rear view

I was looking back at my posts from early 2021 that followed the arc of a long manic episode. The posts from that time aren’t scary like some of the deep depression posts from the old blog, but they are interesting to me.

My episode started with the side effects of starting on Latuda in November of 2020; I felt pretty good for a few weeks, but I started climbing the hill in December. By January 2021, I was frequently staying up in the middle of the night, my anxiety was climbing, and my OCD symptoms became overwhelming. I couldn’t concentrate at home or at work, I was having panic attacks, and I almost left my job out of frustration. After quitting Latuda and returning to Abilify, there was a long downslope where my symptoms were decreasing steadily, but were still there. I was afraid something had permanently changed in my brain. It wasn’t until May when a solo mini-vacation brought some relief from the storm.

Looking back from a year later, I am reminded how much I was struggling. This manic episode seems odd because on one level I knew what was happening and how dangerous it was, but at the same time I was very much caught in its uncontrollable grip. I didn’t think I could fly, but I believed that my life would be better if I tore everything down at work and at home. Had I followed through with my late-night schemes, it could have damaged my family relationships, cost me tens of thousands of dollars, and jeopardized the continued treatment for myself and for Nicole. I think I escaped the episode just in time, because I don’t know what I would have done if I had remained manic for a longer period.

My bipolar experience has been mostly depression, with very brief manias or mixed episodes followed by a deep spiral. This episode was different in that it had a long buildup and a long letdown, and I didn’t crash in the same way I had in the past. Since that time I have had no mania and a few depressions, and not with the abruptness and intensity as in the past. I know mania will happen again in the future, but I think having been through this most recent episode makes me better equipped to deal with it.

broken

You can only beat your head against the wall so many times before you crack, spilling your hopes onto the floor. You struggle to pay the price of existence, and the costs are staggering. Damaged and broken, you barely survive the day, and get no relief from a fitful sleep before waking up again. The cycle of hopelessness is not a circle but a downward spiral, a black hole from which positive things never escape. Your carefully constructed life is shattered by a disease with no empathy. The beast is not satisfied until its victims lie on the floor, crushed by its destructive power.

thanks for the memories

My daughter and I both have memory problems, and I believe they are directly related to bipolar disorder. We were talking about this recently, and she said she has forgotten lots of things, but it also feels like she never made the memories at the time; there is simply nothing there to remember. I never thought about it that way, but when she said that, it completely made sense.

I’ve given this more thought since that conversation. Looking back at what I remember and what I’ve forgotten, it seems like my ability to make and retain memories correlates to how severe my bipolar mood swings were at the time, and the depressive moods in particular.

I remember some of the depression “highlights” over the years, but during the times I was severely depressed there seem to be large blank spaces in my mind. School happenings, kids’ milestones, and my own work life just blend into a grey fog. I also have some memorable manic or mixed moments, but I seem to remember mental images from those times rather than the context of what was happening on either side. These memory snapshots don’t do anything to help me remember the life events surrounding the moments I do remember.

The memory loss feels strange, but just as odd is my ability to retain many events from times when I was alone. For example, I can remember locations I delivered or picked up from while I was a truck driver. I can remember places I’ve been hiking or exploring or just driving around by myself. I can remember vivid details about places I visited many years ago. In addition, I can remember lots of useless information and trivia (people always told me I should try out for Jeopardy, but I never wanted to).

My memories are often triggered by something else, whether it is music, a photo, or a geographic location. If I can associate a moment in time with a particular song, I will remember it for many years. For example, I recently listened to some music by Wham! for the first time in a long time, and it triggered a memory of driving through the Sierras in the dark when I was 18. A Hall & Oates song reminds me of a railroad crossing on a main boulevard in San Jose. A Tears For Fears song reminds me of a girl I liked in 9th grade, but also specifically of one part of a highway in Sacramento when we were on a school trip together.

I guess the part that bothers me is that I don’t know what is normal and what is not in my bipolar-addled brain. I think most people make memory associations from photos or music. I realize that normal people don’t remember everything about their lives, and usually just the highlights are what they remember. But I don’t think people typically have long years of time where they forget virtually everything. People have told me I had a great memory because I can tell them obscure details from events long ago, but I feel like my memory is getting worse all the time. I don’t know if it is caused by bipolar brain chemistry, long-term effects of psychotropic drugs, or early dementia coming on.

running to stand still

Up. Down. Sideways.

Hopelessness. Defiance. Acceptance.

Spinning wheels, hit the brakes, stuck in first gear.

Restlessness. Depression. Mania. Fear. Anxiety. Psych meds with a whiskey chaser.

I don’t have a center right now. I can’t find balance. My brain is all over the place.

My doctor called me back tonight, and he is going to try a couple of things. My faith is wearing thin.

Work piling up, waiting for me to stop feeling overwhelmed and make my brain work properly. The forecast doesn’t look good for that at the moment.

I’m also calling a therapist tomorrow. Without help, I’m a train wreck waiting to happen, and I can’t crash right now. Actually I can’t ever, but that’s another discussion for later.

panic! at the home office

So Friday afternoon I may have had a little panic attack. Apparently I posted something here and then trashed it immediately. Then I started drinking.

I was trying to email a request form to someone for a project, but I didn’t know just what to say. But I got stuck thinking about it, and it never got sent. Then the 10 am department meeting happened, and the department manager started demanding more output than we have been producing lately. Just what I needed to hear. After the meeting, I froze up again.

I took a long lunch, thinking I would take a break and calm down, then get back to work. The getting back to work never happened, and instead of producing more, suddenly I’m producing less. Thinking about this made me start freaking out, and I gave up around 2 pm. I literally got into bed and covered up hoping I could calm down, but it just got worse. I briefly thought about calling my psychiatrist, but I don’t think I could have made it through the phone call, and I didn’t want to get sent to the hospital involuntarily.

So when my shift ended at 3:30, I poured a glass full of scotch whiskey and started drinking with the intent of knocking myself out as quickly as possible. After an hour I was successful, and I slept until about 8 pm.


I fear the manic episode from January has permanently damaged something in my already defective brain. I can’t organize tasks, I can’t follow through, I can’t regulate my mood, I can’t control the anxiety. I can’t stop thinking that I will no longer be able to do my job, and that I will have to find something less stressful for much less pay and worse benefits.

Before the manic episode I was relatively unhappy at work but I was able to cope with the stress and managed to produce work in a timely manner. Now I am completely unable to deal with my mental state. I have no coping skills; I have nothing in the toolbox that I can use to improve my situation. My fight-or-flight instinct has been engaged, but I have nothing to fight with. The urge to flee is overwhelming.

The only thing that helps me relax is when I am doing something new, like yesterday when I drove new roads for a few hours and walked at a park for over an hour. But there are only so many roads within a reasonable distance, and I can’t do that every day. Eventually I have to come back home to my life, and start thinking about everything again.

I will call my doctor on Monday when I am relatively calm and explain the situation, and see if he can recommend something.

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.

manic word dump

I wrote this in about two minutes last week when I wasn’t sleeping. I think this stream-of-consciousness rant sums up what was going on in my brain at the time. Thankfully, I’m feeling more calm now, and I’ve been sleeping all night for past three nights.

===

I might be a little manic I don’t know why well maybe I do it’s because of fucking chemistry my brain is a mess I’m not wired right I listen to my doc I take my meds like a good patient but they make me even worse depression sucks but being manic sucks a little harder and not in a good way billy joel said too high or too low there ain’t no in between and that’s how I’m feeling this month get on the roller coaster riding the colossus spinning off to every extreme I was in this state once and tore apart all my computers just for fun now I am up all night reading blogs and doing word searches and disturbing the cats who wonder why the fuck I’m up every night one moment I’m asleep and then my eyelids open and my train of thought is like the japanese bullet train the shinkansen I think and there’s no going back to sleep now and it’s fucking exhausting so I have to wait for the offending drug to clear my system and then we’ll see if I get depressed again it’s the great circle of bipolar and what comes around goes around the block and down the freeway and out of town until one of these days when I crash

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.

up, down, sideways

I have been in the midst of a hypomanic spell, but I think it has ended. It was actually more of a mixed mood, because while I was exhibiting my typical signs of hypomania, I was depressed as well. During these times I have especially jumbled and chaotic thinking (more than normal), decreased ability to concentrate, feelings of work-related stress, increased nervousness and anxiety, restlessness, irritability, higher blood pressure, decreased sleep when I need more sleep, and increased appetite. I also increase the rate at which I pick at my fingers, leaving them raw and bloody sometimes (which warrants a separate post someday). At the same time I have very depressive thoughts which take the form of catastrophizing, lack of self-esteem, pessimism, and obsessive thinking. 

Ironically, I produce some of my best poetry during these times when my creative energy is high but my thoughts are especially dark. I wrote something the other day which is honestly too dark to share right now, but it sits on my computer as a reminder of my thought process at the time.

I had an appointment with my psychiatrist during the middle of this phase, and it was very stressful for me. First he took my blood pressure, and it was 162 over 105, which is not good; I take medicine to control my BP, and usually it is much lower. I told him I wasn’t surprised; I tried to explain what was going on, and tried to discuss ADD symptoms (another future post), but I wasn’t expressing myself very clearly. In addition he had three med students in the room (all females), and it was a little distracting with them listening. Then there was a banging on the roof, which kept taking my attention away from the moment. He worked with me though, made an adjustment to my medication, and I felt better as I left. 

However … I wondered if the P-doc and the students talked about my case, and it bothers me not knowing, but obviously I’m making too big a deal out of it if it is still on my mind. I overanalyze and obsess over every social situation, because I feel like I fuck up most of my interactions with people. I feel like I said the wrong thing, or I was misunderstood, or that they are judging me afterward (the worst). I always wish I could think about it, then go back to the situation and fix whatever I did poorly the first time (as if that would work).

high inquisitor

I have questioned my memory of the person I was in the past. I think I was a decent person, but at the same time broken, awkward, and angry due to the years of abuse. I tend to remember the worst of who I was and how I treated people, and I remember the stupid things I did because of early-onset bipolar. These feelings happen during my depressive moods, and I have a difficult time escaping the darkness that envelops my thought processes.

I have this irrational desire to question my old friends to find out what I was like from their perspective and see how terrible a person I really was. I found something I wrote here during a depressive spiral in 2011:

I keep going back to my memory to try to find the answers on my own, but I need [old friends’] testimony as evidence to build the case against myself. I want to know if they remember everything the way I do, if their story checks out with the alleged facts in my mind. I have to know what they were thinking or feeling at the time, why they did what they did, why they cared about me in the first place, what I did to drive them away, … and why they decided they could no longer trust me. I need them to tell me how badly I hurt them, and if those scars remain, and if they think about those times with sadness or anger. I want them to confirm that I was really the monster I think I was.

I’ve had people from the past tell me they remember me as a basically good person and a good friend who seemed to have things figured out. Maybe I really fooled them, which makes me a disingenuous fraud, or they aren’t being truthful; either way, I don’t believe them. I think they are trying to protect my feelings, trying to be supportive and kind rather than honest. That’s not what I want from them; I want the unvarnished facts, don’t pull your punches, give it to me straight … I can handle the truth.

I want to know … but I don’t know if I have the right to ask these questions. I want to put people I’ve loved through this insane line of questioning even though it might hurt them now more than I ever did before. Sometimes I’m prepared to torture my friends and family to get the truth, and fuck the consequences. … I know I shouldn’t do this, to myself or my loved ones, but I’m still obsessed. I still want to know, even if I have to hurt them to get the answers.

 

I have had to accept that people from my past grew up and let go; they’ve moved on, lived their life, and made their choices … while leaving me in their past. They have forgotten the exact details of that afternoon in 1986, or that weekend in 1989, or that evening in 1993. They don’t remember what song was playing, or what cookies we shared, or where we sat in the grass. They have done what adults do, leaving the details to fade into the background, just remembering the highlights, maybe feeling a little nostalgia when looking at an old yearbook, but then closing the yearbook and coming back to the present.

Sometimes I don’t know how to do that. Sometimes I want to punish myself by examining everything in painful detail, repeatedly analyzing what went wrong and what I could have done to fix it, wishing I could go back and just make a small revision or two, and wanting to find out how the story could have ended.