Not so well

I wish I could say I used this blog more but as usual it is spasmodic. I am still in a patch of depression that is hard to bear. It’s like any life or fun has been sucked out of life for the last 8 weeks. I feel only connected to life by the love of my family and a kind of weird obligation to my work. Outside of this I just think of dying, darkness and self harm. on really bad days I write notes, pick dates and contemplate methods. Even on better days things are just flat and gray. I find it next to impossible to laugh and struggle to make conversation with all but those I absolutely need to, which makes it hard to feel like you even belong on this earth. Even things that I am normally fanatical about like kayaking i am not feeling confident or happy about.

My meds for depression it seems are maybe at too low a dose. Bupropion in Australia is only approved for smoking cessation at a reasonable price, but for depression at the very low dose of 150 mg it costs $70 per month, if you need a higher dose… you do the maths, it is unaffordable. The vagaries of this are hard to communicate with psychiatrists, a bit easier with psychologists and next to impossible to verbalise to even those you love. In the meantime what can you do, try to put up a brittle front and hope it passes soon.

Feeling Better

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It has been quite a while since I last posted, this could mean one of two possible bipolar scenarios I guess. The feeling worse whether by elevation or depression position the feeling better position. Fortunately for me it has been the latter. Why has it happened firstly I bit the bullet and went for my first foray into the world of  private psychiatrists. It has been my good luck to get in with a Doctor who is well respected and skilled. He started off by looking at my Lithium levels, they were only o.5 which he said was inadequate, he has now upped the Lithium dosage  in a slow release form, and will be looking to continue to do this until my levels are closer to 0.8 or higher. He mentioned that Lithium at higher levels has an antidepressant action, something I was not aware of. He also checked to see when I had discontinued  Pristiq (perhaps the most useless antidepressant I have ever been prescribed) to see if I could safely take Bupropion AKA Zyban in Australia.

The commencement on Zyban has exactly matched a sustained and definite improvement in my mood. At first I also experienced some diarrhea and irritability, both of which have now passed. Zyban is quite unique (atypical) in its structure, it is actually a substituted amphetamine derivative that targets the dopamine and norepinephrine receptors, unlike most of the others which prefer seretonin  and or norepinephrine receptors.

When he prescribed it he was quick to say that the major downside of Zyban is the cost ($70 per month) as it is only covered in Australia under the PBS if used for purposes of smoking cessation. This is completely different to the US where Bupropion (Wellbutrin) as in the top 3 most prescribed antidepressants. My Doctor also informed me that it was one of the best antidepressants in terms of research data affirming its efficacy. So why isn’t it on the PBS for depression… its hard to say, I guess Governments take the attitude that there are so many other drugs approved for depression that another one is not necessarily needed. In any case it’s great to be feeling well at any cost and it just may be worth an email to the powersthat be to find out why.

Current meds: Lithium 1350mg, Zyban 150mg and Zyprexa 10mg… hoping to knock off the Zyprexa to just for emergencies soon!

And so the wheel turns

The medication wheel turns again,  after a really bad run of depression my psychiiatrist has reversed his “antidepressants cause rapid cycling” rule and lashed out with a prescription for Pristiq. I have no experience with this medication, only its cousin Effexor (the compulsive gambling drug). My memories of it are a bit splintered but as I recall it wasn’t that effective, still I am open to Pristiq. Personally my choice would have been Parnate… old fashioned I know, dietary restrictions as well but supposedly great for bipolar depression. Currently my meds are:

  • Lithium 125omg
  • Lamotrigine 150mg
  • Seroquel 100mg (PRN)
  • Olanzepine 10mg
  • Pristiq 50mg
  • Fish Oil and sometimes SAMe

For me bipolar depression is like everything fading to grey, the point of life just evaporates and you become an empty shell, incapable of effective communication even with friends and so lethargic you need 2-3 coffees or Red Bulls to get going in the morning. Staying in bed is not an option, sick leave is limited and money is needed to keep us afloat. The doctors always seem to worry about Mania and Hypomania but dismiss for some reason the depression as a lesser thing. THEY DON’T HAVE TO LIVE IT!!

So much depends on your doctor’s approach, a conservative doctor like mine will hover very closely to lithium, maybe lamotrigine and reach for the antipsychotics frequently. Personally I’m sick of antipsychotics with their sedation, hangovers, weight gain and other side effects. I am lucky though that he has referred me for a review at the Black Dog Institute who specialise in mood disorders and in particular those that do not respond well to conventional treatments.

My wife pointed me to the following site, probably familiar to many but really interesting:

http://www.madambipolar.com/2012/07/5-treatments-for-bipolar-depression-you.html

The therapies here sound exciting, now to find a doctor with the spine to think out of the box and try one of these.

Half a Bag of Cement

What weighs about 15kg… my 2 year old son or half a bag of cement… or the amount of weight I have gained since starting Zyprexa.  I have been taking this drug now for about 4 months so this represents quite a gain in weight, I am active, I whitewater kayak regularly, run and ride my bike to work, my diet isn’t perfect but it is not terrible either yet still I keep gaining weight. It is starting to become a stressor in its own right because it is starting to interfere with exercise a bit and with mood perhaps now to a lessor extent… but 2 months ago it was starting to emerge as a trigger for feeling depressed. My Doctor says that Olanzepine drives appetite up…. something I remember from when I used to take Avanza, but she also says it does the deadly weight gain double and slows the metabolism as well as driving appetite.

So what does this mean… I feel a bit trapped now, I have come to depend somewhat on Olanzepine to manage breakthrough episodes of both manic and especially depressive symptoms. It really is a good drug and in my humble opinion a bit better than Seroquel . I find it however really hard to reign in my appetite, eating has become a compulsion even if it is mainly healthy stuff, and regardless of the exercise I still am slowly getting heavier. I will be seeing a dietician and my GP next week but I really wonder what good it will do, short of discontinuing Zyprexa I just don’t see an answer.

 

Euthymia and Lamotrigine

Finally after 6 months of rapid cycling I can see some manner of light at the end of the tunnel that isn’t the light of an incoming train. For the past 3 weeks I have experienced the beginnings of what I hope to be sustained Euthymia. What triggered it after so long rapid cycling is a little hard to definitely define but it is highly likely that the combination of removing antidepressant medication from my treatments, increasing the amount of regular exercise I do and most importantly the addition of Lamotrigine to compliment my lithium and olanzepine therapy. I am now up to 75mg of Lamotrigine after starting at 12.5mg and am having no problems with the dreaded rash. the tipping point seemed to come at 37.5 mg when I started to string a few stable days together, by the time it hit 50mg there was a clear pattern emerging.

So there it is, there is an end to rapid cycling, and brittle mood states for my bipolar. In particular the removal of periodic serious depression on regular intervals has been very comforting and liberating. It is early days but quite exciting to feel a bit more normal than I have since leaving hospital.

Quote for the day

Received this at work today… seemed quite profound and not spammy so I thhought it would be safe to propogate… if not safe at least it is nice writing 😉

“My other piece of advice, Copperfield,” said Mr Micawber, “you know. Annual income twenty pounds, annual expenditure nineteen pounds nineteen shillings and six pence, result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery. The blossom is blighted, the leaf is withered, the god of day goes down upon the dreary scene, and, in short, you are for ever floored. As I am!”
–David Copperfield, Charles Dickens

Spanxiety

Here’s a picture that arose from a psychologists session where the practitioner got me to visualize what anxiety looked like for me.

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For me anxiety feels like a few things…. My first image is a rotating fine steel brush being run around my insides, constantly without rest or respite, and hard to work with in therapy. My psychologist got me to revisualise the feeling, this time it came up as a spiky bubble floating around on my insides. At peak times and panic attacks the bubble expands and rotates, rubbing away my being from the inside. The good thing with this image for me is that it is a bubble that with relaxation and concentration and even medication can be deflated when things get bad.

Mash Up MAOI

Feeling very messy today, it is day four of the slide into the black abyss. All I want to do is eat sleep and think about dying. Its not like I want to its

just like seemingly every 14 days a lack veil of toxic fog descends from above, seeps in through my pores, my alveoli and anywhere else It can get in. The implausibly destructive and negative becomes plausible… fixating. Socially and emotionally like a hermit crab I retreat into the darkness of my cramped and dank shell… and wait. Things from the past that cement the thought of how crap I am take root and grow, splitting the bedrock of my being. So tiring, so tired of life… but deep down somewhere is a thread that says keep going it is worth it.

In all of this I make vague attempts at rationalizing my treatment. Researching for the hope of a magic bullet. Given the numerous depressive incidences I’ve had in the last 3 months I have been on Fluoxetine I think even without the benefit of a degree in Psychiatry I can safely say it is not working. Can’t go back to Lamotrigine, dont want to go back on Ritalin… options seem be running out. Thinking about asking Dr “Cold Distant” if he could try me on Deprenyl, its meant to work for depression and ADHD. I won’t hold my breath, he’s not one to listen to his patients, anyway heres hoping. Would really love to know if anyone has been prescribed a MAOI type drug for Bipolar depression and or ADHD, and how it went. Any advice would really help.

Abcd BPD, hijk ADHD

Feeling lost, tired and empty, bipolar depression never ceases to hit me like a cricket bat to the head. For me you know the depression is really bad when even after last monday’s whitewater paddle there was no discernable lift in my mood. This is day 4 of this episode, hope things change soon. I still struggle to understand this illness, so many questions… but the two that really puzzle me are

Why after so many years on a long cycle punctuated by euthymia do I now find myself rapid cycling on a fortnightly basis?

Why can the doctors only control the ups and not the low moods?

After a short trial of IR Ritalin, we have decided to not treat the ADHD. Whilst it did help my concentration, especially during low mood states when it is at its worst… it did so at a cost.  It seemed to cause a degree of agitation, put me off my food and give me pronounced tinnitus.

Currently my meds sit at:

  • Lithium 1250mg
  • Olanzepine 10mg
  • Fluoxetine 20mg
  • Quetiapine PRN

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I am also struggling with change in my care in the public health system. Doctor 1 considered increasing seroquel to be the answer to all problems and was generally disinterested, doctor 2 was visionary and experimental, but shortlived leaving me with doctor 3 who is super conservative, rude and cold. Similar with my case workers, I have gone (without warning) from a highly medical minded nurse to a somewhat vague but nice enough psychology graduate on part time placement.

Somewhere inside am hoping things will change, my cycles will get longer and that a suitable treatment for the depression will materialize, but for the moment I am stuck in depression’s quagmire until further notice.

Ritalin 20

Is been four days now since I commenced on medication for ADHD, on the balance of things it has been somewhat of a revelation on some respects. Despite what my Dr and case worker said nothing really prepared me for what can only be a flood of information, spoken, textural and meta-language that I had missing. All of a sudden a conversation with more than one person has become easier, I can sustain attention and maintain its thread. My timing and ability to find words and overcome verbal stumbles with humour and confidence too has improved. It is still early days but even things like driving and being more present and in the moment when I have been playing with my kids or rocking the baby to sleep have also improved.

It is way too early to see how it impacts my Bipolar…. in fact I would be really interested to know if anyone else has issues with worsened bipolar symptoms due to their ADHD meds. The major side effects seem to be increased anxiety and hand tremors…. and thrice daily dosing which is a major pain. My doctor informs me that in order to get a long acting version of Ritalin (at subsidised PBS pricing) is to “fail with the immediate release medication. He was however unclear on how one actually fails.

I guess the biggest hurdle regarding ADHD and its medication in the diagnosis and commencement of treatment process has been stigmatisation. I am at a point where I feel happy to be open and forthcoming about being bipolar, however this blog excepted revealing or discussing ADHD is much harder. In my work I have come across many people with ADHD, some will freely admit drug seeking and doctor shopping, others describe how useful the medication has been for their lives… for these people (unlike myself) either way I do not judge… it is neither me or what is expected in my work.