Now that the fever of mania has broken and my thoughts are clumping back together again, I can finally take a few calm moments to discuss some of the finer points of the medications that help to keep folks like me from diving out a 14th-story window or spending every single dime they’ll ever make in their lifetimes.
For somebody with a relatively brief psychiatric history, I’ve got a LOT of experience with meds. Just about the only ones I haven’t tried are lithium, the older anti-psychotics like Haldol, and some of the anti-seizure meds that they also use as mood stabilizers in bipolar disorder. At this moment in time, I’m using five different medications to tame my own BP monster: Lamictal (mood stabilizer), Klonopin (anti-anxiety), Zyprexa and Geodon (both anti-psychotics), and the occasional Ativan for breakthrough anxiety. And that’s without the anti-depressant I just came off (and which may be restarted if I can’t get out of a depression on my own).
Ah, anti-depressants……the bane of the psychiatrist’s existence. Some doctors, including mine, are reluctant to use them in bipolar patients because of the risk they pose for inducing mania; however, they can be extremely valuable in cases where the usual treatments, like a combination of a mood stabilizer and an AP, aren’t enough. The main problem with these—besides provoking manic episodes—is the unpleasantness of withdrawal, which is known by the politically correct name of discontinuation syndrome.
This can include weird sensations like ‘brain zaps’ and numbness or tingling in different areas of the body…..hell, I could write you a book on that, because I’ve done it multiple times and wound up a hot, weepy, pissed-off mess every time. But although it hasn’t been pleasant, this one has (so far) been the easiest withdrawal I’ve ever been through, mainly because my brain seems to be much more interested in the extra mood stabilizer and the anti-psychotics I’m feeding it; in fact, I’m not sure it’s even noticed that the Celexa is gone.
Speaking of mood stabilizers: I’ve been on Lamictal for almost two years now. It was my very first bipolar medication, and it’s the one I always think doesn’t do anything until the dosage goes up. Then suddenly it’s like “Thanks, I needed that!” Ironically, it’s also the one I’m most afraid of dinking around with, because on some level I know darn well how much better life has been since I started taking it. I’m on quite a bit of the stuff—typical dose is 150-200 mg/day and I’m taking 300—but if it pulls everything else together, I’m happy.
And speaking of pulling everything else together……for me, treatment is a lot like a standing on a four-legged stool: I can manage without one of those legs, but try yanking a second and I’m going to be sprawled flat on my assets in the dirt. I know. I’ve seen me do it.
Then there are the anti-psychotics, which sound like something straight out of “One Flew Over The Cuckoo’s Nest”; it took me awhile to stop getting hung up on the name. While a lot of BPs can manage their illness while using them on a PRN (as-needed) basis—and some never need them at all—I am not one of them, so I’ve had to learn to think of the drugs as mood stabilizers, which is indeed their function in bipolar disorder.
This is one of those times that it’s good to be a healthcare provider, because the half-dozen pages of literature that come with the pills every time I fill the scripts are full of dire warnings that would scare the daylights out of the average patient. It starts with a blurb about what conditions the drug is used to treat (schizophrenia and bipolar 1……and we all know I’m not schizophrenic. Right?) and goes into absolutely everything that can possibly go wrong during treatment. It ain’t pretty. But I take those meds because the alternative is worse.
And then there’s my beloved Klonopin, the anxiolytic (anti-anxiety med) of choice for someone who was born nervous and only got worse with age. I still have the old standard, Ativan, as a backup in case the ‘Vitamin K’ doesn’t hold me, but I seldom need to use it. There are few things more frightening than a full-blown panic attack—your throat feels like it’s closing up, your heart pounds and you feel short of breath, and there’s this indescribable sense of impending doom…..like you could die at any moment. I’ve gotten so bad during a couple of mine that I saw black spots appear in front of my eyes and thought I was going to faint. I’ve said a few times that if I were ever to attempt suicide, it wouldn’t be during a manic or depressive episode, but rather during a time of extreme anxiety, because that is the only emotion I cannot tolerate for more than a short while.
Klonopin prevents all of that. One half-milligram tablet is all I need most of the time to keep both the panic attacks and my chronic anxiety down to a dull roar. It’s also some of the cheapest mental healthcare on the planet: I pay less than five bucks for a month’s supply.
So, that’s a little bit about the meds that keep me sane (most of the time anyway). What are yours?