My journey with medication to treat my symptoms of bipolar II
My face is covered in ash, and I am almost crying with elation. My heart feels like it may burst. The steam train has just pulled out of the station, and my mind’s eye is full of the images of the glorious girth of the massive cylindrical steam chambers, the cold blue-sky sunny air full of white and grey steam, and the black-iron, red-glossy-paint of this man-invented travel machine. As the two engines pass, hauling slow, I am conscious of the giddy ridiculous grin of surprise and awe that must be on my face, and the engine drivers looking at me all hung out of their windows like kings in their castles. Eight, or maybe more carriages, full of passengers peering out their windows, pass by only a few metres from me. I am forty one years old, and I can’t alter the crazy, elated expression on my face.
A few minutes later, I crash with equal weight of down-turned emotion, just as I had previously been lifted by wild elation. The light of the sun is unbearable-bright, and my hands are over my eyes; sounds are piercingly loud and I block my ears; I try to breathe, slow and even. My thoughts are scattered.
At the same time, there is a clear sense in my head that knows this emotional cycle is not trustworthy – it is merely a reaction to the medication that is now in rapid decline in my body. From 1000mg of Sodium Valproate per day, down to 100mg each mealtime; a total of 300mg per day. The dizzy spells are easier, by comparison, to cope with. They come and go when the lowered drug amount has troughed to the extent my brain is running on empty, in effect. It is a weird proprioception change, where for a few seconds I am out of body and as if my physical self may be under some other power. Sometimes my visual perception is affected too. This is familiar to me now, having been on medication that messes with brain chemical balance for over five years. There is also the change in dream intensity, the occasional nausea and headaches, and occasionally night sweats. By far the worst part is the overwhelming self-doubt that comes as a result of being on brain-altering medication: can I trust what I’m feeling?How much of these feelings, these sensations, these…moods – how much are the drugs? And how much of ‘me’ is left?
The rapid decline of the medication levels in my blood is mostly by accident. Because of the strength of the drug taken is harsh on the stomach lining, I have been taking Nexium to stop the tearing, burning pain of the tablet as it dissolves and begins its process of absorption. My lack of organisation has meant that I have run out of Nexium and the script for it, just before a long weekend. I choose to drop the dose a little more quickly, and space the taking of the tablets out over the day instead of taking them together. This is a fairly informed decision; not entirely irresponsible. Firstly, part of me wants to know what it is to be in that no man’s land of drug-starvation, as a self-education practice. Secondly, I have taken a calculated risk with the symptoms of quick withdrawal by ensuring I am in a safe environment for the following few days – and it is only 100mg per day less than recommended by my psychiatrist. I am also still on Escitalopram, which does blunt the moods a little. And thirdly, I am still in denial: what little of ‘me’ is left is hoping that I don’t need the drugs at all.
The result of this calculation, however, has created in me a person not altogether amicable in a family situation. My reactions to medication, my mood swings, my irritability, my speaking before I’ve taken my foot out of my mouth – these are all things that are difficult to live with. Sometimes I hate myself – despite the lack of practicality of this emotion – for what I’ve ‘brought’ on my little family. It has been frightening, this drug. At full or ‘therapeutic’ dose, I am in a sort of fog. My short-term memory and short term thinking processes are most affected. I will think of something, then go into another room and completely forget what my initial thought was. Not like the haphazard forgot-where-I-left-my-keys kind of forgetting where there are some shreds of memory to help in your search, either. No, it is a complete blank space. When I go into my thinking to find the usual triggers for memory, there is nothing there. It’s like my brain is actually vacant. My ability to order my day, according to priorities and time, is weak. Thinking back to that time, now, it is a memory as much charged with negativity as is the bipolar depression symptoms that drove me to seek out medication in the first place.
Coming out of the fog, as the drug leaves my system, I notice my ability to socialise increasing. I wonder momentarily, a little excited, whether I am actually cured entirely. Perhaps now I will be a sort of normal person, who is effective in social interaction and not endlessly black-mood reclusive. It is only as I write “I’m clearer than I’ve ever been” along with rapid-fire chat to an online friend I realise that instead of being clear, I have only been in the hypo phase, triggered perhaps by the decreased drug in my brain chemical balance. Sure enough, I soon feel in the throes of the low; panicked thoughts of friends who are leaving, doubts about my worth, suggestions in my mind that perhaps the people in my life would be better off without my madness. And the bitterness of realising that this time of apparent lucidity has also been untrustworthy. Who the hell am I now and what is left of me?
I see that I am in a danger zone of suicidal ideation, and negativity; I must let go of any feelings that I am in charge and am able to make decisions about my future or indeed, even my present. I need new medication. But this means I might watch myself sink into another medicated fog of what feels like mediocrity, invisibility, and inconsequentiality, where I am merely a normal person, with nothing more to offer ‘the world’ than any other person; where I only need to be a mother and wife and friend in the social circles I’m in. No more a person with so much to offer. How boring. How much I prefer the other me, the excellent me, the winning me, the me who is an expert. So much more exciting.
What is this bipolar thing? I try to think about this in terms of a sort of cave-man, hunter-gatherer logic. A survival self. What point does this extreme cycling of emotion have? And what point does this crushing, unceasing low mood have? I’ve read about one recent idea about explaining the state of depression in humans: according to as yet unknown triggers, the body/mind/brain creates a sense of self that is slow, careful, tentative. The cave woman hunkers down to wait out the storm, wait out the danger. There is a possibility of influence from seasonal light changes, and their effects on the body’s clock, which can be tricked by artificial lights and stress arousal. There is a shying away from social interaction, to preserve energy. A seeking of sleep, both actual and desired, to preserve energy and heal. There is a lack of appetite, and yet a mechanical, habitual desire to consume calories – again to promote a hunkering-down, a hibernate state. And there is the doom-filled cloud that descends at every opportunity – if it ever lifts at all – that promotes a deep desire to hide, to cower, to always suspect danger and threat and ultimate catastrophe.
I wonder: depression, then, could be a direct reaction to an over-abstracted life, promoting a return to the physical, the touchable. This is the body, this is my body, this is the reality, this is what is now. The only problem is, I have two children to nurture into their own Worlds full of possibilities. I have a Masters degree to complete and a public health field to seek fulfilling work in, I need to prepare for my future retirement, and I will need to be able to invest in my fledgling offspring as they approach adulthood. I have artworks that beg to be made and exhibited, and friendships to nurture. And so I go to the next Pill. This time, after a long time thinking that there was no Magic Pill, I am prescribed Seroquel. Since the failure of Sodium Valproate, and three attempts at Lamotrigine that each time resulted in an all over body rash despite the first positive signs of cognitive control, I remained simply on the escitalopram for a year. I did a lot of hiding. My family knew that if I weren’t anywhere obvious, they would find me on my bed or curled up somewhere sleeping or otherwise zoned-out. When this new year began, I decided I didn’t want another year of sleeping, hiding, and the endless cycle of feeling confident and setting up umpteen pursuits and then feeling horribly tentative and tearing down what I’d set up. And in between those states of high and low, long periods of dysthymia. I researched other bipolar medications, and despite my initial fear of the drug, Lithium seemed worth a try. After all, as a ceramic artist I had used it extensively in my own glaze recipes. Lithium, when combined with other metallic oxides, produces wild effects of colour and texture in glazes. It is a volatile salt within a glaze matrix. Just the thing for me…?
The doctor had other ideas. He cited lithium’s long-term renal detriment, and decided on Seroquel after hearing of my symptoms – acute mixed-episodes and rapid cycling. Like my reaction to deciding that lithium was an option, hearing about Seroquel left me feeling instantly buoyed. There is another pill I can try. I’m flying.
The active substance is quetiapine. It is in the family of antipsychotics, essentially a tranquiliser. A sedative. As such, it is taken at the end of the day. I begin on 25mg tablets. They’re tiny pinkish pearls, about the size of a baby’s pinky fingernail. You can swallow them without water. As I begin, within the first three days I notice the sedative affect. I sleep in two hours more than normal, despite sleep interruptions that in the past have been a signal to my circadian mechanism that it’s time to start the day. My morning run is harder, my legs feel heavy. I also feel some initial low-blood-pressure effects, occasionally feeling a bit short of breath or a dizzy spell for a few seconds following getup from a sitting position. But it’s manageable. And the sleep at night is the kind of sleep I haven’t had since…early childhood, before the nightmares started. Never has sleep been so sweet.
It is the logic of it, though, that strikes me with a sense of relief: Tell the body, by taking nightly sedatives over a long period of time, that night time is the time to hide, to retreat, to curl up, to hibernate. Daytime is for living. I am sure this is a simplistic conclusion about the drug effect in the body, but right now, it is enough to remove the fear about taking sedatives. I begin using a mood app, to make sure my memory is not affected by my mood, so I know if I’ve been up or down and to see any patterns.
I’m now two months in; taking 50mg of Seroquel at night, and 20mg of Escitalopram in the morning. By admitting my dose, I feel humbled because I wonder about how high those doses are in the context of others’ mental health diagnoses. I know I have only mild bipolar II, and that there are others who have a much more difficult time with their moods and their medications. I am also ever grateful for the public health system that allows my medication to be subsided, making it affordable. These feelings crystalise further my desire to pursue my education in public health, to protect and nurture our anxious and depressed species toward a calmer and self-actualised existence.