I started mood stabilizers in November 2011, and after about 2 months of adjustments, I felt better than I had in years – clear-headed, stable, and just more myself. Added to my existing cocktail of stimulants for ADHD and bupropion (Wellbutrin) for depression, it seemed like a minor concession to bipolar disorder, medication-wise.
Recently, however, I experienced a bout of depression that was fiercer and longer than I’ve experienced in quite awhile. With both monthly hormonal shifts and high anxiety over a new job, the stage was set for a mood swing. This one was notably worse than any “blips” in recent memory and I lost several work days, which only increased the anxiety.
So it was with some trepidation that I went to my psych appointment earlier this week, at which point I was also starting to feel a bit better. It was already incredibly hard to admit how depressed and anxious I had felt just days before, not to mention feeling like I must be exaggerating or overly dramatic. I was armed with my mood charts and notes to keep me honest and had a good discussion with the psych nurse, who seems to really want to figure out the causes, and not just treat the symptoms.
In the meantime, treat the symptoms we shall. Returning to the subject of the post, that means medication. It’s no secret that working out the right cocktail of psych meds for bipolar disorder, particularly if co-morbid with other conditions (as is so often the case, particularly with anxiety), is a process that can take awhile. Years, even. Some people never find a good combination.
It can be enormously frustrating to try one drug after another, seeing little improvement but many side effects. At some points, the cure can be worse than the disease. So I dragged my toes about going to the psych nurse, because I knew that after only about 6 months of relative stability, I was in for a change of meds. I also knew that something needed to change.
To deal with breakthrough depression, I’m trying an additional SSRI, sertraline (Zoloft). I can limit it to half the month (consistent with treatment for PMDD), or take it all the time. I plan to try the minimal approach to start. I took sertraline around 15 years ago during a very tumultuous period in my life, but I barely remember it and it carries the risk of triggering mania. Another SSRI had previously made hallucinate, so that’s something I have to watch carefully. On the plus side, it’s weight neutral.
And after two months of discussing anxiety symptoms, the psych nurse prescribed an anxiolytic. Maybe it’s because I said I figured a panic attack was a normal response to prep for an oral surgery procedure? So now I have a benzodiazepine, more specifically lorazepam (Ativan), in a very low dose to take as needed. Just when work-related anxiety becomes paralyzing, or I start having a panic attack. I’ve read enough on benzos to know that you don’t screw around with them without consequences, so I’m treading cautiously.
I feel worse about adding two new psych meds, even on an as-needed basis, than I did about adding each of the three before them, although one at a time. Managing bipolar (and ADHD) has taken me from one prescription back in 2000 to five in 2012. That alone is depressing. One might think it symptomatic of our overprescribing society, but every drug has been carefully weighed for benefit over risk and collateral damage. They help me remain functional, and that’s my bottom line.
Hopefully I’ll see some relief from symptoms without intolerable side effects. By my calendar, it’s time to start the new antidepressants today. Hopefully I can find a little more stability sometime soon.
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