Meds update

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?

 

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Spooky Action, not much of a distance

I am fastidious about my pre-bedtime routine. This is dictated by my (bipolar) anxiety and OCD. In the living room, I make sure the TV is off, the lights are off and the door is shut. This is how it always is, how it always has been.

This morning I came downstairs and stopped when I saw the door open and lights on. My first thought was that I’d  been burgled (unlikely as the house is as tight as a drum). But no, the lamp I always use was on and another lamp I seldom use was also on. The TV had switched itself off on the power-saving mode.

There was no sign of a break-in; windows were intact as were front and back doors.

This hasleft me feeling ill and uneasy all day. Thinking about it, I can guess only at two posible explanations:

Memory lapse (wouldn’t be the first) probably linked to the dissociation I have with my bipolar. Brief psychotic episode (again, wouldn’t be the first). Had I come downstairs in the night and watched TV or done something else? I have no history of sleep-walking.

It’s all very strange. Spooky action indeed.

 

 

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.

So long ago. So clear?

This October has marked one year since I began taking Quetiapine (Seroquel) and yesterday my son told me I am very much better (“nicer”) than I was thirteen months+ ago. Personally, I can’t see it, though I’m aware that the meds have worked their virtual miracle on my out of control, life-long bipolar symptoms. I have no reference point to ‘getting well’ as I’ve never been well.

Although I only sought medical and psychiatric help two years ago, at the age of 54, I can recall mood swings and what I now assume were brief psychotic episodes back to the age of four. So then, a half century of bipolar and depression, untreated and ignored by those who knew me. Who know me.

Having had eight months off from my stressful job last year, I have managed to stick at it for a couple of months now without missing a single day. I’m stubborn; I won’t let bipolar dictate its terms to me anymore. I must have always been stubborn, otherwise I’d have sought help before now. Actually, as you’ll know if you’ve been reading this sporadic blog (sorry), I did present myself to my GP when I was 20 with severe depression. He told me: “Pull yourself together” and sent me away without help. I was so embarrassed I waited almost a quarter of a century before handing my current GP a letter detailing my illness.

I know exactly when the light bulb above my head lit up regarding bipolar. I’d tried several different anti-depressants over the years for reactive depression: divorces, deaths in the family. That kind of thing. But these meds had made me ill; none of them worked. Then I read a book called ‘Why Am I Still Depressed?’ and it all made sense.

Which brings me to October 2016 and twelve months of Quetiapine (and at some point the addition of fluoxetine). The Q dose crept up and I now take between 500-550mg a day in three or four doses; the days I’m in work I take that extra 50mg for anxiety.

The biggest issue for me has been the Fat or Mad? decision. It became apparent early on that I had to make a choice, and I chose not to be mad. So in a year I’ve gained over a stone in weight and my general fitness has suffered greatly. No-one talks about the physiological symptoms of bipolar, but they’re very much there. I’m sedated half the day and I ache like hell from tip to toe.

I still don’t sleep through the night, not by a long way. I wake every hour or so then fall asleep again quickly. My anxiety level is still higher than I expected it to be by now, and my mild OCD with it. The meds haven’t really touched the OCD at all. Neither did the nine months of CBT I received last year before starting meds.

I look back on hypomanic and manic phases with more embarrassment and utter bewilderment. How on Earth was that person me? A stupid question as I have no idea what or who me is.

Some things disturb me more than others now. About the illness, I mean. The dissociation is scary and confusing. I tried to get help for that during my therapy but after dragging this issue out from the depths of me, it was then left unaddressed. Yes, the dissociation disturbs me; I don’t like it at all.

The meds have lessened the occurrences of ‘extremely intrusive suicidal ideation’. It’s clipped the top off the highs and the bottom off the lows. I’m more stable. The fact that I’m compliant – both with taking my meds and attending my psychiatrist appointments – shows that I’m in a better place than I was. Not a good place, just a better place.

 

 

 

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.