pays, or my old doctors not taking new insurance, or whatever element of the system seems broken at the time. This time, my concerns are a little different.

October has always been a fishy month to me, and I don’t consider myself superstitious but usually when something weird goes down or people are acting very strange, it is in October.

Anyway, first my general doctor started acting very strange and making me incredibly uncomfortable. He’s began giving me these long “pep talks” about how I need to look inside myself and find happiness, naturally this is one of the biggest turn-offs you can come across when you have a mood disorder. This has happened twice now, and though I understood when it happened the first time (I had a breakdown in his office) the second time it was completely unwarranted and generally had nothing to do with anything we spoke about in my appointment (regarding stomach pain). This man has always been a good doctor to me, very smart and professional for several years, and I know he is coming from a place where he is intending to help me, but for the most part while I was stuck in that little cold room with him trying to make extended eye contact it felt like if either of us is insane, it is definitely him.

Next it was my GI specialist. I needed a prescription refill order and she failed to return any of my calls, messages, or emails for three days. When she finally did send the order, she sent the wrong order to the pharmacy and never called me back. After calling the office again (to make another appointment) all of the notes from our last appointment have mysteriously vanished and there is no record of it. Needless to say, this (even more than the above problem) makes me extremely nervous. I realize she is a busy woman, but I feel like my experiences last week are definitely bordering on (if not already) unprofessionalism. I ran out of medication saturday, I still haven’t heard from her or her office.

Finally, my therapist quit unexpectedly two weeks ago. He had scheduled a follow up appointment with me last week, but the receptionist called me that day and said he never showed up. By the time this happened I couldn’t help but laugh.

I don’t have much of a plan of action for the first two doctors (maybe they’ll get their sheezy together?) but as far as therapy is concerned, I’m ready to switch clinics. The one I have been going to the last three years I’ve had a lot of problems with, and the people who work there are very inexperienced. Instead I’ve began pursuing a community clinic specializing in patients on medicaid with more significant mental health problems (me!), at this point I’m just hoping to get in before next month when things become extremely (more) stressful.

Tonight I have an appointment with my psychiatrist and I am keeping my fingers crossed he hasn’t completely fallen off the deep end too.

Complication Damage Control

After last Friday’s realization (regarding the delusional state I’d been overtaken by) I contacted my psychiatrist. He prescribed me the ODT (orally dissolving tablet) version of Rispiridone as I haven’t been able to stomach lactose recently and lactose is an inactive ingredient in several (if not most) psychiatric drugs.

The lactose acts as a base for the medication to be applied to in most tablets, but usually isn’t used in extended release tablets, capsules, and orally dissolving tablets. I figured this out after a delirious game I played last week called, “why are certain drugs making me vomit?” The result? The vomity drugs were the ones that contained lactose as an inactive ingredient. I was not surprised, since I haven’t been able to tolerate lactose in food for over a month now.

Had this not been an issue, I would have just taken my typical emergency dosage of rispiridone right away… but at the (very slow) rate my stomach has been healing I have been doing everything in my power not to upset it and in conjunction, not further upset my mental state.

By the time my psychiatrist and I got this plan sorted out it was already late afternoon on Friday and I had spent most of the day with my hands clenched on either side of my head. I don’t know if I was hoping to squeeze out the delirium or if I was simply trying to make lemonade out of lemons, but I figured if I could wait until I got the prescription filled everything would be relatively ok.

Of course, that was assuming any of the pharmacies in a five mile radius of my apartment had the ODT version of rispiridone. Not one did. I called them all, and yelled at the technicians who worked at most of them. The best they could do was have it by monday and I didn’t know if I could make it.

I also didn’t know what the alternative would be. Would I have to go to the emergency room again? I’ve already been to the emergency room four times in the last six months, and I was even more concerned that doing that would result in being given more medication I would have no control over, having more bad reactions (triggering uncontrollable vomiting), and starting over (again) in terms of trying to give my stomach a leg up.

I trudged through the weekend by being about 10% mentally present in everything that took place and trapped in my own head, full of a horrible amount of noise, the other 90%.

The noise. Every time I mentioned it I imagined myself with the snarled, green face of the Grinch who stole Christmas.

I have tinitus (ringing in the ears) anyway, but since starting up wellbutrin again the ringing has become exponentially worse. When I feel alright I can kind of ignore it by pushing it to the back of my mind, but when I don’t feel alright and all of that stuff near the back of my mind gets giant neon signs shaped like arrows pointing at it, the ringing joins hands with the other noise (negative thought chatter, obsessive thought loops, and internal radio station playing the first ten seconds of five different songs in a loop in my brain) that takes place when I become agitated and though bad enough on its own, it easily combines with ambient noise to form a wall of noise I can’t get beyond.

When I get trapped like that by the noise, that’s when things get truly dicey. I become very desperate and impulsive, and when I’m already in a suicidal state I fall into red-alert really quickly.

The first thing I did yesterday was contact my psychiatrist and negotiate reducing the wellbutrin dose in hopes of helping the ringing. Today I can say that this change has helped, so I am really feeling relieved in terms of that already.

I have also still been having a significant amount of nausea, dizziness, and blurry vision that did not improve after stopping the seroquel. I am hopeful that this might be linked to the wellbutrin and by lowering the dosage I can get a reduction in these symptoms.

After procuring and taking the ODT rispiridone last night I must say that it was probably the most awful thing (well, medication) I’ve ever tasted and even this morning it made my taste-buds act funny.

Despite that fact I woke up after a night free of nightmares (something that hasn’t happened in several weeks) and even though I hear a little, high-pitched whine, my mind feels considerably less cluttered. I generally consider the typical tablet form of rispiridone to provide relief in the form of a foggy stupidity, but I feel much more alert today than I expected. I can’t say for sure that this is only due to the rispiridone because I am also taking half as much wellbutrin as I was two days ago, but either way I am very glad to get some relief.

The bad side? Welllllllll… my hands did start twitching uncontrollably after imbibing the rispiridone last night, so I need to spend a little more time talking to my healthcare team before I could consider attempting to take it in an every-day fashion (and not as needed as I have been) but just the fact that I have something I can take in an emergency at this point makes me feel significantly less stressed.

These mixed episodes with psychosis have usually come on in waves for me, so even though I feel good about making it through one I am not going to try to fool myself into thinking this is the end of that super fun delusion time. I’m just hoping that if I can continue to be gentle with my stomach and not rock the boat, the waves that come next might be a bit less severe.

More Rest, More… Butter?

Very quick update.

Please do not be offended if I do not answer your calls, texts, or emails in the next few days. Between the physical illness I’ve been having and intense insomnia I have stumbled into a place of extreme irritability, confusion, delusion, and paranoia.

Yesterday I shampooed my hair three times because I couldn’t figure out which bottle was which. I also snapped at my poor old granny on the phone, which is why I am instigating a period of Sarah-radio-silence until I can talk like a civilized human being to people again. Or, at least, civilized-ish.

On the upside, after some really fun biopsies of my stomach lining I do not have celiac disease (thanks doc!), I have finally slept four hours in a row (thanks benadryl!), I’ve been enjoying a John Cusack movie marathon, and I ate 1/8 teaspoon of butter this morning on an otherwise very dry bagel (weee!). This is huge progress (especially since I spent a big chunk of time earlier this week doing more vomiting) and I hope it means I will soon be able to stop putting olive oil and salt on my noodles and eating with my eyes closed pretending it is butter.

Once I get better at the not-hating-everyone bit I should hopefully be on my way to recovery on all fronts (well, that and once intestinal infection is ruled out). Usually the emotional instability part takes a bit longer to catch up, but who knows… maybe if I drink enough smoothies I’ll start to feel peppier.

Fixation Without Representation

As I went through my belongings in preparation of moving the last two weeks I found a letter that confirmed my suspicion. It was something of an intervention letter from my best friend in high school expressing her concern (and rightly so) for my apparent fixation and total inability to focus on the present -one of the symptoms that contributed greatly to my subsequent (first) psychiatric hospitalization.

The irony was that as I read the letter, I was experiencing a mixed/depressive episode (something my psychiatrist has nicknamed the “three quarters” episode comprised of three quarters depression and one quarter mania) with very similar symptoms as that first big episode.

I can’t claim to be an expert on the human brain or the human heart, or even to know much about which of my symptoms “lend themselves” to which diagnoses… what I can say is that in the realm of what I experience, fixation has been a big problem for me and has greatly contributed to some of the most torturous episodes I’ve ever experienced.

So bipolar, OCD, anxiety… it all feels irrelevant. When my mind and my emotions are one train on one track it seems futile to try to categorize the details. All I know is that the train is headed one way; toward self annihilation.

The fixation issue seems to come about most often when I find myself under a particular amount of scrutiny or rejection. While there are times someone might say,

“You’re being irrational and fixating on things,”

I can usually gladly follow the logic around how the person arrived at that conclusion. Being able to understand where that person is coming from, I can say, “why yes, I am doing those things. Thank you.”

The trouble starts when I am being insulted (and perhaps finding out about it later) or people seem to be going out of their way to attack me (or manipulate me) and I can’t find the logic in it.

An example I can throw out is from the first time this really took place, when my ex-boyfriend was stringing me along while dating another girl. His actions and words did not match whatsoever, and all I wanted, all I longed for, was to understand why.

My mind begins to obsess over every little detail. Every contradictory or accusational thing that has been said echoes over, and over, and over again in my mind, and the only course of action I can seem to take is to argue and plea my case against them.

This month I received some extremely bizarre (and untrue) accusations about myself that left me in the same position. Why would my ex-therapist (among others) act so nice to my face, and then write such bizarre accusations about me in her files? Why would the people I am trusting (the situation involved several others I’m not at liberty to disclose at this point) go out of their way to screw with me? How does attacking someone having a decidedly hard time help anyone?

The voices of all of these people banded together in my mind and took turns bashing me. Every second of every day it was all I could think about, and it was all I could do to argue with each voice, to try to contradict it, to try to stand up for myself… knowing my efforts were truly fruitless and that the voices wouldn’t listen, and even if they did, the relinquishment of their manipulation would only take place in my head (and not in real life).

This is a big part of the reason I couldn’t blog about anything. Every time I tried to write a blog post, I could only get one or two sentences in before the pleading would spill out of my head through my fingers into the computer. I was desperate to focus on something, anything else, but this was one situation where writing only fed the beast. I tried at one point just to write a personal piece about what I was thinking, the arguments, and what was happening. I stepped away from the computer seven hours later and still felt I had barely touched the tip of the iceberg.

Through all of this obsessing, I was angry. I was depressed. I couldn’t sleep because it was all I could think about. In a matter of days I was whittled down to a sharp point, extremely reactive to everyone and everything around me.

If the topic of suicidality in our culture is taboo, the topic of homicidality is taboo to the 10th degree. I realize this, but honestly the issue of homicidality is also one that will send me straight to the hospital much more quickly than most lingering thoughts of suicide will. It is something I have to deal with, and in these sorts of situations (mixed episode, feeling like my back is up against the wall, feeling like I am being attacked from all angles -including from within my own head) I become extremely concerned for the safety of the people around me. When I have spent all of my energy talking back to these angry, accusational voices… I don’t have much energy left to funnel toward self-control.

In a sense, I got lucky. Having that “three quarters” episode meant that I only really spent 1/4 of my time in raging attack mode, and these outrageously angry moments came at me in waves book-ended by the other 3/4 of my time in severe, suicidal depression. If those rage waves would have been any closer together (or longer in duration) I would have opted for hospitalization without question. As it was, I was on the fence… and only because I was supposed to move in a matter of days.

Personally, I think the sort of rapid cycling I experience makes hospitalization a difficult prospect because my mood can change several times just in the time it takes for the intake procedures. At the same time, when it cycles and I am in an impatient unit I quickly get the boot, which doesn’t help because it can quickly cycle back into a dangerous place (within minutes, hours) of being discharged. I’ve experienced a lot of frustration around this phenomenon and because of this it isn’t unusual for me to feel more upset upon leaving than I did when I checked in.

Through all of this, my psychiatrist has really been one person I feel that I can trust. He suggested I go home and wait it out, and I spent the vast majority of my time confined to the apartment until the rage waves subsided and switched exclusively to depression (minus the insomnia).

The end result felt a little counter-intuitive, because what ultimately seemed to help me move past the fixation (and I say that but it still comes and goes) was not talking about it. Not writing about it.

I mean, I tried those things at first (talking about it and writing about it) because those are two things that have always helped me feel a sense of relief in the past about things that were making me anxious. What I experienced this time around though was that talking about the situation with my therapist (for example) only led to his voice contributing to the ones in my head. Every time I was talking about it, I was thinking about the situation more and more, which left me stuck in that “thought loop”.

Writing was equally as fruitless. I tried as hard as I could to outline an argument for myself, to make sense of the pieces I had, and it only left me with new questions to fixate upon. Every word was like a dagger, and seeing them all clumped together gave them more momentum.

Apart from my medical support team, I only told three people what actually happened. I avoided everyone else (for fear they would ask about my current state) until I felt comfortable allowing one or two people to try to draw me into their world of the present. Funny anecdotes about their jobs, or their cats, or whatever. Tiny tidbits to focus on besides me.

Those tidbits made up a gateway, and the moment I fell through the other side was the first shower I took in the new apartment. I was messing with the shower-head spray mechanism and accidentally turned the spray into a high-powered water gun that hit me in the chest and almost knocked me over. The sheer impact and surprise of the situation made me laugh out loud uncontrollably (imagining myself and Kramer with his industrial power shower head)… and for the first time in weeks I breathed a sigh of relief.

Ultimately I’m still not ready to talk about the incident that triggered this whole fiasco (I don’t want to re-start the fixating thought-loop), and though I’ve had a day or two where I’ve been able to come up for air, I’ve noticed some of the mixed symptoms returning in the last 24 hours. Luckily I have an appointment with my psychiatrist this afternoon and an entire blank canvas of an apartment full of possibilities.

Mental Health First Responders; More Qualified for a Crisis than Police

Did you know that in the event of a mental health emergency in America, calling the police may not be the ideal move to make?

Living in Seattle with a mental illness that has involved psychosis and potentially homicidal urges has often left me incredibly concerned about my own safety. I’m sure you’re thinking, “that can’t be right, after what you just described shouldn’t you be worried about harming the people around you?” 

I do, in fact it is something I am constantly hyper-aware about because I want to keep the people around me safe. I take many precautions to avoid hazardous situations, which can mean anything from sedating myself, isolating myself, or voluntarily committing myself when necessary.

The terror I feel comes from something else, namely a situation where I might be psychotic and either making noise (and bothering my neighbors) or so “out of it” that a friend, family member, or neighbor calls the police to check on me or to get me help.

I can’t say I know anything about police in other parts of the US, but in Seattle the police often have little (if any) training on how to interact with the mentally ill. In the last five years this has been a common theme, and there have been many serious situations where mentally ill people have been killed by police officers who didn’t know how to handle mental health crises.

What do people having a mental health crisis need? They need someone who can communicate with them in a non-threatening way and provide a psychiatric evaluation on site for a potentially immediate hospitalization without causing the situation to escalate.

As it turns out, there is a service that exists in many, if not most states across the county where mental health professionals can be called right to your home to respond to a crisis. 

Yes, apparently there is a first-response service designed to deal with mental health emergencies! When I discovered this, I was initially both excited and concerned; excited because I feel infinitely safer with this system in place, but concerned because I had never heard about it before. Chances are, I expect you haven’t either… and what good does this service do if people don’t even know about it?

The trouble is that the contact information for this service is usually different from county to county within a state, and from what I understand each state has its own laws about exactly who can be committed (involuntarily) for hospitalization and in what situations. This makes my job of providing you with the information you need to receive these services rather difficult (and I’m sure that is partially why nobody I’ve talked to really seems to know about this). What I can say is this;

This page is the WA state DSHS page on “Designated Mental Health Professionals” (or DMHP as they’re called here) with a little information on the state program. As I said, the contacts are broken down by county but there is a full list of contact information for WA state here (as well as a link to this list on the DSHS page I linked to above). I’m going to be adding these links to the Links page as well so anyone who needs to can find them in a pinch.

As for the rest of you readers residing in the US who might find yourselves either experiencing a mental health crisis or party to one, I would highly recommend doing an internet search to find the contact information for the team in your area to have on hand in case of an emergency. You may want to search for something like;

Mental Health Crisis Response (your state or county)
Mental Health First Responders (your state or county)

When in doubt, I would say a good way to go is to search:

Mental Health Crisis Phone Number (your state, county, or city) 

Once you have a crisis phone line number for your area, you should be able to call and ask about a Mental Health Crisis Response team in your area and the best way to reach them in an emergency.

I know there have been situations for me when going to the emergency room seems important, but difficult because going out into the crowds of the city or riding the bus could put myself and others at risk for a bad situation. Likewise I can think of times when I have been extremely concerned about some of my peers with bipolar disorder who were unable to drive to the emergency room due to psychosis. How much easier would things be if I could bring that treatment right to the emergency itself?

I think we are reaching a point in America where people are becoming increasingly concerned about mental health crises, if for no other reason than the alarming increase of violent situations being associated with them. Just yesterday on The View co-hosts were urging viewers to call the police in “any situation where someone thinks they see someone acting insane” (their words, not mine). This can pose big problems for those of us with mental illness, and while police are slowly starting to get the training to help them neutralize a mental health crisis with words (instead of weapons) it still seems incredibly important to me that we are able to protect ourselves by reaching out to well-trained medical professionals in a crisis situation before (potentially uninvited) uniformed people with guns show up who might escalate things.

I have been reading about this at some length, and NAMI suggests that in the event of a crisis, after someone has called mental health first responders it can be a good idea to call your local police department, simply to alert them that you have already called responders and to avoid surprise visits by the police if they are being/have been called by neighbors about a disturbance.

Don’t get me wrong, I am a fan of the police. I think they are doing a good thing here, I just don’t think we’ve reached a point (at least, not in Seattle) where officers are ready to take on situations with mental health crises (or, at least, those episodes that are not resulting in extreme violence -which is most of them). I actually spoke to two police men about this last week, and they were the first to admit they don’t know the first thing about mental illness or how to interact with someone with mental illness. When the topic came up, one said to me;

“I would probably just tell my buddy [experiencing mental illness] to man up.”

This was an extremely intelligent, well-seasoned policeman. The facts are that police officers operate in the cities and towns where all manner of people live, and their work often requires them to be more than a soldier or a detective. Is this their fault? No, but in order to fill that gap in service there needs to be someone with the knowledge of mental health crises who can take over in an emergency.

As it turns out, those people exist! They may not be organized on a national level (the way the police are) but I think that might be something we (as a nation) should consider. After all, what good is a service that nobody knows about? All we want is the ability to help ourselves, and knowing exactly who to call (or who our loved ones can turn to) in the event of a mental health emergency can be the difference between an effective crisis intervention and a situation that escalates into something dangerous.

Today I am urging you to take a few minutes to do a little research to prepare yourself in case of an emergency. If you are someone who experiences intense mixed episodes or mania with or without psychosis, or even depression with psychosis I would highly recommend adding the number for a mental health crisis first response team in your area to your emergency contact list, wallet, or refrigerator, and sharing that information with your family and friends for future reference. As for everyone else, it never hurts to be better prepared for a crisis situation, and anything we can do to make it easier for those around us to take care of us when we can’t take care of ourselves is a win!

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.