behind

I’m playing catch-up this week. I’m way behind on work projects, on reading blogs, on writing, on projects at home, on planning for the future, blah blah blah, yada yada. I made some progress on work stuff this week, so I feel a little better about that.

I also got my second vaccine shot, so I am fully juiced and ready to go. I’m ready to lick door handles and have someone cough on my airline food as I travel to a crowded city. Okay, maybe not, but I do feel more at ease knowing I have a little protection. I can see the possibility of everyone requiring a booster sometime in the next 12 months (I guess Pfizer has already indicated this). I was sore at the injection site until yesterday, and I was tired and achy for about 48 hours after the shot, which was about what I expected. Nothing serious, and I didn’t miss work.

I also saw my psychiatrist this week. I printed out part of this post and let him read it, and he said it was textbook OCD. (I also told him his “How are you doing” forms are crooked on the paper, and it mildly bothers me.) He said we can work on the anxiety first, and then see if the OCD symptoms need more attention. I agree with that, since the OCD gets worse with higher anxiety. In addition, he said I was much more stable when I was taking Abilify, so maybe we should go back to that. I had the same thought previously, so I told him that was fine. I’ll just have to eat better and get more exercise somehow. I’m also going to quit the Wellbutrin, since it can cause instability and maybe anxiety.

Last week I met with the therapist for the first time (same office as my p-doc). We got to know each other a little, and he was interested by some of my problems (social anxiety, lack of self-esteem, avoidant tendencies, inability to deal with stress, etc.) He said something that bothered me though: when I was explaining about being overwhelmed at work, he didn’t seem to accept the reality that I absolutely cannot take a week or more off work for my mental health right now – maybe an occasional day or two, but not an extended period. I also don’t feel like I can ask to have some work shifted to other people, because everyone I work with is swamped and unhappy and drowning in projects. The day after he suggested I ask for less work, I received two more projects. Yay. We’ll see what he has to say on Monday.

The weather is cool but nice, so I am going outside to enjoy some nature and not think about life for a while. But first, I need Second Breakfast (the best meal of the day).

instability

I’m used to my brain throwing curveballs now and then, but since the most recent manic episode something seems to have permanently changed for the worse. I’ve lost whatever stability I had in the previous year, and it has been replaced by rapidly changing highs and lows.

Since quitting the Latuda, I have had significant OCD and anxiety problems (see this previous post). I started taking Klonopin a week ago, just a small dosage, and I don’t think it has helped very much. Most days I have been edgy and frazzled, like I am just barely in control of things.

I have slept okay some nights, then not so much on other nights. There have been a couple of days where I was so tired I was falling asleep at my desk (one benefit of working from home). I had to nap during my lunchtime to feel better. Then I wasn’t tired at bedtime, and I had to self-medicate with a little whiskey to fall asleep.

On two days this past week I have been so wound up at the end of the day that I have to get out of the house. I ended up driving about 2+ hours both times. Friday night I just had to get on the freeway and go fast; yesterday I wandered aimlessly through Amish country before finding a freeway and coming home.

Another thing wrong with my brain is my reaction to caffeine. Apparently I can only drink decaf coffee, because when I have regular coffee the tics and shakes increase within an hour. Soda seems to have a lesser effect, but I still feel it. It fucking sucks because I love coffee, and decaf usually tastes bad.

I’m glad I am dealing with this now and not at an office full of people (another benefit of working from home). I don’t have to hide my daily roller-coaster from everyone and pretend to be “fine”, whatever the fuck that is. My wife knows I am abby-normal right now, and she’s concerned, but is mostly just trying to stay out of my way. I have been telling her I’m not in any danger, which is true.

I don’t want to admit it, but maybe I should go back to the meds I was taking six months ago and see what happens. I was stable, I was sleeping, and I felt like I was mostly in control. However, I was depressed most of the time, so that wasn’t good. Now, I’m just feeling exhausted and hyperactive at the same time.

Sorry if this is rambling; I’m just spewing this out and not editing at all. Just like my thoughts right now. It’s bedtime, so I’ll see if I can get some sleep. Bye for now.

tics

I’m not talking about blood-sucking arthropods, but the little movements and rituals that are the major symptom of OCD or maybe Tourette’s. I’ve had little tics and quirks since I can remember, but usually they were only present during stressful times. The rest of the time, they didn’t have control over me and I could ignore them.

During the most recent manic episode brought on by taking Latuda, I started having uncontrollable “tic seizures” where I would be lost for seconds to minutes at a time, then only by force of will could I stop them for a few moments. I could maintain calm stillness if I really concentrated (which is the opposite of being calm), but eventually I would surrender to the urge.

I tap or flick things repeatedly with my fingers. I blink my eyes forcefully, way more than necessary. I blow air on my fingers. I tap my mouse on the desk over and over. I click my teeth. I scratch my chin or my head. I wiggle my feet or my toes. All of this is fueled by the need to “get it right” – the right sound, the right amount of force, the right number of times, or the right rhythm. If I don’t get it right, I feel like I have to keep doing it until I succeed, and I never do. These rituals are not involuntary, I’m doing them purposefully and I’m fully aware I’m doing them.

I quit taking Latuda two weeks ago, and my psychiatrist tells me it should take no more than a week for the drug to wash out of my system, but the tics remain worse than ever before. I find them in control much of the day, every day, and only when my brain is fully occupied can I really prevent them from happening. I have had difficulty with concentration and focus over the past year or so, and when my mind is spinning or drifting, the tics are more difficult to control. They get worse with stress, and my anxiety is feeding them. They get worse with caffeine, which is bad because I need my coffee in the morning.

Between the manic episode and the increasing control of the tics, It has been mentally exhausting for the past three weeks or so. My work is suffering, and because I am working remotely it is too easy to take time away from the computer to try to relax. It has been difficult to work a full day every day, I am taking too long on projects, and I am struggling to meet deadlines. After work I just want to drink myself to sleep, but I have (mostly) avoided that so far.

My p-doc wants to put me on Klonopin or Ativan to calm down a little and hopefully reduce the tics, but my employer’s safety requirements and drug policy might be a problem. We are randomly tested to federal standards for opioids, marijuana, PCP, cocaine, and heroin. In addition, I’m not supposed to take any drug which might affect my “ability to perform” safety-related tasks. Klonopin is on that list, so if I do take it, I have to demonstrate to the safety police that it doesn’t affect me during work hours. Hopefully I can work with the company on this problem. I won’t ask my p-doc to be untruthful, but I wonder what will happen when they find out I have bipolar and anxiety disorders.

I don’t know if the manic episode or the Latuda triggered something in my defective brain, but something has changed, and I hope the effects are not permanent. I’m actually concerned for my future because of this. I am worried that my mental health problems will cost me the best job I’ve ever had, and send me into an uncertain future of trying to find a new job at my age. I’m not that old, and I can do good work when things are under control, but age discrimination still exists. I hope I’m just overthinking everything.

In the meantime, I’m exhausted, and I’m struggling.

withdrawal symptoms

Latuda is marketed as a treatment for bipolar depression, but they don’t tell you that it prevents depression by placing you into a constant manic or mixed state. I had to stop taking it last week because I had been manic for about three weeks.

The withdrawal symptoms of Latuda are significant and apparently long-lasting. I got more sleep last night, but I’m still waking up in the middle of the night for extended periods. In addition, my brain is still restless even though my body is tired. I sat all day yesterday and fidgeted because I wanted to do something, but I didn’t know what to do and I couldn’t concentrate on anything. Finally, the akathisia effects continue; the “twitchyness” is still causing me to blink my eyes and tap on things with my fingers repeatedly and shake my feet almost constantly. I’m hoping these symptoms will decrease this week.

Several years ago I had bad luck coming off a high dose of Effexor, but those effects were completely different: auditory hallucinations, nausea, and dizziness. I’m not having any of those now.

latuda update

I started taking Latuda at the end of November, then increased the dose in late December. At 40 mg, you just say “Latuda”. At 80 mg. when you’re manic and haven’t slept through the night in two weeks, you say “LA-TUUUUUUUU-DA!”

I talked to the psychiatrist yesterday. He couldn’t keep my appointment because he was sick, but he called me to discuss the medication. I told him of my manic symptoms, and he said it was a side effect of the medication. Yeah, I guess so. He suggested I drop back to the lower dose for a couple of weeks and call him back to see how it goes.

I didn’t tell him that I dropped down to the lower dose about five days ago, and I’m still having side effects, so I plan on dropping the dosage to zero in about 3 or 4 days. I can feel how the medication is still causing me problems. I have the choice what to do, and it just doesn’t feel right.

Basically for about 3 weeks now I have had elevated mood, racing brain activity, a lack of sleep, and increased blood pressure. I told the Dr. C that in addition to those side effects I was “twitchy”, meaning I couldn’t stop fidgeting and blinking my eyes and tapping my fingers (things that happen without Latuda but which were made much worse with it). He said that sounded like akathisia, and he hoped it would go away with the lower dosage. I don’t think it will stop until the drug is completely out of my system, because the twitchiness hasn’t slowed down at half dose.

And here I am in the middle of the night again. I slept five hours yesterday and three so far tonight, when normally I need eight or more hours. Good times.

more medication changes

I finally decided to make the effort to get an early appointment with my psychiatrist. I let him know my depression has worsened and is persistent, and I wanted off Abilify due to the weight gain. He listened to me (for which I am thankful), and suggested we try Latuda for the bipolar depression. It is an atypical antipsychotic but it works differently than Lamictal (that’s the limit of my knowledge at the moment).

I agreed to try it, despite the known side effects of nausea and possible vomiting. When I read the pamphlet, it said a small percentage of people have weight gain, as opposed to Abilify where everyone blows up. I can’t do any worse at this point.

I am still taking Wellbutrin for depression, but we will probably wean off that as soon as we know if the Latuda will work for me (and if I can afford it).

As I’ve said before, the bipolar changes and fluctuates over time, and stability is a moving target for me. That’s why I don’t believe anyone who says you can “recover” from bipolar. You can’t stop it, you can only hope to contain it.

drugs and depression

This is the depression that never ends, yes it goes on and on my friends. I can pretend to be in a good place for everybody – family, work, psychiatrist – but I can’t fool myself. I can’t concentrate on work, I don’t enjoy anything, I don’t go anywhere, and all I do is eat comfort food. I don’t do anything for my own physical or mental health except keep popping pills. It sucks right now, and It. Is. Always. There.

I don’t want to tell my psychiatrist, because I’m afraid he would put me on more medication. I want fewer pills, not more. With his recommendation I slowly weaned myself from Topamax; I immediately gained 10 pounds, and I feel like a goddamn bloated walrus, but my brain is a little clearer and not as foggy. Next I would like to decrease the Abilify, which is the reason I can’t lose weight.

I would consider another drug if it would relieve the depression. I want to keep the Lamictal (my wonder drug) to prevent cycling, keep or add to the Wellbutrin for depression, and slowly wean from the Abilify. If my psych wants to replace Abilify with something else I might do it. Fuck it, better living through chemistry.

this so-called recovery

People who don’t have mental illness seem to think that you can recover from all mental illness. I suppose it’s in how you define “recovery”. If you see recovery as having no more symptoms and leading a “normal” life, I’m afraid that’s a myth for me.

I believe recovery, by this definition, is possible for some people with anxiety or depression or other disorders where therapy is the primary treatment, possibly enhanced with medication. But I think people like me who have bipolar or schizophrenia or other serious lifelong conditions have to accept that being symptom-free is nearly impossible.

I have accepted for some time that I will always be chasing stability, that I will always need a cocktail of medication to control the bipolar, and that I will fight it to a draw on most days. Some days it will win, and I won’t be able to function at all; most days the meds help me deal with it and allow me to pretend to be a functional adult.

That doesn’t sound like recovery to me. It seems more like a fight to the death, and at the moment, I’m hoping to die from something else and not the bipolar.