The sleep disorder didn’t exactly bring on the Bipolar disorder; as the sleep specialist, who was also a psychiatrist, said, they have no idea why this happens but it does, and without fail – there is much documentation on this…I’ve checked. I was diagnosed in a teaching hospital and spent hours in the medical library, searching through texts and publications from years ago, and everything up-to-date. It is because the disorder was diagnosed relatively late in life…in my early forties…that I had been clinically depressed for much of my life and on many courses of anti-depressants, even had done some types of heavy-duty therapy by this time, having been suicidal more than once, I was text-book perfect for this configuration.
As this Dr. said, they didn’t know why it happened but as they tried to treat my sleep disorder, plus pull me out of my deep depression – he could almost guarantee, I would be Bipolar within a year. And I was. I have Bipolar 2 disorder and have done enough research myself, and enough therapy, and been on enough drug trials to know where I am with the disorder now, I believe.
The doctor that diagnosed me is long retired. At one time, grown frustrated with my treatment, he suggested I try to become a candidate for the Bipolar Clinic, another division in the same teaching department where I was originally diagnosed. We both worried that my sleep disorder might negate any chances for entry there. However, the head of that clinic relished the challenge, so I bounced around there for several years, “training Residents” as the secretary liked to tell me, every time there was a change-up in who was handling my treatment.
I was pretty optimistic when I started there, thinking I’d have access to the newest treatments, and also the newest drugs etc. It was not a good time. I didn’t realize that the Residents would be able to dictate much of what happened to me, and if I was very ill, and much of the time I was, they fiddled around with my cocktail to such an extent that I became much worse, and no-one seemed to know what was happening. Thank heavens my husband was paying attention. He finally insisted on coming in with me and asking the head of the department what the ultimate outcome was supposed to be for me…was I supposed to get well? Stay out hospital? What?
It’s very interesting when someone sane takes over for someone presumed, not sane – and speaks up for them. I was assigned a “real psychiatrist” then and put in hospital finally, and we started to work together trying to sort out what would work for me. It still wasn’t ideal, but it was way better than it had been. And I was out of the clinic which wasn’t working for me at all. (One thing the new psychiatrist brought to my attention was that I was probably entitled to disability benefits from the government – she had asked me what were some of the things that kept me depressed – not enough money and feeling guilty about not being able to work was high on the list and she said matter-of-factly that I had my benefits though, right? Ah, no…never realized I was entitled. I applied and not only got them, but got them retroactively so got a big fat cheque just as we moved into our new house…that was a boost in so many ways.)
During all this time, I myself kept meticulous records of what medications did and didn’t work for me, and started protesting when doctors took me off things that worked and putting me on things that I knew didn’t work. I think I did this because I noticed when I protested something to one of the staff, I realized their records sucked…they either didn’t write things down, or their writing was illegible, or they were in such a hurry they often wrote things down incorrectly. Maybe it was way back then that I realized instinctively I was going to have to be responsible for my own mental health.
It was also during this time that I learned about Buproprion (from an ad in Psychology Today or some such – aka Wellbutrin, Zyban etc – the only antidepressant I’d heard of that didn’t have a drowsiness component, still is.) At that time, it was used to help people stop smoking but it was being considered for depressives. I asked if I could try it. I researched it myself and learned that it worked on the noradrenals, and somewhat on serontonin – a sister drug to Effexor but without any sedative properties (at that point, Effexor had come closest to helping me, but still made me drowsy).
Wellbutrin is still the only antidepressant that works on these hormones, the only one that doesn’t induce any sedative effects.
A couple of things happened when I started taking this drug…I read it had the capacity to induce seizures but because my sleep disorder “jerks” are considered a type of mini seizure (myoclonic in nature) – I had taken clonozepam for years (also known as Rivotril in Canada, and something else in the States). This is a scary drugs for many patients and doctors alike. If I had a nickel for everytime I’ve heard, “…You can’t just stay on clonozepam…it’s addictive…you’ll need more and more…etc. etc.” I have been on this drug right from the get-go (1992) and the most I’ve ever needed is 2.0 mgs. At present, I take 0.5 mgs.
Because of my sleep disorder, it is hard for me to stay awake during the day, the reason I was seeking an anti-depressant with no sedative properties…Buproprion fit the bill. However, the highest dosage recommended at first – 300 mgs. – didn’t touch my depressions. To stave off depression, I take 450 mgs. and have done for over 5 years. I have gone as high as 600 mgs under doctor’s supervision and in hospital; it broke a particularly bad depression. I only used that amount once and would not like to again. I have tried tapering off from 450 mgs. several times and come to the conclusion; for me, it’s not a good idea.
Even with a non-sedating anti-depressant, I usually have trouble staying awake for an entire day. Naps are not a good idea, not recommended, as they interrupt the quality of my night-time sleep. So – even though I am Bipolar, I take stimulants…and I regulate the dosage of those myself. My doctors – the last two – have agreed that I am the best arbiter, the one who should decide, which dose is working. I have not been manic in over eight years. I tend to err on the side of going down rather than going up, and have to be careful of that.
Ever mindful of the seizure components – Buproprion has them too – I take more things to counteract these, during the day and at night. Also, being Bipolar, it makes sense that their should be mood stabilizer in the mix, but after trying every single thing they could think of ( from the old stand-by Lithium – at least 3 times, to Tegretol, to Valproate Acid, to Carbamazepine. (cannot remember the spelling for any of these except lithium, so forgive me) – we all came to the conclusion, that they not only didn’t stabilize my mood, they plunged it lower than ever, and in the case of lithium, it poisoned me. Apparently it’s not that uncommon for a person to prove lithium-toxic. They don’t tell patients that until they start showing the symptoms for fear they’ll all complain about it…sheesh.
However, with no mood stabilizer and no sedative properties in my anti-depressant, plus stimulants being used to keep me awake during the day, even I could see the potential for flipping me manic. We set out to find something to counteract all of these things without plunging me into the dark again.
Finally – an anti-psychotic, Seroquel – that I take at night and that helps me submerge into that delicious fourth stage of sleep but doesn’t give me a hang-over – worked.
Sooo – just a few other tweaks for arthritis and ongoing esophagitis, another anti-seizure med for daytime use and a small adjunct to go with the Wellbutrin (synthroid) plus an Estraderm patch…and I’m good to go.
I know, it all sounds like too much, and confusing. At first it was…but if you had lived the life I was – or rather wasn’t – before, you might have gone this route as well. I had tried everything else. Dietary changes, holistic remedies, various courses of ECT…all to no avail.
When I figured out a pharmacological cocktail that worked for me, in conjunction with a doctor who was willing to work with me, and that I trusted implicitly, my life started to make sense, and I actually started to live.
Unfortunately, when this beloved man, who had also become a friend, died suddenly…and I learned not only was he dead but that he’d taken his own life…I came completely undone.
It took a complete bout of unprecedented mania that almost cost me everything – I left my husband, my kids, everything…I thought I was healthy and convinced everyone I knew that it was so (everyone except my husband who said from the first that he thought I was unwell; he had people keeping tabs on me, fearing for my well-being)…
Within approximately five months (after leaving everything) and ten months of my doctor’s death, I suicidally crashed. Luckily for me, my husband caught my fall, got me to the hospital, and saved my life.
After a month of catatonia on the Psych Ward, I decided that I needed to be responsible for my own mental health. I knew what needed to be done – what meds worked, what didn’t – that I couldn’t depend on the doctor I loved for any more support – he was, after all, dead. I made a pact with myself, that no matter what, suicide would never again be an option, and that I would never again hurt my family the way I had…(That is one thing about my particular brand of mania; every bout I’ve had, I can point to and say distinctly – well, I did THAT – I will never do THAT again. Example – once I borrowed money and opened a business; another time, I used a charge card and bought all the left-over Halloween costumes etc. in a store, figuring I would open another type of business; and once, I left home, in a really big way.)
It was a slow process, that climb back to the forgiveness of family – my husband had always believed I was ill, so he was the first to forgive, but I left him for another man ostensibly, forgetting wasn’t going to be an option.
Our girls, on the other hand, were livid that their Dad would take me back so easily. It was they that had discovered my betrayal in the first place, something I will never forget nor forgive myself for – I don’t care how sick I was – no mother should ever expose her children to that type of blatant disregard for their feelings, or what I was doing to their Dad.
When I finally got out of hospital, I didn’t go home right away. I had rented an apartment while I was sick (costing their Dad a small fortune – he was getting ready to sell our house and split the proceeds by the time I came around) – but I went back there where I had a year lease, and while we worked on our marriage and the girls got used to the idea of their mother moving back into the house.
Our eldest began talking to me almost right away (probably because she still lived at home) but we argued vociferously, and often. She was not ready to forgive me for a long time. We’re going through a rough patch right now (this, after years of getting along well, and being, what I thought of as close) so maybe she’s still very angry, it’s hard to tell. I do know that what’s going on now is breaking my heart in a whole new way, so maybe what they say – karma’s a bitch – is true.
Our youngest didn’t speak to me for over a year. However, when she was ready, she and I had it out in one long evening – then it was over. She and I are closer than we’ve ever been.
We all did group therapy as a family. My husband and I did couples therapy – admittedly, there were things wrong in our marriage when I left him and I couldn’t just walk back into the relationship as if everything had been fine. Kudos to him for realizing that, even after such betrayal and so much hurt.
The doctor I’d been seeing before the one who died was also the one who originally helped me sort out my meds. To her credit, she called me as soon as he died and offered to take me back immediately. That was really good of her – to start with someone new at that point would have been horrendous. She is more a dealer than a doctor. She asks me if we’re still doing the “status quo” thing and I tell her if I need anything adjusted. She has even said to any resident she’s training, “We’re so lucky with Sharon, she manages her meds all on her own.” Not that comforting, but fortunately, I am at a place where that works for me. I don’t know what would happen if I needed to get into the hospital…I’m not sure she’d believe me, and I’m also not sure she could swing it. Money has more or less dried up in the healthcare business here. Where I used to pretty much be able to snap my fingers and get a room on the fourth, as we called it…now, I think you pretty much have to go in on a stretcher unconscious, or with your wrists slashed vertically and blood running free.
Well, that’s a hell of a note to end on…as you can see…not the things to put on a ModPo thread…it is personal, and it reads like and War and No Peace.