Off My Game

I feel like I have been a little off my game for the past few days.  I hadn’t given it any thought but this evening I gave it a lot of thought.  On Tuesday, in an effort to rid myself of hallucinations, or what my psych-doc calls “Visual Illusions”, we changed some of my medication around.  It doesn’t seem like much but I went from 125mg of Nortriptyline to 150mg and from 75mg of Amitriptyline to 50mg.  Now, the way the chemistry is supposed to work out the two drugs are supposed to be almost the same.  Amitriptyline is like Nortriptyline except that it also induces sleep.  Once the sleep causing part has been processed by the liver it is chemically the same as Nortriptyline.  Given that explanation, the adjustment being made should not cause any problems.  But, as we all know, med changes of any kind can be problematic.  So, if I ever actually had any “game” in the first place, this little change may be what’s whacking me about.  Hopefully things will get better over the next few days.

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My Argument for Bipolar Disorder

I’m thinking about the time between when I was diagnosed with depression and when I was diagnosed with Bipolar Disorder.  I received my first diagnosis from an actual psychologist in late 2003 to early 2004.  It’s not that clear to me because it was not that big a deal to me.  I had, in the past year, come off a bout with cancer which turned itself around in pretty short order.  I wasn’t quite feeling like myself, more down than usual. So I went to a psychiatrist, was diagnosed with depression, got a prescription for an anti-depressant and went on with my life.  I figured it was all part of the healing process, part of having cancer and so would become part of my life.  I took my anti-depressant as I should. I stopped drinking as I should.  I saw my doctors as I should.  Everything was as normal as it could be.

In the spring of 2005 I was given the opportunity to move across the country, from Virginia Beach to San Diego.  So I did.  When I got to San Diego, I found a new set of doctors and went about my merry way. But something was different.  I went out a lot more often, spent money more freely, had a lot of one night stands.  I also had more and more bouts with depression.  At first I attributed it to being worn out from the increased pressure to perform at work.  I didn’t even identify it as depression.  When I talked to my psychiatrist about it, I told him I was having a hard time sleeping and he prescribed Ambien.  This worked for a while, I was rested and work was easier to deal with but my highs were getting higher.  I was spending more time at work or I was working at home in the evenings, on top of that I was still going out at night.  Pretty soon the candle was about to meet in the middle and boy was I going to get burned.  I told my psychiatrist that I was having problems sleeping again and he prescribed Lunesta.  I took Lunesta for about a week or so and then things started going sideways.  I was having problems at work, I wasn’t treating my co-workers and customers with the respect they deserved then I started hallucinating.  The main hallucination had little men trying to get into my apartment. The rest of this story has been told earlier in this blog and I don’t think I need to rehash it here.

The thing I came away with when really looked at it, is that I should have been diagnosed with Bipolar Disorder at least as early as 2005.  The problem is that no one could see it.  I was in a new town, with new friends and we were all just out to have a good time.  This would have been fine if I hadn’t previously been diagnosed with depression and on an anti-depressant.  If I had the Bipolar diagnosis at this time I believe there would have never been as psychotic break. Up until I had the psychotic break my anti-depressant prescription never changed.  After that, I was diagnosed with psychotic depression which made more sense and different medications were given.  It wasn’t until I moved here in 2012 and had a full psychiatric work up by my current psych-doc that I was diagnosed with Bipolar Disorder and started on the path to figuring out just which medications are right for me.  I am finally getting the treatment needed to make me level.

To some, Bipolar Disorder sounds like a horrific diagnosis.  For me, it sounds like music to my ears.  To me it means that I’m getting my life back.

I Am In Remission

Some time over the past two weeks, a long time friend commented on one of my posts.  I had said that I was level and have been for some. She said that she was glad that I was in remission.  Remission…  It wasn’t until this evening as I was driving  home that I really thought about this.  Is it possible for BPD to be in remission?  Now that I have been diagnosed, I know that the diagnosis is right for me.  But before that, my treatments were hit and miss.  It wasn’t until half way through ECT that I really started to see the light.  There have been a few stumbles both up and down but it feels like my psychiatrist and I have found a good combination of medications.  I haven’t had an extended bout of mania or depression for at least six months.  If that is remission then I guess I’m in it.

Here’s where I question that.  Most of the BPD blogs I follow talk about it being very unpredictable.  They say it can rear its ugly head at any point in time, whether it is well controlled or not.  Since well controlled is where I am right now, how likely am I to relapse?  More importantly, how much faith can I put on being in remission? Can I relax?  I would go on with that train of thought but I know what all the answers would be… No.  I have to remain vigilant.  I have to keep taking my medication and keep seeing my docs and therapist as scheduled.  I have to keep doing the things, like writing on this blog, that keep me level.

Largely used in the Cancer community, remission is defined as: the state of absence of disease activity in patients known to have a chronic illness that cannot be cured. Since BPD is chronic illness that has no known cure, I suppose the use of that term is appropriate for us in the BPD community as well.  But is it right for me?

I don’t want to take anything away from those out there that are battling cancer, who have been in remission and are now fighting again, or are in remission and have been there for a while.  I, myself, am a cancer survivor.  My battle had lasted 3 months when I was pronounced cancer free.  I guess you could say that I am in remission and have been for 10 years.  I guess it all depends upon the type of cancer it is/was and what the prognosis is/was.  As for me, I have a full body scan every year and every clear scan is another year in remission.

Since I am already in remission (have I said that word enough?) I guess it is OK to add another one to the pot.  As long as I understand there are actions I must take in both instances to keep myself there.  As well as certain things I have to look out for and talk to my doctors about in both circumstances.

Hi, I’m Gavin and I am in Remission.

My Psychiatric Meds

This post is in response to a question by bpnurse’s The Klonopin Chronicles.  I was writing it as a reply but it got so big I turned it into a post.

My meds…. Let’s see.

I’m on Lithium (mood stabilizer) 300 mg in the morning and 600 mg at night.  I’ve been on that for a little more than a year and it seems to be working very well. It was added to my other meds when I my diagnosis was changed from psychotic depression to Bipolar II. I have the “Lithium Tremors” which usually get me when I’m tired or have had too much caffeine.  They make it hard to type and control a mouse, hold a glass, fork spoon etc. and don’t even try to type on a cell phone.  But, like I said, it works well so I deal with the side effects.

Next is Nortriptyline an older anti-depressant that my psych-doc in San Diego put me on two and a half years ago when my diagnosis was psychotic depression. 125 mg at night. It’s been working pretty well, I had a large bout of depression earlier this year and was having problems sleeping and I was using more ambien than I or my psych-doc was comfortable with so he added the next medication.

Amitriptyline, which is also an older anti-depressant.  It has a hypnotic effect, or, it helps me get to sleep and stay asleep at night.  It also synthesizes into Nortriptyline in the liver.  I that 75 mg of that every night, so it’s the same as taking 200 mg of Nortriptyline.  My psych-doc killed 2 birds with 1 stone.  Upped my anti-depressant to pull me out of my funk and helped me get sleep without the use of a narcotic sleep aid.

The last psychiatric med I’m on is Abilify.  15 mg every night.  Abilify is an anti-psychotic that is working about 95% of the time.  I have breakthrough psychosis, but I have learned to deal with them.  Sometimes they freak me out but it doesn’t happen very often.  I was put on Abilify in San Diego as well.  Since my Manic episodes tend toward full blow psychoses the Abilify is there to keep the psychoses and manic episodes in check.

Before this particular cocktail was found, I was on a handful of other things like Lamictal (bad rash and sores), seroquel, zyprexa, prozac, effexor and zoloft.

The last time I talked with my psych-doc, I told him that he was well regarded in mu NAMI peer support group because most of them had him treat them when they were in-patient and we got on the subject of how he prescribes medication.  He said that he likes to think of himself as a chef because he treats each patient differently and tweaks their medication until it works.  I’m not sure the metaphor exactly works but I can say he has done that with me and after a year of tweaking, I think he has found the right combination.

A Good Day

Today I had meetings with my psych-doc and my therapist, BACK-TO-BACK, IN THE SAME DAY.  This is the first time it has happened since I moved to NC.  I usually end up missing one appointment by a week.  The other thing that is so great about seeing them both on the same day is that it is a 45-55 minute drive.  As I’ve said in previous posts, car time for me is KING.  But if I can consolidate appointments like I did today…. all right, I’ve gone on enough about that.

The appointment with the psych-doc went very well.  It was the first time I had seen him in 6 weeks and during that time I had a couple of hypo-manic episodes.  He was not alarmed, the duration wasn’t very long (48 hours or so) and they were “self-adjusting”.  Since it had been a year and a half or so since I had had one, he wasn’t concerned at all.  If they start happening more frequently, he said we word start medicating for them.  He took a look at my lab work and said that everything was good.  Since I’ve been (for the most part) level for 6-7 months he didn’t think we needed to meet again until late January.  That’s 12 weeks ………………. 3 months away.  I guess I’m doing better than I thought, at least in his eyes.  We’ll see how the holidays treat me.  My holiday season last year was not the best.  As I’ve mentioned before, I was starting Lithium and attempting to start Lamictal.  I had bad side effects and withdrawal effects with Lamictal so Christmas and the surrounding weeks were not that great.

Now, I have no medication changes and I will be able to spend time with my sister and her family without the issues I was having last year.

YAAAAAAAAY!!!!!

My trip today also included stops at a couple of grocery stores, Bed, Bath and Beyond (Coffee for the Keurig) and COSTCO.  There was a beautiful sunset on the way home and now it’s time to scrounge up some dinner.

What a good day!

Trying to Remember

I am trying to remember
The last time you were here
It was during an episode
You came to my rescue

A week in the hospital
I didn’t want to stay
You signed me out early
The only one who would dare

I stayed at your house
You kept an eye on me
I was elated
To know you cared

We took walks in the park
We went back to that beach
You took me to your family’s
Cabin up in the woods

You slept on the couch
So I would get plenty of sleep
This wasn’t the time
For physical things

When it came time
To see the doctor
You took me and stayed
No one ever did that for me

I watch the sun
At the horizon
At OUR beach
I am sad that
You are not here

I smile at the same time
Knowing you’re at home
Getting dinner
Ready for us

— GB

The Point

I’m very sorry if some of this is a rehash of previous posts.  Everything just piled up on me this afternoon and this is what came pouring out.

What was the point?  What was the point of all that I have done for the past four years.  What was the point of seeing all those different doctors?  What was the point of seeing all those different therapists?  What was the point of seeing all those Physician’s Assistants and Nurses?  What was the point of having Intensive Cognitive Behavior Therapy?  What was the point in having ECT Treatments for two and a half years?  Why did I have to endure all the medication changes? Why did I have to move four times?  Am I any better off now than I was four years ago?

That last question is a very complicated one.  The answer is going to be equally complicated, if not more so.

The basic answer is I don’t know.

I’m a different person than I was four years ago.  I have a better understanding about what is going on in my life.  I have a better understanding about what is going on with my body and mind, including my mental health.  I am always learning something new.

With that in mind the answer is yes.

Four years ago I was an established, successful man.  I had a good career.  I was thought well of in my field.  I had just gotten a huge promotion.  I had many friends.  Now I have none of that.  I live with my parents, I live off of Social Security Disability.  I do have a few friends, but not as many as I used to.

Given that side of the coin the answer is no.

Changing doctors and therapists was necessary to find the right ones who would give me the care that I needed.  Intensive Cognitive Behavior Therapy worked a little but in the end was very helpful in that it was where I learned about ECT.  I believe that ECT is what enabled me to get to where I am now.  The moving around (which also required changing doctors) was due to the fact that my parents were taking care of me and they’re not rich, nor would I ask them to completely support me.  When my corporate disability ran out in San Diego, we moved to my aunt’s house is Elk Grove, CA.  We stayed with her until my Social Security Disability kicked in.  Then we moved to an apartment in Sacramento, CA, which is about 25 miles North of Elk Grove.  Most of the rest of my family lives in the Elk Grove-Sacramento area and it was good to spend time with all of them.  The move North from San Diego included a change in ECT Doctor and facility.  I was well taken care of.  When the ECT Treatments got to the point that they were far enough apart.  I moved to and my parents moved back to their home in North Carolina.  I have been here almost a year and a half.

The moves, the medication changes and the doctor and therapist changes all have good reasons.  And while there was some consternation and actual physical pain, I have had positive results so far.   ECT has made the biggest difference to my life.  While I hope I never have to have it again.  I would get the treatment in a instant if it would be beneficial.

So the answer as to whether I am better off now, than I was four years ago is absolutely YES.

Four to five years ago, while things looked like they were great for me, the monster that took me out was growing.  The success was a mirage that the monster was eating.  The bigger the success the bigger the monster was.  It was only a matter of time before it broke me.  When it did, it was like a toxic bomb had gone off.  No one wanted to be around me.  Thankfully, two co-workers called my psychiatrist (that’s a story for another day), called my parents and convinced me then took to me to the hospital.  One even retrieved my parents from the airport.  If it wasn’t for those two I don’t know where I might have ended up.  I would thank them if I could but I don’t know where they are.

My parents, on the other hand, dropped everything they were doing and rushed to San Diego.  If it wasn’t for them doing that and then making decisions about my care in the beginning I probably would have ended up in the San Diego mental health care system.  Their help and consult has helped me get back on my feet.  I’ve come a long way in the last four years and there is none of it that would have been possible without them.