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.

 

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”.

 

 

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.

 

96 Hours

Wednesday 23rd Dec.

Wow, how many times this year have I been told to recognize my triggers? It’s got to be.. well, a lot. And how come, every time, despite knowing the theory of it all, in practice I never can?

Slept badly, waking often through the night inside a long vivid dream full of colour and overall goodness. And walked into town in the morning, stopping off at a large supermarket that was doing a good impression of the Sacking of Rome. But was I stressed? No, not one bit; in fact I was calm, and taking no notice of the carnage going on. I actually noticed this, just as I’d noticed the disturbed sleep.

But did I recognize my triggers? No.

And then later, this afternoon and suicidal in the bath, listening to the one song I always listen to when I’m Mixed. No.

Well, actually it was then, finally that I did. But by then I’d had 16 hours of this and that’s how long it took me to finally – finally! – recognize my triggers. And they’re so damned obvious, so damn recognizable that.. how did I miss them? How did I miss them, yet again? Doh!

How did I miss them the past 4 days, come to that? Sunday: two things happened.

My.. delusion.. well, my main one.. That I had a near-fatal accident some time back, probably whilst driving. That something very very bad happened to us (me and my son). And that now I’m either in a coma or catatonic; either way, I’m lying there and all this.. THIS.. is in my imagination. Not real. It kind of blurs with the solipsism I’ve flirted with unintentionally since my teens.

And on Sunday it was worse and I got stuck in a loop of really, really believing this delusion. And I got scared, and panicked a little because it meant..

well, it meant something BAD. The worst. And I can’t even say it because saying things can make things happen. And this is why I have my obsessions and compulsions; it’s a barrier; totems. So Sunday I got all OCD in the midst of this. THIS.

But that wasn’t the only thing. The other thing was I started smelling things. Really strong things, and I asked other people if they could smell them because the smells were really, really strong. And no-one could smell them. Then the next day, Monday, I could still smell them.

And last night, when I woke, I could smell them.

And now, four days later, it’s finally hit me. Finally suck in. The triggers! Only now we’re way past that, and whatever triggered whatever has bedded-in and left me with.. well, what they triggered.

Ninety-six hours and I’ve been triggered all over the place. Up, down, mostly both. And now I’m thinking that 2 months on the meds.. they’re not entirely working, are they?

Quetiapine 300mg XL – 5 weeks today.

It’s so difficult to get up in the morning, almost impossible in fact. I don’t think ‘sleep paralysis’ is involved, just that I’m so woozy and sedated that I keep dozing off again. I’m setting the alarm clock for 10am but this is proving futile; 11 is the best I can hope for, it seems.

But today, I’m incredibly woozy. I discussed, often, with my therapist my delusion that nothing is real. Or rather, nothing is real outside myself and that I am probably in hospital, medicated or comatose after a traffic accident or some extreme psychological trauma. There are signs of this I recognise in whatever state of being I’m currently in.

The main one revolves around coincidences. I won’t go into this too much, but I have believed that things are unreal through a ‘logical’ progression of thoughts based around how frequent coincidences make themselves apparent. Frequent and commonplace to the extent that they cannot be appearing naturally. Externally, objectively.

I had a shock ten minutes ago when I realized that I might in fact, at this moment, be dreaming and not awake at all. When I have this delusion I can to some extent control it consciously; I can ‘predict’ or ‘make happen’ some things that happen or more usually words that are said.

So just now I had the idea that the random word butterfly would make itself apparent very shortly – either spoken on TV (there’s no-one here with me) or read online. The occurrence of this word would, I know, almost certainly prove that this current existence is not real but exists only in my own mind. I have had several instances of such [solipsistic?] states in the recent past.

So far, the word hasn’t been spoken, so I am a little more content that I am awake. A look at my Twitter feed had a name including the word butterfly, and while I’m prepared to put this down to coincidence, I’m not 100% certain this is the case.

This is my problem at the moment. I looked online for mentions of sleep/wakefulness blurring in bipolar II but there’s very little at all. It might be part of my dissociative disorder linked to, or existing independently of, my bipolar.

I do realize this piece of writing is muddled and possibly incoherent. I don’t want to ‘tidy it up’. I don’t think I’m hypomanic at the moment, or particularly low. I generally know when these moods are happening. What I don’t know however is when I am in a mixed state, cycling rapidly. That’s why it’s a dangerous mood for me. I worry this delusion is indicative of a current psychotic episode. Hopefully it will settle or run its (usually brief) course. I do feel so very out of sorts today.