How Was The Ketamine?

I thought you’d never ask.

Ketamine. I had five treatments intravenously, dosed at 0.5 mg/kg initially. (If you’re new here, having arrived via the Rabbit Hole, the short story is that I’m slowly dying of Bipolar Disorder and in order to try every last thing to palliate the psychache, I’m trying the latest quasi-experimental thing: medically supervised ketamine infusion therapy.) The plan was to gradually increase the dose, but my body didn’t like that (weird very uncomfortable muscle spasms). So we stayed with the initial dose.

The treatments themselves turned out to be more of a chore than a vacation. My veins suck because, connective tissue badness. They are these tiny spidery things that instantly explode when touched by a needle. Therefore, I was touched by many needles in order to get five IV infusions in, and now, every halfway decent vein I had is a purple blotch, with yellow and green accents. Beautiful. Hope I don’t need any emergencytype treatment any time soon, because I donated all my veins to Vitamin “K.”

But what about my brain? You inquire. After all, she’s the star of this shitshow. The only reason I would go to such extremes of drug-taking and expense (did I mention the expense? Oy vavoy).

Let’s see…I can’t really judge how I feel by how I feel…yes, I know….really the only way to tell how I’m feeling is to look at what I’m doing, because aside from the affective part of the affective disorder, my main symptom of depression is the one where I turn into, like, a rock, moving only under extreme duress, kind of like what normal people do when they’re asleep, except in my case, I’m not asleep at all. Ever. Just. Not. Moving.

I’m still kind of lethargic, but my appetite is back. Apparently I was too depressed to notice that my appetite had gone south. I had lost over 10 lb, but my residual anorexic self was sluggishly applauding that. She’s now disgusted that I’m making omelettes at 9 a.m., as opposed to breakfasting on frozen Trader Joe’s Indian food at 5 in the afternoon. I’m moving around, noticing the extreme layer of desert dust that is covering absolutely everything. That’s a sign, noticing things. Getting up and doing something about it–that’s still in the realm of the theoretical, but at least the notion does flit through the cold molasses of my mind.

I was really hoping that the irritability part would go away. It has abated somewhat, but Atina the Wonder Doggess is still keeping an eye on me in case of explosions. I feel bad, because I grew up “walking on eggshells” around my mother, and I hate it that I give my loyal pup reason to do the same around me. I really feel like climbing into a hollow tree trunk and staying there for the rest of my assigned days.

So I would say I’ve had a partial remission. Better than none! We’ll see how long it lasts. I’m supposed to have another treatment in a couple of weeks, but I don’t yet know how or where. One minute at a time.

Today Is Another Day: Rapid Cycling

As you may remember, yesterday I was painting my toenails in the middle of the night.

Alas, that was not to last.  I woke up this morning with a feeling of dread in the pit of my stomach.

After I finally went to sleep last night, with the aid of more Seroquel, I woke up a bunch of times because my arms were numb and tingling.

Fuck, you know, this has been going on in one form or another for several years.   I’ve been writing it off as probably due to my arthritic collar bone, but this is different.

My medical experience gives me all kinds of terrible fears.  MS is the main one these days.

I remember the day in medical school when they taught us all the bad things that can possibly happen to breasts.

My then-husband came home to find me huddled in the bed hysterically crying.

“What’s wrong?” he asks.

“My breasts!  They’re a ticking time bomb!  I want them off right now!”

“There there,” he said, not knowing what else to say.

The next day I ran to the Student Gynecology Service to get a pre-operative exam.  The kind Nurse Midwife examined me and assured me that at the moment my breasts were not explosive, and offered to re-check them whenever I started feeling breast-anxious.

I felt rather foolish, but relieved that at the age of 29, nothing was wrong with my breasts.

Why do I make these digressions when I’m depressed?

Maybe it’s because I don’t really want to engage with the depression.  I know it will pass, and something else will take its place, but when it’s on me, it’s literally on me, and all over me, and in me, and I can’t shake it off.  All that happens is I start crying and feeling like someone is trying to rip out my guts, and doing a pretty good job at it.

Then it passes, just as quickly as it came.  What follows might be a period of “normality,” meaning, neither hot nor cold, and this is heavenly.  But it never lasts.

Hypomania, or frank mania with psychosis, tends to raise its ugly head at night, about bedtime; which for me is at 9 pm because my meds take 12 hours to wear off.  Actually they take 13 hours, but that is an embarrassing amount of time to sleep, so I actually set an alarm for 9 am.

I can tell the (hypo)mania is on its way because my bedtime knockout cocktail doesn’t do a thing.  I’m awake playing Solitaire on my iPad, which usually bores me to sleep, except now I’m totally awake: uncomfortable in my skin, twitching, restless.  I don’t want to look up because sometimes my wallpaper turns into ugly faces.

I follow the protocol my shrink and I developed for these very occasions: more Seroquel.  Another 50 mg till it knocks me out.  And a double dose of my benzos for good measure.

Sometimes it takes a couple hundred more milligrams of Seroquel to do the job.  I have an incredibly low tolerance for Seroquel, so my maintenance dose is only 100 mg.  I know, I know, some of you take 600-800.  That would put me to sleep for several days.  I usually get to 300 before it’s knock-down time.

The good thing about hypo/mania is that it can be controlled, if recognized early enough.  Depression, though…that’s another beast.

Bipolar depression is different from “regular” depression for reasons I don’t know.  I was treated with regular antidepressants for years, and was pretty much suicidally depressed the whole time.  Vitamins “L” (Lithium and Lamictal) saved my life, quite literally.  Blessings upon the quirky head of my neuropsychiatrist, who was on call when I was hospitalized the first time, and got my bipolar figured out.

The only adjustment we can do for the depression part of the roller-coaster is to up the Lamictal by 50 mg, which puts me at 200.  More than that pops me over into mania.  It’s a delicate balance, as you can see.

So the only thing I can really do with this depression is to wait it out.  Sometimes it does get suicidally bad, and then I have to think about my dog and my son, and what my suicide would mean for them.

I put them in that order, because my dog is helpless without me (although yes, I could put her in Rescue, but that thought makes me cry harder) and my son second, because even though it would tear him to pieces, he is at least able to provide for himself, unlike my dog.  I know that makes no sense but that is how it happens to fall out in my brain.

I’m starting to feel tired now, which means this part of the wave is coming to a close–I don’t know exactly when–and what happens next I cannot guess.

OH NO!!!!

Hello, dear readers.  I think I have flipped.

I caught myself giving me a pedicure at 11:45 PM.  And really enjoying getting artistic about it.  It came out brilliantly, if I may be so obnoxious.

Hm.  Something does not feel quite right.

So I smoked half a joint, meditatively.

That’s when I got it.

I have been a slump since last Wednesday.  Well, not exactly a slump.  I would call it a triggered, dissociated, PTSD’d mess.  But it seems that under that pile of oozing slime, the Black Dog was lying relaxed, head up, tongue hanging out and dripping, waiting.

As I was enjoying my joint it hit me:  Silly silly, you have been depressed all week.  I mean, you have felt terrible, am I wrong?

But now have no fear, because Hypomania has made her entrance.  What fun!  Actually it is, if I don’t ruin anything important in the process.

Who knows how long I could stay up tonight, answering mail since last fall and calling Israel to check on the abysmal state of my bank account, since I haven’t been back in almost a year.  I could, in fact, put away the unspeakable piles of **stuf** that has collected on every flat surface.  I have to push objects away on the table in order to have space to eat.

No, not really that bad, most of the time.  Just during the down spells, where I have no interest whatsoever in that big envelope that promises instant gazillionair-hood.  I throw it all on the table.

Then if I’m lucky I’ll have a nice productive flip.  If I can stand still enough I can get all sorts of things done.  But **sigh** there is little danger of that.  Plenty to do in the big world!  Now, if I can just find a way to stay in this pleasant condition and not get into a mixed episode (shudder) or pop all the way into mania–not fun……..but now for the extra dose of Seroquel so I can get some sleep tonight….

Feeling Suicidal? Change the Channel.

Things have been going in a dismal spiral that has been threatening to turn into a full-blown tailspin.  For the last three days I have ruminated night and day about death: fervent wishes for a speedy natural death, and in the absence of that, turning to my old faithful suicide plan, painless, tidy, nothing to clean up and nobody’s trauma.

There is no good reason for this, if you discount the deep spell of depression.  Here I am in the Holy City of Jerusalem at the holiest time of year, and especially now that it’s sukkot:  the happiest time of the year for us Jews.  So what’s the deal?

OK, so I have had to move twice in two months because of the bedbug plague that is sweeping the city.  Bedbugs get me down.  They give me more than the creeps, little bastards sucking your blood all night and hiding out in your underwear drawer during the day!  Chutzpeh!

I had the second apartment exterminated three times, each time involving leaving for 10 hours, then scrubbing the floors and all the surfaces multiple times so as not to poison myself and my dog.  Nevertheless I have had a nasty headache for weeks, which has gone away after moving to the third apartment which so far (please G-d) does not have bedbugs like the first two.

Along with all the other bedbug mitigation work, I have to wash and dry everything over and over.  Right now everything I own is on the roof baking in the sun (they can’t stand heat and drying), which was fine until it rained the other night.  I have not had the strength or ambition to climb back up on the roof and undertake damage control.

So circumstances are getting me down, yes.  It’s an overlay on the bipolar depressive phase.  But it could be deadly, because just a few hours ago I was planning when and where.

And then I broke my policy of strict isolation (because when I’m like this I am such a zombie, flat affect, flat voice, no reactions) that it freaks people out and is very unpleasant for me.  And if they’re people I like, I might just burst out crying and that just makes things worse.  So isolation it is, and yeah, I know, it’s not good.

So this evening a very special event was planned in my congregation in honor of this day being the passing of Rebbe Nachman of Breslov, in the year 1810, who was a revered spiritual leader, and is the guiding spirit of many members of our congregation.  I had to go.  I wanted to see everybody, hear what the rabbi had to say (even though I only understand about every third word of his Hebrew) and generally be with my peeps.  I did not set myself a time limit: if I got uncomfortable, I gave myself permission to leave at any time.

Not only that: since my Hebrew birthday falls out tomorrow, I booked myself a massage tonight.  Yeah.

When I got to the party I was feeling pretty low and didn’t know if I would be able to handle it.  But there was singing and someone was playing a djembe (African hand drum) badly, and I saw another djembe that didn’t have anyone playing it.  Now, I happen to have studied djembe for four or five years, and played with an African dance troupe.   I have stopped playing because of severe issues with my hands, but since I was planning to die I didn’t care if I fucked up my hands more so I picked up the free djembe and warmed up quietly, getting the feel, and then the old feeling came back and I popped right back into the common West African dance rhythm BADA bada BADA bam, working the bass and the slaps and tones and rim shots just like old times.  And for some reason, I didn’t break blood vessels in my hands or hurt my two bad wrists or any of that.  And feeling the groove of the people singing and getting underneath the inexperienced drummer and giving him a boost so he could ride my wave was intoxicating.

I forgot all about suicide.

Then I went and had a 90 minute massage.

Now I’ve taken my meds and am going to bed, with a lot to think about.

I’ll think about it in the morning.  At Tara.  Or maybe in the Old City.

Voices of Mental Illness: Breaking the Silence of Stigma

Graham Shiels is the author of The Bipolar Place, and a partner in the stigma-fighting campaign, Faces of Mental Illness.  He is a husband, a mail carrier, lives in Livepool, England, and he is a Voice of Mental Illness.

BSS: How long have you known that you are living with a mental illness?

GS:  For me it’s not a simple, x amount of years, answer. I was first diagnosed with a mental illness when I was 22. That would be 13 years ago. However, I think I have had a mental illness as early as the age of 12 or 13. I remember crying myself to sleep nearly every night for what seemed like a year, but I didn’t know what I was crying about. I wasn’t aware back then I had a mental illness, but I also had the feeling that not everyone felt this way.

BSS:  Can you share with us your diagnosis/diagnoses?
GS: Depression & then later Bipolar Type 2.
BSS: When were you diagnosed with these?

GS:  As already mentioned I was diagnosed with depression 13 years ago. I was diagnosed with bipolar just over 3 years ago.

BSS:  How were they diagnosed?  Did you have any special testing?

GS: I was diagnosed with depression after my girlfriend (now wife) basically suggested I go to see my GP. Not so much, because I wouldn’t go, but more a case of I didn’t know what the hell was going on & I needed the help/push to get me there.

I was diagnosed with Bipolar 10 years later. I saw a psychiatrist for the first time after I had thankfully failed in a suicide attempt. I’d basically decided, that if I was going to live through bouts of depression at least once a year, I’d rather not be here.

I wouldn’t say I had any special testing. I was only diagnosed with bipolar due to my history of depression & then the psychiatrist looking back through my medical details realised I more than likely had been bipolar for a long time.

BSS:  Was your illness diagnosed correctly the first time, or did it take time before the right diagnosis was arrived at?  Do you feel that you do indeed have the correct diagnosis now?

GS: I think I had been misdiagnosed with depression for a long time. Whether I ever suffered from depression or if my depression transformed into bipolar or if I suffer from both is anyones guess. I honestly think most of the diagnosis we have, linked to our brains, will at some point be re-evaluated. Simply because there is still much we need to learn about the brain. I’d be very surprised if when I’m in my fifties I’ll still be classed as having bipolar type 2.

BSS: Have you ever been hospitalized due to your illness?  How many times?  Do you think it helped?

GS: I’ve only been hospitalised when I took an overdose, but that was your standard A&E department.

BSS:  Are you on medications for your illness?  Do they help?  What about side effects?

GS: I take Sodium Valproate (mood stabiliser) & Fluoxetine (anti depressant). Yes I think they do help, but I’m a big believer in balancing it with healthy eating, drinking & exercise. I don’t suffer badly with side affects thankfully. Fluoxetine does make me sweat a little more than average, but nothing so it’s overly noticeable. Sodium Valporate can cause diarrhoea, but again I’ve not really suffered from it.

BSS: Have you ever had ECT (Electroconvulsive therapy)?  How did it affect you?  Did it help?
GS: I’ve never had ECT & until much more is understood about the brain I would refuse it. I truly believe to use ECT in a time, where there is so much we don’t know about the how the brain works, is akin to the blind leading the blind.
BSS:  What other things do you do to help with your illness?  Do you go to individual therapy?  Group? Other things?  What, if anything, seems to help?

GS: Currently, I’m working as a postman which enables me to walk & cycle on average 4 hours a day. For me, exercise is just as important, if not more so, than the medication used for treating bipolar type 2. I’ve only been a postman for less than a year. Before this I’ve mainly worked in an office environment. The lack of exercise in an office job, meant I needed to try & exercise in a gym or by running & cycling outdoors. One of the problems with this is finding the motivation to do the exercise outside of work, when all I wanted to do was relax & enjoy my ‘down time’.

Since I’ve been diagnosed with bipolar I’ve reduced the amount of alcohol I drink. I’ve cut out drinking during the week & only drink at most, one bottle of wine when I do allow myself  a tipple. Alcohol is a natural depressant & so as I suffer more from the depressive side of bipolar it seems like common sense to monitor my alcohol intake. If I’m going through an episode of hyperness or depression I cut out alcohol altogether.

One tool I’ve learned,  which surprised me how useful I found it, is my Alternative Journal. It is a CBT tool that helps change how you think about the things you see on a daily basis. I was talking to a counsellor about how, sometimes, when I’m depressed, I struggle to see the positives that are there all around me. He suggested that I begin to log the things that make me happy in a day. Whether it be a stranger smiling at you, a kind gesture or something that made you smile. So it works like this: Grade yourself out of 10, then write down as many positive things that have happened (aim for ten positives). Read through what you’ve written & then regrade yourself. Hopefully you will feel a little more positive. However, I only really felt the full impact of this exercise after doing it for six to eight months. I now automatically  see the positives around me & pause to appreciate them.

Over the last 13 years I’ve seen many counsellors. In general they’ve been very helpful, but I can’t stress enough to be careful that you’re in the right frame of mind for counselling. It’s easy to go to counselling with the aim of helping yourself, but sometimes you just need to let yourself be. After all, picking at a wound isn’t the best way to heal it.

BSS:  How has your illness impacted your life (jobs, education, relationships, children, alcohol, drug abuse….._)

GS: I honestly believe the number of redundancies I’ve had (3), have been as a result of my illness. Of course other reasons have been given. Don’t get me wrong, I understand if you’re off work a lot because of an illness, at some point a business may need to cut back. I simply find it annoying that a company won’t just come out & be honest, giving the real reason. Or heaven forbid they actually allow a form of flexible working allowing me to continue in my job.

My education was certainly affected, both in school & university. I had no idea what was wrong in school & ended up leaving two years early, to escape the bullying & isolation I felt. At university I distracted myself with clubs, drinking & trying to have fun. This worked to varying degrees, suffice to say I enjoyed my time at uni, my grades did not 🙂

Relationships have been fine for me.  I’m lucky I have a great wife who has been with me for 14 years. My family is, well, complicated, but those I care about have been great.

I’ve never had problems with addictions to drugs. That’s not to say I haven’t dabbled in the lesser recreational stuff…but errrr… we’ll leave that there 😉

BSS:  Have you ever felt discriminated against because of your illness, or had to deal with disparaging comments, denied a job or other opportunities?

GS: Other than losing jobs, I feel were linked to my illness, I can’t say I’ve had any problems. Mainly because, only until recently, I’ve been open about having bipolar. I’m sure if I was open about my illness from day 1 I would have come across some discrimination. Currently I wouldn’t let anyone get away with disparaging comments, as I feel much more confident as a person & would be only too happy to point out the error of their ways 🙂

BSS:  If you could give advice to someone else struggling with mental illness, what would it be?

GS: Don’t struggle in silence. Be open with those you trust. If people would rather not be around you after you open up to them, as hard as that is, are they worth your friendship?

BSS: Anything else you’d like to add?

GS:  Don’t give up. The down cycles of mental illness, truly horrible as they can be, are temporary. You can get through them & enjoy your life. That may sound cliched, but I’ve found from my own experience, it to be true.

You can find Graham at his blog, The Bipolar Place, as well as at the helm of the Faces of Mental Illness project, currently found on Youtube, Facebook, and Twitter.

depression comix #37

I love this. If I had a dollar for every time some never-been-depressed person has sprung this one on me, I’d be…but wait, maybe that’s why I never tell anyone other than my therapist.

depression comix #37.