Tag Archives: antipsychotics

The Bees Knees

Though I do have mania that occurs on its own it has always attacked me more like a lightning bolt. It hits rapidly and jolts me into some kind of dream world before disappearing as quick as it came on.

When I have manic symptoms for an extended period of time they are almost always mixed episodes where depression intermingles with the lightning long enough to keep it grounded. In those cases the result tends to be more like ongoing electrocution, quite unpleasant really.

Of course, that is only naturally occurring mania. For someone who has spent five years cycling through medications to try to find one that helps out with my treatment resistant bipolar disorder, you can be sure I am no stranger to medication induced mania too.

Generally speaking, pairing an antidepressant with a depressed person can send that depression packing… but when you give an antidepressant to me (and to many people with bipolar disorder) my depression suddenly busts through its shirt like the incredible hulk and screams, “I’m the King of the world!” before doing a keg stand.

For whatever reason my body takes this phenomenon one step further. I can have mania induced by many different kinds of medications, anything from nasal sprays to opiate painkillers to antipsychotics.

I was reminded of this fact in full force over the holiday weekend while I was trying my hand at taking Geodon again. I slipped into mania without even realizing it, being far too wrapped up in my new life plan to become a ventriloquist to sleep and then crawling around in the bike lane of Seattle streets collecting several dozen dead bees that had gotten too much sap on their wings to fly, dying along the streets and sidewalks.

The funny thing in these situations is when I can actively think about what I’m doing and how it must look to all of the people walking past me but feel powerless to stop it, and then I go on to notice that I am totally comfortable with that powerlessness so I might as well just enjoy the ride.

It wasn’t until I realized that I hadn’t paid any of our bills, our rent, and hadn’t renewed our lease on time that I began to think that I might need to stop taking Geodon. Even then, I didn’t feel completely sure… thank goodness it was also giving me periodic headaches and stomach cramping or I might have let it carry on a few more days.

As expected, within forty eight hours of discontinuing it I was rapidly sliding down into depression. I had strained one of my quads at some point -probably when I was picking up all those bees, I can’t typically feel pain during mania so it is hard to say- and had to spend two days resting because I couldn’t walk!

It’s funny to me how even with medication induced mania I feel some sense of shame after it’s over. Like maybe I could have done something to stop myself, or recognize it earlier, or whatever. Of course my doctors and therapist have all told me that I shouldn’t be embarrassed because it wasn’t my fault… but there is something difficult for me about resigning to the fact that sometimes I really don’t have control over myself.

Needless to say, I haven’t been posting as regularly as I would like but now that I’ve experienced the worst mixed episode I’ve had in at least five years, the most intense period of mania I’ve had in five years, subsequent intense depression, and psychosis (a story for another day) in the span of about two months I’d say I’m doing pretty well, all things considered.

 

 

 

 

Finding Psychosis in Unlikely Places

Lately things have been up, up, up! A rather profound and relatively welcome change from my typical morose malaise dragging down even the most cheerful of moments. Things seemed to be going perfectly well when I hit a bit of a speed bump last week and started noticing my slightly-elevated hypomania (and general stability) being peppered with hysteria riddled buckshot.

Right now in the DBT (Dialectical Behavioral Therapy) group I am in we are learning about a skill called check the facts which involves taking time out to look at the big picture and discern if my reaction to events (or if my interpretation) might be colored by unwise reasoning (like jumping to conclusions).

I felt like I had a pretty good grasp on the skill and practiced it multiple times before that speed bump I was talking about last week. In these periods of agitation and intense depression-laced moments (lasting a couple hours at a time) I could no longer find “the facts”. It seemed like my ability to step back was totally negated, adding fear and panic to my already disoriented state.

I have always had a hard time identifying psychosis when it is happening, or at least identifying it before it has altered my psyche in a profound way. Typically the only way I have been able to pinpoint it in the past was after the fact, faced with a trail of breadcrumbs leading in several opposing directions at once.

Granted, I have experienced a few situations where the psychosis I was experiencing was something that seemed pretty easy to point out at the time. The overwhelming need I had to live with gypsies and time I thought I had become a werewolf are definitely two examples, but both occurred many years ago. Since then things have changed, and the psychosis I experience now is almost exclusively tied to fear, not euphoria or grandeur.

The fears are almost always something that could happen. Typically not things that are likely, but possible in the realm of actual life events. My boss trying to undermine me at work was a pretty infamous episode I had, but this time it was a little closer to home and my fear revolved around my boyfriend and an impending doom of our relationship.

In my mind, my boyfriend was trying to push me away to the point where I would become fed up with him and break up. Though this is not even remotely based in reality I was certain it was happening (but only for 1-2 hours 3-4 times a day) and I became terrified to speak to him. Unfortunately not speaking to him only fed into the awkward feeling I was having, making the whole thing seem more real.

For me, psychosis is typically like a real asshole lawyer. It builds a case based on tiny clues that are generally considered meaningless in our everyday lives, and when there are big pieces missing to corroborate the story, it makes them up. I’ll often find myself with memories of saying or hearing things that never actually happened, despite feeling very much like they have.

Trying to reason with someone who isn’t playing by the rules (psychosis) became relatively meaningless in my experience this last week. I felt overwhelmed by mass confusion because trying to check the facts led to so many contradictory facts that I didn’t know who or what to believe.

And that’s when my boyfriend found me.

I tried to explain why I was upset (without knowing at that point that I was even experiencing psychosis). It didn’t seem like him to be vindictive or evil, after all our relationship had always been like a slow, lazy river as opposed to the Niagara Falls of my last relationship. I blamed him for a long list of things that apparently never happened, and when trying to express my confusion I suddenly started laughing. Yep. That’s when I figured it out, the contradictory breadcrumbs were coming from many different directions and were made of several individually delicious but totally different and clashing baked goods.

[insert emergency antipsychotic here]

Things have been fine since, and while these sorts of episodes always lead me to feeling rather embarrassed and apologetic I was very lucky that I had some help in pinpointing this situation early. Being able to celebrate my birthday over the weekend without any added psychosis was huge.

Corey reminded me that this sort of thing tends to crop up for me when I am starting to get stressed. It was a good reminder to pay attention this holiday season and do my best to remain relaxed. I never want to come off as being a “Scrooge” but finding a way to celebrate the holidays without totally losing control of myself can be a big challenge. High-five to my man for being smart and compassionate!

On a final note, I am in the market for a new psychiatrist. This last one has made some comments that were more harmful than helpful, so this week I hope to switch to the next doctor on deck. Stay tuned!

The Many Faces of Psychosis

My attempts at writing lately have not been particularly fruitful, but I have finally gotten some sleep. Unfortunately, the sleep was also accompanied by several intense conversations with my health care team pointing to ongoing psychosis the past few weeks (at least).

When it comes to psychosis I find myself in something of a pickle. I have not been able to tolerate taking an antipsychotic on a daily basis (because of intense side effects like ultra-rapid weight gain and feeling so fatigued and exhausted I can barely move) so my psychiatrist allows me to take it only in times I am experiencing psychosis. It definitely isn’t the sort of thing I would generally expect is a good idea, however my rapid cycling paired with my inability to tolerate the drugs for more than a few days at a time make it more useful than, say, nothing at all. Many times it seems like one or two days are enough to kick the legs out from under the psychosis before my mood cycles away from it.

The biggest hurdle in this method for me has been being able to identify when the psychosis is present on my own. With a good team looking out for me (my boyfriend included) it becomes easier… but even after meeting this “character” (psychosis) on and off for at least the last 50% of my life I have a hard time picking it out of a crowd.

Meeting psychosis when physically ill or on various medications has left memories that were already too fuzzy around the edges to be able to account for an accurate depiction.

Meeting psychosis when manic has been like stumbling upon a huge party where the music and lights are easily drowning out the words and the intentions of the faces I see around me.

Meeting psychosis when in a mixed episode has been like crawling into a crime novel where I don’t know who I can trust, and psychosis might look just as innocent or guilty as anyone else I stumble upon… leaving me with no distinguishing features.

Finally, meeting psychosis when I feel (or think I feel) stable has been the most confusing thing of all. The encounter is totally unexpected, and I find myself quickly trying to write the ensuing conversations and situations off as simple irrational fear or rapid mood swings happening too fast for me to put a defining stamp on them.

The best indicator I have of psychosis is when pieces of my life, pieces of stories don’t line up the way they ought to. When the memories I have don’t correspond with the half dozen other people who were there at the time. When my boyfriend seems to have me caught in a “lie” but as far as I know, I’ve only spoken the truth.

At any rate, I expect to spend the rest of the day on the couch due to the exhaustion I feel from the rispiridone today, but if that is what is necessary to aid in alleviating the confusion, I am ready to do it.

There and Back Again; A Bipolar Surgery Patient’s Tale

While I’m not in a position to either calmly nor collectively express myself right now, I thought it important to pop in and let everyone know that at the very least, I survived surgery last month.

Healing from the surgery itself seemed to bring me no more pain than I was experiencing prior to the surgery, however I hit a number of speed bumps that have made it exceptionally difficult to write.

The first was a nerve in my abnormal cavity being pinched by my diaphragm post-surgery, and while this was very painful it was the fact that the doctors couldn’t rule it out as a blood clot that made things very intense for a short period right after surgery.

After that I had a really bad reaction to some of the medication I was given (not a new experience for me, given the reactions I’ve had to most psych drugs… I have the same problem with drugs in all categories). After being unable to consume anything but water for three days (including my normal medications) I slipped into a very interesting delirious state that quickly escalated into mania.

So the third hurdle was a bipolar one and frankly one I was rather expecting -though I can’t say I was expecting mania, more of an expectation for depression (given the pain). Things started out energetic and euphoric and after a couple of days without sleeping my boyfriend confronted me about his concern that I wasn’t resting properly. This was enough of a red flag for me to prepare myself for taking my as-needed I’m-kicking-mania-to-the-curb antipsychotic that evening, but even if it hadn’t been the paranoia and conversations I began having with people who were not present later that day were enough to get the job done.

After taking the emergency rispiridone I spent 48 hours in a zombified, half unconscious state. It wasn’t until the emotional void wore off that I found myself plummeting down the depressive rabbit hole.

I’ve gone back up and back down a couple times since, had probably twice as many panic attacks as usual, and I am honestly really struggling to find a balance between taking care of myself and resting. I expect that this is difficult in a normal situation, but resting when I can’t sit still and going to my follow up appointments when I am feeling exhausted has been doubly difficult. The emotional roller coaster isn’t fun, but not being able to rely on my body for information on how it is feeling at any given time (since my energy level fluctuates with my mood, not my level of health) is confusing, at best.

It is important to me to try and take a positive spin on this, and even though this has been difficult I am generally managing to claw my way through (with a LOT of outside help). Despite how overwhelmed I feel, finding out this week that I will need a second larger surgery in a month or two to address the issues found during the first surgery has left me with a loss for words. When it is hard for me to identify how I feel about something, it is even more difficult for me to write about it.

I have many thoughts and experiences I want to write about, and while they are things I plan to share I have no foreseeable timeline. In the meantime just know that I will be posting whenever I find myself in a place somewhat less tumultuous.

Thanks for reading!

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.

A Missed Dose

In the last 28 years I have not skipped or missed a dose of medication.

Wednesday night as I huddled in the ER (for the second time in two weeks) the team of doctors and nurses surrounding me looked started as I told them this fact. I guess it never occurred to me that this might be unusual in any way, but in an emergency room where they’re relatively used to patients with mental illness suddenly stopping their medication and sailing into big episodes that might be landing them there… well, I quickly felt that the staff probably did not believe me.

It is true, though. And while most people would try to praise this as an act of good self control or healthy living I fear that the truth is actually somewhere in the realm of the opposite.

You see… when I was 17 I was taking an antidepressant that (little did I know) was slowly dissolving any semblance of sanity I had left at the time. Despite the fact that it was making me worse and worse, I took it religiously. At the time I was being treated for obsessive compulsive disorder, and frankly there were many things in my life that I needed to do religiously or I firmly believed I would die very suddenly.

I have always been the sort of person that once a routine has been established I have a very very hard time deviating from that routine, even when it is harming me. For the last several months, for example, I have eaten one large fried egg over medium and a slice of buttermilk toast for breakfast every day (at least, every day that I could eat). There are times when I struggle with the notion that I probably shouldn’t eat so many eggs (hello cholesterol), but the best I can do when I feel really ballsy is switch out the buttermilk toast for an english muffin. Not eating this breakfast is… well… wrong.

Anyway, at 17, taking said antidepressant religiously and spiraling into a very dark, weird place I was quickly in an psychiatric inpatient hospitalization situation. Within 24 hours I became outrageously ill, and I’m talking the most ill I had ever felt in my life up to (and even after) that point. Eight hours of uncontrollable vomiting and dry-heaving, and dizziness to the point of being unable to even dress myself.

This also happened to be the time when one of the nurses decided to display an abuse of power, laughing at my sudden illness, yelling at me, accusing me of having an eating disorder, and refusing to help me for several hours. By the time I was able to deduce that I was having withdrawals from my usual medication regimen, the damage was already done, and the fear this experience had instilled in me took root very firmly.

I could not and would not ever stop taking any medication suddenly for any reason again if it was in my power, and the paranoia and fear that manifested from this situation has often swung me into the danger zone in the opposite direction. What I mean is that while I don’t feel compelled to stop taking my medication suddenly (or act cavalier about keeping up with taking it), I have become even more obsessive and paranoid about taking these pills. To top it off, I’ve had many instances of not being able to remember if I took them or not, and then accidentally taking them several times over just in case I had forgotten.

Realistically this doesn’t provide a much more safe environment, and suffice it to say that withdrawal of many drugs is probably extremely preferable to overdose.

I had been feeling really rough on wednesday, a lot of the dizziness and nausea from the week previous had returned. By the time I took my dosage of lithium for the night, I vomited it back up in a matter of minutes.

Though I had already been advised earlier in the day to go to the ER by my doctor to receive intervenes nausea medication and fluids, it wasn’t until the panic of suddenly being lithium free for the first night in four years set in that I was heading straight for the hospital. I was certain that if I didn’t feel horribly sick already (and I did) I was headed for a night of fire and brimstone.

By the time I got to the ER I was hitting patches of uncontrollable crying. I was terrified, and even though the seasoned internet sage reported I would likely only experience mental and mood symptoms from the missed dose, the way my body reacts to medications (or lack thereof) has been significantly different than the norm in almost every situation. I had no way to know what might happen next.

So the doctors dealt with the nausea and the fluids, and when I brought the idea of “missing” (or losing, rather) my lithium dose that night the doctor instinctively told me to take it again when I got home.

Now, given my history, this is something I had already considered myself. However, I had been pretty dehydrated for a week or so and I was concerned because dehydration can lead to lithium toxicity. When I said this to the doctor, I also mentioned that I have already experienced lithium toxicity before and wouldn’t like to do it again. His conclusion was that they would check my lithium levels in the blood they had already taken earlier when I checked in.

Thirty minutes later he walked into my room and commented that my lithium levels were a bit higher than he expected. He advised I wait until the next night to continue with my lithium.

Among the papers I was given when I headed home for the night was the lab report that included my lithium level. It was nearly twice my regular level.

When I read that I was immediately glad I had gone to the ER and not just taken the lithium again. If I had, I would have undoubtedly experienced lithium toxicity, as I was nearly there already. For the first time I felt grateful for having vomited… and I can’t help but feel slightly mystified at the possibility that my body was rejecting the excess lithium all on its own.

I am now back on track with my medications and working with a GI specialist to try to pinpoint the source of my stomach issues. It is a little funny how not eating can make eating something as basic as plain white rice taste amazing!

Wrapping Up the Seroquel Journey

Things with seroquel have gone from bad to worse to emergency status.

After lowering my dosage from 50 mg to 25 mg a couple weeks ago my GI issues seemed to get slightly better. The intense pain I was having subsided, and I was no longer running to the bathroom every thirty minutes. I took this as a sign that the bulk of the abdominal issues I’ve been having have been triggered by (and if not, largely fueled by) the seroquel.

I wanted to give the remaining 25 mg of seroquel time to let the side effects from reducing my dosage subside so I could see if 25 mg would still be causing me problems. After three weeks the nausea I was having in the evening started to grow. I found myself needing to pop a tums every hour, and then every thirty minutes, and then every ten minutes. I used pepto bismol and pepcid and drank ginger ale, and by the time I could see where things were heading, I tried to make an appointment with my GI doctor. That appointment still hasn’t happened yet, it takes place later this week.

Soooooo the only thing I could do was to contact my psychiatrist and express (quite urgently) that I needed to be taken off the seroquel completely. He consented, but by that time it was too late.

The nausea became completely overpowering, and I became so dizzy I couldn’t look at the television screen or even the screen on my phone without vomiting. My stomach pain (like the nausea and dizziness) grew exponentially and last Thursday I quickly found myself in a situation where it had been 24 hours since I could keep water or food of any kind down.

My doctor had given me some anti-nausea medication that wasn’t working. By the time I got to the ER they shot me full of two more kinds that didn’t help. The third helped, but made me dizzy until I became nauseated again. Well that, and it gave me hallucinations.

By Thursday night I had only been able to eat about 600 calories total over the previous three days. I’d had three hours of sleep (because the nausea was so intense). And even though I’d stopped taking the seroquel the day before (after shit started hitting the fan so I knew this wasn’t a product of withdrawal) things continued to escalate for another 24 hours.

The reason I went to the ER was because after going so long without water (and subsequently becoming dehydrated) I knew I would need some fluids or I would run the risk of experiencing lithium toxicity again. That and I needed something to help with the nausea because I wanted desperately to sleep.

Two sacks of fluid via IV and (I think) three types of anti-nausea medication later (frankly I can’t remember a lot after the hallucinations took place) I asked them to let me leave. The staff seemed in no hurry to find “the cause” of my intense pain and nausea/vomiting and I wasn’t concerned about that because I largely believe it to be the seroquel. I also have that appointment later this week with my GI doctor anyway who knows my history and seems like a pretty smart lady, so all I wanted was something to help me make it through the week to the appointment.

Though I had expressed my theory about the seroquel, there were several other theories going around. Maybe an ulcer was to blame, or pancreatitis (which it isn’t, the test came back negative later), or any other number of things.

The concoction of medicines they injected me with in the ER allowed me to sleep for the first time in several nights, and while on Friday I was sill experiencing pain and extreme fatigue my nausea was improving. I also managed to eat half a bowl of soup, and a few crackers without incident.

By Saturday my appetite was slowly returning. I felt hungry for the first time in over six weeks (as the seroquel had suppressed my appetite over that entire time) and my energy and alertness were beginning to return. Though I was still having stomach pain and nausea, they were largely only taking place after eating and in the evening again.

On Sunday I felt relatively normal, despite only being able to eat very small amounts and being fairly dizzy upon walking around. The pain was still present, but again, mostly after eating and in the evening when my stomach is the most full.

I have been avoiding all foods that don’t mix well with ulcers (dairy, caffeine, pretty much everything I was avoiding before this anyway when my symptoms were getting worse) just in case an ulcer is playing some kind of role in this situation.

At this point just the fact that my symptoms have been improving like this (and within 48 hours of stopping the seroquel) I feel certain that if that medication wasn’t causing the bulk of the issues, it was at least feeding the fire. My issues seem to be receding now instead of ramping up, so either way I feel like I’m on top.