The Rehab Diaries Part 3 – Week 1

Finally, we touched ground at the clinic.

The first thing they do, after you fill out the paperwork and pay the gap, is take your vitals and take a picture to put in your file so the staff coming in on the next shift can match names to faces.  I’ve had several pictures taken over the years to account for aging – and my hair being a different colour in each one.

In all my previous pictures I look either depressed or agitated but in this one I was concerned that I look inappropriately cheerful.  There’s a good reason for that though – after I’d had my medical and was awaiting the nurse with my admission package, BF ducked into my bathroom.  The nurse came in while he was doing his business.

She apparently didn’t hear him flush the toilet and wash his hands while she was setting up the camera.  When he threw open the door just as she was pressing the button, she startled so badly that she jumped and we had to take the photo again.  The second one came out but it was obvious that I was trying to supress my amusement.

After BF left, I was to have my admission appointment with a doctor who I hadn’t worked with for five years, as my regular hospital psychiatrist was away.  I was a little nervous about this meeting; I had been a difficult patient to deal with at the time but was having a lot of trouble expressing what was wrong with me, and took a lot of frustration out on my care team.  As a result I was told again and again that they had no idea how to help me.  I harboured a deep distrust of mental health professionals for a few years after.

My communication skills have improved since then and bearing in mind that I didn’t get along with my current psychiatrist when we first met, I was willing to give him a chance.  I figured it was a better option than starting with yet another doctor who I don’t know at all.  I was relieved to find that he was willing to give me another chance too, and after the official admission business he asked me what I hoped to achieve with this admission.

I explained the deal with my current medication.  The mood stabilisers seem to be struggling on their own.  The efficacy of Topamax is unclear.  My anxiety is out of control.  I probably need to be on antipsychotic drugs as well as mood stabilisers – as many bipolar patients do – but we’ve had trouble sticking with one so far because of side effects.

He listened, and conceded that this would be worth a try…and if I left it with him, he would come up with something.  Wait, what?

Turns out I didn’t have a good appreciation for how gung-ho my regular psychiatrist’s approach is.

In our next appointment three days later I found my frustrations from five years ago resurfacing somewhat.  The doctor seemed unwilling to make a solid decision and kept throwing the conversation back to me, asking me if I had other ideas.  Um, why go through three years of psych residency if it were that simple?

I pressed him and he listed off some antidepressants to treat my low mood which was met with an (admittedly ungracious) groan from me.

“Pristiq?  PRISTIQ??? Don’t you remember what I was like when you put me on pristiq before?”

“remind me?”  He quipped innocently

“kinda nasty.”

He suggested Cymbalta, saying that some of his bipolar patients had seen improvements on the drug but I was hesitant, maybe unfairly due to the number of people of mental health forums I’ve been haunting despairing over side effects.  I said I would ask my dad, also a doctor, for a second opinion.

Finally he printed out some information on the natural supplement SAMe, explaining that it could be a cheaper way to regulate my sleep and depression.  Oh great, now we’ve exhausted all our pharmaceutical options I thought glumly as I left.  Clearly he thought he was giving me greater autonomy over my treatment plan but at the time I felt like I had all these decisions on my shoulders that I’m unqualified to make.

I spend a lot of that week in bed.  I was low, in mood and in energy.  BF normally cares for his mother but she had been in respite for a few weeks so he was with me constantly.  Whether I liked it or not.  All BF all the time.  I just didn’t have the energy to entertain him and I was getting more annoyed by his presence because I felt like he was just doing it to ease his own guilt, rather than because he thought he was helping me.

On one such day he said he was coming over.  I told him no, I wasn’t up for company but he turned up anyway.  In the mood I was in I told him that if he must be here fine, but I said I didn’t want to talk so I wouldn’t.  And rolled over and went to sleep.

I napped most of the afternoon while BF lay on the floor playing candy crush, every now and then being woken up by an overdramatic look-at-me sigh from him.  About two hours in when sighing his feelings out got him nowhere he got up and stormed out.  I’m not sure how long he was gone for as I was asleep in between but he came back with my nurse who looked a little perplexed.

“You should get up.” She turned to him “She hasn’t eaten today.”

I pulled the covers over my head. “Too bad.”

He yanked the quilt off my bed. “Nope!  We’re going for a walk.  Even if I have to wheel the bed out the front door.”

After some protests from me – and a threat to roll me off the bed that probably would have been carried out – we did go for a walk to the nearby lake, and ate Thai food in the sun.  My mood improved for about five minutes.

I was hoping to debrief with the nurse over whatever my boyfriend said to her, but she wasn’t in for the rest of the week.  If he wants to be around and harass me fine, but I don’t want him annoying the staff.

That was a conversation I wasn’t able to have until week two.

So you’ll be hearing about that in the next instalment of the rehab diaries.

Mac

 

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Topamax. It ain’t tops

Ha…ha…punny.

Things haven’t been great for awhile, so my doctor decided to mix up my medication.

 I’d been subsisting on a mood stabilizer and melatonin antidepressant to regulate my sleep. She was iffy over the melatonin and suggested removing it. I cried. She changed her mind.

 She did decide to supplement my mood stabilizer with another one – topiramate, or topamax. I take an extra pill, tiny pill that must be no more than three millimeters across, every morning and evening.

 She took me through the potential side effects, of which one really stood out –

 Appetite suppressant.

 See, in my experience that should read as:

 Heinous nausea.

 I wasn’t too worried otherwise, because my current mood stabilizer didn’t give me any side effects even in the beginning worse than some broken sleep and mild constipation.

 The day after the night I started, we had a party in the evening and I was running around trying to clean the house in dreadful heat. If I was feeling washed out that day, I put it down to that.

 The next day though I hit the wall hard. Well, I would have if I’d been able to get out of bed. Heinous nausea did indeed make an appearance. After the first few days it’s reduced to being around only three hours after I take it but trying to fall asleep feeling like I’ve just downed a three course meal is a challenge.

 My mood was stabilized all right. Stabilized in a very bad place.

 My depression over the past two weeks has been dreadful. I spent hours in bed staring at the ceiling, with even my thoughts slowing to a plodding pace. Plodding over things that happened ages ago that are suddenly at the forefront of my mind and I can’t get them out, trying just wears me to tears.

 On top of that I’ve been getting headaches. Which is ironic because as well as mood stabilization topamax is supposed to stop migraines. I’ve never had a migraine in my life and I hardly think that these are as bad but they’re still nasty. Paracetamol and ibuprofen don’t help. And funnily enough it’s localized to where that bloody Frisbee attacked me…

 I saw my GP a few days after I started and as soon as I slouched into her office she told me she was concerned. The fact that I was low – more specifically that I hadn’t showered in some time – was clearly evident.

 I told her I had started topamax and she looked surprised. “Topiramate? I’ve only ever seen that used for seizures” – I raised my eyebrows – “but these psychiatrists always find alternative uses for drugs in practice I’ve found.” She added quickly. “come and see me in a week, if you’re still feeling gross I’ll give Dr *psychiatrist* a call”

 I continued to be low with bouts of irritation that haven’t gone away. I can’t leave the house, except near the middle of the night to do my grocery shopping. I can’t stand the sound, sight, touch of people. I fought off intrusive thoughts compelling me to commit violent acts toward my self and other people. This is a symptom I associate with a manic episode.

 I’m not sure if my out of control moods are as a result of the meds not working yet, of them not working at all, or of them interacting and cancelling each other out. After a particularly violent episode of intrusive imagery I left a message for my psychiatrist asking for emergency advice. I will put up with a lot while adjusting to new meds but being bombarded with violent imagery isn’t something I want to deal with for too long if I possibly don’t have to. As yet, I haven’t heard back from her.

 I saw my GP again yesterday and happened to have the first good day I’d had in two weeks. So she’s decided that I’m doing better. Now I’m back down again and no idea where this is going.

 I’m still certain that this is going to cumulate in a hospital visit and I’m ok with that. This medication business needs to be sorted out…not once and for all because it doesn’t work like that but at least for a long stretch.

 

Mac.

Jessica Marais’ Bipolar Disorder is Not About You

I’ve always been interested in how the topic of mental health is handled by those in the public eye.  While celebrities might live lives far removed from our own, their take on complicated matters like a bipolar diagnosis tends to be both influential and reflective of the views of society as a whole.  Every now and then you see a story about a celebrity coming out of the ‘mental health closet, and I’m always all over those like a rash.

So when I saw the story about Jessica Marais’ interview with Woman’s Day appear on my news feed, I fell down the rabbit hole exploring every facet of it.

Here’s the news.com.au story, which summarises the Woman’s Day one:

Click here

And here’s one published on Mamamia, which goes a bit more in depth and takes opinions from other people living with bipolar disorder

Click here

If you can’t be bothered clicking, here’s the abridged version:

Jessica Marais, 29 year old mum of one, has struggled with bipolar episodes from age 12

She has a family history of the disease

She chooses not to be medicated and feels that her condition is controlled well

She has done cognitive behavioural therapy and says it was beneficial

she feels her toddler can “pull (her) out of” depression

The author of the Mamamia post reached out to the Black Dog institute for comment.  They supplied an overview of bipolar disorder but refused to comment on the specifics of Marais’ case.

There was an undercurrent of uncertainty in the Mamamia article because the author wasn’t sure how to feel about Marais’ revelation, because some of the things she said do seem to be controversial on the surface.  They ended the article with a selection of comments from bipolar suffering readers, which ranged from congratulating her on her bravery for coming forward to condemning her irresponsibility for (apparently) suggesting that all bipolar can be controlled without meds.

I don’t love the way this story has been approached.  Bipolar disorder is only discussed on an in dividual level, rather than acknowledging sufferers as the diverse population that we are.  All commenters used their own experiences as a measure of how well Marais was managing her condition, and were critical of her when they found that her experiences and management strategies were different to theirs.  Which is wrong.

Because guys?  Jessica Marais’ bipolar is not your bipolar.  It is not my bipolar.  We have a disease that presents on a spectrum that varied widely in presentation.

I suspect that the reason the folks at Black Dog didn’t want to comment on Marais case was because they didn’t want to present her as a single embodiment of all bipolar sufferers.  She isn’t, and I can’t find any point where she claimed to be.

I have bipolar disorder.  Like Marais, it appeared around age twelve and has been a major feature of my life ever since.  My experiences are widely different than what she represents hers as, but I don’t think that’s due to any lies or irresponsibility with management on her part.  Since I was properly diagnosed at age 20, I’ve read up extensively to educate myself on the disease as a whole, not just what it means for me.  So with that in mind, I’ll be offering my perspective on the story.

I find it interesting that she mentions her family history.  It’s been proven that there is a genetic link for the disease.  I know my family has enough problematic mental health genes to supply material for a whole psychiatric conference, but the only person apart from me who has been diagnosed with bipolar is my paternal grandmother.  I remember my dad talking at length with my doctor when she broke the news about my diagnosis to him at my request.  After he was done, he put down the phone, turned to me and said sadly “I supposed I should have expected it in one of you”  I think anyone who has been recently diagnosed should do a little digging in the family closet.

The major issue people have with her interview was where she claimed that she doesn’t need meds because she’s done CBT.  I have to admit, when I first read that I groaned out loud.  I know when I skip meds even for a few days it’s a pretty rapid descent into cray-cray town.  I can understand why it garnered such a negative reaction from the public because remember the last Australian public figure with bipolar who claimed he could handle himself off his meds?

Because I do:

465883-matthew-newton

via http://www.news.com.au

…yeah.  Sure hope he’s changed his mind.

But in the midst of my not-another-Matthew-Newton despair, my wise mind kicked in and I remembered what I’ve learnt about bipolar as a spectrum.  Her bipolar could well be more manageable than mine, I just don’t know.  A lot of bipolar people I was in hospital with were involved in group therapy for CBT, DBT and interpersonal therapy and responded well to it.  Jessica would have learnt about distress tolerance, self talk, diversion tactics amongst other things which once she’d practiced enough to make it second nature, could help take the edge off when she’s having an episode.

She also talks about self awareness which makes me think that she is actually controlling it without meds, or is well on the way to at least.  If you’re experiencing mania or depression, recognising those episodes for what they are will help you be more proactive in overcoming them.

There are bipolar people like me who will likely rely on meds for the rest of their lives but many people with a mental illness diagnosis won’t.  They may need them to be on and off to overcome rough patches but with the right kind of support and therapy they may cope just fine off them.  Once again – bipolar disorder is a spectrum.  For some it’s heavily debilitating, others are towards the lighter end of the scale.  Marais is likely one of those people.

She doesn’t say that meds are unnecessary for all bipolar patients, she was simply stating what works for her.  And quite frankly, there just isn’t enough talk about what a huge fucking difference behavioural therapies can do for people with mood and personality disorders.  Many people who need it don’t get it because they’re suspicious of and there needs to be more people who’ve done it publically talking about how it helped them.  So for singing the much deserved praises of behavioural therapies Jessica, THANK YOU.

The last point which I found interesting was where she says that her kid has been beneficial for her depression.  Now I don’t think she’s saying that to cure depression you should up and start reproducing, but it was a surprise to me because I’d assume that someone with a bipolar diagnosis would be a heavy risk for PND.  Then again, I’ve had more than a few friends who’d struggled with depression tell me that they actually saw improvement when they started a family.

Why is that, I wonder?  If I were to guess, I’d say a kid is a sure fire way to keep you busy.  My hospital psychologist was fond of saying that the best cure for depression was to do the opposite of what you feel – lying in bed doing nothing, not stimulating your brain is perpetuating the imbalance in your brain.  I’d imagine that finding motivation to get out of bed and face life is much easier when you have a little human screaming at you to do so.

If you could take anything away from this article, it’s that I ‘d rather you not look at a mental illness diagnosis as a one size fits all profile.  No treatment plan is going to be perfect for everyone and if someone is happy and healthy we should trust their ability to do right by themselves, even if we don’t agree with their methods.  This is why I love celebrity mental health stories – the more different experiences that we see, the more we will come to understand that the mentally ill community is one of diversity, and different experiences should accepted, not condemned.

Rock on, Jessica Marais.  You’re not obliged to share your personal life, but I’m glad you did.