Slowing down

If you look carefully, and you shouldn’t feel the need to, you can see the signs of me slowing down. Mornings get harder (and they’re never really my strong suite, but I’ve impressed myself lately), I stop answering the phone (which is always my strong preference but sometimes I’m better at it), I stop doing anything much around the house (which isn’t saying much but still), I stay in bed longer and longer, getting up and going is harder, and I dive into my laptop and live there because its more predictable and controllable in there than in the outside world. I jump into a world that isn’t reality, where beautiful music and sitcom laughter falsely pep me up. But I take falsely pepped up over no pep most days.

This week I haven’t been doing so well. I know why, but I can’t seem to shift it and improve my mood. There’s just been this one thing that’s bugging me, and I haven’t been able to physically do anything about it to this point and its just biting and biting. That has worn me down as well as consuming my thoughts with less than impressive ideas about myself. It’s brought about a constant level of fight or flight instinct in me, and between palpitations and just feeling amped up it hasn’t been fun.

At work on Sunday a patient came in desperate for something to help him sleep. He really seemed quite beside himself, saying he can’t get to sleep til 2am, doesn’t sleep long, and then is bombed out all day and can’t get anything done for being tired. It seems like a pretty clear case for handing out a Pharmacist Only sleeping tablet, but this man is on an old school medication that interacts with EVERYTHING! He was well aware of this and told me about it before I could ask about other medications. So I did the proper thing and checked to make sure that I could offer him a safe option. Most of the medications we can sell are sedating antihistamines like Phenergan and Polaramine which you may well have heard of. But these interact with his medication so they’re out. There was only one option (other than referring him to his doctor whenever he could get in) so I set him up with that, explained it all to him, reassured him that it was fine, advised him to take a half dose to start with and we both went on our way happy.

Then I got a call from him saying he’d read the leaflet in the box (of course, he would be the one in twenty to do so!) and it said not to take it. I explained again that the reason not to take it with his medication was because of drowsiness not another side effect, and in his case we wanted the drowsiness. At this point I recommended he discuss it with his doctor before taking it if he didn’t feel confident, but he said I was the medicine expert so if I said it was okay, then he was okay with it. Flattering to hear, but a bit of a terrifying responsibility at the same time. But I was happy from what I read so all good. But that call back set off some doubt in myself, some insecurity that maybe I got it wrong and I just cannot get rid of the [insert adjective] questioning in my head!! I looked it up again, and again, and although it seems right, there’s just something!! Did I do the wrong thing? Should I have not given him anything and hoped he could see his specialist soon? Is my knowledge still not up to date enough? What if something happens?? That last one is a killer of peaceful thoughts! Is it likely? No. But…and that is pretty much the loop my brain is feeding me.

I’ve tried to breathe: in 2 3, out 2 3 4 5. I’ve tried distracting myself, thinking of something else like our holiday to Queensland sometime later this year: I now have put together the most thorough bird watching to-do list that you’ve ever seen, have an order pending for a Cairns specific bird book, and GPS coordinates for good locations! I tried eating: fail. Telling a colleague: they weren’t concerned but what does that mean? The responsibility doesn’t rest on their shoulders so…I was asked to work yesterday so I was going to look the patient up and give them a call to check everything is okay, but my shift got canned. So that phone call got pushed out til tomorrow. It’s been a long week!! I’m just stuck in quandry, in limbo waiting for the knife to fall, the bell to toll, the consequence to descend on me. ARGH!

So my mood has struggled. Monday I was in bed til lunchtime, or after lunchtime; sometime around 3pm possibly. I don’t think I did a single thing. Wake up, sleep, wake up and breakfast, sleep, wake up and snack, sleep, wake up and drive 2 minutes for KFC, sleep, dinner, sleep. Very interesting. I was bugged by this sleeping tablet business all day, but I didn’t realise how much it was sapping my energy, motivation, interest in anything else til later. But every time I woke up either overnight or during the day it was right there, clear as crystal in the front of my mind!

Yesterday I managed to get out because I had a voucher with a use-by date to redeem at the aquarium, and at Pancake Parlour; freebies are a good motivator. Breakfast/brunch near an open fire while sorting bird photos on my laptop was pretty fun!!

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Then on to the aquarium where I enjoyed walking around in a removed kind of way, apart from the lovely shallow rock pool with little rays and elephant sharks (which are so ugly!!) and little fishies; that was awesome. Then on to the behind the scene package where we got in a glass bottom boat and watched rays and sharks and fish swim just beneath us. That was pretty cool. But the breakthrough was feeding the rays. I’m not talking about the little ones, I mean the Smooth Stingray species that is 3 or 4 metres across. They come up to the side of the tank for feeding, and they aren’t meant to, but they flap flap flap their “wings” against the side and cause huge splashes!! So naughty, and so fun fun to watch and take photos of! That got me laughing out loud; I really enjoyed that. I was smiling for ages after that.

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Then I went down a couple of levels to the bottom of that tank so I could watch the big sharks and rays swimming around through the glass; another wonderful experience! That really did it for me, and it is SO important to have things that do it for you on not so great days. Last stop was the penguins, and a cute penguin onesie for a baby who I know will be coming later in the year. I was still wrecked by the end of the day, I was still dragging myself around the levels of the aquarium, I was still tired but I got some smiles and laughs in which makes it a win as far as I’m concerned. It didn’t take much to suck that out of me, but at least it was sucking from happy to regular, not from regular to down. That’s a good thing too.

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We had a chat last night, hubby and me. Something about me being in a rut, lost in my laptop, not really engaging with the world or him. And I recognised it then as a symptom, that I really was down a bit and struggling a bit and it was cause and effect happening right there in my easy chair. I was almost at a point to make an appointment with my GP for a pep talk and pick me up, but I’m still holding that card because I see my psychiatrist next Tuesday.

So what about today? There is purely one reason why today worked. Wheel Women had a ride on that I had RSVP’d too but wasn’t sure if the weather would turn out good enough. Last night hubby said: “go even if its raining because there’s only meant to be a small amount of rain, so if it’s raining its probably nearly done”. And it happened exactly like that. Even though it was POURING rain when I woke up, I got up, got dressed, got ready, checked in to make sure the ride was still going ahead, and drove over to Kensington. It rained the ENTIRE way over there, except the last 1 to 2km, and then it was the most spectacular morning you could possibly imagine. Blue skies, the Maribyrnong river was looking stunning in blue as it reflected the sky, the grass was green and it was good to be alive with friends enjoying the sunshine and the fresh morning. That alone does it for me, and I would have been so disappointed had I stayed home.

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Instead we had a lovely time chatting while we rode, chatting over coffee and chatting all the way home again!!! And then, because I wanted to check out some birds (so wishing I had my camera in these perfect conditions!!) and get some shots of the city that I couldn’t take while I was riding, I did the whole thing again!! Yep, 2 loops along the Maribyrong and I can’t think of a better way to spend the day! Right now, I’m happy. I have a low level of anxiety still going on but I think I might take a Valium to give me a bit of a break from that so I can enjoy this feeling of happiness and friendship and accomplishment. Every time I do that ride along the Maribyrnong I remember the first time when I thought it was the hardest thing in the world! Now I just spin along and enjoy it for the scenery, and don’t even notice the kilometres going by. It’s nice having landmarks to show how far you’ve come!! I always appreciate them.

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What else was good about today? I went back again to look at birds and I found some terrific ones!! A Hardhead duck so close I could touch it when they’re normally shy birds. A stunning male Superb Fairy Wren in full blue plumage on a fence post in the sun (oh camera, wherefore art thou camera??!!). A group of Little Black Cormorants fishing together. A pair of Red-rumped Parrots flying off JUST in front of my wheel! A Great Egret in slow, graceful flight. Beautiful, lovely day. Plus a new Wheel Women friend. And watching a recent Wheel Women member improving with every ride; I love that!! Let’s hold on to that happy!!

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Don’t panic!

On Sunday I had a bad day.

I woke up feeling bad, kept feeling bad and managed to go to bed feeling only marginally less bad. Thankfully I woke up better on Monday and I’m trying to forget about it and put it behind me. But it was an unwanted reminder that sometime, somewhere, somehow there is going to be a relapse. It’s just a fact. But I really don’t want it!!

So what is a bad day?

I just felt bad!

I know; not terribly articulate. But that’s about all I had on the day.

To my husband’s frustration. It’s hard to be the one on the sideline asking what’s wrong and getting “I don’t know”, over and over. Like, surely you know something about what’s wrong; you must know a bit about what’s happening. But I didn’t; I still don’t. And of course there’s nothing to show for it that would give either of us a hint.

It’s also hard to be the one trying to figure out an answer to the question “what’s wrong?”. I just couldn’t explain it. Between being the one on the sidelines, and the one in the thick of it, there aren’t any winners!

In hindsight I can break it down, a bit. It’s like having a bad taste in your mouth, except its in your mind and its a lot harder to shake than by chewing gum or brushing your teeth, mainly cos you can’t get at it as easily. The bad taste makes you feel icky, yucky, unsettled, nervous, uncomfortable, sad, upset, despairing, weird, a bit spacey like you’re on the outside looking in, a bit in pain and a lot confused.

And why? Why did I have a bad day? I don’t know why. Probably there is no reason why. Or maybe there is and I’m just totally missing it. I don’t know why it happened, or why it happened today, and I probably never will. But it had gone for now, so let’s be happy about that and just leave it be. Obsessing about it won’t do any do, I’ve proved that amply by now.

So what to do about it?

Sleep.

Go back into oblivion where your brain shuts down enough of your thought processes to give you some peace. I woke up at about 9am in a sorry state, went back to bed just after 10am til 11.45pm, and went out for some lunch with hubby and family, more to avoid explaining why I wasn’t up for it as compared with actually feeling like going. Then back to bed just after 1pm til 4pm, a few hours up, then back to bed as soon as possible. It’s not living, but it’s surviving and on a day like this, that is all that counts; surviving.

So I survived, and the next day was better. Who knows how it all works. Just another story in the life of. Thanks for reading.

Canberra Day Six

16th September, 2016

Well friends, another day, another adventure. I felt myself getting a bit tired mentally today but tomorrow is going to be bright and sunny, and I’m getting out and about! Just thinking up ideas, and planning what to do gets me up out of my rainy slow mood into a better gear.

So many options for tomorrow!

The spring flower festival Floriade is opening tomorrow; one look at the website and I’m excited! Not so excited about how far I’m going to have to walk to get there…might take my bike. Then there’s the Raiders game…if you’d listened to a quarter of the radio that I’ve heard this week you’d know this is the biggest thing since sliced bread! Something about NRL, I think that’s rugby, and Canberra’s team that lost last week but still have a chance at the grand final because this week they’re gonna win the final, but they already played the final, but they’re playing the final so get behind it…I’m lost!! Whoever these Panthers are that are fighting them, I hope they understand the gist of it all! Tsk, rugby! Bring back AFL!

Then there’s an NRS (national road series) road race which for the uninitiated is a bike race over 3 days for the best in the country who haven’t made it to international pro level, or who have stepped down from pro level. My husband thinks he’s one of them so we’ll probably go check it out at some point; they’re usually a lot of fun with side carnivals. Might even show him a loop of Lake Burley Griffin now that I know it like the back of my hand haha! Then there’s my birding, a loose plan for lunch with hubby at Piallago and the possibilities are endless!

Today rained then was sorted of fine then drizzled and I wasn’t sure when was the best time to go riding so I ended up not going, which is a shame. I think it would have topped off my day in better fashion than a sleep. But too late for that. Tomorrow is another day. On a recommendation I checked out the Red Hill lookout today, another rainy view! Are you seeing any repetition here? There’s a cool restaurant up there that I wouldn’t mind checking out another day. But tomorrow is going to be sunny! Maybe I’ll do Mount Ainslie, Mount Pleasant and Red Hill lookouts all in one! I’m still glad I went the places I did this week in the rain, but I’m excited to go back in the sunshine. So Red Hill lookout, then a random drive around looking for little strips of local shops where I might buy a present for a friend; finally found one in Yarralumla on my second detour. Sadly because I dropped hubby to work at 8am, the shop wasn’t open but at least I found it so I’ll be back.

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Back home, a bit of blogging and website portfolios, then down the street for a couple of jobs. Lunch, games with the cat who is become a good friend of mine and hubby’s, a nap and deluxe nachos and long chats over dinner! Awesome Friday night. And now even a timely bedtime!! I so need it, and can’t wait for tomorrow to dawn for more adventures! What’s your pick of activities? Comment and let me know.

Dozy

Dear lovely readers, I am having the best time! I’m well, I’m happy, I’m productive, I’m energetic, not needing as much sleep or naps, I’m doing stuff, back on my bike, I’m out taking photos of birds, socialising, I’m having house guests, getting organised, spring cleaning of all things!! It’s remarkable and it’s thanks to my psychiatrist, thanks to the extra purple pill per day that I’m taking and thanks to my brain for accepting the intervention gracefully and allowing these happy days. I owe thanks to every lovely person who checks in on me when I’m unwell, so thank you so much; I’m glad I can write good news!

[Written a couple of weeks ago on One Of Those Days! I’ve been too busy living a happy life to write this week! YAY!]

Today I didn’t wake up, not altogether. I’m feeling a bit dazed, and a lot like there is a thick fog well settled well over my brain, and down over my neck, my shoulders and half way down my chest!

I’m struggling to open my eyes, and to keep them open, more to the point. They certainly aren’t fully opening. They just have an irresistible almost magnetic draw to close, and the sleep in the corners of my eyes clagging them together is adding to the problem. You know those moments, when people say they need matchsticks to prop open their eyelids? Except that’s usually at the end of the day, not the start of it. Bleary eyed, irritated and itchy, my eyes just aren’t ready for a new day. I realise this isn’t a first in the history of humans. Other people wake up like this too, it’s not just me. But this is after a full night’s sleep, a good rest. I should be rearing to go.

My whole body feels like its wrapped in a deliciously warm lovely blanket from which it would have to put up a great and tiring fight to escape. Well, I guess that’s not so metaphorical; I am still in bed, and I roll around enough in the night that it’s quite likely I’m twisted tight in the sheets by morning. My body is heavy and weighty and it just seems too hard to move it at all. And why would I want to put in that level of effort when I’m in such a nice situation? Oh yeah, to be the adult that I apparently am. But I can’t really think straight enough even to start planning what shape the day is going to take. What time do I need to get up again? And do I really need to get up, or can I cancel whatever I had planned? Assuming I can actually get this hefty body up out of bed. It’s like I’ve lost all muscle tone and I have to use my mind like a lifting machine to lift each dead weight limb, one at a time and they won’t cooperate! You know, one of those caterpillar diggers with the lifting clamp? Or one of the machines that nurses use, whichever environment is easier for you to visualize.

Drowsy, thick in the head, awful eyes, impossible body, can’t see where to start. And it’s my fault, my husband would remind me! Love you, baby; you really know how to phrase these statements. I am of course joking, he only says it nicely and when I know its the truth anyway.

But it’s true, it is my fault, in a manner of speaking. I took my tablets too late last night, and now I’m hung over. Basically.

I take my tablets by alarm, sort of. When you are prescribed a medicine that has to be taken twice a day, you should ideally take the 2 doses 12 hours apart. Says Miss Pharmacist, but what does Mrs Patient do? So, when will you take it?

It actually takes a bit of working out. Will you take your tablets at 7am and 7pm? 8am and 8pm? Really anything 12 hours apart works. Except there’s a complication because one of the tablets that you take at night with the second dose makes you drowsy and then comatose! It kicks in anywhere between 15 and 30 minutes usually. Sometimes it doesn’t really kick in for ages and I can stay up for an hour longer or more, but sometimes it kicks in fast and that’s it for the day. When I feel it starting to make my eyelids heavy and my insides warm and fuzzy, I head upstairs before I can’t stand straight anymore from dizziness and lack of balance! Please never try to see me at this time of night: the whole whites of my eyes go reddish and I scare myself looking in the mirror! It’s all gone by morning thankfully. In the past I’ve tried to push through the sedating effects but they won’t be argued with! I’ve crashed my way around my bedroom, lurching from wall to wall unbalanced and unable to see straight, and unfortunately having to go to the bathroom! There I sit, having done with the toilet, unsure if I can stand up and get back to my bed next door, feeling weak and heavy as a dead weight. Ask my husband, I think he’s had some interesting amusements in the early days of me using this drug! I’m talking about quetiapine, a mood stabiliser very well known for the drowsiness that it causes, among other things.

So, theoretically I could take my morning tablets at whatever time, then most of my evening tablets 12 hours later, then the sedating medication when I’m ready to go to bed…but that means having life interrupted 3 times a day instead of 2. It sounds trivial when I’m taking so many meds crucial to my health, but when I’m well I’d rather not spend all day taking tablets. So I want my meds in two convenient slots, but what times? If I’m working, this is especially critical. I want to take my meds before work, say 8am. But I don’t want to take my sedating tablets at 8pm and go to bed with the children. Plus its so early in the evening that I’m be sure to be awake bright and early at 4am or something inconvenient! So I tend to push out the night dose to 9pm, 10pm or later. If I’m busy, I just wait til I’m finished doing whatever I’m doing and I’m ready to go to bed and THEN I take them. I intend to get to the point where I’m NEARLY ready for bed, take my tablets and get a little sleepy while finishing off whatever, and go to bed nice and drowsy read to go off to a deep sleep. But I often forget and finish what I’m doing completely before taking my meds. The later I take them, the more likely it is that their effect will hang over into the morning. By much trial and error over 2 years, we’ve figured out that 9 to 9.30pm is the ideal time to take my meds at night, giving me possibly up to 10pm to do whatever in the evening and allowing me to wake up fresher. But unfortunately last night I took my sedating tablets at 11.30pm! Which messes up my system, although it is a fairly flexible system to be honest! When my night tablet alarm goes off I’m just as likely to snooze or ignore as I am my morning alarm. Some little rebellion in me about having to take meds. It never works out well for me. And so, here we are. Sedated, drowsy, heavy, tired; finding it hard to get going.

It’ll get better but slowly, across the course of the day, and it’s probably just going to be one of those days where I shouldn’t drive, need to find something riveting to do to keep me awake, or just succumb and stay in/go back to bed! I guess this is one of those days where not having a job works out for me. I might manage to get up and go to work on a day like this, but it’s questionable what quality of work I would produce, and it’s probably in most people’s best interest that I don’t go at all. So if I’m working, I need to be a lot stricter with myself in taking my meds on time. There’s a fascinating concept called presenteeism which I recently became aware of. You know, like absenteeism where you’re absent from work? Except this is when you are unwell, under stress or otherwise compromised in some way, but you turn up anyway and consequently put in a worse day of work than you might usually. A workplace was looking at how much presenteeism cost them as opposed to absenteeism, and whether it is really better sometimes for staff to just stay home. Doing so would theoretically reduce errors, complications, injuries that may arise from incomplete focus. I don’t know how they’ll measure any of it, but I’m watching on with great interest.

So yes I supposed you could say that being hung over and non functional is my fault. I get tempted to have late nights, to be like everyone else, carefree and not worrying about things like tablets. I know it’ll catch up with me the next day, but in the evening when it’s all going down it doesn’t seem as bad as it will be in the morning. So I push out the time a bit here and a bit there, a lot here, too much there! I do have to be careful that I don’t get myself into a different time zone, taking my tabs at 11pm and 11am or worse and really messing up my hours. While I’m off work I can be a rebel and mess up my sleep pattern and sleep in til lunchtime. Who cares, basically! But work is something that I want and need, and when it comes it’s back to taking tablets by the alarm. Like a good girl. For the best.

Mania

[Written 20th October 2014, updated along the way, most recently 28th July 2015 ]

There’s a question that I’ve been trying to answer ever since I was first diagnosed with bipolar disorder and experienced the first obvious manic episode: how can I know when an episode of mania is coming on?

I have been working on answering this question for a while. Hence the start date for writing. It’s taken time, experience, reflection and I’m still not there yet. Here’s what I’ve got so far.

It’s not like people imagine. There’s no flash from the sky that strikes you down in the middle of your ordinary day changing you in an instant from deeply depressed to wildly happy.

There’s no sudden chemical reaction that causes an immediate switch from happy Harry to sad Sally. You won’t be mid conversation with me and I’ll sudden lash out with anger or anything dramatic like that. I promise. I also won’t suddenly slump into deep depression.

It’s much more subtle than that.

I have bipolar disorder type 2, or manic depression. As opposed to bipolar disorder type 1, or classic bipolar, which involves intense highs followed by agonizing lows.

In the six months or so before my diagnosis of bipolar, I would exist mostly in varying depths of depression with the odd dilly dally into sub-mania, or half strength, quarter strength mania. So sub-manic that I didn’t even know it was happening for the first few episodes! It was like a partial lessening of my depression, not very distinguishable from my usual depression. It certainly wasn’t the full mania thing; I didn’t get the happy, carefree, superhero mood to balance my sorrows. I actually noticed a worsening of my depression when the lighter mood ended rather than noticing a lightening of my depression. I felt that I was having cyclical worsening of my depression, whereas the mental health nurse in ED saw a recurring very weak mania.

Moods don’t change 50 times a day. I should know. When I was first provisionally (meaning this-is-what-we-think-it-is-but-we’ll-wait-to-see-before-we-commit-to-the-title) diagnosed with bipolar disorder I was in a phase called rapid cycling. As it kind of suggests, rapid cycling is where your mood cycles/changes rapidly! Pretty self explanatory.

What this meant for me literally was about once a week over three or four weeks I would descend into the big black pit from where I could see no possible exit other than stopping living in it. That’s what being suicidal is all about; utter hopelessness. It’s awful and very hard to bear.

But then I’d be a bit better again, and think, oh that wasn’t so bad. If it happens again I’ll definitely tell someone, but I’m okay now so it’s all good. Except that each time I went in it was worse! And worse, and worse until I was done with it! Luckily I had an appointment with my GP on the day I was done with it so that instead of being done, I went to hospital and you know the recovery story after that. Or if you don’t, it’s time to hit the archives!

So rapid cycling. Once a week, not once a day, 10 times a day or anything fantastical. That’s rapid cycling.

For the “regular” patient with bipolar 1…weird statement, I’m sure every one is different and there’s nothing regular about it!…mood changes might be more likely to occur every few months or even once or less per year. Maybe every few years once a person is medicated. But when they come, they can be a serious force to be reckoned with!

So my original question: how do you know when it’s coming?

I’m still not completely sure.

I’ve found that needing less sleep or unusually restless sleep, waking many times in the night and waking for good in the early morning hours is a sign of mania, which doesn’t rest, and wants to be on the move the whole time.

I usually have a couple of days of being more irritated/frustrated/annoyed about small things than usual. Ask my poor husband! I stub my toe and scream in full on rage at the pain and the stupidness of myself to do such a dumb, painful thing. I mess something up and totally lose it, raging at myself for my incompetence. I just can’t tolerate anything less than perfection in myself. I take a wrong turn in the car, get lost, run late and just burn up the road in furious outrage at my incapability to do anything right. I fumble my keys, my phone slips out of my fingers, 1 drop one of the 10 things I’m balancing in my arms while I walk blind down the stairs and write myself off as a useless, worthless human being! When actually I’m a regular human being possessed of a mood that makes me think I can do a lot more than I a) can or b) should.

At this point, the best way to end things and to not keep on getting worse and worse, is to go to bed and sleep. For however long it takes to wear off the mania.

It’s truly a strange disorder. In essence, this is what depression is, being upset and down on yourself, but this time instead of getting melancholy about being useless, I get mad, really mad! Not at you, don’t worry. The majority is forcefully muttering stupid, idiot, fool, dummy at myself under my breathe. The rest is taken out on my poor hubby, who tends to have a bad habit of laughing when I’m this mood and massively exaggerating the events of the day. Of course the more he laughs, the closer I get to bashing him with the rolling pin! Once the mood passes we laugh about it together, but at the time he makes me furious!!! Livid!!!

Then there is getting teary about silly things more than usual, although that can come with the depression cycle too. I’m naturally an easy crier, which goes against my attempt to be cool, calm and collected! I think I can see now that when these PMS-ish symptoms start, it’s time to take a breath and check what’s really going on. I say PMS-ish cause that’s how it kind of feels, although I maintain that I don’t get (much!) PMS…my husband prefers to not answer so who can tell?!?

Add some annoying heart palpitations which make me nervous about being anxious again and you have a pretty complete picture.

I suppose the more important question is, how do I know when I’m a bit manic? Easy! I have had some pretty perfect examples!

One day a while back, I woke up spontaneously at 5am without an alarm, feeling fully rested and completely ready to hit the floor running and get things moving! This from a famously unlover of mornings!
I had motivation, organisation, energy to boot and I’m full on into my job list!!! Check check check check check..what’s next???

All this despite being exhausted for the previous 4 days, not getting out of bed until 5pm one day a few days back and having a 4 hour “nap” two days before missing half of a family birthday! Whatever comes my way, today I’m all over it!
Before 8am I’d been for two laps around the park; most days I wouldn’t even be awake yet! And I never walk! I catch the bus/train/tram/friends car/taxi before I walk, except when Chester’s making an effort to get me out of the house and we do a slow stroll around the park…today I was striding! I was considering jogging! Today I’m on fire!

But I have to keep a careful check that I don’t get too cray-cray, too outgoing and chatty, too effervescent and bubble off the reservation! I don’t want to wander into the real manic territory of getting all spendy with the money I’m not earning, getting over confident with betting/gambling (not really a worry is my theory since I never do that anyway…), being over-enthusiastic/ambitious to the point of being a bit delusional or putting myself in dangerous situations that I think I can handle or just physically burning myself out being bouncy and happy and carefree and all over it!

The other classic manic thing is getting a bit over-affectionate…Chester won’t complain, as long as I keep it within the house!

And one perk: I’m so active, and busy PLUS I don’t get hungry as much and don’t wear out at all! So mania. Love it! Love it more when it stays more than a day or two but it’s usually pretty short lived. Love it the most when it isn’t followed by a big black lump of depression but that can be a common switch. In general, I’d prefer if I didn’t get depressed at all or manic at all. I love the energy of mania but it can also make me irritable, restless and impulsive and I start to get claustrophobic and nervous about all my typical old scary movie type phobias. And there’s nothing much I love about depression. So after an episode of sub-mania it’s back to the psychiatrist for a review and a new opinion of what to do next. I’m guessing there’s a lithium or valproate dose increase in the works…and that’s okay with me! Whatever it takes to get back to a comfortable holding pattern of “normal” moods. The aim is always for the lows to not be as low, and the highs not as high. Middle ground; that’s what we’re chasing. Here’s to it!

So, fortunately/unfortunately this has been the story of my bipolar. Fortunately I don’t get the massive mania with delusions, super hero thoughts and even hallucinations. Unfortunately my mood swings tend to be often, like weeks and months and they do throw me off balance each time. Despite what I’ve tried to learn about my mind and my body from my experience so far, and the fact that I know mood swings will come in spite of my meds, they still creep up and catch me unawares. And so far they do unfortunately seem to be getting bigger and more intense each time…but I won’t borrow trouble before it comes.

The last question is how can other people tell that I’m manic? My husband has some answers for that list! I may be a bit short with you, or seem a bit edgy and I will be less patient than usual. I’ll be more sociable than usual but it’ll be a bit fragile if things go wrong. I try to keep it together for everyone else but sometimes some sharp answers slip through my filter; I apologise in advance!

Tales of a missed dose

[Written 16th June 2015]

This is a story of what happens when I miss a dose of medication.

What happens depends whether I miss a morning dose or an evening dose. As I write this I’m suffering from missing an evening dose so let’s go with that.

At night I take several tablets: quetiapine, lithium, valproate, rosuvastatin, pantoprazole. Mood stabiliser, mood stabiliser, mood stabiliser, anti-cholesterol, antacid. Yes, it takes that many stabilisers to keep me going!

In the morning I take thyroxine, venlafaxine, Levlen, valproate, lithium. Thyroid hormone replacement, antidepressant, contraceptive, mood stabiliser, mood stabiliser.

All done! Hopefully...I'll still count the tablets out every morning and night to double triple check

In terms of missing a dose, lithium and valproate aren’t the worst to miss as a patient because I’ll be taking some again soon. This is not an official pharmacist, GP or psychiatrist recommendation! Lithium and valproate should ALWAYS be taken twice a day, as close as possible to 12 hours apart for the best effect! And I repeat! This is because for lithium a healthy person’s kidneys clear it out of you in that time frame so to keep a steady level you should take it consistently. And for valproate it’s your liver. That’s why you should respect these two organs very highly! They are very important. But what I’m meaning is its not the worst in terms of the adverse effect of missing a dose. If I miss taking lithium at bedtime, I take it first thing the next morning which gets it back in my system before I physically notice that it even left. My overall level will be a bit lower for a few days which isn’t ideal, but it will work back up to speed soon enough. And I do have a level at least.

Whereas for medications that I take once a day, I’ll miss the effect for 24 hours. Which sucks. Plainly and simply!

boxes, bottles, tablets, capsules

Quetiapine is one of the once a day tablets. It is prescribed to me to prevent mood swings, reduce my anxiety and has the handy effect of giving me a good night’s sleep. It was doing this a bit too well for some months there and I was doped out all of the time, but my awesome psychiatrist recommended a change in the times I take it and we’re back up to speed. Yes!

So, do I get a mood swing if I miss one dose? No. Really not. The chemistry isn’t that reactive. In the same way that it takes weeks of first taking the medication to get the benefit, it takes longer than one day to mess up the whole thing. But I do have a rough day afterward, and a rough night too! It’s a bit like I’m sitting in my car going along nicely and I know where I am and where I’m going and how I am and suddenly another car rear ends me, or bumps into the side of my car at a right angle. Slowly of course, not fast. So my mood just takes a hit, a bump and suddenly I’ve jumped along or across and I find myself somewhere other than where I just was, a bit disorientated about how I got there and sort of catching up with what just happened and where am I now and how I am and are we still okay? That following day I may be in quite a different mood from the one before, either peppy and edgy and anxious and manic, or slow, and silent, and flat and a bit away with the fairies. But that doesn’t qualify as a mood swing, just a sudden small change that affects my day.

After missing a dose here and there I have now gotten the side effects of missing my nightly dose of quetiapine down in a pretty clear timeline. Yes, there are side effects from NOT taking your tablets, as much as taking them. Something to consider.

So here’s the quetiapine absence timeline.

strips, tablets, capsules

10 to 11pm: I can’t get to sleep.

This is a terrible thing. I need my sleep. Always have, and always will I guess, but especially since I’ve been sick. So does everyone, I realise. If I don’t get a good night’s sleep the next day is a struggle, emotionally. So I toss, and I turn, and I turn, and I toss. After an hour of this, if I’m alert enough, I’ll think to myself, self, why can’t I get to sleep? I usually go straight to sleep! Then I’ll look in my pill box, see my tablets, mentally or physically hit myself in the head, take them and all is good in the world. Just like that. If I’m not thinking too clearly, I might think to take a Valium and at least get some sleep. If I’m dull-witted, which is at least half of the time, I’ll eventually wrestle myself to sleep. It sounds funny to say, but I’ve become very good at putting myself to sleep. I nap most days from necessity, and there is a skill involved in going from activity to sleep in a short space of time. I guess shift workers eventually excel at this sort of thing. So I’m quite adept at getting myself in a comfortable position, getting the temperature right (cannot sleep well unless it is right!), darkening the room, doing a conscious relaxation of as many muscles as I can, and stilling my mind into sleep.

Say I managed that. Next time check?

3am. Yep, wide awake, fresh as a daisy, ready to go at 3am. I toss, and turn, and can’t get comfortable, and I’m restless and my poor husband is rocking and rolling every time I turn and I’m messing with his sheets, and he has to go to work tomorrow even if I don’t, so I try to lay still and physically can’t! Why am I awake, I’m usually asleep, what is happening, oh….ahhhh! Tablets! I forgot them! Duhh! I hate that moment! I try to do my utmost to prevent it, but it still happens and it does feel like a failure every time I somehow mess it up! So, should I take them now? The dilemma! It’s 7 out of 12 or 24 hours through the medication time period. So I can’t take all of them. Maybe just some of them. Can’t take quetiapine, I’ve missed the boat on that one otherwise I’ll sleep all day. And I’ll be taking lithium and valproate soon anyway, and can’t double dose. What about the rest? Which are nothing really, in the scheme of me being wide awake at 3am! Cholesterol and stomach medication. Sure I can take them, they should be taken regularly but it’s too late for my sleep. The next dilemma then: try to force myself to sleep again, or just get up, take my laptop to the spare room and do something else? Who knows? Depends what I’ve got on the next day really. I can never decide!

medication list

8am: I’ve finally given up the ghost on sleep so I’m up and peppy and full of life and only just partially anxious and ever so slightly manic and energetic and going to run the world! If I haven’t already taken one to sleep, now is the time for a Valium to wind back the jets on being super woman and achieving all my life goals in one sweet day! And talking my husband’s ear off and planning one hundred chores like a complete going through of the entire kitchen plus 3 loads of washing on a rainy day and lunch with girlfriends and all kinds of magical things. ‘Woah, says my husband, that’s too many things for today. No do that another day, you’ve got enough things for today. How about you sit down for a minute, what about some mindfulness? I think you should do some mindfulness…how about you go and do that now?’ At around about this point I have now blown my nose for literally the THIRTIETH time since waking for the final time. THIRTY. You just can’t blow you nose till it feels empty; there’s always residual. And it’s pretty much like a tap. The medical term is rhinorrhea, like diarrhea but your nose is melting and there is a constant liquid dripping, dripping, dripping!! Quetiapine dries you out like anything so you get dry mouth (and want to drink Coke all the time!), dry nose which leads to sores and blood noses, some degree of constipation which no one wants to know about and some urine retention. The last one isn’t noticeable on any other day, until the missed dose day and then I realise that yes I really have been holding back! TMI I know, but you wanted the whole story right?

But the nose thing really gets me! If I notice nothing else in the middle of the night, I do notice my nose dripping incessantly! It’s an instant giveaway! It’s different to regular waking up in the morning and blowing your nose. It’s more like hay fever without the sneezing but the medication to stop it cannot be taken til nighttime!!! Cue fierce under breath bursts of ‘idiot’!

And then it’s just getting through the day like usual, but bearing well in mind that you’re a bit high today, a bit edgy, a bit fiddly, a bit anxious, a bit overstrung so remembering to breath, relax, calm, easy, gently does it. And I should mention that the other things ease off too, just not in such an obvious diagnostic way. I have the right amount of saliva in my mouth (who knew that was a thing!) and going to the toilet is a breeze, like really easy, like maybe a bit too much and too many times! So happy thoughts!

medication box, tablets

Now the morning lot and venlafaxine. Anyone who is involved in the prescribing, dispensing, and before too long taking venlafaxine knows about the withdrawals. It’s described in the textbooks and it happens like the textbooks. Exactly like. I used to think this was pretty cool. I still do theoretically, but in practice I either love or hate that they’re so reliable and unavoidable. I love them if I notice it before I’ve left the house for a work day because I immediately fix the shortcoming. I hate them if I notice once I’m already on the way to the bus stop and I don’t have time to turn back, or I’m on the bus, on the train, on the tram, in the building. Then it sucks because I know what’s coming and I can’t do a thing about it! Unless I can get to my doctor for an emergency script but that means paying full price, and after all it’s nothing life threatening. Not bad enough to pay three times the normal price! And believe it or not borrowing stock from the shelves is not strongly encouraged by my employers nor is it in any way legal!

What the symptoms/adverse effects of missing venlafaxine are: electric shocks/tingling in your fingers, light headedness/feeling like my head is spinning/wondering if I’ll faint, nausea. Nothing fun. Nothing dangerous. They don’t make for a good day, and I have to wait til the next morning to fix it! More banging of palm to forehead and severe muttering to oneself!

So that the what. The why is a whole other adventure and I don’t have time today, but hang in there and soon we’ll have another chat and look at the other part of the problem. Chat soon!

Last night I had a dream…

Anxiety, depression, antidepressants.

Condition, condition, treatment.

Cause of dreams, cause of nightmares, cause of crazy, surreal, nonsensical, weird-as concoctions of ideas and sequence.

Either way, not a great night’s sleep!! And a poor night’s sleep leads to waking up tired and already sick of the day, and that’s no way to feel better about life!

In December last year I got started on a second and more sedating antidepressant to help with my anxiety, and depression. I was initially scared of being on two antidepressants simultaneously. The pharmacist in me was screaming “serotonin sydrome, serotonin syndrome!” [see author’s note]. But then I took it, as directed, at 9pm at night. Within in half an hour a warm fuzzy feeling was spreading all over me and I was feeling sleepy. So I went to bed. I fell asleep straight away, no tossing and turning and trying to force myself to sleep. No fretting, anxiety, stress, fears for tomorrow. Just pure sleep. Bliss!

I fell asleep, and stayed asleep. All night! In fact I couldn’t get up the next day! The doctor had warned me about this so I had started the medication on Christmas Day. I dragged myself out of bed about 9.30am, tried to keep my eyes open over breakfast and finally gave up after a shower and went back to bed about 11am. I slept solidly for two hours and woke up feeling a bit better, but still sleepy – luckily it was a small family lunch for Christmas so it didn’t matter too much. The next day was better, the next even better and within four or five days I could wake up bright and early as soon as my alarm went off and head off to work. And I was getting a full night’s sleep every night!! I was no longer waking up feeling like someone had “punched me in the face” as my doctor describes it, pretty accurately!

Oh mirtazepine! I still have a soft place in my heart for this wonder drug that put me to sleep, kept me asleep and then allowed me to wake up and get on with my life.

I’ve changed medications a lot since then. I had to get rid of mirtazepine because the doctors wanted to start quetiapine instead, an antipsychotic/mood stabiliser to stop me swinging from one end of  the spectrum to the other. It is also sedating. It does a pretty good job with my sleep: it certainly puts to sleep, and keeps me asleep, but I’m having this annoying phenomenon of waking up every morning at 4am or 5am bright as a button!

And to all the helpful people who say “just get up” – thank you for your advice but I respectfully decline!! What kind of time to get up is 4am?? What am I meant to do at that hour of the day? How am I meant to occupy myself all day? It’s hard enough as it is! So I go to the toilet and get back in bed and start the fight with myself to get back to sleep. Unfortunately by the time I succeed it is time for my hubby to get up and a much more reasonable hour of the day to be awake, and I’m conked out! Completely out to it! So my actual getting up time is more like 8am, 8.30am, 9am, 9.30am. Which doesn’t work well with a plan to go back to work eventually on a 8am to 5pm shift…but hey, I really shouldn’t be getting ahead of myself!

I asked my psychiatrist about this early waking thing. At first I thought it was just going to be a temporary thing, but it’s going on and on. He doesn’t want to increase the quetiapine dose anymore; I’m already fat and have cholesterol problems which are in part due to this medication and neither of us want to worsen that! Besides I’ve been started on lithium since which he hopes will be my main medication and the idea is to eventually reduce and possibly cut out altogether my antidepressant and mood stabiliser. His opinion on the matter is that depression is the cause. Early waking can be a typical sign of depression in his view. Bummer!! I was hoping it was something medication-induced that was more easily fixed than depression! Ah well, at least I got most of a good night’s sleep. Mostly.

There’s still the odd crazy antidepressant dream. I’ve heard about other people on antidepressants having strange out of context or deranged dreams, so I guess it’s something that can be part and parcel of treatment. I’ve had a lot more in the past but since being on a mood stabiliser they’ve been a lot rarer.

However I had one last night that got me thinking about this again.

Here’s the reality as background. My sister is a chemistry and nutrition teacher and mostly we get on well. We had a phone conversation last week that was really nice, we had a good chat about different things and only stopped because we had to go out for a date.

Now here’s the dream. I get invited to go to a private girls school to give a lesson on nutrition but I can choose exactly what I want to give the talk on. I choose to talk about waist circumference and it’s link to heart disease. I go to give the talk but I get lost and I’m running late so I have to call ahead and tell them I’m going to be late; not impressive for a guest lecturer! I finally get to the classroom and there are 5 girls; a bit surprising for a guest lecture but okay. Somewhere in the dream the classroom becomes a car and the number of girls drops to two!! Anyway when we get to the car part my sister (the nutrition teacher) turns up and begins heckling me about my facts, saying that they are not evidence-based, the greatest insult in modern medicine! I respond but suddenly I can’t find the evidence that I had before and can’t fight back against the allegations. It turns into a bit of a shame fest for me as a lecturer and then I start getting criticised for my lecturing style, my notes and my slides and it descends into a big higgle-di-piggle-di and I wake up!! Ridiculous!!

Questions: I have no idea on what authority I’m giving this talk, why me? I don’t really have to guess why waist circumference; it’s clearly because mine is well over the line and I need to do something about it other than eating chocolate! Why am I running late – I don’t actually do that much anymore; I’ve really turned over a new leaf. How did we get into the car and why? Why a private school; I went to public schools and have no idea what private schools are like. Why is my sister even there, she lives in a different state? Why are my facts being questioned, especially by my sister who would absolutely support them in real life?

There is no reasoning why with these dreams, they just have to be brushed off as we go on with life. Sometimes they are harder to brush off but I’m sure that looking for meaning in them isn’t very productive. If you beg to differ, and can find a meaning, I’m listening.

So sleep, dreams, life. All wrapped up together and getting the perfect balance is an art. It’s not perfect now, but it’s a long way better than it used to be so I’d like not to fight it but to be glad for what I’ve got and make the most of it!

[Author’s note on serotonin syndrome: when prescribed a high dose of a medicine that increases serotonin like SSRI and SNRI antidepressants, or when prescribed a combination of two medications that increase serotonin there is potential for a patient to develop serotonin toxicity or serotonin syndrome. I have been prescribed both at different times and have never experienced any problems; that is not to say it doesn’t happen, but it is not common. If you believe you have been prescribed one of these you should discuss serotonin syndrome with your doctor/psychiatrist. I am not an authority on the matter and won’t be giving a list of symptoms to look out for. ]