Another Month of Klonopin

If you’ve been following my blog, you know that I’ve been on klonopin for a while. But now it’s set in stone, I’m on it for a month until the zyprexa can really kick in. I don’t know if I can stand it. The double vision is really starting to irritate me and yesterday I was so exhausted that I slept through class. I have a lower dose now in the morning, but it’s still a lot that I’m taking. As for withdrawal, my new pdoc says that we’ll cross that bridge when we have to, but in the mean time it’s trying to prevent any new episodes.

This whole episode has really shaken me up. Having a break of psychotic symtoms is not pleasant and is requiring a lot more drugging than I really thought. I’m also not really looking forward to the next few days of sedation from zyprexa. It’s already making me groggy and I just want to sit and sleep. I’m expecting a similar set of sedation+agitation episode and that was hardly bearable the first time around. The things that I do to be normal.

Good news is that my morning walks are really helping clear my mind in the morning. I have reduced stress and greater clarity of mind afterwards. And it’s so simple. Wake up, shower, take a short walk, chase after the geese in the park. So even in the stress of all this, I’ve at least come across something simple that helps me. That small amount of habitual behavior is really helping.

That’s about all I can write for now, the zyprexa is knocking me out. Maybe some coffee will perk me up and get me going again, until then, it’s sleepy time.

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.

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 8 – Caffeine and Agitation

Caffeine is definitely out. Coffee makes me restless to the point of not being able to sit down. Tea seems to have less effect, so it’s definitely coffee. Still, nausea does not subside with tea, but it’s been going down. I think it’s just a reflex reaction to all the drugs that I’ve been pumping into my body. Overall, it was a rough day since I was experimenting with caffeine all day. It’d probably be better if I didn’t increase my lamictal at the same time. Changes in lamictal always makes me more sensitive and less addicted to caffeine, so my reaction is probably pretty strong compared to other people.

In light of going on Abilify, this week has felt very long. My sense of time is mildly screwy since I feel like I’m two or three days ahead because of how long my days feel. It’s not a bad feeling. I often get anxious when I feel that I don’t have enough time to complete things, so it’s definitely reducing my anxiety in that respect. I also haven’t noticed any trending on my anxiety scale, so it doesn’t appear to have any side effects of anxiety, which is a huge plus.

Looking over the uses at RXList, I know now that this would be a horrible drug for containing a manic episode in my life. It has an upping effect to the point that I went to a pharmacist to make sure that it doesn’t cause manic episodes in people with BP I. I guess it did make me sleepy for a few days, but now it’s reversed its effects. All my previous antipsychotics seem to be better since when I was manic and I took it in the morning, I was pretty much functionally normal for the entire day, even if I was mildly sleepy.

In light of everything I’ve gone through in the past week, I’d definitely put abilify at the end of a list of antipsychotics, just like my psychiatrist did. There are others that have milder side effects and are easier to adapt to, I’d take those first any day over this past week which has been a hassle of constant monitoring and odd side effects of nausea, weight loss, caffeine reactions, agitation, sleepiness, changes to my sleep cycle, and changes to my time cycle. It’s been a powerful drug, and I think that it will work in the end better than the others, but it has required much more investment on my part than any other drug that I’ve taken yet.

Why do I medicate – My philosophy of treatment

So I’m stuck here at my parent’s home until I can get my car looked at and I can drive back to Madison. I thought that I’d share my outlook on medication.

One way of looking at medication for bipolar, or any mental illness for that matter, is to medicate to the point that you’re “normal” again. That is, there is some type of archetypal mind that ours should align to, and it is also this archetype that we depart from when we are diagnosed with mental illness. Medication corrects this departure.

I find this view as the common sense view that I’ve encountered. It’s derived from our usual understanding of physical illness. There is a way that our bodies should be working, though it’s on a sliding scale, and illness is a departure from that. Medication restores you. Think of strep throat, something has caused you to depart from normal functioning through an invading microbe and it is the responsibility of medication to remove that so you can be normal again.

I think this view is wrong though. First, I do not think that there is even close to an archetypal mind that is normal, I think that it is even more vague than a properly functioning body archetype. Second, I think that it is wrong in its understanding of how we normally medicate. And third, I think that it is an incorrect way of viewing how we should medicate.

The first point is something I won’t dawdle with too much. Mainly, I’d just like to see what a normal mind is supposed to be like. I haven’t found one yet, so this is a “show me” kind of argument. Weak, yes, but it’s not the main point.

The second point is that medication in the physical world is not a restoration to normality, it’s a restoration to functionality. We take pills to get us back to a functional state that we desire. We take penicillin for strep because strep undermines our desired functionality, and it can kill us. We take pain medication so that we can get through the day and accomplish what we want to do. Our intent in medicating physical illnesses is in increasing our functionality in some way or another. We generally think that there is a normal level of functionality associated with this though, and that’s where the common sense view comes in. Suffice it to say though that underlying the common sense view is an entirely different view about what we are actually doing, which is a focus on functionality.

The third point is about what we should be doing. My answer to this is that we should medicate to the point that we can accomplish what we want to do without hindrance from our diagnosis. And this should usually be done with as few drugs as possible. The idea behind this is that we have a level of functionality that we want, but our diagnosis prevents us from doing it. Just as I want to be able to drive back to Madison, by my anxiety is getting in the way of it. Medication is there to help remove that obstacle so that I can attain the level of functionality that I want to have. It also leaves medicating an ailment up to the individual. There is no over arching level of functionality that one must be at, rather it is defined by the individual for what they are willing to try to accomplish and what they are willing to cope with. That is, what should be medicated is a function of the desires of the particular individual, not some objective norm. But, it needs to be tempered by the reality in that there must be an objective basis for the impairment, not simply a subjective feeling of impairment.

This seems relatively nice, but it also means that you cannot criticize people for how much they medicate. We generally look down on the stereotypical suburbanite house wife that’s having a sad go at it and sees an advertisement for antidepressants and wants to go on them. If she really does have some mild depression, then she should go on anti depressants, or maybe just talk therapy (there are many types of treatments that do not involve drugs). What usually gets us annoyed is that often times we think of these people as simply imagining their symptoms. But this violates my second commandment, which is that there must be an objective basis for impairment.

Still, this does leave some room for some sort of norm to be used. Yet, I think that this norm is a sliding scale that is far more like physical norms. One can manage pain and cope with it. It is not normal to be in pain all the time, just as it is not normal to have panic attacks while driving, but it is on a sliding scale that we can recognize some degree of loss of functionality. Yet, it does leave a grey area for just where the objective measure comes in. And there I think that we need to simply side with caution, that maybe the impairment is not evident to us but to the individual it may seem substantial. This is where we have professionals enter. It is their job to recognize impairments and separate them out from normal everyday life’s ups and downs. Otherwise, we could simply WebMD our symptoms and have it spit out the appropriate pills from walgreens. The emphasis on having professional diagnosis cannot be overstated, however hard it may be or even if they get it wrong sometimes. Nobody’s perfect, but we don’t criticize our physicians for missing something every once in a while.

It may seem that I’m advocating for a lot of medication, but I’m really advocating for a lot of treatment. The fear we have of over medicating people seems to stem from people thinking of physical illness as different from mental illness. Every year we’ll probably have to go to the doctor at some point for a physical illness, so why is it so bizarre to think that we might need to see a psychologist every once in a while. And just like colds that can go away on their own with some help, psychologists can recognize mental disturbances that also can go away on their own with a little help. And at the end of the day, what we’re really looking for is trying to keep people not just healthy, but functioning at a level that they desire. If it takes meds, so be it, vitamins, so be it, but the extent to which one is given drugs should still be moderated by a professional, just like antibiotics should be moderated by doctors. But if you’re seriously ill, whatever that illness is, I think it’s up to you to figure out how much you really want to medicate.

Are we over medicating?

I just received a new panoply of drugs today. Out with the xanax and risperidone, in with the abilify, klonopin, and higher doses of lamictal. Some of the people I live with seem slightly stunned at the rapidity of which I’ve tried different drugs. Some have expressed complete distrust of our drug culture by claiming that we are over medicating or that drugs do more harm than good.

There are a lot of claims going on up there. But I’ll take a quick stab at a few. First of which, some drugs do actually harm more than they do good. I’ve been on one and I got off of it quick. But my reaction wasn’t an empirical generalization that all of these drugs are bad, I just accepted that these kinds of medications are new and it’s a crap shoot to find the right one.

Second, are we over medicating. On the one hand, I wonder if we would have the John Nashs and the Kurt Godels if we medicated individuals. But that’s a very selfish way of looking at it. It’s saying that we, as a collective society, wouldn’t be better off if their lives had been better. What a horrible thing to say. Additionally, one can still be productive and highly intelligent on these medications, it’s not a give or take, it’s an equilibrium that is aimed at. So this is both a selfish idea and a false dichotomy.

Finally, are we medicating too much. My answer to this is that we may be in some areas, but what we really need to do is become better at detection so that we medicate correctly. If we accidentally over medicate, I think that this is better than the other outcome. I would gladly have risked being incorrectly medicated if I could have spent the past 5 years of my life much more well adjusted and also avoiding the pit of hell that I went through in december. To say “think of all those who don’t need the medications” is just more talk that puts mental illness to the side until it becomes unbearable. Rather, we should be proactive and try to stop things like bipolar before it turns into a suicidal episode. It’s a sticky area, but where do you want to fall on this issue: putting someone on a drug that they can quit anytime of their life to manage a mental illness that they might find that they do not have, or do you want to side cautiously and try to stop individuals from falling into a full blown mental illness? The point that I’m trying to get across is that people who are taking the wrong medication can stop, but people with mental illness cannot stop their illness. I for one, err on the side of caution, but it’s reasonable to be on the other side as well. What do you think?

P.S. This is a heavy post day since I’m just zonked out with stress and drugs. Writing seems to be the biggest thing that I can do.