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You Want Me To Take WHAT!?

July 4, 2013

…..was the first thing out of my mouth when the on-call psych resident said she was prescribing Zyprexa for me during an acute manic episode last summer. As a nurse, I’ve given the drug to many people over the course of my career, but up to that point I’d never dreamed that I would need such a medication myself. Although I knew on some level that I DID need one (and badly), I couldn’t help getting hung up on the term antipsychotic and I immediately went into denial mode.

“But I’m not psychotic,” I protested. “I’m just a little out of control and I’m starting to freak out.” A little out of control didn’t even begin to cover it. The day before, I’d harangued a co-worker who’d had the misfortune to express interest in my experience with bipolar disorder…..for well over an hour. I couldn’t sit still during a staff meeting and got the giggles so badly at one point that I was asked to leave. I was so giddy that people were staring at me like I’d suddenly sprouted three heads, and so irritable that even the phone ringing on my desk sent me into a blinding rage. And then there’d been the 20 minutes I’d spent explaining to the office manager why re-electing President Obama would destroy what was left of our nation.

Psychotic behavior? Hardly. However, I was aware that I was not in total control of my faculties, and I desperately needed to sleep after having gotten maybe 12 hours of shut-eye in 4 or 5 days. So I accepted the prescription, picked it up at the pharmacy, and sat down to contemplate how it had come to this.

Now, I knew that one does not have to be certifiably street-rat crazy to need an AP. But I have this alarming tendency to go completely stupid when some medical calamity happens to me; the same thing happened when I was diagnosed with diabetes. Here I’d taken care of literally hundreds of diabetics during my career, but when I became the patient, I suddenly forgot everything I knew and had to start over again, as if I’d never learned it to start with.

And so it was with the idea that I needed an AP to bring me down off this manic episode. The Zyprexa turned out to be a godsend; not only did I escape hospitalization, it brought me down quickly enough that I only missed four days of work. It worked so well, in fact, that I stayed on it for several months, even though it was originally intended as a PRN (as needed) for agitation associated with mania. Unfortunately, it had to be discontinued for sending both my weight and blood sugar levels into the stratosphere, and for awhile I bumped along without an AP at all.

This, however, lulled both my pdoc and me into a false sense of security that my illness could be well-managed without one. By February I was manic as hell again, I wasn’t sleeping, and I’d become an expert at pissing people off with my razor-sharp tongue and lack of filters. So we agreed to try a baby dose of a different medication that wasn’t as apt to screw around with my blood sugars or put on weight, and that’s how I wound up on my current AP.

But it wasn’t until the mixed mood episode from Hell that Geodon really proved its worth and cemented its place in my treatment program. The downside to that (besides the cost!) is that I really CAN’T control my illness without an AP, and I wish this weren’t the case. I’d prefer to believe that I have only a mild form of the condition, but of course if that were true I wouldn’t need four different drugs to muzzle it. Even now, I can feel the summertime crazies simmering just below the surface, but the AP is suppressing the worst symptoms and only allowing a bit of hypomania to escape.

That’s a big difference from last summer, before I discovered how valuable these drugs can be and how serious my symptoms can get when I’m not taking one. Sometimes I can’t help comparing my regimen with those of the other people in my support group and feeling a little envious of the folks who I think are worse off than I am, but who manage without having to take APs. Then I remember how conservative my doctor is with medications, and realize I’d probably be a zombie if somebody else were prescribing for me because my case isn’t as minor as I want to think it is. Can anyone say reality check?

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