Power of a pill

When you have a chronic illness you understand the importance of taking your medications as prescribed.

The trouble with some illnesses, such as bipolar disorder, is that the medications and dosages required to keep you well can change over time.

Finding the correct dosage can be tricky and when you do find that magic prescription you certainly don’t want to mess with it.

From my experience with bipolar disorder every psychiatrist has his or her own opinion about what medications work best and how you need to tapper off of, or alter, medications as needed.

I have been seeing a resident psychiatrist. Every visit I would see the resident and the he would tell me his thoughts on my medication and then an attending physician would come in and tell me what he or she thought. Most visits I would have the same resident, but the attending, who had the final say on my treatment plan, always changed. And so did my treatment plan. This became worrisome when I decided that I wanted to get off of my medications to try and conceive.

Some docs prefer a more conservative approach while others shrug off the idea of getting off my meds for pregnancy as no biggie. Typically the doctors I saw who were more easy going about getting off my meds were new male residents.

I knew I needed to find an experienced psychiatrists who was female. I thought I female doctor would take my concerns about pregnancy more serious than a male doctor. I realize just how sexists that sounds. And I acknowledge it is in fact sexists.

I’m okay with my sexism because I know that a female doctor works best for me. Trying to have a baby is a complex, emotional issue. Particularly if you have health problems that stand in the way. I admire people who can just get pregnant on a whim without thought to how it will play out. I am not one of those women. Even if I didn’t have bipolar disorder I would not be one of those women. It’s just not my personality.

For over seven years I relied solely on lithium to manage my moods. It worked great, but a several months ago my anxiety and depression seemed to need more than lithium. I got on 50 mg of Zoloft, which seemed to do the trick for a while.

After a few months on the 50 mg, my depression started to creep back and seemed to be even worse than before. I felt on edge at work and drained when I came home, crying at the drop of a hat.

The resident I saw during this bout increased my dose of Zoloft to 100 mg. This complemented the 900 mg of lithium I took daily.

The extra Zoloft made me feel happy, really happy. Soon I felt elated and decided that I should get off the antidepressant. After all, it would be one less thing to worry about when I decided to get off all of my medications to conceive.

I tapered off of the Zoloft in about week. A day after my last dosage, I felt amazing. My therapist classified me as hypomanic but warned me that coming off of the Zoloft could have side effects.

Two days later my mental state completely collapsed. Nothing could motivate me and I couldn’t stop crying. It seemed as though I had dove head first into a deep depression.

After only three days of this depressive state I found myself in a dry heave style of crying. I had put out calls to my doctor, but they weren’t returned. I decided to go back on the Zolft at 50 mg (and get another doctor).

Within a day I felt like myself again, not depressed or elated, just myself.

I never realized what dramatic impacts such subtle shifts in my medications can cause. Now that I am back to myself I’m hesitant to change my medications again. I know I will have to before I can conceive, but I will never again take for granted the power of these pills.

Mania's seductive high

Sometimes on the weekends my husband and I like to veg out by watching random documentaries and trashy reality shows. And by sometimes, I mean nearly every weekend.

Last weekend we watched a marathon of Drugs Inc. on the National Geographic Channel. Episode after episode we watched people trying to chase the high they remember from their first time. Some of the episodes featured drugs I had never even heard of.

I have never been adventurous when it comes to experimenting with drugs but I have experienced the rush and intensity of mind altering highs.

Mania and hypomania are a natural, and often unavoidable high, those of us with bipolar experience.

I, ever the conscientious person, always alert my therapist and doctor when I start to feel the buzz of hypomania. After being hospitalized in 2005 after a full blown manic episode I am determined to avoid mania at all cost.

But things have changed in my life. With the comfort and trust of a husband and the absence of a full-time job, I felt that a little hypomanic joy couldn’t hurt anybody.

When I noticed my mood start to escalate, I didn’t have the urge to call my doctor and ask if my lithium should be increased. Instead I embraced the urge the laugh, shop, dance, have sex (with my husband), drink wine and be happy. Really happy. 

I started to wonder if maybe my giddiness might be a symptom of hypomania. My thoughts were also becoming more rapid.

I worried my last post about the pair of red corduroy pants embroidered with dogs that I recently bought my husband might be a sign that I hypomanic. Maybe, just maybe.

I thought my increased sex drive might be a sign. Perhaps, but my husband certainly wasn’t going to complain about that.

I blamed Christmas on my increased shopping and relished in the creativity my rapid thoughts produced.

When I started annotating 50 Shades of Grey for theological themes and cultural trends, I knew I had a problem.

Still, I didn’t want to lose the joy and insight my hypomanic buzz provided.

When you are manic or hypomanic, it’s as though you are looking at the night’s sky and the more manic you become the more constellations you are able to see, the more the dots connect, the more intense your happiness becomes. When you are manic the world is yours. And who wants to give that up?

My therapists picked up on my hypomania at our recent session. The longer I spoke, the more obvious it became.

She recommended that I talk to my doctor about increasing my lithium levels and told me I should cancel my plans to hit up the flea markets after our session.

You should not be shopping right now, she warned.

I made an appointment to follow up with my therapist in about a week and requested that my doctor (or his nurse) call to discuss changing my lithium dosage.

There, I thought, I did the responsible thing. There is no reason why I should not go to the flea markets. I had $40 cash burning a hole in my pocket.

My mind began to flood with all of the vintage home goods I could find. I had to go to the flea markets. I had to.

Then I paused.

No, I reminded myself. I don’t have to. I am still in control.

And that is the difference (or rather one of the differences) between mania and hypomania. When you are hypomanic you still have a certain amount of control. When you are manic you have no control. When you are manic you are captive to manic impulses and urges.

In the battle of bipolar disorder when you are hypomanic you still have the opportunity to retreat.

And that’s what I decided to do. I retreated. I didn’t go shopping. I talked to the nurse. I came home, cleared my thoughts and wrote this blog.

Battling the beast of mania, trying to chase that high, can be sad and descriptive as the lives I saw on Drugs Inc. It’s a battle I don’t want to fight. So today, I chose to retreat.

There but for the grace of God, and lithium, go I.