When You Reach The End Of The Road

It finally happened.  Officially, I mean.  I’ve reached the end of the line.  After six-and-a-half years of extremely intensive psychiatric treatment, the first fiveish with an incredibly bright, creative, thinking-outside-of-the-box younger doc; the last year-plus with a man long experienced in the mood disorder game (not to mention numerous consults along the way), it has been made manifest.

There is no medication, no medication combo, no singular or plural that exists currently in this country that I can both tolerate and achieve lasting stability with.

Stamp it.  Signed, sealed, delivered, done.

I got this news “officially” last Monday, when I saw my psychiatrist.  But I think I had seen it coming for some time before that.  Not consciously.  I mean, I knew we — I — had been through it all, and after the last failed trials with amphetamines to treat my depression (they did, for about four hours in the morning, then I crashed, hard), I wasn’t actually expecting anything going into this appointment.  In fact, I had reached a point of complete lack of expectation.

There is a word, adhedonia, which is a symptom of depression.  But loosely translated, it means an utter lack of interest in absolutely anything.  It’s not even sad, it’s just. . . void.  And that’s where I was with my appointment.

It’s very strange for me to think about that, after nearly seven years of going into my psych appointments, every three weeks (excepting last year), always expecting something — we would add this, subtract that, increase or decrease a dosage — this one I went into with nothing.  Which kind of confirms for me that I already knew.

So, that begs the question:  What do you do with a woman who carries a whole alphabet soup worth of diagnoses — Bipolar 1 (with psychotic features), and four severe anxiety disorders (I won’t list them all) — who is now minimally maintained on a benzodiazepine and an anti-convulsant that actually failed all the clinicals as a mood stabilizer (I am not a clinical — but you knew that)?

My psychiatrist’s answer, one I heard repeatedly when I looked for a new doctor only a little over a year ago, is for me to look for trials.  Go national.  These studies have access to new medications that are not FDA approved, so he can’t prescribe them.  Which would be awesome, I’m sure, if I had the money to do that.

He also made it abundantly clear that he will still be there to prescribe what I have now, and available if I need to see him.  He is still my psychiatrist.  But he didn’t think scheduling any follow-ups was necessary.  I didn’t disagree.

When I wrote the opening few paragraphs to this post, I was — as one would expect — feeling extremely lost about what happens to me next.  I’ve been facing some very hard truths for a couple of months now, and this was one more I could no longer avoid looking in the eyes.

But a funny thing has happened to me since then.  I actually feel. . .  Relief.  Freedom.  Happiness.  Optimism about what lies ahead.

I am in complete control of everything once again.  Control is probably my biggest potential trigger, and I began to lose it, slowly but surely, before seeking treatment in 2006.  I didn’t start regaining real, meaningful control until just a few months ago.  Now the rest of it has been handed to me, if not on a silver platter, then perhaps on one made of old copper.  The kind that has turned so green you would initially discard it as worthless, but when you take a closer look and clean it properly, you realize its value is far more than you ever imagined.

So here is my answer to the question above, the answer which really matters.  What do I do with myself now?

I exercise.  I’ve been back to kickboxing and it has worked wonders, even when I’ve felt a misery at dragging myself out of bed at three a.m. (yes, really).

Keep my sleep sufficient.  I can cheat a little here and there, but I need to be in bed, sleepers ingested no later than six p.m. (again, really), as a general rule.

I’m adding in yoga once again.  New DVDs, new reasons to work my body while completely clearing my brain.  I need the calm nothingness it provides.  Kickboxing is for letting it all out, yoga is for forgetting that there exists anything which needs let out in the first place.

Keep my level of stress so low it barely registers.  This is a challenge, but it is vital.  And something as simple as committing to attend a certain event — or trying to stay on top of blog comments, say — when I’m not in a place for it can cause severe decompensation for me.  That’s legalese for “total nervous breakdown”.

Get out more.  Do positive things for me.  Take myself out to lunch.  Get my hair done.  Go on a long drive.  See my girls.

Be vigilant.  The last and most important aspect to dealing with this.  There are medications I can take very short-term, on a rescue only basis, as well as adjustments to my daily life that I know to make.  I will keep contact with my doctor, but fortunately he has left me a decent supply of these drugs to have at hand so I don’t have to wait on him.  The difference between one day and three when you are experiencing prodromal symptoms of a mood episode is the difference between preventing one and diving in deep.  And after all these years, I have an unheard of ability to sense intimately and immediately when something is going amiss in my mind and body, and go straight into “triage mode” as naturally as if it were an everyday activity.  Because it was, for so many years.

Last year, the year I healed and spent my time secure in the knowledge that this was different, that whatever happened down the line, I would deal with it — it would never again get bad like it had been for so many years — that time was more critical than I knew.  Because what it taught me is the truth.  I have no idea what lies ahead.  What I’m looking at, what I’m facing, it’s madness — both in the literal and figurative sense.  But I’m not frightened.  At this very moment, I’m not so much as batting an eyelash at what may come.  I can handle it, whatever “it” may turn out to be.

The road, for me, it’s come to an end.  In front of me there is a dense jungle, filled with all sorts of dangerous things.  But I have made myself a pathway in, and I know that while danger awaits, so does rare beauty.

It makes me think of The Princess Bride, and the Fire Swamp:

Princess Buttercup:  We’ll never survive!

Westley:  Nonsense.  You’re only saying that because no one ever has.

(If you haven’t seen this movie, stop everything you’re doing and watch it.  Now.)

Relevant Reads:
“I’ve Just Wakened Out Of A Nightmare” (I Was Just Thinking. . .)
The Finish Line (I Was Just Thinking. . .)
Three Weeks (I Was Just Thinking. . .)
Once More Unto The Breach, Dear Friends, Once More. . . (A Canvas Of The Minds)

© Ruby Tuesday and A Canvas Of The Minds 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Ruby Tuesday and A Canvas Of The Minds with appropriate and specific direction to the original content.

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