Not a lot

A long period of silence here. Things go on, nothing really changes though the summer break has finished and I’ve now returned to work.

The first few days left me exhausted despite them involving very little work. Maybe it’s the getting up early added to the usual insomnia and other sleep issues?

Mood is relatively stable, though last week I got stuck in a prolonged bout of suicidal ideation. I judge these thoughts by imagining I have a button next to me I could push for instant death; how often I would do this tells me how my low- or mixed mood is.

Aiming at – as usual – trying to keep a 100% work record, no sickness leave. I do well, and Management knows it; my line manager says he doesn’t know how I manage to come into work at all, let alone be there and do my (teaching) job satisfactorily and even do it to a high standard. I surprise myself at how I manage to hold down a professional post, albeit part time (60%) now.

I also seem to have (touch wood) levelled out with how much weight I’ve gained since starting meds 3 years ago – Fluoxetine, Valproate, Quetiapine. I’m not losing weight, just gaining it more slowly.

Life isn’t easy. It isn’t easy if one doesn’t have a mental illness. As Samuel Beckett put it:

“I can’t go on. I’ll go on.”

 

 

 

 

Exhausted

‘You want to know why I feel exhausted?’ I asked.

‘No, not really. But go on, if you must..’

I haven’t slept right through the night even once in perhaps 30 years. Not once. I ache down to my very soul; if you thought bipolar is solely a mental illness then you’re mistaken. It’s also a physiological illness, a painful one. Between the disease and the medications they pound away at muscles, joints and bones 24/7.

Then I have to hold down a job. A stressful job at that. And when I’m not holding down a job I have to run a house and be a single parent. Not wanting to end up living in a sty that has hundreds of baked bean cans stacked on the stairs or newspapers going back to the 80s, I have to cook and clean the same as the rest of you. Pride, necessity. Being civilised and human, I guess.

And the moods.. they’re all over the place as I have a layered illness, that’s the best I can describe it. I might be hypomanic for months and depressed for months but on top of this I have acute shifts in mood, often very brief intrusions of one mood type upon another. Ultra-rapid cycling. Ultradian.

That means my mood can shift dramatically within one day: periods of hypomania and periods of depression, and most significantly periods of mixed-mood which for me are always the most dangerous and unwanted. When I’m mixed I am depressed enough to want to die but high enough to be able to make such a thing happen.

Today I stood by the kerb at a pedestrian crossing. Lorries were thundering past at 30mph and it took all that I had not to take one step forward just as the next lorry was approaching. Fighting this urge is exhausting. On the way to the crossing I’d experienced some kind of hallucination (more than, I think, a delusion per se) where I was suddenly walking along seeing the ground from 7’+ high. I’m 5’ 5”. That lasted just a few seconds, but dealing with this was tiring nonetheless.

It’s all one thing on top of another. Chronic, acute, a bit of this a bit of that.

Then there’s the meds: 20mg of fluoxetine in the morning (slightly sedating) with 100mg of quetiapine (more sedating). Then another 200mg of quetiapine mid-afternoon, followed by yet another 200mg of quetiapine in the evening.

This isn’t even a lot of meds for someone with bipolar (plus anxiety and OCD). I’ve met people who are taking 15+ doses of meds per day.

Spending most of the day (and night) sedated is physically wearing. I have to fight myself to leave the house, to walk, to exercise. To live rather than simply to exist. Plus, I self-medicate with alcohol by late afternoon though thankfully I’m in control of this and I manage to keep within my weekly recommended consumption as an adult male. That’s a miracle in itself!

I have to put on a brave face, a smile for my son so he doesn’t worry about me too much. This act requires energy and focus and tires me out also.

All of this, and more. Not just for a day, a week, a month, a year; I’ve been battling this more seriously for a couple of decades and on the whole since my late teens and indeed probably my childhood. I’ve only been on meds for several months, only sought treatment 2 years ago.

Everything I’ve described happens almost every day. Most of it happens every day.

It’s no wonder I feel exhausted.

 

Update

Wow, it’s been a while since I updated this! Is it a case of ‘no news is good news’? Well, yes and no.

My medication seems to have been settled though a mistake on my repeat prescription indicated ordinary release Quetiapine rather than the extended release I’d been taking. I decided to stick with this mistake, if only because my eating pattern wasn’t dictated by the need to take the meds on an empty stomach.

I jiggled (is that a medical term?) the dose throughout the day to suit me further so now I take: 20mg fluoxetine and 100 mg quetiapine at breakfast time; 200mg quetiapine late afternoon; 200mg quetiapine an hour before bedtime –ish.

The quetiapine has worked well at controlling moods, especially hypomania / mixed. As for side effects, I’ve put on three-quarters of a stone in 6 months and I have chronic lower back pain and a variety of other aches. I’m always sedated to some extent though even on 500mg quetiapine I still haven’t slept through the night even once in decades.

For some reason I’ve never been able to fathom I am always – always – worse on Sundays. I assumed it was because of work on Monday but being off for 8 months recently, and now being on 6 weeks summer break, hasn’t made much difference. My anti-anxiety medication of choice (as long as it’s mid-afternoon+) is a glass or two of white wine. Well, it works.

I still have some delusions; always the same ones as I’ve been having for a few years now. I have (manageable.. so far) psychotic episodes, particularly when in a mixed mood. Anxiety and OCD go hand in hand and can be a nuisance. I have extremely intrusive instances of suicidal ideation and these are worrisome; they too generally happen in higher/mixed mood.

I returned to work in my stressful job a month or so ago and it went OK. The start of next academic year this September will dictate how I am and how I feel.

 

Quetiapine, end of first month.

End of first month, and I have mixed (sic) views. The past two weeks have been Quetiapine XR 300mg at bedtime. (Remember, it was 25mg+25mg+100mg for the first two weeks.)

Straight away, I felt less woozy by the afternoons – although dragging myself out of bed much before 11am has been quite an effort; and a mostly futile one at that. I’ve even taken the car out, one afternoon this past week. A shopping jaunt, much overdue.

I still marvel at the many comments online detailing how 25mg has knocked people out for 12+ hours and solved all their insomnia problems. How come 25 works for them but 300 doesn’t work for me?

The past few days I’ve noticed a difference again; the meds seem to be having less of a beneficial effect on my bipolar II symptoms, particularly anxiety and OCD. Strangely, I think the C part of the latter has been eased a little, whereas the O is as overwhelming as ever. Actually, a bit worse. Having bipolar is bad enough; add OCD into the mix and life can be pretty awful most of the time. Actually, always.

Yesterday I felt so anxious I thought sod it. Sod it, I’ll self-medicate again, and had a couple of small glasses of white wine. Well, it’s helped for decades, and although I’ve not touched a drop of alcohol for a month, I felt it was worth a try. After all, it doesn’t seem to be banned; just not recommended. What’s the worst that can happen? Well, falling asleep, it seems. And that would be a good thing, not bad.

As it was, I didn’t feel at all more sleepy and the wine did seem to ease my anxiety to some extent.

At my last psychiatrist appointment (when the Quetiapine dosage was doubled) she mentioned that when we next meet (at the end of the month) she’ll see if I can tolerate 600mg a day. That’s quite an advance from my initial 150mg isn’t it? I assume higher the dose, the more side effects.

I’ve done some walking, very little exercise bike work, watched what I’ve eaten, and have only put on 4-5lbs during these 4 weeks of meds. It seems I’ve got off very lightly – so to speak – in that respect. There are some horror stories online!

The most successful effect of the meds has been a ‘topping and tailing’ of my moods. Although I’ve sensed some hypomania, until this afternoon it hasn’t made a nuisance of itself. And while my default position as ever is ‘mildly depressed’ I’ve mostly remained at that state. Yesterday and today, with the anxiety making an unwelcome house-call, there have been some mixed episodes – always the most dangerous for me, with all symptoms becoming more acute but especially anxiety, restlessness and the feeling that every cell in my body is buzzing and shaking.

I’m also getting a bit peeved by the frequency of comments on social media saying that ‘hypomania can be pleasurable’. Well, come and spend an hour in my metaphorical shoes when I’m hypomanic and then tell me how good you feel. I’ll wager the answer is ‘not very’.

I have some spare Quetiapine 25mg tablets and I’m tempted to increase my prescribed dose independently. Say, one of those mid-afternoon? I’ll declare it to my psych of course. But for the next two weeks, I feel I need something and obviously wine isn’t going to solve many problems. Is it?

Week 3 (Meds)

Day 16 of Quetiapine (150mg/day)

Update on how I’m coping with my meds: I’ve spent all of the past fortnight essentially zonked-out. Lethargic, tired, but still not sleeping at night even with a bedtime dose of 100mg. I wake up often, as I always have, but I go back to sleep quickly and it doesn’t seem to be hypomania that’s waking me – like those hellish weeks before I started on medication. I get up late, dozing and snoozing. So I’m probably getting the hours (of sleep) I need, but it would be nice to sleep right through the night. Just once a decade would suit me!

The dreams are long, vivid, story-like. But not unpleasant and not particularly anxiety-driven. Strangely, most of them involve my childhood home. [There are PTSD issues related to that part of my life.]

I’ve put on weight, but only a few lbs – but I walk 10-12 miles a week (2-4 miles at a time), I haven’t drunk any alcohol for almost 3 weeks, and I’m being careful with what I eat and when I eat it.

It’s early days, but my hypomania appears to have been clipped, though there was a sudden episode last week that came right out of nowhere, very fast. And it went almost as swiftly, leaving me low. But nothing I couldn’t handle.

My anxiety level seems to have dropped a bit (something my psychiatrist noticed immediately at this morning’s appointment) but my OCD seems untouched by the meds. Although there was no reason it should do, I had nonetheless hoped it might help.

I haven’t driven my car since starting Quetiapine; I daren’t – I’m not too confident walking in a straight line at the moment, let alone having horse power at my command.

Psychiatrist this morning pointed out that the 150mg/day dose is too low to treat bipolar and has recommended 300mg XR a day, taken in one go at bedtime. I’ll start tonight. After 20 years of not sleeping through the night even once, let’s see if this does the trick!

My next appointment is in a month; I have the option to double this new dose to 600mg/day from then.

So, chapter 2 of this medication story starts tonight. Watch this space…

Zopiclone.. what is it good for?

Absolutely nothing, and I’ll say it again. Absolutely nothing.

Well, for me at least. Having been given this so I can get some sleep (not slept right through the night even once in 20 years), I took half a tablet Sunday night. I woke up at 5.50am, so a result of sorts. Took the other half Monday night and woke at 2.05am, then 3.10am, then..

So I dived right in with a whole tablet Tuesday night and slept till 5.30am. Didn’t take any at all last night as I had to do the ‘school run’ at 8am this morning. Jeez… that was arguably the worst night of my life. Acute hypomania (I’ve been hypomanic for 5 weeks now, a total break in my rapid cycling norm), and the third time I woke up last night it was still only 12.30am.

To say last night was hell is to let hell get off lightly.

So I googled Zopiclone + hypomania trigger this morning and while there’s a number of articles and threads they seem to be saying that the tablets themselves might be a trigger, rather than what I assumed – stopping them even after just a few days.

Has anyone else here had an issue with Zopiclone when hypomanic (or otherwise)?