I’m on a relatively recent cocktail of meds now and overall they’re doing their job. The side effects are substantial, significant. I continue to pile on the weight (quetiapine). I ache literally in every cell of my body, constantly. I’m sedated much if not all of the time. I still don’t sleep through the night.
20mg of fluoxetine caps the low moods. 600mg of quetiapine stops the psychosis and the high / mixed moods pretty successfully. (Though see my other post of today.) And the latest, 500mg of valproate stabilises my mood. These three meds seem to have made friends though they gang up to bully me now and then. They know I need them.
I still have ‘extremely intrusive suicidal ideation’. I still have ‘rapid and uncontrolable mood fluctuation’. But regarding the former, I can control it more (hopefully – time will tell). And the latter, the valproate seems to have gone in with fists flying there.
It’s taken months to get the GP surgery and local pharmacy to get my (psychiatrists’) prescription right. This has caused me a lot of stress and worry. It’s isn’t rocket science; it’s a straightforward repeat prescription that should take moments to set up. So far it’s been 3 or 4 months of getting it wrong. Three or four months of stress. I wrote my GP surgery a begging letter recently, imploring him/her to get the ‘script’ sorted. I can do without the hassle basically.
I speak to no-one about my illness. No professional has come forward to offer me counselling or has even offered an ear. It’s all bottled up, and I hold down a stressful job because I hate the thought of being defeated by the evil bipolar monster. I’ve spent the day shaking and confused (again, see my other post of today). Got home, had a couple of glasses of wine, took my meds. Is it bedtime yet?
The past three weeks have been dedicated to getting used to an increased dose of quetiapine (now up to 600mg daily) and the introduction of valproate (500mg as Epilim Chrono). The fluoxetine has stayed the same at 20mg; psychiatrist wanted to double that dose to 40mg but I tried that once before and it triggered hypomania.
So far the valproate doesn’t seem to have kicked-in. Psych says this can take 2-4 weeks and couple of 6-8 weeks before noticing any change in mood. The valproate / increased quetiapine together have had a very sedating effect and at the moment this would seem to be the only side effect so far.
It’s been a real pain trying to get the prescription sorted with GP and pharmacy; the former seems to find it impossible to write a simple repeat prescription and the latter seem inept at getting a stock of quetiapine. Though I’ve noticed the past month that several people on Twitter have also reported problems of pharmacies getting stocks of it.
The school year has now ended and in the end I managed to have only 4 days off sick. I was aiming at having 0 days this academic year, after the several months I had off last year. I see these 4 days as failure, though no-one appears to agree with me.
I’m going away on holiday to the Med; I’ve worked bloody hard for it.
I started going downhill again a month ago. GP tried to get me seen by assessment team the same day but it took a week. Then I had to describe it all again; for what seemed like the hundredth time.
And again, another long assessment. My psychiatrists said something about juggling my medication a little and trying to get me more (1:1) CBT therapy. Last time I had therapy for several months I’d yet to start on the meds and it did very little for me I think. If I get more therapy now it will be interesting to see how it goes alongside medication.
So a couple of days ago I had my follow-up meeting with the psychiatrists; another ‘20 minute’ one that turned into 50 minutes.
The bottom line of which is that my Quetiapine has been increased almost to maximum dose – up from 500mg to 600mg. Fluoxetine remains at 20mg. And Valproate has been added into the mix, at minimum dose: 500mg. Lithium was discussed but I was told the side effects wouldn’t agree with me – and anyway, Valproate is better for OCD (and its anxiety trigger).
I’m relatively stable at the moment, hence the reason I’ve not written anything here in a while. The sole reason for this stability is my meds. After all, I don’t have any other help or input – in this respect I’m where I was three years ago, before therapy and starting on quetiapine + fluoxetine. I am theoretically in the care of my GP though I never see my GP.
After having so much time off work last year (several months) my main objective this academic year was to have no time off at all. That’s how stubborn I am! But here we are, seven weeks from the end of the school year and I have 100% attendance.
It doesn’t mean I’m “better”. I’m not; there’s no cure for bipolar. No cure for anxiety. No cure for OCD. No cure for the dissociation (DID). There’s just medication; damage limitation.
I still, of course, get intrusive suicidal thoughts. I still don’t sleep well. Surely 550mg quetiapine + 20mg fluoxetine daily should be knocking me out all night? But no, I’ve not slept through the night in decades, if I ever did at all. My short term memory has taken a severe hit (I suspect some of this is memory lapses linked to the DID symptoms) though my long-term memory in many respects would put your average elephant to shame.
Quetiapine continues to function in making me fat. It’s a straight either / or choice with these meds: Fat or Mad. I’ve opted for the former, somewhat reluctantly.
There’s a blog piece to be written about the DID symptoms I’ve experienced through my life and I’ll write than when I’m able to collect those thoughts together.
Allow yourself, wherever possible, to be not well. Some days are like that; in fact many days are like that. But it’s easy to feel guilty handing your day over to something outside your control. If you have a job, it’s even more difficult. But on those not well days, take it easy: watch TV for too long; don’t shower if it’s not essential (and when is it essential?); indulge, mindfully, in your drug of choice later in the day (thanks, I’ll have a kir or white wine).
Get some sleep. Preferably at night. OK, so this is totally outside our control and I really don’t know what the answer for insomnia is. Mine is chronic and seemingly without reason. It used to be worsened by night-time hypomania but I’m medicated now.
Speaking of which, always – always – take your meds. Don’t change the dose without consulting your psychiatrist / doctor. Follow your medication programme closely. And if you’re bipolar then why aren’t you on meds?!
Exercise isn’t the be-all and end-all; sure, a little walk on a sunny day isn’t going to hurt you. I discovered quite recently that too much exercise can trigger hypomania. So before you decide to climb that mountain, take heed to allow plenty of time and be mindful the whole time that you – not your illness – are in charge.
Treat yourself. Indulge in those treats that ease your moods. Could be music – those old favourite tunes – could be chocolate (tell me about it..), could be a glass of wine (go easy, young fellow!). Don’t let it be anything destructive; hypomania rules that part of you so stand up to it, show it who’s boss. In theory at least.
If you must buy loads of crap, buy cheap crap. And no, that Harley is definitely not cheap, even if it is cheaper than a yacht. I bought four USB drives the other day, didn’t need any of them but I can handle a £20 hit and they’ll get used eventually. Maybe not in my lifetime, but eventually.
Do what the Walker Brothers and Edith Piaf told us and have no regrets. Don’t obsess on things. Just learn from things.
Try not to kill yourself; it leaves a hell of a mess and doesn’t achieve much. It also means you’ve lost.. and you’re not a loser are you?
Talk about it. Preferably to someone with ears.
Get a grip. Do what it takes to stay sane. Yes, of course it’s a battle. A daily battle. Focus on the endgame: not the battle but the war. Be who you are.