Wednesday, July 11, 2018

Making a Bipolar Type II Instruction Manual: Part 2 'Zombie Balloon & the Dragon'

Dear Lamotrigine (brand name Lamictal),

Where've you been all my adult life?
Where were you when I couldn't move for an hour or two because of paralytic depression or when I only made myself move because the kid needed a peanut butter sammie and it was like walking uphill with lead boots and the air was viscous?

Thing about trying to write a tongue-in-cheek bipolar guidebook as you navigate the treatment is the treatment is a fucking hellscape in the beginning.

The first medicine we tried was quetiapine (Seroquel). I was a floating weird zombie for a couple of days and the constant leg and feet motion thing I have became a horrible beast trying to crawl its way out of my skin. That segued into a hypomanic episode that skirted the edges of actual mania and I just... NOPE. Not my drug.

So S switched me to lamotrigine. This is one that has to be titrated up to the full dose. (That's like weaning but backward if you're not a spoonie who needs a whole box or tiny cute briefcase for her meds.) At 25mg I felt no difference at all which, after a week and a half as a Twitchy Zombie Balloon was fine.

Then it was time to double that dose and I was scared. Having been through medicine triggered mania twice in the past few months I just wanted to burrow away and never deal with bipolar ever again and rewind and just be not diagnosed and pretend I was still a "regular" depressive who can't focus on anything ever ever ever.

But I reminded myself of the times I went off my SSRIs.
The severity of my mood dysregulation.
How badly my lack of concentration is affecting my life.
The fact that lamotrigine can help headaches. (!!!)
That stress is the cause of tension headache. (Right there on the tin.)

So I doubled my dose, and lo—

There were no initial adverse effects. And slowly it dawned upon me that HEY most (I'll get to that) of my emotions are appropriate in type and severity to the situation.

For me.

They're still pretty fucking extra, which is good. Because I am an EXTRA BITCH. And I was terrified that treatment would turn me into some bland robo-Heidi. Meaning some not-Heidi.

The only thing is... I'm angry. I'm like mythically angry. I went Dragon on a friend this weekend and after apologizing I was telling him I don't have a "mildly annoyed" register anymore. I just get royally pissed and instead of locking that shit down in the name of Hurt No One's Feelings Ever I just unleash all the fury of Hell upon the world.

It feels like a volcano that's been stoppered for forty years, all the lava and steam held in. Then the cork popped and oops, it seems it's a bottomless volcano that goes to the very mantle of the earth and cannot be stopped.

I used to be so confrontation-averse and now I just breathe fire and lava everywhere and I'm having quite a lot of trouble processing this.

While I'm extremely proud of the strength of this Dragon self, I take no pleasure in being hurtful. And the goal is to feel and express emotions apprortiately. But I don't really know what appropriate anger looks like for me. And yeah—I'm still waiting to get into a therapist.

I read, and it tickles me, that this sort of compartmentalization thing—calling my angry self The Dragon, for instance—is a dissociative thing that's common with bipolar people.

So that's where I am now: Still Extra as Fuck but far less depressed and people now whisper in my fiery wake, "Don't Poke the Dragon."

Tuesday, July 10, 2018

Tuesday Noon, a poem for mom

You took a last breath
with summer light reaching
in a hundred horizons
through slats in window shades.

It was a Tuesday noon
and the sun arranged
that just for you, collector of pretty
sunshine things & cobalt blue.

Seventeen years on and
I can’t breathe when the day
comes around, impossible still

as the sun
setting at noon.


for mom, 2018

(c) Heidi Richardson Evans

Wednesday, June 13, 2018

Making A Bipolar Type II Instruction Manual in Real Time: Chapter 1 'Let's Do Get Help'

Trigger Warning: anxiety, depression
brief mention of suicidal ideation

So, I disappear from the blog pretty often because the PC is the Evil Blue Light Emitting Box of Headache Triggering Badness. The headaches are under much better control lately but I super disappeared for a while anyway.

I needed to have some downtime. I was gathering myself to write about an experience I had this spring. I’m not delving deep right now, just acknowledging that it happened.

I had a psych crisis in April and had to be hospitalized for a few days. I was extremely unstable and it had been building for a while, but the past few years things have been notably worse. The nearly constant pain of the headaches tipped me into what was like something I’ve never really felt this intensely before. My always-mercurial moods were changing to extremes I couldn’t navigate, cycling between numb paralytic depression to a severe panic attack to dissociative states within a few minutes. It was terrifying.

Me, pretty much all of March and April. Fun.
It really sucked goat balls in there, but I met some incredible people. Mostly they were patients. Please note my extreme shade at the doctors and nurses. Story for another time.

Anyway, I got stabilized back to the normal I’d been used to of late. Which is to say, not very, but I wasn’t obsessively thinking of self-harm. So I got to be not in a psych hospital on my birthday, which was a peachy keen treat.

Obviously I needed follow-up care. I called around and found a treatment center that would see me based on income because my copays even with my Medicare are FUCKING INSANE. 

I had to wait two months for the new therapist, and I was scared shitless. Remember the extreme shade I threw at the doctor from the clinic? She'd given me a drug from a class I'd told her explicitly I couldn't take, and it threw me into a manic episode. It was horrible so I was feeling extra skittish about new psych practices.

But obviously treatment was necessary.

Being my obsessive geek self, I couldn't stop thinking how this scene perfectly illustrated my hesitance about seeking treatment:


So I let my rational self hurl my crazy at S, my new psychiatric NP.

And holy fucking shit.

I didn't expect to see a new psychiatric provider and just jump neurodivergent spectrums at age 42.

I expected to hear that my ADHD had become far, far worse than it's ever been and that maybe some (or even most?) of my anxiety symptoms were actually sneaky hyperactivity impulses being thwarted by a body that can't be in motion as much as a body should be.

I've always crashed over social norms during conversations like a hundred caffeinated bulls in a hundred earthquaking china shops, so yeah, I suspected my ADHD was very, very out of hand.

But stimulant medications for ADHD don't work for me because of my generalized anxiety disorder. No questioning the diagnosis: I have the characteristics; the treatment just doesn't work. It happens.

So I was nervous energy tweeting as I approached appointment time, and I shared my Thor & Loki "Get Help" scene, then tweeted my three diagnoses, ADHD, anxiety, and depression. People have multiple diagnoses. Whatever.

I definitely did not expect to hear what S, my new nurse practitioner, told me. Within two minutes she said she thought I was bipolar type two, anxious distressed. She went through a good, thorough interview to confim and the diagnosis fits like the DSM sees into my brain.

So to be clear: My surprise isn't because the diagnosis doesn't make so much sense. I'm surprised because I'd suspected I was bipolar back in college, and my psychiatrist then was adamant that I wasn't. Therapists and other psychiatrists over the years supported that, so I closed that door in my mind.

But when she said it, it was a key fitting into place with a perfect series of clicks, tumblers lining up and everything falling into place.

Bipolar Type II is very hard to nail down, it turns out, and it's extremely common for depressives to be diagnosed with it later. S told me it often shows up as an epic breakdown in the twenties or forties and I had both. (She was pretty salty about the fact that it's so common but practitioners are so hesitant to diagnose it.)

It's a wild fucking ride already and I've had all of two days for the information to sink in. I really want an instruction manual for this shit and there isn't one. So hey. I'm going to share what I can (as I do) and maybe someone else finds this relatable.