Bye Bye Abilify

It’s over between me and abilify, I’ve been cheating on it with zyprexa. See, while on abilify, I still had suicidal impulses and suspicious thoughts except for right after taking it. Zyprexa keeps the bad thoughts away completely. Even back at thanksgiving, where I felt fragile and close to a meltdown, zyprexa kept the suicidal thoughts back. So, it’s bye bye to abilify.

Over all, my chat with my psychiatrist went well. She’s rather amazed at how well I’m handling this whole waiting game. Apparently others start to crack much sooner and much more disastrously. She also mentioned that I should be feeling like crap to some extent. My psychotic episode was like having a heart attack in her book. It takes time of rest and healing to really get back to 100%. It doesn’t happen overnight and it takes some care and rest to really get back on two feet. With that said, I’m getting another 50% bump in how much lithium I’m taking. Hopefully this will be the dose that works for me, 1800mg is a lot apparently. But it’s all about the serum levels and how much is getting into my system, which apparently isn’t a whole lot.

I’ve also discovered something brand new, as in I haven’t felt it in ages, I’m not irritable. This morning, I was pleasant with my girlfriend and today I went through phone call after phone call to get my meds straightened out and faxed to the right place. And yet, I wasn’t irritated, I was just dealing with it. In general, I felt very normal today. Much more normal than I felt back in september. I wasn’t overflowing with energy and enjoying everything like I would if I was manic. Instead, I just got what had to be done, done.

That’s about all I can write for now, I’m exhausted from the activities of the day. I’m dozing off as I write this. But in summary, things are looking up for once, and maybe I’ll finally get stabilized on lithium so I can remove things like lamictal and make room for a stimulant.

Deep Breaths

I’m going back to my apartment today and am feeling very anxious about it. I’ve had a hard time with cars since my last one had brake failure (there’s apparently a recall out on the faulty hose) and then a cam shaft sensor went haywire and the car just started to lurch uncontrollably while I was on a two lane county highway. That and I often have panic attacks while driving on the interstate. What takes people 2 hours to drive will take me at least 3 with all the breaks and cigarettes to keep me calm. When driving, I need to manage my anxiety without the help of xanax too, otherwise it’s going to be DWI time.

Today I don’t have to drive, but it’s just as horrible riding along. I’ve come to discover something that is super important to my anxiety, which is control of my environment. I have a huge personal bubble. Before, it was because I was paranoid. I thought people were judging me and colluding. Now it’s because I can’t control their thoughts. That may sound bizarre to think, but I feel that I have to be prepared for anything at any given moment. And so my thoughts can’t focus on what is at hand. But what another person represents is a force that is outside my control and so my bubble must shrink. Driving explodes this to a situation where it could be deadly. With someone else driving, it’s insane because now I don’t have any control over anything.

So I’m taking deep breaths, practicing some mindfulness, and trying not to obsess about it.

But I honestly don’t want to go back to my apartment. Despite that, I need to face reality and get things done. I also don’t want to stay here at my parents. Really, I don’t want to be anywhere, I just want to disappear. The depression is still sinking in deeper so it’s telling me these things. It’s also making me feel defeated since another week has passed and my lithium is not up to therapeutic levels. It’s like running a race right now, but the finish line keeps being set further back.

This is just going to be a very emotionally draining day, I can tell by the way that it’s started off already. But I just need to get through it all and then I’ll feel better. It always helps my depression to get some things done. I just wish that they were important things.

Bummed, More Medication Please

I’m thoroughly bummed right now. I got a call from my psychiatrist about my lithium levels; they went from .29 to .39 after doubling the dose. I need to get to .6 for it to be therapeutic. It looks like I’m going to be on a lot of lithium. And as I said, it kinda bums me out since it’s another week gone by that lithium isn’t going to be doing anything for me. Granted, I’m looking at this long term, so an extra week isn’t that much, but I’d like to be stable now!

And that level of stability just is not coming from the antipsychotics. They’re doing their best, and I can practically feel myself getting pulled from dark thoughts, but they’re not supposed to handle the leg work, they’re to help with psychosis and keep me stable through the little fluctuations. They’re not meant to be monotherapy.

On that note, I think that my lamictal level is too low. It’s not providing any sort amazing stabilization, but then again I’m a resistant rapid cycler. It is delaying or keeping off depression with only small amounts bubbling up. But I wouldn’t feel bad about increasing that at some later date after lithium gets worked out.

With all this said and done, I’ve got a plan of action that I’m going to lay out to my psychiatrist. We keep zyprexa where it’s at, and plan a long term removal of abilify since zyprexa seems to be doing more good for me lately than abilify. Then after lithium is checked out, see if lamictal needs an increase or can manage a decrease. Finally, testing for ADD to see if I need something else added in. On wednesday I’ll see what she has to say about that.

Delaying My Trip Home

This weekend has been too emotionally draining on me. I have nothing left in terms of will power to work on my thesis or even just reading. Even writing this post comes with long pauses of just staring. So I’m delaying my 2 hour car ride back to my home. I just feel messed up emotionally. Every morning I wake up and feel like I’m a hair’s width away from a meltdown. So I’m just taking a day off from everything.

I think part of the fragility is because of the klonopin. I’m so used to medicating every last emotion into a hypnotic haze that now I need to get used to feeling all over again. I’m still taking it, but I’m taking a little less than prescribed. I just can’t take the haze any more.

On a positive note, there is no suicidal ideation at all. Usually when I feel this defeated and tired I start to get negative thoughts and suicidal ideation. That’s just gone. I’m depressed for sure, but the dark thoughts are not there. Given the time line, the increase in abilify might be working that was 5 weeks ago, but it’s been 3 weeks since I increased zyprexa. One of the two, or both of them seems to be keeping the dark voices away.

I have also noticed very little brain fog while on lithium compared to the usual norm. In between waking and taking klonopin, my brain feels like its all there. It’s not a very positive mindset, but it feels intact. The brain fog that I’ve been warned about on all of these drugs just isn’t happening. I might have a theory about why this is. ADD runs in the family and is often comorbid with bipolar disorder. After talking with my sister and brother in law, both of whom have it, the normal brain fog that I feel is similar to what they experienced. I have to dredge up some research, but the ADD might be producing a brain fog that I’m used to handling. So, I might also want to be tested for ADD. This is a long term plan since I don’t need more medications. Still, it’s something to think about.

Theory of Mind and Bipolar Disorder

In a study done by N. Karr, theory of mind deficits were studied in people with bipolar disorder. Theory of mind is a concept invented by philosophers. Having a theory of mind is having an ability to attribute things like desires, beliefs, and other mental states to people beyond one’s own mind. So the study focuses on how well individuals with bipolar disorder can attribute correct desires and beliefs to other people.

The test is a simple one designed originally for schizophrenics by Christopher Frith. The test consists of 6 stories that are read and simultaneously shown a series of cartoons depicting what was happening. All the stories involved some degree of deception and two questions were asked, one “reality” which was about the story, and one theory of mind question about the mental states of someone in the story. In the study with bipolar patients, there were first order and second order questions. First order questions are questions like “what did X believe happen”, while a second order question would be “what belief did X have about what he believed?” Second order theory of mind questions revolve around what mental states we have with respect to other mental states rather than about something in reality.

Still with me? Good, I’ll try to clarify with comments on this one since first-order/second-order stuff can get very confusing very quickly. The best way to think is that second order states are things like how strongly one believes something to be true. That is, you believe that X is the case, but you believe that you believe weakly that X is the case. And if you don’t get it, don’t feel bad, it’s something that a lot of peple struggle with, myself included.

The last set up for this experiment was a comparison of theory of mind capabilities throughout mania, depression, and remission. The results were interesting:

As you can see, normal people were able to interpret the mental states of others without difficulty. However, across the board there were deficiencies in individuals with bipolar disorder. Particularly interesting to me is that depressed individuals score higher than manic individuals. This goes to support some of what Nassir Ghaemi reported on, that individuals with depression have a better grip on reality. The question then becomes, what reality do they have a better grip on? It seems that in terms of memory recall and attributing mental states, they fare worse than normal controls; but in other tests concerning how much control one has over reality, people with depression fare better than normal people. So it seems that depression cuts both ways in terms of how one relates to reality.

This also personally makes a lot of sense to me considering how bad I am at determining what other people are thinking. I’m terrible at it. I feel there are always too many options and I never know which one to choose. I kind of understand people, but they’re always rather alien to me whenever I’m in a manic state.

What about you? Do you often find it difficult to figure out what people are thinking or feeling when manic or depressed?

 

References:

http://journals.cambridge.org.ezproxy.library.wisc.edu/action/displayAbstract?fromPage=online&aid=5061076

http://www.sciencedirect.com/science/article/pii/S0165032702000083#ref_BIB13

Complete Silence

I finally have silence in this house. I’ve managed to get through thanksgiving with the help of 4mg of klonopin. Didn’t nap once during the day I was so agitated. The buzzing confusion of cooking and my family telling me everything all at once. It was too much. I had no safe area where I could just curl up in a calm silent place.

My family is my family, but they tend to be more interested in themselves than in me. They want to talk about all the things that are happening in their lives, and I listen. But I can only listen so much. I had a little bit of a chat with my sister about bipolar disorder, my brother in law was just diagnosed with it. But, the entire day still revolved around everyone else. It blurred itself into a cacophony of voices all demanding attention. The only way I didn’t break down into tears or yell at any of them was because I sedated myself.

To some extent I regret not letting them know just how fragile I was feeling. That I didn’t want to hear about their lives non stop. I probably should have let them know how I was feeling yesterday when I was just hammered with feelings of failure. And by the way, thank you so much to Jill Nottelton, you cheered me up like no one else has. I still feel off balance, but I keep rereading your comment and it makes me feel alright again.

But now I finally have my quiet time. It’s peaceful in this room with everyone either asleep or away with friends. I still feel like my emotions have been put through the blender and want to break down crying. Breathing exercises are not doing it for me. Nor is music. I just feel emotionally tired and I can’t wait until I get to see my psychiatrist again. I always feel better after talking with a therapist. For now though, I’ll settle for my moments of silence.