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

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.

 

So happy I could die.

 

 

Suicide is a complicated business. Or rather, bipolar suicide ideation is a complicated business.

Being ‘suicidally depressed’ and wanting to die is how most people imagine the subject. To be so low, so clinically depressed that life has no meaning other than that it should end. Wholly and completely. It is utter despair with, in that moment (which might be a prolonged moment; linear time doesn’t always apply here) nowhere to go, no escape route. No solution other than un-life.

But as I say (and of course I can only speak about my own, personal experiences) suicidal ideation in bipolar can be a very different kettle of fish. So to speak.

Medicated (Quetiapine 400mg, fluoxetine 20mg) I haven’t had an extreme low or high for a while. What I do still have however is the hypomania and mixed mood episodes I’ve always had. Rapid – or ultra-rapid – cycling, at least they don’t last long. Not long enough to dig themselves a sizeable hole or system of clogging trenches I have to drag my metaphorical feet through.

Having suicidal thoughts because one is ‘happy’ is where the complicated bit comes in. And I imagine those people who’ve never experienced it – personally or with a family member perhaps – find it impossible to comprehend.

Put some favourite music on, loud: maybe those old or new Underworld tracks, that Oceansize song, anything from ‘Definitely Maybe’ or the first Strokes album – basically anything upbeat and rowdy, something singalong.

Have a glass of wine or three. Get lost in the moment.

I’m never happy, per se. Never have been. Anhedonia. So when I feel like I might be, like in these moments I’ve mentioned, I get suspicious. I’m aware (but perhaps not entirely aware, consciously) of the mood; but it’s a very welcome relief from the usual overwhelming pain of bipolar and anxiety (with its associated mild OCD).

Fuck, yeah… I’m happy! I’m dancing, one with the music. With the wine. With the universe at that moment!

WBBcc

So hell, yes, why wouldn’t I kill myself? Why on Earth not? It’s the logical thing to do. I’m – unknown to me at the time – depressed enough to want to die but high enough to have that energy, that ultra-rare joie de vivre to carry it out.

Mixed mood suicidal ideation is the most dangerous for me, by far. Then, it makes absolute, perfect sense to kill myself. As I say, Yes! Whyever not?! I’ll never be as happy again as I am at this moment and I want to celebrate, to prolong this happiness.. by dying. Confusingly and ambivalently however, I want to live forever. In fact, I will live forever! How could that fact possibly not be true?

“Life has no meaning the moment you lose the illusion of being eternal.” – Jean Paul Sartre.

Fortunately this kind of mood state pays me a visit at home. Occasionally it descends (or ascends?) upon me when I’m driving, alone. Music playing, sun shining, countryside slipping by each side of that motorway or A road. I’m so happy that I see a lorry speeding towards me in its own lane and for a moment think I want to remain in that ecstatic moment by turning the steering wheel sharply and ploughing into that vehicle. Did I mention the sun’s shining? I’m doing 60, he’s doing 60.. that a 120 mph impact. Sorted!

Then the moment passes. For now at least. What was the trigger? Well, it was probably nothing external. Just me; my electricity.

Was I aware at the time? No, or at least barely. Was I ‘myself’? No. Was I in control of my actions? Subconsciously, automatically, hopefully. Consciously, no. But I’m alive. At least, for now, same as it’s ever been.

 

 

 

 

 

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.

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?