Oh, two of my least favorite concepts: gambling and medication adjustments.
We’ll start with gambling, because it’s more straightforward. As much as I spend lots of money on things most people would consider frivolous or disposable (clothes, makeup, pens), I have never believed in the concept of throwing money away. To me, that’s exactly what gambling is. I could spend a buck and, against the odds and in my wildest dreams, wind up with hundreds of thousands, maybe even millions of dollars because of it. I could also write a work of literature comparable to Joseph Heller’s Catch-22. I think the chances are about equivalent, because while I am a gifted writer, Mr. Heller himself made an assertion to the fact that nobody, not even he writes another book like that one. To finish the analogy, I have never so much as shelled out for a scratch ticket or put a quarter in a slot machine.
I used to say that I would be one of those individuals who never plays the lottery, then one day decides to buy a ticket and wins The Big One. But I got older and I lost whatever little seed of belief (and it was minuscule from day one) I had in this, because I know I won’t ever buy a lottery ticket. Besides, to me there’s just something unfair about that idea. You read about (or know) little old men who buy their tickets faithfully once a week. I want one of them to win big, not me. I know I can’t control the universe (or I’ll at least leave you all believing that), but I won’t contribute to them having less of a shot. Now if I could live my life in the films Casablanca, or Gilda, or anything of the type, my take on gambling would be entirely different, I suspect.
I digress.
Medication adjustments. Anyone with a mental health issue, especially one as nebulous and individualistic as manic-depression, do it with me, *SIGH*. Most of us play with meds and combinations and dosages our entire lives. If we’re lucky, it gets less arduous as we learn what works for us and what doesn’t, but it isn’t ever completely over, not until the only thing you’re wearing is a toe tag.
I thought I was pretty well past the more intensive and uncertain phase of medication roulette. I hadn’t found a good combo, actually quite the contrary. Nothing in the treatment algorithms worked for me, nothing unusual and off-label worked for me, we went through combinations and dosages and different combinations and different dosages, and I had non-responses or intolerable side effects. Side effects being a whole different post, but not the kind you have to suck up and deal with in the name of euthymia. The kind that cause you to shatter one of your mother’s holiday plates because you set it down on the counter – you just perceived that the counter was three feet closer to you than it actually was. The kind that gives you such overall mental impairment that you are quite literally a zombie. You walk (sort of) and you talk (sort of) and your moods are controlled, but only because you are now so doped that it’s as though someone shot up your brain and body with a local anesthetic that didn’t remain localized. That’s not a life. That barely even qualifies as an existence.
I did have a few good medication reactions, rare as they were. I found something to act as a mood stabilizer – and I developed drug-induced parkinsonism. I found a thyroid supplement (as in prescription, not health food store supplement) that worked beautifully to obliterate my depression (I cannot even get a whiff of an anti-depressant, no matter how loaded up I am on mood stabilizers, I go through-the-roof manic) – until I wound up in the ER and it was discovered that I was so incredibly hyperthyroid that my heart could have fibrillated at any moment and I was extremely fortunate to not have already dropped dead.
So I came to terms with the fact that my moods would have to be managed with sub-par, unusual medication choices (Valium for mania, Phentermine for depression, most docs aren’t down with that), introduced and withdrawn with my moods. But mostly I would be my own medication – not “willing away” my symptoms, but always remaining just that much more vigilant, and altering my life accordingly. All bipolar individuals have to do this in varying degrees, but I had to do it more because it had become the only choice.
The only good to come out of this was that since there would be no ‘magic bullet’ for me, and since I had tried it all – no exaggeration, would you like my shrink’s number? – and kept detailed notes, I wasn’t going to have to be put through the wringer again as far as meds. Incidentally, while I use the term ‘magic bullet,’ I don’t mean for any of you to think that I think any manic depressive has their cure-all pill(s). But many, if not most, do have their standbys which they know they can take regularly with a positive effect, and their go-tos when they need something more. Me, I just happen to be wired a little differently even in the context of such a highly individualistic diagnosis.
Except while I was away, I became manic (And On The Next Day She Got Manic – an explanation of sorts, read and ‘enjoy’). Had I been in my own home, I probably would have been able to work to bring myself down. But I wasn’t, and I wasn’t going to ruin my time or spoil anyone else’s by letting my mania escalate further.
This post is getting much longer than I intended, so the very short version of what happened next and is happening now is this: I took a medication I didn’t especially want to, it made me better for a few days and then it made me much worse, and now I’m working with different meds to try to bring myself to a place where I can take over without them. Just because I have to manage mostly on what I have learned works for me in a non-pharmaceutical capacity, doesn’t mean that I don’t know when I need medicinal intervention, at least temporarily.
One last note – I don’t want for anyone reading this to think that I am 100% medication-free, because I’m not. My presentation is too severe, and I have found one or two things which I take daily to help me stay more level. But my particular regimen and condition are just the same as me and can be described with the same word, uniquity.
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A Canvas Of The Minds 
I was originally going to say. “Oh, ugh, not again,” because I know so intimately what you have been through. And then I thought that regarding that, and also past posts and comment responses, perhaps you should at least let all the bloggers know about our relationship, because I can’t write comments that are especially useful since we’re constantly talking and you already know my take on everything.
It’s got to be frustrating to have to go through this again, and again, and again. I have a similiar problem, but tweak it a little. I find a combo that works, and we go with it for a duration of time. It could be 3 months, it could be about six. I max out at six. Change the dose, change the meds, and try again. So far, so good. Lamictal worked wonders when I first started. But I’ve gradually had to increase dosage as I’ve gone. I’m up to 250 now and I believe we max out at 400. I still have awhile to go.
My body builds a tolerance to things pretty quickly. It killed the hope of Ativan in a year and a half. I maxed it out and now I’m done with it. It’s starting to kill Wellbutrin. I have one more dosage increase before I’m done with that one. Ths is all with the exception of Lamictal. I’ve been on that for two years and only once in the last year have I had to have that adjusted. I figure it’s only a matter of time though.
So where to go from there? I don’t want to spin the wheel again. I finally got rid of the nasty side effects of these medications and then we’ll have to start all over! I don’t want to even think about destabilizing any worse than it’s already been. I hear stories of people who gain 50lbs and lose their hair because of mood stabilizers. Or those who get on an antidepressant and go off the deep end because of a severe manic episode. I can’t even handle the idea of gambling. I have too much to lose. Waaay too much that I’ve scraped and fought for to have in my entire life.
It seems I often can’t get a firm diagnosis (don’t get me wrong, I have diagnoses, it’s just that how my diagnoses fit often seems nebulous), so how’m I even supposed to know what medications to try? It seems like it’s mostly trial and error and guesswork. I’ve never had any of those “go-tos when I need something more.” I know Wellbutrin works, and Lexapro might, but then there’s a bunch of other experimentation. I often have a great deal of anxiety, yet I don’t take any anti-anxiety meds; I try to manage it on my own. Professionals are hesitant to give me hardcore anti-anxiety medication because I can be too sensitive to drugs. Helping with the depression helps a little with the anxiety, but not nearly enough . . . ugh, it’s all so complicated and connected and vague. Last time, my pdoc wanted me to try Lithium, but I’m a little afraid of trying that, so I said no. I need to do more research about it before I can even have an opinion on it, though.
I think sometimes we focus too much on the diagnosis (hence my “labels are for jelly jars”). I understand why you want so much to know, but the right diagnosis doesn’t always make treatment easier, from a medication standpoint. It certainly didn’t help me any. And the wrong diagnosis doesn’t really matter if you’re getting what you need. I have a friend who was given a Bipolar II diagnosis and Lamictal about five years ago. I knew she wasn’t bipolar, she had depressive episodes and severe anxiety. But the Lamictal helped her, so I didn’t say anything. She recently reached the same conclusion that I did, as did a new psychiatrist. But, again, the Lamictal helps, so the treatment isn’t being changed (she’s debating what to do about the anxiety component).
It is all “. . . trial and error and guesswork.” Throw a dart, see if it sticks. I think the thing about professionals not wanting to give you “hardcore anti-anxiety medication” — by which I’m guessing you mean benzos — is crap (on their part). You can dose those drugs so low, and then split to get a baby dose. My mom is so medication sensitive that she hates, hates the way ibuprofen makes her feel, she basically never swallows a pill, but she still takes Valium (10 mg, yet) before she flies. Although there are so many antidepressants that are good for anxiety, which would be a much better solution for you overall. I would do research on those. I can’t offer you any personal opinions there, as I learned early in the game that antidepressants are a big no, no, never, not under any circumstances for me.
As far as lithium, I would continue to resist if I were you. It’s a wonder-drug for so many people, but it comes with serious, often permanent side effects, and constant blood work. I also think it’s a bit much for you, as it’s typically only prescribed for Bipolar I or suicidal depression.
Research is good, though. Do lots and lots of research on everything.