Saturday, November 26, 2011

Geodon Withdrawal

Well, I now know why I couldn't sleep.

I'd accidentally missed two days' worth of my Geodon and Cymbalta. And it was the Geodon withdrawal that was making me wired - among other things. What happened is this: I filled my weekly pill box, but ran out of Geodon and Cymbalta as I was filling it. No problem, I thought - I'll see my psychiatrist in a few days, he'll give me a prescription. Saw the psychiatrist, he gave me the prescription, but forgot to fill it Wednesday and obviously couldn't fill it on Thanksgiving. I thought I'd had enough in my pill box to get me through to Friday, but... no such luck. And because I take all my meds from my pill box during dinner, it's easy to forget which pills I've taken and which I haven't.

The upshot of missing my Geodon and Cymbalta was fifty-six hours of wakefulness, and at the forty-eighth hour additional symptoms: hot flashes and cold sweats, light-headedness, and worst of all these horrible electrical impulses that went from my brain to my feet. They were so bad I could barely walk. They were so bad that as my body, desperately tired, started to fall asleep, I'd be woken from my dreams by horrible, horrible brain zaps.

As my psychiatrist's office was closed for Thanksgiving, I ended up in the emergency room, where it was first suggested that I might have missed a dose of Geodon. In the emergency room with the on-call psychiatrist, I pieced together the last day I could be sure I'd taken all my meds, which made my symptoms make sense.

So now my family's out the cost of another ER visit, and I put everyone through a lot of stress and worry over an avoidable mistake. Everyone's being really nice about it, but I feel like /shit/. I could have avoided this if I'd been more careful and responsible.

Friday, November 25, 2011

Late Nights

It looks like I'm going to have been awake for forty-eight hours straight, and I'm terrified by this. I'm totally exhausted - physically ill - and I just can't get to sleep. In desperation I tripled the dose of the benzodiazepines I was prescribed, hoping I'd finally drop off, and... nothing. I'm woozy, I'm physically ill, and I still can't make myself fall asleep.

I think if I could finally conquer my sleep issues, I'd be able to live a relatively stable life, even with my diagnosis of bipolar disorder. Medications help, but sleep - really ironing out sleep - is so critical. It seems that sleep is the first thing to go wrong and the last thing to mend when I have an episode. Before I get depressed, for instance, my body starts to need more sleep than usual. A week or two after the hypersomnia begins, my mood starts to drop, and my sleep gets worse and worse. Meds can help fix the mood issues, but the sleep issues persist; it takes real sustained effort to get my sleep back on track.

I've been working hard - with help - to be able to sleep normally. Unfortunately, I haven't made much progress. For the past month, while my mood's been fairly stable, my body has been demanding ten to eleven hours of sleep per day. Worse, if I wake up after less than ten or eleven hours of sleep, I find it impossible to function - I can barely keep my eyes open, I'm not safe to drive, I stumble as I walk down the street, I fall asleep on the exercise bikes at the gym during my morning workouts. It's more than the usual morning grogginess, it's like being drugged.

And now, suddenly, I can't sleep. What precipitated all this was spending last night sleeping on the futon, since my brother was home for Thanksgiving and I gave him my bed to sleep on. I always have insomnia when I shift my sleeping arrangements - always. And I'd sort of forgotten this in my desire to make my brother more comfortable, and the upshot is that I couldn't fall asleep last night. And now I can't fall asleep tonight - I'm completely wired right now. And I took three Tylenol PM and three benzos, and by all rights I should be zonked out. And instead I'm increasingly clearheaded and feeling weirdly antsy and energetic, like I want to take a long walk or something crazy like that. It's two in the morning! I have to be up at six. I've been awake now for forty-two hours. And I'm not tired.

This is bad, obviously. Sleep deprivation is one of those things that brings about mania, after all, but more than that this is going to fuck up my circadian rhythm in a major way, and what progress I've made toward a regular sleep schedule is probably going down the drain.

I don't know how I'm going to get through tomorrow - there's a lot I have to get done - and I'm worried that I'm going to start hallucinating again, something that happens to me if I'm sleep-deprived. Out of the corner of my eye, things start to move that aren't supposed to move. The light switch on the wall starts to slide right and left, or to twist into shapes that are no longer rectangular. I see thousands of ants crawling out of pillows. I see the light fixture on the ceiling pulsing and twisting and throbbing. I know it's not real, but unless you've lived through it - lived through either psychiatric hallucinations or a really bad trip - it's hard to express how awful it is to have the world start to be untrustworthy. The best thing I can compare it to is being in an earthquake: the sudden panic that the rules you take for granted, ie that the earth is stable, are suddenly thrown out the window.

So yeah. I am not a happy camper.

Wednesday, November 23, 2011

Holidays and a few other things

Thanksgiving is almost here, and once again I'm bracing myself for the holidays with my family. Historically, my parents fight terribly over the holidays, particularly over Christmas; last Thanksgiving went well, however, but mostly because it was my father's first sober Thanksgiving in decades. My mother still drinks.

I hope she doesn't drink this Thanksgiving - it would be rotten if, in this small house, my mother got drunk and lost her temper the way she has in the past. She's having a rotten time right now at her job, which she hates, and she's pissed that her boss gave her neither the Wednesday before nor the Friday after Thanksgiving off; so of course the temptation to get really drunk and blow off some steam is there for her. I get it, I really do (as much as someone can who never drinks when she's angry) but I am afraid.

I hate being afraid every time a major holiday rolls 'round. It sucks that when people mention Christmas, my first thought is of domestic violence and drunken verbal abuse, but it's true. My parents have just been awful to each other and to some extent to their children for the past decade.

Why? For all the usual reasons. Holidays are stressful. My mother in particular feels it - she hates watching the money go out for what feels to her like manufactured cheeriness, a false happiness where everyone is expected to act delighted regardless of what they feel. And this pressure to look and act happy makes my mother miserable, and drives her to drink. My father's reasons for drinking I understand less well - in part it's a response to my mother's consumption, and the stress he feels being around an angry drunk. In part he had his own demons, I suppose.

But my mother drinks a lot less now than she used to. This family, which I'm so used to thinking of as a failed family, works a lot better now than it did three years ago, or five years ago, and god knows it works better than it did nine years ago, when things were really dark. I talk about a lot of private things on this blog, but some secrets aren't really mine to share, so I'll not say anything further in this vein.


There are a lot of street people in this town on the central coast of California where I now live. It shocks me, who for so many years lived on the east coast, to see on every street corner someone in a dirty jacket, maybe with a bike and a knapsack or saddlebags crammed to the gills with gear, or else with a cardboard sign that reads, "Hungry Please Help".

At first my reaction to being importuned for money or conversation was to ignore people - just to breeze on by and pretend I couldn't hear them. I am a shy and private person in many ways and being accosted on the street makes me nervous. But for a variety of reasons, I've gradually changed from ignoring street people to actively interacting with them. I had a conversation with a lady sitting on the street with a little dog the other night; I asked her if she'd like me to buy her dinner and she said "No, thanks, I've already eaten - it was a good night." So I gave her a little money for her dog, and talked with her a bit, and went home. Liked her more than the guy I met in a bar that night.

I made sandwiches and handed them out five days ago - sandwiches and cokes and apples. I don't like giving money, because I don't have much of that, but nobody in this family starves, thank god, so I feel okay taking food to give to the hungry. I'm getting to know some of the people, who usually frequents which part of town.

You ask why? Because I see myself in each one of them. Sometimes very strongly. Yesterday, driving to the supermarket to do the Thanksgiving shop, I saw a woman with her husband asking for money by the side of the road. I knew this woman. I'd been in the hospital with her. I won't betray the confidences of group therapy more than to say that when I met her she was actively delusional, and I very much doubt she's able to get her medications if she and her husband are homeless, as they appear to be.

I see myself in the homeless in part because - hokey as it sounds - I really truly believe that all men are brothers, all women sisters, in god if in no other sense, and that therefore we all owe it to each other to be kind and to give what we have to those who need it. It's not a terribly organized theory of charity, but it's the loving-kindness aspect of Christianity that I like so much, admire so much in that religion (and really, don't all religions advocate for helping the needy?). And in part I see myself in the homeless because I'm chronically mentally ill, currently unemployable, and if not for my family could very well have ended up in the streets, with all that that means.

So this Thanksgiving, I thank god that I am not homeless.

Sunday, November 13, 2011


One of the rougher parts of being mentally ill is always wondering what's the disease, what's you, and how much point there is in struggling against a particular symptom or side-effect.

I've been having bouts of hyper-somnolence lately where I wake up so tired I feel drugged, sleepwalk through the day until I can nap for a few hours, and for the rest of the day feel tired and low until I go to bed, usually quite early in the evening. These days are very hard on my family - it's rough for them to try to work around my exhaustion, which is pronounced and unusual, and it's also hard for them because they know, as I do, that irregular sleep is very bad for people who are bipolar and can cause or exacerbate episodes.

Dr. Dumas (who is going to work out, it looks like) thinks the Geodon may be the culprit. He's switched the time I take it from dinner time to right before bed, which is a pain because I have to eat substantially when I take this pill for it to be absorbed properly, and it's going to be hard for me to keep losing weight as rapidly as I have been if I'm eating a sandwich every night before bed. I found Dr. Dumas's explanation of why taking Geodon later should work better dubious, but I'm willing to try.

If it doesn't work, however, I'm tempted to ask him to stop the Geodon. This makes me nervous, for several reasons: first, because it was at least in part due to the Geodon that I snapped out of my most recent suicidal depression; second, because if I stop the Geodon I'll certainly have to up the Lithium, a drug I historically haven't tolerated well; and third because any major change in medication could destabilize me again.

So the calculus is difficult: is it worth having irregular, disruptive sleep habits (where three days out of the week I'm sleeping 12+ hours a day) but decent mood? Or is it worth risking my mood for the uncertain benefit of stable, regular sleep?

And added to all this is the question that maybe, if I tried extra hard, I'd be able to stay awake and fight through the tiredness despite the drugged feeling I get. Maybe if I were really, really tough and gritty and hard-working I could defeat the side-effects. It's hard to know. Hard to know.

Life is uncertainty.

Friday, November 11, 2011

Interviewing Shrinks

It's 5 am, and unfortunately for me, I've been awake since 3. I fell asleep at 7:30, and my body clock is all out of whack - as per usual, my bipolar brain is fighting my attempts to get a regular sleep schedule down. The plus side: more uninterrupted time for blogging!

Last week I had my first visit with the second of two psychiatrists I've seen in the region. The first is an eminent guy at a famous university. Let's call him Dr. Schmidt. He's a colleague of my grandfather's (my grandfather is a well-known Australian psychiatrist who's written a number of books on child psychiatry). Dr. Schmidt is a child psychiatrist, but he agreed to see me as a favor to my grandfather to give a second opinion and referrals to other docs. He's the guy who referred me to the psychiatrist I saw last week - let's call him Dr. Dumas.

I didn't like Dr. Dumas, but because I was so damn tired I was completely sedated through our first interview, and I didn't get a chance to interview him the way I wanted to. I'm at the point where I've seen enough different shrinks to know what I like and what I don't, and I don't want to see a guy I dislike, or with whom I disagree about important stuff. I'm hoping that, on a second visit, Dr. Dumas will improve. Here's what I didn't like about him:

1. His office was a total mess. Piled high with books, food, papers, all the way to the ceiling. Very uncomfortable to be in, very weird to be in. Bespeaks a disorganized mind - I'm frequently messy, too, especially when I'm doing poorly.

2. He swore, a lot, inexplicably. I think he works mostly with adolescents, and maybe it's an affectation he's picked up, trying to impress the kids with how "down" he is. Whatever his reason, there's no excuse for a shrink saying, of my side-effects, "That fucking sucks."

3. On a related note, he treated me weirdly as a child. For instance, he insisted on showing me magic tricks with a deck of cards. Why on earth should I care? What's the point? How does it relate to my treatment?

4. I just got a bad vibe. Harder to explain, but everything from his messy office to his ugly bowtie made me feel uncomfortable with him.

5. Finally, he prescribed me benzodiazepines for zleep. If I'd been more alert, I would have insisted- HELL NO! I'm not taking /anything/ with the possibility of drug dependence. HELL NO!

It might all be me, but I doubt it. During the meeting I have with him today I'll try to hash out what his treatment plan might look like, what his goals are, and what his methods might be. I'll ask him about his training and his affiliations.

And I expect him to get snippy about it. Doctors are used to being treated with unquestioning respect, and it's hard, as a patient, to convince your doctors to treat you with any respect at all as an educated consumer. Doctors don't like the consumer model of health care, and it has its problems, but I'd much rather be empowered through the consumer model than not at all.

I have no idea what the therapist I'm seeing this morning is going to be like. I was referred to this guy by Dr. Dumas, so I hope he's alright and not a weirdo, because it was hard enough getting an interview with him.

Tuesday, November 8, 2011


I've always been a terrible procrastinator, and that's what I'm doing right now - avoiding a chore I dread. What chore? Applying to a few California state schools for next fall. I need to apply for my brother's financial aid consideration, and I need to attend some school - any school - to keep my student loans deferred. But oh god, I don't want to go to a California school. I like California well enough, and I'm a good student when I'm sane, but I'd be a commuter student, and it's hard to make friends at a new school period, let alone when you're only there for classes. Of the three schools I'm applying to, I'd far and away prefer to go to UC Santa Cruz - it's the best of the three schools - but CSU Monterey Bay and Monterey Peninsula College are far cheaper and far closer. I'd be commuting more than an hour every day to go to Santa Cruz; the gas alone would be expensive, but the tuition is also more costly - twice what I'd pay at CSUMB, and much more than I'd pay at the local community college, MPC.

But it's hard to try to get excited about taking community college classes. My parents are friends with two professors in the area, one at CSUMB and one at MPC; both teach in subjects I care about - the professor at MPC is the head of their Great Books program, and the professor at CSUMB teaches biology - and I'm going to get to meet them this Saturday at my parents' dinner party. So I'll show up, be cheerful, look as normal as I possibly can in front of people who know about my mental breakdown because this party was cancelled a month ago so that my folks could fly me to California, and just grin and bear it.

But yes. Decreased expectations. And I do know I'll be happier and better off in any school rather than no school, but god damn it I want to be at St Johns, I want to be in Maryland, I don't want to be in California.

Sunday, November 6, 2011

Decreased Expectations

It's hard for me to believe it, but in August I was walking with my father at the Presidio, and we were talking about my plans for Medical School - how best to finish up my pre-medical requirements as a post-baccalaureate student. I was going to apply to Hopkins and Goucher, and my fallback was the excellent University of Maryland system. I'd be living near my friends even after I left my undergraduate life, and I'd be independent. I was so excited.

Now? I still don't have a degree, and may not have one for several years. My father's trying to convince me to get a paralegal certification, so that I'll have an employable skill that will enable me to live independently in "a few years, when you're more stable." My head knows that it's smart, that it's a way to get some job security (after all, even if I never got a job as a paralegal, I could get secretarial work). But my heart?

I can't believe this is what my life looks like. I'm scared of spending my twenties, the years which should be the freest and most independent of all, living in my parents' home, dependent on them for food, shelter, and the medical care I evidently need, with no friends in the area and of course no boyfriend or girlfriend, because how can you really date as an unemployed sometime student living with the 'rents in suburbia, with no car? It never happened last time, that's for sure.

Maybe this sounds entitled. Life never happens as planned, I know that rationally. But there's a big part of me that feels... cheated. When I was a kid, I was usually the smartest student in the room. Teachers would take me aside, tell me I was going to be so successful, that I could be anything I wanted. When I was teased at school my father would comfort me by telling me that one day I'd be the judge sentencing my bullies to jail time - a little over the top, I know, but you get the picture. What I'm trying to say is, I thought that part of the social contract was, if you work hard and you're smart, you'll have a good life and be rewarded for your efforts. But it isn't that simple if you get sick or for a whole lot of other reasons, like poverty or debt or bad family life.

I dream a lot about running away and escaping. I fantasize all the time about winning the lottery (though I don't buy tickets - I know they're a bad investment when you haven't got any money!) and using the money to move to Greece or travel the world. I think about money all the time, in a way that makes me feel low and mean. I feel a bit like Lydgate, from Middlemarch, shocked that such petty things could drown out my thoughts of philosophy! and science! I even fantasize sometimes that maybe I'm not really bipolar, I've actually got some bizarre parasitic infection that makes me seem crazy, but when a doctor figures it out, they'll cure me and I'll be sane for the rest of my life.

The last time I wrote, I was very fragile. I was trying to process a scene from the movie Margin Call, where a trader flirts with suicide on top of a skyscraper before deciding "not today". And I ended up triggering myself instead. In fact, I spent the night in bed with my mother - something I hadn't done since I was a very small child. The next day was my first appointment with a psychiatrist from the area, a peculiar man with a bow tie and a penchant for profanity. I didn't like him, but I'll try him a few more times - I was half asleep the first time I saw him, and that didn't help matters. He prescribed me benzodiazepines for sleep, which I am not going to take - insomnia isn't a huge problem for me right now, it's waking up in the morning that I have trouble with, and I'm scared of habit-forming substances. Petrified, actually.

I'm okay. I actually enjoy a lot of things about my days - I saw redwoods today! Huge beautiful trees that you could stand inside of, one that was forty-five feet around. I saw sea otters playing at Elkhorn Slough in Moss Landing. I saw a beautiful rainbow after the storm. But I also cry a lot, I think a lot about what I've lost, and I'm lonely a lot of the time. Things are good - for now - with my parents, and I hope it lasts, because if that goes I might get desperate again, and I make poor choices when I'm desperate. But for now I'm okay.