In the Blink of an Eye

Well, something sort of odd happened tonight. As I was browsing the NY Times website…well, the headline kind of jumps out, doesn’t it: “At Least 100 Dead in India Terror Attacks.” It seems so distant, so—somehow—ordinary. Bad things happen to people halfway across the globe every day, right? Well, I’m looking through the coverage on this, and what do I see? A link to photos of this nightmare by one of my Flickr contacts and a fellow traveler. Whoa. All the way across the globe became just next door in about one second.

Pediatric Bipolar (or, Children on Drugs)

Round-up:

November 19, 2008
FIRST THEY’RE DRUGGING OUR DRINKING WATER, NOW OUR KIDS? WHAT NEXT?
From an M.D. and professor of psychiatry.

We also have the specter of two year olds being diagnosed with bipolar disorder and treated with these medications.

Stop giving antipsychotics to kids who don’t have the diagnosis of childhood schizophrenia.

November 18, 2008
Use of Antipsychotics in Children Is Criticized
The latest installment in the on-going saga.

June 8, 2008
Researchers Fail to Reveal Full Drug Pay
“Researchers” being the foremost advocates of pediatric bipolar disorder.

The Harvard group’s consulting arrangements with drug makers were already controversial because of the researchers’ advocacy of unapproved uses of psychiatric medicines in children.

Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality.

September 4, 2007
Bipolar Illness Soars as a Diagnosis for the Young
I made some comments on this one a while back.

August, 23, 2007
A Neuroscientist’s take on the issue.
Wear your flame retardant suit for this one. Although, I do have to say that when I was on Seroquel, I might as well have been lobotomized. It was not pleasant. I couldn’t concentrate long enough to string a few words into a coherent sentence, when, that is, I could stay awake.

And when they say pediatric bipolar disorder, they’re talking pre-adolescent.

One issue I have with all of this is that pediatric bipolar disorder is not like grown-up bipolar—different manifestations, different symptoms. So if it’s in kids, it doesn’t look like bipolar disorder in adults, and is similar enough to ADHD/ADD to be “misdiagnosed” as such, maybe it needs its own name.

As far as continuity into adulthood, the only study of its kind that I have found states,

Over eight years of follow-up, 44.4% of children with bipolar disorder displayed manic episodes after age 18, reported Barbara Geller, M.D., of Washington University in St. Louis here, and colleagues in the October issue of Archives of General Psychiatry.

This rate was 13 to 44 times higher than population prevalences, which strongly supported continuity into adulthood and the credibility of diagnosis in childhood, they wrote.

The researchers conclude that 44% of children in the study were correctly diagnosed as having bipolar disorder. My question is, what about the other 56%?

And I’m still not even going to get into giving these powerful psychotropic drugs to children. I just can’t imagine what they must do to a growing brain.

From “An Idler’s Glossary”

ennui: Boredom may come and go, but ennui [from the Latin word for "hatred of life itself"] is a totalizing force which judges the world… and finds it unspeakably tedious. To be ennuyé is to be paralyzed by apathy and disgust, but simultaneously nerve-ridden by over-stimulated sensations. To the over-sophisticated urbanite, each tick of the clock can seem to say, as it did to Baudelaire: “I am life, intolerable, implacable life!” See: ACEDIA, APATHETIC, BLASÉ, BORED, LACKADAISICAL, LETHARGIC, SPLEEN.

This sounds a lot like manic-depression.

An Idler’s Glossary

via Paper Cuts

How Am I?

Still not so hot. I basically spent all of June, July, and August in bed in a drug-induced stupor. Klonopin and lithium (and maybe the Lamictal too) kept me lethargic, that is, when I wasn’t just plain asleep, and Wellbutrin made me perfectly content to stay in bed in a little mind-racing fantasy world. Since then, I have changed, rearranged, and discontinued different meds, but although I’m out of bed now, I hardly ever make it out of the house, and I’m obsessing over Battlestar Galactica for hours on end.

I’m no longer on an antidepressant because it’s a hypomanic time of the year for me and the Lexapro that the doctor prescribed makes me crazy. But that means that I’m beating myself up for being such a loser (and yes, I am, by anyone’s standards–I don’t work or do anything in any way productive, including housework, and well, I’m not exactly a trophy wife either). And I am very not happy with things. There are things that I want to do but can’t manage to do. And this feeling always leads to the “I’m just a lazy person” and “I have no self-discipline” and “I’m just useless” self-recriminations. There is also the problem of focus. I can concentrate (even long enough to read real books), but I can’t decide what to read, which leads to reading 3 or 4 books at once and not really getting what I could out of them and feeling like I am not accomplishing anything. Even more frustrating is that I can’t figure out what it is that I want to do, either “for the rest of my life” (as in career, or even a job) or “what shall I do today.” The answer to the latter question and my response to it, “nothing, because I don’t feel like it,” is the more immediate reason for feeling like such a loser and lazy bum.

I am making some progress though; I’m managing to do very small, in-no-way strenuous chores. As far as useless activities go, I am managing to read some of the books that otherwise only serve as decoration on my bookshelves (the few I have de-odored in the new, non-smelly bookcases), and even did a little yoga the other day. On the other hand, the few forays out into the larger world involved buying shoes I can’t afford, although even that is sort of working out because I can’t decide what kind of shoe I want, so I keep buying and returning, which is actually a very clever way of dealing with the urge to buy an entire new wardrobe. It’s hard for Mr. Hyde to go on a shopping rampage when Dr. Jekyl is so very indecisive.

That Which Was to Be Continued

But I still need to see a doctor, asap. Unfortunately asap to see a good psychiatrist in this town is about two months. (It was my lack of patience that got me into this situation in the first place.) So, panic ensues, and reigns for a few days.

And Now for Something Completely Different

So, yeah. I go back to the doctor a week later (see Status Update).

He wants to send me for psychometric testing. Ok.

He isn’t going to put me back on any meds.

He’s not sure what’s wrong with me. I don’t fit the standard profile. He doesn’t know what to do with me, especially after we discover that my insurance won’t cover testing with the person he wants to send me to (who is apparently considered a quack by some others in the profession). I hate this. Every time I go to a new psychiatrist (in medieval Louisiana), he or she feels the need to re-diagnose me. My previous diagnosis (made in Texas) isn’t trusted because “I don’t know who that is.” What the hell? Get the records, you moron. I’m usually too messed up to realize this as it is occurring and/or do anything about it. I’m too desperate. So, I always end up with the depression with anxiety diagnosis again, and, what’s worse, a treatment plan in which the mood stabilizer is considered superfluous.

I’m freaking out. In so many ways. Not only am I facing treatment (or lack thereof) from someone who either has never heard of or doesn’t believe in bipolar disorder, type 2, but I’m completely unmedicated and panicking because the soonest I can get in to see a doctor in a trusted practice is, well, two months.

So, I do what any good psych patient would do–I go to the medicine cabinet and put myself back on meds. I decided to go with lithium and bupropion (Wellbutrin). Out of pure fear, I take what I know to be sub-therapeutic doses, just so I’m not completely insane. It calms my brain enough for me to stop feeling like I need to crawl out of it. My husband, however, is in for an unpleasant experience.

to be continued…

Status Update

Well, went to the shrink. I was in fact taking the prescribed amount of Lamictal. Shrink is puzzled. I am not. I’m extra-super-sensitive to anything I take. Maybe the increase wasn’t gradual enough, you say. No, perfectly ok to go up by 100mg when have already reached minimum (yes, folks, I was on the minimum therapeutic dose). Shrink puts his little shrunken brain to work. Maybe we should get you off this anti-seizure crazy stuff. Yes, I say, it freaks me out, always has. Maybe we should get you off the Wellbutrin (which I had just started) too. Great idea, I say. Let’s take you off of everything, he says. I begin to freak out. I have not been med-free in, oh, about ten years, and absolutely religiously faithfully taking a mood-stabilizer since my brain broke in 2004. Very afraid this makes me, all this talk of getting me off of everything. But then he amends this with, let’s get all this anti-seizure drug out of your system. Still a little wide-eyed in fear. Then, he says: What do you think about lithium? I love it; I think it’s the best thing ever, I say.

Lithium has its scariness factor, but is very easy to monitor and manage. It’s very simple: you take too little and you’re still crawling up the walls (or out of your skin, whichever the case may be); you take a little too much, you get sick; and if you take way too much, you die. But, see, the easy part is that if you start getting sick, you can immediately stop taking it without the danger of, say, having seizures or other freaky things. Easy to get out of the system, and quickly. And the thing with lithium is that it is, outright, the best option for stopping a crazy episode in its tracks. This happens to be one of the reasons that I am happy to switch back right now. Lamictal is a great maintenance med, but lithium straightens things up quickly when the moods go all wonky.

I got on Lamictal after thinking long and hard about being on a drug that is meant to control seizures in epileptics and is only somehow accidentally effective in controlling bipolar disorder. I was very anxious about this sort of experimenting on myself. (As I have said before, anyone with bipolar disorder is an experiment in progress, no matter the choice in meds or in choosing not to get treatment.) I really thought that Lamictal, with all of its freaky side-effects and possible seizure-inducing potential, was scary. But at that point, this is what I felt and why I chose to begin taking Lamictal. And, it seems that Lamictal is better at staving off depressive episodes than lithium, which is best at keeping the mania at bay.

I could keep going on and on about Bipolar Disorder I vs. Bipolar Disorder II, etc., etc, and spring and mania and fall and depression and pretty little line graphs illustrating the peak suicide times of the year, but, well, I’ve had enough. Haven’t you?

So, for now, I’m getting off of (almost) everything mental. I have a sufficient enough supply of Xanax (prn) to keep me from offing myself in a fit of feeling that I’m about to succumb to impending permanent madness–my personal flavor of severe, not-so-existential panic attack. As much as I hate feeling stupid, I abhor the thought of so viscerally feeling like I’m trapped in my head with myself ’til the end of time. And at some point soon, I’ll be getting back on lithium and also starting on one of the tricyclic anti-depressants, the name of which I cannot remember at the moment. We’ll see what happens this time.

It Sucks…

…that I have spent the majority of the past four years of my life in either lethargy and apathy or consumed with trying to assess whether the meds are making me a certain way or the disease. All of this plus brief “happy” periods of hypomania and not-brief-enough mixed states. All these years wasted in “self-contemplation,” i.e. tremendous, perverse narcissism.

But who else cares?

In the many years before 2004, I was impulsive, self-destructive, and foolish at the very least. I was also a horror to deal with. But, I really didn’t care. The moods came and went, but I lived them. I lived an extremely fucked-up life in varying states of misery and elation. Introspection was infrequent and brief. But I was out there living a life.

Identity Crisis

From my favorite source of all things news and news-like:

Who Are We? Coming of Age on Antidepressants

The article raises an issue that I have often contemplated and found disconcerting, particularly after starting on mood stabilizers. I am not one of the victims (?) of being medicated as an adolescent, a period that for many is a time of self-exploration and personality development. While not far removed in age from the patient mentioned in the article, mine was still a time in which major mental diagnoses were delayed until adulthood (mostly because of the belief that many are not truly triggered until then). I had had mild mood swings as a teen, enough to make me seem somewhat different from my peers, but nothing debilitating. Behavior that was different was not necessarily considered deviant.

I was the classic case for my generation. I was not diagnosed with major depression (incorrectly, of course) until young adulthood. And of course not diagnosed correctly until about 10 years later (the average for what is now called bipolar 2). I was diagnosed with major depression at nineteen, an age I consider to be on the far side of the cusp of transition to adulthood, in my case anyway. (It is my mother’s view that I left home at the age of 15.)

Back to the actual issue. Obviously, one becomes a much different person with age. But for those who have been on anti-depressants since (sometimes–shudder–before) puberty, what do they have as a comparison, a control in the experiment? Is your brain different from what it would have been without taking meds? Lithium has recently been reported to grow gray matter. What can those meds do to the physical brain of children and adolescents, whose brain structure is different from those of adults, and still forming?

I do believe that introducing anti-depressants and similar medications at any age changes the neural pathways. I do believe that this forms a “personality” different from the unmedicated potential. Now is there nothing the same? If you replace some of the boards on a boat during repairs, is that the same boat that you had before? Hell, what if the new boards work better? Different, but fundamentally the same? (Sorry for that mutilation of the metaphor.)

This issue is a difficult one, particularly when one tries to take one’s life experiences into the equation. Did I walk into that situation as a result of emotional problems that are known to cause really bad judgement? Or I am I just that stupid on a fundamental level? Would I have taken a different direction had I been on meds?

What I find most disturbing is that question of identity. Who on earth am I? There is no better way to describe the difference these meds make on perceived identity. Is that angry, impatient, unhappy, raging thing really me? Or, better yet, where has that quiet and thoughtful introverted person gone? Is that an aspect of my personalty that doesn’t come out so much anymore, or is that a symptom of depression? Have all these meds over the years created (or let loose) other, completely different aspects of a personality?

Do moods intensify my “personality”? Do meds conceal it? At least I have a baseline.

But, still, who am I?

N.B. The omission of the question of the dangers of suicide versus being put on meds is deliberate.

Meds Again

I just don’t have it in me right now to follow up on my teaser, but maybe someday….

What I can say is that, about a week ago, my shrink finally started moving me off of Paxil, for which I am very grateful, because the dosage had been so messed up by the events of the past few months that I started toward hypomania & a lovely mixed state. I was talking a mile a minute and couldn’t stay still on some days and was turning into Mr. Hyde on the others–you know, mean, cruel, impatient, yelling at people, and hating the world in general and my own life in particular.

So, anyway, I’m getting off Paxil and moving onto Wellbutrin. We’ll see how that works. It’s pretty good so far, but I’m still on a tiny dose of Paxil right now. I’m feeling pretty good during the day, but am having trouble getting to sleep.

The shrink gave me Xanax because I was climbing the walls the day I saw him and had been having anxiety attacks. I have used it a couple of times since making the change, but mostly to get to sleep (because I have a constant dialogue going on in my head, yes dialogue) since the anxiety is fading.

But see, the problem with Xanax is that it makes you stupid. Yesterday I was noticeably (to me) stupid and, what is worse for me, losing words again. The words are there in my brain, but I can’t access them, which is incredibly frustrating to me, and doubly so now that I have been getting better.