Just Lamotrigine

… yeah. I didn’t take the trazodone Wednesday night, nor Thursday, nor last night. And I’m doing better. I feel like I’ve woken up from a bad dream. And speaking of dreams, I’m back to my usual anxiety dreams – which I KNOW are dreams once I wake up. So much better.

My anxiety is kinda overwhelming tho. I’d almost forgotten what it was like to feel like this. I have a thing I need to be not only present at but act in a professional capacity. I think I can deal with it, but I’d wanted to go to a cultural event at my local library – no pressure there, just show up have fun and leave. But I was kinda freaking out about it – especially the leaving and getting to my later commitment on time part – so I guess I’m not gonna go. It’s just easier that way. There will be other opportunities … right?

*sigh*

I’m kinda doubting whether I’ll ever be able to find and maintain gainful employment.

I don’t want to stay on just lamotrigine, and either way I’ve been thinking for a while that it would be good to increase my dose slightly. I’m debating whether I should ask to go back on fluvoxamine or clonazepam. The former was a rocky start, but I got used to it and I think staying on it might’ve been good for me. The latter … I don’t think I ever had any problems with it – I don’t remember any. It helped with my anxiety. It’s not the safest med in the world but you know what, fuck it. I’d rather be functional while I’m alive than live longer.

Something tells me getting my prescriber to agree to this won’t be easy. I’m writing her a letter in hopes that will prevent me from ‘acting irrationally’ at our next appointment.

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New Prescriber, New Meds

I had my second appointment with my new prescriber last week. At our first appointment, she told me she’s not a fan of one of my medications, Clonazepam, and said she wants to start weaning me off it so I can start taking something else. She wanted to put me on a SSRI (selective serotonin reuptake inhibitor) “to help with both depression and anxiety.” I resisted because I’ve had bad experiences with two different ones. There were no changes to my meds last month.

But this month she reiterated the need to get me off Clonazepam and told me to start cutting the pills in half. She also said there are medications that help with hording and prescribed me one, Fluvoxamine Maleate. It’s a SSRI. I’m torn between not wanting to take it because I’m scared of how it might affect my brain and the rest of my body – and wanting to take it because I can use all the help I can get to deal with this hording.

I talked to Wakana about it and she seemed very concerned about the change in meds, especially since I only just started seeing this prescriber. I’ve been taking half doses of Clonazepam since September 1st; so far I’ve already had two days (Monday and today) when I felt ill enough that it affected my functioning, and almost kept me from following through on important plans. I’ve been feeling down, slightly queasy, less sure of myself, tired, anxious, freezing (as in fight, flight, or freeze), and sometimes twitching – in other words, like crap. I suspected on Monday that I was having withdrawal symptoms; Wakana confirmed it today. I have an important meeting tomorrow at noon, and another Friday evening; I don’t have time to malfunction because of changes to my meds.

I’d say “especially changes that are based on the prescriber’s philosophy rather than the medication’s effects on me,” but it’s a little more complicated than that. Clonazepam can be addictive, it has interactions with a lot of things, and I was questioning how much it’s been helping me. I feel like I need more support vs the depressive symptoms than I’ve been getting from Lamotrigine. (There’s no way I’m going off that, though. It keeps my brain from trying to kill me.) To this prescriber, at least, all signs seem to point to SSRIs. I don’t quite get why she’s so obsessed with them.

I’m starting a new bottle of Lamotrigine tomorrow, so I figure it’s a good time to start taking the Fluvoxamine. But I’m really not sure whether it’s the right choice – especially since Wakana pointed out that I’m already addressing the hording without this med, and we agreed that many of the problems I’m facing can only be addressed by getting Fox to take responsibility as well. What will this stuff do to me?

I don’t know, but Wakana suggested tracking my mood and I think it’s a good idea. I’m not sure exactly how I want to do it though – I’ll probably find an app – and I’m annoyed that I don’t have a way to get a baseline. I’d rather not do one retroactively, I’m already having issues because of one change in meds, and I was having issues before that due to interpersonal drama – in short, there are too many variables to determine whether whatever I’m experiencing has anything to do with a particular medication.

I’m just feeling more and more like I want to be done with everything. That’s not a good sign…

Finding the Words

It’s been five weeks since … I still don’t have a label for it. It just is.

Well I guess I could say “my old wounds got torn open, setting me back a year or two in my recovery to how I felt and functioned about 18-24+ months ago.” (‘Recovery’ – to the degree to which I find that term relevant – isn’t a unidirectional, continuously-getting-better process. It’s complicated and messy and all over the place. So this can’t be a setback, just an unexpected and more-difficult-than-anticipated part of the journey. Perhaps a necessary part? It’s certainly reminded me of how vulnerable I am – but also how resilient I am.)

I’m inclined to say “that’s a bit melodramatic” but, well, it’s my truth. Coming back from that hasn’t been easy. For a while I took a break from activism, particularly the being-a-leader-in-a-grassroots-organization stuff. I’ve been getting back into it, almost to the point where I feel like I’m “pulling my weight” again – putting in effective work commensurate with the roles I have. But I’m also addicted to Terraria, my apartment is as messy as ever (what an understatement!), and my relationship with Fox … let’s just say both my therapists seem to agree it should be my primary focus. And one basically suggested he should quit his job so he’ll have energy to put into our relationship.

It’s been about 3.5 weeks since I visited Ron in the hospital and 2.5 weeks since ze was released. Ze lost zir job and couldn’t go back to zir parents’ house because their terms were unreasonable to the point of being unhealthy, so ze is currently homeless. People are doing what they can to help and ze says ze feels better. Ze seems better too – most of the time. Sometimes zir “speech seems pressured” but it’s usually connected to particular topics, and it’s possible to move the conversation elsewhere. Ze listens to me.

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I forgot to refill my prescriptions until I ran out – of course on the day I was running late and had to rush out the door. I tried to put in the refill request for the clonazepam first, but was unsuccessful; somehow my prescriptions got de-synchronized so I was out of refills with that Rx number and I didn’t have the new one to put in. I was in crazy anxiety rush mode, so I didn’t try refilling the lamotrigine – even though it had 2 more refills with that Rx number.

I asked Fox to go to the pharmacy for me and he did, because he’s wonderful. He said (they said) they didn’t have anything in the system for me. I was tabling at a pride event and he had to leave for work and it was Sunday, so there wasn’t really any opportunity to follow through on anything.

On Monday I realized I should’ve tried to refill the lamotrigine, better to have one of my meds than neither, right? That was no problem, but I had to speak to a pharmacy representative to deal with the clonazepam. The person I talked to at the pharmacy had an irritating tone to her voice and was too nonchalant, like there was no problem with them not having the information necessary to make sure I have access to a medication that keeps me alive. She didn’t even try to be polite like saying ‘sorry’ – but she did offer to fax my prescriber. And she explained that the clonazepam prescription had expired because it’s a controlled substance, so it has to be filled within 30 days.

I walked to the pharmacy with my inner voices screaming, an irritable mess, barely holding myself together. By the time I got the lamotrigine my ears were ringing and my eyes were so full of static everything was in a darkened haze and I couldn’t think straight and everything felt completely WRONG. That was after missing one dose – and it’s not even that high a dose. I took the dose – better to at least take one of my meds, right? and everything cleared within minutes. The difference was noticeable to Ron over the phone.

I had to play phone tag with my prescriber for a couple days, but I was able to refill the clonazepam today. I didn’t notice as much as an effect when I took it, except that maybe I’m a bit calmer? And I was rather sleepy, I attributed it to waking early from a bad dream, but the medication is known to make people drowsy. Ron seemed surprised I’m able to function at all taking [my dose] of it every day.

To be honest, between what ze’s been telling me about it and what I’ve read online, I’m a bit wary about staying on the clonazepam. Apparently it’s habit forming and it’s better not to take it for extended periods of time. But my prescriber added it for a reason – I think because even with my mood stabilized I was still struggling with anxiety. And I don’t know if I wrote about this yet, but my prescriber is retiring, so I need to find a new one within the next month or two. I’d rather not change my meds until I’ve developed a good rapport with the new prescriber.

So, yay, I’m back on my meds! I anticipate that going a day without lamotrigine and two days without clonazepam will have thrown my levels off; it might take a while for them to get back to normal. And I’m a bit shaken by how profound my (withdrawal?) symptoms were before I took the lamotrigine. I’d come to accept that I’ll probably be taking these medications for the rest of my life, and I’d rather do so consistently than risk going back to how things were before I started taking them. Still, this was a rough reminder of how dependent I am.

TW: verbal, emotional, & sexual abuse; transphobia; description of manic symptoms

I should not have allowed Ron to drive home at 2am two weeks ago. I should have talked zir into going to the hospital.

I just … I’ve read about how traumatic mental health hospitalization can be. I volunteered on a locked adult psych ward – and I was terrified they’d figure out I should be there as a patient and prevent me from leaving. Ron talked about how horrible being hospitalized was, I’m not sure if that was before or since the last time I wrote about zir. On a personal level I’m generally inclined against seeking medical help – especially going to the hospital – unless absolutely necessary, like life or death … But I shouldn’t have fallen back on that. I risked Ron’s life, allowed zir to go untreated for another week – during which zir symptoms got worse and zir behavior became a risk to zirself and others – and allowed it to get to the point where ze was involuntarily committed (by someone else).

Worse, I subjected myself to nearly 48 hours of being ranted at, manipulated, and abused. I feel like it’s set me back at least a year, maybe two, in terms of my own mental health. I’ve spent the past week on an emotional roller coaster, replaying the most painful moments over again in my mind, and debating whether I have any right to describe someone else’s symptoms on my blog. Well, those symptoms interacted with my mental health issues to make it so there are times when I feel dead inside. I’m having self-harm thoughts and urges again. That’s mine to write about!

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Compassion / Pay It Forward

TW: mention of suicidal ideation

Ron had two really bad days in a row, and didn’t sleep in between. Ze told me ze was suicidal. On the first day I took time from my visit with Banji to have an extended phone conversation with Ron, anything to keep zir connected. On the second day I drove for five hours, successfully chaired a 90-minute meeting, reconnected with Fox after 5 days apart, then welcomed Ron into our home at 10:30pm. We decided to hang out in the back yard.

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Hypomanic and Depressed at the Same Time

I read an article today and now my world makes so much more sense. In a Depression Bipolar Support Alliance (DBSA) “Ask the Doc” article, Dr. Mark Bauer, MD states that:

“[T]he most common mood state in bipolar disorder is a mixture of hypomanic/manic and depressed symptoms. In fact, the classic picture of bipolar disorder having a course alternating between the poles of high and low moods is an over-simplification.”

He goes on to explain mania and hypomania more clearly, basically describing them as hyperactivation – feeling “sped up” and driven. This can feel good (e.g. grandiosity), bad (e.g. irritability), and everywhere in between. In other words, mood and activation level are two different things.

Ergo, we can think of bipolar disorder as

“a condition of recurring depressive periods punctuated by periods of hyperactivation – and sometimes these periods of hyperactivation alternate with slowed down, depressed periods, but at other times they overlap.”

That. Is. My. Life. It’s very rare for me to experience a period of time with no depressive symptoms; at best my symptoms become few and mild enough that I don’t meet the criteria for clinical depression for a couple days to a few weeks. But periods of hyperactivation… just look through my blog and you’ll see my posts about “I’m going to do this new thing that will change the world,” staying up all night composing, “now I’m getting better and I’m mad at Fox all the time,” and most recently “Let’s Play Skyrim!”

I usually feel better during my periods of hyperactivation because 1) I have energy to do things and 2) I’m hyper-focused on something that’s meaningful to me, at least while the hyperactivation lasts. Sometimes I don’t feel so good because I want to Do All The Things!!! but I can’t focus on one thing to do, so my mind is a jumbled mess. I’ve also tried to be a part of too many different groups at once, which invariably results in me feeling overwhelmed, backing out, feeling guilty, and my depression symptoms becoming more severe. As far as I can tell, all of my periods of hyperactivation have occurred at times when I also met the criteria for mild depression. (Possibly also moderate depression.) In other words, I’ve never had a discrete hypomanic or manic episode.

I try not to put too much importance on labels; what’s really important is that the needs of the person with a mental health issue are being met. But having a label creates a container for my experience; I can understand it and talk to other people about it and know I’m not the only one who’s had that experience. Finding labels that accurately describe my experiences helps me feel safe. I obviously can’t diagnose myself, but the label “bipolar disorder” seems to become more accurate the more I learn about the experiences it’s intended to describe.

I know I’ve been “depressed” lately because I’ve been feeling sad and/or grumpy, isolating, having trouble eating full meals, apologizing for my existence, and thinking “I want to die” when I’m tired. I feel like it’s only a matter of time before my world starts unraveling (again): I worry about Fox’s safety, our rats’ health, my own health, the house burning down, etc. Calling these experiences “depression” helps me separate a bit from them, accept them, and engage in self-care.