I am fastidious about my pre-bedtime routine. This is dictated by my (bipolar) anxiety and OCD. In the living room, I make sure the TV is off, the lights are off and the door is shut. This is how it always is, how it always has been.
This morning I came downstairs and stopped when I saw the door open and lights on. My first thought was that I’d been burgled (unlikely as the house is as tight as a drum). But no, the lamp I always use was on and another lamp I seldom use was also on. The TV had switched itself off on the power-saving mode.
There was no sign of a break-in; windows were intact as were front and back doors.
This hasleft me feeling ill and uneasy all day. Thinking about it, I can guess only at two posible explanations:
Memory lapse (wouldn’t be the first) probably linked to the dissociation I have with my bipolar. Brief psychotic episode (again, wouldn’t be the first). Had I come downstairs in the night and watched TV or done something else? I have no history of sleep-walking.
It’s all very strange. Spooky action indeed.
The past three weeks have been dedicated to getting used to an increased dose of quetiapine (now up to 600mg daily) and the introduction of valproate (500mg as Epilim Chrono). The fluoxetine has stayed the same at 20mg; psychiatrist wanted to double that dose to 40mg but I tried that once before and it triggered hypomania.
So far the valproate doesn’t seem to have kicked-in. Psych says this can take 2-4 weeks and couple of 6-8 weeks before noticing any change in mood. The valproate / increased quetiapine together have had a very sedating effect and at the moment this would seem to be the only side effect so far.
It’s been a real pain trying to get the prescription sorted with GP and pharmacy; the former seems to find it impossible to write a simple repeat prescription and the latter seem inept at getting a stock of quetiapine. Though I’ve noticed the past month that several people on Twitter have also reported problems of pharmacies getting stocks of it.
The school year has now ended and in the end I managed to have only 4 days off sick. I was aiming at having 0 days this academic year, after the several months I had off last year. I see these 4 days as failure, though no-one appears to agree with me.
I’m going away on holiday to the Med; I’ve worked bloody hard for it.
I started going downhill again a month ago. GP tried to get me seen by assessment team the same day but it took a week. Then I had to describe it all again; for what seemed like the hundredth time.
And again, another long assessment. My psychiatrists said something about juggling my medication a little and trying to get me more (1:1) CBT therapy. Last time I had therapy for several months I’d yet to start on the meds and it did very little for me I think. If I get more therapy now it will be interesting to see how it goes alongside medication.
So a couple of days ago I had my follow-up meeting with the psychiatrists; another ‘20 minute’ one that turned into 50 minutes.
The bottom line of which is that my Quetiapine has been increased almost to maximum dose – up from 500mg to 600mg. Fluoxetine remains at 20mg. And Valproate has been added into the mix, at minimum dose: 500mg. Lithium was discussed but I was told the side effects wouldn’t agree with me – and anyway, Valproate is better for OCD (and its anxiety trigger).
I’m starting to rattle.
Quetiapine, fluoxetine joined by lorazepam. And ’emergency’ crisis meeting with MH assessment team next Monday. It never ends, does it? #bipolar
I’m relatively stable at the moment, hence the reason I’ve not written anything here in a while. The sole reason for this stability is my meds. After all, I don’t have any other help or input – in this respect I’m where I was three years ago, before therapy and starting on quetiapine + fluoxetine. I am theoretically in the care of my GP though I never see my GP.
After having so much time off work last year (several months) my main objective this academic year was to have no time off at all. That’s how stubborn I am! But here we are, seven weeks from the end of the school year and I have 100% attendance.
It doesn’t mean I’m “better”. I’m not; there’s no cure for bipolar. No cure for anxiety. No cure for OCD. No cure for the dissociation (DID). There’s just medication; damage limitation.
I still, of course, get intrusive suicidal thoughts. I still don’t sleep well. Surely 550mg quetiapine + 20mg fluoxetine daily should be knocking me out all night? But no, I’ve not slept through the night in decades, if I ever did at all. My short term memory has taken a severe hit (I suspect some of this is memory lapses linked to the DID symptoms) though my long-term memory in many respects would put your average elephant to shame.
Quetiapine continues to function in making me fat. It’s a straight either / or choice with these meds: Fat or Mad. I’ve opted for the former, somewhat reluctantly.
There’s a blog piece to be written about the DID symptoms I’ve experienced through my life and I’ll write than when I’m able to collect those thoughts together.
1. Plough car into a suitable concrete wall somewhere on the M4:
Well, I’ve only just washed it, not to mention having T-Cut that scratch.
2. Take a shower after dark, drink copious amounts of alcohol, lie naked on lawn on a chilly night.
It’s a bit cold out there, and cosy indoors – what with the thick jumper and the central heating. And ‘Homeland’ is on in a minute.
3. Cut wrists.
That’s going to hurt, isn’t it? And there’ll be blood everywhere, I’ve only just started Spring cleaning.
4. Drink copious amounts of alcohol, swallow a few sleeping tablets. Jump off high building.
I don’t like heights and high buildings. They make me want to jump off. Oh…
5. Shoot myself.
Don’t have a suitable weapon. Nerf gun with foam ‘bullets’ borrowed from son probably not going to do the job to be honest, even at point-blank range.
6. Overdose of meds.
Couldn’t understand the document about quetiapine o.d. I found on Google – it was far too technical. Does it or doesn’t it?? Also, fluoxetine o.d. seems unlikely.
As Samuel Beckett put it: ‘I can’t go on. I’ll go on.‘
Today, again, I’m not me. Today,
again, I see reflections of elsewhere;
else-one. Some other to be. Buzzing
with a particle pulse of happening,
sampling on another level, distant.
Withdrawn and imagining how the
smooth cut of a wet stem makes
the flower undone. I’m not here
today; something is, but not me.
I am that close to the atom, see?
However much I improve, however much I remain stable, I’m still balancing on the edge of madness. So much so that I feel, even with a smile on my face, that balance could be tilted and into the mire I slip.
There’s no doubt I’m so much better now than I was all my life until the climb began a couple of years ago. While therapy did little except drag up tons of old stuff (childhood issues, physical and psychological abuse) that was then left to fester un-dealt with, the meds – currently 550mg Quetiapine, 20mg fluoxetine – have clipped the ends of my mood swings. There’s been no obvious hypomania for quite a while now, no deep low. My sleep is still almost as bad as ever and decades have passed since I slept right through the night – if indeed I ever did so.
Anxiety is always there to some degree; it’s the main symptom of my ultradian bipolar that hangs around stubbornly poking a long stick at me. The OCD, while a nuisance and often unpleasant, is mild and I can handle it.
I’ve had to live with this my whole life – I don’t just have bipolar, I am it – and as the saying goes, I’ve survived every bad day I’ve ever had. I’m still here.
But I’m still doggedly hanging onto sanity. Those claws could slip any moment making me fall into madness.
I call it (but only to myself) the other one. That other me sharing my body but lurking in the shadows rather than being out here with Me. The one in the mirror sometimes. Dissociation is something else I’ve always had; I can remember it in existence as a child. I’m uncertain whether the other one wants to choose madness. I think we always opt for survival, and bipolar suicidal ideation I believe to be little about actually wanting to die but rather, wanting to be free. To be whole, to be well. Whatever that is.
On the edge of madness, 24/7. Fighting a range of battles, physical and psychic. It’s quite the balancing act. Sanity is winning a struggle against ‘inner demons’ or the other one. Always teetering, always throwing one’s weight in the direction of self.
My advice, from experience:
- Allow yourself, wherever possible, to be not well. Some days are like that; in fact many days are like that. But it’s easy to feel guilty handing your day over to something outside your control. If you have a job, it’s even more difficult. But on those not well days, take it easy: watch TV for too long; don’t shower if it’s not essential (and when is it essential?); indulge, mindfully, in your drug of choice later in the day (thanks, I’ll have a kir or white wine).
- Get some sleep. Preferably at night. OK, so this is totally outside our control and I really don’t know what the answer for insomnia is. Mine is chronic and seemingly without reason. It used to be worsened by night-time hypomania but I’m medicated now.
- Speaking of which, always – always – take your meds. Don’t change the dose without consulting your psychiatrist / doctor. Follow your medication programme closely. And if you’re bipolar then why aren’t you on meds?!
- Exercise isn’t the be-all and end-all; sure, a little walk on a sunny day isn’t going to hurt you. I discovered quite recently that too much exercise can trigger hypomania. So before you decide to climb that mountain, take heed to allow plenty of time and be mindful the whole time that you – not your illness – are in charge.
- Treat yourself. Indulge in those treats that ease your moods. Could be music – those old favourite tunes – could be chocolate (tell me about it..), could be a glass of wine (go easy, young fellow!). Don’t let it be anything destructive; hypomania rules that part of you so stand up to it, show it who’s boss. In theory at least.
- If you must buy loads of crap, buy cheap crap. And no, that Harley is definitely not cheap, even if it is cheaper than a yacht. I bought four USB drives the other day, didn’t need any of them but I can handle a £20 hit and they’ll get used eventually. Maybe not in my lifetime, but eventually.
- Do what the Walker Brothers and Edith Piaf told us and have no regrets. Don’t obsess on things. Just learn from things.
- Try not to kill yourself; it leaves a hell of a mess and doesn’t achieve much. It also means you’ve lost.. and you’re not a loser are you?
- Talk about it. Preferably to someone with ears.
- Get a grip. Do what it takes to stay sane. Yes, of course it’s a battle. A daily battle. Focus on the endgame: not the battle but the war. Be who you are.