About seven weeks ago, I had a severe psychotic break. But, I fortunately found a mental-health care team that promised some hope. However, there were a lot of surprises and concerns that came along with this, and which are growing.
The first issue is that my diagnosis was elevated to Bipolar I-predominate manic, and currently psychotic. And, that I had been in a predominately manic mixed-state for at least a couple of years. Gee, who says life is a bore!
When I had the diagnosis of Bipolar II, it took me a couple of years to come to terms with it, and what it would mean for my future. And, it took me about five years to become, what I thought was, stabilized. But, even though I did accept it, I still thought that my life events and decisions were essentially a result of conscious decisions I had made, and that my “eccentric” behavior was simply part of my personality.
But now, with the new and escalated diagnosis, I’m reeling. Initially with this diagnosis, I had, and am still going through, all types of phases in dealing with this, both physically and emotionally.
Emotionally, I am having a hard time accepting this. I’m realizing that my entire life has been absolutely out of my control—I feel like the bipolar has robbed me of everything pleasant and productive that I could have had/achieved. I can’t think of anything in my life that has been authentic, except for art. At least there’s art.
But the incredible, unconscious spending sprees, misery I suffered in my teens, twenties, and thirties, all of the dangerous activities and events I blindly participated in, the self-medicating with street drugs, the terrible choice of friends (most of them), and not to mention the even worse choice of men, I now realize was all a result of being bipolar. And, even though I was able to work in the arts, I turned down opportunities to work as an artist in favor of working in art museums (I did find satisfaction working in the museum field, but always regretted that I never had the time nor headspace to create some spectacular artworks). And, while on the topic of work, I have been fired from every job (including temporary clerical jobs) since 2000. That’s a long time. I had always attributed it to bad work situations, bad bosses, bad institutions, bad bosses . . . but never to my own behavior. See, I thought I was managed.
And, now with the new diagnosis, my condition has reached the top level of Bipolar Disorder. There is no higher diagnosis. This shatters and frightens me. This is, to me, a giant slap telling me that my life is going to get much, much harder. With every bipolar episode, there is no turning back. This means that any subsequent episodes (depressive or manic) will be worse than any that went before. After one episode, the next will be worse. Then the one after that will be worse than the previous. And so on, and so on, and so on. I thought it was hard enough to begin with, and now I’m really having a hard time accepting that it’s much worse than I had thought. I’m paralyzed by these feelings.
Physically, for the past two weeks, I've been essentially unmedicated. Well, not entirely unmedicated, but medicated at the bare minimum (I’m still on the Lamictal). This is wreaking havoc with my life.
Vinnie Barbarino Gimme Drugs
My first (new) Psychiatrist Immediately determined that the Cymbalta I had been on for years was actually making my condition worse, and that the Lamictal, that I thought was the wonder drug, was simply ineffective. Great. That day she started weaning me off of the Cymblta (oh, those horrible shock-waves are still lasting), and simultaneously titrating me up on Geodon. My team was very concerned with my psychosis (yeah, it was really bad), and their first priority was to bring the mania down. So, the titration of the Geodon was hot and heavy:
Day One – 40mg
Day Two –40 mg
Day Two – 80 mg
Day Three – 120 mg
Day Three – 160 mg
Day Four 200 mg
Day Five and beyond – 240 mg.
My body couldn’t handle it. By day four I was so disabled that I was stumbling as though drunk, sweating profusely, and having to crawl up the stairs. And, crawling up the stairs, I had to take a break mid-way and lay down to rest. Even my cats were worried. They were crawling on me, meowing, and licking me. Scary.
Day four, with the major jump to 200 mg, I woke up in bed needing to vomit NOW. I managed to make it to the toilet, but barely. Scarier.
Day five, with the next radical jump in dosage, I woke up in bed projectile vomiting. I consider myself lucky to be alive. The rapid titration essentially knocked me out, and if I hadn’t woken up, I would have aspirated. Overdose. Terrifying.
I was taken off of the Geodon and put on Risperdal. Yuk. That only maintained the mixed-episode, and made me EXTREMELY angry and aggressive, shaking, and COLD. So, I decided on my own to split the dosage and take it only at night. Bad nightmares. Really, really bad nightmares, and ongoing agitation, cold, shaking, irritability, and a ton of invasive thoughts and ruminating, and a dive into depression. Hell, sheer Hell.
I phoned in and asked for a Benzo to reduce the anxiety just a little. My kingdom for a Xanax! Did I get a Benzo? No. Instead I was given Gabapentin. Now, I have had issues with Gabapentin before. A few years ago I had to go to the ER for uncontrollable and violent shaking of my limbs and head. After 16 hours being shuttled between Physical ER and Mental ER, I was dosed with Neurontin (Gabapentin). It sent me into an extreme mania. Now, the important thing to know here, is that my experience with Gabapentin is in my chart. Why, oh, why did she give it to me? Did she not consult the chart?
I knew it was a bad idea. I knew it was the wrong prescription. But I took it anyway. And, sure enough, it sparked a mania. I was up for four days. But it wasn’t a “fun” mania. I was shaking, anxious, and terrified about what was happening to me. And I was constantly cold (still). And, of course, I soon crashed into a deep depression.
I went to visit the doc again. And, as referenced in a previous post, she wanted to check me in to a Mental Health Residence. “NO.” So, she decided that she was at a loss as to how to medicate/stabilize me, and that she couldn’t help me any further. She handed me off to a Department of Health Services Community Mental Health organization. Great, government care. I took myself down to a lower dose of the Gabapentin, and took it only at night, but it was still giving me problems-I was sleeping, but still shaking and extremely anxious. And, the depressive episode was becoming worse, and worse, and worse. And I was becoming more and more paranoid. More Hell.
It took more than a week to meet with the intake process for the new team, and I didn’t get to meet with a Psychiatrist for a week. Since he was going to be on vacation for two weeks, he decided to not start me on a new regime. He did, however, prescribe Ativan 1 mg, daily as needed, to last until he returned.
I tried the Ativan . . . nothing. So I started making calls. First to the new team, explaining that the new doc had prescribed Ativan, but that it was ineffective, and to please prescribe something else to reduce the anxiety. Nothing doing. They don’t know me well enough, and the Psych is out, so no prescription. Well, I went back on the phone and called the original team to ask for something. Nope, I’m no longer in their care so they can’t prescribe anything. “You should contact your new team”. Grrrrrrrr. So there I was, anxious, depressed, hopeless, and paranoid. The case manager from the new team called, “How are you doing?” “Awful, life is terrible. I have no hope, and no faith” “Gee, that’s too bad, but hopefully there will be something to help you when the Psych returns. Have a great day!!” Have a great day? Who is this person!!???
I had one more chance, slim, but a chance. I called my general practitioner and explained what was happening. He’s seen me for the last five years and agreed to double the Ativan dose and gave enough to last until the new Psych returns. Now, I’m doped, stumbling, brain-dead, and moving further and further into the depression. Just get me through the three more days until the new Psych comes back, and please let him have some good news.
Did I say frightened, yet? There are not many drugs left for me to try. I’ve been on the following, none of which worked:
· Depakote -- Anticonvulsant
· Lamictal – Anticonvulsant
· Prozac -- SSRI
· Celexa -- SSRI
· Paxil -- SSRI
· Propranalol – Beta Blocker (used for high blood pressure and tremors)
· Cymbalta -- Serotonin-norepinephrine reuptake inhibitor
· Abilify – Atypical antipsychotic
· Geodon – Atypical antipsychotic
· Risperdal – Atypical antipsychotic
· Gabapentin – Gamma-aminobutyric acid
So, what’s left to try? The Anticonvulsants, SSRIs, and SNRIs don’t seem to work, but I’ve still included them in the list of everything else I can find:
· Seroquel – Atypical antipsychotic (I’ve heard sooo many bad things about Seroquel, I really do not want to go there).
· Latuda—Atypical antipsychotic (I’ve heard of this, and have heard good things. But, it’s used as an anti-depressant. Maybe it will figure in with whatever other med combinaion they decide to give me)
· Saphris – Atypical antipsychotic
· Vraylar – Atypical antipsychotic
· Iloperidone – Atypical antipsychotic
· Paliperidone – Atypical antipsychotic
· Zyprexa –Atypical antipsychotic.
· Lithium – Miscellaneous antipsychotic (This is completely old-school medication and requires monthly blood checks. I REALLY don't want to go to there)
· Topamirate Systemic -- Anticonvulsant
· Levetiracetam – Anticonvulsant
· Symbyax – Anticonvulsant
· Venlafaxine – Serotonin-norepinephrine reuptake inhibitor
· Desvenlafaxine -- Serotonin-norepinephrine reuptake inhibitor
· Sertaline – SSRI
· Escitalpram – SSRI
· Bubpropion – Antidepressant/Smoking Cessation
· Clonodine ----Antiadrenergic agent, centrally acting
· Verapamil – Calcium blocking agent/group IV antiarrhythmic
· Armodafnil – CNS stimulant
· Tiagabine – Gamma-aminobutyric acid reuptake inhibitor
There's not a hole or cave deep enough for me to crawl into and hide, and I’m afraid of my future. Very, very frightened.