More meds and some Med

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.

 

tabs for blog2

Starting to rattle

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 starting to rattle.

epilim

 

June update

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.

 

10 tips

My advice, from experience:

  1. 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).
  1. 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.
  1. 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?!
  1. 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.
  1. 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.
  1. 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.
  1. Do what the Walker Brothers and Edith Piaf told us and have no regrets. Don’t obsess on things. Just learn from things.
  1. 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?
  1. Talk about it. Preferably to someone with ears.
  1. 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.

22 of them

Time passing fast, almost the end of January.

I’ve been pretty much discharged by my psychiatrist as I’m seemingly one of her success stories; the meds appear to be working. The fluoxetine is clipping the extreme lows, with Quetiapine helping it out and of course clipping the highs as it does so. Poor overworked Q!

I returned to work at the end of last July, just before schoool broke up for the 6 week summer break. And I’m still there, having not missed a single day so far. That’s how stubborn, some would say how strong, I am. I’ve had a lifetime, middle-50 years, fighting, struggling, but ultimately winning.

It takes concentration, a continual fight, to exist. Yes, that’s what it comes down to: maintaining existence.

My enemy (well, part of the pack) is still that damned intrusive suicidal ideation that looks for any glitch in the system, any gap atomically small. And says “hey, do it! Why wouldn’t you?”

Why wouldn’t I.

And I’m in this war alone; single for almost 2 years. Almost friendless, alone. I was pretty much discharged by my psychiatrist at my latest appointment in the shadow of the New Year. Now I really am on my own. Me and my meds. Featuring battles such as “fat or mad” – I continue to put on weight despite my best efforts.

I don’t trust the meds; it would be extremely foolish to do so. Madness still breathes and creeps inside me. I still don’t sleep. I’m sedated much of the time, I’ve stopped writing (poetry, fiction). Meds and me, we’re like that chess game in “The Seventh Seal”.

 

 

Bipolar psychosis

There was no doubt a process that led me from Saturday night to Monday morning

I haven’t been very low for a long while (thanks to the 20mg fluoxetine / 550mg quetiapine meds) but I felt it had arrived during the night. Although I was wide awake at 5am Sunday morning I just couldn’t get out of bed. When I eventually did, I could barely move all day.

What dragged me down further was having to think through the logistics of the aftermath of the 3rd World War in 2030. And the 4th World War in 2032. I’ll be old and possibly not even still around, but my son will be.

This morning I knew I really shouldn’t go into work, but I’m stubborn and I pretend I’m in control of my own illness. Call it stupidity if you like.

So I went to work. And the day was marked with memory- and cognition issues. I must have appeared stupid and clueless to my staff. So of course I began to worry about that too, and decided at one point that I should hang myself from the overhead projector while the kids and staff were out at lunch.

Maybe doing this I could avert the next two world wars, seeing as how they and everything else anyhow are my own creation because life isn’t real.

Life isn’t real, I’ve mentioned before, because there was some kind of accident – probably car-related – and I am in fact in a coma or catatonic on a psychiatric ward. I am there creating all that is the world and being; nothing is real. (This is my most common, and overriding, ‘delusion’ – of course I don’t accept it is such a phenomenon.

All this is going on while I’m trying to work, either at home yesterday or in class today. It’s going to be one of those evenings where I can only laugh because it’s so ridiculous, so absurd, that I’m ending the day still alive. Driving home on the rush hour motorway was interesting, to say the least, as one of my planned suicide methods is to drive into a concrete pillar at speed.

But hey, I’m still alive. Again.