Manic Depression: A Brief Explanation

authoress in motion, explanations, major depression, medication, rapid-cycle bipolar disorder, self-harm, stigma

I finally got around to editing the explanation video on bipolar disorder/manic depression (I prefer the latter term as I feel it’s more descriptive).

In the video, I talk about the different categories of bipolar disorder, what each phase (from depression to mania and mixed states) is and what it feels like, and tips for dealing with a mixed episode.

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A brief update.

authoress in motion, major depression, medication, rapid-cycle bipolar disorder, three hopeful thoughts

This is just a brief update on my current meds, treatment plan, and moods. If you’re into videos and want to see the authoress in motion, check it out. 🙂

Breaking up is hard to do.

medication, ptsd

I’m considering “breaking up” with my current psychiatrist, and it’s a tougher decision to make than I’d anticipated.

I like her as a person, but I feel as though we’re not meshing that well on the doctor-patient front. My depression has been particularly difficult to get a handle on, and treatments that previously worked (like Cymbalta) have suddenly stopped helping for no apparent reason. Yesterday, I called and left a message for her with my third request for an increase in my Effexor dose.

The first time, I was told to be patient and give it more time. When I met with her the week after I went to the ER for my panic attack and pleaded my case (since missing a dose and having a dose that was probably too low to begin with kicked off that whole mess), she added risperidone and told me she didn’t want to increase the Effexor until we’d given the other drug a chance to work.

It’s been a few weeks and the only thing the antipsychotic has done is make me even more drowsy than usual–I’m like the goddamn Dormouse to begin with, and the only change is that now I’m really sleepy on top of being really depressed. And in my desperation, I’ve found myself turning to some pretty unhealthy methods of coping with the low-mood-negative-thoughts-constantly-wanting-to-cry thing.

I called the office again today to see if my message had gotten through; after I gave the doctor filling in a quick (probably 30 second) summary of what’s been going on, she agreed to call in a small increase to see if it helps. It might not; I might need to try another drug. But at least I felt like my concerns were being heard.

I feel like my regular doctor and I have had this disconnect for a while now, and I plan to address it at our next appointment. She’s not a bad doctor by any stretch of the imagination, though there’s a pretty clear class divide between us (she suggested Weight Watchers, which is too expensive to even contemplate, when I expressed concern/anxiety over my weight, and has recommended name-brand drugs and alternative medicine that I can’t afford multiple times, despite me repeatedly telling her that our budget’s tight as it is–therapy is expensive) and I think that’s causing some issues.

I tend to avoid conflict at all costs, so it’s going to be tough for me to broach the subject. But I feel like she really knows her stuff, so I don’t want to just “dump” her. I want to make sure we’re on the same wavelength and see if things improve from there first. On the other hand, I’ve been stuck with doctors who aren’t willing to listen to my concerns and give me what I need, and I don’t want to fall into that trap again (ask me about the thyroid debacle that went down last year).

Are you avoidant? Have you ever had to break up with a doctor? Tell me about it in the comments!

Another new beginning.

medication, ptsd, stigma, therapy

I’ve decided to use my writerly skillz to document my latest round of treatment for the PTSD and major depressive disorder with the end goal of potentially selling excerpts or actually finally finishing a “book.” I realized that a memoir in the traditional sense would be the wrong move for me right now, since there’s no real resolution yet and I’m not ready to relive all the trauma. I also thought that writing it while I’m undergoing treatment–almost like a diary, but more polished and meant for others to read–will help me gain new insights into my conditions and my treatment as well as helping others understand what living with these disorders is actually like (hint: it’s a daily struggle). Below is the small bit I’ve written so far. As always, comments and questions are loved!

I meet Susan for the first time on a cool, rainy day in early June. We make polite small talk for a few minutes before she asks why I am here. My voice is robotic and well-rehearsed as I summarize nineteen years of trauma in under a minute.

“You’ll like Susan very much,” the on-call therapist had said to me over the phone a week before, trying in vain to calm me down during my first-ever panic attack. And I do–she is young and stylish, hippie-chic in her embroidered flats and colorful scarf. She gazes at me with concerned eyes as we begin discussing my dissociative symptoms. She asks me to describe what a typical episode of derealization is like versus depersonalization,  how long they typically last, how I know I’m having one. I explain the unnerving disconnect from my surroundings and between my mind and body from the moment I wake up each day until I go to bed late each night. This disconnect, this disquieting dreamlike feeling that has existed in varying degrees each day for the last year, is back in full force as I ghost my fingertips over the creamy leather of the armchair, my brain taking a second or two to catch up with the physical sensation, just as it always does.

When Susan speaks, her voice is solemn. “Well, it’s not great.”

I force a laugh in an attempt to chase away the sick churning that has started in the pit of my stomach at her words. It doesn’t work. “Yeah, that’s probably really bad,” I agree, trying to keep my voice casual.

“No,” she replies gently. “I meant that the prognosis doesn’t look great. A whole year of these dissociative symptoms without a break is pretty extreme.” I bite my lip and flick my eyes toward the ceiling, struggling to steady my breathing and ward off tears. This helps me calm myself and I fix my gaze once again on hers, fingers interlaced around one bare knee.

I mention a therapist I saw in June of 2012 who was disturbed by my “flat affect” and thought that any sign of emotion–even uncontrollable sobbing, which I frequently did in her office–was good. She pushed me to reveal too much too soon, and instead of having a dissociative episode that lasted a day or two, I’ve been plagued by feelings of unreality ever since. There is no relief for me, and in this moment, I feel that there never will be, that there is no hope, that the only escape from all this numbness will come when I finally kill myself. But I convince myself that I need to stay positive and tell her that while I understand the prognosis is grim and I understand that we could potentially make things much worse, I still want to try. Any chance at relief is better than living like this.

Susan explains that my defense mechanisms, which were very helpful and kept me alive when I was a child, were likely highly triggered when I was forced to relive the trauma in one massive chunk during therapy. This, she says, is what will make our therapy difficult. She will need to be constantly vigilant, always looking for “cracks” in the facade, little slips of the tongue or small clues that give her an opening into my psyche. If she can get in that way, she says, we can work around the defense mechanisms enough to make progress. As she speaks, I imagine her as a cat burglar dressed in black, shining a tiny pen light into the darkest recesses of my mind. The work will be very slow and therapy will be very difficult, but I mustn’t get discouraged. And above all, we need to trust each other. I need to tell her when I’ve had enough, or perhaps set a limit–fifteen minutes of talking about one topic before “changing the channel” to avoid triggering my defenses is one suggestion, and I readily agree to it. I am so desperate for relief, any relief, that I am willing to agree to anything.

The next day, I see my psychiatrist again. I tell her in a flat, quiet voice how I feel I’m having a relapse of my depression; the Effexor doesn’t seem to be working all that well, and it’s been a year since I last had a complete absence of dissociative symptoms. As I recite these facts, my eye are fixed on the large digital scale sitting in the middle of her office. We talk about different treatment options–she is in favor of Abilify, but I balk at the drug when I learn that there is no generic equivalent. I’d been on Cymbalta for a few months in late 2012 but after I reached my maintenance dose, it stopped working, which was probably just as well; I couldn’t afford the $40-a-month price tag on top of my other bills and medications. We settle on risperidone, which my psychiatrist tells me is a “mood stabilizer” that should help alleviate some of the dissociative symptoms as well. Since it is to be taken at night, she says it may even help me sleep, though she warns me that it can cause weight gain.

She invites me to step onto the scale when I confess that I don’t know my weight; at this point, I haven’t weighed myself in several months, knowing from years of experience that it’s unlikely to go down no matter what I do. Besides, I have just gotten comfortable in my own skin again and don’t want to get hung up on a three-digit number when I have more important things to worry about, such as my rapidly declining emotional state.

I watch, mute, as “154.5” pops up on the little screen in fat black letters. I look at her and shrug, and this time I don’t even have to feign disinterest because for the first time in four years, the number means nothing to me. I sit through a brief lecture about how I’ll need to be re-weighed when I come back in a month, because even a few pounds gained can be a red flag that my body doesn’t like the drug and is likely to put on even more weight if I remain on the risperidone.

She explains that sometimes it takes a while to find the right combination of medication. I nod, we chuckle–silly brain chemistry!–and she sends me away with three prescription sheets and a lopsided little smile. I realize that I’ve just been prescribed an antipsychotic, but it doesn’t bother me. My interest in psychology began when I was a sophomore in high school and continued all the way through college; the term “psychotic features” and the names of various drugs don’t feel scary or threatening, but instead seem like familiar old friends. It occurs to me that perhaps I should be annoyed that my doctor didn’t simply call a spade a spade, but I have other things to focus on, such as navigating through the fog that descends every morning when I wake up.

I begin to see my defense mechanisms as a dragon, something living in the darkest recesses of my mind that I must be very, very careful to tiptoe around; I know from years of experience that waking them up, no matter how innocent my intentions, can have severe consequences.

I spend the day after my psychiatry appointment walking around in a daze. As I apply my makeup before work on Friday morning, I watch my husband in the mirror and jokingly tell him that it feels like being high without the benefits of actually being high. He smiles, but there’s something serious in his eyes; he knows it’s not a joke at all and that this weird detached feeling has become my new reality. It’s difficult for me, but it’s more of an annoyance than anything–something else to deal with. I can’t imagine what having a sick wife must be like for him. I worry that I’m turning him into a tragic Leonard Woolf type, but I feel helpless to stop it.