Obtaining My New Mind-When Drugs Finally Work

I’ve been highly fortunate. I’ve found a cocktail of drugs that has had rapid success in stabilizing my moods without brain fog. It is the primary concern of mine to be able to stabilize my moods without sacrificing any of my mental capabilities. Unless it’s a severe depression, my mind works fairly well regardless of the mood that I am in. Coupled with being in academics, I’m forced to focus on maintaining my cognition as my primary target. And I’ve found it on abilify and lamictal.

I’m not ruling out the possibility of needing to change my dosing here and there, maybe a little more abilify, or a little less of the lamictal, but the buckshot has definitely hit the target and has stabilized me to a considerable degree. My manias no longer fly out of control, and my depressions are mild. Above all else, I’ve also gained a new reprieve from anxiety and paranoia. They are still there, but not in the same way that was crippling my ability to even call people. It’s really one of the greatest successes I’ve had in my life.

It’s highly strange though to now look back on my previous mind. I no longer identify with myself in a manic or a depressed state. Usually, I have the distance to say that what I do in those states is really not myself acting, but now it’s far different. I have a hard time even associating myself with those emotional states. I understand them and remember them, but it’s harder to hold in my mind what they feel like. It’s almost as if someone very close to me had them, but I did not have the episodes myself.

The outcome of this is a minor identity crisis. I have this new mind that seems to work better than it did before. There are mood swings, which I’m very used to, but there is a new element of clarity and expanded limits. I can no longer tell whether I’ll burn out or react negatively to a situation. I became a recluse to hide my behaviors and prevent any social interaction from worsening them, but now I seem to be able to tolerate more. But this leaves me uncertain as to how far my limits are.

I’ve red lined in the past, where I reached my limits and broke. But now those limits have changed, and I don’t know where they went. I don’t know if all of them are better, or if some have shrunk while others have grown. I really don’t know where I am and am in uncharted waters.

This is different as well from the changes in limitations that happen when I go on a new drug. New side effects are really not that new, and I adapt to them quickly because it’s clear how much they are impairing me. Traditionally, the side effects do not shift my social interaction or even stamina all that much. But now, all those goal posts have been moved, and I’m lost without knowing how far I can go.

As a result, I’m actually taking a small vacation due to the drug working. I’m taking only a single class this fall and sitting in on some others. I’m unsure of how far or how long I can withstand the pressures of academics, and I don’t want to be caught in another trap of taking on too much. It may seem strange to think that after getting better I need time off, but that’s exactly what I need because I do not know how much better I am. I don’t know how long I can withstand daily stress from reading, writing, arguing, and being judged on my work. So, as counter intuitive as it might seem, now that I’m better, I’m taking time off. Hopefully, at the end of it, I’ll know where I sit again and can feel comfortable in my own skin, knowing how far I can truly go.

Adventures in Abilify – Day 31 – Management of Mania

A few days ago I managed to trigger a hypomania with coffee and a hangover from a beer. It was a good test case for abilify’s mania management. And it worked. It didn’t blow open into a full blown mania. Rather, it’s kept me mildly hypomanic so that I feel good, but not in a delusional way or with massive thoughts of grandeur. It’s kept me mellow and happy instead. A major advantage that I’ve found is that it’s kept my sleep cycle in check. Often, when I’m manic, like most people, I sleep a lot less. This is a wonderful feeling, but it’s still sleep deprivation and my mind starts to wane with only a few hours of sleep each night. Lack of sleep also worsens my mania by undermining my impulse control a few days into sleep deprivation. It’s kept my sharp, active, and combined with the behavioral activation practices that I employed yesterday, highly productive without stopping for anything in between.

Over all, abilify has just chilled me out. It’s rounded off the time in which I swing, so that I’m not flip flopping moods in a matter of an hour or two, so I have more time to prepare and analyze where I’m headed. By keeping my moods in check, I also have massively increased focus and productivity. I still seem to be distracted easily, and I love stories, but I find that any story will do. Right now I’m addicted to Star Trek Voyager (reliving my childhood in the process). But in the times off from watching it, I get a lot done. I’ve been able to right and research a 10 page paper in a single 5 hour sitting. I’m still not happy with it, but it’s good enough in my opinion. It’s condensed, quick, and to the point, which is good enough (though I could go on for page after page if I really could get into it).

An odd thing is cropping up in my mood journal though. I’m generally more self sufficient and do not need to interact with people. I withdraw more into my mind and am very happy there. I like not having to interact with people and spending days at home doing things that I want to do without other people is incredibly satisfying. I don’t fear talking to other people, I’d just rather not and instead do it on my own. Though, agitation and anxiety are at an all time low, so that’s a good sign.

In the end, after 1 month, I’ve been restored to moderate to high functionality considering the rapid cycling and extremes of my moods. I’m still not functional in the way that normal people are, but I’ll take my eccentricities any day over normality.

Losing One’s Mind – When Medication Fails

It would be impossible to talk about medication without talking about its failures. Especially since failure is more prevalent than success. I talked yesterday a bit about what I felt like before going on medication, so today I’ll talk about what it is like to have to stop medication.

In my opinion, medication is a real crap shoot at times. Over the past 9 months, I’ve been on a lot of drugs that do not work. There’s celexa (twice), atenolol, propanolol, seroquel, risperidone, xanax, and klonopin. Over this summer, I’ve tried three antipsychotics, with only one working, abilify. All the previous ones ended in horror shows. And at the end of each of the failures, I always had a similar thought, that I’m losing my mind.

One of the main ways that I’ve seen drugs fail is that they simply didn’t do anything. This was especially the case when I was given beta-blockers for my anxiety. Nothing happened. There weren’t any side effects either. I used to think that this wasn’t a horrible way for a drug to fail, but it still is. The beta blockers were supposed to control my heart rate and reaction to stressful situations so that I didn’t get a panic attack. And they seemed to work a little bit, but I couldn’t really test them out in any substantial form without really stressing myself out. So I marched right into an exam with high hopes that the drug of choice among performance artists for stage fright might work, and then promptly melted down. The failure of a drug to perform does two things as a result, first it is a waste of a lot of time in taking it, but the second is that it brings a great deal of uncertainty into planning my activities. Even when I was unstable, I knew my limits. I knew when I could or could not deal with something and planned accordingly. With the addition of a new drug, I need to find my barriers all over again. And if it does nothing, then I wind up in a lot of unpleasant circumstances that I could have avoided. Additionally, if it doesn’t work, then these situations might destabilize me without having the proper medication to bring me back. So I often find this failure to be the most exasperating way to fail since it’s just time and energy to do nothing.

Another bothersome way that drugs might fail is by having intolerable side effects. This personally happened to me when I was taking risperidone. I was planning on dumping it rather quickly, but then it started up with paranoid hallucinations (that’s for the next section). Sometimes, the drugs do help, but the cure is worse than the disease. The difficulty with this is that it’s hard to tell what’s worse. Sure, I had fatigue and lower sex drive and felt just rather apathetic, but is that better or worse than swinging around every 6 days from manic to depressed with a mixture of suicide and mixed states thrown in? Add in the fact that it’s hard to remember what I felt like 6 weeks ago, and there’s a recipe for a difficult decision. Our brains are not wired that well to handle such evaluations, it’s like deciding between a strudle that will make you nauseous and a bowl of ice cream that will make you constipated. The choice is neither! But that’s not always an option. The tug of war between these two options is enough to drive one mad in its own rights. My own experience has taught me to just choose the neither and try going for another option. But it took a long time to figure that one out.

Finally, the drug can cause a complete mental break. Seroquel caused a mixed state with paranoid hallucinations, and risperidone just caused the paranoid hallucinations. Sometimes the drugs really do drive me to be a little insane. It’s exhausting to go through this. Not only is it time and energy wasted, but the destabilization and trauma of the episodes is enough to leave me bed ridden or completely out of touch with reality for weeks. And the after effects do not necessarily go away. Seroquel disrupted my memory to a significant degree and caused me to restart 3 of my classes since I could barely remember anything from the previous few months. Failing in this way doesn’t just reset to normal, it makes things worse than before.

These three ways that drugs can fail are exhausting and an everyday reality of taking new drugs. What can be even more exhausting is that medications might fail at one point, but work at another time. So there is no final say in whether the drugs in fact do work. It can be maddening. But not all is despair and failure. Tomorrow I’ll talk about the two successes in my life, lamictal and abilify. The success is relatively new, and I’m not that used to it yet, but I’ll talk a little about the hopefulness that comes with finding what works.

Caffeine and Hypomania, A Dangerous Mixture

Something brand new happened to me today. I was mildy hungover and sleep deprived (from 1 small beer too! grrr) so I caffeinated heavily today. Something fascinating happened, it triggered a hypomania. At first I thought it was just the caffeine making me energetic, but there was no crash, no sugar low, no nothing. It just kept going and going. And for the past few days, I’ve had fatigue and sleep issues around late at night where I couldn’t stay awake past 10 and I would sleep till 9am. It was troublesome to say the least, but not a horrible depression. Still, I’ve swung out of it into the exact opposite, rather than a hypodepression, I’m hypomanic.

Why is this? Two factors in my opinion. My psychologist pointed them out to me a while ago, but it’s taken until now to really put it together. The first factor is the alcohol. He stated that it has a kindling effect, meaning that it causes mood instability. If I’m swinging down, it’ll make me go further down; going up, it’ll make me go up. For a long time, I thought that this only worked while the alcohol was in my system. So whatever mood I was in previous to the drinking would in fact be what is kindled into a stronger phase.

Now I find that it simply causes instability in general. This morning I wasn’t feeling that great, but the coffee acted as an antidepressant and swung me up. Now, for the record, I’m particularly sensitive to antidepressants. Celexa took a whole 48 hours to put me into a full on mania. So it doesn’t surprise me now to say that I must be sensitive to the effects of caffeine. But I am surprised at the fact that it triggered a hypomania. This hasn’t happened before when I drank coffee. I felt better in the past and had more energy, but nothing that was sustained.

And while I am hypomanic, so I’m not really that concerned, my more rational mind is pointing out to me that this might be very dangerous. I tend to drink more when manic which will only make it worse. Additionally, now that I’ve put two and two together, it seems that I might be trying to trigger manias using this combination. This is particularly dangerous since the stable me doesn’t want manias. They’re dangerous and heavily disruptive to my daily life. It also means that I have to pay special attention to my coffee intake for the next few days to prevent me from going any further. This, however, will be more difficult because I can already feel my impulse control slipping. For all I know, tomorrow I’ll just chug a pot of coffee to try and get the high back. I can’t tell what I’ll do, that’s the scary part of having manias.

Furthermore, while I’m feeling great now, there will be a crash. I don’t get manias without a coup de grace ending of depression that is equal in magnitude. That means that the marathon of stability that I’ve been running, with only mild depression here and there, might be over. And it often takes a while for me to stabilize again after having a quick mania-depression combo.

The only good part of this is that I get to put abilify to the test of stability and depression control. I’ll see soon how deep I go down and how quickly I go there, and then how quickly I bounce back. It should be an informative few days. And the only reason I’m not too worried is that I’m starting to get that hypomanic “I’ll survive anything” feeling. Which is great for now, but my mind is screaming at me to stop this before it gets out of hand.

Gaining a New Mind – Before Medication

This is a two parter about the prospect of developing a possibly new personality as the result of taking medication. Antipsychotics and mood stabilizers present a unique option to those with mood instability, they offer the prospect of having a new mind and personality. The changes are hardly subtle and there is a positive or negative response, the rapid onset of behavioral changes is frightening. After all, how many times does one not only have the opportunity to radically change their mind, but actually experience it? Having gone on multiple drugs that promise change, I always experienced a mix of positive an negative feelings about it in light of past experience.

The negative aspect stems from the raw uncertainty of medication. On the one hand, the drug might be beneficial, but there is also a fairly strong likelihood of the drug failing. Antipsychotics have produced hallucinations and dangerous mixed states in me instead of helping me. They’ve also helped eradicate parts of my memory so that I have blank spots instead of remembering my friends. New drugs don’t promise that they will not do this, but it’s always a risk. Even before experiencing these severe symptoms, the long list of symptoms ranging from tardive dyskinesia to diabetes and hallucinations, even the rare death, is enough to take anyone aback a bit.

Additionally, after being unmedicated for so long, I became rather used to my mood swings. The instability was as much a part of my identity as anything else. Even the promise of mood stability means removing something that I identify with. This doesn’t mean that I necessarily enjoyed my instability (though I did enjoy the manias quite a bit), but it was something that I was used to. Change is scary no matter what, and changing something that is intimately connected with something as personal as moods is even scarier.

Not only is it scary, it’s also puzzling. I often wonder what it will be like to be on a new medication. Until abilify, I had not be stabilized by much of anything except for lamictal decreasing the severity of depression in my cycles. Without remembering what it is to be stable, the prospect of it is confusing in many ways. It’s not like trying a new dish at a restaurant, it’s like traveling to another country for cuisine, and you don’t speak the language. There’s no guarantee that I’d even like what I felt like on the other side. Many drugs have a flattening effect on moods, so I might not even feel normal on the other side, I might just be flat, which is not appetizing in any way.

These are just some of the thoughts that run through my head whenever I go on a new drug. There’s more emotions and puzzlement over whether I’m even going to take the trade off between the side effects and the improvement, or what time should I decide that the drug is not working, or even what should I do if I can’t tolerate this drug. All of these flood over me before trying out a new medication, no matter how long I’ve been on them or tried as many as I have.

In the next installments, I’ll talk about what it feels like to have a drug fail and what it is like to have one succeed (so far at least).

Adventures in Abilify – Day 28 – Depression and Cessation of Nausea

Four weeks have gone by. The past few days I’ve been depressed. My energy level has been low, sleep has been an issue, concentration is diminished. But there’s good news, I’m highly functional. It really took a while to realize just how functional I was. I was still able to do relatively demanding cognitive tasks like thinking about my thesis. Last night I was able to write about 3 pages and this morning I worked on another half page. The most interesting thing to have developed is the lack of withdrawal from other people. I don’t hide and ignore emails or phone calls. I put some things off, but I’m relatively on top of things. Abilify has substantially helped in that regard.

I’m also napping a lot less. Before I was taking 2 hour naps in the afternoon, now I just need a quick 20 minute nap. Which in my opinion is probably pretty close to average for most people’s needs. It’s just that I take my nap instead of powering through it. I’m also staying up a little later and getting up earlier again. So fatigue is less and less an issue, even though I’m depressed, I need a lot less sleep than before.

What I still cannot figure out is what it is doing to my metabolism. Today I was feeling rather perky until I ate a bagel. Now I’m feeling sluggish and tired again, even with coffee in me. Hydration helps with this feeling, but I’m at a loss as to what exactly is causing this fatigue. I see my psychiatrist tomorrow and maybe he’ll have an idea as to what is happening, or maybe I need to see a nutritionist.

Despite the odd fatigue associated with eating, the nausea has completely gone away. No dry heaving in the morning or gagging when I smell food. I can drink coffee and be ready to eat if necessary. So the symptoms do subside in time, quite considerably in fact. And this is a departure from my other tries with seroquel and risperidone. Those side effects stayed with me, but here it seems that everything is manageable on abilify.